Health Protection (Coronavirus, Restrictions) (No. 2) (England) (Amendment) (No. 3) Regulations 2020

Lord Bethell Excerpts

Friday 18th September 2020 Lords Chamber

Moved by

[Lord Bethell]

That the Regulations laid before the House on 14 August be approved.

Relevant document: 25th Report from the Secondary Legislation Scrutiny Committee.

Motion agreed.

Health Protection (Coronavirus) (Restrictions on Holding of Gatherings and Amendment) (England) Regulations 2020

Lord Bethell Excerpts

Friday 18th September 2020 Lords Chamber

Moved by

[Lord Bethell]

That the Regulations laid before the House on 27 August be approved.

Relevant document: 25th Report from the Secondary Legislation Scrutiny Committee.

Motion agreed.

Health Protection (Coronavirus, Wearing of Face Coverings in a Relevant Place) (England) Regulations 2020

Lord Bethell Excerpts

Friday 18th September 2020 Lords Chamber

Moved by

[Lord Bethell]

That the Regulations laid before the House on 23 July be approved.

[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.

--- Later in debate ---

[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

Lord Bethell Excerpts

Friday 18th September 2020 Lords Chamber

Moved by

[Lord Bethell]

That the Regulations laid before the House on 7 August be approved.

Relevant document: 25th Report from the Secondary Legislation Scrutiny Committee

Motion agreed.

Health Protection (Coronavirus, Wearing of Face Coverings in a Relevant Place) (England) (Amendment) (No. 2) Regulations 2020

Lord Bethell Excerpts

Friday 18th September 2020 Lords Chamber

Moved by

[Lord Bethell]

That the Regulations laid before the House on 21 August be approved.

Relevant document: 25th Report from the Secondary Legislation Scrutiny Committee.

Motion agreed.

Health Protection (Coronavirus, Wearing of Face Coverings in a Relevant Place and on Public Transport) (England) (Amendment) Regulations 2020

Lord Bethell Excerpts

Friday 18th September 2020 Lords Chamber

Moved by

[Lord Bethell]

That the Regulations laid before the House on 27 August be approved.

Relevant document: 25th Report from the Secondary Legislation Scrutiny Committee.

Motion agreed.

Coronavirus

Lord Bethell Excerpts

Wednesday 16th September 2020 Lords Chamber

[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

Lord Bethell Excerpts

Tuesday 15th September 2020 Lords Chamber

[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.

Anti-obesity Strategies

Lord Bethell Excerpts

Monday 14th September 2020 Lords Chamber

[Baroness Bull]

To ask Her Majesty’s Government what assessment they have made of the impact of anti-obesity strategies on people suffering, or recovering, from eating disorders.

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

My Lords, eating disorders are serious life-threatening conditions, and it is important that people have access to the right mental health support in the right place and at the right time. We carefully consider all views on our measures to reduce obesity. This includes feedback from a wide range of experts in response to our public consultations on specific policy proposals.

[Baroness Bull (CB)]

My Lords, as the Minister says, eating disorders are indeed serious mental health issues, but their relationship with obesity is complex. Many obese people also live with eating disorders, which means treatment is not always as simple as rebalancing calories in and out. Does the Minister accept the expert advice that elements of the new strategy, like food labelling and calorie counting, are dangerous triggers for eating disorders, and that slogans emphasising personal responsibility stigmatise people whose obesity has more complex roots than a failure to get a grip? Will he agree to meet with me and eating disorder specialists to discuss how this important strategy can be more effective for its intended audience and avoid collateral damage for those people for whom “Eat less, exercise more” is a dangerous message?

[Lord Bethell (Con)]

My Lords, I entirely agree with the noble Baroness that serious eating disorders are complex, and we need to resource the medical attention required by people with serious mental health issues. However, I do not completely align with her view that all obesity is not a matter of personal responsibility, nor that the education of people about the content of their food through labelling cannot be an important part of our battle against obesity. Covid has spelt it out clearly to all of us. Some 67% of the country is overweight in some way or another. But this is a policy that we are determined to get right, and I would very much welcome the opportunity to meet with the noble Baroness and her team.

[Baroness Thornton (Lab)]

My Lords, following on from the noble Baroness’s question, do the Government have eating disorder experts, including those with lived experience, advising them as part of their anti-obesity strategy? It seems to me that is one way of making sure that the messages do not disadvantage those who have eating disorders. There is a reason why advocates for those with eating disorders have been very critical of the language being used. Could the Minister commit to reviewing the campaign in light of this?

--- Later in debate ---

[Lord Bethell (Con)]

The noble Baroness is entirely right: we do rely on the advice of charities, academics and experts in eating disorders. We do not do anything without full consultation with those who have expertise in eating disorders. We review the campaign regularly, and we will be taking into account the view and feedback of those experts, charities and patient groups as a part of that review.

[Lord Truscott (Ind Lab)]

My Lords, what action are Her Majesty’s Government taking to tackle eating disorders, especially among the young, whose mental health may have been severely impacted by the current Covid-19 pandemic?

[Lord Bethell (Con)]

My Lords, the Government are committed to ensuring that everyone with an eating disorder has access to timely treatment. That is why we set up the first waiting times to improve access to eating disorder services for children and young people so that, by 2021, 95% of children with an eating disorder will receive treatment within a week. Figures show that in Q1 of 2020, 87.7% of children with an eating disorder received treatment within one week in urgent cases, and 86.8% within four weeks.

[Baroness Warsi (Con) [V]]

My Lords, I welcome the Government’s recent announcement of additional funding for community-based mental health initiatives and ask my noble friend whether the Government can ensure that their latest obesity strategy is mindful of and responsive to the underlying emotional issues, as detailed by the noble Baroness, Lady Bull. The causes are often far more complex than the Government’s current approach.

[Lord Bethell (Con)]

My Lords, I completely endorse my noble friend’s views. When it comes to mental health challenges and connections between obesity and mental health, the resources need to be put in place and the sensitivity she speaks of applied. I return to my earlier comments: 87% of the country is involved in this. Not all have mental health issues; some simply need to take responsibility for their weight.

[Baroness Parminter (LD) [V]]

The National Audit Office’s report last week on tackling obesity confirmed that there is limited evidence that calorie labelling in restaurants reduces total calories consumed. How will the success or otherwise of the Government’s proposed calorie labelling in restaurants be evaluated? Will it take into account the potential harm caused, given that the ability to track calories can be highly triggering for those with or vulnerable to developing an eating disorder?

[Lord Bethell (Con)]

My Lords, we are tracking the success of this obesity strategy, although it should be understood that this is generations in the making and may well take a while to work through. I come back to my previous comments: calorie labelling is a very important element of people’s education about the content of their food and often their drinks, including alcoholic drinks. We support that measure as an important part of our strategy.

[Baroness Verma (Con)]

My Lords, will my noble friend take into account that in the south Asian community there are larger numbers of people with diabetes, heart disease and a lack of vitamin D? Through his campaigning and communications—he has been really mindful of this—will he try to ensure that we are also reaching communities in which exercise and sport do not always come as a first priority? Is he willing to meet with me and a team of people working on this?

[Lord Bethell (Con)]

My noble friend is right, and Covid has really spelt out the challenge in this area to the NHS and the Government. The incidence of serious Covid effects on BAME communities has been more intense because of the prevalence of diabetes and overweightness in many of those communities. We have relooked at our marketing and communications to those communities and need to redouble our efforts. That is why, as part of the obesity strategy, we are putting in serious, concentrated efforts in reaching the communities, as my noble friend advised. I would be glad to talk to her about how we can do that better.

[Baroness Uddin (Non-Afl)]

My Lords, children and adolescent adults with eating disorders battle multiple debilitating physical and mental effects. Eating disorders have one of the highest morbidity rates among psychiatric conditions, causing untold helplessness and grief for families and professionals constantly struggling with a lack of adequate financial resources and services, as evidenced by Ignoring the alarms: How NHS eating disorder services are failing patients, a report by the Parliamentary and Health Service Ombudsman. In light of this report and a significant body of evidence known to health services and experts in the field, can the Minister assure the House that sufficient advice has been sought and a thorough, evidence-based risk analysis undertaken to mitigate the potential harmful, detrimental impact of the public anti-obesity campaign on those suffering and recovering from disorders?

[Lord Bethell (Con)]

My Lords, I am not sure I agree with the premise of the question. It is not my belief that the anti-obesity campaign will generate massive negative repercussions. The NHS’s work in this area has developed immensely and we are putting a huge amount of money into it, including through our mental health strategy. I support the strategy we are applying.

[Lord Rennard (LD)]

My Lords, the need for psychological support for people with such eating disorders is often identified through face-to-face meetings with GPs. Is the Minister satisfied that it is possible, in safe conditions, for people to obtain such meetings at the moment and that, if such a need is identified, sufficient psychological support is available for them?

[Lord Bethell (Con)]

The noble Lord is probably aware that a letter has been sent to GPs inviting them to step up to their responsibilities for face-to-face meetings. Everyone should have a face-to-face meeting if that is what they require and need. One of the surprising and interesting outcomes of the Covid epidemic is that many mental health services have been successfully delivered through video links. It has meant that people who may feel vulnerable about attending a GP’s surgery or mental health clinic have had the opportunity for consultations. We will look at how to expand that kind of interaction.

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

My Lords, I have spoken to GPs about this issue. Particularly in cases of obesity—which they all agree is more common for people living in deprived areas—they say the difficulty now is that patients do not come in person to a surgery. Therefore, if someone tells you their obesity is still well under control, you have no way of assessing that. They suggested that I put it to the Government that there should be better liaison between schools and GPs, because schools see families all the time and become good judges of whether people are putting on weight. They can also provide exercise and advice on diet. GPs are willing to look after these people but say that if you cannot actually see them, how do you know that what they are telling you is the truth? What will the Government do to encourage liaison between schools and GPs?

[Lord Bethell (Con)]

My noble friend makes an incredibly thoughtful, practical point. Of course, it is easier to tell whether someone is abiding by their obesity commitments if you see them face to face. With regard to schools, I remind her about the hundreds of millions of pounds going into school exercise through the sugar tax payment. That is completely transforming exercise in schools and will have a profound effect over many generations.

[The Senior Deputy Speaker (Lord McFall of Alcluith)]

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

Covid-19 Update

Lord Bethell Excerpts

Monday 14th September 2020 Lords Chamber

[Lord Scriven (LD)]

My Lords, these Benches welcome anything from the Government that is based on rational evidence and can prove to be effective in this public health crisis to keep people safe and reduce the spread of the virus. So does this Statement live up to that? Unfortunately, yet again the sales pitch from the Secretary of State last week fell short of what is required to be effective. It has to be based on fact and scientific evidence that the public have confidence in and understand.

I have some simple questions for the Minister. Now that the scientific evidence has been produced, members of the public are asking why children under 12 and 11 are included as part of the six. Why can they be in a school in a class of 30 but from 3.30 pm they cannot be in a house with seven people, including their two grandparents? What scientific evidence exists to suggest that that causes more harm than 30 children in a classroom?

There is something else that people have asked me. Why is it that I can go to the office and be there with 20 people until 4 pm, but at 4.15 pm, if I go to the pub, I have to be in a bubble of no more than six? The evidence may be there, but it has to be explained in a way that those questions can be answered and the public have confidence in those answers. Inconsistency, rather than the public not having confidence, is one of the issues that the virus breeds on.

The public health message has to be clear and consistent. The regulations do not just bring in a power of six; there are quite a number of exemptions, including a legal definition of “mingle”: for the first time since 1393 it becomes illegal to “mingle”. Can the Minister give a legal definition of “mingling”? I can go to an event with six people but I cannot mingle beyond those six if it is an event run by a charity, a public body, a philanthropic organisation or a business. If I open the door for somebody and speak to them to thank them, am I mingling? If I stop somebody who I know and speak to them, am I mingling? What is the legal definition? That is going to cause confusion and not be consistent.

These regulations and rules have to be developed in a collaborative manner with local areas to be effective. Why was the Local Government Association informed of the Covid-secure marshals only one hour before? If the rate is rising so fast and we need to be effective today to monitor six people and no more, where are those marshals’ powers as of today and in which legislation?

It is quite clear that action needs to be taken to stop this virus, but it is time for the Government to stop and be much more strategic and considered and to implement legislation and systems in a more collaborative way. People’s lives and livelihoods depend on the Government getting this right, but unfortunately this Statement is not a complete and right answer.

[Lord Bethell (Con)]

My Lords, I thank the noble Baroness and the noble Lord for their perceptive and thoughtful questions. On the noble Baroness’s questions about the level of alert, to my knowledge it has not changed. It was reduced from four to three on 19 June; it remains subject to review on a weekly basis, but we are not in a position to raise it at the moment.

The noble Baroness asked about the rule of six and why we had committed to six as opposed to anything else. The short answer is that we are seeking to have rules that are simple to understand and straightforward to apply. We accept that during the last few months the guidelines have grown increasingly complex and difficult to understand in all their detail. Across the board, with “Hands, Face, Space”, the rule of six and other measures that we are seeking to publish, there is a genuine effort to engage the public in a really simple lexicon of how we can beat the coronavirus.

Sir Mark Walport, the head of UKRI, was right in his warning that the jeopardy is enormous. If we do not get this communications challenge right, and if people think they are confused and think they have a way out because it is in some way complicated, we will fail, the disease will come back and we will have tens of thousands of deaths; we will have an NHS that is challenged; we will have an economy that is shut down; and we will have a generation that is lost to education. Those are the stakes, so we are determined to get it right. I am happy to stand here for as long as it takes and be pub-quizzed on “What about this? What about that?” if it means that we get it right.

However, the public seem to understand these simpler rules. The response from the public in our planning focus groups and in the response since their publication has been extremely positive, and we think we are on the right track. This is advice that was informed by SAGE and we went through its models in great detail.

The noble Baroness and the noble Lord, Lord Scriven, asked why children are included. The bottom line is that we want to keep it simple. Children are vectors of infection; they can pass the disease from one generation to the next. Time and again, in city after city, we have seen an infection that starts with a young person, moves to mum and dad, then to grandma and grandpa. It takes weeks or sometimes months for that progress to take place but, as I have said at this Dispatch Box before, as night follows day, the infection moves through the generations unless we take steps to break the chain of transmission. The rule of six is a critical, unambiguous step in the Government’s strategy for doing just that.

The noble Baroness and the noble Lord, Lord Scriven, asked about marshalls, so let me just say a word about that. This measure came from our engagement with local authorities. Local authorities are looking for ways in which they can implement the right measures to disrupt crowds forming and, as the noble Lord, Lord Scriven, said, mingling—a concept which, frankly, I do not think needs much description and nor do members of the public. In order to break things up, they are looking for ways in which they can have both the authority and the personnel to do that, and we have responded by putting in the right regulations to do that and by providing the right resources. But it will be up to local authorities to implement that in detail.

The noble Baroness asked about shooting and hunting. My understanding is that guidelines on all sorts of sports and activities where the rule of six is in any way ambiguous will be issued in the coming days.

The noble Baroness asked about Hammersmith, and I am extremely grateful for the tip-off. I will look into it, as I have done when other noble Lords have alerted me to concerns they might have. I am extremely concerned that there might be a breakdown in the asylum centre in Hammersmith. However, I reassure the noble Baroness and the House that directors of public health are responsible for this kind of implementation, and the benefit of directors of public health is that they work across all departments. Some directors of public health have a health background, some have a police background and some come from a leisure background, but they all hold the ring when it comes to local implementation of local measures, and therefore they are the best-placed people to ensure that situations like this are not overlooked.

The noble Baroness asked whether we should be reviewing the current measures for pubs, clubs and workplaces. The simple answer to that is yes, absolutely; we should be reviewing it—and we do review it every single week. We are on tenterhooks because, if we get this wrong, the jeopardy is enormous. We are working as hard as we can, with regulatory measures such as the rule of six, marketing measures such as “Hands, Face, Space” and containment measures such as the test and trace programme, in order to keep the economy open, to keep our educational institutions open and to keep life as normal as we possibly can. If we do not—if we fail—it will go back to where we were before, and I hope memories are not so short that people do not remember quite how imposing and draconian the former lockdown was.

On test and trace, the noble Baroness quite reasonably asked about the capacity and about demand. I can reassure her that the capacity has literally never been higher. We are up 7% week on week and—if I can provide the right figures here—we will have a capacity of 500,000 by the end of October. We have 500 centres, including five major laboratories, 236 mobile testing units, 72 walk-through testing sites, and more sites opening all the time. For every 1,000 people in this country, we test 2.43 a day; that compares with Germany at 1.15, Spain at one and France at 1.15.

We are throwing everything we can at the test and trace system, but it is true that demand has gone up. Part of that demand is through children returning to school. I welcome enormously the return of children to school, but it is an un unambiguous fact that this has led to a very large increase in the number of children being sent to testing centres—often bringing their parents and other household members with them—and that has put an enormous pressure on the system.

Another feature is asymptomatic testing. Estimates are that between 20% and 25% of those turning up for a test are currently asymptomatic. If we had all the tests in the world, that would not be a problem and I would welcome it, but right now we are building the system, we are under pressure and we need to communicate more clearly to the public that asymptomatic testing is not supported by our current testing system.

The noble Baroness asked about social care—quite rightly, as this is a major feature; we are concerned about it, and I know that noble Lords are concerned about it. I reassure the noble Baroness and the House that care homes are absolutely our number one priority. This was reiterated in meetings with the Prime Minister last week. Some of the capacity challenges in places such as walk-in and drive-in centres are because we have put care homes front of the queue and because those tests are taking priority.

The noble Lord, Lord Scriven, asked a number of extremely detailed questions, some of which I have touched on. He asked why we have included children. He is entirely right that, in Scotland, they have not included all children and in some other countries they do not do so either. We have taken a different view. Partly, that is on the epidemiological advice from SAGE; partly, that is on the marketing advice from our communications department, which is insistent that we are clear and unambiguous with the population; and, partly, that is the CMO’s advice—he rightly identifies children as potential vectors of infection, particularly in intergenerational households.

The noble Lord, Lord Scriven, asked for consistency. Well, we are consistent in that we are determined to break these chains of transmission. The science is not simple; if it were, the disease would have been beaten. It bounces around, and we are doing our best to fight it. We are communicating as best we can on all the science we have.

In terms of collaboration, I pay a massive tribute to all my colleagues at the department, in other departments, in local authorities, at PHE and in the NHS. It is difficult for me to explain in great detail in a short amount of time the immense amount of cross-departmental, inter-agency collaboration that has sprung up around Covid. The amount of data that is shared, the number of Zoom calls and the working together are absolutely phenomenal. The noble Lord cited that the LGA did not know about the marshalls plan until the last minute; I am afraid to say that it must have been the last one on the list.

[The Deputy Speaker (Baroness Finlay of Llandaff) (CB)]

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.

[Viscount Eccles (Con)]

My Lords, last week I pursued the question as to whether there were precedents for using emergency powers under an old Act—this is an Act from 1984—and also whether the Government had any plans to change the procedure to one that is more like what we have come to expect over many years, so that we debate these regulations before they came into force. Many of the questions that are asked would be much sharper if the debate was before the regulations came into force. It would be better, because the future is more interesting than the past—and doubly so in these hybrid days, when debate is not as easy as it is in normal circumstances. Indeed, one reason for thinking that we should change is that there must be an impression that the Executive are riding roughshod over us, when what is actually needed is consensus—as has been indicated by the two Front-Bench speeches today—and I think that consensus is available. Will the Government have another think, decide it is better to be in front and implement some changes that will make Parliament’s job easier?

[Lord Bethell (Con)]

I thank my noble friend for his comments, but my perspective is slightly different. The fact is that this disease is incredibly aggressive and nimble; we sometimes have to turn decisions around literally within hours. I cannot think of another situation, other than war, where the decision-making has to be quite so quick. I would love to be able to bring regulations to this House for full debate in advance of their implementation, but no human institution can move at that kind of speed—it is just not possible. In answer to his question, we have no plans to switch horses at the moment. We are working as hard as we can to bring regulations here as quickly as we can, and I pay tribute to the House authorities for doing everything they can to put regulations in front of the House as quickly as they can.

[Lord Patel (CB) [V]]

My Lords, the Office for National Statistics records over 52,000 deaths of people whose death certificates have Covid-19 as a contributory cause. More than 42,000 of these deaths were of people over the age of 65. As the numbers of infections increase, which they are, more older and vulnerable people will be infected—as has happened in France—leading to a rise in hospital admissions and deaths. What plans do the Government have as the rate of infection increases in our country to protect the elderly and more vulnerable?

[Lord Bethell (Con)]

My Lords, we are discussing, among other things, the very regulations we are putting in place to protect the elderly and vulnerable. The rule of six, although not part of this provision, is an emphatic commitment to protect the people whom the noble Lord cites. I add that we are concerned about not only the elderly and vulnerable; we are increasingly concerned about the phenomenon of long Covid, which hits the young. It is one of our objectives to rid this country of Covid altogether and to protect all demographics.

[Baroness Donaghy (Lab) [V]]

My Lords, in answer to my noble friend Lady Thornton’s question about the alert level, the Minister said that to his knowledge it had not changed, although it was subject to weekly review. However, these are the Government’s own levels. How can the level stay at number 3, which means “virus contained”, when number 4 means “virus not contained”? Does the Minister really think that an average travel requirement of 6.4 miles to a testing centre, with 10% of people having to travel up to 22 miles, is acceptable after all these months?

[Lord Bethell (Con)]

The change in the alert level is done in consultation with the CMO and it is his advice that the circumstances have not changed enough for us to move it. On the average travel time, most reasonable people would consider six-and-a-half miles a reasonable distance to travel for such an important test.

[Baroness Barker (LD)]

My Lords, why is it safer to allow six individuals from different households to meet together indoors, rather than limiting it to members of two families?

[Lord Bethell (Con)]

My Lords, the phenomenon we had noticed was that large groups of people, sometimes in pubs and sometimes in other congregations, would seemingly be from two households, but that the actual definition of “household” was proving to be extremely flexible in the minds of many people. Therefore, putting an integer into the formula makes it much clearer.

[Lord Dobbs (Con) [V]]

May I return to the issue of political gatherings, which my noble friend and I discussed last Thursday? He mentioned that protests such as those we have seen recently from Extinction Rebellion might not be outlawed quite yet, but it is not really a matter of outlawing political protest—I did not ask for that. However, can he understand how deeply outraged many would feel while spending their Christmases abiding by the very difficult rule of six if, out their window, they were watching political protesters who do not give a monkey’s about the rules? Will he confirm that political protesters are subject right now to precisely the same rules as the rest of us?

[Lord Bethell (Con)]

My Lords, I sympathise with my noble friend’s point, but I remind him that the regulations come into force later today. It is up to the Metropolitan Police to implement crowd dispersal but the sentiments he expresses are ones that I share.

[Lord Laming (CB) [V]]

My Lords, will the Minister please accept that while there may be good reason for the Government to ratchet up further the restrictions on social distancing, it is surely unreasonable to at the same time pressure people to return to their offices? These two objectives are incompatible, as was shown by government officers last week. Surely the Government should accept that they can press either greater social distancing or a return to offices, but not both?

[Lord Bethell (Con)]

My Lords, I do not think that this Government are pressuring anyone into doing anything. We are keen to give those who have a reason to, whether personal or professional, the confidence to return to their workplace. I pay tribute to the very large number of employers who have invested a huge amount in making those workplaces socially distanced and safe for employees.

[Lord Rooker (Lab) [V]]

My Lords, the Statement makes it clear that the numbers of cases are rising. Will the Health Minister give the House his personal assurance that sufficient personal protective equipment will be available, unlike during the first wave?

[Lord Bethell (Con)]

I am very glad to make that assurance: 13 billion items of PPE have been procured and made available for NHS, social care and other key workers. I pay tribute to my colleague and noble friend Lord Deighton, who has led our efforts on this. The situation is completely transformed from that of earlier this year.

[Baroness Hussein-Ece (LD) [V]]

My Lords, in the past week, over 700 schools have reported Covid cases among teachers and pupils, but getting a test is difficult for many. I declare an interest: my seven year-old grandson went back to school last Monday and got a high temperature. He was told to stay at home and his parents tried all week to get a test for him. They were sent to Brighton and eventually managed to get one 10 miles away, but that is because they have a car. What happens to families who do not have a car but want their children to go back to school and not lose out? Why are test kits not being made available to schools or local authorities, maybe in clusters, to enable equal access for all children and teachers to such kits so that they do not have to self-isolate unnecessarily for 14 days and can—like my grandson, whose test was thankfully negative—go back to school?

[Lord Bethell (Con)]

I thank the noble Baroness for her testimony, which completely resonates with me. The current national prevalence is around one in 1,500, so there is a strong likelihood that, in a school with 1,500 kids, one of them will turn up with Covid. We are aware of the challenge of febrile children who have a temperature, as children often do, and are naturally anxious to get a test. We therefore provide kits of tests to schools, but we are not able to turn schools into testing centres—I do not think that parents, teachers or schoolchildren would like us to do that. We have also prioritised social care, the protection of hospitals and the asymptomatic testing of key workers over schoolchildren for the moment. As our capacity increases, that will be reviewed.

[Baroness Redfern (Con) [V]]

My Lords, this virus has shown it is extremely difficult to eradicate or keep under control until a vaccine is produced. I ask the Minister about people being asked to isolate because data has shown that some are facing real hardship. We are told that this is a central reason for people sometimes ignoring advice. Are Ministers looking at the possibility of helping with extra financial support?

[Lord Bethell (Con)]

The noble Baroness is entirely right that the isolation protocol is extremely onerous for some people and has a huge impact on their life, mental health, income and social life. I completely understand the point she is making. We are keeping the question of financial support under review and will continue to look at this important subject.

[Baroness Coussins (CB) [V]]

My Lords, picking up on one of the points made by the noble Baroness, Lady Thornton, what arrangements have been made to enable compliance with the rule of six for asylum seekers living in reception centres or hostels that have communal facilities for eating, sleeping, washing, cooking and leisure time? This could be a national issue, not just in Hammersmith. Also, why is there no link on the National Asylum Support Service website to any Covid information or advice in languages other than English and Welsh?

[Lord Bethell (Con)]

My Lords, asylum hostels are one example of a very great many that will have to put thoughtful arrangements in place in order to comply with the rule of six. I pay tribute to their efforts.

[Lord Campbell-Savours (Lab) [V]]

My Lords, why insist on a mask-wearing policy totally at variance with international practice? Surely, by now the Government can admit to the major benefits: they alert others to danger, signal an element of risk and, when worn without valves, protect both users and those in the immediate vicinity. Therefore, why not revisit the whole policy and promote the enforcement of wider and appropriate usage—a very, very much needed U-turn?

[Lord Bethell (Con)]

My Lords, I pay tribute to the noble Lord’s campaigning on this issue; he has contributed to the Government changing their strategy on mask wearing. However, we are here discussing the onerous burden that these measures put on people in this country, and we have to be careful not to overburden them. The CMO’s guidance on masks is that the science remains ambiguous. I know the noble Lord does not agree with that, but that is the CMO’s advice. We have come a long way on masks in order to change policy on this and, as the scientific evidence changes, we will review that policy.

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

Since the Minister wants to keep things simple, could he explain to families that are separated what the rules now are? In my case, I am a single father of three young boys who live with me every other week. They live in a household of six on the other weeks, and it includes another child who also lives in another household part of the time. Which of us are allowed to get together when?

[Lord Bethell (Con)]

My Lords, that is the pub-quiz question of all pub-quiz questions. There are special provisions for families that are, like the noble Lord’s, separated or complex. Those guidelines have been published, I believe, and I would be glad to send him an email with a link to them.

[Lord Blencathra (Con)]

[Inaudible]—simple rule and the long overdue emphasis on better and stricter enforcement. Does my noble friend not agree that when a law is systematically and routinely broken and not enforced, it brings the rest of the law into disrepute? Therefore, will he encourage the police, in the strongest possible measures, to stop turning a blind eye to massive house parties, raves and woke demonstrations and tell them to get off their knees and enforce the law?

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, I completely endorse my noble friend’s comments on raves, but the effectiveness of these measures is reliant not just on police implementation but the compliance of the British public. While I understand his point on mandation and police action, it is really the personal decisions and social pressure of the British public that will make these work, and I cannot help but pay tribute to them for their sensible approach to Covid to date; that is where our trust really lies.

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

My Lords, following on from the previous question, effective policing requires the consent of those being policed, and those enforcing it need good training and interpersonal skills. Covid marshals—when they are actually implemented—could well face some resistance from those who have had enough of being told what to do. Will marshals have the power to issue fixed penalties, and does the noble Lord agree that friction with them could cause breaches of the peace and place even more demands on the police themselves?

[Lord Bethell (Con)]

My Lords, I do not know the precise legal powers of the marshals, but I remind the House that city centres and public areas frequently have civilian marshals of one kind or another to help guide public gatherings. This is a not uncommon aspect of city and public life, and I have an enormous amount of faith in the good sense of the British public to go along as requested without legal mandation.

[The Earl of Clancarty (CB) [V]]

My Lords, the WHO’s watchword has been “test, test, test” to isolate the disease, so I am in favour of the Prime Minister’s stated ambition of mass testing. With regard to Operation Moonshot, have the Government a date in mind for testing audience members at theatres and sports venues? Secondly, does the Minister agree that we should now be testing at airports, as British Airways is asking for?

[Lord Bethell (Con)]

My Lords, we have embraced the “test, test, test” recommendation in a very big way, and the noble Earl is entirely right to aspire to using testing to enable a return to the economy, theatreland and all sorts of public gatherings. We are looking energetically at this, working with suppliers, academia and the NHS to figure out ways of using the new testing technologies in the way he describes.

However, we are at a relatively early stage and I am not able to make announcements on this here today. We have funded—to the tune of £500 million—a huge amount of investment in these technologies and, when they are right, we will roll them out in the theatres and airports of Britain.

[Lord Hunt of Kings Heath (Lab)]

My Lords, we have heard a lot from the Minister today about the importance of obeying the law, yet a Bill has been introduced in the other place today that essentially sees the Government seeking to break the law. I refer him to what Geoffrey Cox, the former Attorney-General, said this morning:

“When the Queen’s minister gives his word, on her behalf, it should be axiomatic that he will keep it, even if the consequences are unpalatable. By doing so he pledges the faith, honour and credit of this nation and it diminishes the standing and reputation of Britain in the world if it should be seen to be otherwise.”


He went on to say:

“It is unconscionable that this country, justly famous for its regard for the rule of law around the world, should act in such a way”.


Does the Minister think this a good example to the public, and does he not fear that the appeal to the rule of law regarding the rule of six might just fall on rather stony ground?

[Lord Bethell (Con)]

My Lords, I am here to support the regulations before the House, not to comment on the issues about which the noble Lord asks.

[Lord Greaves (LD)]

My Lords, the noble Lord has previously congratulated people in my part of Lancashire on how well we are doing, which I do not quite agree with; we are working hard. Why are people, whether in our borough or the surrounding ones, still not able to book tests locally when we usually have three testing stations going? Some are being told to ration the number of tests they do each day, which involves gaps of perhaps two hours when they will not accept any bookings, even though the testing kit and the people are there, and the tests could be carried out. However, people are not being allowed to use them.

[Lord Bethell (Con)]

My Lords, the amount of testing we are doing is increasing enormously. Most people who book a test do get it locally, and that test is delivered quickly and on time. The result arrives within 24 hours and we are doing a million tests a week, which is well within the bounds of our business capacity.

The noble Lord is right that the system is under scrutiny and pressure. Not everyone is getting a test where and when they want it. However, overall, it is reasonable to ask people not to make frivolous demands upon the tests, and to ask that those who are asymptomatic wait until there is further test capacity before they step forward to ask for their test.

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

My Lords, can my noble friend tell me what the Government have identified in English children under 12, including babies, that makes them, to use his phrase, “a vector of infection and a Covid hazard”, that does not apply to children in Scotland, who have been back at school for weeks? And on the subject of making things easier to understand—simplifying matters—why is it okay in England to meet one’s grandchildren in the pub but not in their family home if the household consists of six people?

[Lord Bethell (Con)]

My Lords, Scottish children are just the same as English children, but the Scottish Government have decided to take a different approach; we celebrate the differences between our two nations in this. With respect to meeting in the pub, you cannot meet more than six people in the pub and you cannot meet more than six people between two households. The arithmetic is reasonably straightforward.

[Viscount Waverley (CB) [V]]

My Lords, it is clear that face masks are a critical component of slowing the virus. Following on from the observations of the noble Lord, Lord Rooker, and other noble Lords, how self-sufficient is the UK expected to become in the supply of PPE, and are there targets for the supply of face masks in particular?

[Lord Bethell (Con)]

My Lords, we have taken huge steps in the domestic production of PPE. In some matters, where the production is relatively straightforward, such as aprons, we have taken huge steps forward and the vast majority of our production is done at home. For some products, such as gloves, that are more complex because of their shape, we are having to work harder. The progress of my noble friend Lord Deighton’s Make strategy for PPE has been profound, and we are looking at making up to half of our PPE requirements in the UK.

[Baroness Blackstone (Ind Lab)]

My Lords, given the intrusive and damaging effects, especially on family life, of the decision to limit social contacts to six people, can the Minister say why it was decided to apply this both inside and outside, rather than to follow the Welsh Government’s position of applying the new ruling only to meetings inside? Does he agree that medical evidence suggests that the chance of contracting the virus outside is tiny in comparison with inside, and that, with regard to his quest for simplicity, nobody is so simple that they cannot tell the difference between inside and outside.

[Lord Bethell (Con)]

My Lords, I agree that everyone can tell the difference between inside and outside, but everyone also has eyes, and may have seen, as I have, how people crowd together in the forecourts and beer gardens of Britain. If they were all standing on draughty hillsides with the wind blowing the disease around, that would be one thing, but the simple fact is that our prevalence has gone up—the evidence speaks for itself—and that is why we need to be clearer about this simple measure.

[Baroness Uddin (Non-Afl)]

My Lords, in the US 513,000 children have been infected as of 3 September, with 70,630 cases reported in the past two weeks. Only this morning in my locality, all reception classes bar one were shut down due to the Covid infection of a teacher. As a father, the Minister will understand that many parents remain fearful and are seeking assurance and evidence of safety. Holding the Government to account after a tragedy has occurred would be meaningless. What lessons can we learn from our friends in the US and elsewhere about minimising the spread of infection among teachers and children in the UK, with the inevitable consequence of transmission to their homes and vulnerable loved ones in their families?

[Lord Bethell (Con)]

My Lords, policymakers around the world are facing exactly the same dilemma. We are determined to have the schools back, because the long-term effects on young people—particularly the least advantaged—will be profound if we shut the schools. The noble Baroness is entirely right to say that parents are naturally concerned that the safety of children, and other generations that they may come into contact with, is at risk. That is why we are massively prioritising the return of schools and introducing measures such as the rule of six to break the chain of transmission and thereby protect the schools from closure.

[The Deputy Speaker (Baroness Finlay of Llandaff) (CB)]

I apologise to the noble Baroness, Lady Verma, who I should call now.

[Baroness Verma (Con) [V]]

Thank you, Deputy Lord Speaker. My noble friend has talked about Covid, but I think it is important in the same debate to talk about the flu injections that are available to help people reduce their ability to catch Covid. Will my noble friend ask the pharmacies that are distributing flu injections to step up their communications, in particular to people with south Asian backgrounds, who are slightly resistant to going into pharmacies to get flu jabs? I know from my experience of having to persuade my mother that this is an issue, and it would be helpful to get the communications about getting flu injections out as quickly as possible, so that people build up their immunity as quickly as possible.

[Lord Bethell (Con)]

My Lords, we are hopeful that this season the number of flu injections will be a massive increase on previous seasons. We will, therefore, be putting huge responsibility on the shoulders of pharmacies and pharmacists to deliver them. I take on board completely the very good advice from my noble friend about the reputation of pharmacists compared to GPs, particularly in certain communities. I trust that the pharmacy profession will be doing an enormous amount to promote the flu injection itself, and to reassure its customers about the efficacy of its service. It is, however, an idea that I will take back to the department.

[Baroness Noakes (Con) [V]]

My Lords, when we had questions on the Statement last Thursday, I asked the Minister two questions that he did not answer. I have another opportunity now. Can the Minister say what evaluation the Government have made of the economic and societal impact of alternative responses to the spike that we are seeing in infection rates? Secondly, will they publish that evaluation?

[Lord Bethell (Con)]

My Lords, we have a very clear example of what will happen to the economy if the infection comes back. We will have to close down society as we did before, and the economy will suffer profoundly as a result.

[Baroness Neville-Rolfe (Con)]

Most of the Covid measures made under the Public Health Act 1984 have major adverse effects on the economy and on the treatment of other fatal diseases. We cannot go on like this indefinitely until we have a vaccine. We need a new strategy that offers a degree of protection where it is needed, for example in care homes and for the very elderly, and that restores economic and social life. Are the Government now developing such a strategy, and when will we hear about it?

[Lord Bethell (Con)]

My Lords, my noble friend describes in the most beautiful and succinct way exactly the strategy that we are following. It balances on the one hand a fight against disease, a breaking of the chain of transmission, the protection of the NHS and the saving of lives, and on the other a measured, thoughtful and reasonable opening up of the economy, workplaces, schools, shops and other valued economic assets. We are working hard to get that balance right. I believe that we have got it right, but we are open to suggestion and we review the situation incessantly. Until we have a vaccine and other therapeutics to fight this disease, that is the life and the road that we will be walking.