Covid-19 Update

Lord Bethell Excerpts

Thursday 12th November 2020 Lords Chamber

[Baroness Jolly (LD) [V]]

I thank the Minister. I am going to address testing and tracing. He may not have answers but I should be grateful if he could write to me. There have been more than 10 million downloads of the NHS Covid-19 contact tracing app. There have also been many complaints of Bluetooth draining batteries. I second those. Will he confirm whether there is a solution in the pipeline for that issue? If people do as I do and just switch off Bluetooth, the system will not work. How many of these app users are active? If 10 million people are actively telling the world where they are and are checking in and out of where they have been, that is wonderful. But if they do not do so, it is not terribly helpful.

Critically, how many people have been triggered via the app to isolate? Of those, what proportion have had their isolation checked and by whom? Testing is quick and easy but the delay in response time is unhelpful. Swab processing time is not reducing due to the increase in the number of swabs, and labs are taking longer. Is there yet sufficient capacity, and how many staff are being trained weekly to take on the extra capacity? Can the Minister indicate the cost of taking a swab and getting the results back to the individual? Finally, will he confirm when he expects to move to lateral flow tests, which are much quicker and would transform the lives of the staff of care homes, their residents and visiting families?

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

My Lords, I am extremely grateful for the thoughtful questions of the noble Baronesses. I shall try to answer them as completely as I can but will write on any that I have omitted. As regards the questions about students, the programme of works with universities is extremely ambitious. I pay tribute to vice-chancellors and university administrations for working extremely closely with the Government, with the test and trace service and the DfE to mobilising the necessary arrangements in order to achieve the return home for Christmas.

This will include a large amount of mass testing on university campuses and in digs. There have already been successful pilots at Durham and De Montfort, using a variety of testing techniques and formats. Some tests have been done using telemedicine, some using traditional clipboard and picnic table techniques. There is further testing piloting to be done, but the indications are that this is proving an extremely successful model. It means that students can look forward to returning home for Christmas, confident that those who have the disease have been screened, and families can look forward to seeing students safely again.

On the testing of NHS workers, I agree with the noble Baroness that it is a priority. We are moving quickly on this. The purchase of tens of millions of lateral flow tests is a complete game-changer, and we remain committed to providing testing for the 1.3 million NHS workers. We aim to use lateral flow tests for some of these tests. NHS workers are themselves clinically trained, and it is appropriate for them to be able to use these tests. Therefore, we believe we can change the course of staff testing in the NHS environment using the new technology and a new approach to testing. I am extremely grateful to NHS colleagues for their participation in this important initiative.

Turning to DPHs, the noble Baroness is right that this is an important breakthrough. Again, the rollout of the lateral flow tests is important in that. She asked me about care homes, and she could have equally asked me about schools. I can deliver the same message on both: we have been sensitive to the appeals by DPHs for autonomy—for them to be able to make their own decisions, use their local intelligence and use their insight. That is why we have been reluctant to give any firm guidance on how they could or should use those tests. It is entirely up to DPHs to use the tests in the way they choose. But it is our expectation that some of those tests will be used in care homes, though there are other provisions for care home testing, and some will be used in schools, as well as for outbreak management and community testing.

The period for isolation is a subject under constant and rolling review by the CMO’s office and the policy team at DPH. I wish I could provide some kind of breakthrough—that the virus had in some way changed and was no longer infectious in people after a week or eight or nine days—but I am afraid I cannot provide that information. The frustrating thing about this virus is that it sits in the back of the throat or nose and remains infectious for an unfeasibly long time. That is why we are cautious about making dramatic changes in the isolation protocols.

What rapid testing provides is the opportunity to do frequent testing. The noble Baroness asked me about seven-day PCR tests; more likely and efficacious would be regular testing, every day or every other day, using the lateral flow tests, to do some form of test and release. We believe that avenue is more likely, and the CMO’s office is looking closely at that. It is entirely up to that office to make announcements on that score.

On adult social care, I reassure the noble Baroness that adult and child social care colleagues are fully involved in the preparations for a vaccine. She is right that social care provides its own set of challenges for the administration of the vaccine, but those are exactly the people we need to target with the vaccine. That is why they, particularly the elderly, are at the highest level of the JCVI’s prioritisation list. We are putting all our efforts into making sure that the vaccine delivery works for them.

The noble Baroness asked about ethnic minorities. May I put the question slightly differently? A number of difficult-to-reach groups have seen a high infection rate. It is a priority for us to make sure that the message on the vaccine breaks through any cultural, linguistic, demographic or other social barriers to get through to those groups who need it. They are not groups defined by race or the colour of their skin but by their proximity or otherwise to the normal course of government. We have learned through Covid that these groups are incredibly important from a public health point of view. From a values point of view, we owe it to them to do our best to reach them and we are putting the resources in place to do that. As for children, we have no current plans to vaccinate them. In terms of international partners, we are very focused on ensuring that all the intellectual property and manufacturing resources that we can possibly effect are put to work to get the vaccine into the arms of those around the world.

On cold storage, I reassure the noble Baroness that we have been on this for months. We have been aware of the demanding storage need of the Pfizer vaccine for a substantial amount of time and cold storage arrangements have been put in place. It is not necessary for that cold storage to be literally at the end of every street because the travel time for the vaccine is reasonably flexible. We have in place exactly what we need, not only for the Pfizer vaccine but for the Oxford vaccine and the others in the pipeline. JVT and Dr June Raine at the MHRA were crystal clear when they said that safety will not be compromised. I endorse their comments.

I will say a few words about our approach to managing messages to those who might feel anxious about the vaccine. This is not a moment for rebuttal or for attacking those who have questions about the vaccine, whatever those questions are and however far-fetched they might be. Our approach is to take all questions at face value, tackle them sincerely and approach them in an open-hearted way. By being defensive we play into the hands of those who have bad intentions, and by being aggressive we only amplify those causing trouble. Instead, we want to have an open dialogue with those who have concerns to emphasise the safety of the vaccine and, more generally, the normality of taking vaccines. It is with that kind of approach that we hope to deal with those who have concerns about taking vaccines.

The noble Baroness, Lady Jolly, asked a number of questions about the app. I cannot give her precise numbers on absolutely everything she asked but I can reassure her on a couple of things. There have been 20 million downloads, not 10 million. Take-up of the app has been enormous and, week on week, we see a huge number of check-ins on the venue-based element of the app, which is a huge part of its effectiveness. It helps us enormously with contact tracing. As for Bluetooth and the battery, I am disappointed to hear that the noble Baroness has had trouble with her phone. On the whole, that is not the feedback we have had from users and the recent update has emphasised the low-energy aspects of the Bluetooth protocol that the app uses. We think it will improve the performance of the app and lessen its drain on the battery.

The noble Baroness asked about tests; I will answer broadly. The innovation that we have seen in diagnostics for Covid has been incredible. It has included far-fetched—to me at least—technologies such as mass spectrometry. Some innovations have used the plastic lateral flows, which, although low-tech in their appearance, use extremely advanced technologies and chemicals to achieve accuracy, speed and cost performance. Some, such as LAMP, have taken old technologies and repurposed them for a new use. It has been extremely exciting to see. It is my aspiration that we will see an inflection point in diagnostics in the UK. This will aid an overall strategic step towards early intervention and put diagnostics at the heart of our medical science. It has already played an important part for a long time, but this will put it centre stage. I pay tribute to the work of Professor Mike Richards, whose review of the future vision for diagnostics in the NHS provides us with a target to aim for as we expand and invest in our diagnostics around Covid.

[The Deputy Speaker (Baroness McIntosh of Hudnall) (Lab)]

My Lords, we come to the 30 minutes allocated to Back-Bench questions. I ask that questions and answers be brief so that I can call the maximum number of speakers.

[Lord Patel (CB) [V]]

My Lords, the Minister referred to several areas where the lateral flow test will be deployed. The early reports from Liverpool’s mass screening using the test suggests that it performs well, with higher specificity and sensitivity, meaning that there is a negligible number of false positives and false negatives. That being so—and accepting that the vaccine will change the whole scene when it is available—apart from the areas that he has already mentioned, can he confirm what I have just said and give us the latest figures from Liverpool? Can he go on to say what plans the Government are making for the deployment of this test in other public areas to open up the economy?

[Lord Bethell (Con)]

I thank the noble Lord for his characteristically detailed and forensic question. The lateral flow test, as I am sure he knows, has the terrific advantage of giving very few false positives, but we do not pretend that it gives a clinical-level analysis of all the negatives. We therefore do not use it in a clinical setting as a symptomatic test; we use it as a screening test for asymptomatic cases. That is why it has been so valuable in a mass testing environment such as Liverpool. We can back up the tests of those who are positive with a double test, either with another lateral flow test or with a PCR test, to ensure that we do not create a problem with too many false positives. We are working on the protocols now to figure out exactly what kind of rate of second testing we need to get a fair analysis.

The noble Lord is entirely right that the vaccine will be a game-changer, but not everyone will take it immediately and we are not sure how long each vaccine will last for, so there will be a role for testing even after the vaccine has been deployed. In the meantime, testing is very much focused on social care, clinical workers, schools and universities. Those are the four areas where we are focused at the moment, but we hope it can be used further to enable the opening of the economy, as he alluded to.

[Baroness Noakes (Con) [V]]

My Lords, there have been estimates that hospital-acquired Covid infections are as high as one-quarter of all hospitalised Covid patients, which seems pretty shameful and is likely to be a major contributor to the Covid death statistics. What do the Government currently estimate the impact of hospital-acquired Covid infections to be, and what action are they taking to deal with it?

[Lord Bethell (Con)]

My noble friend is entirely right; in any epidemic, nosocomial infection is one of the greatest challenges faced. If you want to find a recent infection of Covid, the best place to find it is where there is someone already with the disease, because that is the way that epidemics work. Hospitals necessarily have a high concentration of those with the disease. It is true that during the early months of the epidemic, when there were challenges with PPE and when practices within hospitals were not as disciplined as we would have liked, nosocomial infection, as it often is in epidemics around the world and throughout history, was a big challenge in hospital care and social care. That has been extremely well documented. However, I pay tribute to colleagues in the NHS who have come a very long way in the administration of PPE, confinement practices and infection control. The nosocomial infection that we are seeing is at dramatically lower rates than it was in the past, and that is due to the hard work and science of those in the healthcare sector.

[Lord Wills (Lab) [V]]

The Minister will be aware that during the first lockdown the utilisation of beds in the private sector, under its partnership agreement with the NHS, was 20%. What reassurance can the Minister give that there will not be a similar underutilisation of capacity for testing in the independent sector in the weeks and months ahead?

[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.

[Lord Loomba (CB) [V]]

My Lords, it is very good news that there is now a potential vaccine that shows prospects of good efficacy. The Health Minister showed MPs in the other place that mass rollout of the vaccine would be ready to start from as early as the beginning of December, and we have placed an order for 40 million jabs. Given that the vaccine is still not approved as 100% safe or approved by the authorities, can the Minister give more information on the reality of how long it is likely to be before a safe rollout takes place?

[Lord Bethell (Con)]

My Lords, I am afraid I cannot offer a firm schedule or confirmed dates for the rollout because they depend on the independent judgment of the MHRA, the CMO and the JCVI. These important decisions are out of our grasp, but it is clear that the progress made by Pfizer, AstraZeneca and other companies in the vaccine’s pipeline has been dramatically quicker than had initially been expected. We are making preparations to have the NHS ready for the beginning of December in case a vaccine is available by then.

[Lord Clark of Windermere (Lab) [V]]

My Lords, this just highlighted the key role of GPs in any vaccine rollout, but in parts of the country there is a dire shortage of GPs with, on occasion, surgeries being run by nurse practitioners and other specialist nurses to great effect. Will the Minister check that, in the absence of GPs, nurse practitioners will have, first, full authority to activate any initial planning; secondly, empowerment to undertake the necessary continuing administration for the vaccination rollout; and thirdly, current authorisation to prescribe and vaccinate applicable in any national rollout?

[Lord Bethell (Con)]

I thank the noble Lord for his championing of nurse practitioners, because we are going to rely on all qualified healthcare workers to administer an injection to support this huge project—one of the largest of its kind in recent national history. I also emphasise the role of pharmacists who will, where appropriate, deliver the vaccine as well. We need a massive, mass-scale effort to deliver this vaccine. We will be empowering all those qualified to deliver the injection to do so and we are extremely grateful to them, including nurse practitioners, for their help in this matter.

[Lord Jones of Cheltenham (LD) [V]]

My Lords, President-elect Biden has shown refreshing leadership by setting up a panel of scientific experts to deal with Covid-19. Why, then, do the Government think that a venture capitalist married to a government Minister is best placed to chair the Vaccine Taskforce rather than an expert in vaccines?

[Lord Bethell (Con)]

The role of Kate Bingham, the head of the Vaccine Taskforce, has been to acquire vaccines—and that is what she has done. She has served the nation brilliantly by acquiring six of the vaccines on four of the platforms. We should be extremely grateful for the work that she has done. It was not remunerated, and it was extremely effective. To knock those who have contributed voluntarily to our fight against Covid is not appropriate at this stage.

[Viscount Waverley (CB) [V]]

My Lords, notwithstanding the Minister’s positive and sensitive remarks this evening, can it be confirmed that, despite SAGE advice and planning, a national mass Covid testing programme has been ruled out by No. 10 this week? If that is the case, who mandated the decision and what was the rationale for doing so?

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[Lord Bethell (Con)]

The noble Viscount is better advised than me. As far as I understand, mass testing remains a central part of our battle against Covid and we remain committed to that programme.

[Lord Moynihan (Con)]

My Lords, there is growing concern that the unique Pfizer vaccine, with an mRNA genetic molecule that cellular machinery reads in order to build proteins, could be incompatible with the World Anti-Doping Code for all sports men and women, including Premier League footballers and Olympic athletes. Since the World Anti-Doping Agency already bans the use of agents designed to impact genome sequences if they have the potential to enhance sport performance or provide unfair advantage, and pursuant to my noble friend’s very helpful answer yesterday, will the Government undertake to work with the World Anti-Doping Agency and offer comprehensive advice to the sporting world before any vaccine programme begins?

[Lord Bethell (Con)]

I am extremely grateful to my noble friend for flagging up this important concern, which I acknowledge is a serious worry for those in the athletic and sporting arena. Colleagues at DCMS are aware of this concern. It is extremely early days and we do not know what the impact of the vaccine will be on the kind of protocols analysed by the World Anti-Doping Agency, but we have sought advice from the WPA on this matter and I will be happy to convey it as soon as it arrives.

[Lord Liddle (Lab) [V]]

My Lords, this week’s news about the vaccine has been a great uplift at a very grim time. However, rolling it out will prove a massive logistical challenge, as I think the Minister accepts, at the same time as we are trying to repair the gaps and strengthen our test and trace systems, and trying not to damage the rest of the services provided by the NHS. Does this not all require a massive upscaling of the command and control capabilities of the Government? What steps are they planning to put in place to manage this phase of the crisis more successfully than they have managed it so far?

[Lord Bethell (Con)]

My Lords, I share the noble Lord’s sentiment that the vaccine is an uplift and a source of optimism, but I hope that he will not mind if I also use this opportunity to say that the British public—all of us—must stick with the protocols that are in place at the moment. It is not early enough for us to depart from social distancing and the current regulations around the lockdown. However, his point is extremely well made. We are determined to use the respite of the current lockdown to fill the gaps, to improve performance where it is needed, to address acknowledged weaknesses in test and trace, particularly in the tracing area, and to improve our performance thoroughly. However, I do not necessarily acknowledge the need for an upscale in the command and control elements. Certainly for the administration of the vaccine, we will be working through the existing NHS infrastructure, putting GPs’ surgeries and pharmacies at the centre of delivery. Test and trace is run through existing ministerial structures, with accountability to Parliament, and we intend to keep it that way.

[Lord Greaves (LD)]

My Lords, the Statement is very positive about the quickie lateral flow tests. It refers to the pilots in Stoke-on-Trent and Liverpool and the fact that mass testing will be carried out in 67 other authorities. However, the list does not appear to include Lancashire, which I thought was part of that testing. Can the Minister confirm that Lancashire is part of it, even though it has been missed off the list, and is it the whole of Lancashire or just some of the 12 districts in Lancashire? The Statement also refers to the Government’s strategy of suppressing the virus and supporting education, the economy and the NHS until a vaccine is available. That is fine but, once again, it does not home in on the people who are really suffering—close family and friends, and particularly old and vulnerable people. A recent report—released this week, I think—from the Red Cross, called Lonely and Left Behind, really shows up the misery and mental disarray that a lot of these people are in. Some have been locking themselves down and have been frightened to go out since the early spring. Does the Minister understand that, if a system of quickie testing of this kind and then vaccination are to be brought in, these people have to be treated as an absolute top priority, and that the first thing the Government have to do is to give them the confidence to take part in it?

[Lord Bethell (Con)]

My Lords, I reassure the noble Lord that the 67 DPHs who are taking the tests in the first round are those who stepped forward. I believe that they include DPHs in Lancashire, but I shall be happy to confirm that. Regarding the Lonely and Left Behind report, the noble Lord put it extremely well. Of course those are the people who have been extremely hard hit by the pandemic. I hope he will acknowledge that we have put those who are older and vulnerable at the top of the prioritisation list—there has been no ambiguity about that. They will be vaccinated first and will therefore be freed from lockdown. When the vaccination is available, it will be a massive priority to get our society open again and to get the love, tenderness and support to the people whom he described—all things that are needed in order for them to have happy and fulfilled lives.

[Lord Forsyth of Drumlean (Con) [V]]

My Lords, why has my noble friend not answered my Written Questions on the following: on false-positive tests, which were due on 28 September; on the legality of using the Public Health Act for lockdown, which was due on 14 October; and, finally, on why those Questions have not been answered, which is also overdue?

[Lord Bethell (Con)]

I can only apologise to my noble friend for the slowness in replying to his Questions. It is not a reasonable excuse, but the Department of Health and Social Care has been overwhelmed by the pandemic. A large amount of our correspondence is behind schedule. I have worked hard to try to catch up on that, but I apologise to him sincerely for the delay. When I get back to the department tomorrow morning, I will chase it up and get him replies to his perfectly reasonable Questions.

[Lord Rooker (Lab) [V]]

In the fourth paragraph of the Statement, the Secretary of State boasts that over 10 million people were tested at least once through NHS Test and Trace. The figure for the latest week, published by the Minister’s department today, is 10,800,031—a rise of 613,000 last week, or 87,600 a day. The week before, it was 88,200 a day, and the week before that it was 95,153 a day. Why are we going backwards in testing people at least once through NHS Test and Trace?

[Lord Bethell (Con)]

My Lords, the capacity that we have in track and trace is growing dramatically; the number of tests we have taken is going up. It is true that testing demand does fluctuate. There was a moment when universities had a very large outbreak and there was a huge amount of demand from universities, and there may well be other reasons why testing demand goes up in the future. But I reassure the noble Lord that the capacity, speed and accuracy of testing in this country are making huge progress on a day-by-day basis, and I pay tribute to those involved in the project.

[Lord Willis of Knaresborough (LD) [V]]

My Lords, a key factor in controlling Covid-19, with or without a vaccine, is test, trace and isolation, and I fully support that. Yet the recent survey indicated that some 20% of those asked to isolate actually failed to do so, rendering the system far less effective than it should be. What is the reasoning behind the reluctance of the Government to move from PCR to lateral flow testing for the test and trace programme, following the extensive clinical evaluations by PHE and Oxford University, which found 99.6% accuracy, including on the key criterion for track and trace of detecting asymptomatic carriers? Surely, accurate 48-hour testing would enable virus-free contacts to return to normal activity quickly, rather than sitting at home for 14 days.

[Lord Bethell (Con)]

My Lords, the noble Lord is entirely right on two things, and wrong on another. He is entirely right that isolation is absolutely key—without isolation, there is no point in testing or tracing. It is true that not everyone who is asked to isolate does isolate, but we have a programme in place to try to encourage, inform and inspire people to isolate. He is entirely right that lateral flow tests offer huge advantages, in terms of the speed at which they can be used, their cost and their flexibility. But we have bought tens of millions, maybe even hundreds of millions, of these tests in recent weeks. We are deploying them in mass testing, and we have completely followed the advice and inspiration of the noble Lord in this matter in a massive way.

[Lord Bilimoria (CB) [V]]

My Lords, Sir John Bell, the Regius Professor of Medicine at Oxford University, has said that these inexpensive, easy-to-use lateral flow antigen tests, when used systematically, could reduce transmission by 90%. Could the Minister confirm that the trials are already showing that these tests are picking up 75% of positive cases and 95% in the most infectious individuals? If that is the case, when can we have these millions of tests that Ministers have spoken about deployed, not only in the NHS, care homes, schools and universities but at airports, factories, offices, workplaces, theatres and even sports grounds, so that we can get our economy back firing on all cylinders very soon?

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[Lord Bethell (Con)]

As ever, I am inspired by the noble Lord’s passion for this subject. He has totally won the argument in this matter, because we are putting into the field millions of tests, as he recommended and continues to champion. The pilot in Liverpool is extremely exciting, and the tests themselves are proving both easy to administer and accurate in their diagnosis. We are working on ways of using these tests in a mass testing capacity. Universities and social care are two user cases that we have prioritised, and we are looking at using the lessons of Liverpool in other areas. In all matters, we continue to be inspired by the noble Lord.

[Baroness Pidding (Con) [V]]

My Lords, I join with others in welcoming the news regarding a possible vaccine and shall look forward to hearing more in the coming weeks. At last, we have some light at the end of a very dark tunnel. With lockdown 2 expiring on 2 December, it is critical that businesses are able to make plans now for post the release date, especially with Christmas looming so close. Can my noble friend the Minister give an indication as to what the plans are for after this date? We understand that tiers will be reintroduced. Will those tiers stick to the same measures we had before in each tier? How will different tiering be determined and, most importantly, at what point will businesses be advised?

[Lord Bethell (Con)]

My noble friend is right that the advice to business is extremely important, and we are ambitious to try to unlock the economy to enable people to return to as normal a life as they possibly can and to prepare the country for Christmas. However, it is too early to tell exactly what the state of the pandemic will be on 2 December. There is a review of the tiering system, and we will learn the lessons of the last round. The Prime Minister has made it very clear that he is committed to returning to a regional tiering system, but the exact dimensions and specifications of that system are under review, and communication to business of how, and to which regions, it will apply will be forthcoming once the analysis of the contagion has been completed.

[Lord Hunt of Kings Heath (Lab) [V]]

I declare my interest as a member of the GMC board. I return to the Statement made by the Secretary of State, in which he said, referring to NHS staff:

“The deployment of the vaccine will involve working long days and weekends, and that comes on top of all the NHS has already done”.—[Official Report, Commons, 10/11/20; cols. 746.]


The noble Lord will be aware that the GMC granted temporary registration to around 27,000 doctors in order to help out with the pandemic crisis. My question is: has the department considered using these doctors, not many of whom have actually been used by the NHS so far, for the vaccine programme? Will he look into that?

[Lord Bethell (Con)]

My Lords, the noble Lord raises a very good point. We pay tribute to all those who stepped forward, whether they were young doctors at the end of their training or older doctors who were returning to the profession. It was a really important and touching moment when those doctors stepped forward. He is right that not all of them were needed or used during the pandemic. My understanding, from the deployment team, is that they are looking at all avenues to have the largest army of people possible in order to use the vaccine. I am not exactly sure of the exact status of the 27,000 doctors he alluded to, but I would be glad to write to him with details.

[Lord Robathan (Con) [V]]

My Lords, according to local media, on Tuesday the city of Leicester—I live in Leicestershire—recorded the highest number of infections since the beginning of the pandemic. Leicester has been locked down since June, so could my noble friend confirm that this is the case, and, if it is, could he say whether this has happened because we do not know very much about the virus, whether it is the case that lockdowns do not work—as some people say—or is he going to blame the good people of Leicester for not abiding by the regulations?

[Lord Bethell (Con)]

I greatly thank the people of Leicester for their patience with the lockdown and with the very large number of measures that have been put in place there. The noble Lord is aware that some communities live and work very close to each other, and the transmission of the disease is affected by a very large number of factors. I cannot explain to him exactly why the infection rates are so high in Leicester today, but I absolutely applaud all those who have been working hard in that city to keep the epidemic at bay.

[Lord Mackenzie of Framwellgate (Non-Afl) [V]]

My Lords, following on from the last question, recent evidence shows that the north of England has been affected hardest by Covid-19 in terms of infections and deaths, caused mainly in hospitality settings. Compliant citizens are upset by the minority who flout the law. When the lockdown ends on 2 December, restrictions such as wearing masks and distancing will be only as effective as the public’s compliance. As the police cannot be in every pub, shop or restaurant, is it not time for the enforcement of such measures to be done by the venue itself, with the ultimate sanction of immediate closure by the police or local authority for wilful non-compliance?

[Lord Bethell (Con)]

The noble Lord is completely reasonable in his concerns but that is not the approach we are taking at the moment. Actually, public support for the lockdown measures—the wearing of masks, social distancing and restrictions on travel—has been amazing. Lockdown has been largely by consent and extremely well supported by the public in their behaviour. We are extremely proud that in Britain we do not need the Army on the street with their guns or the police fining people on the street, as they do in other countries. I pay tribute to the British public for the way in which they have gone along with those measures. The noble Lord makes the point that some people have been in breach of the rules and there have been prosecutions and fines. However, they have been minimal and have had their effect. We will continue to operate at the kind of level at which we have been operating to date.

[Baroness McIntosh of Pickering (Con)]

My Lords, my noble friend will be aware of my interest in the Dispensing Doctors’ Association. Will he update the House on where we are with the vaccination programme for the over-50s? What use will be made of dispensing doctors in rural areas to dispense the Covid-19 vaccine? I hope he will rely on them fully because they have the network to provide it in much the same way as the noble Lord, Clark, explained.

[Lord Bethell (Con)]

My noble friend will be aware of the prioritisation list published by the JVCI. I am afraid that the over-50s, of which I am a member, are not highest on the list, but they are at least halfway down. Prioritisation starts with the over-80s and works down from there. I completely endorse my noble friend’s comments on dispensing doctors. We will be relying on all parts of the healthcare ecology to deliver the vaccine. It will be a massive national project. Getting to hard-to-reach rural communities is incredibly important, particularly people in those communities who are older and perhaps do not travel. Dispensing doctors pay a pivotal role in that, and I pay tribute to their contribution to the vaccine.

[The Deputy Speaker (Baroness McIntosh of Hudnall) (Lab)]

My Lords, the time allotted for Back-Bench questions has now elapsed.