Living in a COVID World: A Long-term Approach to Resilience and Wellbeing (COVID-19 Committee Report)

Baroness Neville-Rolfe Excerpts

Wednesday 29th November 2023 Grand Committee

[The Minister of State, Cabinet Office (Baroness Neville- Rolfe) (Con)]

My Lords, I join all those who congratulated the noble Baroness, Lady Lane-Fox, on her speech and on the work that she did in chairing this committee. She brings a thoughtfulness and a knowledge of digital way beyond most of us, which has made this report a very special piece of work and has allowed her to pioneer new methods of data-gathering, which I think will be used elsewhere. I thank all noble Lords for their interesting contributions today, despite the rival attraction. It is good to see so many noble Lords here, including the noble Lord, Lord Alderdice, who was right to emphasise cost-benefit and the speed of change. My noble friend Lady Fraser of Craigmaddie was here earlier.

Of course, two years have elapsed since the report was printed, but the good news is that that means that we can take advantage of what has been achieved since then and celebrate the fact, as we should, that we are no longer tied down by Covid and, in my case at least, that NHS vaccinations for the most vulnerable and elderly groups continue to help in protecting so many of us, especially in this House.

The COVID-19 Committee’s insightful piece of work in its Living in a COVID World: A Long-term Approach to Resilience and Wellbeing report rightly highlights the importance of building resilience to ensure that we are equipped for future crises. That is where I would like to start, not least since it fits in with my responsibilities at the Cabinet Office. We have made substantial progress on resilience. Earlier this year, we debated the UK Government’s new resilience framework which sets out the Government’s plan to strengthen the systems that underpin our response to a range of risks. The Resilience Directorate, in the Cabinet Office, works across government to ensure that the UK is better placed to prepare for, respond to and recover from risks and hazards—extreme weather, terrorism, pandemics and so on. I thank the noble Baroness, Lady Merron, for her kind words about Mary Jones. We will be publishing an update on resilience shortly—we stand by that promise—and look forward to debating this matter further with the noble Baroness and with other colleagues, such as the expert, the noble Lord, Lord Harris, who I was pleased to see in his place earlier.

As part of the commitments made in the resilience framework, we are establishing new ways of identifying and assessing chronic risks to the UK, the continuous challenges facing the UK, generally over a longer timeframe. This complements the national security risk assessment and sets out the most serious acute risks to the UK. The Government’s national risk register, the external version of the classified risk assessment, was published in August. It is specifically aimed at risk professionals and practitioners across society who benefit from having more information about risks. It is the most transparent version yet, which I am pleased about, and it helps to develop a shared understanding of preparedness for risks facing the UK. Our whole-of-society approach, which picks out what several noble Lords have said this evening, is important to building the resilient society that the right reverend Prelate the Bishop of London emphasised very rightly.

Chapter 2 of the committee’s report outlines the challenges we face, such as the digital and tech revolution, demography and the response to climate change, although it perhaps underplays the economic problems we all face as a result of the enormous cost of seeing Britain through the pandemic. A prosperous economy makes it easier to cope with Covid legacies in health, education and the other areas identified today. Alongside the longer-term forward thinking of the Resilience Directorate, we remain committed to learning from the Covid-19 pandemic, building on the reset mentioned by the noble Baroness, Lady Merron. Today’s debate has been very helpful.

The noble Baroness, Lady Lane-Fox, was right to commend the work of local communities during the pandemic and their role in resilience. I remember what a brilliant job my local village volunteers did during the pandemic. They delivered drugs and donated food to some of the poorest in our area and prioritising deliveries to those with a safeguarding risk. We must build on that joint endeavour. Although the UK Government have a central role in assessing and planning for risks, the local level is the foundation of the UK’s resilience. The many local resilience forums in England, Scotland and Wales, as well as the emergency preparedness groups in Northern Ireland, play a critical role in bringing together local responders, such as the emergency services, to plan for risks.

It was interesting to be taken back by the noble Lord, Lord Allan of Hallam, to all the exchanges on testing, the location of testing sites and the local endeavour that included faith groups. We have learned from those experiences in our planning and the way that we will approach things going forward.

The right reverend Prelate also highlighted the importance of local faith leaders in lots of different ways. The Government recognise the importance of such figures. Indeed, we worked closely with them during the pandemic in developing guidance, using places of work safely and working with a diverse and dispersed network of community champions. Community champions were found to strengthen regional capacities to deal with Covid-19, while the community vaccine champions programme found that religious minority groups aware of CVC-funded activities were significantly more likely to have booster vaccinations.

The pandemic was an unprecedented event that I hope will not be repeated. Everyone had to do their best and often make difficult decisions where there was no blueprint. I was on the Back Benches at the time, but I think the degree of uncertainty in such crises may have faded from memory. All such crises have unexpected features. For example, it was not unreasonable to prepare for a flu epidemic like the one which killed so many, particularly young people, in the 20th century. It is not possible to have a plan for everything, as is rather suggested in the report with the call for a “just in case” model. This would be very expensive and we would be unlikely to get it right, but I agree that we must focus more on prevention and take a more whole- of-society approach to risk management. To pick up the point made by the noble Lord, Lord Alderdice, there has to be some surge capacity. That happened during Covid in many different areas of government. We have to be careful not always to focus on the negative.

Looking back, there will be decisions that we got right but also important lessons to be learned for the future, and that is why we set up the Covid-19 inquiry. My noble friend Lord Robathan questioned the Government’s decision to lock down. The inquiry was commissioned to consider decisions such as that and it will report its conclusions, which we will consider in due course. We need to learn the lessons of Covid in a spirit of transparency and candour, and there are many conflicting views.

Progress on the inquiry is well under way—as we all hear on the radio all the time—and much of the focus is on issues identified in the committee’s report that we are discussing today. Public hearings for module 1 are focused on pandemic preparedness and resilience. Module 2 hearings, going on at the moment, are focused on core decision-making and will conclude on 14 December. Future modules will focus on healthcare systems, vaccines and therapeutics, and government procurement—I note the points made by the noble Lord, Lord Allan. Our new Procurement Act has of course made many changes in the light of the difficulties of Covid, including strengthening the existing legal duties in respect of conflicts of interest and introducing greater transparency requirements, which I think we all welcome.

On levelling up, many of the committee’s recommendations focus on how the Government can and should deliver their commitments to levelling up. Our White Paper published in February 2022 recognised that not every person in every part of the UK shares in the UK’s success, which is why the White Paper outlined 12 ambitious missions to level up the UK, some of which we have touched on today. A number of the recommendations relate to transforming our approach to devolution and giving more power to local government. The White Paper set an objective that every part of England seeking a devolution deal should get one by 2030. In December 2022, we announced five new deals, which will bring devolution to over 51% of the English population. A further four new devolution deals were announced in the Autumn Statement.

The noble Baroness, Lady Lane-Fox, emphasised the significance of well-being. Well-being is an important consideration for the Government when making spending and policy decisions. She raised the issue of funding for well-being; I understand that departments across government have worked with and provided funding to the What Works Centre for Wellbeing and others to date. We will continue to explore how best to measure well-being and deliver improvements across the UK. The Treasury’s Green Book sets out how to appraise policies, programmes and projects and requires all social, economic and environmental benefits and costs to be considered in appraisal. Further, the noble Baroness will be aware of the ONS well-being index and the national well-being dashboard. This intelligent use of data measures well-being across the country in a number of areas and can be a useful tool for practitioners.

Perhaps even more important in this area, however, is the Government’s progress on reducing inflation and promoting growth through measures announced in the Autumn Statement, as this is the best way to support the sustainability of public spending in areas such as well-being. In this year’s local government finance settlement, the most deprived areas will receive 17% more per dwelling than the least deprived areas.

I have not gone through the local government issues; they were dealt with but nobody has raised them today. However, I am happy to talk to people if they want me to. Noble Lords will know that I am always very keen to make sure that local government contributions are appreciated and funded.

On health, the pandemic placed an unprecedented level of demand on NHS services. The NHS has since been provided with record levels of staffing and funding to tackle waiting lists. NHS England achieved its target of virtually eliminating waiting times of two years or more for elective procedures in July 2022, and waits of 18 months have been reduced by over 90% in the last two years. Additionally, as part of the first-ever long-term workforce plan, record numbers of doctors, nurses, dentists and other healthcare staff will be trained in England, backed by over £2.4 billion of funding for additional education and training places.

On increasing access to healthcare services, the NHS app—which noble Lords mentioned approvingly—and the NHS website are delivering a proactive, personalised digital NHS experience for patients and their carers. This has come on a lot since the noble Baroness, Lady Lane-Fox, and I worked together on this in the Cabinet Office. However, as the noble Lord, Lord Patel, pointed out, this is not an easy area. As he said, the public are generally supportive of these measures but less happy when technology comes between them and the clinicians. Like him, I believe that online consultations, although useful, can be overdone.

Of course, GP practices are individual businesses with partners. Many are outstanding and some face more challenges. I have certainly seen how the appointments system has been digitalised in recent years. That has freed up GP surgeries. The report today in the Telegraph examined 95 cases; of course, any serious incident of the kind referred to is one too many. However, NHS guidance and clinical training incorporate red-flag symptoms that would prompt a GP or practice staff to move to a face-to-face appointment. Even more importantly, patients also have a right to request a face-to-face appointment whenever they deem it necessary and practices should comply with that, unless there are good reasons to the contrary such as a particularly infectious disease.

The right reverend Prelate the Bishop of London rightly set out the importance of tackling health inequalities. This is one of the 12 missions set out in the levelling-up White Paper. The major conditions strategy, which the Government intend to publish in early 2024, will explore how we can tackle the key drivers of ill health in England to improve healthy life expectancy, as well as reduce pressure on the NHS and reduce ill health and related labour market inactivity. We are also tackling health disparities through interventions such as the NHS’s Core20PLUS5 programme, which focuses on improving physical and mental health outcomes in the poorest 20% of the population.

We know the pandemic has had and will continue to have an impact on mental health and the well-being of many people. That is why we are investing £2.3 billion of additional funding per year by March 2024 compared with 2018. This funding will expand mental health services in England so that 2 million more people can receive NHS-funded mental health support. We are also continuing to roll out mental health support teams in schools and colleges across England.

Probably the most worrying effect of the pandemic has been on schoolchildren and infants. There is a question as to whether we got school closures right. We acted swiftly in helping our children recover from the impact of the pandemic and have made available almost £5 billion for ambitious multiyear programmes to support education recovery. We are training more early years staff in the latest teaching for communication and language, maths and personal and social development. A number of other important interventions were touched on in the report, such as the Nuffield early language intervention programme, which has played an important role in improving reception-age children’s language and communication skills following Covid-19.

Finally, let me turn to digital transformation. The Covid-19 pandemic had one advantage. It ushered in a revolution in digital ways of working for all of us, which would otherwise have taken decades. The noble Lord, Lord Alderdice, gave us some telling examples—notably changing decades of practice by the late Queen. Schools and public services rose to the challenge remarkably. However, the pandemic brought into stark reality the need to make digital innovation accessible to all.

As the committee found, the nature of digital inclusion is cross-cutting and the onus sits on every government department to support its service users to tackle digital exclusion. We now have a new department, DSIT, focusing more strongly on such matters and much going on elsewhere. Across government, the Cabinet Office is playing its part with the Central Digital and Data Office and our new AI directorate, which is driving the adoption of new technologies in the public sector, making services more accessible and improving productivity and value for money. This is a very important part of the revolution.

The noble Baroness, Lady Lane-Fox, was right to raise the importance of long-term thinking. The Government have clearly made long-term decisions for a brighter future, such as setting up the Covid inquiry to learn lessons from the pandemic, the levelling-up White Paper and the long-term plan laid out by Rishi Sunak in October. Of course, we welcome the recommendations of committees.

I particularly identify the Select Committee on Risk Assessment and Risk Planning, chaired by my noble friend Lord Arbuthnot, which encouraged the Government to think ahead, particularly on resilience. It is a very good example of the influence of critical thinking in this House, as is the report that we are discussing today. Long-term thinking implemented by a cross-departmental approach is also important. I think that the noble Baroness, Lady Merron, was saying that. That is why I volunteered, somewhat reluctantly, to take part in this debate, and why her experience in the department is important to the debate. Being able to look right across the board has been a very good aspect of this report and this debate.

I thank the noble Baroness, Lady Coussins, for her arresting and wide-ranging speech on the importance of language skills and interpretation in health inequalities and injustice. I completely agree on the importance of languages in schools. It is not an area of mine, but I echo everything that she said. I would add that primary care providers should ensure that patients have access to translation and British Sign Language services as required to support consent, mental capacity and clinical assessments. Primary care providers can request support for reasonable additional costs from their local commissioner, which will assess whether claims for such costs are reasonable and represent value for money. That is an example of where we are thinking about the point that she was making, although her speech was wide-ranging, and I look forward to reviewing it again.

I have tried to answer where I can. Clearly, I do not deal with some of these issues on a daily basis. In particular, I shall have to write to the noble Baroness, Lady Merron, on the issue of the immunocompromised. I say in concluding that we share many of the sentiments of the committee’s report. We agree that the Government and the country must learn lessons from the Covid-19 pandemic. I hope that I have shown that progress is being made on many of the difficult issues that were highlighted by the report. My special thanks to the chair and the committee and to those who gave evidence—many people in very difficult circumstances—as well as to the clerk and to his or her team and noble Lords who took part in the debate today.