Covid-19

Baroness Brinton Excerpts

Thursday 23rd April 2020 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for repeating the Statement. I join him and the Government in saying that our thoughts are also with all those who have lost their lives to this horrible virus. I pay tribute to the NHS and social care staff who have lost their lives. I know the Minister agrees that the number of victims who appear to have come from BAME communities is very concerning. Can he confirm reports that BAME people make up 72% of all NHS and carer deaths with Covid-19?

We welcome the announcement of an inquiry. It would be great if the Minister could provide further information about the scope of the inquiry and when it will report its initial findings.

The Minister said he believes that we are now at the peak, but we are nevertheless heading for one of the worst death rates in Europe. The Government have told the public that their response to the pandemic will always be guided by science but, as the Minister will be aware, there are often different views within the scientific community, so I repeat the call that we have made from these Benches in the past that the Government should publish the evidence underpinning their decision to recommend, for example, a seven-day rule for isolation. This is important for public confidence, given that the Government’s advice appears to contradict the advice by the World Health Organization, which advocates a 14-day rule for isolation based on evidence that people can still transmit the virus after 10 days or more.

Despite many questions, it remains unclear why the UK did not participate in some of the European procurement projects. The Chancellor of the Duchy of Lancaster said this was because we missed an email, whereas a senior civil servant at the Foreign Office said in evidence to a Select Committee that it was a political decision, before retracting that comment several hours later. The lack of transparency is deeply unsatisfactory. It would help if the Government published a background briefing so that we could see exactly what happened. We believe that it is necessary to get to the bottom of this situation now to ensure that the UK takes part in any future EU schemes that may help us deliver PPE to those putting their lives at risk on the front line.

The Government have repeatedly said that they are “ramping up”—this is an expression I do not enjoy, and I certainly intend never to use it myself—testing capacity, but the latest statistics show that only 14,629 NHS tests were carried out in the last 24-hour period, eight days before the Health Secretary’s self-imposed deadline to reach 100,000 tests. This is despite testing centres having a capacity of 39,000 checks a day. Why is more than half the country’s testing capacity still going unused when tens of thousands of NHS and social care staff, along with other critical workers, are being forced to self-isolate because they have not been tested? It is very concerning that the number of tests being undertaken is not increasing. Even if the capacity does reach 100,000, that is not the same as access. The latest statistics reveal that the number of tests performed on Tuesday was two-thirds that of the previous day. The Minister needs to tell the House what on earth is going to happen and when we can see the daily increase of tests.

Earlier this week the Health Secretary pledged to test immediately anyone in the social care sector who needed it. While elderly residents can be tested in the homes they live in, staff still have to travel. I learned earlier from the Minister that there are plans in place to change that, so I would like him to explain how soon those alternatives will come on stream.

Testing and contact tracing are vital to managing the UK’s response and easing lockdown restrictions. The new NHS app mentioned is very welcome. Can the Minister set out the timeline for when that will become available?

Finally, will the Minister confirm that the combination of some spare capacity in the NHS and the Government’s view that we now have reached the peak of the virus means that postponed NHS treatments and procedures will resume imminently? Although we understand why some elective treatments were postponed, the delay for many illnesses, including cancer, involves its own risk. It is therefore important that people receive the necessary treatment as soon as possible when it is safe to do so considering the impact of the virus. What support are the Government giving to trusts to help them manage demand amid the ongoing situation and give patients confidence that they will be treated in a Covid-free hospital?

[Baroness Brinton (LD)]

I thank the Minister for repeating the Statement and for his work on testing. We may have some difficult questions for him, but I hope I have the support of the whole House in saying thank you to him and his team for the work they are doing on this difficult area.

I too thank all the staff and volunteers in the NHS and the wider social care sector and other key areas who have been working during this crisis, whether directly on the front line or in supporting families and our children in schools. We send our condolences to the families of the bereaved, and are pleased that many people are recovering, even though we know that, if they have had it badly, it takes time. From these Benches, we echo the concerns about the high percentage of BME deaths, among workers and non-workers alike.

The Statement says that there are 3,000 spare critical care beds, but ITV reports that care home residents now account for up to half of Covid deaths. However, last week the Daily Mail reported that care home residents were still being asked to sign letters to say that they would not go to hospital in the event that they had Covid-19. Will the Minister confirm that these critical care beds in hospital are not spare? There are plenty of people in care homes who could use those beds but they have been put under pressure, no matter how gently, to sign the letters.

It is good to see the Nightingale hospitals coming on board—even if they are empty, for the right reasons. One of the concerns expressed has been about the staffing and the initial request that any patient had to have staff accompanying them from their previous hospital. Can the Minister say that this has now definitely stopped and that staff with appropriate critical care experience are able to be recruited? I gather that this has also been a problem for increasing the number of beds.

There was a good message in the Statement for people to go to their GPs and to use 999 for emergencies, but today there was a report of somebody who had a severe heart attack not being picked up urgently, as heart attacks are still second-level priorities to Covid. As a result of that 20-minute target rate, sadly the patient died. Is there any rebalancing of priorities for ambulances now that we seem to be over the peak of cases?

On equipment and medicines, it is good to hear that there are now just over 10,000 ventilators. Are they full ventilators, or does that include CPAP and BiPAP machines? How many more are to come? There have been some worrying shortages of medicines for those who need to be sedated, and recently we have heard news that there is a problem with kidney dialysis and kidney medicine for people who have come out of intensive care and require long-term support. Is there a shortage of such medicines, what other medicines are at risk and what proposals are there to remedy that problem?

We have spent many hours today talking about PPE. We are still waiting for supplies for everything outside hospitals. On 6 April, Clipper was heralded as being about to solve this problem, but it is still woeful. Until the social care and community sectors get the support they need, they will continue to be worried about the spread of Covid.

The Turkish ambassador has written to various people in the APPG on Turkey, setting out the actual arrangements—as opposed to those reported by the Government—concerning the delay in the package that appeared to get stuck. Turkey actually donated 250,000 pieces of medical protection equipment to us; the rest came through privately. Can the Minister say when the remainder of the consignment due from a Turkish supplier will arrive?

It is good to hear that formal arrangements for testing, tracking and tracing are now under way, but the WHO always puts in a third word alongside “test” and “trace”: “isolate”. Any mention of isolation in the Statement is notable by its absence. Taiwan, South Korea and Hong Kong have all managed to suppress further bursts of Covid because of the arrangements for not just testing and tracing but isolating. It is good to hear that an app will be available, but the Minister will know that there are people with technical experience concerned about whether it is appropriate to use Bluetooth for it, because of security issues. Can the Minister assure the House that this is not the case and that people’s data will be used only for NHS purposes and will absolutely not be able to be used by any providers of the app or beyond? The 18,000 tracers announced by the Secretary of State just before this Statement are a good start, but we will need more for good national coverage. Worryingly, Mr Hancock said a few days ago that all this will be operated centrally. Is that still the case, or will he use the existing trained tracers that there are in local communities, whether environmental health tracers in councils or in local health teams? It seems rather bizarre to try to cover the country on that level.

On shielding, it is good that there is a request to create more volunteers and to celebrate the volunteers, but notable by their absence in the Statement are the many people who have not yet had their letters on shielding and whether any further groupings may have to consider shielding—which I understand is the case.

I congratulate the Government on their progress on test and trace, but confirm that we are extremely concerned about supplies of equipment and medicine and hope that things will be remedied speedily.

[Lord Bethell]

My Lords, I greatly thank the noble Baronesses, Lady Thornton and Lady Brinton, for their extremely perceptive and thoughtful questions. I will answer them, in the words of the moment, at pace.

The noble Baroness, Lady Thornton, asked about BAME. The precise figures for BAME deaths are not to hand. PHE will have a very thorough investigation into this. It will come up with a scope and a delivery date shortly.

On isolation, one of the frustrating and awkward things about the virus is how unpredictable it is and how many unknowns there are. It confounds expectations. The question of isolation remains one for which we are reviewing our advice. We are in constant contact with other countries to learn more about best practice.

On the European project, I make it absolutely 100% clear that there was a cock-up, not a conspiracy. There were emails from Europe to us that were missed; there were meetings that our side missed. It was a great shame that that opportunity was missed, but we have put in place the processes and arrangements to work with our European partners on future procurement if they are helpful to the NHS and our care system.

The noble Lady, Baroness Thornton, is quite right to ask about capacity and testing. The blunt truth is that infection rates have gone down dramatically. The lockdown has had a profound impact. The KCL infection rate graph has gone from 2 million to half a million. That has a profound effect on demand for tests. Access is no longer a problem. At 5 pm, on the No. 10 presser, the Secretary of State explained how key workers can access a test for themselves. A major advertising campaign will begin tomorrow. They can either attend the drive-ins or Amazon will deliver a test to their home. Therefore, for those without a car, travel is not necessary. That capacity will be essential when we build the kind of track and trace capability that we will need to take us out of lockdown.

The noble Baroness, Lady Thornton, asked about postponed treatments. I echo her sentiments entirely. It is of grave concern that the numbers of non-Covid deaths can be worse than of those who die of Covid themselves, as in any epidemic. The message in the Statement is crystal clear: if you need treatment, contact your GP or your hospital. We will do everything we can to give you the treatment that you need. We are trying to use this hiatus to clear some of the backlog. The noble Baroness mentioned cancer. That is a particularly tricky problem because those cancer patients in treatment who have challenging immune systems will not wish to attend hospitals where there is Covid. We are doing all that we can to try to make arrangements and provide hygienic arrangements for them.

The noble Baroness, Lady Brinton, asked about care beds. Let me slay one myth: the ONS is very clear about the proportion of deaths at care homes. It is 10%. It is an offence to misrepresent the cause of a death. Causes of death are reported to PHE. The CQC carries that information to the ONS. These are reliable figures and I would be glad to send those who suggest that it is more than that the details on the ONS website. There is no pressure on anyone to be in a bed that is not recommended by strong clinical advice. It is true that we have spare hospital bed capacity, but it is not true that we are pressurising anyone to stay in a care home who should be in a hospital bed.

The noble Baroness, Lady Brinton, raised the question of medicines. That is an area where our supply chains have been put under extreme stress. Suppliers in China, India and America have all been under pressure and we have been in conversation at government and corporate level to ensure we have supplies. The noble Baroness is right that some of the first-choice medicines for sedation have been in short supply, but there are ample and various back-ups for those medicines. She is right that a feature of the Covid disease, is, it seems, that it attacks the kidneys and there has been a big increase in the need for kidney dialysis and the drugs associated with it. We are putting in place the supply chains necessary to fill that need.

As for the Turkish ambassador, I am not going to give a blow-by-blow account of every plane and truckload of kit that comes to Britain; all I can say is that we are extremely grateful to both the Turkish ambassador and to our Turkish corporate providers and we find the scrutiny they have been put under unfortunate and regrettable.

Turning to track and trace, I confirm that isolation is an absolutely intrinsic part of the track and trace regime: it just does not rhyme so well, so you never put it at the end, but “track, trace and isolate” is the programme. I have been given a thorough briefing by the Taiwanese CMO on their use of track and trace and, having a Taiwanese wife, I can tell noble Lords that I am up to speed on their achievements in that area.

On app security, I assure the House that the Bluetooth we are using is the latent, not the overt, Bluetooth: data is not carried in the same way as in overt Bluetooth, and one of the reasons we have chosen that method is the strong security offered. I also reassure the House that we have strong data arrangements. It is one of the reasons we have gone for a latent Bluetooth technology, and no data will be shared with our technology providers.

Lastly, the noble Baroness, Lady Brinton, is entirely right to raise the tracing part of track and tracing. I reassure her that we will be using a variety of different methods. There will be a central bank of callers. We will also be using local resources where they are necessary, and we will also be using friends networks. We have learned from the best case studies from abroad that often the influence of friends in persuading people to isolate has the most profound effect.