Covid-19 Update

Lord Bethell Excerpts

Thursday 8th July 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, one year ago when lockdown was lifted, we had around 1,000 new cases a day. Yesterday it was 32,000 new cases. Equally concerning, cases are doubling every nine days; hospitalisations are going up; ventilation bed occupation is going up; NHS Providers, as the noble Baroness, Lady Thornton, has said, is talking about hospitals moving back into created-Covid wards and managing safe areas. GPs and hospitals are all reporting a worrying large increase in young people with long Covid, putting further pressure on their services, let alone the worries of an epidemic of long-term illness in the working population. Anecdotal evidence suggests that some hospitals are now considering cancelling some staff summer leave. Wonderful as yesterday’s England victory was, the sight of 60,000 fans walking down Wembley Way in very close proximity with hardly a mask in sight was concerning. As with the England-Scotland match, we must expect a surge in cases. Yesterday, the BBC asked Dr Mike Ryan of the World Health Organization about the UK proposals to lift all restrictions on 19 July. He replied:

“The logic of more people being infected is better is, I think, logic that has proven its moral emptiness and epidemiological stupidity”.


The letter in today’s Lancet from 100 senior medics and scientists echoes the WHO view. What are the Government doing to explain to the experts why their strategy is safe?

I will return to the substance of the Statement later, but I start by thanking the Minister for the meeting yesterday with other Peers, Blood Cancer UK and the Anthony Nolan trust to discuss the immunocompromised and the clinically extremely vulnerable. There are over 2 million CEV who had to shield—that is 3% of the population. So, arising from questions I have asked the Minister many times before in your Lordships’ House, I will ask the following. The CEV, of whom I am one, are worried at the total silence to them over recent weeks since shielding ended formally but, with stay-at-home advice still in place, with cases rocketing daily and all restrictions easing, can the Minister explain how advice to them is being co-ordinated publicly by government? One blood cancer patient said today to an APPG of parliamentarians that the dissonance of their safety versus everyone else’s freedom was hard to bear, especially with no advice. In particular, who has clinical responsibility for drawing together the different issues of therapies, responses to vaccines and continuing care for underlying diseases, and which Minister has overall responsibility?

Overnight, there have been some suggestions from journalists that shielding might even return. If so, that needs to be communicated very urgently to those at high risk, who have not been told about their low vaccine antibody rate. They may be planning to mix with people, or perhaps even go on holiday. Will benefit support for the CEV who have to stay at home but cannot work from home be reintroduced? If the Government are serious about the irreversibility of the lifting of all restrictions, some of the CEV will not be able to return to work for weeks, or even months.

I turn to testing. There are reports today that the Government plan to charge for the lateral flow tests from the end of this month. As LFTs are supposed to be the great self-regulators that the Government are relying on, how much are people going to be charged? You do not pay the Government for a blood test to see whether you have picked up any other infection. The level of charging for PCR tests for people returning from abroad also remains a big issue. Last week in your Lordships’ House the noble Baroness, Lady Vere, told my noble friend Lady Ludford that PCR tests could be obtained at a price of £85 for two. My noble friend’s local pharmacy is charging £398 for a test on the same day, or £240 for the next day for two tests. I know other members of the public have reported similar problems. Can the Minister say how the pricing of PCR tests is being managed and, perhaps more importantly, where one can find the “£85 for two” tests?

On Tuesday, I set out what we from these Benches seek in a return to normal life. We want people to return to work as soon as possible, to be able to mix with family and friends and for our children to be able to have consistent access to education without interruption. We also agree that now is the time to start to do some of that but—and it is a big “but”—we cannot get rid of all the safeguards that protect people mixing together while the virus is still live. An effective test, trace and isolate system is essential. This Statement makes it clear that that is being dismantled. Can the Minister explain why that makes any sense?

Last night, Sebastian Payne of the Financial Times reported the re-election of Sir Graham Brady MP as chairman of the 1922 committee, and tweeted:

“Brady’s re-election is … a reminder of why Johnson is dropping masks and nearly all other … restrictions on July 19: ministers privately say the government no longer had the … votes to keep the measures in place. Relying on Labour would have been … difficult for the PM.”


Are the Prime Minister and the so-called Covid Recovery Group now putting health and lives at risk for their own principles?

Finally, with the threat of 100,000 cases by the end of the month, with hospitals saying they are already worried about the increase in patients and with the threat of the new lambda variant and new north-east variant under investigation, please will the Minister confirm that these changes are not irreversible and that the protection of the NHS, and the safety of all the people in this country, remain the Government’s priority?

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

My Lords, I am enormously thankful to the noble Baronesses, Lady Thornton and Lady Brinton, for such thoughtful questions. I will certainly try to address as many of them as I can.

In reply to the noble Baroness, Lady Thornton, on the advice we get, I am afraid, as I said last time, that we of course draw on lots of advice from lots of people. I completely acknowledge, as she rightly pointed out, that no decision in this pandemic is risk-free. She set out the list of possible risks very well. There is always the possibility that there will be new variants. We are extremely concerned about the existing 1 million people who have self-diagnosed with long-Covid symptoms; the possibility that that number may rise is very much on our minds, and we are putting in place NHS provision to assist in diagnosis and treatment of that.

We are extremely concerned that test and trace resources will be stretched. We are therefore looking extremely closely at the policy around testing and isolation, while providing test and trace with the resources it needs to get through any increase in the infection rate. I also completely acknowledge the concerns of the NHS Confederation on hospital beds and hospitalisations —although the statistics on those today are extremely encouraging.

Those are all acknowledged concerns that we keep close track of, while putting in place measures to mitigate and minimise their impact. However, the noble Baroness, Lady Thornton, half-answered her own question, because she is entirely right: we need to focus on getting the NHS back to speed in order to address the very long waiting lists and to get elective surgery back on track. It is very difficult to find an answer to the question, “If not now, when?” That has been tackled by the CMO and a great number of people. It must surely be right that we take the inevitable risks of restarting the economy and getting people back to their normal lives at the moment of minimum risk from the virus, which has to be in the middle of summer. Assessing those risks precisely is incredibly complex. Impact assessments of the kind that we would normally associate with legislation are the product of months of analysis. They often identify one relatively straightforward and simple policy measure. We are talking here about a machine of a great many moving parts.

I cannot guarantee that any model anywhere could give us accurate projections of the exact impact of what is going to happen this summer. We are, to a certain extent, walking into the unknown: the Prime Minister made that extremely clear in his Statement. As such, we are ready to change and tweak our policy wherever necessary in reaction to events. However, what we know very well now on the basis of our assessment of the data, and because of the pause we put in place to give ourselves breathing time to assess and additional time to roll out the vaccinations, is that that direct correlation between the infection rate and severe disease, hospitalisation and death has massively diminished. There is a relationship, but it is a fraction of what it used to be.

We can therefore look at a period where those who are at extremely low risk of any severe disease may see an increase in the infection rate, because we know that those in the highest-risk groups have been protected by two doses of the vaccine, and two weeks, and because we are working incredibly hard to get as many in the high-risk groups vaccinated as possible—half a million a day—and to roll out the vaccine to younger cohorts. That is the balance. I cannot deal in certainty here, because certainty does not exist. Balance is key, and I believe the balance we have here is the right one.

The noble Baroness asked specifically about the NHS Covid app. It is in some ways emblematic of the kind of decisions we are making at the moment. She is entirely right: the anecdotes are loud and clear. The app is pinging loudly around the country as the infection rate moves up. To clarify the legal point, as noble Lords probably know, the app protects privacy. We do not know the identity of the person who has the app. In fact, we have no information about people who have the app at all because it has such rigorous privacy protection. As such, the ping from the app is advisory but a telephone call from test and trace is mandatory. That has a legal status and a breach of that advice could lead to an FPN or a knock on the door. It has a different status in that respect.

Given the large number of infections and the large number of pings, we clearly need to review the way in which the app works. The Prime Minister talked about this earlier today. He talked about moving from a quarantine-and-isolation approach to more of a test-and-release approach. We are not quite there yet but we are clearly well on the way. Therefore, I would be glad to clarify how we have made those decisions once they have been announced.

The noble Baroness, Lady Brinton, talked about the plight of the immunosuppressed. I am grateful to her and to Anthony Nolan, Cancer UK and others who were on the call yesterday. I express complete sympathy with the point made by the noble Baroness. If you are at home and your immune system does not work as well as other people’s, and you see the rest of the country opening up, you will feel extremely uncomfortable, as though the world has moved on and that you have perhaps been left behind. Those were the feelings described to me by the experts I met yesterday. On an emotional level, I completely sympathise with that. There are some people in this country whose immune systems do not protect them from flu and contagious diseases that would have no impact on those with a fully functioning immune system. We have complete sympathy for those people.

I acknowledge the noble Baroness’s point that there is a need for clear advice because the immunosuppressed are a highly diverse group. There may be people recovering in hospital with a completely flatlined antibody system, compared to someone who has rheumatoid arthritis but is otherwise living at home and is mobile. It must be right that that communication is done on a tailored basis through the healthcare system. We will look at ways in which we can ensure that GPs are informed and have the right information in order to give that bespoke advice.

The dissonance is hard to bear. I recognise the noble Baroness’s point but I do not necessarily have a suite of answers for absolutely everyone in this condition. We have large investments in antivirals and in therapeutic drugs, including some of the monoclonal antibodies that may offer some protection to some people in this situation, but it is not going to be a blanket measure. As a result, we are putting a huge amount of investment in the OCTAVE study, which looks specifically at ways in which vaccines, boosters or therapeutics can be used to protect those whose immune systems are not right. Ultimately, it is going to be down to the vaccine. The vaccination of a large proportion of the population, including the carers who look after the immunosuppressed, is how we will offer protection to these people.

On the noble Baroness’ question about the LFT system being dismantled, I do not recognise those press reports. On the provision of PCRs by the private sector, she asked how prices are determined. The answer to that is through the market. The marketplace introduces competition and innovation. I am pleased to say that the price for tests is coming down and will come down further. The one provided by Chronomics for TUI is now £30; that is a very encouraging sign that there is more to go.

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

We now come to the 30 minutes allocated for Back-Bench questions. I ask that questions and answers be brief so that I can call the maximum number of speakers. I call the noble Baroness, Lady Nicholson of Winterbourne.

[Baroness Nicholson of Winterbourne (Con)]

On behalf of the whole House and the whole population, I congratulate the Minister on his magnificent work during the entirety of the pandemic and, of course, all his colleagues and everyone in the National Health Service. It has truly been a real world-beater and we are all so grateful. I have a matching point on Covid-19. I had understood, maybe wrongly, that males are affected slightly differently to females. Given that hospitals now accept self-identification of males and females, does this impact on the statistics or indeed on the treatment that everyone receives?

[Lord Bethell (Con)]

My Lords, I understand the question put by my noble friend but I am afraid that I do not recognise the anecdote to which she refers in terms of hospitals’ treatment of individuals. Nor do I particularly recognise the generalisation that males and females are affected by the disease differently, but I would be very happy to look into this matter and write to her if I can find more details.

[Baroness Finlay of Llandaff (CB)]

I thank the Minister for his responses and for the meetings he has set up. Using his words, given the challenges of “getting the NHS back to speed”, as well as the predicted rise in seriously ill patients with infections— both from influenza and Covid variants such as beta, lambda and others that may emerge—what contingency plans are being developed and activated now? What is being done to increase bed capacity for the autumn and winter and to recruit, train and upskill staff who have currently stepped back from or retired from clinical care, to increase overall capacity?

[Lord Bethell (Con)]

My Lords, the noble Baroness is entirely right to make the connection between Covid and flu. We regard the winter as presenting two pandemics, and we will treat them with equal energy. Flu and Covid have the same net effect on the healthcare system, which is to be a huge drain on resources. So we are putting a huge amount of effort into the vaccine and boosters for Covid and the vaccination against flu. They can be taken together, and the advertising and promotion distribution to identify priority groups will be extremely energetic. That is the most important thing we can do to protect the NHS. Our second priority, though, is getting the beds to which the noble Baroness referred used for elective surgery. We do not want to see the NHS heaving under the pressure of Covid and flu. We want to see it addressing the backlog.

[Lord Winston (Lab) [V]]

My Lords, to return to my noble friend Lady Thornton’s first question, given the continued rise of the variant mutations and increasing infections, can the Minister report on a simple biological issue? What rapid mathematical calculations are in the Government’s possession to assess and predict the increasing risk of further new variants evolving that may escape the current vaccines or are more virulent? If he is unable to answer this question now, perhaps he will be kind enough to write to me.

[Lord Bethell (Con)]

My Lords, I cannot promise to have a simple algorithm to make the calculation that the noble Lord refers to. I will ask the system if such a thing exists, but I have never come across such a thing. The challenge he alludes to is entirely right: the vaccine pressure on the virus will create the circumstances in which variants are possible. That is why we are investing heavily in sequencing, not only here in the UK where everyone positive is now sequenced thoroughly and studied, but also offering that around the world through NVAP—the new variant assessment platform—to try to understand what is going on in markets around the world. To date, we think that we have tracked down all the current routes that the virus is taking, and we are satisfied that they are met by the vaccine, but we keep our eyes peeled.

[Lord Scriven (LD)]

My Lords, evidence shows that those in close contact with a positive case need to be traced with 48 hours to break the chain of transmission. Regardless, if close contacts have to self-isolate or self-test, how does stopping a mandatory requirement to register, either digitally or manually, on entering a venue such as a pub or restaurant help with the effective tracing of close contacts if no record exists of people in venues where positive cases are identified?

[Lord Bethell (Con)]

My Lords, the registration of people going into events is an onerous responsibility for the hospitality industry and we have to make a proportionate assessment of what kinds of burden we are putting on the economy and society. With more than 60% of the population now having been double vaccinated for over two weeks and with the vaccination programme going along at 500,000 a day, it is the moment to start backing off on some of these obligations. That means dismantling some of the infrastructure of test and trace, which we seek to do in a proportionate and logical fashion.

[Baroness Browning (Con) [V]]

Given the prediction of increased infectivity, what internal guidance is being given post 19 July within the NHS? Will GP surgeries, A&E and outpatient departments revert to their former practices, or is the guidance that they should retain face masks, distancing and hand gel use?

[Lord Bethell (Con)]

My Lords, on the three specific locations the noble Baroness asked about, I understand that those practices will remain in place, but I am happy to check that and write to her. As for going back to where we were before, I think some things will change for ever.

[Baroness Bull (CB)]

My Lords, 120 scientists have written to the Lancet and today come together in an emergency summit to ask the Government to rethink their plans. The editor in chief warned against

“a plan driven more by libertarian ideology than prudent interpretation of the data”

and called for continued mask-wearing, distancing and increased vaccine coverage. A YouGov survey found that two-thirds of people want to continue with masks and an ALVA survey found that three-quarters of people did. So why have the Government decided to end this simple yet effective measure? It costs the economy nothing, but it would be life-changing for the clinically extremely vulnerable, who will be forced back into lockdown by this shift from a public health approach to so-called personal responsibility.

--- Later in debate ---

[Lord Bethell (Con)]

I am always grateful for the challenge of medics in the Lancet and elsewhere. I would like to reassure them that this is not a question of libertarian ideology but a question of assessing the risks faced by the country. We have discussed masks several times in the Chamber. I would like to reassure the noble Baroness that masks simply are not a panacea; were the whole country to wear masks for the rest of their lives, we would still have pandemics because they offer only marginal protection.

[A noble Lord]

Nonsense!

[Lord Bethell (Con)]

I am afraid we cannot have in place laws on the intimate practicalities of people’s lives for the long term. We do not have a law on sneezing. I would not think of sneezing in the presence of noble Lords, but I do not accept that I should be given a fine for doing so.

[Lord Campbell-Savours (Lab) [V]]

My Lords, following calls from the BMA, the RCM and Cambridge University Hospitals, can we have an assurance that in every setting where health workers are caring for patients with suspected or confirmed coronavirus, the health worker will be wearing at least a close-fitting FFP3 mask, thereby maximising personal protection? Can we be assured that the wearing of regular masks in such conditions will not be permitted? Mask specification is critical in healthcare settings.

[Lord Bethell (Con)]

My Lords, the noble Lord’s expertise on mask specification is well known in the Chamber and I bow to his greater knowledge on this. Of course, healthcare workers, social care workers and anyone exposed to those known to be carrying coronavirus should have entirely appropriate and significant protection. I do not know the precise mask numbers, but I would be glad to write to the noble Lord to confirm the current guidelines.

[Lord Oates (LD)]

Is the Minister aware that the comments he just made about the effectiveness of masks are not just nonsense but dangerous nonsense? Will he withdraw them?

[Lord Bethell (Con)]

I do not accept that at all. The noble Lord does this debate no favours by using that kind of language. The argument I make is extremely reasonable. It is supported by the Chief Medical Officer and the other scientific advisers we have in government. I would like to ask the noble Lord to reflect on the manner of that question.

[Lord Bilimoria (CB) [V]]

My Lords, I was contacted by NHS Test and Trace and asked to self-isolate earlier this week. I am double jabbed, I have no symptoms, I have had Covid, I have been testing myself every day with lateral flow devices and I am negative every day. The CBI, of which I am president, is finding that many companies and businesses are complaining of losing employees. The NHS itself is complaining of losing staff because of self-isolation. Surely, we have to move as quickly as possible to a test and release system so that people can get on with work. Will the Minister confirm that lateral flow devices will continue to be made available free to businesses and citizens? If not, it will be penny wise and pound foolish.

[Lord Bethell (Con)]

My Lords, I am sympathetic to the noble Lord’s frustrations, but he is illustrating the delicacy of the inflection point we are currently at. Only 60% of people are in his fortunate position of having had two jabs for over two weeks. That is a huge reservoir of tens of millions of people who are unvaccinated. There is also a very large number of people—3.5 million in total—on the shielding list who have some kind of vulnerability. The noble Lord could be carrying the disease even though he has been double vaccinated. Of course I aspire to the destination the noble Lord described, but we cannot rush it. We are taking it in a proportionate and logical fashion, and we are absolutely keeping our eye on the kinds of down side risks the noble Baroness, Lady Thornton, described.

[Lord Balfe (Con)]

My Lords, I welcome the fact we are losing our obsession with Covid and learning to live with it. Earlier this week the Minister mentioned the NHS winter plan and said that it would be published. When will it be published and will there a be an arrangement for it to be debated and regularly reviewed so that we can see how we catch up with the huge backlog of health conditions that need dealing with?

[Lord Bethell (Con)]

I am grateful for my noble friend’s kind comments. On the NHS winter plan, he is right that I implied that it would be published. I have looked into this and my understanding now is that it is not a document due to be published imminently, as a winter plan was published in the autumn of last year. There are plans in place and I am working hard to try to provide my noble friend with whatever information I can.

[Baroness Donaghy (Lab)]

I asked the noble Lord on Tuesday what assessment the Government have made of Covid deaths and long Covid rates after the proposed 19 July changes. He did not answer. Will he do so now?

What incentive is there to uphold the test and trace system when a common interest between employer and employee is keeping their workplace open, particularly if sick pay is poor and self-isolation an unaffordable choice? If, as the noble Lord says, we do not know how many people use the app, how will we know if its use is dropping like a stone? What evidence will we have that it is becoming less effective?

[Lord Bethell (Con)]

My Lords, I did not quite say that I did not know how many people use the app; I said that we do not know who is using it. We keep an eye on it and, to date, its use has not dropped, but we are naturally concerned that trust in the app will deteriorate and that is why we are looking carefully at the advice that comes out of being pinged. Some 19 million people have the app. It is an enormously valuable resource, and one that we believe has made a big impact.

Predicting long Covid and infections is extremely difficult because we do not know what the infection rate is going to be. We are in a race against the virus. I hope that very soon the impact of the vaccine will bring R below one and the disease will start going down instead of up. But I cannot tell the noble Baroness, exactly when that date will be.

[Lord Robathan (Con)]

My Lords, last month the Minister made some highly critical comments about my having had the temerity to question the wisdom of government restrictions. Yet we now know that the last Secretary of State did not believe in their value either. Given the small risk to children and teachers from the virus, can my noble friend explain what the value has been—backed by evidence—of severely disrupting the education of hundreds of thousands of children by enforced isolation? Or should we be similarly sceptical about that policy?

[Lord Bethell (Con)]

My Lords, I know that my noble friend is sceptical of almost everything to do with the Government, and I am not quite sure how to address that question—but I will take it seriously. The bottom line is that children are a vector of infection, and, during the tough days before the vaccine, they were the ones who spread the disease around, accounting for a very large proportion of the numbers. As a father of four, I can tell you that it was extremely frustrating to have our children sent home, but, none the less, it was an important and impactful aspect of our fight against Covid.

[The Earl of Clancarty (CB)]

My Lords, at the press conference on Monday, the Prime Minister drew a distinction between crowded Tube trains and relatively empty carriages on trains, where he might choose not to wear a mask. The Health Secretary made exactly the same point on Tuesday’s “Today” programme. However, the Minister will be aware of the research showing that aerosols can hang in the air for many hours in enclosed spaces—which train carriages are. Despite what the Minister has just said about face masks, will that important factor be taken into account when a final decision is made about mask wearing on trains and other public transport?

[Lord Bethell (Con)]

The noble Lord will remember that, when we spoke about masks the day before yesterday, I re-emphasised my personal commitment to wearing masks. In no way do I want to leave noble Lords with the impression that I do not think that masks can play a role—I just do not think that we should be guilty of displacement and assume that masks will somehow solve all of our problems. The thing that will solve all our problems is the vaccine, and, when a larger proportion of the country is vaccinated, that will make an impact. But the noble Lord is entirely right: aerosols do hang in the air for a long time. You can breathe and cough into the air now, and someone can walk into that cloud minutes or even an hour later and catch the disease, as happened in the famous incident in Australia. We are very conscious of the point that the noble Lord makes, but a proportionate strategy on masks is reasonable.

[Lord Hain (Lab) [V]]

My Lords, I accept of course that the choices for Ministers such as the noble Lord are very difficult, but, with just half the population fully vaccinated, experts say that the 100,000 daily Covid cases predicted by the Secretary of State after he lifts restrictions could mean around 200 deaths daily. Is that an acceptable price to pay for living with the virus, when Professor Anthony Costello predicts a rampant third wave?

[Lord Bethell (Con)]

My Lords, the Secretary of State did not predict 100,000; he accepted that it was a possibility. I do not accept that we should welcome any deaths in any way. Our hope is that, in the race against the disease, the vaccine will win, R will be brought to below one, the spread of the disease in the UK will be brought under control and any third wave—there will be one of some kind—will be focused on the unvaccinated young, whom the disease largely passes straight through. That is what we are planning on, but we accept that there are risks; that is why we look at the situation daily, and we will change our policies if necessary.

[Baroness Uddin (Non-Afl)]

My Lords, I thank the noble Lord for the Statement. Given the warnings of millions of infections and millions suffering from the serious impact of long Covid, are we not opening up too soon without planning, as was well stated by my noble friend Lady Donaghy? Worryingly, we apparently do not have data on the numbers of infections and those with long Covid among those who have been fully vaccinated, as I have—why? Like others, my grandchildren are among the millions of children affected by many school absences, with many finding the regular testing extremely difficult. Is the Minister aware of Abu Dhabi’s Biogenix Labs’ non-invasive saliva testing, which is being used widely and effectively? Are the Government considering a rollout among our own school population? Finally, I add my voice to calls for the Government to publish an equality impact assessment, specifically with the differential effect on diverse and vulnerable communities.

[Lord Bethell (Con)]

I completely accept the question on whether we are moving too soon; it is a perfectly reasonable question. The counter suggestion is this. Say we waited until 85% of the population is double vaccinated, which would be in, say, October—would that necessarily be a better time to do this, when the NHS is at its most stretched and the winter conditions and cold encourage the spread of the virus? We have looked at it really carefully and, on the balance of risk, today is the right day to make these decisions.

On saliva testing, I pay tribute to those who are working here in the UK on the LAMP system, which we have prioritised with a huge amount of investment, particularly for those from special needs schools who find swab testing uncomfortable or really do not like to do it. We hope to report back but I am afraid to say that saliva testing has so far proved to be quite a difficult challenge, and it has not met all the tests that we would have liked it to have done.

[Lord Cormack (Con)]

My Lords, declaring an interest, I ask my noble friend to guarantee that all octogenarians will have a booster jab in the autumn? I apologise for returning to this, but can he guarantee, on the Floor of this House today, that all care workers in care homes will be obliged to be vaccinated no later than September?

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, we have a prioritisation list for the booster and the third jab. It is my understanding that octogenarians are in category 1, but I am happy to write to my noble friend to confirm that point, in case I have got that wrong. I share my noble friend’s aspiration on care home workers. We are in a consultation; I cannot make the guarantee that he asks for because it is an honest consultation. We have to take people with us: this is not something that we can impose on people against their will. When the consultation has passed, I am hopeful that we will be able to take the steps that he describes.

[Lord Rooker (Lab) [V]]

I congratulate the Minister on his track record of appearances in the House. I will raise two brief subjects with him, both of which have been raised today, neither of which he has addressed. First, are there plans to charge for the lateral flow test? It is now being delivered to people less than 24 hours after they request it, and requests will certainly go down if there is a charge. A clear answer on that would be useful. The second issue is shielding. When the Prime Minister makes a Statement on Monday, in advance of 19 July, it is crucial that something is said about people who were shielding before; they must not be left in limbo and ignored. They could at least be given a warning that they will be given, say, a week or 10 or 14 days before they need to shield, which would remove part of the worry from the large changes due to take place on 19 July. I ask the Minister to respond on lateral flow test charging and shielding, please.

[Lord Bethell (Con)]

My Lords, on lateral flow tests, I said that I did not recognise the press reports that the noble Baroness mentioned, and I still do not. On shielding, I completely agree with noble Lord. Some 1.5 million patients are identified as CEV-equivalent through the new QCovid model, and they have been added to the shielding patient list, with 820,000 who had not previously been invited as part of the JCVI cohorts 1 to 4 given priority access to vaccines. Overall, 3.8 million—I think I said 3.5 million earlier—individuals are on the shielded patient list, and we continue to maintain that through the NHS. We will look at the QCovid model and see if we can apply mix-and-match vaccines, booster shots and third shots to that model, and if we can bring together a new risk assessment for those who are vulnerable. That list could therefore be applied to any future shielding or protection that may be needed.

[Lord Mackenzie of Framwellgate (Non-Afl) [V]]

My Lords, I ask the noble Lord the Minister, in his usual courteous and helpful manner at the Dispatch Box, to provide answers to points raised yesterday with the Prime Minister in another place. In his usual way, the Prime Minister answered by asking yet another question, which of course earned another rebuke from the Speaker. If infections are allowed to rise, perhaps to 100,000 per day, how much are hospital admissions likely to increase and how many deaths may result? Why are the changes regarding isolation not taking effect until 16 August, with all the disruption to businesses in the interim?

[Lord Bethell (Con)]

The bottom line is that we believe that any rise in the infection rate will not have an impact on hospitalisation in a way that will disrupt the NHS. This is something that we have worked on with NHS colleagues, the clinical directors, the CMO’s office and the JBC, and we have taken into account a large variety of advice, including from SAGE. At the end of the day, it is our belief that, despite the rise of a third wave, hospitalisation rates will be manageable.

[Baroness Bennett of Manor Castle (GP) [V]]

My Lords, following on from the question from the noble Lord, Lord Rooker, about the 3.8 million patients on the shielding list, will there be special provision for them to have antibody testing? Many of them may have had the vaccine but will not be sure whether it has been effective. Will there also be practical support for them? For example, if they do not feel that it is safe to go out, will there be help with shopping, special arrangements for medical appointments and other practical help?

[Lord Bethell (Con)]

We have committed to issuing guidelines for the vulnerable and immunosuppressed before 19 July. I cannot share with the noble Baroness at this stage exactly what those guidelines will say, but her points are very well made. We have not made a decision on antibody testing yet, but she raises an important point. We have a number of therapeutics and antivirals that may provide either prophylactic protection or support in the case of infection. Knowing whether somebody has antibodies before they go into the winter is one of the things that should really help to provide reassurance as well as important clinical data on how treatment might pan out. We are looking at the use of antibody tests for that reason.

[Baroness Ritchie of Downpatrick (Non-Afl) [V]]

My Lords, the Statement says that there are currently no plans to vaccinate the under-18s. Can the Minister indicate what the possible timeframe could be for reversing that decision and vaccinating that cohort, taking on board that around 0.5% of pregnancies are to girls aged under 18? Will he further elaborate on the fact that the Prime Minister indicated that there will be deaths—quite a large number—when we open up? What level of deaths do the Government consider acceptable?

[Lord Bethell (Con)]

My Lords, the vaccination of children is something that we are looking at; it is with the JCVI at the moment, I understand. I do not have the precise timetable at my fingers. What I will say is that we of course need to vaccinate as many adults as we can and will therefore move to children after that, because they are the ones who least need that protection. My nephew has been vaccinated in another country; I have spoken to him about it and it is very touching to hear him describe how he now feels that he can visit relatives who might be vulnerable or have co-morbidities. He sees it as a contribution to the national well-being. That is exactly the spirit in which we go into this but, as I say, it is up to the clinicians to make their pronouncement. We wait to hear from them before we can make a decision.

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

My Lords, all supplementary questions have been asked.

Covid-19 Update

Lord Bethell Excerpts

Tuesday 6th July 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, on the 73rd birthday of the NHS yesterday we supported and echoed the thanks to everyone in the NHS and the care sector for their extraordinary and humbling response to the pandemic, which continues to this day. We are far from being an NHS back to normal, whether through increased Covid cases, the backlog of hospital appointments and life-threatening delayed diagnosis, all the way through to the more routine but also vital services. So, our best present to the NHS will be to lift restrictions and return to normal in the safest way possible for them, for patients and the wider health of our country.

For months, the Prime Minister has talked of “data, not dates”. The data shows cases running at over 25,000 per day and predicted to rise to 50,000 per day by the end of the month. Hospitalisations are up and even ventilator bed use is up, which, while not as bad as in the previous two waves, is putting pressure on the hospitals dealing with them.

There is a large surge of cases in the north-east, and there are concerns that a new variant may exist there. Cases in the UK of the lambda variant from Peru are now being investigated as it appears more transmissible and possibly more resistant to vaccines. If the UK is following the route out of the pandemic used by Israel and the USA, we should note that both those countries are now finding that that system is not working for them: Israel’s proportions are picking up again and Florida is struggling to cope with a very large surge in cases.

Yesterday’s Statement was a case of ideology over science. It says that the vaccine is a “wall of defence”, but it is a wall with holes in it. First, one-third of adults have not yet had their second jab; nor have any children. That is a reservoir of millions—not just thousands, as the noble Baroness, Lady Thornton said—who are at risk of catching Covid, whether seriously or not, and passing it on to others. Secondly, double-jabbers are not conferred with magical total immunity and protection, and we know that they can transmit it too.

We on these Benches want to start with a return to normal and to lift restrictions. We desperately need to kick-start the economy, to start to socialise again and, as my noble friend Lord Scriven said last month, to live with Covid as it is now endemic and will be with us for some years to come. However, that means providing the safety net needed to ensure that people are as safe as possible. Asian countries that managed their pandemic well learned from SARS. The use of face masks became routine and a matter of personal and wider social responsibility, allowing life to continue in the flu season and in the pandemic. They also maintain strong and effective test, trace and isolate systems all the time. We will be discussing test, trace and isolate in detail following the Statement that is due to come to your Lordships’ House on Thursday, but the proposed reductions in test, trace and isolate will remove the UK’s ability to manage outbreaks swiftly, during which time others will catch and pass on Covid.

When we drive into our towns and cities, we rely on local authorities to set up traffic systems, including traffic lights, to help to guide us on safe journeys, regulate movement and reduce harm and damage. But it is as if “freedom day” is getting rid of all our traffic lights.

Proportionate responses are needed, and these include face masks. Early last year, even the WHO was equivocal on the use of face masks but, as the world became aware that this is a respiratory disease passed on through droplets, most countries moved to face mask mandates. On 19 July we switch to rules that make it only the responsibility of individuals. Thankfully, most people have taken that responsibility seriously, but not everyone has. That is important because, despite what the Minister said in response to my question yesterday about the clinically extremely vulnerable, there is no direct reference to the CEV in this Statement—unless he meant the passing reference to them being part of the priority group that will get the third jab. They need to know where they stand. There is no new advice, just the burning of the remaining rules that keep them safe.

Last night the Government published the Health Protection (Coronavirus, International Travel and Operator Liability) (England) (Amendment) (No. 5) Regulations 2021 and brought them into force at 6 am this morning. This amendment allows supporters of foreign teams with tickets for the final stages of the Euros to travel. Tens of thousands of foreign fans will be waved in, despite the high number of daily cases and despite 1,300 cases among Scottish fans after they travelled to Wembley to play England last month. I am not surprised: it is a crowd-pleaser. But as a legislator I find it extraordinary and unacceptable that the Explanatory Memorandum states this amendment is needed “to protect public health”. Frankly, that is in complete contradiction to the regulations themselves. Such inconsistent behaviour from the Government typifies a desire to please people, rather than think ahead and manage scenarios.

What we need is careful planning when lifting restrictions that keeps people safe by having effective measures in place: face masks in risky environments; test, track, trace and self-isolate rules that protect people; and funding for those who have to self-isolate. That is the way we can move to a new normal, to an economy that can work again, with health traffic lights around us to manage and minimise Covid.

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

My Lords, I am enormously grateful for the thoughtful questions from the noble Baronesses, Lady Thornton and Lady Brinton. I will address the first question from the noble Baroness, Lady Thornton, on where we get our advice from and will try to explain a little bit about how these decisions are made.

We get advice from a wide variety of inputs. They include the NHS, and we look very carefully at NHS capacity and projections for trying to catch up with the very large waiting lists that we have for electives. We get advice from schools about the prevalence of infection and attendance at schools. We look to Parliament for guidance, scrutiny and challenge. We have talked to GPs about the front-line picture that they see. We look to the JVCI for epidemiological advice. SAGE provides an important challenge and interesting support, particularly in terms of modelling, but it is not the sole repository of all the evidence for our decision-making. We are extremely grateful for its input but we have to take on board a very large set of perspectives when we make these decisions. We cannot rely on just one data set from one group. It is a holistic situation, and we have to balance a lot of different and competing needs at the same time.

That is why the decisions made in the Statement yesterday and in the Statement made by the Secretary of State an hour ago are proportionate and have, I hope, the caution, care and clarity that the noble Baroness quite rightly referred to. She is right that some infections will, very sadly, lead to severe disease, hospitalisation and, in some cases, death. But the proportion of those infections is much smaller than it was before the vaccine arrived. We have successfully vaccinated a huge proportion of those who are the most vulnerable to this disease. As a result, although infections are rising, the impact on hospitalisation and death is a very small fraction of what it once was.

We need to proceed with caution, keeping a very close eye on those relative relationships, but the picture that we see at the moment is relatively straightforward: the vaccine works. The statistics for both the BioNTech and the AstraZeneca vaccines are incredibly impressive in terms of both hospitalisation and transmission.

The noble Baroness challenged me to explain what I thought might be an acceptable level of deaths. I do not wish to split words with her, but the honest truth is that I do not accept any deaths as acceptable. I am not just trying to be smart with the language. It is our mission, particularly in the Department of Health but in the Government as a whole, to try to tackle all deaths as well as we possibly can.

All health decisions are always based on a balance of risk, whether it is a GP taking your blood pressure in his or her surgery or whether it is for big demographic interventions of the kind that we are debating today. Balance is the essence of public health decisions, and we are trying to make the best possible decisions around this. They have to take into account the huge challenge that the NHS faces in tackling business-as-usual disease. Millions of people have not turned up for the diagnostics that they should have taken or to have examinations of the lumps and bumps that they are worried about. There is a huge catch-up in terms of the waiting lists, and those have an impact on illness, long life and death. We have to balance the priorities of the pandemic and those of our existing healthcare system, and also the usual life of our communities. That is why we are taking the route that we are.

The noble Baroness, Lady Thornton, raised public transport. That is not only a practical and very important context for this discussion; it is iconic of the decision to move from mandation to a voluntary principle on behalf of a large amount of the public for a large number of the measures that we did, at one point, put into law. We are trying to seek a new covenant with the country based on consideration for each other. The noble Baroness put it extremely well, and I entirely share her scruples. I have four children—who are vectors of infection, to put it politely—and I attend a large number of business meetings, including here in the House, and I regard myself as a high-risk candidate for carrying the disease. I have never caught it myself and I have been vaccinated but when I sit on a Tube train I wear my mask, not to protect myself but to protect the person next to me. That is my personal assessment and my personal decision. That is the spirit in which we are inviting people to step forward and make their own decisions and to be considerate to each other.

We cannot have laws on all these matters for the rest of time. At some point we have to ask the country to step up and take responsibility and to have personal agency in these decisions. If we do not put that challenge to the country in the summer months, when our hospitals are relatively safe and the virus has the right conditions, when will we be able to make those decisions?

I agree with the noble Baroness about the position that many workers find themselves in. She is right that PHE data is very daunting when you look at the low-paid, front-line workers who drive taxis and buses or are in all sorts of other front-line positions. They have been hard hit by the pandemic, partly because of their living conditions, partly because of their environment and partly because of the prevalence of comorbidities, but also because of the risk that they personally put themselves at. I call on everyone to be considerate on that point. We need to think about the kind of risk that people are putting themselves at when they go about their normal day-to-day work. I ask people to be thoughtful about infectious respiratory diseases and, in fact, all diseases. That is why the Prime Minister has talked in the terms that he has.

In the meantime, we are making changes to the way we are doing things. The noble Baroness, Lady Thornton, asked me about children. To be clear: the Secretary of State said in his Statement that anyone under 18 who is a close contact of a positive case will no longer need to self-isolate after 16 August. Instead, children will be given advice about whether they should get tested, dependent on their age, and will need to self-isolate if they test positive. These measures will come into force on 16 August, ahead of the autumn school term. That is a proportionate response to the changed situation we find ourselves in, with the massive rollout of the vaccine and the evidence that we can see in front of our eyes of the impact of the disease on those who are under 18.

In reply to the noble Baroness, Lady Brinton, I spoke about the Secretary of State’s speech yesterday, in which he said very clearly, on the clinically extremely vulnerable, that guidelines will be published, and that remains the case. We are extremely sympathetic to those whose immune system does not allow the vaccine to have an impact. What use is a vaccine that supports your immune system if your immune system does not work very well? That is a challenge that more than a million people in the country face, and we are working extremely hard to address that issue. That work includes a huge amount of research through the OCTAVE study and a massive investment in the antivirals task force and the therapeutics task force. Those who are clinically extremely vulnerable, particularly those who are immunosuppressed, have not been forgotten and are very much the focus of our efforts, but it is an extremely difficult challenge to meet.

--- Later in debate ---

[Lord Lansley (Con)]

My Lords, I support the move from legislation to guidance in relation to the measures in the Statement. But does my noble friend agree that there is a case for continuing regulation of the circumstances where somebody is the contact of somebody who has tested positive? Can he update the House on what the Government are proposing regarding relaxing some of the restrictions for those who are contacts of positive tests?

[Lord Bethell (Con)]

My noble friend puts it very well. Clearly, with the infection rates rising but with a very large proportion of the country vaccinated, it is worth reviewing this. As the Secretary of State said in his Statement earlier this afternoon, from 16 August the Government intend to exempt people who have been fully vaccinated from the requirement to self-isolate if they are a contact of a positive case, with a similar exemption for under-18s. Anyone who tests positive will still need to self-isolate regardless of their vaccination status. Symptomatic testing will continue to be available. This is a proportionate direction, given the state that we are in.

[Baroness Masham of Ilton (CB) [V]]

My Lords, how much research is being done into long Covid? Many people feel misunderstood and frustrated as they want to get better and many long Covid clinics are not yet open.

[Lord Bethell (Con)]

My Lords, I completely sympathise with the frustration that many feel when they have the symptoms of one of the many syndromes associated with long Covid. According to the ONS, more than 1 million are in that situation. Those symptoms might range from extreme tiredness, aches and pains, to cardiac or respiratory exhaustion. Our fears are that long Covid will be a horrible legacy of this disease. NIHR has half a dozen research projects at the moment, and I understand that it will be looking for more. The clinics the noble Baroness described are being rolled out at speed and I pay tribute to the NHS, which has a 10-point plan for dealing with long Covid. I would be glad to share a copy of that with the noble Baroness.

[The Lord Bishop of Rochester]

My Lords, while there continue to be understandable anxieties and not least concerns about potential pressures on the NHS, many will welcome the prospect of the removal of restrictions on gathering in a range of settings including, I note, for communal worship, singing and performances. Given the move from rule and regulation to guidance and good sense, do Her Majesty’s Government intend to issue any guidance specific to places of worship and in relation to communal singing in settings such as community choirs, other choral groups and schools, or is that to be left to the good sense of those responsible?

[Lord Bethell (Con)]

The right reverend Prelate puts it extremely well. I pay tribute to all the community groups which have an influence on the thinking of the nation. I encourage them to use that influence to engender and support a spirit of community consideration so that we can try to come together as a nation and approach public health in a way that is considerate to each other.

On the specific point of singing, as I took my place, I noticed that the Secretary of State for the Department of Digital, Culture, Media and Sport was in the process of making a Statement, and I refer the right reverend Prelate to that. I am afraid I have not had a chance to read it.

[Lord Clark of Windermere (Lab)]

My Lords, as the Government have already admitted, one result of their new controversial policy will be an extra 100,000 cases a day of Covid-19, possibly within the next month, which will lead to further heavy demands on an overpressed NHS. How do the Government intend to retain the already overworked and burned-out health workforce going into this battle on an offer of £1 a week pay rise after all the effort they have put in?

[Lord Bethell (Con)]

My Lords, I pay tribute to the NHS, but the rise in infections among mainly very young people will not necessarily lead immediately to a large increase in the demands on the NHS. An extraordinary aspect of this disease is that it targets the elderly and those with comorbidities and leaves the young largely alone. The proportion of people who have the disease in the months to come will mainly be the unvaccinated. Those are mainly the young and our modelling, which is supported by the NHS, suggests that our resources in healthcare can support that kind of situation.

[Lord Scriven (LD)]

My Lords, the Health Secretary this morning said that there could be 100,000 cases per day by mid-summer as a result of lifting the restrictions in the Statement. Professor Neil Ferguson’s analysis today, based on the delta variant and the age group affected, shows that would equate to about 100 deaths per day. That will mean an extra 15,000 deaths by the end of the year. Is the Minister aware of and comfortable with that projection of extra deaths, when he says from the Dispatch Box that the policy he now advocates leads to a low level of deaths?

[Lord Bethell (Con)]

I am not comfortable with any deaths. The suggestion that we are going into any of this with a sanguine, devil-may-care attitude is quite wrong. We approach the matter with extreme caution. But many people are dying because they have missed their cancer appointments. There will be people who die of flu this winter; there will be many people who die of all manner of diseases. We cannot focus only on Covid—we cannot make it the sole priority of our healthcare system and our entire economy. At some point we need to move on.

We will remain extremely cautious; we have all sorts of back-up resources in place that we can pivot to should there be an escalation of Covid hospitalisations and deaths. I do not need to list from the Dispatch Box any of the things we are all worried about. This is the right decision right now; it is proportionate, and it gives us the space to address the many other health issues we have as a nation.

[Lord Udny-Lister (Con)]

My Lords, I congratulate the Minister and the Government on taking this decisive decision to start getting the country back to normal, and in particular, to start getting the economy back to normal. Of course, this could not have been done without the success of the vaccine rollout. All that goes back to last March and April, when some very decisive decisions were made. The Prime Minister made it clear on a number of occasions that the way out would be vaccination.

I urge the Minister to go a little further and start getting the Government back into their offices in Whitehall and elsewhere and start helping those businesses which are so dependent upon our town centres—and, indeed, even this Whitehall area—to get them back together. I also urge him to start looking at the traffic light system, especially as Germany has now opened its borders to India. Now is the time to start trusting the vaccines.

[Lord Bethell (Con)]

My Lords, I completely concur with my noble friend’s analysis. This is an opportunity for the economy to bounce back, and I am really encouraged by everything I hear from the private sector in terms of the energy, enthusiasm and resilience of the UK economy. The large number of people who will be holidaying at home this summer provides one shot in the arm for the hospitality industry, which I know it is taking advantage of.

When it comes to borders, we have to be careful. One does not like to think about it, but the existence of millions and millions of people with the disease today means that the possibility of further variants has to be on the agenda. That is why we take it one step at a time, and I pay tribute to those in Border Force and the managed quarantine scheme for the work they have done. It is ironic that the variant delta, which started in India, is now so prevalent in the UK that it is possible to think about India coming off the red list. But there are variants elsewhere that we have to be wary of.

[Lord Berkeley of Knighton (CB)]

My Lords, is the Minister aware—I think he may not be given his recent response to the right reverend Prelate—of the latest government-sponsored PERFORM-2 scientific research? It substantiates what noble Lords have been telling the Government for weeks: there is no difference in aerosol droplets between professional and amateur singers. Given this, is it not time now to finally stop an indefensible farce that restricts amateur choirs from singing, just as they observe tens of thousands of football and tennis fans chanting away? It is no good on counting on 19 July to sort it out as there may be further prohibitions in the future.

[Lord Bethell (Con)]

My Lords, I am not aware of all the details of the latest Statement. It is my understanding that there is substance there; I gather that there will be change and I look forward to reading about that.

The noble Lord gives me an opportunity to reflect widely, and I hope he does not mind if I do so. There have been lots of uncomfortable inconsistencies and moments of disproportionality where noble Lords have rightly challenged the Government as to whether they have got every dotted “i” and crossed “t” absolutely right. The singing issue is probably the most graphic and certainly the most discussed example. I will personally be hugely relieved if we can move on from the current situation.

[Lord Campbell-Savours (Lab) [V]]

My Lords, is it not obvious that if you reduce mask wearing on public transport and in public places, those who believe they are more exposed to the virus will then reduce their use of public transport and avoid public places? People who are fearful of more liberated environments will avoid them, leading to a slowdown in the return to work that the Government want. Indeed, it is the reverse of what the Government want. Why remove those restrictions that offer the only way of securing public confidence in the new regime that is being proposed?

[Lord Bethell (Con)]

I applaud the noble Lord for his advocacy of mask wearing, but of course this issue cuts both ways. He is right that we need to build back trust in sharing space with one another, but I am not sure that mandatory mask wearing either builds trust or erodes it. If we give people the impression that wearing masks is somehow a panacea that protects everyone on a tube train or in a lift, that is a false impression. Masks are not a panacea. In fact, for some people, they can be a source of grave concern and be enough to send them back home to seek safety. I take the noble Lord’s point that we have to be clear about this, but I am not sure that mandatory mask wearing, or even ubiquitous mask wearing, is either a universal antidote to the spread of the disease or necessarily builds trust in the manner he describes.

[Baroness Tyler of Enfield (LD) [V]]

My Lords, continuing on this theme: “masks work” is the clear message from Public Health England. Both Sir Patrick Vallance and Professor Chris Whitty have said that they will continue to wear a mask in crowded indoor spaces, primarily because it protects others. Critically, it does not hold back the opening up of the economy, but rather provides a safeguard as social distancing rules are relaxed. Can the Minister tell me why there is so little in the Statement about our social responsibility to others, including front-line transport and shop workers, and the clinically extremely vulnerable? In this scrapping of masks, we are condemning millions with poor immune systems to be trapped in their homes, too afraid to go to the shops or their workplace or to use public transport.

[Lord Bethell (Con)]

Since this is the second question on masks, I hope the noble Baroness will not mind if I go off on a tangent. Masks do work a bit; they are not a panacea. What is really important is that when you are ill, you stay at home. That is the big behavioural change that will make a big difference in the year to come. That is where Britain has got it wrong in the past. Too often we have put our workmates, fellow travellers and school friends at risk by heroically going into crowded indoor places and coughing all over them. I hope that is one habit that will stop and that that will be a legacy of this awful pandemic.

[Lord Moynihan (Con)]

My Lords, I congratulate the Government on the progress made on a well-financed vaccination programme that continues to win the war against the worst effects of the virus. Will my noble friend the Minister and his colleagues now ensure that as much effort and commitment will be put into a lead role for the new office for health promotion in his department, to co-ordinate government policy and ensure that we place national well-being, physical and mental health at the centre of policy priorities for all age groups as we emerge from Covid?

[Lord Bethell (Con)]

I am very grateful to my noble friend for raising the office for health protection, because it is an office that I am extremely hopeful for. It will be giving clinical leadership from the CMO. It will bring together all the enormous resources of data that we have brought together in the pandemic response. It will, I hope, capture the national mood around healthy living, including, as my noble friend rightly points out, eating habits and physical activity habits. It will work through local authorities, it will not be a large organisation like UKHSA is, but I hope it will have an enormous impact. I look forward very much indeed to discussing it more in this Chamber.

[The Earl of Clancarty (CB)]

My Lords, come 19 July it will be all too easy to assume that everything is okay in the arts and night-time economy. Is the Minister aware of the recent Public Accounts Select Committee report which says that without a government-backed insurance scheme there is a “survival threat to festivals”—pretty strong words. The report also backs further support for freelancers and the technical supply organisations decimated by Covid. It will be a hard road back, and I hope the Government continue their support, including plugging the gaps in support that remain.

[Lord Bethell (Con)]

My Lords, I do think we have an opportunity, now that the pressure has backed off a bit, to be thinking a lot more about the exactly the sort of subject that the noble Earl raised. I am an avid festival goer, and extremely sad about the way in which they have been hit so hard. The role of freelancers in the arts is absolutely critical. I know that my right honourable friend the Secretary of State for Digital, Culture Media and Sport has these points very high on his list of priorities.

[Baroness Donaghy (Lab) [V]]

My Lords, one person’s choice is another’s imposition. Even when mask wearing was mandatory on the tube, some broke the law and there was no policing. So-called choice will cause conflict and confusion. Can the Minister assure me that the Government are not reverting to type and their original herd immunity policy based not on the science but on “let us see how it falls”? Although he does not accept any deaths, as he said, what assessment has been made of the impact of this new policy on death rates and long Covid rates?

[Lord Bethell (Con)]

My Lords, I do not have the figures to hand, but I reassure the noble Baroness that the policy on masks was very diligently imposed and a large number of people did get fined. We have to ask ourselves as a society whether we really want to live in a country where simple behavioural habits, such as wearing a mask or not, make you susceptible to arrest or fines. That is a very uncomfortable place for a country to find itself. The noble Baroness is right: that does introduce ambiguity, but we are sophisticated people and can live with a degree of ambiguity. We need to learn how to live not only with this disease but with each other. The dilemma that the noble Baroness points out is one that we will all have to debate, understand and learn to live with. We are not in any way letting this disease get on top of us. We are fighting it through the vaccine, we are supporting the vaccine with test and trace, and we have a tough borders measure. We are taking the battle to the virus and will continue to do so.

[Baroness Altmann (Con)]

My Lords, I welcome this Statement. As my right honourable friend Sajid Javid says, he is Health Secretary not just Covid secretary. The successful vaccine programme means that we must urgently address the shocking build-up of other health damage, physical and mental. Not opening now would cause more deaths from non-Covid causes. I have two questions for my noble friend. First, will he confirm that the Government recognise that so-called zero Covid is unachievable and we cannot stop people catching it? Secondly, will he provide details of the Government’s winter contingency plans for the NHS and Covid?

[Lord Bethell (Con)]

My Lords, I wish zero Covid was possible. I wish we had never had it at all in this country, but it is a fiendishly clever virus and it gets around the measures we put in place to try to fight it. I can, very sadly, confirm that zero Covid is not something we can plan for in this country. What we can plan for is the winter. I reassure my noble friend that the NHS has extremely thoughtful and diligent plans for the winter. It has a specific winter plan and I would be happy to write to my noble friend with a copy.

[Baroness Prashar (CB) [V]]

Does the Minister agree that reliance on the good sense and responsibility of the public should be supported by clear guidance, backed by scientific evidence? If so, will he please tell the House whether the Government are planning to provide such guidance and explanation? How will it be made available in an easily accessible form?

[Lord Bethell (Con)]

My Lords, that is an extremely broad question. I reassure the noble Baroness that we have published thousands of pages of guidance, many of which have been across my desk, and it has been a privilege to read it all. We have developed better thinking on how we do guidance: I would like to think that it is now written in clearer English and in more languages, and has been made more accessible to those who have reading challenges. We have developed those important learnings over the pandemic.

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

Does the Minister agree that it would be preferable if the guidance was similar throughout the whole of the United Kingdom, especially for those of us who travel regularly from Scotland to London? What discussions and meetings does he have planned with the Ministers in the devolved authorities to try to achieve that?

--- Later in debate ---

[Lord Bethell (Con)]

I am sympathetic to the noble Lord’s travel arrangements, but I do not philosophically think that harmonisation of all regulations across all the nations of the United Kingdom is necessarily desirable. It is important that people have trust, and sometimes that trust is built on local leadership that takes a different perspective or has different circumstances to try to manage. There has been a large amount of discussion about the differences in the guidance between the nations. My personal experience is that, like DNA, 99% of it is common, with very small differences—although they are inconvenient to handle and manage. I have been travelling up and down the country as well, and, in fact, the consistency has been very large.

[Lord Mann (Non-Afl)]

Until last week, British citizens who were four years old and younger returning to this country were not required to be tested while quarantining. Why was this change made last week, so that four year-olds, three year-olds, two year-olds, one year-olds and newborn babies now require testing in order for fully vaccinated families who have been properly tested and are negative to be able to get out of quarantine? What is the medical evidence that suggests that testing these babies will help?

[Lord Bethell (Con)]

My Lords, I confess that the noble Lord’s question is new to me. I will look into that matter and write to him with an update.

[Lord Caine (Con)]

My Lords, while I very warmly welcome this Statement, my noble friend will be aware that some batches of the AstraZeneca vaccine have yet to be approved by the European Medicines Agency, placing a question mark over the eligibility of some 5 million double-vaccinated Britons for the EU vaccine passport. Can my noble friend assure the House that the Government are working towards a swift resolution of this issue, which ought to be achievable?

[Lord Bethell (Con)]

I am extremely sympathetic to the situation that my noble friend and a large number of other people find themselves in. I reassure him that we are seeking a solution to this issue with the EMA, and I am hopeful that we will get there some time soon.

[Baroness Greengross (CB) [V]]

My Lords, given the significant increase in Covid-19 infection rates in the UK in recent weeks, what assurances can the Government give to people in the social care sector that there will not be a repeat of what happened in early 2020, when 30,000 people in care homes died of Covid-19? What is the difference between making people wear a seatbelt in a car and a face mask on a train? Both are in the interests of health and safety and are surely in the spirit of community consideration.

[Lord Bethell (Con)]

My Lords, I completely understand the noble Baroness’s concerns about those in social care. In the provisions that we have put in place for the vaccine, I reassure her that we have those who are elderly and vulnerable absolutely at the top of our minds. As she knows, we are putting in place arrangements for a third shot for those who were early on the prioritisation lists, and we are working on booster shots, should those prove to be necessary. The vaccine is our absolute front line in the battle against the virus. We are seeking to protect most those who are in social care, the elderly and the vulnerable, which is why the vaccine arrangements have been prioritised in that way.

[Lord Balfe (Con)]

My Lords, I welcome the Minister’s conversion to living with the disease, which I have said for some time that we have to do. In answer to my noble friend Lady Altmann’s question, he mentioned that there was a winter plan. I would also welcome a copy of that and an assurance from him that plans will come forward to tackle the waiting lists, both regionally and by specialisation, so that we can deal with the huge backlog that the NHS now has to face.

[Lord Bethell (Con)]

My Lords, I remind my noble friend that we have awarded £1 billion to kickstart elective recovery, supporting providers to address backlogs and tackle long waiting lists. We have also awarded a further £6.6 billion to recover health services from March to September. These are substantial investments and will go a long way to address this considerable challenge.

[Lord Haselhurst (Con) [V]]

In light of the eagerly awaited easing of restrictions, but noting the continual penetration of the delta variant in particular, do the Government remain confident that there are sufficient supplies of the necessary vaccines to win the race against a virus that continues to prove itself disruptive and dangerous?

[Lord Bethell (Con)]

Yes, I can reassure the noble Lord that we have in place a strong supply chain that will meet the schedule that has been outlined by my friend the Minister for Vaccinations, Nadhim Zahawi. We are also seeking to develop new vaccines, should they prove necessary—because it has been one of the surprising but reassuring aspects of our vaccination policy that a third boost is as useful and efficacious as it is. However, should another variant emerge that somehow eludes the current suite of vaccines, we have in place arrangements to develop, manufacture and distribute more.

[Baroness Wheatcroft (CB) [V]]

My Lords, the Statement is about the need for a return to normality—[Inaudible] —businesses depend for their trade on those who go to work in offices in cities and town centres, so can the Minister—[Inaudible]—and what instructions will they get about 19 July?

[Lord Bethell (Con)]

My Lords, I did not quite catch all the details, but I got the gist of the question. I reassure the noble Baroness that the return to offices and our high streets and towns is of paramount importance, and we are working on guidelines on that matter. I cannot guarantee that absolutely everything will go back to exactly what it was: we have learned lessons from the pandemic, and we want to put this country into a shape where we are resilient should another one emerge. However, it is my hope that the economy will bounce back extremely quickly, and there is good evidence that it will.

[Lord Bellingham (Con)]

My Lords, as a strong supporter of the Government’s policy on the coronavirus, I was nevertheless critical of them being very slow to enunciate a clear policy on masks over a year ago—so I have a lot of sympathy with those noble Lords who have expressed concern about the imminent lifting of compulsion regarding masks. Surely one possible compromise might be to keep masks where you have passengers on public transport sitting or standing next to each other?

[Lord Bethell (Con)]

My Lords, I hear my noble friend’s words loud and clear. The Government have indicated that we will leave it to those who run the transport systems themselves and to local politicians. There is a good case for a degree of devolvement and subsidiarity in this matter. He is right that masks do perform an important role, but they are not a catch-all, and it is therefore reasonable to leave those who run the transport systems to make decisions for themselves.

[The Deputy Speaker (Baroness Henig) (Lab)]

My Lords, the time for Back-Bench questions has now elapsed.

Health Security (EU Exit) Regulations 2021

Lord Bethell Excerpts

Monday 5th July 2021 Grand Committee

Moved by

[Lord Bethell]

That the Grand Committee do consider the Health Security (EU Exit) Regulations 2021.

Relevant document: 6th Report from the Secondary Legislation Scrutiny Committee

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

My Lords, the sharing of information and co-ordination of health protection activity between all parts of the UK and with our international partners is absolutely critical to the prevention of and response to serious cross-border health threats. Covid-19 is a good example. There are others today; there will be more in the future.

These regulations will ensure that this essential co-ordination is maintained following our departure from the EU. They enable us to deliver high levels of human health protection across the whole of the UK. They modify retained EU law on health security to establish a stand-alone UK-wide regime. But these regulations are not alone: they form part of broader, ongoing work to improve our health security capabilities.

This work has included the establishment of the new UK Health Security Agency—UKHSA. The UKHSA combines key elements of Public Health England and NHS Test and Trace, including the Joint Biosecurity Centre. The role of UKHSA will be absolutely critical. It will be our permanent standing capacity to plan for, prevent and respond to threats to health. It will deploy the full weight of our analytic and genomic capability on infectious diseases. It will work with partners around the world to lead the UK’s global contribution to health security.

These regulations will support the UKHSA and the other UK public health agencies—Public Health Wales, Public Health Scotland and the Public Health Agency of Northern Ireland—in quickly identifying and responding to a wide range of health issues. They will ensure that we maintain a robust and consistent UK-wide approach to health security that allows us to work effectively with our international partners, including by linking into international surveillance systems.

On our international collaboration and leadership, I remind noble Lords that last month the G7 committed to working towards adopting a standardised minimum health dataset for patients’ health information. This included: working through the International Patient Summary standard; developing internationally shared principles for enabling patient access to health data; and promoting the use of open standards for health data. This highly technical work will have huge practical dividends.

I will say a word about implementation. Noble Lords will know that the UK-EU Trade and Cooperation Agreement—TCA—was announced on 24 December 2020. These regulations will help us meet the TCA’s health security arrangements. The TCA provides a strong basis for the UK and EU to continue to co-operate on health security. It includes a commitment to inform each other when new public health threats are identified in either the UK or the EU. It gives ad hoc UK access to the EU’s database for sharing alerts: the Early Warning and Response System—EWRS. It provides for the UK to attend the EU Health Security Committee in support of response co-ordination, and a commitment to co-operation between the UK and the European Centre for Disease Prevention and Control—ECDC.

It is because of these arrangements that the UK was given access to the EWRS for Covid-19 from January 2021. Our current access avoids any disruption in the flow of public health data during the pandemic. The UK has also continued to attend meetings of the EU’s Health Security Committee—HSC.

I will say something about the substance of the regulations and why these amendments are being made to retained EU law by this instrument. While a member state, the UK was required by EU law to co-ordinate and share certain types of information on health protection with the EU; to give a recent example, early alerts on newly identified threats. As health protection is predominately a devolved competence in the UK, to meet these obligations effectively the four UK nations had to co-ordinate and share the required information with PHE, the UK’s focal point for communication with the EU.

However, following the end of the transition period, this retained EU law relating to health security no longer operates effectively to set rules for such co-ordination on a UK-wide basis. Therefore, these regulations modify and transfer functions previously carried out by the EU to a new UK health protection committee and to the UKHSA, working in co-operation with Public Health Wales, Public Health Scotland and Northern Ireland’s Public Health Agency.

Let me give some examples: first, on early alerting and the EWRS. The importance of early alerting was amply illustrated by Covid-19. Speed of action is absolutely critical. It is imperative that when a threat is identified, information is shared rapidly to enable the quick implementation of control measures that will reduce transmission rates in the general population and protect individuals. To ensure that we have a robust early alerting system in the UK, these regulations require the UK’s public health agencies to notify the UK’s focal point within 24 hours of any new threats that have been identified. For the purpose of these regulations, PHE is designated as the UK’s focal point, with this function soon to transfer to the UKHSA. In this role, the UKHSA will be responsible for receiving alert notifications of serious cross-border threats to health from the different parts of the UK, then working jointly with them to conduct rapid risk assessments and put in place co-ordinated response measures as necessary.

To meet our obligations under the TCA, the UKHSA must also notify the EU of any threats occurring in the UK which may present a risk to EU member states. In return, the EU will notify the UK of any emerging threat in Europe which may present a risk to us. If the UK and the EU agree it would be beneficial for the UK to have access to the EWRS for any threat, the UKHSA will be responsible for uploading and receiving related surveillance information.

Secondly, I will say a word about UK-wide surveillance. It is critical that we continue to conduct UK-wide epidemiological surveillance on known communicable diseases. Therefore, these regulations make provision for the UK’s four public health agencies to conduct surveillance on a shared list of communicable diseases and related special health matters. This is vital for improving our understanding of the prevalence of infectious diseases across the whole of the UK.

Thirdly, on co-ordination across the union, these regulations require the UK Government, the devolved Administrations and the UK’s public health agencies to consult each other with a view to co-ordinating their respective monitoring and early warning of, and their response to, serious cross-border health threats. They must inform each other of any substantial revisions to preparedness and response planning.

Fourthly and finally, on governance, to support the implementation and functioning of these regulations, we are establishing the UK health protection committee. The committee will have representation from all parts of the UK and will function to provide advice on the list of communicable diseases and related special health matters that are subject to UK-wide surveillance, and the associated operational procedures.

As health security is an area of devolved competence, we have obtained formal consent for the regulations from the DAs. On this point, I pay tribute to the spirit of collaboration across the devolved Administrations. For example, just last week I had a hugely productive call on the life sciences vision with Minister Ivan McKee, Minister Maree Todd, Minister Robin Swann, Minister Paul Frew and Minister Eluned Morgan—the noble Baroness, Lady Morgan of Ely. I thank them for their collaboration. In parallel, we are working together with the DAs to develop a common framework, which will strengthen UK-wide governance arrangements on the prevention and control of serious cross-border health risks.

These regulations are critical. I beg to move.

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, I am enormously grateful for noble Lords’ perceptive comments and the questions that they raised. As the noble Lord, Lord Hunt, said so persuasively, these regulations are vital to maintaining UK-wide collaboration on health security and put in place the necessary mechanisms to allow us to engage effectively with our international partners on infectious diseases and other cross-border threats to health.

I am grateful for the demanding and analytical questions asked by all noble Lords on closer co-operation with the EU. I reassure my noble friend Lord Lansley that the regulations will ensure that implementation of the health security chapter of the TCA is effective and complete through the establishment of a robust UK-wide regime that can share the information required to meet our TCA obligations.

As to my noble friend’s comments on EU performance and future plans, we will have to wait to see where it is coming from. In the meantime, I reassure him that we were prompt to request access to the EU’s Early Warning and Response System in relation to the Covid-19 pandemic and that the EU was equally swift to grant that access. We are committed to continuing such positive co-operation on monitoring serious cross-border health threats where it is in our mutual interest and to maximising the benefits of TCA provisions. These regulations set the foundation for us to do exactly that.

The noble Lord, Lord Hunt, asked about the timing of the UKHSA/PHE transfer. The MoU between PHE, UKHSA and the ECDC is currently being negotiated. On the noble Lord’s questions on the TCA, the health security arrangements contained within the UK-EU TCA provide for continued collaboration between our world-leading scientists and technical experts and the ECDC, including on Covid-19 as we continue to tackle the pandemic. We are working with the ECDC to consider how we can best support the continuation of this co-operation and collaboration between our respective experts in future, including through the conclusion of an MoU.

The noble Baroness, Lady Brinton, and my noble friend Lord Lansley asked about the WHO. Both the UK and the EU recognise the importance of continuing to work together to protect our citizens from infectious diseases and other cross-border threats to health. We already work together in multilateral groups and organisations, including the Global Health Security Initiative, and this agreement ensures that this will continue where it is in our mutual interest. These regulations address the threats arising from infectious disease and non-infectious threats, such as chemical and environmental hazards. This is in line with existing national policies and the International Health Regulations—IHR—2005.

The noble Baroness, Lady Brinton, asked about the involvement of local health teams. I confirm that the UKHSA design will incorporate effective co-ordination with local authority health protection teams. I reassure the noble Baroness, Lady Merron, that engagement with the DAs is extremely frequent and during the pandemic has been happening on a weekly basis, at least. We are committed to maintaining that very close co-ordination, which is supplemented with weekly meetings among the four CMOs that I understand are extremely productive.

I completely agree with the noble Baroness that this country was hard hit because of the bad health of our population. That is why we are bringing forward plans for the Office for Health Promotion, where the relevant parts of PHE will be rolled into an extremely effective and energetic organisation which will be focused on the country’s underlying health conditions, under the clinical oversight of the CMO. We will unveil plans for that office shortly.

I emphasise that the passage of this instrument is critical in the prevention and control of serious cross-border threats to health in order to maintain a high level of human health protection across all parts of the UK. The regulations act on our intentions to strengthen domestic capability in health security and they are also imperative in helping us meet our obligations under the TCA with the EU. I hope very much that I have been able to answer the questions raised by noble Lords, and with that in mind I commend these regulations to the Committee.

Motion agreed.

Coronavirus Act 2020 (Early Expiry) Regulations 2021

Lord Bethell Excerpts

Monday 5th July 2021 Grand Committee

Moved by

[Lord Bethell]

That the Grand Committee do consider the Coronavirus Act 2020 (Early Expiry) Regulations 2021.

Relevant document: 1st Report from the Secondary Legislation Scrutiny Committee

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

My Lords, the one-year status report of the Coronavirus Act, which was laid in Parliament on 22 March, recommended the expiry of 12 provisions, and the suspension of a further two provisions and two parts of a third provision. I am sure noble Lords will join me in recognising that this is testament to the hard work and sacrifice that has helped us to get to this point. The regulations were laid under the draft affirmative procedure to allow noble Lords this opportunity to scrutinise the Act, as we have always committed to.

Having helped bring this Act through Parliament last year, I am enormously pleased to speak in support of this draft statutory instrument. Taking steps towards returning to normal and being able to switch off some of the temporary emergency powers in this Act is very much in line with the direction our country is moving in and fulfils the commitments the Government made from the Dispatch Box at the time.

The Coronavirus Act was introduced to enable the Government to support and protect as many people as possible during the pandemic. It has been, and continues to be, an essential tool in our toolkit, helping to mitigate transmission in our communities, enabling crucial financial support, and protecting and supporting the NHS and other public services. Ultimately, it has helped to save lives.

The Act ensures that the NHS has the capacity to deal with peaks of the virus by allowing the temporary registration of nurses and other healthcare professionals. It protects critical societal functions—for example, providing courts with the ability to use video technology—and allows us to provide effective support packages to individuals and businesses, such as the Coronavirus Job Retention Scheme and the Self-employment Income Support Scheme.

Now to the matter in hand. The Government conducted in-depth assessment of all the Act’s provisions as part of the one-year review. Today we are debating 12 provisions that we propose to expire early. I thank colleagues in the devolved Administrations for their engagement, support and consent in expiring the relevant provisions that apply to them. Eleven of these powers will be expired for all the nations they extend to—for example, Sections 8 and 9, which across all four nations were never needed thanks to the extraordinary alternative arrangements put in place. I firmly believe that this highlights our desire to remain aligned as a United Kingdom as we move to the next phase of our response.

On the specific provisions, we are expiring Sections 8 and 9, which facilitated emergency volunteering leave and compensation leave for emergency volunteers. Thanks to the fantastic effort by the NHS, these provisions were not needed. Other measures, such as NHS Professionals, other agency and bank staff, and the Bring Back Staff scheme, have been more appropriate to address the need for trained clinical staff.

Section 15 allowed local authorities to ease some responsibilities under the Care Act so that they could continue to meet the most urgent and acute needs in the face of Covid-19 by streamlining assessment and charging for care retrospectively. In England, only eight authorities used these powers—and none since 20 June 2020. There is strong support for expiring the provision, as the social care workforce has remained resilient under pressure and able to continue to deliver its duties. Expiry of this provision shows just how much progress we have made through the resilience of the health and care system.

We are also expiring Section 24, which allowed biometric data held for national security purposes to be retained for additional time; five provisions that required information for businesses and people involved in the food supply chain; Section 71, which allowed a single Treasury Minister to sign on behalf of all Treasury Commissioners; Section 79, which extended arrangements for business improvement districts; and Section 84, which allowed for the postponement of General Synod elections. We also suspended a further three provisions in the Act when, on 21 April, the Coronavirus Act 2020 (Suspension: Temporary Judicial Commissioners, Urgent Warrants, and Disposal of Bodies) Regulations 2021 came into force.

I have always been clear that these powers should not be in place any longer than needed. That is the approach we have sought throughout. All powers in the Act have been kept under continuous and close review. The powers we are debating are not required anymore; we have taken steps to remove them through this instrument.

The Government recognise the vital importance of parliamentary scrutiny. We heard and responded to the calls from this House, and we built rigorous checks and balances into the very fabric of the Act. Arrangements to facilitate accountability and transparency include conducting two-monthly status reports on the non-devolved provisions, as well as a one-year status report. Under Section 98 of the Act, the temporary provisions are also subject to a six-monthly review and renewal vote in the House of Commons. The first and second of these were held on 30 September 2020 and 25 March 2021 respectively, in which Parliament agreed to the continuation of the temporary provisions in the Act. We will lay a report covering the next six-monthly review before the end of September. The third six-monthly debate and renewal vote will take place shortly after; this will provide the opportunity, as previously, to debate the provisions in detail and consider their continued application based on the latest evidence.

The remaining provisions in the Act serve three core purposes: shoring up capacity in the health and care system; ensuring the delivery of essential public services, such as enabling virtual court proceedings; and providing financial and other support to businesses and individuals. While the period of the pandemic remains, so does the need for the Act. However, the six-monthly review process concluding in September will assess each of the temporary provisions rigorously, and we will expire all those deemed no longer necessary and proportionate to the response.

People and businesses need certainty. They, and we, want to see restrictions being lifted. This is the direction we are looking towards, and this is the direction we are taking. We have come a long way, and we should look ahead to the next six months as a chance to focus on the positives, on recovery and on reaching the next milestone in our road map. I beg to move.

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, I am enormously grateful to noble Lords for their thoughtful and perceptive comments. I will try to answer some of the points made in this important debate directly.

The noble Lord, Lord Hunt, asked about the synod. I assure him that this provision allowed Her Majesty the Queen, by Order in Council and at the request of the most reverend Primates the Archbishops of Canterbury and York, to postpone the dissolution of the synod of the Church of England and so to postpone the election that had been due to take place in the summer of 2020. The Church of England agreed that the provision had served its purpose and may be expired, with elections being held online this year.

For the noble Lord, Lord Hunt, the noble Baroness, Lady Merron, and the other noble Lords who asked about the Care Act, I will spend a moment providing some reassurance on the easements that we are expiring. The Care Act easements were a temporary measure to help local authorities to continue to meet urgent needs in the face of Covid when they were expecting extraordinary pressures. Following our review of the provision in March 2021, which included consultations with stakeholders across the adult care sector, the decision was made to expire the provisions as they had not been used since 29 June 2020. I emphasise that point to any noble Lords who may be unclear on it: the provisions have not been used since then.

There was strong support to expire the provision from groups representing people with care and support needs. Local authorities were in a better position in terms of planning, support and the use of mutual aid than they were when the easements provision was first introduced. No local authorities have operated easements since 29 June. Only eight local authorities out of 151 operated easements before then. A report by ADASS showed that local authorities used easements in very limited ways, such as using streamlined templates for assessments, conducting virtual assessments and postponing reviews and rescheduling them to a later date. No council moved from Care Act eligibility to a human rights threshold.

I want to address the anecdotes raised by the noble Baroness, Lady Brinton. Let me be absolutely clear that no support was necessarily removed as a result of these easements. The department has worked with Think Local Act Personal—TLAP—and the Association of Directors of Adult Social Services to understand the impact on individuals. Across this research, there have been no concerns that the councils that enacted easements ceased to support people, nor data to suggest that any groups were adversely affected by the easements.

However, we noted that, due to poor communications, some people reported feeling that they were impacted by easements even in areas where easements were not operated. We have commissioned research via the National Institute for Health Research to explore the impact of easements on individuals. The outcome of this research will be published over the next year. Anyone who feels that they have not had the care and support they should have had should first place a complaint with their local authority.

I will now move on to the impact of Section 24 and the regulations made on it, since that was raised by a number of noble Lords. On 29 April 2021, the independent Biometrics and Surveillance Camera Commissioner published a statement on the regulations made under Section 24. It sets out that almost 1,500 individual biometric profiles have had their ordinary statutory retention deadline extended as a result of the regulations, thereby protecting against the loss of biometrics of individuals assessed as presenting a risk to national security. The commissioner commented that he is

“satisfied that the section 24 power has been used in a responsible and proportionate manner and only when scarcity of resources or time limitations meant that the biometrics of individuals assessed as presenting a real risk to national security might otherwise have been lost.”

He also stated that he has

“seen nothing to indicate that the police have applied the provisions in anything other than the manner intended: necessarily, temporarily and proportionately.”

Section 24 is a regulation-making power; no further regulations are being made under it. This is because the mitigations put in place by CT policing mean that it is confident that, despite the ongoing effects of the pandemic, no extension will be required.

On the question asked by my noble friend Lord Moynihan, I express massive sympathy for all those missing out on important rites of passage, such as graduation, and other important events in the calendar, particularly for our young people. There cannot be a noble Lord in this proceeding who does not have an anecdote of this nature from their own friends and family group. We look forward to the day when we can change these arrangements; that day is drawing closer every moment.

I will say a word about tenants and residential tenancy to my noble friend Lord Bourne. On 12 May, a statutory instrument was laid that extended longer notice periods for residential tenancies until 30 September. My noble friend asked about the possibility of further financial support for tenants; I will take his questions back to the department and write to him accordingly.

In response to question from the noble Lord, Lord Scriven, about when the regulations will come into force, I assure him that they will come into force as soon as possible, once approved by both Houses of Parliament, and will be signed by a different Minister in the department.

The noble Baroness, Lady Brinton, asked about provisions for CEV individuals. I assure her that these have not been publicly announced and that the Secretary of State’s statement, which will occur in another place shortly, will provide some information on that.

On my noble friend Lord Moynihan’s point about Wembley, these events are part of the events research programme, which is why they are allowed to have large crowds. They are essential to our understanding of Covid transmission.

The noble Baroness, Lady Fox, asked whether we can go further and faster with the expiry of the Act. I can confirm that the next six-monthly review of the Act will take place in September; we are certainly assessing the remaining powers with this in mind. It is too early for me to make further proclamations on the decisions to be taken in September or in advance of the next review date for step 4 of the road map. Noble Lords will have listened to my Statement last week on the review of the data. We have to be cautious in our journey along the road map but we have reason to be optimistic about the future. More and more people are receiving the vaccine and giving us greater protection.

I thank everyone for participating in this debate and for their sacrifices throughout the pandemic.

Motion agreed.

Health: Dementia

Lord Bethell Excerpts

Monday 5th July 2021 Lords Chamber

[Baroness Couttie]

To ask Her Majesty’s Government what is the national average waiting time for a referral to a memory service following a suspected dementia diagnosis; and how this has changed since January 2020.

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

My Lords, data on wait times for referrals is not collected for memory services. However, NHS Digital does collect data on new memory assessment referrals, which saw 2,136 people referred to a memory service in May 2021—a 17% increase compared to April 2021. This compared to 2,896 new referrals made in January 2020. The Government take referrals extremely seriously: they have made £17 million available this financial year to NHS England and NHS Improvement to support memory services and increase diagnoses.

[Baroness Couttie (Con)]

I thank my noble friend for his Answer and declare my interest: my brother is a trustee of Dementia UK, an organisation which recently produced a report, Facing It Alone—which I hope my noble friend has read—highlighting the challenges faced by families and health professionals when tackling dementia. What steps are the Government considering to address the gap in diagnosis and access to post-diagnostic support, such as increasing the number of admiral nurses and the amount of primary care, as called for by Dementia UK? Will he also consider facilitating a meeting between the appropriate Minister in the other place and Dementia UK to discuss what more can be done to meet the requirements of these vulnerable people?

[Lord Bethell (Con)]

My Lords, I pay tribute to the role of admiral nurses and the model developed by Dementia UK; it is indeed a very valuable contribution. The dementia team at the department met with Paul Edwards, director of clinical services at Dementia UK, in April 2021, to discuss how we could work together more closely. I am happy to follow up on that meeting with any recommendations that Dementia UK might have for how we can focus on this important area.

[Baroness Crawley (Lab) [V]]

My Lords, is it not the case that there are just not enough diagnostic consultants and memory service nurses to reduce the waiting list that the noble Baroness, Lady Couttie, referred to? Given the number of people with dementia who, sadly, have passed away during Covid, when will the Government change the law to enshrine the rights of care home residents to have family visits?

[Lord Bethell (Con)]

My Lords, the focus on diagnosis is critically important. That is why Challenge on Dementia 2020 set a target of two-thirds of people living with dementia receiving a formal diagnosis. At the end of May 2021, DDRs were 68.8%, compared with 61.7% at the end of April. We are working hard to get these numbers back up, and the £17 million fund which I referred to is one contribution to that. But the noble Baroness is entirely right that this is an important area, and we are focused on it.

[Baroness Barker (LD)]

My Lords, during Pride month, the Alzheimer’s Society and Opening Doors London did a lot to highlight the experiences of LGBT people with dementia. Does the Minister agree that when the Secretary of State for Health insists on wearing a rainbow badge, it is unacceptable for people to turn up to services only to be misgendered or to have their family relationships ignored or undermined, and that there should be a process of sorting out training for staff so that people are dealt with appropriately?

[Lord Bethell (Con)]

My Lords, I take seriously the testimony of the noble Baroness. I am not aware of the specific concerns that she describes, nor am I completely up to speed on the precise arrangements of the training, but I would be glad to correspond with her on this matter.

[Baroness Blackwood of North Oxford (Con)]

My Lords, while virtual assessments were vital during the pandemic, without further diagnostics many led to a diagnosis of unspecified dementia. An accurate diagnosis of dementia subtype is critical to good management, especially in complex cases. Given the backlog, there will understandably be a temptation to deprioritise those who have a preliminary diagnosis from a virtual assessment, but this would be a false economy. How can the Minister ensure that those with a provisional diagnosis will be invited back for a comprehensive assessment after the pandemic has finished, and for imaging and other diagnostics where necessary?

[Lord Bethell (Con)]

Few people are as enthusiastic as I am about the benefits of digital medicine and virtual consultations, but I completely acknowledge my noble friend’s point: this is one area where we absolutely must have face-to-face assessment. The diagnostic tests and assessments she describes play a critical role, and those whose conditional assessment was done virtually must be cascaded into a face-to-face assessment, as she says. That is why we have put the funds in place to ensure that this backlog is caught up with.

[Baroness Wheeler (Lab)]

My Lords, not only are there deep concerns about the sharp drop in memory clinic referrals during the pandemic; the Alzheimer’s Society also has very real fears that the virtual assessments currently taking the place of attendance at memory clinics run the risk of exacerbating inequalities in treatment and excluding large cohorts of patients. What is the Government’s overall strategy for ensuring that vital day care and hospital services are reopened and that the backlogs in referrals are addressed, for providing the rehabilitation that people with dementia need to counteract the effects on their cognitive and physical function, and for providing support for their mental health and well-being?

[Lord Bethell (Con)]

My Lords, guidance to help enhance best practice in dementia assessment and diagnosis was recently updated and published to support a personalised approach and choice in the delivery of remote consultation or face-to-face diagnosis. The guidance was developed in collaboration with stakeholders, including those with lived experience, and through the Dementia Change Action Network. I completely acknowledge the point that the noble Baroness makes. We are working as hard as we can to get the kind of face-to-face assessments she describes. They play an essential role in what we do.

[Baroness Brinton (LD) [V]]

My Lords, the 2019 national memory service audit carried out by NHS London reported that a quarter of English dementia services were unable to provide or refer on for carer psychoeducation. Knowing the struggles that my stepmother had over a decade ago getting recognition, let alone support, as my father’s dementia worsened, these figures remained stubbornly low. Can the Minister say when early support will automatically be available for all carers of those diagnosed with dementia?

[Lord Bethell (Con)]

My Lords, I pay tribute to the role of carers in the kinds of situations the noble Baroness describes. We are doing an enormous amount to supply training for carers in all facets of their delivery, including support in caring for those with dementia. I am not sure that I can make the guarantee that she seeks right now, but I reassure her that this is one area of our investment in carers that we take extremely seriously.

[Lord McColl of Dulwich (Con) [V]]

My Lords, while these patients are waiting for appointments, could some way be found to encourage relatives and close friends to help those with early dementia by having frequent conversations with them and helping them learn by heart poems they used to be able to recite in earlier years? That might also prove helpful to those relatives and friends, because loss of memory tends to affect us all as we grow older.

[Lord Bethell (Con)]

My noble friend makes a very touching and constructive point, because social engagement and involvement in the community keep older people sharp and their brains engaged and help stave off the ravages of age and the diminution of mental faculties. We all have a role to play in supporting the elderly and those with mental challenges. My noble friend is entirely right to call on the entire community to step up to that role.

[Lord Blunkett (Lab) [V]]

I draw attention to my declaration in the register as a dementia champion. The corollary of the question that has just been put is that reduced contact, reduced socialisation and reduced activity accelerate the onset of dementia. Of course, that has been happening over the past 16 months. Will the Minister commit to investing in the voluntary and charitable sector in this area so that it too can play its part in supporting families and helping it to reaccelerate back into social action?

[Lord Bethell (Con)]

I accept the noble Lord’s point. The corollary is right: there are those who have not had the engagement they once had, and it is fair to assume that that has accelerated their decline. The role of charities and communities in trying to provide that back-up support is critical. That is why we have provided £515,000 to the Alzheimer’s Society to support its Dementia Connect programme.

[Baroness Fox of Buckley (Non-Afl)]

I am very glad to hear the response from the Minister on virtual consultations, but can I press him to urge an immediate reinstatement of face-to-face memory services and recognise that for those with cognitive and sensory impairments, Zoom is especially disorientating—it is for me, let alone anyone else? Will he also urge GP surgeries to open fully face to face—they are not at present—as doctors often spot signs of dementia when patients access services for other reasons? I think that would help.

[Lord Bethell (Con)]

I completely accept the noble Baroness’s point. It is clear that the benefits of digital do not play out for the elderly and those who face dementia and other similar conditions in the same way as they do for younger people and those accustomed to and familiar with Zoom and other digital services. She is entirely right that the symptoms and features of dementia, Alzheimer’s and Parkinson’s are sometimes picked up only through face-to-face engagement. That is why we are working hard to reopen GP surgeries and to ensure that such appointments can take place.

[The Lord Speaker (Lord McFall of Alcluith)]

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

Covid-19: Wuhan Institute of Virology

Lord Bethell Excerpts

Wednesday 30th June 2021 Lords Chamber

[Viscount Ridley]

To ask Her Majesty’s Government what assessment they have made of the possibility that the COVID-19 virus escaped from a laboratory at the Wuhan Institute of Virology.

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

My Lords, with the increasing threat of zoonotic diseases crossing the animal-human divide, learning how Covid was transmitted to humans and is spread is absolutely crucial to preventing future pandemics. The much-delayed WHO-convened Covid origin study reported on phase 1 of its investigation in March. The report made recommendations for further studies. The Government’s belief is that it is vital that phase 2 of the investigation does not face the same delays and that it is given full access to the data necessary for the next part of its work.

[Viscount Ridley (Con)]

I thank my noble friend for that Answer. Viruses like this have not been found near Wuhan in bats or any other animals. The closest relative to this virus was brought to Wuhan by scientists from 1,000 miles away to a laboratory that had been manipulating SARS-like viruses for 15 years. There it was sequenced in 2017 and 2018 in a biosecurity level 2 laboratory. Most of that information was found out by independent investigators, not volunteered by the Chinese authorities. Will my noble friend unequivocally condemn that lack of transparency and join other nations in calling for a full and independent investigation? Will he clarify who is in charge in the British Government of answering that question?

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, I entirely agree with the sentiments expressed by my noble friend. We are absolutely calling for a timely, transparent and evidence-based phase 2 study, including further investigation in China, as recommended by the experts’ report. We agree with the Independent Panel for Pandemic Preparedness & Response that member states should give the WHO greater powers to investigate outbreaks of pathogens with pandemic potential within member states.

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

My Lords, I commend the Minister for an excellent reply to the noble Viscount’s Question—a reply obviously informed by the excellent staff at the Department of Health and Social Care. In the light of that, can I gently ask why, as a Minister, did he feel it necessary to have a parliamentary research assistant?

[Lord Bethell (Con)]

My Lords, I have written to the commissioner for standards in response to that precise question and I should be glad to share that correspondence with the noble Lord.

[Baroness Walmsley (LD) [V]]

It is believed that given the slow rate of mutation of Covid viruses, Covid-19 would have taken around 35 years to evolve from its nearest known relative. What has been done to identify any intermediaries in which it may have lived during that period and any knowledge useful for preventing future pandemics that may arise from that knowledge?

[Lord Bethell (Con)]

I entirely agree with the noble Baroness. It is extremely frustrating that we do not know the steps of evolution that this virus went through. It has come to us completely out of the blue. That leaves us in a vulnerable state when we are preparing for the next pandemic. It is absolutely essential, as any epidemiologist will say, that one knows and understands where the virus came from—whether that is the water pump handle for an outbreak of cholera or a virus from China.

[Baroness Blackwood of North Oxford (Con)]

My Lords, the situation could not emphasise more clearly the need for genuine global participation in transparency in surveillance and pathogen sequencing to respond to future pandemics and epidemics. I was pleased to see the progress at the G7 on this but, if the global anti-pandemic action plan is to have any teeth, we will need to ensure that countries such as China contribute trustworthy data to global surveillance in the future. What steps does the Minister envisage to ensure that this happens?

[Lord Bethell (Con)]

I completely agree with my noble friend. The international health regulations need to be amended in that respect. It was one of the aspects of the pandemic preparedness treaty that was brought to Carbis Bay for the G7 earlier this year. We are working extremely hard, through our G7 chairmanship, to ensure that this relatively obscure but absolutely critical international treaty has the teeth it needs to do the work on genomic sequencing and pathogen identification that needs to be done.

[Lord Patel (CB) [V]]

My Lords, does the Minister agree that for a better understanding of the current pandemic and future pandemics, identification of the progenitor genome of SARS-CoV-2 is important? We need more data, despite having sequenced more than 1 million SARS-CoV-2 genomes. The escape of pathogens from labs is not new. Examples are smallpox and anthrax, and also SARS, which escaped from several labs in different countries in 2003. Does the Minister agree that we urgently need to address global regulation of labs that undertake gain of function experiments on pathogens?

[Lord Bethell (Con)]

My Lords, I agree with the noble Lord’s appeal for more data—but, candidly, as I know he knows, it is not just quantity of data that we need; it is the right data. Where we are struggling is in getting genomic sequencing of new mutations from the furthest reaches of the virus’s spread. We need a systematic programme around the world that shares the sequences of new mutations with academics who can study and assess them. Without such a systematic programme we are flying blind. That is why we are working on the new variant assessment platform and other pandemic preparedness projects.

[Baroness Merron (Lab)]

My Lords, scientists are warning that we are in an era of pandemics, and that viruses more deadly, contagious or resistant to antibodies than Covid-19 could emerge. What steps are the Government taking to prepare themselves and the country for the next potential pandemic, and will the Minister commit to ensuring that future pandemic preparedness plans are independently assessed and reported to Parliament?

[Lord Bethell (Con)]

My Lords, I pay tribute to the Chief Scientific Adviser, Sir Patrick Vallance, who is leading the pandemic preparedness work. He is doing an enormous amount both on the international treaties through our G7 chairmanship, and on the internal domestic re-envisaging of our healthcare system. We need to invest more in public health, and we also need the data, the diagnostics and the patient behaviours that support really rigorous tracking down of diseases when they arrive. The noble Baroness is entirely right: pandemics will come, sooner rather than later.

[Lord Jones of Cheltenham (LD) [V]]

Why, within days of becoming Prime Minister in July 2019, did Mr Johnson scrap the Threats, Hazards, Resilience and Contingency Committee, which was set up precisely to ensure that the UK was ready to cope with a pandemic?

[Lord Bethell (Con)]

My Lords, with the greatest of respect to the noble Lord, I am not sure whether the pandemic that just hit us could have been solved by a committee, however august and impressive. We need a national response, and the national response to this pandemic came from the Prime Minister and the top of Government, and involved the entire nation. For that we are enormously grateful.

[Baroness Pidding (Con) [V]]

My Lords, in an article in the Financial Times in May, Sir Patrick Vallance said that the Prime Minister had asked him, ahead of the G7, to pull together relevant experts to start looking at how a future pandemic could be dealt with more swiftly—and, most importantly, on a global basis. Can the Minister advise us what progress has been made on this?

[Lord Bethell (Con)]

My Lords, I attended the presentation by Sir Patrick Vallance at the G7 health track in Oxford in June, which was received extremely well, both by Health Ministers from the G7 countries and by the chief executives of the major pharmaceutical companies that are partners in that work. We are using our chairmanship to nudge it along, and it will cover both the pharmaceutical and the demographic elements of pandemic response. This is an example of where Britain is showing leadership in the world to carve out a clear idea of how we can respond to pandemics better in the future.

[Lord Alton of Liverpool (CB)]

My Lords, I return to the point made by the noble Viscount earlier. Who in the British Government is in direct touch with the US National Institutes of Health, and especially Professor Jesse Bloom, about the deletion of genomic sequences, which he said had no plausible scientific rationale? If it is proven that the virus came from the Wuhan laboratory and that that fact has been concealed by the Chinese Communist Party, does the Minister agree that Magnitsky-style sanctions against individual officials would be the beginnings of an appropriate response by our Government?

[Lord Bethell (Con)]

My Lords, specific official engagement with the investigation is done through PHE, and we have a PHE official sitting on the investigation. That is the right way of conducting a scientific dialogue. The DHSC and FCDO also have extremely active interests in this. As for the tone in which the noble Lord talked about how we should approach this challenge, I say that we have to work in partnership with other countries. There is no way in which we can demonise one country or another in this matter. Partnership is the only way ahead. What we can, I hope, bring to the party is a sense of urgency and a sense of focus.

[The Lord Speaker (Lord McFall of Alcluith)]

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

Covid-19 Update

Lord Bethell Excerpts

Tuesday 29th June 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, I echo on behalf of these Benches the concerns about the treatment of Professor Chris Whitty. It is totally unacceptable, and it is good news that the police are now investigating this.

Just now, in reply to my question on the Urgent Question, the Minister said that the health and social care Bill has been published. Over the last few minutes I have been searching the web, but I cannot find it— can he help me any further?

Yesterday’s Statement from the new Secretary of State struck an interesting new note. The department is clearly no longer going to be led by data but by dates. Yesterday, 22,868 new cases of Covid were reported. This time last year, when lockdown was finally lifted, daily cases were under 1,000. Even with the high level of vaccinations, this is causing illness and pressures on the NHS—even if it is a different kind of pressure to that of a year ago. On Sunday, Andrew Marr reported on his programme that his own experience of catching Covid had been difficult. He said that, while he had not needed to go to hospital, he was more ill than he had ever imagined possible, and it was not an asymptomatic experience. In the light of this and the reports of growing numbers of people living with long Covid, can the Minister say why data will now clearly not factor into the decisions about 19 July?

On these Benches, we believe that we need to learn to live with this disease, but unlike the Statement from the new Secretary of State, we do not believe that this is just about vaccination, important though that is. This week, Israel has found that, despite early and comprehensive levels of vaccination, the delta variant is ripping through its communities. We have argued since February 2020 that controlling outbreaks is vital. Can I ask the Minister about the provision of test, trace and isolate arrangements moving forward? Specifically, have local directors of public health been given access to emergency funding for the provision of surge testing and tracing and vaccination in their communities? When will the pilots for increased support for those needing to self-isolate be published? We still believe that people should be paid their wages if asked to self-isolate. As that number is considerably fewer than six months ago, it would be not only cheaper for the Treasury but a much more effective way of ensuring that the spread of the virus is reduced.

Usually the Minister agrees with me on the importance of test, trace and isolate, even if we perhaps disagree on how that should be funded and supported. Can he respond to the concerns of the doctors and scientists who are appalled with today’s proposals that company directors will be able to temporarily leave quarantine for business meetings? People are still furious that the Prime Minister delayed adding India to the red list, with the resultant rapid spread of the more transmissible and more serious delta variant. As Professor Christina Pagel says:

“luckily elites don’t get or transmit covid.”


Stephen Reicher, the eminent behavioural scientist, said he was horrified by the

“scandalous misuse of science as a cover for political decisions … which is putting us all at risk.”

When commenting on the DCMS report published on Friday, he said:

“The headlines and the political response isn’t just an exaggeration, they directly contradict what the report says. It warns that the research wasn’t designed to draw any conclusions about the effects of events on transmission and mustn’t be used to do so”.


Yet Ministers and the press are all reporting that these events in the trial had no effect on infections and were safe to reopen.

Yesterday, a No. 10 spokesperson explicitly denied that government Ministers have used private email addresses. They said:

“Both the former health secretary and Lord Bethell understand the rules around personal email usage and only ever conducted government business through their departmental email addresses”.


This is directly contradicted by the Second Permanent Secretary in meeting minutes published by the Sunday Times. Those minutes clearly state that former Health Secretary Matt Hancock

“corresponds only with private office via a gmail account”.

As the Good Law Project has reported, on 19 April 2020, the noble Lord, Lord Feldman, emailed the noble Lord, Lord Bethell, at his private address, about the availability of Covid-19 test kits via a Canadian company, saying:

“Certainly worth contacting … to see if they can help … and the pricing seems competitive.”


Self-evidently, this is government business, and specifically within the portfolio of the noble Lord, Lord Bethell. The noble Lord, Lord Feldman, once co-chair of the Conservative Party, was writing to the Minister at his private email address on government business. In addition, I note that the Minister’s meeting with Abingdon Health on 1 April 2020 was not disclosed on the ministerial meeting schedule.

We note that, unlike the response from the noble Lord, Lord True, on the earlier UQ, it is not possible for the public to access private emails; the Freedom of Information Act specifically excludes it. Not going through the formal government-approved routes, whether for emails or declarations of meetings, gives the impression that perhaps the Minister has something to hide from his dealings with a former chairman of the Conservative Party and the company he was acting for. I note that the company was awarded an £85 million contract after the meeting and the emails.

There has been considerable speculation about the role of Ms Gina Coladangelo as a lobbyist, unpaid adviser to Matt Hancock and then a non-executive director for the Department of Health and Social Care. The press and media have also reported that the Minister gave Ms Coladangelo a parliamentary pass last year. Can he tell the House what personal parliamentary service she provided for him during that period? Does the Minister feel that his position is tenable, given this evidence?

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

My Lords, I am enormously grateful for those extremely thoughtful questions. As ever, I welcome the challenge and scrutiny that the House of Lords always provides on these matters.

I completely endorse what the noble Baronesses, Lady Brinton and Lady Thornton, very thoughtfully said about Chris Whitty. Chris Whitty and JVT are both complete legends, and both have been accosted in public. This is completely unacceptable. We must look at the security of those who serve us so well, and we must somehow address the disrespect that often happens when public figures walk in public. It is a great regret that this has happened.

The noble Baroness, Lady Thornton, asked about nurses’ pay. I repeat to her what my right honourable friend the Secretary of State for Health said yesterday: this absolutely remains a priority. We must have a fair pay settlement. That pay settlement is going through the pay review process at the moment, and we look forward to receiving the output on that.

Both the noble Baronesses, Lady Brinton and Lady Thornton, asked about the basis for the optimism that we have at the moment. I have stood at this Dispatch Box for 18 months as the purveyor of difficult news to the House, and have lived through some very difficult moments in that time. I am acutely aware of the concerns that noble Lords have. I think the questions put were very reasonable and deserve a clear answer, so let me explain why we are a bit more optimistic than I think we ever could have been in the recent past. The case rates are slowing down, for both over and under-60s. Hospital admissions among the over-60s have started to fall, and while there are signs in both measures that the rate of growth is slowing, there is just not enough to fundamentally change our assessment of the risk of delta. In the last two weeks, we have seen case rates fall in both Bolton and Blackburn. That is an incredibly important observation, and one that bears testimony to the effectiveness of the local authorities, test and trace, and all of those who have contributed. It is mainly driven by the under-60 group, but not wholly. Rates among older people are plateauing right across the country at a lower level, and hospitalisations and severe illness are being prevented by people being doubled vaccinated against Covid-19. There are very clear signs that the vaccine is working in lots of ways.

By 19 July, two significant things will have changed that may give us stronger confidence. First, we will have offered a first dose to all adults in the United Kingdom. The NHS states that it can do this by 19 July. We will have also given a second dose to a higher proportion of over-40s, giving them more protection against hospitalisation. Secondly, we will be very close to the school holidays, which start on 26 July, and school-aged children being out of school. This will significantly reduce transmission among the population which is unvaccinated and has driven case growth. Universities should also be out.

We are monitoring the data every day. So far, we have not seen indicators that substantially change our assessment of the four tests. I hear loud and clear what the noble Baroness, Lady Brinton, says about Andrew Marr and his experience. Vaccination is not a panacea. It does not save everyone from any illness at all, but it has a significantly strong effect for us to move on to the next stage.

In terms of the backlog, I assure the noble Baroness, Lady Thornton, that we are putting funds in place to do whatever it takes to get us back to where we began. I cannot give the specific reassurances she asked for on whether specific funds will be extended, but it is our aspiration to work as hard as we can. On GP data, I assure her that the clinical trial progress that we have made on things such as Regeneron in the last few days gives us such a clear inspiration and motivation for ensuring that we get this project right. On trusted research environments, we have demonstrated that we listen and that we will change how we implement the GP data transfer, but our objective remains resolute. We are committed to continuing with this programme of work.

I will give a very clear response to the very important question regarding emails, asked by the noble Baronesses, Lady Brinton and Lady Thornton. I am absolutely rigorous in ensuring that government business is conducted through the correct formal channels. Contracts are negotiated by officials, not by Ministers. Submissions from officials are handled through departmental digital boxes, and that is right. Official decisions are communicated through secure governmental infrastructure.

I have read the Ministerial Code; I have signed it and I will seek to uphold it in everything that I do. The guidelines are clear that it is not wrong for Ministers to have personal email addresses. I have corresponded with a very large number of noble Lords in this Chamber from both my parliamentary address and my personal address. That is right and I will continue to do so. In their enthusiasm, third parties often seek to engage Ministers through whatever means that they can find, including their personal email. That is not the same as using a personal email for formal departmental decision-making. Those who have seen material on the internet should judge it extremely sceptically, because distorted fragments of evidence do not provide sufficient grounds to rush to judgment on how Ministers do their business.

I do not recognise the substance of the comments of the Second Permanent Secretary, as referred to by the noble Baroness, Lady Brinton, and he has indicated to me that he does not recognise the substance of those comments. I completely recognise the comments that were made regarding the meetings with Abingdon Health. The meetings schedule from that week was overlooked because of an administrative oversight. It has now been uploaded to the internet. I will be glad to share a link to that register. On the complaint made by Anneliese Dodds, I have written to the Parliamentary Commissioner for Standards and would be very glad to share that letter with the noble Baronesses, Lady Thornton and Lady Brinton.

I take this post extremely seriously. During the work of the pandemic, many people—officials, Ministers and those in industry—worked extremely hard to address the severe epidemic that we face, and I am extremely proud of how that business was conducted.

[The Senior Deputy Speaker (Lord Gardiner of Kimble) (Non-Afl)]

We now come to the 30 minutes allocated for Back-Bench questions. I ask that questions and answers be brief so that I can call the maximum number of speakers.

[Lord Haselhurst (Con) [V]]

My Lords, I note the impressive acceleration of the vaccine rollout and its relevance towards taking step 4 on 19 July, at a time when relief at the end of restrictions could lead to lack of caution and a surge in cases. Have the Government assessed whether it might be safer to prioritise those requiring first jabs over those waiting for their second—or, indeed, the opposite?

[Lord Bethell (Con)]

My Lords, the question of prioritisation is one for the Joint Committee on Vaccination and Immunisation. In terms of operational delivery, we have moved to a moment of opening up jabs to all those over 18, and many places do not even require an appointment. Between now and 19 July we are escalating the speed at which we deliver the jab. I encourage all ages to step forward for their first jabs, and those who have an appointment for the second to ensure that they make use of it.

[Lord Patel (CB) [V]]

My Lords, some of the vaccines used in the United Kingdom have been found to be less effective against the beta variant currently spreading in South Africa. What assessment have the Government made of the risk of travellers from South Africa bringing the beta variant to the United Kingdom following the rugby tournament that is taking place there?

[Lord Bethell (Con)]

As ever, the noble Lord is extremely perceptive in his questions, and he is right that as we vaccinate more and more of the population, the risk will become less from highly transmissible mutants and more from those which can somehow escape the vaccine. The South African variant is the one that so far has demonstrated the greatest escapology. For that reason, we are extremely cautious about visitors who may come from areas that have the South Africa variant, including South Africa itself.

[Baroness Donaghy (Lab) [V]]

My Lords, although the Statement is upbeat, it does say that hospitalisation has doubled since May. This will not be solved in three weeks. What would it take to extend beyond 19 July on safety grounds and is the Minister ruling out restrictions this winter? Also, will the proposed top-down reorganisation of the NHS be abandoned?

[Lord Bethell (Con)]

My Lords, hospitalisations have doubled but the vast majority of them are among people who have not been double-vaccinated for plus two weeks. It is very striking, when you look at the list of who is in hospital, how many simply have not been vaccinated. That is why our focus is on seeing through the vaccination programme, particularly getting all those at-risk groups—those over 50—double-vaccinated as soon as possible.

I cannot rule out anything, but I am more optimistic today than I have ever been, and that optimism is grounded on a very careful study of the facts, having sat through the joint biosecurity presentations day in, day out, for months on end. While I cannot be 1000% confident of everything, since this virus has a lot that it can throw at us, I really am hopeful for the future.

[Lord Scriven (LD)]

My Lords, to minimise the need for another national lockdown, effective local test, trace and isolate systems will need to be in place. Therefore, can the Minister explain why, in the test and trace budget, centralised corporate services, which has no front-line test and trace activity, has £931 million more allocated than the localised front-line test, trace and contain allocation? If he does not have those figures to hand, can he please write to me, although not from his personal email address?

[Lord Bethell (Con)]

My Lords, I suspect that I have corresponded with the noble Lord from my personal email address; I am deeply hurt that he does not want to receive any of my emails again, but not entirely surprised. The waiting at test and trace has moved dramatically, as I think the noble Lord knows, from the central supply of testing and tracing services to a much more local model, and that does not always manifest itself in the corporate accounts of the organisation. It manifests itself in both the management and the delivery, and I pay huge tribute to those who are involved in the local implementation. As I said earlier, the way in which the delta virus infection rates, which were skyrocketing at one point, have been turned around in places such as Hounslow, Blackburn with Darwen and other areas of the north-west is phenomenally impressive and is a tribute to the impact of test and trace.

[Lord Farmer (Con)]

My Lords, what has the SIREN study most recently established about the effectiveness of infection-induced antibodies over time? Furthermore, as per my Written Question, answered by the Minister on 2 June 2021, why has not Public Health England or another government-backed health body conducted a review of research on the long-term effects of face mask wearing when clinicians such as Antonio Lazzarino from UCL’s Institute of Epidemiology and Health Care cite deleterious health effects?

[Lord Bethell (Con)]

My Lords, SIREN is one of the most thought-provoking and interesting of all the many studies that we have done. It is a sad fact that we do not understand many of the aspects of the body’s immune system, and that is why we are so committed to that study. It suggests that once you have had the virus, your body’s immune system is extremely strong. The proportion of people who catch it a second time round is incredibly small. That is good news for those who have caught it and for those who have had the vaccine, because if the immune system works well after catching the virus, it probably works well after the vaccine. However, we continue to publish from the SIREN study. On the health impacts of wearing face masks, I am not fully across that, but I will be glad to write to my noble friend with any details that I may have.

[Lord Harries of Pentregarth (CB) [V]]

The Government have been concerned for some time that even though someone is symptom-free and has had both vaccine jabs, there is still some risk that they might pass it on to others. But surely the risk must be minuscule. Have the Government ascertained how minscule the risk is compared with other much more major kinds of risk, and has there been a danger of the Government overcompensating here, particularly with respect to those in that position wanting to enter this country?

[Lord Bethell (Con)]

My Lords, what a perceptive question from the noble and right reverend Lord—he absolutely hits the nail on the head. The honest truth is that we do not have the precise figures on this but the indications are that he is right: the vaccine does not stop you being infected or transmitting it, but it reduces the chances of both those things dramatically. That is one of the reasons why we have kept our foreign travel arrangements under review. It is possible that the effect that he describes may mean that we can look very thoroughly at foreign travel—I think all noble Lords would welcome that.

[Lord Hunt of Kings Heath (Lab) [V]]

My Lords, I have no doubt about the Minister’s personal integrity but he will recognise that he is part of a Government who are not exactly renowned for their probity or truthfulness. I want to ask him about lateral flow tests. There have been reports that the accuracy of this test, which has been less than 100% in any case, is less still when it comes to the delta variant. Can he say a little more about that, and what discussions are taking place with UK companies, who appear to have developed better models which may be more accurate?

[Lord Bethell (Con)]

My Lords, the noble Lord is entirely right that the Porton Down verification team has looked extremely closely at all lateral flow tests and their sensitivity to the delta variant in particular. There is suggestion and some indication that for very low viral loads, the LFTs are not quite as sensitive, or if they are sensitive, the band is less easy to read. However, for higher viral loads—in other words, the kind of viral loads that the body needs to carry to be infectious—there is no change of sensitivity. Therefore, from that point of view the LFTs continue to perform their original purpose very effectively but we need to keep a very close eye on sensitivity with the new variants.

I pay tribute to all UK companies which are coming forward with LFT, PCR or genomic sequencing tests. I am extremely proud of the progress that the UK diagnostics industry has made. We have extremely high standards and extremely high validation and authorisation protocols through Porton Down. Those standards are very difficult to achieve but we are working extremely closely with UK companies to try to get them over the line so that they can play an important role in our response to the pandemic.

[Baroness Tyler of Enfield (LD) [V]]

My Lords, the Statement places great emphasis on regaining freedoms but has relatively little to say on the specifics of how we learn to live with Covid, as we surely must, given the rising number of new cases and concerns about new variants. Apart from a very brief mention of care workers, there were no other details of how the planned end of restrictions on 19 July will affect care home residents and their families. Can the Minister say what thought is being given to how we learn to live with Covid in care settings and when we can expect to see detailed guidance on this which balances the need for protecting the elderly and vulnerable from infection and improving the quality of their daily lives?

[Lord Bethell (Con)]

My Lords, the noble Baroness’s question is entirely reasonable and I wish I could be more specific on the precise timing. The honest truth is that we look at the data every day; our experience through this pandemic is that our understanding improves every day and therefore the guidance that we provide is often provided at a relatively late stage. It is an unfortunate aspect of this awful pandemic and one that I know noble Lords have commented on with vigour in the past, but it is an unavoidable fact of life. However, the comments made very thoughtfully and persuasively by noble Lords about the conditions in care homes, the restrictions that are put on residents and the pressure that that puts on them and their families have been heard loudly and clearly by all those in the department and across government, and we will seek to address those concerns when the moment is right.

[Lord Lancaster of Kimbolton (Con)]

I remind the House of my interest as Deputy Colonel Commandant Brigade of Gurkhas. According to the Daily Telegraph, 63 unvaccinated Gurkha veterans have now died in Nepal. Had they lived in the UK they would have been vaccinated, but because they left the Army before the law was changed, they have no right of abode here. Under the Armed Forces covenant which we are enshrining in law, we have a duty of care to our veterans, and the differential way in which we are treating our Gurkha veterans from their UK counterparts is a clear breach of that covenant. Just 20,000 vaccines, or less than 3% of a single day’s rollout in the UK, is all that is required. When will those vaccines be made available?

[Lord Bethell (Con)]

My Lords, I pay tribute to the points made by my noble friend and to the persuasive and energetic way in which he made them. Our thoughts go to those in Nepal, who face an awful position; the pandemic there is running extremely hot. I reassure my noble friend that colleagues at both the Department of Health and the FCDO are fully aware of the concerns of the noble Lord and the Nepalese people. We will put in place the kind of vaccination provision programme that we would like to see as soon as we can. Our priority for the moment is the UK. For all the reasons I just described, we must continue the march towards 19 July and get our own people vaccinated. However, my noble friend makes the point well; the sums involved are relatively small and we will seek to address them as soon as we reasonably can.

[The Earl of Clancarty (CB)]

My Lords, there is a growing feeling in the arts that they are being taken for a ride. Up to 60,000 will attend the Euro semis but festivals such as Kendal Calling, with less than half of that capacity, and now WOMAD, have had to cancel because they have no access to the Events Research Programme data or to a government-backed insurance scheme. On top of that, despite the Costello study, our amateur choirs are restricted to six while professional choirs in similar settings are not. For the arts, none of this makes sense.

[Lord Bethell (Con)]

My Lords, I completely understand the noble Earl’s points. On WOMAD, I have a particular interest in that fine festival and I am extremely sad to hear that it has been cancelled, and to have to change my family plans accordingly. I reassure the noble Earl that we have not overlooked the arts at all. They are absolutely paramount in our thoughts. The events research programme is making progress, but it consumes a high number of tests and we simply do not have the capacity, despite the huge investment we have made, for the kinds of figures that would be needed to open up the whole of the arts world at this stage. But I am hopeful that the research we are doing will create the kind of persuasive data necessary to figure out safe ways of reopening the arts, so that we can get back to the life we had as soon as possible.

[Lord Rooker (Lab) [V]]

I welcome the Minister’s openness and transparency about his conduct. I also support what he said about the attacks on Dr Whitty. If there are no arrests before the end of the day, it will just show how useless the Metropolitan Police is under its current leadership. In his Statement, the Secretary of State talked about keeping the NHS safe. What I have not really connected, both from the previous Question and this Statement, is that keeping the NHS safe cannot be done in isolation. The issue of social care and its reform is inexorably linked to keeping the NHS safe, and that point does not seem to be used by Ministers as a serious connection. Finally, without abuse, if this country starts boosters or third jabs later this year when people in countries such as Nepal are still going without vaccinations, it will be a thundering international disgrace.

[Lord Bethell (Con)]

My Lords, I have failed in my mission, because I have sought to convey to the Chamber that we completely understand that the NHS, social care and public health—the three sectors of our healthcare system—are inextricably linked. That is why we are bringing to the House the health and social care Bill that we are. That is why we have already brought about a large number of reforms, including ICSs and the integration of various diagnostic elements, and have sought to bring more parity for social care workers and those in public health. The noble Lord absolutely hits the nail on the head. I completely agree with his point, and that is our guiding star for the future.

[Lord Cormack (Con)]

My Lords, if we are to return to normality on 19 July, as the new Secretary of State has stressed in the other House is his aim, can my noble friend assure me that the question asked by the noble Earl, Lord Clancarty, will be properly and effectively answered by a return to normality with choirs, inside and out? Can he also assure me—and I am sorry to press him on this yet again—that, by the end of August at the latest, all care home workers will have to have been vaccinated?

[Lord Bethell (Con)]

My Lords, I am grateful for the opportunity to address both points. On singing, I have heard loud and clear the points made by many noble Lords, particularly my noble friend Lord Cormack. The right honourable Secretary of State for Health said very clearly yesterday that it was his aspiration that we should return to normal as soon as possible and that he himself would be joining in the singing when it happens. I completely echo that point.

On social care workers, I am advised that we are working as hard as we can to get through the very delicate employment law and the consultations necessary. I know my noble friend would wish that this could all happen a lot more quickly, but the way in which we go about the treatment of our workers needs to respect their human rights, and that is why it is important that we do this in a thoughtful way. It is also necessary to build trust in the vaccine and I do not think that there would be anything gained by in any way pre-empting those processes.

[Lord Hussain (LD)]

My Lords, the hotel quarantine for those returning from red-list countries is having a huge, stressful impact on those using the hotels. I have a couple of examples to share and one or two suggestions to make. The first case is family A from Huddersfield. They went to bury their father in Pakistan. On return, they had huge difficulty booking hotels. At Heathrow Airport some family members were taken to Swindon and others to Camberley, which are about 50 miles apart. They could not be put in the same hotel, for some reason. They have made a formal complaint. I have received a copy of it and I am willing to send it to the Minister as well. It shows the level of dissatisfaction people are feeling.

The second example is from my home town, Luton, where, sadly, a young teenager lost his life in a tragic incident. His father and some other relatives, including somebody who is epileptic, were in Pakistan at the time. On their return, whatever amount of stress they had, they were taken to the hotel straightaway and were not allowed out, other than just coming for the funeral.

The third example—and I would say a more tragic one—is a family who went to Pakistan before it was put on the red list. The father was under stress and there are two disabled children. The mother died there and the children are waiting to come back to the UK—

[Lord Hussain (LD)]

My Lords, the suggestion is, please can those returners be tested and those who are found to be positive asked to quarantine in their own home? To observe their quarantine, they should have some kind of electronic tag instead of being put in expensive hotels and having these terrible experiences.

[Lord Bethell (Con)]

My Lords, the noble Lord’s testimony is very moving and I have no doubt that the red-list system has put a lot of pressure on a lot of families. I personally sign off on these exemptions, and every evening as I go through them and read about the stories people have, it breaks my heart—and I do it with huge regret indeed. However, the noble Lord needs to understand that we put the red-list system in place to protect this country. People simply cannot expect to travel in large family groups as if the pandemic had not happened, and they cannot expect the testing system to work as some kind of barrier to infection. We have tried that. It did not work. The proof is absolutely categoric.

If I may be honest with noble Lords, it is likely, unfortunately, that we will have to live with some red-list countries for some time to come. That is one aspect of the unwinding of this pandemic that is not likely to go away very quickly. I completely take on board the noble Lord’s guidance. If he would like to write to me about the specific examples, I would be happy to correspond with him. However, I would not be levelling with him if I did not make it clear that this is something that we are extremely committed to.

[Baroness Altmann (Con)]

My Lords, I welcome my right honourable friend Sajid Javid to his new role and also offer my public endorsement of the integrity of my noble friend the Minister. I echo the words of this Statement that we must learn to live with Covid, so that our country benefits from the fantastic vaccine success. I fear we have lost perspective on real life. Zero Covid and stopping people being ill with just one disease among the myriad diseases around us all our lives are wholly unreasonable—and indeed unattainable —aims. Can my noble friend comment on when we will take more seriously the mental health damage that lockdown and deprivation of freedom to see all our loved ones is causing, and the importance of trusting the British people to decide for themselves who they need to meet and hug and who—as the noble Earl, Lord Clancarty, and my noble friend Lord Cormack said—they feel safe to sing with?

[Lord Bethell (Con)]

My Lords, I hear my noble friend’s comments loud and clear, and I think that we have hit some kind of inflection point where our focus is now much more on the learning-to-live rather than the saving-life dimension. I say that with unbelievable caution, having, as noble Lords know, been through all sorts of rollercoasters of expectation over the past year. I am extremely hopeful that the vaccine has laid out a clear path out of this pandemic. It is one that is fragile, delicate and could be overturned at any point, but, so far, the vaccine has seemed to be extremely durable.

On the mental health of the nation, I completely agree with my noble friend. It has put huge pressure on families, loved ones and communities. There have been positive benefits—my honourable friend Nadine Dorries spoke movingly about that to the Health and Social Care Committee the week before last. Some families in some communities have been drawn closer together— there is good evidence for that—but, for a great many, there has been a huge amount of pressure. I, for one, look forward very much to some lessening of that burden.

[Lord Taylor of Goss Moor (LD) [V]]

The Minister has just commented that there may be red-list countries for some time to come, and that is clearly correct. That is a reflection of two things. First, many countries, particularly poorer countries, have not been able to vaccinate at our rates—not even close to that. The changes to Covid, which are making its spread both more easy and more dangerous mean that it is ripping through many of those countries and threatens many, many more deaths. Secondly, in doing so, it increases the chances of variants being bred in those countries and ultimately finding their way here—we know from experience that they will find their way here sooner or later. So, while feeling more optimistic about the situation here in the UK, what can we do to further ramp up the effort to support countries around the globe that are struggling to vaccinate their populations, struggling to save lives and, frankly, struggling to stop the creation of new variants that threaten this country?

[Lord Bethell (Con)]

The noble Lord is entirely right: those three things are linked. We cannot live in a world where there is a high infection rate in large parts of it, where new variants prosper and where we cannot travel. That would be inhuman and unpragmatic. I met with the CEOs of the major companies that manufacture the vaccines in Oxford during the G7, and we discussed this point in great detail. It is frustrating, but I also have optimism that the manufacturing capability in the hubs around the world—in the geographical places where populations live—are being built today and, by the middle of next year, there will be a huge amount of vaccine capacity in order to address this problem. It is frustrating that it cannot happen overnight, but vaccine manufacturing capability takes time to build up, as we know only too well. However, those investments are taking place, and I believe that, as a world, we can beat this pandemic together.

[Lord Lansley (Con)]

Notwithstanding the disclosures of the past few days, may I tell my noble friend that I, for one, very much appreciate what Matt Hancock did and the immensity of the effort he put in to combat Covid infection? Step 4 is not a return to normality, so, for example, self-isolation requirements will continue after contact tracing. The Government now have a lot of research to look at whether daily lateral flow tests can replace self-isolation both for schools and for businesses, which are must disrupted by self-isolation. Can my noble friend say when the Government may be able to proceed to allow some schools and businesses to shift to daily lateral flow tests?

[Lord Bethell (Con)]

My noble friend’s comments are very much appreciated and taken on board. On his question about daily lateral flow testing, he is very perceptive and correct. This is an area that we have been exploring for some months, and we are working extremely hard to bottom it out with rigorous clinical trials—clinical trials are difficult to nail down, by their nature, but we have invested substantially in them. He is right that, for schools, for international travel and for contacts—those three things—daily testing may well offer an alternative to 10-day isolation. That would be a huge relief to many in the country, and it is something that we are very focused on delivering.

[Baroness Fox of Buckley (Non-Afl)]

I welcome the change of tone when the new Secretary of State said that the big task ahead is to restore our freedoms—freedoms no Government should ever wish to curtail. Regime change is a bit disruptive, so I ask the Minister: are all the department behind this new approach, because it is in rather stark contrast to the Secretary of State’s predecessor’s more doom-laden, illiberal approach? As we have seen in this debate, there seems some reluctance, at least within Westminster, to allow fellow citizens to embrace freedom.

[Lord Bethell (Con)]

The noble Baroness is quite right to ask the question, but I would say to her that it is not actually the regime that has changed, although the regime has changed; it is that the data has changed. Last Tuesday, I sat through Covid Gold, which is our big set-piece data session—a two-hour deep dive into national and local data. Every week for the past 70 weeks, that has been a very chilling experience where we have looked at the progress of and tactics of this awful virus, and I have often left it with a very heavy heart. Last week, I genuinely felt that we had reached some kind of turning point and, on Friday, when I sat in my kitchen, I felt a great weight beginning to lift off my shoulders for the first time in a very long time. I cannot disguise from your Lordships that there may well be more surprises left in this virus. I cannot promise that I will not be standing at this Dispatch Box giving bad news at some point in future, but, right now, I am more optimistic than I have ever been, and I think that the Statement by my right honourable friend the Secretary of State reflected that.

[The Deputy Speaker (Baroness Pitkeathley) (Lab)]

My Lords, the time for questions has now elapsed and, with regrets and apologies to those noble Lords whom I was unable to call, we must move to the next business.

Social Care Reform

Lord Bethell Excerpts

Tuesday 29th June 2021 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, in last week’s very powerful debate on social care, noble Lords from across the House made it clear that we cannot build a better future for our country after Covid-19 without transforming social care, but instead of a firm date for the Prime Minister’s clear plan, we had the usual reassurances from the Minister that it was still absolutely under way, we would see some social care foundations in integrated care systems under the NHS and care Bill but that it would still be the “end of the year” before the Prime Minister reveals his clear plan to all.

Over these nearly two wasted years we have had delays and broken promises. Almost 42,000 care home residents have died from Covid-19, 2 million people have applied for support but had their request refused, tens of thousands have had to sell their home to pay for care, millions of families have hit breaking point and staff have been appallingly let down. Even after all the horrors of this pandemic, nine out of 10 councils say that they face care budget cuts this year.

While the Government dither and cancel key meetings and the Prime Minister blocks various funding options, the social care funding crisis deepens. Now we see in the Daily Telegraph that the new Secretary of State considers that we are completely at the wrong stage of Parliament to launch a new social care strategy. What is going on?

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

My Lords, the commitment to publishing a review of social care is absolutely heartfelt. We have delivered on Brexit and the vaccines, and we will deliver on social care. The Prime Minister has made it crystal clear that that will be done by the end of the year; that commitment remains in place. It will require enormous financial commitment by the whole nation at a time when our finances as a nation are extremely stretched. Therefore, it is entirely right that very careful consideration is given to it. It will also involve a very large amount of engagement with other parties and the relevant stakeholders. Again, this is not something that has been rushed. We have just been through the most awful pandemic; it is not possible to do a review of this generational nature at the same time as fighting this awful disease, but we will be true to our commitments and deliver the plan as promised.

[Baroness Brinton (LD) [V]]

My Lords, in last Thursday’s debate on social care and carers, the Minister said

“a plan for reform absolutely is under way. We have before us the building of foundations, which will be laid in the social care measures in the health and care Bill, which will support us in working together”.—[Official Report, 24/6/2021; col. 447.]

Arising from that, is it planned to publish a White Paper or any other consultation document or, as the Minister’s speech implied, will the reforms be published as part of the health and social care Bill without any wider consultation? Given his answer just now to the noble Baroness, Lady Wheeler, will parliamentarians be ask to make decisions on the health and social care Bill without seeing the details of the future social care reforms?

[Lord Bethell (Con)]

My Lords, new legislation will increase integration between health and social care by removing barriers to data-sharing, enabling joint decision-making and putting more power and autonomy into local systems. The noble Baroness is entirely right on that. The Bill has been published and the noble Baroness is very welcome to engage in some of the engagement sessions that I have had on it already. I should be glad to run more, if that would be helpful to her. A White Paper and a public consultation are not planned.

[Lord Lansley (Con)]

My Lords, press reports suggest that the Prime Minister is in favour of including in social care reform the Dilnot commission recommendations that are now a decade old. In doing so, he could bring into force Sections 15 and 16 of the Care Act 2014, which this Parliament passed seven years ago. Will the Government now consider doing exactly that to enable a cap on care costs to be implemented rapidly?

[Lord Bethell (Con)]

My Lords, we are extremely respectful of the Dilnot commission report and the recommendations in it, particularly those highlighted by my noble friend on Sections 15 and 16. It is one of many proposals that we will look at very carefully. We cannot make a commitment to anyone in particular at this stage but, as I said to the noble Baroness, we will put forward a full plan by the end of the year and will remain true to that commitment.

[Baroness Campbell of Surbiton (CB) [V]]

Can the Minister assure the House that any proposals on the funding of social care will ensure that working-age disabled people who use care services can access the support that they need to live a full and independent life in the community and that the funding will be sufficient to ensure that they no longer have to pay for it, avoiding inequitable and unfair financial hardship?

[Lord Bethell (Con)]

My Lords, I hear the noble Baroness loud and clear. Indeed, the needs and priorities of those with disability and the role of care for disability and the emphasis on care in the community are things that we hear loud and clear. I am not in a position to make any commitments on finances standing at the Dispatch Box at the moment, but the noble Baroness’s points are heard loud and clearly, and I would be glad to take them back to the department.

[Lord Lilley (Con)]

Does my noble friend agree that it would be better for the state to enable homeowners to insure against the potentially catastrophic risk of social care, rather than diverting billions of pounds desperately needed to pay for the care system for those unable to pay for themselves, instead using those funds to subsidise people, like most Members of your Lordships’ House, who want to pass on to our heirs homes worth hundreds of thousands or even millions of pounds? How would that be levelling up?

[Lord Bethell (Con)]

My Lords, the point made by my noble friend is entirely thoughtful and persuasive. Indeed, there may well be a role for insurance rather than any other mechanism, and it will be one of the options that those who define the policy will look at extremely carefully. The point that he makes about the desire of homeowners to pass on their homes to future generations is completely understandable and human, and one that will take into close consideration.

[Baroness Hollins (CB) [V]]

My Lords, further to my noble friend Lady Campbell’s question, will the Minister commit to mentioning working-age disabled adults every time social care reform is discussed? The needs of older people living in care homes are important, of course, but that is an easier focus for improvement. The real challenge is to improve care and support for disabled adults living in their own homes, including people with learning disabilities and autistic people.

[Lord Bethell (Con)]

I am extremely aware of the point the noble Baroness is making. A very large proportion of those in care are not elderly at all but the young and adult disabled who need some care for some condition, whether physical or mental. Their needs are paramount in these reforms. We will not forget the people the noble Baroness describes; the financial arrangements for supporting them are one of the things we absolutely want to take on in these reforms.

[Lord Rogan (UUP) [V]]

My Lords, as well as declaring that he had a clear plan to fix the crisis in social care, Mr Johnson stressed in his infamous Downing Street speech of July 2019 that he was the Prime Minister of the whole United Kingdom. When the social care plan is finally brought forward, what guarantees can the Minister give to demonstrate that Mr Johnson’s Government value the social care needs of the people of Northern Ireland every bit as highly as those of patients residing in England?

[Lord Bethell (Con)]

My Lords, the noble Lord makes an entirely fair point. The needs of those who reside in Northern Ireland are paramount in our minds. I would be very glad to meet the noble Lord and discuss how their views and needs can be best incorporated in the policies we are developing.

[Baroness Falkner of Margravine (CB) [V]]

My Lords, does the Minister accept that public opinion has shifted, and that the public are now prepared to pay more to ensure that the elderly and vulnerable are properly looked after? Will the Government look at other countries’ attempts to deal with this tricky problem in terms of financial commitment? Japan has a surcharge for people over a certain age—I believe it is between 40 and 45 —and Germany has long had a solidarity tax to pay for particular hypothecated items. Will they at least look at this before the autumn spending review?

[Lord Bethell (Con)]

My Lords, I reassure the noble Baroness that we are looking at foreign parallels. The examples she gives are extremely instructive and thoughtful. I cannot speak for certain on where the public are on this, but I share her sentiments; I think the pandemic has demonstrated that the public are more connected with and thinking more about those in care than ever before in our nation’s history. It is exactly the right moment in terms of public sentiment to address some of these issues. The generosity of spirit towards the elderly living in care could not have been higher than it was during the pandemic. In that matter, I completely agree with the noble Baroness.

[The Senior Deputy Speaker (Lord Gardiner of Kimble) (Non-Afl)]

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

Hospital Waiting Lists

Lord Bethell Excerpts

Tuesday 29th June 2021 Lords Chamber

[Lord Balfe]

To ask Her Majesty’s Government what assessment they have made of the time needed for waiting lists for hospital treatment to reduce to the levels they stood at on 1 March 2020; and what plans they have regularly to publish data on waiting times for each (1) medical speciality, and (2) geographical region.

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

My Lords, the horrible dividend of this awful pandemic has been the impact on the wider healthcare service. That is, I am afraid, what epidemics do, but we recognised the threat from the beginning and have worked hard to keep open essential NHS services. We have financed the biggest surge in healthcare spending in NHS history, including £1 billion this year to tackle head on the waiting lists and diagnostic backlog so that we can get back as soon as possible.

[Lord Balfe (Con)]

My Lords, that was an interesting statement but it did not answer any of the Question, which is: what is the Government’s estimate of the time needed to get waiting lists back to the state of a year ago and, secondly, what plans do they have to regularly publish data on waiting times for each medical speciality and geographical region? That is the question; would the Minister like to answer?

[Lord Bethell (Con)]

My Lords, waiting lists are published throughout the NHS and I would be very happy to write to my noble friend with details of the web locations for that data. We are working on the forecasts at the moment. It is not possible to forecast precisely when we can back to where we were, but I reassure my noble friend that a huge amount of work is going on to get there as quickly as possible, including 1.8 million diagnostic tests and treatment for 1.1 million patients since April 2021.

[Lord Hunt of Kings Heath (Lab) [V]]

Even if we get back to where we were in March last year, it will be a status quo in which all the key targets have been missed. When will the Government get back to meeting the targets that they inherited in 2010 with the Liberal Democrats? They have presided over a gradual but disastrous deterioration in overall performance.

[Lord Bethell (Con)]

My Lords, there has been an enormous pandemic, which has, of course, had a huge impact on the healthcare system. During the pandemic, the financial support for the NHS—as well as the system support—has been huge and had a huge impact. We are looking at a backlog and working hard to get through it, but noble Lords should be in no doubt that we are thoroughly committed to getting back to full operational capacity.

[Baroness Brinton (LD) [V]]

My Lords, around 10 million people across the UK are affected by arthritis, and the widespread impact of rheumatology conditions costs the NHS over £10 billion a year. The recent British Society of Rheumatology report, Rheumatology Workforce: A Crisis in Numbers, lays bare the shortage of all multidisciplinary staff, including the consultants, nurse specialists and physiotherapists who are needed to deliver the NICE treatment guidelines. This shortage of staff and funding is already impacting severely on rheumatology waiting lists. Can the Minister say how this funding and workforce gap can be addressed with immediate effect? If he does not have the figures and answer to hand, please can he write to me?

[Lord Bethell (Con)]

The noble Baroness points very well to exactly the kind of challenge that we face at the moment. She is entirely right that conditions such as arthritis and rheumatology require complex combinations and collaboration between many different staff, as well as the application of new and effective treatments and therapies. That is exactly where we are working hard to catch up. I will go back to the apartment, dig out any statistics I can and write to her accordingly.

[Lord Udny-Lister (Con)]

My Lords, waiting lists were too long pre the pandemic and there are now some 6 million people awaiting treatment of one kind or another, many of them in a lot of pain and discomfort. The National Health Service has learned a lot during the pandemic. Will the Minister publish how he intends to speed up the treatment that these people need? Can he also advise whether he routinely uses his private email with his contacts?

[Lord Bethell (Con)]

My Lords, the publication of NHS plans around the catch-up is happening on a regular basis, and there will indeed be further communication from the NHS on this. On the use of private email, I reassure noble Lords that I have read and signed the ministerial code and I seek to uphold it in everything I do.

[Baroness Wheatcroft (CB)]

Specialist surgical hubs have been demonstrated as an effective way of dealing with surgery and would be particularly helpful in dealing with the backlog of cases. Can the Minister say what plans there are for developing specialist surgical hubs, as the Royal College of Surgeons has advocated?

--- Later in debate ---

[Lord Bethell (Con)]

Surgical hubs are exactly the kind of interesting and progressive medical developments that we need to embrace to get through the backlog; in fact, that kind of specialism creates a huge amount of efficiency for the system and a better service for patients. We are working hard to understand how we can use them more effectively, and I would be glad to write to my noble friend with any details we have on the progress that we are making.

[Baroness Thornton (Lab)]

My Lords, the Royal College of Radiologists tells us that 62,000 patients were waiting six weeks or more for a CT or MRI scan, and there may be as many as 45,000 missed cancer diagnoses. There are terrible shortages of skilled staff, fewer scanners than the majority of comparable countries in the OECD—we have half the number in France and a third of the number in Germany—and about a third of our scanners are obsolete or nearing obsoletion. Given the huge waiting list catch-up that the NHS faces, these diagnostic facilities are absolutely vital. Will the Government provide the necessary investment to address this urgent challenge—and in what timescale?

[Lord Bethell (Con)]

I agree with the noble Baroness that diagnostics is one area where this country needs to make further investment. In the 2020 spending review, we ring-fenced £325 million of capital spending to support NHS diagnostics; the funding will be spent on new equipment, digitising NHS imaging and the pathology networks. New capacity is also coming through the new community diagnostic hubs and pathology and imaging networks. This work is critical, and we are working hard to make sure that it is effective.

[Lord Scriven (LD)]

My Lords, data from four major studies shows that disadvantaged groups have faced the greatest disruption to medical care during the pandemic. How are the Government ensuring that these health inequalities are dealt with in reducing the NHS backlog, and what targets have been set to deal with this issue?

[Lord Bethell (Con)]

I completely agree with the noble Lord that the pandemic has illustrated the severe health inequalities that exist across the country as well as the need to address them. The resilience of our health system depends on addressing those who can create the biggest demands on it. There is both a preventive agenda and an agenda for getting through to the communities, to communicate effectively that they can find the treatment they need in their local authority. The Help Us Help You advertising campaign is particularly targeted at the disadvantaged to encourage them to come forward for diagnosis and treatment.

[Baroness Stuart of Edgbaston (Non-Afl)]

My Lords, the original Question requested a breakdown of geographical regions for waiting lists. Workforce shortages will be a continuing problem, and not just for catching up on the waiting lists. Will the Minister recognise the link between training facilities in regions where there are shortages and the ability to fill those vacancies? He will be much more successful in catching up with waiting lists if he pays greater attention to training places, regions and availability.

--- Later in debate ---

[Lord Bethell (Con)]

I completely take on board the noble Baroness’s advice. When it comes to recruitment, it is right that local engagement with local education has to be the way forward. I can report that the recruitment efforts and marketing campaign that we have put in place to recruit 50,000 new nurses, more GPs and more staff across the healthcare system are working extremely well. There is a renewed interest in careers in health—that is one good dividend of this awful pandemic.

[Lord McColl of Dulwich (Con) [V]]

My Lords, the Government’s £1 billion elective recovery fund is most welcome. Will the Minister support this sum being made available every year until we see light at the end of the tunnel? Can he encourage health authorities to redouble their efforts to get the 40 million people in the UK who are overweight to return to a normal weight and thereby begin to release resources to treat more urgent cases, such as cancer patients?

[Lord Bethell (Con)]

On the elective recovery fund, I cannot make that commitment at the Dispatch Box but I reassure my noble friend that we are in it for the long haul and we recognise that this will be a major project needing major resources. When it comes to the health of the nation, the obesity strategy is a cross-departmental and energetic programme that tackles the issues that my noble friend is concerned about. He is entirely right that the costs of our healthcare system are predetermined by the overall health of the nation, and that is why we encourage people to eat well and lead healthy lives.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, the time allotted for this Question has elapsed. We now come to the fourth Oral Question.

Social Care and the Role of Carers

Lord Bethell Excerpts

Thursday 24th June 2021 Lords Chamber

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

My Lords, I join other voices in congratulating the noble Baroness, Lady Jolly, on securing this debate on a subject that is absolutely at the top of the agenda, both here in the House and more widely. I wish her godspeed in her journey to other climates in the defence sector—I wish her very well in that new brief. I also genuinely commend noble Lords for an enormously moving and persuasive debate, with very personal and thoughtful contributions from all sides of the House.

Any Minister who listened to today’s debate, or to any of the interventions that we have had on social care in the last year, would want to start by paying tribute to carers, both unpaid and paid, for all the work that they do in care homes, people’s homes, day centres and other settings, year after year, during this awful pandemic and, as many noble Lords have noted, in the difficult period in the near future of getting back to normal life. I have heard and completely acknowledge the testimony about the significant personal and structural challenges faced by the sector from those who live and work in it. These challenges were exacerbated and highlighted in the pandemic. I do not pretend that they have not put pressure on the 290,000 who live in care, the 630,000 who depend on care, the 1.5 million who work in care and the many millions of family carers who contribute to care.

I will take a moment to reflect on the huge amount that we have done to provide support, at pace, to the social care sector during the pandemic. As we went into it, there were both strengths and weaknesses across the sector, but we started from a point where the quality and satisfaction with the care sector was high, and there was a range of provision for those who needed care. That point is sometimes lost in a debate such as this. As of March 2020, 84% of all social care settings were rated good or outstanding by the CQC, and 89% of those receiving local authority-funded support were satisfied with it, with 64% saying that they were very or extremely satisfied. The importance of raising this point is to pay tribute to the hard work and dedication of those who work in social care: the social care workforce, the care assistants, the care home managers, the social care workers and the family members, who have all contributed to those incredibly impressive statistics.

I will take a moment to remind my noble friend Lord Astor, and all the many noble Lords who quite understandably questioned our efforts to protect the sector during this awful pandemic, of a few of the things that we did. We published bespoke, tailored guidelines on how to safely provide care and protect those we love during the outbreak; these were used by families, care homes, care providers, domiciliary carers, unpaid carers, local authorities and others. From a standing start, we built up a huge capacity for regular testing: to date, we have sent out more than 35 million PCR swabs and 85 million LFTs to care homes, and we have done more through community testing in the NHS. We set up a massive PPE supply chain, completely from scratch, and through the PPE Portal, we have provided 2.4 billion items of PPE free to providers. As of 30 May 2021, we have provided 440 million items through local resilience forums and local authorities.

We have prioritised health and care workers and older care home residents in the UK vaccines delivery plan, offering vaccines before 15 February to residents in care homes, to older adults and their carers, those over 70, the clinically extremely vulnerable and, very importantly in this debate, front-line health and social care workers on an equal footing. We moved quickly to provide financial support, and have now provided £1.8 billion in specific Covid funding for adult social care. We set up regional assurance teams, and have supported safe discharge with £2.8 billion—a colossal sum—including an extra £594 million announced earlier this year. With this in mind, I very gently challenge the implication made by some noble Lords that, during the pandemic, we overlooked social care, the vulnerable or the elderly.

To address the specific subject that the noble Baroness, Lady Jolly, has raised in this debate, I turn to the social care workforce. The 1.5 million people who make up the paid social care workforce provide an absolutely invaluable service to the nation, working tirelessly to support people of all ages who need care. As the pandemic has made clear, we as a nation are totally indebted to their selfless dedication and compassion. Like other noble Lords, I pay particular tribute to the moving personal testimony of the noble Baroness, Lady Thomas, who spoke so engagingly about her carers. I thought of the carers who looked after my father and other loved ones, and I was really moved by the way in which she spoke about this. As she and the noble Baroness, Lady Cavendish, said, these people may be low paid but they are extremely highly skilled. I want to make sure that all noble Lords pay tribute to them.

What we heard from the noble Baroness, Lady Thomas, and in other very moving personal testimonies, was completely consistent with what I heard in my meeting with Carers UK and Care England earlier this week. They brought other carers, who talked about their very challenging and difficult lives in the last few months, and I found engaging with them extremely moving indeed.

I completely hear the noble Lord, Lord Pendry, who pointed out the impact of the pandemic on those who work in social care. Perhaps I may reassure him that we have taken steps to support social care workers during the pandemic. We identified paid carers as key workers in response and gave them much-needed acknowledgement of their critical role in keeping people safe and supported. Through the infection control fund, we ring-fenced funding for providers to be used for measures such as helping to maintain normal wages of staff who may need to self-isolate.

More recently, in December 2020, we appointed Deborah Sturdy as the chief nurse for adult social care to provide professional leadership to the workforce, delivering clinical and professional advice across the social care sector. Huge thanks are owed to her for that.

I have heard loud and clear the words of noble Lords on parity, education, recognition, career progression and autonomy, points that were extremely well made. To the noble Baronesses, Lady Donaghy and Lady Barker, I completely acknowledge that the well-being and mental health of the social care workforce are paramount and have been under threat during these challenging times. We have invested over £1 million in social care well-being and worked alongside the NHS and other organisations to provide a package of emotional, psychological and practical resources for the workforce in a way that has not been done before and I hope has made a difference.

There are at least 6.5 million unpaid carers—around 10% of the entire population, according to the census. Other noble Lords mentioned other equally impressive figures. As my noble friend Lady Browning and the noble Baroness, Lady Watkins, rightly pointed out, that number is even bigger if we include informal carers. The life of those looking after those with terminal diseases is particularly difficult, as was rightly described by the noble Baroness, Lady Finlay. As she rightly and positively made the case for a carers’ allowance, I should reassure her that the consultation on carers’ leave last year demonstrated huge interest in this area—there were 800 submissions—and we will reply in due course, as per our manifesto commitment on that.

Of those unpaid carers, 23% have high-intensity caring responsibilities of more than 50 hours a week. I clearly heard the personal testimony of noble Lords. I have met some of those carers and acknowledge that their life has been incredibly challenging during the lockdown when day centres and other forms of respite were closed, and when the full burden of care fell heavily on their shoulders—month after month, night after night.

We recognise the impact that the pandemic has had on carers and we responded. Perhaps I may single out four areas. First, there was the provision of free PPE to unpaid carers living separately from the people for whom they care. Secondly, there was funding to charities, such as the £500,000 to the Carers Trust and £122,000 to Carers UK to extend its helpline. Thirdly, we gave them priority for vaccines, which I have mentioned already, with carers being put into cohort six, in line with the JVC advice. Fourthly, we published guidance tailored to carers, enabling them to identify themselves and their needs so that those could be more easily met, with ongoing work to help carers on respite and breaks.

To the noble Lord, Lord Dubs, and my noble friend Lady Browning, I completely acknowledge that the challenge continues as we try to return to normal. Day services in particular have been raised by a great many noble Lords, as well as by Carers UK and carers England. The services provide an important form of respite for carers, and allow people with support to meet others and have a break from their obligations. The noble Baroness, Lady Wheeler, and my noble friend Lord Astor gave moving, precise personal testimony on that and I completely acknowledge the point. I wish to reassure all those noble Lords that we are helping to ensure the safe continuation and restarting of day services. We are working with the Social Care Institute for Excellence to publish guidance. We have undertaken work with ADASS and local authorities to understand the barriers. Specifically in answer to the question of the noble Baroness, Lady Wheeler, there is now a joint ministerial task force between DHSC and MHCLG, working specifically on that initiative.

Moving on to workforce development, perhaps I may reassure the right reverend Prelate the Bishop of Carlisle that I agree with him completely that this is a key element of how we can improve social care. As we come out of this pandemic, it is essential that we make sure that we continue to have a workforce with the right values, skills and knowledge, and with real prospects for career progression, if we are to provide a high-quality service for those with need of care services.

I reassure my noble friend Lord Forsyth that we are continuing to commission and fund a range of training opportunities and other programmes to help recruit people in this sector. To give a couple of examples, we have provided £27 million to expand the Think Ahead programme to train 360 graduates in career switches to become mental health social workers; and there is the workforce development fund, which distributes about £12 million a year for training and qualification at all levels. That has helped almost 3,000 establishments to support more than 14,000 learners in 2018-19. The 2020-21 fund will continue to focus on key sectors.

I can only agree with the noble Lord, Lord Pendry, that Covid-19 has exposed some of the long-term inequalities in our society. Research from PHE and others continues to show those disparities.

To the noble Baronesses, Lady Jolly and Tyler, and my noble friend Lady Altmann, I agree that there have been some home closures, but so far there has been no major overall impact on bed numbers in the care sector. The largest regional loss of beds since March 2020 has been a 1% loss in London. Perhaps I may therefore reassure noble Lords that the Care Quality Commission is closely monitoring the financial health of the largest and most difficult-to-replace adult care providers. This allows the commission to warn local authorities if a provider is likely to fall over.

In response to my noble friend Lady Browning’s call, perhaps I may reassure her that a plan for reform absolutely is under way. We have before us the building of foundations, which will be laid in the social care measures in the health and care Bill, which will support us in working together. It will increase integration, reduce bureaucracy and enhance public confidence in accountability. I reassure the noble Baronesses, Lady Tyler, Lady Hollins and Lady Watkins, that these measures will include a new enhanced assurance framework to improve oversight of how social care is commissioned and delivered to people.

To the noble Lord, Lord Dubs, the measures will help us to get much better data from providers on what is going on at a local level so that we can, as he rightly described, follow the evidence of what works and what does not. The health and care Bill will also introduce a new place for social care in the integrated care systems, which will capture and build on some of the joined-up working that has accelerated in some areas already during the pandemic where local collaboration between health and local government, and between different parts of the NHS, has previously been essential to supporting people. With that in mind, I reassure the noble Baronesses, Lady Hollins and Lady Watkins, that we are developing enhanced assurance frameworks.

To my noble friend Lord Lilley and all those who raised the long-term reform of financing social care, it absolutely remains a government priority and all options are being considered, including those of my noble friend. The Prime Minister will be making an announcement on this before the end of the year. To the noble Baroness, Lady Pitkeathley, I say that boldness will be our watchword.

By way of conclusion, I thank those who have spoken so eloquently on this important topic. I know that noble Lords are all deeply committed to supporting the social care sector and would once again wish to join me in thanking all those on the front line providing care and going the extra mile every day. I am enormously proud of their efforts and immensely grateful to them all. We absolutely must not lose sight of what is important. This means doing our utmost for people who rely on social care and their families. In the words of several noble Lords, bring it on.