Covid-19 Update

Lord Bethell Excerpts

Monday 16th March 2020 Lords Chamber

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

My Lords, with the leave of the House, I will now repeat a Statement made in the House of Commons by the Secretary of State for Health. The Statement is as follows:

“Mr Speaker, thank you for allowing me to make a Statement at this time. The coronavirus pandemic is the most serious public health emergency that our nation has faced for a generation. Our goal is to protect life. Our actions have meant that the spread of the virus has slowed in the UK. I pay tribute to the officials at Public Health England and the NHS for their exemplary approach to contact tracing and their work so far. However, the disease is accelerating, and 53 people have sadly now died. Across the whole House, our hearts go out to their families. Our policy is to fight this virus with everything we have.

Last week, my right honourable friend the Chancellor confirmed a £30 billion package of financial firepower, including a £5 billion contingency fund to ensure that the NHS and social care system have the resources that they need. We will give the NHS whatever it needs and we will do whatever it takes. We will get through this by working through our action plan to contain, delay, research and mitigate the virus. That plan has two overriding aims: to protect the NHS by building it up and flattening the curve, and to protect life by safeguarding those who are most vulnerable. We will do the right thing at the right time, based on the best scientific advice.

Earlier, I attended a COBRA meeting, chaired by the Prime Minister, to decide on the next steps in our plan. I can report to the House that we have agreed a very significant step in the actions we are taking from within our plan to control the spread of the disease. These actions will change the ordinary lives of everyone in the country. We appreciate that they are very significant and I understand that people will be concerned. But we have come to the view that they are necessary to save lives and to stop this disease.

First, based on the updated scientific advice, we are today advising that if you or anyone in your home has a high temperature or a new and continuous cough, then you should stay at home for 14 days. If at all possible, you should not go out even to buy food and essentials. Instead you should ask others for assistance with your daily necessities. The exception to this is for exercise. Even then, you should keep at a safe distance from others.

If it is not possible to receive deliveries at home, then you should do what you can to limit your social contact when you leave the house to get supplies. Even if neither you nor anyone in your household have symptoms, there is more that we ask of you. Today we are advising people against all unnecessary social contact with others and all unnecessary travel. We need people to start working from home if they possibly can. We should steer clear of pubs, clubs, cinemas and restaurants. We should only use the NHS when we really need to. This advice is directed at everyone, but it is particularly important for the over-70s, pregnant women and those with some health conditions. It is especially true of London, which the evidence suggests is several weeks ahead of the rest of the country. These measures will be disruptive, but they will save lives.

In a few days’ time—by this coming weekend—we will need to go even further to ensure that those with the most serious health conditions are largely shielded from social contact for around 12 weeks. We want to ensure that this period of maximum shielding coincides with the peak of maximum transmission; and while the risks of transmission at mass gatherings such as sporting events are relatively low, from tomorrow we will be withdrawing our support for mass gatherings. This will free up critical workers we need to deal with the emergency and ensure a consistent approach to social contact.

Secondly, we are increasing our testing capabilities yet further. The UK has tested more people than almost any other major economy outside of China, South Korea and Italy. We have already increased the number of tests to 5,000 a day. This is now on its way up to 10,000 and then radically further.

Thirdly, we are boosting the NHS. Ventilation is mission-critical to treating this disease and we have been buying up ventilation equipment since the start of this crisis, but we need more. Today the Prime Minister hosted a call with the nation’s advanced manufacturers, asking them to join a national effort to produce the ventilators we need. We have set up a dedicated team to do this, and we are hugely encouraged by the scale of the response so far. Later today, the NHS itself will set out the very significant steps it is taking to prepare.

Fourthly, on Thursday, we will introduce to the House the coronavirus emergency Bill. This Bill will give us the powers to keep essential services running at a time when large parts of the workforce may be off sick. Some of these measures will be a very significant departure from the way we do things in peacetime. These are strictly temporary and proportionate, and I hope that many will not have to be used at all. They will only be activated on the basis of scientific advice and will only be in place for as long as is clinically necessary.

Finally, we are ramping up our communications efforts so that people know what steps they need to take to protect themselves, others and the NHS. Tackling coronavirus is a national effort and everyone has a part to play. The more people follow the public health advice, the less need there is to bring in the draconian actions which I am keen to avoid. Of course, we must not forget the simple things we can all do: washing your hands; following the public health advice if you have symptoms; and looking out for the most vulnerable in the community.

The measures I have just outlined are unprecedented in peacetime. We will fight this virus with everything we have. We are in a war against an invisible killer and we have to do everything we can to stop it. I commend this Statement to the House.”

My Lords, that concludes the Statement.

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[Baroness Brinton (LD)]

I too thank the Secretary of State and the Minister for the Statement. I also thank the Prime Minister, the Chief Medical Officer and the Chief Scientific Adviser for the press conference earlier, which laid out the new advice that we will have to take into account. I will come to this at the end of my comments, but I note in particular the advice to people over 70 and with underlying health conditions; I have been asking in your Lordships’ House for specific advice for about six weeks now—at last, it is here. A couple of points of clarification would be useful but it is extremely helpful.

I also thank all NHS and social care staff, public health officials in our local communities and other public servants who are all now working above and beyond even the emergency duty. We on these Benches recognise them across the country in everything they do. Our thoughts are with those who are currently ill and the families of those who have died.

I will not repeat much of what the noble Baroness, Lady Thornton, said, but I want to make the point that the past week has seen a big sea change in attitude among not just the public but many experts who may not be epidemiologists but certainly have an understanding of modelling. It is important to keep them onside by making sure that the modelling is published; I echo the concerns that that has not happened yet, although I note that Chris Whitty said that it would become available in due course.

I share the horror at the Daily Telegraph article being behind a paywall. Notably, some of the largest American newspapers are making every single article on coronavirus free so that the public can access it; I wonder whether we could encourage our newspapers to do the same.

On testing, which seems to be the big issue of the day, I had an email from a friend who has been in a hospital in London with a severe case of coronavirus. That person is recovering now, but it was noticeable that there was an astonishing lack of knowledge on the part of paramedics, NHS 111 and others that breathing difficulties were a symptom. It was assumed that she was having a panic attack, although she had never had one in her life before. It was clear that A&E was completely overwhelmed. There was not enough protective equipment, and the doctor who saw her said that when doctors themselves became sick at their hospitals they were told to self-isolate for seven days but were not being tested, so they did not know whether they were immune or infectious.

The doctor concerned was desperate, and said that testing seemed to be happening only in care homes and in hospital outbreaks. The whole system had been overwhelmed. According to the Health Service Journal, the Department of Health and Social Care has said that the regime is set up to provide testing, but at the moment it is unclear how it will be applied. More and more of the people we are asking to go on to the front line are feeling very exposed.

Moving on to some workforce issues, various airline companies have announced that they are in real trouble; I think everybody understands why. And they are not alone. From these Benches, I express real concern about the Prime Minister’s announcement today, in which he encouraged people not to go to clubs, cinemas, restaurants and theatres. That is likely to mean that many of those businesses will not be able to claim on their insurance, as they could if this was an instruction, as opposed to a guide. Can the Minister tell us why the Prime Minister used that framing? It will cause serious problems for many small businesses.

As for other money issues, it is reported that there is a very large drop in donations to food banks. What will the Government do to ensure that the many thousands of people who rely on food banks will continue to get the support they need, when most people are no longer dropping two or three items into the boxes as they leave the supermarket?

There was some debate recently, involving the House of Commons Library, about sanctions for those attending jobcentres. According to the Library report, Will Quince MP had said that there would be discretion, and that people would not be sanctioned as long as they let the jobcentre know before the appointment. There are two problems there. First, if someone is sick they may not be able to call in and spend the hours it takes on the phone to do that. Secondly, if staff at the DWP are ill, there may not be enough people available to take those messages. Surely during this crisis—the Prime Minister has made it plain how severe it is—sanctions should be stopped for everybody.

Finally, on the advice to the over-70s, I am grateful that Chris Whitty said this afternoon that anybody, adult or child, with an underlying condition, including anybody who had had to have a flu jab, should consider taking action, especially if they have respiratory problems. Can the Minister confirm that and make it clear? I understand that the message about flu jabs has just come down from the website, so I am concerned that there will be confusion. There is no doubt about people who are immunosuppressed, but will he please reassure people who use inhalers—that is certainly one of the categories on the Department of Health and Social Care website—that they will be included?

[Lord Bethell]

My Lords, I thank the noble Baronesses, Lady Thornton and Lady Brinton, for their testing but important questions. Let me go through them systematically. As there were quite a few, I will do it at pace.

I can reassure the Chamber that the CMO has committed to publishing advice. It is extremely complicated, because the models used by SAGE are the result of many different collaborators submitting papers to a central committee, so publishing something simple and robust that can be used by third parties is not as easy as it might initially seem. But that commitment has been made, and we support the commitment to transparency.

In answer to the question from the noble Baroness, Lady Thornton, about other countries’ data, I reassure the Chamber that there is an extremely strong spirit of collaboration between the countries of the world in fighting this virus. The Prime Minister had a G7 call over the weekend, in which there was a very strong commitment by those countries. That will begin a cascade of inclusion to other countries around the world in order to launch a real commitment to combating the virus. That spirit of collaboration is a powerful and encouraging dimension of an otherwise very difficult situation.

Both the noble Baronesses asked about tests: this is a really important question. The tests that we have are, rightly, being concentrated—as the noble Baroness, Lady Brinton, alluded to—on ICU units and care homes. The reason is that it is likely that those who show the most symptoms are also the most infectious. Therefore, the people who are most likely to catch the virus are those who are nearest those who have the strongest symptoms. Those include our healthcare workers, who not only deserve to be protected but need to be, in order to keep our health and social care system working. That is, therefore, where the tests are being focused.

It is also worth saying that, until the end of this week or next week, we are at the very tail end of the winter flu cycle when, if you have a cough or a cold, it could be any number of viruses. However, that is likely to change and, as we go forward, if you do have a cough and a temperature, it will be most likely that you have coronavirus and so the relevance of testing diminishes. None the less, we are working extremely hard to increase the number of tests available and the way in which we test will move to bedside instead of central testing. We hope to be able to develop an at-home test. I believe that there is news of that on the horizon.

The noble Baronesses, Lady Thornton and Lady Brinton, both asked about the media. I reassure the House that the article in the Telegraph was not behind a paywall; it was freely available from 11.20 pm last night. I can confirm that, if any noble Lord has any concerns about it. The Prime Minister has made a commitment to daily updates, in the company of his medical advisers. The public have clearly found that approach reassuring, and it will continue during this important phase of the virus.

The noble Baroness, Lady Thornton, asked about those with underlying health conditions and whether the definitions were clear. The noble Baroness, Lady Brinton, asked about flu jabs and whether those on the flu jab list would be contacted. I reassure both noble Baronesses that those on the flu jab list will be contacted by their GPs within the next few days. Advice will be given and, where necessary, health and care packages put in place for them. Those with underlying health conditions will be contacted by local GPs in order to clarify exactly what kind of risks individuals face.

Both noble Baronesses rightly brought up the question of the economy. This is an area of massive concern, not only to the Government but to everyone whose job and livelihood are threatened by a slowdown in the economy. Without doubt, the recommendation to close clubs, pubs, theatres and all manner of social gatherings will have a profound effect on the economy. The Chancellor has already committed billions of pounds to an economic fund to try to support those industries. Further work is being put into place to ensure that businesses can see this epidemic through.

Those who are homeless or in the gig economy will be the particular focus of measures. We are working extremely hard to change the system of statutory sick pay to include those who would not necessarily be captured by the usual arrangements. That work is still in progress, but we look forward to providing an update when the coronavirus emergency Bill is brought to Parliament on Thursday.

The noble Baronesses, Lady Thornton and Lady Brinton, asked about ventilators. These are clearly the key pieces of equipment that we need to combat the most profound effects of the virus. We have 5,000 in our stock and are working extremely hard to increase that number dramatically. Industry has responded extremely positively. We have been overwhelmed by the response from all parts of industry, from big, established companies to innovators, academics and those with good ideas for how to increase the number of ventilators. We were already in the market many weeks ago and have done a lot to shore up our supplies.

It is entirely right that any number of ventilators will not be any good if you do not have the staff to man them, so we are going about retraining existing clinical staff in how to use them. To give an example, on Saturday I sat next to a surgeon who has found that his operating theatre has been turned into a respiratory support unit. He and his anaesthetist are learning how to work the respirator.

The NHS undoubtedly faces a period of enormous pressure. There is no amount of special pleading that I can do from this Dispatch Box to hide the fact that front-line clinicians and support staff will be under huge pressure. They will take profound personal risks and they are being asked to deliver an important national duty. As I am sure that everyone in the Chamber does, I pay tribute to the work that they have already done and to the work in prospect on the horizon.

Lastly, the noble Baroness, Lady Brinton, asked about food banks. I reassure her that we have a full understanding of the challenge faced by charities—the collapse of not only food donations but financial donations. That is why special provision has been given to DCMS to provide funds for charities, which will play an incredibly important part in many aspects of this national effort, particularly in providing the kind of support to social care needed for those who face an extremely difficult time of loneliness and exclusion as they take the correct decision to socially distance themselves from this virus.

[Lord Lamont of Lerwick (Con)]

My Lords, could my noble friend clarify some of the stories about possible future steps that the Government might take, particularly regarding those over 70? There have been some stories about a relatively draconian policy of self-isolation for a very long time that might itself promote certain health problems in those people if the isolation were carried out to that extent. This story appeared in newspapers. On the other hand, we have had the statement by the Chief Medical Officer of Scotland saying that Scotland would not follow such a policy but would be more limited in calling on elderly people to cut back their social contacts by 20% or something like that. Do I take it from today’s Statement that the latter version of the policy is the direction in which we are going?

[Lord Bethell]

My noble friend is entirely right to ask about the exact guidance. I will be clear: everyone in the country is being asked to cut out non-essential social intercourse and to work from home where possible. In the case of over-70s, that is particularly true. If you are over 70, the guidance is very clear: you should take great care of yourself because you are in a very difficult position. Those who have underlying conditions, whether they are over 70 or not, must take particular care of themselves.

As the CMO explained very clearly earlier today, the advice is moving towards those people distancing themselves or even shielding themselves completely from social intercourse. My noble friend Lord Lamont is entirely right that that comes at an enormous cost. Isolation and loneliness will be extremely difficult challenges for those involved. There is a massive mental health issue on the horizon. As a community and as a country, we are going to have to figure out how we come together to provide support for those who have made the entirely right and responsible decision to stay away from society.

[Lord Hain (Lab)]

My Lords, can I press the Minister on the question of financial support? In 2013, a parliamentary report stated that taxpayer outlays direct to the banks were £133 billion. People were not told then not to fly or not to go to restaurants, theatres or any kind of hospitality outlets. Now, we hear from the Chancellor that there will be £12 billion: £7 billion support for businesses and £5 billion for the NHS. This is nothing like the scale of financial support that is needed from Governments, either globally or particularly in Britain, to meet the challenge that he has described so eloquently.

[Lord Bethell]

The Government are under no illusions about the size of the challenge. The package announced in the Budget was an initial commitment. Whatever funds are needed will be made available, in particular to support the NHS and our social care but also to support hard-working businesses and those that provide employment and sustenance to the country.

[Lord Berkeley of Knighton]

My Lords, could I tempt the Minister to say a little bit about the antibodies test? Obviously, the test being used at the moment to tell you if you have coronavirus is a swab test. But the one that could make a huge difference to NHS staff would be an antibody test, particularly if it gave one immunity. This could completely transform the workforce and people’s ability to get to work if they had been exposed in the past. Could he say a little more about that?

[Lord Bethell]

The noble Lord has hit upon an essential conundrum of the testing framework. I am not the expert who can give chapter and verse, but my layman’s understanding is that the antibodies test on which he rightly focuses is some way away. The biggest difficulty for testing is knowing who has had the virus but never shown the symptoms. Unfortunately, one of the difficult challenges for our response is not yet having that test; it holds us back, but we are working on it very hard indeed.

[Lord Scriven (LD)]

My Lords, my question follows on from the noble Lord’s question on testing. The reason why mass testing is important is that data aids the science, and science aids the response. There are two types of test. One is the PCR—swab—test, which tells you whether you have the coronavirus. On that test, what is the stock level within the NHS and how many more are on order so that rationing will not have to be as narrow as it is at the moment? If the Minister cannot answer that question, could he write to me to let me know? Secondly, on antibody testing, it has been trialled in Singapore, there are certain licences in China and I am aware of at least one biomedical company in Belfast that is producing 20,000 a day. Which companies are the Government in contact with on the antibody test, and when do they expect this test to be available within the NHS? Again, if the Minister cannot answer directly, could he write to me please?

[Lord Bethell]

The noble Lord, Lord Scriven, asks all the right questions. The honest answer is that it is a changing situation. The information that I had on this a week ago has changed even to today. What I can tell you is that there is an enormous global effort going into research in this area. The noble Lord, Lord Scriven, rightly cites the Singapore test, about which we are in touch and keen to find out more. A huge number of offers are incoming to the central co-ordinating committee. An enormous amount of funding and money is coming not just from the UK but from America, Europe and all the major nations trying to crack this. I live in hope that we will be able to do mass testing within the near horizon.

[Lord Bridges of Headley (Con)]

My Lords, with regard to the preparedness of the NHS, what is the occupancy rate at the moment for adult critical care beds? I understand that figures published on Thursday last week showed them at 83%. What is it now? Secondly, would my noble friend please heed the words of the secretary-general of the Independent Health Professionals Association, who has pointed out the burden and costs of the current IR35 rules on bringing consultants who are currently freelancers back into the NHS, and points to the need for these rules to be suspended at a time when the NHS is going to need to attract these workers back in to provide the care that we need?

[Lord Bethell]

Occupancy rates are changing all the time as we cascade patients from one class of bed to another in order to make room and prioritise those who are hit by the virus. We are doing an enormous amount to expand the capacity of beds—for instance, converting operating theatres into respiratory support units and moving patients into beds where they may be more comfortable. Provisions for IR35 will be made in the coronavirus emergency Bill later this week.

[Lord Boateng (Lab)]

My Lords, I want to raise the issue of two groups who are particularly vulnerable in terms of social isolation: the deaf elderly and the black and minority ethnic elderly. What assurance can the Minister give the House and the wider community that, in their communication strategy, the Government will take the needs of those two groups into account by signing, in terms of verbal and oral communication, and translation in terms of written?

[Lord Bethell]

The noble Lord is entirely right to ask about this. I am pleased to say that, thanks in part to the advocacy by the deaf community, a signing translator was provided for the briefing from No. 10 Downing Street earlier today. That is a sign that we are listening to those who advocate on behalf of these groups. However, I have to be honest with the Chamber: there are a large number of groups who deserve special treatment, and although we are moving as fast as we can in order to provide the best possible care and service that we can, I cannot pretend that there are going to be tailored packages for each and every vulnerable group in the land. We are just going to have to pull together and do the best that we can under extremely difficult circumstances.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I applaud the fact that the Statement focused on the need to protect the most vulnerable, but many people are hugely financially vulnerable. Does the Minister agree that we need national solidarity to ensure that no one needs to fear losing their roof over their head, having their gas or electricity cut off or not being able to buy the food that they need? Will the proposed Bill include: an end to all benefits sanctions, as the noble Baroness, Lady Brinton, referred to; a suspension of all evictions; an end to the five-week delay for housing benefit; and ensuring that no one’s utility is cut off because they cannot pay the bill? The Minister made particular reference to the homeless. Will provision be made if they need to isolate? If they are ill, will they have safe and appropriate provision? Asylum seekers are people in our community who are very vulnerable with little money. They could contribute if allowed to work. I think we have just seen the first case of the virus in a prison. Will the Bill include special provision to make sure that prisons are safe places in the coronavirus epidemic?

[Lord Bethell]

On prisons, which are clearly an area of grave concern, I reassure the Chamber that guidelines were published earlier today for the management of prison populations and the introduction of cohorting in order to divide those with the virus from the rest of the prison population. On the other questions, I reassure the House that we are alive to the desperate circumstances that some people find themselves in. The financial arrangements being put behind the handling of coronavirus will be generous, and we will not stop supporting those who we love and care for.

[Lord Campbell of Pittenweem (LD)]

My Lords, I would like to raise with the Minister the question of government language. The second last paragraph of the Statement begins, “We are in a war against an invisible killer”. I understand that a balance has to be struck in ensuring that the public understand the importance of what we are engaged in, but language of that kind can have the effect of causing panic. In particular, may we have an end to the unofficial and unattributed briefings taking place at weekends that give rise to melodramatic headlines, which can only damage public confidence?

[Lord Bethell]

In defence of both the Prime Minister and the Chief Medical Officer, I pay tribute in particular to the Chief Medical Officer and the Government Chief Scientific Adviser for the incredibly measured, considered and transparent way in which they have gone about communications. I bear testimony to the calm and thoughtful advice that has been given to us by the scientific community. We are seeking to share that advice as openly and transparently as we can by having daily briefings from Downing Street, at which both the CMO and GCSA are present.

[Lord Forsyth of Drumlean (Con)]

My Lords, following the comment of my noble friend Lord Bridges on IR35, which will impose huge costs and burdens on small businesses and entrepreneurs, would it not be sensible for the Government to defer its implementation? More importantly, it is obvious that these measures are going to result in a deep recession in this country. Many good businesses are going to go to the wall, unless they are helped with their cash flow. Declaring an interest as a banker, I know that the banks will want to extend credit to those businesses, but the regulatory rules and the senior managers regime prevent them from doing so. Of course public health is the most important thing, but it is of the utmost importance that the Government enable the banks to provide support for those businesses, and that they recognise that the Budget package, welcome as it is, is a mere flea-bite compared to what is required—and required now.

[Lord Bethell]

My noble friend is entirely right; it is a point well understood in Government. But he does slightly answer his own question, because our priority at this stage is to ensure that the medical and clinical response is right, and that the message gets across to the public about what they can and should do to protect themselves and delay the spread of this virus. I reassure him and the House that the economic impact of this virus is fully understood, and that there will be a full package of measures announced at a later date, once we have got this initial response out of the way.

[Lord Davies of Stamford (Lab)]

My Lords, the UK has withdrawn from the European Medicines Agency without putting anything in its place. This means that no new compound can be registered, licensed and made available for prescription in this country. The new compound might be an antiviral agent effective against coronavirus, or could equally be the vaccine which we are all waiting for. Can the Government tell the House, with urgency, what they are doing about this major gap in the provision of public health in this country?

[Lord Bethell]

I reassure the noble Lord that, as with the response to HIV some years ago, we will not allow any lacuna or gaps in the regulatory arrangements or any delays of the regulatory kind to stand in the way of our response to the virus.

[Baroness Hamwee (LD)]

My Lords, the Minister referred to a recommendation about people not going to pubs, clubs, and theatres. The Society of London Theatre has been instructed to close all theatres by DCMS tonight, and that is now happening. Is it a recommendation, or an instruction? This is important, not just because of behaviour but for insurance purposes in particular.

[Lord Bethell]

The noble Baroness makes an important point. I have received numerous, moving and important communications from those who own, run or support pubs, clubs, theatres and venues in this country. In response, I say that we have moved quickly, as the scientific evidence of this virus has developed quickly. This needs to be addressed by the DCMS; it is not within my purview, but I understand that it will address it.

[Lord Cormack (Con)]

Will my noble friend say a word or two about the Bill that is going to come before both Houses of Parliament? Is he effectively saying that those of us who happen to be in our 70s or 80s will not be allowed to take part in that debate, or is this merely advice? Could he also tell me whether there are testing facilities within the Palace of Westminster?

[Lord Bethell]

The Bill will arrive on Thursday and the plan will be published then. In terms of those who wish to attend the House, all I can do is share the advice of the CMO, which is very simple and very clear, but it is down to the choices and decisions of those here as to how they wish to conduct their travel and attendance arrangements.

[Lord Howarth of Newport (Lab)]

My Lords, my noble friend Lady Thornton alluded to some confusion in the Government’s communications over the weekend as to their policy in regard to herd immunity. No doubt the policy is a nuanced one but is it possible for the Minister to state succinctly and definitively what it is? Also, I think the public are finding it hard to understand the Government’s new provisions on eligibility for sick pay and social security. In particular, will he explain what support the Government are giving to self-employed people in low-paid and insecure work who are now being told by the people they normally work for not to come into work and that they will not be paid? How are the Government going to protect them?

[Lord Bethell]

On government priorities I will be really simple and clear. The Government’s priorities are to save lives and to support the NHS. That is our objective and that is what we are throwing our energies into. In terms of sick pay and support for the self-employed, provisions for those have yet to be published, but when they are I look forward to them being discussed.

[Baroness Ludford (LD)]

My noble friends Lady Brinton and Lady Hamwee have tried to get an answer from the Minister on this question of enabling businesses to claim on their insurance. If they are just advised to close, as I understand it, most of them would not be able to do so, but now we hear from my noble friend Lady Hamwee that DCMS has actually instructed theatres to close—but only theatres. What about restaurants, bars, clubs and everybody else? It does not seem to be a very coherent situation and for the Minister just to say that it is not within his purview to answer this question is frankly not good enough. Could he please give a clear answer as to whether not only theatres but other businesses will be instructed by the Government to close, so as to enable them to claim on their insurance policies?

[Lord Bethell]

As the noble Baroness will be aware, this is a fast-changing situation. I cannot come to this House, in all honesty, and give an account for every single element of the strategy since we have turned around some of these decisions in very quick time. Our focus is on health and on our clinical decisions. When I am able to deliver an answer to that question, I will do it. As soon as I can, I will be glad to write to the noble Baroness.

[Lord Barwell (Con)]

I welcome the Prime Minister’s commitment to a daily press conference. It is vital over the difficult weeks and months ahead that people hear directly from him and from the Chief Medical Officer what the Government’s position is. If large numbers of people are either going to have to self-isolate because one of their family is symptomatic or going to have to effectively withdraw from society for four months, a lot more people will need their food delivered to their home. What can the Government do, first to encourage people not to panic and hoard things when it is not necessary to do so, and secondly to allow the supermarkets to scale up their at-home delivery? At the moment, if you register as a new customer, you cannot get a booking for three or four weeks.

[Lord Bethell]

My noble friend Lord Barwell is entirely right. The question of deliveries is an acute concern. There are intense conversations going on on a daily basis between Defra and the food retailers. I understand that there are assurances that there are significant stocks of food and that these are going to be made more available. It is not something that we are currently deeply concerned about. The belief is that as people fill their larders, they will reach a certain point when they will begin backing off the kind of stocking up that they are doing at the moment and it will be possible for those who need it to get those deliveries.

[Baroness McIntosh of Hudnall (Lab)]

I am sorry to ask the Minister to return to the issue of closing theatres—and I declare an interest as the deputy chairman of the Royal Shakespeare Company—but reassurance is needed that, by following the instructions or the advice or whatever it is that has been issued, theatres and no doubt other businesses as well are not inadvertently invalidating their insurance arrangements. I understand that the noble Lord finds it difficult to give assurances but I think that one is particularly necessary, not least because it might save the Government some money in the long run.

[Lord Bethell]

The noble Baroness is entirely right. As a trustee of Sadler’s Wells, I understand completely the implications of what she is saying, her point about insurance, and the confusion there might be about what the current status is. I simply cannot answer the question right now. I am not trying to avoid a difficult question; I simply do not have the information. When I do, I will be very happy to write to her and to others who have asked about this.

[Baroness Smith of Newnham (LD)]

My Lords, the Minister has told us several times that the key government priority is to deal with the health crisis of Covid-19. But what work are the Government doing to ensure that the other issues that have been raised, for the self-employed and for small businesses, do not lead to such severe crises that we see an outbreak of suicide because people simply cannot cope and think they do not have a future? It is not only the virus: there needs to be a whole series of decisions around questions that have been raised this evening, to which we have not yet had any answers.

--- Later in debate ---

[Lord Bethell]

The noble Baroness is entirely right to be concerned about the holistic challenge we face. We are working hard in different areas to answer each one of those issues as they come along, whether in the area of mental health, social care or the economy and the entertainment sector. Today’s announcement is focused on the clinical response, but I will be glad to answer any questions on specific subjects as they arise.

[Baroness Hooper (Con)]

My Lords, would driving in a private motor vehicle between one point of self-isolation and another still be within the definition of self-isolation?

[Lord Bethell]

Yes, it would.

[Lord Mann (Non-Afl)]

My Lords, will the Government be giving precise advice to agencies dealing with the homeless? Will care workers on zero-hours contracts who need to go into self-isolation be paid by anybody? Are the Government relying on the House of Lords to set the best example in following the Chief Medical Officer’s advice?

[Lord Bethell]

On the provisions for those on zero-hours contracts, that is an area that is particularly knotty and difficult. It is absolutely the focus of the current negotiations on statutory sick pay and other provisions; it is one we care very much about getting right. As for the advice for those in the House of Lords, I cannot repeat the advice of the CMO more times than I have already. I very much hope that everyone will follow it.

[Baroness Barker (LD)]

My Lords, based on the models that the Government are using, can the Minister say when he thinks we will reach the peak transmission spike?

[Lord Bethell]

The situation is fluid. The CMO spoke about this in detail at the press conference. He is not speculating or giving an exact date, because the modelling is not as clear as one would hope it to be. However, it will certainly be within weeks, rather than months.

[Lord Adonis (Lab)]

My Lords, there is a gaping black hole in the economic package announced in response to this crisis. I hope that the Minister has picked up from the repeated questions of noble Lords on all sides that there is acute concern about this. I do not think it is possible to separate the public health emergency from the wider social and economic emergency. People will not go off sick and companies will not be able to give clear guidance to their employees until the Government can answer the questions which have been asked around the Chamber. There is an absence of a clear government policy on sick pay, which is after all the means by which people will survive if they self-diagnose or are diagnosed with this virus. Each day that the Government cannot answer this will lead to more needless spreading of the disease. I know that the noble Lord is the Health Minister and not an Economy Minister, but it is totally unsatisfactory that the Statement gives no clear guidance to the country on the economic aspects. He talked about this being published on Thursday, with the Bill, but that is three days’ time. We are in a massive national emergency; that statement should come tomorrow. Every hour that the Government delay will see the disease spread further, cause needless distress and lead to people going out of business.

[Lord Bethell]

The noble Lord is entirely right in his analysis that getting the social and economic package right is imperative for delivering the social behaviour response to the virus. It is completely understood by the Government that, to get people to abide by the kinds of provisions and recommendations coming from the CMO, there has to be a whole-person solution, and that includes figuring out the money. We understand that and are working on it. We have already altered some of the provisions for statutory sick pay so that people can claim after one day instead of four, which is an important change. We are negotiating with the Treasury, the DWP and other parties on making further changes.

[Lord Davies of Gower (Con)]

My Lords, Swansea University today announced its first case of Covid-19. Given that students travel from all other countries to universities—perhaps in greater numbers than to some sporting events—what particular advice will the Government give to universities?

--- Later in debate ---

[Lord Bethell]

My noble friend will be reassured to know that guidance for education settings was published a couple of hours ago. This includes advice to universities both on travel and on what to do when someone develops the symptoms of coronavirus. I would be glad to place a copy of this in the Library or send it to any noble Lords who would like to see it.

[Lord Cormack]

My noble friend did not answer the question about the testing facility within the Palace of Westminster.

[Lord Bethell]

The noble Lord is entirely right. To be honest, I do not know the answer to that question, but I would be glad to find it out and write to him with the details.

[Baroness Hamwee]

As there are five seconds left, may I apologise to the House for having failed to declare my interest as a trustee of a theatre when I asked my question?

Coronavirus

Lord Bethell Excerpts

Thursday 12th March 2020 Lords Chamber

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

My Lords, I shall repeat a Statement made by my right honourable friend the Secretary of State yesterday evening in the other place on coronavirus. In the repeat, I will use the most up-to-date figures, which have changed since last night. The Statement is as follows:

“Mr Speaker, this afternoon, the World Health Organization declared coronavirus a global pandemic. I have spoken to the Leader of the House and we have had discussions; we have resolved that we will keep Parliament open. Of course, in some ways, the House may have to function differently, but the ability to hold the Government to account and to legislate are as vital in a time of emergency as in normal times. Our democracy is the foundation of our way of life.

Turning to the advice that is being provided to Parliament, I start by welcoming the way in which you, Mr Speaker, are working with the Government. I know how seriously you take the well-being of all Members and staff in Parliament, and the Government will continue to work closely with you, the Lord Speaker and the authorities in both Houses in the coming days and weeks. As the Leader of the House said in business questions last week:

“The public will expect Parliament to sit, and to get on with its job ... Our approach will be guided by the best scientific evidence and medical advice, and we will take all necessary measures to deal with this outbreak.”—[Official Report, Commons, 5/3/20; col. 984.]


Mr Speaker, I know that you are committed to providing as much information to Members and staff as possible and to taking any action that is required. A cross-parliamentary group of senior managers meets daily to plan the response to Covid-19 and ensure business continuity, with close input from the Government. It is essential that the parliamentary authorities continue to work closely with the Government and in line with medical advice, and I commit us to that endeavour. Both Houses are conscious of our national role at this time, and by basing decisions on the very best public health advice, we can be confident that we are doing the best we can to respond to this virus.

Around the world, the number infected is rising. Here at home, as of today, 456 people in the UK have tested positive and eight people are now, sadly, confirmed to have died. The positive cases of course include my honourable friend the Member for Mid Bedfordshire. She has done exactly the right thing in following the official advice to self-isolate, and I know the whole House will wish her well as she recovers. Public Health England has world-class expertise in contact tracing, which it initiated as soon as her case was confirmed. It will contact anyone whom it thinks may need testing. This will include only those who have had close contact. The advice of the Chief Medical Officer is that close contact is defined as being within two metres of someone who has active symptoms for more than 15 minutes. Those who have not been in close contact with my honourable friend since Thursday have no cause for concern in this case, and anyone who has concerns should seek guidance from Public Health England. I also know that my honourable friend wants me to pass on her thanks to officials at Public Health England and the NHS, who have been brilliant throughout.

Of course, a Member of the House and Health Minister testing positive has brought this issue home to us all, and I know that the public will be concerned that coronavirus has now been deemed a global pandemic. The official advice is clear: people should go to NHS 111 online or call NHS 111 if they think that they have symptoms of coronavirus, notably a cough and fever. Of course, the best way to minimise the risk to yourself and others is regularly to wash your hands.

Earlier today, I chaired a meeting of COBRA. Our response will be built on the bedrock of science. It is clear that we will need legislation to ensure the best possible response, and I can tell the House that I have invited the Official Opposition to meet with me first thing tomorrow to discuss the proposed emergency Bill that we will set out before the House next week. In addition to the measures that my right honourable friend the Chancellor set out in the Budget earlier, the Bill will include measures to help the national effort to keep vital public services running, to support business and to help everyone play their part.

Adult social care will be at the front line of our response, with social care providers looking after many of the most vulnerable in society. We are working closely with the sector to make sure that it is ready. Tomorrow, the Prime Minister will chair a further meeting of COBRA to decide what further measures may be necessary.

We will do the right thing at the right time. I know how worrying this is. I know that people have deep concerns. I know that everyone will play their part in this national effort to defeat the virus. The best way to beat it is for us to work together. We will do whatever it takes. We will give the NHS whatever it needs. We will do all that we can to keep people safe and get through this together, as a Parliament and as a nation. I commend this Statement to the House.”

My Lords, that concludes the Statement.

--- Later in debate ---

[Baroness Brinton]

I apologise for using an inappropriate term. None the less, even yesterday the Secretary of State said that we were not in delay. I recognise that things are moving very fast, but it is worrying that the Government keep saying that they are following the clinical advice yet there seem to be some differences in this. That matters in the light of what is happening elsewhere in Europe. Whether we close schools is obviously down to the advice of Chris Whitty, who is an epi- demiologist. He has been clear that there are disadvantages as well as advantages. What we are concerned about is that it is beginning to feel as though the professional advice is differing slightly from the political advice.

I am very pleased that the Government have responded to the WHO news about moving to a pandemic, and this morning’s letter from Chris Whitty to all doctors is extremely helpful in setting out their roles in being flexible and having to do things differently. But we know that the Italians have struggled with the number of hospital beds in ITU, and of ECMO beds, ventilators and other specialist equipment. By the way, it is really good that China is now helping Italy out. Learning as a global community from one outbreak area onwards is excellent.

However, the data paints a worrying picture. Japan and Korea top the OECD table for hospital beds per thousand at 13 and 12; Italy has 3.2 and the UK 2.5. What is happening to ensure that we have the ITU beds and ventilators that will be needed for the more severe cases which, as the news from Italy has shown, has been very problematic? Last night, a former public health director, Professor John Ashton, said on “Newsnight”:

“We’ve got a complacent attitude … We’ve wasted a month. If this now spreads the way it looks as though it’s likely to spread, there will not be enough hospital beds and people will have to be nursed at home.”


I am afraid that there are still holes in the advice and action, especially in social care. I shall repeat the concern that yesterday no extra money was provided in the baseline Budget for social care. Also, while the Secretary of State made it clear that social care is being included in the emergency coronavirus grant, that is for adult social care only. I repeat the question that I and my colleagues in another place keep on asking: what about the most vulnerable children who are often on ventilators or, if not, they end up on ventilators if they get even a cold? If there is no extra resource for them, that is a real problem. Many parents are hearing that everything is about care for the elderly. Children may be asymptomatic, but these children will not be, so it is vital that they are given support. If the Minister cannot answer that now, I would be really grateful for a reply outside.

The Secretary of State talked in the Statement about everyone working together. As we move into the delay section, we already know that directors of public health, councils and other key stakeholders such as CCGs are doing fantastic work, but—as many of us know that communication between Public Health England and the directors of public health has been a problem—can the Minister reassure the House that those lines of communication are working effectively and being monitored by senior people in both the NHS and government?

I echo the points about the announcement of the public health grant. That is the Secretary of State for Health and Social Care’s responsibility. We are only a fortnight away from the new financial year. It is ridiculous that we do not have the details.

Will the Government relax appraisal and re-registration requirements during Covid so that we are fighting the virus and the specialists are not having to fill in paper the whole time?

Finally, where is the personal protective equipment for social care? It will undoubtedly be needed, not just in care homes but for those being nursed at home.

[Lord Bethell]

My Lords, I thank the noble Baronesses for those excellent questions. I will take them at some pace, because there were a lot of extremely worthwhile questions and I will try to answer them as best I can.

The noble Baroness, Lady Thornton, asked about advice. I would like to explain to the Chamber the effectiveness of the contact tracing that Public Health England has put in place. Nadine Dorries shared her diary with Public Health England officials. They have gone through an extremely thorough contact-tracing process and have identified those individuals most at risk. It is a feature of our strategy for dealing with this virus that we have put contact tracing very much at the heart of what we do. It has proved an extremely effective measure. I understand from the Chief Medical Officer that more than half of those positively identified as carrying the virus in the UK have been identified through contact tracing, which is an indication of how thorough that process is and how effective it has been.

For those who remain concerned, the guidance from 111 is that it is those who show symptoms who should present themselves for a test. Those who have been in proximity but are not currently showing symptoms should use common sense and isolate if they feel like it, but that is not the positive guidance from 111.

The noble Baronesses, Lady Thornton and Lady Brinton, both asked about containment and delay. The truth is that we are in a transition period. The CMO’s advice is that the virus will almost inevitably spread through the British population, but the testing statistics speak for themselves. On 11 March 2020, 27,476 tests had taken place and only 456 had tested positive. The simple arithmetic of that is that if you are ill and feeling poorly at the moment, you probably do not have coronavirus. We are still at the tail end of the winter flu cycle; many germs are still in circulation. As yet, although coronavirus has been identified in many places in the country, it is not turning up in a very high incidence or proportion of those tested.

We are not complacent about this; we take it very seriously indeed. We can see the storm on the horizon, but the question of timing is incredibly delicate. I understand the frustration and concern in this Chamber, the media and the general public that not enough is being done, but the science, modelling and guidance from those who study epidemics are clear that we have to get the timing right. When we do, we will move emphatically, clearly and in a focused way, but we have to get that choice right.

The noble Baroness, Lady Thornton, specifically mentioned schools. The evidence suggests that, thankfully, children are not strongly affected by this virus, if at all. It is not currently clear whether those who are infected are infectious. There are strong signs that if they are infectious, they are not very infectious. There needs to be a degree of sense when it comes to the infection. In the balance between the social and economic effects of closing schools and taking mums and dads out of the workplace versus the safety of the children, particularly the effects on clinical and care workers, the opinion of the Chief Medical Officer and those who advise him is that closing schools is not the correct option in the UK today.

The noble Baroness, Lady Thornton, asked about the LGA and social care associations. I will reassure her on two fronts. They are very much engaged in all our preparations. Money is very much on the table and the resources that they need to combat this virus will be there to top up their budgets. The same is true on public health funding: the CMO is actively engaged with directors of public health to ensure that they have the resources they need.

The noble Baroness also asked about inspections for care homes and recent submissions by those who run care homes. I assure the House that we are listening to all those organisations that have concerns about inspection regimes and meeting legal requirements when physical resources and resources of people and time are under huge pressure. We hear their concerns loud and clear and will be making realistic provisions about those inspections and legal requirements.

The noble Baroness asked about the charitable sector. I hear its concerns but hope that this incident will be a massive opportunity for communities to come together and for the charitable sector to play an important role in providing support in care and to clinical staff. Funding for the sector is being looked at by DCMS. I have been updated by the Minister concerned, who assures me that their plans are progressing and that engagement is happening in a very serious way.

The noble Baroness also asked about CCGs and shared her anecdotes about the pressures on CCGs. Let me be absolutely clear: pressure is inevitable. There will be huge pressures on the people and the resources at every level, particularly in front-line and primary care, but we are working extremely hard to ensure that they have the physical manpower and administrative resources that they need to meet the challenge. For example, the noble Baroness, Lady Brinton, asked about PPE suits. They are being delivered, if not this week then next week. We have listened to the concerns of CCGs about the provision of suitable protection resources, and deliveries are happening as we speak. I hope that the recent letter from the CMO provides the kind of clear guidance that CCGs have been looking for.

In terms of registration documentation, the noble Baroness, Lady Brinton, asked about those returning to work. It is a primary concern of ours, because the current arrangements for those seeking to return to work in front-line clinical roles are clunky and administratively onerous. The process takes a long time and is completely unsuitable for the challenge we have ahead. That is one of the important measures that we will be addressing in the week ahead.

Specialist beds are our primary concern. The experiences of China and Italy make it crystal clear that those who have severe respiratory responses to the virus are creating the greatest demand on resources and are at the greatest risk. We are doing everything we can to convert existing resources into relevant, suitable provisions for those who will need respiratory help, and we are working hard with the oxygen manufacturers and providers to ensure that we have the kit and the personnel to answer that need.

Both the noble Baronesses, Lady Brinton and Lady Thornton, asked about social care. I reassure the House that the financial provisions outlined by the Chancellor yesterday will include all aspects of social care, including those relating to children and the most vulnerable in society. Directors of public health will be included in decisions about how those financial resources are allocated.

[Lord O'Shaughnessy (Con)]

My Lords, I am grateful to my noble friend for repeating that Statement and providing that reassurance. We all respect that this is an incredibly difficult and finely balanced decision, and, to some degree, we all need to trust in the process and those who are leading it. We have great scientists who are doing so.

Will my noble friend do two things? First, can he talk a little about the welcome funding that was in the Budget yesterday to support the economy and the health system through this outbreak? What exactly will that be spent on and what can be spent quickly to good effect? Secondly, to pick up an issue that was raised by the noble Baroness, Lady Thornton, but was also mentioned yesterday about capacity in the system, particularly in care homes, I am very worried about vulnerable people who require domiciliary care whose workers might get sick. Who will care for those people? We may need to think completely out of the box in how we do this. Can we stand up a volunteer army of post-infected people who have DBS checks to take on these kinds of responsibilities? Going about things in the ordinary way will not deal with the consequences of this crisis when it really hits. I would be grateful if my noble friend could expand on some of the plans the Government are making for these consequential impacts, which are not to do with the virus, but are very much to do with the impact on the health system.

[Lord Bethell]

I thank my noble friend for those questions. In terms of funding, the Treasury has provided immediately a £5 billion contingency fund to ensure that not only the NHS but local authorities have the resources necessary for both clinical and social care. The kinds of items that the money can immediately be spent on include boosting staffing, particularly in the NHS, which might include re-employing retired doctors and nurses and recruiting and offering compensation to volunteers who agree to help provide health and social care services full-time for the period of surge.

The precise arrangements for how that volunteering army can be put together will have to wait until we have the legal provisions for that army because there are important questions of indemnity, legal registration and DBS checks, all of which have been raised in this Chamber previously and which we take very seriously. But it would be premature to describe plans that are being worked on at the moment until we have tabled the sorts of legal requirements that we will need.

Funding will also ensure that we have the right drugs, supplies and equipment. Lastly, there will inevitably be a backlog of care after the virus has passed. We are conscious that this backlog will put a long-lasting strain on our medical and social care arrangements, and we are putting in the resources today to ensure that the backlog can be addressed in the future.

[Lord Judge (CB)]

My Lords, for those of us who are trying to plan next week, when will the Minister be in a position to let us know when the proposed emergency legislation, and in particular the Bill, will be able to be examined; in other words, when will we see a draft that we can look at and reflect on?

[Lord Bethell]

The noble and learned Lord asks a very reasonable question. I reassure him that the Leader of the House will make a Statement to that effect and she will outline the schedule for the publication. That will be for the Leader’s Office to decide.

[Lord Blunkett (Lab)]

My Lords, I commend the Government for the measured approach they are taking and the Minister for his helpful responses this morning. I chair the Sheffield City Partnership board; it will be partnership at local level that will deliver, as the noble Lord, Lord O’Shaughnessy, described, the civil effort that all of us will need to put in. Will the Minister indicate now whether he has taken on board the questions raised about the public health grant and about some of the money from the £5 billion that he mentioned going into facilitating local government—which has been severely damaged over the last 10 years—to provide the capacity to co-ordinate, as it did with the floods, the partnership approach needed at local level?

[Lord Bethell]

My Lords, I reassure the noble Lord, Lord Blunkett, that local authorities will undoubtedly provide a huge amount of the response to the coronavirus, not only in social care but in supporting business, giving pastoral care to those who are vulnerable and left alone and providing the community cohesion that we will need to get through a very difficult time for society. Extremely generous funding has been put in. That money is trickling through the system and I know that my colleagues at the Treasury are working hard to ensure that everyone has the information they need.

[The Lord Bishop of Portsmouth]

My Lords, in thanking the Minister, may I ask him whether he can give any information on the precautions and particular challenges in prisons, where, for instance, social distancing, isolation and provision of hospital services will be difficult to achieve?

[Lord Bethell]

The right reverend Prelate is entirely right to raise the question of prisons. Prisons provide an enormous challenge when it comes to the virus. The idea of prisoners living in prisons while the virus passes through such a tight-knit community concerns us enormously. I reassure him that the Ministry of Justice is looking into this carefully. It is using the experience in Italy and in China to understand how to provide for this in a humane and responsible way that preserves the security of our communities. It will publish advice on that shortly.

[Baroness Jolly (LD)]

My Lords, I declare my interest in the register. I was pleased to hear that the Secretary of State had included social care in the Statement. Could the Minister clarify what support will be offered to providers of social care to vulnerable adults with a learning disability?

[Lord Bethell]

The noble Baroness is entirely right to ask about a specific group. As yet, I do not have a clear answer on the exact demographic that she describes, but I reassure her that our understanding is that this will hit hardest the most vulnerable in our society. The entire focus of our provisions is therefore to make sure that the most vulnerable are looked after best.

[Lord Forsyth of Drumlean (Con)]

My Lords, yesterday I asked my noble friend whether he would give guidance to employers on the standards of deep clean required to enable people to return to premises. He indicated that he thought that the CMO did not think that this was necessary and that such advice would be “red herrings or distracting”. I read in the newspapers today that, sadly, a case was identified in the Treasury, which arranged a deep clean overnight so that people could return to work. Speaking as an employer with buildings where continuing services are important to consumers, customers and others, as well as to maintaining employment, we would like to carry out a deep clean every night, so that, if a case was identified, the premises would be safe, but we do not know what standard of deep clean is required. Frankly, asking a cleaning company what it would recommend does not seem the basis on which best to protect not just the staff of the building but also the businesses. May I reiterate the plea for some guidance? If that is not possible, perhaps we could be told what the Treasury decided.

[Lord Bethell]

I thank my noble friend for his question on deep cleaning. I reassure him that no one is suggesting that the best efforts of any employer to protect the welfare of their staff is in any way irrelevant or undervalued. Cleaning is an important response to this virus and those who decide to put resources into cleaning their premises are entirely to be lauded. There is clear guidance on the PHE website. I have put that guidance in the Library and would be happy to arrange for it to be emailed.

Let me try to explain the nub of the question. The CMO has not put the daily deep cleaning of offices or any work premises at the top of his priorities. The reason for that is that it takes only one person to touch a doorknob at 7 am for that doorknob to be contagious for the rest of the day, whereas a pair of hands can be cleaned many times a day. If you do the arithmetic of how the virus is spread—as the modelling professionals do at SAGE—constant handwashing, which we bang on and on about, is the most effective way of preventing the virus spreading. When that no longer proves an effective measure, the CMO will undoubtedly change the guidance and publish that guidance widely.

[Lord Harris of Haringey (Lab)]

My Lords, I am slightly surprised by that answer. I was not going to ask about this but, none the less, I will. Surely, what the noble Lord, Lord Forsyth, is asking is: if an employer wants to go above and beyond the current minimum level of requirement, where can they get guidance? That seems quite important. The question I would like to ask the Minister is this: obviously, we wish Nadine Dorries all the best for her recovery, but is the line by which she acquired the virus yet clear? If it is not possible to answer that, of those people who have been confirmed to have the virus, in how many cases is the route by which they acquired it known? If that route is not known, clearly this is much more endemic than has previously been said.

[Lord Bethell]

My Lords, not wishing to return to question of deep cleaning too many times, I just reassure the noble Lord that the published guidance is very clear. It says that this virus can be cleaned with conventional soaps and conventional detergents, of the kind already freely available and used by cleaning companies. There is nothing technically challenging about the cleaning of offices, homes or hands in the case of this virus. It is just about thoroughness. That guidance exists. If it would be helpful, I would be happy to share it with noble Lords in this Chamber.

It is not possible to discuss Nadine Dorries’s case in detail. On community contagion, which is the nub of the question, we have reached the stage where the origin of every positive case is not known. In other words, there are people who have picked up the virus for whom no simple explanation can be given for where they got it. Therefore, the CMO has stated clearly, including in briefings to noble Lords, that his opinion is that the virus is present in the community but, as I explained, that the levels of positive testing suggest that it is not very prevalent. The CMO in his briefing estimated that between 5,000 and 10,000 people had the virus earlier this week. Those are the kinds of proportions we are talking about at this time.

[Lord Campbell of Pittenweem (LD)]

With respect to the Minister’s answer on the management of intensive care facilities, is that management being done by health boards, regionally or centrally? In particular, is regard being given to it being done on a United Kingdom- wide basis? I have in mind that, if there is a problem in Newcastle, Edinburgh might be recruited to assist with that and vice versa. Is this being approached on a UK-wide basis or rather more narrowly?

[Lord Bethell]

I reassure the noble Lord that this is a whole-health family challenge. I thank all my colleagues, in every part of the NHS, PHE and all the arms-length bodies, who have been involved in the response. Yes, the guidance and direction are coming from the top, and the expertise is coming from the scientists who advise and guide us, but it has been up to individual managers at every level of the NHS to step up to this challenge. The response has been formidable, impressive and reassuring. I wanted to take a moment to bear testimony to that response.

Regarding the devolved nations, the four CMOs are working incredibly well together. It is reassuring to see how closely their response has been tied. It has been a whole-country, UK-wide response and there is a lot of consistency across the different nations.

[Lord Pickles (Con)]

My Lords, may I ask about the unintended consequences of President Trump’s announcement last night? As my noble friend will be aware, a considerable amount of commercial cargo is carried on passenger flights, including medicine and vital medical equipment, plus time-sensitive exports. While our European neighbours will bear the brunt of the announcement, it will undoubtedly have a knock-on effect on supplies to the United Kingdom. What discussions are the Government planning with airlines to ensure these vital medicines and medical supplies come through?

[Lord Bethell]

The supply of medicines is of concern. We have built substantial stockpiles of all medicines that we feel we need. We are working through what the implications of President Trump’s declaration might be. My understanding is that we are presently very confident about the secure supply of medicines.

[Lord Layard (Lab)]

My Lords, if we look abroad, especially to Japan and China, it is clearly not as inevitable as the Government assume that this disease will become widely spread through the population. Extraordinarily, in Hubei province, the epicentre of the disease, the proportion of the population who caught it was 0.1%. So how can we be hearing our experts talking about up to 80% of our population being affected? This cannot be right; it is based entirely on the assumption that our approach will be very passive. Can the Minister assure me that we will move to a really stringent regime next week?

[Lord Bethell]

The noble Lord asks a question that is on the minds of a lot of people who have been reading into the subject. The concern of the CMO is that if you bring intense social behaviour restrictions to bear on a population, you can temporarily suppress the spread of the virus. If you ask the entire population to stay at home, and close down every business, public space and event, you can suppress circulation. However, the moment you lift those restrictions, the virus spreads with a vengeance. It is often the most vulnerable who are then hit with a second peak, which can take out the provisions needed to support them. That is the CMO’s primary concern. The Government’s objective is to manage the situation so that the virus spreads in as limited a way as possible, and is spread out over time to allow medical and social care resources to be given to those who need support.

[Lord Trefgarne (Con)]

My Lords, my noble friend referred to the inevitable increased level of activity in the National Health Service. What success has been achieved in recalling recently retired NHS staff to help?

[Lord Bethell]

The recruitment of recently retired staff requires some changes to legislation, which are being studied at the moment. We look forward to bringing them to the House in the near future. I am happy to update the House on those provisions, once we have made further progress.

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

My Lords, I welcome the decision of the Government, and the meetings of the joint commissions, that Parliament should continue to operate properly in our democratic society—not least, as the noble and learned Lord, Lord Judge, said, so that we can deal with the draft legislation for this emergency. But has any assessment been made of potential dangers from the large groups of visitors, from many countries, who wander around—and are taken around—this building? That might create dangers that put the question of our sitting in doubt.

[Lord Bethell]

The noble Lord’s point has been raised with me by staff of the Palace, who are concerned about this. It is not for me, I am afraid, to answer this question; it is for the officers of the House. I know they are looking at this matter and are being advised by the Chief Medical Officer.

[Lord Forsyth of Drumlean]

My Lords, I return to the question of deep cleaning. My noble friend says that the advice is clear. Could he confirm that, if an employer arranges for all surfaces within their premises to be treated, that will be sufficient to allow staff to come back into the building safely?

--- Later in debate ---

[Lord Bethell]

My noble friend clearly feels passionately about the subject. I am not personally in a position to provide the reassurance he seeks, but I will try to find the information for him. I will share with him the regulations as they stand.

Dementia: Accident and Emergency

Lord Bethell Excerpts

Wednesday 11th March 2020 Lords Chamber

[Baroness Wheeler]

To ask Her Majesty’s Government what steps they are taking as a result of the analysis published by the Alzheimer’s Society on 22 January showing a 34.5 per cent increase in the number of people with dementia being admitted to accident and emergency departments in 2017–18.

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

My Lords, we are implementing our Challenge on Dementia 2020 commitment to make this the best country in the world to live with dementia. The NHS long-term plan commits the NHS in England to improving the care provided to people with dementia and their carers, including through supporting people in the community and avoiding unnecessary admissions to hospital. People should receive high-quality care in hospital and be discharged in a timely and appropriate way.

[Baroness Wheeler (Lab)]

I thank the Minister for his response and congratulate him on behalf of these Benches on his confirmation in his post. We look forward to continuing the good and constructive working relationship we have had with him since he took up this brief.

These findings from the Alzheimer’s Society research are truly shocking. The 34% increase in emergency admissions of dementia patients to A&E departments represents an increase of 100,000 patients over five years—the equivalent of over 1,000 patients each day. Much of this is the result of the scarcity of appropriate care support in the community or of care home places able to provide the specialist dementia care that is needed. Does this not also underline the scale of the problem the NHS faces in freeing up hospital beds to address demands from future coronavirus hospital admissions? What is the Government’s strategy for ensuring the continuing care for people with dementia in the coming months and in the longer term? Will further guidance and funding be issued to hospitals and care homes specifically to deal with this situation?

[Lord Bethell]

The noble Baroness will be aware that the identification of dementia patients in England has risen dramatically from 42% to 67%, which more than accounts for the increase in the Alzheimer’s Society’s numbers. We are, however, concerned about this issue and remain focused on pulling together a new challenge on dementia strategy for the next five years and on ensuring that beds are liberated in a timely and reasonable fashion.

Coronavirus is naturally a matter of high concern in our preparations. Care of existing vulnerable and lonely people and the elderly is a massive priority, and we are putting in place plans to provide that care.

[Lord Forsyth of Drumlean (Con)]

My Lords, if the care of people with Alzheimer’s and other conditions is such a priority, why have the Government not responded to the Economic Affairs Committee report on social care which came out seven months ago, and why was there nothing in an otherwise excellent Budget speech on social care, which we have been promised now for year after year after year?

[Lord Bethell]

The noble Lord is quite right to point out the delay in providing an answer on social care. That is why the Secretary of State for Health and Social Care wrote to Peers earlier this month, initiating a round of cross-party conversations and putting in the diary the beginnings of a process to pull together cross-party agreement. That cross-party agreement is essential to providing a long-term solution to this important problem.

[Baroness Brinton (LD)]

My Lords, I want to pick up on the point of the noble Lord, Lord Forsyth, about the lack of any extra funding for social care in the Budget. There was a reannouncement of just over £1 billion from before Christmas, but the Local Government Association states that social care generally needs about £4 billion to be able to maintain any sort of service to meet demand, which rises to £14 billion by 2030. Just saying that we are getting together to start to talk about social care problems is not enough. Where will extra money come from to remove people from hospital who do not be need to be there and to fund social care properly?

[Lord Bethell]

The noble Baroness is entirely right to say that this is an important issue. Short-term funding has been put in place for the best possible short-term arrangement, but this is a long-term problem that cannot be solved by any Government on their own. It requires cross-generational and cross-party agreement. That is why an important and well-organised set of engagements has been initiated. It is timetabled, and the Government have committed to action in this area.

[Lord Laming (CB)]

My Lords, does the Minister agree that it is most unfortunate, to say the least, that many of the staff who are caring for patients with Alzheimer’s disease and other forms of dementia have been classified as unskilled? Most people who have experienced those services and met the staff involved recognise their skill and the contribution that they make to their fellow citizens. They should be valued.

[Lord Bethell]

The noble Lord makes an important point. I completely sympathise with it. Low paid does not mean unskilled or unvalued. We are looking at the classification, but I should like to communicate the value that we put on the people who care for those we love and the importance they play in our society.

[Baroness Ritchie of Downpatrick (Non-Afl)]

My Lords, will the Minister consider a meeting of the British-Irish Council to deal specifically with the rising level of dementia cases throughout our devolved institutions, as well as England, with special reference to social care and the need for investment in it? It is urgently required.

[Lord Bethell]

The noble Baroness is quite right that this issue is not limited to England. The devolved Administrations are very much focused on it. I will look into the relevance and possibility of the kind of meeting she describes.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, will the Minister say what today’s announcement of a freeze on alcohol duties—a continuation of the policy that the Government have pursued since 2012—will do to aid Alzheimer’s? Will it increase it or lessen it? What research is now being done to indicate that there is a clear link?

[Lord Bethell]

This Government are committed to science-based policy. There is undoubtedly a link between personal behaviours and outcomes later in life. Public policy should be aligned to create the best possible outcomes for all people in Britain. The noble Lord’s points are well made and we will follow them up.

Covid-19: Deep Cleaning

Lord Bethell Excerpts

Wednesday 11th March 2020 Lords Chamber

[Lord Kennedy of Southwark]

To ask Her Majesty’s Government what guidance they are giving the public authorities and businesses on the deep cleaning of private and public spaces, buildings and facilities in the wake of COVID-19.

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

My Lords, on 26 February, Public Health England published guidance on Covid-19 decontamination in non-healthcare settings. The guidance describes best practice in cleaning, the appropriate disposal of materials, the disinfection of equipment and the personal protective equipment that should be worn. As present, Public Health England advises decontamination only where there has been a possible or confirmed case of Covid-19. In all other situations, normal cleaning procedures should be followed.

[Lord Kennedy of Southwark (Lab Co-op)]

My Lords, I refer to my relevant registered interests. This virus can remain infectious on surfaces for up to 96 hours. My Question stems from my observation that many public and private buildings, facilities and spaces may have been swept and cleaned but not cleansed. There is an important difference here. Does the Minister agree that we have a serious challenge? Can he set out the steps the Government are taking to meet it, particularly how departments are working together and not in silos?

[Lord Bethell]

My Lords, the noble Lord, Lord Kennedy, makes an important point. Cleaning and cleansing will be uppermost in all our minds, and I assure the House that it is a source of great focus in the efforts to combat Covid-19. However, I will try to persuade the noble Lord that we have only limited resources, time of those involved in the cleaning processes and good will from the public, so timing is essential when we are delivering measures to combat the spread of Covid-19. The CMO has been very clear on this: personal hygiene in washing hands and avoiding the spread of the virus to the face and skin should be the priority for us all. That is the focus of the Government’s efforts at this stage.

[Lord Forsyth of Drumlean (Con)]

My Lords, I declare an interest as chairman of a bank. The issue that the noble Lord has raised is very important. If someone is diagnosed with coronavirus, good practice means that no staff are allowed back into the building until it has been deep cleaned. An alternative would be to deep clean the building every night, so that if there were a case people could continue in their work, but to be able to pursue such a policy you need to know exactly what needs to be done to maintain the welfare and safety of the workforce.

[Lord Bethell]

The noble Lord is entirely right that cleaning is important, but the kind of deep cleaning protocols he described are not those recommended by the CMO at this stage of the epidemic. The SAGE group of statisticians and epidemiologists is modelling the outbreak of the virus very closely. Its computer models track the behaviours of the virus, the demographics of the country and the behaviours of people in different circumstances. Its focus is to try to ensure that we channel all our efforts into effective measures and do not explore red herrings or distracting policies that might prove counterproductive or distract from effective measures.

[Baroness Brinton (LD)]

Can the Minister assist the House? He said just now that advice was published at the end of February on how to decontaminate non-hospital environments. It is extremely difficult to find; I have not managed to find it yet. It is clearly difficult for cleaning companies to find. One company in the UK which works across a number of our cities published its own advice to its cleaners which was taken from the Singapore standards. If people cannot find this advice, how on earth do they know what the NHS wants people to do in this country?

[Lord Bethell]

I completely take on board the noble Baroness’s observation. I have here a copy of the regulations and I am happy to lay it in the Library. It is on GOV.UK in exactly the place you would expect to find such guidance, but I take on board the comments. We are spending millions of pounds on public information and employer advertising. More will be done to ensure that this kind of information reaches the people who need it. I will ensure that the message is heard loud and clear.

[Lord Hannay of Chiswick (CB)]

My Lords, does the Minister recognise that there is some anecdotal evidence—I declare an interest, because my grandson is involved—that the time gap between taking a test and verifying whether it is positive is growing? This involves great distress and problems for the rest of the family concerned. Can he look into whether there is any way of ensuring that this gap does not continue to widen?

[Lord Bethell]

I would like to reassure the House that my understanding is that the gap is not widening, but quite the opposite. An enormous amount of resources have been put into the various elements of the testing process, including the transport of tests to the testing centres, the turnaround of the tests and the return path to the testee. They include technological solutions that speed up that process dramatically. For Peers who are concerned, there is a special helpline for those who think they are displaying symptoms. I highly recommend that anyone who is concerned makes use of it.

[Baroness Whitaker (Lab)]

Is the Minister aware that in the city of Brighton, there are notices in almost all the public places advising people to cough only into a tissue and then to bin it? When I went into my local Boots in London, there was no such notice, and I saw four people coughing without any shielding. When I asked the shop assistant if she could advise people not to do that, she said, “There is nothing we can do about it.” Can Her Majesty’s Government not do as well as the government of Brighton?

[Lord Bethell]

The noble Baroness is entirely right to emphasise the importance of personal hygiene. The Government are working hard to drive these messages home. Ultimately, it is up to the public to embrace the messages. A substantial public awareness campaign was launched 10 days ago. From the polling that we have done so far, it appears to have been extremely effective. Based on that polling, we will be launching a further campaign to ensure that everyone is aware of the hygiene protocols the noble Baroness describes.

[Lord Lansley (Con)]

My Lords, the Minister made a good point about timing. Sometimes certain measures require preparation by public authorities and the public before they can be initiated. Does he agree that we may be not too far off a point when we ask those who are elderly and have underlying health conditions not to leave home, and that many public authorities—parish councils, town councils, local government, the NHS and Age UK—might soon want to undertake preparations?

[Lord Bethell]

My noble friend is quite right that measures require preparation. This Government are determined not to be caught on the hoof. In his public statements on Monday the CMO was clear that there are three areas where the modelling suggests there might be a major difference to the delay processes that the House has heard about and understands. My noble friend is also right that the safeguarding of older and vulnerable people would be a likely candidate for that. A substantial amount of time is required though, maybe 10 to 12 weeks or more. It is important that social acceptance of that kind of measure is in place before it is initiated. We are also looking at modelling the kinds of changes which would mean that those who display any symptoms might seek to socially distance themselves or that those who have been tested think about ways of putting space between themselves and their families. These are the kinds of illustrative examples that the CMO has already discussed publicly, and the Government are preparing for those kinds of scenarios at the moment.

[Baroness D'Souza (CB)]

My Lords, I am told on good scientific evidence that the Covid-19 virus is surrounded by a fatty skin, and that therefore the only way to deal with it effectively is by using hot water and soap. Can the Government slightly modify their advice? I am not sure that gels or cold water will have the intended effect; only hot water and soap will.

[Lord Bethell]

The CMO has been very clear on this important point, and I thank the noble Baroness for making it. The virus is washable. Sanitisers, cold water and soap work, but undoubtedly, hot water and soap for 20 seconds while singing a song of your choice is by far the best way of dealing with this threat.

Health Protection (Coronavirus) Regulations 2020

Lord Bethell Excerpts

Wednesday 11th March 2020 Lords Chamber

Moved by

[Lord Bethell]

That the Regulations laid before the House on 10 February be approved.

Relevant document: 5th Report from the Secondary Legislation Scrutiny Committee. Considered in Grand Committee on 9 March.

Motion agreed.

Coronavirus

Lord Bethell Excerpts

Monday 9th March 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, with the leave of the House, I shall repeat an Answer to an Urgent Question asked in the other place earlier today. The Answer is as follows.

“Madam Deputy Speaker, the coronavirus outbreak continues to advance around the world. The number of cases in China and South Korea keeps rising, but at a slowing rate. However, the outbreak in Iran, Italy, Switzerland and now France and Germany is growing. In Italy alone, we have seen 1,492 more cases overnight and 102 more deaths. Here in the UK, as of this morning, there were 319 confirmed cases. Very sadly, this now includes four confirmed deaths. I entirely understand why people are worried and concerned, and we send our condolences to the families.

The UK response is guided by our four-point action plan. We continue to work to contain this virus, but we are also taking action to delay its impact, to fund research and to mitigate its consequences. Throughout, our approach is guided by the science. That is the bedrock on which we base all our decisions. Our plan sets out what we are prepared to do, and we will make the right choices of which action to pursue at the right moment.

The scientific advice is clear: acting too early creates its own risks, so we will do what is right to keep people safe. Guided by the science, we will act at the right time and we will be clear and open about our actions and the reasons for them. These are the principles that underpin the very best response to an epidemic like this.

Turning to research, I can report that we have made available a further £46 million to find a vaccine and develop a more rapid diagnostic test. We will continue to support the international effort. Here at home, the NHS is well prepared with record numbers of staff, nurses and doctors. I want to thank all those involved for their work so far.

The number of calls to the NHS 111 service has increased and we have recruited an extra 700 people to support that effort. The 111 online service is now dealing with more inquiries than voice calls. To date, Public Health England has tested nearly 25,000 people and the time taken to test is being reduced as we bring in a new system for faster results.

Responding to coronavirus will take a national effort and everyone must play their part. Of course, that means the Government, but it also means everyone washing their hands more often and following public health advice. There is much more that we can all do both through volunteering and through support for those who are most vulnerable. We will shortly bring forward legislative options to help people and services to tackle this outbreak. The Bill will be temporary and proportionate, with measures that last only as long as is necessary, in line with clinical advice.

I can also report that over the weekend we initiated action to assist the 120 passengers on the “Grand Princess” cruise ship off the coast of California in coming home.

We will stop at nothing to get this response right and I commend the Statement to the House.”

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for repeating the Statement. I shall ask three questions as quickly as I can so that as many people as possible can get in to speak.

My first question concerns vulnerable people in residential homes and the learning disabled who may be being supported, either by charities or at home by their parents. We need to include these people in the planning. I do not expect the Minister to respond to the point, but I will put it on the table. There are lots of people who have not been mentioned but need to be taken into account.

The 111 service is clearly under incredible pressure, given that it apparently took 120,000 calls in the first week of March. I want to ask the noble Lord about the training that 111 staff are receiving. If 700 new people have been taken on, how is their training being accelerated and is it being properly funded?

Finally, when the Select Committee saw Professor Whitty last week, he explained that half of all coronavirus cases in the UK are most likely to occur in just a three-week period. Based on recent trends, have the Government estimated when that peak might begin, and is the noble Lord sure that hospitals have enough bed spaces so that they are able to cope?

[Lord Bethell]

My Lords, the noble Baroness has expressed concerns about those in residential homes and people with learning difficulties. The needs of all the most vulnerable in society are paramount. There is no doubt that intense pressure will be put on social services, social care and clinical care. We are doing all we can to ensure that support is in place, which will include the mobilisation of civil society, charities and volunteers to take up some of the pressure being put on those services.

On training provision, modern call centres have very flexible working arrangements whereby staff are brought on and off contracts. Those who have already received 111 training are being brought back on to the front line. The funds for that are properly in place.

On the timing of the peak, it is impossible to say with certainty when that will be, but the CMO is crystal clear: we will do everything we can to spread it out over the summer and we will keep this House and the public up to date.

[Baroness Brinton (LD)]

My Lords, I also thank the Minister for answering the Urgent Question. Going back to my point about advice for vulnerable people, it is good to hear that advice is finally planned, but vulnerable people need that advice now. I have been saying this in your Lordships’ House for about three weeks. Will the Minister please let us know when we are going to get it?

My second question follows up on the previous one about 111. In addition to the worrying report from the woman on the “Today” programme this morning who kept not getting return calls over a three-day period, despite a high temperature, cough and many other symptoms, we also picked up on people ringing 111 with clear symptoms being told that they cannot be tested because they cannot name an individual who has been diagnosed with coronavirus. I repeat the same question: are the new call handlers being trained effectively?

[Lord Bethell]

The noble Baroness is absolutely right about the importance of guidance and I reassure her that an enormous amount of work is being done to draft clear guidance for employers, volunteer groups and all parts of society, which will include case studies, FAQs and detailed recommendations. That work is being guided by the CMO and senior officials at PHE.

As for 111, we look very closely at the metrics for the return of calls. Overall, the headline figures suggest that the 111 service is bearing up incredibly well under intense pressure, but I do not deny that there must be people who have had bad experiences. These pressures sometimes lead to poor results and we will keep a very careful eye on that.

[Lord Kakkar (CB)]

My Lords, I declare my registered interests. Clearly, the decision to move from the phase of containment to that of delay is essential to sustaining the ability of the health delivery system to deal with this problem.

What objective criteria will be used to determine how that decision is taken? How are the behaviour and natural history of this disease elsewhere in the world being used to inform when we should move from containment to delay?

[Lord Bethell]

The noble Lord asks an important question. The truth is that it is more of an art than a science. Efforts were made to look at clear metrics for triggering this result, but it is a complex situation and our understanding continues to develop. It is ultimately up to the judgment of the CMO and the confidence of the Secretary of State to make that call.

[Lord Lamont of Lerwick (Con)]

My Lords, how many intensive care facilities are at upwards of 90% of utilisation and what can be done to increase the amount of facilities for people who need respiratory aid? What additional intensive care units could be created and what other facilities could be made available?

[Lord Bethell]

Enormous effort is being put into increasing the number of intensive care facilities, particularly in the area of respiratory support. Different types of respiratory support unit are being put in place and the number is increasing on a multiple rather than an arithmetic scale.

It is not just the kit that is an issue but the people needed to operate it, because these units and the respiratory machinery are extremely technical. We are putting enormous effort into ensuring that the right people are in place to work the machines.

[Lord Lea of Crondall (Non-Afl)]

My Lords, can the Minister shed further light on which countries research vaccines and how this can be agreed internationally? Are there difficulties with the process by which this division of labour is carried out? There could be a lot of duplication and not sufficient single-minded co-ordination.

[Lord Bethell]

The noble Lord asks an important question about the critical element of the research phase of our plan, and we have announced £46 million of additional funding for this area. Britain’s scientists are providing a leading contribution to the international effort. That effort is being conducted in an extremely transparent, open source fashion, with important details on genomic material being shared widely and openly. My understanding is that it is being done in a spirit of public collaboration.

[Lord Patel (CB)]

My Lords, does the Minister agree that what we have learned so far from the outbreaks in other countries, and even the small number of deaths in this country, is that the vulnerable groups are people aged over 65—more men than women—and those with underlying conditions? What is the Government’s strategy to protect the elderly and reduce their risk of getting this disease?

[Lord Bethell]

The noble Lord is entirely right. The CMO’s effort is now to identify those groups who require the greatest priority of assistance. We are not sure, and the CMO has not declared, at exactly what age that should start. He is considering publication of the exact details of the priorities in future. It seems that it is not necessarily gender-specific but that the state of your immune system is the key driver. In some areas, of course, men have very bad habits when it comes to things such as drinking and smoking. The CMO has made it clear that if you want to do one thing to avoid getting the virus, it is giving up smoking.

[Baroness Finlay of Llandaff (CB)]

Will the Government give specific guidance on deferring or cancelling gatherings of clinicians and other healthcare professionals at conferences and examinations required for career progression, and specifically ask the regulators to allow alternative routes of registration and validation?

[Lord Bethell]

The noble Baroness asks an important question about trying to keep our clinical staff healthy and fit. That is one of the biggest priorities in an epidemic such as this, because the pressures on the NHS are made worse if clinical staff are themselves poorly. At this stage the CMO has not decided that the cancellation of conferences or major events is proportionate, but that remains one of the options laid out in our CV plan. If necessary, provisions for videoconferencing and alternative ways of attending training will be considered and put in place.

Health Protection (Coronavirus) Regulations 2020

Lord Bethell Excerpts

Monday 9th March 2020 Grand Committee

Moved by

[Lord Bethell]

That the Grand Committee do consider the Health Protection (Coronavirus) Regulations 2020.

Relevant document: 5th Report from the Secondary Legislation Scrutiny Committee

[Lord Bethell (Con)]

My Lords, in the time available to me, I would like to remind your Lordships of the level of seriousness with which we should address the level of Covid-19 and the context for the Government’s response. I will then explain the workings of the regulations in detail and how they fit into our wider strategy for addressing the outbreak.

On 31 December 2019, Chinese authorities notified the World Health Organization of an outbreak of pneumonia in Wuhan City, which was then classified as a new disease, Covid-19. On 30 January 2020, the WHO declared the outbreak of Covid-19 a public health emergency of international concern.

Based on current evidence, the main symptoms of Covid-19 are a cough, high temperature and, in severe cases, shortness of breath. It is a new virus, so there is a lack of immunity in the population and, as yet, no effective vaccine. This means that Covid-19 has the potential to spread extensively in the population.

As expected, case numbers are increasing, but the UK remains well prepared for such outbreaks. As of 9 am on 9 March 2020, 24,960 people had been tested in the UK, of whom 24,641 were confirmed as negative and 311 were confirmed as positive.

Although our knowledge is growing by the day, much remains unknown. The four UK Chief Medical Officers have made it clear that the disease currently presents a moderate risk to the public, but that planning and preparation for the potential of a more widespread outbreak is sensible. As the Prime Minister has made clear, there could be a very significant increase in the number of cases of coronavirus in the UK.

Tackling Covid-19 requires a robust, integrated and proportionate response. On Tuesday 3 March, the Prime Minister introduced the UK’s coronavirus action plan, providing the public with information on what the Government have done and on their plans to tackle the coronavirus outbreak.

The Government’s approach to tackling Covid-19 can be summarised in four phases: contain, delay, research and mitigate. The Government have focused hard over the past weeks on the containment phase, taking precautionary measures to limit the spread of the virus as much as possible. A crucial aspect of that is ensuring that people who are contacts of known cases or are considered to be at high risk of infection are isolated from others for a period of time, ensuring that they cannot infect others but can readily access help if they fall ill.

--- Later in debate ---

[Baroness Finlay of Llandaff (CB)]

My Lords, first, I apologise to the Committee that I came in late. The business proceeded slightly faster than I realised, but I am most grateful to noble Lords for allowing me to intervene briefly.

The comments made by the noble Lord, Lord Campbell-Savours, clearly illustrated the need for messaging out to the public. One of the difficulties is that the answers to many of his questions are just not known scientifically. It is a range of probabilities only; the way the virus behaves on different surfaces and with different substances is different. The infectivity may vary with the viral load to the individual as well as the individual’s own immune system. That makes it really complicated in terms of defining. You cannot give a false sense of security to people by saying, “Well, you are fit and well, and your immune system is okay”, because those people may become very ill, particularly if they have a large viral load. We saw that with the Chinese doctor who initially highlighted the problem. Tragically, he died.

I take this opportunity to ask a few questions. This order refers to Public Health England but we have devolved Administrations, and Public Health Wales and Public Health Scotland operate differently. Some aspects of this statutory instrument concern the police and justice, yet the Ministry of Justice and its overarching responsibilities are not devolved, so there is a difficult interface between the devolved and non-devolved competencies. Can the Minister provide some reassurance on the daily round-table consultations that are going on to make sure that decision-making is absolutely seamless and that the devolved Governments are taking forward—and, I hope, mirroring—such legislation so that we do not end up with different systems operating across what are effectively artificial borders? In areas such as Shropshire, there is a huge amount of cross-border flow between England and Wales. Linked to that, can the Minister clarify that equipment, and its distribution to where it is needed, is also part of the consideration of the protection of the public so that we do not have an outcry if one part of the country cannot access equipment as well as another?

Testing is difficult: it is a complex and finite resource, and it takes some hours to run the test. A lot of the public do not understand that it is not like a pregnancy test; it is not a quick dip and a quick answer. With such a finite resource, will the Minister clarify where the governance sits for the management of negative results? One of my anxieties is that people may have a false sense of security from a negative result, because they may get the infection the day after it and subsequently become positive. Although it is helpful to confirm positive cases, a negative result does not mean that you are not going to get the coronavirus infection further down the road.

Linked to the cross-border issues, can the Minister also confirm that the use of beds and the availability of things such as ITU beds and ECMO are being considered across the whole country? I worry that difficult decisions are going to have to be made and it will be very important to have clear standards against which to make them. If it looks as if we are becoming like Italy, that will certainly more than stretch services to the limit; it will take them beyond it.

Will we need additional statutory instruments for the reregistration of people with healthcare professional qualifications of any sort? If so, when will we see them? I was rather hoping that it might be today. This relates to my earlier question about registration on specialist registers. Is the GMC working to find alternative ways of putting those who have completed training on the specialist register without bringing them all together in an exam hall, which seems to be an unwise move when their competencies have already been assessed through training?

That concludes my questions, but I thank the Minister for his clarity, for explaining things really well, for answering questions on the Floor of the House and for answering unanswerable questions with such honesty. It is terribly important that he and those advising him try to be very clear and open about the things that we do not know.

[Lord Bethell]

My Lords, I will start by talking about two matters that are not central to the regulations but which are important pieces of context. I thank the noble Lord, Lord Campbell-Savours, for his incredibly candid and heartfelt comments, which none of us here could help but be moved by. I would also like to express sympathy for his personal situation. We all know friends, relatives and people who are in a vulnerable position. While the CMO’s advice is that for a lot of us the virus does not present a huge risk, for some people it does. That cannot but be on their mind and we think about them a lot, so I am grateful to the noble Lord for bringing that message of seriousness and his personal testimony.

I will also address directly the noble Lord’s questions. I am afraid that I cannot answer the important technical questions he asked; I am grateful for his appreciation of that fact. However, I reassure the Committee that our approach is to seek to be as transparent as we possibly can be. In answer to the noble Lord’s question, there is a daily update on the PHE website, where all the figures that we know and can prove are published—they go up at 1.45 pm every afternoon. That is a serious matter, and we are looking at ways of making that a more easily accessible dashboard with a deeper set of numbers that you can look at locally; we could then publish as reasonable and proportionate an amount of figures as possible while keeping secure the anonymity of those involved.

The other part of our approach comes very much from the spirit of the CMO himself, whom many of your Lordships will have met. He is an enlightened character who is extremely committed to evidence-based policy recommendations. We all plague him with questions much along the same lines as those the noble Lord, Lord Campbell-Savours, asked, seeking from him reassurances about particular technical questions. He is able to speculate and to say, “Maybe this or maybe that, but I can’t give you any clear reassurance on that because there is no data on it”.

One of the things about trying to preserve the pact with the public that our decision-making is supported by evidence is to avoid going into the kind of tempting speculation that the situation draws you into. There is temptation there, but, as a cardinal rule, we have to apply a self-restraining ordinance on trying to give people the answers and the speculation that, emotionally, they naturally want. The questions of the noble Lord, Lord Campbell-Savours, are exactly right, and I reassure him that battalions of scientists are trying to get to the bottom of those answers. Lots of evidence is being worked up, and I believe that answers to many of those questions will be forthcoming. However, until they have the sign-off from the scientists, it is not right for us to indulge in speculation. That is the foundation of our approach, which I mentioned earlier. Although it is incredibly frustrating, from a public policy point of view it is the right approach. However, I will try to address just a couple of the questions that the noble Lord asked, without falling into my self-defined bear trap.

The noble Lord, Lord Campbell-Savours, asked about masks. Broadly speaking, except for the most comprehensive hazmat suits that cover you from head to toe, masks are mainly used to limit the number of germs that you emit rather than that you consume. I think we are all interested in the work going on in Taiwan, where all schoolchildren wear masks, not to protect them from the germs but to try to stop them infecting the people next to them. That is an interesting insight, but it is not the approach that the CMO has recommended.

On the delicate issue of mortality rates, I completely sympathise with the noble Lord’s point that there is wild speculation on these numbers, and it would be fantastic to have a more reliable set of figures. I will say only that it is extremely difficult to know mortality rates, because you simply do not know how many people have the virus in the first place. Large numbers of people are infected and infectious but completely asymptomatic and never go near a test kit, so we cannot know what the mortality rate is at any age. I recommend that the noble Lord treats all mortality rates data with great suspicion. It is not the way we are guiding ourselves.

--- Later in debate ---

[Baroness Brinton]

In the past they have been on that register, and the big concern is the move from one department to another. If I am being told that that is not the case, that is not the feedback I am getting from directors of public health. As the Minister knows, I have other concerns about the relationship between Public Health England and directors of public health, which is why I asked for clarification.

[Lord Bethell]

I completely understand the point of clarification. If there is information available on what proportion of directors of public health are also public health consultants, we will share it with the noble Baroness. However, the way that the regulations are drafted at the moment means that the powers in the regulations are held not by directors of public health but by public health consultants.

[Baroness Brinton]

I am sorry to interrupt the Minister again but the point is not about the register kept by Public Health England. My point concerns the definition of public health consultant—I am afraid that Hansard now has the relevant document, otherwise I would quote from it—and most directors of public health have to do that qualification because the job description, which is in the statutory guidance, says that they must be registered. That is my problem, and I know that it is clearly a problem for some of them as well. There is a bigger issue here. Should this become a pandemic and we see a large spike in numbers, we will need everyone qualified in public health to be able to do this, and there seems to be a problem in excluding the people at the heart of managing coronavirus within their wider communities.

[Lord Bethell]

The noble Baroness makes a very reasonable point. My understanding is that this decision was made not on a personnel basis but on an administrative basis. We are seeking to restrict the number of people who are able to execute these potentially quite serious powers. Having a list of available people is a legally clear and responsible way of doing things, but creating a new administrative definition goes beyond the powers of these regulations. However, I have already taken on board the noble Baroness’s points about the role of directors of public health in this epidemic. Those points have been listened to and are being followed up, and I will continue the dialogue that we already have in place on that.

The noble Baroness, Lady Thornton, asked why the 2008 powers are not sufficient. The answer is that it is mainly for practical reasons. The 2008 Section 2A powers give local councils powers but mobilising local councils to do things, sometimes at the weekend, sometimes at ports where they are not necessarily administratively present and sometimes overnight, is administratively a challenge. We found that in practice during the containment at Arrowe Park, it was really Public Health England officials on the ground who dealt with the situation and who needed these powers both in their back pocket and in their administration of the situation. That is why we have sought to do this. It is fair to say that a lessons-learned review is expected in the years to come and this will be the kind of issue that we will look at again.

The noble Baroness, Lady Thornton, asked what the difference is between detention and isolation. Although I do not have the legal definitions in front of me, my understanding is that isolation can be in someone’s house—literally holding them away from the rest of society—whereas detention involves confining someone to a place that they cannot leave, such as a police cell or a jail. Both are covered in these regulations. It is worth saying that you could, for instance, seek to isolate someone in a hotel room near the Arrowe Park facility and that would be covered.

The noble Baroness also asked about magistrates’ courts. I reassure her that MoJ colleagues were fully consulted on this and they did not see a problem. The objective was to try to create a low bar for an appeal to make the appeal process as easy and accessible as possible, recognising that these are very serious powers and we want to make them as sensitive as possible. In terms of police involvement and whether the police would wear suitable suits, they absolutely would. Police officials are highly protective of their workforce. Public Health England is working closely with the police to ensure that they have both the guidelines and the kit necessary to protect the workforce.

On the term of the regulations, I agree with the noble Baroness that two years is longer than we hope or pray this virus will continue. However, the advice from the CMO was that we cannot necessarily plan for that. Viruses sometimes last longer than expected; they can create multiple strains, and it may take time to have the lessons-learned review and to bring in new powers. That said, it is also possible that a coronavirus Bill that overtakes these regulations will be brought to the House later this month and the sunset clauses would necessarily be included in that.

[Lord Campbell-Savours]

Will the Minister reconsider something that he said to me? He said that he could not answer many of the questions that I asked. Almost all of them were to do with contamination, and virologists can answer them—I am told by a virologist that they can all be answered; we went very carefully through them. Can the Minister take each of the questions that I asked and answer them individually on the basis that virologists will be able to give him the information that he requires?

[Lord Bethell]

The noble Lord, Lord Campbell-Savours, is entirely right to press me on this. I should be honest: obviously, I am not a doctor. However, we have arranged for another briefing from the Chief Medical Officer in Room G at 4 pm tomorrow. He is the epidemiologist who can convey to the noble Lord both the extent and limits of current understanding of the virus. I have sat with him sufficiently long to have the impression that a lot of speculation, guidelines and history are associated with such viruses that we might reasonably apply to this one. However, its behaviours are not fully understood. Although the genome is broken, we do not fully understand its genetic makeup. The advice from the CMO generally is to hold back on pretending to understand things that are not yet fully explored.

[Baroness Thornton]

I say to my noble friend that I would not use the internet as my source of information on any of these issues. I would use the BBC, which has been running extra programmes—in fact, I have just received an email from the head of the World Service listing all the extra programmes that the BBC is producing which will give us lots of advice. Its website is useful. I want to put it on the record to my noble friend that I would steer clear of those sorts of discussions on the internet and look at the BBC’s websites.

[Lord Campbell-Savours]

The great majority of the British population will not go into some of the technical areas that my noble friend would go into. That is why I am trying to find a single source of information for people to be able to go to which is authoritative and gives answers, with the latest information and knowledge available, on each of the questions I have asked. I persist in believing that the Government should arrange for this information to be made part of the public debate, because it would be helpful to everyone concerned.

[Lord Bethell]

I understand the point and will take it back to the department.

The noble Baroness, Lady Finlay, asked about testing. She is entirely right to focus on that, because we are at the stage of the cycle when questions about testing are very much on our minds. She asked where we were focusing our testing. The most important area for testing is those people who are most vulnerable but who might have the virus. She is entirely right that someone who tests negative today may well test positive tomorrow. Where that is most dangerous is within hospitals. Hospitals are centres of infection. It is one reason why, if you phone 111, they recommend that you do not go to your hospital or your GP. Therefore, testing within hospitals is where we are focusing our resources.

I reassure the noble Baroness, Lady Finlay, that we are moving incredibly quickly to increase capacity of ECMO beds. There will be a huge amount of pressure —we cannot hide that—but those most in need are being prioritised. Training is going on to support those with the technical knowledge of how to run the equipment and purchasing is going on to create new kit.

On reregistration of clinical professionals, all the concerns raised in Committee and in the Chamber about the provenance of people seeking to reregister are fully understood. Provision is being made to make sure that criminal record checks and competence checks are in place. However, these remain incredibly valuable and skilled people who can support us, so we are determined to mobilise them if possible.

[Baroness Finlay of Llandaff]

I referred to difficult decisions possibly being made. Can the Minister reassure the Committee that the Government are working with the heads of all the royal colleges—particularly their ethics committees—to make sure that unified guidance is going out to commissions across all the disciplines? Unfortunately, the different colleges have at times a tendency to work in their own silo, but this will be across all of them. It will have to go across the professions, rather than across the individual trusts and internal organisations. Therefore, a round table or regular consultation with them to make sure they all give the same messages is important, and it would reassure the public.

[Lord Bethell]

The noble Baroness, Lady Finlay, makes an important point. The CMO currently has a weekly call with all the presidents or relevant members of the royal colleges, and there is an incredibly energetic interface between officials at PHE and the colleges. New guidance is being drafted at the moment. As our understanding of the epidemic increases so the CMO’s certainty and confidence about the advice he is giving will be clearer. We are therefore seeking to publish really good guidance for employers, voluntary organisations and all the groups who need it. The CMO also works closely with the CMOs of the other three nations, and I understand that is an incredibly healthy and productive relationship. It has served very well to ensure that the devolved authorities are fully involved in decision-making and that there is transparency on key issues such as ethics, which the noble Baroness was right to mention.

Motion agreed.

Health Service Safety Investigations Bill [HL]

Lord Bethell Excerpts

2nd reading (Hansard): House of Lords
Tuesday 29th October 2019 Lords Chamber

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

[Lord Bethell (Con)]

My Lords, I beg to move that the House do adjourn during pleasure to await the arrival of a Bill from another place. There will be a message on the annunciator showing when the House will resume.

Safety of Medicines and Medical Devices

Lord Bethell Excerpts

Thursday 28th February 2019 Lords Chamber

[Lord Bethell (Con)]

My Lords, I start by congratulating the noble Lord, Lord Carrington, on a really touching and thoughtful maiden speech. We are all hugely moved by memories of his father, and many here will remember him with great fondness. He was a man who embodied the values of the House: courage, professionalism, public service and, very famously, a strong sense of discretion. From the evidence of his splendid maiden speech, the new Lord Carrington should have no fear of following in his father’s huge footsteps. I am sure he will make a powerful impression on the House, particularly in his chosen fields of finance, the rural economy and the arts.

I thank the noble Lord, Lord O’Shaughnessy, for bringing this important debate to the House. I also thank the Library, which has produced a massive, 20-page blockbuster that tackles this technical subject with huge helpfulness. My main interest in the debate is in the area of drug development and the potential for a more agile approach to drug regulation. I am very grateful to those who have already spoken about medical paternalism and the growing scepticism of patients about medical and scientific authority.

It has been my experience of human nature that, when facing an adverse condition, people are prepared to suspend normal attitudes to risk. My father, the late Lord Bethell, suffered severely from Parkinson’s disease. I remember sitting with him in the office of the eminent Professor Tipu Aziz, a great expert in Parkinson’s. My father had avoided all contact with the medical profession for his entire life as an article of faith, but there was Professor Aziz suggesting that he wanted to drill a very large hole in the top of my father’s head and then inject his brain with an untested dopamine mixture. My father, a cautious man at best, thought this was an incredibly exciting idea and was 100% up for it. He was enormously frustrated when he did not qualify for the pilot. I think that is an indication of the changing attitudes that people have, as my noble friend Lord O’Shaughnessy mentioned, when they face medical adversity.

I must declare an interest as a trustee of the Scar Free Foundation. I shall tell the House another story: last year I visited the Centre for Conflict Wound Research, where I met members of the Casevac Club, which is like a modern-day World War II Guinea Pig Club. They are lending their bodies to medical research. There was an amazing veteran with no legs who had a massive scar across his entire torso. He was having a laser puncture his scar 400 times a second in a lattice formation on one side of his body but not the other, in an excruciatingly painful treatment, in order to get important data on the effectiveness of this new skin-healing process. I felt that this was an incredibly moving metaphor for the determination that some people show and the sacrifice that they are prepared to make for medical science.

My noble friend Lord O’Shaughnessy put it very well when he talked about those who live normal lives who expect a regime of safety. I want to talk about that. No one wants an uncontrolled Wild West approach to medical regulation. In fact, that would be utterly counterproductive to investment; I am aware that under certain circumstances when drugs are tested, early problems might prevent investment in later trials.

I highly recommend the report of the Panel on Monitoring the Social Impact of the AIDS Epidemic. That epidemic is fascinating, as the rulebook was essentially thrown out of the window in the mad dash for a cure, and there was essentially a patient mutiny. There was incredible progress and innovation, but there were also terrible mistakes. There were cul-de-sacs and snake oil, and less fortunate, poorer people did not get access to the right treatments. The financial costs were enormous, and the political pressure and risk tolerance were probably unrepeatable. I think we should try to learn the lessons of that episode.

I am very grateful for a briefing from Professor Derek Alderson, president of the Royal College of Surgeons, who talked me through its recent Commission on the Future of Surgery. Its report speaks about the rising use of medical devices and the urgent need for a unified national medical devices registry to make it easier to keep track of what products are on the market and to measure performance and issues. I instinctively lean away from new regulations and registers, and I am aware of the #WeAreNotWaiting movement, which some noble Lords may have followed. However, given recent experiences, which have been spoken about so touchingly by Members of this House, including the noble Lord, Lord Hunt, and the noble Baroness, Lady Cumberlege, it would be wise to support this measure. I was utterly persuaded by his argument, and I urge the Minister to move forward on these recommendations, as indicated in the words of Jackie Doyle-Price in another place earlier this month.

By way of conclusion, I want to make the case to the Minister for an energetic approach to medicine development and data generation that allows for early and progressive patient access to medicine. The European Parliament has handily called this “adaptive pathways”. For me, that phrase encapsulates a really good mixture of three essential ingredients: a thorough, data-driven approach to evaluation; a compassionate attitude to the natural human desire for cures; and a pragmatic recognition that patient feedback is an essential component of the research process. I am excited by the results of the European Medicines Agency pilot and by the UK’s accelerated access review, but my heart sank when I read about the slow pace of change. I urge the Minister to exert her considerable persuasive powers to put a red-hot fire under this process.

Healthcare (International Arrangements) Bill

Lord Bethell Excerpts

2nd reading (Hansard): House of Lords
Tuesday 5th February 2019 Lords Chamber

[Lord Bethell (Con)]

My Lords, I thank the Minister for her excellent introduction and her absolutely excellent maiden speech. I have known her since before she was an MP, followed her progress with absolute awe and grown to respect particularly her expertise in health technology—an area which is a huge opportunity for the country but will also need a lot of scrutiny from the kind of expertise found in this House. I look forward to many engagements on that subject.

On this legislation, I thank the members of the Home Affairs Sub-Committee of the EU Select Committee—the noble Lord, Lord Jay of Ewelme, and his fellows—for their excellent report. What I found striking was the great concern it expressed about the potential loss of existing reciprocal healthcare rights, the dangers of the cost to the NHS and the potential administrative burden, and the large amount of coverage that the report received in the press. It was a brisk reminder of how an overlooked area of policy and machinery of government which is precious to a lot of people needed to be focused on as we approach Brexit.

I was grateful to the noble Lord, Lord Thurlow, for his reminder of the costs of this area of government—it was an important point. I was grateful also to the noble Lord, Lord Lansley, for reminding us that, if we are to take away freedom of movement, we should perhaps get rid of such reciprocal rights—there is a sort of logic to that. I am here to reject both those arguments and to make an appeal in the opposite direction. I want to try just for a moment to extend the debate outside the Chamber, beyond Brexit and Henry VIII powers, to offer a little reminder of how many of the public might regard this as not only a healthcare issue but as one that touches on a subject that is very important to most of them; that is, travel.

Travel has changed dramatically in the public mind. It is not felt to be a luxury any more, as it was when I was a child. It is felt more to be a right and a form of expression; it is a part of one’s education, and it is critical to business. We can all wonder about the sense of entitlement among the modern generation, but I for one celebrate the benefits of travel. It satisfies the yearning to improve oneself personally and, among the business community, enables one to reach exciting new markets. In the context of this debate, we have not really talked much about the benefits of travel both to the country and to individuals. Underpinning that yearning for travel is a desire for frictionless, risk-free and affordable travel. The reciprocal rights that we are talking about are there to provide that kind of cover.

I do not think that there will be a massive change in the country’s mindset in respect of travel just because of Brexit and 29 March; if anything, quite the opposite. There has been a huge boom. Last year, Britons undertook 73 million trips overseas, representing an increase of 4% on the year before—that is a hell of a lot. That growth has gone on at a very steady rate for many years. That growth will go on into the future and we should think in policy terms about its implications. The range of destinations that people are travelling to is only getting wider.

People are also relocating in later life. We have heard a lot about the 190,000 people who have already moved to Tuscany, Provence and the costas, but that number is also edging up. We have to accept that we face the possibility of making provision for an ever larger number of people.

Some 27 million Britons already have an EHIC—the noble Lord, Lord Foulkes, showed us his; I thank him for that. We in my family have six of them; I do not have mine with me. I was staggered when I heard that the figure was 27 million. That is an unbelievable number. For a public policy to be quite so successful and to get through to nearly half the country like that is a huge achievement. There will be public policy professionals who are incredibly envious of that sort of penetration. There were 250,000 claims against those cards last year. Again, that is a daunting number—much higher than I could have imagined.

My appeal today is for us to try to think about this policy not just in terms of the daunting prospect of Brexit, the constitutional implications of the Bill and the cost, but through the lens of the macro changes that we see in society about people’s yearning to go overseas, to take their business and their families with them and to see other lands. We should think about future-proofing this overlooked part of our healthcare provision and accepting that we may need to extend those arrangements in terms not only of their geographical reach but of the sophistication of how we manage them. We should communicate a clear statement to British people and the outside world that nothing that happens around Brexit is about turning our backs on the world or closing the doors. Rather, we should show through our reciprocal healthcare arrangements that we will guarantee fair and reasonable treatment for people who visit Britain and support our own citizens who might run into difficulties when they travel abroad.