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Volume 802: debated on Monday 9 March 2020


My Lords, with the leave of the House, I shall repeat an Answer to an Urgent Question asked in the other place earlier today. The Answer is as follows.

“Madam Deputy Speaker, the coronavirus outbreak continues to advance around the world. The number of cases in China and South Korea keeps rising, but at a slowing rate. However, the outbreak in Iran, Italy, Switzerland and now France and Germany is growing. In Italy alone, we have seen 1,492 more cases overnight and 102 more deaths. Here in the UK, as of this morning, there were 319 confirmed cases. Very sadly, this now includes four confirmed deaths. I entirely understand why people are worried and concerned, and we send our condolences to the families.

The UK response is guided by our four-point action plan. We continue to work to contain this virus, but we are also taking action to delay its impact, to fund research and to mitigate its consequences. Throughout, our approach is guided by the science. That is the bedrock on which we base all our decisions. Our plan sets out what we are prepared to do, and we will make the right choices of which action to pursue at the right moment.

The scientific advice is clear: acting too early creates its own risks, so we will do what is right to keep people safe. Guided by the science, we will act at the right time and we will be clear and open about our actions and the reasons for them. These are the principles that underpin the very best response to an epidemic like this.

Turning to research, I can report that we have made available a further £46 million to find a vaccine and develop a more rapid diagnostic test. We will continue to support the international effort. Here at home, the NHS is well prepared with record numbers of staff, nurses and doctors. I want to thank all those involved for their work so far.

The number of calls to the NHS 111 service has increased and we have recruited an extra 700 people to support that effort. The 111 online service is now dealing with more inquiries than voice calls. To date, Public Health England has tested nearly 25,000 people and the time taken to test is being reduced as we bring in a new system for faster results.

Responding to coronavirus will take a national effort and everyone must play their part. Of course, that means the Government, but it also means everyone washing their hands more often and following public health advice. There is much more that we can all do both through volunteering and through support for those who are most vulnerable. We will shortly bring forward legislative options to help people and services to tackle this outbreak. The Bill will be temporary and proportionate, with measures that last only as long as is necessary, in line with clinical advice.

I can also report that over the weekend we initiated action to assist the 120 passengers on the “Grand Princess” cruise ship off the coast of California in coming home.

We will stop at nothing to get this response right and I commend the Statement to the House.”

My Lords, I thank the Minister for repeating the Statement. I shall ask three questions as quickly as I can so that as many people as possible can get in to speak.

My first question concerns vulnerable people in residential homes and the learning disabled who may be being supported, either by charities or at home by their parents. We need to include these people in the planning. I do not expect the Minister to respond to the point, but I will put it on the table. There are lots of people who have not been mentioned but need to be taken into account.

The 111 service is clearly under incredible pressure, given that it apparently took 120,000 calls in the first week of March. I want to ask the noble Lord about the training that 111 staff are receiving. If 700 new people have been taken on, how is their training being accelerated and is it being properly funded?

Finally, when the Select Committee saw Professor Whitty last week, he explained that half of all coronavirus cases in the UK are most likely to occur in just a three-week period. Based on recent trends, have the Government estimated when that peak might begin, and is the noble Lord sure that hospitals have enough bed spaces so that they are able to cope?

My Lords, the noble Baroness has expressed concerns about those in residential homes and people with learning difficulties. The needs of all the most vulnerable in society are paramount. There is no doubt that intense pressure will be put on social services, social care and clinical care. We are doing all we can to ensure that support is in place, which will include the mobilisation of civil society, charities and volunteers to take up some of the pressure being put on those services.

On training provision, modern call centres have very flexible working arrangements whereby staff are brought on and off contracts. Those who have already received 111 training are being brought back on to the front line. The funds for that are properly in place.

On the timing of the peak, it is impossible to say with certainty when that will be, but the CMO is crystal clear: we will do everything we can to spread it out over the summer and we will keep this House and the public up to date.

My Lords, I also thank the Minister for answering the Urgent Question. Going back to my point about advice for vulnerable people, it is good to hear that advice is finally planned, but vulnerable people need that advice now. I have been saying this in your Lordships’ House for about three weeks. Will the Minister please let us know when we are going to get it?

My second question follows up on the previous one about 111. In addition to the worrying report from the woman on the “Today” programme this morning who kept not getting return calls over a three-day period, despite a high temperature, cough and many other symptoms, we also picked up on people ringing 111 with clear symptoms being told that they cannot be tested because they cannot name an individual who has been diagnosed with coronavirus. I repeat the same question: are the new call handlers being trained effectively?

The noble Baroness is absolutely right about the importance of guidance and I reassure her that an enormous amount of work is being done to draft clear guidance for employers, volunteer groups and all parts of society, which will include case studies, FAQs and detailed recommendations. That work is being guided by the CMO and senior officials at PHE.

As for 111, we look very closely at the metrics for the return of calls. Overall, the headline figures suggest that the 111 service is bearing up incredibly well under intense pressure, but I do not deny that there must be people who have had bad experiences. These pressures sometimes lead to poor results and we will keep a very careful eye on that.

My Lords, I declare my registered interests. Clearly, the decision to move from the phase of containment to that of delay is essential to sustaining the ability of the health delivery system to deal with this problem.

What objective criteria will be used to determine how that decision is taken? How are the behaviour and natural history of this disease elsewhere in the world being used to inform when we should move from containment to delay?

The noble Lord asks an important question. The truth is that it is more of an art than a science. Efforts were made to look at clear metrics for triggering this result, but it is a complex situation and our understanding continues to develop. It is ultimately up to the judgment of the CMO and the confidence of the Secretary of State to make that call.

My Lords, how many intensive care facilities are at upwards of 90% of utilisation and what can be done to increase the amount of facilities for people who need respiratory aid? What additional intensive care units could be created and what other facilities could be made available?

Enormous effort is being put into increasing the number of intensive care facilities, particularly in the area of respiratory support. Different types of respiratory support unit are being put in place and the number is increasing on a multiple rather than an arithmetic scale.

It is not just the kit that is an issue but the people needed to operate it, because these units and the respiratory machinery are extremely technical. We are putting enormous effort into ensuring that the right people are in place to work the machines.

My Lords, can the Minister shed further light on which countries research vaccines and how this can be agreed internationally? Are there difficulties with the process by which this division of labour is carried out? There could be a lot of duplication and not sufficient single-minded co-ordination.

The noble Lord asks an important question about the critical element of the research phase of our plan, and we have announced £46 million of additional funding for this area. Britain’s scientists are providing a leading contribution to the international effort. That effort is being conducted in an extremely transparent, open source fashion, with important details on genomic material being shared widely and openly. My understanding is that it is being done in a spirit of public collaboration.

My Lords, does the Minister agree that what we have learned so far from the outbreaks in other countries, and even the small number of deaths in this country, is that the vulnerable groups are people aged over 65—more men than women—and those with underlying conditions? What is the Government’s strategy to protect the elderly and reduce their risk of getting this disease?

The noble Lord is entirely right. The CMO’s effort is now to identify those groups who require the greatest priority of assistance. We are not sure, and the CMO has not declared, at exactly what age that should start. He is considering publication of the exact details of the priorities in future. It seems that it is not necessarily gender-specific but that the state of your immune system is the key driver. In some areas, of course, men have very bad habits when it comes to things such as drinking and smoking. The CMO has made it clear that if you want to do one thing to avoid getting the virus, it is giving up smoking.

Will the Government give specific guidance on deferring or cancelling gatherings of clinicians and other healthcare professionals at conferences and examinations required for career progression, and specifically ask the regulators to allow alternative routes of registration and validation?

The noble Baroness asks an important question about trying to keep our clinical staff healthy and fit. That is one of the biggest priorities in an epidemic such as this, because the pressures on the NHS are made worse if clinical staff are themselves poorly. At this stage the CMO has not decided that the cancellation of conferences or major events is proportionate, but that remains one of the options laid out in our CV plan. If necessary, provisions for videoconferencing and alternative ways of attending training will be considered and put in place.