Folic Acid

Lord Bethell Excerpts

Wednesday 23rd June 2021 Lords Chamber

[Lord Dodds of Duncairn]

To ask Her Majesty’s Government what progress they have made with the response to their consultation about the fortification of flour with folic acid.

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

My Lords, the administration of folic acid to the bread of the nation to avoid around 500 neural tube defects a year is exactly the sort of preventative health intervention that we are putting at the heart of our health strategy. I am pleased to say that progress is being made, and I thank the devolved Administrations for their engagement in this measure to ensure that we have alignment between the four nations. I reassure noble Lords that this remains a priority for the Government.

[Lord Dodds of Duncairn (DUP)]

My Lords, surely the Government have run out of time and must now announce that they will follow the science and finally act to help to prevent the entirely avoidable numbers of babies born with neural tube defects? Recommendations were to be announced as soon as the recent elections were over, and if we are serious about preventative medicine and health, surely on this issue, where UK research has led the way to many other countries taking action long before now, there really can be no further delay or excuses.

[Lord Bethell (Con)]

My Lords, I entirely agree with the noble Lord that we are committed to following the science and are totally persuaded by it. However, I cannot avoid the fact that there were elections in devolved nations, which have meant that politicians and Secretaries of State in some of those countries were not available to engage with. I am pleased to report to the House that we have made a lot of progress in engaging with the devolved nations. We could not possibly do this policy without their support, buy-in and alignment. Progress is continuing at great pace, and I look forward to returning to the House and updating it at a future date.

[Baroness Kennedy of Cradley (Non-Afl) [V]]

My Lords, in March this year, the noble Lord said that the Government were taking time to create a

“solution that is endorsed by mill owners, paediatricians and all the relevant stakeholders.”—[Official Report, 23/3/21; col. 720.]

Given that the position of UK flour millers is acceptance if the Government decide to introduce mandatory fortification, and given that there is overwhelming support from the medical community, why are the Government dragging their feet and not introducing this measure, when it is proven to reduce neural tube defects in babies? Next month is the 30-year anniversary of when this link was proven. Why are we taking so long to put this measure in place?

[Lord Bethell (Con)]

My Lords, the noble Baroness is entirely right: medical opinion on this matter has absolutely consolidated around support for it, and the consultation in September 2019 was extremely positive indeed. I am extremely grateful to mill owners, both the large industrial ones, which make a lot of the white flour, and the artisanal mill owners, which had complexities of their own. The engagement with them has been enormously positive, and I cannot see any obstacle on that front. However, there is a machinery of government point that needs to be addressed: we have to work it through the devolved nations and other arm’s-length bodies, and we are doing that at pace.

[Baroness Altmann (Con) [V]]

My Lords, from my noble friend’s responses, the House will be clear that this decision is under way. Could my noble friend give some idea of whether we might expect an announcement before the Summer Recess? We know that hundreds of children being born with spina bifida and anencephaly, which can be so damaging to themselves and their families, could be avoided. The sooner we do this, the sooner we can stop such problems occurring.

[Lord Bethell (Con)]

I agree with my noble friend; she is right that this is a priority. However, it is not within my gift to simply grant a decision on it; it needs to be worked through both industry and government. We are making progress on this. It is a huge national undertaking for us to put substances literally in the bread of the nation. The public deserve to feel confident that that decision has been made thoughtfully and responsibly, and it is entirely right that we take care to dot the “i”s and cross the “t”s.

[Baroness Hayman (CB) [V]]

My Lords, the Government have had an awfully long time to dot the “i”s and cross the “t”s. When the MRC research first came out, my children were the age that my grandchildren are now. Some 80 other countries have moved more speedily than the UK on the evidence provided by the UK-funded MRC research. As well as the noble Lord making progress on this before the Summer Recess, will the Government look at what the barriers were that made us as a country so slow to come to the decision to fortify flour?

[Lord Bethell (Con)]

My Lords, this Government’s progress on this really came to a head in the consultation in September 2019, and we have been on course to implement these measures since then. It is unfortunate that the Covid pandemic intervened at that point and we had to put work on this project on hold until April of this year. Since April, we have had to deal with the elections in the devolved Administrations. That, unfortunately, creates an insuperable barrier to taking the measures through all the necessary checks and alignments. I reassure the noble Baroness that we are totally committed to this policy, we are moving at pace and I look forward to further progress shortly.

[Lord Rooker (Lab) [V]]

I very politely remind the Minister—and it is on the record—that the three devolved Governments were in favour of this policy before the English Government were, so there cannot really be any substance of any delay from the devolved Governments. I know this because, with scientists, I discussed it with some of the Ministers. My other point is that, given that we already fortify with three substances, there cannot be any technical difficulties whatever in the flour mills in adding folic. There should not be any long-term delay of a technical nature, should there?

[Lord Bethell (Con)]

My Lords, I agree with the noble Lord. Can I just take a moment to bear testimony to his patient and determined campaigning on this issue? He has held the Government’s feet to the fire on it, and I am grateful for his focus. He is right that we are hopeful that there should not be any substantive delay with the industry. A huge amount of work has gone on in the consultations and the dialogue we have had, and I am grateful for that. However, the Senedd and Scottish parliamentary elections in May meant that new personnel were at the top of government. We hope that they are as supportive as the noble Lord so rightly pointed out, but there is a process to get the official endorsement that we need to take this forward and we are waiting for that paperwork to come through.

[Baroness Walmsley (LD) [V]]

My Lords, is the Minister aware that 50% of pregnancies are not planned? Therefore, while the Government consult and procrastinate, what communication is being planned with women of childbearing age to tell them that they need to take a folic acid supplement before they start a pregnancy to avoid NTDs in their babies?

[Lord Bethell (Con)]

My Lords, this Minister is very aware—personally extremely aware—of the fact that 50% of pregnancies are not necessarily planned. As the noble Baroness knows very well, that is one of the reasons for this policy and that is why we are so supportive of it. The education that goes to new mums and dads on folic acid is done through GPs, and we are always looking at ways to enhance that. But I think there is no better of way of ensuring that folic acid gets to the right people at the right time than through this measure, and that is why we are supporting it as energetically as we are.

[Baroness Gardner of Parkes (Con) [V]]

My Lords, can the Minister comment on whether the Government have been working with the health authorities in other countries to review the evidence from the more than 80 other countries where folic acid has been mandatorily added to food products?

[Lord Bethell (Con)]

My Lords, it is my understanding that both the Department of Health and Defra have been engaged with other countries on this matter. I will be glad to write to the noble Baroness with any details that we may have on record.

[Baroness Merron (Lab)]

My Lords, I listened to the Minister’s answer where he referred to delays as a result of the Covid pandemic and the elections in the devolved Administrations. While they may be recent issues, this delay well precedes both those important events. As my noble friend Lord Rooker and others have so eloquently expressed, patience on this is long exhausted and parents-to-be cannot be expected to continue to carry such risk. Can the Minister tell the House exactly when babies will be protected? Is the delay that we have seen over decades due to any change in the Government’s position?

[Lord Bethell (Con)]

I absolutely reassure both the noble Baroness and all noble Lords in the Chamber that there is absolutely no equivocation on behalf of the Government in this matter. It is a huge undertaking to put a substance in the food of the nation. It is therefore something that has to be endorsed by all the relevant bodies, including the four nations and other arm’s-length bodies. We have to ensure that we have all the public health sign off and the industry support that we need, and we need to take the public with us. There will be a moment when we need to sell this to the public, and they will have questions and we will need to have a dialogue. When that happens, I would like to have crossed all the “t”s and dotted all the “i”s so that we are in great shape. That is why we are being as thorough as we can. I reassure all noble Lords that there is no question of us going backwards on this.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, the time allowed for this Question has elapsed, and we now come to the second Oral Question.

Covid-19: Care Homes

Lord Bethell Excerpts

Thursday 17th June 2021 Lords Chamber

[Lord Scriven]

To ask Her Majesty’s Government (1) on what date, and (2) in which policy document, testing for COVID-19 was offered as a matter of policy to those leaving hospitals and going to care homes.

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

My Lords, the Covid-19 hospital discharge service requirements were published on 19 March 2020. They stipulated that patients’ Covid-19 test results, negative or positive, should be included in their discharge documents. On 15 April, we built on this with the adult social care action plan, including a policy of testing all patients prior to discharge to a care home. I remind noble Lords that the WHO acknowledged the threat of asymptomatic transmission on 9 July 2020.

[Lord Scriven (LD)]

My Lords, last week the Secretary of State said that a policy of testing patients going to care homes was brought in

“as soon as we had those tests available”.

That was in mid-April 2020, and more than 500,000 tests were carried out to mid-April 2020. Only 25,000 would have been required to test all patients being discharged to care homes. Can the Minister explain these figures and the contradiction in the Secretary of State’s statement that they highlight?

[Lord Bethell (Con)]

My Lords, I do not quite understand the noble Lord’s figures. As of 14 March 2020, the seven-day rolling average showed that there were 51,741 discharges a day from hospital, of which 1,123 were from hospitals specifically to care homes. That was at a moment when our testing capacity was 3,000 a day. A month later, on 15 April, the rolling average was 22,000, of which 548 were discharges from hospitals specifically to care homes. By that date, the testing capacity was 38,766.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, we need granular details such as dates and decision-making processes not to play the blame game but because we need to understand precisely how Covid got into care homes. In that context, can the Minister tell us when and why the policy decision was made to make vaccines mandatory for care home staff, going against the Government’s stated opposition to jabs for jobs and against the crucial ethical principle of medical consent? Does the Minister understand that for care home workers, vaccinated and non-vaccinated, this looks like decisively shifting the blame from official culpability for the scandal of how Covid got into homes on to hard-pressed front-line workers?

[Lord Bethell (Con)]

My Lords, we are in the middle of a consultation on mandatory vaccinations for care home staff. One thing I would remind the noble Baroness of is that the vast majority of infections in care homes last year were through staff, not through discharge.

[Lord Balfe (Con)]

I think the question the public want the answer to is why so many people died in care homes. Will there be an inquiry which will try to get to the bottom of that simple fact?

[Lord Bethell (Con)]

My Lords, PHE has published a report on that. It calculates that around 1.6% of the deaths in care homes were directly attributable to discharge. That number is very sad, but it is a relatively low proportion. This will, of course, be a subject covered in the government inquiry that the Prime Minister has already announced.

[Lord Laming (CB) [V]]

My Lords, I feel sure that the Minister will agree that it was extraordinary that, when relatives were prevented from visiting their loved ones in residential care, and many of the residents could not understand why they had been abandoned, at that very time patients were being admitted from hospital without having been tested for this virus.

[Lord Bethell (Con)]

My Lords, I completely sympathise with the point on those in care homes receiving a very tough challenge when they have been prevented from seeing loved ones. We have had to take extremely severe infection control measures, many of which are still in place for the reasons that have been discussed in this Chamber before. But I challenge the noble Lord’s point on testing. We brought in testing when asymptomatic infection was recognised and when the capacity was available.

[Baroness Wheeler (Lab)]

My Lords, can the Minister explain why the Secretary of State continues to justify himself by quoting the seriously underestimated PHE January to October 2020 data assessment on hospital discharges to care homes of 286 Covid deaths? The National Care Forum of care providers has repeatedly made clear how fundamentally flawed and incredibly partial that data is. Only limited numbers of symptomatic patients in hospitals and care homes were tested, and cases not tested before death are not included. Even the chair of the House of Commons Science and Technology Committee has said that relying on this for a full picture of the situation is a stretch of the imagination. We owe it to the people who have died, their relatives and care home providers to have full, accurate and independent information. How is the Minister going to ensure that it is urgently provided, so that we can genuinely learn from what happened?

[Lord Bethell (Con)]

My Lords, I acknowledge the noble Baroness’s concerns, but the PHE report is extremely thorough. I am not aware of it being revised, but if it is, I would be glad to share that information with the noble Baroness.

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

My Lords, respected health commentators and statisticians say that excess deaths—that is, deaths above the expected number—is a more accurate way of looking at the scale of deaths in care homes due to Covid. Care home residents make up just 0.7% of the population. In the first wave of the pandemic, deaths in care homes accounted for 44% of all excess deaths for that period in England and Wales. What does the Minister think this says about the effectiveness of the so-called protective ring thrown around care homes and what lessons have been learned?

[Lord Bethell (Con)]

My Lords, we were never in any doubt from the very beginning that the virus presented a huge threat to care homes. They are where the elderly and the vulnerable are housed, in conditions where it is extremely difficult to enforce infection control and where there is a large amount of intimacy between residents and staff. We knew from the experience of other countries that care homes were very likely to be an area where infection and severe illness, and potentially death, would be highly prevalent. There is no doubt that care homes suffered the brunt of this virus, and for that matter I am extremely sad indeed. Noble Lords should realise that we put every measure in place that we humanly could have done. We gave a huge amount of resources, including £2.8 billion via the NHS specifically to support enhanced discharge processes and the implementation of the discharge to assess model.

[Baroness Altmann (Con)]

My Lords, I apologise to my noble friend for adding to the burden that he bears in answering this question. I know he cares deeply about this situation. However, it is important for lessons to be learned, so that we have no similar experience in future. The letter sent by the NHS to care homes on 15 April 2020 states:

“Where a test result is still awaited, the patient will be discharged … pending the result ... This new testing requirement must not hold up a timely discharge”.


I do not believe any of this was a deliberate attempt to infect care homes, but I do believe that care homes need infection control and that there was a lack of follow-up for patients who were discharged positive.

[Lord Bethell (Con)]

My Lords, I am grateful for the tone of the question, but its assumption is, I am afraid, quite wrong. Before April 2020, there was very little evidence and no scientific consensus whatever that asymptomatic transmission posed any risk. For example, the World Health Organization said on 2 April:

“to date, there has been no documented asymptomatic transmission.”

My noble friend may remember that differently. They were very difficult times, and we made decisions on very limited information. We made the best decisions we could have done under the circumstances.

[Lord Dubs (Lab) [V]]

My Lords, as late as March last year there was clear evidence coming from Italy about people dying in nursing and care homes there. Surely if we had been half-awake we would have realised that what was happening in Italy was a solemn warning to us, and we should have acted accordingly. Why did we not do so?

--- Later in debate ---

[Lord Bethell (Con)]

I saw the images the noble Lord refers to and was shocked and moved by them. That is why we moved massively, including, in March, announcing £594 million in order to support care homes, and massively supporting them through the NHS. We did an enormous amount from the beginning. The effects on care homes have been profound and are extremely sad, but I am afraid to say that this presumption that we either did not enough or took the wrong advice is not supported by the facts.

[Baroness Meacher (CB)]

My Lords, let us focus on what government can do now. My concern is that the Government are overcompensating for the very high early death rate in care homes, for whatever reason, by imposing wildly disproportionate controls over double-jabbed, tested visitors. For example, they have to wear PPE and social distance, as we know, and there is no hugging—thus wrecking the final months for these people in care homes. I ask again: will our excellent Minister—I mean that; he is an excellent Minister—put to the Prime Minister the risks and benefits of scrapping these controls?

[Lord Bethell (Con)]

My Lords, I am extremely sympathetic to the noble Baroness’s point and conscious of her specific point that we could be in danger of over- reaching or in some way emotionally overcompensating for perceived mistakes in the past. We are conscious of that possibility, but I would like to reassure the noble Baroness that it is not the case. The decisions we have made on infection control and on visiting in care homes are tough—they are hard—but in recent weeks there have been outbreaks in care homes in London and Bolton in which vaccinated residents have caught the disease and had serious symptoms. That is something we are extremely wary of. When the vaccination has reached a higher proportion of the population and R is below 1, we will be in a position to change these policies. We will do so at pace and as quickly as we reasonably can, but until that moment arrives we have to take these tough decisions.

[The Lord Speaker (Lord McFall of Alcluith)]

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

Health Protection (Coronavirus, Restrictions) (Steps and Other Provisions) (England) (Amendment) Regulations 2021

Lord Bethell Excerpts

Wednesday 16th June 2021 Lords Chamber

Moved by

[Lord Bethell]

That the Regulations laid before the House on 17 May be approved.

Relevant document: 3rd Report from the Secondary Legislation Scrutiny Committee. Considered in Grand Committee on 7 June. Instrument not yet reported by the Joint Committee on Statutory Instruments.

Motion agreed.

Health Protection (Coronavirus, Restrictions) (Steps and Other Provisions) (England) (Amendment) (No. 2) Regulations 2021

Lord Bethell Excerpts

Wednesday 16th June 2021 Lords Chamber

Moved by

[Lord Bethell]

That the Regulations laid before the House on 15 June be approved.

Instrument not yet reported by the Joint Committee on Statutory Instruments

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

My Lords, we are making excellent progress along the spring 2021 road map, and we now have one of the most open economies and societies in this part of the world. But we all want to see restrictions lifted even further, and on that I am optimistic. However, we know we cannot be complacent. As the Prime Minister set out in his address to the nation on Monday, we do need to hold at step 3 of the road map for just a little longer. This is vital. The very latest scientific data and evidence show us that we must proceed with the utmost caution. By pausing at step 3, we are seeking to protect the progress we have made on infection rates and the vaccine rollout, and to make absolutely certain that we are on a stable footing before we go further.

Unfortunately, the prevalence of the highly transmittable vaccine escapee delta variant has shifted our assessment of the risks. It is now the dominant variant across England, accounting for 90% of cases, and it is set to spread around the world. Its R number is estimated to be 60% to 80% higher than the previously most widespread alpha variant. The overall R number in England has increased and is now between 1.2 and 1.4, meaning that we are in the age of doubling times. We need to be in an age of halving times. Early evidence suggests an increased risk of hospitalisations with the delta variant compared with the alpha. This pause will bring us more time in the race between the vaccine and the virus. It will ensure that we as a nation are equipped as well as we can be to take on the virus and the delta variant.

Can I say a word about the vaccine? Increasing the number of second jabs is absolutely crucial. The data that we have at the moment suggests that the vaccines are less effective against symptomatic disease cause by the delta variant, but that protection increases after two doses. Two doses of the vaccine has now been shown to be highly effective in reducing hospitalisation from the delta variant, with the latest PHE data suggesting that this could be 96% for the Pfizer vaccine and 92% for the Oxford/AstraZeneca vaccine after the second dose.

In this time, while we pause step 3, we will deliver many more first and second vaccine doses. There are currently 1.2 million over-50s and 4.3 million over-40s who have had their first jab but have not had their second. By 19 July all those over 50 and the clinically extremely vulnerable who have had their first doses by mid-May will have had their second dose—or will have been offered it. Second doses for all over-40s will be accelerated by reducing the dosing interval from 12 weeks to eight weeks. All over-40s who received a first dose by mid-May will be offered a second dose by 19 July. All adults aged 18 and over will be offered a first dose by 19 July, two weeks earlier than planned.

I am confident that we can hit those targets, not least because our vaccination programme has made great progress. A network of vaccination sites continues to operate brilliantly across the UK; there are now more than 1,990 vaccination sites in England, with more coming on line in the days and weeks ahead. Thanks to the tremendous efforts of all those involved, more than 41.8 million people in the UK have received their first dose and 30.2 million their second. From today, all adults over 21 can book their first dose.

Vaccine supplies are robust and delivering to forecast. For the Pfizer vaccine, we expect supply in June to be 30% more than in May, and July’s will be 80% more than in June. Supplies should be sustained at this level in August. So I thank everyone involved in the vaccination programme for their continued efforts to maintain this tremendous progress over the weeks ahead.

I would like to anticipate a couple of the questions that may arise in the debate ahead, and I will start with borders. A number of noble Lords have asked why, if the delta variant has changed our assessment so much, we did not act sooner, protect our borders more quickly and prevent the variant entering the country. I would say that we did act quickly to reduce the importation of the delta variant; we took the decision to add India to the red list immediately upon being advised that this lineage of variant was potentially higher risk than any other variants under investigation, and several days before the delta was considered a variant of concern. We acted quickly and with caution. The contribution of variants to the surge in cases in India was at that time unclear. We added India to the red list on 23 April, with arrivals having to quarantine for 10 days in a hotel. Before India was red listed, everyone had to quarantine on arrival for 10 days, take a pre-departure test and two further tests on days 2 and 8 of quarantine.

The decision to add and remove countries from the red list is made by Ministers, informed by the latest scientific data and public health advice from a world-leading range of experts. As with all our coronavirus measures, we keep the red list under constant review, and our priority remains to protect the health of the UK public. However, this does not change the fact that this virus is a formidable enemy and needs to be tackled on many fronts. Border measures are important, but that does not mean that we can be complacent elsewhere. We have learned that Covid likes to take advantage of complacency, which is one reason why we each need to take individual responsibility for tackling the virus. We all need to follow the public health advice to protect the progress that we have made.

I will now move on to a topic that I know many noble Lords are interested in: singing. We are aware that singing can increase the risk of Covid-19 transmission through the spread of aerosol droplets. It is particularly dangerous indoors, where the particles can build up and, as with any activity, the cumulative effect of aerosol transmission means that the more people are involved, the higher the risk of transmission. The guidance mirrors our approach elsewhere to be more cautious indoors than outdoors and to be mindful of the impact that our actions have on other people.

Finally, can I say a word about adult social care vaccination? An extensive six-week consultation on making the vaccine a condition of employment for care home staff concluded on 26 May. It saw a fantastic level of engagement; we see a clear public health rationale for driving vaccination uptake in care homes.

So I am confident that we will be in a stronger position by 19 July. This pause at step 3 will help us reduce the number of hospitalisations and deaths and will protect the NHS. I commend these regulations to the House.

Amendment to the Motion

Moved by

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, this delay comes with huge regret—no one likes to see step 4 delayed in this way. I start by acknowledging that it will have an impact on many people’s lives. We have talked a lot in this Chamber about singing. I do not think that it is necessarily the biggest impact, but it is iconic and important. I am disappointed that I have not been able to satisfy my noble friend with my comments on it. I have the guidance on singing here, and I make it clear that the Government are not banning singing or dancing. We know that people want to get back to normal activities, but they need to acknowledge that singing and dancing can increase the risk of catching and passing on the virus. We know that singing is risky; that is proven. Covid can spread from person to person through small droplets in aerosols, and singing increases the risk of transmission through these. It is particularly dangerous indoors.

I return to the question of singing because I want to convey a sense of the science basis on which we have made these decisions and because of the importance we put on individual responsibility. We advise on amateur singers, sports matches, bars and restaurants and audience participation—I should be glad to share with the House a copy of this advice—we allow outdoor singing for amateur singers, audience participation and at sports matches, and professional choirs and singers are permitted to rehearse and perform in any number. That is a way of trying to say that a huge amount of consideration has gone into the practical impact of this advice and these guidelines, and where we have made tough decisions, it has been done with consideration.

I can give some good news to the noble Baroness, Lady Thornton. BEIS estimates that there will be 50,000 weddings in the four weeks from 21 June. To give the Chamber a sense of scale, assuming an average reception size of 50 people, that means that 2.5 million people will be able to go to a wedding this summer, and I know that that will be a huge relief to many of them.

I shall take a moment, a long moment, to address my noble friend Lord Lilley’s point seriously, because it is an important one. I agree with him wholeheartedly that we will learn to live with Covid, with some people catching the disease and, sadly, a very small number of them succumbing to it. The nation will need to commit to public health measures to fight new variants and outbreaks, as we have done through history. But let me address his strongly held view that we are today ready to unlock.

Yes, the vaccine programme is going well—and I can confirm to the noble Baroness, Lady Thornton, that the supplies are in place to commit to the programme as advertised—but the supply is still limited only to the supplies we have booked, so we need another month to offer it to everyone. Despite the effect of the vaccine on infection, transmission, serious disease and death, to which my noble friend referred in his very persuasive speech, infection rates are rising, and they are rising dramatically. The noble Baroness, Lady Brinton, put the statistics extremely well. The doubling rate in many LAs is just six days. The infection rate in schools is bubbling up. Outbreaks in social care are becoming regular.

We have been here before. To give your Lordships a specific example, in a city such as London, which has a relatively young population, there is a huge reservoir of potential novel, unvaccinated people, so we are just not quite out of this yet. Even if the vaccine does prevent severe disease, I remind noble Lords that there are more than a million—nearer 2 million—people who are immunosuppressed for one reason or another and for whom the vaccine does not offer a way out at all.

I also remind my noble friend Lord Lilley that if the infection were to be rife, even if the consequences were not disease and severe illness, it would not be consequence-free. We do not know the incidence of long Covid, but we do know that many of the people who have long Covid are completely asymptomatic, and we know that high rates of infection increase the conditions of mutation. That is what happened in Kent, to very grave effect, in September. So I say to my noble friend that I think this delay is necessary; it is right.

I remind the noble Lord, Lord Scriven, that red-listing is not decided by some simple algorithmic relationship to infection rates. Red-listing is used principally to keep out variants of concern. During the period that he talked about, we were understandably focused on the South African variant, and it was the South African variant that was rife in Pakistan and Bangladesh and that led us to red-list those two countries. We did not have a copy of delta. We did not have the necessary sequencing data. The WHO had not attributed it as being a VOC. Let us look at what actually happened. The delta variant became a variant of concern on 7 May 2021. By this point, India had already been on the UK red list for a full two weeks.

I absolutely sympathise with the difficulties faced by individuals, families and businesses which my noble friend Lord Robathan reflected on. On his specific point, which was also raised by my noble friend Lady Neville-Rolfe, an impact assessment was not published for this instrument because it is a temporary measure extending the steps regulations for only a short period. But I completely understand their point, and I reassure them both that in making these decisions, we continually assess the economic and societal impact of restrictions, balancing these with risks to public health.

On my noble friend’s substantive point, I am always grateful for the challenge he brings. Over the last 18 months, he has expressed his scepticism. He is sceptical about the effectiveness of lockdowns. On both 9 October and 12 November, he questioned whether additional restrictions in Leicester were having any impact at all, yet we know that lockdowns work. In Leicester, we managed to reduce the daily incidence rate from 135 cases per 100,000 on 28 June to 25.3 cases per 100,000 on 3 September.

My noble friend is sceptical about the accuracy of tests. On 6 October, he claimed that a high proportion of tests bring back false positives, yet after 193 million Covid tests, we know that this is not true. Independent confirmatory testing of positive samples indicates a test specificity that exceeds 99.3%, meaning that the false positive rate is less than 1%.

My noble friend has been sceptical about the rate of deaths from Covid here in the UK, and he is sceptical that the Covid death rate is a cause for concern. On 24 July last year, he questioned whether the death rate was really that bad. On 23 September, he told us that the death rate is still

“only between 1% and 2% of the average daily death rate in this country.”—[Official Report, 23/9/20; col. 1889.]

My noble friend is sceptical that the NHS capacity has ever been at risk. On 29 July last year, he said that hospitals were “not particularly full” and that they had not been “swamped”.

My noble friend is sceptical that world leaders are right to consider and worry about this pandemic so much. In May 2020, he said:

“According to the figures, perhaps 316,000 deaths around the world so far have been linked to CV-19. This is awful—every one is tragic—but it is not callous to point out that some 60 million people will die anyway around the world this year.”—[Official Report, 18/5/20; col. 949.]


My noble friend is sceptical about the Government’s whole response to the pandemic. I remember that he told the House:

“A huge number of people, including me, are concerned that we will overreact—although the Minister has said that we will not—and cause panic in the country, where panic should not be seen.”—[Official Report, 3/3/20; col. 521.]


He said that in March 2020, and I did not agree with him then. With 128,000 deaths in the UK and around 4 million deaths around the world, with a million people in the UK reporting long Covid symptoms, and with the rise of this nasty, highly transmissible, vaccine-evading new variant which seems set to spread around the world, I do not agree with him now.

I do not believe in doing nothing in the face of the evidence. I do not believe in leaving the elderly and vulnerable to fend for themselves or hoping that the virus will somehow blow itself out. I do not expect the economy to rock and roll even as the death toll rises and public confidence collapses. We are prepared to take tough decisions to save lives, protect the NHS and get us out of this awful pandemic, and we will continue to do so. For that reason, I ask my noble friend to withdraw his amendment. I beg to move.

Covid-19 Update

Lord Bethell Excerpts

Tuesday 15th June 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, we on these Benches echo the support of the noble Baroness, Lady Thornton, for the Commons Speaker’s statement yesterday on the Government’s continued abuse of Parliament.

We repeatedly warned the Government that sending out mixed messages about lifting restrictions on 21 June would cause problems. Even in March, the Prime Minister made it evident that he wanted us out of restrictions “irreversibly”—his word—by next Monday. What is worse is that we are now in a fourth Covid wave because of his desire to visit President Modi in India in mid-April. The resultant dangerous dithering about putting India on the red list contrasted sharply with the TV news. Every evening, we saw that the then delta variant was scything through India. Even then, Indian epidemiologists were talking about a much faster transmission. We on these Benches have repeatedly asked why India was not added to the red list on 2 April.

At yesterday’s press conference we were warned that the current delta variant wave will likely peak in mid-July, as cases, hospital admissions and patients needing ICU increase steadily. Even if vaccines mean that hospitals are not being overwhelmed, there is an increase. The UK now faces continuing restrictions entirely because of the Prime Minister’s delay.

The academic paper Estimating the Failure Risk of Hotel-based Quarantine for Preventing COVID-19 Outbreaks in Australia and New Zealand, published in February this year, calculated the risks and likely seeding of variants in the light of infection control and surveillance used locally. It now provides an essential baseline to assess seeding of cases coming from abroad. Devan Sinha of Oxford University and other UK scientists have used this to look at the seeding of the delta variant in the UK. He noted that 96% of the seeding of the delta variant occurred after 2 April—that is, after Pakistan and Bangladesh were added to the red list but India was not. He estimates that putting India on the red list on 2 April would have delayed the current wave by a further four to seven weeks. That four to seven weeks would have meant that all over-40s had had access to a second dose and, at seven weeks, most over-30s. He said that the wave would have been

“much smaller and mostly neutered”.

What have the Government learned from this delay? Why did it take so long for the delta variant to be moved from a variant of interest to a variant of concern? Despite MPs, Peers and scientists all asking in early April, Matt Hancock told the Commons that it would be listed as a variant of concern on 20 April. In fact, it was not listed until 7 May. Even worse, surge testing did not start until May either. If it was serious enough for India to be added to the red list by 23 May, why was it made a variant of concern only on 7 May? Was the delay with PHE or with Ministers?

The necessary continuation of restrictions at the current level means that a number of support schemes are now out of kilter with the restriction levels. These include lifting the embargo on evictions, the reduction in furlough support while people are still being asked to work from home if possible, and other business support mechanisms. Please can the Minister say whether they will be extended until we know that we are lifting restrictions completely? When, oh when, will any of these Statements or communications make it clear to the clinically extremely vulnerable and their families and friends what they are expected to do?

The Statement lists the areas where restrictions are to be lifted, many of which will be welcome, especially the 30-person limit on attending weddings, receptions and commemorative events, and out-of-school residential visits in bubbles of up to 30. But I ask again about mask wearing in schools, given the continuing increase in delta variant cases among children. Will there be specific guidance for these events, including lateral flow testing before and after, so that any outbreaks at a wedding could be tracked and managed? What level of new Covid cases per day would change the pilots on large events with higher capacities, especially the ones planned at full capacity?

It is good to see the removal of enforced quarantine for care home residents after trips out of homes. I never did understand that one, given that staff and visitors did not have to self-isolate.

It was good to hear the emphasis in the statement from Professor Whitty and Sir Patrick Valance on the importance of the second dose. I repeat my regular plea that all Ministers use this as a reference point. Far too many only ever use the number of people having had the first dose. With the delta variant, it is even clearer now that two doses are essential.

Why on earth did the Prime Minister say yesterday that 19 July is definitely the terminal day for restrictions? We all hope that he is right, but if he and Ministers are led by data, how can he say that?

Finally, the Statement refers to surge testing in areas where the variant is also surging, but maps show such a steady rise in cases across the country. Can the Minister confirm that there are enough test, trace and isolate staff to manage effectively this fourth wave of Covid?

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

My Lords, I am enormously grateful to the noble Baronesses, Lady Brinton and Lady Thornton, for such thoughtful and searching questions.

[Noble Lords]

Oh!

[Lord Bethell (Con)]

As ever, I am also grateful to my own Benches for their support in these difficult times.

This Statement from the House of Commons has been reflected on very thoughtfully and accurately, as shown by some of the questions. I remind noble Lords that the rollout of the vaccine is happening at pace, but it deserves to have a breath and the space to be seen through, all the way, before we make categoric steps towards opening up. I emphasise in reply to these questions that the supply of the vaccine has stepped up. Pfizer’s forecasted supply in June will be 30% more than in May; in July, it will be 80% more than in June; and we hope to have that sustained level in August. By the week commencing 19 July, we will have offered all adults a first dose, as well as a second dose to those aged over 40 who have had their first dose by mid-May.

This rollout will be absolutely transformative. It will mean that we overtake an important inflection point: the numbers of those who have had their second dose, and who are therefore, as statistics show more and more clearly, highly resistant to this virus, and certainly to severe disease and death. This variant is undoubtedly much more transmissible, by between 50% and 80%. It is therefore completely proportionate and reasonable that we take this moment to delay step 4 and give the vaccine rollout the space that it needs.

I will build on the point from the noble Baroness, Lady Thornton, about the work done by the Sanger Institute on genomic sequencing. It is only because of enormous investment, and the skills and expertise of those in genomic sequencing in the UK, that we understand as much as we do about the variant. In her comments on India, the noble Baroness, Lady Brinton, spoke about the process of analysing VOIs and VOCs. She is entirely right to allude to the fact that this is an extremely complicated matter. This analysis is down to the scientific judgment of those who have a copy of the variant. It took a very long time to get a physical copy of the variant from India, or even to have a digital sequence of it. That is why these things can take some time.

This demonstrates why we need to tidy up and invest in international systems for surveillance. An enormous amount of energy went into the G7, and I can report to noble Lords that, during the health track, we made great progress in the pandemic preparedness work stream in setting up an international scheme for exactly this kind of surveillance. It is imperative that we know what is happening in communities all the way around the world, because we are all touched by the mutations of this virus, wherever they happen. We continue to invest in the national variant assessment platform, which is our offer to the world to genomically sequence any variant sent to the Sanger, so that we can share that data with countries around the world.

We have also invested enormously in the control of our borders. Through both its red list and its amber list, the managed quarantine service has done an enormous amount to stop the transmission of new variants into this country. I pay a huge amount of tribute to Border Force and those in MQS, who have done a terrific job of bringing in this completely new infrastructure and this service that has done a huge amount to keep out variants—including the Manaus variant, the South Africa variant and others—through the red-listing process.

The noble Baroness, Lady Thornton, asked about school-age children and mask wearing. It is important that we keep a balance. Even though the infection rate is creeping up among school-age children, we need to protect the life they have in schools. In areas of enhanced response, the wearing of masks is now a recommended option for those who seek to take it up. That is a proportionate response in areas of rising infection. But across the estate, we think it is proportionate to step away from that at the moment.

On isolation payments, I can share with the noble Baroness that we are putting £2 million of funding into an agreed pilot across the Greater Manchester area, testing ways to encourage people to comply with self-isolation rules. The pilot will include support and engagement teams who will work with households within 24 hours of a positive test. The pilot is expected to reach 13,000 people over 12 weeks, and I am hopeful that it will guide the way forward in this area.

The vaccination surge is absolutely working. We saw a dramatic change in the vaccination uptake among the community in Bolton in particular. That is one area of Britain where the infection rate is coming down, which demonstrates the effectiveness of both the vaccination surge and the testing surge. We are now focused very much on accelerating second doses, particularly for over-40s. Millions of over-40s have had their first dose; some have an appointment for their second dose and some do not. It is very much the focus of our efforts to ensure that we get those people over the line and finish the job, to protect them and the ones they love.

This is an important development in our steps programme. It is frustrating, but there is an enormous amount to be optimistic about and it is in that spirit that we have made this decision.

[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 Forsyth of Drumlean (Con)]

My Lords, what is the point of this Statement? It was briefed to the newspapers over the weekend and the contents were given to members of the press for scrutiny. So Laura Kuenssberg has done the job and there seems to be little for us to do—which may account for the grumpiness I see around the Chamber. Has my noble friend seen the excellent report of the Constitution Committee of this House published on 10 June, entitled COVID-19 and the Use and Scrutiny of Emergency Powers? It is damning of the Government’s use of secondary legislation without proper consultation—of which today we have yet another example. Will the Government mend their ways and accept the recommendations in this excellent report?

[Lord Bethell (Con)]

My Lords, I absolutely pay tribute to the Constitution Committee. It was generous enough to have me appear in front of it, and I gave several hours of evidence. I am glad to see that my noble friend read the report; I hope he enjoyed my evidence in it as well. In that evidence I made it absolutely crystal clear that the Government work with the laws at our disposal; that is what we have to hand. There may be a time when Parliament chooses to review those laws. Now is not the time, but when it is we will do it.

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

My Lords, is the Minister aware that many people would like to know whether, having had two vaccinations, they have antibodies? Is this possible? Also, there has been a shortage of the Pfizer vaccine. How can this be increased worldwide?

[Lord Bethell (Con)]

My Lords, I agree with the noble Baroness that many are curious about whether they have antibodies, but I warn her that the presence of antibodies does not necessarily correlate with immunity. Some people have strong immunity and no antibodies, and some have antibodies but not immunity. This is one of the mysteries of the body’s response to the disease and one of the reasons why it has been such a confounding disease to fight. But if anyone does want an antibody test, they should ask their GP and it can be arranged.

[Lord Clark of Windermere (Lab) [V]]

My Lords, very bluntly, we are facing this unpalatable Statement today because of the Prime Minister’s inability to take decisions. The Government learned of the arrival of the Indian variant as early as 25 March, yet took no action for 30 days, allowing 20,000 people to enter the UK. The result is that they put the public’s health at risk. As a consequence, we now face a further four weeks of restrictions, with accompanying hardships. Have the Government learned their lesson?

[Lord Bethell (Con)]

My Lords, I am not sure whether I accept the characterisation presented by the noble Lord. We have worked incredibly hard to bring in a managed quarantine system that is a novel, new introduction into the UK. We have done extremely well in fighting off many of the variants that have come to our shores, including the Manaus variant, the South African variant and others. We have strong links with Pakistan, India and Bangladesh, which means there is a lot of traffic between our countries. I am not sure whether it would ever have been possible to prevent this variant making landfall in the UK at some point. But we have done an enormous amount in the UK to delay and prevent the arrival of these variants, and for that I am enormously grateful to those involved.

[Lord Scriven (LD)]

My Lords, following the data is the Government’s mantra. Using the Government’s own test and trace data, for the two weeks prior to Bangladesh going on the red list it had a positivity rate of 3.7%; India’s was 5.1%. Of all variants entering the UK, including the delta variant, more than 50% of cases came from India and fewer than 5% from Bangladesh. So if the Government were following the data on 2 April, why was Bangladesh put on the red list and not India?

[Lord Bethell (Con)]

The noble Lord is enjoying the benefit of hindsight very much indeed; we can all use the retrospectoscope. The data he refers to was not available to us at the time. We did not know that the variant now known as India 2 was a variant of concern. We did not know that it was going to be the most transmissible one. There were three variants in India; we did not know at that point which of them would present the most problems. It is extremely easy to sit here, look back and say that one person should have done this and another should have done that. I ask the noble Lord to try to sit in the seat of those who made the decisions at the time.

[The Lord Bishop of Leeds]

My Lords, regardless of matters of hindsight, does the Minister agree that prolonging the restrictions might be justified for certain reasons? I do not demur from that, but the prolonging of inconsistencies is a serious impediment to public adherence to the rules. You do not have to look very far to see where the discipline broke down a long time ago. For example—this is not special pleading; it is just at the forefront of my mind—you can sing in a pub but not in a church. This is what brings the rules into disrepute, and therefore people do not agree with them.

Secondly, can the Minister say something in response to Michael Gove’s reported comments about acceptable death rates? We have learned to live with acceptable death rates from flu and other seasonal diseases. Will the Government do some work on what might be an acceptable death rate from Covid in future and be up-front with the country as to what that might be? I think we can take it.

[Lord Bethell (Con)]

I hear loud and clear the frustration of many noble Lords on the question of singing in churches; it is enormously frustrating to those who have a passion for singing. But I would be pretending to be other than I am if I did not level with the right reverend Prelate and say that this is an airborne, aerosol disease. It is breathed into buildings at huge risk to those inside, and there is a direct correlation between infection rates, that aerosol and that kind of singing. The decision has been made with huge regret and not without a huge amount of scientific analysis, and those who have made their case have been heard loud and clear—but we have to fight this virus and prevent people getting sick.

I do not accept the right reverend Prelate’s view that discipline has broken down. Quite the opposite: I am astounded by the British public and their adherence to voluntary guidelines and arrangements. I pay tribute to the British public, and I do not think that the right reverend Prelate does any favours when he suggests that discipline has broken down.

Lastly, I really do not accept the concept of an acceptable death rate. That is not how we play the health system in this country. We are here to save lives; that is our priority. There is a balance between the economy, freedom and lives, but as a Health Minister my starting point is to save lives.

[Baroness Sugg (Con)]

My Lords, it is great to see the data on the efficacy of vaccines against the delta variant, but we know that that might not always be the case in the future. The announcement from the Prime Minister that we will share 100 million of our excess vaccines is a welcome first step, but the G7 failed to achieve its 1 billion target, let alone the 11 billion that the WHO says is needed. Does my noble friend the Minister agree that variants present one of the greatest threats to the unlockdown here in the UK and that the pandemic is not over here unless it is over everywhere? What are the next steps to ensure that low-income countries are vaccinated as soon as possible? Given the success of our vaccine programme, will the UK take a leadership role in this, as we continue our G7 presidency?

[Lord Bethell (Con)]

Yes, I entirely agree with my noble friend on this matter: we are of course only safe when we are all safe. As chair of the G7, we have done an enormous amount to try to show leadership in this area. The G7 committed to share at least 870 million doses directly over the next year and to make these doses available as soon as possible. But the numbers involved are absolutely enormous: 870 million is an astonishing figure, but it is not near to the 8 billion that we ultimately need. At the end of the day, we need manufacturing in all the regions of the world. That is why, as the supporter of the AstraZeneca vaccine, which is made on a profit-free basis and on extremely generous terms to manufacturers of the world, Britain has given an enormous benefit to the world. I very much hope that the manufacturing can ramp up to meet that need.

[Baroness Meacher (CB)]

My Lords, I welcome the small but vitally important concession to care home residents in the Statement. However, the Prime Minister has left in place the cruel and unnecessary controls over care home visits. Even visitors who have had two vaccinations and a negative test before visiting must wear PPE and maintain social distancing—no hugging, for example. This is inhuman, particularly for people with dementia, and the risk must be close to zero. Will the Minister plead for immediate changes to those really unnecessary rules? They are well overdue.

[Lord Bethell (Con)]

The noble Baroness makes the case extremely well, and I agree with her sentiment that the rules are extremely tough. I have heard loud and clear the many noble Lords who have made this case, and we look at it very carefully and thoroughly. At the beginning of the pandemic, one of the most alarming images—and one that has always stuck in my mind—was that of care homes in Spain in Italy, where so many of the residents had died. What we know for sure is that, even with the vaccine, the virus can spread through a care home at great pace—typically half of residents will be infected the moment the virus arrives in a care home. Even with the vaccine, we still have to step carefully, and that is why these measures are still in place. I very much hope that they will be lifted, and I will celebrate that along with all noble Lords who have made this case to me in the past.

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

My Lords, following the comments of the noble Baroness, Lady Sugg, when Gordon Brown called the G7 summit an “unforgivable moral failure”, was he not right? With potentially billions to vaccinate, the West has miserably abandoned the moral high ground on vaccine supply, leaving it to the Chinese and Russians to win new friends and secure influence worldwide. Has not Prime Minister Johnson, with his short-sighted, unimaginative approach, damaged our credibility across the world? We should have been a major worldwide vaccine distributor-producer; we failed, and we failed miserably.

[Lord Bethell (Con)]

No, I am afraid the noble Lord completely overstates the case; I do not accept the characterisation he has made at all. The challenge is enormous, and he is right to feel that this is one of the most important tasks for humanity in the round—I cannot emphasise that enough. But the practicalities are that, in Britain, we make hardly any vaccine at all. It is not for us as a nation to manufacture the vaccine. Where we have contributed is, first, through the science—particularly the AstraZeneca vaccine—and, secondly, through global leadership. The Prime Minister, through the G7, has sought to use that post as much as he can, in order to promote the vaccine. I do not accept that China and Russia have in any way contributed anything like the West has done; the numbers simply do not support that. We are working extremely closely with the regions of the world—with Africa, South America and beyond—in order to set up the kind of manufacturing that those countries need to provide their people with the safety from the virus that they deserve.

[Lord Dodds of Duncairn (DUP)]

My Lords, urgent decisions on Covid restrictions are needed elsewhere in the United Kingdom as well. Does the Government accept, however, that decisions that are for a devolved Government to make must be that devolved Government’s responsibility, and their responsibility alone? For Westminster to impose its will on the Assembly on devolved matters would be totally unacceptable and would lead inevitably and inexorably to a collapse of confidence in devolved institutions.

[Lord Bethell (Con)]

I am enormously grateful to all the devolved authorities for the work that they have done with the vaccine and in healthcare. Generally, it has been a very close collaboration, and one that I hope continues.

[Lord Hussain (LD)]

My Lords, in early April, when the Government put Pakistan, along with Kenya and the Philippines, on the red list, they gave us reasons which many people believe did not add up—but I am not going to argue with that. What we did not know, and still do not know, are the criteria for those countries to be taken out of the red list, as there are millions of people affected by that. In April, in Pakistan, new cases were running at over 6,000 a day. That has now been reduced to just over 1,000 a day. Pakistan has made a huge improvement in reducing the number of Covid cases. Will the Minister tell the 1.4 million British people of Pakistani origin living in this country when the Government plan to take Pakistan off the red list, and what are the criteria?

[Lord Bethell (Con)]

The noble Lord is entirely right to ask about the route out. That is exactly what we hope to be thinking about very soon. The criteria will include how much vaccination we have here in the UK and the efficacy of that vaccine against all the variants present in the world. They will also include the presence of variants in the other countries; there is a stepped process for analysing that. Lastly, they will include the infection rates in those countries. We hope to be able to take concrete steps on that shortly. The treaties necessary to have mutual vaccine recognition are being discussed at a high level as we speak.

[Lord Cormack (Con)]

My Lords, my noble friend will not be surprised if I ask him whether he can guarantee that, by 19 July, all care home workers will have been vaccinated. But could he also answer this question? Why is he allowed to go down to his local pub and sing “Roll Out the Barrel” but he cannot go into his local church and sing “Guide Me, O Thou Great Redeemer”?

[Lord Bethell (Con)]

I completely accept the challenge. These anomalies exist and he is entirely right to beat up the Minister for this kind of stuff. It is unbelievably difficult to write guidelines that touch so many different parts of life, and I would not pretend for a moment that there is 100% consistency in everything that is done. But I have made the point emphatically: these things are done to save lives and protect people from infection. They are done with a heavy heart, having looked at the scientific evidence, with a sense of regret that we are letting down those with a passion for singing and religious worship, and in the hope that we can get rid of them very soon. We are taking concrete steps as quickly as we can to deliver the vaccines. In terms of care homes, as he knows, there is a consultation in process and that consultation is working its way through.

[Baroness Prashar (CB) [V]]

The Prime Minister rightly says that we have to learn to live with Covid. Therefore, does the Minister agree that, while vaccinations provide protection and effective test and trace is essential, it will continue to be necessary to take sensible precautions for self-protection if we have to learn to live with this virus and its variants? Does he also agree that there is a need for continuous public education and clear, consistent guidance to explain why these precautions are necessary? If so, apart from the effective rollout of vaccinations and test and trace, what plans do the Government have in the longer run for promoting a public education health programme?

[Lord Bethell (Con)]

I am enormously grateful for the question from the noble Baroness. She gives me an opportunity to lift my head for a moment and think about a brighter future, because she is entirely right. One of the possible benefits from this awful virus is a different approach to public health that is much more effective in fighting contagious diseases, where we have much more effective tests for everything from flu to RSV to things like Covid as well, and where we can get therapeutic drugs to people the moment they test positive so that they do not fall sick. We can use this investment in public health to help level up some of the health inequalities that have beset this country so heavily.

[Lord Hunt of Kings Heath (Lab)]

My Lords, is there not a problem in looking for a different approach in the future? The precedent set by the Government’s attitude to Parliament fills one with a great deal of concern about the way our parliamentary democracy is going to work. Can he simply tell me why the Prime Minister did not make a Statement to the Commons last night?

[Lord Bethell (Con)]

My Lords, the Secretary of State was there. I thought he presented the steps regulations extremely clearly and did a great job.

[Lord Roberts of Llandudno (LD) [V]]

Can I ask the Minister what we have learned from the treating of this pandemic to help us face the future? We have learned very clearly how much countries depend upon one another. Our first vaccines came from Belgium. Can we make sure we do not build walls, but build bridges, as we look forward to the future?

[Lord Bethell (Con)]

My Lords, I am extremely touched by the noble Lord’s words, and I completely endorse his meaning. It was awful last year when we saw multilateralism and global co-operation fracture and decay. We had to look to our friends and resources within our own borders to answer the pandemic. That did not work and will not work. The noble Lord is absolutely right. From a pragmatic point of view, we depend upon global supply chains for the benefit of global science. From a personal and human point of view, we depend upon the solidarity of humankind to get us through these awful moments. I completely endorse the noble Lord’s point.

[Baroness Altmann (Con) [V]]

My Lords, I commend my noble friend for all his work helping fight this dreadful pandemic; I know his dedication is second to none. I hope he will forgive me for asking: what is the endgame? He has said today that we must prevent people getting sick, but that seems to mean just getting sick with one illness: Covid. What about the suicides, heart attacks and cancers that are being missed because of lockdown? Covid is responsible for less than 1% of deaths right now. Can we not trust the British people to be sensible and choose the risks they are willing to take, along the lines the noble Baroness, Lady Meacher, said, using the example of the Government banning hugging for care home residents? I find this intrusion in our private everyday lives deeply frightening.

[Lord Bethell (Con)]

My Lords, I absolutely forgive my noble friend because that is an extremely sensible question. I take it on board completely. The endgame is to end a contagious disease that has exponential growth. As she knows, R is currently between 1.2 and 1.4. If it goes unchecked, this disease will spread pretty much through the whole population. The vaccine is excellent at keeping people out of hospital, but not everyone. It is excellent at preventing deaths, but not for everyone. It is good at stopping the disease, but only half of the disease. We must get enough vaccine out there so that the disease will not run through the entire population and lead to the deaths of thousands, tens of thousands, or more. That is the endgame of this project.

[Lord Trees (CB)]

My Lords, will the Minister confirm that the Covid cases reported daily in the media are not clinical cases? They are not sick people but positive results of the PCR test. Given that the PCR test is incredibly sensitive and can detect tiny numbers of virus particles, what proportion of positive tests is likely to develop clinical disease?

[Lord Bethell (Con)]

My Lords, the PCR test is very sensitive. Most people who take the test are presenting a symptom, so a very high proportion of those positives are people who have the disease when they take it. Of course, there are many who have the disease and do not take a test at all, so there is more disease in the population than accounted for in the positive tests. There is a very small proportion of people who might have shreds of the virus from a previous infection who then test positive, but it is thought that that proportion is very small.

[Lord Robathan (Con)]

My Lords, yesterday the Prime Minister said that this extension of restrictions will

“save many thousands of lives”

and he was backed up by the Health Secretary. Since 18 May, the weekly average number of deaths per day from Covid has been in single figures—almost all of whom will have had underlying health conditions—while each day about 450 people die from cancer. Will the Government publish, or will my noble friend give Parliament the opportunity to see, the evidence and research behind the “many thousands of lives” saved?

[Lord Bethell (Con)]

My Lords, I completely understand the point. There is a lag to the deaths. At the moment, we are seeing the infection rate go up, which is leading to a small increase in hospitalisations. As my noble friend quite rightly points out, that increase has not been seen in deaths yet, and thank goodness for that. We do not know for sure what proportion of infections will lead to severe disease or death. We know it is a percentage; we do not know exactly what percentage. But should the disease spread through millions in the population, which is entirely possible without the NPIs we have in place, then the number of deaths will be very significant—possibly as many as we have seen already.

[Baroness Hoey (Non-Afl)]

I do not think the Minister should dismiss so lightly the questions about inconsistencies in the regulations. This really does get home to whether the public are going to believe in and carry out those regulations. Can I give him one example? Wimbledon is going to be full to capacity with singing, clapping and cheering—yes, outside—but how on earth then can weddings and outside receptions not be allowed to sing, cheer and do all the things that happen at weddings? These inconsistencies do not make common sense. The Minister needs to understand that.

[Lord Bethell (Con)]

I hope that the noble Baroness will accept my apology if I have in any way suggested that I am flippant about inconsistency—I am not. What I have in my mind is the huge amount of work that is done by policy officials in order to try to be as consistent as possible. I pay tribute to the colossal human effort that goes into trying to make sure that everything we do is aligned. It is a monumental and very difficult task.

The noble Baroness is right to say that Wimbledon is a big event pilot, quite different in its ambition and its tone to some of the other events—for instance, the care homes that the noble Baroness, Lady Meacher, referred to. What we are trying to do is to take fairy footsteps out of the pandemic. Wimbledon, for instance, will account for many hundreds of thousands of tests as we use very rigorous testing procedures to try to protect the rate of infection in that big event. If it is successful, it will help us lead our way out of this horrible arrangement.

[Lord Rooker (Lab) [V]]

At a personal level, I feel very sorry for the Minister. He must realise that there are considerable doubts across both Houses about the Prime Minister’s sincerity and truthfulness. Have we been told the whole truth and nothing but the truth about the delay over dealing with India?

[Lord Bethell (Con)]

Yes, we have.

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

My Lords, in this pandemic, as always, the difficult judgment that has to be made is between lives and livelihoods. Decisions have been taken to protect lives by retaining the existing measures for a further month. The Minister will no doubt appreciate that I and other noble Lords have been extensively lobbied by musicians, independent workers in the hospitality and entertainment sectors, who have fallen through the cracks with no support. Does he not agree that it is reasonable to argue that an equitable balance now would be to provide targeted financial support to those self-employed and freelance workers who have not had a fair deal throughout this crisis?

[Lord Bethell (Con)]

My Lords, having worked in the music industry for 15 years, I absolutely identify with the challenge he describes. However, I remind him that we have been emphatically forthcoming in trying to support workers through this difficult pandemic. We have provided £70 billion for the furlough scheme and £33 billion for the self-employment income support scheme, which would touch many of the musicians to whom he refers. We have stepped forward financially in a very big way and will continue to do so until the end of this awful situation.

[Baroness Fox of Buckley (Non-Afl)]

The Minister has said several times that there are grounds for optimism. Does he not realise that this delay has caused despair? The Minister urged opponents to sit in the seats of decision-makers. Can I urge him to sit in the seats of the trashed events industry today and those likely to lose their jobs in hospitality, sport, theatre and so on? I appreciate that many people and the public remain nervous of living with the virus, despite the wonders of the vaccine. However, is it not the job of the Government to lead with courage, to reassure people not to be unduly frightened or succumb to fatalism, and to protect the unquantifiable non-Covid-related social fabric of society, which they are tearing up?

[Lord Bethell (Con)]

My Lords, I sympathise with those in the events and hospitality industry. As I said a moment ago, it is an industry I have a huge affection for. I worked in it for many years and I know through my friends and family who work in it how hard hit it has been, in particular for those who work on a casual basis and enjoy it from an aesthetic point of view as well as needing work of a casual nature. But these decisions are tough and hard. It would have been easier, perhaps, to have given ground in areas where we have been pressed and lobbied, but we have, where necessary, made the tough decisions based on the science and the advice that we have from clinicians in order to protect both life and the economy. At the end of the day, we do not have an economy if we have a pandemic running through our society. We do not have trust and we do not have people going out and about and enjoying normal lives if there is disease. That is one important reason why we have backed the decisions we have made.

Covid-19: Proof of Vaccination

Lord Bethell Excerpts

Monday 14th June 2021 Lords Chamber

[Lord Blunkett]

To ask Her Majesty’s Government what facility they will make available as proof of vaccination for those wishing to travel who do not have a smart phone and access to the verification app.

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

My Lords, since May, individuals in England who have had two doses of an approved Covid-19 vaccine have been able to demonstrate their vaccine status for international travel. The services can be accessed through digital and non-digital routes, via the NHS app and the NHS website or by calling 111 to request a letter. The devolved Administrations are making available similar letters for use in travelling overseas. Over 63,000 people have requested a letter since the service was launched.

[Lord Blunkett (Lab) [V]]

I am very grateful to the Minister for his positive answer. Can he tell the House exactly how long it takes to get a printed letter as opposed to downloading the app, and how this will relate to the new electronic travel authorisation, which hopefully will coincide with lifting restrictions on British travellers here and abroad?

[Lord Bethell (Con)]

My Lords, 57,000 people have received their letters so far. I am not aware of any delays. Those who wish to can use a pharmacy for the delivery of their letters. It is encouraging news and we have gone to considerable lengths to meet the suggestions of charities which we engaged with on the letters. They are available in different languages and in Braille.

[Lord Harris of Haringey (Lab)]

My Lords, I refer to my interests in the register. It sounds as though what you really need is a secure card that proves your identity and has important information uploaded to it, such as your vaccination status—something my noble friend was introducing, only to have it scrapped by an incoming Conservative Government. We have had 10 wasted years. If there is to be a vaccination app or some other certification, can we be assured that it will not contain data that purports to show that holders are safe to travel because they have had a negative test under the absurd test and trace scheme? The BMJ has reported that the level of false negatives is of the order of 30%. Such negative tests have no probative value, despite the Government, according to the Public Accounts Committee, wasting £37 billion on them.

[Lord Bethell (Con)]

My Lords, that is not our approach. Our approach is to try to use whatever technologies work in order to open up our borders. The idea that 30% of tests are not correct is an unhelpful suggestion by the noble Lord. We will be using testing in the validation app.

[Baroness Browning (Con) [V]]

My Lords, I declare my interest as a vice-president of the National Autistic Society. My noble friend will be only too well aware that many on the autism spectrum are very IT-savvy. However, can he help those who would find it quite a challenge to phone 111? Is there any way the Government can communicate with the autism community, perhaps through the charitable sector and others, to make alternative arrangements other than just a phone call?

[Lord Bethell (Con)]

My Lords, we have engaged considerably with the sector on exactly these kinds of matters. GPs and pharmacies are briefed to help those with difficulties get this material. We are also conscious that some with autism may struggle to take a test and find the process of swabbing intimidating, so we are looking into workarounds for that.

[Lord Scriven (LD)]

My Lords, regardless of whether you hold a paper or digital record, personal health and data will be held on a central database. Can the Minister therefore inform us which government departments and private sector organisations will have access to the data on the central database?

[Lord Bethell (Con)]

My Lords, vaccine data is held in the vaccine database and in the patient’s record. We abide by the principle that the data is owned by the patient.

[Lord Flight (Con)]

My Lords, the Minister has really answered this question already, but may I add that it surely would be possible for vaccination units to have supplies of certificates that they could issue to people when they come to get their first or second vaccination?

[Lord Bethell (Con)]

My noble friend alludes to having pre-printed certificates. In fact, each vaccine certificate has a tailored two-dimensional QR code that is designed for each person. Therefore, it is necessary to print the certificate for the person because it has their specific details on it.

[The Earl of Clancarty (CB)]

My Lords, I am a little confused by what the Minister is saying. Is he saying that we are not going to get a proper Covid passport, as the EU will be offering from 1 July and Ireland from 19 July in both digital and physical options? Could he answer that in detail?

[Lord Bethell (Con)]

My Lords, I apologise for not being clearer; I will be crystal clear right now. Today, you can have a digital certificate on your iPhone, you can have a digital certificate that is printed out from your computer or you can call a number and have a paper certificate sent to you in the post immediately. All of those options are live today.

[Baroness Thornton (Lab)]

Disability campaigners are deeply concerned about the integration of health data into cultural participation and worry that the Government’s plans to set up the vaccine passport scheme could undermine the rights of disabled workers and audiences who cannot have the vaccine because of a health condition. What steps are the Government taking to ensure that any scheme that is introduced obeys the seven key inclusive principles, including complying with the Equality Act in making reasonable adjustments to ensure that disabled people do not face discrimination?

[Lord Bethell (Con)]

My Lords, I am very alive to the concerns of the disabled. We have to balance the need to limit the spread of this virus to save lives, but in a way that is fair and just to all people. We are very much engaged with disability and other charities to ensure that that works. The noble Baroness is right that there will be some people for whom the vaccine does not work and who could yet catch the disease. We need to make provision for those people, and we are working on that.

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

My Lords, I am concerned for the significant numbers of people with existing mental health problems who often do not feel comfortable with smartphone devices, as the information overload such phones can provide can exacerbate their feelings of stress and anxiety. I am pleased to hear the Minister say that other channels will be available to these people, but what arrangements are the Government putting in place to ensure that they are aware that options other than smartphones exist that they will be able to use?

[Lord Bethell (Con)]

My Lords, all the promotions for vaccine certificates through travel agents and GPs make very substantial reference to the availability of paper letters and the channel of being able to call 119 to receive them. I completely sympathise with those who do not want to use their mobile phones for everything, and some will prefer a letter in the pocket to an app on their phone.

[Baroness Rawlings [V] (Con)]

My Lords, I thank the Minister for his clarity, but proof of vaccination is irrelevant if we are prohibited from travelling. The Prime Minister is rumoured to have discussed travel to and from the United States with President Biden at the G7, but what are the predictions regarding UK citizens travelling to Europe, apart from Albania, which seems to be okay?

[Lord Bethell (Con)]

I do not know about Albania specifically, but the freedom to travel in Europe is, of course, in part defined by Europeans themselves. We are in conversation with all European countries at the moment as to how our vaccine certificate scheme can be aligned with theirs. Indications from Europe are that they are interested in having a two-vaccination programme for entry as well, but we are trying to understand that more thoroughly.

[Baroness Hoey (Non-Afl)]

My Lords, I welcome the choice that people are being given in how to prove that they have been vaccinated. However, as the Government further the digital economy, will they make it clear that no one will be left behind, so that those who do not wish to go online and to always communicate in that way will never be prevented from using the telephone or corresponding by letter to access any government service?

[Lord Bethell (Con)]

Yes, I completely endorse that sentiment. I pay tribute to 111 and 119, two facilities that have been used to an incredible extent during this pandemic. A lot of people would much prefer to hear someone at the end of a telephone, to have that reassurance and that personal touch. That is why we have substantially invested in both those resources and will continue to do so.

[Lord Vaizey of Didcot (Con)]

My Lords, I love the NHS app—in fact, I used it yesterday to gain entry to Wembley stadium to watch England’s great victory over Croatia. Will the Minister consider making sure that additional vaccinations can be loaded on to it, such as the flu vaccination, and starting a major advertising campaign to increase the numbers from 6 million to who knows what?

[Lord Bethell (Con)]

My Lords, I pay tribute to the England football team, who did extremely well; I am glad that my noble friend was able to attend. He is entirely right: this is an incredibly valuable resource. We have a very strong preventive agenda in our healthcare strategy. The vaccine has demonstrated how we can use modern medical technology to prevent the spread of disease, and it is by using thoughtful technology like this app that we can popularise and make useful a vaccine approach that could reach out to other diseases.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, all supplementary questions have been asked and we now move to the next Question.

Covid-19: Vaccines and Pregnancy

Lord Bethell Excerpts

Monday 14th June 2021 Lords Chamber

[Baroness Cumberlege]

To ask Her Majesty’s Government when they will (1) analyse, and (2) regularly share, data relating to the safety of the use of COVID-19 vaccines in pregnant women with the Royal Colleges and other relevant parties.

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

My Lords, it is vital that we know what treatment is appropriate and safe for pregnant women, so it is imperative that clinical trials are inclusive of this group where possible. The current advice to vaccinate pregnant women is based on a US real-world study of more than 125,000 people. Recruitment to the first Covid vaccine study in the UK involving pregnant women was launched on 17 May. In addition, adverse reaction reports on Covid-19 vaccines in pregnant women are collected by the MHRA, carefully assessed and reviewed.

[Baroness Cumberlege (Con)]

My Lords, I thank my noble friend for that Answer. I must say, though, that there is a lot of concern among the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives that the take-up of the vaccination among pregnant women is not routinely published. I would like to know from my noble friend what the real commitment to doing this is, what proportion of pregnant women have been offered a vaccine, what proportion of those women have accepted it and what proportion of them have had two doses. What is the mechanism for linking this data with follow-up in relation to the outcomes for women and their babies?

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, my noble friend made a clear case for the importance of improving the way in which patient data is collected and analysed in this country. It is something that we are working on at the moment. She highlights a very difficult situation. A third of women do not know that they are pregnant, of course, and, when they are pregnant, their data is first caught at the hospital where they decide to have their birth. Those databases are not easily linked. We do not have a countersignal for pregnancy at the moment; it is therefore not an acute priority. However, I take my noble friend’s point and will look into it further.

[Baroness Blackstone (Ind Lab)]

My Lords, I declare an interest as chair of the trustees of the Royal College of Obstetricians and Gynaecologists. The RCOG survey found that more than half of those who declined the vaccine did so because they were waiting for more information about the safety of the Covid-19 vaccination during pregnancy. Will the Government, as a matter of urgency, issue guidance to all pregnant mothers explaining that the vaccination will not harm their unborn babies? Will they also provide facilities for pregnant women to be vaccinated at antenatal clinics as a mechanism to increase the take-up of vaccinations by pregnant women?

[Lord Bethell (Con)]

I am extremely grateful for those constructive suggestions from the noble Baroness. We have a very large amount of materials specifically for pregnant women, including guidance for pregnant women and a guide for women who are of childbearing age, pregnant or breastfeeding; those are widely distributed by GPs. However, as I said, a lot of pregnant women do not know that they are pregnant, so it is not possible to reach all of them all the time. At the moment, our priority is to ensure that those aged over 50 take their second jab. We will sweep up other demographics, and we will make that a priority when we reach it.

[Baroness Brinton (LD) [V]]

A close family member rang her surgery to ask for advice about being called for vaccination while breastfeeding. They said that it was nothing to do with them and told her to ring the main vaccine booking line. That person said, “Just ask the person who vaccinates you”, who said, “Oh, I don’t know. I’ll have to check”. Last week, Channel 4 reported that this is a widespread problem for pregnant and breastfeeding mums. It is evident that there is no clear guidance for front-line staff on what to tell mums. Can this be remedied as a matter of urgency?

[Lord Bethell (Con)]

The noble Baroness alluded to a problem that is, I am afraid, commonplace in the healthcare system: an acute sensitivity about giving advice to those who are pregnant because people are very concerned about giving the wrong advice, which sometimes leads to no advice being given. We are aware of this problem but I assure the noble Baroness that material is given to those on the front line—I have mentioned some of the materials that we have published—and GPs have all that material at their disposal. We have recognised this problem, we have moved on it and we are making as much material as possible available to the right people.

[Baroness Gardner of Parkes (Con) [V]]

My Lords, I hope that noble Lords can see me because I do not seem to be being picked up very well. Can the Minister comment on what additional steps are being taken to publicise the up-to-date position to women who are either trying for a baby or are pregnant? Is this information being shared with the organisations in this field, such as the National Childbirth Trust and Mumsnet, to share with their communities?

[Lord Bethell (Con)]

My Lords, the up-to-date advice is this: get the vaccine. That is absolutely being promoted very widely.

[Baroness Wheatcroft (CB)]

My Lords, if the up-to-date advice is “Get the vaccine”, which is exactly what it should be, what work is being done to assess the effect on women of having Covid during their pregnancy? What is the effect on the child? Is there any research on that?

[Lord Bethell (Con)]

My Lords, the noble Baroness points to one of the challenges of longitudinal research: the babies have not been born for very long, of course. We need to do long-term studies to understand the effect. There is no evidence at all of a negative outcome but we will need to monitor that; research resources will be dedicated to looking at it.

[Baroness Merron (Lab)]

To tackle the risk of stillbirths and emergency Caesareans among mothers who are giving birth and have contracted Covid-19, as we see the vaccination programme extend further—particularly into the younger age groups—will the Minister look at prioritising pregnant women for vaccinations? I refer particularly to women in the later stages of pregnancy.

[Lord Bethell (Con)]

My Lords, the JCVI has a clear set of prioritisation protocols, which we are sticking to. The fact of being pregnant does not seem to have a direct impact in terms of severe disease or death, so there is no clear evidence at the moment for putting in or changing the prioritisation of pregnant women. However, we constantly review that and we are naturally concerned to protect both the mother and the child.

[Baroness Barker (LD)]

The Minister referred to women who do not know that they are pregnant. The place where women go to find out whether they might be is a pharmacy. What are the Government doing to make sure that pharmacies are places where women can access accurate information and guidance?

[Lord Bethell (Con)]

The noble Baroness is entirely right. Pharmacies have played an absolutely critical role in the vaccine rollout, and we owe them huge thanks for their contribution. Pharmacists have undertaken a huge amount of training in both the delivery and explanation of the vaccine. I attribute some of the success of the vaccine programme to the extremely effective communication from pharmacists on all aspects of the vaccine, including relating to pregnancy.

[Lord Hunt of Kings Heath (Lab)]

My Lords, would it not be a good idea if the Chief Nursing Officer and the Chief Midwifery Officer gave a conference from Downing Street to reinforce the message that the Minister has given today about the safety of the vaccine? Can he tell me what the Government are doing specifically about the conspiracy theories going round in relation to safety risks to mothers and babies?

[Lord Bethell (Con)]

My Lords, when it comes to conspiracy theories, we have found that the best people to communicate on that are those who women and mothers trust and are dealing with during their pregnancy, typically their nurses and doctors. We have ensured that all the right materials are there, so that difficult questions can be answered in a collaborative dialogue. That is the most effective way of dealing with this.

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

My Lords, can the Minister comment on or indicate the extent of the level of co-operation between the UK Government and the devolved Administrations regarding vaccination take-up and pregnant women?

[Lord Bethell (Con)]

My Lords, the vaccine programme has worked extremely well across all the nations of the UK, and there is a huge amount of collaboration, particularly between the CMOs. Material is routinely shared between all the countries, and I am not aware of any differential outcomes in any particular part of the UK.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, all supplementary questions have been asked.

Carers: Support

Lord Bethell Excerpts

Thursday 10th June 2021 Lords Chamber

[Baroness Wheeler]

To ask Her Majesty’s Government what steps they are taking to ensure that carers get the support and breaks they need.

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

My Lords, the love, commitment and sheer hard work of Britain’s unpaid carers have saved lives and made a huge difference to the country’s most vulnerable. The nation is hugely grateful. I completely recognise the impact the pandemic has had on access to support and breaks. Local authorities have an important responsibility to assess carers’ needs, and I pay tribute to the efforts of local authorities as we work together to reopen day and respite services.

[Baroness Wheeler (Lab)]

My Lords, I commend to the Minister Carers UK’s excellent 40-page report produced for Carers Week. In it, we hear from carers themselves, not just on the lack of essential breaks and respite but on caring during the pandemic, their own health and their worries about when key day care and other services vital to the loved ones they care for, and suspended during lockdown for over a year now, will be reinstated. If he reads the report carefully, he will see the reality of everyday life for thousands of carers. Funding given to councils during the pandemic has not been anywhere near enough for the vital role they have been expected to play, and the funding the Minister repeatedly refers to has simply not reached carers. How will the Government address this appalling situation and ensure that unpaid carers are given the funding and support they need and deserve?

[Lord Bethell (Con)]

My Lords, I too pay tribute to the Carers UK report. I read the very moving personal testimonies in that report and for that reason I took a call with Carers UK this morning in order to understand the recommendations it has made. There is an enormous amount to do. The practical role of the department is to work with local authorities to ensure that day centres and care services are reopened. There are massive infection control issues, but we are working extremely hard with local authorities to ensure that that reopening can happen quickly so that carers get the support they need.

[The Lord Bishop of Carlisle]

My Lords, I declare an interest as co-chair of the Archbishops’ commission on social care. Given that there are 750,000 young carers in England and that some 27% of them regularly miss school because of their caring responsibilities, can the Minister tell us whether Her Majesty’s Government have any plans to identify these children and offer them extra support, not least in the wake of the added disruption to their education that has been caused by the pandemic?

[Lord Bethell (Con)]

My Lords, the testimony from the right reverend Prelate is entirely right and is echoed in the Carers UK report. The point he makes about identification is key. One of the good things that came out of the pandemic is that we made progress on identifying and putting together registers of carers. That was seen in the delivery of the vaccination, when nearly 1.6 million of them received the vaccination early as part of priority group 6. I agree with the right reverend Prelate that more needs to be done on data collection.

[Baroness Altmann (Con) [V]]

My Lords, will my noble friend join me in commending the work of unpaid carers in this country who have done so much to help through the pandemic? Will he request that Her Majesty’s Treasury and the Department for Work and Pensions consider increasing the carer’s allowance, which pays anyone caring for somebody less than £2 an hour for at least 35 hours a week of care? The complexity of the current system, with overlapping benefits, would certainly be advantaged by significant simplification. At the moment, people need advice before they understand whether they can claim carers benefit.

[Lord Bethell (Con)]

My Lords, I completely agree with my noble friend on commending the role of unpaid carers. We could not have got through this pandemic in the way we did without them. The system is complex and work is under way at the DWP to try to simplify it. As my noble friend knows from her significant expertise, this is a difficult task but we are very focused on it.

[Baroness Pitkeathley (Lab)]

My Lords, I declare an interest as vice-president of Carers UK, and in that capacity and further to his phone call this morning, will the Minister agree to meet Carers UK and interested colleagues in the House to discuss further the contents of this important report? I know he understands the moral and ethical case for supporting carers, as he has made that very clear on many occasions, but I want to ask him about economic issues. If carers reach breaking point—this report shows that many of them are at that point—and they give up caring, any other form of care costs vastly more, so will the economic contribution of carers be taken into account when proposals for social care reform are brought forward? Might we even hope that they could influence the Treasury?

[Lord Bethell (Con)]

My Lords, I can reassure the noble Baroness that economic considerations absolutely will be borne in mind. It is a huge challenge to take on the massive economic benefits of unpaid carers, and I will be glad to meet Carers UK—I have in fact already begun scheduling a follow-up meeting to this morning’s call.

[Baroness Brinton (LD) [V]]

Too often, the family carers of children with the most serious and complex health needs are at the back of the queue for care breaks, and many had no breaks during the pandemic at all. Research by Together for Short Lives has found that cash-strapped English local authorities fund just 1% of the care costs of children’s hospices which provide these short breaks. Does the Minister agree that the Government need to fill the £400 million funding gap in social care for disabled children as a matter of urgency, to ensure that these carers get the breaks they desperately need?

[Lord Bethell (Con)]

My Lords, as the noble Baroness knows, we have worked very closely with hospices to fill the funding gap that hit them hard during the pandemic, and I pay tribute to those who worked so hard looking after younger vulnerable people. The pressure on care breaks has been intense during the pandemic.

[Baroness Donaghy (Lab) [V]]

My Lords, 81% of carers are taking on more care since the start of the pandemic and, as the Carers UK report says,

“Most striking is the lack of confidence that carers feel about support in the future.”


Carers UK is calling for a new deal for carers, with an urgent review of breaks provision by the Government, better respite care, an uplift in universal credit and sufficient funds for local authorities to provide support. The Minister has already said he will meet Carers UK, which is very welcome. Will he also be prepared to meet other interested parties to see what can be implemented?

[Lord Bethell (Con)]

The noble Baroness is undoubtedly right that carers have taken on a hugely bigger burden. More carers have been involved in looking after loved ones and families; those already working have worked longer hours; and the kinds of work they have done has been extended because some local authority provision has not been possible during the lockdown and the pandemic. I recognise that it is taking time to reopen many of those services, but I reassure the noble Baroness that we are working hard, we recognise the issue, and the issue of breaks in particular is one that concerns us. I will be glad to meet anyone she recommends.

[The Lord Speaker (Lord McFall of Alcluith)]

I call the noble Lord, Lord Pendry. No? In that case, I call the noble Lord, Lord Dodds of Duncairn.

--- Later in debate ---

[Lord Bethell (Con)]

The noble Lord puts it very well. Breaks are key. Some 6.5 million carers work flat out throughout the year. It makes all the difference to them if they can have moments of respite when they can lift their heads, conduct their usual tasks and get a little mental clarity. We are very focused on this issue, but I am grateful to the noble Lord for raising it.

[Lord Dubs (Lab) [V]]

My Lords, I also join colleagues in paying tribute to the millions of unpaid carers. Even before the pandemic, they were keeping the whole system going. The Minister has paid tribute to their need for respite care. Can this be translated into something tangible? How many weeks respite care can an unpaid carer have? I know unpaid carers who are desperate to have just a small break from their 24/7 commitment and work. How much time should this be? Furthermore, local authorities are in desperate financial difficulties. Surely, there should be some help for them so that they can provide residential respite care and give unpaid carers the chance to continue.

[Lord Bethell (Con)]

My Lords, I cannot provide a direct answer to the noble Lord’s reasonably broad question, which illustrates the very wide range of care undertaken by Britain’s unpaid carers. As the noble Lord rightly says, some are working 24/7, almost without respite, in incredibly demanding and challenging circumstances, others are dropping in to see a neighbour for an hour or two a day, and there are many permutations in between. It is really important to have local provision so that there is tailor-made support by people who are close and in the community. I am afraid there are not the kind of blanket measures that the noble Lord seeks, which is why we work through charities and local authorities to provide the support that people need.

[The Lord Speaker (Lord McFall of Alcluith)]

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

NHS Digital: Primary Care Medical Records

Lord Bethell Excerpts

Tuesday 8th June 2021 Lords Chamber

[Baroness Cumberlege]

To ask Her Majesty’s Government what assessment they have made of the plans by NHS Digital to collect primary care medical records; and in particular, the arrangements for (1) patient consent, and (2) the sharing of patient data with third party organisations.

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

My Lords, data saves lives. We have seen that in the pandemic, and it is one of the lessons of the vaccine rollout. The GP data programme will strengthen this system and save lives. That is why we are taking some time to make sure it is as effective as possible, so the implementation date will now be 1 September. We will use this time to talk to patients, doctors and others to strengthen the plan, to build a trusted research environment and to ensure that the data is accessed securely.

[Baroness Cumberlege (Con) [V]]

My Lords, I am very grateful for the Minister’s reply, especially hearing that this is all to be put back until 1 September. That is a very good decision, because we have heard that patients have not been able to get their GP to accept the information on the form for them to opt out of the proposed system. The system is not working at the moment, and we are very concerned. There was a thought that the system would be anonymised, but that is not what is proposed. It is pseudo-anonymisation, with NHS Digital having the capacity to identify individuals. There is no capacity for people to unanonymise. It needs a really thorough rethink. I very much congratulate—

[Lord Ashton of Hyde (Con)]

Could I ask the noble Baroness to ask her question?

[Lord Bethell (Con)]

I am enormously grateful for the noble Baroness’s endorsement of our decision to delay the rollout. As the absolute epitome of the patient safety cause, she knows more than anyone the importance of data to that cause. I completely endorse the points she made.

[The Lord Bishop of Carlisle]

My Lords, informed consent is at the heart of good patient care. Can the Minister tell us what plans Her Majesty’s Government have to inform patients that they have the right to opt out of having their personal medical information collected in this way? How will this be advertised?

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, engagement with the Royal Colleges, the BMA and GPs on a one-to-one basis has brought about a system that has a national data opt-out and a tier 1 opt-out with GPs. This is fully explained in all our materials and there has been a campaign to raise awareness among patients. We are taking a brief pause to ensure that patients have almost as much time as they could possibly have to make the decisions they would like to make. That is a wise decision in the circumstances.

[Lord Young of Norwood Green (Lab) [V]]

My Lords, by coincidence, I received a text from my GP surgery yesterday inviting me to click on a link if I wished to opt out of having my data shared. I do not. Does the Minister agree that data sharing plays a vital role in advancing diagnosis and cures for a range of diseases and illnesses? Of course we need to ensure that there is public trust on anonymity. Can he give us more information on that and on cybersecurity?

[Lord Bethell (Con)]

I am grateful for the noble Lord’s anecdote. It is no coincidence that he got the text yesterday. We have energetically promoted this opportunity to patients and we are grateful to those who have engaged. He is entirely right. Patient data played a critical role in the development of the shielding list during Covid, in the recovery clinical trials programme and in the vaccine priority list. Clinical data is essential for patient safety. That is why we are modernising the system by which we access it.

[Baroness Hollins (CB) [V]]

My Lords, the choice on the opt-out preference form is either:

“I do not allow my identifiable patient data to be shared outside of the GP practice for purposes except my own care”,


or:

“I do allow my identifiable patient data to be shared outside of the GP practice for purposes beyond my own care.”


The big question is: what is identifiable? For some people with disability, mental health and/or trauma histories, data might be easily identifiable. I knew nothing of this until last week. I await with interest the noble Lord’s reply.

[Lord Bethell (Con)]

The nature of the data is very explicitly described in the documents that the noble Baroness will have referred to. If she likes, I would be very happy to send her a full set of details. Of course, many patients have engaged with the process and, like the noble Lord, Lord Young, have made the wise decision to remain enrolled in the system.

[Baroness Thornton (Lab)]

My Lords, my honourable friend Jon Ashworth called for this delay yesterday in the Commons. It is not often that we can say thank you to the Minister at such short notice, but it is very welcome that the Government have agreed to this delay. The eighth Caldicott principle—I assume that the Minister is aware of the principles—makes it clear that it is important that there are no surprises for the public around how confidential information about them is used. If GP data can be used by a third party, be they public or private, how will that principle be fulfilled?

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, I am grateful to the noble Baroness for her kind remarks. As she knows, there is an incredibly rigorous system for ensuring the safe curation of this data, and I pay tribute to the Caldicott Guardians, the ICO and the IGARD board, which has put in place a very tough and rigorous surveillance system to ensure that all the data sharing that goes on within the NHS complies with the legal requirements and the guidelines laid down by law and by the NHS. These are tough conditions and they are applied very rigorously.

[Baroness Brinton (LD) [V]]

My Lords, it is a relief to hear that there will be a delay, but I am astonished that the Government have left it this late. When will the data protection impact assessment for this be published, and will the Minister place a copy of the DPIA in the House Library, so that Members can read NHS Digital’s own statements about the privacy risks and the impact of the programme? It might help the ICO in its deliberations about whether the system proposed is safe.

[Lord Bethell (Con)]

I am grateful for the question. I will look into that date and share whatever materials are available.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am fully behind the sharing of information, for the reasons that the Minister explained. But does he agree that to ensure public confidence, the Government have to do something about the current clunky opt-out approach that they have taken and make it easier, and publish the names of the companies to whom this information will be given and what they are paying for it? The Government must not hide behind commercial confidentiality. We as patients have an absolute right to know this.

[Lord Bethell (Con)]

My Lords, I agree with the noble Lord that the opt-out system deserves to be looked at. We are undertaking a review of the opt-out system to streamline it along the lines that he described. However, he peddles a slightly false impression. There are extremely detailed considerations in the IGARD minutes, available online—39 pages from the last meeting—which go into great detail on the arrangements for the sharing of each piece of data. On payment for the data, I remind him that—as I am sure he already knows—these are payments for costs and not payments for any kind of charge. All data is shared for very strict reasons to do with research and planning. There are no other reasons for sharing the data.

[Lord Stirrup (CB)]

My Lords, we urgently need better flows of clinical data between different parts of the NHS, but the public are understandably anxious, given the well-publicised data leaks and thefts of recent years, and particularly given that the proposed scheme is not limited to the NHS but includes external third-party commercial enterprises. Why have the Government done so poorly at explaining to the public the need for such information flows and the health benefits that they bring? Why have they not, at least in the first instance, constrained the sharing of data more narrowly, in order to build up the necessary degree of public confidence?

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, I contest the premise of that question. I have not had a single complaint from anyone who has had the vaccine or been on any prioritisation list for the vaccine. Tens of millions of people have had it and they embrace the fact that their clinical data was used to roll out the vaccine. I accept the noble and gallant Lord’s point on explaining. We can do more to explain to the public. We want to engage the professions and the public in a story about how they can use their clinical data more emphatically. On the way in which the data is shared, it is already extremely tightly controlled. I would be glad to go through that with the noble and gallant Lord if that would be helpful.

[The Lord Speaker (Lord McFall of Alcluith)]

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

Covid-19 Update

Lord Bethell Excerpts

Tuesday 8th June 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, I declare my interest as a vice-president of the Local Government Association. I also want to thank the Minister for his long stint at the Dispatch Box, yet again.

I want to start with the issue about consultation on NHS Digital patient data, which the noble Baroness, Lady Thornton, just alluded to. In 2013, the Government wrote to every household to explain the care.data project. This new scheme has had no such communication with the public. As people hear about it, they are increasingly concerned about the breadth of data that will be captured. Will the Minister agree to use the delay to ensure that every adult in England is written to as a matter of urgency, including an opt-out form they can use if they so choose?

I also want to pay tribute to our health workers and carers—paid carers and especially the unpaid carers—who have gone not just the extra mile over the last 14 months but a whole marathon. Can the Minister say what steps the Government are taking to help the exhausted staff and carers who know that there are many miles still to go before we are through this? Help is needed right now for them in an emergency plan that does not just focus on getting back to work as normal.

The Minister is right to say in the Statement that there is no room yet for complacency. The delta variant will not be the last variant trying to wriggle between those who are protected and those who are not. We are concerned that there is not a focus on communicating to the public about how we need to find a way to live with Covid circulating, as my noble friend Lord Scriven said yesterday. We have moved into Covid being endemic, and the public will want and need to know what they should do over the next few months.

Communication about the vaccine figures is cheering to hear, but still too many Ministers talk about the one-dose level, not the two. The Minister in the Lords, to his credit, usually make that point, but the Prime Minister and many other Cabinet Ministers do not make it clear that we need 90%-plus of adults to have had two doses before we are anywhere near safe, and that social distancing, mask wearing and hand washing will still need to happen.

I thank the Minister for giving more information yesterday on the isolation support pilots. He said:

“In Blackburn and Bolton, this will include trialling broadening eligibility during surge testing, so that all those who are required to self-isolate, who cannot work from home and earn under £26,000, receive a £500 payment.”—[Official Report, 7/6/21; col. GC 202.]


That is still only £50 a day if you are expected to self-isolate. If you are told to isolate on a Monday, and usually work nine to five, this works out at £7.81 per working hour—less than the minimum wage. If the minimum wage is the very minimum that the Government believe an individual can live on, why are they paying less than this to people for doing the great public good of self-isolating? What about people who work in risky occupations and have been told to isolate multiple times over the last year? For them, it is not just one period of 10 days.

From these Benches, we believe that the Government need to pay people’s wages. Now that fewer people should be required to self-isolate, as community cases are lower, we should be diverting resources to really get right what the Government have been getting wrong all along. We must stop Covid in its tracks. Examples from other countries show that paying wages has a strong and demonstrable effect.

On international travel, the red terminal at Heathrow is an improvement, but there are still issues with those arriving from amber countries, who are asked to jump on public transport to get home and need to travel in various ways before they are tested, once in this country.

Given the increase in cases of the delta variant among primary-age pupils, would the Minister outline what measures are being taken to prevent transmission in schools? When will the JCVI report on vaccines for 12 to 17 year-olds? Are any plans beginning to consider whether vaccination should happen for the under 12s? We strongly echo the comments of the noble Baroness, Lady Thornton, about mask wearing in schools. Is this really the right time to stop that happening?

Finally, I note that the consultation on vaccine and testing certificates has closed. Will the Minister say when the Government will publish their plans following that consultation? What type of legislation will be brought in on this, and will Parliament be able to see and comment on any regulation prior to it being enacted?

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

My Lords, I am thankful, as ever, to both noble Baronesses, Lady Thornton and Lady Brinton, for thoughtful and challenging questions. I will try to deal with as many as I can.

The noble Baroness, Lady Thornton, asked about the narrowing of doses. May I remind her that for those classed as vulnerable and those aged over 50, the dose period has been narrowed from 12 weeks to eight weeks. We are giving some latitude in the areas of special enforcement for the narrowing of the doses. I completely endorse her points on that and reassure her that plans are afoot. As for moving the age group to those aged over 18, our instincts are that the JCVI prioritisation process has worked extremely well. It is clear, it is fair and it has been effective. In conversation with those at the G7, I received a huge amount of admiration from other countries for how well that prioritisation process has gone. Therefore, we are reluctant, at this very late stage, to jump the gun on that, but I take her point that particularly those in areas where the infection rate is ticking up may benefit from early vaccination. Therefore, we constantly look at and review that point.

As for vaccination of children in schools, raised by the noble Baronesses, Lady Brinton and Lady Thornton, as they know, the MHRA has given its approval. The ball is now in the JCVI court. We are going to wait for it to pronounce. The state of our vaccine supplies means that we do not have a supply for children at hand right now, so there is scope for a really thoughtful conversation on that. When the JCVI has pronounced, the Government will engage on its recommendations, but I do hear, loud and clear, the obvious support that it has in this House.

As for the Nepal variant, I cannot say exactly how much of it came from Portugal, but it is true that it was present in the UK before Portugal was green-listed, so I think it is fair to say that not all of it came from there.

Moving on to NHS staff, I completely pay tribute to the contribution of NHS staff and those who work to support the NHS, social care and public health. I recognise completely the picture painted by the noble Baroness: many feel exhausted and burned out. Our focus is therefore on recruitment and the recruitment of more GPs and nurses is going extremely well. I would be happy to share updated statistics on that if it would be helpful. The work plan—the NHS People Plan—has within it a clear outline of the kind of workforce planning that we have in place. That is something that the recruitment programme has fully embraced.

I agree that the pressures on A&E, and on acute late-stage interventions from the NHS, have been rising for years—for decades. This is an unsustainable model in the long run, which is why this Government are fully committed to the prevention agenda. We have put in place plans for the Office for Health Promotion. That will be the device for using data to support our prevention agenda, and we will be working particularly with local authorities, and increasingly through the NHS, to ensure that we are putting in place measures that improve the nation’s health and that we do not just focus on those who are already extremely ill.

Moving on to data, I thank the noble Baroness for her kind comments. I completely agree that transparency is absolutely right. We want to be as transparent as possible, with both the professions and the public. These are complex issues. I accept that we could do better to improve our communications. We will be using this two-month hiatus as energetically as we can to engage the public and the professions in the changes that we are bringing about. They are changes that are absolutely essential for any modern use of data to promote resource allocation—when it comes to the workforce, as the noble Baroness rightly pointed out—and for research. I really would encourage all noble Lords who are interested in this to look at the minutes of IGARD. Noble Lords will see exactly which data uses are being sanctioned, and will be amazed by the extremely high-level, science-led research programmes that the GP data is contributing to. It will reassure noble Lords that this is an extremely well guarded and thoughtful process, and a massive asset to the nation. I agree with the noble Baroness that our data is a huge national asset; it is there to benefit patients and is mainly used for clinical trials and for planning within the NHS. That is right and I can reassure her that that is the way we intend to continue.

The noble Baroness, Lady Brinton, asked about mental health support for care workers and NHS staff. I reassure her that we have put in a huge amount of support for NHS staff: 10,300 calls have been made to the helpline, there have been 4,600 conversations on the national line and 200,000 downloads of the app, and 500,000 have engaged through the web page. The provision of mental health support for NHS staff has been extremely helpful for those stressed by the last few months, but we continue to invest in that area.

I remind the noble Baroness, Lady Brinton, that those receiving isolation payments are still eligible for their benefits. They will get support from housing benefit and other benefits if they qualify.

The noble Baroness asked about schools. The use of testing to protect schools has been one of the phenomenal success stories of this pandemic. There have been 65 million tests deployed since January, and a million tests were deployed on Sunday alone. That is both to break any chains of transmission within schools and to protect the opening of schools, which every parent in the country knows is an essential objective of our pandemic response.

On certification, we are making an enormous amount of progress. That is a Cabinet Office lead. When the plans have been crystallised, they will be published, and I am extremely hopeful that we will be able to make progress.

Lastly, the noble Baroness, Lady Thornton, mentioned the memorial wall. I am aware of it and have seen very moving pictures. I have not yet visited the wall, but I will take this prompt to go. While I am not across the future plans for the wall, I am grateful for the suggestion and will take it up.

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

My Lords, 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 Balfe (Con)]

My Lords, could the Government try to get back the initiative so that we are talking about a health service and not constantly talking about Covid? I have some numbers: 114 people are in hospital with the delta variant. Of those, 83 are unvaccinated, 28 have had one dose and just three have had two doses—114 in total. This morning, the cancer support unit released some new figures: referrals are down by 350,000 over the year, there is a backlog of 40,000 new patients, and the survival rate is back to 2010 levels. We have this completely out of kilter, and it is largely because the Opposition are obsessed with it. I ask the Minister to go back to the department and try to reclaim the huge tragedy of unmet need in the National Health Service that has built up because we have done nothing but prosecute Covid. We have to learn to live with it.

[Lord Bethell (Con)]

My Lords, I completely understand my noble friend’s concerns, but I do not accept that we have done nothing. It is quite wrong to suggest that the NHS has done nothing but Covid. In fact, I am incredibly impressed by how well services have been maintained during an extremely difficult period. Were he to join clinicians in the NHS or the department, he would know that there is a laser-like focus on catching up. I remind him that there were 1.86 million urgent referrals and over 470,000 people receiving cancer treatment between March 2020 and January 2021—that is not doing nothing. An extra £1 billion is being used to boost diagnosis and treatment across all areas of elective care. On 25 March, NHS England published its 2021-22 priorities and operational planning guidance, and there is a Minister-led group under Minister Ed Argar, which is absolutely focused on the restart in cancer care in particular. I reassure my noble friend that there is a focus on this, and we are doing everything we can to get through the incredibly important backlog of work that needs to be done.

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

My Lords, the Statement confirms that a continued increase in vaccinations is essential to defeat the new delta variant, which has now become dominant. I believe it is the six-month anniversary of the first vaccination, so I congratulate the noble Lord on the progress so far. Has he considered consulting behavioural scientists about what incentives might create a greater vaccine take-up, as has happened to some extent in the United States? Also, there are still many vaccine sceptics out there who are influenced by conspiracy and other ridiculous scare stories propagated deliberately on social media. Can the noble Lord reinforce the Government’s message with a campaign to vaccinate for victory on the very same platforms that are carrying the negative messages?

[Lord Bethell (Con)]

My Lords, I am grateful for the noble Lord’s comments. Yes, we are engaged with behavioural scientists, but I reassure him that lotteries for vaccines are not on the cards. Taking vaccines into communities has proved an extremely effective measure. I led a call with council leaders in the north-west—from Lancashire and Greater Manchester—and there I heard about the effective use of small mobile units and tents to bring vaccination teams into either religious or community settings to make it easier to get a vaccine. That simple measure appears to be a really winning formula, and one that we are investing in in a very big way.

[Lord Moynihan (Con)]

My Lords, I echo my noble friend Lord Balfe’s figures on Covid-19 hospitalisations: of the 114 people in hospital, just three had received both doses of vaccine. Does my noble friend the Minister agree that the best approach the Government can follow is to continue with an urgent and comprehensive vaccination programme—with the further easing of restrictions secondary to the goal of a successful national vaccination campaign—using, not least in local communities, positive influences in communities wherever possible? Will he also accept the thanks of the Olympic and Paralympic athletes for the positive approach the Government and the International Olympic Committee have taken to ensure that athletes and their support staff will be vaccinated before leaving for the Olympic and Paralympic Games in Tokyo?

[Lord Bethell (Con)]

I am extremely grateful for my noble friend’s comments on the Olympics, and we wish our Olympic champions all the best luck. We keep our fingers crossed for Tokyo, under very difficult circumstances. On the vaccination programme, he is entirely right: positive influences are key. It has been interesting that the positive influences we think have made the biggest impact are not necessarily only the celebrities—they are community influencers who work in clinical settings and are present at a grass-roots level in communities. That is why a large volume of videos, endorsements, community meetings and answering quite reasonable, but sometimes very sensitive, questions from the public have been the essence of our vaccination communications programme. It seems to be extremely successful: the younger age groups seem to be stepping up for the vaccine in proportions that we could not have believed possible some months ago, and we hope very much that this will continue.

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

My Lords, my 13 year-old son is a chorister at Truro Cathedral, where they have composed a song, “Gee Seven”, which 25,000 children across this country and others will sing online to G7 leaders tomorrow. He says the thing that they want most is for the parents and grandparents of children in poorer countries that have not had access to vaccines to get the access that parents and grandparents have had in this country, so that those other children can feel safe about their families. Will the Minister and his colleagues think about that before vaccinating teenagers in this country, who are not at great risk? The COVAX programme is currently 192 million doses short of its targets for supporting poorer countries. Incidentally, if that is not enough morally, he might also consider that so long as we are not successfully vaccinating in these poorer countries, the chances of new and more dangerous variants coming to this country and causing deaths again are all the more likely.

[Lord Bethell (Con)]

My Lords, the noble Lord points out a dreadful dilemma that is on our minds all the time. I completely agree with his point that supporting those in the developing world is a priority and responsibility for those of us in the developed world. His son is entirely right that we should be thinking very much of those who are vulnerable or in urgent need as we consider our vaccination programme. But our responsibility as a Government is to the British people. We must look after the British people first, and there is no benefit to anywhere in the world if Britain comes close to shaking off this awful virus but falls over at the last minute because we have not seen the job through. We intend to support COVAX in the way he describes—in particular, the manufacturing of the vaccine in regional hubs. There, the AstraZeneca and Oxford vaccine has played a critical role. The profit-free availability and generous licensing arrangements being offered by AstraZeneca are having a huge impact on the global rollout of the vaccine. In the meantime, we are absolutely driving through the vaccine programme here in the UK, in the knowledge that, if Britain can emerge safely, that is of benefit not only to British taxpayers and patients but to the whole world.

[Lord Lancaster of Kimbolton (Con)]

I remind your Lordships’ House of my interest as Deputy Colonel Commandant Brigade of Gurkhas. I thank my noble friend for his part in ensuring the Government’s swift response to the plea for help from Nepal in the delivery of some essential medical supplies. But there is one element missing: vaccines. Given that the Government have committed, via the COVAX consortia, to deliver 2 million vaccines to Nepal, and given that my noble friend has just said that vaccinating the developing world is a priority, I simply ask him why the UK cannot deliver those 2 million doses of vaccine bilaterally now and simply net them off our contribution to COVAX in future.

[Lord Bethell (Con)]

My Lords, I pay tribute to my noble friend for his advocacy on behalf of Nepal; we are all extremely moved by the stories from Nepal and the challenge that it has had from Covid. We are extremely supportive of his initiative for both medical supplies and the vaccine but, as I said, there is a sequencing challenge here. Our priority as a Government is the British people. It is important that we see the job through. As the noble Baroness, Lady Brinton, pointed out, there is a threshold to which we need to get the British public to ensure that the R rate remains below one and that the new India variant, or any other variant, does not run amok and drive up hospitalisation in the UK. Until we have reached that point, we must focus on the job at hand. In the meantime, and in parallel, we are doing absolutely everything we can to grow global manufacture of the vaccine and ensure that countries such as Nepal receive secure and reliable supply. My noble friend should be reassured that we are absolutely firm in that commitment.

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

My Lords, we have often heard it said that we will not all be safe until the whole world is safe. Today, UNICEF, the children’s charity, is lobbying the G7 Ministers, asking for an ongoing distribution of vaccines to poor and developing countries, rather than supplying surplus vaccines at the end of our programme, because they may not be able to use them in the best possible way at that stage. Will the Minister, further to the answers he has already given, go back to his ministerial colleagues and the Prime Minister and urge them to please undertake that global vaccination programme, along with other G7 countries, now? The WHO said yesterday that inequitable vaccination is a threat to all nations.

[Lord Bethell (Con)]

I completely endorse the sentiments of the noble Baroness and can absolutely reassure her that this is top of the agenda for the G7 leaders’ meeting later this week. The Prime Minister will absolutely be ramming home the message that she put extremely well. Roughly 1 billion vaccinations have been done around the world so far; that leaves another 7 billion or 8 billion to do. We need manufacturing on a scale that the world simply does not have today to see that job through. That is why the UK has contributed so much through the AstraZeneca vaccine, which is a wonderful, portable, cheap and flexible platform for creating vaccines for the world. We are ensuring that that magic source is available to all those who can contribute vaccine manufacturing capacity anywhere in the world. In the meantime, we will ensure that any capacity that we have after we have done the British public is made available, but we have to see the job through here in the UK. It would be utterly counterproductive if the UK, having got so far, tripped over at the last hurdle.

[Lord Caine (Con)]

My Lords, having spent much of the Whitsun Recess trying to do my best to support the beleaguered hospitality sector in west and north Yorkshire, two messages rang out loud and clear: first, the problems that many establishments are facing with staff shortages, in part due to Covid restrictions, which are affecting levels of service; and, secondly, the absolute calamity for many establishments if the lifting of Covid restrictions is delayed beyond 21 June. Can my noble friend therefore assure the House that, in taking what I accept are finely balanced decisions about lifting restrictions, the plight of our hospitality sector and the livelihoods of those who work in it will be properly considered?

[Lord Bethell (Con)]

I pay tribute to those in the hospitality and related sectors—both those who manage and those who work in it. It has been one of the toughest aspects of this awful pandemic to see these valued and important industries really hammered by the closures that have been necessary to stop the transmission of this awful disease. I hear my noble friend’s message absolutely loud and clear. We are on the final slopes of this journey. We want to ensure that, when we open, we stay open and there is no yo-yoing. That is why we are committed to looking at the data in the run-up to 21 June. His point is extremely well made, and we will definitely take it on board.

[Baroness Uddin (Non-Afl)]

I thank the Minister for repeating the Statement and, in doing so, pay my respects to all carers, particularly those unpaid carers, without whom many more may have perished. I have two points. First, how are the Government encouraging GPs and hospitals to monitor and collect information on patients who may be concerned about or reporting long Covid symptoms without knowing it, and those who may be complaining of or experiencing post-vaccination effects? Secondly, now that the JCVI recommendation is being considered for vaccination of 12 to 15 year-olds, the Minister will be fully aware of the major concern aired by parents—who are all over the radio, with their views and questions—feeling confused about informed choices. Can the Minister assure all parents that, if vaccination is approved, they will be given the fullest information available on the potential side-effects, and that no parent who may choose to opt out of the vaccination for this age group will be pressured or demonised?

[Lord Bethell (Con)]

I am enormously grateful to the noble Baroness for raising in the same breath the importance of secure data arrangements and the question of what we are doing on long Covid, because we could not do what we are doing on long Covid if we did not have access to GP records. The truth is that we are doing an enormous amount. Long Covid, as the noble Baroness knows, is touching more than 1 million patients here in the UK. We have got NICE to take steps to put in place a really clear clinical definition. The NHS has mobilised Covid-specific clinics, which we acknowledge are under pressure but which are an extremely valuable resource for understanding this dreadful condition. NIHR has mobilised research resources, and I pay particular tribute to Great Ormond Street and its CLoCk research project, which is looking at long Covid among children—something which of course concerns us all. Lastly, the royal colleges have done an enormous amount to present both new data and training tools to their members and to feedback information from the front line. Long Covid will be one of the lasting and most concerning aspects of this dreadful pandemic, but we are putting everything we can into dealing with the consequences.

[Lord Cormack (Con)]

My Lords, may I once again raise with my noble friend an issue that I have been returning to for some months now? When are we going to ensure that all those who attend to the most intimate needs of residents of care homes are vaccinated? There are still far too many who have refused vaccination; it should be a condition of employment that they are vaccinated. My noble friend has indicated sympathy with this point of view, but nothing has yet been done.

While I am on my feet, as we have plenty of time and we are allowed to raise two points, why was the advice to choral societies changed after 17 May? Suddenly, 2 million singers and 40,000 choirs can only rehearse with six people indoors. This has caused enormous distress and the cancellation of many performances. It has damaged morale in places such as Lincoln very significantly.

[Lord Bethell]

I pay tribute to my noble friend. He was an early bird in championing the vaccination of social care workers. He has made his point clearly and has definitely influenced policy in this area. I would like to reassure him that it is simply not the case that nothing has been done. A review is going through the matter at the moment. This is not something, I am afraid, that could be implemented by government fiat; it is important that we go through the process, not least to maintain people’s trust. One of the aspects of the successful vaccine rollout is that we have not behaved abruptly. We have not sought to admonish or to demonise anyone who is hesitant about taking the vaccine. Instead, we have sought to engage, and that is the reason why we are going through an extremely thorough review and engagement programme. I completely understand my noble friend’s frustration that this cannot be done more quickly, but I would like to reassure him that, on balance, this is the way in which to get the task done in the most impactful and effective way that we can think of.

On choral societies, I completely sympathise with my noble friend’s point. I was at Garsington Opera on Sunday, and my spirits were lifted by the sound of the singing in that wonderful place. I have only the assessment of the PHE officials to hand; it has become clear that the dangerous presence of aerosols in the air has been the really effective transmission mechanism for this dreadful disease. It is just an unavoidable and inescapable truth that people singing their heads off will fill a room with loads of infectious aerosol, and that is the reason why this decision has been made. It is regrettable, and I understand the consequences and I have been contacted by many who are concerned and affected by it. But I would like to reassure my noble friend that it has been done for the best reasons and for, I believe, very strong scientific reasons.