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.

Covid-19 Update

Lord Bethell Excerpts

Thursday 10th September 2020 Lords Chamber

[Baroness Barker (LD)]

My Lords, this is a Statement made two days ago in the other place, but it has been largely overshadowed by yesterday’s deluge of hyperbole and hokum. The Prime Minister said yesterday:

“We know, thanks to NHS Test and Trace, in granular detail, in a way that we did not earlier this year, about what is happening with this pandemic. We know the groups that are suffering, the extent of the infection rates, and we have been able, thanks to NHS Test and Trace, to do the local lockdowns that have been working.”—[Official Report, Commons, 9/9/20; col. 609.]


If that is true—and given the record of the Prime Minister and Health Secretary, one is always entitled to ask whether it is—how come local authorities and directors of public health are given only limited access to the test and trace case management system and not given full access to the contact system? Why are the Government sitting on data or passing it to companies run by their mates, instead of passing it to local authorities, which, for weeks, have been trying to predict and manage the inevitable spike in infections that follows people starting to travel and going to school and university. Why are they not getting that data in a timely manner?

From the start of this pandemic, experts advised the Secretary of State to invest in public health teams and NHS labs that are numerous and easily reached by many communities, including in rural areas. Instead, he gave the money to outsourcing firms such as Serco and G4S, which have no expertise and have not had to compete for the contracts. He could have invested in local public services; instead he has built a system on a foundation not fit for purpose. On Tuesday, in the Statement, the Secretary of State for Health said of care homes that

“we have met our target to provide testing kits to all the care homes for older people and people with dementia that have registered to get tests.”—[Official Report, Commons, 8/9/20; col. 517.]


But on Monday, the Government were forced to apologise for continuing delays to Covid-19 testing for care home bosses and GPs, who are threatening that these will lead to more infections among vulnerable people.

The Secretary of State’s own department, the Department of Health, admitted to breaking its promise to provide test outcomes within 72 hours. Care managers have described the Government’s centralised testing service as “chaotic” and “not coping”, amid reports that whole batches of tests are coming back not only late but also void. Testing officials told care homes by email on Monday morning that

“immediate action has been taken at the highest levels of the programme to bring results times back”

within 24 hours.

“We apologise unreservedly to … you … and your staff.”

The ring of steel that the Secretary of State claimed to have put around care homes never was. With upwards of 40,000 deaths, when will the Government sit down with care home providers, local authorities and CCGs to develop a comprehensive system of testing and supply of PPE? It does not have to be world beating; it just has to work.

The Prime Minister’s Statement yesterday would have been risible were the consequences not so serious. Most ludicrous of all was the announcement of a team of Covid-secure marshals to enforce the new laws on public gatherings. The Government could have done any number of things. They could have announced resources to enable the rehiring of retired public and environmental health professionals, since there is a shortage. They could have given funding to local community and voluntary groups to communicate ongoing health risks and the law to communities. They could have given additional funding for trained police officers to work with health officials and businesses to improve adherence to infection control. But, no, instead we got another vacuous attempt to steal the headlines. Maybe these marshals, with no training, no resources, no local management and no authority could join up with the 750,000 volunteers for the NHS and the trackers, and like them they could sit and twiddle their thumbs, waiting for the phone to ring.

One thing we can be sure of is that this is another stunt which will be an utter waste of time, money and resources. Local authorities, police forces, health authorities and schools are using their professional expertise and local knowledge to plan effective public health interventions. They are not only following the science but also using it to actively protect people in their authorities. In stark contrast, this Government ignore advice, misrepresent the science and carry on winging it, but the data on infections and the lack of reliable testing are evidence that the Prime Minister’s bumbling bombast and the Health Secretary’s growing litany of half-truths are indicators of world-beating incompetence and, sadly, people in black and minority ethnic communities and poor communities will suffer the consequences. It is time for the Government to change.

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

My Lords, I am enormously grateful for the thoughtful and informed questions from the Front Bench, and I echo the comments about teachers made by the noble Baroness, Lady Thornton. The return to school is a fundamental priority of the Government. It is a massive challenge for those involved, for governors, teachers, parents and school kids. I endorse the thanks the noble Baroness gave to teachers, who are performing incredibly well. The high return rates—percentages in the mid to high 90s—is remarkable and shows enormous confidence in the system among schoolchildren and their parents.

I also echo the noble Baroness’s thanks to NHS and social care staff who are preparing for winter. Enormous amounts of preparation are going into that. In response to the point made by the noble Baroness, Lady Barker, I reassure the Chamber that engagement with social care, local charities and local councils is incredibly intense and we are working extremely hard with local partners in all areas.

The noble Baroness, Lady Thornton, asked when the new regulations will be delivered. I am afraid that I cannot confirm the precise date, but I can reassure her that this Government are committed to being accountable to Parliament for those regulations and I look forward to that debate.

The noble Baroness also asked about the sequence of announcements. I reassure her that the Prime Minister brought his Statement to Parliament in good faith to update Parliament first. We cannot prevent leaks from happening, and leaks that get on to social media and then into the papers are something that we did not design or deliberately create. They are something that we regret. It would have been massively our preference for the Prime Minister to put Parliament first in his announcement.

The noble Baroness also asked about the testing system. The capacity of the testing system has never been higher: it has increased by 10,000 per day for the last two weeks and continues to increase dramatically. But demand has never been higher either, and there are good, laudable reasons why that demand is going up. The number of tests for supporting the vaccine programme has gone up. The number of tests to support our therapeutics programme has gone up. The surveillance of local prevalence has gone up, and the marketing around the use of tests by those who show symptoms has proved to be much more effective and the take-up among those who have Covid-19 symptoms has gone up. For those reasons we are extremely pleased by that effect.

However, there has also been a significant rise in the use of tests by asymptomatic individuals, largely tied to children returning to school. That is why we have been clarifying the guidance on the use of tests—that they should be used by those who have symptoms and not by those who are asymptomatic. One day, when the capacity is there and the system can bear it, I hope that we will move towards a system where anyone can have a test whenever they like, however they feel, but right now we must live within the system that we have. We are doing hundreds of thousands of tests per day and clarifying with teachers and parents that tests should be used by those who show symptoms and not by those who are seeking some other form of guidance.

Regarding the questions asked by the noble Baroness about the moonshot, I am a little confused. “If we cannot do millions of tests today, how can we expect to be able to do millions of tests tomorrow?” seems to be the question. I will answer it very clearly. The innovation around testing has moved much quicker than anyone could have expected in terms of scale, cost, accuracy and speed. The industry and the professionals in the NHS, academia and private business have come together in a triple helix to collaborate in a massive revolution in testing, which has changed considerably in this country from the days when we were struggling to do 2,000 or 3,000 tests per day to when we had the capacity to do 200,000 or 300,000 tests per day.

We have a clear view of how we can dramatically increase the tests. That clear view has two components: those tests that use existing technology that is purchasable in today’s world, and a clear idea of where innovation will take us in the very near future. This Government are committed to grabbing the opportunity of that innovation in order to dramatically increase the number of tests. There will be nay-sayers who will question whether that innovation will deliver, and undoubtedly there will be set-backs. Not everything will deliver as promised. However, I am extremely optimistic that we will be able to harness the power of science and innovation to invest in the backbone of our data and our delivery mechanisms, and to engage with the British public to deliver a testing system that enables us to return to the life that we love.

The noble Baroness, Lady Thornton, questioned whether the testing system could be relied on to deliver results. Let me explain: the people of Luton and Leicester have used testing and contact tracing, and infection rates are dramatically lower—less than half what they were in late July. Those are two excellent case studies of how our system of testing and contact tracing has turned around difficult situations and pushed back the spread of Covid by breaking the chain of infection. The noble Baroness also asked what we will do to improve the system as it stands. There are three areas of improvement: first, technology; secondly, infrastructure, by which I mean the data and the presence on the ground; and thirdly, engagement with the public so that they understand how to engage and we understand better how to interact with the public.

The noble Baroness, Lady Barker, asked about the contact system and gave some statistics. I reassure her that since 28 May we have rung 272,000 people who have been reached by the test and trace system. Where communication details have been provided, the service has reached 88.6% of close contacts, and 78.4% of people who have tested positive have been reached. Within the bounds of epidemiological effectiveness, these are extremely impressive statistics. Compared with those from other countries, they range among some of the highest. It is an incredibly impressive set of results for a system that was stood up in relatively recent history. Local public systems are complementing the central contact tracing hub, and I pay thanks to all those local authorities that either work with their full-time employees, or, as is often the case, have employed local businesses, to support it.

We have hit our target on care homes—the noble Baroness, Lady Barker, might like to take a moment to celebrate that. We are also trying to work with a degree of transparency in our operations. I do not regret for a moment the fact that the operational senior leadership in the track and trace team has been on the level about the present supply constraints, with social care and the general public. I reassure the noble Baroness, Lady Barker, that care homes absolutely remain top of our priorities. Many of the frustrations the public face, such as longer distances to travel, are exactly because we have put care homes first and have therefore had to dial down some of the availability of tests to the public. We sit down with care homes to discuss winter preparations. An indication of that is the 31 billion items of PPE that we have contracted to buy for this winter—an astonishing figure. That pays great tribute to the work of the noble Lord, Lord Deighton, and the PPE team, who have built up a fantastic stock.

Finally, I would like to express a small amount of confusion about the remarks from the noble Baroness, Lady Barker. On the one hand, she attacked the involvement of major private companies and central control of our track and trace system, but on the other hand, she attacked civic engagement, the volunteering of members of the public to support our track and trace system, and local initiatives whereby NHS trusts have brought back retired staff. The combination of these two themes is the heart of our success, and I celebrate both.

[The Deputy Speaker (Lord Rogan) (UUP)]

We now come to the 30 minutes allocated for Back-Bench questions. I ask that questions and answers be brief, so that I can maximise the number of speakers.

[Lord Lansley (Con) [V]]

My Lords, the consistency of messaging over time is immensely important to secure public support and adherence. Over the last six months, we have consistently explained that indoor and outdoor gatherings are significantly different, and that the scientific evidence has clearly shown much greater risk for indoor gatherings. Can my noble friend the Minister explain to the House why the Government appear to have abandoned this important distinction in their current guidance?

[Lord Bethell (Con)]

My noble friend is right to point out this important change. The truth is this: from the feedback we had from the public, and from our own analysis of the facts, we see that our guidance was growing increasingly complicated and was confusing the public. While the science may suggest all sorts of clever differences between one situation and another, and between inside and outside, the guidance is effective only if it is clear, understood and obeyed. At the end of the day, what we have done is to clarify some of the more complex areas of our guidance to make it more effective.

[Baroness Meacher (CB) [V]]

My Lords, sadly, Professor Spiegelhalter has seriously questioned the Prime Minister’s rather splendid Moonshot mass testing proposal. I understand his concerns. Nevertheless, can the Minister assure the House that he will press for a significant investment in saliva home-testing kits, to enable families with a parent in the former shielded group and with children at school to live a reasonably normal life? Children need to be at school, but the lives of these parents are now in grave danger—I am sure the Minister appreciates this—with the R number above one and, as yet, no daily testing capacity. Can the Minister say when daily testing will be available for these families and other top-priority groups in the country?

[Lord Bethell (Con)]

I reassure the noble Baroness, Lady Meacher, that saliva testing is a massive priority for the Government. I reassure her and Professor Spiegelhalter that the positive error rate in the saliva test trials in Southampton has been incredibly low—virtually zero. From that, we take great reassurance that this will be an effective vector for testing.

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

My Lords, will the Minister accept that the reason for scepticism about the Moonshot gimmick is that the Government have a consistent record of overpromising and underdelivering? The Minister will know that the latest test and trace stats are not good: they show that 69.2% of close contacts of people who have tested positive with Covid-19 in England were reached—that is the lowest percentage since the scheme was launched. What would he say to Bridget Phillipson, the MP for Houghton and Sunderland South? Because Sunderland has a rising number of cases, she checked online this morning the availability of tests: no home tests were available and no drive-through tests could be found. Later in the morning, the only test offered was a two-hour drive away in Scotland. Why should anyone believe the ideas that the Government float from week to week?

[Lord Bethell (Con)]

My Lords, I completely and utterly reject the noble Lord’s suggestions. I remember well the nay-sayers, the sofa epidemiologists and the sceptics who, when we had testing at the level of 5,000, poured cold water on the idea we would get to 100,000. We hit that target. We have made amazing progress since and we will continue to push for more testing.

[Baroness Walmsley (LD) [V]]

My Lords, the Secretary of State has blamed the recent failure of laboratories to process tests in a timely way on members of the public who are not eligible—as he calls it—seeking to take a test. Is this not another example of Ministers blaming someone else for their failures? How do people know if they are not eligible? If they are concerned about something, what system is in place to enable testing centres to know who is eligible, so that they can refuse to test those who are not?

[Lord Bethell (Con)]

The noble Baroness is right, but it is sometimes difficult to know whether you have the symptoms of Covid, the flu or something else. That is why it is a complicated matter. What we have seen through our engagement with the public in the last few weeks is people who show no symptoms of anything but who seek a test to provide themselves with reassurance. It is not a question of blame, but rather of clarification: we simply do not have the national resources to support that kind of activity.

[Baroness Noakes (Con) [V]]

My Lords, as a Conservative, it grieves me that the Government are pursuing policies, such as the rule of six and Covid-secure marshals, which belong in a police state. The Government have chosen a highly risk-averse approach, driven by guesstimates of hospitalisation and mortality rates, and doubtless derived from mutant algorithms. In the meantime, the economy is tanking. Can the Minister say what evaluation the Government have made of the economic and societal impacts of different responses to the small spike we have seen in infection rates? Will they publish that evaluation?

[Lord Bethell (Con)]

My Lords, it is not a mutant algorithm that is sending people to hospital in France, Spain, Belgium and other countries up and down Europe, and it is not a desire to introduce a police state that is seeing prevalence leading to hospitalisation and death in many countries in Europe. It is our fear that Britain is going that way that leads us, regretfully, to put these measures in place; it is not any desire to exert state influence.

[Lord Patel (CB) [V]]

My Lords, I am sorry that the Minister keeps having a hard time, but that is partly because he is having to defend the indefensible. I had a completely different question to ask, but I have changed my mind and, instead, will follow on from the question asked by the noble Lord, Lord Lansley, and the Minister’s response to it. In terms of transmission of the disease indoors as opposed to outdoors, which bit of science is confusing?

[Lord Bethell (Con)]

I answered the question as clearly as I possibly could. This is about communication and clarity and making sure that people understand the instructions; it is not about science. If that is not effective then the guidelines are pointless.

[Baroness Andrews (Lab)]

My Lords, perhaps I may take the Minister back to the question asked by the noble Baroness, Lady Walmsley. I was sorry to hear him say rather dismissively that people are clogging up the system because they seek some sort of reassurance, although they do not have symptoms. That seems to me a perfectly natural and human reaction. Can he confirm that basically government policy now is actively to discourage anybody without any symptoms in any situation seeking a test? If that is the case, what is his answer to the letter that he received from the directors of public health in the south-east, who are deeply worried that an area of low infection could easily become an area of high infection? What will he say to the universities that have introduced testing for all students, asymptomatic or not, because they want to protect their local communities, given what we know from America—from Chapel Hill, for example—about the absolutely devastating effect that university populations can have?

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, it is not a question of blaming anyone or of in any way condemning people’s natural curiosity. However, the bottom line is that we have only so many resources, and people know full well whether they are showing symptoms of some sort. It is not appropriate that someone who shows no symptoms whatever uses valuable, scarce resources that could and should be used for more important priorities. We could not be more clear about that. Universities are using private testing facilities, and we applaud and support them on that. It is my sincere hope that one day we will have sufficient testing facilities to be able to offer everyone a test whenever they like. However, we do not live in that world today, and that is why I deliver the message that I do.

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

The Minister has just said that a significant plank of the policy is not the science but communications. I fear that the Moonshot programme falls into exactly that category. I do not believe that it can be delivered at the scale that the Prime Minister has talked of, but, if it could, it would throw up false results that would overwhelm track and testing and mislead people, throwing both education and the economy into further chaos. Is not the right policy to target the groups that we know are vulnerable to this disease with the protections that they need, starting with care homes, and to allow the rest of us, and the economy and education, to move forward?

[Lord Bethell (Con)]

The noble Lord is right to be concerned about false positive results. However, our experience, our piloting and the emerging technologies suggest that that will be the case in a relatively small proportion of the tests and is entirely manageable within a mass population testing system. With regard to the idea that we can somehow identify vulnerable groups and target them pre-emptively, I wish that that were true, but this disease constantly confounds expectations and turns up in places where we least expect it. If we could tell people that they were going to get the disease, we would not have this problem in the first place.

[Baroness Blackwood of North Oxford (Con) [V]]

I thank the Minister for his answer, but those who were formerly shielding, those whom we had identified as being most at risk, will be watching the rise in cases and some of this debate with anxiety. There were a number of problems with the rollout of the shielding programme the first time round, and we have new evidence about who is most at risk from Covid. Has there been a reassessment of the criteria for those who might need to shield this winter? If so, what is the Minister doing to ensure that this is communicated early and much more clearly to both those who will not need to shield this winter and those who might need to, so that we can reduce anxiety among those groups and protect the most vulnerable?

[Lord Bethell (Con)]

I completely recognise the problem identified by my noble friend. I reassure her that the expert sub-group NERVTAG is developing a predictive risk model to enable a more sophisticated approach to clinical risk and to identify more clearly those who need to shield. The model incorporates known relevant risk factors, such as age, sex, BMI and ethnicity. We are working at pace and will continue to engage patients, those on the shielding list, healthcare professionals and the voluntary sector as we embed this important insight into what we do.

[Baroness Campbell of Surbiton (CB) [V]]

My Lords, the Minister will be aware of the difficulties faced by disabled and older people during the first major lockdown, such as insufficient social care support services. Will the government guidance to this group now change to address those difficulties, especially if the R rate keeps rising over the coming months? Will he now consider switching off the social care coronavirus easement powers, which were meant to be only a temporary measure, especially as local authorities are now telling us that they no longer use them? These easement powers are a major cause of anxiety among older and disabled people, and it would be an easy thing to do—just switch them off. They are no longer needed, yet they cause untold anxiety.

[Lord Bethell (Con)]

My Lords, I am not sure that I have a precise answer to the noble Baroness’s question on easement powers. It was my impression that they had not been used in the vast majority of areas—only in a few areas—and that, where they had been applied, their use had been of a mainly administrative rather than practical nature. However, I am happy to look into the question that she asks and to reply to her by letter.

[Lord Harris of Haringey (Lab)]

My Lords, the noble Lord has responded rather testily to a number of your Lordships in providing answers. In particular, he failed to answer the substantive question from my noble friend Lord Hunt of Kings Heath about why people were being sent, or being told to go, such extraordinary distances when they wanted and needed a test. He says that he does not want to have the blame game, but that is blamed on people who did not need a test going for one. First, can he tell us what those figures are and, secondly, can he reassure us that the messages he is now giving out will not lead to people who should be tested feeling that they should not bother the system? That would be just as big a danger.

[Lord Bethell (Con)]

I shall be extremely careful about how I reply to that question because I would not want to come across as testy. The noble Lord is right: it is a challenge to strike the right balance between guiding towards testing those who truly need tests because they have symptoms and trying to get those with less of a priority away from testing. I reassure him that, even under current circumstances, 90% of those who apply for a test get one within 20 miles and the average distance to travel is six and a half miles. Therefore, even though some of the anecdotes about being recommended to travel long distances might seem extraordinary, the lived reality of most people who go for tests is that they are quick, near, accurate and effective.

[Lord Truscott (Ind Lab)]

My Lords, will the Minister confirm that Her Majesty’s Government will not let people die for ideological reasons? Are the Government prepared to buy a vaccine from any country, provided that it is safe and it works?

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[Lord Bethell (Con)]

My Lords, this country has been absolutely on the front foot on vaccines. We have negotiated agreements with six different vaccine providers for 340 million courses of vaccine. We are completely open to anything that is effective, and we have championed the cause of fair vaccine distribution on a global basis.

[Lord Robathan (Con)]

My Lords, I regret to say that this Government’s policy on Covid is contradictory, confusing, hugely damaging to the country and, frankly, nonsensical. Should I have the opportunity, I will vote against it. We were exhorted, from the very beginning of this public health crisis, to save lives. As noble Lords know, some 11,000 people die on average every week in the UK under normal circumstances, so can the Minister tell us how many people under the age of 65 have died of coronavirus in the last 26 weeks? Of those, how many did not have some serious underlying health condition such as diabetes, obesity, respiratory problems or the like? If he does not have those figures to hand, perhaps he might write to me and put them in the public domain by putting them in the Library.

[Lord Bethell (Con)]

My Lords, I entirely welcome the challenge from my noble friend but, respectfully, I completely disagree with his approach. I want to flag two issues. The first is the enormous public support for the Government’s response to Covid and their adherence to the measures we have introduced. The second is the recent King’s College survey, published today, showing that on top of the deaths, 300,000 people in the UK have reported symptoms that last more than a month and 60,000 have been ill for more than three months. The effects of this disease go far beyond the “simply recover the next day” effects of flu; it is a profound illness that we are right to try to suppress.

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

My Lords, how is new technology being brought to the front line to deliver critical care and services across the country? Is the Minister aware of the desperate shortage of doctors and nurses working on the front line of infections, and that they are exhausted? What can be done to solve this problem?

[Lord Bethell (Con)]

The noble Baroness absolutely speaks my language when she talks about the technology that is being brought into the front line. My sincere hope is that Covid will bring a benefit to the healthcare system by being an inflection point whereby we introduce new technologies in a whole host of fields to bring in much greater community-based treatment for people, digital technology and the more effective sharing of data, among a wide range of technical advances. Regarding the workforce, I completely sympathise with the noble Baroness’s comments. I pay tribute to those who work hard on the front line and am aware of the challenges and difficulties they face. This Government have committed to recruiting 50,000 more nurses. We are more than half way there already, and we will continue to recruit to ensure that we have the human resources needed to meet our commitments.

[Lord Dubs (Lab) [V]]

My Lords, what is the policy regarding the testing of domiciliary social care workers? What is being done to ensure that these people—who are at risk themselves and meet and support the very vulnerable, travelling around to different people every day—have full protective equipment and that they use it?

[Lord Bethell (Con)]

The noble Lord is entirely right to emphasise the challenge of itinerant domiciliary care. Such workers were always a vector for potential disease and are putting their own lives on the line. That is why we have radically changed the guidelines. We have put more resources in place to ensure greater support for domiciliary care, PPE is stocked for them to use and there is regular individual testing

[Lord Dobbs (Con) [V]]

My Lords, the new guidelines require political protests to be “organised in compliance with” government rules and

“subject to strict risk assessments”.

Who will undertake these assessments, when and how will they be undertaken—I presume they will have to be undertaken before any protest is mounted—and does this mean that the type of protest we saw the other day by Extinction Rebellion will by definition be unlawful?

[Lord Bethell (Con)]

My Lords, my understanding is that the risk assessment is done by the local police force in conjunction with Public Health England, but I am happy to check that and write to my noble friend. With regard to Extinction Rebellion, I found the protest last week particularly tedious but I am not sure if it will be outlawed quite yet.

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

My Lords, the Minister has taken great pains today to stress the need to ensure that our limited number of tests are well used. I want to revisit the issue I have raised with him before: the list of symptoms as a result of which people are encouraged to take a test. I am sure he is aware of the University of Belfast study of paediatric infection rates, which showed that among children with antibodies a cough was no more common than among those without, while gastrointestinal symptoms such as diarrhoea, vomiting and abdominal cramps were significantly associated with coronavirus infection. Given that many other countries, including the United States, and the World Health Organization list a greater range of symptoms, will the Government consider communicating clearly with the public when the tests are needed, based on the scientific evidence?

[Lord Bethell (Con)]

The noble Baroness raises a very difficult subject. A huge amount of work has gone on in this country and others to define the most effective possible list of symptoms. The honest truth is that this disease manifests itself in different people in a great many different ways, and we have done a huge amount to try to understand the list of symptoms to be described in a way that will capture the greatest number of people in the clearest way possible. We keep that under review, but the work that has gone into it could not have been more thorough.

[Lord Bilimoria (CB) [V]]

My Lords, a programme of nationwide mass testing is exactly the ambition we will need to build confidence in the public and businesses before a vaccine becomes available. Professor Devi Sridhar of Edinburgh University says that the only safe way is mass testing. I agree with the Minister: look at where we were in March, with 2,000 tests a day, and now we have the capacity for well over 300,000 tests. Given that, why can we not get on with instant mass testing? The Abbott BinaxNOW test laboratory in America is producing antigen tests—10 million this month and 50 million next month—that give results within 20 minutes, and they are already FDA-approved. Why can we not do that at such speed? Can we get this into the market quickly? Likewise, Germany started testing at airports in June, and France did so in August. Why can we not start testing at airports quickly? Jobs, the economy and lives are at stake.

[Lord Bethell (Con)]

My Lords, we could not be moving more quickly to engage with the producers of tests in order to sign up the resources we need to put in mass testing. That cannot be switched on overnight, but we could not be moving more quickly. On airport testing, the CMO has been crystal clear: he is deeply concerned about day-zero testing and about any but the most thorough airport testing measures. We were caught out on this at the beginning of the epidemic and we remain extremely cautious.

[Lord Berkeley (Lab)]

My Lords, I want to follow up on the Minister’s answer to the noble Lord, Lord Bilimoria, about airport testing. Apparently, we have this world-beating system and many millions of tests that we can do, but now we have limited resources. The number of people who have had to cancel their travel arrangements, lost money and not come back—for whatever reason—is enormous and it is affecting the air industry as well. If our testing system is so good, surely it can be done at airports, plus track and trace, which has worked quite well, even for one plane that came from Greece. I hope the Minister will take this away and try to move it forward a bit more quickly.

[Lord Bethell (Con)]

The noble Lord, Lord Berkeley, is entirely right that the impact of this on our economy is profound, affecting the tourism economy, business and the professions. It is not something that we undertake lightly. However, it is the science-based belief of the CMO that the challenge presented by global travel is so profound that this is a step we have to take. When there is a surfeit of testing—when there is a vast amount of it—we may be able to put in place much more extensive measures, but, even so, the CMO remains extremely cautious on this point. However, we are working with Heathrow, the airlines and the airports to keep the matter under review. We take into consideration pilots and are working closely with them to try to resolve the issue.

[Baroness Neville-Rolfe (Con)]

I do not want to add to my noble friend’s difficulties, but I have received some worrying reports that pregnant women are prevented having the father of the baby with them right through labour or when undergoing related treatments, such as scans. This can be devastating, especially if there is bad news, such as a miscarriage. Can my noble friend the Minister do his best to get the rules changed across the country, so that parents can support each other at this vital time?

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[Lord Bethell (Con)]

I completely understand the point that my noble friend is making. The issue of scans is compounded by the problem that many scanning machines are in small, airless rooms, where the risk of contagion is high. None the less, I completely recognise the point she makes about the pastoral and psychological effect of splitting people up at this incredibly sensitive time in their lives. We are reviewing it and we very much hope to make some progress.

[Baroness Blower (Lab) [V]]

My Lords, can the Minister say whether the Government will publish the science behind the decision not to test teachers and education staff—I congratulate them on being back at work—routinely and regularly, bearing in mind that there have already been school closures due to outbreaks? Is it a matter of science or of testing capacity?

[Lord Bethell (Con)]

My Lords, the regulations are not in place at the moment to test the millions of teachers and other important workers who are returning to the workplace on a regular basis. We have neither the science nor the capacity to do so, but we are reviewing this and looking at ways of using testing to restore confidence and enable a return to workplaces or other situations where social distancing is more challenging.

[Lord Lucas (Con) [V]]

My Lords, I encourage the Government to be completely open with the data and research regarding this epidemic and to put it all on the GOV.UK website. When we opened up the data on BSE, the problem was solved within two weeks by researchers who were outside of government. When Ofqual refused to open up on its algorithm, it resulted in our recent troubles and disasters. Being open with data results in much more criticism, but that criticism is much better directed. And it makes it much easier for people like me to accurately defend government policy.

[Lord Bethell (Con)]

I completely agree with the sentiments shared by my noble friend. Transparency has the effect of sunlight, putting a spotlight on information. It helps those who wish to contribute to make their efforts felt. We have embraced transparency: I cite the example of SAGE, where the minutes of its meetings and the data it works on are routinely published. I completely endorse my noble friend’s comments.

[Baroness Wheatcroft (Non-Afl) [V]]

My Lords, given that there have been hardly any tests available to Londoners for at least the last four days, and probably much longer, can the Minister say what belief we should have in the statistics for the prevalence of the virus in the country, and in particular in London? Furthermore, the Health Secretary—when he was not blaming the public for the shortage of available tests—did admit that there were problems with a couple of contracts. Could the Minister explain what those problems are and why, according to the Health Secretary, it will take a couple of weeks to sort them out?

[Lord Bethell (Con)]

My Lords, the statistics on prevalence are provided by the ONS. They were published yesterday and today—both the ONS and REACT figures. I would be happy to share links to those publications with my noble friend. Regarding the troubled contracts, I do not know the quotation to which she alludes but if she would like to correspond with me, I would be glad to try to figure it out.

Covid-19: Rise of Positive Tests

Lord Bethell Excerpts

Wednesday 9th September 2020 Lords Chamber

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

My Lords, our assessment of the recent rise in positive tests is that we are deeply concerned, particularly about rates among young people, and particularly at a time when children are returning to schools and people are returning to the workplace. We are constantly looking at the latest data on the spread of coronavirus and have worked hard to contain outbreaks early to reduce the spread, protect the NHS and social care sectors, and save lives.

[Baroness Thornton (Lab)]

I thank the Minister for that Answer. I was finding it difficult to know in which direction to point myself in framing a question about our testing system, but he has given me the two issues that I want to raise. First, can he tell the House what effect the increase in Covid infections is having on R? What is SAGE advising? The second question is to do with schools. What is a head teacher to do when they have successfully got their pupils back into school and then inevitably have pupils who have symptoms, are at home and need a test—as do their families—but are unable to get one because the nearest centres are either not carrying out tests or have run out of them, the labs cannot process them, or they have been offered testing many miles away and may not even have a car? How are our schools to remain open and safe if the national testing system is not working as it should, and when will this be resolved?

[Lord Bethell (Con)]

My Lords, the impact on R is not entirely clear at the moment. ONS and REACT figures will be published shortly, and they will have the statistical analysis that the noble Baroness asks for. However, it is safe to say that R is up. With regard to schools, the Government have made it clear that our support for the return to schools is completely emphatic. However, I remind the noble Baroness that the average distance travelled for tests, even at this stage, remains 6.4 miles. Ninety per cent of people who book a test travel less than 23 miles, and 90% of tests undertaken in our mobile sites are still converted in 24 hours.

[Baroness Lawrence of Clarendon (Lab)]

My Lords, the Government have imposed 14 days’ isolation on people travelling from certain countries where the virus is increasing. What steps have Her Majesty’s Government taken to ensure that children travelling back with their parents are not returning to schools—so that a child with the virus goes to school on day one and the children then have to be isolated?

[Lord Bethell (Con)]

My Lords, the quarantine arrangements we have put in place are essential for containing the spread of the disease. We completely sympathise with parents who have found themselves caught overseas. However, we implore them to abide by the quarantine arrangements and return their children to school once the 14-day quarantine has passed.

[Baroness Jolly (LD) [V]]

My Lords, when Covid-19 first struck, care homes were almost forgotten. Will the Minister explain to the House what is the recommended Covid-19 testing regime for residents, visitors and staff in care homes, and what organisation monitors the tests in those local care settings?

[Lord Bethell (Con)]

Testing arrangements for care homes have, as the noble Baroness, Lady Jolly, alluded to, risen dramatically. Testing is done in a large variety of ways. For large care homes, mobile testing facilities are put in place; for care staff, facilities at local NHS hospitals are in place; and we invite visitors to have tests in advance of visiting their loved ones. This is all overseen by the NHS Test and Trace programme, and the CQC remains the auditor of the care sector.

[Lord Kakkar (CB) [V]]

My Lords, I draw noble Lords’ attention to my registered interests, in particular my membership of your Lordships’ Science and Technology Committee. In his appearance before that committee in July, the Government’s Chief Scientific Adviser suggested that the higher the number of cases in circulation at the beginning of winter, the greater the likelihood of a significant peak of disease. What assessment have Her Majesty’s Government made of scientific evidence on the threshold at which the number of new cases might suggest that we can no longer be confident that the NHS will have sufficient capacity to deliver both its routine winter service and manage resurgent Covid-19 admissions?

[Lord Bethell (Con)]

My Lords, we are well within the threshold that the noble Lord, Lord Kakkar, alludes to, but we are concerned about winter. That is why we are putting in place new restrictions and new arrangements to stop the spread of this disease, protect the NHS and save lives.

[Baroness Manzoor (Con)]

My Lords, the level of coronavirus has risen significantly since late July and, as my noble friend the Minister knows, the disease is having a disproportionate effect on black and ethnic minority people. Can he therefore say exactly what the Government are doing to ensure that these groups are fully accessing NHS Test and Trace, and what additional support is being given to those who work in the hospital and care sectors?

[Lord Bethell (Con)]

My Lords, we are deeply concerned about the BAME incidence of this horrible disease. We have put in place extensive new marketing arrangements targeted at BAME audiences. We have targeted our testing arrangements through mobile testing and door-to-door availability at that communities that have been hardest hit, and there are guidelines to NHS trusts to put in place the necessary safety arrangements for those with a BAME background.

[Baroness Jay of Paddington (Lab) [V]]

My Lords, following the Government’s statement that the rise in infection rates is due largely to increased spread of the virus among young people, what strategies do the Government propose to adopt to ensure that returning students, for example, and others, comply more stringently with public health regulations?

--- Later in debate ---

[Lord Bethell (Con)]

We are deeply concerned about the spread among students. Some of that spread will take place in universities, and I pay tribute to the efforts of vice-chancellors to put in place social distancing arrangements in universities; we hope that they will have an impact. However, some of the effect is in their social life—in pubs, clubs and bedrooms up and down the country. That is the responsibility of the students themselves, and we are looking at measures to enhance and enforce the social distancing measures that will stop the spread of this disease.

[Lord Scriven (LD)]

My Lords, on a day when the Prime Minister will order us not to meet in large groups of more than six, why have the Government agreed to support 3,600 people congregating at Doncaster Racecourse today? Have the Government not learned the lessons of the superspreader event in Cheltenham?

[Lord Bethell (Con)]

My Lords, any new regulations will be in place from Monday and will capture events such as the one the noble Lord describes.

[Lord Bilimoria (CB) [V]]

My Lords, I was delighted to hear the Secretary of State, Matt Hancock, announce the Government’s investment of £0.5 billion for testing innovation. Is the Minister aware of Abbott Laboratories’ new $5 antigen test, released just two weeks ago in the United States? On a card, within 15 minutes it can give results anywhere—at a school, a university, in the workplace or at the airport. Ten million are being produced this month in America, and 50 million next month. How soon will we have access to those sorts of tests, which will be a true game-changer in being able to have mass testing around the country?

[Lord Bethell (Con)]

My Lords, I am aware of the Abbott test. I spoke to Chris Scoggins from Abbott yesterday, and I pay tribute to innovators in this country, in America, and around the world for the dramatic increase in the speed, accuracy and scale of these tests. We hope that they will make a big difference.

[Baroness Verma (Con) [V]]

My Lords, given that the virus is spreading and we are fast approaching autumn and winter pressures, can my noble friend ensure that the NHS and local authorities are communicating in different languages to communities to encourage them to go and get their flu injections as quickly as possible?

[Lord Bethell (Con)]

The use of different languages for promoting all aspects of our Covid response is critical. We have massively increased the number, accuracy and stylistic resonance of our marketing materials in order to reach all audiences. I very much welcome the noble Baroness’s remarks.

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

My Lords, many law-abiding people are offended by the organisation of raves in blatant contravention of the rules on numbers and social distancing. What assessment have the Government made of the use of intelligence by the police to stop people travelling long distances to attend such illegal gatherings?

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[Lord Bethell (Con)]

My Lords, I used to organise raves, and I used to love them—but I implore all those who organise raves to stop, because they are creating a massive public health disaster. Fines have been put in place, and we will come after them. But I ask them, “Please, look into your conscience. Stop the raves. Protect lives.”

[The Deputy Speaker (Lord Faulkner of Worcester) (Lab)]

Lord Desai? Lord Harries of Pentregarth.

[Lord Harries of Pentregarth (CB) [V]]

Moving on from the question asked by the noble Baroness, Lady Jolly, about care homes, and the Minister’s response, are the Government publishing the number of cases and deaths due to Covid in care homes? If not, why not?

[Lord Bethell (Con)]

I advise the noble and right reverend Lord that those figures are published on the PHE website. I would be glad to send him an email with the link.

[Lord Dobbs (Con) [V]]

My Lords, what I am about to ask implies no criticism, because this is such a difficult question. The increase in restrictions on social gatherings that have just been announced will be so difficult to enforce. Is there at least a case for us to consider focusing more on mortality rates rather than simply on infection rates, and finding better ways of identifying and protecting the truly vulnerable, while allowing the rest of society to get on sensibly with their lives as best they can in the circumstances, before the costs of trying to protect everyone become both economically and politically unsustainable?

[Lord Bethell (Con)]

My noble friend is entirely right to say that the measures that the Prime Minister will describe will impose a huge burden on the whole country. However, he alludes to a hope that I am afraid cannot be borne out in practice, because we have seen, in country after country, that after prevalence follows hospitalisation and mortality, as night follows day. There is an immediate and strong connection between the rise of mortality and the rate of prevalence in the country as a whole. Children see their parents, and parents see the grandparents, so if we really want to protect all those in society, we have to lean into the disease at every level. In addition, it is emerging that the long-term effects of Covid on young people can be profound. Even those with relatively low or asymptomatic reactions to the disease can be affected by fatigue, loss of memory, breathing difficulties and other long-term effects. It is for those reasons that I ask all young people to ensure that they take every step to avoid catching this disease.

[The Deputy Speaker (Lord Faulkner of Worcester) (Lab)]

My Lords, all supplementary questions have been asked.

Suicide

Lord Bethell Excerpts

Tuesday 8th September 2020 Lords Chamber

[Lord Harries of Pentregarth]

To ask Her Majesty’s Government what steps they are taking in response to the reported rise in the number of people committing suicide.

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

My Lords, one suicide is too many suicides. That is why we published a cross-government suicide prevention workplan in 2019, are investing £57 million in suicide prevention in the NHS, are rolling out suicide prevention plans across the country and are committed to working with charities such as the Samaritans and the Zero Suicide Alliance.

[Lord Harries of Pentregarth (CB) [V]]

I thank the Minister for his reply and what the Government are doing. Unfortunately, male suicides are the worst they have been for two decades. There is particular concern among men between the ages of 45 and 49, and suicide is the highest form of death for those under 50. It is a particular concern in areas of Yorkshire and Humber. In his latest book, Professor Michael Sandel argues that this is part of a wider malaise in society. In a highly competitive society such as ours, there are those left behind without any sense of value, dignity or self-esteem. Will the Minister encourage the suicide strategy advisory group to look at what Michael Sandel has said and its implications for government policy?

--- Later in debate ---

[Lord Bethell (Con)]

The noble and right reverend Lord is entirely right that suicide is an awful form of death. Each one is worth regret, but the numbers are more complicated than he suggests, as the definitions of suicides and the coroner’s assignment of the suicide definition has changed in the period he describes. While we are all concerned about society, I am not sure I entirely agree with his sombre analysis of society’s values. I have a more optimistic outlook than he perhaps does. The Government’s suicide prevention programme entirely addresses the concerns of individuals and is, I believe, having a powerful effect.

[Lord Dobbs (Con)]

Recently published figures show an alarming, significant increase in suicides among young people, even boys and girls aged 10. Those were pre-Covid statistics. Those statistics are heartbreaking and, I think we all agree, inexcusable. Does my noble friend believe that the social media companies are really owning up to their responsibilities in combating abuse and bullying online? Are we owning up to our responsibilities in schools to educate children about the safe use of social media and to pass on to them the wisdom and support they need?

[Lord Bethell (Con)]

My noble friend is entirely right to raise concerns about the role of social media in rising suicide rates among young people. We are doing an enormous amount to protect young people, incentivising every school to identify a senior lead for mental health, creating new mental health support teams and piloting a four-week waiting time to allow swifter access to specialist NHS care. We are also taking on the social media companies and demanding that they step up to their responsibilities.

[Lord Dannatt (CB) [V]]

My Lords, suicides in any section of our society are a tragedy, but I draw the Minister’s attention to suicides among veteran members of the Armed Forces. Evidence from the charity Veterans United Against Suicide suggests that around 69 veterans died by their own hand in 2018, 59 in 2019 and around 37 so far this year. Does the Minister agree that informal evidence is not a reliable basis for understanding the extent of this problem? Would it not be better to once again press the coroner service, when recording a verdict of death by suicide, to note whether the deceased was a military veteran?

[Lord Bethell (Con)]

The noble Lord is entirely right to raise the issue of veterans, who have an incredible and alarmingly high rate of suicide, one that I regret enormously. We are working closely with veterans’ charities to provide the kind of mental health support that veterans need but, all too often, that does not prove enough. His request for greater data from coroners is an idea I will take back to the department, chase down and write to him about.

[Lord Griffiths of Burry Port (Lab) [V]]

My Lords, these are unpropitious times for ordinary people. Lockdown has increased the incidence of loneliness and we are hearing more tales about domestic abuse. With the furlough scheme ending soon, we have worries about the world of work and joblessness. There are increased referrals for mental health problems, and the National Union of Students tells us about the well-being of students, in these uncertain times, as they face a new university session. These all bring their own worries and pressures. All these factors might create a climate in which we see, tragically, the rate of suicides climbing.

Meanwhile, the Government are beset on all sides by energy-sapping programmes to do with the economy, health and education—and Brexit looms. We heard of the loss of a senior law officer just this morning. We have heard about the ambitious programmes of the Government, as outlined by the Minister. Can he assure us that keeping them running and in proper focus will be manageable, given all the other things the Government are being dragged down by, largely as a result of their own ineptitude?

[Lord Bethell (Con)]

Yes, I am glad to provide that assurance.

[Lord Willis of Knaresborough (LD)]

My Lords, ministerial claims to have the lowest suicide rate for seven years, in the fourth report, do not accord with the latest ONS figures from 1 September this year. These show that, at 16.9 per 100,000, England has the highest suicide rate since 2000, with an increase each year since the new strategy began in 2017. Alarmingly, my own region of Yorkshire and Humber has consistently had the highest suicide rate anywhere in the United Kingdom for a decade. What steps are the Government taking to evaluate their existing strategy and produce consistent statistics? What proportion of the £25 million allocated to local suicide prevention plans has been spent in Yorkshire and Humber?

[Lord Bethell (Con)]

I remind the noble Lord that, in July 2018, the standard of proof used by coroners to determine whether a death was caused by suicide was lowered from criminal to civil. That has had a meaningful effect on the number of suicides recorded. I am afraid the numbers for Yorkshire and Humber are not available to me.

[Baroness Thornton (Lab)]

My Lords, we need to return to statistics. Last week, the Health Secretary Matt Hancock told the House of Commons that new figures from the ONS showed that the number of suicides in England fell during the peak of the coronavirus pandemic. Could the Minister confirm to the House that this was mistaken? While the figures cited by the Health Secretary are the latest reported by the ONS, the ONS also clearly said that those figures

“cannot be used to show the number of suicides with a date of death in 2020, including those that occurred during the COVID-19 pandemic”.

It is likely, it continues, that it

“reflects delays to inquests … due to the impact of the COVID-19 pandemic”.

As government statistics show, the last time the suicide rate was this high was 1988. I would like to know what government resources are being applied to this and that they will not be cut back.

--- Later in debate ---

[Lord Bethell (Con)]

The noble Baroness refers to recent statistics, which are, as she rightly points out, subject to change, as coroners’ investigations land on the desk at PHE. I reassure her that the statistics suggest a difference between stress and anxiety, and clinical mental health issues. It seems that one aspect of the coronavirus pandemic is that it has not translated into a massive mental health tsunami, as feared. This is hugely encouraging and a great relief. None the less, we are committed to the mental health support that the Government provide, and continue to support charities such as the Samaritans and CALM, including through the £9.2 million recently given to them for suicide prevention and support.

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

My Lords, sadly, self-harm is a major risk factor for future suicide and is growing among young people. Later this month, the All-Party Parliamentary Group on Suicide and Self-Harm Prevention will be publishing a report of its inquiry looking at the support available for young people who self-harm. Having been closely involved in this inquiry, I ask the Minister whether he will commit to the Government looking seriously at its findings, which were informed by young people who had self-harmed, and to responding in due course.

[Lord Bethell (Con)]

The noble Baroness is entirely right that self-harm is an alarming, distressing and rising phenomenon among young people. I welcome the report that she describes, and commit to having a good look at it, when it is published.

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

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

NHS Counter Fraud Authority (Establishment, Constitution, and Staff and Other Transfer Provisions) (Amendment) Order 2020

Lord Bethell Excerpts

Monday 7th September 2020 Grand Committee

Moved by

[Lord Bethell]

That the Grand Committee do consider the NHS Counter Fraud Authority (Establishment, Constitution, and Staff and Other Transfer Provisions) (Amendment) Order 2020.

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

It is a sad fact of life that the NHS is not immune to fraud. As noble Lords will be aware, this Government have backed the NHS with the biggest cash boost in its history—an extra £33.9 billion by 2023-24. This money will go on investment, recruitment and epidemic response. This is taxpayers’ money and we are determined to get the best return on that investment, so that it makes the biggest difference to the most people. Yet fraudulent activity in the NHS means that the money intended for patient care ends up in the pockets of those who did not legitimately earn it. This is wrong. From a practical point of view, this means that fewer resources are available to be spent on front-line health services such as patient care, healthcare facilities, doctors, nurses and other staff. On a reputational front, it damages trust in the system. From an ethical point of view, it is our duty to fight fraud, because this is taxpayers’ money and we have a duty to spend it appropriately. That is why we have prioritised the NHS Counter Fraud Authority—to ensure that it is an effective counterfraud organisation. We believe it is best that it operates independently as a body which can act without external interference or influence and perform those functions that cannot be undertaken at a local level: serious and complex investigations, such as those that cross borders, and cases of alleged bribery and corruption on a national level.

Since its inception as part of the department in 1998, its function has evolved and in autumn 2017 it was launched as an independent special health authority. As a result, due to the NHS Act 2006, it is limited to a maximum lifespan of three years and so is due to be abolished on 31 October 2020. To prevent this, a statutory instrument was laid on 11 June 2020 to extend the abolition date by three years to 30 October 2023. I will take this opportunity to highlight the important work of the NHSCFA and set out why we need to extend its lifespan for a further three years.

The NHSCFA is a national centre of excellence. Fraud is a hidden crime and to fight it you have to find it. The CFA has done a valuable job in building the right relationships with organisations across the health and enforcement sectors to take that fight to the thieves who seek to deprive the NHS of resources for patient care. The NHSCFA is continually developing its intelligence and investigation capabilities and is breaking new ground in how to detect and prevent fraud. It has also set important national standards for the counterfraud work of NHS providers and commissioners, which apply to independent healthcare providers and NHS organisations. Its work is clearly bearing fruit; the NHSCFA’s latest strategic intelligence assessment shows an overall estimated reduction in losses from fraud of £60 million between 2017-18 and 2018-19. It also shows a £28 million reduction specifically on dental contractor fraud, thanks to a relentless focus by the NHSCFA over recent years, along with an £85 million annual reduction in fraud losses from false claims to entitlement to help with healthcare since 2017.

It is clear that this approach is working and that to change direction now would be a mistake. This concerted approach by NHSCFA to improve fraud awareness and drive up fraud reporting across the NHS is bearing fruit. We need it more than ever, especially when we are in the middle of the greatest threat to public health that we have seen for generations. As part of the government response to coronavirus, the Chancellor has repeatedly said that the NHS will get whatever funds it needs. An initial £5 billion coronavirus fund was established in the Budget in April 2020 and this was increased to £48.5 billion in the coronavirus emergency response fund in the Chancellor’s summer update, of which £31 billion has been approved to support our health services. We are continuing to work with the NHS and HMT to ensure that the NHS gets the funding and resources it needs, so total funding may change.

Although we have seen the nation coming together to celebrate the heroic work of NHS staff, unfortunately coronavirus presents a heightened risk of fraud, where criminals may seek to exploit the situation. Never before has a counterfraud response to protect this investment been so important. To us, “Protect the NHS” is about protecting not just staff but the money that taxpayers contribute to this invaluable national resource. The NHSCFA has played a key role during this period and has produced and shared coronavirus threat assessments with partners, and coronavirus counterfraud guidance specifically for the NHS. This includes guidance outlining the unique risks to the coronavirus response and specific guidance outlining types of mandate fraud and how to identify, prevent and respond to them.

As technology evolves, the risks to the NHS will evolve too, especially from fraud, so we will need organisations such as the NHSCFA to co-ordinate the response at a national level. If we made the decision to abolish the NHSCFA today, it would expose the NHS to significant financial risks. It would mean that there was no ability to accurately record and assess the nature and scale of fraud and to inform the response, both within the NHS and across the wider health group. It would result in serious and complex fraud investigations being transferred elsewhere; for example, to other NHS bodies, the police or the DHSC. It would involve costly additional expenditure for local NHS bodies at a time when they should be focusing on a global epidemic. It would undermine the funding of much-needed resources that are critical for patient care.

I urge noble Lords to keep this vital organisation in place and allow it to keep doing its important work, providing confidence and certainty to so many people. I commend this draft order to the Committee.

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, I thank noble Lords who contributed to this lively debate. I completely endorse the comments of several of them, including my noble friend Lord Naseby, who thanked the CFA for its work. It is tough work; it requires huge diligence. It is not always glamorous, exciting, blue lights and fun; it is about grinding out huge amounts of detective work and auditing and being thorough. I am extremely grateful for the work of the CFA and say a massive thanks for its impact. Some of that is seen directly through the numbers, but a lot of it, as was alluded to by the noble Baroness, Lady Thornton, is seen through soft impacts such as cross-working, “encourager les autres” and a general sense of grip, which it is an important thing for NHS management to have over the system.

With all the taxpayers’ money that is going into investment, recruitment and epidemic response, never before has counterfraud been quite so important—a point made by several noble Lords. The CFA has been instrumental in providing guidance and organisation across the health sector and, very importantly, in sharing intelligence with law enforcement partners.

A number of noble Lords asked about the approach of the CFA. We know that preventing loss is much more cost effective than prosecuting suspects and recovering funds. That is why the CFA does an enormous amount of work on fraud prevention methodologies. It is pushing hard to build and develop capabilities across the NHS and to share national standards and best practice with all parts. That is why it is driving a national, co-ordinated and cross-organisational response focused on prevention—the approach alluded to by the noble Baroness, Lady Thornton.

I say in response to my noble friend Lord Naseby that the CFA was established as a special authority only in 2017, but we have seen from its own strategic intelligence assessment that there has been a year-on-year reduction in fraud loss estimates. For that, we are enormously grateful.

The noble Lord, Lord Jones, asked about the number of prosecutions. The CFA has 45 ongoing investigations, involving 165 suspects. In 37 of those cases, a potential fraud value has been calculated which exceeds £34 million. I hope that that gives the noble Lord an idea of the scale of this work. The estimate for NHS fraud has been reduced, according to the strategic impact authority, from £1.27 billion to £1.21 billion, which shows the recent impact of the CFA. The chair is Tom Taylor and his salary is currently £14,450 for an average of two or three days a month.

The noble Lord asked also about the type of fraud investigated by the CFA. Covid fraud has been focused on—cyber-enabled fraud through malicious emails, apps and SMS texts. It has also investigated fraudulent appeals designed to exploit public sympathy and the spreading of false information. In this, the CFA has worked closely with the Cabinet Office, which has provided incredible support.

On how much fraud is reported to the CFA, it receives around 5,500 reports each year. The figure of 5,500 for 2018-19 was an increase of 700 over the year before. Almost half of those reports relate to fraud committed by NHS staff and a quarter to fraud committed by NHS patients.

My noble friend Lord Bourne asked a number of questions about the budget. The current budget of the CFA, which is an indicative, non-ring-fenced revenue budget allocation, is £11 million. That budget is funded through the DHSC in the same way as other health arm’s-length bodies. In 2019-20, we detected and recovered a total of £126 million which would have otherwise been lost to fraud.

My noble friend asked also about the PPE supply chain. PPE procurement during Covid-19 is currently managed centrally and not by NHS trusts. Therefore, Covid-19 procurement activity falls outside the CFA’s remit. The DHSC anti-fraud unit is working with partners to scrutinise transactions and reduce the risk of fraud against the Government—the noble Baroness, Lady Thornton, asked about that specifically. The CFA is supporting this work, but I will take a moment to give special thanks to my noble friend Lord Agnew, who is very much leading the charge from the Cabinet Office in the anti-fraud campaign. I am a representative member from the health department on what is known as the “fraud board”, which meets regularly to update policies and programmes in this area.

I thank the noble Lord, Lord Bhatia, for his comments. On my noble friend Lord Naseby’s question about the devolved authorities, I want to clarify that the CFA, although focused on England, provides a huge amount of training, technical support, data and other specialist support for DAs. Although they handle this as a devolved area, they benefit greatly from the CFA’s expertise.

My noble friend is entirely right about Covid spending. I would like to have said that everyone behaved immaculately through the Covid campaign, but that is not true. We were subjected to an enormous, co-ordinated and systematic campaign by those who sought to defraud taxpayers. We are conscious of that. We put in place enormous co-ordination with the police authorities in order to spot fraudulent efforts. They were extremely energetic but not always successful, and we have prosecutions in place to chase down fraudsters who sought to take money unreasonably off taxpayers.

Auditing of the CFA is done by the National Audit Office. I reiterate the thanks given by my noble friend Lord Naseby to the CFA.

On the CFA’s three-year cycle, it is an arm’s-length body established as a special health authority under the National Health Service Act 2006, which gives it a maximum tenure of three years. It is therefore out of the electoral cycle. Affirmative secondary legislation is required to extend the tenure for a further three years until 30 October 2023, which is why we are here today.

I think that I have addressed a number of the comments made by the noble Baroness, Lady Thornton, but I reiterate what I said on PPE in particular, which was subject to a concerted, organised effort by the criminal world to defraud the British taxpayer. Our response has been energetic and remains ongoing.

Extending the current model provides an opportunity for the CFA to continue its work. Its budget, which a number of noble Lords asked about, is under review, but we believe that it is ample for the work that it is doing. The department will continue to oversee the function of the CFA in its sponsorship role to ensure that it is fit for purpose. This will also allow the department to consider the best operating model for the CFA in the long term. The order is important secondary legislation that is integral to allowing the CFA independence and a crucial remit to continue. I urge noble Lords to approve it.

Motion agreed.

Folic Acid

Lord Bethell Excerpts

Thursday 3rd September 2020 Lords Chamber

[Lord Rooker]

To ask Her Majesty’s Government whether they have yet been able to form a conclusion on the proposal to add folic acid to flour following the consultation between 13 June and 9 September 2019.

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

My Lords, there are about 1,000 births with NTDs each year. Folic acid is a valuable prophylactic. We recognise that around half of the 700,000 births each year in this country are unplanned; some of mine were. Therefore, adding it as a supplement to some flours potentially offers great value.

[Lord Rooker (Lab) [V]]

My Lords, that is a deplorable Answer. I at least expected an answer to the question. I wanted a date. Would the Minister discuss this with the Prime Minister, who takes an interest in issues only where he has personal experience, such as Covid and obesity? Thankfully, he has no experience of babies born with a lifelong disability, which is what my question is about. Does the Minister recall that the English Government consulted on how, not whether, to implement a policy agreed by the three devolved Governments and the Daily Mail and operated by over 80 other nations? No action is like having a vaccine and not using it. We must do better.

[Lord Bethell (Con)]

My Lords, I pay testimony to the good work of my noble friend Lord Rooker on the campaign for mandatory fortification of flour with folic acid. He introduced a Private Member’s Bill and his work has been earnest. My personal experience is that my cousin James was born with an NTD; he survived two weeks and, sadly, passed away. Therefore, this is a matter that has my personal commitment. However, I am not in a position to give him the date he wishes, but we will come back to the House and answer his Question in due time.

[Lord Balfe (Con)]

I welcome the Minister to his three and a half hours at the Dispatch Box. I first raised this matter as president of the British Dietetic Association, the trade union that represents dieticians. There is overwhelming evidence in support of adding folic acid. As long ago as 1 March 2018, I was promised that the Government would be looking at a date for this to be done. I join the noble Lord, Lord Rooker, in being very disappointed about this. I ask the Minister to get on with this, please. As long ago as March 2018, we were being promised a date and we still have not got one. Please take some action.

[Lord Bethell (Con)]

My Lords, I completely accept the urging of my noble friend Lord Balfe on this matter. He is entirely right. There is very strong scientific evidence in this area; the Government accept that, and this is why they have launched a consultation, which was due to be published earlier this year. However, Covid has blown us away and that is why the announcement has been delayed. The Government have listened to the scientific evidence, which is very persuasive, and the decision will be made when the time is right.

[Lord Patel (CB) [V]]

My Lords, this is the fourth occasion that I have supported this Question put down by the noble Lord, Lord Rooker. Every time, there has been a disappointing Answer. As an obstetrician, I have seen many, many pregnancies result in serious spina bifida and anencephaly. Previously, the Government have used the excuse that overdosing might result if we put folic acid in flour. Would the Minister confirm that the recent research does not support that view?

[Lord Bethell (Con)]

My Lords, the consultation on the proposal to fortify flour ran for 12 weeks from 13 June to 9 September 2019 and was undertaken on a UK-wide basis. The pilot ran extremely successfully; the use of the supplements by the flour manufacturers was affordable and their implementation of the pilot was achieved without much disruption, and it was an encouraging experience that gives us good evidence for taking this matter forwards.

[Lord Turnberg (Lab) [V]]

My Lords, the science is clear that folate supplementation is absolutely safe and a remarkably effective public health measure. Does the noble Lord agree that further delay would be unconscionable, especially for the children still being born with spina bifida?

[Lord Bethell (Con)]

My Lords, delay is frustrating. I completely share the noble Lord’s frustration. Unfortunately, we are handling an epidemic and, once we have got plans in place for the second wave, we will turn our attention to this important and valued matter.

[Lord Palmer of Childs Hill (LD)]

My Lords, I support adding folic acid to flour and, as other noble Lords have all said, the sooner, the better. Has the Minister also considered action using Instagram influencers to encourage young women who diet to use leafy green vegetables, such as spinach, which contains B-vitamin folic acid? Would the Minster agree that, while “Eat your greens” might be a call from the past, it is cheap and still relevant today?

[Lord Bethell (Con)]

My Lords, I entirely endorse the noble Lord’s appeal for us to eat our greens. The concern with this specific matter is unplanned pregnancies, and the suggestion of putting folic acid into flour is to target those mothers who may need the additional supplements at a time when they do not realise they need them.

[Baroness Wheeler (Lab)]

My Lords, we on these Benches and across the House share the deep frustration of my noble friend Lord Rooker about the delay on this vital issue. When the consultation was announced in June last year, the Government also promised that the results would be dealt with speedily and would go hand in hand with major efforts to step up awareness raising, particularly among at-risk groups, such as Afro-Caribbean women and women under 20 years old. What actions have been taken? What assessment has been made of the reason for the stubbornly low take-up of folic acid supplements? What measurable impact has awareness raising had on reaching at-risk groups or ensuring that women whose pregnancies were unplanned are not missing out on these vital nutrients in the early stages of their pregnancies?

[Lord Bethell (Con)]

My Lords, the noble Baroness did, in part, answer her own question. Work to improve the diet of pregnant mothers has progressed impressively, particularly among at-risk groups. However, it is those mothers who do not know that they are pregnant that this measure particularly targets, and that is where its inherent value is. This is why we have conducted a consultation and are looking to make a decision on it in the near future.

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

May I congratulate the noble Lord, Lord Rooker, on his importunity in promoting the addition of folic acid to flour? Folic acid is essential to prevent spina bifida and anencephaly, which occur in utero before the lady knows that she is pregnant; hence the importance of putting it into flour, as they have done in the United States for years without any problems. There really can be no possible excuse for delaying the implementation any longer. Preventing this distressing condition is so essential and costs so little. Therefore, can we have a date for when it will be put into practice?

[Lord Bethell (Con)]

My Lords, I entirely endorse the insight of my noble friend Lord McColl. The United States, Canada and Chile were the first three countries to introduce mandatory fortification, and I note that studies demonstrate a decline in NTDs of between 20% and 25%. These are encouraging statistics and the Government recognise them.

[Baroness Bull (CB)]

My Lords, the 2006 SACN report Folate and Disease Prevention found that there was insufficient human data to say conclusively whether increased levels of blood folate from fortification might impact on the efficacy of anti-folate medication, which acts in chemotherapy by blocking the action of folic acid. The 2017 update is silent on this issue. Can the Minister clarify whether the absence of a reference to this issue is because there is still insufficient data, or is it because research has ruled out any adverse impact of mandatory fortification on those patients taking anti-folate medication?

[Lord Bethell (Con)]

My Lords, I am not aware of any conclusive scientific evidence that contradicts the benefits of folic acid. As I said, the demographic data would seem to suggest that experiences in other countries have been benign. Longitudinal studies take a very long time to emerge and, therefore, we are not expecting a massive change in that data. However, back at the department, I will ask if any science has emerged and I will write to the noble Baroness if I can put my hands on anything.

[Baroness Blackwood of North Oxford (Con) [V]]

I of course join other noble Lords in pressing the Minister to implement mandatory fortification as soon as possible—it really is time—but if he needs additional motivation, can I point to the potential wider benefits in addition to vital prevention of NTDs: reducing anaemia caused by folic deficiency in older adults, for example? Given the inequalities associated with these deficiencies, is the Minister confident that such wider benefits have been fully considered? If not, will he commission the relevant research as a matter of urgency?

[Lord Bethell (Con)]

The noble Baroness is entirely right to explain and expand on the wider benefits, but the benefits in respect of NTDs are extremely persuasive in themselves and the consultation focuses on them. I understand that it is an analysis of those benefits that will form the basis of our decision-making.

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

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

Covid-19: Local Restrictions

Lord Bethell Excerpts

Thursday 3rd September 2020 Lords Chamber

[Baroness Thornton]

To ask Her Majesty’s Government what plans they have to publish the scientific advice which informs decisions to lift restrictions put in place to address Covid-19 in specific local areas.

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

My Lords, data is the key scientific commodity in our fight against Covid. We started with very little; now we have lots, and we are sharing it with our local partners as quickly as the legal, technical and privacy constraints allow. This shared intelligence informs collaborative decisions on local restrictions.

[Baroness Thornton (Lab)]

I thank the Minister. On the ministerial Zoom, I witnessed the Conservative MP for Shipley having what looked like a hissy fit when the Bradford lockdown was announced. Despite recommendations to the contrary from the leader of the council and local public health officials, a month later Shipley has been lifted out of lockdown when other parts of Bradford still in lockdown have lower infection rates. On Friday, the Health Secretary announced that restrictions in Bolton and Trafford would be eased on Wednesday, despite leaving Labour constituencies with lower infection rates in lockdown. It seems that the Government were again lobbied by local Conservative MPs to lift restrictions. However, yesterday, the Health Secretary, with what might be called a skidding U-turn, announced that current restrictions would remain following a significant increase in infection. Will the Minister commit to publishing the scientific evidence behind decisions to impose, maintain and lift lockdown restrictions? Would it be better if discussions with local MPs were on the record? Does he agree that political neutrality and transparency are essential to securing public trust and support for measures locally to prevent a national lockdown?

[Lord Bethell (Con)]

My Lords, I entirely agree with the noble Baroness that local support, trust and collaboration between actors from all political parties are essential to fighting Covid effectively. I pay tribute to the very large number of dialogues and collaborative interventions we have had across the country with local actors from all political parties. Yes, local lockdown decisions are not always popular. They are tough choices and elected representatives find them difficult, but we have found that politics does not play a part in those decisions and we stick to that.

[Baroness Andrews (Lab) [V]]

My Lords, it seems to have been decided that areas of low infection do not need the same degree of access to testing as the known hotspots. Indeed, there are accounts of people in London being directed to Wales because there is not sufficient testing capacity. Is this not exactly the way in which to miss the next hotspots and possibly the trigger of a national spike? Is it not another stable door that is left open? On what scientific evidence was this decision made and will it be published?

[Lord Bethell (Con)]

My Lords, the noble Baroness is right that testing capacity is naturally prioritised to those areas with a major outbreak and that, when supply is constrained, some of the recommendations for travelling, particularly later in the day and in the afternoon, can involve long distances. Our objective is to put in place massive testing capacity right across the country in all areas, whether high or low in infection prevalence. That is our ambition.

[Lord Empey (UUP)]

My noble friend will be aware that regulations differ in each of the home nations and within those home nations. In addition to publishing scientific advice, is he prepared to ensure that there is a single point where persons travelling within or visiting the United Kingdom can go to get the latest restrictions in each particular area so that they are properly informed of what the position is geographically?

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, I have before me a large list of eight or nine public portals where exactly that information can be received. I will lodge links to those portals in the Library and on my Twitter -feed.

[Lord Farmer (Con) [V]]

My Lords, there is a marked polarisation in the country, particularly evident in attitudes towards and poor rates of return to work. Many would agree that this is not about where people can work most effectively but about unnecessary fear, given what the science says about transmission. What are the Government doing to reduce the level of polarisation in the country?

[Lord Bethell (Con)]

My Lords, we are working extremely hard to create confidence in the Test and Trace system and in the effectiveness of our two-tier system of hands, face and space combined with Test and Trace. We are appealing to the country to take necessary precautions but within those precautions to go about everyday life.

[Baroness Jolly (LD)]

My Lords, in the pandemic, I fear that some sectors of the public are losing confidence in politicians. Scientists, on the other hand, are seen as independent and trusted. Surely, advice for politicians from scientists should be published in the interests of openness and transparency. Does the Minister agree?

[Lord Bethell (Con)]

I completely agree with the noble Baroness. The collapse in confidence in politicians is nothing new, I am afraid. I can only pay tribute to British scientists, who have been extraordinary in terms not only of the integrity of their work but its pioneering nature. In many fields, Britain has led the world in the innovative and brave science that we have pioneered.

[Baroness Helic (Con) [V]]

My Lords, lockdowns have seen victims of domestic violence trapped at home with no escape, and underfunded and understaffed support services struggling to provide the necessary help and assistance. In the United Kingdom, support for domestic abuse survivors is often patchwork, with the availability of emergency shelters varying wildly. Can the Minister therefore say what consideration is given in the Government’s scientific advice to the impact of local lockdowns on victims of domestic violence? What measures have the Government taken to provide additional support for services for domestic abuse survivors in the areas subject to local restrictions?

[Lord Bethell (Con)]

The noble Baroness is entirely right that the impact of local lockdowns is far reaching. The impact is not only on families where there is domestic abuse but on children, those who are shielded, the elderly and so forth. The responsibility for caring for those vulnerable groups is with the local authorities. Central government has provided additional funding to support those interventions by local authorities; it is up to local actors to make those interventions, and we are grateful for their work.

[Baroness Meacher (CB) [V]]

My Lords, finally the Government are investing in preparations for widespread home testing, producing results within minutes. What priorities does the Government’s scientific advice recommend for that mass testing? Do they include avoiding local lockdowns, enabling the former shielded parents of schoolchildren to test their children daily on return from school to protect the parent, and solving the nursing-home visitor problem?

[Lord Bethell (Con)]

My Lords, I cannot help but feel that it is not a case of “finally”. This Government could not have worked harder to push for home testing, and we are extremely grateful for the innovations in business and government that have made home testing possible and effective. When home testing is deployable on a mass scale, we will work on a prioritisation of how best to use it. But the noble Baroness is entirely right; the kinds of use cases that she articulated are the ones that we have in mind.

[Baroness Young of Old Scone (Lab) [V]]

Could I press the Minister on the specific Question asked by the noble Baroness, Lady Thornton? The council leader of Trafford has blasted the chaotic way in which the Government have handled local lockdowns, where application and lifting of restrictions has yo-yoed sometimes daily and sometimes hourly, with inadequate consultation with local leaders. It is impossible for councils and local people to plan life on that basis, and it continues to erode trust in the Government. When will the Minister guarantee the publication of clear thresholds and criteria, backed up by published science, on which local lockdowns and their liftings will be based in future? Will he give us a date for that?

[Lord Bethell (Con)]

I apologise to the noble Baroness for disrupting the lives of local officials, but this disease is completely unpredictable. It is prevalent where we least expect it and it travels long distances very quickly. It is a fact of life—one that local authorities will have to get used to—that we cannot always predict where it is going to pop up and that fighting this epidemic is going to require fast action, which is why we have brought about the kinds of regulations that we will debate in this Chamber later this afternoon.

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

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

Covid-19

Lord Bethell Excerpts

Thursday 3rd September 2020 Lords Chamber

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

My Lords, I thank both the noble Baronesses for extremely perceptive and thoughtful contributions and I will try to get through as much data as I possibly can.

I completely and utterly agree with the noble Baroness, Lady Thornton: we are all on the same side. As I said earlier, I pay tribute to the huge efforts across the nation of national and local politicians and officials working collaboratively. There are the occasional lightning points that hit the headlines, but that completely disguises the overall picture up and down the country of a huge amount of collaboration that is going on to great effect. I will talk later about the impact of the local restrictions, lockdowns and infection-control efforts that are making a big impact on this disease.

The noble Baroness, Lady Thornton, is absolutely right to raise the question of capacity for testing because the testing that we have got is proving to be incredibly effective. It is being put to work extremely hard. The marketing that we have done to the population took a massive reboot recently and is proving much more effective. The take-up of testing is up 63% since June. The amount of surveillance that we do now has been hugely upgraded in order to give local authorities and local actors the data that they have cried out for. We provide that data for them in as much quantity as we possibly can.

The regular testing in hospitals and social care, which has been the subject of a huge amount of comment here in this Chamber, is up enormously. Testing is allocated to outbreak management in areas such as some of the cities that have been mentioned here earlier and has had huge effect. Our ambition is to have 500,000 tests by the end of October. Earlier today, the Secretary of State made announcements in detail of how we are going to achieve that. I would particularly like to mention the Lighthouse Lab in Charnwood, which is exactly the kind of modern, impressive, industrialised outfit that is going to help us achieve a huge amount of capacity over the next few months.

The noble Baroness, Lady Thornton, was absolutely on the money when she mentioned saliva tests. Saliva tests are an incredibly exciting opportunity because they are much more usable. For any of those in the Chamber who may have had a swab test, they would know that it was okay, but you do not necessarily want to have a load of them. Saliva tests are much more accessible. The Yale study she mentioned was incredibly impactful when it was published earlier this year and it surprised everyone with conclusive evidence that saliva tests would be just as accurate as a nasal or swab test. That has opened up a huge amount of interest in this area. That is one of the ideas for which we put £500 million into the innovative tests kitty. There is a huge project in Southampton, and hopefully another one in Salford, which will be using saliva testing. I pay tribute to the Southampton authorities, the hospital, and OptiGene and its LAMP test, which uses saliva, and we are really hopeful about that.

The noble Baroness, Lady Thornton, mentioned pool tests. I suspect that she meant multiplex testing, which is the combination of testing in the same well. That is, again, another technology that has the opportunity to massively increase our capacity for testing. It is exactly these kinds of innovations that we have spent the spring and summer pushing really hard on in order to get our capacity up to do the kind of mass testing that has been mentioned by several noble Lords in the discussion.

We have worked really hard in order to get access to GPs for registering patients for testing. This is a not inconsiderable technical challenge. I remind everyone that it is not that difficult for a GP to register a patient on the normal coronavirus testing page. It takes about 45 to 50 seconds. We have worked hard in order to ensure that all testing results go into the GP records and to upgrade the booking system to give GPs that special access.

In terms of the testimony of the noble Baroness, Lady Thornton, it is very difficult for me to comment on an individual’s experience. I do not in any way question any of that testimony. What can I say that is constructive? I share completely the frustration of the experience of the person involved. In particular, there are millions of people who want to know whether the symptoms they have are Covid or not. The ONS data suggest that a lot of people who think that they might have Covid do not actually have it. It is extremely frustrating for them not to be able to clarify that. That is one of the reasons why we are pushing so hard in order to get our capacity up. The long-distance question of when you book a test and get sent to Inverness to have your test is an odd thing to happen, but we are trying to make as many tests possible to as many people as possible. It is up to the individual to decide whether they want to travel a long distance.

The noble Baroness, Lady Jolly, mentioned home testing, which has proved hugely effective. We recently celebrated 1 million home tests. On the whole, that experience has been extremely positive for the vast majority of people, and we have worked hard with our contractors to get the turnaround time down to 20 hours, although there is more that we could do. Not everyone is able to drive to a test site; test sites are not available in many city centres. That is why home testing is important and why we continue to prioritise it.

The noble Baroness, Lady Jolly, is entirely right about cancer. It is a huge problem that, over the last six months, cancer screenings and referrals, and the attendance for cancer procedures, have not kept up with the needs of patients. We are working incredibly hard. I pay tribute to colleagues in the NHS, Sir Simon Stevens and others who are working hard to open up facilities, to use marketing to get people back into hospitals and to create community-based facilities, so that people do not have to travel to hospitals for some of their diagnostic and procedural treatments. Those efforts are making a massive difference. Referrals in June were up by 90%, and 92% of the referrals in June were seen within two weeks. We are working through the backlog more quickly than the current numbers seem to suggest.

The noble Baroness, Lady Thornton, raised important questions about PHE. PHE is incredibly important to both the science and organisation of our response to this public health challenge. We do not blame anyone at PHE for anything—quite the opposite. The Prime Minister, the Secretary of State and others have paid tribute to the expertise and effectiveness of PHE—the staff, the scientists and the organisation—but there are immense operational benefits in getting PHE, test and trace and the joint biosecurity centre to work more closely together. I see that in my own life in the department, in the collaborative working we can do. You can decide to wait to do these things, maybe until after the epidemic, but it is right that we have used the summer months to mend the roof and to take the tough decision to pull through this organisational change now, in preparation for the second wave. No criticism is implied. We want to see these three important organisations working closer together, under joint leadership. I pay tribute to all who have collaborated in this change.

The noble Baroness, Lady Jolly, asked about mass testing. It presents an enormous opportunity, but our capacity needs to meet its needs. As Innovation Minister, I have been blown away by the rate of progress and innovation of our partners in the NHS, business and the big medical organisations on the scale, price, speed and accuracy of tests. It has been phenomenal, and we are beginning to see a route towards mass testing opportunities that we would not have been able to dream of in February or March, when we began this odyssey.

We are conscious of testing of a diagnostic or preventive fashion to break the chain of transmission. That needs to be swift, accurate, prompt and specified on individuals who either are at risk or present symptoms. But, as alluded to by the noble Baronesses, Lady Jolly and Lady Thornton, there is also an opportunity to use testing to provide reassurance that someone is not carrying the infection and perhaps is not infectious to others. This would give them the confidence to return to the workplace and to areas where social distancing is challenging, or to see people who are at risk. We are looking at avenues to develop that kind of testing in every way possible.

We are hugely encouraged by progress made on a vaccine, not only by our own teams in Oxford and Imperial, but by vaccine teams around the world. But let me be frank with the Chamber: vaccines for coronaviruses are notoriously difficult. Vaccines for anything to do with the respiratory system are also very complex, difficult to deliver and unreliable in their long-term impact. The macro challenge is enormous but, given its size, the progress made by some of the vaccine teams is phenomenal. We are giving them all the resources they need to continue making that progress.

The delivery of a vaccine, when it arrives, will be a massive national challenge and the noble Baroness, Lady Jolly, is entirely right to raise it as something worthy of scrutiny. We will need all the resources that our National Health Service, private partners and the whole nation can provide. A huge number of personnel will be required to deliver one or two doses to a large proportion of the population. Certainly, pharmacies and the pharmaceutical profession will play a pivotal and important role in that. We are deeply engaged in consultations with all parties that have a role in delivering vaccines, and we are putting plans together to do that.

We are making great progress with track and trace. I mention the outbreak in Herefordshire because it does not exist. There is no outbreak in Herefordshire: when we spotted a contagion among migrant workers on a farm in Herefordshire, we used track and trace to break the chain of transmission and close down that mini-outbreak. As a result, it did not expand widely into the community and there is no communal outbreak in Herefordshire. In the last week, 81.4% of people transferred to the contact system were reached, 80% of contacts on whom we had information were reached and 452,679 people have been newly tested under pillars 1 and 2. These are incredibly impressive numbers. Track and trace comes in for much scrutiny and attack, but I reassure noble Lords that it is an incredibly important system that provides an important tier in our fight against the epidemic, and has proved effective already.

[Baroness Prashar (CB) [V]]

My Lords, why do we not have testing at airports yet? Leading figures in the aviation industry are expressing frustration and it is having a detrimental impact on the industry. Other countries have managed to introduce testing at airports; why are we lagging behind?

[Lord Bethell (Con)]

My Lords, I completely hear the frustrations of the airport and airlines industries about testing, but I cannot hide from them the simple epidemiological facts. If someone arrives at an airport, they may not test positive if they are harbouring the infection deep inside themselves. It may take days—up to 14 days—for that infection to manifest. I wish it were different; I wish we could set our airports free. Until we find a system that can handle that complexity, I am afraid that we will have to live with the system we have.

[The Lord Bishop of Bristol]

My Lords, North Bristol NHS Trust has recently reported on an audit of 110 patients discharged after being severely ill with Covid-19. Of these, 75% were still experiencing serious symptoms three months later. This is just part of the mounting evidence of the long-term effects of Covid-19 even on those with mild infection in the acute phase. What steps are the Government taking to raise public awareness of so-called long Covid and to invest in the care of those who are now chronically ill?

[Lord Bethell (Con)]

The right reverend Prelate is entirely right to raise this point; it is emerging as a massive concern. The idea that Covid will somehow pass through Britain and leave people untouched, a bit like simple winter flu, is beginning to prove worryingly untrue. Her anecdote from Bristol is completely consistent with what we are seeing across the piece. In particular, those who have had acute infection but also, I fear, some who have had relatively asymptomatic or low-symptom Covid have found in later weeks and months symptoms of fatigue, arrythmia, renal impact, scarring on the lungs and memory loss. These are extremely worrying symptoms. Sir Patrick Vallance, the Government Chief Scientific Adviser, is running an operation to understand what the right reverend Prelate rightly calls long Covid; we are using big data to analyse the scans we have collected from acute patients and to understand the impact of asymptomatic infection. This is an extremely worrying manifestation of Covid, one that we are acutely aware of, and we are investigating very urgently.

[Baroness Browning (Con) [V]]

My noble friend will be only too aware of the consequences of non-Covid patients’ reluctance to present themselves at hospitals and even to GPs for treatment and support. With the winter months approaching, what can he do to make sure that, at a local level, in advance of people having symptoms, they are reassured that they will be safe to approach the NHS? The idea that “it will be all right on the night” and just requires encouragement has clearly not been enough in the past and, I fear, will not be enough in the coming months.

[Lord Bethell (Con)]

My Lords, my noble friend is entirely right that confidence in attending NHS venues is hard hit by Covid. One of the inspiring and interesting things that has happened has been the switch to using telemedicine—video and telephone calls—for referrals. This has been particularly and interestingly used in mental health, where attendance at clinics is something that many patients would wisely seek to avoid, but in fact the delivery of mental health therapy through telemedicine and calls has proved to be incredibly effective and has worked very well. We are working hard, through the NHS, to try to de-weight attendance at venues, particularly big central hospitals, and move much more towards attendance in the community, or through technology, in order to give patients a choice and to increase our engagement at a time when people are fearful of going back to their GP surgeries.

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

My Lords, one of the reasons for the Statement is to look at lessons learned. As the Minister and others have already discussed, the trust of the British people in what they are being told and advised is important. Therefore, what was said yesterday about Bolton and Trafford and their local spikes was not very helpful. Because transparency is really important in building trust, can the Minister tell us what happened between 9 am and the Statement from the Minister after noon to change his mind? He tells us that it was data. What was the data?

[Lord Bethell (Con)]

The noble Baroness is entirely right that trust is critical, and we have to forge a system where local authorities, local MPs and central government work together on these local restrictions. The only thing that changed was that that group of people sat down at 9 am yesterday and looked at the data, and the data was deeply uncomfortable—it did not tell the story that everyone wanted it to tell. No one wanted to lock down those areas, but the data pointed in only one direction. That is the story that is playing out in communities around the country and it is a story that we will all have to get used to. One of the frustrating aspects of this epidemic is that the disease moves incredibly quickly and does not always go the way one would like it to go. That creates turbulence, as discussed earlier, but that turbulence is something that we have to get used to. Politicians, local officials and central government mandarins are all learning to work together in order to interpret that data and apply its implications in a thoughtful and trusted way.

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

Is the noble Lord aware of the situation at Banham Poultry in Norfolk where, as of this morning, 104 people at the factory have tested positive and the public health director has reported that only 52% of contacts have been traced? This has led to the local authority bringing in a company to see if it can improve that figure. What conclusions are being reached as to why, in this instance, there is such a low rate of positive contact with people who may be affected?

[Lord Bethell (Con)]

The truthful answer to the noble Baroness is that I know that there is an outbreak at Banham but I do not know the operational details of the kind she describes. What I can say is that the system is deliberately constructed so that a local director of public health, or the local authority, has the option, if they think it has local relevance, to bring in the resources that are needed for any particular arrangement. If, for some reason, a local director of public health, or the local infection control team, sees an opportunity for bringing in outside resources—a charity, a company, a technology—that is entirely appropriate and welcome. That is exactly the kind of local intelligence and expertise that we depend on to be effective. A central track and trace operation cannot do everything; that point that has been made in this Chamber hundreds of times and is a point that we entirely embrace. I am, in fact, hugely encouraged by the anecdote the noble Baroness tells.

[Baroness Neville-Rolfe (Con)]

My Lords, I was not surprised to see a report in July that a majority of postal tests were not really working. My husband received a surveillance test, but the lancets did not make a hole big enough to provide enough blood, the little bottle for collecting it was too narrow, and follow-up tests were equally problematic. However, my question today is about masks, which were not mentioned in the Statement. On what scientific advice are government recommendations on the wearing of masks based? This is a subject of heated debate in my household—my positive experience of masks in Asia against the scepticism of the scientifically trained.

[Lord Bethell (Con)]

My Lords, I am terribly sorry that my noble friend’s husband had a tough time with the home testing kit. That is not the experience of hundreds of thousands of people who have taken those surveillance kits, and we know that for a fact because hundreds of thousands have been returned, providing incredibly valuable information that is informing all the conversations and decisions that we discussed earlier. As for masks, the CMO has made it very clear that the scientific evidence is not conclusive, but it is reasonably evenly balanced. It is extremely difficult to prove one way or the other the efficacy of masks, but the experience of countries that are fighting the epidemic effectively has often involved masks in one way or another, and my own experience in Asia reinforces that. That is why we have made the recommendations that we have, and we keep it under review until further science emerges. The British public have shown for themselves an interest in and a relatively high commitment to wearing masks, which I think is instructive.

[Baroness Andrews (Lab)]

My Lords, I take the Minister back to airports. I have three questions. First, what is the science telling us about the likely impact—I know that this is a difficult question—of people coming off planes from highly affected countries? Have we done any research on that? Secondly, the Minister said that it is very difficult to test when people come off aircraft because the disease may be inhabiting them but not presenting. Other countries, however, are testing at five-day and even 10-day intervals: have we considered that? Thirdly, if our only strategy is quarantining, are we collecting data on how people are conforming? Are they staying in isolation? How do we know that? Can the science and the data be made available to us? If there is an unknown or even a known loophole, how do we fill that if quarantining is our only strategy?

[Lord Bethell (Con)]

The noble Baroness asks three extremely perceptive questions. With regard to the science of testing at airports, a huge amount of work is being done on this, and I pay tribute to the work of the scientists at SAGE, who have, I think, published several papers on this matter.

The number that sticks in my mind is SAGE’s estimate that of those infected who pass through an airport only 7% would be captured by what is called day zero testing—a tiny proportion. That uncomfortable and inconvenient statistic holds us back from doing what we would love to do—it just does not work. We are looking at seven-day testing, eight-day testing and 10-day testing. This is a lot about risk management: there is a risk curve. I would be happy to share a copy of the SAGE report, which is public, that shows that curve.

The noble Baroness is right to raise quarantine implementation: it is a cause of concern. Quarantine is critical to the effective implementation of our epidemic management. It is a trust-based system. Anyone who has read the papers will know that that trust-based system is under pressure. We are keeping it under review and will be looking at whether it needs to be updated.

[Baroness Benjamin (LD) [V]]

My Lords, it has been widely acknowledged that Covid-19 has disproportionately affected the black, Asian and other diverse communities, with many dying—especially men. There is also a high risk of suicide among these groups. Sadly, I personally know of two people who have taken their lives because they could not cope with the uncertainty of the future. What measures, therefore, are the Government putting in place to ensure that suicide prevention is a government priority and that this group receives the support it needs to face the Covid-19 pandemic?

[Lord Bethell (Con)]

My Lords, on behalf of the House I pass on our sympathy to the noble Baroness, Lady Benjamin, for her experience with the friend who committed suicide. It is a touching story and we feel sorry them.

Suicide is important for this Government and we have a number of programmes that address it. One of the peculiar aspects of the epidemic is that the mental health tsunami that we were all braced for and deeply concerned about has not manifested itself in the way we thought it might. There is currently no evidence that the suicide rate has increased in any way. We keep a careful eye on this. When a major epidemic such as this happens, we worry that it will have a huge impact, particularly on the young—particularly young girls—and those groups, such as BAME, who may feel that the prevalence is higher in their community. To date, however, the statistics suggest that we are blessed by having avoided harsh effects so far.

[Baroness Verma (Con) [V]]

Will my noble friend tell the House what communication plans are in place to ensure that, as winter approaches, all communities are well informed on what measures need to be followed to prevent or reduce the impact of a second wave, and that where spikes are found in local communities, wider immediate testing is available to everyone in that locality? I also thank my noble friend for the funds that the Government gave us in Leicester to ensure that communications were sent out in languages other than English.

[Lord Bethell (Con)]

I thank the noble Baroness, Lady Verma, for her comments. What happened in Leicester has informed our response to the epidemic in many ways, including a much greater emphasis on languages. Many of the publications and technologies that we are rolling out in preparation for the second wave will use a hugely increased number of languages, so that we reach those communities which might otherwise have been overlooked.

In answer to the overall question put by the noble Baroness, I would place massive emphasis on our preparations for the flu vaccine. If we can spare the NHS the pressure of the annual flood of flu infections, we will do the country a huge favour. If we can spare patients the impact of flu that runs down their immunity and leaves them vulnerable to Covid, we will do them a huge favour. If we can get flu vaccine take-up higher, that will be a huge benefit for the system and the country.

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

My Lords, can the Minister advise the House whether self-isolation—in any setting—is enforceable, and if so, by whom? If it is not a legal requirement, is the moral obligation to isolate sufficient in such a serious public health crisis?

[Lord Bethell (Con)]

My Lords, we have limited powers to isolate individuals under the very initial regulations that were published, I think, in March. Our overall approach, however, has been a trust-based system. I pay tribute to the British public, who, on the whole, have gone along with this approach hugely, and it is a tribute to the British way of doing things that we have not been using the police or fines like some other countries have. As the second wave approaches, we must acknowledge that there is more social exhaustion with the disciplines of isolation, quarantine, hygiene and social distancing, and assess whether that approach will last the course. That review is going on now and in the near future we will be putting in place the measures we think are necessary and proportionate.

[Lord Greaves (LD) [V]]

My Lords, yesterday the Minister praised Pendle Borough Council—I repeat my interest—for its work on Covid, which now includes local tracking of positive cases; that is, the kinds of cases that the national system has failed to reach. Can the Minister explain why passing cases to the local level, which should be done within 24 hours, has in some cases taken four or five days? Furthermore, when a case has been reached, and more local contacts have been discovered, why do they have to be passed back to the national level and not quickly followed up locally? They might even be in the same street. Why are district councils such as Pendle not being provided with sufficient funding to cover all the costs of this work?

[Lord Bethell (Con)]

My Lords, once again I pay tribute to Pendle Borough Council, which is an absolute model of local collaboration in the handling of a local outbreak. I am greatly encouraged that Pendle has stepped forward to do local tracing. I do not know the precise details and will not pretend otherwise, but the story the noble Lord tells illustrates a harsh truth: not everyone wants to be traced. Not everyone participates in the system with the kind of enthusiasm one would like. It sometimes takes persistence and determination to track people who may be recipients of some very difficult news about their isolation and how they are going to spend the next 14 days—news that may either have an economic impact on them or seriously disrupt plans for them and their family. It is tough to track and trace people. That is why we work with local authorities to do it, why I was proud to announce the numbers earlier and why I am grateful to the noble Lord for illustrating the point with his story from Pendle.

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

My Lords, reference has already been made by the Minister to the quicker saliva tests for Covid-19. For the avoidance of doubt, can he outline to the House the timeframe for these trials and an implementation timeframe if they are successful?

[Lord Bethell (Con)]

The noble Baroness is completely talking my game here. I wish I could be 100% specific about the timeframes, but we are still going through the validation process. Personally, I am hugely optimistic. The noble Baroness, Lady Thornton, mentioned the work in this area of Yale University, which really changed our perceptions of the role that saliva testing could play. It can be used in the big PCR machines, it may be used in point-of-care machines and there is even a possibility that it could be used in the small plastic lateral-flow machines much loved by the husband of the noble Baroness, Lady Neville-Rolfe. I hope very much indeed to be able to update the House soon and to lay out a framework, but I afraid that at present the validation results have not come through and it would be premature of me to try.

[Lord Balfe (Con)]

Although the Minister mentioned the need to get back to face-to-face visits, it is not mentioned in the Statement. In our local hospital, Addenbrooke’s, the instruction has been that no people are to be seen unless it is absolutely necessary. Indeed, one consultant told me they had been forbidden to see a patient unless they needed to. Our local GP service provides no face-to-face meetings other than after you have been triaged and jumped through some hoops. It even had a tent outside for a time. Can the Minister assure us that some pressure will be put on local hospitals and GPs to get back to normal and start seeing people? As letters in the Times have proved, the fact that you do not see people means you miss serious diagnoses.

[Lord Bethell (Con)]

My Lords, massive pressure is on the NHS from every level to get back to normal. Attendance rates are increasing dramatically in every area of the NHS. I pay tribute to those who have gone through enormous hoops to create safe and protected protocols to have people back in the system, but I cannot hide from my noble friend the fact that the health system will not be the same, going forward. We will have to change our approach to infection control and hygiene and have face-to-face contact in a completely different way. It makes no sense for lots of ill people to congregate in a GP surgery and to spread their disease among one another. We have to rethink the way we did our healthcare in the past in order to protect healthcare workers and patients from each other’s infections and to afford a sustainable healthcare system that can afford to look after everyone.

[Lord Taylor of Warwick (Non-Afl)]

My Lords, one in five NHS staff is from black and ethnic-minority communities, yet six out of every 10 UK health workers killed by Covid-19 have been BAME. What progress are the Government making in urgently finding out why so many BAME health workers have been so vulnerable, even to the point of losing their lives in the cause of serving others?

[Lord Bethell (Con)]

The noble Lord is entirely right to raise the terrible statistics on BAME health workers. It is not conclusively understood why the numbers are as dramatic as he articulated. I am afraid we are still speculating, and a huge amount of work is being undertaken by PHE in this area to understand it better. Some of it is because BAME front-line workers selflessly put themselves in harm’s way in environments where there are higher risks, despite the extraordinary efforts of trusts and CCGs to protect them. Part of it is the living arrangements and part is the behavioural arrangements. These things are explicitly explained in the PHE report, but it is a matter of huge concern. Trusts and CCGs have been urged to put risk-management practices in place according to local needs and arrangements, and the numbers have changed as a result of these policies.

[Lord Bradshaw (LD) [V]]

I want to talk about areas other than London. The bus industry has made huge efforts to make its buses safe for people to use, yet people who put in local lockdowns are still advising people not to use public transport. What is the scientific basis for that advice?

[Lord Bethell (Con)]

My Lords, I do not support that advice. I took the bus to work today and encourage others to do the same.

[Baroness Jones of Moulsecoomb (GP)]

I asked the Minister about this earlier and will send details to him so that it can be checked. Somebody complained that when they went to get a home test for Covid, they were asked to share their information with an American credit-check company called TransUnion, which sounds like data harvesting. I am sure we are all against that. My question is this. The Government have promised regular, weekly tests for care home staff from 7 September. Is that still happening?

[Lord Bethell (Con)]

My Lords, I would be grateful to the noble Baroness for sharing with me the specific detail. It seems extremely strange to me; I do not recognise it at all. The way in which we put together our test registration protocols is to encourage the greatest number of people to register as possible. I am sometimes asked why we do not have more information on the gender, ethnicity and background of people tested. It is for exactly that reason. I would be grateful if the noble Baroness could send me those details and will be glad to check them out.

Huge progress has been made on care home testing. We have massively prioritised the delivery of testing kits and services through the packaging of large numbers of tests to the kinds of care homes that can deliver tests themselves; the attendance of mobile testing units to those that need that kind of support; the connection with local trusts and hospital services so that NHS resources can be used for care homes; or the attendance of care home workers at local NHS trusts for their tests if that is more convenient for them. A huge operation has gone into place, massive progress has been made and I am extremely grateful to all those concerned.