Covid-19: Social Care Services

Lord Bethell Excerpts

Thursday 23rd April 2020 Lords Chamber

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

My Lords, I join the noble Baroness, Lady Wheeler, and others in remembering those who have suffered from this dreadful disease. I pay tribute to those in healthcare and other key workers on the front line who selflessly and heroically help deal with this awful epidemic. I have a personal reason to thank in particular those BAME social care staff who take a particular risk and often take on most challenging tasks.

I thank all noble Lords for the thoughtfulness and scrutiny they have brought in this digital debate to an issue which is, as many have remarked, overlooked but is now, without doubt, at the centre of our national debate. With 40 speakers and a lot of new technology to deal with, I apologise in advance if I cannot respond to all the thoughtful and perceptive questions that have been asked, but I will try to address the most immediate issues raised by noble Lords with a practical update—and I will avoid the lofty, high-level stuff, as requested by the noble Baroness, Lady Thornton.

As the noble Baroness, Lady Wheeler, rightly stated, on 15 April we published our action plan for adult social care. The plan outlines how we have committed to strengthen and support this vital network, for the carers and for the cared. The plan has four pillars, First, our number one priority is to limit the spread of the infection. It is clear, as many noble Lords have rightly said, that personal protective equipment has been an issue for many in the care sector. We recognise that and we set out a PPE plan on 10 April to deal with the issue.

We recognise that PPE is vital to protect NHS and social care staff from contracting Covid and to protect the people whom they care for, and we are acting to ensure that PPE is available where it is needed. We are running hard at procurement; the results are being felt, but there is more to be done. Public Health England has published guidance on good infection control practices, discharge processes, testing and in which scenarios to use PPE to minimise the risk of transmission. We have moved quickly to adapt guidelines to this new, complicated and deadly threat, to be clear in the way we communicate, but I accept that it is sometimes difficult to keep up. I hear loud and clear from the noble Baroness, Lady Wheeler, my noble friend Lady Verma, and the noble Lord, Lord Hain, about concerns on costs. I reassure this virtual Chamber that substantial funds have already been mandated. The question of funding remains under review and, if more is needed, this Government will step up to their responsibilities. We are taking these issues seriously, but the challenge is substantial.

This sector that is made up largely of smaller, independent providers that have historically sourced their PPE on open markets, as well put by the noble Lord, Lord Hain, so we are putting in central procurement support at pace and on the fly. We have developed a parallel supply chain across government with NHSE&I, NHS Supply Chain, Clipper Logistics and the armed services. The parallel supply chain has been established to support care homes, home care and hospices. It is done in the spirit of collaboration, as the noble Lord, Lord Shipley, has rightly recommended. This is already supplying PPE equipment to hospitals and local resilience forums. I reassure noble Lords that this improved speed and reliability of delivery is already relieving pressure on the supply chain.

We are working around the clock to ensure that staff on the front line can do their job safely. As of 20 April, we have released 29 million items of PPE to seven designated wholesalers for onward sale to social care providers. This includes 11.4 million face masks, 13.3 million aprons and 4.2 million gloves.

Let me say something on discharge. We recognise that moving someone from hospital to another area where infection control is important is incredibly delicate. That is why, last weekend, the Chief Medical Officer changed the guidelines so that all patients will be tested before being admitted to care homes, as well as all care home residents. This is welcome news.

On testing generally, I reassure the noble Baroness, Lady Grey-Thompson, and the noble Lord, Lord Hain, that, while testing was initially limited to help manage the demand for tests for the most unwell, this has changed. There is new guidance and considerably more capacity. I reassure the noble Baroness, Lady Wheeler and Lady Brinton, and the noble Lord, Lord Turnberg, that as lab capacity increases every day, we have already expanded testing to include more care home residents and staff.

It is true that the drive-in centres were the quickest to set up, as the noble Lord, Lord Shipley, rightly remarked. However, I reassure the noble Baroness, Lady Barker, the noble Lord, Lord Dubs, and other noble Lords, that this week we have started home delivery of self-administered packs, which will be organised by Amazon, pop-up mobile units organised by the Army, and we will shortly have a retail solution from Boots. This will go a long way to address the concerns of those who find the drive-in centres awkward or unavailable.

On the subject of counting deaths, I reassure the noble Lord, Lord Bilimoria, and other noble Lords that the official ONS figures, which are informed by CQC returns from death certificates, will always capture Covid deaths, whether they are from hospitals, care homes or at home, and that it is the responsibility of doctors to inform PHE of any Covid death.

The 1.5 million social care workers on the front line of the virus are crucial in delivering care to our most vulnerable citizens, so I will say a word on them. I reassure the noble Baroness, Lady Grey-Thompson, that we have capacity for every care worker to be tested, just as there is for NHS staff and their families. PHE will be administering those tests and home testing equipment will be distributed. Social care workers have been designated as key workers, which means that the children of those working in social care can continue to attend school where there is no safe option for them to stay at home.

In response to those who say that government has done nothing, I remind the noble Baroness, Lady Hollins, and other noble Lords that our action plan for adult social care sets out an ambition to attract 20,000 people into social care over the next three months. We will shortly launch a new national recruitment campaign to run across broadcast, digital and social media. The campaign will highlight the vital role that the social care workforce is playing now during the pandemic, along with the longer-term opportunity to work in care.

I am proud to recognise carers and to endorse social care branding with badges and lanyards to create a proper identity and recognition. We have formally introduced the CARE brand to sit alongside the NHS brand in England. It is right that we recognise the hard work of carers and, as the noble Baroness, Lady Wheeler, put it, ensure that they too get support such as queueing priorities like their NHS colleagues. We recognise the immense pressure that the social care workforce may be facing, which is why we have extended a package of helplines and text-based systems across the board to support the well-being of carers and other front-line staff.

Several noble Lords, including the noble Baroness, Lady Finlay, and the noble Lord, Lord Bilimoria, raised the impact of BAME staff working in the social care sector. We have commissioned work from Public Health England to understand how different factors may influence the way someone is affected by this virus.

My noble friend Lord Astor asked about respite for carers—an important point. On 8 April we published guidance for unpaid carers on GOV.UK, which includes general advice, including advice on infection control, links to other information and support and advice on caring where someone has symptoms.

Perhaps I can reassure the noble Baroness, Lady Tyler, who asked about visa exemptions for nurses in social care, and the noble Baroness, Lady Masham, who requested an update on when we might relax the immigration rules to ensure that we have an adequate number of carers, nurses and doctors. The Government are already working with the NHS to ensure that visas are extended to doctors, nurses and paramedics and where, as noted by the noble Baroness, Lady Bull, significant numbers of overseas staff are working on the front line to battle Covid. UK Visas and Immigration has now written to 270 NHS organisations to begin processing these important extensions. I will take away her valuable point that the social care workforce should be included within the scope of these discussions. Many employers across health and adult social care benefit from the skills of overseas staff. However, it is clear that international recruitment will not be straightforward at the moment, nor in the future, due to widespread travel restrictions in place around the world. We are going to have to adapt to this new reality.

The noble Baroness, Lady Sherlock, asked a very valid question on carers’ eligibility for universal credit. We are acutely aware of the issues faced by the self-employed or those on zero-hours contracts. Some individuals employed on zero-hours contracts may be entitled to statutory sick pay; those who are ineligible can claim universal credit or contributory employment and support allowance, depending on their circumstances.

The third strand of our strategy is supporting independence: supporting people at the end of their lives and responding to individual needs. I completely take on board the comment made by the noble Lord, Lord Blunkett, about inadvertently creating a monster in our efforts to slay the dragon of Covid. But I would add that it is not the Government who seek to punish older demographics and those with pre-existing conditions; it is the virus. The objective of our policies is to save lives and protect the NHS and our care services.

Let me give you a few examples. We are working alongside technology firms and voluntary organisations to assist the most at-risk and isolated people with access to vital emotional support and companionship. These efforts are beginning to bear fruit. While unnecessary visits are restricted, we are clear that visits at the end of life are important for the individual and their loved ones, and they should continue. The guidance now makes that clear.

We recognise the specific challenges that disabled people will face as a result of Covid-19, as was raised by the noble Baroness, Lady Bull. We have been taking several important steps to mitigate the impact of Covid-19 on people with disabilities and continue to engage with stakeholders to ensure that their needs are met. For instance, we are improving the accessibility of government guidance and working with the disability unit at Public Health England and NHS England to ensure that important messages reach throughout the communities.

On the DNR notices wrongly sent by some GPs, I totally endorse the comments of the noble Baronesses, Lady Brinton, Jolly and Jones, the noble Lord, Lord Alton, and many others in their condemnation of pre-emptive DNR notices. The CQC has been making that point very well and we all reject that practice.

The fourth strand of our strategy is protecting vulnerable children. The Government understand the importance of having robust social and domestic care provision for disabled and vulnerable children, and the need to ensure the sustainability of social care services. This issue was raised by my noble friend Lord Farmer, the noble Baroness, Lady Massey, and the noble Lord, Lord Addington. We are taking action to ensure that those reliant on such services are identified and supported during the pandemic. I reassure the noble Baroness, Lady Massey, that we are working closely with other government departments, local authorities and partners, such as the Council for Disabled Children, to assess the impact of Covid and local decisions on the provisions of these services.

We know that some families need more support than others and that attending education settings is an important protective factor. That is why we have not only ensured that they can continue attending school but made it clear that we expect them to, as long as it is safe for them to do so. We also encourage families with a child whose SEN needs cannot be suitably supported at home to attend school, but this will depend on a risk assessment. Many pupils with special needs are better off staying at home during the crisis.

Lastly, we are supporting local authorities and providers of care. In March, we announced £2.9 billion of funding to support and strengthen care for the vulnerable. Local government is being supported by £1.6 billion of additional funding to meet extra demands. This funding can be used across all services facing pressure. Further, we have enhanced the NHS discharge process by providing £1.3 billion of funding to allow patients who no longer need urgent treatment to return home from hospital safely and quickly. This funding will cover follow-on care costs for adults in social care or people in need of additional support when they are out of hospital and back in their home, community or care setting. We are keeping future funding under review. We announced over the weekend a further £1.6 billion package for local government to ensure that local government has the funding it needs to respond to the crisis as it develops.

A number of noble Lords asked about VAT. I confirm that providers pay VAT as private entities, but the important thing is that they have support with the costs they are incurring. This is what we are doing through the significant funding. I remind noble Lords that if adult care providers are charities they do not have to pay.

My noble friends Lady Verma and Lord Astor urged the Government to ring-fence this funding. We are taking important steps to ensure that this additional funding is making a difference. For example, as the noble Lord, Lord Dubs, asked, we are asking local authorities to provide information about the distribution of this funding to providers. The Government will continue to monitor pressures in the NHS and local government and will keep future funding under review.

We are also supporting the system through emergency legislation. The Coronavirus Act 2020 came into force on 31 March and brought significant changes to local authority duties under the Care Act 2014. I reassure my noble friend Lord Astor of Hever that the Government are committed to revoking these powers when they are no longer needed. I confirm to the noble Baronesses, Lady Wheeler and Lady Grey-Thompson, that we have received notification that six authorities are operating under the Care Act easement and that I thoroughly support the publication of the details. Those authorities are Sunderland City Council, Middlesbrough Council, Warwickshire County Council, Staffordshire County Council, Birmingham City Council and Solihull Metropolitan Borough Council.

The decisions local authorities may have to consider at this time are not simple and it does not necessarily mean that they are in crisis. The Department of Health and Social Care has issued guidance on easements, including an ethical framework and prioritisation guidance. I reassure noble Lords, including the noble Baroness, Lady Wheeler, that local authorities remain under a duty to meet needs where failure to do so would breach an individual’s human rights under the European Convention on Human Rights. Such easement measures should be used only when absolutely necessary, based on the local authority’s judgment of its ability to meet the needs of people in line with the Care Act.

The disease is a cruel enemy. It attacks the weak and vulnerable, as put very clearly by the noble Baroness, Lady Hollins. Carers and residents are put in a desperate position not because of government policy but because of the reality of this horrible killer. Let me touch on the comments made by the noble Lord, Lord Alton, on the final hours of those in care homes and funeral arrangements for them. As someone who has lost a loved one in a nursing home, I know at first hand that it is a heart-breaking reality of this awful epidemic that we cannot properly say goodbye to the ones we love.

I shall say a few words about the Government’s priorities. We have put this country on hold to save lives and to protect the NHS and our care services. The noble Lord Tyrie, made the financial commitment very clear. I reject the idea put by the noble Lord, Lord Hunt, that this Government treat those in our care homes as second-class citizens. They have been a huge priority in everything that we have done in the past months. Mitigating the impact of the Covid pandemic is the top priority of the British people and of this Government.

This epidemic has undoubtedly put a spotlight on social care. The British people and this Government will never look at social care in the same way again. Today we are working flat out to mitigate the effects of a deadly disease, but things will change. The Government have committed to a substantial review of the sector. It will come when the time is right and, as noble Lords rightly asked, it will be a moment for society to draw up a new contract for social care. It will need cross-party collaboration and a new approach. I would like to hold on to the feeling expressed in this debate. Let us all remember these commitments to a fresh start when that moment comes.

Covid-19

Lord Bethell Excerpts

Thursday 23rd April 2020 Lords Chamber

The Statement was made in a Virtual Proceeding via video call.

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

My Lords, I shall now repeat a Statement on coronavirus that was made yesterday in the other place. The figures have changed since then and this Statement contains up-to-date figures. The Statement is as follows:

“Mr Speaker, first, may I say how pleased I am that the House is sitting once again? At this important time, it is critical that we have the scrutiny and debate provided by this House. I would like to thank everybody involved in setting up these new arrangements. This has demonstrated that no virus, and no threat, will thwart our democracy.

Coronavirus continues to spread throughout the world. The latest figures show that 18,738 people have sadly died here. Our hearts, and the hearts of the whole House, go out to their loved ones. I know that, across the House, we are all united in our determination to fight the virus with everything we have. Today, I wanted to update the House on each part of our battle plan.

First, on the resilience of the NHS, I can tell the House that, for the first time, we now have over 3,000 spare critical care beds in the NHS. That is over three times more than we had at the start of the crisis. It is thanks to the incredible work of an awful lot of people that we have this extra spare capacity, even before we include the new Nightingale hospitals.

Over the past two weeks, I have been lucky enough to attend, either in person or virtually, the opening of four of these new Nightingales—in London, Manchester, Birmingham, Bristol and Harrogate—and there are several more to come, all across the UK, including in Belfast, Glasgow, Cardiff, Exeter and Sunderland. These incredible efforts from our dedicated staff, supported by our Armed Forces, mean that our NHS has at no point been overwhelmed by the coronavirus. Some said this would be impossible.

Today, I want to reinforce the message that non-Covid NHS services are open to patients; the NHS is there for you if you need advice and treatment. I want to address that message very clearly to those most vulnerable to heart attacks and strokes, to parents with young children, to pregnant women and to people with concerns that they may have cancer. I want to emphasise that people with non-coronavirus symptoms must still contact their GP. If you think you need medical help, please contact your GP either online or by phone to be assessed. If you need urgent medical advice, use the NHS 111 online service, or if you cannot get online, call 111. And, of course, if something is serious or life-threatening, call 999. If you are told to go to hospital, the place you need to be in is a hospital. The NHS is there for you and can provide the very best care if you need it.

The second point of our battle plan is on supply and working to boost supplies of core equipment. The full weight of the Government is behind this effort, and again we have brought in our Armed Forces to help us to meet this demand. This includes ventilators—both purchasing extra stock and increasing the production of new ones. We now have record numbers of ventilators, with 10,800 available for use by patients. It includes medicines, so that we can make sure everyone has access to the supplies and treatments they need. And, of course, it includes personal protective equipment too.

In normal times, the NHS PPE supply chain supplies 233 hospital trusts. Currently, 58,000 separate health and social care settings are being supplied with PPE, so we are creating that whole new logistics network from scratch. We have some of the best minds in the country working on this. I am grateful to colleagues from the NHS and Public Health England, the Crown Commercial Service and the Cabinet Office, the Ministry of Housing, Communities and Local Government, the Ministry of Defence and the Armed Forces—again—the devolved Administrations and territorial offices, the Business Department, the Treasury, the Foreign Office and the Department for International Trade, because they are all playing their part.

Last week, I appointed my noble friend Lord Deighton, who delivered the Olympics, to a new role to drive forward PPE manufacturing here. Since the start of this crisis, we have delivered 1 billion items of PPE. We are constantly working to improve the delivery system by buying PPE from around the world. We are also working to make more at home, and I would like to thank all the businesses that have generously come forward with offers to turn their production lines to part of this national effort. I would also like to thank Members from across the House who have put us in touch with businesses in their constituencies. We are actively engaged with more than 1,000 companies that buy from abroad, and we are working with 159 potential UK manufacturers. We have a rigorous system of verifying the offers that we receive, because not all offers have been credible, and it is important to focus on the biggest, most credible offers first. This work is crucial so that we can get our NHS and care staff the kit they need so they can do their jobs safely and with confidence.

The third part is to scale up testing. I have set the goal of 100,000 tests a day by the end of this month. I am delighted to say that that capacity is ahead of plans, even though the demand has thus far been lower than expected. We are therefore ramping up the availability of this testing and expanding who is eligible for testing and making it easier to access the tests. The tests are being conducted in NHS hospitals, as well as through our drive-through testing sites, mobile units and home deliveries. The tests are then sent to laboratories. We now have completed the construction of three Lighthouse Labs, in Milton Keynes, Glasgow and Cheshire. Each site took just three weeks to complete and begin testing. Further, as we have reached the peak and as we bring the number of new cases down, so we will introduce contact tracing at large scale.

The introduction of the new NHS app for contact tracing is also in development. As we do this, we are working closely with some of the best digital and technological brains, along with renowned experts in clinical safety and digital ethics so that we can get all of this right. The more people who sign up for this app when it goes live, the better informed our response will be and the better we can therefore protect our NHS.

Fourthly, we need to make sure that we make the best possible use of science and research to pursue the vaccines and treatments that are essential to defeat this virus once and for all. Here, the NHS is at the forefront of the global effort. We have put more money into global efforts to search for a vaccine than any other country, and yesterday I announced over £40 million of funding for two important projects at Imperial and at Oxford. The vaccine from the Oxford project will be trialled in people from tomorrow, and I am sure the whole House will agree that this is a very promising development.

I will repeat what I said yesterday. In normal times, reaching this stage would take years, and the combination of innovative groups of people at the Jenner Institute in Oxford and the regulator, the MHRA, deserve our special praise because they are both ensuring that the process is safe, yet conducted probably more rapidly than ever before. They deserve the support of the whole House in that work. At the same time, we will invest in manufacturing capability because, if either of these vaccines work, we must make it available to the British people as soon as humanly possible.

The fifth measure that I will talk about in the time available is the one where everyone can play their part: social distancing. I want to thank everyone, across the country, for their steadfast commitment in following the rules, including in this House. It is making a difference. We are at the peak. But before we relax any social distancing rules, or make changes to them, we have set out the five tests that have to be met: first, that the NHS can cope; secondly, that the operational challenges have been met; thirdly, that the daily death rate falls sustainably and consistently; fourthly, that the rate of infection is decreasing; and, most importantly, fifthly, that there is no risk of a second peak.

Finally, we are working to protect the most vulnerable through shielding—this is the sixth part of our battle plan. There has been a huge effort under way across government to contact and support those at risk. We have been boosted by the support and help of the heroic NHS volunteer responders, who signed up in droves within two days of our call to action. An unbelievable 750,000 people put themselves forward for this initiative. With those volunteers, and with the support of the Ministry for Housing, Communities and Local Government, the NHS and local councils, which have done amazing work on this, we are shielding the most vulnerable.

These are unprecedented times for us all. We have all seen the extraordinary impact of coronavirus in our constituencies and all across the country. And even though today we are physically separated, this House is at its best when we are united in our purpose and our resolve. I will keep working with Members right across the House in this fight against this invisible killer. This may be akin to a war, but it is one where all of humanity is on the same side. I commend this Statement to the House.”

--- Later in debate ---

[Baroness Brinton (LD)]

I thank the Minister for repeating the Statement and for his work on testing. We may have some difficult questions for him, but I hope I have the support of the whole House in saying thank you to him and his team for the work they are doing on this difficult area.

I too thank all the staff and volunteers in the NHS and the wider social care sector and other key areas who have been working during this crisis, whether directly on the front line or in supporting families and our children in schools. We send our condolences to the families of the bereaved, and are pleased that many people are recovering, even though we know that, if they have had it badly, it takes time. From these Benches, we echo the concerns about the high percentage of BME deaths, among workers and non-workers alike.

The Statement says that there are 3,000 spare critical care beds, but ITV reports that care home residents now account for up to half of Covid deaths. However, last week the Daily Mail reported that care home residents were still being asked to sign letters to say that they would not go to hospital in the event that they had Covid-19. Will the Minister confirm that these critical care beds in hospital are not spare? There are plenty of people in care homes who could use those beds but they have been put under pressure, no matter how gently, to sign the letters.

It is good to see the Nightingale hospitals coming on board—even if they are empty, for the right reasons. One of the concerns expressed has been about the staffing and the initial request that any patient had to have staff accompanying them from their previous hospital. Can the Minister say that this has now definitely stopped and that staff with appropriate critical care experience are able to be recruited? I gather that this has also been a problem for increasing the number of beds.

There was a good message in the Statement for people to go to their GPs and to use 999 for emergencies, but today there was a report of somebody who had a severe heart attack not being picked up urgently, as heart attacks are still second-level priorities to Covid. As a result of that 20-minute target rate, sadly the patient died. Is there any rebalancing of priorities for ambulances now that we seem to be over the peak of cases?

On equipment and medicines, it is good to hear that there are now just over 10,000 ventilators. Are they full ventilators, or does that include CPAP and BiPAP machines? How many more are to come? There have been some worrying shortages of medicines for those who need to be sedated, and recently we have heard news that there is a problem with kidney dialysis and kidney medicine for people who have come out of intensive care and require long-term support. Is there a shortage of such medicines, what other medicines are at risk and what proposals are there to remedy that problem?

We have spent many hours today talking about PPE. We are still waiting for supplies for everything outside hospitals. On 6 April, Clipper was heralded as being about to solve this problem, but it is still woeful. Until the social care and community sectors get the support they need, they will continue to be worried about the spread of Covid.

The Turkish ambassador has written to various people in the APPG on Turkey, setting out the actual arrangements—as opposed to those reported by the Government—concerning the delay in the package that appeared to get stuck. Turkey actually donated 250,000 pieces of medical protection equipment to us; the rest came through privately. Can the Minister say when the remainder of the consignment due from a Turkish supplier will arrive?

It is good to hear that formal arrangements for testing, tracking and tracing are now under way, but the WHO always puts in a third word alongside “test” and “trace”: “isolate”. Any mention of isolation in the Statement is notable by its absence. Taiwan, South Korea and Hong Kong have all managed to suppress further bursts of Covid because of the arrangements for not just testing and tracing but isolating. It is good to hear that an app will be available, but the Minister will know that there are people with technical experience concerned about whether it is appropriate to use Bluetooth for it, because of security issues. Can the Minister assure the House that this is not the case and that people’s data will be used only for NHS purposes and will absolutely not be able to be used by any providers of the app or beyond? The 18,000 tracers announced by the Secretary of State just before this Statement are a good start, but we will need more for good national coverage. Worryingly, Mr Hancock said a few days ago that all this will be operated centrally. Is that still the case, or will he use the existing trained tracers that there are in local communities, whether environmental health tracers in councils or in local health teams? It seems rather bizarre to try to cover the country on that level.

On shielding, it is good that there is a request to create more volunteers and to celebrate the volunteers, but notable by their absence in the Statement are the many people who have not yet had their letters on shielding and whether any further groupings may have to consider shielding—which I understand is the case.

I congratulate the Government on their progress on test and trace, but confirm that we are extremely concerned about supplies of equipment and medicine and hope that things will be remedied speedily.

[Lord Bethell]

My Lords, I greatly thank the noble Baronesses, Lady Thornton and Lady Brinton, for their extremely perceptive and thoughtful questions. I will answer them, in the words of the moment, at pace.

The noble Baroness, Lady Thornton, asked about BAME. The precise figures for BAME deaths are not to hand. PHE will have a very thorough investigation into this. It will come up with a scope and a delivery date shortly.

On isolation, one of the frustrating and awkward things about the virus is how unpredictable it is and how many unknowns there are. It confounds expectations. The question of isolation remains one for which we are reviewing our advice. We are in constant contact with other countries to learn more about best practice.

On the European project, I make it absolutely 100% clear that there was a cock-up, not a conspiracy. There were emails from Europe to us that were missed; there were meetings that our side missed. It was a great shame that that opportunity was missed, but we have put in place the processes and arrangements to work with our European partners on future procurement if they are helpful to the NHS and our care system.

The noble Lady, Baroness Thornton, is quite right to ask about capacity and testing. The blunt truth is that infection rates have gone down dramatically. The lockdown has had a profound impact. The KCL infection rate graph has gone from 2 million to half a million. That has a profound effect on demand for tests. Access is no longer a problem. At 5 pm, on the No. 10 presser, the Secretary of State explained how key workers can access a test for themselves. A major advertising campaign will begin tomorrow. They can either attend the drive-ins or Amazon will deliver a test to their home. Therefore, for those without a car, travel is not necessary. That capacity will be essential when we build the kind of track and trace capability that we will need to take us out of lockdown.

The noble Baroness, Lady Thornton, asked about postponed treatments. I echo her sentiments entirely. It is of grave concern that the numbers of non-Covid deaths can be worse than of those who die of Covid themselves, as in any epidemic. The message in the Statement is crystal clear: if you need treatment, contact your GP or your hospital. We will do everything we can to give you the treatment that you need. We are trying to use this hiatus to clear some of the backlog. The noble Baroness mentioned cancer. That is a particularly tricky problem because those cancer patients in treatment who have challenging immune systems will not wish to attend hospitals where there is Covid. We are doing all that we can to try to make arrangements and provide hygienic arrangements for them.

The noble Baroness, Lady Brinton, asked about care beds. Let me slay one myth: the ONS is very clear about the proportion of deaths at care homes. It is 10%. It is an offence to misrepresent the cause of a death. Causes of death are reported to PHE. The CQC carries that information to the ONS. These are reliable figures and I would be glad to send those who suggest that it is more than that the details on the ONS website. There is no pressure on anyone to be in a bed that is not recommended by strong clinical advice. It is true that we have spare hospital bed capacity, but it is not true that we are pressurising anyone to stay in a care home who should be in a hospital bed.

The noble Baroness, Lady Brinton, raised the question of medicines. That is an area where our supply chains have been put under extreme stress. Suppliers in China, India and America have all been under pressure and we have been in conversation at government and corporate level to ensure we have supplies. The noble Baroness is right that some of the first-choice medicines for sedation have been in short supply, but there are ample and various back-ups for those medicines. She is right that a feature of the Covid disease, is, it seems, that it attacks the kidneys and there has been a big increase in the need for kidney dialysis and the drugs associated with it. We are putting in place the supply chains necessary to fill that need.

As for the Turkish ambassador, I am not going to give a blow-by-blow account of every plane and truckload of kit that comes to Britain; all I can say is that we are extremely grateful to both the Turkish ambassador and to our Turkish corporate providers and we find the scrutiny they have been put under unfortunate and regrettable.

Turning to track and trace, I confirm that isolation is an absolutely intrinsic part of the track and trace regime: it just does not rhyme so well, so you never put it at the end, but “track, trace and isolate” is the programme. I have been given a thorough briefing by the Taiwanese CMO on their use of track and trace and, having a Taiwanese wife, I can tell noble Lords that I am up to speed on their achievements in that area.

On app security, I assure the House that the Bluetooth we are using is the latent, not the overt, Bluetooth: data is not carried in the same way as in overt Bluetooth, and one of the reasons we have chosen that method is the strong security offered. I also reassure the House that we have strong data arrangements. It is one of the reasons we have gone for a latent Bluetooth technology, and no data will be shared with our technology providers.

Lastly, the noble Baroness, Lady Brinton, is entirely right to raise the tracing part of track and tracing. I reassure her that we will be using a variety of different methods. There will be a central bank of callers. We will also be using local resources where they are necessary, and we will also be using friends networks. We have learned from the best case studies from abroad that often the influence of friends in persuading people to isolate has the most profound effect.

[Lord Mackay of Clashfern (Con)]

My Lords, any decisions on relaxing the present restrictions and on research into treatments and vaccines are very difficult and therefore liable to give rise to differences of opinion, even among scientists and doctors. Will the Government do all in their power to reach agreement with the devolved Administrations on any decision on these subjects? Today, the Scottish Government published Coronavirus: Framework for Decision Making, a valuable aid to reaching the agreement I have mentioned.

[Lord Bethell]

I reassure my noble and learned friend that one of the most distinctive and reassuring aspects of the government response to Covid has been a very strong collaboration between the four nations. That has been epitomised by the strong relationship between the four CMOs, and operationally it has been given teeth by the presence of the devolved Administrations at COBRA meetings, which I attend.

[Baroness Meacher (CB)]

My Lords, I thank the Ministers for all that they are doing in this very difficult situation and, of course, all our wonderful NHS and care staff for what they do every day and every night.

As the Minister knows, the countries most successful in controlling Covid-19 are those with comprehensive testing and contact-tracing systems. We are thrilled to bits that we have two leading research teams in the country—great applause to them—but, until their vaccines are available across the country, the testing regime will be the only approach that will enable a return to any kind of normality. A large-scale sample, or provision, of testing and tracing and so on for care workers will not achieve that objective. Will the Minister tell the House if or when the Government will introduce a comprehensive—I emphasise that word—scheme of testing, contact-tracing and, as has been said, isolation, of all who have symptoms of Covid-19? This means not a sample and not just people in the care sector, but the nation. That is the only way out of the tight corner we are in. If not, can the Minister explain why?

[Lord Bethell]

The noble Baroness, Lady Meacher, is entirely right in the way that she explains things. The driver of that decision is the need to get our prevalence rates and the velocity of the infection down to a reasonable level, so that we have reasonable resources to keep R down by track and trace. I remind her that South Korea, which has used this technique most effectively, does only 20,000 tests per day, because its prevalence levels and velocity of infection are so low.

[Baroness Buscombe (Con)]

My Lords, I should like to say how encouraged I am by what my noble friend the Minister has said today on the progress made in tackling this virus. In asking my question, I stress that I have been urged so to do by many businesses, large and small, across the country—the backbone of our economy.

Will the Minister and his colleagues now accept that we must expect a second wave of the virus, even though we do not know when? If so, it is now crucial to look at working both with and beyond the science, and to take a balanced, proportionate and, frankly, brave decision, with Cabinet colleagues, to put trust in the good sense of the public to ease the lockdown as soon as possible—to allow the economically active to return to work, while retaining sensible social distancing —given that the situation is now having a devastating effect on our economy, and on our ability to afford our NHS, our welfare system, education system and other public services into the future.

[Lord Bethell]

I note my noble friend Lady Buscombe’s question, but I reject the sentiments behind it. I do not regard a second wave as inevitable; I do not share her fatalism. The priorities of the Government are to save life and to protect the NHS and our care system. That requires us to lower the prevalence level, reduce infection and put in place systems such as track and trace to keep a lid on the disease so that we can protect life and our systems.

[Lord Liddle (Lab)]

My Lords, I thank the Minister for his frankness on this occasion. On European co-operation, how have we got ourselves into a situation where for PPE we are so dependent on supplies from China, Turkey and other faraway countries, and allowed ourselves to get into a position where we do not have much domestic manufacture? Similarly, on vaccines, I read a report in the Financial Times that we have no vaccination manufacturing capacity at scale in Britain. If that is the case, should we not look at whether European co-operation can help us there?

I welcome what the Minister said about testing. I had a report locally of care workers in Silloth, in the west of Cumbria on the coast of the Irish Sea, being told that if they wanted to be tested, they had to go to Gateshead, some 80 miles away, with no means of transport to do so. Will there be no repetition of that problem?

[Lord Bethell]

The noble Lord, Lord Liddle, is not entirely right. We have fantastic manufacturing in the UK—I reinforce the view of my noble friend Lady Buscombe that the sector provides jobs for the economy—but we do not have low-margin, high-volume manufacturing. The image of a Burberry gown always sticks in my mind on this point. Burberry makes £500 shooting jackets, but it does not make £5 surgical gowns. That is something that we need to address, and it will be the priority of my noble friend Lord Deighton.

[Lord Scriven (LD)]

My Lords, the South Korean prevalence rate is so low because they have tested, traced and isolated since day one. The Government initially did this and then stopped it. Ten days ago, they said that there would be 1,000 tracers; now, the figure has gone up to 18,000. Why have the Government not kept this system going consistently, which South Korea has proved reduces the prevalence rate of the virus?

[Lord Bethell]

The noble Lord, Lord Scriven, is not correct to say that the Government decided to stop track and trace; there are still PHE track and traces, but when the disease reaches a certain level of prevalence, it simply is not arithmetically possible to track down every new incidence of the disease. Nor is it true that anyone in the Government said that we would have only 1,000 tracers in our call centres. Plans which I have seen are being drafted at the moment which are wildly more ambitious than that. It is our plan to put together a system that is proportionate to the challenge.

[Baroness McIntosh of Pickering (Con)]

My Lords, I declare an interest: I work with the Dispensing Doctors’ Association. It is emerging that all gowns are made to one size, which is posing a problem particularly for larger men and all women. I realise that this matter is being addressed. Can the Minister update us on it today?

I warmly congratulate my noble friend and the Government on introducing the new measures on testing and tracing. It strikes me that, if we could do this as locally as possible and perhaps look to training environmental health officers to be able to do some of the tracking and tracing, it would be a good use of their time.

When it comes to ending the lockdown, I urge the Government to follow the Swedish example of maintaining self-isolation but allowing hospitals, bars, pubs and cafés to open in a regulated and controlled manner.

[Lord Bethell]

My noble friend Lady McIntosh is quite right that we should look at several different workstreams for our track and trace model. As the noble Lord, Lord Scriven, implied, one of the most important things to consider is having surge capacity. Track and trace is very important when you have an outbreak or second epidemic. We need to have in place that additional capacity to track down and isolate those who bring in new infection.

[Lord Touhig (Lab)]

My Lords, refugees and people with irregular status who are medically extremely vulnerable are being deterred from seeking treatment because of concerns around immigration enforcement and charging. What steps are the Government taking to ensure that no one in these circumstances is discouraged or prevented from receiving the treatment that they need?

[Lord Bethell]

The noble Lord raises an issue that I remember was raised during discussions on the emergency Coronavirus Bill. It is my understanding that a generous and open-hearted view is taken on the treatment of those with irregular status in the UK. Now is clearly not the time to try to put in prison those who have irregular status. The precise arrangements escape me, but I would be glad to write to the noble Lord with a precise description.

[Lord Patel (CB)]

My Lords, the Minister mentioned in his Statement the introduction of app-based tracing of contacts, which others have already mentioned. At the same time, I assume that the Government will introduce serology testing and expand the current molecular testing. When will the Government publish the protocol for implementation of this, and how will the public be informed?

[Lord Bethell]

The noble Lord, Lord Patel, will be interested to read the details of our ONS serology tests that have begun earlier this week, which will be published in mid-May. These are surveillance tests and will provide us with the information that we need to understand how the epidemic is developing. At the right time we will also bring in mass serology testing. However, as the noble Lord will be aware, when prevalence rates are around 3%, 4% or 5%, as they seem likely to be, serology tests for managing the epidemic are not relevant yet.

[Lord Lucas (Con)]

I am delighted that the Government are taking resilience seriously. Will my noble friend confirm that the Government will have a permanent stake in the facilities and the intellectual property that they are creating, to ensure that it stays here and is well maintained? Will he also extend the interest in resilience to pharmaceutical intermediates and generics, where we are also seeing problems developing which were also problems when we were contemplating no deal? There seems to be a strong argument for having a better set of arrangements in place in this country to ensure supply in difficult times.

[Lord Bethell]

My noble friend Lord Lucas is quite right about IP, although I bear testimony to the private companies and major corporations which have reacted incredibly generously and enthusiastically by supporting the Government during this crisis. Our supply chains absolutely need to be reviewed. Resilience is clearly more important now than it has ever been. When we look at the way in which our medical, pharmaceutical and device supply chains are put together, they will look quite different in years to come.

[Baroness Walmsley (LD)]

My Lords, the Secretary of State said that he would mention treatments, but he focused only on vaccinations, which are of course important. However, I would like to ask about progress on developing antiviral drugs and the use of serum treatments, about which I have heard encouraging reports. Can the Minister say whether there are any plans to ask recovered Covid-19 patients to donate blood after a suitable recovery period so that the serum could be used to treat very sick patients and help them recover?

[Lord Bethell]

The noble Baroness is entirely right. Serum offers an encouraging opportunity, not least because it is a proven technology. The national blood transfusion service has been asked to start investigating how to collect serum, and a grant for the purchase of new machines to help that has already been made.

[Baroness Pidding (Con)]

My Lords, my question is with regard to testing, and in particular the drive-through testing centres, where we are not seeing maximum take-up. On the priority for testing, that is obviously our key workers, both in the NHS and care homes, but I am mindful that some who may not be able to drive or who may not have access to cars. Therefore, this itself presents a challenge with regard to drive-through centres and their geographic positioning, as they can be considerable distances away. I appreciate that the Minister has already spoken about home testing, and the Statement makes brief reference to the use of mobile units. Surely this has to be the way forward, taking the testing to essential people who are in the front line. Can we not ramp up this operation, employing the expertise in logistical functions of the military? I would be grateful if my noble friend could provide more detail as to what mobile units are and how they operate.

[Lord Bethell]

I would like to recruit my noble friend to our testing organisation, because she has exactly the right ideas, and the programme she described is exactly what we are doing. The Army is putting together 50 transit vans with tents and cones to be able to travel to places such as care homes to conduct testing, particularly at times of epidemic. Amazon is putting together home testing kits, which means that no one need drive anywhere to have a test, and we are working with care homes so that care workers can take the swabs and then drop off bags of them at a reasonable place so that they can be processed by our laboratories. Drive-in testing was an early but limited programme, and we have a lot more going on than that.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I thank the Minister; he has had a lot of work to do in the Lords today. He commented on ONS figures and the analysis it has done on the number of people who have so sadly died. The figure he gave in the Statement was, I think, around 18,000. I assume that these are deaths from the virus of people in hospital. I suspect he will have seen a piece in the Financial Times earlier this week which did some analysis of the ONS figures. It suggested that the figure of deaths caused by the pandemic was as much as 41,000. Have his officials looked into this and can he comment on its veracity?

[Lord Bethell]

I have not seen the piece in the FT, so cannot comment on the noble Lord’s remarks. All I would remind him, as I have said in previous answers to similar questions, is that false reporting of a death is an offence. Doctors are required to make a clear report of a death. If it is associated with Covid in any way, the word “Covid” will be in the death certificate. If it is in the death certificate, it will make its way through the CQC to the ONS figures. There should be no ambiguity about this at all.

[Baroness Ritchie of Downpatrick (Non-Afl)]

Will the Minister provide an assurance that there will be rigorous tracking, tracing and isolation of those in care homes, including the staff and residents? Through its European director, the World Health Organization told us today that there were significant deaths across Europe, including in the United Kingdom and Ireland, and that there is a need to address this.

[Lord Bethell]

The noble Baroness, Lady Ritchie, addresses a very difficult problem. The programme we are looking at, announced earlier today with the change to our guidelines, is the testing of asymptomatic carers and residents in care homes. It is a natural and growing concern that the disease may be present in an asymptomatic form. We are determined to get the infection out of our care homes and the NHS.

[Lord Robathan (Con)]

My Lords, this lockdown is hugely damaging to the country, particularly to the future prosperity and education of our young people. Nobody knows, as the Minister has just said, how many people have had or have this ghastly virus and recovered. Many suggest that it is several million, possibly many millions. If that is the case, it leads to another suggestion: the mortality rate may be less than 1%. Some say—I am not an expert on this at all—that it is as low as 0.1%. If that is the case, what implications would that have on the Government’s policy of balancing the future well-being of this country and its people with dealing with this ghastly health crisis?

[Lord Bethell]

The noble Lord, Lord Robathan, makes a fair point. I reassure him that we are investing in a massive 20,000-person surveillance by the ONS to get to the bottom of the mystery which he describes. Every piece of evidence we have from every country around the world suggests that the number of people who have been through the disease is a tiny proportion of the population, and that the amount of recovery and antibody immunity in the country is likely to be in single figures. This is one of the great challenges of the virus and the situation it presents to us.

[The Earl of Clancarty (CB)]

My Lords, a test, track and trace policy is clearly right, but a week ago, Matt Hancock admitted that 15,000 people a day are entering the UK through airports without medical checks. In just over a month’s time, that will be an extra half a million people entering the country, many of whom may have Covid. Will the Government address this and plug what is surely a gap in their Covid policy?

[Lord Bethell]

The noble Earl, Lord Clancarty, is right that our present guidelines state that those arriving in Britain should isolate if they have symptoms and seek a test from a hospital if it develops seriously. It is clear to me that the way we travel around the world is set to change dramatically in the future, but the CMO has reviewed our airport and port guidelines. He is happy with them, and the evidence suggests that this is not currently a source of new infections in the UK.

[Baroness Altmann (Con)]

My Lords, may I press my noble friend on treatment, particularly with convalescent plasma? As I understand it, other Governments are urgently looking into this. France has put its medical staff into LFB. Have we put any pressure on BPL, which is the only fractionating company available in the UK, to produce pure, hyperimmune immunoglobulins, rather than the whole plasma, so that we can start parametric testing of IVIG and injections of convalescent plasma in the pure hyperimmune form?

[Lord Bethell]

I reassure my noble friend Lady Altmann that we are making this a massive priority. It has huge advantages over other therapeutics because it is plasma and can therefore have an accelerated regulatory advance. I signed for procurement of £20 million-worth of fractionating machines last week to help the blood transplant service create the hyperplasma to which she alludes.

[Lord Randall of Uxbridge (Con)]

The Statement rightly reinforces the message that non-Covid NHS services are open for patients. Would my noble friend agree that it is important to give parents confidence that essential vaccinations, especially MMR, should not be ignored and that they should speak to their GP for further advice and support?

--- Later in debate ---

[Lord Bethell]

I entirely agree with the sentiments and intent of my noble friend’s point. It occurs to me that we should perhaps set up some kind of advertising or promotion of this. I will take that point back to the department.

[The Deputy Speaker]

Baroness Wheatcroft. No? We will move on to Lord Balfe.

[Lord Balfe (Con)]

In the Statement, the Minister referred to the need for people who have other medical needs to still contact their GP. In Cambridge, where I live, the opticians, chiropodists, dentists and surgeries are all closed, with different fierce notices on their doors. When the isolation requirements are lifted, could the Government make it a priority to get these vital medical services open again and get doctors back into surgeries, not at the end of the telephone? Perhaps we could at least teach them that Zoom exists.

[Lord Bethell]

I reassure my noble friend Lord Balfe that the amount of video treatment being given by doctors has gone through the roof. During this epidemic, we have seen the medical trade and patients embrace a huge amount of digital technology. We are working with the colleges to try to get all the services of the medical profession open at this time and the response has been largely positive.

[The Deputy Speaker]

Lord Woolf. No? Lord Dobbs.

[Lord Dobbs (Con)]

Minister, are prisoners in our prison system participating in the manufacture of PPE? Does the crisis not represent an opportunity for many prisoners to not only contribute but move towards some rehabilitation?

[Lord Bethell]

My noble friend Lord Dobbs is right that there seems to be an opportunity, but I have to be candid with him. Our need for PPE runs into hundreds of millions of items. We have delivered more than 1 billion pieces of PPE since Covid began. I am afraid to say that the manufacturing abilities of Her Majesty’s prisons do not reach to that kind of level.

[Lord Blencathra (Con)]

As my noble friend the Minister has just said, in January the NHS had to deliver half a million PPE items to 233 hospitals. It now has to deliver 1 billion items to 58,000 health facilities. The experts in logistics are the military, as we saw from the brilliant No. 10 briefing by General Carter yesterday. Will the Government now hand over complete control of distribution to the Armed Forces? Will the Minister comment on reports that the much-vaunted EU purchasing scheme has not delivered a single item of kit to any EU country?

[Lord Bethell]

I would like to take my noble friend to Skipton House in London’s Elephant and Castle to see the very large room where there is a combination of the diplomatic skills of the FCO, the trade skills of DIT and BEIS, the military skills of the Army and the clinical skills of Health. Seeing all those different skills and abilities work together to deliver the kit that our health workers need is a really impressive sight. That collaboration is the secret to success.

[Lord Sheikh (Con)]

My Lords, my noble friend the Minister referred to the fact that the number of deaths that have occurred as a result of coronavirus stand at 18,738. The BAME community represents about 14% of the UK population, but unfortunately accounts for about 35% of all coronavirus patients in intensive care. The number of people in the BAME community who have contracted coronavirus and died as result is disproportionately high.

My noble friend might perhaps recall that I talked about the burial of Muslims when the Coronavirus Bill was discussed in your Lordships’ House. The Muslim community has got together, and burials are taking place in very difficult circumstances. However, I have been told by leaders of the community that the availability of land for burials should be kept under review and that a system should be provided if the land issue becomes a major problem and burials cannot take place. Secondly, the Government should consider providing additional funds to local authorities, which are dealing with very difficult circumstances. They are stretched to the limit and need additional resources for burials and cremations. Will the Minister comment on those two points?

[The Deputy Speaker]

Minister, if you could be very brief, we might be able to fit in the noble and learned Lord, Lord Woolf.

[Lord Bethell]

I am very grateful for my noble friend’s helpful update, but I remind him that these arrangements are conducted by local authorities. The question that he asks is best answered by those local authorities.

[Lord Woolf (CB)]

I thank the noble Baroness for her consideration. I am afraid that at a critical moment my microphone turned itself off. It is back on now. The Minister rightly referred to hero volunteers. He will be pleased to hear that those volunteers include members of the staff of this House, such as my part-time secretary, who has volunteered. That is worth noting, as are the many others who I am sure are in the same position.

[Lord Bethell]

I thank the noble and learned Lord. Will he please express my and the Government’s profound thanks to his secretary for their contribution? I hope it is proving to be rewarding to him or her personally and impactful to the causes in which he or she serves.

[The Deputy Speaker]

My Lords, the time allotted for the Statement is now up. I thank all noble Lords for being concise, in particular the Minister for his very concise answers.

Covid-19: Medically Vulnerable People

Lord Bethell Excerpts

Wednesday 22nd April 2020 Lords Chamber

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

My Lords, we recognise that though shielding is for individuals’ own protection, it is an immense undertaking. Decisions to advise shielding were taken after very careful consideration. The implications for those concerned are profound. We constantly review all social distancing measures and will continue balancing the need to protect the clinically extremely vulnerable from contracting Covid-19 against the restrictions that this places on their lives.

[Lord Blunkett (Lab)]

My Lords, I appreciate greatly the work that the Minister, his team and his colleagues are doing. I know that he will join me in appreciating the hundreds of thousands of volunteers, and mutual aid programmes at local level across the country as well, who are supporting people who are trapped in their homes. I wonder whether the Minister will discuss with his colleagues whether particular measures, which would not put at further risk those who are most vulnerable, could be adjusted to enable people to be treated in hospital for other conditions, given the concerns of Cancer Research UK and the British Heart Foundation, among others. Could we also take into account that two weeks ago, when I hope we reached the peak of deaths from the virus, there were 2,300 estimated additional deaths not related to Covid-19, which must be a great worry to all of us?

[Lord Bethell]

I completely agree with the noble Lord’s concerns, both about those who are clinically vulnerable and about the potential for a rise in non-Covid excess deaths. The second is a matter of extreme concern. The example of those with cancer who are going to hospital to have operations is a very good and clear example. These matters are very much at the highest level of the Government’s mind.

[Baroness Thornton (Lab)]

I thank the Minister. According to media reports, those who are particularly vulnerable to the virus could be advised to remain shielded for up to 18 months, or until a vaccine has been developed. Can the Minister confirm whether these reports are true? Secondly, the Government have recruited 700,000 NHS volunteers to support those who are vulnerable or shielded. Most of them seem to have been processed but many have been given nothing to do as yet, when there clearly is need. Will the Minister tell me how quickly that issue will be resolved?

[Lord Bethell]

The noble Baroness is entirely right. The prospect of long-term shielding for those most vulnerable is of deep concern. That is why we are pressing so hard on the disease, through the lockdown, to try to get R as low as possible. We will be putting in track-and-tracing measures to ensure that R can be held down and those in lockdown can be freed from their confinement. In terms of volunteers, the response has been incredible. It takes time to turn around all the offers of help that we have, but we are moving extremely quickly to do that.

[Lord Truscott (Ind Lab)]

My Lords, is there not a danger that extending the lockdown for only certain groups might unintentionally discriminate against elderly and vulnerable people? Might a better way forward be mass testing, tracking and tracing, as the Minister mentioned, plus the rapid development of a vaccine? If the Government are going to continue to isolate vulnerable people, will the Minister agree that this should be subject to a view by an individual’s GP?

[Lord Bethell]

The noble Lord makes a reasonable point, but I confirm that it is the virus that makes this discrimination, not the Government. Certain demographics are even more vulnerable than others. It is an unfortunate fact that those who are medically vulnerable are singled out by the virus. We have to put in place measures to protect and safeguard their lives.

[Lord Lamont of Lerwick (Con)]

Following up on the questions from the noble Lord, Lord Truscott, and the noble Baroness, Lady Thornton, when we eventually get to the stage of lifting restrictions I urge the Government not to discriminate against the elderly on the grounds of vulnerability and not to treat them as a single category. Many of the elderly—over half a million—continue to work. They feel acutely the separation from loved ones. They are conscious of their own vulnerability, are perfectly sensible and do not need the threat of law to protect them. Will the Minister remind his colleagues when decisions come to be made about lifting restrictions that the decision is not just for scientists? It is a political question as well. Policy that might be acceptable in China might not be acceptable here.

[Lord Bethell]

My noble friend is entirely right that the political context in Britain is based on rule by consent. We are not an authoritarian state. However, I cannot hide from my noble friend the point that I made to the noble Lord, Lord Truscott: it is the virus that is a discriminator, not the Government. The clinical assessment of risk for many older people, particularly those with medical conditions, is very high. The Government will be guided by clinical advice in their advice and recommendations to all groups, although the effect of safeguarding and lockdown on the elderly is fully understood. We will put in as many mitigation measures as we can to prevent any long-term harm.

[Baroness Brinton (LD)]

My Lords, on 16 March the noble Lord, Lord Bethell, told the House that anyone with an underlying health condition will be contacted by their local GP to clarify what kind of risks they face. A very large number of people still have not had their letter or text from the Government saying that they should be shielding, let alone conversations with GPs. I am in the shielding group and my consultant has told me that I should prepare to be shielding for 18 months. Can the Minister confirm that everyone who should be shielding has now been notified by the Government and their GP that this is the case?

[Lord Bethell]

The noble Baroness is entirely right. Letters should have been sent to all those who should be shielding. I am aware, as she rightly points out, that this process happened extremely quickly and there was a very fast turnaround. I have accounts of people who were sent a letter who should not have had one and I have accounts of people who should have had a letter who did not get one. We are working hard to fill the gap, but 1.3 million letters were sent out and, on the whole, I believe that this exercise has delivered clear recommendations to those involved.

[Lord Lucas (Con)]

To follow on from my noble friend Lord Lamont’s question, can we please ensure that vulnerable people have agency, that those who want to act as the unvulnerable are allowed to, that grandparents who wish to see their children are allowed to, and, at the same time, that those who are young and vulnerable are protected in their decision to continue to isolate and are not discriminated against because of it?

[Lord Bethell]

My noble friend Lord Lucas makes a completely reasonable plea. On a personal level I completely understand where he is coming from. I have elderly relations who I would like to see, hold, touch and socialise with. But, as I said, I cannot hide from the House that this virus is an extremely predatory killer that has in its sights particular demographic groups, including the elderly and in particular those with conditions. It would be wrong of me to mislead the House by pretending that there was an easy way out of this epidemic for those who the disease seeks to attack.

[Lord Carlile of Berriew (CB)]

My Lords, given that some very healthy older people have mistakenly received 12-week lockdown letters, including inaccurate and anxiety-causing assertions that they have underlying medical conditions, will the Government permit an arrangement whereby the relevant GP practice can confirm or refute the issue of the letter and certify to that effect?

[Lord Bethell]

The noble Lord makes a very reasonable request. I have sought clarification from the department on this point, because his suggestion seems eminently reasonable, and as soon as I have a reply I will write to him and share the contents with the Library.

[The Lord Speaker (Lord Fowler)]

My Lords, I regret that the time allowed for this Question has elapsed. I apologise to the few people at the end of the list who have not managed to get in. We will seek to deal with that in the allocation for future Questions.

Covid-19: Extent of Infection

Lord Bethell Excerpts

Wednesday 22nd April 2020 Lords Chamber

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

As of 21 April, 129,044 people have tested positive for Covid-19. This represents less than 0.02% of the population. When the evidence demonstrates that it is safe to do so, we will adjust the lockdown arrangements. We have set out the five conditions that need to be met before lockdown measures are adjusted. These include having reliable data from SAGE showing that the rate of infections is decreasing to manageable levels across the board.

[Baroness Sheehan (LD)]

My Lords, it is very clear that testing is the way out of this. First, there is the immediate urgency of testing front-line health and care workers exposed to high viral loads through lack of proper PPE, and we could do this now if the Government would give the go-ahead to local private research labs with the necessary level-2 clearance, which would not take resources from Public Health England’s needs. Secondly, there is the urgent need for mass testing. Why are the Government forgoing the first in favour of a gold-standard testing regime that they can control from the centre to deliver the second? Can they not do both?

[Lord Bethell]

I thank the noble Baroness, Lady Sheehan, for a very clear Question. I can reassure her on three points. First, front-line staff in the NHS and in care homes are eligible for test on request and we will be opening lines so that they can phone and book their own testing shortly. Secondly, I commend and thank those private research labs already contributing enormously to our testing regime. Thirdly, mass testing is one of the options that we are looking at: the Cabinet Office is devising plans for the medium term and will be publishing them shortly.

[Lord Dobbs (Con)]

First, I very sincerely thank my noble friend for his tireless work during this crisis. Did he by any chance see the BBC report yesterday under the headline “Deaths at 20-year high”? Digging into that needlessly sensationalist headline, intriguingly it reported that the apparent increase was one-third linked to the virus but two-thirds linked to non-virus cases. We all understand that there is an inevitable impact on others while we direct our focus towards the coronavirus, but have the Government undertaken any study of the estimated increase in the number of deaths of non-virus patients during the economic lockdown, and, if so, will they publish its conclusions?

[Lord Bethell]

My noble friend Lord Dobbs is entirely right to put his finger on this important matter. The CMO was clear from the very beginning that Britain’s mortality rate came as much from Covid as from non-Covid deaths. We review this situation regularly and thoroughly, and we will be glad to update the House at a future date. We are very conscious of the threat of which my noble friend speaks.

[The Lord Speaker (Lord Fowler)]

Supplementary question: the noble Lord, Lord Krebs. Lord Krebs? No? In that case, I call the noble Lord, Lord Hain.

--- Later in debate ---

[Lord Hain (Lab)]

My Lords, I declare that my wife is a board member of care providers. How on earth will the Government lift restrictions without universal testing, especially in care homes, where there is virtually no such capacity at all and not even enough personal protection equipment? The charity Leonard Cheshire Disability has been forced to spend an additional £250,000 a month sourcing PPE such as gloves and masks, and a South Wales care provider is spending £100,000 extra monthly. The Government need urgently to give billions more to care homes, instead of leaving them so badly in the lurch during this crisis,

[Lord Bethell]

I reassure the noble Lord that testing has been opened up to all care homes. I pay tribute to the CQC, which played a pivotal role in providing access to Britain’s 12,000 care homes in this regard. Mass testing is an option that we are looking at, but I remind the noble Lord that South Korea, where there is an extremely energetic track-and-trace facility, carries out on average 20,000 tests across the country—fewer than we do in Britain on an average day.

[Lord Oates (LD)]

My Lords, we all understand the immense pressure that the Minister’s department is under, but does he agree that it is unacceptable that capacity is still only at 38,000 tests a day and that much of that very limited capacity is not being used, not least because the testing centres are often in out-of-the-way places that NHS and care staff cannot easily reach? Was an assessment of public transport accessibility made before these centres were chosen, and will the Minister’s department now urgently work with drive-through restaurant chains and other accessible venues to ensure that testing centres are in places that NHS and care staff can easily attend?

[Lord Bethell]

The noble Lord raises a completely valid point on the accessibility of drive-in centres. They suit some people but not all, as he rightly points out. That is why we have brought in at-home testing arrangements, delivered mainly by Amazon. They started on Monday, and we are very ambitious for both their scale and their scope, particularly for the demographics of which he speaks.

[The Lord Speaker]

Supplementary question: the noble Baroness, Lady Lawrence of Clarendon. Lady Lawrence? No? I call the noble Lord, Lord Moynihan, for his supplementary question.

[Lord Moynihan (Con)]

Over 90% of the population will be unlikely to have suffered from Covid-19 when the restrictions are lifted. Will the Government therefore initiate and support a nationwide fitness and recreation campaign, given that physical exercise can help ensure that immune systems become stronger and less susceptible to infections and their most severe consequences and lead to a greater ability to recover from infections?

[Lord Bethell]

My noble friend is entirely right. Fitness and the Covid epidemic are closely connected. The Secretary of State for Health has made it clear that a daily walk should be part of everyone’s lockdown arrangements and we are ambitious to make fitness and diet part of the agenda as we leave the Covid lockdown.

[Baroness Finlay of Llandaff (CB)]

I thank the Minister for being open to communicating with us during the period before Parliament resumed. What assessment have the Government made of combining repeat virus detection with those risk factors that the Intensive Care National Audit & Research Centre’s contemporaneous data has shown are associated with particularly poor outcomes—I refer particularly to high body mass index, indicating obesity—and how will this inform the lockdown exit strategy?

[Lord Bethell]

The noble Baroness speaks of anecdotes of which we are very aware. We are conscious of the stories coming particularly from America about a seeming correlation, if not a causation, between obesity and Covid mortality. Clinical trials and data on this are in short supply. The CMO has not made a declaration on it. But I share her instinct that there is a strong connection. As the noble Lord, Lord Moynihan, suggested, fitness and diet will be important parts of our post-lockdown experience.

[Lord Wood of Anfield (Lab)]

My Lords, we can understand the epidemiological value of antibody—serology—testing. However, I am interested in the public policy uses that may come from this testing. Is it the Government’s intention to use evidence of antibodies in individuals to say that some people rather than others can return to normal life sooner—particularly people of working age and younger rather than older people?

[Lord Bethell]

Serology tests provide important data on the behaviours of the virus. We still do not fully understand what kind of immunity and antibody response will be long-lasting in the body. There are mysteries to this virus that are yet to be solved; serology tests are vital to that and they can play a part in the back-to-work strategy. However, I would remind him that it is a tiny proportion of the population—probably around 5%— who have antibodies. We cannot put the economy back on its feet with just 5% of the population.

[The Lord Speaker]

My Lords, I am afraid that the time allowed for this Question has elapsed. Two noble Lords were not called; I am sure that this will be taken into account in future lists.

Covid-19: Care Home Deaths

Lord Bethell Excerpts

Wednesday 22nd April 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 need for daily figures means that there are two official publications: first, the daily figure that is used in the No. 10 presentation, which includes deaths of care home residents in hospitals but not those who die in the home; and, secondly, a weekly figure produced by the ONS which covers all locations of death, including care homes, but which has an 11-day lag.

[Baroness Wheeler (Lab)]

I thank the Minister for his response. Both Care England and the National Care Forum report an alarming increase in the number of care home deaths, with estimates of more than 6,000 deaths above this week’s official ONS figure of 1,043; we already know that these figures are 12 days out of date when they are published. The National Care Forum has called for the Government to build a ring of steel around care homes to safeguard the most vulnerable among us, with providers suggesting that doctors and nurses should be urgently deployed to fight Covid-19 in homes for older people. They rightly stress that an unprecedented situation calls for an unprecedented plan, as we have had in hospitals. What is the Minister’s response?

[Lord Bethell]

The noble Baroness is entirely right. This is an evil disease which strikes the elderly and those with pre-existing conditions the worst, and those who live in care homes are the most vulnerable. The Government have sought to put a ring of steel in place. We have resourced care homes enormously. Testing is now being focused on care homes to try to reduce the prevalence of the disease, and we will continue to focus on protecting our care homes.

[Baroness Andrews (Lab)]

My question is about the information we have on the deaths of care workers in care homes. Given that so many of our care homes are extensively staffed by BAME workers, and we are incredibly grateful, can the Minister say whether we are likely to have figures for the proportion of BAME staff in those homes who have died? On that point, and in the context of the review, which we welcome, into the disproportionate numbers of BAME workers generally in the health service who have been affected, can the Minister tell us when it will start, who will lead that inquiry and what timetable the Government will be working to?

[Lord Bethell]

I echo the noble Baroness’s timely comments on the role of BAME workers, many of whom have provided an amazing service and put themselves in harm’s way to care for those who are vulnerable. The idea that they are being disproportionately hit by this disease is extremely distressing. The numbers are not to hand so I cannot share precise numbers at the moment, but we are looking into this at speed and trying to understand the causes and the impact of this awful phenomenon. I commit to bring those numbers to the House as soon as they are available.

[Baroness Barker (LD)]

I have heard about a care home which lost one-third of the residents in one weekend. It is that bad. I am told that the Clipper system for ordering PPE is not working and consequently homes are having to try to source PPE by their own independent means and, unlike the NHS, they have to pay VAT on those expensive items. That will push some organisations that were already fairly vulnerable over the edge and they are going to close, so what are the Government going to do to stop that?

[Lord Bethell]

The noble Baroness is entirely right to raise the question of PPE. Looking into the medium and long term, there is undoubtedly going to be a massive demand for PPE in hospitals, care homes and the wider workplace. That has put a dramatic pressure on global supplies. Britain, like every other country, is queuing for supplies of PPE. The Government are throwing enormous resources at increasing supplies. The Clipper system is one of the essential components of getting supplies into the workplace and I believe that is beginning to kick in and is working well.

[The Lord Bishop of Newcastle]

My Lords, it is not just care homes facing these very serious challenges; I have learned that it is also hospices and sheltered accommodation, among other places. Managers responsible for those organisations are under enormous pressure trying to ensure safe staffing levels and the safety of their staff. I hope that sufficient PPE will soon be secured and distributed. Although I recognise the enormous challenge and the efforts that are being made towards that, in the immediate context where we do not have that, can the Minister tell us how the Government aim to advise and support those responsible for running our care homes, sheltered accommodation and hospices, who are having to make such difficult decisions now and many of whom feel abandoned and rather lonely in that responsibility?

[Lord Bethell]

The right reverend Prelate makes the completely fair point that this disease is utterly unfair and cruel in the way that it targets the old and the vulnerable, and those who are in the front line of our care system are carrying the greatest burden of all. Huge resources have been put in place, both financially and in terms of seeking to recruit more staff, but undoubtedly more can be done. Guidelines are evolving at great pace regarding both PPE and other care arrangements, and we are constantly reviewing and updating both the arrangements and guidelines for care home staff, as she suggests.

[Baroness Hollins (CB)]

My Lords, many people with a learning disability share their home with others, with support from social care providers. If a housemate dies from Covid-19, this will be extremely upsetting. Also, many people were taken back to their family home, often by elderly parents, from care settings at the beginning of lockdown. Some will have died there or their elderly parent may have died, leaving them with no familiar support or advocacy. I am concerned about the availability of skills support to people with learning disabilities at such times of traumatic loss. There are accessible resources; I declare an interest as co-author of some that have been developed by Books Beyond Words. How are local authorities supporting providers and families to ensure that those receiving care are supported when someone dies, especially given the easements to the Care Act and the inability of family and friends to visit?

[Lord Bethell]

The noble Baroness raises what is probably the cruellest and most unkind aspect of this awful epidemic: the circumstances of death where those who love and care cannot necessarily be with those who have died or attend the funeral or mark the moment in the way that they would like. It is a cruel and horrible part of this epidemic.

We have put considerable resources into supporting charities that provide care, particularly around bereavement. If the noble Baroness has any charities that she would like to recommend, I ask her to write to me. I would be glad to make sure that they have the resources they need.

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

I have called the noble Baroness, Lady Jones of Moulsecoomb, but we cannot hear her so we will move on.

--- Later in debate ---

[Lord Laming (CB)]

I know that the well-respected Minister recognises that his department is the department not only of health but of social care. Does he agree that there has been an almost total preoccupation in the department with the NHS and a near disregard of social care, resulting in a high price being paid by both individuals and communities? Does he agree that there would be great benefit in a fundamental review of the role of social care, the training and skills of the staff, and a proper regard accorded to those who daily are meeting the needs of the most vulnerable people in our society?

[Lord Bethell]

The noble Lord, Lord Laming, makes a point that I am afraid I cannot agree with. While the press may be more focused on hospitals, we in the department have put an enormous amount of focus on social care. I pay tribute to my colleague Helen Whately, the social care Minister, who does not allow us to spend one minute not thinking about social care. However, the noble Lord is right that social care was deserving of a review in any case, and this epidemic will make that review even more poignant, relevant and important. I very much support his view that a review should take place after the epidemic and that it should be a root and branch look at the social care provision in this country.

[Baroness Jones of Moulsecoomb (GP)]

My Lords, I apologise that I was slow in unmuting. May I come in now?

Covid-19: Removal of Restrictions

Lord Bethell Excerpts

Tuesday 21st April 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, our priorities are to save lives and protect the NHS. When the evidence demonstrates that it is safe to do so, we will adjust the lockdown arrangements. We have set out five clear conditions that need to be met. Adjusting the lockdown arrangements could involve relaxing measures in some areas, while strengthening measures in others. In formulating the right balance, we will be guided at all times by scientific advice and by the evidence.

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

I am grateful to the Minister, but why do he and other Ministers think that the British public are unable to deal with two messages simultaneously? Will the Government now set out a plan for lifting the lockdown in stages when it is safe to do so in each area, just as is being done in other countries and, indeed, is being looked at by the Scottish Government?

[Lord Bethell]

The noble Lord is right that the British public have been incredibly diligent, and I commend all those who have followed the guidelines to stay at home for the impact they have had on the infection rate and the mortality rate. However, we cannot fool ourselves into thinking that the epidemic is over. We have to be clear with, and level with, the public that any changes in the guidelines are some way off, and that they will be presented to the public when our understanding of the medium-term strategy is clear.

[Baroness Thornton (Lab)]

My Lords, I thank the noble Lord for the answer that he has just given, but it still begs the question of why the Government are treating the British public as if they were children. I am sure that it would be possible for them to share their thinking, even at this stage. My question concerns testing. Professor Paul Nurse, director of the Francis Crick Institute, said on 19 March about the way to deliver vital testing at scale:

“Institutes like ours are coming together with a Dunkirk spirit—small boats that collectively can have a huge impact on the national endeavour.”


Does the Minister agree with that approach? Can he tell the House when the Government will be able to utilise all the laboratory capacity, which will ensure mass testing and tracing, and will speed up the likelihood of an exit from the current lockdown?

[Lord Bethell]

The noble Baroness is entirely right. I have spoken to Paul Nurse and commend the Crick Institute on the work it has done to build up the remarkable capacity of 2,000 tests a day. However, there are practical issues with the “Dunkirk spirit”. There are enormous logistical challenges in getting swabs and serology to laboratories. There are logistical problems with them registering the correct patient details and then getting the responses back. We have made substantial advances—the Crick Institute has been a pioneer in this—in bringing industrial levels of organisation both to the very large number of tests done each day and to the logistical backbone necessary to process those results.

[Baroness Brinton (LD)]

Yesterday, the World Health Organization said that Covid is not going to go away, there is not yet a treatment or vaccine and we have to be a Covid-ready society. It still says that any release from lockdown must involve testing, tracing and isolation. Can the Minister say whether there will be enough local sources for testing, comprehensive tracing and arrangements for isolation ready prior to any release from lockdown in the United Kingdom?

[Lord Bethell]

The noble Baroness is entirely right. Tracking and tracing will be absolutely essential for keeping down R0, the transmission rate, when it comes to the implementation of our medium-term strategy. We are working extremely hard to dramatically increase our testing capacity. I assure the House that that capacity is growing enormously, at scale and exponentially. It is our expectation that it will easily meet the requirements of tracking and tracing. That tracking and tracing will be implemented by several work streams. The app already unveiled will be an important part of that, as will the PHE manual contact-tracing resources and the use of any other technological advances and innovations developed as part of this response to the epidemic.

[The Lord Speaker (Lord Fowler)]

Lord Mackay of Clashfern. No? Okay, we will go on. Lord Patel.

[Lord Patel (CB)]

Noble Lords cannot see me, but I hope they can hear me. One of the five conditions the Government have set themselves before any changes will be made to the current lockdown is that they will have to be confident that there will not be a second wave of infection. What scientific evidence will the Government need in support of this decision, and what role will population-based serology testing play in this decision?

[Lord Bethell]

The noble Lord, Lord Patel, asks an incredibly perceptive question. The ultimate decisions will be made by the CMO, who, as noble Lords know, has enormous experience in this exact area. Serology tests play an extremely important role in this by giving an indication of the number of antibodies there are, whether people have a degree of immunity and therefore a sense of how far the virus has spread through the community. However, we are aware of reports that there are recurrences of the virus in people who have emerged and recovered. That creates a great sense of concern around our serology tests.

[Baroness Healy of Primrose Hill (Lab)]

Will making face masks compulsory form part of the exit-from-lockdown strategy? Other countries have implemented it.

[Lord Bethell]

The noble Baroness is entirely right that the use of PPE—certainly in the workplace and, more commonly, in other parts of our life—is likely to be part of our lives in the forthcoming period. However, to date, the British Government have been sceptical about the efficacy of face masks. We do not want to be in a position of misleading or providing false reassurance for the public when there is not sufficient scientific evidence for the relevance of face masks. However, should that evidence emerge and should the guidance change, we will of course follow the science and make the recommendation if it is helpful.

[Lord Ravensdale (CB)]

My Lords, in response to the question from the noble Lord, Lord Patel, the Minister talked about the limitations of antibody testing. Antibody testing can provide crucial information on the penetration of the disease within the population, its lethality and how widespread asymptomatic cases are, complementing work being done in a number of other countries. Can the Minister provide an update on what is being done in the UK on antibody testing?

[Lord Bethell]

Forgive me, my Lords, the beeping of my computer distracted me during my answer to the previous question. I did not want to give the impression that I was sceptical of the use of serology tests; far from it. We are investing a huge amount in research into serology tests of various kinds, both lateral flow and ELISA tests. We have been in touch with more than 180 providers of these tests. The Government recently backed a British-based consortium developing a British lateral flow test of which we have very high hopes and expectations, with a view to potentially doing a large amount of mass testing in the months to come. As the noble Lord rightly implied, you need a level of antibody prevalence for the testing to be accurate and useful. This type of test will be important to us further down the road and I will update noble Lords on the progress of our research as it develops.

[Lord Wigley (PC)]

My Lords, does the Minister agree that the best outcome by far would be for the unlocking to be simultaneous in the four nations of these islands? Does he also accept that that can happen only by the unanimous agreement of the four Governments? Will he confirm that there can be no question of areas ahead of the curve of the pandemic unlocking prematurely and putting in jeopardy the lives of citizens in other areas which are behind the curve?

--- Later in debate ---

[Lord Bethell]

The noble Lord is entirely right. I commend the colleagues from all the nations with whom I have been working over the last month. One of the most singular and impressive aspects of the response to Covid-19 has been the way in which the four nations have worked together. I am enormously grateful to my colleagues for the consistent, collaborative and helpful approach that has characterised this response. Geographical difference is the kind of subject that the CMO will give us advice on. This is, naturally, a huge concern to those who feel that they might be left behind, but the CMO will provide the best advice and we will follow the science.

[The Lord Speaker]

My Lords, I afraid that the time allowed for Questions has now elapsed. I thank all noble Lords who have contributed to the first Oral Questions session by way of a Virtual Proceeding. As the noble Lord, Lord Baker, said, it shows that we can hold the Government to account in different ways. We will, doubtless, get better at it as the weeks go by, but this was a very important beginning and the information that came out was valuable. I thank all noble Lords and apologise to those who did not get to speak. That brings the Virtual Proceeding to an end.

Coronavirus Bill

Lord Bethell Excerpts

3rd reading & 3rd reading (Hansard) & 3rd reading (Hansard): House of Lords
Wednesday 25th March 2020 Lords Chamber

Moved by

[Lord Bethell]

That the Bill do now pass.

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

My Lords, I offer profound thanks to all concerned. I thank the Bill team, who have put together a balanced, thoughtful Bill in an amazingly fast turnaround. I thank my own team at the Department of Health for their enormous support. I thank the team in the Leader’s office and Whips Office who have worked to manage a remarkable programme in order to pass the Bill. I thank those in other parties who have worked in a collaborative, positive and supportive way during the whole process. I thank those who work in Parliament and in the House of Lords who are here today at considerable risk to themselves; they have displayed amazing commitment to this remarkable organisation by being here. I beg to move.

[Baroness Thornton (Lab)]

My Lords, on behalf of these Benches, I thank the Minister for the way he has conducted the Bill. It has been a perfect exercise in consultation and work across the House. I thank not just the parties but other noble Lords who have taken part in this Bill for co-operating and working together in a way that has allowed us to scrutinise it as best we possibly could. I think we raised every issue that we could during its passage. It is important to have those things on the record because, as we move forward, we will need to know that we have asked those questions, and the Government will need to address them.

I thank my team, particularly my noble and learned friend Lord Falconer, who got drawn into this about a week ago, and my noble friend Lady Wheeler. I also thank the people in the office, who of course do all the work. In our case, that is Rhian Copple, who has done a brilliant job in keeping us informed and on the go.

I thank all my noble friends and noble Lords who are not here, but who gave us their views and have been patient. I know that they would have wanted to be here.

Coronavirus Bill

Lord Bethell Excerpts

2nd reading & 2nd reading (Hansard) & 2nd reading (Hansard): House of Lords
Tuesday 24th March 2020 Lords Chamber

Moved by

[Lord Bethell]

That the Bill be now read a second time.

Relevant document: 9th Report from the Delegated Powers Committee

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

My Lords, I bring this Bill to the House with a huge sense of regret about the challenge we are facing and foreboding about the cost to the country of this terrible virus.

The Bill contains key administrative measures that are absolutely essential in helping us to fight the pandemic. It is not everything that we are doing, but it is essential for what we are doing. I am deeply conscious that many Peers are not present for the debate, because they are, quite rightly, following the official medical advice on social distancing and isolation. We have sought to give this Bill a proper level of scrutiny during our extensive engagement. In my remarks, I intend to reflect on some of the concerns that absent noble Lords have raised with me in recent days.

Before getting into the detail of the Bill, let me start by taking a step back and saying a word about its purpose. Fundamentally, this Bill is about buying time. You might not think it from looking at those alarming graphs charting the growth of the disease, but time can help us. With each day that passes, the science gets better. Each day, the models are refined and improved as more data becomes available. Each day brings us closer to faster, more accurate testing capabilities and, ultimately, a vaccine. The infection rate is exponential, but so too is our scientific understanding.

Many commentators have been drawing comparisons between the current pandemic and the grave situation facing our country in 1940. There is value in that, but the historical parallel I would draw is that of the Great War. In 1914, the military planners relied on tactics and technology that would have been familiar to Napoleon. By 1918, the tactics developed would have been recognisable to a veteran of the Gulf War. The learning curve was exponential. I believe it will be the same with this pandemic.

Think how little we knew about coronavirus back in December. The genome had not been sequenced, there was no serology test to tell you if you had already been infected, and we did not even know whether there was human-to-human transmission. Imagine what we will know in six months’ time, once the world’s most advanced economies, including our own, have applied their best minds to solving this problem.

I am an optimist. I am hopeful about our ingenuity and the progress we can make in fighting this virus. That is why time matters. Each day that we can slow the rate of transmission is a small victory that will lead to the ultimate defeat of the virus. We need to buy time for the NHS, flattening the infection curve and raising the capacity line, moving the peak away from the most dangerous winter months. We need to buy time for our society too, saving as many lives as possible and keeping essential public services running as we weather the storm. That is our plan and that is what this Bill contributes to.

There are five main parts to the Bill, and I will take each in turn. The first part is about increasing the available health and social care workforce, shoring up the system as far as possible as it comes under pressure. It allows for the temporary registration of NHS staff and social care workers, for instance those who may have recently retired. It allows recently retired staff to return to the NHS and social care without a negative impact on their pensions. It provides additional indemnity cover, if necessary, to key workers who are called upon to undertake additional duties as part of the response, and it protects the income and employment rights of our dedicated army of NHS volunteers. I know that everyone wishes to thank each and every one of those NHS and social care workers, who are going above and beyond on behalf of the country. We can thank them with deeds as well as words: not buying more than we need, not taking public transport if it is not essential, staying at home to protect the NHS.

The second part of the Bill concerns measures to keep essential services running while easing the burden on front-line staff. This includes introducing flexibility into education legislation, such as temporarily allowing for larger class sizes once schools reopen. It includes expanding the circumstances in which audio and video can be used in the court system. It allows the Home Secretary to suspend airport and port operations if the level of Border Force staff falls below a safe level. To ensure that the Treasury can transact its business at all times, it allows a single Minister or commissioner to sign or act on behalf of the others.

The Bill also ensures that our national security investigatory powers regime remains fully operational during the course of the epidemic, allowing for the temporary appointment of additional judicial commissioners who can sign off vital investigation warrants for our police and security services. Such appointments will be made only at the request of the Investigatory Powers Commissioner. It also allows the Home Secretary to extend the lifespan of a warrant from five to 12 days. Again, this power would be activated only at the request of the Investigatory Powers Commissioner.

Because of the unprecedented pressure on front-line staff, there are some areas where we will have to temporarily relax strict legal requirements for the duration of the emergency. We do not take these measures lightly; they will be triggered only in order to keep people safe and on the basis of expert clinical advice, and they will be relinquished as soon as the danger period has passed. The Bill will allow mental health professionals to secure the advice of one doctor, instead of the usual two, when applying to detain a person with a mental health disorder for the protection of themselves or others. These clauses also allow for flexibilities in the time limits governing the short-term detention of mental health patients. These emergency powers would be activated only in circumstances where there were so few mental health staff available that having to wait for a second doctor would endanger patient safety. Even when enacted, the powers would be used only at the discretion of local mental health trusts, and they would be switched off by government as soon as reasonably possible.

NHS England and NHS Improvement are currently preparing detailed guidance setting out the exact circumstances in which such powers would be used. During the peak period, we also need to ensure that patients are rapidly discharged from hospital when they are medically fit to be. The Bill supports this by allowing the NHS and local authorities to delay continuing healthcare assessments, which can take weeks, until after the pandemic. People who need this support will still receive NHS funding in the interim, but it will mean that local authorities might not meet all the individual’s assessed care needs in full. Instead, under powers in this Bill, local authorities will be required to prioritise people’s most urgent and serious needs and keeping people safe.

Local authorities will still be expected to do as much as they can to meet everybody’s needs during this period, and this will be underpinned by a duty for them to meet needs where not doing so would breach an individual’s human rights. Again, these powers would be triggered only in circumstances in which staff shortages meant not prioritising was putting vulnerable people in danger and they can be switched off while still in the emergency period if circumstances allow. In any event, they would last only for the duration of the emergency.

The third part of the Bill contains measures for delaying transmission of the virus. It gives us the power to restrict or prohibit events and public gatherings and, where necessary, to shut down premises. I know that this will not be easy, particularly for our world-leading creative industries. Yet I have no doubt that the months and years after the pandemic will be a time of extraordinary cultural flourishing for our nation. Consider that William Shakespeare wrote “King Lear”, “Macbeth” and “Antony and Cleopatra” while London theatres were shut down because of plague in 1606. This part of the Bill also allows us to close down educational settings or childcare providers and gives us the power to postpone elections due to take place this year in England until May 2021.

To ensure enforcement of the public health advice, this part of the Bill strengthens the isolation powers of the police and immigration officials, allowing them to detain those at risk of spreading the virus for screening or assessment and to isolate people if necessary. The police or immigration officials would use these powers only in cases in which they had reasonable grounds for thinking that an individual was at risk of spreading the virus, such as due to their travel history or symptoms. It goes without saying that the powers will last only for the duration of the public health emergency. I sincerely hope that they will not have to be widely used because everybody will follow the public health advice, if not to protect themselves, to protect others and the NHS.

The fourth part of the Bill is about managing the deceased. These are not pleasant matters to think about but, as the Health Secretary has said throughout this crisis, we must plan for the worst and work for the best. It expands the list of people who can register a death to include funeral directors. It means that coroners have to be notified only when there is no medical professional available to sign a death certificate. It allows death certificates to be emailed instead of physically presented and removes the need for a second confirmatory medical certificate in order for a cremation to take place.

All of this is designed to ensure that the deceased can be treated with dignity and respect at a time when bereaved families may be self-isolating and many of the professionals who would normally be involved in the process may be unwell. In extreme circumstances, if the level of mortality were to overwhelm the capacity of local funeral services, the Bill contains powers that would allow local authorities to take control of parts of the process. This could include operating crematoria for longer than usual or drafting in parts of the wider public sector to assist. It would be triggered only if there were a risk to public health from not acting.

The fifth part of the Bill contains measures to support people to get through this crisis. It will ensure that statutory sick pay is paid from day one, applying retrospectively from 13 March. It enables small businesses with fewer than 250 employees to get a full refund for sick pay relating to coronavirus during the course of the emergency. It requires industry to provide information about food supplies should it fail to do so voluntarily.

Lastly, the Bill contains clauses that will make it easier to make changes to national insurance contributions, giving us the freedom and the tools to respond to a changing situation if necessary.

This is a Bill for the whole country, jointly agreed by all four Governments of the UK. We understand that it significantly increases government power in some areas, while temporarily scaling back some areas of government responsibility. This is why the Bill has been constructed in a way which means that the different measures can be switched on and off as the clinical situation requires. We have tabled an amendment to give this House an opportunity every six months to confirm that these powers are still required. This gives us the flexibility to respond to the course of the disease. The Bill also requires Ministers to update Parliament regularly on how these powers have been used across the UK. Finally, the Bill will expire after two years unless Parliament decides to extend it.

This is an extraordinary Bill for an extraordinary moment in the history of our country. It gives us the legislative and regulatory toolkit that we need to respond to a constantly evolving situation. It balances public safety with democratic accountability. In a situation where time is the most precious commodity, it gives us more time. I beg to move.

Coronavirus Bill

Lord Bethell Excerpts

2nd reading & 2nd reading (Hansard - continued) & 2nd reading (Hansard - continued): House of Lords
Tuesday 24th March 2020 Lords Chamber

[Lord Bethell]

My Lords, I thank noble Lords enormously for their powerful contributions in this Second Reading debate on this important Bill. It is an incredibly technical Bill; it is nearly 400 pages long. It was drafted on the hoof, at pace and in quick time. Noble Lords have stored up an enormous number of extremely thoughtful and, at times, extremely technical questions; there have been literally hundreds of them in today’s proceedings. I will try my hardest to answer as many of them as I can and I will write to noble Lords where I can, but I emphasise to the Chamber that, given that we will go into recess shortly, my phone remains on for any noble Lords with questions about either the Bill or the ongoing Covid-19 arrangements. I very much want to stay in touch with noble Lords who have questions.

Despite isolation and social distancing, we embraced technological innovation and embarked on a large amount of engagement for the Bill. I thank very much all the parties who engaged on the Bill—the noble Baroness, Lady Thornton, the noble Lord, Lord Newby, the noble and learned Lord, Lord Judge, who is not here, and their various parties and conventions—all of whom engaged in an extremely positive, constructive and important way. The tone adopted was a great example of Parliament coming together. I am very grateful and hope that that will continue during the Bill’s passage.

A number of noble Lords bore testimony to the hard work of NHS staff and those who work in social care. I want to take a moment to say thanks to those who work at Public Health England, without whom we would not be in the good shape that we are in, and who continue to provide incredibly important scientific and supporting work for our healthcare system. I also want to take a moment to say a word of gratitude to every single member of the staff of the House who is here despite the circumstances, as well as to the Bill team, which has literally moved mountains to pull together an incredibly complicated and long Bill in such a short time and done so with great humour and tolerance; huge thanks to them.

I want to use this speech, first, to update the House on a Statement made in another place by the Secretary of State for Health and Social Care earlier today. Ultimately, our goal is clear: we must slow the rate of transmission to protect the NHS. Our instructions are simple: stay at home. People should leave home for one of only four reasons: first, to shop for basic necessities, for example food and medicine, which must be as infrequent as possible; secondly, to exercise once a day, for example a run, walk or cycle alone or with members of the same household; thirdly, for any medical need or to provide care or to help a vulnerable person; fourthly, to travel to and from work but only when it cannot be done from home. Employers should take every possible step to ensure that remote working can happen. These four reasons are exceptions to the rule.

A number of noble Lords, including the noble and learned Lord, Lord Falconer, asked about the powers to enforce the PM’s instructions regarding essential travel and gatherings. For England and Wales, they will be introduced by regulations under the Public Health (Control of Disease) Act 1984. The Coronavirus Bill will give Scotland and Northern Ireland similar regulation-making powers. As the Prime Minister indicated yesterday, these measures are intended to protect the NHS and our social care service, and to save lives. We have taken the right steps at the right time but the spread of coronavirus across the UK is accelerating more rapidly than was originally forecast. Therefore, it is right that this Bill gives all four UK Governments maximum legislative flexibility to reflect the unpredictable circumstances that we will face.

I was pleased to see widespread support in the Chamber from noble Lords for these measures; the measures will, first, increase the health and social care workface; secondly, they will ease the burden on front-line staff; thirdly, they will contain and slow the spread of coronavirus; fourthly, they will allow us to manage the deceased with respect and dignity; and, finally, they will support people in getting through the crisis. However, I assure all Members of this House that none of these powers is taken lightly. The powers that we take in this Bill are not powers that the Government planned to take, but they are absolutely necessary.

A number of noble Lords spoke about the “on and off” aspect of the powers. I want to reassure the Chamber that the Government will activate them only on the basis of scientific advice. Guided by the experts, we will look at the evidence and continually review the effect of these measures.

Many noble Lords pressed me on whether the necessary powers were in place to curtail the provisions in the Bill. To reiterate, such a power is already in the Bill. Most of the powers in the Bill can be suspended and revived by the Government as the science dictates. On top of this, we amended the Bill last night in the other place to allow us to terminate provisions at the six, 12 and 18-month points.

I hope that noble Lords will agree that the Bill achieves the right balance between the necessary powers alluded to by the noble Lord, Lord Newby, and the noble and learned Lord, Lord Falconer, and the proportionality referred to by the noble Lord, Lord Blunkett, and my noble friend Lord Robathan. I am grateful for the endorsement from my extremely learned friend, the noble and learned Lord, Lord Judge, who notes that the Bill is proportionate in the unparalleled circumstances that we face.

I thank those noble Lords, including the noble Lord, Lord Oates, who raised the issue of the deprivation of liberty safeguards. We recognise that we have to strike a careful balance between the need to protect some of the most vulnerable in our society with preventing the spread of the virus. Therefore, we have decided not to alter deprivation of liberty safeguards in primary legislation. However, we think that we can achieve significant improvement to the process through emergency guidance. That will include making clearer when a deprivation of liberty safeguards authorisation is necessary, and the basis on which an assessment can be made, including, for example, phone or video calling for assessment. We are especially grateful to the noble Baroness, Lady Finlay, and other experts, who have worked with us on this. On that note, I also thank the noble Lord, Lord Anderson, who has given sage advice on a number of highly technical and detailed aspects of the arrangements for lord commissioners. I cannot answer those points from the Dispatch Box right now, but I shall certainly take them home and reply to him in time.

This brings me to the Government’s ongoing work to keep the country running. My noble friends Lord Robathan and Lord Naseby spoke movingly about this, as did the noble Lord, Lord Inglewood, the noble Viscount, Lord Colville, and the noble Baronesses, Lady Ludford and Lady Bennett. They have all raised important points about how we will need to fortify our economy and ensure that it bounces back. As I explained in opening, there is a direct connection between the effectiveness of our healthcare measures and our ability to ensure that people can pay their bills and are not driven back to work. The Chancellor has outlined an unprecedented package of measures to protect millions of people’s jobs and incomes as part of the national effort in response to coronavirus. This Government’s response includes strengthening the safety net for the self-employed, who will benefit from a relaxation of the earnings rules under universal credit and deferring income tax self-assessment payments due in July 2020. We have always said that we will go further where we can, and we are actively considering further steps.

The noble Lords, Lord Adonis, Lord Low, Lord Watson and Lord Blunkett, and the noble Baroness, Lady Blackstone, among others, raised the impact of the pandemic on schools and students. As a father of four children who are being home-schooled at the moment, I feel those questions personally. This Government have confirmed that exams will not go ahead this summer and that we will not publish performance tables. These decisions were not taken lightly. There will instead be a standardised grades process set by the Office of Qualifications and Examinations Regulation which will take into account a range of evidence including, for example, non-exam assessments and mock results. Ofqual is working urgently with the exam boards to set out proposals for how this process will work. I assure noble Lords that they will talk to teachers’ representatives before finalising an approach to ensure that it is as fair to students as possible. Furthermore, the Government will issue a statement shortly on what we will do more broadly to ensure that the teaching workforce is maintained.

I turn next to social care and support for the disabled and carers, which was rightly highlighted by the noble Lord, Lord Low, the noble Baronesses, Lady Blackstone and Lady Grey-Thompson, who spoke incredibly movingly on her own behalf and that of the noble Baroness, Lady Hollins. A number of noble Lords expressed serious concerns about the state of the adult social care market to deal with these profound pressures. I assure noble Lords that these concerns are felt very meaningfully at the Department of Health. My colleague Helen Whately is a tireless champion and an effective administrator, who is bringing both money and expertise to bear on this subject.

I completely accept and take on board the testimonies we heard in the Chamber today. The challenge to social care is profound, and many of the anecdotes told and circumstances alluded to in this House are of paramount concern. The challenges we face are enormous. We know that local authorities and providers will do everything they can to continue to meet all needs. The noble Lord, Lord Scriven, spoke movingly and persuasively about that challenge. But we cannot rule out the possibility that, in the coming period, they will need to take difficult decisions and may need to be able to focus their resources on prioritising accordingly to meet the most urgent needs. The inclusion of the Human Rights Act in these provisions is intended to underscore that, where local authorities need to prioritise care during the coming period, there is an absolute and unavoidable obligation on them to meet everyone’s human rights as an absolute minimum. We are developing guidance on how councils can use these powers in the best possible way. The Secretary of State will have powers to direct councils to comply with this.

We also intend to make changes to the current rules regarding entitlement to carer’s allowance for those who have had to take a break in care, so that they can continue to receive carer’s allowance. During the period of Covid-19, emotional support can also count towards the carer’s allowance care threshold of 35 hours a week.

On protecting the most vulnerable, I want to update the House on shielding, which was introduced yesterday. We are writing to up to 1.5 million of the most vulnerable people in the UK to advise them that they will need to shield themselves from the virus in the coming months. We will provide targeted support for all those who will need it, so that they have the food, supplies and medical care to make it through.

I will say a few words about housing, which was touched on by a number of noble Lords. What we are setting out in this Bill delivers on our commitment to protect tenants during the crisis. These measures will mean that landlords cannot start possession proceedings in court for an initial period of three months, providing tenants with a clearly defined breathing space in which they will not have to leave their home because of a new eviction procedure. This is a proportionate response that mirrors the three-month mortgage relief we are giving to landlords with mortgages. We also have the power to extend both the three-month notice period and the date these powers will end, and we are clear that we will use these powers if necessary. This legislation is one part of our package of support; it should not be seen in isolation. We have sought to ensure that tenants will still have income coming in so that they can continue to pay their rent, and additional legal protections for tenants are being introduced.

However, let us not forget that the cold-weather period is a particularly tough time for those sleeping rough, as was quite rightly highlighted by the noble Lord, Lord Adebowale, and the noble and learned Lord, Lord Falconer. Given the grave situation, they quite rightly asked about the steps that the Government are taking to protect and support those who are most vulnerable and living on the streets. Some £1.6 billion of additional funding will go to local authorities to enable them to respond to Covid-19 pressures across all the services they deliver, including stepping up support for the adult social care workforce and for services helping the most vulnerable, including homeless people.

There is much more that can and will be done. Our work is continuing, our funding is increasing and our determination is unfaltering. I welcome the opportunity to meet Social Enterprise UK, an organisation that I am familiar with, and I will ask my personal office to arrange that.

Many noble Lords have asked about the justice system, including the right reverend Prelate the Bishop of Rochester, the noble and learned Lord, Lord Falconer, and the noble Lords, Lord Hastings, Lord Ramsbotham, Lord Blunkett and Lord Scriven, and rightly so; given the way that people are treated in the justice system, this experience may have a profound effect on helping them to recover. In response to why there is no mention of prisons and probation in the Bill, as the noble Lord, Lord Ramsbotham, asks, the Secretary of State has advised that powers exist that are considered sufficient for the needs in prisons and for the probation service at this time. Any decision on the release of prisoners would need to be made by the Lord Chancellor in agreement with the Prime Minister and would need to balance public protection considerations. Any decision to release individuals would also need to take into consideration the shared pressures faced by probation services.

Regarding the extremely delicate and important question of pregnant women, governors have been provided with guidance issued by the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives on supporting pregnant women, and we will continue to provide updates on this. In addition to this, the prison group director for the women’s estate has issued advice on measures that can be used to enable implementation.

I turn to the remarks of the noble Baroness, Lady Barker, who has made some important and pertinent points about abortion. We completely recognise that continued access to safe abortion services has to be a priority, and in early meetings she bore testimony to the challenge and stresses for women in that situation. That will mean that doctors have to work flexibly to ensure that certification can still take place in a timely way, and not to delay women in any way from receiving treatment. There is no statutory requirement for either doctor to have seen and examined the patient. Assessment can take place via telemedicine or webcam or over the phone; DHSC guidance is clear on this point. We are also clear that the doctors can also rely on information gathered by other members of the multidisciplinary team in reaching their good-faith opinion. For these reasons, we do not consider that changes to certification treatment for abortions should form part of the Bill.

I am sincerely grateful for the important contributions made by my noble friend Lord Sheikh and the noble and learned Lord, Lord Falconer, who asked what steps we have taken to ensure that there are no forced cremations for religious followers. This is a very delicate issue, and stakeholder engagement has been moving and persuasive. I reassure noble Lords that we are engaging with faith communities to make sure that contingency measures are designed with due consideration for different practices around managing the deceased.

[Lord Sheikh]

Is my noble friend able to give me the guarantees that the community is looking for with regard to burial and cremation? They are looking for assurances and guarantees.

[Lord Bethell]

My noble friend Lord Sheikh spoke very movingly. The amendment agreed to in the Commons is, I believe, an extremely important step in the right direction. A huge amount of discretion is given to local councils to make arrangements with the communities that they know best. This is a set of decision-making that is best made at a local level, and for that reason I would prefer to leave it in the hands of the amendment and in the hands of the local councils. However, I want to be clear that faith communities will be involved in the drawing up of statutory guidance that will be issued before any direction affecting burial or cremation is issued. It is of the utmost importance during this difficult time that we continue to respect people of faith and their beliefs.

People across the United Kingdom have already responded heroically to this threat, as we knew they would, and it is clear from the quality of discussion that this House will do the same. I am frustrated that there are several noble Lords whose questions I have not been able to tackle; my noble friend Lord Balfe and the noble Lords, Lord Bates and Lord Watson, and the noble Baroness, Lady Bennett, are on my mind, and there are others who may also wish to stay in touch.

I want to be clear that the Bill is a necessary weapon in the fight against coronavirus. The Bill is a vital tool in our efforts to protect lives and, as this debate has shown, it commands broad support.

Bill read a second time and committed to a Committee of the Whole House.

Covid-19: Critical Care Capacity

Lord Bethell Excerpts

Monday 23rd March 2020 Lords Chamber

[Baroness Thornton]

To ask Her Majesty’s Government, in the light of Northwick Park Hospital’s declaration of a “critical incident” and an increasing number of patients across the UK with Covid-19, what steps are they taking to increase critical care capacity in the NHS.

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

My Lords, Covid-19 is the major challenge of our generation. This Government’s priority is to protect life, which is why we are taking urgent action significantly to increase care-bed capacity throughout the NHS, including freeing up almost a third of existing beds. Yesterday, the Government announced a major deal with independent hospitals. That will add to the NHS’s pandemic response 8,000 hospital beds, 1,200 more ventilators and a significant front-line staff number of 10,000 nurses, 700 doctors and 8,000 other clinical staff.

[Baroness Thornton (Lab)]

I thank the Minister for that Answer. It is of course incredibly worrying that, at this stage in the pandemic, Northwick Park Hospital was forced to declare a critical incident over the weekend. That means that it ran out of critical care beds and had to ask neighbouring hospitals to take its Covid-19 patients. It is likely to be two weeks before we may see a steadying of the spread as a result of social distancing measures. If one hospital is already finding itself in such a position, then more might do so in the coming weeks and months. As the Minister said, it is urgent to expand capacity by increasing the number of intensive care beds and ventilators available. Will the Minister detail how many ICU beds and ventilators the Government aim to have in place by the end of the two-week period, at which we hope infection rates will reflect the new measures?

Also, the House may be aware that a fit and healthy 36 year-old nurse is now on a ventilator in Walsall Manor Hospital, having contracted Covid-19. Are the Government confident that the supply of personal protective equipment is no longer an issue after an increase in delivery in recent days and that there are plans to further increase the production of such equipment?

[Lord Bethell]

My Lords, the decision by Northwick Park was entirely welcome, because we welcome the realism and practicality on the part of the management in seeking help when it is needed. We are moving at pace to address the issues around PPE, and I can confirm that there is a massive amount going into the system as we speak. We currently have 3,700 critical care beds; total usage is currently 2,428, of which 237 are Covid-19 related; and our ambition is to increase this dramatically to perhaps 30,000 in time for the crisis arriving in full.

[Baroness Barker (LD)]

My Lords, to increase the number of freelance locums working in the health system, will the Government make specific changes to the NHS Pension Scheme, in particular the death in service benefits, so that we can increase the number of qualified staff? Can the Minister also confirm that the Government are making sure that all GPs and pharmacists have sufficient stocks of asthma and COPD medicines to keep people out of hospital?

[Lord Bethell]

My Lords, we are greatly relying on an influx of staff such as freelance locums in order to increase the numbers at the front line in dealing with Covid-19. Arrangements for the pension scheme are included in the Bill that we will bring to the House tomorrow. On supplies to GPs and pharmacies, a huge procurement programme is going on at the moment, and we are taking stocks out of our no-deal preparations in order to ensure that both GPs and pharmacies are well stocked.

[Baroness Watkins of Tavistock (CB)]

My Lords, many healthcare workers are concerned about their own health, particularly with regard to carrying the virus from their work into their homes and infecting their families. The Financial Times reported this morning that the Government have approached Amazon to deliver coronavirus tests urgently to front-line health and social care workers. This of course would provide some reassurance to staff and enable them to know whether they are infected, and therefore whether they should stay at work. Can the Minister offer an estimate as to when such a scheme could be rolled out?

[Lord Bethell]

My Lords, the bravery and commitment of our front-line staff are to be commended. I think I speak for all of us when I pay tribute to everyone who has put their safety and health on the line. There is no doubt that those in the NHS who are working with those affected with Covid-19 are taking a huge risk, and it is our commitment to support them where we can. Hotel rooms are being booked for NHS staff who are reluctant to return home and who would quite wisely prefer to seek alternative accommodation. Tests are absolutely essential in order to get not only front-line clinical and ancillary staff but the whole country back to work. The Government are committed to finding a way to roll out a testing programme that gives British people confidence that we can beat this virus.

[Lord O’Shaughnessy (Con)]

My Lords, can the Minister be a bit more specific on the diagnostic front? The deal with the private sector is incredibly welcome, and the situation with Northwick Park demonstrates how important it is. However, it is not just about beds and ventilators but people. We know that staff are having to self-isolate because someone at home seems to be ill but they themselves may not be. What kind of numbers are we talking about? The Prime Minister has talked about getting up to 25,000 a day; there are 65 million people in the country. What is the ambition, not just in four weeks but in eight and 12 weeks, of what we might get to and how we will get there?

[Lord Bethell]

My noble friend Lord O’Shaughnessy asks entirely reasonable questions, and he is quite right to press me for numbers. The tests we are talking about for this virus are new—some of them are only a few weeks old. It requires the tests to be tested to ensure that they are delivering accurate results, and for that reason it is difficult to commit to the kinds of numbers my noble friend searches for. However, it is very much the Prime Minister’s desire to have testing as a central part in our battle against the virus, and that is why we are putting enormous resources into it.

[Baroness Northover (LD)]

My Lords, I think I was the first in your Lordships’ House to go through this virus, and I wish other noble Lords the best should they face what I did. I would like to flag to the Minister my experience of the lack of capacity in the NHS only a few days ago. It included: paramedics not knowing that breathing difficulties were associated with coronavirus; no proper delineation of red and green zones when we were in the isolation part of the hospital—we were taken through the A&E part to get there; and inadequate protective clothing of those in that isolation unit. Above all, the poor doctor who was looking after me told me that her colleagues could not be tested for coronavirus even though they were getting ill and had treated and given transfusions to known coronavirus cases. That was two or three days after Chris Whitty briefed us here about how testing was vital and would be continued during what was coming down the track—that is, the so-called delay phase. Can the Minister reassure us that such lack of capacity, which was astonishing in a north London hospital, is being actively addressed?

[Lord Bethell]

My Lords, I welcome the testimony of the noble Baroness and cannot help but be moved by the situation she describes. This virus has moved incredibly quickly. Hospitals are doing amazing work to adapt to the conditions that dealing with the virus requires, and everyone is learning how to do it on the job.

[Baroness Blackwood of North Oxford (Con)]

My Lords, I welcome the reassurance that we have been given by the Minister that testing is being scaled up, especially for health workers, but surely a serological or immunity test will be the real game-changer, because it will allow us to track those who have already had the virus, even unawares, and who are safe to return to work and help the most vulnerable. It is also essential that PPE is available, especially on the front line, to ensure infection control. Can my noble friend update us on whether availability of that is improving and on the training available to ensure that it is used most effectively?

[Lord Bethell]

My noble friend Lady Blackwood is right that there are two types of test. The first is an antigen test to ensure that those in hospital, as workers or patients, do not currently carry the virus, and the second is a serological or antibody test that will confirm that a person has the antibodies and can therefore return to work, either on the front line or elsewhere. Both those tests exist, but mass production is restrained. We are working extremely hard with manufacturers around the world, and with British firms, massively to escalate our capacity.