Coronavirus Bill

Lord Bethell Excerpts

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

Moved by

[Lord Bethell]

That the Bill be now read a second time.

Relevant document: 9th Report from the Delegated Powers Committee

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Coronavirus Bill

Lord Bethell Excerpts

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

[Lord Bethell]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Lord Sheikh]

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

[Lord Bethell]

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

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

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

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

Covid-19: Critical Care Capacity

Lord Bethell Excerpts

Monday 23rd March 2020 Lords Chamber

[Baroness Thornton]

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

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

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

[Baroness Thornton (Lab)]

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

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

[Lord Bethell]

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

[Baroness Barker (LD)]

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

[Lord Bethell]

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

[Baroness Watkins of Tavistock (CB)]

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

[Lord Bethell]

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

[Lord O’Shaughnessy (Con)]

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

[Lord Bethell]

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

[Baroness Northover (LD)]

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

[Lord Bethell]

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

[Baroness Blackwood of North Oxford (Con)]

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

[Lord Bethell]

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

Covid-19: Helplines

Lord Bethell Excerpts

Thursday 19th March 2020 Lords Chamber

[Baroness Watkins of Tavistock]

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

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

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

[Baroness Watkins of Tavistock (CB)]

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

[Lord Bethell]

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

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

[Baroness McIntosh of Pickering (Con)]

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

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[Lord Bethell]

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

[Lord Alderdice (LD)]

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

[Lord Bethell]

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

[Baroness Thornton (Lab)]

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

[Lord Bethell]

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

Covid-19: Vaccine

Lord Bethell Excerpts

Thursday 19th March 2020 Lords Chamber

[Lord McNicol of West Kilbride]

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

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

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

[Lord McNicol of West Kilbride (Lab)]

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

[Lord Bethell]

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

[Baroness Blackwood of North Oxford (Con)]

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

[Lord Bethell]

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

[Lord Scriven (LD)]

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

[Lord Bethell]

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

Contraceptives and Hormone Replacement Therapy Drugs

Lord Bethell Excerpts

Wednesday 18th March 2020 Lords Chamber

[Baroness Thornton]

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

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

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

[Baroness Thornton (Lab)]

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

[Lord Bethell]

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

[Lord Alderdice (LD)]

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

[Lord Bethell]

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

[Baroness Symons of Vernham Dean (Lab)]

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

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[Lord Bethell]

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

[Lord Kakkar (CB)]

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

[Lord Bethell]

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

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.