Covid-19 Update

Lord Bethell Excerpts

Tuesday 29th June 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

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

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

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

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

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

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


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

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

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

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


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

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

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


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

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Lord Haselhurst (Con) [V]]

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

[Lord Bethell (Con)]

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

[Lord Patel (CB) [V]]

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

[Lord Bethell (Con)]

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

[Baroness Donaghy (Lab) [V]]

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

[Lord Bethell (Con)]

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

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

[Lord Scriven (LD)]

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

[Lord Bethell (Con)]

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

[Lord Farmer (Con)]

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

[Lord Bethell (Con)]

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

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

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

[Lord Bethell (Con)]

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

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

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

[Lord Bethell (Con)]

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

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

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

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

[Lord Bethell (Con)]

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

[Lord Lancaster of Kimbolton (Con)]

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

[Lord Bethell (Con)]

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

[The Earl of Clancarty (CB)]

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

[Lord Bethell (Con)]

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

[Lord Rooker (Lab) [V]]

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

[Lord Bethell (Con)]

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

[Lord Cormack (Con)]

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

[Lord Bethell (Con)]

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

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

[Lord Hussain (LD)]

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

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

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

[Lord Hussain (LD)]

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

[Lord Bethell (Con)]

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

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

[Baroness Altmann (Con)]

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

[Lord Bethell (Con)]

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

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

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

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

[Lord Bethell (Con)]

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

[Lord Lansley (Con)]

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

[Lord Bethell (Con)]

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

[Baroness Fox of Buckley (Non-Afl)]

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

[Lord Bethell (Con)]

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

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

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

Social Care and the Role of Carers

Lord Bethell Excerpts

Thursday 24th June 2021 Lords Chamber

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.