Medical Devices (Amendment etc.) (EU Exit) Regulations 2020

Lord Bethell Excerpts

Wednesday 2nd December 2020 Lords Chamber

Moved by

[Lord Bethell]

That the draft Regulations laid before the House on 10 November be approved.

Motion agreed.

Human Medicines (Amendment etc.) (EU Exit) Regulations 2020

Lord Bethell Excerpts

Wednesday 2nd December 2020 Lords Chamber

Moved by

[Lord Bethell]

That the draft Regulations laid before the House on 20 October be approved.

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

My Lords, we all believe that we must protect the safety of patients, while preserving their access to new and innovative medicines. The instruments that we are discussing today, on the UK’s regulation of medicines and medical devices, will ensure that there is a functioning statute book at the end of the transition period. This could not be more important in the context of the Government’s Covid-19 response.

The instruments are generally technical in nature and broadly achieve three things: first, they make minor amendments to existing regulations to take account of the implementation period agreed under the withdrawal agreement; secondly, they implement the Northern Ireland protocol; and, thirdly, they implement certain changes to the regulatory regime in Great Britain to ensure that the regulatory framework is up to date and functioning correctly at the end of the transition period.

These regulations do not prevent the need for future changes but they do preserve the solid foundation of the UK regulatory environment to protect patient safety and to allow the UK to remain a world leader in science and innovation. I will set out some of the key changes in the medical devices SI and then the medicines SI. However, as the SIs are long and technical, I trust that noble Lords will understand that I will not address all elements in the time we have available.

The medical devices instrument will allow CE-marked medical devices to be placed on the Great Britain market for a period of two and a half years. This will ensure continued access to medical devices for patients, while providing time for industry to adapt to future regulations. The Government have created their own new product safety marking—the UK conformity assessed, or UKCA, marking—which will be used across goods regulation in Great Britain. The SI sets out that the UKCA marking can be used for devices certified in accordance with the regulations and placed on the market in Great Britain from the end of the transition period.

The instrument makes a change to the 2019 medical devices SI, which would have inserted into domestic law provisions of the EU medical device regulation, or MDR, and the in vitro diagnostic medical devices regulation, the IVDR. By not including these provisions, we can develop our own system based on patient access, international standards and public health considerations.

The report of the Independent Medicines and Medical Devices Safety Review, led by my noble friend Lady Cumberlege, has made it clear that we must do more to protect patient safety. The Government wholeheartedly agree. We will use the opportunity of leaving the EU to develop a robust, world-leading regulatory regime which prioritises patient safety, innovation and international best practice, using the powers of the Medicines and Medical Devices Bill.

Throughout recent constructive debates on the Bill, I have listened carefully to my noble friend Lady Cumberlege and other noble Lords. We listened to concerns and have incorporated the medical devices information system into the framework for a future regulatory system. We are also in discussion on a number of other important regulatory issues, the details of which I will not go into now for the sake of brevity. I look forward greatly to the public consultation on this future regime next year and to working closely with the life sciences and healthcare sectors on these important considerations.

I now turn to the human medicines SI. From 1 January 2021, the Northern Ireland protocol will apply, so marketing authorisations granted by the EU will continue to apply in Northern Ireland. However, medicines placed on the market in Great Britain must be authorised through the UK national route.

The human medicines SI allows the MHRA to have “regard to” decisions made by EU member states on products approved via decentralised and mutual recognition procedures when considering whether to authorise those products in Great Britain. This policy will ensure that the MHRA can continue to take effective regulatory and safety action on these products.

The medicines SI will ensure that new and existing medicines continue to be on the UK market after the end of the transition period, so that patients are still able to access them in a timely manner. This will be achieved by allowing recognition of decisions by the EU Commission to grant marketing authorisations for centrally authorised products. These products will receive a GB marketing authorisation.

Both the SIs we are discussing today uphold the Prime Minister’s commitment to unfettered access for Northern Ireland’s businesses to the whole of the UK market. The SIs include transparency requirements for medicines and medical devices moving from Northern Ireland to Great Britain, which will allow the MHRA to maintain oversight of products on the GB market and thus protect patient safety.

For medical devices, the transparency requirements mean that non-UK manufacturers placing devices on the UK market will be required to appoint a UK responsible person. The UK responsible person will be required to register devices with the MHRA in accordance with a transitional timetable set out in the regulations. Registration requirements will also apply to GB and Northern Ireland-based manufacturers. Both SIs make changes to ensure that the relevant EU laws will continue to apply in Northern Ireland after the end of the transition period, fulfilling the requirements of the Northern Ireland protocol. I reassure noble Lords that this Government will continue to regulate medicines and medical devices in a way which works for the whole United Kingdom, including, of course, Northern Ireland.

The MHRA will continue to regulate medicines and devices in Northern Ireland. This will ensure continuity for patients and for businesses. Moreover, the Medicines and Medical Devices Bill, currently passing through this House, will provide the powers for future changes to the UK’s regulatory system. Within this, and having tabled an amendment in my name, what is now Clause 43 requires a public consultation on regulatory change before making use of the relevant designated powers in the Bill. The consultation process will help to ensure that the interests of the all interested parties, including devolved Administrations such as Northern Ireland, continue to be fully considered. Officials have kept the devolved Administrations informed of the drafting of this instrument and I am grateful for their continued collaborative approach. In particular, I thank the Minister of Health in Northern Ireland, Robin Swann, who agreed—despite policy for human medicines being a devolved matter—to the human medicines SI being signed solely by the Secretary of State for the Department of Health and Social Care.

To inform the industry, we have published a number of guidance documents which go into further detail on the changes included in the SIs on GOV.UK. In addition, an accompanying series of webinars were held where officials engaged directly with 11,500 industry representatives and provided them with an opportunity to ask questions. My officials also meet regularly with top industry companies and key trade associations, including the Association of the British Pharmaceutical Industry, the BioIndustry Association and the Association of British HealthTech Industries.

It is important to note that these instruments amend pre-existing EU exit legislation made in 2019. A full consultation process was conducted for this pre-existing legislation. Moreover, full impact assessments were conducted for this underlying legislation. As the nature of the changes in the instruments that we are discussing today are in many instances technical, the impacts of these SIs above and beyond the existing legislation do not meet the threshold for further impact assessments and hence these are not provided for. These instruments will ensure that the UK’s exceptional standards of safety and quality regulation of human medicines and medical devices are maintained and enhanced. At a time when we have never been more reliant on all the elements of our public healthcare system for our survival, we must support this. I beg to move.

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, I am enormously grateful for the penetrating and thoughtful questions on this important set of SIs. There were far too many for me to be able to cover them in all the detail they deserve this afternoon, but I will undertake to write to noble Lords if I have failed to address any specific questions.

I start by sharing with the noble Lord, Lord Blunkett, the very positive vibe he gave out about the vaccine. He is entirely right that I have been at this Dispatch Box answering questions on PPE, test and trace and all manner of government challenges, but today is a great day. I do not want to bang on about it, but it is a huge relief to see the authorisation of this vaccine: it is a huge triumph for medical science and a massive breakthrough for humanity. I cannot help emoting so positively on it.

On the precise procedures used, I reassure the noble Lord that, in fact, the procedures used for the authorisation of this vaccine were exactly the same as those we could have used, and do use, under current EU regulations—as he probably knows. Those will change at the end of the month, but, as he probably knows, in October, we brought in specific regulations to allow us to have this opt-out procedure. I pay tribute to the EMA, which is a fantastic regulator with which we intend to work extremely closely. I pay enormous tribute to the MHRA, which has worked with phenomenal diligence, enormous scientific insight and great precision and confidence in order to get this authorisation done so promptly. Dr June Raine, who runs the MHRA, has done a fantastic job, and we should be extremely proud of the role of British regulation in this matter.

On a serious point, this incident demonstrates some of the benefits that will come to Britain’s life sciences industries from the transition. As noble Lords will know very well, we are not planning a massive divergence from either the EMA or the cohort of other regulators—the FDA and others—on a large number of matters. In fact, we have a huge amount of respect for our partners in other countries, especially the EMA. However, in the areas of innovative medicine, where there are new techniques and novel science, and where thoughtful, rapid processing makes a huge impact on the velocity of innovation and where expertise and scientific insight are particularly important, Britain can make a difference. This is where the MHRA will help not only British industry but all of humanity. I very much look forward to reporting back to the House on the progress that we can make in that area.

There have been a large number of questions from noble Lords on whether we are ready for these changes. I assure all noble Lords that we are in great shape. We are in constant liaison with industry and I have regular phone calls, meetings, webinars and bilaterals with industry to ensure that things are in good shape. When it comes to batch testing, which was raised by the noble Baroness, Lady Wheeler, the stockpiling of medicines, and the other matters raised, I can assure noble Lords that we are indeed in good shape. The noble Baroness asked specifically about our conversations with the DPRRC; I cannot give precise answers to her detailed and very reasonable questions, but I will write to her.

I am particularly abreast of the matter of stockpiles, having presented to the Project Defend board earlier today for three hours. I assure noble Lords that the Government are considering the resilience of the country as we approach not only the transition, but also the ongoing pandemic and the winter, simultaneously. We are in very good shape. There is a nationwide, government-wide project to ensure that we are truly resilient. In terms of health provisions, this means not only having stockpiles, but also strengthening our relationships with our suppliers, ensuring the provenance of those supplies and, where necessary—I emphasise that—building up domestic supply. Phenomenal progress has been made regarding medicines and devices, as well as PPE, which typically one associates with production in Asia. We are currently producing more than half our PPE in the UK, and it is possible that we will be producing more than that.

The noble Baroness, Lady Wheeler, is entirely right about the MHRA. We have a winning organisation there, but the emphasis and pressure on it going forward will be extremely important. I assure her that I have regular meetings with the MHRA through the spending review, and its financial plans have been gone through with a fine-toothed comb. Both the MHRA management and the policymakers at the department are reassured that the budgets and the human resources are in place for the MHRA to step up to that challenge.

These are important regulations. I am extremely grateful for the scrutiny that noble Lords have given them and, in that spirit, I commend them to the House.

Motion agreed.

Health Protection (Coronavirus, Restrictions) (All Tiers) (England) Regulations 2020

Lord Bethell Excerpts

Tuesday 1st December 2020 Lords Chamber

Moved by

[Lord Bethell]

That the Regulations laid before the House on 30 November be approved. Instrument not yet reported by the Joint Committee on Statutory Instruments.

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

My Lords, we know this virus well enough now to know that it is not an inconsequential enemy. It has taken loved ones from us, including my godfather, Alan Williams, who some in this House may know. It has separated us from our friends and families and has left people suffering from its ill effects months after first falling ill. This country has made a great collective sacrifice throughout this year, but it has been integral to combating the virus. Regretfully, much as we would wish it were true, this virus cannot be ignored. It has not mutated into a gentler version of itself or blown itself out in the wind. Instead, it remains on the rampage, highly contagious, malicious and mortal, with the old and vulnerable square in its sights, and anyone potentially affected.

While I know that these measures have been hard, this is the reason why we have taken this course. They have always been proportionate to the threat that we face. However, I reassure noble Lords who might be in any doubt that we do not want to leave them in place for one day longer than we have to. We now judge this to be the right time to come out of the national lockdown and revert to a localised approach to managing the virus. Why is that? It is because coronavirus cases are down by 19% in England and hospital admissions have fallen by 7% compared to a week ago. The data tells us that, after many false peaks, the virus curve is finally flattening. The latest assessment from SAGE is that, having reached the summit, we are now walking down the other side, with the R for the UK between 0.9 and 1. Indeed, in its most recent survey, Imperial College London placed its estimate for England at an impressive 0.88.

This is a monumental achievement. After more than three months of growth, this is the first time the R has been estimated at or below 1 for the United Kingdom since mid-August, so at last we can be confident that the virus is coming into check. Only at that point is the danger of our hospitals being overrun starting to pass.

While this drop in the infection rate is encouraging, and confirmation that our national sacrifice has proved successful over the last few weeks, the picture remains varied across the country. That is why we are introducing a framework of regional tiers so that interventions are suited to the situation in any given area. There will be three tiers that apply to the whole country—but, before I go on to them in more detail, I want to spend a moment on the principles that underpin all three.

First, I reassure noble Lords that schools will remain open to protect children’s education and development. Secondly, we will seek to keep as many businesses open and trading as is reasonably possible, to support the people who work within them and the wider economy.

Beyond these core principles, as the winter plan sets out, there are the five key factors in determining the tier of any region: case rates in all age groups, cases among the over-60s in particular, the rate at which cases are rising or falling, the positivity rate and the pressure on the local NHS. When setting boundaries for these tiers, we have looked not only at the human and physical geographies that determine how the virus spreads but at travel patterns and the epidemiological situation in neighbouring areas. We have listened to the public voice, and noble Lords in this Chamber, to fine-tune the system. As a result, people can practise their faith in places of worship, gyms will remain open, outdoor leisure will be permitted and we are doing everything reasonable to allow businesses to remain open.

I turn to the details of each tier. The aim of tier 3 is simple: to bring down the rate of infection when rates are rising too fast. That requires considerable collective effort. Tier 3 will be used only when necessary, in order to protect the NHS and save lives where the virus is threatening to get out of control. Tier 2 is intended rigorously to manage the spread of the virus, restricting indoor mixing outside your household or bubble, although the rule of six will apply outdoors. Hospitality will be open but with restrictions on opening hours and serving alcohol. We want to help all local authorities to move down to tier 1, the least restrictive tier. It has been designed to contain the virus and limit new potential outbreaks. It will apply in areas where efforts to suppress the infection have been successful, and represents a relative return to normality, including for the hospitality sector, although the rule of six for social contact must be maintained.

I reassure noble Lords that the decision to put areas in these tiers was made according to the best possible data and clinical advice. This system offers a sustainable and enduring framework for controlling the virus, as well as offering consistency, stability and clarity on the steps people should take to control the virus. On the effects of these measures, I draw noble Lords’ attention to the evidence paper on the health, economic and social effects of our approach that was published by the Government yesterday. This analysis recognised that:

“The impacts of COVID-19 to date have been significant on health, the economy and society.”


However, it makes clear that:

“Allowing the virus to grow exponentially would lead to”


worse

“impacts, in terms of loss of life and ill health”

and the economy, and

“that would be considered intolerable for society.”

The analysis provided in our paper has been informed by evidence from SAGE and its sub-groups, the ONS, forecasts from the OBR and data on the epidemiology of the virus. As the paper sets out, the balance of evidence supports the need for our tiered approach.

However, the tiers are not the only weapon in our arsenal. We are launching a major community testing programme targeted on the tier 3 areas with the greatest rate of infection. Test and trace will work with local authorities on a plan to get tests to where they are needed most, using military support where helpful and designing their own incentives to attract the right groups. The tier regulations are supported by an increased focus on enforcement and compliance, which is what the local authority enforcement powers regulations are all about.

Throughout, we have listened to and engaged with local authorities to understand how we can support our partners in local government and make sure that they have the right tools in place to ensure that rules are being followed. We know that these are the right tools because our partners in local government helped us to design and build them. The coronavirus improvement notices allow businesses to be given a clear and consistent notice, outlining what changes must be made to meet specific requirements set out in named regulations.

Local authorities will be able to use the notices as an effective tool to communicate with businesses before a fixed penalty notice is issued. These regulations reflect feedback from business and others, who are doing their utmost to support NHS Test and Trace. The changes will support businesses to comply with the legislation while ensuring that NHS Test and Trace has the information it needs to contact people who may have been exposed to the virus.

Finally, by keeping the virus under control through December, the Government can enable everyone to see more of their family and friends over the upcoming festive season. These regulations make provision for extended Christmas bubbles that will allow three households to mix between 23 and 27 December. When following these new rules, it is vital that we continue to take personal responsibility to limit the spread of the virus and protect loved ones, particularly if they are vulnerable. The year 2020 has proved to be an extraordinary one that has brought a lot of hardship and heartache for everyone. With the winter bank holidays on the horizon, we believe it is important that people are able to see some of their family and friends during this time. We have been living with this virus for too long.

As we go into winter, our emphasis is on reducing the pressure on the NHS at a time when hospital admissions are already considerable. Our approach is guided by the need to mitigate the virus as much as possible. We have considered the needs of the British people and are seeking approval here to implement a system that remains uniform and clear, wherever in England you might be. It also provides a proportionate and measured response to the continuing threat of the virus. The tier system is not just a government policy; it is a national endeavour that we must all continue to be active players in, because this virus threatens us all, so we must all play our part in keeping it under control.

I know that these are tough sacrifices at the end of a year of sacrifices but, to continue to be able to protect education and the economy, we must continue to limit our social contact with other people where possible. I commend the hard work and dedication shown by the British public through these trying times. Hope is on the horizon, with new scientific advances being made every day, but we still have further to go. Until science can make us safe, we must put in place these new rules, which will help us to keep the virus under control. I commend these regulations to the House.

Amendment to the Motion

Moved by

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, it has not been the most comfortable two and a half hours of my life, but I have profound sympathy for a huge amount of what has been said in this debate; I really do. I completely understand where the Opposition Benches are coming from on some of the major themes raised. I will go through some of those in detail, but I will summarise briefly before moving on.

On test and trace, I understand the frustration that those on the Opposition Benches have voiced, but I would like to reassure them that the numbers have come up dramatically, that Thursday’s numbers were incredibly impressive and that this Thursday’s will be even more impressive. A massive amount has been done to address the concerns they have quite reasonably voiced in the past.

Huge strides have been made on collaboration with local authorities in the last few weeks. The publication yesterday of the community testing document and the process around that is proof that those commitments are sincere. I have been held to task on the clarity of government communications many times over the last seven months. The way in which even these restrictions have been communicated has had a lot of thought and has landed very clearly indeed.

On my own Benches, there have been extremely clear messages that I personally agree with wholeheartedly on a sentimental basis. Who would want to stand at the Dispatch Box today putting a restraint on the liberty of the British public of the kind we are looking at in these statutory instruments? This is a joy to absolutely no one, and it is done with a huge number of reservations, with concern and with a full understanding of the implications.

On the economic case, I do not need to be told by anybody about the implications of these restrictions on our economy. I know from my own life, my friends and those I love what they mean to our economy. I feel that very harshly indeed and assure noble Lords that those matters are taken fully into account when we put these statutory instruments before the House.

On the complexity of some of these statutory instruments, we are dealing with a difficult and complex situation. Noble Lords have rightly ridiculed the language used, and I have greatly enjoyed some of the language used in tearing into these statutory instruments, but I cannot hide from noble Lords the fact that to be effective they have to be legal. Legal language is sometimes funny but always necessary. We need to do things in a thorough, thoughtful way.

I have sat in more meetings with experts in the last eight months than anyone else in this House, and they drive me nuts, but we appreciate and value the scientific dialectic. We have approached it with an enormous amount of transparency, and there is no point in scapegoating those who posit the best ideas they can. It is up to us as the decision-makers to make our choices, not to blame the experts for the advice they give us.

Lastly, on the democratic element, I have stood here and apologised for the late arrival of statutory instruments and the retrospective nature of some of these debates. But I remind everyone that I am standing here ahead of the application of these statutory instruments and, as the noble Baroness, Lady Thornton, just reminded us, next door—in the other place—they have been approved by a vote of 291 to 78, which is an emphatic win for the Government.

Before I move on, let me tackle a couple of the key questions; I cannot possibly address all the issues that have been raised today. My noble friend Lord Robathan covered an enormous number of points, and I very much value the challenge he brings to the Government in these matters. I remind him that we are all sobered by the statistics that he cited on suicides and cancer, and, of course, those numbers are far too high. I cannot help thinking that, at the end of all of this, we are going to rethink the value of life and think about how much more we can do to address questions like suicide and cancer. But no one is suggesting that we are facing a tsunami of either cancer or suicides that threatens hundreds of thousands of lives in the next few months, or that it might overwhelm the NHS. Therefore, the parity he suggests is not right.

I completely sympathise with the points that my noble friend Lady Neville-Rolfe made so eloquently and thoughtfully on the impact of regulations such as these on the economy and, in particular, on the hospitality sector. I reassure her and all other noble Lords who have raised, quite reasonably, the impact on the economy of these regulations that we absolutely think about education, business and the secondary health impacts of these regulations on the country.

However, when asked about the impact assessment, I remind noble Lords of the very important work done by the ONS, the Home Office, the Department of Health and Social Care and the Government Actuary called Direct and Indirect Impacts of COVID-19 on Excess Deaths and Morbidity. That is a detailed analysis of the various impacts of a strategy of letting the disease take its course, and if anyone wants any guide to what the alternative looks like, that report spells it out extremely clearly indeed. I am extremely disappointed whenever people raise the question of cost-benefit analysis and government analysis that this report is not cited more, because it is an excellent piece of work, and I highly recommend it.

My noble friend Lord Lilley speaks of an institutional bias and groupthink. I respect his challenge enormously. He is entirely right to warn any organisation, particularly one in the grip of a serious pandemic, about falling into the trap of any kind of groupthink. But I remind him that there have been moments when the groupthink went the other way. I remember very well at the beginning of this pandemic, when people told us that Covid was going to be like flu—and then many millions have died around the world. I remember when people said that it would never come to Britain and that it would stay in China where it started, but then the cruise ships showed that the disease did travel, and when it started travelling, it would not stop.

There were those who initially denied that the lockdown in March was necessary, but I think there are few people who would make that case right now. There were people who said that antibodies and T cells would somehow mean that large sections of the population would be resistant to the disease. That has been seen not to be true and, in fact, antibodies in the UK—now that we have tested hundreds of thousands, or millions, of people—are rarely more than 10%, and show every sign of fading away in some people. There were those who thought that the disease might just blow itself out and mutate into something that was harmless, and that the second lockdown was unnecessary. Professor Spiegelhalter has predicted 20,000 deaths before Christmas, and I am afraid that the second lockdown absolutely has been necessary.

I completely understand my noble friend Lord Howard of Rising’s aspiration of somehow segmenting demographics. He makes it sound easy, as if we could somehow split older people off from the rest of society. However, it is not only the view of SPI-M that this is impossible but the view of every single country in the world. Not one country has managed to do what he suggests. It is simply not possible. He may not like this answer and feel that I have not answered him completely but, as on the 180 times I have stood at this Dispatch Box in the last eight months and in the 1,000 letters I have replied to, I am afraid that this is one of those cases where I have sought to answer his question, even if he does not like the answer.

I completely agree with my noble friend Lord Ridley that persuasion is of course better than compulsion. That is exactly the approach we have taken. We have tried to use consent wherever possible. If you speak to the police force or any of the agencies of the state, you will find that that is absolutely the principle we have taken. I also completely agree that the authoritarian approach of China, Korea or Taiwan may suit those cultures and political systems, but they are not for us. However, he is completely wrong to think the public are not with us on our approach. In September, 62% of the public supported our rules; in October, it was 72%; and in November, it was 73%. Some 89% support the wearing of masks and 77%, even now, support the rule of seven. And 76% support the closing of bars and restaurants where necessary. I fear that, sometimes, noble Lords in this Chamber are out of step with the heart of public opinion. While I agree ideologically with the points they make, it is wrong to suggest that they are speaking on behalf of the public in these matters.

I am extremely glad that my noble friend Lady Meyer and the noble Lord, Lord Birt, mentioned the vaccine, because that is very much the focus of our efforts. These restrictions are merely a bridge to get there. No one wants to live under the terms of these statutory instruments. I can report that progress on the vaccine is extremely encouraging; I am grateful to the scientists designing it and those involved in its deployment.

The noble Baroness, Lady Barker, speaks with so much truth and wisdom in her interventions, but I push back slightly on her remarks on the shielding letters. I know my noble friend Lord Cormack thought that they were wise. The shielding letters are extremely clear because people asked for them to be clear. We work very closely with stakeholders to make sure that they are right, and they are passed to stakeholders for their consent before they go out. The 76-page documents are very long because people want to know the answers to detailed questions. When we ask them what kind of detail they want, this is exactly it. The extract the noble Baroness read out seemed to me a model of clarity and exemplary in the wisdom of its advice.

I am afraid to tell the noble Baroness, Lady Hayman, that, if you are going to have boundaries, they must lie somewhere. Regions need boundaries. When you live on the side of one, that is always uncomfortable, but I know no other way of dividing the country.

Where I completely agree with the noble Baroness, Lady Hayman, is on her reference to Dame Sally Davies, who has a point when she says that social deprivation, bad diet and bad living habits have undoubtedly contributed and hit the country hard in this epidemic. Sally Davies is completely right that there is a social justice issue here. Levelling up, which I campaigned on in the last election and which the Prime Minister has evangelical support for, means health outcome equality, if it means anything at all. I completely share the aspiration that a benign outcome of this awful disease would be a national commitment to this agenda, not only for the principles of social justice but, pragmatically, for national resilience.

I will say a few words about trust and authoritarian measures to my noble friend Lord Cormack, who had extremely harsh words about the Government’s motives and their actions. I respectfully remind my noble friend that the Government are not conspiring to separate families, isolate the vulnerable or close businesses but this awful virus. That is what is causing the trouble, and it is our commitment to protect the vulnerable, businesses, the health service and, thereby, to protect the economy and the very fabric of society that leads us to this point. I completely sympathise with his frustration and I take his concerns about liberty seriously, but he is aiming at the wrong target.

The noble Lord, Lord Scriven, asked about the accuracy of lateral flow tests, and I would be happy to enter into correspondence with him on this. It is a short measure. I reassure him that these are an extremely effective screen. We have been using millions of them up and down the country and have become extremely experienced with them. They are not the tests we would use if you were going to go into an operating theatre, but they are the tests we would use if you were going to see Granny.

The noble Lord, Lord Scriven and my noble friend Lord Cormack asked about public understanding of government measures, which is a relevant, pertinent question. I reassure them both that the Centre for the Mathematical Modelling of Infectious Diseases has found that mean contacts—the number of contacts each original case study had—increased gradually from early April to July, which is exactly what we learned during the summer, when contacts began to grow. Since then, contacts peaked in mid-September and have come down, which is an indication that people are taking more seriously the strictures of the Government to socially distance and reduce social contact.

The noble Lord, Lord Greaves, spoke with great humanity about the plight of those in Pendle and the north. I reassure him that we do not think that it was only community testing that led to the decline in Liverpool but the commitment of the political leadership and a terrific civil effort on the part of the whole city. However, community testing did help. It not only helped break the chain of transmission but helped focus minds on the disciplines of epidemic control. He is right that the Army cannot do everything and that the priority is to test people who are most likely to have the disease. On the £500, it has undoubtedly been a struggle for both councils and individuals to claim the money, but we have, as of yesterday, made it accessible through the app, which I hope will change matters considerably.

The noble Baroness, Lady Thornton, and others asked about support; we have provided unprecedented levels of support to businesses and individuals. That includes helping to pay the wages of people in 9.6 million jobs across the country through the Coronavirus Job Retention Scheme, protecting jobs that might otherwise have been lost, and supporting the livelihoods of 2.7 million self-employed workers. Businesses have received billions in loans and tax deferrals.

By way of summary, the noble Lord, Lord Birt, made this central public health insight that we have all learned throughout this pandemic. My health is no longer a private matter. What I have realised is that I might have Covid, therefore, I might infect my neighbour. If I get ill, I will take up a bed in a hospital, and that bed will not be available for you. In other words, this is a classic liberal dilemma, which a number of noble Lords referred to. Of course, we respect everybody’s freedom and liberty but at this stage, with this horrible contagious disease spreading around the country, I am afraid we are all dangerous to others, and that is why we have to bring in statutory instruments such as the one we are looking at today.

Around 633,000 people in Britain have Covid today. We are doing our best. Some 246,298 were isolated by track and trace between 22 and 28 November, but we are going into the winter with far too many people walking the streets, schools and hospitals with a highly contagious and dangerous disease. That is why we have the restrictions we are looking at today, why I stand by them and hope your Lordships will support them, why I hope my noble friend and others will withdraw their amendments, and why I commend these regulations to the House.

HIV: Ending Transmissions

Lord Bethell Excerpts

Tuesday 1st December 2020 Lords Chamber

[Baroness Barker]

To ask Her Majesty’s Government what progress they have made towards ending HIV transmissions by 2030.

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

My Lords, the Government remain fully committed to achieving zero new HIV transmissions in England by 2030. This is why we endorsed the HIV Commission, which was established by the Terrence Higgins Trust, the National AIDS Trust and the Elton John AIDS Foundation, and we welcome its report, published today. I reassure noble Lords that we will consider all the recommendations carefully, including an interim milestone of an 80% reduction in new HIV transmissions by 2025, and how we can expand testing. We will use the insights of the report to shape our upcoming sexual and reproductive health strategy and HIV plan.

[Baroness Barker (LD)]

I thank the Minister for that reply. I am very proud to a member of the party which, before anybody else, advocated that there be services for people with HIV and AIDS, and we will be there until this report is fully implemented and the fight against AIDS is won. Will the Government move to introduce a system of opt-out testing so that all people, including men and women from black and minority ethnic communities, can know their status, and we can get sooner to the point where they can get treatment and stop transmission?

[Lord Bethell (Con)]

The noble Baroness refers to one of the most interesting of the recommendations of the commission’s report. I took a briefing from the commission yesterday; members made that point very clearly, and their arguments were extremely persuasive. We have learned a lot during the Covid pandemic about opt-out testing; I completely understand the value of it, and I will take that recommendation to the department to look at it very closely.

[Lord Herbert of South Downs (Con)]

My Lords, I pay tribute to the long-standing work of the Lord Speaker on HIV and AIDS. I have campaigned beside him in South Africa and have seen the passion with which he devoted himself to this role over many years.

Does my noble friend the Minister agree that the HIV Commission’s recommendation for a plan that the Government should commit themselves to is a wise one which they should adopt? After all, it is D minus 10 now—10 years before AIDS should be beaten, according to the SDG. We have the tools, now we need to implement them.

[Lord Bethell (Con)]

I reiterate the tribute of my noble friend to the Lord Speaker. Over three decades, he has campaigned tirelessly on these issues, and was instrumental as Secretary of State for Health and Social Security in launching the ground-breaking “Don’t Die of Ignorance” campaign, which made an indelible mark—its impact is remembered today. The tenacity that he has shown in making evidence-based decisions in the fight against HIV is a model for us today.

My noble friend makes a very valid point on the need for a plan. We will issue a sexual health and an AIDS plan in short order; they have been delayed by Covid. He reminds us that it is D minus 10, a goal that we take extremely seriously.

[Baroness Clark of Kilwinning (Lab)]

We know that stigma, even fear, can often prevent people going for tests. What does the Minister think we can do to improve the uptake of testing, particularly from those who are at the highest risk of contracting HIV? What does he think we can do to improve the training of those who provide testing to make sure that in future people are more likely to take tests?

[Lord Bethell (Con)]

My Lords, we have made great progress in the area of tests, hitting the UNAIDS 90-90-90 target for the third consecutive year, with 94% of those living with HIV diagnosed, 98% of those diagnosed getting treatment and 97% of those undergoing treatment having an undetectable viral load. The noble Baroness is entirely right: one of the greatest challenges is those who are not tested because they do not know that they should be tested. Part of that is stigma and part of it is encouraging people to step up to get tested. That is the focus of the recommendations in the HIV Commission’s report, which we take very seriously. It has clear recommendations on marketing, which we will be looking at very carefully.

[Baroness Sheehan (LD)]

The Global Fund to Fight AIDS, Tuberculosis and Malaria warns that additional support is badly needed to prevent a reversal in “hard-won gains”. Will we, as a lead funder, join Germany, Italy, Canada and South Africa to increase our contribution to the fund as a matter of urgency? A Written Answer will suffice if that is not in the Minister’s briefing notes.

[Lord Bethell (Con)]

The noble Baroness makes a very good point. The UK Government will continue to be a world leader in our HIV response through our considerable investment in the Global Fund to Fight AIDS, Tuberculosis and Malaria as well as through supporting the Robert Carr Fund to advocate for the rights and needs of the most marginalised groups, such as LGBTQ people and sex workers. In relation to reassurance on the point she asks about, I cannot provide that from the Dispatch Box, but I reassure her that our commitment to these international causes remains robust.

[Lord Collins of Highbury (Lab)]

My Lords, this is a global fight, and, as the noble Lord mentioned, this target is for the SDGs that apply throughout. If we are to meet the global agenda of no new transmissions of HIV by 2030, how will the Government work with all major funders, as he mentioned, to collectively invest the £36.49 billion needed for HIV programming for key populations over the next decade?

[Lord Bethell (Con)]

My Lords, I have already precisely outlined some of our commitments to international funding. Two other areas where we contribute are, first, through our example: by marching resolutely towards the zero transmissions target, we set an important global example, which should not be underestimated. The second is the contribution of our science community, which has been profound and has contributed huge medical insights to the scientific progress on antiviral drugs and in the fight against AIDS.

[Lord Black of Brentwood (Con) [V]]

Does my noble friend agree that one of the biggest barriers to meeting the 2030 target is the stubbornly high rate of late diagnosis, which not only has serious repercussions for the individuals concerned but contributes significantly to health inequality? Does he support the following recommendation in the HIV Commission’s report:

“Every late diagnosis must be viewed as a serious incident requiring investigation … and a report produced to drive change in local health systems”?

[Lord Bethell (Con)]

My Lords, I noticed the recommendation that every late diagnosis should be regarded as a major contagion, reported and followed up by an authority such as PHE. This is something for PHE to consider for itself, but I will certainly write to it to raise the recommendation and ask it to respond to me.

[Lord McConnell of Glenscorrodale (Lab)]

My Lords, the doubling of mother-to-child transmissions around the world is just one of the implications of this year of instability in health services around the world caused by the Covid-19 pandemic. In my experience around the world, one of the greatest fears of those living with HIV is instability, whether that is caused by climate change, conflict or pandemics. What are the Government going to achieve by cutting £4 billion in overseas development assistance when these great crises need so much attention at this time?

[Lord Bethell (Con)]

The noble Lord speaks with great humanity and compassion, but I perhaps need to give a bit of perspective. I am not sure if our UK aid budget is enough to solve all the problems that he describes. The UK remains extremely committed to international aid. In the Covid epidemic and recession, we have reduced our commitment in a small way and have promised to revisit it at a later date. That commitment is very clear, and we will do that in due time.

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

My Lords, cuts to local authority public health budgets of some £700 million in real terms over the last five years have led to sexual health budgets being cut by 25% in this period. The King’s Fund has estimated that restoring spending to the former level

“would require additional investment of £1 billion.”

Given the Government’s commitment to zero new HIV transmissions by 2030, will the Minister tell the House what plans they have to increase investment in HIV preventive services delivered by local authorities? Can the Minister also confirm that there will still be national funding for a prevention programme?

[Lord Bethell (Con)]

The Covid epidemic has disrupted things, but I reassure the noble Baroness that in the spending review 2020 we have confirmed that the public health grant will be maintained into next year, enabling local authorities to meet pressures and continue to deliver important public services. DHSC will confirm final allocations in the coming week, including the position on HIV PrEP. I reassure the noble Baroness that PrEP has proved to be an enormously valuable contribution to our fight against transmissions, and we continue to back it.

[The Lord Speaker (Lord Fowler)]

My Lords, I fear the time allowed for that Question has elapsed.

HIV: Pre-exposure Prophylaxis

Lord Bethell Excerpts

Tuesday 1st December 2020 Lords Chamber

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

My Lords, the Government recognise the huge impact that HIV pre-exposure prophylaxis plays, as part of a combination of prevention interventions, in reducing HIV transmission. That is why we have provided £11 million to local authorities during this financial year for routine commissioning of PrEP. We are continuing to work closely with local authorities and other stakeholders to support the rollout, which will benefit tens of thousands of people.

[Lord Cashman (Non-Afl)]

[Inaudible]—study has shown that they are 100% effective when taken properly and there is no difference in reports of condom use. More importantly, contradicting the claim that access to PrEP would somehow encourage an increase in risky sexual behaviour, there are no other STIs. Therefore, given that one of the key barriers to increasing access to PrEP is it being delivered exclusively through sexual health clinics, what discussions have the Government had about expanding access to PrEP to other healthcare settings such as gender clinics, maternity units, GPs and pharmacies?

[Lord Bethell (Con)]

My Lords, the noble Lord makes a completely fair point. There is absolutely no question of there being a social stigma associated with taking PrEP or any kind of moral cloud over those wishing to take this important therapy. That is not in any way our purpose. He makes a valid point that there are good arguments for the supply of PrEP to be not just through GUM units but also through GPs and perhaps pharmacists. These are arguments that we hear and that we are looking at very closely. I hope that, at some point, I will be able to update the noble Lord on our progress on this matter.

[Baroness Thornton (Lab)]

I remind the Minister, with regard to his last answer about funding, that just because you cannot solve all the world’s problems does not mean that you should not try to solve some of them. On that basis, can the Government provide an update on the rollout of PrEP in England? Is the Minister aware that there are local authorities that are still not providing the drug? When the ring-fenced funding for PrEP runs out in March 2021, will the Government commit to at least the £16 million per annum to make this happen for the future?

[Lord Bethell (Con)]

The noble Baroness makes a fair point. The rollout of PrEP has reached a great many local authorities but not all of them. The funding for it, at £11 million, has made a big impact but it has not covered all the ground. We are aware that this funding package runs out next year and we are in active engagement with local authorities in order to find a new mechanism going forward before July, when the funding will change. That said, our commitment, as I said earlier, to the principle of PrEP and its impact on reaching our targets for transmission remains resolute. I look forward to being able to announce a resolution of this funding formula.

[Baroness Jolly (LD)[V]]

My Lords, access to sexual health services has always been more difficult in far-flung areas such as Cumbria and Cornwall. Often, young gay men do not like approaching the GPs they have known since childhood. The Minister referred in an earlier answer to PrEP. Is he confident that there are adequate alternative opportunities to get local access to PrEP? Will he commit to talking to those in the department who deal with the plan, and will he write to me with a date when PrEP might be easily accessible all across England and put the response in the Library?

[Lord Bethell (Con)]

The noble Baroness makes an entirely fair point. Access to PrEP is not as even as it could or should be. It is a very important tool in our fight against the transmission of HIV, and it is a programme that we support wholeheartedly. However, it takes time to roll out a therapeutic such as this through the entire healthcare system. We have focused its supply through sexual health units because they are the most thoughtful and reliable places for the kind of consultation and expertise needed for a delicate new therapeutic like PrEP. However, she raises a good point that perhaps this should be and could be updated.

[Lord Scriven (LD)]

My Lords, since 2017, both Scotland and Wales have supplied uncapped access to PrEP, so will the Minister tell us what is stopping uncapped access to PrEP in England, so that we do not have a postcode lottery for access?

[Lord Bethell (Con)]

The noble Lord will be aware that there is a detailed conversation with local authorities about ensuring that we get exactly the right balance for funding. As the noble Baroness rightly pointed out, we need to make sure that the supply of PrEP is conducted in a way where there is good consultation and where those who are applying for the therapy are given good advice. That is best done with help from local authorities, and we are trying to hammer out a deal to ensure that that is done thoughtfully. That deal has been delayed by Covid, but we are looking forward to announcing a resolution of that before the next funding round finishes.

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

My Lords, can the Minister confirm that the Government are collecting information on who is accessing PrEP in England? It is obviously crucial to ensure that there is equity among the groups given the currently limited supply, unlike the situation in Scotland and Wales, to which the noble Lord, Lord Scriven, has just referred. Will the Government commit to publishing the data on who is accessing PrEP?

[Lord Bethell (Con)]

I am not sure that I can give the reassurances that the noble Baroness is looking for. These are very delicate and private matters. I am not sure if it is right that the details of who is accessing PrEP are necessarily for are public domain, but I would welcome any suggestion that she might have in correspondence about what exactly she is looking for.

[Lord Paddick (LD)]

My Lords, in January 2016, the results of the PROUD study, in which I was a participant, showed a 90% reduction in HIV infections in those who took PrEP and no increase in other sexually transmitted infections. Why did it take the Government four years from the publication of these results to make PrEP available in England? What are the Government doing to increase the awareness of PrEP among women and the black community?

[Lord Bethell (Con)]

I am afraid that I was not a Minister in the period that the noble Lord is talking about, so I cannot account for that. However, I agree with him that, on the point he raised about access to PrEP among women and the black community, we have a case to answer. I completely acknowledge that, particularly among the black community, this is one of the most difficult areas that we have to tackle in order to hit our objective of zero transmissions by 2030. We are working extremely hard to try to reassure those who are hesitant about taking on such therapies that they are safe, accessible, private and relevant. We need to win that battle in order to hit our target.

[The Lord Speaker (Lord Fowler)]

All supplementary questions have now been asked and we will therefore move on to the next Question.

Health Protection (Coronavirus, Restrictions) (Local Authority Enforcement Powers and Amendment) (England) Regulations 2020

Lord Bethell Excerpts

Tuesday 1st December 2020 Lords Chamber

Moved by

[Lord Bethell]

That the Regulations laid before the House on 30 November be approved. Instrument not yet reported by the Joint Committee on Statutory Instruments.

Motion agreed.

Nutrition (Amendment etc.) (EU Exit) Regulations 2020

Lord Bethell Excerpts

Tuesday 1st December 2020 Lords Chamber

Moved by

[Lord Bethell]

That the draft Regulations laid before the House on 29 September and 21 October be approved.

Relevant document: 33rd Report from the Secondary Legislation Scrutiny Committee. Considered in Grand Committee on 25 November.

Motions agreed.

Covid-19 Update

Lord Bethell Excerpts

Monday 30th November 2020 Lords Chamber

[Baroness Jolly (LD) [V]]

I thank the Minister who is going to respond to this Statement.

The first case of this coronavirus was just over a year ago, on 17 November 2019. Since then, over 1.3 million people have died worldwide and over 50 million people have been infected. The first case here in the UK was on 29 January this year. We watched Italy deal with the cases in late winter, and I am sure that plans were being fetched out of the archives on how we might deal with a pandemic. I know that in 2015 there was a pandemic plan published for an influenza outbreak. Will the Minister tell the House what lessons were learned from that exercise?

I remember walking back to my flat in London on 17 March and my son, who was living with me then, said, “You either go home today, or you stay until this clears”. I went home, and on 23 March lockdown started. Along with many other noble Lords, I stayed away for some considerable time, and Zoom, Teams and virtual working became the new normal.

Hong Kong, which is always waiting for a SARS outbreak, keeps a stock of PPE for all care homes in the event of a pandemic. Is it too early to ask the Minister whether that is something he would now consider for England? I think it was a recommendation of that pandemic preparedness document in 2015.

One area where I would also be grateful for clarification is that of test, track and isolate. At what stage was it decided not to involve the local experts and local authorities? This caused much regional frustration, as this was the biggest public health crisis for many years, and local public health leaders were being sidelined. They know their regions well, and in areas where they did work, it worked well. Let me be clear that in a Lib Dem world, local authorities would test then track those with a positive result and support them practically and emotionally in their isolation.

As the noble Baroness, Lady Thornton, has articulated, many of the public have said that they did not fully understand restrictions. When putting messages together, who did the Government picture they were talking to? From whom did they get their advice? Who did they test their messaging on? This is a case where conversations with the Plain English Campaign, or perhaps the Canadians, would have been helpful.

The last time tiered restrictions were in place, less than half of people in the UCL Covid-19 Social Study said that they fully understood the rules. With changes to the tier system and a five-day relaxation, will the Secretary of State make changes to the Government’s communications strategy to aid compliance?

Some of the Covid economic measures have helped people in the short term, such as the furlough scheme, which our colleagues in the other place fought so hard to get. However, the Government excluded more than 1 million people from Covid support and froze pay for local authority staff, who have also played a vital role in combating this pernicious disease. It is an assault on local authority workers and services.

Nurses too have been hoping for a pay rise. The Chancellor stated:

“Our health emergency is not yet over and our economic emergency has only just begun”.


He explained that the

“immediate priority is to protect people’s lives and livelihoods”,

and that the spending review is set to deliver stronger public services. He continued:

“taking account of the pay review bodies’ advice, we will provide a pay rise to over a million nurses, doctors and others working in the NHS.”

He promised

“the 2.1 million public sector workers who earn below the median wage of £24,000”

that they

“will be guaranteed a pay rise of at least £250.”—[Official Report, Commons, 25/11/20; cols. 827-28.]

That should include porters, auxiliaries, and other key, low-paid hospital workers.

Countless families are facing serious financial hardship. More than 1 million people have lost their jobs, and the devastating impact of this pandemic will continue to be felt acutely throughout the next year. We are also facing big challenges in deep-seated inequality. We must ensure that no one is left behind. The Government win plaudits for the furlough scheme, but they have failed to provide a serious economic strategy for dealing with unemployment, climate change and inequality. I fear the Government’s Brexit plans will make job losses and business closures much worse. No deal or a bad deal would be a huge blow for businesses and jobs just when we need to be recovering from this crisis.

Although the winter plan broadly outlines the five criteria used for determining the tier system, would the Minister be more transparent about what the exact entry and exit points of the tiers will be? I understand it is not always possible to give exact criteria, but even a rough idea would help the public know what they are aiming for when the Government are asking them to make so many sacrifices.

This has been relentless since the middle of May. At a briefing meeting today, we heard that the acute care sector was at full pelt, and this is before winter sets in. The Minister is rightly proud of the Nightingale units. Do we have staffing for them? Should we need them? Many clinical staff are totally exhausted. Many question whether they want to carry on in the profession. Are the Government making sure that a safety-critical profession can reach safe staffing levels by filling tens of thousands of unfilled nursing jobs?

Children are the most vulnerable to the social impacts of local restrictions and have had formative years of their lives severely affected. With the rule of six being reinstated after national lockdown, will the Minister commit to an exemption from the rule of six for children under 12? It really does make sense.

What is the Minister’s current estimation of the likely length of the restrictions? Being open and transparent on likely timings and not creating false hope are critical to maintaining public support for any public health measures. After all, the PM said earlier this year that we would be back to normal by Christmas, and how wrong he turned out to be.

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

My Lords, I thank the noble Baronesses for their thoughtful and searching questions on an important day’s traffic of announcements from the Government. I would like to try to tackle them as comprehensively as I can, but I assure both noble Baronesses that I will write to them on any points I fail to address in these comments.

The noble Baroness, Lady Thornton, started by saying that she felt the endless cycle of lockdowns had not been working. It is undoubtedly true that we all regret the return to a national lockdown earlier this month, but it is not true they do not work. New infections are down by a third, and that is an enormous achievement by the British public, whose discipline and obedience to the restrictions has yielded a massive dividend.

The noble Baroness said that test and trace was not working. It is undoubtedly true that when prevalence levels are so high, when there are more than half a million infections in the country and when new infections are running at five digits, it is extremely challenging for any national testing and tracing system to keep up with that sort of capacity. I beg the noble Baroness to give some ground and acknowledge the achievement of the huge scaling of the number of tests, the vast number of people who have been asked to isolate, thereby breaking the chain of transmission, and the hard work of those who work on the tracing side of the business, which has dramatically increased its performance and will continue to meet target numbers.

The noble Baroness also talked about care homes being stranded. I remind her that we have come a huge distance. I could reel off a dozen achievements in the care homes strategy, but two stand out. First is the regular testing of staff, which has now become a systematic programme that has massively protected those in care homes. There has also been the recent introduction of testing for visitors, which brings welcome relief for those needing to support and visit those in care homes, a much-valued service that needed a huge amount of work to put into place.

The noble Baroness talked about the role of the public. I have alluded to my respect for and thanks to the public. I will be crystal clear: the challenge that we face as a country is not public apathy but the virus itself. There is an absolutely vicious aspect of the virus, which is its high contagiousness. In a room with a few people together, it is quite unlike most contagious diseases in its infectiousness. When we talk about the challenge of social distancing and the need for lockdowns, it is not one another whom we blame: it is the virus itself. I encourage all those who feel frustrated to remember who the enemy is.

The noble Baroness asked whether the tiering allocations would be done in consultation with local authorities. The brief answer to that question is no. We tried that, but it did not prove a successful experiment. The acrimony and large amount of delays created long-standing problems for the implementation of the policy. Therefore, we will be implementing the tiering on a fortnightly basis from the centre. It is a big yes, however, on the approach to community testing and infection control. We absolutely want to work in partnership with local authorities and local DPHs, which have all the powers that they need to decide whom they seek to target and what incentives they would like to provide for those who need to be attracted to testing. I also say yes—absolutely—to transparency, both in terms of the publication of the numbers and our approach to our collaborations. I put on record our massive thanks to local authorities, particularly those that have been working with us over the last fortnight on our community testing programme, the publication of which earlier today is a really important framework of the local-national partnership of which I have spoken at this Dispatch Box many times. It really brings alive that commitment.

The noble Baroness, Lady Jolly, was entirely right that there was an influenza plan, but it envisaged a completely different type of virus. The lessons from the influenza plan, though relevant for the kind of flu envisaged, were not applicable for the coronavirus. A good example of that is the PPE. Had we followed the possibility of preparing a massive stock of PPE for the kind of flu envisaged in the influenza plan, we would have had the wrong kind of PPE. There was nothing that we could have done about that.

The other big learning was on mortality rates. The mortality rates for Covid-19 and the long-standing effects that it has on people are completely unlike those of the kind of flu that we were envisaging earlier. It has been a grave learning curve to have to change our plans to deal with Covid.



In relation to other learnings or things that we have moved on since then, I reiterate a theme that I have mentioned before: our commitment to national and local test and trace. Quite understandably, the noble Baroness challenges me on that point, but I gently remind her that, in February, local authorities did not have any tests; nobody had any tests. We were doing 2,000 tests a day. Therefore, it is all very well saying that we should have left test and trace to local authorities, but there simply were not the resources there to do that. It took a massive national programme and huge national effort to get us up to half a million tests a day, which is something that the local authorities, even in collaboration, could not possibly have done.

The local authorities also did not have scalable tracing capacity. The PHE capacity was designed for ultra-low prevalence rates—for when you are chasing a few dozen carriers of a disease who, perhaps, have recently arrived from overseas. It was not designed for 20,000 infections a day, which is the kind of infection rate we have been looking at recently. It was only by building the data systems, protocols and guidelines, and having tens of thousands of employees, that we have been able to put that tracing capacity in place.

We also did not have the organisational or analytical capacity to do the kind of surveillance that is done through ONS and REACT or the kind of data management that the JBC has done. Now that we have those components in place—the physical, data and diagnostic frameworks—we are in a position to work as a team, both nationally and locally. The noble Baroness is entirely right that that local insight, intelligence, empathy and leadership are absolutely critical for our success, and I encourage her and all those in the Chamber to read our community testing programme, which was published earlier today and which encapsulates the spirit of the local-national partnership of which the noble Baroness has spoken previously in the Chamber.

The noble Baroness challenges me on communications, and I will not deny that it has been one of the great challenges of the pandemic to try to explain, in a fast-changing and confusing climate, the government imperative and recommendations to the public. One of the key things that we have learned is that, sometimes, the desire to share the delicious complexity of the epidemiology stands in the way of simple communication. Sometimes, trying to find the exemptions that are fair to everyone and cater to every single consultative recommendation stands in the way of simplicity, straightforwardness and tractability.

We have learned that, sometimes, it is more important to be simple, clear and straightforward than to try to accommodate every nuance and exception. This is why we have pursued rules like the rule of six, have gone for a simple and easily understood regional tiering process and applied the 10 pm curfew, although we have updated that to an 11 pm curfew, with a drinking-up time of 10 pm. That kind of consistent messaging is what the public, quite reasonably, respond to, which is why we have moved to it.

In response to the noble Baroness’s question about under-12s, I say that there are both the communication and epidemiological reasons that children are vectors of disease. This is an uncomfortable truth because they very infrequently show any symptoms and it is incredibly inconvenient—I say this as someone with four children, three of whom are under 12. However, it would be epidemiologically irresponsible to try to make an exception in that way, and I certainly will be spending quite a lot of Christmas with my family.

In relation to hardship, the noble Baroness makes the point extremely well, and we are totally sympathetic to her point. It is undoubtedly true that the least advantaged will be the hardest hit by this epidemic. It is true because their jobs are hit hardest, particularly those in casual labour, because the virus often hits those who have the most cramped accommodation or low-quality health and because many of those who live on the borderline of life will be the ones nudged into poverty.

The Government have worked hard, with the furlough scheme in particular, to ensure that a financial safety net is put into place, but I have no doubt that there will be a moment when the economic hardship created by the pandemic will be acute, and I have no doubt that the mental health implications of that for the population will be extremely hard. The Government are extremely aware of that and we are trying our hardest to minimise the impact. One reason why we are hitting the virus hard with these tiers is to ensure that we can get the economy back as quickly as we can, mostly to the advantage of those who are hit the hardest.

The noble Baroness asked me about entry and exit points to the tiers, and I have no easy solution for her. There are very clear considerations which we will be looking at when we consider which regions go into which tier: case detection rates, particularly of those over 60; the rate at which cases are falling; the positivity rate; and pressure on the NHS. But this is an incredibly complex matrix of interdependencies. It is not simple to plop it into the kind of easy algorithm that can churn out an answer at the push of a button; nor is it easy to have one simple metric where we can say, “You’ve hit this and therefore you move this way,” or “You’ve failed and you move that way.” If it were so easy we would publish it. The best advice we can get is that we have to consider all those factors when making those decisions. We will do it in a spirit of transparency, but we will have to make tough decisions. I reassure noble Lords that it will happen every two weeks, as the Prime Minister explained, and we will seek to be as fair and thorough as we possibly can.

[The Deputy Speaker (Baroness Morris of Bolton) (Con)]

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

[Lord Caine (Con)]

My Lords, my noble friend will be aware of the great uncertainties facing those who work in the hospitality sector, particularly in those parts of the country that are in tier 3, such as my native West Riding of Yorkshire. What realistic prospect is there of areas moving from tiers 3 to 2 when the next review takes place on 16 December, so that bars and restaurants can at least open their doors for the crucial Christmas period? Rather than grouping together entire regions into tiers, is there not a strong case for more bespoke local arrangements?

[Lord Bethell (Con)]

My noble friend is entirely right about the hospitality sector. It is a sector that we care about greatly and we recognise how hard hit it has been. None the less, we have to be considerate of the fact that the best epidemiological studies suggest that this is an environment where infection hits hard, so we are trying to hit the right balance between the two. As for local areas and trying to be more precise and focused in our tiering, that sounds like a sensible suggestion. However, we experimented with it quite thoroughly during the summer, and I remember standing here at this Dispatch Box week after week running through tweaks to various local tiers, only to find that the virus very quickly leaped from one area to another. It is a frustrating fact that the virus spreads from city to surrounding rural area and from one town to the next with alarming speed. It is also true, as discussed in response to the earlier question, that for communications it is important to keep things simple. For those reasons, we are not envisaging a change to the tiering structure at the moment.

[Lord Bilimoria (CB) [V]]

My Lords, is the Minister aware that just a few minutes ago, before the Statement, a press report questioning the accuracy of lateral flow antigen tests said that 140,000 tests were carried out in the Liverpool City Region, and yet the Statement says that more than 300,000 people were tested in Liverpool and, with the mass testing, cases have fallen by three-quarters and Liverpool has now gone down from tier 3 to tier 2? Why can we not get the communication right so that people can have confidence in mass testing so that it can be rolled out nationally, and show the evidence that it actually works?

[Lord Bethell (Con)]

I am extremely grateful for the opportunity to remind the noble Lord that earlier today we published a fulsome programme of community testing. I would be very glad to send him a copy of it, because it lays out exactly the plan he has just described; I am hopeful that he will celebrate its publication. He is entirely right that infection rates have come down in Liverpool—not just because of mass testing but it has made a contribution—and I pay tribute to the mayor and people of Liverpool for their approach in recent months.

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

My Lords, does the Minister agree that when a country faces a common external threat—to use his phrase, an “enemy”—the best chance of success comes when it is united? If he does, and we are once again seeing splintering and divisions arising quickly after this further Covid Statement, will he speak to his colleague the Prime Minister and seek to persuade him to invite other political parties to get involved in a united approach; to invite Sir Keir Starmer, the leaders of the devolved Parliaments and the leaders of the other political parties so that we can move towards a co-ordinated and co-operative effort while this problem continues to blight the country? As he has demonstrated with Liverpool, there is a very strong case for people working closer together—not permanently, but temporarily—than they have done hitherto. This is required at a national and political level as well.

[Lord Bethell (Con)]

I share completely the noble Lord’s ambition for collaboration and a sense of national unity. I am grateful to the devolved Assemblies and the leaders of the nations for their collaborative approach, and to the leader of the Opposition for his support on a large number of matters. However, right now we need clear, simple, strong government, which is best supplied by the voted-in majority.

[Baroness Walmsley (LD) [V]]

My Lords, at the beginning of the first lockdown in Wales, we were forbidden from going out of our borough or travelling more than five miles for exercise. It worked. Now some Government Back-Benchers are demanding more granularity in the tier areas, with restrictions being eased in boroughs with lower case numbers. If this is to be done, it must be—as the Minister just mentioned—without risking the virus spreading from adjacent high-incidence areas, as it did before. If the Government are inclined to give in to this pressure, will they at least consider imposing travel restrictions in high-incidence areas?

[Lord Bethell (Con)]

The noble Baroness is entirely right. I share her sentiments. We are not inclined to give in to the pressure. There is a temptation for greater granularity, but we have learned the lesson on that one.

[Lord Lansley (Con)]

My Lords, the Faculty of Public Health and the directors of public health have expressed reservations about what they described as the distraction of the mass community testing programme in relation to the requirement to support the vaccination programme. Can my noble friend give them and me some reassurance that the vaccination programme will be an overarching priority for resources and that the testing of symptomatic cases and of essential workers, to which he referred, is a priority for the testing programme? Can he also say whether there is a realistic level of resources to support the community testing programme to which he has twice referred positively?

[Lord Bethell (Con)]

I welcome my noble friend’s challenge. I reassure him that the testing and vaccination programmes will absolutely run alongside each other and that this has already been happening. They are collaborating very closely. The resources being provided for both are generous enough to ensure full delivery of the vaccine. The rollout of the community testing programme is a sign of the success of test and trace, but it will in no way have a negative impact on the deployment of the vaccine programme, which remains a number one priority for the Government.

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

My Lords, given that some people need to go to visit a relative who is dying or otherwise very distressed, will the Government instigate a system whereby these people can register that they will need to travel across boundaries? They may even need to stay over to provide care for some time, to enable a person to be cared for in their own home. Under the current situation, they risk being given a criminal record for breaching rules, and then they may have to try to defend themselves in retrospect after the person has died.

[Lord Bethell (Con)]

I thank the noble Baroness for her characteristically compassionate question. I can reassure her that there are exceptions for essential travel. The kind of scenarios that she just described would seem to me to fit into the definition of exceptional travel. I am happy to look into whether some form of registration process is necessary but, as far as I understand, that has not proved to be the case.

[Baroness Clark of Kilwinning (Lab)]

Many scientists are expressing concern that the easing of restrictions at Christmas is going to lead to a surge in cases in January. Given this and the high incidence of Covid among 11 to 16 year-olds, are the Government actively considering extending the Christmas break for secondary school children as a way to try to curb the spread of the virus?

[Lord Bethell (Con)]

The noble Baroness is right that we are concerned about a post-Christmas surge, but the opening of schools is an absolute number one priority. We will do everything we can to keep the schools open, and that includes schools for 11 to 16 year-olds.

[Baroness Harris of Richmond (LD) [V]]

The Minister and the noble Baroness, Lady Walmsley, have already touched on this, but can the Minister tell me how the Government propose to stop people in the different tiers crossing borders? I declare an interest in this because I live in a tourist hot spot, which suffered badly during the first lockdown from people coming from all those neighbouring areas, which are now in tier 3 and surrounding us.

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, we rely on the principle of consent. We appeal to the good will of the British public. Analysis of Google and transport statistics suggests that, by and large, the British public have abided by the travel restrictions in the tiering structure, but we do keep them under analysis. It is not our intention to have surveillance and a penalty-fine culture, but we will do whatever is necessary to ensure the effective application of the tiering framework.

[Lord Fairfax of Cameron (Con) [V]]

My Lords, while my noble friend the Minister is of course only responsible for health matters, would he not agree that, with the economic emergency—as the Chancellor had said—just starting, unemployment set to double by next year, and thousands of businesses going to the wall every week, to say nothing of the non-Covid health consequences of its measures, the Government would not be facing possible defeat in the other place tomorrow if they had taken a more balanced and transparent approach, particularly recently, to the Covid crisis?

[Lord Bethell (Con)]

My Lords, although I am only a humble Health Minister, I do believe that the frameworks we are recommending are in the best interests of the economy. If the NHS cannot cope, if trust breaks down in society, if people stay at home and will not shop or go to hospitality, and if people are laid off then the economy suffers. If the pandemic and the presence of Covid, as a driver of behaviour in our society, rolls over for month after month, then we will be the long-term sufferers of economic decline. That is the reason why we believe that the tiering and community testing is essential, and that is why we support these measures.

[Lord Craig of Radley (CB) [V]]

Can the Minister confirm that the initial advice from the independent committee on vaccinations is that, after NHS and care homes staff, priority should be given to people over 80 in the rest of the population in order of age and risk? That is medically sound advice, but in the wider national interest would it not be preferable that those who contribute to recovery and education are prioritised over the more elderly who successfully kept themselves free from the virus and do not expect to continue to benefit at the expense of working individuals?

[Lord Bethell (Con)]

The noble and gallant Lord makes a fair point. We looked at the very scenario that he describes, but ultimately our priorities are to save life, protect the NHS and keep schools and the economy going. The best way of doing that is to prioritise the elderly because there is a direct correlation between illness from Covid and age. The best way in which we can protect society and the economy is to ensure that those who are oldest get the vaccine first.

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

My Lords, clear messaging by the Government in relation to Covid is crucial. Can the Minister make it clear that three households meeting over five days in one house at Christmas is not compulsory and that it is perfectly acceptable to take the view that it is not worth the risk? Given that a few weeks ago mixing of households was the demon in the piece, does he agree that having Christmas lunch with five others in a Covid-secure restaurant would be far safer than doing so in an excitable family home with minimum PPE security? Plus, of course, it would bring an important additional benefit to the economy.

[Lord Bethell (Con)]

I am grateful to the noble Lord for what I think was his broad point. I did not quite understand the exact scenario in the restaurant that he described, but I think that he was alluding to the difficult but important decision that every family has to make. He is entirely right: we do not all have to go mad over Christmas and see as many people as we can. Some people will make the quite sensible decision to show restraint and to share the holiday with those they love but not necessarily to travel or see a very large number of people. I salute those people and encourage that kind of attitude.

[Baroness Donaghy (Lab) [V]]

My Lords, perhaps I may come back to of my noble friend Lady Thornton’s question on test and trace. The noble Lord accepted that it was extremely challenging—those were his words—and said that we should accept that there had been a huge scaling up, but we were told that a world-class test and trace system would solve things, and it is far from that. The inconsistencies in results are causing a high degree of scepticism. Can he outline further how the Government will meet that extreme challenge?

[Lord Bethell (Con)]

My Lords, I am not sure that I accept the premise of the question. The scepticism that the noble Baroness describes has not stopped millions of people stepping forward to have tests. Our experience is that those who have direct experience of test and trace—whether they are people who use the app, people who turn up for testing, people who go to hospital and have tests through the NHS or people who are traced—speak of the good service and experience that they have. It is undoubtedly true that test and trace takes a hammering in the press, and its reputation has been hard hit by sceptics who talk down its performance, but, generally speaking, those who actually experience it speak highly of the service.

[Lord Farmer (Con)]

My Lords, just 10 days ago, Professor David Eyre of the University of Oxford reported that, for most people, being infected with Covid-19 protects against reinfection for at least six months. He said:

“This is really good news, because we can be confident that, at least in the short term, most people who get COVID-19 won’t get it again.”


Washington State University research found that just one case out of the multiple millions worldwide suggested that waning antibody levels or a poorly developed immune system to Covid could put people at risk of reinfection. I am aware that studies need to be replicated, but this good news seems to be a very well-kept secret, ignored on the official government web page on the relevance of antibody tests. What would give the Government confidence that potent antibodies linger beyond at least six months in the majority of cases and how small would the tiny minority of proven cases of reinfection have to be in order for them to say that this risk is a price worth paying for society to begin to get back on its feet?

[Lord Bethell (Con)]

My Lords, the Government—and I personally—are extremely interested in this area. Early findings of a study by the Coronavirus Immunology Consortium and Public Health England, which have not been peer reviewed yet, suggest that a strong cellular immune response is likely to be present in the majority of adults six months after infection. At present, there is not enough evidence to rule out people who have positive T cell responses or antibodies to Covid-19 from potentially still playing a role in transmitting the virus to others. However, further research on the level of sterilising immunity provided by natural infection should be available from the SIREN study and the Oxford healthcare workers study before the end of the year. I look forward to the results of those studies very much.

[Lord Bird (CB)]

My Lords, I remind that House that not so long ago the Government put their arms around the homeless and removed them from the streets. They did a highly commendable job because it was the first time that a Government had taken responsibility for rough sleepers en masse. They did not quite finish the job because it was difficult to bring them in. Can we also put our arms around the roughly 200,000 people who, according to the LGA, will fall homeless through eviction? The best thing that we can do is to keep people in their houses. It cuts the cost of poverty and it cuts the cost of homelessness. When people slip into homelessness, the costs double.

[Lord Bethell (Con)]

My Lords, I am enormously grateful to the noble Lord for his very generous comments. I commend him for his advocacy both in the instance of Covid and for his lifelong commitment to standing up for the homeless. He is right that the homeless are undoubtedly super-vulnerable to a pandemic such as Covid and that there is a finance problem for the charities which look after those who live on the streets. He is right that those who have trouble paying their rent and face eviction are in a particularly difficult position. That is why we have put in place a mortgage relief scheme, continue to support the furlough scheme and keep in mind the plight of those who struggle to pay their household bills.

[The Deputy Speaker (Baroness Morris of Bolton) (Con)]

The noble Lord, Lord Liddle, has scratched, so I now call the noble Lord, Lord Dobbs.

--- Later in debate ---

[Lord Bethell (Con)]

My noble friend makes a very interesting point. Our priority right now is to vaccinate the British public. He is right that there are many vaccines available and Britain has made a massive investment in vaccines. We are also supporters of the international distribution of vaccines and the fair access of the developing world and those around the world to vaccines. That is why we support COVAX, Gavi and CEPI. He is right that there is an opportunity somewhere, and we are entertaining ways of supporting such a vision.

[The Deputy Speaker (Baroness Morris of Bolton) (Con)]

I call the noble Lord, Lord Dubs.

[Lord Dubs (Lab) [V]]

I apologise. Does the Minister have any estimate of the number of people who are currently in self-isolation? Does he agree that if these people were to be given high priority for testing, their period of self-isolation would be shortened and more people would be willing to go into self-isolation because they would not lose so much money if they could be tested quickly and resume their ordinary lives?

[Lord Bethell (Con)]

The noble Lord hits the nail on the head. We have already brought into place a test-to-release programme for foreign visitors and we are looking at ways in which such a principle could be applied elsewhere.

[The Deputy Speaker (Baroness Morris of Bolton) (Con)]

The noble Baroness, Lady Noakes, has withdrawn. We are not sure whether we have the noble Lord, Lord Rooker. We do not. I now call the noble Lord, Lord Forsyth of Drumlean.

[Lord Forsyth of Drumlean (Con) [V]]

My Lords, could my noble friend comment on reports in today’s press that four hospitals only, in the whole of England, are busier than last winter? Could he explain how on Saturday Michael Gove warned that, unless the latest regulations were implemented, every hospital in England risked being overwhelmed by Covid-19 cases? Before our debate tomorrow, could he publish the modelling on which this assertion was based?

[Lord Bethell (Con)]

My Lords, I saw the press reports to which my noble friend refers. I remind him that their suggestion that we should be running our hospital system at 99% capacity during a pandemic is not reasonable. It would put our flexibility to deal with any increase in infections over the winter months in an incredibly precarious state. Running at around 88%, which is the current rate, is pragmatic. It would take very little for the 600,000-plus group of people who carry the Covid infection at the moment to have an impact on those bed numbers before the NHS was overwhelmed. That was the point that the Chancellor of the Duchy of Lancaster made, and I thought he made it very well.

[Baroness Stuart of Edgbaston (Non-Afl)]

My Lords, it is a matter of regret that it was not possible to reach agreement on the tiering system with local authority leaders. However, local authorities will be crucial to its implementation, not just now but after Christmas. Birmingham City Council has succeeded in recruiting 468 Covid community champions and has regular meetings with faith leaders and public health. Can the Minister assure noble Lords that close co-operation with local communities, authorities and leaders, irrespective of their party allegiance, will continue, because otherwise we will not succeed?

[Lord Bethell (Con)]

I completely endorse the noble Baroness’s points. I know well the very good work that both Birmingham and the entire West Midlands are doing. Recruitment of champions and liaison with faith leaders are exactly the kinds of interventions that local authority leadership can provide. It is absolutely at the heart of our local and national approach. We are providing the kind of support that local authorities need to pursue these plans, which includes military personnel, testing facilities, data and analysis, and financial support, where necessary.

[The Deputy Speaker (Baroness Morris of Bolton) (Con)]

The noble Lord, Lord Balfe, has withdrawn, so I now call the noble Lord, Lord Moynihan.

[Lord Moynihan (Con)]

My Lords, I congratulate my noble friend the Minister on the importance that he attaches to the safe return of fans to designated sports events, the reopening of many gyms and sporting activities across England, and the financial package announced last week for key sports in need of urgent financial assistance. Does he agree that we now need to help all clubs, particularly grass-roots clubs, to fulfil the critical role of ensuring that the population is as active and healthy as possible, to provide a strong counter to the Covid virus? Delivering and funding that objective must remain a key priority for the Government.

[Lord Bethell (Con)]

I am grateful to my noble friend for the opportunity to mention sports and to thank him for his advocacy of sports, both national and grass roots, during the epidemic. He is entirely right: if there has been one striking aspect of the pandemic, it has been the way that the British public have missed the elite sports that they follow and support avidly, and have increasingly participated in their personal fitness and sport. I cannot help thinking that this pandemic will be something of an inflection point in the British people’s attitude to sport. I support the department’s campaign to encourage people to do more sport. We are doing an enormous amount to open stadia. I am pleased that we have new guidelines that will enable large stadia to open, albeit with social distancing. But my noble friend is entirely right that we must do more to support the grass roots, and I know that colleagues in the DCMS are doing as much as they can to help.

House adjourned at 8.59 pm.

DHSC Answers to Written Questions

Lord Bethell Excerpts

Wednesday 25th November 2020 Lords Chamber

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

My Lords, the very large number of questions which have been put to the Department of Health is completely unprecedented. We had 577 in the whole of 2019. So far in 2020 we have had 1,783, of which 799 have been answered on time and the rest are late. I apologise for that; it is a matter of huge regret. I ask for the forbearance of the House, as the pandemic has put enormous pressure on the department.

The noble Baroness, Lady Thornton, quite correctly alluded to one aspect of the answering of questions: the questions themselves often address novel challenges. Traditionally, we get questions about things that the department has been doing for years and years, where it is easy to pluck out an answer from the database or from the encyclopaedia of answers. The noble Baroness gave a good example of a question where it is difficult to elicit an answer. I know the exact question she referred to, because I have sought really hard to provide an answer to the noble Lord, Lord Bassam. The question of how many swabs have not been returned by post is much more complicated than it might look. There are different types of swabs; different schemes—ONS, REACT, clinical trials—send in the swabs. Inconveniently, they do not pool all the answers. Also, some swabs may sit on a bench or in a cupboard at a house for a long time and it is not possible to know when they are, or are not, sent back.

I cite that as an example of the kind of challenge that we have faced in answering questions from noble Lords. I am not trying to detract from the inconvenience of questions not being answered on time, but I assure the House that we have put in considerably more resources. We have upgraded the quality of the people who are answering the questions and have an absolute commitment to trying to answer them on time.

[The Lord Speaker (Lord Fowler)]

My Lords, I remind Ministers that the instruction to be brief applies to their answers, as well as to questions from other Members.

[Lord Robathan (Con)]

My Lords, I do not underestimate the pressure under which the Department of Health has been put and pay tribute to my noble friend for the number of times that he comes here to answer Questions. However, the data behind this virus is hugely important. I put down a Question asking about the number of NHS workers—doctors and nurses—who have been killed by the virus. The answer that came back was: “We don’t know”. Surely, we must know this. I have also asked a question in this Chamber, not a written one, about what the strategy is without vaccinations. A vaccine has now come, but we must know what the strategy is. Are we going to go into another lockdown if the infection rate rises again? Perhaps the Minister can answer that now?

[Lord Bethell (Con)]

My Lords, matching the data on deaths with the HR records of the NHS is actually very difficult. It cannot be done easily, or even accurately. Our strategy is crystal clear: to protect the NHS, keep the schools open and encourage the economy while we wait for the vaccine to be deployed.

[Baroness Whitaker (Lab) [V]]

My Lords, I am grateful for the answer from the health department on 24 November to my letter of 8 June about the disparity of health outcomes from Covid-19 for Gypsies, Travellers and Roma, although it did not answer our specific questions and was sent only to my cosignatory, Kate Green MP, not me. Will the Minister please answer my question of 21 October, due to be answered on 4 November, asking whether the Government would recognise International Stammering Awareness Day, now long past, with better technological provision for speech and language therapists, which is sorely needed?

[Lord Bethell (Con)]

My Lords, I would be glad to track down the noble Baroness’s letter and get her the answer that she so desires.

[Lord Wills (Lab) [V]]

My Lords, I have every sympathy with the unique pressures being placed on the Minister and his department this year. It was inevitable that mistakes would be made, but the crucial thing is to learn from them, not least because, however encouraging recent news has been, there are still considerable challenges to be overcome before the country can return to normal. When Ministers refuse even to address questions asked of them, it hardly encourages belief that they are prepared to learn lessons from recent months. I have asked many questions about the failure to utilise efficiently the much-needed capacity provided by the partnership between the private sector and the NHS. The responses were a masterclass in a wilful refusal to answer questions. Does the Minister not recognise the damage done by such public denial of the facts?

[Lord Bethell (Con)]

My Lords, I regret enormously that the noble Lord feels that we have, in any way, avoided the facts. We are absolutely committed to learning the lessons of Covid, which will be profound. I note that my right honourable friend the Secretary of State was in front of the House of Commons Select Committee on health for two and a half hours yesterday, answering exactly those questions. It was an illuminating and important discussion and I very much hope that this House will have an opportunity to do the same.

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

My noble friend is, I am sure, aware of the frustrations that the House has just heard. Here is a question to which I do not expect an answer, perhaps, at the moment. How many officials are actually involved in having to provide these answers? Does my noble friend agree that accuracy of responses is more important than speed?

[Lord Bethell (Con)]

My Lords, before the pandemic the parliamentary affairs team was made up of nine people; it has grown to 15. The ministerial correspondence and public inquiries team has grown from 51 people to 111. I think the noble Lord would agree that, at a time when we are trying to deal with test and trace along with programmes on therapeutics, restart, seasonal flu, PPE and vaccines, having 111 people working on correspondence seems the outer limit of what would be proportionate.

[The Lord Speaker (Lord Fowler)]

My Lords, all questions in this section have now been asked. We will come to the next in a moment.

Coronavirus Act 2020 (Expiry of Mental Health Provisions) (England and Wales) Regulations 2020

Lord Bethell Excerpts

Wednesday 25th November 2020 Grand Committee

Moved by

[Lord Bethell]

That the Grand Committee do consider the Coronavirus Act 2020 (Expiry of Mental Health Provisions) (England and Wales) Regulations 2020.

Relevant document: 33rd Report from the Secondary Legislation Scrutiny Committee

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

My Lords, I am pleased to speak in support of the regulations, which were considered and agreed to in another place on 18 November. During the debate on the six-month review of the Coronavirus Act held in September in the other place, my right honourable friend the Secretary of State for Health and Social Care announced the Government’s decision to sunset the emergency provisions to allow for temporary easements of the Mental Health Act 1983 in England, as they are no longer necessary. These provisions may be found in Schedule 8 to the Coronavirus Act. The regulations therefore seek to enact this decision and so expire provisions in Schedule 8 to the Coronavirus Act 2020.

The emergency provisions, which these regulations seek to remove, were introduced to protect the safety of patients by ensuring that mental health services could continue to provide vital care and treatment if there were extreme staffing shortages during the pandemic. The need for them has been kept under continual review, particularly as the Government are extremely conscious that the provisions, had they been commenced, would have had serious consequence for individuals involved.

We are pleased that, due to the resilience and resourcefulness of the NHS in England and its staff, the provisions have not been commenced as they have not been needed. It is huge testament to the dedication and dynamism of NHS staff that mental health services continue to be able to provide support to people detained under the Mental Health Act, while under the extensive pressures resulting from the pandemic.

The Government, NHS England and NHS Improvement have taken a huge range of steps to support mental health services so that, despite ongoing workforce pressures resulting from the Covid-19 pandemic, they can continue to deliver vital care and treatment to individuals. The department and NHS England and NHS Improvement issued Legal Guidance for Mental Health, Disability and Autism, and Specialised Commissioning Services Supporting People of All Ages during the Coronavirus Pandemic. That guidance set out how the Act’s code of practice may be interpreted during this period. For example, it allows for the delivery of statutory forms electronically to allow mental health staff to work more flexibly and reduce risk of Covid infection. It also set out how video technology can be used for medical assessments to be carried out remotely under the Act, to make it easier for two doctors to examine a patient during the pandemic period.

The department has also supported the Care Quality Commission in bringing in a modified second opinion appointed doctor—SOAD—service, which allowed this service to work remotely. This enabled procedures around assessing and approving the medical treatment of patients detained under the Act to continue as normal, rather than enacting powers that would lessen this important safeguard. These measures, coupled with the resilience and innovation of mental health staff, have been effective in mitigating pressures on mental health services, avoiding the need to commence the emergency powers.

In reaching their decision to remove the provisions, the Government have listened to stakeholders and to Parliament. Three parliamentary committees have recommended that we take this step. The Joint Committee on Human Rights report on the Government’s response to Covid argued that the need to maintain robust safeguards for patients detained under the Mental Health Act was heightened, and cautioned that if we enacted the provisions they would weaken the protections available. The Women and Equalities Committee noted concern that the provisions went against the direction of travel towards reform of the Mental Health Act, to

“a more balanced system with more safeguards, more choice and less restriction”,

as set out in the independent review of the Mental Health Act 1983. Further, the Public Administration and Constitutional Affairs Committee report on the Government’s response to Covid and the Coronavirus Act noted the concerns of the mental health charity Mind and its call for the removal of these temporary powers.

The decision to expire these provisions has been positively received by a wide range of stakeholders—including the Law Society and Rethink Mental Illness, which said that the decision came as a relief to many people living with mental illness and their loved ones—and by the House of Commons.

The Secretary of State was not persuaded, even during the initial Covid peak, that switching these powers on was necessary because our mental health services have shown incredible strength and ingenuity, for which I express immense gratitude to NHS staff. These powers are no longer required, and these regulations seek to expire them.

I will take a moment to briefly remind noble Lords about the contents of the provisions that these regulations seek to expire. The provisions would have enabled an approved mental health professional to apply to detain an individual under the Mental Health Act following the advice of one registered medical practitioner, where securing two recommendations was considered impractical or would have led to undesirable delay. The provisions would also have allowed for an extension of the time that hospital in-patients could be temporarily detained, pending an application for longer detention under the Mental Health Act.

For those in contact with the criminal justice system who have a mental illness, the provisions in the Act would have extended the amount of time a person can be remanded to hospital, allowed an accused or convicted person to be sent to hospital on the recommendation of just one registered medical practitioner rather than two, and extended the procedural time limits for transferring a prisoner to hospital.

Since the Coronavirus Act was enacted, the Government have remained committed to keeping all its aspects under close review and have stated that any provisions no longer necessary will be sunsetted. The Act will expire in its entirety two years after the date it was passed, but also contains a power allowing for the expiry of some provisions to be brought forward ahead of that time. It should be noted that these regulations will not expire the transitional provisions within Schedule 8 to the Act; however, those will have no legal or practical effect.

The Mental Health Act 1983 applies to both England and Wales. The application of the regulations differs for each country. I will therefore seek to clarify their effect on Wales. First, those easements which relate to health services in Wales will remain available to Wales. Health is a matter devolved to the Welsh Government. But, secondly, those easements concerning the operation of justice under the Act—that is, for patients under sentence or subject to criminal proceedings—will be removed for both England and Wales. These remain matters reserved to Her Majesty’s Government. With the exception of provisions relating to the Welsh mental health review tribunal, none of these provisions has been commenced. Should it ever be deemed necessary to return to these provisions, the Government will seek to introduce new legislation.

I thank the staff of NHS mental health services, who have coped without the need to turn on these emergency powers through their hard work, supported by the department and NHS England and NHS Improvement and through innovative approaches. I beg to move.

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, I thank noble Lords for a thoughtful and at times very generous debate, for which I am enormously grateful. I thank the noble Lord, Lord Davies of Brixton, for a remarkable maiden speech and offer him a sincere welcome. He laid out his stall very clearly, first as a man of numbers—as many have noted, the debates of the House of Lords benefit from those who are numerate and articulate with numbers as well as words—secondly, as a supporter of the trade union movement, and I look forward to his interventions as a trade unionist; and thirdly, as a man of compassion. He spoke movingly about mental health and the provisions in these regulations, and has marked himself out as someone who I hope will make an important contribution to our health debates—he will be extremely welcome indeed.

We are aware that many people are facing unprecedented strains due to the pandemic and the measures to contain it. The mental health of everyone is absolutely critical in these unprecedented times. We know that some people will experience exacerbated mental health problems as a result of the pandemic, as has been noted by the noble Baroness, Lady Barker. Moreover, people with existing mental health conditions and front-line workers are particularly susceptible.

The noble Baroness, Lady Tyler, noted that self-reporting has gone up. Public Health England’s Covid-19 mental health and well-being report concluded that the UK population’s self-reported mental health and well-being worsened during the pandemic. The largest decline was in April 2020.

Average levels of mental distress have been reported as going up, as the noble Baroness, Lady Fox, noted, although by 8.1% measured by GHQ 12, not the high levels that some noble Lords have referred to, indicating an increase in the severity of mental health problems overall. A robust follow-up survey from July 2020 of children and young people aged five to 16 who were interviewed for the national mental health prevalence survey in 2017 suggests that rates of probable mental health disorder have increased from one in nine in 2017 to one in six in July 2020—a very regrettable development.

We understand that there is increasing evidence of significant mental health consequences for people who have contracted Covid and evidence that Covid itself impacts the central nervous system, which can affect mental health and well-being. Survivors of Covid appear to be at increased risk of psychiatric disorder. For patients with no previous psychiatric history, a diagnosis of Covid was associated with increased incidence of a first psychiatric diagnosis in the following 14 to 90 days, compared with six other healthcare events.

I reassure all noble Lords who have spoken that mental health continues to be a priority for this Government. We are doing our utmost to ensure that our mental health services are there for everyone who needs them during the pandemic. I reassure the noble Lord, Lord Blunkett, that that is why in today’s spending review the Government have announced £500 million more for mental health support for new specialist services for children and young people, plus extra assistance for people with severe mental health illnesses and faster help for those afflicted by depression and anxiety.

The well-being and mental health support plan for Covid-19 published this week is a demonstration of the Government’s firm commitment to support the mental health of everyone throughout this winter and beyond. It outlines the support available to people over the coming winter. This is just one element of our work to deliver a modern mental health service and meet the demands created by the pandemic. We have announced two new commitments to support individuals: first, a winter discharge support package backed by £50 million, which will boost capacity and support good-quality discharge from mental health in-patient settings to help reduce pressures on in-patient beds and keep patients safe over the winter. Secondly, we are taking action to support the physical health of individuals with serious mental illnesses this winter, including support for systems to deliver local, system-level tailored engagement with patients and to develop national thought leadership on outreach.

We are absolutely committed to continuing our investment in expanding and transforming mental health services in England. This will amount to an additional £2.3 billion of extra funding a year on mental health services by 2023 to 2024. I reassure the noble Lord, Lord Hunt, that we are taking a range of steps to support mental health services to be able to manage pressure over the winter period.

Above all, it is essential that the message is heard loud and clear across the country that NHS mental health services remain open for business and will be available throughout the winter. The earlier people receive support on their mental health, the more likely they are to benefit. However, in April this year, only 57,000 referrals were made, compared to 133,000 in April 2019. While figures for more recent months show that referral rates are recovering, they are significantly below last year’s. To help address this, last week we launched a new phase of our NHS Help Us, Help You campaign to encourage anyone suffering from anxiety, depression or other issues.

We will continue to make sure that mental health services, including hospitals providing in-patient treatment get equal access to PPE. All health and social care staff can access priority testing when they show symptoms, including those providing mental health services in hospitals. NHS staff without symptoms can also be tested at the discretion of their NHS trust. Hospitals can test patients, including those admitted with mental health conditions, even if there is a higher prevalence of Covid-19 in their area.

GP surgeries have been requested by NHS England to make improvements to ensure that the physical health of those living with severe mental illness is protected this winter. This includes asking practices to identify people with severe mental illnesses who are clinically vulnerable and offering those people comprehensive physical health checks and follow-up interventions, free flu vaccines to those eligible and a care plan review as appropriate.

The NHS has worked hard to keep mental health services going during the first peak, using technology where needed, but also face-to-face appointments where appropriate. All mental health trusts have established 24/7 urgent mental health helplines, where people experiencing a mental health crisis can access support and advice. In addition, we have provided £10.2 million of extra funding to support mental health charities, including the Samaritans and the Campaign Against Living Miserably.

Talking therapies will continue to be made available remotely, so that people can access help safely from home. The NHS will work to ensure that the option of face-to-face support, quite rightly alluded to by the noble Baroness, Lady Barker, and the noble Lord, Lord Walney, is provided to people with serious mental health illnesses where it is clinically safe to do so.

Public Health England has published its surveillance tracker to monitor the impact of Covid-19 on the population’s mental health. This is a proactive step which will help to ensure that our response to the effects of Covid-19 on mental health and well-being is shaped by emerging data.

The Government have committed more than £400 million over the next four years to refurbish mental health facilities, getting rid of dormitories in mental health locations and benefiting the patients of 40 trusts across the country. We are committed to supporting our staff and investing in the workforce. NHS England and NHS Improvement are also investing £15 million to ensure that all staff get rapid access to expanded mental health services. Staff who are referred will be assessed rapidly, will be treated by local mental health specialists and, where appropriate, will be referred to specialist centres of excellence.

A number of noble Lords, including the noble Lord, Lord Davies, and the noble Baroness, Lady Tyler, asked about Sir Simon Wessely’s independent review of the Mental Health Act. I reassure noble Lords that work is well under way to respond to the review, and we will publish our White Paper in due course. This will pave the way for far-reaching reforms to the legislation and practice, strengthening the rights of patients and upholding the principles of dignity, autonomy and choice, which were enshrined in the review’s recommendations.

Since the Coronavirus Act was introduced, the Government have remained committed to keeping all elements of it under close review and to sunset any provisions that are no longer needed. As I set out earlier, the emergency modifications to the Mental Health Act made by the Coronavirus Act were designed to protect patients by supporting services to be able to continue if unprecedented constraints in the mental health sector put patients’ safety at risk during the pandemic. These provisions were only ever to be used as a backstop, as I told the Committee earlier.

The noble Lord, Lord Blunkett, referred to the very moving speech of the noble Baroness, Lady Grey-Thompson. I remember her words extremely well. Decisions, over which we have no control whatever, about our uselessness will be taken by someone else in the next few months. I am very pleased that the provisions have not been switched on. I reassure noble Lords that at all times the Government have remained conscious of the need to balance those provisions against the rights of individuals detained under the Mental Health Act.

Those provisions have not needed to be switched on due to the adaptations that have been made because of the resilience and commitment of NHS staff. As a result, we believe that now is the right time to remove them so that it is clear to patients, carers, staff and stakeholders that they will not be used. The approval of these regulations by this House to remove these emergency provisions is an important milestone on the journey towards much-needed reforms to the Mental Health Act. These reforms—

[The Deputy Chairman of Committees (Baroness McIntosh of Hudnall) (Lab)]

The Division Bell is ringing. I wonder whether the Minister is coming to the end of his remarks.

[Lord Bethell (Con)]

I am.

[The Deputy Chairman of Committees (Baroness McIntosh of Hudnall) (Lab)]

If the Minister would like to finish, I will then adjourn the Committee and there will be plenty of time for noble Lords to vote.

[Lord Bethell (Con)]

These reforms, which will see that patients have greater autonomy and control over their care and treatment, will be set out in the Government’s forthcoming White Paper on this subject.

Motion agreed.