Covid-19: Government Handling and Preparedness

Lord Bethell Excerpts

Tuesday 8th June 2021 Lords Chamber

[Baroness Merron (Lab)]

My Lords, research released for Carers Week makes sobering reading. During the pandemic, 72% of carers have had no break whatever and, of those few who have had a break, many used the time for housework or their own medical appointments. With the risk of a third wave still a cause for anxiety, what plans are in place, or indeed in development, to ensure that unpaid carers can have restorative breaks and that their needs are at the heart of the Government’s plan for social care reform?

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

My Lords, I absolutely join the noble Baroness in paying tribute to all carers, particularly unpaid carers, who have shouldered a huge burden in the past 18 months. The role that they have played has been a real example of the sense of service and commitment that characterises the social care community in this country. We have put in place a large amount of resources through local authorities and payments to local authorities to support carers. That has helped in infection control and to reduce the itinerant nature of some social care in order to prevent the spread of the disease. But it is undoubtedly true that the burden on unpaid carers remains immense, and we continue to support, both through local authorities and through charities, the work that they do.

[Baroness Brinton (LD) [V]]

My Lords, in the national Carers Week, it is worth remembering that the 2017 report on Exercise Cygnus said:

“Local responders also realised concerns about the expectation that the social care system would be able to provide the level of support needed if the NHS implemented its proposed reverse triage plans.”


It also recommended that local support should be developed and planned for social care and health. Was that recommendation put into practice? Were the concerns expressed by local responders borne out last year? Will the Government now publish their internal review of pandemic preparedness to ensure that the lessons have been truly learned?

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[Lord Bethell (Con)]

My Lords, the noble Baroness is entirely right. It was known at the very beginning and it was clearly understood that those in social care—and those who support those in social care—were in the gravest possible danger in such a pandemic, and we were focused from the beginning on giving them the right amount of support. The Cygnus report correctly identified that, and that was why we put provisions for social care into our action plan from the very beginning. It is unfortunately a truism that those who are most vulnerable are, I am afraid, at greatest risk from such a pandemic, and those who support the vulnerable will shoulder a huge burden. That is why we have put in a large amount of resources to support those people and why, when the inquiry comes, we will undoubtedly focus on how we can improve those processes.

[Baroness Foster of Oxton (Con)]

My Lords, I will move on to another point. At the end of May, Portugal was deemed safe to host the Champions League final; five days later, it was not, despite 100,000 tests by the authorities with only six positives. This caused tens of thousands of people and businesses horrendous disruption and distress. Will my noble friend, on my behalf, kindly remind the Secretaries of State for health and transport that using emergency powers with no debate and with both Houses not sitting yet again is wholly unacceptable and can no longer be tolerated?

[Lord Bethell (Con)]

My Lords, I completely share my noble friend’s frustration at the situation. Of course we all enormously regret the fact that our efforts to open up international travel were unfortunately reversed because of the presence of dangerous variants of concern in the Portuguese community—in this case, particularly the Nepal variant of concern. However, I cannot agree with her that quick decisions based on accurate data are not appropriate in the depths of a pandemic. It is absolutely right that we move quickly to close down a change of transmission and that we protect the vaccine from variants that may present a severe danger to this massive national project.

[Baroness Meacher (CB)]

My Lords, this is rather relevant to the previous question: how many additional Covid cases in the UK were caused by the delay in closing our borders to travel from India after we knew about the new variant? Is the Minister making representations to the Prime Minister and appealing that no such delay should occur again as variants emerge in different countries across the world, to protect the health of the people of the UK?

[Lord Bethell (Con)]

My Lords, I am not sure whether I have the data that the noble Baroness has asked for. I also contest the premise of her question. We have moved extremely quickly when presented with clear data, as my noble friend rightly pointed out, and I hardly need go over the timelines for the decisions around Pakistan, Bangladesh and India, which have been gone over many times indeed. I reassure the noble Baroness that we are absolutely determined, at this delicate phase of the pandemic, to ensure that our borders are extremely tough and that we do whatever we can to keep the variants out. At the same time, we are cognisant that people do have commitments overseas and we are leaning, wherever we possibly can, to opening up the borders.

[Lord Hain (Lab) [V]]

My Lords, does the Minister recall the independent review by Dame Deirdre Hine, presented to the coalition Government in 2011, which said:

“The planning for a pandemic was well developed, the personnel involved were fully prepared, the scientific advice provided was expert, communication was excellent”?


She reported on the exceptional level of preparedness the UK had attained. Why, by 2020, had all that careful preparation by our Labour Government been so catastrophically eroded, despite the fact that the pandemic remained top of HMG’s risk register?

[Lord Bethell (Con)]

My Lords, I am not sure that any Government, even the Labour Government in the noble Lord’s time, could claim to have some kind of forecasting ability that could possibly have predicted the precise shape and impact of this pandemic. Even now there are things about this virus that we do not know. At the beginning, in January, February and March, the precise features of this virus were not fully understood, and it was not possible to prepare for this particular pandemic in its precise shape and nature. To pretend otherwise is doing this House a disservice.

[Lord Houghton of Richmond (CB)]

My Lords, I will follow on from that. The Ministry of Defence and the Armed Forces are often accused of being prepared for the last war rather than the next one. In truth it is impossible to be ready for the next war unless, of course, you intend to start it. The best you can achieve within finite resources is to be ready for “a” war, not “the” war. You must then adjust what is inevitably a generic preparedness to meet a specific set of circumstances. Might the department of health’s preparedness for a global pandemic be more sympathetically viewed if this important subtlety were better explained and better understood? Might the criticisms that are made therefore be more objectively assessed as those that are fair and those that, frankly, are somewhat vacuous?

[Lord Bethell (Con)]

My Lords, we will need to wait for the inquiry for a thorough post-mortem on what was or was not thoroughly prepared for. It is fair to say that the developed nations of the world had invested a huge amount in modern clinical medicine, yet that did not serve to prepare us for the precise circumstances of a respiratory pandemic. I pay tribute not only to those in the public health profession but to those in the military, who did so much and moved so quickly to deliver the kind of protection that this country has benefited from during the pandemic.

[Baroness Wheatcroft (CB)]

My Lords, when the pandemic hit this country, one of the reasons we were so badly hurt was the shortage of intensive care beds, the number of which had been run down progressively for many years, despite the World Health Organization pointing out the inherent dangers in that. So could the Minister say, without waiting for the inquiry, what our policy on intensive care beds is now?

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[Lord Bethell (Con)]

My Lords, as the noble Baroness probably knows, we are investing hugely in new hospital capacity, but I would question whether it was simply the lack of ICU beds that was at the heart of the challenge. The truth is that this was a virus that hit our population massively, and even if we had had double the number of ICU beds, we would have been hard hit and could not have avoided the kind of NPIs that eventually stopped the virus in its tracks. Modern medicine can do many things, but it cannot fight a virus from the wardroom.

Covid-19 Update

Lord Bethell Excerpts

Tuesday 8th June 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

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

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

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

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

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Lord Balfe (Con)]

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

[Lord Bethell (Con)]

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

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

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

[Lord Bethell (Con)]

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

[Lord Moynihan (Con)]

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

[Lord Bethell (Con)]

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

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

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

[Lord Bethell (Con)]

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

[Lord Lancaster of Kimbolton (Con)]

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

[Lord Bethell (Con)]

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

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

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

[Lord Bethell (Con)]

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

[Lord Caine (Con)]

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

[Lord Bethell (Con)]

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

[Baroness Uddin (Non-Afl)]

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

[Lord Bethell (Con)]

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

[Lord Cormack (Con)]

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

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

[Lord Bethell]

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

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

NHS Digital: Primary Care Medical Records

Lord Bethell Excerpts

Tuesday 8th June 2021 Lords Chamber

[Baroness Cumberlege]

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

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

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

[Baroness Cumberlege (Con) [V]]

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

[Lord Ashton of Hyde (Con)]

Could I ask the noble Baroness to ask her question?

[Lord Bethell (Con)]

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

[The Lord Bishop of Carlisle]

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

--- Later in debate ---

[Lord Bethell (Con)]

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

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

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

[Lord Bethell (Con)]

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

[Baroness Hollins (CB) [V]]

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

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


or:

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


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

[Lord Bethell (Con)]

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

[Baroness Thornton (Lab)]

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

--- Later in debate ---

[Lord Bethell (Con)]

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

[Baroness Brinton (LD) [V]]

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

[Lord Bethell (Con)]

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

[Lord Hunt of Kings Heath (Lab)]

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

[Lord Bethell (Con)]

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

[Lord Stirrup (CB)]

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

--- Later in debate ---

[Lord Bethell (Con)]

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

[The Lord Speaker (Lord McFall of Alcluith)]

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

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

Lord Bethell Excerpts

Monday 7th June 2021 Grand Committee

Moved by

[Lord Bethell]

That the Grand Committee do consider the Health Protection (Coronavirus, Restrictions) (Steps and other Provisions) (England) (Amendment) Regulations 2021.

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

My Lords, on 17 May we moved to step 3 of the road map, which seeks to maintain a balance between our social and economic priorities. We need to save lives and prevent a surge in infections, and we need to relieve businesses that have suffered from closures and restrictions on social contact.

As ever, the decision to move to step 3 was informed by data from the Joint Biosecurity Centre, the Scientific Pandemic Influenza Group on Modelling and Public Health England. I express profound thanks to the analysts and academics who support these efforts. The surveillance evidence, epidemiological modelling and policy analysis that support these decisions are a tribute to the highest standards of the British Civil Service.

I want to seize this opportunity to set out some of the very latest data that has been presented to Ministers. As noble Lords will remember, there are four tests. The first is that the vaccine deployment continues successfully. As of 6 June, vaccination uptake is at 76.6% for the 18-plus UK population for the first dose and 52.5% for the second. These figures are aligned with the Government’s published plans and they are a remarkable achievement, but there is more to do.

The second test is that the vaccine continues to be effective at reducing hospitalisations and deaths. Data available at step 3 suggests that two doses of the Pfizer vaccine reduced overall symptomatic disease by up to 80% or 90%, hospitalisations by 90% to 95% and deaths by around 95%, with a similar effect reported for the AstraZeneca vaccine. This is hugely encouraging. In the week ending 21 May, when we moved to step 3, the weekly registered deaths had reduced by 70%. More recent figures show that between 31 May and 6 June there were 59 deaths within 28 days of a positive coronavirus test. That is clear evidence that the vaccine works. However, we must not be complacent. As restrictions ease and social distancing measures are relaxed, we must continue to be vigilant.

The third test is that infection rates do not risk a surge in hospital admissions, putting undue pressure on the NHS. This risk is massively mitigated by the progress of the vaccination programme across the UK. Daily hospital admissions continued to fall throughout March, April and early May. Since we moved to step 3, the number of infections has also been increasing. This is what we expected when lifting some restrictions on social contact. For the seven-day period ending 1 June there were 25,888 new cases across the UK, at a rate of 38 per 100,000. There are some regional variations, with particularly high case rates in parts of north-west England. Despite that rise, the positivity rate in England remains low and is currently at 1.3%. There were 151 daily hospital admissions in the UK on the last complete collection date of 1 June. It is steady as it goes.

The fourth test is that our assessment of the risks is not fundamentally changed by variants of concern. For the seven-day period ending 19 May, there were 2,111 new cases of the delta variant recorded, making 3,424 total confirmed cases. In the same seven-day period there were 7,066 new cases of the alpha variant, making 249,637 total confirmed cases. At this point, the delta variant made up less than one-third of all VOCs.

With cases, admissions and deaths continuing to fall, surge testing in place, the vaccine rollout on track and vaccines proving effective, we judged that the tests to move to step 3 had been met. This does not mean that there is no risk. Indeed, we are extremely alert to the potential for new variants of concern to lead to a rapid worsening of the pandemic.

The assessment from SAGE and the evidence from PHE is that the delta variant is much more transmissible. We deployed a widescale test and trace response across the areas affected by the delta variant, including surge testing in areas such as Bolton and Blackburn. In addition to the existing test and trace support payment, local authorities have significant discretionary funding to offer additional financial support to those who need it. In Blackburn and Bolton, this will include trialling broadening eligibility during surge testing, so that all those who are required to self-isolate, who cannot work from home and earn under £26,000, receive a £500 payment. As ever, we continue to keep the data under close observation, and the Government will not hesitate to take firm action if necessary to protect lives and livelihoods.

That is the context of the decision, and it is a decision that has led to a real lift in the mood and optimism across the country, as a result of the changes made by these regulations. Many businesses have reopened and people are enjoying greater freedoms; they can meet more friends and family and more people can now attend funerals to say goodbye to their loved ones. Weddings, receptions and other commemorative events can be bigger, and we have moved from legal mandating and government rules to guidance which asks people to take personal responsibility when meeting friends and family. The regulations also made some important changes on face masks and table spacing, and we listened to the expertise of the Joint Committee on Statutory Instruments and made some minor technical changes to clarify drafting.

I regret that we are debating these regulations only now, and I regret that they were not laid before they came into force, but, despite our best efforts to lay out a clear and timetabled road map with a predictable parliamentary programme, events moved very quickly—much more quickly than the processes of parliamentary procedure. Noble Lords will remember that the Prime Minister addressed the nation on 14 May to set out that the delta variant was more transmissible and there were some important unknowns. This gave us good reason to consider very carefully our approach and to fine-tune arrangements, and that delayed the smooth running of this process.

I know more than anyone the frustrations felt by noble Lords about those delays, but I very much hope that noble Lords will remember the concerns of that time and appreciate that we waited to have the appropriate data to make these vital decisions. We have sought to expedite these important regulations as much as we can while juggling a difficult situation. The easing of restrictions thus far is hugely welcome and, while we must continue to be cautious, we have good reason to feel optimistic about the future. We will remain vigilant and continue to manage the risk to safeguard the benefit of our collective effort so far.

Finally, I thank once again every person and organisation who is supporting the fight against coronavirus and colleagues here for their contribution to this Committee sitting. I commend the regulations to the Committee.

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, I am enormously grateful for a very thorough debate on these regulations and I will try to pick off the key points. One point is the question of guidance versus law, which almost all noble Lords spoke about. My noble friend Lord Lansley put it extremely well. He is right that it is the British way to seek to use guidance and to appeal to people’s best nature wherever we possibly can; it is our default setting in this country. I for one very much welcome the move from legislative impetus to guidance. I think almost all have welcomed that principle.

However, I am afraid that it is an inevitable consequence of moving from law to guidance that you leave a degree of interpretation up to the British people. That is a dilemma we have to wrestle with in government. I acknowledge the communication challenges. I have said from the Dispatch Box and that I thought one or two things might have been done better, but we have given the British public discretion on how they interpret some of the guidance, particularly on travel.

The truth is that the British public are very clear about the guidance we have provided and are incredibly consistent in their behaviour. Despite the suggestion made by some noble Lords, there has not been an explosion of foreign travel. Quite the opposite: the number of people who went to Portugal while it was open was relatively small. Adherence to isolation, which was raised by the noble Lord, Lord Scriven, remains incredibly high. For positive cases it is around 90%, and for contacts of positive cases it is around 85%. The British public are much clearer in their heads than perhaps some would give them credit for. The public understand that the Government sometimes allow people to do something while not recommending it, much like with smoking.

We are at a stage of the pandemic—the infection rate is currently relatively low—where it is proportionate and reasonable to use guidance over the law and to accept that there are some friction costs to that, but they are within the range of acceptable risk. We are at a stage where things are generally getting better. We hope that we are on a journey out of this dreadful pandemic. It is therefore entirely right that we seek to move away from legislation wherever we possibly can.

My noble friend Lord Lansley made the point on testing, and the noble Baroness, Lady Brinton, raised my noble friend Lady Harding’s comments earlier. My noble friend Lord Lansley is right: the capacity of testing to make an impact on the infection is possibly underestimated at the moment. I cite the example of schools, where 65 million LFDs have been used since the beginning of the year to huge effect. We were extremely concerned about infection rates in schools on their return, and the presence of a new, highly transmissible variant is something we watch extremely closely indeed, but pupils, parents and teachers have worked incredibly hard to use the latest technology to keep a lid on transmission rates. That has worked incredibly well. I note my noble friend Lord Lansley’s points about business travel and will take them away with me. The cost of tests is coming down dramatically, and I would be glad to share details of that with him.

The noble Lord, Lord Scriven, and others spoke about the late arrival of these regulations, for which I express genuine personal regret, but I push back against noble Lords who express outrage and concern. I remember the run-up to 14 May extremely well indeed. I have in front of me, on my computer, the chart of the growth of the Indian variant. Even now it puts chills down my spine as I look at it. Naturally, we were extremely worried about a relatively unknown variant for which we did not have a genomically sequenced example. We had no idea about its impact on hospitalisation and death, but we kept our nerve. We waited for the data to come in from the clinics and for the virologists and biologists to do their work. In the end, we had made the right decision and were able to proceed with these step 3 regulations as intended, and as very clearly outlined in the road map. Although there was a delay in the paperwork, we were able to deliver on our commitments in that area.

There is no way we can ignore the data. In fact, in other matters noble Lords are absolutely emphatic that we should follow the data. This is just a direct and unavoidable consequence of that commitment. We face the same dilemma today. We are not fully clear about the serious illness and hospitalisation impacts of the delta variant. We are waiting for NHS statistics to come in. The CMO has made it clear that he feels we will have significantly more information on that at the end of next week. Until then, we have to hold our course. This is the pattern of these waves and will continue to be so. The fact that our constitution allows us to have agile legislation that adapts to the circumstances is a benefit, not a disbenefit, of the British way of doing things.

I reassure the noble Lord, Lord Scriven, that the Coronavirus Act will last until March 2022. The PCMs to which he referred are largely driven by Section 2 of the 1984 public health Act. Analysis of emergency powers is currently being undertaken by the Constitution Committee, to which I have already given evidence. I recommend that the noble Lord engages with it.

The noble Baroness, Lady Brinton, talked about the immunocompromised, a subject that I am extremely concerned about, as I know she and other noble Lords are. I pay tribute to the work of Birmingham University and the Octave trial. This is a huge challenge for those who have little by way of an immune system. The vaccine clearly will not work in the same way as it does with those with a fully charged immune system. There are huge opportunities from therapeutics and antivirals. We are chasing those down very actively, but I would be glad to meet with her, Anthony Nolan, Cancer Research UK and any other charities she would very helpfully like to convene.

My noble friend Lord Bourne spoke about travellers from the red list. I pay tribute to the managed quarantine system. Last week, there were 115,000 passengers into the UK. Only 9,000 of them were from the red list; 92% of those were through Heathrow. I pay tribute to Heathrow and the creation of its new red terminal. We have to accept that the red list may well be here for some time, but I am very optimistic that we can make huge progress on foreign travel. The mutual recognition of double vaccination protocols is being discussed at the very highest levels and offers a way out from the impact of this awful pandemic. I am optimistic that foreign travel will be able to start soon.

By way of a wind-up, I shall address the noble Baroness, Lady Tyler, who said that the pandemic is not going away anytime soon and give evidence of how dramatically our lives will change, largely for the worse. I am much more positive. Ultimately, the vaccine does work. If it works on the variants we have today, there is every reason to hope that it will work on future variants. We have learned a huge amount about therapeutics, antivirals, diagnostics, tracing, surveillance and treatment of the ill. Where we have a challenge as a nation is in public health, which has been found wanting. The health of the nation is far too poor. We weigh too much, smoke too much and drink too much, and we go into illness in a poor condition. That is the challenge we face as a nation, and the one we will turn to once the pandemic is out of the way.

Motion agreed.

Covid-19: Poverty

Lord Bethell Excerpts

Thursday 27th May 2021 Lords Chamber

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

My Lords, the facts are heartbreaking. Covid, like many diseases, has hit hardest those who are most vulnerable: the poorest, the most disabled and those who work in some of the most difficult jobs. The vaccine rollout and community testing programmes have shown what the country can do, but there is much more to be done. That is why we are publishing a levelling-up White Paper, and health inequalities will be central to that.

[The Lord Bishop of Blackburn]

My Lords, I am grateful to the Minister for his reply and the work that he and colleagues are doing in a fast-changing scene. We know that it is not easy. Does he agree that care for the poorest, most disadvantaged and most vulnerable in the community is one of the signs of a healthy society? Can he be more specific about how equality of opportunity in the levelling-up agenda will be rolled out?

[Lord Bethell (Con)]

My Lords, I can certainly speak for the inequalities we have in health. The right reverend Prelate is entirely right—Covid has been a real reminder of the impact of deprivation and inequality on the population. Those who are disabled are two-and-a-half times more likely to have had some form of life issue with Covid. In terms of deprivation, mortality in the most-deprived neighbourhoods was more than double the rate than in less-deprived neighbourhoods. Those facts are chilling. They are a wake-up call, and we will be working through our levelling-up agenda.

[Baroness Lister of Burtersett (Lab)]

My Lords, as the latest Marmot review made clear, damaging and heartbreaking levels of inequality and poverty, especially child and family poverty, weakened our resilience in the face of Covid. Apart from getting people into paid work, which increasingly is failing to protect from poverty, what is the Government’s anti-poverty strategy?

[Lord Bethell (Con)]

My Lords, I can speak for the health dimension. I should emphasise the work of the office for health promotion. Under the Chief Medical Officer, the OHP will deliver proactive, predictive and personalised preventive strategies. We believe that there is a huge opportunity off the back of Covid to really change the health inequalities of the country, and that is what the OHP will be devoted to doing.

[Baroness Stuart of Edgbaston (Non-Afl) [V]]

My Lords, levelling up is a UK-wide ambition and priority; health and public health are devolved responsibilities. Will the Minister undertake to take a good look at how the various parts of the United Kingdom have dealt with problems that they have faced? For example, Wales appears at the moment to be far more successful in rolling out vaccination than England, Scotland and Northern Ireland. We should not be too proud to learn from each other in order to overcome some of the deep inequalities that have developed over the past years.

[Lord Bethell (Con)]

My Lords, the vaccine race is being contested right across the country, and I take my hats off to all those who are delivering the programme so effectively. We are not too proud to learn from each other. In fact, I pay tribute to, for instance, those in Scotland who have programmes around alcohol and drug use, which are pioneering on a worldwide level. We have to work on this all together, and we will absolutely use the best case studies to apply the best programmes on a countrywide basis.

[Lord Balfe (Con)]

My Lords, I draw attention to my position as a fellow of the Royal Statistical Society. There is an old adage that correlation does not necessarily indicate causation. While it is easy to talk about levels of poverty, there are other factors such as lifestyle and ethnicity, and there will be a need for some multiple regression when studying the consequences. When the committees are inevitably set up to look at the causes and how to deal with those matters, will the Minister make it a priority that a good, well-qualified statistician is included among the members of any committee that is set up?

[Lord Bethell (Con)]

My Lords, I hear my noble friend’s warning very clearly and he is absolutely right. We must not be confused between statistical correlation and causation. However, one thing that has become clear is that in Covid personal health status, particularly obesity, has been a driver of severe illness and mortality. The environments in which people live and work have been a driver of infection. Those two are probably inescapable conclusions and will be central to our levelling-up agenda.

[Baroness Merron (Lab)]

The pandemic has brutally exposed the health inequalities that ran deep in our society even before Covid-19, and it is certainly welcome that the White Paper acknowledges that. However, even the best efforts of an integrated care system can only go so far in preventing ill health. Forthcoming legislation needs to be underpinned by national policy measures and funding to tackle overarching determinants of health. With that in mind, will the Minister comment on why the Queen’s Speech did not contain improved funding for public health, given the Government’s professed commitment to levelling up and building back better?

[Lord Bethell (Con)]

My Lords, the noble Baroness is entirely right that it cannot be for either the law or the Department of Health to solve a national challenge. That is why the Prime Minister has committed to appointing a cross-ministerial board. It needs the co-ordination and focus of many different departments that handle health, social welfare and the culture of the country to tackle these tricky, long-standing and difficult challenges.

[Baroness Fox of Buckley (Non-Afl)]

Could the Minister add the levelling-up agenda to the arguments for not delaying opening up on 21 June? Overcaution at this stage would be particularly devastating for ordinary working people. Even if the cost-benefit analysis is post hoc, I ask the Minister to start looking now at the health impacts of lockdown, not Covid as such, on the less well off. The health impacts of being confined in overcrowded houses, no gardens for kids and worries about job security are likely to have taken their toll, and we need to learn from what has happened.

[Lord Bethell (Con)]

My Lords, it is a difficult fact that males working in low-skilled elementary occupations, such as security guards, had rates of death more than three times higher than the general population. That illustrates that often those in the most difficult jobs face the greatest threat of infection. The best thing we can do for the economy is to get rid of this virus, for which we need vaccination and testing, and that is the Government’s focus.

[Lord Patel (CB) [V]]

My Lords, following the effects of Covid-19, restoring the nation to good health will require a new social compact, backed by a national cross-departmental health inequality strategy. I am pleased to hear the Minister say that the reduction of health inequality will be in the health Bill, but could he confirm that the legislation will include commitments from other departments and the Government?

[Lord Bethell (Con)]

My Lords, we have provisions for tackling obesity in the health and social care Bill, as the noble Lord knows, but the focus of the cross-ministerial board on health will be to bring together government efforts on not just obesity, but health inequality in the round. The board’s remit has not yet been published, nor has its membership or chairmanship, but I reassure noble Lords that that is coming reasonably soon.

[Lord Harris of Haringey (Lab) [V]]

So we have to wait for a cross-ministerial board; that will really make a difference. Overall, the Government’s record has been appalling. Improvements in life expectancy, which had been rising steadily since the 1950s, stalled in 2010 when the Conservatives were elected and throughout the subsequent decade. What is more, according to the King’s Fund, real government spending on public health has fallen by 15% in the last six years. That is not new, so why do we have to wait for the so-called levelling-up White Paper and this cross-ministerial thingy? Why can the noble Lord’s department not get on with boosting public health locally, rather than reshuffling the deckchairs nationally by abolishing Public Health England and diluting that focus?

[Lord Bethell (Con)]

I feel inspired by the noble Lord’s passion for the subject, but it is not fair or reasonable to suggest that death rates in the country are driven by the electoral cycle. Far from it—this Government have been extremely committed to the obesity strategy, not least because of the personal story of the Prime Minister. We have not abolished Public Health England; we have redefined it as two organisations, UKHSA and the OHP. The impact of those will be profound.

[Lord Bird (CB)]

Is the Minister aware of the social mobility pledge, which is trying to remove impediments to people applying for highly skilled jobs so that they do not follow the route that their families may have followed into underpaid jobs, where they remain in poverty for ever? I would very much like him to look at this. I support the pledge and many hundreds of businesses are following that example and removing these impediments.

[Lord Bethell (Con)]

The noble Lord speaks movingly about this important issue and social mobility is itself a massive issue for the country. It does not fall directly within the remit of the Department of Health, but the NHS itself can be an enlightened employer in this respect. Many families have seen great advances in their personal development there, and I hope that it has a spirit of meritocracy and opportunity. I would be glad to write to the noble Lord to share with him the kinds of initiatives designed to increase social mobility that there are within the NHS.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, all supplementary questions have been asked.

COVID-19 Variant: Travel Guidance for Local Authorities

Lord Bethell Excerpts

Wednesday 26th May 2021 Lords Chamber

[Baroness Thornton]

To ask Her Majesty’s Government what plans they have to ensure local authorities are informed of new travel guidance on areas where the COVID-19 variant B.1.617.2, first identified in India, is spreading.

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

My Lords, we are always looking to see how we can communicate more effectively with local authorities. We will have discussions with local authority colleagues this week to make sure that everyone is clear what the expectations are and how we can improve communications going forward.

[Baroness Thornton (Lab)]

My Lords, to paraphrase Matt Lucas as the Prime Minister: “Don’t go to work—go to work. If you can stay indoors, go outside. Don’t go outside—go on public transport. Don’t go to work and then—something or other will happen.” It would be laughable if it were not so serious. I have two questions for the Minister. The amended guidance asks people to minimise travel into and out of the eight hotspot areas. The previous version asked them to avoid all non-essential travel. What is the difference between those two things or is it like the amber countries—you can go there but you should not? If the Government want people to heed their advice, guidance or instructions, why were the notices posted on a website during the night without consultation or accompanying dissemination to people and organisations such as public health, councils and mayors? That does not seem the most effective way to communicate with people.

[Lord Bethell (Con)]

My Lords, the characterisation presented by the noble Baroness is unfair. We are trusting people to be responsible and to act with caution and common sense, as they have done throughout this pandemic, and to make decisions on how best to protect themselves and their loved ones. We are seeking to avoid bringing these measures into law and instead are using guidance. The communication of that guidance could have been done better but we are working extremely hard with regional partnership teams, Public Health England, local authorities, JBC colleagues and the incident management teams to ensure that these communications are done in the most effective way possible.

[Baroness Brinton (LD) [V]]

I declare my interest as a vice-president of the Local Government Association. Earlier, on the “Today” programme, Grant Shapps said that it was down to local authorities to disseminate the new travel guidance to their citizens, but local authorities reported that they had not been told about it. Do the Government expect them to develop telepathic skills? What does that say for the way government truly operates as a partner with our councils, directors of public health and local resilience forums, which are dealing brilliantly with this new, rapidly transmissible Covid variant? Are they getting extra resources to cope with the extra burdens on them?

[Lord Bethell (Con)]

No, the noble Baroness will be relieved to know that we are not relying on telepathy. Instead we have regional partnership teams, which include Public Health England regional directors, and Contain and JBC colleagues, working together with local authorities, and these meet on a three-times-a-week basis at the regional team updates. Attendees can include government departments, including the MHCLG, the DfE, particularly REACT, and the No. 10 Cabinet Office task force. It is through this kind of extremely regular and intense collaboration between all the different parties working on this extremely complex pandemic response that we share data, provide guidance and ensure that the communications are done to the best of our ability.

[Baroness Young of Old Scone (Lab) [V]]

I declare an interest as a resident of Bedford borough. Bedford has repeatedly been let down by the failure of government to share information. It did not get information on test results on cases that tested positive with the Indian variant returning through airports, and now there is this communication failure, which it found out about only when the Manchester press phoned it up to tell it that it was on the website. It has been starved of the Pfizer vaccine and now denied the additional boots on the ground that it needs to deal with the crisis, which apparently have all been sent to the red-wall authorities. What ill will do the Government have for Bedford and what is the Minister doing to sort out the important relationship with key local authorities without imposing top-down lockdowns, either clandestinely or publicly?

[Lord Bethell (Con)]

My Lords, I am conscious of having been asked questions about the vaccine, testing and lockdowns in Bedford before. However, I absolutely reassure the noble Baroness that we approach all areas on an absolutely equitable basis, and in fact I pay tribute to the people of Bedford and the local authorities there for their energetic response to this pandemic. We are working extremely hard with all local authorities to give them the effective powers and resources to deal with the pandemic on a local basis. That means that national co-ordination comes second to local implementation and that these communications are sometimes extremely complex. We should not be surprised if sometimes there are differences between how different areas implement those communications.

[Lord Balfe (Con)]

My Lords, is it not time for the department to stop formulating rules that are neither enforced nor obeyed? Instead, if it wants to publish lists, could it not consider publishing a list of the growing waiting lists for treatments for cancer, heart problems and the many other things which are growing out of all proportion to the amount of effort put into constantly talking about Covid?

[Lord Bethell (Con)]

My Lords, my noble friend makes an extremely pertinent point but the two things are inextricably linked. We can get back and address the backlog of operations to which he quite rightly alludes only if we are not fighting the pandemic and if our wards are not full of Covid victims. Only through the right kind of guidance, testing, the vaccine and the behaviours of the public can we contain this virulent virus, a new strain of which has arrived on our shores, and if we do not, our hospitals will be overwhelmed and we will not be able to address the backlog.

[The Lord Bishop of Blackburn]

My Lords, I declare an interest as resident in the area of Blackburn. After the advice last Friday, I was unsure whether I would be entitled to travel to London for duty this week and allowed to return if I did. There might have been people in both places who would have been equally delighted. There is real uncertainty, disquiet and disappointment at the unclear and mixed messages that have been received, especially among communities that are struggling with very high rates of infection. The point is not so much about information being given but about consultation. What will the Minister do to make sure that this debacle does not happen again and that, to hear the local voice, there will be proper consultation with directors of public health, not just information?

[Lord Bethell (Con)]

My Lords, as I sought to explain to the noble Baroness, Lady Brinton, there is a huge amount of consultation with directors of public health. There are meetings on these matters on a daily basis through the chief medical officer, the silver/gold process and the local outbreak teams. However, the right reverend Prelate refers to a serious issue. We are seeking to avoid the kind of legal lockdowns that the public are quite understandably exhausted by and naturally quite resistant to. Therefore our message to the public is that we are asking them to behave in a responsible fashion, to act with caution and to use their common sense, as he had to in his decision about whether to come to London. We are not seeking to legislate on that, and we are asking people to make those decisions for themselves. I completely sympathise with those who find that challenging and who in some cases would prefer to have some certainty. However, that is what people have asked for and it is the right approach to keep the British public on side during this difficult period.

[Baroness Pinnock (LD) [V]]

My Lords, I refer the House to my relevant interests. I live in Kirklees, one of the affected areas. Yesterday, the new guidance on the Government’s website said, “Avoid meeting inside”. Today, the amended site says, “Meet outside where possible”. Perhaps the Minister can help me. Does it mean that, in Kirklees and elsewhere, pubs, cafés and restaurants must turn customers away from service inside? The Minister has just said, “We must use common sense”. Does that mean that council meetings must be held virtually, not face-to-face, which is what the other part of the Government now demand?

[Lord Bethell (Con)]

My Lords, the noble Baroness has given some very good examples of exactly where we are asking the public, and legislatures, to use their common sense. We are saying, “Avoid meeting inside”, but we are not closing the pubs. We also say, “Avoid smoking”, but we do not ban smoking.

[Noble Lords]

Oh!

[Lord Bethell (Con)]

We have not banned smoking; lots of smoking is going on among the British public.

This is where the public have a role to play. They have agency, they are able to make their own decisions and they can make the sensible distinction between meeting inside when they could be meeting outside and making unavoidable decisions of the kind the noble Baroness alluded to.

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

I will have a go now. The latest advice to people in these areas is to minimise travel and use their common sense. If a family have booked a trip away for the weekend, how would the Minister advise them?

[Lord Bethell (Con)]

My Lords, I would ask them to use their common sense. I am a parliamentarian; I am not telling them or legislating for them on that particular decision. They can see the rising infection rates around them, they know for themselves how this disease spreads and we are asking them to make a sensible, reasonable, common-sense decision about whether that journey is necessary. That is not something we are legislating for, it is what we are putting in guidelines, and I think that that, at this stage of the pandemic, is a reasonable response.

[Baroness Bennett of Manor Castle (GP)]

My Lords, given the long, arduous months of confinement suffered by the city of Leicester, compounded by the confusion caused by the apparent secret lockdown, and then the recognition that the city of Leicester should not have been included on the list, according to the figures—that arose as a result of a faulty calculation—can the Minister explain how the error came to be made in the case of the city of Leicester and how it will be avoided in future?

[Lord Bethell (Con)]

My Lords, guidance for people in Bolton and Blackburn with Darwen was published on Friday 14 May. It was then extended on 21 May to Bedford, Burnley, Hounslow, Leicester and North Tyneside. That guidance has now been fine-tuned, in response to feedback from the local directors of public health and, as the noble Baroness will know, the website has been updated. The chronology of that is relatively straightforward. It could have been done better—that I have made plain to the noble Baroness, Lady Thornton—and we are with working directors of public health, local authorities and others to ensure that we get smoother systems for that kind of thing.

[Baroness Merron (Lab)]

My Lords, I share a lot of the concern in the House about the confusion that has been sown. I am somewhat shocked that the Government did not work closely with those who are dealing with Covid in the affected areas, who are at the sharp end: the mayors, public health officials and councils. They are the local experts, and I implore the Minister to work closely with them. Does he accept that what is really needed in the affected areas now is isolation support, enhanced contact tracing and the rollout of vaccine for everybody?

[Lord Bethell (Con)]

My Lords, I completely object to the false premise of the question. I cannot tell you how hard we are working in collaboration with local authorities, directors of public health and the incredible rhythm of regional partnership teams, regional team updates and the huge amount of data and interaction between all parts of government. It is absolutely phenomenal, and the characterisation by the noble Baroness is just not right. Where I completely agree with her is that we are working as hard as we humanly can to get the vaccine out to everyone, we are doing absolutely all we can to spread testing to all areas where there are outbreaks and we are working extremely hard to improve all those systems.

[Baroness Fox of Buckley (Non-Afl)]

Does the noble Lord agree that in one regard, government communication has been brilliantly successful? In Laura Dodsworth’s new book, A State of Fear, she exposes how the nudge unit, behavioural scientists and SPI-B weaponise fear. She quotes the statement:

“The perceived level of personal threat needs to be increased among those who are complacent, using hard-hitting emotional messaging.”


I genuinely want to know: can the Minister explain why the Government are so adept at deploying huge resources to communicate scary messages but seem so inept in communicating the trust and common-sense messaging he has just explained here but did not manage to explain to local people, which is why they are so confused?

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, I did read that book, and it was based on the premise that the public cannot be trusted and the public cannot make decisions for themselves. That is not the Government’s view.

[The Deputy Speaker (Lord Russell of Liverpool) (CB)]

My Lords, all supplementary questions have been asked.

Covid-19: Variant B.1.617.2

Lord Bethell Excerpts

Wednesday 26th May 2021 Lords Chamber

[Lord Watson of Invergowrie]

To ask Her Majesty’s Government when they will publish data on the spread of the Covid-19 variant B.1.617.2, first identified in India, in schools in this country.

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

My Lords, I pay tribute to the contribution of teachers, pupils and parents in the battle against infections in schools. By the application of hygienic measures, distancing and asymptomatic testing, the spread of the virus has to date been limited. We are very vigilant—we are looking at recent upticks in infection, we react swiftly to outbreaks and we have published variant data twice a week. But we continue to work on ways of having more detailed, setting-specific analysis.

[Lord Watson of Invergowrie (Lab)]

My Lords, the DfE has just published the latest school attendance figures, which showed that the number of pupils in schools in England who had been shown to have Covid-19 had soared by some 33% in the space of a week. Those are national figures, so the increase would have been even greater in the eight hotspot areas. That surely shows the need for the Government to publish the latest data on a local government area basis to ensure that schools have the proper mitigation measures in place for their locality. The second wave of Covid caused immense disruption to children’s education. To ensure there is no repeat of that, will the Government enable secondary schools to carry out lateral flow tests on all pupils in the week following half-term in the hotspot areas?

[Lord Bethell (Con)]

My Lords, there is an enormous amount of data published. I draw the noble Lord’s attention to table 6 in the table test conducted on 28 May 2020, which has an enormous amount of weekly collection data for schools. In that week, 1,967,904 LFTs were taken by schools, and they yielded 1,806 positive results. Those were all examples of where we have cut the chains of transmission. Tests are delivered through a variety of channels, including the community testing channel. Reports on infections in schools are analysed by the tracing programme, and they are then taken through to PHE and JCB. We are looking at ways in which we can aggregate all that schools data into more specific tables. But until we do that, there is already a very large amount of data.

[Baroness Warwick of Undercliffe (Lab) [V]]

My Lords, my noble friend has pointed out that cases are substantially concentrated in school-aged children and young adults, who of course have not yet been vaccinated. Does the Minister agree that it was premature to announce last week that face coverings will no longer be required in secondary school classrooms and communal areas? Does he accept that this policy could drive an increase in infections in our unvaccinated children and young people, as well as in school staff, families and wider communities?

[Lord Bethell (Con)]

I share the noble Baroness’s concern, but I can reassure her on a couple of things. It is, I think, a real tribute to the hard work of parents, teachers and the pupils themselves that the infection rates in schools have been relatively contained, and certainly have not shown the same kinds of behaviours that they did in September of last year. But we remain extremely vigilant, for exactly the reasons the noble Baroness explained. On the question of face coverings, it is a very difficult balance to strike—they are intrusive and disruptive but, on the other hand, they are an effective way of minimising infection. It is an area that we keep a very close watch on.

[Baroness Brinton (LD) [V]]

My Lords, the delayed publication of official Public Health England Covid variant data, which was slipped out during the Eurovision Song Contest results, is bad enough, but can the Minister say whether the Secretary of State for Education has the power to remove official PHE data on cases in schools? If so, what were his grounds for that removal?

[Lord Bethell (Con)]

I really bridle at the suggestion that we run our data publication programme on the basis of the Eurovision Song Contest schedule. That really is not a credible suggestion. There is an issue with positivity rates for some of this data because not every test is registered, and, as a result, it is difficult to draw conclusions about exactly what proportion of tests have become positive. It is for that reason that we are careful about how we present some of the data, and that is behind some of the decisions that have been made about which tables to publish.

[Baroness Blower (Lab)]

My Lords, Deepti Gurdasani, of Queen Mary University, is quoted as saying:

“We know from media reports there are many outbreaks of the so-called ‘India variant’ in schools but there’s no systematic data. In Bolton … it looks like schools are contributing to the rapid spread of the virus”.


She concludes that, in a public health emergency, it is crucial that Public Health England has the public’s trust. Can the Minister say how appearing to censor scientific reports and removing mitigations, such as the wearing of masks in schools, can create and sustain that trust?

[Lord Bethell (Con)]

My Lords, I do not quite recognise the world the noble Baroness describes. In fact, I would say that the work between Public Health England, schools, local authorities and local infection teams has never been stronger, and it has proved to be extremely effective. The noble Baroness is right that schools are often a source of infection, and we remember well what happened in September. In areas such as Bolton, we are very careful to ensure that infection measures are put in place. I do not accept that there is an issue of trust.

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

My Lords, are people who have not been vaccinated and who are diabetic being warned about the dangers of the deadly mucormycosis, the black fungus, which is associated with the Indian variant—and now there is a white fungus also? Is the Minister aware that antifungal medication for the treatment of these conditions has run out in India? Can the UK help? There are many children who are diabetic.

[Lord Bethell (Con)]

I have read reports about the fungus the noble Baroness describes, and they are absolutely chilling and a source of grave concern. I am not aware of that being a threat to British public health; I feel sure that Public Health England is watching it extremely carefully. I take note of the noble Baroness’s point about medicine being in short supply. I will be glad to look into it more closely and write to her with more details.

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

Do Ministers accept that more patient choice would help in dealing with problems over spread due to vaccine hesitancy? Having in mind data on vaccine hesitancy in the case of the AstraZeneca vaccine, when will we have a decision on the authorisation of vaccines of a different brand to deal with vaccine brand hesitancy?

[Lord Bethell (Con)]

That has not been the feedback from the public in the round. There are significant issues around the supply of vaccine, and we very much take an approach of getting the vaccine out of the warehouse and into the arms of the public in as speedy a manner as we possibly can. We are not aware of a huge amount of brand prejudice among the public, and that is entirely right, because all the vaccines are effective: that is the view of the MHRA, the JCVI and the British public.

[Lord Hussain (LD)]

My Lords, the latest data published by the Government show that the Indian variant was detected in 151 local authorities in the week ending 15 May, an 18% weekly increase, with 37 areas reporting the variant for the first time. What urgent action are the Government taking in all 151 areas and their neighbours to get on top of this surge in cases?

[Lord Bethell (Con)]

The noble Lord is entirely right, and I am grateful that he has looked at the dashboard as carefully as he clearly has done and drunk deeply from the rich array of data that we have available there. On a more serious point, there are some significant outbreaks—they are listed very clearly on the PHE dashboard—where we have put in place significant outbreak management procedures, including surge vaccination, surge testing and additional communication with the community. But the noble Lord is right that the Indian variant is proving to be extremely competitive with the Kent variant, and we should expect that to start to spread around the country.

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

My Lords, can the noble Lord update the House on the potential vaccination of secondary school children?

[Lord Bethell (Con)]

I am afraid I do not have a specific update for the noble Lord. It is an area that we will be extremely interested in looking at, but there are regulatory processes to be gone through at the MHRA and vaccine policy procedures to be gone through at the JCVI. They will both be looking at that. At the moment, our focus is on getting the vaccine into as many arms as we possibly can, particularly among the high priority groups, but we will turn to that at some point in the future.

[The Lord Speaker (Lord McFall of Alcluith)]

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

Covid-19

Lord Bethell Excerpts

Wednesday 26th May 2021 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, we can probably all agree that the Minister has drawn the short straw today—and not for the first time, I think.

The issue I want to raise on this Question is that the Government took powers in the road map legislation to impose local lockdowns, so I ask the Minister: are any discussions taking place about whether those powers will be activated in those areas? Secondly, we know that a single dose of the vaccine is less effective against this particular variant, so I repeat the question asked earlier: what plans are there to increase vaccination in the areas most affected by the spread of the Covid variant B16172? Will the Government produce a plan with the local directors of public health to roll out the vaccines to everybody in those areas, and consider including bringing forward a second dose for a larger cohort of people?

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

My Lords, the noble Baroness asks two very pertinent questions which slightly answer themselves, in a way—but let me try to update the House on our plans in that area. She is right that we have powers on local lockdowns, but that is not the focus of our thinking at the moment. Local lockdowns are an important tool, but not one that we think is a priority right at this moment. We are focused on the vaccines. It is beyond doubt that this Indian 2 variant particularly hits those who are not properly vaccinated—and by “properly” I mean “have had two doses and two weeks”. Those who have forgone either their first or second dose are particularly vulnerable, and you have only to look at the infection data and, particularly, the hospitalisation data to understand that.

That is why we have rolled out surge vaccination in those areas. What that means is a huge amount of communication, a huge amount of engagement with the communities and the presence of various mobile vaccination units sent directly into the heart of the communities to provide different channels and mediums by which people can step up for their vaccine. The response has been extremely strong and I am touched, as I have said, by the videos of people in some of those communities, particularly in Bolton, where people have queued up for their vaccines. I pay tribute to the DPHs and local authorities that have facilitated that programme.

[Baroness Brinton (LD) [V]]

I echo the gratitude of the noble Baroness, Lady Thornton, to the Minister for his stamina this morning. Can he say whether each of the 121 local authority areas reporting cases of Covid variant B16172 are being given specific extra resources for mass surge test, trace and isolate and arrangements for surge vaccination on top of their planned allocation for this financial year? Can he say when the pilots for extra help with self-isolation will conclude? When would any likely rollout of a proper approach to supporting those who have to self-isolate, including paying their wages, start?

[Lord Bethell (Con)]

My Lords, the noble Baroness alludes to a dilemma that we face. It is not possible to organise surge testing and have pinpoint outbreak management in 120 different areas. That is just too many and our resources do not stretch to that. Many of the outbreaks are substantial clusters. Sorry—let me phrase that better. There is a small number of very substantial clusters in the towns and cities of which noble Lords will be aware. That is where we are focusing the surge testing and surge vaccination. In the other areas, we are working with DPHs to ensure that they know the best way to target the particular behaviours of the India 2. That means that it has very high transmissibility, which requires an extremely quick reaction to school and workplace outbreaks, and within specific communities. That kind of briefing and guidance has been channelled through the Chief Medical Officer’s department and the kinds of infrastructure that I described in my answers to previous questions. The response has been extremely strong and I hope we are making some impact on the spread of the India virus, but we remain extremely vigilant.

[Baroness Hollins (CB)]

My Lords, my question is about the implementation of quarantine regulations. How many travellers have been required to repeat the 10 days required in a designated quarantine hotel for a second 10-day period, with or without a positive Covid test? What appeal arrangements are in place because public guidance does not mention any? Is there any risk of exploitation?

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, I must admit that I am not aware of a large number of people having to repeat their 10-day isolation, so let me look into that and I should be glad to write to the noble Baroness.

[Lord Forsyth of Drumlean (Con) [V]]

My Lords, in the light of the extraordinary personal vendetta that Dominic Cummings is pursuing against the Health Secretary and the Prime Minister, is it not obvious that the Government must now bring forward the official inquiry into the handling of the pandemic promised by the Government so that the public do not have to rely on a partial, self-serving account, fortified by hindsight?

[Lord Bethell (Con)]

I am extremely grateful for my noble friend’s remarks. The inquiry will, as he says, provide an important moment to look at the lessons that we can learn from the response to the pandemic. The Prime Minister has given extremely clear reasons why the timetable is as he described and we should stick to the timetable that he has suggested.

[Baroness Donaghy (Lab) [V]]

My Lords, I understand the Minister saying that he is focusing on the vaccines and surge testing. I even understand his reply to the noble Baroness, Lady Brinton, that one cannot have surge testing in 120 areas. However, I want to go back to the Bedford issue. Despite the director of health, the mayor and the local MP spending nearly a fortnight saying that the Indian variant was just as bad in Bedford as it was in Bolton, the surge testing took place days later. What weight is given to the advice from the local directors of health? There seems to be an imbalance here because it is the Government’s decision rather than that of the local directors. Can the Minister assure us that there is not a change in policy on this? He stated:

“We are … looking to see how we can communicate more effectively with local authorities”.


Actually, the local authorities are communicating effectively with the Minister. Has there been a change of emphasis on this?

[Lord Bethell (Con)]

Let me assure the noble Baroness that there has absolutely not been a change of policy at all. There are clear channels of communication from DPHs and local authorities to the contain secretariat at NHS Test and Trace, which can mobilise the community testing resources. I am not aware of there being a large glitch in the provision of resources to Bedford but I should be happy to look into it, given that it has been mentioned by two noble Lords. I should be glad to write to her to see whether there is anything that we should be improving specifically for the city of Bedford.

[Lord Loomba (CB) [V]]

My Lords, is the Minister aware of the desperate need for second vaccine doses in Nepal? While the majority of the most vulnerable old people have had their first doses, the suspension of exports from India means that they now cannot get second doses and time is running out. Will the UK offer doses to rectify that situation?

[Lord Bethell (Con)]

My Lords, the noble Lord points out an extremely challenging situation, particularly in Nepal, but, frankly, all around the world there is a global pressure on the supply of the vaccine. Britain has contributed enormously to that through COVAX, our financial support and the AstraZeneca vaccine, whereby nearly half a billion vaccines worldwide have been run through the profit-free AstraZeneca process. However, we are aware of the situation in Nepal. My noble friend Lord Lancaster spoke movingly in his debate on the matter in this Chamber and we take note of the particular needs of that country.

[The Deputy Speaker (Lord Russell of Liverpool) (CB)]

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

Heathrow Airport: Border Control Passenger Safety

Lord Bethell Excerpts

Tuesday 25th May 2021 Lords Chamber

[Baroness Randerson]

To ask Her Majesty’s Government what steps they intend to take to improve the safety of passengers queuing at border control points at Heathrow airport.

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

My Lords, Heathrow Airport has extensive measures to ensure the safety and well-being of passengers and we have been working closely with it, Border Force and others to facilitate as smooth and safe a journey as possible for all passengers. In addition, Heathrow will shortly begin a trial in which direct flights from red list countries arrive into a dedicated terminal, helping to focus operational capacity and reduce mixing between passengers from red, amber, and green list countries.

[Baroness Randerson (LD)]

My Lords, there have been three-hour queues at Heathrow with passengers crammed together, yet aviation is flying at only 15% of its capacity and Border Force says that it is working at full strength. This is the latest in a catalogue of errors by the Government in their border policy. Can the Minister tell us why the Government did not properly ensure that passengers were separated out at Heathrow from the start? When will they have the additional fully trained Border Force staff to provide a safe and efficient service?

[Lord Bethell (Con)]

My Lords, I also saw the images circulating last week of queues at Heathrow Airport, and I agree with the noble Baroness that we do not want to see a repeat of those kinds of scenes. However, I do not agree with her analysis. The Managed Quarantine Service has worked extremely well, and I pay tribute to Border Force for its contribution—we have more Border Force staff working today than we did during the 2012 Olympics. It does, unavoidably, take between five and 10 minutes for Border Force personnel to process each passenger; that is an unavoidable bureaucratic burden, but we have taken the necessary steps to ensure safe travel and minimise the circulation of mixed passengers within the terminals.

[Lord Rogan (UUP)]

My Lords, widespread concerns have been raised by travellers arriving at Heathrow, but clearly there are many other border control points in this country. That being the case, can the Minister give a commitment to urgently share the lessons that are being learned at Heathrow with airport authorities in Belfast and Londonderry? As we begin to welcome family, friends and tourists back to Northern Ireland, after the most testing of periods for the Province’s travel and tourism sectors, there is real concern that our relatively low infection rates could take a turn for the worse if common sense and procedures are not followed in all terminals. As the United Kingdom, we simply cannot afford to get this wrong.

[Lord Bethell (Con)]

My Lords, I completely and utterly acknowledge the concerns expressed by the noble Lord and by communities who live proximately to regional airports. As we look to the opening up of more airports, we are enthusiastically and energetically engaged with those communities. I reassure the noble Lord that the systems that we have in place around both red and amber quarantine have extremely tight restrictions on them, and there is no evidence of leakage into the local communities. We are doing our best to communicate that fact to those who are concerned.

[Baroness Altmann (Con)]

My Lords, Heathrow deserves credit for a number of the measures that it has been taking: dedicated channels for red-list arrivals, trialling a separate terminal for arrivals, and escorting people to separate areas. Would my noble friend agree that, if red-list arrivals are required to wait longer than others, there is justification for that? I hope that my noble friend will not consider stopping the opening up of further travel opportunities because of concerns about the spread of new variants in a population that has been so extensively vaccinated already.

[Lord Bethell (Con)]

My Lords, I join my noble friend in paying tribute to Heathrow, which has worked extremely hard, in a collaborative spirit, with the very difficult, challenging and often fast-changing border and quarantine arrangements. As she quite rightly says, its commitment to the red-list terminal pilot is extremely encouraging. However, I am afraid that I cannot give her the reassurance that she seeks on our mission to ensure that variants of concern that might have an impact on the vaccine will not be diligently and ruthlessly excluded from the country. It is our duty to protect the vaccine, and we will take whatever steps are necessary to do that.

[Lord Houghton of Richmond (CB)]

I draw the House’s attention to my relevant interests in the register. It seems to me that the current pandemic will pass but the future threat will not: mass air travel will return and, with it, so will the risk that, once again, it will become the principal vector by which a localised epidemic could become a global pandemic. Therefore, I ask the Minister: what action are the Government taking to find suitable technological solutions that provide early detection of airborne pathogens within aircraft in transit in order to then take measures to avoid the risk of mass cross-contamination in airport terminals? Who in government is the focal point for such activity?

[Lord Bethell (Con)]

My Lords, the noble Lord is right: this is a 21st-century problem that we may well be living with for the rest of our lives. It is absolutely right that we look at the best and latest technology to try to mitigate risk and reduce the impact on the things that we love doing, including global travel. However, the image that he cited is a little far away at the moment, I am afraid: we are struggling to get accurate tests from a gob of spit, let alone from the air in an airport cabin. However, we are meeting with the firms who are investigating these kinds of technologies; that is done through the innovations and partnerships department of test and trace, and we are hopeful that those technologies will emerge.

[Lord Blunkett (Lab)]

My Lords, I draw attention to my interests in the register. It is very welcome that red-list passengers will now be separated, but, the longer the queues, the more likely the infection is to spread. It cannot be right to take 10 minutes per passenger to clear them through the system. Surely we can use the kind of evidence that is being used in other parts of the world, get our act together and, with the help of this excellent Minister and the noble Baroness, Lady Williams, put pressure on the Health Secretary and the Home Secretary to put even more resource in, and, above all, use technology and the experience in the rest of the world to get this right.

[Lord Bethell (Con)]

The noble Lord is entirely right: this is exactly what we have sought to do—namely, to front-end a huge amount of the administrative burden into the passenger landing form through the CMS computer system so that all the bookings, details and testing are pre-prepared before anyone arrives in the terminal. None the less, travel in the days of a pandemic is a complicated affair. Some people are trying to skip out on their responsibilities, and therefore there is an administrative burden. We hope to roll out e-gates for both the amber and red lists, once the red-list terminals are open. This will take a great pressure off the passenger point.

[Baroness Brinton (LD) [V]]

My Lords, how many of the passengers who flew in from India between 2 April and 23 April have now tested positive for Covid? If the Minister does not have the data to hand, please could he write to me with it? Given the guidance—slipped out by Ministers last week—for Hounslow residents to stay at home because of the Indian variant, what advice are the Government giving to all workers at Heathrow, whether they are from Hounslow or not, to keep them safe from Covid?

[Lord Bethell (Con)]

I do not have the statistic that the noble Baroness asked for, but I would be glad to write to her with it. The surge testing and vaccination in areas of VOC outbreak are now in many communities up and down the country that are not correlated with the presence of airports. They are distinct and specific to each of those communities: we work with the local DPH to ensure that the local outbreak plan is tailored to the needs of that community.

[Baroness Nicholson of Winterbourne (Con)]

Can the Minister reassure his noble colleagues that sufficient attention is being paid by the already overworked Heathrow staff to heavily disabled passengers, such as Dr Ros Sinclair, who is a post-polio victim, with all that that implies? Although there is now a distinction between red and amber, highly vulnerable people will none the less suffer if amber lists and disabled passengers are merged. Is there any possibility of entirely separate lanes for those who are disabled?

[Lord Bethell (Con)]

My Lords, I pay tribute to the officials, Heathrow and the carriers for the provisions that they have put in place for those who have exceptional needs for travel. It is a truth that many people travel for health needs, and many must travel in order to address difficult circumstances that they may have. Therefore, it is entirely right that we put in place a system of exemptions and support for those who are either elderly or have some form of disability. My noble friend is entirely right that it is an unfortunate consequence of the administrative burden of red and amber processing at our ports that there are serious delays, and they fall most heavily on the vulnerable.

[The Lord Speaker (Lord McFall of Alcluith)]

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

Covid-19 Internal Review

Lord Bethell Excerpts

Thursday 20th May 2021 Lords Chamber

[Baroness Merron]

To ask Her Majesty’s Government whether they will publish their internal review of the handling of the COVID-19 pandemic.

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

My Lords, I start by welcoming the noble Baroness, Lady Merron, to the Bench; I am very much looking forward to working with her in the months ahead. The Prime Minister confirmed on 12 May that a public inquiry will be established on a statutory basis to consider the Covid-19 pandemic, including the Government’s handling of it. I can confirm that while DHSC officials carried out a routine internal ways-of-working review, this was absolutely for the purpose of providing advice to Ministers only.

[Baroness Merron (Lab)]

My Lords, the National Audit Office report published yesterday both highlighted the need for the Government to learn lessons at speed and advocated greater transparency. Publishing an already completed internal review of the Government’s handling of the Covid-19 crisis would support a plan to contain the threat of new variants, and I urge the Government to do so. I am interested to know whether the Minister can come to agree with me on this. With experts, including SAGE, warning that it is very much in the balance as to whether further restrictions will be lifted in June, given the dramatic rise in Indian Covid-19 variant cases, will the Government learn the lessons and urgently review travel and quarantine arrangements?

[Lord Bethell (Con)]

My Lords, I absolutely agree with the noble Baroness that we are at a pivotal moment in the pandemic; matters are on a knife-edge. There is so much good news about the effect of the vaccine that we should celebrate, but there is enormous jeopardy in the threat posed by variants. That is why we are very much focused on dealing with the pandemic before us. The inquiry promised by the Prime Minister is for spring next year, and until then we will continue to be focused on today’s pandemic.

[Lord Scriven (LD)]

My Lords, Professor Andrew Hayward, a member of SAGE, this morning said that he thinks we are now at the start of the third wave and that more generalised measures will be needed. As an adviser to government is saying that we need to act and plan now, what generalised measures are the Government planning and when will they be announced, so that people and businesses do not have just 24 hours to plan?

[Lord Bethell (Con)]

My Lords, we are enormously grateful for the advice of SAGE, which, as the noble Lord will know, is a very large collection of scientists, many of whom have many different views. The JBC takes their advice into account, and we are absolutely monitoring the situation as closely as we possibly can. We celebrate the transparency with which the very large amount of surveillance data is handled and published for public analysis. Measures are in place on testing, therapeutics and social distancing, but the number one measure is the vaccine. The rollout of the vaccine is what will give this country the protection it needs.

[Lord Robathan (Con)]

My Lords, I reiterate my congratulations to the Government and all those involved in the fantastic success of the vaccine development and rollout programme. This inquiry does not need to be long and drawn out. Will my noble friend confirm that it will look into the accuracy of—and contradictory nature of some of—the scientific advice received over the last year, the appalling scaremongering of some of the media, the validity of political decisions such as lockdowns, and whether the government reaction to the pandemic, and the reaction overall, has been proportionate?

[Lord Bethell (Con)]

My Lords, the Prime Minister promised on 12 May that there will be a statutory inquiry beginning in spring 2022, as my noble friend alluded to. Its chair and terms of reference will be announced before spring 2022, and it will be for the terms of reference and the chair to determine exactly what subjects are looked at.

[Baroness Andrews (Lab) [V]]

My Lords, I ask the Minister to return to the first Question asked by my noble friend—she asked two—which he overlooked. Does the Minister agree that publishing the internal review could strengthen the strategic plan to contain new variants? Does he agree with me that it would certainly raise public trust and that, because of the inordinate delay until next year in starting the public inquiry, it surely makes sense? Even if this is not a public-facing review, it is of such public interest that he should publish the internal review.

[Lord Bethell (Con)]

My Lords, as I said before, there was an internal ways-of-working review into the department’s early response to the pandemic, way before the threat of variants was on the horizon. None the less, it is our commitment to focus on the pandemic and the threat presented to us by its future evolution. That is why we are focused on today’s measures. We will leave reflection on the past to the inquiry.

[Lord Balfe (Con)]

Does the Minister see that we will keep on having variants of this virus and, to an extent, will have to learn to live with it? I am sure people would be much happier if we were to downscale the amount of advice that we get from a variety of often dubious sources. The sooner we can publish an inquiry into it, the better. We must recognise that the Government faced an enormous challenge. Overall, they have come out of it pretty well, and we should not carp.

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, I am enormously grateful to my noble friend for his comments. I know he has been a vocal critic of some things, and I take his comments in very good measure. On his point on guidance, this is not how the public have presented things to us. They want clear, easy-to-understand guidance. We have learned the importance of publishing in many languages and now regularly publish in 10 spoken languages. The public are in fact hungry for detailed guidance, which is why we have published more than 400 pieces of guidance on GOV.UK, covering everything from funerals, care homes and schools right through to smokers, vapers, houseboat dwellers and singing with children. That is because the public would like to have this kind of advice and recommendation.

[Lord Flight (Con)]

My Lords, I congratulate the noble Lord, Lord Bethell, on how professionally he handles his responsibilities in the Lords. I am sure he will support the Prime Minister’s announcement that a full inquiry will be held next year, beginning in the spring, which will place the state’s actions under the microscope. The existing internal lessons-learned review was an informal exercise, not a public-facing work, which I believe will not be published. It would be wrong to publish it. While there have inevitably been some mistakes, I congratulate the Government and the noble Lord, Lord Bethell, on having got Covid-19 vaccinations moving significantly faster than the EU. I hope he will exceed the speed limit even more.

[Lord Bethell (Con)]

I am enormously grateful for my noble friend’s kind comments. On his point on vaccines, I emphasise the enormous contribution of the whole union behind the vaccine project. It has been a union project to deploy vaccines to every person in the UK at amazing speed and with consistency right across all parts of the union. For that we should be enormously grateful.

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

My Lords, while we all here respect that health is a devolved responsibility, does the Minister not agree with me that one of the problems that arose was the confusion arising from different rules in different parts of the United Kingdom and different messages throughout the United Kingdom? In the inquiry, will the United Kingdom Government talk with the devolved Administrations to make sure that, in future, there is a more co-ordinated response? The virus knows no boundaries.

[Lord Bethell (Con)]

My Lords, the Prime Minister will define the terms of reference and the chair will define how the inquiry deports itself. On the noble Lord’s point about the rules and the suggestion of confusion, I agree that there was a lot of heat and smoke around differences but the truth is that 99% of everything that we did between the different parts of the union was exactly the same. There was a lot of focus on very small differences, but what I celebrate is how much common ground there was in our responses.

[Baroness Altmann (Con)]

My Lords, I echo the congratulations to my noble friend on his dedication to his role, and I welcome the noble Baroness opposite to her position. I join other colleagues in congratulating the Government on their successful rollout of the vaccine, which, from what we can see so far, deals with the variants that have arisen and allows us to open our country back up again after the extraordinary efforts that have been made in connection with the vaccine. In connection with any review, will there be an urgent announcement of an investigation into the way that social care was handled, particularly at the beginning of this, for those people who are so reliant on home care or care homes for their very survival?

[Lord Bethell (Con)]

My Lords, I do not think I need to speculate on this matter; of course social care will form part of the inquiry. It has been an incredibly important part of our response, and we have come a long way in the last 14 or 15 months. I pay tribute to all the people who work in social care, and their leadership, who have done an enormous amount to protect those who live in social care or are supported by it. We as a country have learned a huge amount about how to protect those who are vulnerable and those who are elderly. I also pay enormous tribute to the public, who have made huge sacrifices to protect and save the lives of those who live in social care.

[Baroness Uddin (Non-Afl)]

My Lords, I welcome the noble Baroness, Lady Merron, to her position and look forward to hearing from her. I too pay tribute to the Minister and the Government, including my friend in the other place, Nadhim Zahawi, who has led this very effectively. It is so pleasing to see the uptake of vaccines in all parts of our countries and communities. While we are not privy to any internal findings of the report, does the Minister accept that any current or future review must address the detrimental economic impact on women, people with disabilities and those communities of minority heritage that suffered significant loss of life in the early days? Will such a report also therefore consider whether the lessons of the first wave were learned, and unnecessary deaths and infections subsequently prevented?

[Lord Bethell (Con)]

My Lords, it is not for me to define exactly what the scope of the inquiry will be but the noble Baroness’s points are extremely well made. I emphasise the importance of women. We are in the midst of consultation on the women’s health strategy. It is proving to be an incredibly impactful process and events are being held almost daily. I encourage all noble Lords to submit evidence to the health strategy on any issues that they feel strongly about. This could be a really impactful turning point in the way in which the health of women in this country is massively improved.

[Lord Dobbs (Con)]

Does my noble friend agree that publishing an internal review right now would do nothing less than risking a dodgy dossier, of the sort we have seen before which shed far more confusion than light? Does he not think that the most important use of time right now would be in getting to grips with the anti-vaxxers who are spreading vicious lies, so that we can get on with vaccinating as many people as possible and bringing this country together as quickly as possible?

[Lord Bethell (Con)]

I am extremely grateful to my noble friend for his comments. He is entirely right. The battle against anti-vaxxers has been very successful. We have used a spirit of dialogue with people who have very personal and legitimate questions about a vaccine that requires an injection of fluids into their body. People quite reasonably have detailed questions about its impact. I applaud officials and partners of the Government who have been so effective at conveying the message on the safety and efficacy of the vaccine. It really has demonstrated the power of government and NHS communications at their best.

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

My Lords, I join the chorus of welcome to the noble Baroness, Lady Merron, who referred, as have other Peers, to the National Audit Office report on the handling of the pandemic. Commenting on that, Gareth Davies, the head of the NAO, stressed the need to “learn lessons at speed”. The Minister has often expressed how useful and informative he has found the contributions in your Lordships’ House. Would those contributions not be better informed if Members could absorb and reflect on the findings of the internal review as the country and the world continue to deal with what is, certainly on the global level, a raging and deeply dangerous pandemic?

[Lord Bethell (Con)]

I am enormously grateful to the NAO for the powerful report that it has published. It said many complimentary things about the Government’s handling of the pandemic. I am grateful to noble Lords for the counsel and challenge that they have given here in this Chamber. I point out the vast amount of data and information that we have published, which is at the disposal of the public and parliamentarians. However, confidential advice from officials to Ministers on a means-of-working review is not the kind of thing that I think adds to this sort of debate, and for that reason it is most appropriately kept confidential.

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

My Lords, this morning on BBC News there has been a suggestion that the Indian variant has been due in large part to ineffective track and trace. Would the Minister like to comment on that?

[Lord Bethell (Con)]

My Lords, I do not think that is correct. The noble Baroness is right to ask the question because we should always challenge our systems, but track and trace has really delivered for the country when it comes to the containment of the variants. We were extremely concerned about the Manaus variant. That was why we instigated Project Eagle, an intense application of testing in communities on a very large scale and forensic tracing, putting huge resources into tracking down the movements of those who tested positive with a VOC. We then had the South African variant, which has been successfully contained. We could not have imagined that an Indian VOC of this kind could make its way into this country with such high transmissibility, and I pay tribute to those working in track and trace who have bought us an enormous amount of time so that we can bring in surge testing and surge vaccination to contain and minimise the spread of this variant.

[The Deputy Speaker (Baroness Garden of Frognal) (LD)]

My Lords, all supplementary questions have been asked and answered.