Coronavirus (COVID-19)

Baroness Brinton Excerpts

Tuesday 3rd March 2020 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I thank the noble Lord—the government spokesperson—for repeating this Statement. Our thoughts are always with those who have contracted the virus and we pay tribute, again, to the extraordinary efforts of the NHS and our public health staff. We, on these Benches, are clear: the public health interest must, at all times, be the priority. All the Government’s decisions must support this strategic aim and, where they follow the medical and scientific advice, they will have our support.

I start by raising the issue of the EU early warning and response system, of which, of course, until Brexit, the UK was a member. This early warning and response system has played a vital role in pandemic preparations in the past. It is rumoured that No. 10 overruled the Department of Health, which wished, quite rightly, to be part of the European Union’s safeguarding system at this time. The Prime Minister has said that keeping the public safe was the Government’s number one priority but has refused to seek to retain or apply for membership of the EWRS because of the negotiations taking place at the moment. I understand that the Secretary of State agrees with those of us who believe that tackling fast-moving, global outbreaks—including this virus—could become harder if the UK loses access to the EU’s early warning system for cross-border threats, so I urge the Government to urgently review this stance.

The PM says that there is significant risk of the virus becoming widespread, meaning further measures might be necessary, and that emergency legislation may be necessary to give the Government the powers they need to implement the action plan. I would be grateful if the Minister could set out some kind of timetable for emergency legislation. Will it be primary and secondary legislation, and which department will take the lead?

The plan sets out what the Government could do to contain the virus on the basis of scientific evidence. Drastic steps, such as closing schools, would have major social and economic consequences, so can the Minister advise the House on how they plan to seek a balance?

We agree with the Government’s strategy to contain, delay, research and mitigate, and indeed it has our endorsement. However, can the Minister explain why we have not followed other nations by imposing a travel ban to the UK from higher-risk countries such as Italy, Iran, China and South Korea?

Are the Government undertaking workforce planning as a consequence of self-isolation? This has huge implications both for this stage and the peak stage, in which the Government recognise that up to a fifth of workers could be absent from work. The Prime Minister said today that workers who self-isolate will be considered to be on sick leave. Can he confirm that those who need to self-isolate will not need to visit a GP to receive a sick note?

Two million workers on low pay or insecure contracts in the gig economy do not even qualify for statutory sick pay. The GMB trade union points out that NHS trusts have a huge number of outsourced staff and that a large number of companies providing NHS services do not pay sick pay for the first three days. Therefore, we are looking at cleaners, porters and catering staff who might put their own health at risk when we need them to contain the coronavirus, because they will not be paid if they go off sick. Therefore, I ask that NHS trusts, for example, guarantee that all staff are given full sick pay if they have to self-isolate.

Equally, what action will be taken to reduce the requirements placed on those in receipt of benefits who will not physically be able to attend appointments if they need to self-isolate? Can the Minister guarantee that no financial sanctions will be imposed? No one should be faced with having to make a choice between their health and hardship. Therefore, when the Government consider emergency legislation, will they bring forward legislation to remove those barriers to self-isolation so that all workers can get the sick pay that they deserve?

We know that the elderly and those with chronic underlying long-term conditions such as diabetes or cardiovascular conditions are vulnerable. What is the Government’s latest advice to providers of social care for those in residential settings or staff visiting elderly and vulnerable people in their homes?

On the NHS more broadly through the mitigation phase, we know that last week 80% of critical care beds were occupied. Can the Minister clarify how many beds are available should we need them, and how quickly can ICU beds be opened up? Can we be assured about the extra resource that will be made available to health trusts? Every sample for testing will carry a cost, and that will soon build up. As people self-isolate, that will affect the NHS workforce, and trusts will be forced to take on more agency staff. If retired staff are encouraged to return to practice, the wage bill will increase. Can the Minister explain how retired staff returning will be engaged and protected, and what oversight will be put in place to ensure that they deliver safe care if the revalidation process is to be suspended for retired returnees?

Will the Government provide emergency funding to cover the NHS resource budget and support the NHS through this next challenging period? For example, it is possible that thousands of elective surgeries will have to be cancelled.

Directors of public health are preparing a local response to Covid-19, yet they still do not know what their public health allocation for the next financial year, starting next month, will be. It means that they will be cutting the nurse workloads that they are commissioning at a time when we need those nurses to cover these cases.

Finally, on global efforts to contain the virus, I have already mentioned the European Union EWRS. We will not contain the virus internationally, nor will we be able fully to protect ourselves if the outbreak becomes uncontrolled in countries with weaker health systems. What assistance are we offering the World Health Organization with the international response to Covid-19?

We will continue to raise our concerns responsibly when we have them but, on these Benches, we also pledge to work constructively with the Government, because the public health interest must always come first.

[Baroness Brinton (LD)]

My Lords, on behalf of the Liberal Democrat Benches, I thank the Minister for repeating the Statement. We repeat our thanks to the staff of the NHS and the Department of Health and Social Care, as well as to all those working cross-department on preparing for the various possible outcomes in the event that this escalates.

We also echo the points made from the Labour Benches about No. 10’s announcement that we will not take part in the EU early warning system. It was clear from the media yesterday that the NHS and medical experts all say that we must be part of it. To have No. 10 say, “No, we won’t”—presumably because it has the dirty letters “EU” in it—is extremely unhelpful. Will the Government please review this position as a matter of urgency and, as they said in their Statement, take scientific and medical advice on whether we should be involved?

We welcome the two amounts of £20 million that the Government have put forward for research into Covid-19—the first for the Coalition for Epidemic Preparedness Innovations, but particularly the £20 million for Covid research here in the UK, including on epidemiology and treatment in hospital. Far too often we focus only on blue-sky research. This needs to be very practical and it is—these Benches welcome that.

I apologise for being a broken record on this. However, I am sorry to say that the advice for those who are either vulnerable or have underlying medical conditions is still not clear. The Minister and I have had an email exchange on this matter. The WHO and the American CDC still offer clearer advice to members of their public about what to do if you are either elderly or have underlying conditions than we do in this country, whether you are travelling abroad or in a community that may have some cases. Can this be beefed up? There is a statement in the action plan report that this will be strengthened in due course, but that will be once we get to mitigation.

There are already concerns in the medical and disabled communities about whether people should be shaking hands. I was somewhat concerned to hear the Secretary of State affirming confidently on television this morning that shaking hands was still fine. I am sorry: if you have an underlying condition, you do not want to be shaking hands with people. You should be washing, not doing that. Wearing hand splints, I have learned over the years to wave at people. It is much easier. Perhaps we could get a trend going with that.

We know that emergency legislation is coming up. That is heralded in the action plan. There are some concerns from our Benches on the extent of the mobilisation of retired and former staff. There has rightly been an emphasis on clinical staff. There will be questions that our Benches will look to have responses to. If people, particularly doctors, have been deregistered, perhaps because of retirement, will there be an expedited system, a reduced appraisal system, or a system to take people on who perhaps have not been reregistered but could work under supervision? It is important that these things are both clear and done at speed. But we are extremely concerned that there is no mention of people in other core parts of the NHS and social care system who are not clinical staff. The cleaning, catering and admin staff also keep the NHS and our social care system going. What arrangements are being put in place to provide extra support for them?

Once we move into mitigation and discussion about the possible closure of schools, surely it more important to keep schools open, even if there is only a reduced number of pupils in those schools, if the pupils’ parents are key workers—essential workers in the NHS, the police and other key areas. There is no sign that that has been thought about at this stage. It seems to us that this is an important point to cover.

Finally, after a nearly a decade in your Lordships’ House, I should not be too surprised when Ministers, particularly the Prime Minister, use very positive frames for things. The idea that the NHS will move out of a winter crisis into a landscape of delight once we get to the summer is extraordinary. We know that our social care system is at breaking point. The social care system was grateful for the £240 million provided by the last Chancellor in the autumn. However, the Local Government Association and almost every health think tank say that our current social care system is short of £2.5 billion now, without any impact from coronavirus. Of course, our social care system will have the patients most at risk of serious illness should coronavirus move into our communities. So, without heralding anything in the Budget, which I understand the Minister cannot speak about, can the Minister reassure the House that there will be serious support: for ensuring that there are no delayed discharges because there will be adequate support for social care in the system?

[Lord Bethell]

My Lords, I thank all the other parties for their spirit of collaboration and support during this awesome challenge. That was reflected in the debate last Wednesday and is reflected again today.

I start by reaffirming the commitment of this country and this Government to international co-operation. That co-operation is being led by British scientists, who were the first to crack the genome of this virus and who immediately published their material freely on the internet, which instigated a huge advance in the research being done around the world on Covid-19. Britain remains committed to the WHO initiative and is a very active leader and supporter. Our scientists are flying to some of the hardest-hit countries of the world. Without diminishing our own capability, we are very active contributors of intellectual, practical and personnel support to those in need around the world. I pay tribute to all involved.

On the EWRS, mentioned by the noble Baronesses, Lady Brinton and Lady Thornton, I reassure noble Lords that, in line with the withdrawal agreement, the UK has continued access to the EWRS during the transition period. We continue to share key updates with our European counterparts via this system. As set out in the UK’s negotiating mandate, we are open to exploring further co-operation between the UK and the EU on all matters of health security, including the exchange of information and expertise on infectious diseases such as coronavirus. We are open to exploring mechanisms for the UK and EU member states to continue to share and act on real-time alerts and information on new and emerging health threats, as currently carried out by the EWRS.

Regarding the Bill, as part of the Government’s plans, we are considering what additional powers may be needed to contain and mitigate the spread of the virus and to manage any impact. That Bill will be brought when it is needed; the timing and schedule have not been finalised.

The noble Baronesses, Lady Thornton and Lady Brinton, both brought up school policies. The noble Baroness, Lady Brinton, put her finger on a key and important point of the Government’s policy in this area. It is absolutely essential that services such as schools continue to be open for as long as they reasonably can be, so long as the medical advice supports that decision. Those who provide essential services, including social care and running the infrastructure of this country, depend on schools to be able to go to work. That is why the direction to school heads is, where possible, to keep the schools open. It is possible that, at some point in the future, as part of the delay strategy, the recommendation may change—but it would be done under the guidance of our medical advisers, and with strong epidemiological evidence that such a decision would make a profound difference to the spread of the virus. We are not in that situation yet, so the policy on schools remains, now and for the foreseeable future, that they should remain open where the medical advice confirms that.

On the question of a travel ban, it is true that this Government have not banned travel as some countries have done. That is based on the advice of our medical advisers, who suggest that trying to put in place travel bans to countries such as Italy would be like creating a medical Maginot Line; travellers will seek ways around the ban, tracing contacts will become impossible, and finding evidence of the origins of the virus will be lost in deception. Italy is one country that put in place serious travel bans around the world, and it is facing many of those challenges now with, sadly, a high rate of infection and challenges in tracing the origins of those infections.

Both noble Baronesses asked about sick leave. It is absolutely right that concern should be had for those who make the correct and responsible decision to self-isolate. Government lawyers have looked at sickness pay arrangements and it is very clear that those who self-isolate qualify immediately for statutory sickness pay. They may self-validate for seven days. After the seven days, they may seek an email confirmation of the diagnosis by dialling 111, thereby avoiding an unnecessary and potentially dangerous trip to either their GP or to hospital.

The practicalities of the gig economy, which were quite rightly raised in the debate so far, are challenging. There are provisions in the welfare system, and provisions among employers to behave generously, but this is an area that the Government clearly need to continue to review.

Tributes should be made to health staff, who provide absolutely essential support to keep our hospitals and surgeries open. It is, in fact, at times like this that one realises the profound and important contribution made by non-clinical staff. We owe it to them to provide generous and open-hearted arrangements, so that they can continue their work and, if necessary, self-isolate in financial security and confidence, and the Government are committed to reviewing those arrangements.

The noble Baronesses, Lady Thornton and Lady Brinton, both asked about social care. It is undoubtedly a concern that we all have for those who are older and more fragile—this virus is clearly targeting them. Provisions for social care are absolutely uppermost in the Government’s mind. A huge initiative will be made to recruit both professional and volunteer staff to support the social care industry during this period, when many workers will be self-isolating and support for people—whether they are in homes or living on their own—will be stretched. That recruitment is absolutely key to the Government’s plans.

Arrangements to ensure that that recruitment can include retired professional staff, who may have allowed their qualifications to lapse, may form part of forthcoming legislation, but I reassure the Chamber that the adequate management, supervision and scrutiny of those people will be maintained. This will very much include non-clinical staff as well as clinical staff—which, as I have explained, will be all-the-more important during an epidemic like this.

The noble Baroness, Lady Thornton, asked about funding. I reassure the House that, while the Treasury is carefully controlling the money spent, no clinical decision supported by medical evidence is being held back by financial considerations. The budget has been put in place and the moneys are available to do whatever it takes to manage this epidemic in a responsible and effective fashion.

The noble Baroness, Lady Brinton, is absolutely right to raise the issue of advice to those who are most vulnerable to this virus: those with medical conditions. It was one of the most moving moments of the debate, last Wednesday, when the noble Lord, Lord Davies, also raised it. I have taken these concerns to the CMO, whose office is looking at the modelling and the communications. It is absolutely a number one priority.

New communications are being put together. There is an issue with sequencing: it is the view of the experts that there is little point in seeking to mobilise behaviour change in people before it is required, in case they make those changes to their behaviour, feel that they are unnecessary, lose trust in the system and go back to their old behaviours. So the communication of some messages, the distribution of some advice and the recommendations from the Government need, at times, to obey the logical sequencing of this virus.