Covid-19

Debate between Lord Scriven and Lord Bethell

Wednesday 21st July 2021 Lords Chamber

[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

Debate between Lord Scriven and Lord Bethell

Tuesday 20th July 2021 Lords Chamber

[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

Debate between Lord Scriven and Lord Bethell

Monday 19th July 2021 Lords Chamber

[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.

Covid-19 Update

Debate between Lord Scriven and Lord Bethell

Thursday 8th July 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I cannot promise to have a simple algorithm to make the calculation that the noble Lord refers to. I will ask the system if such a thing exists, but I have never come across such a thing. The challenge he alludes to is entirely right: the vaccine pressure on the virus will create the circumstances in which variants are possible. That is why we are investing heavily in sequencing, not only here in the UK where everyone positive is now sequenced thoroughly and studied, but also offering that around the world through NVAP—the new variant assessment platform—to try to understand what is going on in markets around the world. To date, we think that we have tracked down all the current routes that the virus is taking, and we are satisfied that they are met by the vaccine, but we keep our eyes peeled.

[Lord Scriven (LD)]

My Lords, evidence shows that those in close contact with a positive case need to be traced with 48 hours to break the chain of transmission. Regardless, if close contacts have to self-isolate or self-test, how does stopping a mandatory requirement to register, either digitally or manually, on entering a venue such as a pub or restaurant help with the effective tracing of close contacts if no record exists of people in venues where positive cases are identified?

[Lord Bethell (Con)]

My Lords, the registration of people going into events is an onerous responsibility for the hospitality industry and we have to make a proportionate assessment of what kinds of burden we are putting on the economy and society. With more than 60% of the population now having been double vaccinated for over two weeks and with the vaccination programme going along at 500,000 a day, it is the moment to start backing off on some of these obligations. That means dismantling some of the infrastructure of test and trace, which we seek to do in a proportionate and logical fashion.

Covid-19 Update

Debate between Lord Scriven and Lord Bethell

Tuesday 6th July 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I pay tribute to the NHS, but the rise in infections among mainly very young people will not necessarily lead immediately to a large increase in the demands on the NHS. An extraordinary aspect of this disease is that it targets the elderly and those with comorbidities and leaves the young largely alone. The proportion of people who have the disease in the months to come will mainly be the unvaccinated. Those are mainly the young and our modelling, which is supported by the NHS, suggests that our resources in healthcare can support that kind of situation.

[Lord Scriven (LD)]

My Lords, the Health Secretary this morning said that there could be 100,000 cases per day by mid-summer as a result of lifting the restrictions in the Statement. Professor Neil Ferguson’s analysis today, based on the delta variant and the age group affected, shows that would equate to about 100 deaths per day. That will mean an extra 15,000 deaths by the end of the year. Is the Minister aware of and comfortable with that projection of extra deaths, when he says from the Dispatch Box that the policy he now advocates leads to a low level of deaths?

[Lord Bethell (Con)]

I am not comfortable with any deaths. The suggestion that we are going into any of this with a sanguine, devil-may-care attitude is quite wrong. We approach the matter with extreme caution. But many people are dying because they have missed their cancer appointments. There will be people who die of flu this winter; there will be many people who die of all manner of diseases. We cannot focus only on Covid—we cannot make it the sole priority of our healthcare system and our entire economy. At some point we need to move on.

We will remain extremely cautious; we have all sorts of back-up resources in place that we can pivot to should there be an escalation of Covid hospitalisations and deaths. I do not need to list from the Dispatch Box any of the things we are all worried about. This is the right decision right now; it is proportionate, and it gives us the space to address the many other health issues we have as a nation.

Covid-19 Update

Debate between Lord Scriven and Lord Bethell

Tuesday 29th June 2021 Lords Chamber

[Lord Bethell (Con)]

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

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

[Lord Scriven (LD)]

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

[Lord Bethell (Con)]

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

Hospital Waiting Lists

Debate between Lord Scriven and Lord Bethell

Tuesday 29th June 2021 Lords Chamber

[Lord Bethell (Con)]

I agree with the noble Baroness that diagnostics is one area where this country needs to make further investment. In the 2020 spending review, we ring-fenced £325 million of capital spending to support NHS diagnostics; the funding will be spent on new equipment, digitising NHS imaging and the pathology networks. New capacity is also coming through the new community diagnostic hubs and pathology and imaging networks. This work is critical, and we are working hard to make sure that it is effective.

[Lord Scriven (LD)]

My Lords, data from four major studies shows that disadvantaged groups have faced the greatest disruption to medical care during the pandemic. How are the Government ensuring that these health inequalities are dealt with in reducing the NHS backlog, and what targets have been set to deal with this issue?

[Lord Bethell (Con)]

I completely agree with the noble Lord that the pandemic has illustrated the severe health inequalities that exist across the country as well as the need to address them. The resilience of our health system depends on addressing those who can create the biggest demands on it. There is both a preventive agenda and an agenda for getting through to the communities, to communicate effectively that they can find the treatment they need in their local authority. The Help Us Help You advertising campaign is particularly targeted at the disadvantaged to encourage them to come forward for diagnosis and treatment.

Covid-19: Care Homes

Debate between Lord Scriven and Lord Bethell

Thursday 17th June 2021 Lords Chamber

[Lord Scriven]

To ask Her Majesty’s Government (1) on what date, and (2) in which policy document, testing for COVID-19 was offered as a matter of policy to those leaving hospitals and going to care homes.

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

My Lords, the Covid-19 hospital discharge service requirements were published on 19 March 2020. They stipulated that patients’ Covid-19 test results, negative or positive, should be included in their discharge documents. On 15 April, we built on this with the adult social care action plan, including a policy of testing all patients prior to discharge to a care home. I remind noble Lords that the WHO acknowledged the threat of asymptomatic transmission on 9 July 2020.

[Lord Scriven (LD)]

My Lords, last week the Secretary of State said that a policy of testing patients going to care homes was brought in

“as soon as we had those tests available”.

That was in mid-April 2020, and more than 500,000 tests were carried out to mid-April 2020. Only 25,000 would have been required to test all patients being discharged to care homes. Can the Minister explain these figures and the contradiction in the Secretary of State’s statement that they highlight?

[Lord Bethell (Con)]

My Lords, I do not quite understand the noble Lord’s figures. As of 14 March 2020, the seven-day rolling average showed that there were 51,741 discharges a day from hospital, of which 1,123 were from hospitals specifically to care homes. That was at a moment when our testing capacity was 3,000 a day. A month later, on 15 April, the rolling average was 22,000, of which 548 were discharges from hospitals specifically to care homes. By that date, the testing capacity was 38,766.

Covid-19 Update

Debate between Lord Scriven and Lord Bethell

Tuesday 15th June 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I am not sure whether I accept the characterisation presented by the noble Lord. We have worked incredibly hard to bring in a managed quarantine system that is a novel, new introduction into the UK. We have done extremely well in fighting off many of the variants that have come to our shores, including the Manaus variant, the South African variant and others. We have strong links with Pakistan, India and Bangladesh, which means there is a lot of traffic between our countries. I am not sure whether it would ever have been possible to prevent this variant making landfall in the UK at some point. But we have done an enormous amount in the UK to delay and prevent the arrival of these variants, and for that I am enormously grateful to those involved.

[Lord Scriven (LD)]

My Lords, following the data is the Government’s mantra. Using the Government’s own test and trace data, for the two weeks prior to Bangladesh going on the red list it had a positivity rate of 3.7%; India’s was 5.1%. Of all variants entering the UK, including the delta variant, more than 50% of cases came from India and fewer than 5% from Bangladesh. So if the Government were following the data on 2 April, why was Bangladesh put on the red list and not India?

[Lord Bethell (Con)]

The noble Lord is enjoying the benefit of hindsight very much indeed; we can all use the retrospectoscope. The data he refers to was not available to us at the time. We did not know that the variant now known as India 2 was a variant of concern. We did not know that it was going to be the most transmissible one. There were three variants in India; we did not know at that point which of them would present the most problems. It is extremely easy to sit here, look back and say that one person should have done this and another should have done that. I ask the noble Lord to try to sit in the seat of those who made the decisions at the time.

Covid-19: Proof of Vaccination

Debate between Lord Scriven and Lord Bethell

Monday 14th June 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, we have engaged considerably with the sector on exactly these kinds of matters. GPs and pharmacies are briefed to help those with difficulties get this material. We are also conscious that some with autism may struggle to take a test and find the process of swabbing intimidating, so we are looking into workarounds for that.

[Lord Scriven (LD)]

My Lords, regardless of whether you hold a paper or digital record, personal health and data will be held on a central database. Can the Minister therefore inform us which government departments and private sector organisations will have access to the data on the central database?

[Lord Bethell (Con)]

My Lords, vaccine data is held in the vaccine database and in the patient’s record. We abide by the principle that the data is owned by the patient.

Covid-19 Internal Review

Debate between Lord Scriven and Lord Bethell

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

Debate between Lord Scriven and Lord Bethell

Tuesday 18th May 2021 Lords Chamber

[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.

Office for Health Promotion

Debate between Lord Scriven and Lord Bethell

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

Debate between Lord Scriven and Lord Bethell

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: Resuscitation Orders

Debate between Lord Scriven and Lord Bethell

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

Debate between Lord Scriven and Lord Bethell

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

Debate between Lord Scriven and Lord Bethell

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

Debate between Lord Scriven and Lord Bethell

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.

Future of Health and Care

Debate between Lord Scriven and Lord Bethell

Tuesday 23rd February 2021 Lords Chamber

[Lord Bethell (Con)]

The noble Lord is entirely right: obesity is not only a major issue, it is specifically cited in the Bill, where we have clear measures to try to address it. I do not need to raise it with the Prime Minister or the CMO because they both take it incredibly seriously. The Prime Minister has spoken movingly about his own challenge when he caught Covid—the five stone by which he feels he was overweight, the impact that had on his life chances, and how close to death he came because of obesity when he went into hospital. That was a metaphor for the whole country, and that is why we have launched a major obesity strategy in respect of marketing and advertising. It is why we remain committed to the obesity strategy, and more measures will be rolled out during the course of the year. I am extremely grateful to the noble Lord for reminding me about World Obesity Day on 4 March, which we will be marking very seriously with a publicity campaign.

[Lord Scriven (LD) [V]]

My Lords, nearly 75% of NHS expenditure goes on hospital and ambulatory care. Will the Minister explain how the proposed reforms will, in reality, lead to the redirecting of significant hospital sunk costs into ill health prevention and improving population health outcomes, as implied in the White Paper?

Covid-19 Vaccines Deployment

Debate between Lord Scriven and Lord Bethell

Thursday 11th February 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, we have done an enormous amount to prioritise care home staff, for the entirely pragmatic reason that it would make no sense at all for vulnerable care home residents to be infected by the staff who come and serve them. It is not always possible to put care home staff in exactly the same queue as those residents, sometimes because they are the ones delivering the vaccines. There is in fact a hugely sophisticated NHS route for care home staff to get their vaccine. However, I hear loud and clearly the concerns of noble Lords on this area. Let me please look at it more closely and I will correspond with the noble Baroness, Lady Massey, if I can provide her with any more details that would be helpful.

[Lord Scriven (LD) [V]]

My Lords, some GPs in Sheffield have told me today that their hubs have a zero supply of vaccine and have been closed for over a week. However, they have not yet vaccinated all of their high priority patients. Those patients are now being directed to travel by bus up to 10 miles to the mass vaccination centre, but the most nervous and vulnerable say that they will not go there. What can the Minister say to GPs who are waiting and able to vaccinate patients but have no vaccine because it has all gone to the distant mass vaccination centre?

[Lord Bethell (Con)]

My Lords, I have heard the noble Lord’s concerns about this matter when he has brought them up previously, but I simply do not recognise the story he is telling. I would remind him that 95.6% of those aged 75 to 79 have had the vaccine. This is not the story of people who are concerned about going to mass vaccination centres. There are GP centres up and down the country that are closed because they do not have supplies, and it is supply that is undoubtedly the rate-limiting factor. That is because, as he knows, the supply comes in large boxes. If GPs do not have enough people to use up a large box, we have to prioritise those who have longer lists.

Covid-19: Self-Isolation

Debate between Lord Scriven and Lord Bethell

Wednesday 10th February 2021 Lords Chamber

[Lord Scriven]

To ask Her Majesty’s Government what assessment they have made of the number of people self-isolating who have been asked to do so as a result of testing positive for COVID-19.

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

My Lords, we know that the public continue to make enormous sacrifices. A recently published study by UCL indicated that, in the case of people who have been in contact with someone who tests positive, the proportion who report self-isolating is around 80%. Isolation remains critical to breaking the chains of transmission. We continue to improve our support to those who are asked to isolate.

--- Later in debate ---

[Lord Scriven (LD) [V]]

My Lords, surveys show that approximately a third of people stop self-isolating between one and five days, with many saying that, despite the current cash support, it is the financial crisis that they face that forces them out of isolation and back to work. Is it not time for the Government to deal with this and do what some other countries with high levels of self-isolation compliance do by paying people’s full wages while they isolate?

[Lord Bethell (Con)]

My Lords, the surveys are not crystal clear about practice, but on the whole the UCL survey and our own interrogation of those isolating suggest that compliance is much higher than the noble Lord implies. I pay tribute to local councils, which are doing an enormous amount to provide the kind of economic support that the noble Lord quite rightly alludes to. Blackburn with Darwen, for instance, provides an enormous amount of support for those with annual earnings under £21,152. In Colchester, applicants must not have more than £16,000 in capital, but the council provides a substantial discretionary payment. It is this kind of targeted local support that we believe can make an enormous difference.

Covid-19 Update

Debate between Lord Scriven and Lord Bethell

Thursday 4th February 2021 Lords Chamber

[Lord Bethell (Con)]

The noble Lord is entirely right to raise this issue. There is the awful possibility that the mutant vaccine escape virus could get around the vaccine altogether. We need a plan B, which might be dependent on antivirals as an alternative way of managing the disease. That is what happened with HIV, as we discussed last week. The therapeutic taskforce is looking at antivirals and putting together a plan to upscale our investment in that area. I am aware of Synairgen and ACTIV-2, but he is entirely right that this should now be a greater priority. I will take the matter back for the department to look into further.

[Lord Scriven (LD) [V]]

My Lords, virologists tell us that, even with vaccines, we will be living with Covid for years to come. The Statement says:

“Our mission must be to stop its spread altogether and break those chains of transmission.”


To ensure that this happens, what changes have been made during this lockdown to improve the outcomes of the £22 billion test, trace and isolate system, for when the restrictions are eased?

[Lord Bethell (Con)]

My Lords, I pay immense tribute to the test and trace system, which, at 11 am, published remarkable performance figures, as the noble Lord probably knows; 92% of tests were turned around before the next day, and 86% of contacts were traced. This is an incredible performance. On his specific point, the creation of a variant-of-concern tracing group that is targeted at those rare appearances of VOCs in the community is the important development that we have put in place in reaction to the mutant variants. I pay tribute to Steve McManus, who is running that programme, for the impact that he has already made on the problem.

Covid-19: Vaccines

Debate between Lord Scriven and Lord Bethell

Monday 1st February 2021 Lords Chamber

[Lord Bethell (Con)]

The noble Lord is entirely right: the vaccines are a hugely important development, but so is investment in all therapeutic drugs. We are extremely blessed to have had a contribution towards dexamethasone, tocilizumab and other therapeutic drugs which have greatly improved outcomes for patients in hospitals. He is right that antivirals also present an opportunity. The reason we have supported research into antivirals through the urgent regime in our clinical trials is to ensure that there is sufficient commitment in hospitals and primary care on antivirals. We are tasking the Therapeutics Taskforce with a specific mandate to look at antivirals and whether we should give greater resources to this avenue of therapeutic development.

[Lord Scriven (LD) [V]]

My Lords, having the second dose of the Pfizer/BioNTech vaccines in the right quantities in the right place at the right time is vital. Will the Minister guarantee that people will be able to get their second dose of it at the local GP hub where they had their first dose administered without being directed to a mass vaccination centre to receive it?

[Lord Bethell (Con)]

In response to the noble Baroness, I said that we were confident that we had the supplies of the vaccines to do the second dose. It is not our policy that anyone has the second dose of anything other than the vaccine they had the first dose of. We will work with people to give them the most convenient place to have the vaccine, but I cannot offer the guarantee that the noble Lord seeks.

Vaccine Rollout

Debate between Lord Scriven and Lord Bethell

Monday 25th January 2021 Lords Chamber

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

My Lords, I am extremely grateful for that question, because it will help me to clear up a misconception in this area. Having an NHS number is very important. We cannot know who has had the vaccine and who has not if we do not know what their NHS number is. That is extremely important for their own treatment; it is also best practice. As any clinical practitioner will tell us, it is imperative to know the identity of the person being treated. It is also very important for pharmacovigilance and for the research that will come on the back of the vaccine. If we were to vaccinate a large proportion of the population without knowing who they were, we could not do the research necessary. There will be some people who do not have an NHS number, and we have put in place protocols to ensure either that they can get an NHS number or that a workaround can be found. Those we are pursuing with haste. I emphasise to noble Lords that this is an opportunity to ensure that everyone in this country, whether a visitor or a resident, has an NHS number by the end of this programme.

[Lord Scriven (LD) [V]]

My Lords, here in Sheffield, approximately 45,000 people have been vaccinated, owing to the excellent work of our local GP hubs, but because of lack of vaccine supply, 10 out of 15 of those will be closed and will not be able to get the jab into vulnerable people’s arms again until the middle of next week. Yet the new Sheffield mass vaccination centre has opened today and has vaccine. Local GPs have asked me to ask the Minister why the distant megacentre has been given priority for vaccine supply over the local and effective GP hubs.

[Lord Bethell (Con)]

It is not a question of one place taking precedence over another. I take a moment to applaud and pay tribute to GPs in Sheffield, and to all those who have proceeded at pace and got through their allocation as quickly as they could. That is absolutely the right priority and the right approach, and it is how we are going to get through the population very quickly. However, some people will get through their list more quickly than others, and it would be a mistake then to start asking them to move down the list when there are still those with very high priority who need to be vaccinated. Although I understand that it may be frustrating for a GP to stand idle, those are the practicalities of what we are doing. The mass vaccination centres are essential to deal with the very large numbers of people that we plan to vaccinate over the next few months. That is why the Sheffield vaccination centre is such good news.

Covid-19: Vaccinations

Debate between Lord Scriven and Lord Bethell

Wednesday 13th January 2021 Lords Chamber

[Lord Bethell (Con)]

I am extremely grateful for the noble Lord’s kind words. I know lawyers looked at the question he raises on informed consent; I am afraid I do not have the precise answer at the Dispatch Box right now, but I will be glad to write to him with a clarification.

[Lord Scriven (LD) [V]]

Up here in the north, the Yorkshire Post is running a “shot in the arm” campaign to get the Government urgently to allow the local community pharmacists who are screaming out to get jabs in people’s arms to do so. Why are the Government using excuses about batches of 1,000 for the AstraZeneca vaccine getting in the way of using these safe places on the high street that will improve access in the take-up of the vaccine?

[Lord Bethell (Con)]

My Lords, I am not sure we are using excuses; we are observing practical matters. The priority, quite reasonably, is to get the vaccine in as many arms as possible. We are totally committed to comprehensive distribution of the vaccine that reaches into rural communities and will include working with community pharmacies as important distributors. However, be under no illusion: our priority is speed and reach, which is why the deployment has taken the shape it has.

Covid-19: Variant

Debate between Lord Scriven and Lord Bethell

Wednesday 13th January 2021 Lords Chamber

[Lord Scriven]

To ask Her Majesty’s Government when they first became aware (1) of the new variant of COVID-19, and (2) that such a variant of the virus was prevalent in the areas placed into Tier 4 on 20 December 2020.

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

My Lords, the second variant is a very serious matter. On 8 December, analysis of all genomes available in Kent showed that a new variant was circulating. Ministers were notified on 11 December. On Monday 14 December, the Health Secretary informed Parliament, PHE released a statement and the Government held a press conference on the new variant.

[Lord Scriven (LD) [V]]

My Lords, variant B117 was identified in October. From the second week of December, virus cases started to rocket in London and the south-east, yet the Government’s focus was on how to keep people mixing at Christmas, not on dealing with the alarming spread of the virus, ignoring public health experts who said that a tight lockdown was urgently required. What message of apology does the Minister have for those families attending funerals because the Government acted too slowly to help save lives?

[Lord Bethell (Con)]

My Lords, I am afraid that I just do not recognise the noble Lord’s proposition. Hundreds, if not thousands, of new variants are appearing all the time. Many of them have passed through the process, but identifying those that are threatening, have more transmissibility and are significantly different is extremely complex. As I said very clearly, it was on 8 December that, after analysing all the genomes available in Kent, we showed that an important new variant was circulating.

Covid-19: Vaccinations

Debate between Lord Scriven and Lord Bethell

Thursday 17th December 2020 Lords Chamber

[Lord Bethell (Con)]

I take on board the noble Baroness’s points on the NHS. Its staff have been under huge pressure, which is likely to be sustained into the new year. I pay tribute to their hard work. The JCVI has looked extremely carefully at the prioritisation. The most important thing is to avoid pressure on ICUs and the threat of mortality. That has been done by prioritising age over role. I also pay tribute to the St John Ambulance service, which has done an amazing amount of work in gathering 40,000 inquiries for training on delivering the vaccine. By undergoing training, those people will relieve NHS staff of an enormous amount of the pressure that the noble Baroness rightly describes.

[Lord Scriven (LD)]

My Lords, following on from my noble friend Lady Brinton’s question, it is estimated that between hundreds of thousands and millions of people are not registered with a GP. Some have the most chaotic lifestyles, do not speak English and are not plugged into the most basic services. How will the Government make arrangements for people who are outside normal registration processes to be vaccinated?

[Lord Bethell (Con)]

The noble Lord makes the point well. He is right that there are undoubtedly communities that conventional NHS outreach has not got to; we have learned that fact during Covid. Our immediate priority is to reach the over-80s and ensure that the deployment programme works for those groups that are most at risk. We will be turning our attention to the groups that he describes, but I cannot avoid the fact that, if you are going to get a medical service, you need to be registered with a GP. That is something that some people are going to have to make part of their life.

Coronavirus Vaccine

Debate between Lord Scriven and Lord Bethell

Thursday 3rd December 2020 Lords Chamber

[Lord Bethell (Con)]

I welcome the noble Lord’s challenge and completely endorse his point that tracing will remain important. Not everyone will take the vaccine initially; it will not be available to everyone for months, as the Deputy Chief Medical Officer made plain in his briefing earlier today. Tracing remains a really important feature of our fight against this disease. However, I respectfully suggest that his information is a little out of date: the amount of collaboration on tracing between the national and local efforts, particularly with DPHs such as the one in Cumbria, has come on in leaps and bounds, even in the last few weeks. From my briefings and meetings with DPHs, I know that they have been provided with an enormous amount of data, support and access to tracing resources in order both to bring their local intelligence and insight to bear and to support the national tracing effort. I applaud all those DPHs who have stepped forward in this way, and I am very hopeful that the local-national combination on tracing will pay massive dividends.

[Lord Scriven (LD) [V]]

My Lords, in the first priority group, there are over 3.2 million people aged 80 or over. As the UK will get doses for 400,000 people initially, what access framework is in place to ensure an ethical approach to the vaccine rollout for these first 400,000 people that is not based on having the sharpest elbows or the chance of having a hospital appointment?

[Lord Bethell (Con)]

My Lords, the noble Lord raises an important challenge there; fairness and equity are important in this important time. However, I will try to assess the situation: we have 800,000 doses of a vaccine that is incredibly difficult to transport, requires cold storage and is in vials containing more than 100 doses each. Therefore, practical considerations are pre-eminent at the moment, rather than sharp elbows.

HIV: Pre-exposure Prophylaxis

Debate between Lord Scriven and Lord Bethell

Tuesday 1st December 2020 Lords Chamber

[Lord Bethell (Con)]

The noble Baroness makes an entirely fair point. Access to PrEP is not as even as it could or should be. It is a very important tool in our fight against the transmission of HIV, and it is a programme that we support wholeheartedly. However, it takes time to roll out a therapeutic such as this through the entire healthcare system. We have focused its supply through sexual health units because they are the most thoughtful and reliable places for the kind of consultation and expertise needed for a delicate new therapeutic like PrEP. However, she raises a good point that perhaps this should be and could be updated.

[Lord Scriven (LD)]

My Lords, since 2017, both Scotland and Wales have supplied uncapped access to PrEP, so will the Minister tell us what is stopping uncapped access to PrEP in England, so that we do not have a postcode lottery for access?

[Lord Bethell (Con)]

The noble Lord will be aware that there is a detailed conversation with local authorities about ensuring that we get exactly the right balance for funding. As the noble Baroness rightly pointed out, we need to make sure that the supply of PrEP is conducted in a way where there is good consultation and where those who are applying for the therapy are given good advice. That is best done with help from local authorities, and we are trying to hammer out a deal to ensure that that is done thoughtfully. That deal has been delayed by Covid, but we are looking forward to announcing a resolution of that before the next funding round finishes.

Covid-19: Vaccines and Medical Equipment

Debate between Lord Scriven and Lord Bethell

Wednesday 25th November 2020 Lords Chamber

[Lord Bethell (Con)]

I entirely endorse the sentiment the noble Lord expresses. I offer my profound thanks to the devolved authorities for the immense spirit of collaboration which has characterised the response to the pandemic. Often, it would seem from the headlines that the nations are at odds with each other; that is not my experience. The Christmas negotiations he cites are a very good example of that, and I hope the vaccination arrangements will be the finest moment.

[Lord Scriven (LD)]

My Lords, on 25 September the JCVI reported the serious risk of disease and mortality from Covid according to deprivation and ethnicity. These issues have to be taken into consideration in the vaccination programme, so why does the present list of priorities for the vaccine ignore those factors completely?

[Lord Bethell (Con)]

My Lords, the noble Lord is entirely right that deprivation and ethnicity are key considerations in the morbidity of Covid; we are all acutely aware of them. The JCVI has looked extremely closely at a variety of different models for prioritising vaccination. Prioritisation based largely on age gives the most accurate and thoughtful prioritisation of the vaccine and is also simple to understand and deliver. That is why it has gone down that route.

Personal Protective Equipment: Procurement

Debate between Lord Scriven and Lord Bethell

Thursday 19th November 2020 Lords Chamber

[Lord Bethell (Con)]

The noble Lord, Lord Triesman, misconstrues the nature of events. The Prime Minister made a number of public calls for help, which resulted in more than 15,000 offers. Of course, those had to be triaged. Not all were credible. Some were helpful and some were well-intentioned but not all were practical. We had to find a way of prioritising the most impactful. Anyone in our position would have done the same. This credible list included senior professional healthcare clinicians; members of former Governments of all parties; leaders of British industry; and all manner of helpful people, some of whom came from completely unexpected places. I should be happy to tell the stories of some of those unexpected offers another time. The noble Lord’s description of the prioritised channel is a misrepresentation. I regret that I cannot proceed as he asks.

[Lord Scriven (LD)]

My Lords, let us be clear. The issue is not that people stood up; it is what the Government then did to procure goods and services. Yesterday’s National Audit Office report states

“we cannot give assurance that government … mitigated the increased risks … or applied appropriate commercial practices”

at all times. That is technical-speak for not being able to rule out fraud or corruption. How can the Minister stand at the Dispatch Box and say with any credibility that all the rules were carried out and there were no conflicts of interest? Which should we believe, a line from the Dispatch Box or a report from the National Audit Office?

[Lord Bethell (Con)]

My Lords, I do not really recognise the noble Lord’s technical-speak interpretation of the NAO report. In fact, the report is crystal clear. Yesterday, I quoted from its references to Ministers and conflicts of interest, and I do not think that I need to repeat it: it was crystal clear. However, perhaps I may reassure the noble Lord. I do not pretend for a moment that every single piece of paperwork got done on time during the pandemic—quite the opposite. We rewrote the guidelines on 18 March and reissued them: there is no way that you can jump through the hoops of a normal tendering process when you are in the middle of a massive global land grab. I am not pretending that; I am saying that there were not conflicts of interest, that Ministers were not involved in the procurement decisions and that the nation should be proud of the way in which we responded to the pandemic.

Covid-19: Conflicts of Interest

Debate between Lord Scriven and Lord Bethell

Wednesday 18th November 2020 Lords Chamber

[Lord Scriven]

To ask Her Majesty’s Government what assessment they made of conflicts of interest before engaging specialist advisers to inform their response to the COVID-19 pandemic.

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

My Lords, in our nation’s time of need we have been very fortunate to call on the talents of many, including colleagues old and new, some paid and some unpaid. Appointments are considered on merit and, when required, we ask candidates to declare any interests. We assess these on a case-by-case basis, but declaring an interest is not always a barrier to being appointed. There are, however, robust processes in place to manage any conflict. These ensure that no one gains unfairly from advising the Government.

[Lord Scriven (LD)]

My Lords, can the Minister give a logical reason why a company with no history of supplying PPE that is introduced by a special adviser can be passed from a Minister’s office, be fast-tracked and be 10 times more successful in getting a contract to supply PPE—which sometimes cannot be used because it does not meet the standards—than a company with a solid track record of supplying PPE that has no access to a special adviser or Minister?

[Lord Bethell (Con)]

My Lords, we are enormously grateful for the very many people who stepped forward to offer help during this time. When the Prime Minister made his public call for help, 16,500 people contacted us with various offers. It was, of course, necessary to triage and prioritise that huge list. In that list there were a great many people who had extensive experience in their area; there were people who were new to the game; there were have-a-go heroes; there were multinational companies. There were also those whose intentions were not as pure as one would hope. We approached each and every one on their merit, and there were official guidelines to guide the procurement processes. We have stuck to those guidelines every step of the way.

Covid-19 Update

Debate between Lord Scriven and Lord Bethell

Thursday 12th November 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, I am not sure that I entirely understood the question. In terms of the private beds that we intended to use, that capacity was extremely valuable as a fallback during the first wave, but I am pleased to say that it was not needed. There is some testing in the private sector, but we are not leaning on that at the moment. The testing that is done by the Government is through test and trace, and we are committed to using as much of that capacity as is needed.

[Lord Scriven (LD) [V]]

The Statement says nothing about antibody testing. On 6 October, the noble Lord announced the £75 million single-source purchase of antibody test kits from Abingdon Health. Official correspondence, dated 1 October, reveals that the department had a report by Public Health England that shows that those antibody tests were not accurate enough for their intended use and that the department would delay publication of the report until after the Government announced that they had purchased them. Why was that, Minister?

[Lord Bethell (Con)]

If the noble Lord would not mind, could he repeat the question, because I could not hear the words, I am afraid?

[Lord Scriven (LD) [V]]

The Statement says nothing about antibody testing. On 6 October, the noble Lord announced the £75 million single-source purchase of antibody test kits from Abingdon Health. Official correspondence, dated 1 October, reveals that the department had a report by Public Health England that shows that those antibody tests were not accurate enough for their intended use and that the department would delay publication of the report until after the Government had announced that they had been purchased. Why was that, Minister?

[Lord Bethell (Con)]

I am afraid I am not familiar with the report to which the noble Lord refers. I am glad to undertake to write with an answer to that question.

Covid-19: Vaccine

Debate between Lord Scriven and Lord Bethell

Wednesday 11th November 2020 Lords Chamber

[Lord Bethell (Con)]

We are working extremely closely with the Northern Ireland Administration to ensure deployment of the vaccine; as I said earlier, this will be done on a four-nations approach. The Oxford vaccine is going through the final stages of phase 3. We are very much looking forward to hearing how it is going but I am afraid to say that I do not have a precise date for when that will be.

[Lord Scriven (LD) [V]]

My Lords, what specific arrangements have the Government put in place at our borders to ensure that the vaccine can pass speedily, without hindrance, from Belgium after 31 December?

[Lord Bethell (Con)]

My Lords, we have extremely detailed and thorough arrangements for our borders on 31 December. No problems are envisaged with regard to the vaccine.

Covid-19: Contracts and Mass Testing Programme

Debate between Lord Scriven and Lord Bethell

Wednesday 4th November 2020 Lords Chamber

[Lord Bethell (Con)]

The noble Baroness is right that transparency is key. I take those principles extremely seriously, and that is why we are publishing the contracts. I encourage anyone who is interested in looking at them to look at my Twitter feed, where I published a link to the Contracts Finder service yesterday. I reassure her that, although some connections were made through networks, absolutely every contract had exactly the same technical assurance, exactly the same contract negotiation and exactly the same procurement scrutiny. Those were done by civil servants, and value for money for the taxpayer and the people was guaranteed by that process.

[Lord Scriven (LD)]

My Lords, the Minister seems to say that there is nothing to see here, whereas some of us think that there is a whiff of uncertainty and of some things being not quite right. Therefore, will he agree to appoint an independent forensic auditor to carry out an independent report that can be published publicly to show exactly what has happened with PPE procurement?

[Lord Bethell (Con)]

My Lords, I do not want to give the impression that absolutely everything is perfect. Those were desperate days and we had to do extraordinary things to protect our healthcare staff. I remind noble Lords that other countries were flying in their representatives with bags of cash on private jets in order to seal contracts and some of our supplies were literally taken from under our noses on the runway at Hong Kong airport. They were extremely difficult times and I do not pretend for a moment that everything was absolutely perfect, but I reassure noble Lords that the right procedures were put in place by officials, and I reassure the noble Lord that these figures are currently being validated with the National Audit Office.

Covid-19: Intensive Care Treatment

Debate between Lord Scriven and Lord Bethell

Thursday 29th October 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, the implementation of the long-term plan is under way, despite Covid. We have put the care of the elderly—and, in fact, all those who are vulnerable and in need of social care, half of whom are under 60—at the centre of our efforts. Returning to the point of the question and the article, I remind noble Lords that two-thirds of our Covid in-patients were over 65. Each got the support and treatment that they deserved and needed, and that will remain our commitment during any second wave.

[Lord Scriven (LD)]

My Lords, in April NHS England issued the Reference Guide for Emergency Medicine. Non-conveyance guidelines for ambulance services stated that any care home resident should not be taken to hospital until it was discussed with a clinical advisor. Why, therefore, was a resident in a care home not given equal treatment of access to hospital as an equivalent person outside the care home setting, and has that instruction been withdrawn?

[Lord Bethell (Con)]

My Lords, I do not know whether that specific instruction has been withdrawn; I will be glad to write to the noble Lord on that. I reassure him that, during an epidemic of a highly contagious disease, a hospital might not be the safest place for someone who is ill in a care home; nor would it necessarily be the safest place for someone who has gone to their GP and is sitting in the GP’s surgery. It is therefore absolutely essential that clinical risk management and advice is sought before referral to a hospital. There is no prejudice or unfairness here: it is simply good clinical practice.

Covid-19: Test Results

Debate between Lord Scriven and Lord Bethell

Tuesday 27th October 2020 Lords Chamber

[Lord Scriven]

To ask Her Majesty’s Government what immediate changes they are making to improve the speed of test results for COVID-19.

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

My Lords, in the last two months we have responded to the rising demand for tests, the rising infection rates, the need to protect the front line in health and social care, the need for clinical trials for vaccine-to-medicines, outbreak control and surveillance by doubling the number of tests to 360,000. This has impacted turnaround times, which is regrettable, but we are focused on increasing capacity to raise efficiency, investing in the logistical backbone and encouraging users to the weekends, which will bring turnaround times down to the objective of next-day results.

[Lord Scriven (LD)]

My Lords, this morning I spoke to Allan Wilson, the president of the Institute of Biomedical Science, which represents 20,000 professional lab staff. He wrote to the department in early April to offer his free advice on how to improve the system and get a speedy testing system. Seven months later, the department responded with a letter advising him to go to the government portal for public contracts. Will the Minister now agree to meet the person who probably has the most experience of labs up and down the country? Why are the Government shunning Mr Wilson of the Institute of Biomedical Science in favour of paying £700,000 a day to management consultants?

[Lord Bethell (Con)]

My Lords, I am distressed to hear the anecdote that the noble Lord has just shared with us. We embrace the support and help of anyone who steps forward, particularly someone such as Mr Wilson, who clearly has an enormous amount of expertise. I would be delighted if he would write to me personally and I would be very prepared to meet him. I would also like give massive thanks to all those from all the relevant logistical, pathology, military and medical sciences who have formed an organisation practically the size of Tesco, which is what the national diagnostic system now looks like. It is only with the support of British industry, universities and business that we have been able to build this up and we are enormously grateful for that support.

Covid-19: South Yorkshire

Debate between Lord Scriven and Lord Bethell

Thursday 22nd October 2020 Lords Chamber

[Lord Scriven (LD)]

My Lords, I declare my interests as a resident of Sheffield and, knowing the area well, as a former leader of Sheffield City Council. I note that I will not be the only former leader of Sheffield City Council who will speak on this Statement; unusually, we will probably both agree with each other again.

We have to remind ourselves that going into any of these tiers, particularly very high, and a blanket lockdown is a failure of one thing: an effective test, trace and isolate system. Countries that have that do not have to have blanket lockdowns; it is absolutely vital that the Government understand that.

There is beginning to be a feeling of a north/south divide on this. It is ironic that Greater Manchester has not had any extra support for jobs when it has been in the equivalent of tier 2 for quite a few months. It is telling that, just a couple of days after London goes into tier 2, suddenly the Chancellor is on his feet talking about a tier 2 system for extra job support.

Having spoken to a number of people in South Yorkshire over the last 24 hours, let me tell you what the feeling is: anxiety, fear and uncertainty. I have spoken to people in tears, who have a business and who just do not understand why they are asked to do things. I reiterate the comments of the noble Baroness, Lady Thornton: you cannot plan a business or your life if you have no idea of the criteria and the trigger points for being released from tier 3. This cannot be left to a number of suits in an office, deciding the livelihoods and the businesses of many areas. What are the criteria and the trigger points for release and for going into a certain tier—not just tier 3? They need to be public, not the private judgments of people in a private meeting.

Also, why is the support package per head and not more nuanced? The support package for people in Sheffield is £29 per head—£30 million for business and £11 million for public health—but why is it a flat rate? When we know that older people, BAME communities and deprived people are more affected, why is there not a weighting in an area for those particular issues? They are the ones who will be greatly affected and more spending will be needed. Again, why is the business support package per capita? Why is it not based on the number and type of businesses that will be affected? Why does the formula seem so out of sync with what local areas will need to do?

I am pleased that there is support, at only £8 per head, for public health, which includes a local test, trace and isolate system. From this support, apart from money, what extra resources and expertise will local areas in South Yorkshire be able to call on to implement an effective localised test, trace and isolate system? We want to do our bit in South Yorkshire but we want to see fairness and a package that will minimise the effect of this high-level rate on both businesses and people.

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

My Lords, the noble Lord, Lord Scriven, put the sense of jeopardy and anxiety about the current situation extremely well. Anyone providing for their family or running a business will feel a huge amount of anxiety or even deep concern about the prospects for the next few months, and that is completely understandable. That is why we take all these matters incredibly seriously, why we are focused on it as a Government, and why we have made it such a large priority. The noble Baroness, Lady Thornton, put the grave sense of jeopardy extremely well when she referenced the Vallance graph, which was so derided when it was first posted and which has come to haunt us since then, the clear sense of concern from Jonathan Van-Tam, and the description of the state of our hospitals and intensive care units from Steve Powis. All those were grave warnings and have come to play out in a way that I am afraid worries us all.

At the heart of this debate is a question about the local lockdowns. They are necessary for those very reasons I just described. The infection rates have gone through the roof, they are profound, and they are having an impact right through all the demographics. In many cases they may have started in universities and with young people but they have moved relentlessly through the age demographics and are leading to hospitals filling up in a way that any mathematician, or anyone like me with an O-level in maths, can see is completely unsustainable without a major intervention. Our priority is to try to manage those interventions in a way that strikes the right balance, preserving the economy, keeping the schools open and keeping our lives as normal as possible, but which has an impact on the transmission of the disease. That is why these local lockdowns are so very important, because they are a way of introducing targeted measures to populations in a way that can close down the spread of the disease within a community.

When we say “community”, one of the lessons we have learned is that people travel within their regions a great deal, so we cannot be laser-like and targeted and just shut down a street, a town or a village. We have learned that we have to apply it to substantial regions; otherwise, the disease rolls from one small community to the next. Making these local lockdowns work is not in any particular government interest but in all of our interests. I ask noble Lords to step back from the temptation to introduce party politics into a subject which is driven by genuine public health concerns. It does not help anyone to talk in terms of north-south divides, people being at each other’s throats, scum, or any of the other political rhetoric that has been associated with the last week.

I come back to something that I have said many times at this Dispatch Box. It has been derided by those on the Benches opposite but it remains true and I see it every day of the week. There is a huge amount of bilateral and multilateral dialogue between central government and the agencies of central government—including the Cabinet Office, the DHSC, BEIS, MHCLG, NHS Test and Trace, and the NHS—and those in the regions and in the DAs. There are massive weekly calls, such as the one between the CMO and the DPHs, the one between the BEIS Secretary of State and the business community up and down the country, and the Thursday call between the MHCLG and 350 council chief executives and leaders. There is a relentless drumbeat of engagement and a huge amount of engagement on a one-to-one basis, as was shown by the revealing telephone logs of those on the phone to the mayor of Manchester on Wednesday, which seems to suggest that he was much more in touch with central government than perhaps was apparent from his photo call. I reassure the Chamber that that spirit of partnership to get the local national partnership working is genuine, backed by substantial amounts of money—£1 billion has been pledged for local authorities to support the local lockdown policy—and it is in all our interests to get this to work.

If it does not work, and if there is not the political leadership and trust at a community basis in the efficacy of this approach, we have only one choice. I am looking at the SAGE table which I have in front of me, and it is really clear. These kinds of tactical interventions can knock a point or two off R. However, the only way of knocking an integer off R is a national, home-based lockdown. That is the alternative: that we all go back to March and April, to being at home, with shops closed and no travel. If this local lockdown policy does not work, that is where we will end up, and that is why we are committed to working as hard as we can.

I pay tribute to the large number of those involved in local government at all levels who have worked really hard in their communities to make it work. We are here to talk about Lancashire, and I pay tribute to those in Lancashire who have agreed to and in fact called for the lockdown there. The noble Baroness, Lady Thornton, and the noble Lord, Lord Scriven, are right on the exit strategy. It is absolutely critical that everyone understands what the exit strategy is, and our focus needs to be on that. But I can tell your Lordships that it takes a lot longer to get out than it does to get in. The ramp up is a lot steeper than the ramp down, and it is a big struggle that will need the support of individuals, households, streets, communities, local authorities, regions, mayors and the national resources to make it work. I very much appeal for collaboration in this matter and hope that we can move on from what the noble Baroness, Lady Thornton, rightly characterised as a bit of an unseemly scramble this week.

The noble Baroness, Lady Thornton asked about shielding, which is incredibly important. We wrote to the shielding list on 13 October. That letter struck the balance between the need to protect those who are vulnerable and to take on board the feedback from many, including those in the Chamber today, that extreme shielding—locking up those who are vulnerable —does not support their mental health and will have massive consequences for them personally and for their communities. Therefore, the advice we have provided, in consultation with charities and groups representing those who are being shielded, strikes the right balance.

The noble Lord said something that I need to knock on the head in a big way, because it is a very destructive and counterproductive idea. He said that the fact that we are bringing in local lockdowns is itself proof of the failure of test and trace. That is simply not true. The only way to beat the virus is through the principal interaction of “hands, face, space”. You cannot break the virus’s spread entirely by isolating those who, retrospectively, you have identified as having the disease. That will never work, and we have never claimed it will work. SAGE and the Royal Society have been very clear that the impact of test and trace is complementary but it is not unique. The idea that local lockdowns are somehow solely and uniquely caused by the failure of test and trace takes the responsibility for beating the virus away from individuals, communities, employers, local authorities and the Government. With the greatest respect, I plead with the noble Lord to move away from that rhetoric, because it undermines the public communication of the importance of “hands, face, space”.

I return to my opening remarks. No one could take the development of these local lockdowns more seriously than the Government. It is done with huge regret. We can see perhaps the flattening of some numbers in some places that would indicate that local lockdowns are having an impact. It is too early to call at this stage. However, I live in hope that they will have the impact that we desire, and I live in fear that they will not.

Covid-19: Information Sharing with Police Forces

Debate between Lord Scriven and Lord Bethell

Tuesday 20th October 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, those are two very important and clear questions. However, I will have to take them back to the department and write to the noble Lord with very clear answers.

[Lord Scriven (LD)]

My Lords, despite what the Minister says, this memorandum of understanding has undermined some people’s trust in test and trace. The best way to deal with that is to shed the light of transparency on to what is actually in the MoU. Therefore, will the Government commit to publishing it?

[Lord Bethell (Con)]

My Lords, I commit to publishing the memorandum of understanding; that is our intention. It has to be cleared of some officials’ names and redacted accordingly, and, when we have gone through that process, we will publish it. I will address the noble Lord’s central point, which is very reasonable, and I am glad he made it because he and the noble Lord, Lord Hunt, are entirely right: there is a balance here between the principle of consent, which is how we went about implementing a great many of our measures, and the principle of effectiveness.

We are quite late now in the stage of the epidemic. I think it reasonable to demonstrate the seriousness of the principle of isolation, to make what isolation means crystal clear—and, therefore, in statute—and for the sanction of the law to apply to those people who do not have a responsible attitude and have behaved irresponsibly. It is not our intention to rack up a large number of prosecutions in this area, as it has not been in other areas. However, it is our intention to be clear and determined and to make this incredibly important part of our breaking the chain of transmission as effective as possible.

Covid-19: NHS Application

Debate between Lord Scriven and Lord Bethell

Thursday 1st October 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, I entirely agree with the noble Lord’s observation. These are parallel developments and we are indeed working on them. It is important that the app captures all testing information. We are working extremely hard to ensure that all tests, wherever they come from, whether pillar 1 or pillar 2, are captured in the app. We are also doing an enormous amount to ensure that there are supporting measures for those who work in social care and teaching, so that they have the security of knowing that their workplaces are protected.

[Lord Scriven (LD)]

My Lords, I wish the Minister a happy birthday. So far, £35 million has been spent on the development and testing of the app, which is approximately £15 million more than any other western European country has spent on such app development. Other than the QR code, what functionality has that £15 million been spent on, which is not available in the app of any other western European country?

[Lord Bethell (Con)]

My Lords, the secret sauce of the app is the algorithm at its heart, which takes data from Apple and Google phones and the Bluetooth component, and applies a risk-scoring analysis that judges proximity, velocity and context to give a true assessment of risk. That is how we seek to avoid false positives and false negatives. We have invested in the algorithm in conjunction with Apple and Google and it is an incredibly important piece of added value. Without that algorithm, the app would not work properly.

Covid-19: Tracking

Debate between Lord Scriven and Lord Bethell

Wednesday 30th September 2020 Lords Chamber

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

My Lords, engineers at the Department for Health and Social Care are undertaking an initial assessment of the Exposure Notifications Express capability in consultation with Apple. At this stage, the assessment is paper-based, as software is not available outside the United States. We anticipate ENS becoming available in European countries in one or two months. We continue to assess this capability as information becomes available.

[Lord Scriven (LD)]

My Lords, it is welcome that the Government have finally decided to move to a decentralised system. Apart from the number of downloads, what success criteria that can be attributable to the Covid-19 app have the Government set, how will these be measured and where will the public be able to see progress against those criteria?

[Lord Bethell (Con)]

My Lords, the ultimate aim of the app is to break the chain of transmission. That is done through a number of ways. One is to provide a proximity alert for those who spend time with people who have tested positive. It also has a check-in capability to help our track and trace efforts, and we are building more applications on it all the time. One encouraging statistic is that until 10 o’clock yesterday, there were 6.5 million check-ins through the app. This is an astonishing number and it shows that those who are socialising are using the app.

Coronavirus

Debate between Lord Scriven and Lord Bethell

Wednesday 16th September 2020 Lords Chamber

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

I am grateful for the noble Baroness’s questions. In terms of European rates, Britain is way ahead of many of its fellow countries in Europe. On Friday last week, we did 240,312 tests. It is a massive number and, I believe, the highest we have done on any day. This is a huge achievement and I pay testimony to those in the NHS and in test and trace who have contributed to that figure.

In terms of tests being sent abroad, our testing environment and economy are part of an international system. Reagents, swabs, consumables and machines are regularly exchanged between countries and I pay tribute to the enterprise and energy of the NHS and the test and trace scheme for using whatever schemes they can find in order to process the tests accurately, efficiently and promptly. I will be glad to send the noble Baroness details of the rates which she asked for.

In terms of the increase in prevalence among the middle-aged—yes, we are deeply concerned about this. As I have said at the Dispatch Box before, as night follows day, rates progress from the young to the middle-aged and, I fear, to the elderly. We are keeping a close eye on this progress.

[Lord Scriven (LD)]

My Lords, we know that the Minister is an avid listener of Radio 4’s “More or Less.” In today’s episode, Professor Alastair Grant of the University of East Anglia pointed out that 70% of coronavirus test results were completed within 48 hours at the start of August. Looking at official figures and analyses, he pointed out that by Monday, it was just 11.8%. The Minister may dispute the exact figures, but the trend clearly is down, which is worrying when we need an effective trace and isolate system to trace and isolate people as fast as possible. Can he tell the House and the country by what date all results of coronavirus testing will be turned around within a maximum of 24 hours?

[Lord Bethell (Con)]

My Lords, I am indeed an avid listener of “More or Less,” although I have not heard the episode to which the noble Lord referred. Can I just explain that not all tests need to be done within 24 hours? There are tests that are done for surveillance, to support clinical trials and to help our investigation into vaccines and therapeutics. Those kinds of tests have a much longer turnaround time, and that is entirely appropriate and will be built into the numbers to which “More or Less” referred. Some 89.6% of in-person test results were received the next day after tests were taken; those are the ones that need fast turnaround times and the ones that will be delivered promptly.

Covid-19 Update

Debate between Lord Scriven and Lord Bethell

Monday 14th September 2020 Lords Chamber

[Lord Scriven (LD)]

My Lords, these Benches welcome anything from the Government that is based on rational evidence and can prove to be effective in this public health crisis to keep people safe and reduce the spread of the virus. So does this Statement live up to that? Unfortunately, yet again the sales pitch from the Secretary of State last week fell short of what is required to be effective. It has to be based on fact and scientific evidence that the public have confidence in and understand.

I have some simple questions for the Minister. Now that the scientific evidence has been produced, members of the public are asking why children under 12 and 11 are included as part of the six. Why can they be in a school in a class of 30 but from 3.30 pm they cannot be in a house with seven people, including their two grandparents? What scientific evidence exists to suggest that that causes more harm than 30 children in a classroom?

There is something else that people have asked me. Why is it that I can go to the office and be there with 20 people until 4 pm, but at 4.15 pm, if I go to the pub, I have to be in a bubble of no more than six? The evidence may be there, but it has to be explained in a way that those questions can be answered and the public have confidence in those answers. Inconsistency, rather than the public not having confidence, is one of the issues that the virus breeds on.

The public health message has to be clear and consistent. The regulations do not just bring in a power of six; there are quite a number of exemptions, including a legal definition of “mingle”: for the first time since 1393 it becomes illegal to “mingle”. Can the Minister give a legal definition of “mingling”? I can go to an event with six people but I cannot mingle beyond those six if it is an event run by a charity, a public body, a philanthropic organisation or a business. If I open the door for somebody and speak to them to thank them, am I mingling? If I stop somebody who I know and speak to them, am I mingling? What is the legal definition? That is going to cause confusion and not be consistent.

These regulations and rules have to be developed in a collaborative manner with local areas to be effective. Why was the Local Government Association informed of the Covid-secure marshals only one hour before? If the rate is rising so fast and we need to be effective today to monitor six people and no more, where are those marshals’ powers as of today and in which legislation?

It is quite clear that action needs to be taken to stop this virus, but it is time for the Government to stop and be much more strategic and considered and to implement legislation and systems in a more collaborative way. People’s lives and livelihoods depend on the Government getting this right, but unfortunately this Statement is not a complete and right answer.

[Lord Bethell (Con)]

My Lords, I thank the noble Baroness and the noble Lord for their perceptive and thoughtful questions. On the noble Baroness’s questions about the level of alert, to my knowledge it has not changed. It was reduced from four to three on 19 June; it remains subject to review on a weekly basis, but we are not in a position to raise it at the moment.

The noble Baroness asked about the rule of six and why we had committed to six as opposed to anything else. The short answer is that we are seeking to have rules that are simple to understand and straightforward to apply. We accept that during the last few months the guidelines have grown increasingly complex and difficult to understand in all their detail. Across the board, with “Hands, Face, Space”, the rule of six and other measures that we are seeking to publish, there is a genuine effort to engage the public in a really simple lexicon of how we can beat the coronavirus.

Sir Mark Walport, the head of UKRI, was right in his warning that the jeopardy is enormous. If we do not get this communications challenge right, and if people think they are confused and think they have a way out because it is in some way complicated, we will fail, the disease will come back and we will have tens of thousands of deaths; we will have an NHS that is challenged; we will have an economy that is shut down; and we will have a generation that is lost to education. Those are the stakes, so we are determined to get it right. I am happy to stand here for as long as it takes and be pub-quizzed on “What about this? What about that?” if it means that we get it right.

However, the public seem to understand these simpler rules. The response from the public in our planning focus groups and in the response since their publication has been extremely positive, and we think we are on the right track. This is advice that was informed by SAGE and we went through its models in great detail.

The noble Baroness and the noble Lord, Lord Scriven, asked why children are included. The bottom line is that we want to keep it simple. Children are vectors of infection; they can pass the disease from one generation to the next. Time and again, in city after city, we have seen an infection that starts with a young person, moves to mum and dad, then to grandma and grandpa. It takes weeks or sometimes months for that progress to take place but, as I have said at this Dispatch Box before, as night follows day, the infection moves through the generations unless we take steps to break the chain of transmission. The rule of six is a critical, unambiguous step in the Government’s strategy for doing just that.

The noble Baroness and the noble Lord, Lord Scriven, asked about marshalls, so let me just say a word about that. This measure came from our engagement with local authorities. Local authorities are looking for ways in which they can implement the right measures to disrupt crowds forming and, as the noble Lord, Lord Scriven, said, mingling—a concept which, frankly, I do not think needs much description and nor do members of the public. In order to break things up, they are looking for ways in which they can have both the authority and the personnel to do that, and we have responded by putting in the right regulations to do that and by providing the right resources. But it will be up to local authorities to implement that in detail.

The noble Baroness asked about shooting and hunting. My understanding is that guidelines on all sorts of sports and activities where the rule of six is in any way ambiguous will be issued in the coming days.

The noble Baroness asked about Hammersmith, and I am extremely grateful for the tip-off. I will look into it, as I have done when other noble Lords have alerted me to concerns they might have. I am extremely concerned that there might be a breakdown in the asylum centre in Hammersmith. However, I reassure the noble Baroness and the House that directors of public health are responsible for this kind of implementation, and the benefit of directors of public health is that they work across all departments. Some directors of public health have a health background, some have a police background and some come from a leisure background, but they all hold the ring when it comes to local implementation of local measures, and therefore they are the best-placed people to ensure that situations like this are not overlooked.

The noble Baroness asked whether we should be reviewing the current measures for pubs, clubs and workplaces. The simple answer to that is yes, absolutely; we should be reviewing it—and we do review it every single week. We are on tenterhooks because, if we get this wrong, the jeopardy is enormous. We are working as hard as we can, with regulatory measures such as the rule of six, marketing measures such as “Hands, Face, Space” and containment measures such as the test and trace programme, in order to keep the economy open, to keep our educational institutions open and to keep life as normal as we possibly can. If we do not—if we fail—it will go back to where we were before, and I hope memories are not so short that people do not remember quite how imposing and draconian the former lockdown was.

On test and trace, the noble Baroness quite reasonably asked about the capacity and about demand. I can reassure her that the capacity has literally never been higher. We are up 7% week on week and—if I can provide the right figures here—we will have a capacity of 500,000 by the end of October. We have 500 centres, including five major laboratories, 236 mobile testing units, 72 walk-through testing sites, and more sites opening all the time. For every 1,000 people in this country, we test 2.43 a day; that compares with Germany at 1.15, Spain at one and France at 1.15.

We are throwing everything we can at the test and trace system, but it is true that demand has gone up. Part of that demand is through children returning to school. I welcome enormously the return of children to school, but it is an un unambiguous fact that this has led to a very large increase in the number of children being sent to testing centres—often bringing their parents and other household members with them—and that has put an enormous pressure on the system.

Another feature is asymptomatic testing. Estimates are that between 20% and 25% of those turning up for a test are currently asymptomatic. If we had all the tests in the world, that would not be a problem and I would welcome it, but right now we are building the system, we are under pressure and we need to communicate more clearly to the public that asymptomatic testing is not supported by our current testing system.

The noble Baroness asked about social care—quite rightly, as this is a major feature; we are concerned about it, and I know that noble Lords are concerned about it. I reassure the noble Baroness and the House that care homes are absolutely our number one priority. This was reiterated in meetings with the Prime Minister last week. Some of the capacity challenges in places such as walk-in and drive-in centres are because we have put care homes front of the queue and because those tests are taking priority.

The noble Lord, Lord Scriven, asked a number of extremely detailed questions, some of which I have touched on. He asked why we have included children. He is entirely right that, in Scotland, they have not included all children and in some other countries they do not do so either. We have taken a different view. Partly, that is on the epidemiological advice from SAGE; partly, that is on the marketing advice from our communications department, which is insistent that we are clear and unambiguous with the population; and, partly, that is the CMO’s advice—he rightly identifies children as potential vectors of infection, particularly in intergenerational households.

The noble Lord, Lord Scriven, asked for consistency. Well, we are consistent in that we are determined to break these chains of transmission. The science is not simple; if it were, the disease would have been beaten. It bounces around, and we are doing our best to fight it. We are communicating as best we can on all the science we have.

In terms of collaboration, I pay a massive tribute to all my colleagues at the department, in other departments, in local authorities, at PHE and in the NHS. It is difficult for me to explain in great detail in a short amount of time the immense amount of cross-departmental, inter-agency collaboration that has sprung up around Covid. The amount of data that is shared, the number of Zoom calls and the working together are absolutely phenomenal. The noble Lord cited that the LGA did not know about the marshalls plan until the last minute; I am afraid to say that it must have been the last one on the list.

Covid-19: Rise of Positive Tests

Debate between Lord Scriven and Lord Bethell

Wednesday 9th September 2020 Lords Chamber

[Lord Bethell (Con)]

We are deeply concerned about the spread among students. Some of that spread will take place in universities, and I pay tribute to the efforts of vice-chancellors to put in place social distancing arrangements in universities; we hope that they will have an impact. However, some of the effect is in their social life—in pubs, clubs and bedrooms up and down the country. That is the responsibility of the students themselves, and we are looking at measures to enhance and enforce the social distancing measures that will stop the spread of this disease.

[Lord Scriven (LD)]

My Lords, on a day when the Prime Minister will order us not to meet in large groups of more than six, why have the Government agreed to support 3,600 people congregating at Doncaster Racecourse today? Have the Government not learned the lessons of the superspreader event in Cheltenham?

[Lord Bethell (Con)]

My Lords, any new regulations will be in place from Monday and will capture events such as the one the noble Lord describes.

Covid-19: Self-isolation Payment Scheme

Debate between Lord Scriven and Lord Bethell

Wednesday 2nd September 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, I am not sure that I heard all the question. Can I just explain that those who are isolated for 10 days will receive £130? Other eligible members of their household who have been self-isolating will also be entitled to a payment. Eligible non-household contacts instructed to stay at home and to self-isolate will also be entitled to a payment of up to £182.

[Lord Scriven (LD)]

My Lords, what is the difference in the Government agreeing to pay only certain low-paid people £13 a day to do their civic duty to stop the spread of a deadly virus, but up to £70 a day for anyone to serve on a jury?

Covid-19: Test and Trace App

Debate between Lord Scriven and Lord Bethell

Monday 22nd June 2020 Lords Chamber

[Lord Bethell]

My Lords, it has been my experience that working with some of the biggest companies in the world in pharmaceuticals, in diagnostics and in tech has brought to the fore the paramount importance of partnership with big industry. We have benefited enormously from such partnerships and I thank some of the major companies that we have worked with. However, it is undoubtedly the case that government has its own agenda and it is important that we work to champion the needs of the British public, which is where our biggest interests lie.

[Lord Scriven (LD) [V]]

All avenues to reduce the transmission of coronavirus have to be seriously explored, so what was to be gained by NHSX and the UK Government refusing over a period of months positively to engage with those involved in the COVID Symptom Study app?

Contact Tracing: Personal Privacy

Debate between Lord Scriven and Lord Bethell

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

Debate between Lord Scriven and Lord Bethell

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

Debate between Lord Scriven and Lord Bethell

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?

Covid-19: Contact-tracing App

Debate between Lord Scriven and Lord Bethell

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

Debate between Lord Scriven and Lord Bethell

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.

Covid-19: Vaccine

Debate between Lord Scriven and Lord Bethell

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

Debate between Lord Scriven and Lord Bethell

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.