National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2020

Lord Bethell Excerpts

Monday 8th June 2020 Lords Chamber

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

My Lords, as expected, this has been a moving debate. Who could not be moved by the powerful testimony from the noble Lord, Lord Hunt of Kings Heath, in moving his Motion and by the many noble Lords who have given such clear accounts from the front line of our social care? I have stood at this Dispatch Box—this virtual Dispatch Box—and heard the fears of noble Lords that the social care sector is in some way overlooked. I want to reassure noble Lords that this is not the case.

The country was put on hold three months ago to protect the most vulnerable, at huge cost to future generations. The protection of care homes remains an important consideration in the ongoing lockdown. I welcome the appointment today of David Pearson, who will be known to many noble Lords, as the chair of the Covid-19 social care support task force. Finally, in planning the future of our healthcare, we will be informed by the experience of the last five months—a time when the social care system was the focus of our attention and the whole of government got to know the sector much better. I do not hide from the fact that the last few months have been tough. We may not have had the social care meltdown that other countries did, but there have been difficult times. As such, I am sure that noble Lords will join me in expressing our gratitude to the hard-working staff across the social care sector, local authorities, charities and the NHS.

We all recognise that many of the lowest paid, many of them BAME, put themselves in harm’s way to look after the most vulnerable. The noble Lord, Lord Sheikh, and the noble Baronesses, Lady Pinnock, Lady Uddin, Lady Sheehan and Lady Jolly, made these points very well. For this sacrifice the country is enormously grateful. In particular, since this is Carers Week, I give special thanks and appreciation to our nation’s carers. The noble Baroness, Lady Brinton, rightly referred to the 6.5 million people in the UK who, as the noble Baroness, Lady Thornton, rightly reminded us, are looking after a family member or friend who has a disability or a mental or physical illness, or who needs extra help as they grow older. These are heroes as much as others on the front line, and we give our thanks.

It was instructive to hear from the noble Baronesses, Lady Pinnock and Lady Jolly, about their thoughts on the potential risks around EU exit and its impact on the recruitment of social care staff. The social care sector is vital to the UK, and our future immigration system will ensure that we have access to the skills and talents that we need after the UK leaves the EU. We are continuing to support employers in their promotion of the EU settlement scheme. EU nationals have until 30 June 2021 to make an application to the settlement scheme, and I strongly encourage them to do so.

The noble Lord, Lord Hunt, introduced this debate by bringing to our attention the recently laid National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2020, which I will outline for the benefit of the House. The FNC exists so that individuals or local authorities do not pay for nursing care that is the responsibility of the NHS. My right honourable friend the Secretary of State for Health and Social Care set a national rate in legislation, and he considers it annually.

Following many representations, including in this House by the noble Baronesses, Lady Thornton and Lady Jolly, and a formal review, we increased the FNC flat rate for 2019-20 to £180.31 per person per week, an increase of £14.75. The higher rate has been increased to £248.06 per person per week, an increase of £20.29. This is an overall uplift of 9% on the rate previously set for the financial year. This is a substantial raise that adds an additional £62.4 million of funding into the sector per year, and I am grateful for the welcome from the noble Lord, Lord Hunt, and the noble Baronesses, Lady Watkins and Lady Pinnock, for this development.

The Government have also uplifted the 2020-21 FNC rate by a further 2%. The regulations being discussed today therefore amend the rates set out in the standing rules to £183.92 per person per week for the flat payment. They also increase the higher payment to £253.02 per person per week.

The noble Lord, Lord Hunt, raised the important issue of efficiency challenges. I confirm that an efficiency rate has not been built into the uplifted rate for 2019-20, nor for the 2020-21 rate; the rate was designed to reflect the average cost of nursing care.

However, we are not here today just to discuss that important but relatively small part of social care funding. I shall spell out a few basic points. The long-term financial stability of social care is an imperative for this Government. We have already acted to ensure that the social care sector is properly funded through the epidemic, with major rounds of finance announced earlier this year. Looking ahead, I reassure the noble Lord, Lord Hunt, that we are committed to reform. The manifesto made that clear and the Secretary of State has invited cross-party talks to resolve the complex issues faced, which is the right place to start the process. I reassure the noble Baroness, Lady Wilcox, whose thoughtful and moving maiden speech on this subject is well remembered on all Benches, that these will take place at the earliest opportunity, given the current circumstances. In answer to the noble Lord, Lord Hunt, and the noble Baroness, Lady Healy, that is when the Government will begin to bring forward a plan for social care for the longer term.

The Government have acted to ensure that adult social care is properly funded. At the last spending review, we announced that an extra £1.5 billion would be made available to local government for adult and children’s social care in 2020-21. This came on top of maintaining £2.5 billion of existing social care grants.

The noble Baronesses, Lady Tyler and Lady Bennett, and the noble Lords, Lord Sheikh and Lord Mann, asked about the significant extra funding that the Government had provided. I confirm that the Government expect local authorities to get the funding that they have received to the front line quickly. Local authorities should take steps to protect providers’ cash flows, including making payments on plan in advance and monitoring the ongoing costs of care. I assure my noble friend Lady Altmann and the noble Baronesses, Lady Pinnock, Lady Brinton and Lady Sheehan, that the future of funding in social care will be set out in the next spending review.

My noble friend Lady Altmann raised the financial stability of care homes. We recognise that Covid-19 is imposing significant pressures on the social care sector. We have now made £3.2 billion available to local authorities so that they can address pressures on local services caused by the pandemic, including in adult social care. In addition, in April we brought forward planned social care grants worth £850 million to further support adult and children’s social care.

The Covid epidemic targeted the old and vulnerable; it had the social care sector in its sights. The noble Baronesses, Lady Barker, Lady Watkins, Lady Sheehan and Lady Healy, raised the question of the protective shield announced by the Secretary of State. I reassure noble Lords that the care home support package published on 15 May and the £600 million adult social care infection-control fund represent the next phase of our response for care homes, using the latest domestic and international evidence brought together by Public Health England and drawing on the insights of care providers. This includes making 1 million tests available for residents and workers in care homes, providing a named clinical lead for every care home, infection-control training, the PPE portal as a temporary emergency top-up route and ensuring that every local authority is carrying out a daily review of data on its care homes. Our help to care homes has meant that most of England’s care homes have had no outbreak at all.

The measures we have brought in have created a tsunami of regulations and guidance as we address this horrible disease, and we have responded to requests for clarification from the front line. We have introduced dozens of new ways of doing things. The 16,000 care homes, which range from the big to the small and are supported by half a dozen business models, face their own HR challenges.

We have sought to move quickly and thoughtfully to bring rapid support to a disparate and decentralised care system and have brought in new resources, technologies, supply chains and even the Special Air Service. I have no doubt that, from the point of view of a care home director, it has felt like a confusing set of measures. Under difficult circumstances, there may be things that could have been done better, but I assure the Chamber that we could not have moved faster or with more commitment. The strength of our social care system is the local routes and the tailored offering of thousands of different homes—I acknowledge the persuasive arguments of my noble friend Lady Wheatcroft —but this diversity makes it challenging to implement novel solutions at pace from the centre. I thank those in central and local government who did their best under difficult conditions.

There can be no doubt that the nation’s health and social care is a major priority for this Government. This extends from the fair funding of NHS-funded nursing care and social care more broadly to comprehensive support during the pandemic and, in time, an ambitious plan for reform. We will work with all interested parties—I thank Age UK and the National Care Forum for their briefings before this debate—to make it the most secure and effective service it has ever been. I conclude by thanking once again those working in the social care sector and other front-line services in these challenging times.

Covid-19: Obese and Overweight People

Lord Bethell Excerpts

Thursday 4th June 2020 Lords Chamber

The Question was considered in a Virtual Proceeding via video call.

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

My Lords, Britain is overweight. For too long, obesity has been a huge cost to the health of the individual, the NHS and the economy. Covid is a wake-up call. Initial evidence suggests that obesity may be associated with a higher rate of positive tests for Covid, of hospitalisation, of admission into intensive care and, I say with great sadness, of death. The Prime Minister spoke movingly of his experience. The Government remain committed to halving childhood obesity by 2030 and we are looking at other ways of making a bigger impact on this national scourge.

[Baroness Jenkin of Kennington (Con)]

I thank my noble friend for that Answer. Now that Covid has joined diabetes, heart disease and cancer in targeting the obese, I am glad that the Government are finally taking the obesity epidemic seriously. I encourage my noble friend to look at the measures ready now to be implemented, such as chapter 2 of the childhood obesity plan. What advice is being given to people about how to boost their immune systems to improve their general health but also to be ready to combat Covid if it comes for them?

[Lord Bethell]

My noble friend is recognised for her hard work in this area, and we all admire her championing of healthy living. The CMO’s advice is to focus on weight; that is the best way that you can prepare for winter, for the second spike, to defend yourself against Covid.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I welcome the very firm statement from the Minister and I welcome, too, the Prime Minister’s public statement about him accepting personal responsibility for his size. Can the Government, in taking this renewed, stronger position, recognise that the public need to have all the facts that they can about what they are eating and drinking? In many areas, they are left in the dark and therefore cannot make the right choices. On alcohol, for example, drinking has shot up during lockdown, yet people do not know how much sugar there is in alcohol; there is no proper labelling, including on calories. Can the Minister commit to ensuring that, in the review being undertaken, the public will know what choices they have to make and will know the facts about what they are eating and drinking?

[Lord Bethell]

The noble Lord makes a good case. Chapter 2 of the obesity recommendations makes it very plain that clear labelling and data play a critical and pivotal role in helping people to make choices, but so do interventions on the actual content on the food. We will look at both of those for future options.

[Baroness Brinton (LD)]

Section 8.3 of yesterday’s PHE review on disparities and Covid demonstrated very clearly that Covid, obesity, hypertension and diabetes type 2 were all severely raised for the BME community. Given that the Minister said in the House yesterday that this review was just the first step in understanding Covid in our BME communities, what urgent guidance is going to our primary care sector to advise our BME communities on what they need to do?

[Lord Bethell]

The noble Baroness, Lady Brinton, is entirely right. The review has done an excellent job of laying a path for greater understanding of the disease and is informing the PHE response. GPs already have a very clear work plan for advising BME communities on the threat of diabetes, in particular, and on obesity and healthy living for all circumstances. This will be redoubled during the epidemic that we are experiencing.

[Lord Robathan (Con)]

I welcome the Minister’s statement and indeed the leadership shown by the Prime Minister, but we need to take this further and show leadership from everybody in positions of authority and in politics. I particularly home in on health professionals and teachers because, for too long, there has been, I regret to say, a large number of very overweight people in the NHS and in our schools, setting a very bad example to children and people in hospital. People must be encouraged to take personal responsibility. I am afraid that they know what makes them fat, they need to be told what makes them fat and, dare I say it, they need to be shamed for eating and drinking too much.

[Lord Bethell]

My noble friend is right that personal responsibility and the leadership of those in areas of responsibility are incredibly important. Shame is not a policy that the Government particularly endorse, but I will confess to personally having a sense that I need to lose a stone in order to be match fit for the winter. I commit to my noble friend to undertake this arduous and difficult task over the next three months and will account to him on what progress I have made.

[Baroness Watkins of Tavistock (CB)]

My Lords, global scientific data is clear: obesity weakens immune systems, resulting in increased susceptibility to a range of diseases. Covid-19 has shone a light on the effects of being overweight, and I welcome the Government’s concern and intervention for the future. What plans do they have to work with survivors of Covid-19 who are overweight? There is a real risk that many will suffer post-viral fatigue, which will further exacerbate unhealthy lifestyles and could well result in a significant number of subsequent deaths that are in fact associated with the recovery—or non-recovery—period following Covid-19. Will the Government deliver clear and transparent guidance on healthy lifestyles and provide support to overweight people who have survived Covid-19?

[Lord Bethell]

The noble Baroness is entirely right: there is nothing new to the impact of Covid on those with a high BMI; it is entirely consistent with the impact of other diseases. She is also right that one of the nasty aspects of Covid is its long-term effects, which are not fully understood yet. Evidence suggests that these may be extremely damaging, and it is true that the Prime Minister has spoken about the impact of Covid on him. I have had pneumonia; I know the long-term damage of these kinds of diseases on people. We are looking very hard at offering the kind of support that she describes to those who have been hard hit by Covid.

[Baroness Thornton (Lab)]

My Lords, as many noble Lords have said, obesity is a significant risk factor in Covid-19. It is critical that we turn the tide on obesity at the earliest opportunity, and this means starting early in life. What steps are the Government taking to implement the measures outlined in chapter 2 of Childhood Obesity: A Plan for Action? Will the Minister commit urgently to restart existing plans to reduce salt, sugar and calories in our everyday foods, extend the soft drinks levy to other sugary and high-calorie foods, limit the advertising of junk food to children and ensure that people are not inundated with promotions for unhealthy food and drink?

[Lord Bethell]

The noble Baroness is entirely right that chapter 2 outlines an extremely thoughtful roadmap for how to address this issue. It is currently being reconsidered. I cannot make the guarantees she asked for from the Dispatch Box, but I can assure her that we are working hard to see how we can use the example of Covid to make progress on this important agenda.

[Baroness Tyler of Enfield (LD)]

My Lords, given the Prime Minister’s welcome recent statement that a more interventionist stance is needed to tackle obesity, is the Minister aware of a recent poll by the Obesity Health Alliance showing that 72% of those surveyed supported restrictions on shops promoting unhealthy foods in prominent areas, including checkout areas, and 63% wanted the sugar tax on soft drinks extended to other sugary foods? What plans do the Government have to introduce these measures, working collaboratively with supermarkets and other food retailers?

[Lord Bethell]

The noble Baroness is entirely right to suggest that Covid might be the infection point—the intervention necessary to wake up the nation to the dangers of obesity. We are keen to use that moment to make progress on this important issue.

[Lord Foulkes of Cumnock (Lab Co-op)]

My Lords, I declare a very personal interest in this issue: a recent Lancet article raised concerns that obesity is now shifting severe Covid disease to younger ages. Will the Government put in place public messaging not of shame but of sympathy and encouragement to younger adults?

[Lord Bethell]

The noble Lord is entirely right to raise the issue not only of younger adults but of children. These habits are formed extremely early and are hard to kick; if interventions are to be effective nationwide, they need to be aimed at all parts of society, particularly younger ages, when people pick up the behaviours of a lifetime.

Covid-19: Response

Lord Bethell Excerpts

Wednesday 3rd June 2020 Lords Chamber

[Baroness Brinton (LD)]

My Lords, I too thank the Minister for the Statement. From these Benches, we send our condolences to the family of Lord Rea; he will be missed. I also repeat the support from the Liberal Democrat Benches for everyone working hard to help contain and reduce Covid-19, from the magnificent front-line staff in the NHS and the care sector to all key workers, whether visible to us or not: we know that you have given your all. We also send our condolences to all those who have seen the death of families and friends over the last four months.

The World Health Organization has insisted repeatedly that no country should start to lift lockdown until Covid-19 is no longer in the community. With the noble Baroness, Lady Harding, confirming that there are still over 8,000 new cases per day, clearly it is still in the community, and WHO also says that lockdown should not be lifted until a full test, trace and isolate process is in competent operation across the country, which it is not.

Can the Minister explain why Ministers took the decision to start the process of lifting lockdown even though the Chief Medical Officer refused to allow the threat level to reduce from four to three? Unlike other European countries, which started lifting lockdown only when the daily death rates were below 10, today the department reports a total of 359 people died in the UK in the last 24 hours. Why was the shielding advice changed over the weekend, and why was no guidance sent out to GPs, care homes and clinical groups? I can confirm, as someone who is shielding, that I still have had no advice, by text, by letter or by telephone, on what I should be doing now that the advice appears to have changed. What can the Minister do to reassure people who are shielding that this is safe advice?

What steps are the Government taking to prepare for flare-ups of cases in our communities, and, worse, an early second wave? Will the care sector be involved in that preparation, given that they appear to have been left to hang out to dry in order to protect the NHS? I understand that unlike hospitals, the care sector has not been approached at all yet.

In the Statement, the Secretary of State refers to the publication of the Public Health England report on disparities and the risks and outcomes of Covid-19. The Runnymede Trust summarised the problems with the report, saying that there were not

“any recommendations on how to save BAME lives.”

What specific guidance is being provided to the NHS and care sectors to protect BAME staff in high-risk Covid-19 areas? Can the Minister comment on the report from the Western General Hospital that BAME locums were disproportionately placed on rotas in coronavirus-intense wards, and that the hospital has experienced a recent and very large spate of cases?

Yesterday, the Office for National Statistics wrote its second letter in four weeks to the Secretary of State, challenging him in the bluntest terms and accusing him of obfuscation and confusion on the number of daily tests carried out. Can the Minister give the House a date when we will be able to see real and consistent data on testing, approved by the ONS, back- dated and adjusted, so that there is no room for any misunderstanding?

I return to the issue I have raised repeatedly with the Minister: the care sector. At the weekly APPG on Adult Social Care update today, we heard again from across the sector that it still faces a number of problems, some of which the noble Baroness, Lady Thornton, outlined. To be clear—before the Minister responds again, saying that this is just anecdotal evidence—we were told that this is happening in a large number of care homes and settings in wide areas right across England. This is not a one-off.

First, a number of CCGs are still pushing care homes to take block-bookings of patients coming out of hospital without having had Covid tests. The Prime Minister and Secretary of State have repeatedly said that this has never happened. It has happened and is still happening. When will it stop?

Secondly, on PPE, the care sector says that the Clipper system is finally starting to be rolled out across the country—a mere eight weeks after your Lordships’ House was told that it was only a handful of days away. However, care homes report that deliveries are still only a portion of their original orders, meaning homes still have to make decisions about rationing. Can the Minister provide a date by which the care sector will receive all the PPE it orders and needs?

Thirdly, the Minister told us that all care homes would be offered tests by 6 June. I repeat my question from two weeks ago as to why some homes are excluded from the portal so that they cannot access tests. These are homes for learning-disabled adults and disabled people under 65. Given the worrying comments on the inequalities data in the PHE report, when will this change?

Fourthly and finally, I echo the points made by the noble Baroness, Lady Thornton, about it being essential for all health sector staff to be able to access repeat testing to keep people safe. While it is true that it is happening for NHS staff, it is not true that our care homes or staff working in the community are able to access regular testing. Can the Minister please provide a date by which staff in care settings will have regular testing? This is vital because there are so many asymptomatic cases. They need parity with the NHS.

I recognise that I have asked a large number of specific questions and hope that, even if the Minister cannot answer them now, he will be able to write to me and others taking part in the Statement. Perhaps he could also answer any of the questions from the noble Baroness, Lady Thornton, if he cannot answer them now.

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

My Lords, I start by echoing the words of both noble Baronesses and give thanks for the contribution of Lord Rea to the House. I did not know him well but have read the many testaments to his work. He clearly lived a full life and made a massive contribution to the House, for which we should all be thankful.

I echo the noble Baronesses and give a moment of thought to all those who have had deaths in their family and among their friends. I have lost both an aunt and a godfather to Covid in the last few weeks; my family has not been untouched, and I think—

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

My Lords, I think we have lost connection. Is the noble Lord, Lord Bethell, back?

[Lord Bethell]

Yes, I am back. I apologise for my broadband. I was addressing the question of the Prime Minister’s words. I have no doubt that there will be a judgment of history on whether the Government have made every decision correctly and whether every call we have made was right. There will have been mistakes, for which I am happy to put my hand up. But I am proud of the response to Covid, not just from the Government but from everyone involved.

With the leave of the House, I will single out five things. I am proud of the Lighthouse Labs. I am proud of the Nightingale hospitals. I am proud of the fact that the NHS stood up under relentless pressure when so many people thought it would fall over. I am proud of the fact that we ducked the worst effects of the epidemic, which many people forecast might lead to deaths of up to 400,000 people; everything that we know about the disease suggests that those forecasts were quite right and utterly realistic. Of course, the death rate is far too high. I have reiterated my thoughts for anyone who has lost someone and I feel very sad about the number of people who have died. And I am very proud of the scientific response, particularly by our vaccine researchers, who are world-leading in all this.

There has been an amazing collaborative effort by all parts of society, from the SAS to returning nurses, from front-line NHS workers to the private sector. It makes me profoundly sad when I hear people talk so negatively and so angrily about the way this country has responded. I totally put my hands up as a member of the Government for any mistakes that we may have made in our decision-making, but I ask noble Lords to speak a little more positively about this incredibly impressive effort and to remember that, when they speak in a negative way about the response to Covid, they are addressing not just the Government and the Government’s response. They are addressing everyone from postal workers to shop workers, the NHS and everyone who has been involved in this response. Having worked very much at the centre of things, I feel genuine pride in this effort.

The noble Baroness, Lady Thornton, asked about the PHE report. It is important, but it is preliminary research. It does not answer every single question about the complex issue of the differential rates of infection and mortality from this disease. It remains a mystery why some groups are much more profoundly hit, and it is not clear whether the differences are behavioural, social or genetic.

I say to the noble Baroness, Lady Thornton, that it appears that those areas of the NHS with the highest prevalence of infection are not those involving the front-line workers, where the use of PPE has actually protected workers from the worst effects of Covid. It has been among other parts of the hospital—in the canteens, among the porters and among back-room staff—that the prevalence has been highest. That is because infection has often happened where workers have touched each other or socialised. I mention this just to put paid to the idea that there has in any way been an irresponsible attitude, or that the NHS has in any way inadvertently put those with vulnerabilities in harm’s way.

I am not quite sure if I completely understood or heard the precise reference, but I did hear the phrase “structural racism” in the NHS. I react very sceptically towards that phrase and, to be honest, with a profound sense of anger. The NHS is not a racist organisation. This has been raised in previous debates and I reject it wholeheartedly at every level. If I have misunderstood the remarks of the noble Baroness, Lady Thornton, I hope that she will clarify them, but I want to make a clear stand on that point. There is clearly work to be done to understand better why some groups—older people, BAME groups and those who are overweight—have been hit so hard by the disease; that work is ongoing.

The noble Baroness, Lady Thornton, asked about test and trace. I want to be clear about a few things. As my noble friend Lady Harding said at its launch, this is a huge project which has been put together at pace and not every part of it is working immaculately. I admit that there are ragged edges but in essence it is working incredibly well. The people involved are working extremely hard. It is a coherent, thoughtful and, I believe, in many ways a world-beating outfit. I would like to ask anyone who is interested in finding out more about it to let me know and I will be glad to talk them through it or to invite my noble friend Lady Harding to go over the work of the test and trace programme. I genuinely believe that anyone who finds out about its workings cannot help but be impressed by it. I want to make a special testament to the private contractors who have made a contribution to it. I do not agree with people who denigrate those who work in the private sector for doing so—quite the opposite. My experience of working with private contractors who have contributed to the response to Covid has left me extremely proud of them and impressed by the results.

On local engagement, if it was the case that directors of public health, local environmental officers and local infection directors were not engaged, that is no longer true. The joint biosecurity initiative has done a fantastic job of briefing and tying in the local response. Tom Riordan from Leeds, who will be known to many noble Lords, is leading the charge on this. He is doing a fantastic job of working with local groups. Our response to Covid is now more local at every level and, as a result, is much better than it was.

The turnaround time for tests is important and is the focus of the operational priorities of the test and trace programme. Some 85% of the tests carried out through the drive-in centres are now done within 24 hours. The data is shared with GPs, although it is very hard work to tie in the test and trace computer program with the GP computer program, and more work needs to be done on this. I do not hide the fact that we are working extremely hard to bottom out and make more secure the operational arrangements of the test and trace programme. It was a huge infrastructure project which was thrown together very quickly, but I pay my thanks to those who are making extremely rapid progress on it. Perhaps I may share a point with noble Lords. Last weekend, I took a “secret shopper” test. I booked it at 6 pm on Saturday. I took the test at 11 am on Sunday at the Wroughton centre on the edge of Swindon, and I got the result at 6 pm on Monday showing that I had tested negative, of course. It was an extremely easy process. It took me 10 minutes on Saturday and 10 minutes on Sunday. The text I got was very clearly marked as being from the NHS, as it was, and it was a thoroughly professional and easy-to-handle experience. I invite all parties to try to support this important national project rather than denigrating it, because it relies on public trust and we really need the public to believe in it. They will do so only if our leaders support it.

I utterly agree with both noble Baronesses that people need to be able to understand the data—it is a really important project—but perhaps I may share a genuine and honest dilemma. We have sought to publish data as promptly and in as much quantity as we humanly can. The result of that, though, is that it is not all audited and checked and therefore it is often revised. That creates the kind of problems which David Norgrove has quite rightly identified. We are working extremely closely with David to try to close the gap. We are working closely with the Office for National Statistics to ensure that all future data is fully audited, but it is usual in peacetime to take months to iron out these processes before the publication of official data, and data is not published on a daily basis for exactly the reasons identified by both noble Baronesses. We have real and consistent data published by the ONS which is properly audited. That is completely robust data and we try our hardest to make right the data that goes into the daily updates. However, there is a tension between being prompt and being procedural, and we have sought hard to try to hit the right combination of the two.

The noble Baroness, Lady Thornton, asked about shielding. I reassure her that in no way are these announcements made for politically motivated reasons. We have been asked by many groups to address inconsistencies in the shielding arrangements. It is entirely reasonable for the Government to lift the shielding arrangements; that was done at speed and we are working extremely hard to ensure that those who were shielded are informed properly and that GPs and the NHS are part of that process.

Both noble Baronesses, Lady Thornton and Lady Brinton, asked about care homes. I reassure them both that 60,000 tests are carried out per day, and all those homes with outbreaks are being tested and retested. It is too early to tell exactly, but we are well on the way to hitting our 6 June target, and the amount of testing going on in care homes is extremely high.

As regards the anecdotes concerning CCGs being under pressure, as I understand it, to accept elderly people who are coming from hospitals into care homes, I would be very grateful if the noble Baroness, Lady Brinton, would write to me with those examples, because they are shocking, if they are true, and are completely against government policy and the agreed procedures of the NHS. I would be very happy to take up the case if she could give me chapter and verse.

On the future of the NHS, the noble Baroness, Lady Thornton, quite rightly asked what kinds of lessons we have learned. I will share two. First, one of the good things that has come out of the Covid epidemic is that the social care sector, the NHS and the public health sector have worked much more closely together than they have for a long time. We need to learn the lessons of that and figure out ways to ensure that they work even closer than they do right now. As regards the backlog, the Government completely acknowledge the challenge of catching up with the massive amount of procedures and medical work that will need to be done once Covid is under control. We have already made a full and clear commitment to funding the catch-up in that backlog, and we are putting in place the necessary preparations to staff and facilitate the catch-up process.

The noble Baroness, Lady Brinton, asked about the decision on lifting lockdown. It was the right decision and it was entirely consistent with advice from the CMO. The numerical threat level, which is organised by the CMO, is completely independently arranged, and I regard it as a testimony that it has been held at a high level, which shows the scientific independence of that process.

On preventing future flare-ups, I will flag two very important developments. First, I have already mentioned the joint biosecurity centre, which is currently being organised by Tom Hurd, and which is proving to be a really important development in arranging local responses to local flare-ups. These flare-ups may be anything from a school, a business or even, in the Weston case, a whole hospital. Being able to mobilise both the expertise and the analysis, support and data in order to jump on these flare-ups is an essential part of keeping a lid on the epidemic, and I pay tribute to the work of the biosecurity centre.

Secondly, we are working extremely hard to stockpile the necessary medicines and supplies for the winter. Our focus is very much on preparing for the winter in every possible way to prepare the NHS, social care and our public health response. We are using the summer months to mend the roof and ensure that we are in good shape. We very much hope to avoid a second spike, but we are fully aware of and preparing for the threat.

I remind both noble Baronesses that many European countries had more than 50% of their deaths in the social care sector. In fact, a low proportion of deaths in Britain have been in the social care sector, relative to other European countries. I appreciate completely that that is of no interest or value to those who have lost loved ones in the social care sector; I mention it only so that we have a sense of perspective.

On our response to and actions on the threat to BAME workers in the NHS, clear guidance has been sent from the top of the NHS to trusts, asking them to put in local measures that each trust regards as appropriate to protect BAME staff. This is entirely the right response to encourage and allow local trusts and the social care sector to make their own arrangements in their response. We continue to analyse the numbers to understand this problem more fully.

[The Deputy Speaker]

We now come to the 30 minutes allocated for Back-Bench questions. I ask that questions and answers be brief so that I can call the maximum number of speakers. I will now pass the chair over to the noble Lord, Lord Haskel.

--- Later in debate ---

[Lord Bethell]

My noble friend makes an incredibly valuable point and I completely share her concerns, but I will share two important points, if I may. First, we cannot avoid the fact that this disease has a 14-day incubation period. It is extremely tough to protect our borders from infection by a disease that may not be detectable, even at our borders, during that period. Secondly, while the peak is raging, additional infection from foreign visitors makes only a marginal difference, whereas at this stage, when we have worked so hard to get the prevalence down and reduce infectiousness, the threat of new infection from foreign visitors is higher. That is an irony that the CMO is fully aware of, but it is entirely right that we have brought in these measures. They are constantly under review. The impact on tourism and other industries is hugely regretted, but to rid the country of Covid they are proportionate.

[Lord Patel (CB)]

My Lords, I thank the Minister for repeating the Statement. Before I ask my question, let me say this: with the greatest respect to the Minister, if he thinks that no degree of racism exists in the NHS, I suggest that he speaks to those people from ethnic minorities who work in the NHS and see how they feel. I accept his comment that examination of what has happened hitherto is for another day, but we have to examine the current strategy for suppressing the virus, which we have not done successfully. In this regard, the latest initiative is the Government’s test and trace scheme. A great degree of transparency and trust will be required to make this a success. Can I ask the Minister: what matrix will the Government use to demonstrate the success of the project?

[Lord Bethell]

My Lords, I bow to the experience and wisdom of the noble Lord, Lord Patel, particularly in the matter of racism in the NHS. I would not for a moment suggest that there is no racism at all in the NHS—or any large organisation—and I deeply regret any bad experiences he may have had. The accusation, however, was of structural racism in the NHS, and that is what I push back against. The NHS as an organisation is not racist, and I reject the suggestion that it is.

As for the matrix of success, that is an extremely perceptive question, and a bloody tough one—exactly the kind I would expect from the noble Lord. To summarise, it is to reduce R: if we can get a lid on R0 and stop the index case from spreading the disease to more people, then Test and Trace will have succeeded.

[Lord Turnberg (Lab)]

My Lords, like the Minister I too went to have my Covid test recently. There was hardly anyone there—lots of testing stations but no customers and no queues. I was in and out in five minutes. I was not surprised, therefore, that while 200,000 tests a day are available, many fewer are being taken up. I ask the noble Lord, therefore, whether the Government will open testing to the wider public and not restrict it to those with symptoms. There are many asymptomatic carriers and we need to know who they are and where they are.

I also reiterate the question about how soon test results will be available in hours rather than days. We can do it, but when will it be rolled out?

--- Later in debate ---

[Lord Bethell]

I can reassure the noble Lord, Lord Turnberg, that all people, of all ages, are currently eligible for testing. I accept that communication about this has not got through to everyone, and we are working very hard to communicate the information widely. A very large marketing campaign to make it clear began earlier today—I saw the adverts when I drove in on the M4 this morning.

I can also tell the noble Lord that because the infection and prevalence rates are so low, we have a machine with spare capacity. That is being used for surveillance and to cleanse the social care sector and the NHS sector through asymptomatic testing. The machine is on standby for the winter, and, as we lift lockdown, to protect society from any rise in the infection rate. The turnaround times are already getting much tighter and in many cases are less than 12 hours.

[Baroness Hussein-Ece (LD)]

My Lords, the Minister said that the review of disparities in Covid had revealed what we already knew: that those most at risk include minority communities, particularly BAME people. We also already knew that the guidelines for people with inequalities replicate existing inequalities. I am sure that public health directors up and down the country have known about these inequalities, and have published reports about them, for many years. The Minister says that it is a great mystery, but really the report just touches on the inequalities.

Does the Minister understand that those from BAME communities, who disproportionately work in front-line services and the jobs he mentioned, are being hit? They are extremely worried, and very angry at this response. I understand that there cannot be a huge raft of recommendations, but there needs to be more guidance on protecting people, not just in the health service but more generally for those who employ people from BAME communities.

I will give an example from my own community. The Turkish and Turkish-Cypriot communities in this country are around only half a million. We have lost somewhere in the region of 250 people; we have all been touched by this, myself and my community. In Germany, there are 3.5 million Turks, and they have had about 50 deaths. The figures are stark.

On 19 May, I asked the Minister whether he would consider meeting campaigners and health professionals to put in place a proper Covid race equality strategy, for now and beyond. Will he please take that back and agree to meet us, and others, who are determined that we will have a proper response to this terrible virus that is disproportionately impacting on our BAME communities?

[Lord Bethell]

The noble Baroness is entirely right. These diseases always hit hardest those who are most vulnerable, and the most vulnerable often include those who are poorest, who have existing morbidities and who are vulnerable in some way. She is right that this is an age-old truth; it is as old as history itself.

I was referring to the scientific links between the disease and the death rate. To clear up the point, if I may, the mystery that we do not understand is the biological explanation of why the disease appears to hit some people harder than others. That mystery is being unravelled, but I cannot pretend that we fully understand it at the moment.

As to the noble Baroness’s invitation to meet groups, I remember it well and would be very glad to take it up. I will ask my private office to be in touch to make those arrangements.

[The Deputy Speaker (Lord Haskel) (Lab)]

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

[Lord Balfe (Con)]

My Lords, I want to go back to the testing centres question. I also had a test, but I had to drive to Stansted from Cambridge. Many people in our community do not have cars and do not drive. What is the Minister doing to make it possible for all major towns to have testing facilities that can be reached either by public transport or on foot?

My second point is more doubtful. Many people do not seem to realise when they should be tested, or, for that matter, how often. If you are tested at the beginning of June, when do you need to be tested again, if at all? What does the test prove, apart from the fact that you do not have the virus? It does not prove that you have had it or will not get it. Will the Minister step up the publicity campaign he just mentioned, so that people can be better informed?

[Lord Bethell]

I deeply regret that my noble friend had to drive from Cambridge to Stansted. We are working hard to address that and are looking at alternatives. We have now put up more than 100 sites, and I hope very much indeed that there would now be a site nearer him. We have also pioneered at-home testing, which we believe will address his key point, and we are trialling walk-in centres for city centres such as Cambridge.

My noble friend’s last point is entirely right. You should have a test when you show symptoms, but defining the symptoms of any disease, and in particular this disease, is very difficult. We do miss some people who do not show any symptoms, and some people who think that they have the symptoms actually have the symptoms of something else. It is a real dilemma and part of the battle we face against Covid.

[Baroness Hollins (CB)]

My Lords, the Statement does not address yesterday’s report from the CQC showing more than double the expected number of deaths of people with learning disabilities during lockdown—something we were warned to expect by colleagues in Italy. Will the noble Lord explain what is being done to better protect everyone in this group, including those living in residential care, but also people made vulnerable because of visits by support staff, who often visit more than one person living in the community?

[Lord Bethell]

I thank the noble Baroness for her question, which I think I understood. If I understand correctly, she is asking about those who live in social care and residential care. I commend the work of Helen Whately, the Social Care Minister, who has been an amazing champion for social and residential care. She holds our feet to the flames daily to ensure that more work is being done. Testing is one area where we have made huge progress. The provision of PPE, raised by the noble Baroness, Lady Brinton, is another, despite everything noble Lords might have read. I pay tribute to my noble friend Lord Deighton, who has brought about a huge amount of manufacturing in the UK. There is, however, more that we can do and we are working as hard as we can.

[Baroness Healy of Primrose Hill (Lab)]

Could the Minister explain what changed between 12 May, when I asked him what advice could be given to those shielding and was told that they must remain inside until at least the end of June, and last Saturday evening, 30 May, when the advice suddenly changed with no warning and the clinically extremely vulnerable were told that they could go out?

[Lord Bethell]

The noble Baroness asks a good question. One thing that changed was that there was a large amount of representation from those being shielded that the mental health consequences of their isolation were having a profound effect. There were very touching and moving stories, and the scientific analysis of that was extremely persuasive. We have sought to be flexible, but the advice remains very clear: those who are clinically vulnerable have to take extremely good care of themselves. Even though the prevalence is lower, they have to be aware of the consequences of this awful disease.

[Lord McNally (LD)]

My Lords, earlier today, a former Prime Minister, Mrs May, intervened at Prime Minister’s Questions to ask about the security of data, including medical data, if there was a no-deal Brexit. The Prime Minister’s reply was the usual “It’ll be all right on the night”. Does the Minister agree that it would be an enormous betrayal if proper systems were not put in place well before the deadline for any departure? The medical and other data that we receive from Europe are an integral part of fighting this disease and should not be put at risk for ideological reasons.

[Lord Bethell]

I completely agree with the noble Lord. The Prime Minister said that it was down to the negotiating table to sort out this important matter. I will leave it to the negotiators.

[Baroness Falkner of Margravine (Non-Afl)]

I understand that we have to wait for the data to come through that addresses what underlying health conditions and comorbidities might impact on BME critical care and death rates from Covid, but, to reassure the community while we are waiting for further information, I wonder whether the Minister’s publicity campaign could be very directly targeted at those vulnerable groups to make it very clear that they should avail themselves of the testing capacity available—indeed, that they might even get priority—so that they have some reassurance that, should they have any of the symptoms, they will be seen to as soon as possible?

[Lord Bethell]

The noble Baroness makes a powerful point. The frustrating truth is that many in the groups and communities of which she speaks take the fewest number of tests. Getting through to these groups is extremely important, so they can seek the clinical help they need if they are suffering from Covid. We have worked extremely hard with our marketing department to ensure that hard-to-reach communities get the marketing messages that will be effective. The noble Baroness provides a really reasonable reminder and I will redouble my efforts to ensure that those marketing messages are focused on the right communities.

[Lord Ribeiro (Con)]

My Lords, I appreciate that “test, trace and isolate” is in its embryonic phase and that we have yet to learn the lessons of the pilot on the Isle of Wight, but at the height of the pandemic Sir Paul Nurse and other academic researchers offered, in the spirit of Dunkirk, to assist the Government with their “little boats”. Sadly, this approach failed to find favour, with a central approach then being used. Will my noble friend assure me that, as we head to a national rollout of “test, trace and isolate”, the Government will remain open to offers of help from those in the security and medical fields?

In addition, the PHE report identifies worrying outcomes from BAMEs who contracted Covid-19, as others have said, but the analyses did not cover comorbidities such as hypertension, which is common in the Asian and African populations, diabetes or obesity, which was mentioned in 21% of Covid-19 death certificates. Can my noble friend say when these factors will be considered, in order to provide a clearer picture for BAMEs who are at risk of contracting Covid-19 now and when the next wave comes in the winter?

[Lord Bethell]

My noble friend makes an incredibly perceptive point on the BAME research. He is entirely right that this important aspect of our understanding in relating the ethnic, social and behavioural elements of the response to the disease is essential. The report has not covered all the ground yet: that work is being done at the moment, as I mentioned earlier. Frankly, only when all those elements are linked together will we get a full picture.

Regarding the “little boats”, we absolutely celebrate them. In order to get the industrial-level testing numbers up, it was correct to back big laboratories that could do the automation necessary to achieve that. I am a huge admirer of Sir Paul Nurse and have spoken to him often. The role of laboratories such as his is in connection with their local NHS trusts. Many local laboratories are doing extremely good work with local NHS trusts and we are putting measures in place to facilitate and encourage such connections.

[Lord Liddle (Lab)]

My question concerns the “track and trace” system. I declare an interest as a county councillor in Cumbria, where we have had severe outbreaks of the virus. A world-beating system was supposed to be in place on 1 June and we were given, as I understand it, less than two weeks’ notice of what the local government involvement in this “track and trace” arrangement would be. Does the Minister think that this has been handled adequately? How does he see the relationship between what is done by local authorities and what is done nationally by the Serco system that is being recruited?

--- Later in debate ---

[Lord Bethell]

I completely understand the noble Lord’s frustration, but I remind him that in Covid time, two weeks is ages. We have been moving so quickly to cover the ground that we have had to stand up very big programmes within a fortnight. He speaks with frustration that there seems hardly enough time to get things organised, but that is the pace at which we have had to move. The prevalence rate is down and the infection rate is down—that is not say we are complacent, but now is the moment when we are bedding in our operations.

The noble Lord is entirely right that our focus and our investment of time is in stitching together the local response, which is, as many noble Peers have said in these discussions, an essential part of our response. As I said earlier, the work of the Serco call centres, of the directors of public health, of Tom Riordan, of local authorities—all these need to be stitched together. It is extremely complex, but that is what the team of my noble friend Lady Harding is doing at the moment.

[Viscount Waverley (CB)]

Following a previous response by the Minister that touched on politics, will he clarify an issue that is exercising the country at large? Is the response by government to corona led by science or by taking note of science? If the latter, what are examples of choices by government that differ from that of scientific advice?

[Lord Bethell]

The noble Viscount asks an incredibly broad question, upon which many a treatise could be written. I can best answer by giving my personal experience, which is of being in meetings where the scientists absolutely lead our thinking, where their clinical judgment takes precedence over any lay opinion and where we have been advised by unbelievably impressive and experienced clinicians, epidemiologists and scientists from different groups. My experience is that those voices have been the ones that prevailed in almost every debate. However, not everything can be answered by scientists and there are political decisions to be made. Ultimately, major decisions such as on lockdown, on the strategy for test and trace and on how to run a vaccine strategy are informed by scientists, but politicians have to make big calls. That is the same in every single major national project. I think we have got the balance right. We have tried to put the science, quite rightly, at the heart of the decision-making, and sometimes we have been led into quite politically awkward situations by the good judgment of our scientists. I pay tribute to them and their judgment. My personal experience is that we have listened to and been led by them wherever necessary.

[Lord Scriven (LD)]

My Lords, I remind the Minister that holding the Government to account for their decisions in no way undermines front-line workers, whose jobs have sometimes been made harder by their decisions. As the Government say that we are moving to local flare-ups, which body has full responsibility and legal powers—now, today—to implement and control a local lockdown?

[Lord Bethell]

The arrangements for local lockdowns are not fully in place. In fact, the policy around them is in development and a full decision has not been made on what arrangements we will make for lockdowns. The joint biosecurity centre will be absolutely central to those arrangements. It is the hub into which the intelligence on prevalence and infectiousness comes and which pushes that information out into the local area to help advise directors of public health, local authorities and other local services on local arrangements. I believe that it will develop the expertise and the co-ordination role which the noble Lord asks about.

[Baroness Bennett of Manor Castle (GP)]

My Lords, in answering the question of the noble Lord, Lord Turnberg, the Minister said that a test is available to anyone who wants one, and that this is being advertised on the M4. I am looking right now at the nhs.uk website page headed “Ask for a test to check if you have coronavirus”. Highlighted on that page, it says:

“Please help the NHS by only asking for tests for people who have coronavirus symptoms now.”


Can the Minister explain that? Also on that page, it lists the three symptoms for which it suggests we should have a test. Yet when I go to the Centers for Disease Control and Prevention website—the US body—it lists 11 lots of symptoms, including: fatigue; muscle ache; headache; sore throat; congestion; nausea or vomiting; and diarrhoea. Have the Government considered expanding the list of symptoms, and if they have not, why not?

[Lord Bethell]

If I was not clear, I hope the noble Baroness will forgive me. The test is open to anyone in the population. It is not restricted to key workers or those who are over five, as it once was. However, the clinical advice is that you should seek a test only if you show symptoms, partly because the test will not necessarily work if you do not have symptoms. That remains the case.

With regard to expanding the list of symptoms, we changed the symptoms about two weeks ago. We have done a huge amount of work to understand the best way of recommending symptoms. This is an amazingly complicated area. A lay person like me would think it was not too difficult to define symptoms for an important disease, but actually it is an extremely contested area. We have broadened it, we keep it under review, and if what we have done is not working well enough, we will update it again.

[Baroness Verma (Con)]

Does my noble friend not agree that where there are densely populated communities and a greater risk of spreading the coronavirus, testing should take place through booked appointments with their regular GP surgeries? Many of those communities do not know how to access online appointments and come from larger families. They could then also be asked about how they were following the guidelines set down by the Government. My worry is that many communities are not being communicated to and are falling through the gaps. I urge the Minister to take that on board.

[Lord Bethell]

I agree with my noble friend. It is a grave concern that key communities, particularly those to which she alludes, are not hearing the message and do not have the available resources for booking tests. We are working hard on that. In particular, we are working with GPs to ensure that they have the ability to book tests. They can of course do so on the portal like anyone else, but we are working to create a special prioritised facility for GPs to be able to book tests for their patients. I completely agree with my noble friend’s assessment that in many communities GPs play a trusted role. A practical issue is that many GP surgeries are currently closed, but I welcome the fact that many are now reopening.

[The Deputy Speaker (Lord Haskel) (Lab)]

My Lords, the time allotted for the Statement is now up. The day’s Virtual Proceedings are now complete and are adjourned.

Hospitals: Patient Safety

Lord Bethell Excerpts

Thursday 21st May 2020 Lords Chamber

The Question was considered in a Virtual Proceeding via video call.

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

My Lords, despite Covid-19, the day-to-day health of the nation remains the business of the NHS. That is why the NHS has issued a new operating framework to help hospitals to continue providing essential and emergency care for patients who do not have Covid-19. This guidance is being kept under review. I have placed a copy of the framework in the Library.

[Baroness Browning (Con)]

Emergency admissions, of which we have seen many, though perhaps not enough, have resulted in people being very afraid of going into hospital, because there has been a lack of information for the general public. For example, what happens at the triage stage, what sort of PPE will people be wearing and how will they be protected? What can the Minister do to reassure the public that they will be safe and, on top of their emergency, will have the absolute minimum chance of getting Covid-19?

[Lord Bethell]

My Lords, I acknowledge that people’s concerns have led to a decline in attendance at A&E. That is why the NHS is running an “Open for business” media campaign, encouraging all patients in need of urgent or emergency medical care to seek appropriate treatment, including, where appropriate, attendance at A&E.

[Lord Clark of Windermere (Lab)]

Is the Minister aware that North Cumbria Integrated Care NHS Foundation Trust has confirmed that for five weeks 100 staff working in its operating theatres had to use respiratory face masks that had not been individually fitted, putting patients and staff at risk? The regulatory-fit test had not been applied. Can the Minister look into this and check that all the other trusts in England are not making the same error?

[Lord Bethell]

The noble Lord raises a question about north Cumbria, which I do not know about specifically, but I reassure him that the arrangements for PPE in hospitals have been made extremely professionally and thoroughly. Billions of items of PPE are available, and training on the fitting, wearing and changing of PPE is provided for all front-line clinical, support and other staff.

[The Lord Bishop of London]

The report recently published by the Institute for Public Policy Research, Care Fit for Carers, found that half our healthcare workers have said that their mental health has deteriorated since the Covid-19 crisis began. What supplementary provision is being put in place to deal with the mental health needs of NHS staff?

[Lord Bethell]

My Lords, I acknowledge the expertise of the right reverend Prelate the Bishop of London, who, in a former life, was the Chief Nursing Officer. She raises an important point; the mental health of staff is of enormous and grave concern to the NHS, to the department and to social care. We are investing money in providing additional mental care support and are working closely with the colleges to find out how best we can provide that important support.

[Lord Ribeiro (Con)]

My Lords, the specialist guidance on the management of non-coronavirus patients needing acute treatment, issued on 20 March, put senior decision-makers at the heart of triaging patients referred for admission. To assist them, what role would testing for Covid-19 play on admission, and what proposals are there to utilise the Nightingale hospitals as a step-down facility for Covid-19 patients, thus reducing their numbers in NHS hospitals and allowing those hospitals to deal with the backlog of cases?

[Lord Bethell]

My Lords, there was some interruption in hearing my noble friend’s question but, if I understood him correctly, the answer is that all patients are now tested on entry to hospital. Until their test result has arrived, they are treated as though they have Covid-19 and isolated wherever possible.

[Baroness Barker (LD)]

How will the Government enable hospitals to work on a regional basis, co-operatively, to optimise the use of surgical and radiological resources?

[Lord Bethell]

I am afraid that at the moment, I cannot give a precise and thorough answer to the perceptive and very detailed question asked by the noble Baroness, but I will be glad to.

[Baroness Fall (Con)]

We pay tribute to all those doing so much to help Covid-19 sufferers. However, we must not lose sight of others, such as cancer sufferers, who are being adversely affected by being afraid to go for diagnostics, having surgery and treatment cancelled, low supplies of key drugs such as painkillers, and research budgets being hit. Can the Minister reassure the public about this and tell us what he is doing to address these problems?

[Lord Bethell]

The situation of cancer patients is of grave concern. We have restored all the treatments, surgery and other systems necessary for treating cancer, and we have put in place testing facilities so that those with suppressed immunity can be tested and therefore enter treatment centres with confidence. It is a situation that we maintain under review, and we are working hard to ensure that drugs and painkillers are in ready supply.

[Baroness Campbell of Surbiton (CB)]

My Lords, there are many specialist units that provide ongoing support and life-saving treatment to people with long-term, complex disabilities. Many of these units have been turned into Covid wards, for example, the National Spinal Injuries Centre at Stoke Mandeville. Will the Minister inform me when these units are likely to return to their original function? What is happening to this cohort of patients in the meantime?

[Lord Bethell]

My Lords, the NHS chief executive, Sir Simon Stevens, has written to all NHS organisations signalling a change in the phasing of our response to Covid and inviting them to return operations given over to Covid to their previous use wherever possible. I hope very much that this will lower the impact on patients that the noble Baroness described. If she has a specific example in mind, I would be glad to inquire about it.

[Baroness Thornton (Lab)]

Is the Minister aware that some NHS trusts are diverting 999 and GP emergency admission calls to hospitals other than the nearest hospital to avoid transmitting Covid between patients? Can he tell the House when that will stop? Do the new guidelines allow the Government to provide finer-resolution data on hospital admissions, which will assist understanding of optimal admission, treatment and resource allocation strategies?

--- Later in debate ---

[Lord Bethell]

The noble Baroness speaks about infection control measures regularly undertaken by trusts. Ambulances frequently take patients not to precisely the nearest hospital but to the one best suited to treating the patient. These infection control measures have been extremely effective and will continue for the foreseeable future.

[Baroness Jolly (LD)]

My Lords, NHS Providers has concerns about the Government’s testing strategy for Covid-19. Will the Minister tell the House when every patient and health and care staff member with suspected Covid-19 symptoms who needs a test will consistently be able to get one within an appropriate turnaround time? When will the updated strategy be published?

[Lord Bethell]

My Lords, every member of the NHS or social care employee can currently get a test when they present symptoms. They can do that through their employer, directly through the online service or a hotline. The turnaround time in 95% of tests is within 48 hours.

[Lord Singh of Wimbledon (CB)]

There is a widespread fear of contracting Covid-19 on entering hospital, even where there are Covid and non-Covid zones. What steps can the Government take to reduce this real fear by limiting Covid patients to certain hospitals or by other measures?

[Lord Bethell]

The noble Lord speaks of a fear that I recognise. It is a sad feature of our times that patients who should be in hospital are anxious about attending because of possible infection with Covid. Different trusts approach this in different ways. Some sites have been deemed Covid-free and are used for, for instance, cancer treatment, whereas larger sites manage differently, perhaps by allocating certain buildings to be Covid-free and others not. We have tried our hardest to reassure the public that they can proceed in the NHS with safety.

[The Lord Speaker (Lord Fowler)]

My Lords, the time allowed for this Question has elapsed. We now come to the second Oral Question, from the noble Lord, Lord Teverson.

Dental Care

Lord Bethell Excerpts

Wednesday 20th May 2020 Lords Chamber

The Question was considered in a Virtual Proceeding via video call.

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

My Lords, the NHS and the Chief Dental Officer have worked hard to reopen the dental sector, with the aim of restarting routine dental care as soon as we safely can. In the meantime, over 500 urgent dental treatment centres have been set up in each NHS region, to provide urgent face-to-face care for patients.

[Lord Farmer (Con)]

I thank the Minister for his reply. Untreated and moderate dental problems can become severe and potentially life-affecting. Infected teeth were a major cause of death in the 19th century. I note the 500 urgent dental care hubs already set up in England following strict guidelines, but can my noble friend say why the regulator cannot simply modify the existing guidelines used in the hubs to make them transferable to local dental practices?

[Lord Bethell]

The noble Lord is entirely right that poor dental care is extremely damaging to individual health. The current situation is one that we massively regret, but the safety of patients and dental professionals is paramount. The aerosols generated by dental drilling and other dental practices leave the threat of germs in the air in a dental practice for hours to come, which could be caught by staff or future patients. It is for that reason that we have focused the infection protocols in 500 special units that have the right kit, the right training and the right arrangements.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I declare my interest as president of the British Fluoridation Society. I recognise the work done in setting up urgent treatment centres, but they are patchy in England and many provide only for pain relief and tooth extraction. Many high street dentists are in danger of bankruptcy, because the Chancellor’s schemes to help businesses have not been applied to them. Will the Minister consider setting up a programme of work with the BDA and the Chief Dental Officer to establish a national plan to get dentistry back on track and save the profession from ruin?

[Lord Bethell]

My Lords, I completely understand the points that the noble Lord has made. He refers to a situation that we are fully aware of, and I completely agree with his analysis. The truth is that tooth extraction avoids some of the risks that I described, but treatment in the centres is not limited to extraction and other protocols are arranged. The Chief Dental Officer is working on a dental plan, and we are liaising with colleagues in the Treasury to see what more can be done to help dental practices.

[Lord Rogan (UUP)]

My Lords, United Kingdom dentists, too, are heroes and heroines of this pandemic. In Northern Ireland 100 dentists were sought to run emergency clinics, but more than 400 stepped forward, and dozens more have volunteered to work in care homes. A recent BDA survey warned that three-quarters of Northern Ireland’s dental practices could collapse by the summer because of Covid-19. Like the noble Lord, Lord Hunt, I ask the Minister urgently to consider adopting a UK-wide approach to saving our dental sector from disaster.

[Lord Bethell]

The noble Lord’s concerns are well understood. Practices that depend on private income are particularly affected, because the NHS has guaranteed the income to NHS practices for their NHS work. We are working on a UK-wide national plan, and it is a massive priority for the Government.

[Lord Duncan of Springbank (Con)]

My Lords, I echo the points made by the previous speaker: £7.8 billion is spent on private dental health care, yet dental practices of this nature are among the only businesses not to receive the full business rate relief. Will the Minister commit to ensuring that they receive adequate provision, as a matter of urgency, to ensure that these practitioners do not disappear from the high street?

[Lord Bethell]

My Lords, I cannot make the commitment that my noble friend seeks at the Dispatch Box, but I promise to convey his thoughts to the discussions taking place between DHSC colleagues and the Treasury.

[Baroness Harris of Richmond (LD)]

My Lords, a recent poll of around 2,000 dentists and dental professionals found that 97.5% of them supported a vote of no confidence in the leadership of the office of the Chief Dental Officer of England. What is the Government’s assessment of this?

[Lord Bethell]

My Lords, it is not the role of the Department of Health and Social Care to have a view on the popularity of the Chief Dental Officer. All I can say is that the support he has provided for the profession is enormously appreciated, and we have a lot of confidence in his work.

[The Earl of Shrewsbury (Con)]

My Lords, I declare an interest in that my brother-in-law is a dentist. My noble friend will be aware that many private dental practices have already sourced and stocked their requirements of PPE. Is he satisfied that when NHS dental care resumes, practitioners will have adequate supplies for dentists, their staff and their patients?

[Lord Bethell]

My Lords, the Government are buying billions of items of PPE and putting them into the supply chain. That supply chain includes dentists, and we are working hard to ensure that all dentists, both in the urgent treatment centres and in other dental practices that may reopen in the short term, have exactly what they need.

[Lord Low of Dalston (CB)]

My Lords, when will the NHS be able to look beyond the current crisis and get back to routine eye care by opticians and eye clinics, which plays such a vital part in preventing blindness?

[Lord Bethell]

The arrangements for eye care, similarly, are an extremely delicate matter, because the eye is a potential source of infection, and both workers and patients are at risk through work done by opticians. We are extremely keen to get back to normal, but we put the safety and care of patients and staff first.

[Baroness Thornton (Lab)]

My question to the Minister is an amalgam of those already asked, and I want to press him on them. Everyone needs dentists to be able to survive this pandemic and to be open to do their job as soon as possible. What financial support might be given to the sector to make that happen? What steps are the Government taking to ensure that there are treatment guidelines and access to PPE?

[Lord Bethell]

My Lords, I completely endorse the point made by the noble Baroness, Lady Thornton. I lost a front tooth a few weeks ago and I cannot wait for the dentists to reopen because it is both uncomfortable and embarrassing. We are providing enormous financial support through NHS contracts, which we have honoured 100% through the epidemic whether or not dentists are seeing patients. However, we recognise that there is a problem with the private sector, and we are working with colleagues in the Treasury to try to find a solution.

[Lord Bradshaw (LD)]

It is the private dental sector that is probably in most trouble, because of a lack of financial support given by the Government and the question whether private dentists have adequate access to PPE, to which the Minister has referred. Will he address those questions? What meetings have taken place with the BDA to deal with these problems?

[Lord Bethell]

My Lords, at present there are restrictions on private dentists opening; the guidelines are clear on that. We are putting in place provision of PPE for when those guidelines are amended to allow the reopening of dental practices. We are also giving thought to how we will get through the large backlog of dentists’ work that will need to be done to catch up on those missed appointments.

[Baroness Boycott (CB)]

It was pointed out recently by Public Health England that snack buying has gone up hugely in the past few weeks of the crisis. As Ministers know, the main reason that children go into hospital and have anaesthetics is to have all their teeth out as a result of eating sugary foods. Will the Minister guarantee that, when the crisis is over, the Government will bring the obesity Bill back to Parliament and get it through this time, because this is a tragedy for our youngsters?

[Lord Bethell]

The noble Baroness is entirely right. I confess to having a profound biscuit habit through the Covid epidemic which I am wrestling to get over. On a serious note, the Covid epidemic has put a spotlight on the health of the nation. There seems to be some evidence that we have suffered badly from the epidemic partly because of obesity. The Prime Minister has commented personally on this issue. It will be a priority of the Government to address this point once the epidemic is over to restore the health of the nation and to tackle obesity.

[The Lord Speaker (Lord Fowler)]

My Lords, the time allowed for this Question has now elapsed. I thank all who put questions and the Ministers who answered. That concludes the Virtual Proceedings on Oral Questions. The Virtual Proceedings will resume at a convenient point after 12 noon for the Private Notice Question on scientific evidence relating to the reopening of schools.

Covid-19: Care Homes

Lord Bethell Excerpts

Wednesday 20th May 2020 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, this Urgent Question taken yesterday in the Commons on coronavirus and care homes covered much of the ground in the Statement taken by us last night. Sadly, it is clear that Ministers’ claims to have thrown a protective ring around care homes ring hollow in the light of the latest ONS figures on deaths in care homes: 9,495 residents in England and 480 in Wales. These figures are still ringing alarm bells, as the number of deaths involving Covid-19 as a percentage of all care home deaths continues to rise this week. As Martin Green of Care England told MPs yesterday, most care home residents should have been prioritised from the start. He also stressed that there are still huge issues with testing, with results lost and staff waiting eight to 10 days to find out whether they have coronavirus.

I ask the Minister about reports on the PHE study on genome tracking to investigate outbreaks in care homes, which last month found that bank and temporary agency care workers, often employed on zero-hours contracts, had unwittingly transmitted Covid-19 between care homes as cases surged and they were moved from home to home to cover staff vacancies. Does this not raise even further doubts and questions about this ring of protection? Why was this issue not recognised early on as a crucial factor in any infection-control strategy?

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

My Lords, the issue the noble Baroness raises was recognised in the very early stages. The problem of itinerant staff who move from one resident or patient to another was always going to be one of the most difficult to tackle. They perform an absolutely vital role in the care of non-domiciliary patients. That is why we put more money in to pay for more staff, provided PPE for the staff who were working and continue to upgrade the testing arrangements for both staff and patients, to ensure that they are protected.

[Baroness Brinton (LD)]

Yesterday, Professor Dame Angela McLean said testing had been prioritised in the NHS over care homes. Today, Justice Secretary Robert Buckland said the Government had prioritised the NHS over care homes as well. Yesterday’s Health and Social Care Select Committee also heard members of the care sector report continuing and widespread problems with PPE—chaotic, unreliable and extremely expensive, with the Clipper system promised two months ago still not rolled out. When will the Government ensure that our care sector gets the urgent priority support outlined in the Government’s social care action plan on 15 April, needed to keep residents and staff safe?

[Lord Bethell]

The noble Baroness is quite right to focus on the importance of social care, but I think she unfairly characterises the effort made to ensure that social care is protected. The social care action plan announced on 15 April has been enormously important and extremely effective. Also on 15 April, we rolled out outbreak testing for all symptomatic care home staff and residents. We brought in extra funding on 16 April, with £850 million in existing social care grants. There has been new guidance and more money for local authorities, and we have launched a workforce recruitment campaign for care home staff. An enormous amount has been done. Care homes were always vulnerable, and we have sought to put every possible measure in place to protect them.

[Baroness Newlove (Con)]

My Lords, I am grateful for the Statement. Unfortunately, I am having hearing issues, which are overriding the voices.

Can the Minister tell us what the business model is for care homes? We are seeing so many deaths in our care homes because of Covid-19 that it highlights that there may be underlying issues. We must think of the staff who are caring for the most vulnerable in our society.

[Lord Bethell]

My noble friend raises one of the key features of our social care system. It is provided by 12,000 different care home providers—or 16,000, depending on how you measure it—many of whom have very different business models. This creates a rich and diverse tapestry of provision, but it is also extremely difficult to engage with from a central campaign provision. That is one of the challenges that we have faced when rolling out support such as PPE and testing. We do not believe that the business models are inappropriate, but undoubtedly we have challenges when we are trying to reach all the care homes with an equal and central format.

[Lord Bilimoria (CB)]

My Lords, the Statement says that 27% of coronavirus deaths in England have taken place in care homes, whereas in Europe the average is around half—but does the Minister agree that in Hong Kong, Singapore and South Korea there were zero deaths in care homes, and in Germany, a country with a population of 90 million people, 3,000 deaths? Also, can he confirm that no patients were ever sent from a care home to a hospital and then back from a hospital to a care home without being tested? Can he reassure us, as the Statement says, that the testing of all care home residents and staff, with and without symptoms, is now taking place? That is 2.5 million people. When will it be done by, and will it be done on a regular basis? Some care homes are saying that it will be necessary to test many times a week.

[Lord Bethell]

The statistics which the noble Lord refers to are correct. It is probably more appropriate to compare the British care home statistics with those in Europe rather than Asia, which had previous experience and different models. With regard to care home testing, not everyone needs to be tested every day. Not every care home has an outbreak, and we must focus our resources on those that do. Regular testing may be necessary for them, but it is not correct that, for example, 2.5 million people need to be tested every week. That is not the advice from the scientists or the CMO. We want to focus our tests where Covid-19 has been found, and we must use our testing resources to expunge the disease from those locations.

[The Lord Bishop of Portsmouth]

My Lords, we know how crucial the social care sector is, and the huge challenges it faced even before Covid-19, with 120,000 care assistant vacancies. Can the Minister therefore respond to the excellent suggestion from the most reverend Primate the Archbishop of Canterbury that we establish a royal commission on social care, not to blame but to learn, so that we have the right information to make the right decisions and provide the right services for these most vulnerable people?

[Lord Bethell]

My Lords, this Government have already made a very clear commitment to review the social care sector; that was made before coronavirus. The experience of coronavirus will no doubt put a massive spotlight on our provision for social care. It is entirely right that we review all of our arrangements. The vacancy question that the right reverend Prelate raises is an important one, and that is why we have launched a massive recruitment campaign, and why we have brought in minimum wage legislation which has seen rises in the pay of social care workers that are historically at the high end.

[Baroness Altmann (Con)]

My Lords, care homes tell me that they are still being required to take residents from hospital who may have Covid-19. May I ask my noble friend whether scientific and medical advice supported the guidance issued in the action plan of 15 April that, prior to discharge into care homes, patients must be tested but will be discharged “pending the result”, despite spare capacity in the NHS? Will the Government urgently consider altering that guidance?

[Lord Bethell]

My Lords, the guidance has been reviewed by the CMO, and we stand by it. I can confirm that all patients leaving hospital for care homes are, as a routine, tested. When they arrive at a care home, they are treated as if they might have Covid, and they are put into an area of isolation, until either the test has come through or their diagnosis has been confirmed. This is a way of protecting care homes, and it is necessary to continue the traffic of people from hospital to care homes, in order to have the beds available for those who need them more.

[Lord Turnberg (Lab)]

My Lords, among the many reasons why we have done so badly in protecting our care home residents from this dreadful illness is the almost complete lack of adequate public health services at the local level. A few years ago, when I was chairman of the then Public Health Laboratory Service, we had a robust network of public health expertise in every locality which did all the testing and tracing of infectious diseases across the country. All that has been eroded over very many years, and I fear we have lost that local expertise—the doctors and the other staff that could have done the job that we are now left struggling to fulfil far too late. I ask the noble Lord whether he will make it a priority now, as a matter of urgency, to begin to fill that huge gap in our network of local public health services.

[Lord Bethell]

The noble Lord is more expert on the history of public health than I am, but I do not doubt the story that he talked about. I reassure him that Covid has definitely made us all think again about the very clear priority that local public health provision must and will provide. I would like to pay testimony to those public health officials—public health directors, environmental health officers, infection control officers—who play, and are currently playing, a huge role in controlling the epidemic.

[Baroness Prashar (CB)]

My Lords, the Statement is encouraging on one level but very disappointing on another, since it does not recognise that initially there were delays and problems. Consequently, care workers in those homes were working in very difficult and distressing circumstances, often without PPE and on low pay, in many cases below the real living wage. Will the Minister agree that they deserve not just applause but proper protection and a real living wage?

[Lord Bethell]

My Lords, we ensure that the social care system is funded so that providers can pay the national minimum and living wages to care workers. Since the introduction of the national living wage in 2016, care worker pay has increased at a faster rate than before. I share the noble Baroness’s praise for care workers. As a group, our million-plus care workers have massively delivered for the country. They deserve our praise, our thanks and a tribute from this House.

[Baroness Blackwood of North Oxford (Con)]

My Lords, I congratulate the Government on publishing the data behind their assessment of the Roche and Abbott ELISA tests. The transparency is welcome, but given the latest evidence on how asymptomatic cases affect transmission and how challenging infection control has been in care homes, can the Minister say whether care workers and care home residents will now be prioritised for antibody as well as PCR tests to give them the best data to improve infection control?

[Lord Bethell]

My noble friend Lady Blackwood is quite right that the Roche and Abbott antibody tests are a great step forward. It shows how diagnostic technology is progressing very quickly. We are determined to use all the benefits of modern technology in the fight against Covid. Our announcements on antibody testing in the NHS, in the care service and for key workers will be announced shortly. When it is, I assure her that NHS and social care workers will be on an equal footing.

[Lord Dubs (Lab)]

My Lords, in answer to an earlier question, the Minister said that it was not appropriate to compare us with what happened in Hong Kong, South Korea and Singapore, which had no deaths in care homes at all. He preferred to compare us with Europe. Is the truth not that we took our eye off the ball and that as a country we failed to learn from what was happening elsewhere? We failed to learn good practice and we actually lost two months, where we did nothing very much until we tried to catch up just now. Surely we failed pretty badly.

[Lord Bethell]

The noble Lord makes a comparison that history will have to judge on, I am afraid to say. I think that I am making a fair point when I say that Britain can really only benchmark itself against its close neighbours. The experience of Asian countries taught them an enormous amount, but it is not one that has seemed proximate or relevant to us in recent times. I am afraid that I can only leave it to history to judge whether we made mistakes. It would be wrong for me to prejudge that at this moment.

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

My Lords, I must apologise because I allowed everybody to come in. I had mistaken the timing and had allowed this to run for 15 minutes instead of 10. I must make it clear that this does not set any precedent. It was my error.

The Virtual Proceedings will now adjourn until a convenient point after 7 pm for the second Urgent Question repeat.

Covid-19: BAME NHS Staff

Lord Bethell Excerpts

Tuesday 19th May 2020 Lords Chamber

The Question was considered in a Virtual Proceeding via video call.

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

My Lords, the Government are deeply concerned about these groups. That is why we have asked Public Health England to review the evidence. In advance of PHE’s recommendations, NHS England has written to NHS services so that, on a precautionary basis, employers can risk-assess staff at potentially greater risk and make appropriate arrangements accordingly.

[Baroness Lawrence of Clarendon (Lab)]

I thank the Minister for that Answer. I have been asked by the Labour leader to conduct a review into the effects of Covid-19 on the BAME community. Are the NHS and Government making sure that BAME nurses are properly shielded with adequate PPE? Have they considered taking BAME nurses and staff off the front line, as they are overrepresented in the death toll of the virus?

[Lord Bethell]

As I mentioned in my previous Answer, arrangements have been put in place for local trusts to risk-assess all employees, including BAME nurses, and to assess whether they are at a higher risk and, if necessary, to change their rotas and staffing arrangements accordingly. I understand that some trusts have already taken these measures.

[Baroness Wheeler (Lab)]

My Lords, I pay tribute to my noble friend Lady Lawrence for the leading role she is playing in finding out why BAME communities and health workers are disproportionately bearing the brunt of Covid-19.I understand that the Public Health England review of ethnic minority health records and data is due to report at the end of May. It is looking into how factors such as ethnicity, deprivation, age, gender and obesity can affect the impact of Covid-19. People from ethnic minorities may also be at a higher risk due to the prevalence of co-morbidities such as diabetes, cardiovascular conditions and sickle cell disease. Overall, black people are dying with Covid-19 at almost double the rate of white people. Can the Minister say what the next steps will be after the PHE review and what are the Government’s plans, remits and timescale for the more in-depth analysis and inquiry that is needed to better understand entrenched health inequalities and to respond to the needs of BAME communities and health staff?

[Lord Bethell]

The noble Baroness put this very well. We are deeply concerned about genetic differences between groups. This virus is like malaria and other viruses in that it affects different ethnic groups differently. We are concerned about behavioural issues such as diet and environmental issues such as urban versus rural living arrangements. We have already invited health trusts to put in place arrangements to protect our BAME NHS workers. We are also inviting other academic studies, of which there is a large number, to look at the various concerns about how the virus has hit different groups. We will be commissioning a very large amount of medical research into this important area.

[Baroness Uddin (Non-Afl)]

I salute my noble friend for her relentless uphill struggle to combat institutional discrimination in our country. No one can ignore the sobering statistics on front-line deaths among members of minority communities. These have raised the deepest fears about the tragic number of deaths. Leaders in the NHS who are responsible for diversity have also said that the Government have been too slow to act to protect NHS front-line staff. What measures are in place to monitor this situation and to assure BAME staff that they can be confident about continuing to provide their services to the NHS in safety?

[Lord Bethell]

I completely and utterly reject the suggestion by the noble Baroness that there is institutional racism in the NHS. That is a completely inappropriate slur and I invite the noble Baroness to retract it at a future date.

[Lord Bourne of Aberystwyth (Con)]

My Lords, I recognise that this one nation Minister and one nation Government are committed to action, but clearly there is an urgency about this. I realise that we have the Public Health England review, but after that, how soon will the Minister be expecting to take action to ensure that its recommendations are implemented forthwith?

[Lord Bethell]

I can reassure my noble friend that action is already being taken. Individual trusts are putting in place trials and arrangements to try out different forms of amelioration, including changing staff rotas and taking vulnerable staff out of the front-line wherever possible. We will build on these pilots and trials in order to move as quickly as we can. The causes of the massive difference in the effects of the disease on different ethnic groups are not clear yet, so it is not possible to say for sure which pilots will work. However, we are moving as quickly as we can and we will build on the evidence base in order to put in effective measures.

[Baroness Hussein-Ece (LD)]

My Lords, this pandemic must be a wake-up call for us all. The Government’s review is not sufficient. BAME people make up 72% of NHS and social care staff and are 4.2 times more likely to die. Given all these separate initiatives referred to by the Minister, will he meet key leaders from BAME communities to look at establishing a Covid-19 race equality strategy, to find solutions to the current crisis based on the collective experiences of service and sacrifice from these communities?

[Lord Bethell]

My Lords, I share the noble Baroness’s tribute to BAME staff in the NHS, who, as she rightly points out, are on the front line and putting themselves at risk. We should all, as a nation, be enormously grateful for their contribution. I also salute those in the NHS moving quickly to address the concerns and evidence that the disease itself is discriminatory. I would be glad to meet representatives, but I want to be clear that the processes in place in the NHS are reasonable, proportionate and will, I believe, deliver the needed results.

[Lord Blencathra (Con)]

Will my noble friend the Minister please ensure that the inquiry carefully and thoroughly investigates all anomalies? While black Afro-Caribbeans have a much higher than death rate than white people, I understand that the rate is even higher for Filipinos and far lower for the Chinese. Will the inquiry also look at why 70% of those dying are men, which is nothing to do with race, and why obesity, diabetes, vitamin D and blood thinners all seem to be factors in this epidemic?

[Lord Bethell]

The noble Lord is entirely right. This disease is racist, fatist and sexist. We need to understand why it is discriminatory in all these areas. I reassure the noble Lord that the National Institute for Health Research and UK Research and Innovation have jointly called for research proposals to investigate emerging evidence of an association between ethnicity, behavioural and social factors, and the adverse health outcomes it is generating.

[Baroness Finlay of Llandaff (CB)]

Given the association that there seems to be between a wide range of factors, are these being centrally collated? Are the Government producing guidance on, for example, vitamin D supplementation in the event of deficiency being detected, so that the national results are rapidly rolled out, and those cases where risk is discovered can be managed and supported?

[Lord Bethell]

I reassure the noble Baroness that the data is being centrally aggregated. ONS has published figures on ethnicity and the CMO and PHE are both scrutinising them. On their list of issues to consider is the role of vitamin D, where the evidence is interesting but unproven.

[Baroness Healy of Primrose Hill (Lab)]

To follow further on the data, many medical bodies, and the Science and Technology Committee today, are calling for greater collection of real-time data on infection and deaths by protected characteristics, and for it to be recorded, analysed and shared so that urgent action can be taken to prevent deaths of front-line staff. What assurances can the Minister give that this work is actively underway now?

[Lord Bethell]

I reassure the noble Baroness that we have a large amount of data—although we could do with more and better. The collection of death certification data, for instance, has already improved dramatically and we are working hard to ensure that the evidence is there to inform our policy-making.

[Baroness Benjamin (LD)]

My Lords, the coronavirus crisis has exposed the fact that the majority of NHS BAME healthcare staff—including Filipino workers, who are often forgotten—hold junior positions and are therefore more likely to find themselves on the front line in the fight against Covid-19; many have lost their lives doing so. After this crisis, what will the Government do to encourage the NHS to develop better career paths and promotion initiatives for its BAME staff?

[Lord Bethell]

The noble Baroness is entirely right. We owe a huge debt of gratitude to those BAME staff, whether black Afro-Caribbean or Filipino, who have put their lives at risk on the front line. It is a wake-up call; we should always be thinking about how we can accelerate opportunities for all members of staff. Those who start at the lower ranks should be given whatever opportunities are available to progress to a higher rank. The noble Baroness is entirely right that this puts a spotlight on our commitment to those groups. I completely endorse her point.

[The Lord Speaker (Lord Fowler)]

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

Mental Health Services

Lord Bethell Excerpts

Tuesday 19th May 2020 Lords Chamber

The Question was considered in a Virtual Proceeding via video call.

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

My Lords, the NHS has issued guidance to services to support them in managing demand and capacity across in-patient and community mental health services. Services have remained open for business as usual as a result. We remain committed to the additional investment in mental health services set out in the NHS long-term plan. We have provided an additional £5 million to mental health charities to support their work during the pandemic.

[Baroness Tyler of Enfield (LD)]

My Lords, the Royal College of Psychiatrists warned last week that the nation faces a mental illness “tsunami”. Those on the front lines of our health and social care services have gone above and beyond to tackle this dreadful virus, but now may themselves face significant mental health problems. Thousands have lost colleagues, endured serious illness or experienced major trauma. Will the Government commit to investing in a world-class mental health response to Covid-19, including by setting up specialist support services for those on the front line of our NHS and care services, mirroring the services available to our armed services personnel?

[Lord Bethell]

I join the noble Baroness in paying tribute to those working in mental health in the NHS. They have kept services running in extremely difficult circumstances and their impact has been extremely powerful. Although we are aware of the deep threat of a mental health tsunami, as was warned, the evidence to date is that these people have done an amazing job of addressing the concerns of those who are suffering under coronavirus and the lockdown.

[Lord Howarth of Newport (Lab)]

My Lords, does the Minister accept that the implications of the Covid-19 pandemic include loneliness, a sense of entrapment, income and employment insecurity, substance abuse, relationship problems, bereavement and other factors that are liable to be severe? Resources will be needed for many interventions. Is he aware of the growing evidence base on the important benefits of the arts and creativity for mental health? What plans do Ministers and NHS England have to accelerate the spread of social prescribing, supporting people with mental health conditions to engage creatively with the arts, culture and nature?

[Lord Bethell]

My Lords, I completely recognise the noble Lord’s warnings. He rightly warns about the huge pressure of lockdown on people, and rightly mentions the benefits of the arts—particularly social prescribing, of which I am particularly supportive. I pay tribute to the Permanent Secretary of the Department of Health and Social Care, who has allowed me to bring Tilly, my working cocker spaniel, into the office to provide me and my fellow workers with some kind of support from an animal. I know that canine support is valuable. We are working hard to support the kind of social prescribing of which the noble Lord speaks.

[Baroness Newlove (Con)]

My Lords, this is an interesting area which I was concerned with both in my former role as Victims’ Commissioner for England and Wales, and personally. As well as viewing mental health services through Covid, we must recognise the risks to pre-existing services, which were an underfunded postcode lottery with not enough qualified professionals. Our front-line workers are now dealing with a pandemic that none of us could envisage. Will the Minister speak to the Secretary of State for Health to ensure sustainable funding for access to mental health services, and that support is given to mental health workers, who will be the front-line workers again? We must ensure that people’s ability to access the services does not just become a tick-box system governed by an algorithm within an app. There has to be sustainable funding for a least five years to invest in the care and support needs of the most vulnerable in society.

[Lord Bethell]

I recognise the insight of my noble friend Lady Newlove, who speaks from experience of these matters. I reassure her that the funding in place from the long-term plan for mental health has been substantial and will support a dramatic change in mental health services. We will be supporting mental health workers who, as my noble friend says, have delivered under difficult circumstances. Their creativity is demonstrated by the introduction of video and other technical facilities to keep mental health services going during the lockdown. I pay tribute to their inventiveness and creativity at this time.

[Baroness Barker (LD)]

My Lords, is data on mental health support, A&E presentations, referrals to community mental health services, crisis resolution callouts and detentions under the Mental Health Act being collected during this period—yes or no?

[Lord Bethell]

My Lords, I understand that it is a firm “yes”, but I will check that answer and revert to the noble Baroness if there is any different information.

[Baroness Hollins (CB)]

My Lords, yesterday the Guardian reported a study by Public Health England which showed that agency staff working between multiple care homes in London were unwittingly spreading Covid-19 during the surge of the pandemic. Given the evidence of the vulnerability of those receiving care, which includes working-age adults with mental health needs, is there really a commitment to parity of esteem between physical and mental healthcare? Why has the testing strategy not been amended properly to cover these groups?

[Lord Bethell]

The noble Baroness rightly points to one of the most difficult aspects of the Covid epidemic—the itinerant staff who pass from one vulnerable person to the next. We recognised this issue at the beginning and put money in to try to ameliorate it. When testing was expanded weeks ago to key workers, it was deliberately targeted at these staff and this continues to be prioritised.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, children’s lives have been disrupted, not only educationally but socially and emotionally, as friendship patterns have changed. The Minister will know that these relationships can be fragile but are essential to good mental health and well-being. What are the Government planning to do to provide additional support to schools to help with the problems they will inevitably encounter when children return?

[Lord Bethell]

The noble Baroness is entirely right. I am living with four children who are greatly distressed at losing their friends and not being able to stay in touch in the way they would like. We will undoubtedly need to provide support to schools to cover a list of mental health issues. The Secretary of State for Education is working on plans for that.

[Baroness Thornton (Lab)]

My Lords, as a nation, a vast number of us have seen our mental health deteriorate during the coronavirus crisis, so the challenges facing our mental health services are even greater than they were before. Surely we need a strategy to take us through the Covid-19 pandemic that takes account of the most welcome promises in the NHS long-term plan and addresses and scrutinises the impact of the pandemic on mental health and learning disability settings, including the impact of the temporary measures in the emergency legislation. Such a strategy must address how and when the DoLS legislation will be rolled out, and when and how the Government will bring forward reforms arising out of the review of the Mental Health Act. Does the Minister agree that these are the key ingredients of such a strategy? When will we see progress in this area?

[Lord Bethell]

The noble Baroness is right: the Covid epidemic will throw a spotlight on our mental health provision. That provision is already benefiting from an extra £2.3 billion a year by 2023-24. We have already brought forward the 24/7 crisis lines that were due to be delivered in 2023-24, and I think there is a good case for bringing forward other parts of our mental health strategy to address mental health issues during the Covid epidemic. Undoubtedly, we will focus very shortly on ways of doing that.

[Baroness Jones of Moulsecoomb (GP)]

The Stevenson-Farmer review of 2017, which was set up by the then Prime Minister, recommended strengthening the 1981 health and safety regulations on mental health first aid. Will the Government commit to picking up those recommendations and implementing them?

[Lord Bethell]

The noble Baroness raises an important point. I will confess that I am not, and will not pretend to be, completely across the matter she raises, but I will write to her with a clear answer.

[Lord Polak (Con)]

My Lords, I declare an interest: my daughter Natasha is an art therapist and co-founded the charity Arts Therapies for Children, which works in 19 schools. The impact on the mental health of children brought up where domestic abuse is the norm is sadly clear; it is all they know, and often they think that the problems encountered are their own fault. It is during these years that they develop and learn how to value themselves and others. Therefore, the impact of domestic abuse can lead to a skewed view of who they are, which can be taken into adulthood. Will my noble friend the Minister ensure that resources are targeted at supporting charities and mental health services that work with these vulnerable children?

[Lord Bethell]

I pay tribute to exactly the sort of charity that my noble friend’s daughter works in. They provide invaluable and often unseen benefits to society. We have already made available considerable financial support for similar such charities. If my noble friend would like to write to me with the details of the one he described, I would be glad to consider it. Undoubtedly, these charities will play an important role in dealing with mental health issues of the kind he describes during the mop-up after Covid.

[Lord Ramsbotham (CB)]

My Lords—

--- Later in debate ---

[Baroness Verma (Con)]

Will my noble friend assure me that all communities will be able to access appropriate mental health services? What work is being done to speak to local women’s and girls’ groups in the ethnic-minority communities, where language and access to online services may often be a barrier?

[Lord Bethell]

One thing that Covid has thrown a light on is that digital communications have been greatly improved; the use of video conferencing in mental health services is one of the things that have helped. Groups that do not have access to video conferencing need to be reached in other ways. We are working on using telephones and community outreach to do that. My noble friend is entirely right that this needs to be a focus of our work.

[The Senior Deputy Speaker]

I return to the noble Lord, Lord Ramsbotham.

[Lord Ramsbotham]

My Lords, does what the Minister has said apply to prisons and probation?

[Lord Bethell]

I pay tribute to the Prison Service, which in extremely difficult circumstances has managed to provide pastoral care and clinical segregation in our prisons in a way that has completely outperformed expectations. The effect in prisons has been profound and the mental health of prisoners is concerning. The degree of lockdown in prison cells is an awful aspect of this disease, and undoubtedly we will have to work very hard to manage and deal with the mental pressures on prisoners, which are extremely unfortunate.

[The Senior Deputy Speaker]

My Lords, the time allowed for this Question has elapsed. The Virtual Proceedings will now adjourn until a convenient point after 12.45 pm for the Motion in the name of the noble Baroness, Baroness Stedman-Scott. Proceedings in the Chamber will be taken at a convenient point after 12.30 pm.

Covid-19: Response

Lord Bethell Excerpts

Tuesday 19th May 2020 Lords Chamber

[Baroness Brinton (LD)]

My Lords, I thank the Minister for the Statement. The ONS statistics this morning showed that over 44,000 people have lost their lives, with the Financial Times estimating that the total figure is now well over 60,000 when a percentage of excess deaths is taken into account. From these Benches, we send our sympathies to all bereaved families and friends, and our thanks and support to the amazing front-line staff in the NHS, social care and community sector, and to others in key roles working to save lives and keep people safe.

The Secretary of State began his Statement by talking about flattening the curve, but yesterday an article in the British Medical Journal said:

“What is clear is that the UK’s response so far has neither been well prepared nor remotely adequate … Above all, the response to covid-19 is not about flattening epidemic curves, modelling, or epidemiology. It is about protecting lives and communities most obviously at risk in our unequal society.”


We agree.

I echo the points made by the noble Baroness, Lady Thornton, about the acceptance, at last, by the Government of a third symptom, anosmia, but many other countries have more symptoms. France says that you should self-isolate if you have any symptom on a list of 10. Why do our Government still refuse to increase that list?

The Secretary of State has repeated his claim that he has prioritised testing in care homes, yet he still repeats that testing for everyone in care homes, whether staff or residents, will be only “offered” by 6 June. The Adult Social Care APPG is still hearing of care homes waiting for that “offer” of tests, and of others that have had tests but results still going astray or taking 10 to 14 days to be returned. On that basis, if Ministers are really prioritising care homes, why does the Statement announce testing for members of the public over the age of five now while people at the heart of the firestorm of Covid in care homes still have to wait up to two weeks before being offered a test?

Still on testing, can the Minister tell us the percentage breakdown of PCR testing results versus antibody testing results? If not, can he tell the House when this information will be publicly available? We need as many PCR tests as possible as part of an effective test, trace and isolate programme. How many of those carrying out testing are paid roles versus volunteers? A couple of weeks ago, the Minister told your Lordships’ House that testing would be extended through, among other things, a deal with Boots. Five days ago, Boots had an advertisement seeking volunteer testers taken down after public outrage that a company that had been given a commercial contract with the Government was relying on volunteers to carry out the work. Was using volunteers part of its tender to government? If so, does the Minister approve of companies using volunteers while pocketing public money in a contract?

On tracing, it is encouraging to hear that more than 21,000 tracers have been recruited, but today there are reports of people recruited receiving multiple emails congratulating them on being successful or attending online training that has completely fallen over and failed technically. Can the Minister say what percentage of those 21,000 have received full training and are now working as tracers? Last week, the Secretary of State said that local tracers would be used, whether local health or environmental health tracers, as well as central ones. Can the Minister say how many local tracers—that is, not Serco call-centre tracers or central NHS tracers—there will be from the 21,000?

The Statement asserts that the Government now have all the elements to roll out their scheme of test, track and trace, but I repeat that there is no focus on isolation for those who have to quarantine. Test, trace and isolate is used not just by the WHO but by many countries. What plans are in place to support people isolating, whether at home or in a quarantine unit, once lockdown is lifted? They will feel much more vulnerable at that point, when everyone else is moving back into their normal lives. Experience from Taiwan, Germany and South Korea shows that community health support for those in quarantine is more likely to make it successful. Again, countries that have been successful in containing the virus all had fully operational test, trace and isolate programmes up and running from day one. Given that each new venture the Government have undertaken during this crisis, as outlined in the BMJ article—from expanding PCR tests from a low base to manufacturing ventilators, supplying PPE and now the tracer app—has had a very problematic start, to put it kindly, are the Government starting to run full contact tracing now, using new staff in an area that has sufficient cases of coronavirus, before lockdown starts to be lifted but particularly by 1 June? It would be inappropriate for schools to return and people further to return to work without such a system in place.

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

My Lords, I thank the noble Baronesses for their penetrating and searching questions. I will go through them systematically.

First, I want to say a few words, partly in response to the appeal for transparency from the noble Baroness, Lady Thornton, and partly in response to some of the suggestions about the performance of the Government in their response to Covid. I assure the House that the Government approach this epidemic in a spirit of openness and transparency, and we would like to work in partnership with other parties. I simply reject the suggestion, consistent in some of the questions, that the projects undertaken by the Government have in any way been characterised by failure or disappointment.

I bear testimony to the huge achievements of those who have worked extremely hard to throw up remarkable schemes which have been enormously successful and massively mitigated the effect of this disease. The testing network, the ventilators, the lighthouse labs and the nightingale hospitals were all hugely ambitious ventures, greeted with scepticism when launched and accompanied by complaints while being thrown up. But their achievements have been enormous: they have had a huge impact.

I would therefore like to turn around the tone of this debate, to be a little more positive, and celebrate the huge achievements of those who have thrown their heart and soul into the response to coronavirus. I pay tribute to their achievements and to the personal sacrifices many of them have made by giving up their time, and even putting their lives at risk, to conduct these important roles.

Quite reasonably, both noble Baronesses asked whether the Government regard isolation as part of the programme. I can reassure them that isolation is absolutely the key point. The way to stop transmission is for those who have symptoms, and especially those who have tested positive, to shield themselves from the rest of society in order to prevent the spread of the disease. Everything that we do in the test and trace programme is ultimately to promote good behaviours by the British public, so that people who have symptoms will distance themselves from the rest of society, putting a brake on the disease. It is absolutely imperative, and at the heart of all our communications.

I pay tribute to the British public, who have made huge personal sacrifices during this lockdown. The culture of isolation will be an essential part of keeping a lid on the disease. The Government are committed to providing mental health support, and practical and cultural support, for those who are in a state of isolation. I thank both noble Baronesses for throwing a spotlight on that.

I want to convey to the House the enormous complexity of identifying the key symptoms of this disease. By any common sense, it would seem incredibly obvious how to spot Covid, but I have sat in numerous meetings running through the data and know how difficult it is to have a consistent set of symptoms that can be understood clearly and communicated simply to the public. The data on this disease is extremely complex. As I have said to the House before, this disease is a very difficult adversary, as characterised by the way in which symptom checking is so difficult. We have moved to a new and upgraded set of symptoms, and we may well have to move again. However, we are seeking to encourage absolutely anyone who has any symptoms to declare them and seek a test.

Perhaps I may move quickly through the questions put by the noble Baroness, Lady Thornton. I reassure her that the NHSX app is very much part of our plans. The Isle of Wight programme has been enormously successful and take-up rates have been huge. But it did teach us one important lesson: that people wanted to engage with human contact tracing first, and quite reasonably regarded the app as a supplementary and additional automated means of contact tracing. We have therefore changed the emphasis of our communications and plans to put human contact tracing at the beginning of our plans and to regard the app as something that will come later in support.

I reassure the noble Baroness that the testing of NHS and care staff is an absolute priority. Testing by the NHS of both groups is well under way. As announced by the Secretary of State, we are looking carefully at bringing in antibody testing to answer the question from staff who may query whether they have had the disease in the past, and to understand better what the role of immunity might be. The science is not firm; the lessons are not clear; but we need to understand the role of antibody testing and find out how it can help us combat this disease.

I advise the noble Baroness, Lady Thornton, to be very wary of private tests. They vary enormously in quality, as I know through my own experience. The time after having the disease when you take the test impacts enormously on the test and the assumptions one can make about a positive test are not proven. You cannot currently share with an employer any impression that you might have immunity, on the basis of a test.

I reassure both the noble Baronesses that our involvement with local groups in the tracing operation is being energetically promoted. We have appointed Tom Riordan, the chief executive of Leeds City Council, to lead this part of the programme. He is running an excellent programme to work with local authorities, directors of public health, environmental health officers and local resilience forums to ensure that our tracing system is as local as it possibly can be. It cannot all be done locally: some of it is better done digitally, and the highly automated routines of the app are very good. Some of it must be done at scale on a national basis by the massive call centres that we are throwing up, but some of it is best done by local groups. Those processes are being put in place energetically and I thank GPs, local directors of public health and all those who are engaged in them. We will be putting together local Covid plans that will be implemented by the relevant local authorities. These will form an important part of keeping a lid on this contagion.

I also pay tribute to those who are helping to organise the major test centres, including Serco, and those who have stepped up to take roles as contact tracers. They are going through complex training at the moment; it is a challenging task. No one wants to hit the phone and tell someone that they have to isolate; it is a tough message to have to deliver. I have no doubt that there will be problems with this complex and difficult task, but I pay tribute to those involved and express my gratitude to those running the programme.

On care homes, as the noble Baroness, Lady Thornton, rightly described, every death is a source of great sadness. However, I pay tribute to all those who have put their safety on the line by delivering tests in care homes. I reassure the noble Baroness, Lady Brinton, that there is a website where any care home that wants a test can register their interest and get a response promptly. Any care home worker who wants an individual test can access a site where, as a key worker, their test will be prioritised. There should be no reason why any care home or care home worker should wait two weeks, as suggested in the question.

I put my hand up and explained that mistakes were made 10 days ago when, due to problems with our Northern Irish test laboratory, some care home tests were either delayed or voided. That was an enormously regretful situation, but, when you put together an operation of this scale at such pace, some mistakes will be made. We have done an enormous amount to rectify those mistakes. Bringing in the noble Baroness, Lady Harding, to run the operational side of our testing regime is a great step forward.

I will also say a word in defence of the volunteers who are working at our drive-in test centres. These are often furloughed workers who do not need paid employment, but they are spending their time usefully and are often committed and have a sense of public service. I bridle at the thought that they would be sneered at or in any way insulted. The role of Boots in recruiting them is entirely honourable, legal and appropriate for the times we are in, and I very much thank those volunteers who have dedicated their time and risked their personal safety to do this difficult and possibly risky job. It is not appropriate to suggest that there has been public outrage at this arrangement—quite the opposite. The British public support this kind of individual public service.

The recruitment of tracers is going extremely well indeed: 21,000 have been put in place, which is way beyond our initial expectations, and the training is going well.

This programme is developing very quickly. We will seek to make announcements about it later this week and there will be a further rollout next week. I am extremely proud of the achievements that we have made, and I thank everyone who is involved very much indeed.

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

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.

--- Later in debate ---

[Lord Bethell]

My Lords, as I stated this morning, I would be glad to meet with community leaders. However, I emphasise, as I said this morning, that it is the disease that is racist, and the Government and the NHS are doing an enormous amount to try to protect BAME workers, to whom we owe a huge debt of gratitude. I will do everything I can to help protect them.

[Lord Balfe (Con)]

My Lords, this morning, the ONS revealed that some 50,000 UK citizens are cross-border workers—in other words, English people who work part of the time outside the UK. Roughly 25,000 appear to be businessmen. There is no evidence that they are carriers; there is every evidence that when they fly back or come back on the Eurostar, they would be happy to be tested. The government proposals to suddenly clamp down on this and basically stop international business happening are not welcome and will do enormous damage to the British economy. Can the Minister try to influence his colleagues in transport to the effect that this development is not needed?

[Lord Bethell]

My Lords, I pay tribute to my noble friend’s commitment to freedom of travel—and he will remember my father’s own commitment to it. The sad truth, however, is that it is very difficult to prove a negative: to prove that someone does not have the disease or that they have not recently become infected and have the disease in a latent way or that they are young, fit and well. The restrictions are in place for those reasons. I advise my noble friend that we are working on finding a solution, but none is immediately available.

[Baroness Jolly (LD)]

My Lords, with many GP appointments now held online, the public are going to their local pharmacies for advice as never before. Pharmacies have received from the department little or no support with reconfiguring their premises, many have had no support sourcing PPE and staff are not automatically considered for routine testing. Have the Government forgotten the pharmacy profession? Will additional support be made available to our high street pharmacies as they continue to serve patients throughout the Covid-19 pandemic?

[Lord Bethell]

The noble Baroness is entirely right: this epidemic has demonstrated, if it needed to be demonstrated at all, the key role that pharmacists play in the health of the nation. I pay tribute to the role of pharmacists in providing support and filling the gap after GPs’ surgeries have closed. I reject, however, the idea that they have had no support. PPE has been provided, any pharmacist is prioritised as a key worker, and we will continue to offer support and to help grow this valuable sector.

[Lord Hope of Craighead (CB)]

My Lords, is there not a danger of sending out mixed messages? The Statement begins by celebrating what has been achieved together by flattening the curve, but the devolved nations in the UK are still behind the flattening of the curve achieved in London. It then says that, thanks to the resolve and shared sacrifice of the British people,

“we are now in the second phase of this fight.”

This is not so in Scotland, where I live. We are still firmly in lockdown and likely to remain so until June. Should those who prepare these Statements not be a bit more careful in their choice of language? Is there not a risk to those who live in Wales and Scotland if people who live in England are misled into believing that those other parts of Great Britain are in the second phase of the fight too?

[Lord Bethell]

I first pay tribute to the devolved nations for working so closely together, as characterised by the very close work of the four CMOs. The noble and learned Lord is entirely right that different parts of the country move at different paces—the disease does not respect national boundaries in any way—but public health messages have to be clear to be effective. It is difficult to speak in terms of one region or another being in different phases of the disease, but I completely accept his point that local variations may well be necessary. When they are, and if it is possible, we will have to shape our communications to that cause.

[Baroness Crawley (Lab)]

My Lords, if, as the Statement says, we in England are now in the second phase of the fight against coronavirus, and given the need to turn our attention to the huge backlog of operations and procedures for those non-Covid NHS patients on waiting lists, will the Minister inform the House if and when NHS England will renew its current important contract for capacity and diagnostics with independent hospitals? I understand that the contract is coming to a close at the end of June.

[Lord Bethell]

The noble Baroness is entirely right: the backlog of operations and procedures will be a daunting task for the NHS to tackle. We have prioritised it. Simon Stevens has told the NHS to throw the doors open to try to get through this backlog. As a result, we will live with the effects of Covid for months to come. I am not fully aware of the contract of which she speaks, but I will try to find out its status and will write to her with additional information.

[Baroness Meacher (CB)]

My Lords, I thank the Minister for his helpful responses so far. The UK had just under 50,000 excess deaths in less than six weeks from 20 March. Does the Minister agree that the NHS was overrun at that time and had the unbearable choice either to let Covid-19 patients die or to deny treatment to patients with life-threatening illnesses such as cancer and kidney failure? Were we unable to make extensive use of the Nightingale hospitals to save lives due to staff shortages or for some other reason? I would be grateful for the Minister’s response.

[Lord Bethell]

I am extremely grateful for the noble Baroness’s comments. Since she asks for my personal opinion, I would say that, no, the NHS was not overrun. It has been a huge achievement that the NHS has stood firm on its feet. Operationally, it has been extremely sound. It was never overwhelmed, either by Covid-19 or by other operations. The Nightingale hospitals were not needed in the end because the lockdown was adopted by the British public and the infection rate was reduced. That is a huge testimony both to the British people and to the NHS.

[Baroness Ludford (LD)]

When the Health Secretary told the other place yesterday that he was preparing to roll out his contact-tracing app, he rejected the plea from my colleague, Daisy Cooper MP, for a law providing for specific, rigorous safeguards. When does the Minister expect to get the response from the Information Commissioner on the data protection impact assessment for the app, which has been judged by privacy experts to be confusing and misleading?

[Lord Bethell]

The noble Baroness raised the data protection impact statement, which I have read. I did not find it confusing; I thought it was extremely straightforward and it has been welcomed by a large number of the privacy groups I have spoken to.

[Baroness Bennett of Manor Castle (GP)]

A few minutes ago, responding to the Front-Bench questions the Minister said that the heart of the Government’s message was that

“people who have symptoms must isolate themselves”.

How does the Minister square this with what he said to me last Thursday? He said:

“No one working in the NHS should go to work if they feel ill or have a temperature”


but that this

“is not necessarily true for people who work in normal workplaces.”—[Official Report, 14/5/20; col. 806.]

We were of course at that point talking about care homes. If we look at the Government’s launch last Tuesday for the document Our Plan to Rebuild, this says:

“If a negative test is returned, then isolation is no longer required.”


If the Government’s position has changed, should this not be made clear to the public?

[Lord Bethell]

The noble Baroness undoubtedly knows that anyone who is ill with anything whatever should not go to a hospital. Being ill is not the same as having the symptoms of Covid-19. Anyone who has the symptoms of Covid-19 should isolate immediately.

[The Earl of Clancarty (CB)]

My Lords, what support is the Department for Health and Social Care giving schools in the provision of the PPE needed before schools open?

[Lord Bethell]

It is the responsibility of the Department for Education to provide schools with PPE.

[Lord Truscott (Ind Lab)]

My Lords, I find the Government’s Statement very complacent. Sadly, for many in care homes, these initiatives have come too late. I have three questions for the Minister. Given the increasing disquiet over Her Majesty’s Government’s response to Covid-19, will the Minister commit to a public inquiry on the part of the Government?

I return to two other questions asked earlier, which the Minister did not answer. When will the proposed testing, tracking and tracing system go live? Lastly, are the 21,000 contact tracers sufficiently trained in his view?

--- Later in debate ---

[Lord Bethell]

It will be for others to decide whether an inquiry is necessary. For my part, I am enormously proud of the Government’s response and the NHS’s response to Covid-19, and I stand full square behind the decisions and actions we have taken.

[Lord McConnell of Glenscorrodale (Lab)]

My Lords, I welcome the fact that in the Statement it is clear that the Chief Medical Officers of the four nations of the United Kingdom agreed jointly to amend the identifiable symptoms for Covid-19. That stands in stark contrast to the mixed messaging of the weekend of 10 May and the days thereafter. What action have the Government taken since 10 May to ensure that the next round of announcements by the Prime Minister and the three First Ministers are more coherent and better co-ordinated in the interests of not only a clear public health message across the United Kingdom but the economic recovery that we will need in all four nations afterwards?

[Lord Bethell]

My Lords, we work extremely closely with the devolved Assemblies, the four CMOs and the four nations to have a consistent four-nations approach to Covid. We very much welcome Nicola Sturgeon’s support for this consistent approach.

[The Earl of Erroll (CB)]

How are vaccines going to work if, as the Government say, the presence of Covid-19 antibodies in a test do not mean that a person is immune? I think that quite a few people are confused.

[Lord Bethell]

My Lords, the noble Earl is stretching my scientific knowledge with his question. All I can say is that different vaccines work in different ways. Anyone with antibodies who has beaten the disease has the capability of beating the disease, but vaccines ensure that that capability lasts longer, hopefully for life.

[Lord Rennard (LD)]

My Lords, does the Minister listen to the excellent BBC Radio 4 programme “More or Less”? If so, he may have heard the total demolition of the claim that 100,000 tests were being conducted each day by the end of April. Much doubt has also been cast on claims that care homes were always included in government figures. Trust in government is vital at the moment, so does the Minister think that a body such as the Office for National Statistics should be given the role of vetting figures that are quoted in the daily Downing Street press conferences?

[Lord Bethell]

My Lords, I do listen to “More or Less”. I absolutely love it, and it is a shame that I did not hear the episode to which the noble Lord refers because I would have reprimanded them greatly. The 100,000 tests a day are done very clearly. I would be glad to take the noble Lord, Lord Rennard, to visit our Lighthouse Labs to see the remarkable automation and robotics that achieve that remarkable effect. On the care home figures, we work hard in order to create prompt, immediate, daily figures. Those are then verified and put into the official national figures that are curated by the ONS. Having operational figures that are delivered quickly is important for decision-making. Having figures officially verified by the ONS to audit those results is an entirely appropriate way of doing things. It is a system that works, and we currently have no intention to change it.

[Baroness Ritchie of Downpatrick (Non-Afl)]

Is the Minister confident that the public health surveillance system in the UK is able to detect and manage cases and their contacts and identify at-risk cases—that is, test, track and trace?

[Lord Bethell]

I am afraid I did not hear the full question from the noble Baroness, but if I understood her correctly, she referred to track and trace. I reassure her that we are putting a huge amount of resources into that surveillance. It is true that surveillance does not currently exist. We do not have the facilities that some Asian countries, such as Taiwan and South Korea, had following SARS, about which we now know so much. We are putting the correct resources in place, and we hope very much to have a detailed local and demographic understanding of where and how the disease is progressing. That information is essential to beating it.

[Baroness Bull (CB)]

My Lords, many people in learning disability care services have very complex care needs that make them vulnerable to Covid-19. Indeed, recent numbers from the CQC showed that the provisional number of deaths reported across all settings where autistic people and/or people with learning disabilities may live was 175% greater than expected over the month from 10 April. When will the welcome extension of testing to all care settings announced today roll out? Can he confirm that regular testing will be available, given the potential of the virus to be spread between care homes by so-called bank staff filling temporary vacancies?

[Lord Bethell]

The noble Baroness is entirely right that the deaths of those with learning difficulties have been one of the most disturbing and sad aspects of this disease. We are focused very much on ensuring that we protect those with learning difficulties, such as those with autism, in whatever way we can. With regard to recurrent testing, the tests that we have are not a limitless resource and we have to prioritise them. Although we have massively increased the number of tests that we have, it is not possible to test millions of people on a very regular basis with hundreds of thousands of tests. However, we are using them intelligently and prioritising areas where there are infection control problems. We believe that that is the most effective way of using our resources.

[Lord Campbell-Savours (Lab)]

I want to return to the issue of face masks, which I have been raising with the Minister since early March. Are Ministers following the intense debate going on among a worldwide line-up of international experts, particularly virologists, who forcefully argue the need for their use? If Ministers are not, will they now ask their civil servants to dig out the hundreds if not thousands of articles and research papers written by those experts, which have convinced over 50 countries worldwide to introduce face masks on a mandatory basis? The position that we are taking looks increasingly ludicrous.

--- Later in debate ---

[Lord Bethell]

I reassure the noble Lord that we look at this issue constantly. It is a subject that the British public are deeply concerned about. There is an instinctive human belief that face masks make a difference, but the scientific proof that they do so is not crystal clear. Although some countries have committed to them, we are still in the process of reviewing them. We have a positive attitude towards implementation but we are guided by the CMO and by scientists. As the evidence builds up, and the noble Lord is quite right that in many places it is indeed building up, we will make the right decision on face masks.

[The Deputy Speaker]

I call the noble Lord, Lord Low of Dalston. I do not think he is on the call, so I call the noble Baroness, Lady Randerson.

[Baroness Randerson (LD)]

I have listened carefully to this debate, and the Minister seems to say in every answer how well the Government have done throughout this whole pandemic. If that is the case, how have we come to the point where well over 35,000 people have died? I invite the Minister to tell us now where the Government went wrong.

[Lord Bethell]

The noble Baroness is entirely reasonable. I apologise if I give the impression that I am in any way complacent or if I am unapologetic about what we have done. She is entirely right: this is an awful disease that has hit this country extremely hard and not everything we have done has worked as well as we had hoped. Undoubtedly, when we look back, it will be judged that the Government have made mistakes; of that I am absolutely sure. I approach this question with humility. I completely take on board her point that questions that resist the idea that we have made mistakes are quite wrong.

However, I want to try to convey the enormous commitment and focus that the Government, the NHS and the people who are involved in the greater project have thrown into this project. It is not a massive shambolic mess littered with political stupidity and corruption, as is implied by some of the critics of the Government. Actually it has been a venture that has had a huge amount of innovation, collaboration and good will behind it. I am afraid I cannot help but seek to salute and pay tribute to those who are involved.

[Baroness Jones of Moulsecoomb (GP)]

My colleague on the Isle of Wight, Vix Lowthion, tells me that the public there are not clear about the aims and objectives of the trial they are taking part in. Can the Minister tell me now what are the criteria for success of the Isle of Wight trial?

[Lord Bethell]

One of the criteria of success is to learn from the pilot, which takes an early version of the app and hopes to develop learnings from it; we now have two or three. One of them, which I have mentioned, is that it is probably a mistake to launch an app before you have got the public used to the idea of tracing. As I mentioned in an earlier answer, that is something we have taken on board. When it comes to launching the test and tracing programme, we will begin with the tracing, not with the app.

--- Later in debate ---

[Lord Bilimoria (CB)]

My Lords, the Minister said that isolation is essential for those who have symptoms. It was only yesterday that the Government finally included the loss of the senses of smell and taste as a symptom. I fell ill with coronavirus on 15 March and lost my senses of taste and smell. At the time, it was not an official symptom. I could not even get tested then—indeed, not even doctors and nurses could—yet the WHO has been saying since the middle of March that we should “Test, test, test”. Eventually we have come around to doing it now and we are ramping it up. As the noble Baroness, Lady Thornton, pointed out, the WHO said eight weeks ago that the loss of taste and smell should be considered a symptom. How many hundreds of thousands of people have now been infected and have infected others because this was not an official symptom? The WHO has also said that social distancing should be one metre, but we say two metres. Why are we not listening to the WHO, or only eventually listening to it? Why are there these inconsistencies?

[Lord Bethell]

I am very sorry that the noble Lord had coronavirus, and it is good to see him on such fine form and in characteristically enthusiastic shape. The bottom line is that lots of people do not lose their sense of smell or taste, and the addition of this symptom was delayed because we did not want to put off those who had not lost their sense of smell and taste from declaring their symptoms. The WHO is right about many things but not about everything.

[Lord Liddle (Lab)]

I thank the noble Lord, Lord Bethell, for the directness and frankness of his answers tonight, and I agree with his praise for the NHS workers and many others who have played such a valiant role in fighting this virus. However, does he not agree that, as time goes on, it is becoming clear that we have the highest number of deaths in Europe and that this gives a new and very tragic meaning to the concept of British exceptionalism? Does he not agree that there will have to be some kind of independent inquiry into where this all went wrong?

[Lord Bethell]

My Lords, the noble Lord is right. As a nation, we have been hit really hard by this disease and it is heart-breaking. I would have loved this country to have somehow dodged the bullet and not been the one that was hit so hard. We all feel it: we feel a great sense of responsibility and a great sense of sadness that so many lives have been lost, and that there are so many for whom the result of having had the disease and survived will be life changing. One thing that we have learned is that this disease hits you really hard and some people will never fully recover from it. However, I cannot help but pay tribute to those involved.

I do not know why we have been hit so hard. I do not know whether it is due to British behaviours and the fact that we have obesity in this country. I do not know whether it is because we are such an international country with such a large number of people coming to and fro, particularly from China. I do not know whether the Government made massive and colossal mistakes, as their critics suggest, and whether we got it all completely wrong. All I know is that the response to this disease by the British public, the NHS and the Government has not lacked energy, innovation and enthusiasm, and I stand here at this virtual Dispatch Box extremely proud of our country and of the people who have played a role in the response to this disease.

[Baroness Wheatcroft (Non-Afl)]

My Lords, the public might find it easier to stick within the rules now governing our life with coronavirus if they understood the logic. Therefore, can the Minister explain the logic or the science behind the fact that a household consisting of my son, his wife and their daughter can meet with only one member of a household consisting of his father and his mother at any one time?

[Lord Bethell]

It is very simple. If you have one person from another household meeting your household, the chances are that you will all respect the two-metre social distancing recommendation. The moment a second person is present, the proximity gauges and the way in which you all relate to each other become confused. You all start standing nearer to, and breathing all over, each other, and it becomes easier to catch the disease. That is just a simple human observation and is based on human nature and on the physical science of proximity. The example that the noble Baroness gives is a really good one, and I completely feel her frustration that her two families cannot spend time together. However, the behavioural scientists are absolutely adamant on this point, and to me at least it is common sense.

[The Deputy Speaker]

My Lords, I apologise to the noble Baroness, Lady Coussins, who is the only speaker whom we were not able to call within the 30 minutes. The time allotted for the Statement is now up. The day’s Virtual Proceedings are now complete and are adjourned.

Covid-19: NHS Contact Tracing App

Lord Bethell Excerpts

Monday 18th May 2020 Lords Chamber

The Question was considered in a Virtual Proceeding via video call.

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

My Lords, we have put privacy at the heart of the app and how it works so that you do not need to give your personal details to use it. We have worked in partnership throughout with the National Cyber Security Centre and the Information Commissioner’s Office. The science around immunity is currently uncertain and there are a number of issues that we need to address to understand potential certification.

[Baroness Jones of Moulsecoomb (GP)]

I thank the Minister for his response but that is certainly not the information that I am getting from other places. A Dr de Montjoye from Imperial College’s department of computing has written a paper in which he says that, if the Government are to use this app properly, it is very important that they are transparent about it. Can the Minister commit the Government to transparency about whichever app they use?

[Lord Bethell]

Professor de Montjoye is entirely right that transparency is key. That is why we have published the open source code for our app, as well as a PPIA privacy notice, and blogs setting out the approach that we are taking. We will continue to go about our business in a transparent way.

[The Lord Bishop of Portsmouth]

My Lords, the Minister has reminded the House that tens of thousands of people on the Isle of Wight have downloaded and used the app. People of the island often feel—with, I regret, some justification—that they are considered last if at all. Now, despite the questions about privacy, effectiveness and rollout, they have been the first to step up and make a significant contribution to the nation’s common good. Will he undertake to look at how their service might be recognised?

[Lord Bethell]

My Lords, where the Isle of Wight leads, the country follows. We are enormously grateful to islanders for taking this pilot on board with energy and enthusiasm. I would like to consider ways of recognising that. One important lesson that we have learned from the island project is that the human touch of contact tracing is incredibly important and we will be implementing that at later stages.

[Lord Arbuthnot of Edrom (Con)]

My Lords, I declare my interest as chairman of the Information Assurance Advisory Council. In normal times, the cybersecurity advice that we would all give would be to keep the Bluetooth on our mobile telephones switched off unless and until we need it in a private setting. But these are not normal times. What advice would my noble friend the Minister give to help us protect ourselves while using this app?

[Lord Bethell]

My Lords, the Bluetooth used by the app is the latent Bluetooth, which does not need to be turned on and off. Our advice is for everyone to ensure that they keep their Bluetooth on. In fact, we will be issuing specific advice to doctors and other health workers who spend a lot of time in each other’s company, to ensure that the app does not create erroneous data.

[The Earl of Clancarty (CB)]

Does the Minister agree that immunity or health certificates have the potential to be socially divisive and foster prejudice if they were valued by employers? Why else would you want them? They would also implicitly endorse the Government’s original, much vilified, herd immunity policy. They are a terrible idea and the Government would be wise not to go down this road.

[Lord Bethell]

My Lords, I completely hear the noble Earl’s reservations about certification. Our plans are in development. We are fully aware of the concerns that he has expressed about their potentially divisive nature, but the public deserve to know whether they have had the disease. We have to use whatever technology we can to help shake off the economic and social effects of this virus. Therefore, we retain an open mind on the use of certification.

[Lord Reid of Cardowan (Lab)]

Does the Minister accept that the proposed tracking app we are discussing will effectively exclude those who do not have a smartphone or the experience, knowledge or capability to operate apps or Bluetooth? That will disproportionately exclude the elderly, the poor and the disadvantaged—exactly the groups most at risk from Covid-19. What plans do the Government have to include this group in any future tracking and testing regime?

[Lord Bethell]

My Lords, the testing and tracing regime depends on three legs: access to tests; updated methods of the classic contact tracing run by individuals, using phones and the internet; and lastly, importantly but not exclusively, the NHS app. We are very much focused on ensuring that the vulnerable, the elderly and the digitally poor are in no way excluded, which is why we have put the human element at the centre of our plans.

[Lord Scriven (LD)]

Will the Minister give a cast-iron guarantee that, as the app evolves, it will not use location tracking or seek personal identification information as a condition of use?

--- Later in debate ---

[Lord Bethell]

My Lords, we have no current plans for using geolocation information. However, we have an open mind on options for users being able to share data of several different kinds, and we are open to the idea of consumers making those choices.

[Lord Balfe (Con)]

I want to ask the Minister about the immunity certificates. At the moment, as I understand it, medical science does not tell you whether you are immune. It can tell you whether you have had it, but surely we do not yet know whether Covid mutates. So how can you issue an immunity certificate, and, importantly, how can you make sure that it is not forged?

[Lord Bethell]

My noble friend is entirely right. The science on immunity is confounding and we do not fully understand it, although we are investing a huge amount of time, money and effort into understanding it better. We believe that there may be an opportunity to understand immunity better, and that will inform and make safe people’s commitment to going back to work. No decisions have been made yet, though, and we have in our minds all the reservations that my noble friend described.

[Baroness Falkner of Margravine (Non-Afl)]

Given what we know about the NHS app, I have to say that my greater concern would be about the data held by Amazon or Google, rather than by the NHS. Does the Minister accept that the countries implementing track and trace, particularly those in the EU, are all countries that have an ongoing system, decades-old, of using ID cards? Would the Government consider the fact that trust in government in those countries, even privacy-obsessed Germany, is higher due to the state having held data, not centrally but in some form, through an ID card system? Maybe they should look at that.

[Lord Bethell]

My Lords, ID cards do not form part of the British tradition. We work on a system of consent and we have a very high level of trust in the Government. The app is particularly well suited to a country that has a universal NHS system, and that is one reason why we have designed it in the way that we have.

[Baroness Thornton (Lab)]

Can the Minister confirm that the national rollout of the NHSX app has now been delayed until June? Does he share my concern that a government spokesperson has said that it is possible for the test and track system to work without an app, and for the lockdown to be relaxed further without a system operating at all? This is deeply worrying, given that the Government have admitted that they should never have stopped track and trace in the early stages of the pandemic and now appear to be reneging on a commitment to make it a priority.

[Lord Bethell]

My Lords, it is entirely right that test and trace does not need a digital app to be effective. I reassure the House that prevalence levels are reducing across the country, as is the infection rate. It is only because prevalence and infection are reducing to manageable levels that we can even consider reducing the lockdown and maintaining pressure on infection through test and trace. The app brings many benefits of being able to automate millions of transactions a day, but it is not intrinsically necessary, and we believe that it would benefit from being introduced later, rather than earlier, than human-based tracing mechanisms.

[Lord Randall of Uxbridge (Con)]

My Lords, what discussions has my noble friend’s department had with other Governments around the world, and what lessons can be drawn from their experience of such apps?

[Lord Bethell]

My Lords, we are in discussions with many other Governments—those in the east, which have a tradition of these apps, and fellow travellers like ourselves. It is a highly technical and difficult area; Britain is leading the way in many ways and we have learned an enormous amount. I have personally spoken to the Taiwanese Government, who have taught me an enormous amount, and those conversations continue regularly.

[The Lord Speaker (Lord Fowler)]

My Lords, the time allowed for this Question has elapsed. It is worth noting that, in the whole Proceeding, we excluded only two possible questioners, so apologies to them. I thank your Lordships. That concludes the Virtual Proceedings on Oral Questions. Virtual Proceedings will resume at 3.30 pm for a Private Notice Question on post-Brexit customs arrangements in Northern Ireland.