Covid-19: One Year Report

Lord Bethell Excerpts

Thursday 25th March 2021 Lords Chamber

Moved by

[Lord Bethell]

That, for the purposes of section 99 of the Coronavirus Act 2020, this House takes note of the One year report on the status of the non-devolved provisions of the Coronavirus Act 2020, published on 22 March 2021.

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

My Lords, it has been a year since the House passed the Coronavirus Act, and this anniversary gives us a moment to reflect. Despite the remarkable challenges of the past year, the spirit of co-operation and consensus that epitomised the passage of that Bill at that time of national crisis stands firm today. Now, a whole year later, it seems that our legislative approach has stood the test of time.

Our response required using the tools that were already available, such as the Public Health (Control of Disease) Act 1984, and at the same time rapidly developing new tools such as the Coronavirus Act. This dual approach has enabled us not only to tackle the public health threat but to underpin our public health response with a broader package of civic and financial support.

At the time we looked very closely at the Civil Contingencies Act, and I know many noble Lords feel we missed an opportunity there, not least because it might have meant that we engaged more fully with Parliament, but also because it would have taken us down an all-UK approach that would have perhaps somehow have spared the pressure on the union. However, the truth is that that choice was never possible. The Civil Contingencies Act is a provision of the last resort and its use is subject to very strict triple-lock criteria. A change to the CCA would have been necessary for it to have been usable. Instead, we used the Public Health Act 1984 to enact most of our public health legislative responses to the virus. It is an unloved Act, and many suggest we stretched it beyond its intended purpose. That is not true. We used it for what it was designed to do: to protect the population from communicable diseases of pandemic proportions. Indeed, the Act had been enhanced after the swine flu pandemic in 2008 with amendments specifically to enable a rapid response to a pandemic. Further, we chose to use the 1984 Act because it was and remains preferable to use existing powers. It was and is the right way to respond.

The 1984 Act provided us with many of the tools to respond to the public health risk, but it did not give us everything we needed. We needed to support our people: individuals, businesses and the economy; to shore up the capacity and resilience of our health and care systems; and we needed the continued delivery of essential public services. These are the three reasons we introduced the Coronavirus Act and, one year later, they are the reasons why we still need it. Yes, vaccines are happening at breakneck speed, but we are not out of the woods yet. We all need the continuation of this support and, while it is still required, it is our duty to provide it. The continued need for this dual legislative approach does not mean that we should remain static. A key feature of our response has been our ability to adapt and to respond to a changing set of circumstances, and this is precisely what the road map and today’s legislation are about: taking cautious steps towards ending public health restrictions and getting back to normal.

I will take a moment to reflect on a few of the benefits and achievements of the Act. It enabled the temporary registration of over 15,000 nurses, midwives and nursing associates, as well as over 21,000 temporary paramedics, practitioners, radiographers and other professionals. It has eased the burden on front-line staff by reducing administrative tasks, so that their time can be focused on where they are most needed. It has facilitated innovation, with comprehensive indemnity arrangements that give clinical staff the confidence to treat their patients to the best of their ability. The Act has allowed us to provide key financial support and resilience to individuals and businesses impacted by Covid-19 through schemes such as the Coronavirus Job Retention Scheme, the Bounce Back Loan Scheme and the Self-employment Income Support Scheme.

The Act has preserved access to justice by enabling 750,000 hearings to take place through remote technology. Section 78 of the Act has enabled local authority meetings to take place either remotely or in hybrid form. Death rates are now coming down, but it is worth remembering that we used the Act to guarantee the continuation of death management services, easing the administrative burden at a time when funeral services were struggling and the nation’s morgues were almost overwhelmed. Section 18 of the Act modified death and stillbirth registration; since the provisions came into force, nearly 95% of death registrations in England and Wales have been completed by telephone.

I completely acknowledge that some aspects of the Act cause noble Lords concern. We did not take the measures lightly and we do not use them freely. However, it remains vital to have the ability to take appropriate action for our response to be effective. These key functions that I have just described illustrate why we seek Parliament’s approval today to keep the powers in place.

When we introduced the Coronavirus Act a year ago, we were clear that this was only a temporary measure. We made a promise to Parliament that we would not keep any provision in place for longer than was necessary, and we have made good on that promise. In line with the spirit of the Act, we are dropping every single additional provision possible. Today we are announcing the expiration of 12 provisions, which represent nearly 25% of non-devolved powers. Recommending the expiry of so many provisions is a clear demonstration of our commitment to balancing the ability on the one hand to respond effectively and on the other to ensure that only those provisions deemed necessary and proportionate are kept in place.

We note our thanks to our colleagues in all devolved Administrations for their collaboration in working to expire so many provisions. In addition, we are also suspending a further three provisions; the full one-year status report outlining the outcome of this review was laid before Parliament earlier this week. The temporary modification of mental health and mental capacity legislation is one example of a provision which we had already expired on 10 December 2020. We identified that these provisions were no longer required due to the commitment and resilience of NHS staff—and there is a long list of other provisions we have retired.

Over the course of the pandemic there have been all manner of unexpected twists and turns; just as the virus has evolved over time, our response has had to evolve. We worked hard to get the tiering system right, because we wanted a system that worked for the whole country. The differential approach we took last summer yielded significant results, for instance in Leicester, where the incidence rate decreased from 135 per 100,000 to below 40 by the end of August 2020. However, it also had its downsides: it led to more legislation and some confusion. The tier system was intended to bring consistency, but we have since realised that simplicity and clarity are absolutely paramount. The emergence of the Kent variant showed us the value of a national approach. Our learning from the tiers has also enhanced what we have been able to do in the road map.

I know that lots of noble Lords feel frustrated and like they have not been heard, but I want to reiterate that they have been heard, and we have been listening. We are sensitive to feedback, as demonstrated by some of the adjustments we have made. We have introduced support bubbles to enable people at risk of isolation to access their informal support networks. We have changed the rules on places of worship, keeping churches, mosques, synagogues and other holy places open for communal worship throughout the last lockdown. Today we are making an amendment to the self-isolation regulations to include additional exemptions to allow people to self-isolate to support a pregnant person as a birthing partner. We introduced shielding to protect those most at risk of the virus. We know, however, that shielding has been hard, and we listen to feedback and modify guidance wherever possible.

Noble Lords also asked for local authorities to be brought in, and they have, through the contain framework. Contain works closely with local authorities to understand the challenges they are facing and to help ensure that national responses provide the support local areas need. The challenge provided by parliamentary scrutiny over the past year has enabled us to make our approach more sophisticated, and the road map, with its emphasis on simplicity and clarity, has benefited greatly from these challenges and improvements.

We cannot stop now. There is more to do. That is why I am setting out the eagerly awaited sequence of steps to ease restrictions and lead us towards lifting limits on social contact by 21 June. We could not have reached this point in this journey were it not for the provisions and achievements of the Coronavirus Act, our world-leading vaccination programme and the perseverance and commitment of the British public. There are four clear steps which rely on four clear tests, each of which is underpinned by the scientific evidence. Opening too early or too quickly risks a further lockdown. Therefore, our approach focuses on data, not dates, which I know will be well supported here.

As long as we see no significant regional disparity, the steps for easing restrictions will be taken at the same time across England in a national approach. The first measures of step 1 took place on 8 March, with an amendment to the all-tiers regulation. As promised, we prioritised education, and all school and college pupils have now returned to face-to-face education. Alongside the pre-existing exercise provision, the regulations allow outdoor recreation with your household or one other person and make provision for the gradual reopening of care homes for visits. On 22 March, we laid the steps regulation, which enables us to move forward to the next stage of the road map and puts the remaining steps of the road map into law.

Today marks the start of a new chapter, one of progress and happier times to come, but it is only the start of the journey. We need to be cautious and not put the significant progress we have achieved so far at risk. I thank noble Lords for their continued, constructive challenge and all those who worked so hard on this cross- government, cross-public service movement to fight this horrible disease. I pay particular tribute to the noble Baronesses, Lady Brinton and Lady Thornton, who have made sure that their challenges have been heard and reflected on. Our approach has been better for it. It is not possible to namecheck everyone, but I single out thanks for all those NHS and social care staff, volunteers, returned healthcare staff, and the Army, who were involved in the deployment of the vaccine. Lastly, I extend an enormous thank you to the general public for continuing to follow the lockdown rules. The attitude of the public remains resolute. These measures are doing the lion’s share of the work in protecting everybody’s families and loved ones. I commend these regulations to the House.

--- Later in debate ---

[Lord Bethell (Con)]

I very much thank noble Lords for an incredibly broad and wide-ranging debate. It has been a really honourable birthday party for the Coronavirus Act, and I hope that the Act is grateful for the tributes it has had. I confess that I am proud of the Act, and proud of the collaborative spirit in which it was drafted and passed. I am proud of the measures it supported to make the lives of the people of Britain a lot better during this awful pandemic and I am enormously grateful for the wide-ranging support here in this House during the last year. There has been scrutiny and challenge, but I am grateful to noble Lords for the general tone of support offered to the Government, and to myself in particular.

In terms of the regulations, I think the noble Baroness put it very well: the regulations we are debating today are tough but they are necessary, and I cannot think of a better way of putting it than that. On the specific question asked by the noble Baroness, Lady Thornton, on gatherings, I would be glad to write to her with an answer. On the questions that many noble Lords had on the road map, I am not in a position to do a road map pub quiz from the Dispatch Box right now. The Prime Minister has laid out a really clear schedule and there are update sessions already built into that schedule. Noble Lords will need to wait, I fear, for updates from Downing Street on that.

Instead, I should like to pick out two or three of the major themes that noble Lords raised in this broad debate. One of the most powerful came at the beginning with the comments from the noble Lord, Lord Hunt, reinforced by many other noble Lords, on the issue of health and the question of levelling up. I recognise the deep concerns, which I share, about the spotlight that the pandemic has put on the health of the nation. Without doubt, one of the reasons why we have been hit hard by the pandemic is that large parts of our population are simply not in great shape at the moment. They have either poor health, poor living conditions or poor circumstances. The noble Lord’s comments were absolutely spot on.

My noble friend Lord Moynihan put an emphasis particularly on BMI, weight and fitness in the country. They are clearly not good enough and there is widespread acknowledgement of that. That is in no way to shame any individual or section of society. It is a simple fact of life that we do not compare well to other countries. The Prime Minister has spoken movingly about his personal experience and the issue is something that the nation has to have a conversation about. The obesity strategy is a framework for that, but it is not the only thing that we will be doing in this area.

Our reach-in as government—not just as national government but in local government, agencies of government and the NHS—to some parts of society is just not good enough. This is not a BAME issue, although that is part of it; I am talking about everywhere from the sweatshops of Leicester to the apple orchards of Herefordshire. There are too many communities where we simply do not get our message across or have a dialogue, and where our services are not provided in a way that people find accessible. We have to ask ourselves tough questions about how we can do better. That is because we are only as good as a nation as the health of the most vulnerable people in our society. That includes everyone from working-class white communities in South Wales all the way through to those in the mill towns of northern England. We have to work with faith groups, on our languages and on the services that we offer in a great many ways.

We have to join up our healthcare services. That is something for which the healthcare system has been calling for a long time, which was apparent during our engagement exercise two years ago. It is well built into the NHS Bill that will be coming our way very shortly. We have to join up primary, secondary and public health across the piece. Only in that way can we address the population health issues that have bedevilled the country in the past year.

Lastly, we have to embrace technology. We have done a huge amount of good work in the past year with data, med tech and a more 21st-century approach to healthcare. There is still a huge amount that we need to do. We need to encourage people to engage with their own patient records and data and help them to understand that they can take greater responsibility for personalised medicine if they engage with their patient records and systems. I am optimistic that we can make progress in that area.

My noble friend Lady Noakes and a great number of others remarked on the impact of the pandemic, not just on those who have been ill from Covid but on all the others who have not had either elective surgery or treatment, or missed out on diagnostics and testing—those secondary impacts on the healthcare system. That does not come as a surprise. It is neither a secret nor a conspiracy. It is exactly how epidemics hit healthcare systems. It happens time and again.

[Baroness Penn (Con)]

My Lords, I am sorry to interrupt the Minister’s speech but those participating remotely cannot hear it. Therefore, the House will adjourn while we try to resolve the technical issues.

--- Later in debate ---

[Lord Bethell (Con)]

My Lords, to pick up from where I left off: as my noble friend Lady Noakes quite rightly pointed out, the effect of the virus is not limited to those who catch the disease; it has a profound effect on the entire healthcare system. We are going to work extremely hard to catch up; £1 billion of funding has already been committed, with £325 million on diagnostics. These are massive commitments, and we want to use the catch-up as a forcing agent for important improvements to our healthcare system. It will make it more efficient and deliver a better patient outcome.

I know many noble Lords have been focused on social care. The pandemic has certainly hit the social care of both adults and children extremely hard. Any pandemic is going to hit the most vulnerable. But we have moved emphatically to meet the challenge of the pandemic. We have done everything we could to keep the infection rate down, with a huge cost to the Treasury. We have put special measures in for PPE, for care workers and for diagnostics, and we have put in a strict vaccine prioritisation scheme which saw those living in social care at the front of the queue.

On illegal immigrants, I reassure all noble Lords that anyone who is in the UK, whether they have a passport, NHS registration number or any other administrative practicalities, can have the vaccine under any circumstance. They do not need to be plugged into the formal structures of the NHS. It is, however, a terrific opportunity for the NHS to upgrade its patient records and its systems, and the NHS is grabbing that opportunity with both hands. It is also an opportunity for patients to engage with their own patient records, as I discussed earlier.

There are many reasons the pandemic has hit the healthcare system so hard. But there are also many reasons for us to use this immense disruption as an inflection point for improving the healthcare system we have got. The launch of the UKHSA, which was announced yesterday, will combine test and trace, PHE and the JBC in a new pandemic protection agency, with a huge impact in resources. The NHS Bill will, as I said earlier, bring together a new collaborative approach between the different arms of the healthcare system. There will be an overall pivot from late-stage acute medicine to early-stage preventive medicine, which was already outlined in the NHS long-term plan. The vaccine itself is the ultimate icon and metaphor for the preventive approach. We are going to be working extremely hard on that agenda.

There are also terrific behavioural changes in the public, who are embracing new technologies such as telemedicine, have appreciated the value of tests such as the Covid test and will, we hope, take a more positive approach to vaccines such as the flu vaccine. We are preparing for a very large flu vaccine season in the autumn and winter.

A number of noble Lords raised the question of private enterprise and the accusation of corruption. I completely and utterly, once again, reject the baseless accusations the noble Lord, Lord Scriven, and others have made of corruption and cronyism. Yes, we made a national call to action for everyone to step forward to help us out. Yes, thousands replied, including hundreds from this House. Yes, the quality was variable, to put it politely. Yes, we triaged that list. But that was not fishy; that was efficient. His accusations are without evidence; they are corrosive, and they are demeaning to those who have served this country so well.

To the noble Baronesses, Lady Bennett and Lady Bowles, the noble Lord, Lord Desai, and others who have alluded to the role of private enterprise in this pandemic, let me say this: it is completely dreamy to think that we could have dealt with this pandemic without the enormous support of private enterprise. The vaccine was provided by AstraZeneca. It was only because of its innovation, manufacturing skills, reach and expertise that we are where we are today. Manufacturing is done by a large number of private firms, including for diagnostics and PPE. The surge capacity of major outsourcing companies is absolutely essential when stepping up to a pandemic of this kind. I do not need to remind noble Lords in this Chamber that the services of GPs, dentists, radiographers and a large amount of the NHS’s capacity are provided by those who own their own companies. Many of the contractors who build and clean our hospitals and care for the people we love are from private enterprise. Those who denigrate the contribution of private enterprise do those who care for us no service at all. Rather than demonising the private sector and those who work in it—

[A noble Lord]

Nobody has done that.

[Lord Bethell (Con)]

Yes, they have. Order!

Rather than demonising the private sector and those who work in it, we should be celebrating the invaluable contributions of those who have given so much. I single out the noble Baroness, Lady Bennett, who did exactly that.

Some noble Lords, including the noble Baronesses, Lady Thornton and Lady Brinton, have expressed concern about the transparency of the Government’s approach. I assure both of them that transparency absolutely has been our watchword. We have published SAGE minutes, SPI-M minutes and SPI-B minutes. We have published an enormous amount of epidemiological information from the ONS, from REACT and from public and local authorities. No. 10 has given regular briefings on an almost daily basis. We have published the major contracts of those suppliers who have supplied us. We really could not have done more to share the intellectual property, analysis and commercial details of our response to this pandemic.

To those noble Lords with concerns about the workings of the virtual House under the circumstances of the pandemic, let me say this: I completely understand and share the frustrations of those who feel that the current circumstances are not a full-blooded version of Parliament in normal times. I agree that it is not the same. I think that Ministers get the scrutiny they deserve —they are under an enormous amount of pressure—but I acknowledge the points made by my noble friend Lord Cormack and others who yearn for a return to normal service.

The House has been heard in the debates that I have been in. The House has been heard when it has called for a great number of reforms. In different debates, I have run through lists of where we have moved on issues that the House has raised in particular. I have been here. I have appeared at the Dispatch Box 248 times. There have been 1,959 individual speaking events. There have been 25 Oral Statements, eight general debates, 28 OPQs, 17 TPQs and 1,229 FoIs. The idea that we have not been accountable is not quite right. I want to take a moment to thank the Lord Speaker, the usual channels and the staff of the Houses of Parliament for the amazing job they have done to keep the House open. I know that I speak on behalf of all those in the Chamber when I say that.

The noble Baroness, Lady Noakes, said that she is concerned about the impact assessments and economic analysis. This has been a recurring theme in many of our debates. As Health Minister, I have some sympathy for her points, but I would point her to Analysis of the Health, Economic and Social Effects of COVID-19. It is an utterly emphatic document that answers many of the points she alluded to. While she may not like the findings, the report does make it clear that the colossal and massive effects of the pandemic are so huge that there is no way of avoiding them other than getting rid of the pandemic itself.

I was greatly moved by the words of my noble friend Lady Stroud and her concerns about a torrent of fear, but I will be honest: I do not recognise the situation that she described. The idea that the press has somehow been cowed into submission and some kind of blind compliance by politicians or regulators is simply not my experience. The idea that scientists have been pressurised by the Government is not the view of the scientists themselves, nor does the evidence suggest that the great British public have been intimidated by government excess. In fact, it is the opposite: as noble Lords have heard from me before, the evidence suggests that the British public support enormously the NPIs, lockdowns and infection controls that we have put in place. That support for lockdown measures remains extremely high.

We are here to make laws. My experience of making laws over the past year is that they are being put in place not to lead to prosecutions or in any way intimidate the public but to be clear. The public deserve and expect Governments to be crystal clear about the behaviours that they hope for from the public. We respect the good sense of the British public, who, for their part, have a need, interest and requirement to know what is expected of them. That is why we reach for the law book when we are applying lockdown and NPI measures. I was hugely moved by the words of my noble friend Lady Stroud on the mental health of young people, but suggest that the connection between this and government lawmaking is not as strong as she suggests.

A number of noble Lords spoke of a dystopian legacy from the pandemic. My noble friends Lord Farmer and Lady Noakes, and the noble Baroness, Lady Fox, spoke in moving terms about the loss of liberty, coercion, mandation and a perpetual cycle of locking down, and remarked, quite rightly, that these are un-British values. As I have said before, I never expected to be standing at the Dispatch Box bringing in these kinds of regulations. But I think that my noble friend Lord Farmer overreaches when he says that we are creating a world that is hardly worth living in. We are protecting those who are vulnerable and those who are elderly.

While the challenge of the pandemic is enormous—the effects on health, education and the economy are profound—my outlook is much more optimistic than that of my noble friends. There is an opportunity for a positive legacy from this pandemic. It takes the form, for instance, of the reboot to our health system that I described earlier. There is an opportunity for a degree of civic renewal, evidenced, for instance, by the massive volunteering that we saw in both the return of healthcare professionals and those who sought to help their neighbours and those in need. There is great evidence that the British people want to be involved in supporting their neighbours and loved ones, and that is an opportunity that we should grab.

There has been a massive reboot in our attitudes to the old and the vulnerable. For those who saw them, the Shipman documentaries on the BBC raised the question of whether we have respected, cared for and loved the old. In this pandemic, we have seen how the lives and final years of the vulnerable are valued. The whole of British society has made an enormous sacrifice to demonstrate its love for the elderly and the vulnerable. We should hold on to that.

There is a new confidence around science, particularly around the vaccine, the ability of science to solve problems and Britain’s commitment to scientific discipline. And there is a new confidence about Britain’s role in the world. Those are British values that we should be proud of and can hold on to. If we make the right decisions, we have a chance to make sure that there is a benign legacy from this awful pandemic. We need to take the right steps to do that, and that it what lies before us in the year ahead.

In the spirit of that optimism, I ask the noble Baroness, Lady Brinton, to stand down from her Motion to Regret. Nothing is perfect. Much of what happened during the pandemic is admirable, but we are in a much better place today than we were, and I very much hope that she sees fit to withdraw her Motion.

Motion agreed.