Coronavirus Act 2020
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Lord Scriven (LD)
My Lords, I have so far not had a chance to welcome the Minister to his new role. I wish him well. I think he has already found out that it is going to be a very busy portfolio, and, with the present climate we find ourselves in, quite rightly so.
Before the Minister was in post, many statutory instruments were laid before Parliament after they had come into operation, as the noble Lord, Lord Hunt of Kings Heath, just said. This has continued to be a worrying trend, because it is a way of getting round normal parliamentary scrutiny. It becomes ministerial diktat and law by the scribbling of a Minister’s pen.
The statutory instrument says:
“These Regulations are made in response to the serious and imminent threat to public health”.
Paragraph 6.7 of the Explanatory Memorandum says:
“In accordance with section 45R of the 1984 Act, the Secretary of State is of the opinion that, by reason of urgency, it is necessary to make this instrument without a draft having been laid before, and approved by a resolution of, each House of Parliament.”
We are talking not about something that puts somebody into isolation to stop the spread of coronavirus but about relaxing when people can come out of self-isolation. It is not an imminent threat; it is not an emergency. The Government knew that 27 September was coming and could have planned for it so that normal legislation could have gone before Parliament, rather than this emergency approach of ministerial diktat, which affects millions of people in this country. It has to stop. There are times when emergency legislation for public health use is appropriate but, like others, this one is not appropriate.
What stopped the department and Ministers knowing that 27 September was coming? This did not have to be emergency legislation if they had planned ahead. This statutory instrument was laid five days before the planned date of extinction of the previous regulation. It is either poor planning or legislation to try to bounce Parliament. Either way, it is not acceptable.
I declare an interest as a vice-president of the Local Government Association, as set out in the register. The other part of this is about the powers to local authorities. I have believed right from beginning, as other noble Lords did, that local authorities should play a large part in this, rather than having national responses. Some national responses were needed, but so was a more local response.
Back in March 2020, I tabled an amendment to the original Bill with a power of general competence for local authorities to be able to act, which would be debated through normal legislation without statutory instruments having to keep coming with powers for local authorities. We were told that that was not required, so why do statutory instruments need to keep coming with powers for local authorities? Why did the department not listen at the time and grant a power of general competence in an amendment to the Bill, which could have been dealt with in the normal way rather than in emergency legislation? It has to stop. I want to talk about some interventions that might be required based on where we are at present as a nation.
I am clear that we will need interventions over and above those in place, but the Government are not listening to public health experts, people who work in the NHS or the epidemiologists who say that further action on Covid is required now, not just to deal with the potential crisis in the NHS but to stop future lockdowns that harm the economy and people’s livelihoods. They are saying it is a step to stop lockdowns, so I would like to understand from the Minister why that advice has not been taken. What assurance do the Government have that if action is not taken now and cases continue to rise, as well as the pressures on the NHS, either local or national lockdowns will not at some point be required? What modelling exists at present to prove that point?
I want to look at the rates per 1,000 population. On a seven-day rolling average from yesterday’s figures, the UK has 488.5 cases. France has 54.9 cases, Portugal has 51.9 and Spain has 28.3. Even taking into account testing variations, the UK is a significant outlier there. I know what the Minister will say: “Oh, there’s a lower death rate—that’s why. It’s not just cases. We have to look at the death rate”. Let us look at the death rates in those countries. On the rolling average for the last seven days, Spain has a death rate per million people from Covid-related disease of 2.87. Portugal has a death rate of 3.12 per million; France has a death rate of 1.88 per million; and the UK has one of 10.7 per million. In terms of both cases and deaths, the UK is an outlier.
I suggest that the reason why the UK is an outlier is that those other countries, rightly, are vaccinating—in some cases, they have now increased their vaccination rate above that of the UK—but have not put all their eggs in one basket. They are taking mitigation and vaccination as a way to deal with a public health crisis, because this is not a political or philosophical discussion. It is not an argument of libertarians versus those who believe in a more restrictive approach to the state. This is about public health and trying to keep people alive and healthy. It is about taking lessons from what is happening abroad and using them as good practice. If experts are not being listened to, I suggest that people look at what is happening abroad and learn the lessons there: mitigation and vaccination combined are a way of dealing with this. It is about having not draconian lockdowns but simple mitigations, so let us look at some of the issues within those mitigations.
Some politicians are worried that the public just will not buy some of the issues. A UK YouGov poll from today clearly shows that the public are becoming worried and starting to get ahead of the Government: 81% support having face coverings on public transport and 76% are for them in shops and restaurants. Meanwhile, 67% support social distancing in pubs and restaurants—but there is no majority for lockdowns. We have become a country obsessed with having plan A or plan B. It does not have to be such a binary choice. We could take steps to deal with the threat to public health as we come into winter. We could look at what happens abroad and bring about the use of mandatory face coverings, which have no economic impact. If you are a libertarian, their use restricts freedoms very little but helps reduce cases, along with other issues. We could ask for face coverings on public transport and in shops.
Some noble Lords opposite are shaking their heads. I am not basing my facts on some theoretical study; I am basing them on what is happening in France, Portugal and Spain. That is the evidence, not an academic study. Mitigation, along with vaccination, works. If not, noble Lords will have to explain when they get up why those countries have fewer cases and deaths. It is because they are not just jabbing but asking for face coverings.
Now, there are other, much wider things in plan B that I do not support. For example, I do not support the use of Covid vaccination certificates—not as a matter of political philosophy but because, although someone may have a certificate saying that they are double-jabbed, we know that 30% of people who are double-jabbed also get the virus and could be asymptomatic. It gives a false sense of security. That person may go out thinking, “I’m jabbed, I’m okay, I’ve got my vaccination certificate”, but they could be one of the 30% of people out there who are asymptomatic and helping to spread the virus. So, the reason why I believe that vaccination certification is not worth introducing is practical, not philosophical.
We are at a severe crossroads in this public health crisis. If we go one way, the country will go into lockdown and there will be harder economic and social consequences. That road means continuing as we are, putting all our eggs in the vaccination basket and not taking extra action now. Or there is another way we could turn: phasing in some simple mitigation requirements, such as face coverings and potentially looking at social distancing. These are not like the draconian “Stay at home to work” order or lockdowns.
I believe that we need to take a different course. To avoid lockdown and the harm we have seen, we need to do something extra beyond just talking about vaccinations. European countries that have taken those measures show that it can be done. They will not eradicate the virus, but they will mean we manage it better, helping the NHS and the economy and doing something that we need to do: take our advice and approach from public health, not political philosophy.
Lord Kamall (Con)
I can only repeat what I have said previously but I will look at this in more detail and respond to the noble Lord if he is not satisfied with my response. I will try to make sure that I send a satisfactory response.
A number of noble Lords talked about the evidence around face coverings. Some noble Lords said that they definitely work. Others said, “No, there is no evidence that they work”. Others said, “Actually, they are useful as part of an overall package of other measures”. If the data suggests that the NHS is likely to come under unsustainable pressure, the Government will implement their prepared plan B. That is why we have explained it in advance: so that we cannot be accused of doing things at the last minute. Plan B would include legally mandating face coverings in certain settings, but we are not yet at that stage. The continued efforts of the public in practising safe behaviours and getting fully vaccinated will be critical to ensuring that the NHS does not come under unsustainable pressure.
Lord Scriven (LD)
This is an important issue that goes back to what the noble Lord, Lord Hunt, said. We keep hearing the phrase “when the time is right, we will implement plan B, if required”. Who will the Government take that advice from? Will it be SAGE, which, until now, has given the Government clear scientific advice that the Government have acted on—sometimes belatedly but they have done so? What are the criteria and who will give the advice on determining when the time is right within normal government business, if SAGE is no longer seen as having the primary role in advising, since its remit is during times of emergency?
Lord Kamall (Con)
Before I answer that in more detail, perhaps I may say that we are not putting SAGE into a subordinate role. It is independent and we rely on its advice. However, as I mentioned, we also rely on the Chief Scientific Adviser, the Chief Medical Officer, the UK Health Security Agency, the NHS and others, and balance up views within the scientific and medical professions. I hope I have also laid out the range of data that is examined. The decisions are data-led. We look at immunity, the ratio of cases to hospitalisations, proportional admissions and so on to see whether the data suggests that the NHS will be overwhelmed. That is what leads to the difficult decision-making and balancing up whether the time is right.
One noble Lord—I think my noble friend Lord Ridley —and many others referred to the research of the London School of Hygiene & Tropical Medicine showing the range of views. Some scientists are saying that the virus will grow while others are saying that if we keep doing what we are doing and rely on the booster vaccines, the numbers will drop off. As one can imagine, there is a range of views but I reassure the noble Lord, Lord Hunt, that we have not relegated SAGE. It is independent and we listen to its advice, as we listen to the advice of others.
On face coverings, the point made by my noble friend Lord Robathan was interesting regarding people who say they are in favour of face coverings but, as he sees when he travels on public transport, a smaller percentage wear them. That shows some of the difficulties in polling, whereby there are stated preferences but also revealed preferences. Although many people say that they will do things, one should judge them by their behaviour. I note that my noble friends Lady Foster and Lord Ridley also raised concerns about the efficacy of wearing face masks.
SAGE evidence states that face coverings, if they are worn correctly and of suitable quality, are likely to be most effective, at least in the short to medium term, in reducing transmission indoors where social distancing is not feasible. Reviews by the UK Health Security Agency in June 2020 and January 2021 found evidence that the use of face coverings in the community helped to reduce transmission. Once again, we have a range of views on the efficacy of face masks.
My noble friend Lord Robathan talked about schools, universities and transmission. In universities, there have been low case numbers among students since the end of the 2020-21 academic year, although there have been slight increases in recent weeks.
My noble friends Lady Foster and Lord Ridley asked why the Act was not being repealed. Correct me if I am wrong, but I believe the noble Baroness, Lady Fox, also asked that. Throughout the pandemic, the Government have been clear that the measures will not be in place any longer than absolutely necessary. That is why we are expiring a number of powers in the Act and intend to expire even more when, we hope, there will be a significant landmark in our progress. The two-year lifespan of the temporary provisions of the Act was chosen to ensure that powers remain available for an appropriate length of time and can be extended by the relevant national authority.
My noble friend Lord Balfe asked about test and trace, and the cost. We have released £280 million in funding thus far, which is broken down as follows: £114 million to cover the costs of the main test and trace support system, £116 million for discretionary payments, and £50 million for administrative costs.
My noble friend Lord Naseby asked about minority vaccine uptake. He asked what the Government were doing to drive uptake among ethnic minority communities. We are well aware of this issue and a lot of work is being done with a number of local community associations to work out the best way to reach them. Only yesterday, I asked the noble Baroness, Lady Benjamin, about how we could tackle particular demographics and got some very valuable advice from her on how we could focus. I fed that into the department, so hopefully that will be part of our strategy. What we have seen is pop-up temporary vaccination sites at many places of worship and community locations. One of the things we have been advised is to go to where the unvaccinated are and to see how we can pursue a targeted campaign.
The noble Baroness, Lady Brinton, asked whether there would be a charge for lateral flow tests. Anyone in England can continue to order free lateral flow tests. I am afraid that I am going to run out of time, so I will write to noble Lords.
NHS England Funding: Announcement to Media
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Lord Kamall (Con)
My noble friend makes a valuable point. It is important that we are accountable to Parliament, and we will continue to be so. I hope that the fact I am here today shows a willingness to be accountable to Parliament.
Lord Scriven (LD)
The Minister has just said in a previous answer that, to deal with the social care crisis, a Bill will be coming forward. The crisis is now. Care homes are not able to take people and are turning them away because of the lack of staff. You will not clear hospitals while social care cannot hope. What will the Government do now to deal with the social care crisis in this country?
Lord Kamall (Con)
The money that has been announced is for April 2022 onwards, for three years. In dealing with the specific issue now, believe me, we are having conversations within the department and elsewhere about how we address some of the issues that people are raising with us.
Men’s Health Strategy
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Lord Kamall (Con)
I thank the noble Lord for the advice that he has given me to date on many issues relating to this portfolio. In terms of a specific men’s health strategy, it was quite clear that we needed a women’s health strategy because for many years women’s health had not been given the consideration that it needed, including on a whole range of issues such as clinical trials and data, for example. On male life expectancy, the issues that men face are quite disparate, so we target particular issues such as systemic heart disease, cancers, particularly prostate cancer, the fact that more men than women die from suicide, alcohol-related deaths, drug-poisoning, smoking and obesity. We look at those and target them specifically, rather than putting them into an overall men’s strategy.
Lord Scriven (LD)
My Lords, we should not look at men as one homogenous blob. There is more than a nine-year life expectancy difference between men in the top income bracket and those in the bottom 10, which is more than the life expectancy difference between men and women in those brackets. What will the Government do to ensure equity and fairness to tackle this deep-rooted health inequality for some men?
Lord Kamall (Con)
The Government have launched the Office for Health Improvement and Disparities and part of its remit is to make sure that we look at inequalities within the health system, particularly gender inequalities or those to do with income strata, and at how people in different income brackets are affected differently. That is why the word “disparity” is in the name of the office.
Covid-19 Update
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Baroness Wheeler (Lab)
My Lords, I thank the Minister for reading the Statement.
Yesterday, the Secretary of State said that the pressures on the NHS due to Covid-19 are “sustainable”. Today, we have the Commons Statement desperately trying to reinforce this message when, in reality, we see ambulances backed up outside hospitals, patients waiting hour upon hour in A&E, cancer operations cancelled and NHS staff worn out and exhausted. Yet still, as we head into winter, the Government refuse to trigger plan B or tell us what the criterion is for doing so. Can the Minister spell out exactly what evidence and criteria will be used?
The British Medical Association is the latest front-line body to call for plan B’s immediate implementation. Why can we not just make the wearing of masks on public transport, for instance, mandatory now? We must remember that SAGE, the Government’s scientific advisers, called for plan B-type measures when the Government’s autumn and winter plan was first launched, with Sir Patrick Vallance stressing the importance of going early with measures to stop rising cases.
Once again, the Government have failed to learn the lessons of the early stages of the pandemic. This hesitation to follow advice will lead to more cases, more hospitalisations and more deaths. The Secretary of State’s warning that cases could rise to 100,000 is chilling. Today, we have the sobering update from the Government’s own Covid dashboard showing 52,009 new coronavirus cases—the highest daily total and the first time the daily tally has topped 50,000 since 17 July.
It is obvious that plan A just is not working. The vaccination programme is stalling, particularly given the very late vaccinations for 12 to 15 year-olds and the mixed messages and worryingly low uptake of booster jabs. Ministers cannot blame the public when 2 million people have not even been invited for a booster jab, and on current trends the booster programme will not be completed until March 2022. Currently, there are just 165,000 jabs a day. Will the Government commit to 500,000 booster jabs a day and ensure that the programme is completed by Christmas, as it needs to be, particularly given the growing evidence of waning vaccination protection among double-vaccinated older and more vulnerable people? We learned from leaked data yesterday that only a quarter of care home residents have received a booster vaccination. Can the Minister confirm that this is correct and tell the House what urgent action the Government are taking to address this?
On children, where the highest rate of infections is concentrated and infections are running at 10,000 a day, only 17% of children have been vaccinated. This is a stuttering and wholly inadequate rollout of the children’s vaccination programme. Does the Minister recognise that this slowness exposes the folly of the drastic cuts over the past decade in the number of school nurses and health visitors who support these immunisation programmes in our communities? Will retired medics and school nurses be mobilised to return to schools and carry out vaccinations?
As the winter crisis looms, the rollout of flub jabs is also crucial to bringing down hospital admissions and ensuring that the NHS can cope, but it is also painfully slow. Only 6% of over-65s have been vaccinated, and across the country we hear stories of cancelled flu jabs at GP surgeries and of pharmacists running out of supplies. Why are supplies apparently running so low, with infections, meanwhile, running so high? What are the Government doing to ensure adequate stocks at GP surgeries and chemists to meet the demand? Can the Government guarantee a flu jab to all those that need it by December? We must get ahead of this virus, because otherwise it gets ahead of us.
Can the Minister also comment on reports in today’s media that as well as plan B, there is now active consideration of a plan C: no household mixing—in other words,
“a lockdown by the back door”,
as the shadow Secretary of State, Jonathan Ashworth, has called it. Can the Minister tell the House what is actually under “active consideration”, in the words of the Health Minister on Radio 4 this morning? No household mixing would be deeply concerning for many people who were prevented from seeing their loved ones for months at a time during the first and second waves of lockdown.
I am sure noble Lords will have much to say on mask wearing, as they did during yesterday’s PNQ. Ministers continue to sow confusion, including among themselves, with the Secretary of State’s comments in the Commons yesterday that politicians should “set an example” and wear masks in crowded spaces—yet the Leader of the House subsequently told MPs that there was no such advice for workplaces. Can the Minister explain what is going on?
The Statement also refers to the agreement with Pfizer and MSD on two new antiviral drugs, which we of course welcome, as they play a vital role in stopping a mild disease from becoming serious. Can the Minister tell the House about the expected timetable for MHRA approval and any provisional details on availability and rollout?
Finally, on social care funding, as usual we welcome the announcement at the end of the Statement of additional funding for local authorities to support staffing and care work through the winter, assuming that the £162.5 million workforce retention and recruitment fund is actually new money and not part of previous repackaged funding. Could the Minister confirm this? Can he provide more details as to how and when this money is to be available and how it will be allocated to local authorities?
Lord Scriven (LD)
My Lords, I too welcome the Minister’s reading the Statement from yesterday. We are discussing this on the day when more than 50,000 Covid cases have been recorded in the UK for the first time since 17 July. There have been over 52,000 cases and 115 deaths; 8,142 people are in hospital with Covid, and 870 of those are on a ventilated bed. We are discussing this just hours after the Royal Cornwall Hospitals NHS Trust has declared a critical incident because of the pressures it is under serving the people of Cornwall.
That shows why this Statement is not a master class in providing a range of effective public health measures to tackle a virus that spreads at speed, and more a master class in trying to keep the libertarian wing of the Conservative Party happy. The “jab, jab, jab” message is important but, when some people go on to the booking system now, they are not able to book. They are told to ring 119, as my honourable friend in the other place, the Member for St Albans, Daisy Cooper, said early today; when they ring 119, operators tell them that they cannot override the system. I ask the Minister what is going on with the booking system and how soon it will be repaired. The “jab, jab, jab” message is important, but it is not, in itself, going to deal with the severity of the public health crisis we face. As Professor Adam Finn, a member of the JCVI, said yesterday, vaccinations in themselves are not going to stop us falling off the edge of the Covid cliff.
I want the Minister to explain these different rates, if plan A, of vaccination, is working. The seven-day rolling averages for Covid-19 cases per 100,000 of the population are: in the UK, just under 500, and rising sharply; in France, approximately 60, and falling; and in Spain, approximately 50, and falling. Even considering the variation in testing rates, the UK is clearly an outlier. Take a look at three months ago, when the Government removed all mandatory mitigation measures. The picture tells you the true story of why “jab, jab, jab”, as a public health strategy, is not enough to deal with the Covid-19 problems. Then, the UK had approximately 300 cases per 100,000, and it now has 500; France had approximately 220, and it now has 60; and Spain had approximately 350, and it now has 50. It is because France and Spain, as well as other countries, have jabbed, jabbed, jabbed but also mitigated, mitigated, mitigated. Indecision is our greatest enemy in the fight against this disease.
Let us be clear: those of us who ask for extra mitigation measures, such as the use of mandatory face coverings, do so to stop the crippling lockdowns that have come before. The Government, as the Health and Social Care Select Committee has reported, have acted too little too late before when dealing with this virus. This means that the damage, both to public health and the economy, is greater than it would have been if the Government had listened to the expert advice and acted sooner.
On one very important mitigation measure we could take, the mandatory use of face coverings, the Minister said yesterday, answering a PNQ:
“Personally, I do believe that many people should be wearing masks and that there is evidence for this.”—[Official Report, 20/10/21; col. 145.]
If good evidence exists that wearing face masks helps to reduce the transmission of Covid-19, why have the Government stopped their mandatory use in indoor settings? Could the Minister please enlighten the House on what evidence the Government have that asking people to use self-judgment on wearing a face covering in certain indoor settings is more effective than making them mandatory? I am sure that evidence will be at the Minister’s fingertips, as it is official government policy. They would not make up such an important policy to ditch a mitigation measure that could save lives without the use of good evidence—would they?
Furthermore, can the Minister explain why, at Prime Minister’s Question Time yesterday, hardly any Tory MP sat on the green Benches had a face covering on, and why, today, a Minister sat on the government Front Bench in this House wore a mask below his chin, with both his nose and mouth exposed? Whose evidence are they following? What leadership and example does it set to the nation if the Government are, on the one hand, asking us to use our self-judgment to wear a face covering, but government Ministers and MPs in the House of Commons do not?
The evidence of experts in public health and epidemiology, and figures from Europe, show that a mixture of vaccination and mandatory mitigation measures is required, if the spread of the virus is to be contained to manageable levels, so that later in winter we do not have to slam on the brakes and have yet another lockdown.
Can the Minister clarify something that he said yesterday during a PNQ? When asked whether the Government still had confidence in SAGE and its workings, the Minister replied:
“May I write to my noble friend on that?”—[Official Report, 20/10/21; col. 146.]
I know that the Minister is new and that he did not have all the details to hand, so I am giving him a second chance. Can he confirm from the Dispatch Box that the Government do have confidence in SAGE and the advice that it gives?
It is time to be clear that the message on vaccination take-up and extra mitigation on issues such as mandatory face coverings are required. Otherwise, we will be left in a situation where, unfortunately, more people will die than is necessary, the Government will be behind the curve in dealing with the virus and much more draconian measures will have to be taken. Now is the time for plan B, not for dithering and not taking the measures that are required.
Covid-19: Plan B
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Lord Scriven
To ask Her Majesty’s Government, further to the rising number of Covid-19 cases and comments made by the NHS Confederation regarding the reintroduction of certain restrictions, what criteria they have put in place as the triggers to implement their Covid-19 “Plan B”.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
I thank the noble Lord for the very important Question. As set out in the Government’s comprehensive Covid-19 Response: Autumn and Winter Plan 2021, if the data suggests that the NHS is likely to come under unsustainable pressure, the Government have prepared plan B contingency measures. We monitor a wide range of Covid-19 data closely, so we can act if there is a substantial likelihood of this happening. We also track the economic and societal impacts of coronavirus to ensure that any response takes into account those wider effects in a balanced way.
Lord Scriven (LD)
My Lords, Professor Stephen Reicher, a member of SAGE’s sub-committee, said yesterday:
“I don’t want lockdown … The danger is if you do nothing … in terms of infections, in terms of long Covid, in terms of hospitalisations … they will be left with no alternative.”
Based on what the Minister has just said, what evidence do the Government have of why scientists such as Professor Reicher are wrong in seeking mitigation measures now to deal with the worrying number of viral transmissions as a way of stopping future lockdowns?
HIV Action Plan
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Lord Kamall (Con)
I thank my noble friend for his question. The four features he referred to are aligned with the independent HIV Commission’s recommendations. The Government have welcomed the HIV Commission’s report and are currently considering its recommendations to inform the development of the forthcoming HIV action plan. Our specific decisions regarding resources for the HIV action plan are being taken as part of the ongoing comprehensive spending review.
Lord Scriven (LD)
My Lords, over a year and a half ago, Jo Churchill, the previous Parliamentary Under-Secretary of State for Health, said that the Government were seriously considering access to pre-exposure prophylaxis for HIV in community pharmacies and GP practices. Will the Minister say when this will happen, and, if he cannot, what is holding this up?
Lord Kamall (Con)
As the noble Lord says, in March 2020 the Government announced that the HIV prevention drug PrEP would be routinely available across England in 2020-21. It is now routinely available in specialist sexual services throughout the country. The settings in which PrEP could be made available outside these health services, such as pharmacies, will be considered as part of the ongoing work on the development of the sexual and reproductive health strategy and the HIV action plan. We plan to publish the HIV action plan later this year to coincide with World AIDS Day on 1 December, and the sexual and reproductive health strategy shortly thereafter.
Covid-19
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Lord Bethell (Con) [V]
My Lords, the noble Lord, who is so wise in these matters, has answered his own question. If necessary, we will do what it takes, but the aspiration is clear: we are seeking to get the vaccination level to such a high rate that R is below 1 and no further lockdowns are necessary. That is an honourable, reasonable and epidemiologically sound objective.
Lord Scriven (LD)
My Lords, the Secretary of State for Health and Social Care is living proof that, despite having two jabs, 20% of individuals can catch and be spreaders of coronavirus. If this is the case, why are the Government, as a matter of policy, going to use internal Covid passports as a public health measure to deal with the virus in large venues? At best, they will give individuals and venues a false sense of security. At worst, for those who are double jabbed, infected but asymptomatic, they will be useless in the fight against the spread of this disease.
Lord Bethell (Con) [V]
My Lords, this is the clinical advice given to us by clinicians. I cannot answer the whole question in the round in this brief session, but a number of considerations include not only that vaccines offer a significantly reduced rate of infection but that the level of infection is much lower, the viral load is much lower, and therefore the infectiousness is much lower. The aggregate effect is that a group of people who have been vaccinated, with a few who have the disease, is less infectious than a group of people who have been tested, however good the test.
Medical Devices (Coronavirus Test Device Approvals) (Amendment) Regulations 2021
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Lord Alton of Liverpool (CB)
I thank the noble Baroness, Lady Thornton, for giving us the opportunity to have a discussion around this; I will support her amendment. I am very pleased to follow the noble Lord, Lord Hunt of Kings Heath, and to echo some of his remarks and questions.
In doing so, I return to a Question that I put during Oral Questions, in an earlier part of our proceedings today, where I specifically asked about the number of lateral flow tests that have been produced and where they have come from. My interest in this originated during a hearing of the International Relations and Defence Select Committee, when were told by a witness that he was delighted that a package had arrived at his home containing a lateral flow test and that it had originated in China. This prompted me to ask a Written Question about how many of these tests had been produced in the People’s Republic of China. The Answer I was given was staggering: we had bought not 100,000 or 1 million, but 1 billion. I also asked, in that same Question, two other things: how much this had cost British taxpayers and which companies, both British and Chinese, were involved in these deals. I did not get an answer to the second two parts of my Question, so I tabled a further Written Question, asking again. It stands on our Order Paper today as having the greatest longevity of any unanswered Written Question. It was tabled on 12 May and it was due to be answered by 26 May; it is now 20 July. It is grossly discourteous to the House for Written Questions not to be answered in this way—it would have maybe saved the Oral Question having to be asked earlier on.
At the heart of that Question is the issue of due diligence. I echo something that the noble Baroness, Lady Smith of Newnham, asked during our earlier exchanges. The duty is on the Government, not on individuals, to ascertain, as the purchaser of these lateral flow tests, what the supply chain transparency is. I should mention two things here: I am a vice-chair of the All-Party Group on Uyghurs and I have a Private Member’s Bill before your Lordships’ House on supply chain transparency. What due diligence has been done in establishing the provenance of these lateral flow tests, and why have we not had answers? Perhaps the Minister can give the answers to us now. Who are the companies that have been involved in the purchasing of these tests and what has been the cost overall?
I would also like to ask the Minister something that was put to him on 12 July by the noble Lord, Lord Rooker, in Grand Committee. It is always a pleasure to find myself on the same side of arguments as the noble Lord, Lord Rooker. When I took my seat in another place, over 40 years ago, it was the noble Lord, then as Jeff Rooker MP, who welcomed me; I am glad he has lost none of his bite.
The noble Lord asked the noble Lord, Lord Bethell— I read the Minister’s reply and he did not appear to answer him in that debate, so I simply reiterate the noble Lord’s question:
“why do we need to buy the NHS Test and Trace kits for the lateral flow test, the one being given out by local chemists, from one of the Chinese Communist Party-approved companies? How do we know they are not made with slave labour? What kickbacks go to that corrupt political party? What efforts are being made to get them made in the UK—dare I say Europe—or, indeed, Commonwealth countries? We now have the capacity to check the tests in laboratories. Why have we not done something about manufacturing capacity? Why are we reliant—we appear to be reliant—on the fix of the Chinese industrial structure, which is controlled by the Communist Party or it cannot operate?”—[Official Report, 12/7/21; col. GC 430.]
That is at the heart of this question and of the debate today. It is not a trivial issue. One billion of these tests have been purchased by the UK. Just think what the costs of that will be: if it is 50p a time, that is half a billion pounds; if £1 a time, that is £1 billion. We have a right to know.
This is a point that the noble Baroness made in her remarks earlier: there needs to be not just due diligence but transparency. As far as I am concerned, there has not been sufficient transparency. We are right to press on this, just as it was right earlier to raise the issue of Hikvision. These are cameras that have been put up in our town centres and high streets all over this country, in NHS hospitals and in schools, and they are manufactured in Xinjiang. They are the same cameras being used to monitor Uighur people, 1 million of whom are incarcerated in camps. That company has been banned in the US but not here, and I would be keen to hear from the Minister what the Government—because he will be speaking for the whole Government—are doing to enforce such a ban in the UK.
Lord Scriven (LD)
My Lords, we on these Benches support the principle of this SI. Of course we want to see a mandatory standard for tests. I do not think anyone who spoke in Grand Committee argued against the principle of the SI, but there are concerns about a few issues in it. The Minister replied to the issues raised in Grand Committee with soothing words rather than convincing answers, hence the noble Baroness, Lady Thornton, has tabled her amendment to the Motion today.
I want to raise a few of the issues that the Minister either ignored by not answering or used soothing words about but did not give convincing answers to. The first question is: if we are to have a mandatory standard for tests, why have we got new Clause 39A, which is an exemption from the mandatory tests and standards that can be applied at the stroke of a ministerial pen? What is the point of having a mandatory standard for safety if the Secretary of State, at the stroke of his or her pen, can decide to do away with that? In what circumstances and for what reasons would the Secretary of State wish to bring in tests that would lower the mandatory standard, and how would the public know that they were purchasing a test that did not meet the statutory standard that had been set?
I want to address the issue of openness and transparency, as raised by the noble Lord, Lord Alton, and the noble Baroness, Lady Thornton, regarding the validity of the standard of the test as well as human rights issues. Where is the research in public on the validity of the standard of the lateral flow tests, particularly the one from China brought in via Innova, the main intermediary for a Chinese company? This test, as raised in Grand Committee, was given a class I notice in America, and an FDA email says it is not effective and gives the instruction:
“Destroy the tests by placing them in the trash”.
That is the same lateral flow test bought for billions of pounds by the UK. Again, there were soothing words from the Minister in Grand Committee about this: he said that the Government were working with the FDA. That might be true but having two differing positions— the Government saying that the test is safe while the FDA says to throw it in the trash—is not working together. Could the Minister elucidate on why the British Government still feel these tests are safe when the FDA says they should be thrown in the trash? Which part of the FDA’s analysis do the Government disagree with?
The key issue for me is the one that the noble Baroness, Lady Thornton, has already raised: this is not linked into the total public health system to deal with the virus. The key issue is not the standard of the tests themselves but that it should be linked into test and trace. To say that we are going to have a high standard without linking it into the test and trace system is like saying you want the best electric car in order to be environmentally friendly, buying it and then, once you get it home, realising that the nearest charging point is 100 miles away. This is not fit for purpose. To be so, tests must be integral and integrated into the test, trace and isolate part of the public health response to coronavirus.
I ask the Minister, as I and others did in Grand Committee: if someone carries out a private test, how does that link into test and trace? There is no mandation anywhere in UK law to say that a private test, once proved positive, has to be fed into the test and trace system. All the evidence suggests that the way to deal with the virus most effectively is to break the chains of transmission within 48 hours. If tracing is not told that you have tested positive, there is no way to have an effective public health response. So, even if you have the best standard of tests, with no tracing or isolation the chain of transmission will continue.
When I and others asked in Grand Committee, the Minister said that this is also a significant public health policy change. I am not aware of any infectious disease anywhere in the UK or in the world where a market approach to the testing of infectious diseases has become the bog-standard approach, but that seems to have been the Government’s policy after September.
The Minister mentioned Germany in Grand Committee, saying that that country had moved to a specifically private-led testing system. There are two differences in the German system. First, it is controlled by state subsidies; to do it, the companies get a state subsidy, which has now been reduced significantly so the level of private testing is levelling off. Secondly, and most importantly, there is a mandatory requirement in German law to report positive cases from those positive tests to the national Covid test and trace system in Germany.
This statutory instrument, while well intentioned, is riddled with weaknesses. It is not linked to the test and trace system and will not help keep the country safe. It will not have the desired effect, and we will end up with a system that basically has a good standard of tests but then does not do the next, vital part, which is to trace people and then support them in isolating.
That is why we on these Benches will support the amendment to the Motion tabled by the noble Baroness, Lady Thornton—unless the Minister can come up with convincing answers this time, not just soothing words.
Lord Bethell (Con) [V]
My Lords, I thank the noble Baroness, Lady Thornton, for her support for the regulations in the round, for her supportive words about the role of the private sector in the round and for raising many important points in her amendment to the Motion, stressing the vital role of NHS testing as we continue to manage the pandemic.
I want to clarify that these regulations are not connected to the future of free NHS testing. This SI, as noble Lords have noted, is solely focused on ensuring the quality of any Covid test in the UK and that they are of the same standards as I would procure for the NHS.
It is self-evident that poor-quality tests, when used privately, could pose a risk to the health of not only the individual but the public. All that is necessary for entry of Covid test products into the UK market is controlled by EU CE marking, which, as noble Lords noted, is currently a self-declaration process for most Covid-19 tests on the UK market. The performance declaration made as part of this EU marking does not need to be independently verified ahead of sale of such tests. There is no legally binding agreed process for establishing performance. That just is not good enough. It became clear as I sought to procure tests at scale for the national effort that many kits that had passed a CE mark were not fit for the real world. I say to the noble Lord, Lord Hunt, that it is not right that the quality of tests correlated to any particular nation; this applied to all nations.
I say to the noble Lord, Lord Alton, that we have audited the supplies of medical devices and there are no current slavery or human rights concerns. We do, however, remain vigilant. I regret that his question on sourcing has not been answered, particularly because there is a very large amount of public material on the procurement framework, the suppliers to it and the arrangements we make to run that framework. I will address that gap with speed, and with regret.
I reassure the noble Lord, Lord Scriven, that there is a very large amount of published material on the internet on the validation of tests, including the protocols and the results from Oxford University and Porton Down, which conducted the validation of the tests. These validation protocols have been assessed by a very large number of experts, and I would be glad to send him links to the protocols and the assessment processes. I reassure him that our tests have been tested against alpha, beta, gamma and delta variants and successfully detect all of them.
The noble Lord, Lord Alton, referenced “kickbacks” to the Communist Party. I very kindly and respectfully ask him to remember that British officials have operated a remarkable procurement programme during the pandemic at the very highest standards of integrity. I gently ask him to provide evidence for such accusations before making them in the House.
To the question of why we buy so many tests from China and not from Britain, the simple answer is that they pass our protocol and meet the requirements of the procurement framework regarding quantity, speed and product design, for example. We buy them to ensure a good deal for taxpayers and effective tests for the public.
I completely agree with the noble Lord, Lord Hunt, that we need a strong UK manufacturing base. I reassure the noble Lords, Lord Alton and Lord Scriven, and others who have raised this point that we have a major programme on this, with subsidies, expertise and support available. I would be glad to arrange a briefing session to run noble Lords through all the measures we have in place to support the UK diagnostics industry. I believe the high-quality regulations we are discussing today provide the certainty business and investors need to invest in the UK diagnostic system. We need this market to provide additional capacity at the time of the pandemic, to ensure that we have outstanding testing capability while also encouraging innovation.
I was keen to take an evidence-based approach to developing this policy, so we ran a very successful consultation that had a broad range of respondents. Some 73% agreed that mandatory validation of tests prior to entry to the market was the best approach; 88% of those agreed that this should be legally backed; 71% agreed that a validation process would not significantly reduce supply; and 79% agreed that mandatory validation processes will increase safety.
In April this year we launched the universal testing offer, so now anyone in England can access free LFD self-tests by ordering online or collecting then at over 9,000 pharmacies across the country. To reassure the noble Baroness and all noble Lords concerned about this, our recently published road map out of lockdown made it clear that we are keeping in place key protections, including free testing for people with symptoms, but we are standing down the workplace testing regime, as the noble Baroness, Lady Thornton, rightly pointed out, from 19 July.
On the rationale for regulation, I welcome the support of the noble Baroness, Lady Thornton, for NHS tests, which have always been of the highest standard. The objective of the legislation is to ensure that the same high standards for tests that we see upheld when the Government buy them are equally reflected in the testing market for all consumers. That market already exists in this country; over 1,000 providers are already going through the UKAS accreditation process. These tests are being used to enable activity across many areas of the economy, including travel, film, TV production and sport. It is critical that we put in place processes to ensure that these tests are high quality and accurate: that is what this law does.
On the integration of private tests and the NHS test and trace system, I reassure the noble Lord, Lord Scriven, and the noble Baroness, Lady Thornton, that significant work has already successfully linked private sector testing results with the NHS Covid app, the JBC and test and trace. When a test is conducted by a testing provider, whether public or private, the result of that test, whatever the outcome, is legally required to be reported to PHE as a notifiable disease by the provider. To the noble Lord, Lord Scriven: this is true for a private test or a public test, and I would be glad to send him a copy of the long-standing regulations that make this law. This must be done within 24 hours for all positive tests. Any self-administered test provided by the Government can be reported via our online portal by members of the public. Any positive test reported to PHE will be passed on to our contact tracing system.
The draft impact assessment has now been published in the interest of transparency, as has an impact statement. It is a living document, and we want to make the best analysis available. We intend to update the impact assessment and address the RPC’s comments ahead of the introduction of the second SI in the autumn. I would like to put on record my thanks to the RPC for working so closely with us and at such pace on this matter.
I want to ensure that all tests are available in the UK, whether they are offered by the NHS, a charity or a private provider, and whether they are supplied by a British diagnostic firm or an overseas firm. I thank the noble Baroness for giving me this opportunity to respond to her important points. I beg to move.
Covid-19: Aligning UK and Foreign Entry and Return Requirements
Lord Scriven Excerpts(2 years, 9 months ago)
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Lord Scriven (LD)
My Lords, the director-general of the International Air Transport Association has said that the Government now have
“no coherent policy on international travel.”
To prove him wrong, can the Minister state what data the Government are using to determine the positivity rate for the beta variant on mainland France, and what that data shows for the cases of the beta variant on mainland France?
Lord Bethell (Con) [V]
My Lords, the noble Lord’s question has behind it a genuine dilemma. The amount of genomic sequencing in countries around the world is limited. No other country has the degree of genomic sequencing that we have here in the UK, and we do not have perfect vision of what variants of concern are present in other countries, including even in France. We work very closely with Governments, including that of France, to have access to whatever data they have—but, to an extent, we are operating with imperfect data.
Medical Devices (Coronavirus Test Device Approvals) (Amendment) Regulations 2021
Lord Scriven Excerpts(2 years, 10 months ago)
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Lord Scriven (LD)
My Lords, of course these Benches welcome the general thrust of the regulations—that tests should be safe and that there should be a standard across the UK. However, we also raise the same issue as a number of noble Lords, including the noble Lord, Lord Moynihan, about their timing, and ask why this is emergency legislation. I am afraid it is becoming a bit of a trend that the Government bring things through in emergency legislation. If the instrument had come through a different route in which we had a lot of time, we could have asked many of the questions that we are now asking, and improved and amended the legislation to deal with some of the issues. This is so important, because this is about testing and trying to give the country a sense of what the new normal will be.
The underlying basis of this is a significant change of public health policy. I am not aware of any other infectious disease where public health policy on testing is left purely to the market—unless the Minister can advise otherwise. There is a real issue of this being about not just market failure but the role that public health, public health professions and the public sector will play to ensure that this works.
I say that because, without being linked to the test and trace system, there is a sense that testing in itself will become not as effective as it could be. This SI assumes that public policy will be for most testing to be done outside the NHS, and possibly for a charge. So once these tests are approved and there is a standard, how do mandatory tests then get into the tracing part of test and trace? There is no legislation at present to suggest that has to happen. Employers, or particularly an individual at home, could take a test and it turn out to be positive. Coming back to what has been said many times before in the House and in Grand Committee, if people feel that they cannot afford to self-isolate, they are not going to give details about them being positive.
The question is: if this becomes predominantly a market-driven approach, done by employers and businesses bringing in customers, as the Explanatory Memorandum suggests, or by individuals at home, how does that then trigger tracing? How will it trigger a person having to inform somebody, either locally or nationally, through test and trace, that they are positive? Significantly, how will tracing then kick in to help ensure that the chains of transmission are dealt with as speedily as possible, particularly since evidence suggests that 48 hours is the maximum time before the chain continues to spread?
Regulation 39A says that the Secretary of State can make an exemption for tests coming on to the market which are not tested. In what circumstances does the Minister feel that the Secretary of State would be able to use the power under Regulation 39A? How will it be reported to Parliament or to the public, so that they know whether the test they are getting—or potentially buying—has not been through the statutory testing regime?
I want to further explore something mentioned by the noble Lords, Lord Lansley and Lord Rooker. It is to do with the Innova test and the recommendation in the email from the Food and Drug Administration, which said that this test should be thrown “in the trash”—that was the exact quote. Since it was a class I recall, I need to know what extra testing or analysis has been done by the UK Government based on what they have seen from the FDA and that recall. When was that done and what is the outcome of that testing or analysis, based on the extra evidence that has come from the FDA?
Finally, I would like to ask whether free testing will still be available on the NHS. If it is to be available, a number of questions arise. If I could have free testing on the NHS and it is not means-tested, why would I buy a test, unless certain categories of organisations will not be allowed to use the NHS test? At the moment, people going abroad are not allowed to use the free NHS test. Is it anticipated to be the same for organisations such as businesses—for their staff and for customers coming in, et cetera? What thought has been put into that?
These issues, and the others which noble Lords have raised, are important because this is a matter of public health and of how we contain the virus in the most effective way possible, while keeping people safe. I come back to my opening remark: this is not emergency legislation. It should have been laid normally before Parliament, so that we could have dealt with it and tabled amendments. I would have hoped to make this better, to keep people safe and to deal with proper testing across the UK.