Contact Tracing: Personal Privacy

Lord Scriven Excerpts

Thursday 11th June 2020 Lords Chamber

[Lord Bethell [V]]

My Lords, the greatest insight from the Isle of Wight experiment was that human contact tracing needed to be the first stage of our rollout of the test and trace programme and that, in the sequence of things, the app should come later, when people have got used to the principle of contact tracing. The use of private companies by the Government is commonplace, and we have had no adverse comment on or reaction to that usage.

[Lord Scriven (LD) [V]]

Ten years is the norm for holding medical research data, so what epidemiological reasons require data from the app uploaded to the NHS central database to be held for 20 years?

[Lord Bethell [V]]

My Lords, the data that an individual puts on the app is entirely voluntary. No data is held for more than 28 days until somebody takes a test. Once that test has taken place, the individual has the opportunity to upload further data. That data is held for clinical trials and to help us understand the epidemic. There is the opportunity for us to delete all that data at the end of the epidemic, and that assessment will be made at the right time.

Covid-19: Response

Lord Scriven Excerpts

Wednesday 3rd June 2020 Lords Chamber

[Lord Bethell]

The noble Viscount asks an incredibly broad question, upon which many a treatise could be written. I can best answer by giving my personal experience, which is of being in meetings where the scientists absolutely lead our thinking, where their clinical judgment takes precedence over any lay opinion and where we have been advised by unbelievably impressive and experienced clinicians, epidemiologists and scientists from different groups. My experience is that those voices have been the ones that prevailed in almost every debate. However, not everything can be answered by scientists and there are political decisions to be made. Ultimately, major decisions such as on lockdown, on the strategy for test and trace and on how to run a vaccine strategy are informed by scientists, but politicians have to make big calls. That is the same in every single major national project. I think we have got the balance right. We have tried to put the science, quite rightly, at the heart of the decision-making, and sometimes we have been led into quite politically awkward situations by the good judgment of our scientists. I pay tribute to them and their judgment. My personal experience is that we have listened to and been led by them wherever necessary.

[Lord Scriven (LD)]

My Lords, I remind the Minister that holding the Government to account for their decisions in no way undermines front-line workers, whose jobs have sometimes been made harder by their decisions. As the Government say that we are moving to local flare-ups, which body has full responsibility and legal powers—now, today—to implement and control a local lockdown?

[Lord Bethell]

The arrangements for local lockdowns are not fully in place. In fact, the policy around them is in development and a full decision has not been made on what arrangements we will make for lockdowns. The joint biosecurity centre will be absolutely central to those arrangements. It is the hub into which the intelligence on prevalence and infectiousness comes and which pushes that information out into the local area to help advise directors of public health, local authorities and other local services on local arrangements. I believe that it will develop the expertise and the co-ordination role which the noble Lord asks about.

Covid-19: NHS Contact Tracing App

Lord Scriven Excerpts

Monday 18th May 2020 Lords Chamber

[Lord Bethell]

My Lords, the testing and tracing regime depends on three legs: access to tests; updated methods of the classic contact tracing run by individuals, using phones and the internet; and lastly, importantly but not exclusively, the NHS app. We are very much focused on ensuring that the vulnerable, the elderly and the digitally poor are in no way excluded, which is why we have put the human element at the centre of our plans.

[Lord Scriven (LD)]

Will the Minister give a cast-iron guarantee that, as the app evolves, it will not use location tracking or seek personal identification information as a condition of use?

Health Protection (Coronavirus, Restrictions) (England) Regulations 2020

Lord Scriven Excerpts

Tuesday 12th May 2020 Lords Chamber

[Lord Scriven (LD)]

My Lords, these regulations are about the management of public health, not how to uphold public order. It is, therefore, a great pity that, due to the way that the Government have introduced them, the debate has become mainly about public order. Confusion was initially due to the words and grand statements of Ministers which were, at times, at odds with the actual provisions of the statutory instrument. On exercise, Ministers said, “Once a day, close to home”. Yet the SI does not restrict individuals to that. We had police stopping people unnecessarily and Derbyshire police using drones to shame people walking legally. There were issues around shopping, with Ministers talking about what “essential items” were. Yet the SI does not define essential or non-essential items; it states the law on where you can buy them. We had trolley spying by some police forces and the famous Easter egg debate. None of these was to do with public health issues around Covid-19. The police college had to send out guidance to cut through ministerial soundbites and state what was actually law within the SI. We are taking note of them again but tomorrow, as the Minister said, some of the provisions will change, due to them being out of date and as the new, graduated, measures to release lockdown start.

However, confusion has started again as we debate, not the science of public health, but the words and confusions of Ministers on public order issues. For example, public health advice indicates that you have a low transmission risk if you meet one other person outside your household outdoors and stay two metres apart. Yet the debate is now about the difference between meeting in a park or in your garden. The public health message is again getting lost: it makes no difference to public health, or the transmission of the virus, whether you meet one person outside, at a distance of two metres, in a garden or a park. Are we going to have police tiptoeing over people’s garden fences to see whether they are meeting one other person outside their household?

These SIs, and the new ones tomorrow, will be an important part of public health measures and the management of Covid-19. Will the Minister and the Government keep to that, and not give us soundbites that focus on people in parks or gardens, or on Easter eggs? We need to see these as helping to reduce Covid-19 and enhancing public health and not as a matter of public order where the debate moves away from people feeling safe and knowing to do the right things which the SIs say by law they have to.

Covid-19: Contact-tracing App

Lord Scriven Excerpts

Wednesday 6th May 2020 Lords Chamber

[Lord Bethell]

My noble friend Lady Blackwood is entirely right. The testing and the surveillance done by testing give us powerful insight into the demographic reach of the virus and information on a very broad basis on the regional reach, but we are looking for a much more granular level of detail from the very powerful, multimillion level of detail that the app can provide. The value of those surveillance details has led us to design the app in the way we have.

[Lord Scriven (LD)]

Matt Hancock has said that the app is to flag up our proximity to someone else using the app, not to track our movements. So why do the terms and conditions of the app request access to track our precise location based on GPS or network-based systems?

[Lord Bethell]

My Lords, the app works by using the Bluetooth tags which are shared once you have declared symptoms or you have had a positive test. It does not rely on GPS tracking. If the terms and conditions are broader, that is because we want to try to provide the most thorough set of conditions that encompass all the data provided by the user’s telephone. However, I can reassure the House that it is Bluetooth tagging that is used by the app and the surveillance system.

Covid-19

Lord Scriven Excerpts

Thursday 23rd April 2020 Lords Chamber

[Lord Bethell]

The noble Lord, Lord Liddle, is not entirely right. We have fantastic manufacturing in the UK—I reinforce the view of my noble friend Lady Buscombe that the sector provides jobs for the economy—but we do not have low-margin, high-volume manufacturing. The image of a Burberry gown always sticks in my mind on this point. Burberry makes £500 shooting jackets, but it does not make £5 surgical gowns. That is something that we need to address, and it will be the priority of my noble friend Lord Deighton.

[Lord Scriven (LD)]

My Lords, the South Korean prevalence rate is so low because they have tested, traced and isolated since day one. The Government initially did this and then stopped it. Ten days ago, they said that there would be 1,000 tracers; now, the figure has gone up to 18,000. Why have the Government not kept this system going consistently, which South Korea has proved reduces the prevalence rate of the virus?

[Lord Bethell]

The noble Lord, Lord Scriven, is not correct to say that the Government decided to stop track and trace; there are still PHE track and traces, but when the disease reaches a certain level of prevalence, it simply is not arithmetically possible to track down every new incidence of the disease. Nor is it true that anyone in the Government said that we would have only 1,000 tracers in our call centres. Plans which I have seen are being drafted at the moment which are wildly more ambitious than that. It is our plan to put together a system that is proportionate to the challenge.

Coronavirus Bill

Lord Scriven Excerpts

2nd reading & 2nd reading (Hansard) & 2nd reading (Hansard): House of Lords
Tuesday 24th March 2020 Lords Chamber

[Lord Scriven (LD)]

My Lords, what extraordinary times we live in. Those who have followed Sheffield politics will know that the noble Lord, Lord Blunkett, and I tend to disagree quite a lot on things, but on this occasion, I agree with quite a lot of what he had to say.

This Bill has jaw-dropping and eye-popping powers, which, if we were to have them explained to us in the normal run of the mill, would lead us to think that a military dictatorship had just come in and was trying to get control. However, we are not in normal circumstances when it comes to some of the powers needed to deal with this public health crisis—that is what we need to call it; let us stop using the words of war and talk about the battle to keep people alive and safe. We are in a public health crisis and some of the powers will be needed.

The role of this Parliament and this House over the next two days will be to try to improve the Bill wherever we can and, I hope, to persuade the Government to accept some of the suggestions that will come from around this Chamber. Our role is also to make sure that the powers that the Government and individual Ministers wish to take are reasonable and proportionate to the public health crisis that we face. Some of them will be tough measures, and we understand why, but we will also have to make sure that the Bill’s powers are for the minimum length of time possible and are to deal only with the coronavirus.

A number of provisions in the Bill, particularly those to do with local elections and their suspension, do not refer to coronavirus—in the clauses or the schedules. I understand that the Bill may have been written in haste, but we need to be clear. Every clause and every schedule needs to refer to coronavirus. The power in the Bill for Ministers to extend, for two years, also had no reference to extending purely because of coronavirus.

I would like to explore this issue with the Minister: why six months? If the powers are so broad, why does Parliament and this House not get a say every three months, not just to debate the issue but to get a vote on some of the issues? The powers are so wide and have such effects on individual lives that such a vote is needed.

The social care provisions will mean that the lives of some of the most vulnerable people will become intolerable. If the pressure on local authorities means that they cannot make such provision, which they have to legally, individual lives and families could be shattered. These powers are so wide, with their effects on individuals and families, that three months is long enough. What, in dealing with this public health crisis, would prevent a review at three months?

I declare my interests in the register as a vice-president of the Local Government Association and, like the noble Lord, Lord Blunkett, a former leader of Sheffield City Council. Those of us who have been council leaders will know that many issues arise in a local community in the normal run of things, and local government does not always have the power to deal with them, even though communities look to local government to do so. In fact, local government is probably best placed to make clever, local interventions to deal with the problems that people face. Local government will have to deal with many issues that are not in the Bill. What if the vast majority of refuse collectors get the virus? How will the refuse be collected? If it is not, it will lead to another public health issue, for environmental health officers.

It would be wise to give local authorities a general power of direction on burials and on death so that, if they give an instruction, bodies in their jurisdiction have to act. It will go much wider than death; there will be many things that great planners and people who work in Whitehall have not thought of because the consequences are probably unintended or have not been thought through, but it will be down to somebody in each local area to make significant decisions about what is needed. If we are to help local communities to survive as best they can and deal with the issues that no one has thought of, we will have to give somebody—I suggest that it should be a local authority—a general power of direction. I urge the Minister to look at that carefully.

Finally, I thank the many hundreds of thousands, if not millions, of individuals up and down this country who are volunteering and supporting their local community in trying to get through this, especially the great people on the front line of our NHS and the people who are keeping our shelves stocked. Those local efforts and individual interventions will help communities to get through this.

Covid-19: Vaccine

Lord Scriven Excerpts

Thursday 19th March 2020 Lords Chamber

[Lord Bethell]

My noble friend has an important and exciting idea, and I am grateful to her for communicating it to me in advance of today’s Question. I have already taken the idea to Treasury colleagues. I have not had a formal response, but the idea supports a pressing and important need in the essential life sciences sector and seems to have strong merit. I hope it will go far.

[Lord Scriven (LD)]

My Lords, the Question asked by the noble Lord, Lord McNicol, was very clear: it is not about the production of a vaccine but the facilities to manufacture that vaccine at scale. At the moment, the Government have made £46 million available for research into the vaccine. What money and planning are going into the facilities so that, once a vaccine has been made, it can be produced at scale in the UK?

[Lord Bethell]

The focus on the actual production of the vaccine is a matter of sequencing. We are moving incredibly quickly in all areas, but the focus at the moment, I think understandably, is on trying to get a product developed. In that respect, I bear testimony to the Oxford Vaccine Group and Jenner Institute at Oxford University, which have been shortlisted for the CEPI group of seven for potential vaccine development. This is an incredibly important development and shows the strength of Britain’s contribution to the development of vaccines.

Covid-19 Update

Lord Scriven Excerpts

Monday 16th March 2020 Lords Chamber

[Lord Bethell]

The noble Lord has hit upon an essential conundrum of the testing framework. I am not the expert who can give chapter and verse, but my layman’s understanding is that the antibodies test on which he rightly focuses is some way away. The biggest difficulty for testing is knowing who has had the virus but never shown the symptoms. Unfortunately, one of the difficult challenges for our response is not yet having that test; it holds us back, but we are working on it very hard indeed.

[Lord Scriven (LD)]

My Lords, my question follows on from the noble Lord’s question on testing. The reason why mass testing is important is that data aids the science, and science aids the response. There are two types of test. One is the PCR—swab—test, which tells you whether you have the coronavirus. On that test, what is the stock level within the NHS and how many more are on order so that rationing will not have to be as narrow as it is at the moment? If the Minister cannot answer that question, could he write to me to let me know? Secondly, on antibody testing, it has been trialled in Singapore, there are certain licences in China and I am aware of at least one biomedical company in Belfast that is producing 20,000 a day. Which companies are the Government in contact with on the antibody test, and when do they expect this test to be available within the NHS? Again, if the Minister cannot answer directly, could he write to me please?

[Lord Bethell]

The noble Lord, Lord Scriven, asks all the right questions. The honest answer is that it is a changing situation. The information that I had on this a week ago has changed even to today. What I can tell you is that there is an enormous global effort going into research in this area. The noble Lord, Lord Scriven, rightly cites the Singapore test, about which we are in touch and keen to find out more. A huge number of offers are incoming to the central co-ordinating committee. An enormous amount of funding and money is coming not just from the UK but from America, Europe and all the major nations trying to crack this. I live in hope that we will be able to do mass testing within the near horizon.

Health Service Safety Investigations Bill [HL]

Lord Scriven Excerpts

2nd reading (Hansard): House of Lords
Tuesday 29th October 2019 Lords Chamber

[Lord Scriven (LD)]

My Lords, I too welcome the Bill. Like many noble Lords who have spoken before me, I think that the concept of keeping people safe by having a safer health service system, and implementing learning to improve safety, is to be welcomed. However, I wish to raise some issues within the Bill. Noble Lords have already raised some of them but there are one or two in particular which have not been raised so far, and which I want to bring to the attention of the Minister.

The noble and learned Lord, Lord Judge, has already stated clearly that the powers in the Bill are quite wide. In some respects, they make Henry VIII powers look quite narrow. The Bill is constructed in a way that allows the new organisation not only to set its own homework but to do it, then to mark it and be the sole judge of whether it was the right homework in the first place. We therefore need to look at the Air Accidents Investigation Branch and how the Civil Aviation Act 1982 gives a framework for independent investigation, rather than it being more or less carte blanche. You cannot have independence with such a total lack of framework. As we go through the Bill, in the great time that will be available to us in Committee, we should look at whether the framework needs to be a little narrower rather than having such broad powers as the board deciding what triggers an investigation, what the criteria are, who can be brought in and how it should carry out the investigation. We need to be a little sharper and crisper on this.

One issue that I wish to raise regards Clause 5, and the healthcare provided in Crown interests. The noble Baroness, Lady Finlay of Llandaff, touched on this. A patient’s journey is not determined just by the fact that they are being treated by the NHS. If you are a prisoner seeking equivalent healthcare in a prison, then to be honest quite a bit of the care that you receive will not depend on the NHS. If there are no prison guards available to transfer you or, in the same way—because there is a power relationship—if you are not able to raise concerns, these are real issues. The Bill has been written specifically through the prism of health and NHS professionals. That is understandable but the context of where healthcare is given, particularly when it is meant to be equivalent, on a Crown estate means that the Bill has to go much wider.

I think it is Clause 7 which refers to listed persons, but they are all to do with health. There is nothing to do with the Prison Service or the Ministry of Justice, which will be as important as healthcare providers in terms of where healthcare is provided. How have the Government looked at the contradictory legislation which will create problems in places such as the Ministry of Justice, for example on data sharing? There are four levels of data sharing within the Prison Service and health, some local and some national, but there are also rules which the Ministry of Justice is bound by on the use of data which contradict things in the Bill. We need to be much more joined up on how this is done. As I say, there is a real power relationship here between a prisoner and their family and their healthcare. We need to think through the different levels of how investigations will be carried out and have safeguards, particularly for patients and families, in the places where that kind of power relationship happens.

I want to come on to the issue of the independent providers, as other noble Lords have done. The Minister gave her view, right at the beginning, that the Paterson review is the reason for this provision not being brought into this Bill. Let us be clear: the Paterson review is a non-statutory investigation into things that went wrong in the independent sector, and it will make recommendations on what might need to change in that sector. It has nothing to do with independent investigation on a non-blame basis about how future investigations in the private sector will continue. That is what this Bill is about, and the two things are completely different.

I find it unbelievable that a person who is treated in a private sector hospital whose care is NHS-commissioned somehow has a right to different levels of safety, and somebody in the next bed whose care is non-NHS-commissioned does not, within the same institution. It is nonsensical. The provision has to be for both private and NHS patients. Surely this Bill should be about patient safety, regardless of who is commissioning or providing the care. That should be a central tenet.

I am the 10th speaker, and I am surprised that no one has raised the subject of social care: where is it in all this? I refer the House to my interest in the register as a vice-president of the Local Government Association. Thinking about the route and the complexity of care, this is about not just NHS care but social care as well. If an individual is receiving both social care and healthcare, which are meant to be integrated in a care package, what role will this body have to look at issues in social care that have led to a lack of safety? How will such recommendations be looked at? Will safety and the subsequent reports be looked at comprehensively? Will this body have teeth when it comes to social care?

I support what my noble friend Lady Parminter said about the PHSO, the ombudsman. Let me be clear: trust in this organisation means trust among staff who work in the health service but among patients and families as well. The two should not be ranked to make one more important than the other. As the Bill is written, this organisation is the author of the homework and the judge of the homework, but trust will fall down if, where something has happened to an individual, the PHSO is not able to get to vital information. There will be contradictory recommendations and results about what has happened; one systematic and one about the patient. There will then be a breakdown in trust. There is clear guidance already on the use of data between public bodies. There is also the issue that, on many occasions, the PHSO uses anonymised data to be able to come to conclusions. If this is to be a last resort for patients and their families, we need to look again at the way in which the PHSO can access data from the safe space.

My final two issues come back to what a number of noble Lords have said. It is all right having reports and recommendations, but their implementation within the NHS is renowned as being complex because there are so many organisations. I am not clear how this will be audited and its implementation checked. I come back again to how the Bill is written. Some of the recommendations and their implementation will be on the NHS, and all the bodies listed in Clause 28 as having a duty of support are NHS bodies. No bodies are listed that are not NHS, such as social care bodies or the Prison Service, but they will need to implement changes. However, as the Bill is drafted, this new body has no role in supporting them in that implementation. What will be done to ensure that this body can look at organisations beyond the NHS that are vital in addressing the systematic failure in patient safety?

Finally, and I will be very fast on this, I want to reiterate a number of issues. As a former NHS manager and as a patient in the NHS, I am indebted to clinicians, but clinicians have one view of the world. This is not to deride that—their training and their view of things leads them to a certain way of looking at issues and they use their expertise in that—but the non-executive directors have to be a broad range of people. It comes back to trust. Patients, clinicians and even some people who are not within the health service spectrum can bring their expertise to this. We need to think a little more broadly about who the non-executive directors will be.

As I said, I welcome the thrust of the Bill. It can and will contribute to patient safety, but there are issues that have to be thought through. If they are not, the body will not be able to produce the reports, and the NHS—or should I say healthcare and non-healthcare settings where healthcare is provided—will not implement the changes that will mean patients will be safer.