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.

Covid-19: Helplines

Lord Bethell Excerpts

Thursday 19th March 2020 Lords Chamber

[Baroness Watkins of Tavistock]

To ask Her Majesty’s Government what plans they have to establish a COVID-19 specific helpline in addition to NHS 111; and whether any such helpline could be staffed by retired medical and nursing professionals.

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

My Lords, as part of its coronavirus response, NHS 111 has already trained an additional 1,000 call-handlers. NHS England has been clear that investment will increase as demand continues to rise. As part of the health system’s wider response to the coronavirus, the GMC, the NMC and other professional regulators have written to professionals who have left their registers within the past three years to ask them to return to support the coronavirus response.

[Baroness Watkins of Tavistock (CB)]

My Lords, I first acknowledge the Lord Speaker’s demonstrable leadership in deciding to work from home. We need to remember that we are televised and we need to model the behaviour we are asking of the rest of the country. I thank the Minister for his response, but draw his attention to the fact that there are many retired professional health workers who wish to contribute to the NHS and social care needs of our population in all four countries of the UK but who have their own health concerns. Many, like myself, are fit enough to return to clinical practice and are of course willing to do so. However, utilising others by quickly teaching them a specific algorithm for the Covid-19 virus could relieve anxiety and provide advice to our population and, in particular, relieve NHS 111 to deal with other concerns. We are very worried that, even in the short term, people with perhaps severe problems who should be ringing 999, but do not know that until they have rung 111, will have to wait a disproportionately long time. I wonder whether we could see how quickly we could get a specific line using the expertise of the people I referred to.

[Lord Bethell]

The noble Baroness, Lady Watkins, reflects the feeling of all the House in her comments on the Lord Speaker, and I entirely endorse her comment that we must all respect the guidance and advice given to us by the Government. I pay tribute to the Lord Speaker for his comments on that subject.

In terms of 111, she is entirely right that the NHS is under acute pressure, which is particularly felt on the front line in the interaction with concerned people who are understandably phoning 111. The 111 system is recruiting a large number of new handlers. In addition, we have put a letter through the GMC, NMC and other professional bodies and there will be a registration page on the front page of those bodies’ websites—it will be going up very shortly, either tomorrow or very soon afterwards, I believe—for recently retired professionals to register their interest in rejoining their local NHS health authorities in some way. Those applications will then be passed on to the local authorities and triaged, and the applicants will be allocated suitable responsibilities. I pay tribute to all those who are thinking of returning or have returned to active service, often putting themselves in danger and taking risks in the service of the NHS to look after patients. The skills of the recently retired may range from those who are younger and active and can be on the wards through to older people who may have desk-based tasks, but it is up to the local authorities to decide where best they can conduct their services.

[Baroness McIntosh of Pickering (Con)]

My Lords, will my noble friend join me in congratulating the Lord Speaker on the leadership he has given? I declare my interest, as in the register: I work with the Dispensing Doctors’ Association. Can my noble friend address the question of professional indemnity for those wishing to return to practise as recently retired nurses, doctors or other medical professionals? Can he also address the question that I have written to him about regarding the severe shortage on the front line of PPE, which is apparently in warehouses? It really needs to get to the front line.

--- Later in debate ---

[Lord Bethell]

The question of indemnity insurance is addressed in detail in the coronavirus emergency Bill. We are fully aware of the concerns of anyone returning to work, and indeed anyone who might have indemnity insurance in one area of practice but who will be asked to take on exceptional duties required as part of this emergency—the surgeon, for instance, who takes on respiratory support duties. Those indemnities will be thorough and will cover all work. In terms of the warehouses for PPE, it is incredibly important that there is load allocation according to the need for the PPE, not necessarily the demands of local authorities. There is therefore an active allocation of PPE to those areas that have the highest incidence of the virus. That is being managed centrally in a thoughtful and professional manner.

[Lord Alderdice (LD)]

My Lords, I direct the House to my medical and other interests in the register. I have no doubt that NHS 111 and other helpline medical professionals and health professionals will give the best advice. But Professor John Ioannidis at Stanford University has pointed out that we are making major changes in the way we run society, on necessarily limited evidence for what happens with this virus. Can those working on NHS 111 and any other advice lines also take epidemiological data on the length of time and types of symptoms and, particularly, geographical spread, and feed that data back to research institutes inside and outside the NHS, so that we can get the best handle possible, as soon as possible, on how this virus operates?

[Lord Bethell]

The noble Lord, Lord Alderdice, is entirely right: one of the features of this virus is its extremely unpredictable nature. The way in which it reacts in different people at different times is extraordinarily diverse. Some people appear to be completely knocked out by it; some have the lightest possible symptoms. There seems to be an alignment with age. We are all enormously thankful that the young and very young seem to be blessed by having the light symptoms. We are all extremely concerned about the old, but it is not even as simple or as linear as that. A huge investment is being put into understanding the virus better. I am pleased to report to the Chamber that international co-operation on that is extensive and positive, and that British researchers are at the leading edge of pulling together that data.

[Baroness Thornton (Lab)]

My Lords, this is a question on co-ordination. Yesterday, I saw the script that 111 is using right now; it was perfectly intelligible and sensible. However, it was out of step with what was on Public Health England’s website. I am sure that is a timing issue but it is rather important, because it will increase anxiety. Moreover, the digital exclusion of the elderly and vulnerable is a really serious problem because suggesting to people that they should go online in the first instance is entirely inappropriate for people who can manage a phone, but that is about it. Many of us are probably related to people in that position, so having plans to deal with that—as suggested by the noble Baroness, Lady Watkins—is very important.

[Lord Bethell]

The noble Baroness, Lady Thornton, is right that the Government have moved incredibly quickly, particularly in the last two weeks. The pace of the virus has been faster than initially expected. The response by some of our international partners has in part conditioned our response, and we are working extremely hard to ensure that all parts of the machine keep up with each other. There will inevitably be occasional glitches, but I pay tribute to the NHS, Public Health England and, in fact, the entire Whitehall machine for moving incredibly quickly and, under the circumstances, demonstrating a relatively high level of consistency in the advice as policy has changed.

Covid-19: Vaccine

Lord Bethell Excerpts

Thursday 19th March 2020 Lords Chamber

[Lord McNicol of West Kilbride]

To ask Her Majesty’s Government what steps they are taking to ensure that UK production facilities are able to develop and produce sufficient quantities of any vaccine for COVID-19.

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

My Lords, vaccine development is moving very rapidly but is still at a very early stage. The Government are working closely with industry to assess UK manufacturing capability for a range of potential new vaccines. The type of capacity and specific route needed to take this further will be determined by the technology used to produce the vaccines and the types of vaccines produced.

[Lord McNicol of West Kilbride (Lab)]

I thank the Minister for that Answer. The Question is about not just the production of vaccines but the production facilities to mass-produce them. Understandably, the priority now must be supporting those infected and the front-line staff with the production of ventilators. However, we should be planning for what comes next, as the Minister said, and the development of vaccines is part of that. What discussions have been had, or decisions made, between the Government and UKRI about scaling up? When we get the vaccine, that will be fine, but what about the ability to scale it up? We will need to build the factory now; normally that comes after. Can we explore a little further whether the work on scaling up is happening, as well as the development of the vaccine?

[Lord Bethell]

The noble Lord, Lord McNicol, is entirely right to focus on the importance of vaccines. The Government are extremely concerned that the entire public have a clear line to having confidence that they can rid themselves of the threat of the virus so that we can all get back to work and normal life. That will not be possible until we have a vaccine. If I may digress for a moment, one consideration is that, for a vaccine to work, it will have to be taken by billions; for that, it must be as safe as houses. I contrast that with the vaccine for Ebola, where the death rate was at nearly 80% and a just-about-good-enough approach could be taken. However, the coronavirus has a relatively low mortality rate and the introduction of an added risk factor into the population is something we can avoid. For those reasons, the development of a vaccine is considered to be at least a year or 18 months off. However, the noble Lord is entirely right that planning for the production of the vaccine, when it is fully developed, is front of mind for the Government.

[Baroness Blackwood of North Oxford (Con)]

My Lords, ever since John Snow discovered the link between the famous London water pump and the cholera outbreak in 1854, UK scientists and innovators have led global efforts to tackle infectious diseases. We should be very proud of that. However, many UK biotechs and healthtechs which are leading the race to fight Covid-19 are loss-leading and will struggle to raise risk capital in the current climate to maintain operations. One very simple intervention the Treasury could make would be to pay R&D tax credits in advance. This would be matched very well to each individual company and could be based simply on their most recent claims. Will the Minister look into this as a matter of urgency?

[Lord Bethell]

My noble friend has an important and exciting idea, and I am grateful to her for communicating it to me in advance of today’s Question. I have already taken the idea to Treasury colleagues. I have not had a formal response, but the idea supports a pressing and important need in the essential life sciences sector and seems to have strong merit. I hope it will go far.

[Lord Scriven (LD)]

My Lords, the Question asked by the noble Lord, Lord McNicol, was very clear: it is not about the production of a vaccine but the facilities to manufacture that vaccine at scale. At the moment, the Government have made £46 million available for research into the vaccine. What money and planning are going into the facilities so that, once a vaccine has been made, it can be produced at scale in the UK?

[Lord Bethell]

The focus on the actual production of the vaccine is a matter of sequencing. We are moving incredibly quickly in all areas, but the focus at the moment, I think understandably, is on trying to get a product developed. In that respect, I bear testimony to the Oxford Vaccine Group and Jenner Institute at Oxford University, which have been shortlisted for the CEPI group of seven for potential vaccine development. This is an incredibly important development and shows the strength of Britain’s contribution to the development of vaccines.

Contraceptives and Hormone Replacement Therapy Drugs

Lord Bethell Excerpts

Wednesday 18th March 2020 Lords Chamber

[Baroness Thornton]

To ask Her Majesty’s Government what assessment they have made of the shortage of supply of (1) contraceptives, and (2) hormone replacement therapy drugs, in the United Kingdom, and when they expect that the normal supply of these products will resume.

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

My Lords, we are aware of ongoing supply issues with some HRT drugs and a limited number of contraceptives. We are sympathetic to those affected. I am pleased to say that the supply situation for HRT started to improve at the end of February and continues to improve during this time. However, we will work closely with all suppliers and share relevant information on availability to the NHS on a regular basis to ensure that patients can access the medicines they need.

[Baroness Thornton (Lab)]

I thank the Minister for that Answer. I am very happy that things are improving, because a number of HRT medications and contraceptives remain unavailable until the end of this year, some patients have been told, or until they do not know when. I understand that some of the shortages are triggered by supply problems in China, with some of the components of the popular HRT patches being increasingly in demand for other types of treatment that, in their turn, have become scarce. Of course, one guesses that further disruption in China in the wake of the coronavirus will affect the production and supply of prescription drugs. Does the Minister share my concern that online pharmacies are exploiting desperate women by charging up to four times NHS prices for HRT and contraception?

[Lord Bethell]

The noble Baroness, Lady Thornton, is entirely right that supply problems persist. The NHS looks after 11,000 drugs and at any one time around 100 or 150 have supply problems. It is a great frustration to those concerned and we are cognisant that HRT has been a persistent problem for more than a year. However, the outlook is positive. I reassure the House that Covid-19 has not had an impact on the supply of HRT. We do not envisage there being a connection or a problem. I share the noble Baroness’s concerns that online pharmacies might take advantage of the situation, but it is a marketplace: it provides choice and is regulated.

[Lord Alderdice (LD)]

My Lords, when women go to the chemists to get their prescription, they might well find two problems. The first is the one the noble Baroness mentioned—inadequacy of supply—but it is also increasingly likely that pharmacists themselves will fall ill, so not only the advice, but even the dispensing of available pharmaceuticals will be impossible because they will have fallen ill. Can the Minister tell us what conversations Her Majesty’s Government have had with the Royal Pharmaceutical Society to free up some of the normal professional regulations and requirements for exemption and insurance so that relatively recently retired chemists may come back to fill in the gaps that will undoubtedly be there and which will make many pharmacies ineffective because there is no chemist to dispense?

[Lord Bethell]

The noble Lord is entirely right to focus on pharmacists. I pay tribute to the important role they play in communities. Their role will be essential in the forthcoming months when enormous pressures will be put on hospitals. We will be encouraging people to avoid areas of infection. A typical pharmacy where there are two pharmacists, who might be related or even married, will clearly be under pressure. Two people working closely together are clearly an infection challenge. That is why we have engaged very closely with the pharmacy industry. The noble Lord is entirely right that the possibility of using recently retired pharmacists is being considered. Soon-to-qualify pharmacists might face early call up. Many have already been written to and there might be provisions in the forthcoming coronavirus emergency Bill to expedite the regulatory changes the noble Lord suggests.

[Baroness Symons of Vernham Dean (Lab)]

My Lords, the Minister just told the House that HRT has been in short supply for over a year. Why have the Government not taken effective action on this before now?

--- Later in debate ---

[Lord Bethell]

The noble Baroness is entirely right to express her frustration. It is enormously frustrating for those concerned and for our medicine supplies. Medicine production is a long-term business. There was a point when HRT consumption went down, but then demand grew exactly when some production facilities had backed off their supply. It was an incredibly unfortunate combination of events that has led to this situation, but I reassure the House that we are working extremely hard to provide alternatives and to replace those most favoured products that are in short supply at the moment.

[Lord Kakkar (CB)]

My Lords, I remind noble Lords of my declared interests. Has thought been given to whether novel therapies that might soon become available from research elsewhere in the world might be applied to the management of patients infected with coronavirus in our own country? Is the Minister content that the current regulations that govern the use of medicinal products in man are sufficiently flexible to allow for drugs that not only currently exist but might be repurposed for this, and for novel and innovative therapies, neither of which might be licensed for use in the United Kingdom at the current time, to be made available without further impediment if that was thought to be a useful intervention?

[Lord Bethell]

The noble Lord, Lord Kakkar, is entirely right to stress this point about regulation. I assure him and the House that we are working extremely closely with Public Health England and the MHRA to ensure that there will be no regulatory hurdle that prevents the swift introduction of proven, safe products into the UK market. This is a massive priority that has had great scrutiny from both the department and Downing Street. It is one that we are focused on and will continue to focus on.