Covid-19 Update

Baroness Barker Excerpts

Tuesday 6th October 2020 Lords Chamber

[Baroness Thornton (Lab) [V]]

I thank the Minister for this Statement, which was made yesterday in the Commons, and for the one made on Thursday in the Commons. It seems like a good idea to take them both together, since the news about the unreported and untracked positive tests needs urgent scrutiny, and the Minister does not have to suffer double the pain of explaining the very real problems we face with the winter and the second spike.

For example, today, we see another increase in positive tests—14,522 cases reported, with two-thirds of those in the north and north-west. To summarise, we have had people being told to travel hundreds of miles for a test; hundreds of children out of school unable to get a test; tracers sitting idle, watching Netflix; care home tests taking days to be processed; the Minister’s hyperbole, saying this could be a moment of national pride, like the Olympics; and a Prime Minister in a complete muddle over the rules. The Prime Minister seems to be able to learn large chunks of Greek by heart, so why, when he does regional media, could he not at least learn which lockdown rules apply where? It is not much to ask.

The questions from my honourable friends Jonathan Ashworth and Stella Creasy in the Commons yesterday were very pertinent. The reason why they needed to ask what the contractual teams were for the contracts supplying test and trace is that they are not working well and a large amount of public money is being spent on them. Is it not sensible to ask if there is a break clause if goods being purchased with public money are faulty or not working properly, given that they have been sold to us as world-class and planet-beating? What did the Secretary of State say to these questions? Unfortunately, he reverted to the government line of blaming Public Health England. Can we see the terms and conditions and profit margins on all these contracts? Is it true that there is no break clause addressing whether these contracts do what they are supposed to? As the former chair for a few years of the procurement committee of a local CCG, at a very lowly level in the NHS, I can tell the Minister that these are vital questions which have to be asked—questions for which I would expect to be held to account.

Does the Minister agree that transparency would ensure proper governance and accountability for those charged with the stewardship and responsibility of spending public money? Let us examine this for a moment. Is it true that Public Health England’s older version of Excel has a 65,536-row limit, meaning that, in the data transfer from the big CSV file, rows were chopped off? Can the Minister confirm that the data could not be handed over to Public Health England due to the size of the Excel spreadsheet files? Why are critical databases in a national pandemic being hosted on Excel spreadsheets? Is it true that the upgrade to a later version of Excel, which copes with just over 1,000,000 rows, costs about £100? Is this an issue with one particular lighthouse lab or across all the lighthouse labs? Public Health England’s sources say that they report the data when they get it from NHS Test and Trace, so if the information is coming in incomplete, they cannot do their job.

We know that the budget for test and trace is in the region of £10 billion to £12 billion, and it seems to me that an IT audit might have been a good place to start. Was there one? What did it say? We know it is true—so, presumably, does the Secretary of State, who is ultimately responsible for Public Health England—that Public Health England’s budgets were cut by 40%. So, is it the case that Public Health England had no IT upgrades of any kind recently? Given what we know, is it legitimate to ask where all that money has gone?

Why in October, after all the promises of the Prime Minister, the Secretary of State and the noble Baroness, Lady Harding, are we now facing the possibility of 60,000 people unknowingly spreading Covid in their homes and communities, which might account for some of the sudden increases seen today? Have all those people been contacted, traced and isolated?

These are not irrelevant, disloyal or silly questions: they are vital if these matters are to be remedied. They are vital if the Government are to dispel what communities are feeling, described on Sunday by the leader of the Labour Party, Keir Starmer, as

“This deep sense of despondence, anxiety. And actually, what they want is hope.”


We on these Benches want the Government to do that: to give hope. Assuring us that they have everything under control will, however, not work anymore, because it is clearly not true.

Surely, what is needed is transparency and a strategy, expressed with clarity, that everybody understands and supports. It is, furthermore, urgent. Tonight, a group of leaders of the largest councils in the north—Manchester, Leeds, Newcastle and Liverpool—has written to the Prime Minister asking for, among other things, significant local control and support. I beg the Minister not to chant the mantra that test and trace are working closely at local level, because clearly they do not believe that it is. Again, it does not seem to be true. I hope that the Government will respond positively to these councillors.

Yesterday, Jeremy Hunt asked whether responsibility for NHS and care home staff testing should be moved to hospitals and laboratories, and that idea was repeated by the Nobel laureate Paul Nurse, of the Crick Institute, on the radio this morning. The fundamental problem is that there is no strategy: there is a vacuum. That is because there is division in the Cabinet over which strategy should be followed. This needs to be remedied and a clear way forward explained.

Finally, with regard to the part of the Statement concerning treatment: will the Minister clarify whether the establishment of Orbis will be in co-operation and collaboration with EU medicine protocols or in competition with them? Will Parliament scrutinise Orbis, and when?

[Baroness Barker (LD)]

I thank the Minister for yet again turning up at the crease to defend what is becoming increasingly indefensible: the poor performance of the NHS Track and Trace system.

The noble Baroness, Lady Thornton, was right to note the admission in this Statement that 16,000 positive results had not been uploaded, and that by yesterday only 51% of those people had been contacted, despite the injection of resources into NHS Track and Trace over the weekend to try to make up the deficit. Given that we know that each person who tests positive is likely to report between four and five contacts, that is potentially 60,000 people who last week were walking around, not self-isolating and possibly infecting others. It is not their fault—they did not know. It is a really significant breach of trust.

In the part of the Statement that I find most curious, the Secretary of State said that the Chief Medical Officer’s analysis of the Government’s assessment of the disease as a result of the new data was that

“its impact has not substantially changed.”

Can the Minister give us further detail about that? The omission of 60,000 people not having any impact does not add up at all. The Secretary of State went on to say that the Joint Biosecurity Centre had confirmed that

“it has not impacted the basis on which decisions about local action were taken last week”.—[Official Report, Commons, 5/10/20; cols. 625-6.]

When will that data come through and when will we be able to see the impact on local areas? As these statements make clear, the virus is beginning to have different impacts in different places. Can the Minister say at what point directors of public health were informed about this breach? Six months in, it is clear that, when local authorities are properly resourced and given correct and timely information, the virus is managed and contained. The major problems come about when decisions are made centrally, poorly communicated and badly executed.

Time and again, it comes back to track and trace, whether it is about a lack of skills and capacity or a lack of foresight. Who could not have foreseen the impact that hundreds of housefuls of students moving around the country in September would have on transmission?

Yesterday when this Statement was debated in another place, speaker after speaker, mostly from the Conservative Benches, got up to complain about the effect of the 10 pm arbitrary cut-off. They explained how well-run businesses, especially in the hospitality sector, will be going to the wall because of continued use of blunt instruments designed nationally and applied over wide geographical areas. How long will it be before the Government realise that local people—local professionals, directors of public health and environmental health officers—have detailed knowledge about businesses in their area, their hygiene ratings, their previous breaches of licensing conditions and where crowds congregate? When we can get decision making to a more local and granular level, we will be better able to protect good businesses without jeopardising public health.

I welcome the announcement of hospital funding for upgrades to A&E departments. We need a greater capacity for A&E. However, could the Minister give the House the definition currently used by this Government of what constitutes a new hospital?

On the Orbis project, we go into this having left a safe and highly effective system of medicines regulation, one where patient safety is paramount. How does the Government propose to withstand the commercial imperatives of American pharmaceutical companies in these circumstances?

The public are getting very worried about the extent to which the Government continue to wing it. It is time for them to bear down on the fundamental flaw in their strategy—thinking that they know best in the centre, above people who are professionals at a local level.

[Lord Bethell (Con)]

My Lords, I thank the noble Baronesses, Lady Thornton and Lady Barker, for their remarks. The noble Baroness, Lady Thornton, is entirely right about the situation that we face. The latest update, as of 4 o’clock today, is that we have 14,542 daily positives today: 2,833 are in hospital with Covid; of those, 496 are on ventilators, and I am sad to report there were 76 deaths.

These are numbers that make us extremely focused on the challenge of Covid. Earlier today we debated the rule of six, when there was a large amount of challenge about whether such rules on social distancing were really necessary. We were reminded in clear terms about the social impact of separating those who love each other. Here we are talking about the impact on the health of the nation and the threat presented to those who are vulnerable, elderly and have pre-existing conditions. Getting the balance between these two things is extremely challenging, but that is the strategy of the Government—to bear down on the virus while protecting the NHS, education and the economy until we can see a way out through the vaccine, through therapeutic drugs and through mass testing. That is our approach.

I make no bones about it; the errors made over last weekend with the data was extremely regrettable. It undoubtedly causes grave concern among those in Parliament and the general public. I cannot hide from anyone the importance, impact, and severity of the situation. However, I would like to say a few words in mitigation. First, I pay tribute to those at PHE who have pulled together a remarkable system in extremely difficult circumstances, across the length and breadth of the country, integrating many systems into one. I know that that may seem like a trivial challenge and beside the point when we are dealing with a national emergency like this, but these are incredibly complex and difficult tasks. They have involved extremely committed personnel on the technology side of things who have personally checked a huge amount of the numbers. As my noble friend Lady Harding explained, it was through the perseverance of some of those personnel that the mistake was identified.

Between 17 and 23 September, 87,000 were identified through our testing and tracing programme; that is a phenomenal number of contacts where we had the opportunity to intervene and break the chain of transmission. Some 83.7% of those were reached and asked to isolate. I completely appreciate the concerns of those speaking in the Chamber today about the test and trace programme, but those figures are remarkable. That we have set up a system that can intervene in the lives of so many who are carrying coronavirus and can bring to bear such pressure on the disease after such a start as we had at the beginning of the epidemic is a phenomenal achievement. I know that the last thing one wants to be, at this stage of things, is a hollow champion of empty achievement, but that is a hell of a thing for this country to have got to.

There have been questions about the collaboration between the centre and northern leaders, and I cannot hide the fact that there are some quite fruity discussions on the pages of the newspapers and news channels between different community leaders. However, we have to be adult about this and acknowledge that there are different roles for different parts of government. The mayor of a city simply does not have a huge laboratory in which to do tens of thousands of tests a day. The mayor of another city simply does not have a control room filled with PhD analysts who can crunch the numbers and run massive supercomputers with complex algorithms to look at millions and millions of items of data within minutes. These are not the functions of local government, nor will they ever be.

Likewise, the JBC, the Department of Health and Social Care and the Cabinet Office do not have the local knowledge of what is going on on the ground and are not expected to speak a wide range of languages. We do not know what the behaviours are of people on a street-by-street basis. That is the role of local government, and it is through the collaboration of the local and national that we will beat this disease. To try to throw up a false dichotomy and set up test and trace as a scapegoat to blame and punish for the frustrations we all feel about the disease is counter- productive and reveals a shallow understanding of a complex situation.

The noble Baroness, Lady Thornton, said that perhaps care home testing should be sent to hospitals. In many cases, hospitals are involved in care home testing and handle the staff of care homes, but hospitals have to cover their own clinical demands, and pillar 1 is stretched to do the testing of hospital staff and patients. Landing that additional burden is not something that the NHS would welcome.

With regard to the northern leaders and their running commentary on the work of test and trace, I reassure the House that the conversations held in private on a daily—and sometimes hourly—basis have an altogether more collaborative tone. I have been privy to a large number of those conversations; there is a huge amount of expertise on both sides of the conversation, and one should not take too seriously the knockabout commentary in the newspapers and on TV.

The noble Baroness, Lady Barker, asked for an update on contact tracing, and she is entirely right. To have missed a substantial number of contacts during those days was a really big disappointment, but we have moved a huge amount of resources in order to catch up. There has been a phenomenal catch-up already, and I understand that my right honourable friend the Secretary of State will be updating the other place on the progress of that shortly.

I reassure the Chamber, however, that all those who had a positive test were informed promptly. There was no omission in that respect. Therefore, the primary index case, and the person of greatest threat to community transmission, was identified and isolated, and that chain of transmission was shut down.

I will now address the questions about the CMO and the JBC and their analysis of our numbers. I reassure the noble Baroness, Lady Barker, that the integrity of the CMO is unimpeachable; if he judges that the change in numbers has not changed policy, I reassure the Chamber that that is a good judgment that is completely consistent with the way in which we have behaved over the last few weeks.

The noble Baronesses, Lady Thornton and Lady Barker, both asked about Project Orbis. This is a welcome move, enabling the UK to join an international framework to provide concurrent submissions and regulatory views of oncology products, which may allow UK patients to receive earlier access to medicines in the future. I pay tribute to colleagues at the MHRA, who I know have worked really hard on collaborating with American, Canadian and Australian regulators. I am extremely optimistic about the dividends from this collaboration. It augurs, promisingly, similar future collaborations across the health sphere.