NHS Counter Fraud Authority (Establishment, Constitution, and Staff and Other Transfer Provisions) (Amendment) Order 2020
Lord Bethell Excerpts(4 years, 1 month ago)
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Lord Bethell
That the draft Order laid before the House on 11 June be approved. Considered in Grand Committee on 7 September.
Health Protection (Coronavirus, Restrictions) (No. 2) (England) (Amendment) (No. 2) Regulations 2020
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Lord Bethell
That the Regulations laid before the House on 23 July be approved.
Relevant document: 24th Report from the Secondary Legislation Scrutiny Committee.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con) [V]
My Lords, I beg to move that these regulations, originally tabled by my right honourable friend the Secretary of State for Health and Social Care, be approved.
I will start by summarising the changes to the regulations. The Health Protection (Coronavirus, Restrictions) (No.2) England) Regulations, which I will refer to as “the national regulations”, were laid on 4 July. There have been five changes to the national regulations, the first of which were debated and approved in both Houses before the recess. Today’s debate will focus on the second, third and fourth amendments to those regulations.
The second and third amendments to the national regulations continued to ease business closure restrictions. The second amendment to the national regulations permitted the reopening of businesses and venues from 25 July, including: indoor swimming pools, including water parks; indoor fitness and dance studios; and indoor gyms and sports courts and facilities. Alongside these changes the Government produced supporting guidance advising that the most high-risk activities within those business and venues, such as saunas and steam rooms, should not reopen.
From 15 August the following venues were permitted to open: bowling alleys; indoor skating rinks; indoor play areas, including soft play areas, with several adjustments advised in guidance, such as the closure and removal of ball pits; casinos; and exhibition halls and conference centres, with guidance advising that this is only to enable government-endorsed pilots for the time being.
Alongside those regulatory changes, there was also a series of non-legislative changes to allow close-contact services, including treatments on the face, to resume. These included: allowing socially distanced and outdoor performances to take place; pilots for large crowds in sports stadia and business events; and the relaxation of guidance on wedding and civil partnerships to allow receptions of up to 30 people.
As set out above, these amendments opened businesses and venues that had been required to close, with Covid-secure guidance developed with industry and medical advice to ensure that they opened in a safe way. This has meant that now, nationally, only nightclubs, dancehalls, discotheques, sexual entertainment venues and hostess bars are required to remain closed. These are considered to pose a high risk of transmission due to the close proximity of those attending them.
Regarding the fourth amendment on strengthening enforcement of national regulations, although we were able to successively ease business restrictions over the Summer Recess, we also now better understand how the infection is transmitted and the role of social activity within this. That is why the Government have acted quickly to strengthen the enforcement and restrictiveness of social distancing measures against the backdrop of a slow but steady increase in infection levels nationally.
The fourth amendment to the national regulations, which came into force on 28 August, created a new offence of holding or being involved in the holding of an illegal gathering of more than 30 people, giving the police the power to issue a fixed penalty notice of £10,000 to deter the most egregious breaches of social distancing measures.
I want to say a word about the justification for using emergency powers and give an explanation of how decisions are made. We have needed to use the emergency powers to amend these regulations so that we can respond quickly to the serious and imminent threat to public health posed by coronavirus. I know that these national regulations have caused disruption to people’s lives by placing restrictions on who they can see, what they can do and where they can work. Just as the Secretary of State has a legal obligation to protect public health, he is obliged to ease restrictions as soon as it is safe to do so.
The Government continue to pay close attention to the measures, assessing them to ensure that they continue to be necessary and proportionate. These regulations set out that a review of these restrictions must take place within 28 days. However, the Secretary of State for Health keeps their necessity under constant consideration between these formal review points. The question to be considered is whether the “restrictions and requirements” contained within the regulations remain necessary for the public health purposes of the regulations.
Each restriction must be judged by reference to its continuing necessity as the crisis develops, and be based on the available information, at each stage, about the effectiveness and impact of the measures. We use the best available science, along with consideration of the most up-to-date data available at the time to inform decisions. Central to this continues to be a robust assessment of the rate of transmission and infection. However, this Government have also undertaken significant wider analysis and evaluation of the national regulations, including consideration of economic impacts, the level of compliance with the measures, the amount of enforcement needed and impacts felt by local authorities. Understanding the full impacts of these regulations is key to continuing to improve our approach to controlling the virus. This shows the Government’s commitment to ensure that restrictions are in place only for as long as necessary, and the evolution in our understanding and approach to tackling the virus.
Perhaps I may say a word about local restrictions. Over the Summer Recess we have combined tightening restrictions in areas with outbreaks with the easing of business restrictions nationally. As welcomed in the debate just a few weeks ago, we have given local authorities powers to act quickly in response to local outbreaks by closing specific premises, shutting public outdoor spaces and cancelling events. We want to build on this trusted partnership with local government so that we can have a more targeted and localised response to any future outbreaks. We asked all councils to develop dedicated local outbreak plans. We gave councils £300 million in new funding to support this and published the Contain framework, providing further guidance on managing local outbreaks.
Where regulations have been required, the Government have worked with local partners to develop tailored and proportionate restrictions based on the best scientific evidence available, varying from a single factory to an entire region. These interventions have been underpinned by scientific evidence—[Inaudible]—to analyse this local data and provide the scientific advice—
Baroness Penn (Con)
My Lords, we have a problem with the connection. I suggest that we adjourn for five minutes.
The Deputy Speaker (Lord Lexden) (Con)
My Lords, I call on the noble Lord, Lord Bethell, to resume his speech.
Lord Bethell (Con) [V]
My Lords, may I say something about local restrictions? [Connection lost.]
Lord Bethell (Con) [V]
My Lords, may I something about local restrictions?
Over the Summer Recess, we have combined tightening restrictions in areas with outbreaks with the easing of business restrictions. [Connection lost.]
Baroness Penn (Con)
My Lords, with your permission, I shall complete the Minister’s opening speech. May I say something about local restrictions? [Laughter.]
Over the Summer Recess, we have combined tightening restrictions in areas with outbreaks with the easing of business restrictions nationally. We have given local authorities powers to act in response to local outbreaks by closing specific premises, shutting public outdoor spaces and cancelling events.
We asked all councils to develop dedicated local outbreak plans, gave them £300 million of new funding to support this and published the contain framework, providing further guidance on managing local outbreaks. Where regulations have been required, the Government have worked with local partners to develop tailored and proportionate restrictions based on the best scientific evidence available, varying from a single factory to an entire region such as the north of England. These interventions have been underpinned by scientific advice and local data provided by a combination of Public Health England, the joint biosecurity centre and NHS Test and Trace.
On Monday 14 September, noble Lords will have seen the rule of six come into effect. This change brought the gathering policy from guidance into regulation, mandating that people can gather only in groups of six. This applies both indoors and outdoors. Single households or support bubbles of more than six are still able to gather, and there are a small number of exceptions, such as for work, schools, weddings and organised sports activities. As the Prime Minister announced last week, these measures are not a second national lockdown but are aimed at preventing the need for one.
It is thanks to the public and their continued effort that we have been able to slow the spread of the virus and start cautiously to return to life as normal. Although time has passed since the peak we saw in the spring, the threat posed by the virus has not gone away. Now, with winter approaching, we will keep doing whatever it takes to keep it under control. I am grateful to noble Lords for their valuable contributions to these debates and for continuing to challenge us to do better in this vital area of public policy.
I believe that we have met the bar set for us in these debates. These regulations are a proportionate and necessary use of the powers that Parliament has asked us to use. I commend them to the House.
Lord Bethell (Con) [V]
My Lords, this has been a moving and emotional debate. I would like to start, before I go on to my scripted speech, by addressing three key points raised by noble Lords. First, I would like to thank noble Lords for their patience for my not being in the Chamber today, and for, as was described, my “dodgy connections”. I would have liked to be there, and it is my intention to be there in future.
Two themes have been raised time and again, which I would like to address. One is the processing of regulations. Before I talk formally about this, perhaps I may share with the House the fact that decision-making in Government over the last six months has turned on a penny. We have often been in situations where we thought we were going to do one thing at the beginning of a meeting, we have come out of the meeting with new data and new insights, we have made a completely different decision and have had to implement that decision later in the day. This has been extremely tough in many ways, and it has been tough when it comes to scrutiny and bringing regulations in front of the House. I reassure the House that parliamentary scrutiny is valued by the Government, by Ministers and by everyone who brings regulations to the House. It is a massive priority for us that these debates are taken seriously.
Secondly, in response to the many touching personal testimonies of noble Lords during this debate, I say that the individual impacts of these regulations on people in the country are not underestimated by anybody. The stories of grandchildren, parents, split families, the difficulties over childcare and practical matters—these are terrible impacts of this horrible disease. We work extremely hard to try to minimise those impacts, and we try to design the guidelines so that they will have the smallest possible impact. We value enormously the feedback we get from Parliament, from civic groups and from representations, and seek to tweak the guidelines accordingly. I would just like to put those sentiments on the record.
I now turn to the questions posed by noble Lords. My noble friends Lady Neville-Rolfe, Lady Altmann and Lord Forsyth, and the noble Baroness, Lady Hayman, all touched on the frustrations of the public, and I think I have just addressed that. The personal testimony of all of them was extremely moving. I reassure the noble Baronesses, Lady Thornton and Lady Donaghy, and my noble friend Lord Bourne that we do bring the full force of government behind our decision-making. The process of COBRA has given way to the processes of COVID-O and Covid Gold. These are extremely well-managed processes; they are on a weekly roster and have made a huge impact on government.
On parliamentary scrutiny, I completely recognise the concerns of a great many noble Lords, including my noble friend Lord Cormack, the noble Lords, Lord Liddle, Lord Dubs and Lord Scriven, and others. They have all raised concerns about the way in which we are using Section 45R of the Public Health (Control of Disease) Act 1984.
Arrangement of business is a matter for my right honourable friend the Chief Whip and the usual channels. Standing Order 72 prevents us from taking affirmative SIs until the JCSI has reported on them, and that does create delays. Where regulations have to be debated, those debates take place in light of the reports of the JCSI. I reassure my noble friend Lord Bourne of Aberystwyth that regulations are reviewed every 28 days. The first review was on 31 July, the most recent review took place on 28 August and the next one will be on 25 September. I remind the House that Ministers have provided Oral Statements in relation to the introduction of new measures or significant changes, and Written Ministerial Statements following amendments when Parliament is sitting.
The noble Baronesses, Lady Walmsley and Lady Jolly, and my noble friend Lady Neville-Rolfe all asked questions about the £10,000 fine, which is a significant amount that reflects the seriousness of the new offence. I reassure noble Lords that this is an extremely defined offence. It is anticipated that the fines will be small in number but huge in impact. The Metropolitan Police has responded to 1,000 unlicensed events between June and the middle of August. This has created a massive public health threat, which we take seriously. To answer the noble Baroness, Lady Jolly, I had no role in any of these events, but I reassure her that bingo halls have been reopened.
On the economy and Covid-secure guidance, I reassure my noble friends Lady Neville-Rolfe and Lady Noakes, and the noble Baroness, Lady Wheatcroft, that the Government are committed to lifting the regulations as soon as it is safe to do so, enabling the economy to restart in a way that keeps people safe. Covid-secure guidance has been developed in close collaboration with industry and medical experts to help keep businesses open wherever we possibly can, and at every stage we have looked to support business and people returning to life as normal, but striking a balance between that and public health commitments. We have seen the positive news from the ONS that in July the economy grew by 6.6%, meaning that GDP is now 18.6% higher than the April low.
On the NHS, the noble Baroness, Lady Walmsley, raised an important point about capacity, particularly on caring for those who are experiencing the long-term effects of Covid. We are extremely focused on the effects of long-term Covid, particularly for those who have not displayed symptoms, and the Government are providing an extra £3 billion of funding for the NHS.
The noble Baronesses, Lady Hayman and Lady Uddin, asked about children and the rule of six. We have set up clear and consistent limits on the rule of six for children of any age in any settings. This makes things easier to understand for the public and easier to enforce by the police and public health officials. We will keep this under review but the CMO has been clear that children are unfortunately a vector for infection, and a national outbreak among children would have a profound impact on the whole country.
The noble Baroness, Lady Uddin, and the noble Lord, Lord Singh, asked about the severe impact of the disease among the BAME community. I reassure them that we are doing everything we can to market our public health messages to these communities and research the effects of this disease among them, putting in place the appropriate protections wherever we can.
The noble Baroness, Lady Bennett, raised an important point. I can confirm that there is a legal exemption to the rule of six for the purpose of formal childcare provided by a registered provider and in settings not formally registered that provide wrap-around care, such as school clubs, breakfast clubs and sports clubs, as well as for children’s youth clubs. When childcare is provided informally, gathering limits should not be exceeded.
The noble Baroness, Lady Walmsley, asked about the right to protest. I reassure her that we are clear that peaceful protest is a vital part of a democratic society and is a long-standing tradition. She asked who was responsible; those who organise the protests are responsible for them, and it is their responsibility to ensure that they comply. The police’s role will be to check that they are complying and to disperse them if they do not. On this, I would be glad to write to the noble Baroness, Lady Thornton, on her detailed questions about fines.
On sport, my noble friends Lord Naseby and Lord Moynihan raised important questions about being able to exercise within the rule of six. There are exemptions for organised sports and licensed physical activities, including 30 exempted sports. Outdoor activity is safer from a transmission perspective and it is often easier to distance, but not all sports can be Covid-compliant.
I reassure the noble Baroness, Lady Hayman, that these measures are kept under review, and I understand the tough decisions made by families.
On inconsistencies regarding face coverings in gyms, I can confirm to the noble Baroness, Lady Wheatcroft, that we have mandated the wearing of face coverings in indoor settings, as it is not always possible to maintain social distancing.
This is an extremely fast-moving and changing situation which the Government have moved swiftly on to protect the public health. The state of the infection is changing very quickly, as my noble friend Lord Bourne rightly pointed out. The rate of infection has been affected by the return of school and the return to work, and we can see in countries overseas the impact that has on hospital attendance, ventilation rates and, in some places, on death rates. We are moving quickly to adapt.
I completely understand the frustrations. However, we have seen huge achievements from the implementation of these regulations in tackling the spread of the virus, and these regulations before us today, those we will see later and their predecessors have been a major part of that. Although we have significantly progressed in our fight against the virus, now is not the time for complacency, particularly as we head towards winter and prevalence rates are rising. More regulations will be coming but we will keep under review the way in which those are handled. I beg to move.
Health Protection (Coronavirus, Restrictions) (No. 2) (England) (Amendment) (No. 3) Regulations 2020
Lord Bethell Excerpts(4 years, 1 month ago)
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Lord Bethell
That the Regulations laid before the House on 14 August be approved.
Relevant document: 25th Report from the Secondary Legislation Scrutiny Committee.
Health Protection (Coronavirus) (Restrictions on Holding of Gatherings and Amendment) (England) Regulations 2020
Lord Bethell Excerpts(4 years, 1 month ago)
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Lord Bethell
That the Regulations laid before the House on 27 August be approved.
Relevant document: 25th Report from the Secondary Legislation Scrutiny Committee.
Health Protection (Coronavirus, Wearing of Face Coverings in a Relevant Place) (England) Regulations 2020
Lord Bethell Excerpts(4 years, 1 month ago)
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con) [V]
My Lords, I beg to move that the Health Protection (Coronavirus, Wearing of Face Coverings in a Relevant Place) (England) Regulations 2020 and the three instruments amending those regulations on the Order Paper in the name of my right honourable friend the Secretary of State for Health and Social Care be approved.
These regulations were made by the Secretary of State on 23 July and came into force on 24 July. The Government introduced the regulations to make it mandatory to wear face coverings in some indoor settings, such as shops, supermarkets and indoor transport hubs in England, and we have subsequently amended them to ensure that we continually took the necessary steps to protect public health as lockdown restrictions eased over the summer. Amendments were made on 8 August, 22 August and 28 August accordingly to extend the requirement to wear a face covering to a wider list of indoor settings now open to members of the public, providing clarity on who is exempt, the circumstances in which a face covering is not required and around continuing to ensure the enforcement powers given to police and Transport for London are reasonable and proportionate.
These regulations are helping to save lives. They are exceptional measures, brought forward to mitigate the unprecedented impact of the Covid-19 pandemic, and comply with all the Government’s obligations in relation to human rights. I urge the Chamber to approve these regulations and the amending regulations so that we may continue to use these powers to protect the public.
The people in this country have played and continue to play a vital role in helping us in our national effort to beat coronavirus. We therefore introduced these regulations to give members of the public the confidence to visit public indoor spaces safely and enhance protections for those working in these settings. This was explained by the Secretary of State when he addressed Parliament on 14 July and announced these measures, and reiterated this week by my ministerial colleague, the honourable Nadine Dorries, in the other place.
Since 24 July it has been mandatory to wear a face covering in indoor places such as shops, supermarkets and enclosed shopping centres. We have received positive support from the retail sector, including the chief executive of the British Retail Consortium, who has said that face coverings can
“make shoppers feel even more confident about returning to the High Street.”
Additionally, the chair of the Federation of Small Businesses has said:
“As mandatory face coverings are introduced, small firms know that they have a part to play in the nation’s recovery both physically and financially, and I'm sure this will be welcomed by them.”
The Government continue to review and refine their advice on face coverings, informed by the latest scientific evidence. Prior to these regulations, the Government had already been encouraging the public to wear face coverings in enclosed spaces where they may find it difficult to maintain social distance and come into contact with others they would not usually meet. Furthermore, face coverings have been mandatory on public transport in England since 15 June. While face coverings are not a substitute for social distancing and good hand hygiene, the scientific evidence suggests that when used correctly, face coverings may have some benefit in reducing the likelihood of those with the infection passing it on to others, particularly if they are asymptomatic.
As further sections of the economy have reopened and more people have been returning to work, we have amended the scope of the regulations to cover an extended list of indoor public settings such as museums, galleries and places of worship. Additional amendments aimed to provide further clarity to members of the public on where face coverings would be required, who is exempt and the circumstances which may constitute a reasonable excuse. The regulations have also been amended to help deter repeat offenders across public transport and indoor settings. Similar measures have been introduced across the UK with the requirement to wear face coverings in shops, other indoor premises and on public transport—and internationally in countries such as France, Germany and Spain, to name a few.
I will now outline what the regulations do and then set out the policies and processes underlying their development, implementation, monitoring and review. The regulations we are considering today require members of the public to wear a face covering in relevant places, such as shops, supermarkets, enclosed shopping centres, banks, post offices and indoor transport hubs. There have subsequently been amendments to include further indoor premises, including museums, galleries, cinemas, bingo halls, libraries, community centres, public areas in hotels, crematoria and places of worship.
The regulations do not apply to children under the age of 11 or to employees working in those settings. The wearing of any protective clothing or personal protective equipment by the workforce is a matter for their employers following a risk assessment and is part of their health and safety responsibilities.
The regulations include a definition of “shop” to ensure that this captures the majority of retail premises, as well as a list of further premises included and a list of premises excluded from the requirement to wear a face covering—for example, a gym. Those lists have changed as more premises have been able to open.
The guidance on GOV.UK describes a face covering as a covering of any type covering the wearer’s nose and mouth. People need to make or buy their own, and guidance has been published online that shows how to make and wear a face covering. We are asking people not to use medical-grade PPE, which should be reserved for health and care workers. However, someone wearing actual PPE would be compliant with the regulations.
While the Government expect that the vast majority of people will comply with the rules, as they have done throughout the pandemic, the regulations give powers to the police and TfL officers to enforce the requirement to wear a face covering. TfL officers may enforce only inside a transport hub. This could include denying entry to the relevant place and/or directing members of the public to wear a face covering. The police will use their usual “Four Es” approach: engage, explain, encourage, and enforce only as a last resort. In the event that a person fails to comply with a direction by a police constable or TfL officer, they are able to remove the member of the public from that relevant place.
The regulations also include powers for police constables, police community support officers or, in relation to the relevant TfL hub, a TfL officer, to issue a fixed penalty notice to anyone over the age of 18 who is in breach of the law. This is a fixed penalty of £100, reduced to £50 if paid within 14 days of a notice being issued. Amendments that came into force on 28 August allow for fines to double for each offence under these regulations or the equivalent regulations on public transport up to a maximum value of £3,200. This is intended to address repeat offenders across indoor settings and public transport. There is no reduction for early payment from the second or subsequent penalties. The National Police Chiefs’ Council data published on 27 August shows that eight fixed penalty notices were issued between 24 July and 17 August.
Although we want as many people as possible to wear a face covering, we recognise that some people are not able to wear one for a variety of reasons. The regulations exempt children under the age of 11, employees or officials acting in the course of their employment in their premises and emergency responders when on duty. Subsequent amendments to the regulations to extend the scope of indoor places led us to add an exemption for elite sportspersons acting in the course of their employment, training or undertaking competition, and pupils under the age of 19 undertaking education or training within a place of worship as part of the curriculum of a religious school.
Although there is no general exemption on health or disability grounds, we recognise that for some, wearing a face covering is not possible on medical or equalities grounds or would cause distress or difficulty, and that there are certain situations where wearing a face covering is not practical or reasonable. The regulations therefore make provision for “reasonable excuse”, which may apply in certain circumstances and which provides persons in those circumstances with a reasonable excuse for not complying with the requirements set out in the regulations.
The regulations set out a non-exhaustive list of specific circumstances that are considered to be a reasonable excuse for not wearing a face covering. This includes where a person is unable to put on, wear or remove a face covering because of a physical or mental illness, impairment or disability, or where a person is speaking to or providing assistance to someone who relies on lip-reading, clear sound or facial expressions to communicate.
We have also taken into account other circumstances where there is a reasonable excuse to fail to wear a face covering, or where a face covering can be removed for reasons of safety or practicality. Members of the public can remove their face covering to avoid harm or injury to themselves or others, to take medication and, if it is reasonably necessary, to eat or drink. People do not have to wear a face covering if they are entering a relevant place to avoid injury or to escape a risk of harm and do not have a face covering with them.
Employees in these settings can also ask a member of the public to remove their face covering for identification purposes. We have been working with stakeholders to make sure that staff and the public are aware of the exemptions in place and that some people may have a reasonable excuse for not wearing a face covering that may not be apparent. We are also clear that people do not need to prove that they are exempt from the requirements to wear a face covering or have a reasonable excuse, and they should not be challenged about this. Authorised persons enforcing these regulations are expected to use their discretion and judgment when considering reasonable excuses and exemptions in the circumstances.
These regulations have been supported by a communications campaign explaining where face coverings are mandatory, how to wear one safely and encouraging understanding and awareness of those who may not be able to wear a face covering. We have set out the full detail of this policy in our guidance.
As expected, reports indicate widespread compliance with the requirement to wear a face covering in relevant indoor settings, and surveys suggest significant public support. The Office for National Statistics public surveys showed that from 29 July to 4 September, at least 96% of adults in England had worn a face covering when shopping. This figure has remained consistently high. However, we should not expect participation to reach 100% as there will always be people who are exempt or have valid reasons why they cannot wear a face covering.
A review clause is included in the regulations, requiring a review of the need for the requirements imposed by the regulations within six months. A sunset clause is also included so that the regulations expire at the end of 12 months after the day they came into force.
We will continue to monitor the impact and effectiveness of this policy in the weeks and months ahead, and we will develop our approach to enforcement and communicating the policy as necessary.
Lord Bethell (Con) [V]
My Lords, I thank all those involved in this debate for a really important contribution. This face-coverings debate is always a very tough one. It is tough because in many of our areas of response to Covid we have really clear evidence-based decision making. In the area of lockdowns, we have a huge amount of information from the ONS, REACT and our test and trace system. With the clinical trials of our therapeutics, we have incredible data from patients and from recovery. We have a numbers-driven approach to a lot of the response on Covid, but in this area of masks—there is no two ways about it—it is heavily contested. The proof points on whether masks make a difference are not proven. Different groups have different perspectives. Therefore, we are left to rely on principles of common sense, taste and preference, and those are not the principles on which we can run an effective epidemiological response to this horrible disease.
Our epidemiological response has two levels. The first and by far the most important level is reliance on hygiene and social distancing—the “Hands, Face, Space” protocol. That is the one that will beat the virus and it is the one advocated by the CMO, and the CMOs from all the nations of Britain, and it is our primary front in our battle against Covid. The second tier is test, trace and isolate, which is effective and important for surveillance, and is proving to be impactful in breaking the chain of transmission.
Turning to face coverings, I am grateful to all noble Lords who have contributed to this debate. Like my noble friend Lord Blencathra, I particularly thank the noble Lord, Lord Campbell-Savours. He has provided evidence-based commentary and been an advocate, in very reasonable terms, for the wearing of face coverings and we are grateful for his characteristically energetic contributions. I hope to answer his specific questions in turn.
The noble Baroness, Lady Bowles, put it well. We cannot lean on clinical trials and scientific modelling to provide clear-cut solutions on this one. Where does that leave us? Since 11 May, we have brought in a proportionate and evolving strategy on masks. It has been brought in in a way which does not compete with social distancing and hygiene as the Government’s priorities. The messages we have put forward on face coverings are designed so that they do not confuse the public about their importance. My noble friend Lady Sanderson put it really well. We cannot give the public the idea that wearing a mask is in any way a defence against the disease or an effective substitute for social distancing. If we did that, we would be blowing up our first line of defence.
Turning to noble Lords’ questions, the noble Lord, Lord Campbell-Savours, made a strong point about valves. These are typically used in medical PPE, where they are highly regulated, but he has observed, as I have, their clumsy use in retail face coverings. Any face covering that fails to stop the transmission of droplets is not achieving its basic objective and would therefore be in breach of our guidelines, which are clear. We will look into whether further communication is needed on this point.
Many noble Lords, including my noble friend Lady Hooper asked about compliance. As my noble friend Lord Hayward, the noble Baroness, Lady Barker, and others have stated convincingly, the ONS statistics on compliance do not completely align with one’s personal experience. We therefore took the decision to strengthen the penalty system for face-covering regulations to discourage non-compliance, in particular for repeat offenders. The laddering of fines which was brought into force on 28 August has coincided with a massive increase in the public’s use of face masks, or at least that is my perception.
As several noble Lords have rightly argued, it is important that people who are exempt are not accosted or abused in any way. I welcome the appeals made in this Chamber for “No mask” badges for those who are exempt. I celebrate the fact that a design for such a badge is published on GOV.UK.
A number of noble Lords, including the noble Lord, Lord Rooker, and the noble Baroness, Lady Barker, have accused the Government of mixed messages. We have worked hard to communicate well on this, but we are competing with our principal messages of social distancing and good hand hygiene. For that reason, we have not put the marketing and messaging about face masks at the top of our messages.
A number of noble Lords asked about recent research. The noble Baroness, Lady Noakes, is entirely right. In August, the WHO updated its guidance on,
“specific considerations for the use of non-medical masks, also known as fabric masks, by children as a means for source control in the context of the current … pandemic.”
It also advises on the use of medical masks for children under certain conditions. We are seeking to follow that guidance.
In August, SAGE SPI-B reviewed evidence which suggested that mandating face coverings was one of the key behaviours to help deliver Covid-safe large events in large venues. This is in conjunction with other behaviours, including regular handwashing and social distancing.
Other research has been published by the Health and Safety Executive for the benefit of employers. This includes research on the effectiveness of surgical masks against a range of airborne particles and older research to help inform greater compliance with wearing face masks. Further research is being funded by UKRI about the effectiveness of face coverings and face masks and the factors underpinning compliant behaviour with face-covering regulations. Emerging findings are published on the UKRI Coronavirus Hub. I encourage all those with an interest in the area to keep track of that source of evidence.
In September, SAGE reviewed evidence which suggested mitigation of the risk of transmission of the virus in higher education settings through measures including face coverings. This is particularly in educational settings and areas of universities where social distancing may be more difficult.
In response to the question asked by the noble Lord, Lord Greaves, about testing, let me clear that we are by no means at the end of our ramping-up of testing. His testimony about his experiences in Pendle is powerful, and I would be glad to meet the noble Lord to discuss them.
My noble friend Lady Hooper raised an important point about ensuring that guidance for face coverings is clear and communicated to all. I reassure her that we will publish accessible guidance, including in other languages, which will cover how, when and where to wear them safely.
The noble Baroness, Lady Massey, asked specifically about the use of face coverings in schools. The Department for Education has updated its guidance on wearing face coverings in schools following both the WHO and SAGE statements on children. The Government’s priority is to get children back to schools and colleges safely.
The noble Baroness, Lady Ritchie, asked about a potential Covid-19 vaccine and when it might be possible. I reassure her that the department, along with NHSI and PHE, is currently planning for the delivery of any successful vaccine candidate.
We keep the area of face coverings under close review. The public mood on this has shifted considerably. We are aware of a more nuanced understanding about the use of face coverings by many in the public. We will revisit this subject regularly. This has been an informative and powerful debate. I hope therefore that the noble Baroness, Lady Thornton, feels able to withdraw her amendment.
Health Protection (Coronavirus, Wearing of Face Coverings in a Relevant Place) (England) (Amendment) Regulations 2020
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Lord Bethell
That the Regulations laid before the House on 7 August be approved.
Relevant document: 25th Report from the Secondary Legislation Scrutiny Committee
Health Protection (Coronavirus, Wearing of Face Coverings in a Relevant Place) (England) (Amendment) (No. 2) Regulations 2020
Lord Bethell Excerpts(4 years, 1 month ago)
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Lord Bethell
That the Regulations laid before the House on 21 August be approved.
Relevant document: 25th Report from the Secondary Legislation Scrutiny Committee.
Health Protection (Coronavirus, Wearing of Face Coverings in a Relevant Place and on Public Transport) (England) (Amendment) Regulations 2020
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Lord Bethell
That the Regulations laid before the House on 27 August be approved.
Relevant document: 25th Report from the Secondary Legislation Scrutiny Committee.
Coronavirus
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Baroness Thornton (Lab)
My Lords, the Prime Minister claimed again today that the UK does more Covid tests than anywhere else in Europe. This is not true. Denmark does almost twice as many per 1,000 people, and the UK figure includes antibody tests, which others do not do, and is based on when tests are sent out and not on results. So it is more hyperbole.
I hope today we can look at facts. There is now a backlog of 185,000 swabs and tests are being dispatched abroad. Can the Minister advise the House how many tests have been sent abroad, to which countries, the processing time and the void rates? If the Minister does not have that information at his fingertips today, can he please to write to me and put the answer in the Library?
Secondly, Coronavirus infection rates among middle-aged people have reached the same level now as rates among those in their 20s two weeks ago, and Professor Neil Ferguson has warned us that infections are back where they were in late February. So what discussions have the Government had with the Joint Biosecurity Centre and the CMO about raising the alert level from three to four?
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
I am grateful for the noble Baroness’s questions. In terms of European rates, Britain is way ahead of many of its fellow countries in Europe. On Friday last week, we did 240,312 tests. It is a massive number and, I believe, the highest we have done on any day. This is a huge achievement and I pay testimony to those in the NHS and in test and trace who have contributed to that figure.
In terms of tests being sent abroad, our testing environment and economy are part of an international system. Reagents, swabs, consumables and machines are regularly exchanged between countries and I pay tribute to the enterprise and energy of the NHS and the test and trace scheme for using whatever schemes they can find in order to process the tests accurately, efficiently and promptly. I will be glad to send the noble Baroness details of the rates which she asked for.
In terms of the increase in prevalence among the middle-aged—yes, we are deeply concerned about this. As I have said at the Dispatch Box before, as night follows day, rates progress from the young to the middle-aged and, I fear, to the elderly. We are keeping a close eye on this progress.
Lord Scriven (LD)
My Lords, we know that the Minister is an avid listener of Radio 4’s “More or Less.” In today’s episode, Professor Alastair Grant of the University of East Anglia pointed out that 70% of coronavirus test results were completed within 48 hours at the start of August. Looking at official figures and analyses, he pointed out that by Monday, it was just 11.8%. The Minister may dispute the exact figures, but the trend clearly is down, which is worrying when we need an effective trace and isolate system to trace and isolate people as fast as possible. Can he tell the House and the country by what date all results of coronavirus testing will be turned around within a maximum of 24 hours?
Lord Bethell (Con)
My Lords, I am indeed an avid listener of “More or Less,” although I have not heard the episode to which the noble Lord referred. Can I just explain that not all tests need to be done within 24 hours? There are tests that are done for surveillance, to support clinical trials and to help our investigation into vaccines and therapeutics. Those kinds of tests have a much longer turnaround time, and that is entirely appropriate and will be built into the numbers to which “More or Less” referred. Some 89.6% of in-person test results were received the next day after tests were taken; those are the ones that need fast turnaround times and the ones that will be delivered promptly.
Lord Balfe (Con)
I want to talk about care homes and hospital in-patients, many of whom have been marooned for literally months. One of the problems is the testing regime. Could I ask the Minister, first, to give priority to relatives of people in care, so that they can be tested and go in and see their loved ones? Secondly, there is clearly a problem with a lot of the staff, because they are moved around a lot. Can the Minister undertake that his department will consult UNISON, the main trade union for those staff, and see what it can do to open things up so that people in care homes and hospitals are able to be visited again?
Lord Bethell (Con)
My Lords, I note my noble friend’s comments. However, I flatly deny that the social care system and social care homes have been in any way marooned. We have made a profound commitment, particularly in the testing environment, to supporting social care. One hundred thousand tests a day out of our capacity of between 200,000 and 250,000 are ring-fenced for social care and delivered to social care every day. Many of the challenges that we have for walk-in and drive-through testing centres are exactly because we are so committed to the ring-fenced testing for social care. That is a commitment that we are proud of and remain committed to.
I want to clarify with my noble friend that it is not an appropriate use of government test and trace capacity for relatives to use test and trace as a convenient method to find out whether they have the disease before they go to see relatives. That is not an appropriate use and not in the guidance.
As for UNISON, we are very much engaged with the union and are supporting staff in every way we can. However, I very much take on board my noble friend’s notes, and we will maintain that correspondence.
The Lord Bishop of St Albans
My Lords, can the Minister clarify one or two issues? Does the rule of six mean that it will no longer be possible to have any public marking of Remembrance Sunday outdoors this year? Will he also clarify whether this effectively means that all public protests and demonstrations are now illegal?
Lord Bethell (Con)
I thank the right reverend Prelate for his question. I thank greatly those local authorities and charities that are putting in place Remembrance Day service arrangements that will abide by the new rule of six. Some of those guidelines are being written now, and I will be glad to share the guidelines with the right reverend Prelate when they are published. One thing I note is that virtual attendance at these services and the use of virtual remembrance books will be an aspect of Remembrance Day this year.
Lord Bilimoria (CB) [V]
My Lords, Professor William Hanage of the TH Chan School of Public Health at Harvard University has said of the lack of mass testing that:
“By the time you become aware of the problem it is likely to already be much larger. You are not going to detect outbreaks if you don’t look for them.”
He also said that you need
“very good diagnostic tests as well as tests that may be less sensitive but can be used more frequently.”
I am totally with the Government in their aim for mass testing, but would the Minister agree with Professor Alan McNally of the University of Birmingham that the £500 million already announced
“could have funded around 33 million standard swab PCR tests that could have been run in well-equipped university labs”?
Why is that not happening? On rapid saliva tests, the Abbott Laboratories’ BinaxNOW $5, 20-minute test has been FDA approved, with 10 million tests produced this month and 50 million to be produced next month. Why are we not getting on with it? We need to do this really urgently. Does the Minister agree?
Lord Bethell (Con)
I completely support the noble Lord’s commitment to mass testing. We are looking at ways in which to use less sensitive machines to provide the kind of prophylactic testing to which he alludes. I thank very much indeed all universities for their contribution to our testing programme.
Lord Triesman (Lab) [V]
My Lords, in the course of the pandemic, a significant number of contracts with private companies have been signed without tender and a number of these have been in areas such as PPE and test and trace. Most appear to have failed to deliver essential services and equipment—
Lord Triesman (Lab) [V]
I do not think I can get much closer to the microphone without eating it.
In the course of the pandemic, a significant number of contracts have been issued to private companies without tender. What is the value of the contracts that have been signed without competitive tender? Will the Minister place in the Library a list of all such contracts, their value, the companies involved and their ultimate beneficial owners?
Lord Bethell (Con)
That list is already published. I would be glad to send the noble Lord a link.
Lord Lansley (Con) [V]
My Lords, one of the big risks this autumn is from students going to university and, perhaps more particularly, returning from university in the run-up to Christmas. How has the guidance been prepared with universities to try to mitigate that risk? I know that Cambridge University is looking even at the possibility of testing all its students on a weekly basis.
Lord Bethell (Con)
My Lords, I thank colleagues at the DfE for their hard work in providing guidelines to universities and to vice-chancellors for implementing thoughtful arrangements for the return of students. It is very much the ambition of this Government that universities are brought back to life and that education and the impact of their work continues. None the less, it is not just the campus environment that concerns us—it is also the off-campus activities of students. For that, we look to universities to provide pastoral guidance to students to ensure that they are socially distanced and behave responsibly. We are keeping an eye on those behaviours and, should outbreaks or prevalence rise among students, we will have to review those guidelines.
The Deputy Speaker (Lord Duncan of Springbank) (Con)
My Lords, the time allowed for this Question has now elapsed.
Covid-19: NHS Long-term Plan
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Lord Hunt of Kings Heath
To ask Her Majesty’s Government, in the light of the Covid-19 pandemic, what plans they have for changes to the NHS long-term plan.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, I pay tribute to the NHS for its remarkable achievements in response to Covid-19, from freeing up an additional 33,000 beds for Covid patients, to maintaining access to primary care by ensuring that 93% of GP surgeries offer video consultations, and swiftly mobilising an additional 65,000 former clinicians to help fight the virus. Learning from the Covid response will naturally inform future service priorities. However, at present, the Government’s focus remains on supporting system recovery and any amendments that may be needed to the NHS long-term plan will be considered in due course.
Lord Hunt of Kings Heath (Lab)
My Lords, I thank the Minister and echo his tribute to the magnificent efforts of health service staff. I remind the House of my membership of the GMC board. He will know that the NHS entered this crisis underpeopled and under-resourced, and that a huge backlog of work has built up. There have been estimates that as many as 10 million people will be waiting for treatment at the end of the year. There is an issue with cancer patients waiting for tests and treatment. Can he give an indication of the work being done, despite the pandemic, to get the NHS back on track? Surely he agrees that the NHS five-year plan will have to be recalibrated to take account of this.
Lord Bethell (Con)
I thank the noble Lord for his generous comments towards the NHS. Undoubtedly it is true that, after a massive epidemic such as the one we are living through, we will have to rethink some of our priorities and learn from Covid, but I will add a few comments about the restart. The focus on getting patients back into hospital is having a huge impact on cancer waiting lists. Attendance at GP surgeries is increasing all the time, and waiting lists are coming down dramatically. I pay tribute to NHS staff for their hard work on this matter.
The Lord Bishop of Carlisle
My Lords, given that the health protection remit of Public Health England is to be subsumed into the new national institute for health protection, can the Minister tell us what steps Her Majesty’s Government will take to ensure that health inequalities are robustly addressed through programmes of health education and promotion, as envisaged in chapter 2 of the NHS Long Term Plan?
Lord Bethell (Con)
My Lords, the right reverend Prelate is right; health inequalities are a massive priority for the Government. Covid has demonstrated how health inequalities play out when an epidemic such as this one hits the country. That is why we put education and levelling-up on health generally as major government priorities, why we are investing in 50,000 new nurses and 40 new hospitals, and why health remains a number one priority for this Government.
Baroness Browning (Con) [V]
My Lords, my noble friend will be aware that the long-term plan has set an ambitious target for 2028 of 75% of cancers being diagnosed at stages 1 and 2. Does he agree that this must involve GPs, and that GPs having face-to-face consultations with patients is the only way that this target will be achieved?
Lord Bethell (Con)
We are enormously proud of the commitment to early intervention on cancer. This is the absolute core of our life science priorities. It is envisaged that we will have a revolution in the diagnostic capabilities of the NHS in order to hit these targets and, where necessary, face-to-face GP appointments will be made available. However, I am not sure that every single appointment needs to be face to face. One of the learnings of more than half of the 100 million consultations that took place between March and June was that telephone and video appointments can be extremely productive.
Baroness Masham of Ilton (CB) [V]
My Lords, is the Minister aware that late diagnosis causes many disasters in many health specialties? Does he agree that the respiratory programme is vital and has been highlighted by Covid-19? Should we not be training and employing more doctors, nurses and physiotherapists as respiratory specialists across the country in the long-term NHS plan?
Lord Bethell (Con)
I completely agree. It is a grave shame that too many diagnoses happen late. We are proud of our acute care, but it is this Government’s mission to move to a priority around early intervention which will have a huge impact on the quality and length of people’s lives and make modern healthcare more affordable. The noble Baroness is entirely right that respiratory interventions are an important priority.
Lord Desai (Lab) [V]
My Lords, it is not good enough just to praise NHS staff. Will the Government commit to spending a certain percentage of GDP on health as soon as possible? I suggest that 12% of GDP should be spent on health; then we would not have a repetition of this disaster.
Lord Bethell (Con)
We do not just stand and praise. We are recruiting a huge number of new staff—50,000 more nurses and more GPs—and we invest in them through our people plan.
Baroness Jolly (LD)
My Lords, the long-term plan cannot be delivered without effective community nursing support. Community nurses get people out of hospital and prevent others from being admitted. Currently, the service is short of several thousand nurses. What changes does the Minister expect to be made to get these nurses recruited, trained and operational?
Lord Bethell (Con)
I am grateful to the noble Baroness for raising the importance of community nursing, and all community-based healthcare, including community diagnostic hubs. The interest in nurse recruitment has risen dramatically—by 138% in recent months—partly because of our massive advertising campaign and the renewed focus of NHS trusts in community nursing, which will be matched by opportunities to provide training for those who step forward for jobs.
Baroness Altmann (Con)
My Lords, in light of the experiences of people relying on social care during the current pandemic, might the NHS long-term plan make some adjustments to account for the need for integration between NHS and social care? When can we look forward to the proposals for radical social care reform, to ensure parity of esteem for the NHS?
Lord Bethell (Con)
My noble friend is entirely right to raise the importance of social care. Undoubtably, one of the things that we have learned through Covid is that the NHS and social care sectors must work more closely together. That was always envisaged as one of the pillars of the long-term plan. It is now an increased priority. That has been witnessed through much closer collaboration in recent months between trusts and the social care industry. We continue to invest in social care, providing councils with access to £1.5 billion for adult and social care in 2020-21, as extra support during this difficult time.
Baroness Thornton (Lab)
Following on from the question asked by the noble Baroness, Lady Altmann, I must try to pin the Minister down. Can he commit to publishing a plan for the future funding and provision of social care by the end of this year, as the Prime Minister promised in January? My honourable friend Liz Kendall MP has today written to the Secretary of State about the need for a clear social care winter plan. What steps are the Government taking to ensure that no one with Covid-19 is discharged from a hospital to a care home, to prevent a repeat of the terrible impact that this had in the first months of this crisis?
Lord Bethell (Con)
My Lords, I cannot commit to a social care plan before the end of the year. It will require a huge amount of political collaboration and I suspect it will take longer than the next few months. I remind the noble Baroness that we have a £600 million infection control fund to help social care through the winter.
Lord Stirrup (CB)
My Lords, despite additional Covid funding, many NHS trusts are having to cut back on crucial capital investment programmes because of increased financial pressure. For example, some hospitals are having to replace obsolete and ineffective scanners with slightly newer but far from up-to-date models. Does the Minister agree that when the NHS long-term plan is revised, it will need to include a recovery schedule from these perhaps inevitable but nevertheless damaging short-term responses?
Lord Bethell (Con)
My Lords, the Chancellor has made it clear that catch-up support for the NHS to recover from the impact of Covid is an important part of his financial projections. However, I remind the noble and gallant Lord that we are investing in 40 new hospitals. It is a massive capital investment and the impact on our healthcare service should not be underestimated.
The Lord Speaker (Lord Fowler)
My Lords, the time allowed for this Question has elapsed. We now move to the next Question, which is from the noble Lord, Lord Storey.