Covid-19 Internal Review

Lord Scriven Excerpts

Thursday 20th May 2021 Lords Chamber

[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.

Covid-19 Update

Lord Scriven Excerpts

Tuesday 18th May 2021 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for being here to take this Statement. We keep meeting like this; it is over a year now. I wonder whether our relationship needs to move on.

The Covid variant first detected in India looks as though it has now seeded in 86 areas and is set to become the dominant strain in the UK within the next few days or weeks. Indeed, many experts think that it was a mistake for the Government to go ahead with the easing of lockdown restrictions implemented yesterday. I suppose that there must be increasing doubt about whether the further lifting of lockdown measures will be able to go ahead as planned next month. I will not ask the Minister to give any definitive answers on that because I absolutely accept that uncertainty is the name of the game. However, I quote one of the four tests that the Government set out for proceeding with the road map out of lockdown, which is if

“our assessment of the risks is not fundamentally changed by new Variants of Concern”—

in other words, if there are new variants of concern, that may be the issue. Is this still the case?

The Royal Statistical Society, which promotes the proper use of data, is concerned that the Government have failed to publish the information justifying their decision that stage 3 of lockdown easing should go ahead because the new variant threat has been met. Will the Government publish the framework for that decision and the data that fed into it so that people can be assured that the facts justify the policy? Can the Minister confirm reports in the Times that officials have drawn up plans for local lockdowns modelled on the tier 4 restrictions introduced last year, and that, under these measures, people will be advised to stay at home and non-essential shops and hospitality will be closed, if the new strain is not brought under control?

On Bolton and Bedford, I regret to say this, but it seemed that the Secretary of State reverted to a blame game yesterday, perhaps to deflect from the fact that the Government did not do enough to protect us from this new variant. He said that people infected by the new variant in hospitals in Bolton had refused or not taken up the vaccine and had chosen not to take the jab. I felt that was very unfair.

My honourable friend the MP for Bolton, Yasmin Qureshi, says that the vaccine is not easily accessible to some of the poorer and BAME communities in Bolton: for example, some people have to take three buses to get to the vaccine centre in the centre of the town. If you are not mobile and do not have flexibility in your working hours, or are a key worker and have caring responsibilities in a multigenerational household, you are not refusing the vaccine if you cannot get to it.

Turning to Bedford, the Secretary of State, Matt Hancock, has said that Bedford is now to be among the areas given surge testing, as the borough recorded the second highest rates of Covid-19 infection in the country, and that cases were doubling every five days. This comes after the MP, the mayor and the health chiefs all called on the Government to act quickly to prevent further spread of the variant in Bedford. For days they have felt ignored. They have felt that the Government wanted to recognise the new variant as a northern problem, which clearly is not the case because it is in Bedford. My honourable friend Mohammad Yasin MP said that, after a fair bit of dither and delay, he welcomes surge testing in Bedford.

Can the Minister tell us whether it is true that Bedford has no access to the Pfizer vaccine at the moment? This must limit a comprehensive vaccine campaign in that town; you cannot do a comprehensive vaccine campaign, especially if you are dealing with the under-40s, if you do not have two or three of the vaccines that are available. I am aware also that reports of many people choosing to delay their jab were about concerns over side effects and whether they would be available for work or might struggle to manage their responsibilities. So the Government must give resourcing and support on these issues and improve the flexibility, information and understanding at a local level.

The Minister is also aware that achieving the truly remarkable vaccine take-up among adults will still leave 20% of the wider population—our children—unvaccinated, meaning of course that the virus can still spread. So can he update the House on any plans to vaccinate the under-18s? It also remains unclear for how long vaccines prevent Covid-19. Initial studies suggest that it may be six months, or possibly longer. Well, those who were vaccinated in December are rapidly approaching that. So we need to know whether there will be declining protection from Covid and what assessment the Minister has made of this risk. Can he update the House on plans to roll out booster shots this autumn?

Finally, at this critical time when we need to work internationally, why are we the only G7 nation cutting our aid budget? How can the Government defend cutting our contribution to vital science and research projects? Given the Government’s total silence on President Biden’s support for the temporary lifting of patent protections to increase vaccine production, should we assume that the British Government do not agree with the President?

[Lord Scriven (LD)]

My Lords, I too thank the Minister for coming before the House to deal with this Statement, and also for his work ethic in dealing with Covid-19 over the last 14 months.

From these Benches, we have always said that we will support whatever is proportionate and follows evidence to keep people safe. The more that you delve into the Government’s reason for not including India on the red list at the same time as Pakistan and Bangladesh, the more it feels like a big ball of candyfloss that initially seems tempting but disintegrates on touch. Yesterday, both the Minister and the Secretary of State said that India was not put on the red list at the same time as Pakistan and Bangladesh because of the positivity rate.

Looking at the figures for the two weeks before Bangladesh and Pakistan were put on the red list, the positivity rate for India was 5.1%. For Pakistan, it was slightly higher at 6.2%, yet for Bangladesh it was lower, at 3.7%. The same data—the Government’s test and trace data—shows that in the same two-week period, 50% of all new variants entering the UK, including those of concern, were from India: the largest country by far. Therefore, variants of concern and positivity rates show India to be on a par with, or ahead of, Bangladesh and Pakistan. So what data were the Government actually using, if it was not their own test and trace data? Can the Minister place on the record that data and the raw data which made him, and the Secretary of State, say that India’s positivity rate was three times higher?

Another area of concern is people entering the UK being huddled together at the border with people entering from red-list countries. One needs only to look at the significant Twitter feeds from yesterday of people arriving from green or amber countries, who were spending up to four hours in queues to get over the UK border and having to stand next to and mingle with people entering from red-list countries. Heathrow and Manchester Airports were responding that, despite asking the Government for more border staff to deal with the issue, none had been forthcoming.

This was planned. We knew that international travel was allowed and the Government knew that the traffic-light system was being introduced, so why have the Government not carried out the wishes of the airport operators to ensure that more border staff and more guidance are available to segregate those entering from red-list countries? This is a clear public health crisis at our border, and the Government have not, to date, solved it. So, as a matter of urgency, when will this public health breach right at our borders be solved?

Finally, as variants of concern continue to enter the country and replicate at speed, “isolate, isolate, isolate” becomes vital. Yesterday, the Secretary of State in another place indicated to Munira Wilson MP that the Government were worried that isolation might not be as robust as required, and that some pilots were taking place. Can the Minister outline where they are, what the parameters of the pilots are and when the results will be made public? Also, overwhelming evidence now shows that people on lower salaries must be paid their full wages and given support to ensure that they can comply with full isolation requirements. Will the Government now look at this as a matter of urgency?

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

My Lords, I am enormously grateful for the very detailed and thorough questions from the noble Baroness and the noble Lord, and I am also appreciative of and touched by their kind comments.

The noble Baroness asked about the Indian variant and the uptake of the vaccines. I reassure her that we are doing absolutely everything that we can to ensure that there is a thorough uptake of the vaccine among all communities. She spoke touchingly about the feeling of blame associated with those in hospital who people hear have not taken the vaccine. I hear her comments, but there is no attribution of blame meant in this. It is a simple statement of fact that if you do not take the vaccine that is offered to you, or if you do not take two doses, and you then expose yourself to the virus, that is putting yourself in substantial danger, and it is a clinical observation that many of those who have ended up in hospital with severe disease are those who have not had the vaccine, even though they may have been offered it.

The noble Baroness asked about accessibility. She is entirely right that there are some people to whom we as a healthcare system have not made ourselves accessible enough. During this pandemic we have moved on from using the phrase “hard to reach” and we now think of it in terms of people who find us “hard to access”. She makes a perfectly reasonable observation in that respect, but I reassure her that we have absolutely bent over backwards to do everything we can to put the vaccine in front of all groups in the country, particularly those in areas such as Bolton, which we recognise have in the past been places where we have not got our message across.

I personally am hugely touched by the videos I have seen of people now queueing to have the vaccine. I applaud all community leaders and those who work with communities in Bolton, who have clearly mobilised a huge amount of public sentiment behind the vaccine programme. We are seeing a transformation in the penetration rates among some very important communities.

There is more that we can do. I am open to any suggestions from noble Lords on how we can do better, but I would like to reassure noble Lords that we have strained every sinew in trying to achieve vaccine equity across all groups in the country. That is true not only in Bolton but in Bedford, and I am disturbed to hear that people in Bedford feel they may have somehow been overlooked. I do not believe that is the view of the Vicky Head in Bedford, the DPH, and we have worked extremely closely with her. I assure the noble Baroness that cluster 2, linked to 12 cases in Bedford, was targeted immediately. An MTU went to the community on 8 May, and two community sites were opened up on 10 May. We have absolutely prioritised Bedford, as we have Sefton, Leicester, Nottingham and London—all areas where clusters have broken out. There is absolutely no question of prioritising one area over another. On the availability of the Pfizer vaccine in Bedford, that is news to me. I will be glad to look into that and to write to the noble Baroness accordingly.

On children, as noble Lords will be aware, this is an area in which some of the vaccine companies are making considerable progress in their clinical trials. None is categoric yet. It is too early to have agreed policy in this area, but the noble Baroness makes a very good point. Opening up the Covid vaccine, as we have with the flu vaccine, means that not only are children with some kind of vulnerability, particularly to long Covid, put into a safe place but that the transmissibility of that important age group can be reduced.

I am afraid we cannot know for certain the long-term effect of the vaccine until time has passed, but the CMO’s view is that the indications on the body’s immune system are extremely strong. At this moment it seems the vaccine is working, and our confidence is at a reasonably high point, but we remain vigilant. VoCs could emerge that either reduce the effectiveness of the vaccine or, for instance, effect some kind of decline in protection from the vaccine. That is why we have put in place contingent plans for boosters in the autumn. Those boosters might be of the existing suite of vaccines that are proving extremely effective. We are also looking for VoC vaccines that may be used to supplement the range of immune responses so that they cover any new mutations or variants that may emerge.

I cannot immediately recognise from the Bench the data the noble Lord, Lord Scriven, gave on the India VoCs. I wonder whether it was data that emerged after we made the decisions, because a lot of the sequencing data is retrospective; it takes between a week and 10 days to emerge from the Sanger Institute. That is one of the difficulties in making these decisions, which sometimes seem so clear-cut in retrospect. When you have the data available to you on the day, the decisions are not necessarily quite so apparent.

I do not really recognise the criticisms the noble Lord makes of the red list system. The red list system we have in the UK is an incredibly important shield and is proving extremely effective. Segregation is unbelievably difficult during travel. It is very difficult to segregate amber list and red list passengers on a plane, train or ferry. Within an airport it is very difficult to segregate people, because of the physical proximity. That is why travelling is dangerous, why we tell people not to travel and why, when people do travel, we tell them to isolate. Travelling is dangerous, and that is not news to us or to the people who get on those planes in the first place. The ultimate sanction here is that, particularly as we go into the summer, we tell people: travelling is not for this year. Please stay in this country.

On the isolation pilots the noble Lord referred to, we are running a large amount of work on pilots for isolation generally. If he would like to write to me about the particular pilots he was referring to, I will be glad to give him an update. I am afraid I am not quite clear at this stage which ones he is referring to.

Health Protection (Coronavirus, Restrictions) (Steps and Local Authority Enforcement Powers) (England) (Amendment) Regulations 2021

Lord Scriven Excerpts

Monday 17th May 2021 Grand Committee

[Lord Scriven (LD)]

My Lords, these regulations were laid on 7 April. It is ironic that we are discussing them today, as we start moving to step 3. If they had been discussed earlier, the facts on 9 April might have been raised to help us keep all local areas safer. On 9 April, Bangladesh had the South African variant but not the Brazilian variant but was put on the travel red list. Pakistan had neither the South African nor the Brazilian variant on that day but was put on the red list. India had both the South African and Brazilian variants and the emerging Indian variant but was not put on the red list. On 9 April, cases per 100 million on a seven-day rolling average were 21 in Pakistan, which was put on the red list, and 43 in Bangladesh, which was put on the red list. India had 84 cases per million—four times as many as Pakistan—but was not put on the travel red list.

Why, with more cases per million and with both the Brazilian and South African variants present, and the emerging Indian variant, was India left off the red list on 9 April? If the Government had followed the data, it would have been put on the red list. However, the Government were following a date—24 April—so that the Prime Minister could go on a trade mission. Dates, not data, yet again, will cause problems for individuals, families and businesses. In the period between 9 April and putting India on the red list, 900 people a day entered the country—nearly 20,000 people. They could have been carrying the South African, Brazilian or new Indian variants.

One can only assume that this was yet another abject failure of government to act with speed and good judgment to secure the nation’s borders and keep people safer. When trade deal trips trump the public health and safety of individuals and businesses, you have to ask when a government Minister will take responsibility and resign. By not putting India on the red list and by following a date and not data, the Government have put businesses and individuals at risk of illness, death and bankruptcy. It is time now for an independent inquiry to learn lessons and to put in place secure border restrictions to ensure that people stay safe and what we see in Bolton is not replicated in any other community in this country.

Office for Health Promotion

Lord Scriven Excerpts

Thursday 29th April 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, Covid has been an extremely important educational experience; we have backed off from using the idea of “hard to reach”. Instead, we try to be much more effective at making ourselves approachable for the kinds of people the noble Lord talks about. He is entirely right that the levelling-up agenda means nothing if it does not mean levelling up health outcomes; we are very focused on addressing the kind of health inequalities he refers to. That will be a central mission of the whole project.

[Lord Scriven (LD)]

My Lords, I declare my interest as a vice-president of the Local Government Association. The public health grant to local authorities is 20% lower per head in real terms than it was in 2015-16. Restoring spending per head to this level would require an extra investment of £1 billion. How can poor health prevention and promotion of well-being be achievable and sustainable with such reductions in local public health funds?

[Lord Bethell (Con)]

My Lords, local public health resources have made a huge contribution in the last year through Covid. I pay tribute to those in local public health who have contributed so much during the pandemic. The grant to local authorities is slightly beyond the scope of the Office for Health Promotion, but the noble Lord’s point is very well made.

Covid-19: Update

Lord Scriven Excerpts

Tuesday 20th April 2021 Lords Chamber

[Lord Bethell (Con)]

The noble Lord is right that the backlog is a grave issue, and we are fighting as hard as we can to address it. The big guns of the NHS are moving from Covid to addressing the backlog, but we should not overstate its threat either. Large parts of the NHS remained open all the way through Covid, and I pay tribute to those in the NHS who worked extremely hard to ensure that many elective procedures and much diagnosis continued. We do them and their reputations no favours if we imply that the NHS was in any way doing less than it should have done to work through Covid. But the noble Lord is right; this is a grave issue, and we take it extremely seriously.

[Lord Scriven (LD)]

My Lords, overwhelming evidence now exists that lower-paid people are less likely to take a test, self-isolate or isolate for the full period, due to not being able to afford to do so. What extra support will the Government now put in place to deal with this Achilles heel of the test, trace and isolate system?

[Lord Bethell (Con)]

My Lords, we put in place a considerable amount of support for those on low wages, including the furlough scheme, and a huge amount of economic support. It is true that those on low wages have wage pressure put on their lives, but we have statutory sick pay for those who are sick and out of work, and we have a huge amount of investment in local government and in charities, which also provide support for those who live in deprivation.

Covid-19: One Year Report

Lord Scriven Excerpts

Thursday 25th March 2021 Lords Chamber

[Lord Scriven (LD)]

My Lords, one year on, when the situation has changed, so should the response and the laws required to deal with the next phase of the pandemic. With over 126,000 people dead and many families missing loved ones this Easter, it should have been a time for the Government to seriously reflect on the approach required for the next stage of dealing with this public health challenge.

Despite some powers being dropped, the number of powers within the Act that have never been used or have hardly been used that will remain on the statute book, and the number that have been used repeatedly and incorrectly but also stay on the statute book, is telling. If the Government were committed to learning to improve the safety and resilience of the nation, they would have agreed to a public inquiry into the response to the pandemic—an independent assessment of what has gone well and what has not gone so well. That would have informed the changes that are needed in this Act and in future SIs.

The powers relating to “potentially infectious persons” under Section 51 and Schedule 21 of the Act have been used a total of 10 times by public health officers, but never by police or immigration officers, yet such powers are now also in the Health Protection (Coronavirus, International Travel) (England) Regulations, made under the Public Health Act. Why have two powers in two different Acts for the same issue?

As other noble Lords have said, the latest Crown Prosecution Service review of Covid prosecutions this week found that all six prosecutions under the Coronavirus Act in February had been incorrectly charged, bringing the total to 252 incorrectly charged, with not a single prosecution that was correctly brought. These powers are clearly not fit for purpose and are used in ways that unlawfully restrict individuals’ liberties—a good reason why nodding through these powers is not in the best interests of citizens or of improving an effective public health response. These powers within the Act should be dropped.

Talking of keeping people safe, in the last year we had the situation of care and NHS staff having at times to wear binbags rather than PPE. Some of the PPE and communications procurements have a stench of cronyism hanging over them, coming to light only when organisations such as the Good Law Project have taken the Government screaming and kicking to court—donations of over £8 million made to the Conservative Party by some of those who have contracts, and existing and established companies thrown aside in favour of those who had links to the Secretary of State’s WhatsApp messaging service or who were able to have meetings with the Minister in this House, who then had the door to the VIP channel opened and subsequently got lucrative deals. Companies with no record in health but who have run local pubs, manufactured pet food, or sold expensive jewellery, carpets and furnishing were given contracts for PPE via the VIP channel—in some cases for equipment that was not fit for purpose and did not meet UK safety standards. All those who had the golden door of the VIP channel open to them were 10 times more likely to get a contract than those established suppliers of PPE who did not get on to that channel, along with the eye-watering fact that up to three times the normal market rate was able to be claimed before serious questioning or auditing of such quotes was done.

I am sure that the Minister, as always, will gloss over this appalling cronyism. If there is nothing to hide, why do the Government still refuse to publish who nominated companies to go via the VIP channel and what recent contact they had had before companies got on the channel? It is telling that the National Audit Office report notes that, in some cases, the appropriate paperwork around those in the VIP channel was not kept. When the public inquiry comes, it will show that, at a time when we required procurement of the highest standards, some were more bothered about greed and used their contacts to pursue that. This review of the Act should have had a clause inserted promoting more open, transparent and ethical procurement.

Back in March 2020, these Benches indicated that the powers in this Act had to be proportionate to the health risk we faced, which required an equal partnership between local and national government to ensure that the response would keep people as safe as possible. On both these issues, the Government did not listen and are still not listening and acting to fully unleash the talents and skills of those in communities up and down the nation to improve the way we tackle public health issues. It is for those reasons that I will support my noble friend Lady Brinton’s regret Motion.

Covid-19: Resuscitation Orders

Lord Scriven Excerpts

Wednesday 24th March 2021 Lords Chamber

[Lord Bethell (Con)]

I will gently push back against the noble Baroness: the policy is absolutely crystal clear. Blanket DNACPR is not the policy of this Government, as was repeated time and time again in our communications, which I would list if I had more time. Training is the issue: we need to give the front-line workforce the skills it needs to apply these very delicate but critical interactions. That is the recommendation of the report, and that is where we are focused on applying the lessons.

[Lord Scriven (LD)]

My Lords, does the Minister agree with Age UK that the report is the tip of the iceberg and requires the Government to bring forward proposals as part of a complete overhaul of the advance care planning system?

[Lord Bethell (Con)]

No, my Lords, I do not accept that the report is simply the tip of the iceberg; it is very thorough and goes into the matter extremely carefully. However, there are important lessons on training to be learned and they will be driven by the ministerial oversight group.

NHS: Pay

Lord Scriven Excerpts

Tuesday 9th March 2021 Lords Chamber

[Lord Bethell (Con)]

I am grateful for the economics lesson from the noble Lord. I will take those recommendations and pass them on to colleagues at the Treasury.

[Lord Scriven (LD) [V]]

My Lords, the £37 billion found for the predominantly private sector-led test and trace system equates to spending more than £1 million every day for the next 100 years. How does the Minister reconcile that with the statement that the Government cannot find the money to fund more than a 1% pay increase for front-line NHS staff?

[Lord Bethell (Con)]

My Lords, the test and trace system is part of an essential response to a virus pandemic that has shaken the world, and the costs of that pandemic are enormous. I regret them very much and wish with all my heart that we did not have to spend this money on our pandemic response, but there is no other way of cutting the chains of transmission and responding effectively to this awful disease. The ongoing pay arrangements for nurses and doctors are commitments that we will live with for years to come, and there is a difference between the two.

Covid-19: Brazilian Variant

Lord Scriven Excerpts

Tuesday 2nd March 2021 Lords Chamber

[Lord Bethell (Con)]

The noble Lord is entirely right. Things are happening around the world which are causing a great deal of anxiety. Stories of possible reinfection in South Africa are extremely concerning and the huge spike in infections in South America has not been properly explained. It is possible that there are a number of mutations, and mutations of mutations, there. The truth is that we do not have the genomic or immunological data that we need to fully understand what is going on. That is why we have taken a precautionary approach, as the noble Lord recommends. We have instituted both managed quarantine and a red list which we keep under review. If we feel it necessary to extend that list, we will do so.

[Lord Scriven (LD) [V]]

My Lords, tracing new variants will be key in the next phase of this public health challenge. So why does the £22 billion test and trace system not have an individual identifier on each test posted to homes, along with an integrated database? This way, every test could be traced back to an individual, regardless of where the test was sent from, or even if a person incorrectly filled in a form.

[Lord Bethell (Con)]

I endorse the noble Lord’s observation that tracing is important. I pay tribute to the Operation Eagle team. The noble Lord will note that the South African variant, which made landfall in the UK, is currently being contained through the immense work of this team. They are throwing a blanket over communities and doing a huge amount of forensic, detective work in tracing variants. As to his specific point, it is possible for someone to walk up to a testing station, take the test, be handed a form and not fill it in. We are trying to understand if those were the circumstances in this case.

Covid Contracts: Judicial Review

Lord Scriven Excerpts

Monday 1st March 2021 Lords Chamber

[Lord Bethell (Con)]

The right honourable Secretary of State for Health and Social Care put it extremely well. For those of us who were there at the time, the priority was saving lives, not publishing contracts or focusing on anything other than the protection of those who work and live in care.

[Lord Scriven (LD) [V]]

My Lords, 25 million masks that could not be used were supplied by a pest control firm in a £59 million deal, while a Mauritius hedge fund got £252 million, and, again, the face masks could not be used. There was also a £70 million contract with a Florida jeweller for gowns that could not be used. Will the Minister commit to a judge-led public inquiry into the handling of such PPE procurement?

[Lord Bethell (Con)]

As the noble Lord knows, I cannot comment on some of those cases specifically because they are subject to legal action at the moment. However, in broad strokes, I say that there were a lot of people who stepped forward to help us in our time of need; I do not condemn them. Some of them came not from the PPE industry but from others. I am extremely grateful to all those who stepped forward to help us when we needed it.