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Covid-19: Response

Volume 803: debated on Wednesday 3 June 2020


The following Statement was made on Tuesday 2 June in the House of Commons.

“With permission, I would like to make a Statement on coronavirus.

Thanks to the collective determination and resolve of the nation, we are winning this battle. We have flattened the curve, we have protected the NHS, and together we have come through the peak. Yesterday, I was able to announce that the level of daily deaths is lower than at any time since the lockdown began on 23 March. Today’s Office for National Statistics data shows that the level of excess mortality is also lower than at any time since the start of the lockdown, falling on a downward trend. The ONS reports 12,288 all-cause deaths in England and Wales in the week ending 22 May. That is down from 14,573 in the previous week. That latest figure is still above the average for this time of year and we must not relent in our work to drive it down, but it is now broadly in line with what we might typically see during the winter. We never forget that each of those deaths represents a family that will never be the same again. This House mourns each one.

We are moving in the right direction, but this crisis is very far from being over and we are now at a particularly sensitive moment in the course of the pandemic. We must proceed carefully and cautiously as we work to restore freedom in this country, taking small steps forward and monitoring the result, being prepared to pause in our progress if that is what public safety requires. So today I would like to update the House on two important aspects of the action we are taking.

First, NHS Test and Trace is now operational. That means that we have updated our public health advice. Since the start of the crisis, we have said to people that you must wash your hands, self-isolate if you have symptoms, and follow the social distancing rules. All those remain incredibly important, but there is a new duty—and it is a duty—that we now ask and expect of people. If you have one of these symptoms—that is, a fever, a new, continuous cough or a change in your sense of taste or smell—you must get a test. We have more than enough capacity to provide a test for anyone who needs one and we have more than enough capacity to trace all your contacts. So, to repeat: if you have symptoms, get a test. That is how we locate, isolate and control the virus. By the way, I make no apology for this overcapacity. The fact that we have thousands of NHS contact tracers on standby reflects the fact that transmission of the virus is currently low. If we were in a position where we needed to use all that capacity, it would mean that the virus was running at a higher rate—something that no one wants to see.

Secondly, I want to update the House on the work we are doing to understand the unequal and disproportionate way that this disease targets people, including those who are from black or minority ethnic backgrounds. This is very timely work. People are understandably angry about injustices and, as Health Secretary, I feel a deep responsibility, because this pandemic has exposed huge disparities in the health of our nation. It is very clear that some people are significantly more vulnerable to Covid-19, and that is something I am determined to understand in full and take action to address.

Today, I can announce that Public Health England has completed work on disparities in the risks and outcomes of Covid-19, and we have published its findings. PHE has found the following. First, as we are all aware, age is the biggest risk factor. Among those diagnosed with Covid-19, people who are 80 or older are 70 times more likely to die than those under 40. Being male is also a significant risk factor. Working-age men are twice as likely to die as working-age women. Occupation is a risk factor, with professions that involve dealing with the public in an enclosed space, such as taxi driving, at higher risk. Importantly, the data shows that people working in hospitals are not more likely to catch or die from Covid-19.

Diagnosis rates are higher in deprived or densely populated urban areas, and we know that our great cities have been hardest hit by this virus. This work underlines that being black or from a minority ethnic background is a major risk factor. That racial disparity holds even after accounting for the effects of age, deprivation, region and sex. The PHE ethnicity analysis did not adjust for factors such as comorbidities and obesity, so there is much more work to do to understand the key drivers of these disparities, the relationships between the different risk factors and what we can do to close the gap.

I want to thank Public Health England for this work. I am determined that we continue to develop our understanding and shape our response. I am pleased to announce that my right honourable friend the Equalities Minister will be leading on this work and taking it forward, working with PHE and others to further understand the impacts. We need everyone to play their part by staying alert, following the social distancing rules, isolating and getting a test if you have symptoms. We must not relax our guard but continue to fight this virus together. That is how we will get through this and keep driving the infection down. I commend this Statement to the House.”

The Statement was considered in a Virtual Proceeding via video call.

Before I ask the questions we need to address, I wish to record the deep sadness felt by me and my colleagues at the death of our friend and comrade, Dr Lord Nic Rea, two days ago. Nic was much loved across the House and gave me unstinting support and health advice over many years.

In March, the medical director for England said that keeping the number of coronavirus deaths below 20,000 would be “a good result” for the UK. Therefore, I start by asking whether the Minister agrees with the Prime Minister when he says that he is proud of our efforts in the UK. They have resulted in an ONS figure of 60,000 excess deaths due to Covid-19, even if at present the Government are admitting to only almost 40,000. The UK has 2% of the world’s population and we have had 13% of the deaths from Covid. I suggest to the noble Lord that some humility is required here. We can be as proud as we all are of our NHS, support staff and all key workers but it seems inappropriate to be proud of leading us to where we are today.

I would like to ask about disparities in the risk and outcomes of Covid-19, as covered in the PHE review, which addressed the unequal nature of the risks of this virus. The review reveals that the virus poses a greater risk to those who are older, male and overweight. The risk is also described as “disproportionate” for those of Asian, Caribbean or black ethnicity. It makes no attempt to explain why the risk to BAME groups might be higher.

Yesterday, the Royal College of Nursing released data that supports PHE’s findings. The survey found that for nursing staff working in high-risk environments, including those working in intensive and critical care units, fewer than half—43%—of respondents from a BAME background said that they had enough eye and face protection equipment. This is in contrast to two-thirds—66%—of white British nursing staff who were content. Has the Minister read this report, and what is his view of its findings?

An earlier draft of the PHE review seems to have included responses from the 1,000-plus organisations and individuals that suggested that discrimination and poorer life chances were playing a part in the increased risk of Covid-19 to those with BAME backgrounds. Why was that section omitted? Why was the report published a week late? Is it true that the omitted part included recommendations like that from the Muslim Council of Britain, which stated:

“With high levels of deaths of BAME healthcare workers, and extensive research showing evidence and feelings of structural racism and discrimination in the NHS, PHE should consider exploring this in more detail, and looking into specific measures to put in place to tackle the culture of discrimination and racism”?

Apparently, these words did not survive contact with Matt Hancock’s office over the weekend. Is that true? Does the Minister agree with the Muslim council that the clear statement about the need to introduce change would surely give greater meaning to the statement by the Secretary of State that “black lives matter”?

Moving on, the Prime Minister assured us that by 1 June we would have a world-class track and trace system. I assume that he was misinformed, as crucial parts of the system do not exist and will be in place only at the end of June, which is what the noble Baroness, Lady Harding, says. Furthermore, the fragmented mess of using private contractors has been a disaster. Some recognition is finally being given to the role of expertise and knowledge at the local level and in local authorities, yet even these local experts were not consulted about the system and seem to be in the dark about just how it is supposed to work—just ask any department of public health how confident it is that we have a world-class system. Surely such a system should have the capacity to turn around tests in 24 hours, and we are nowhere near that point.

Over two weeks ago, I asked the Minister a series of simple questions. Who would call me if I tested positive? If the call is from a call centre, how will I know that it is genuine and to be trusted? The deputy at Public Health England seems to think that we would know through the expert questions that the tracer will ask. Clearly, she has never been on the receiving end of skilled online or telephone fraudsters. This is an important question. If it takes over 24 hours to get the test results and the tracing does not start within 48 hours, surely the system of protection will have broken down by then? Would the information, which is held centrally for some years, go to my GP? It is unclear where that data will be stored and what rules will apply. Can the Minister please explain?

An analysis published by Cancer Research UK has outlined that as many as 2.4 million people in the UK have been affected by a backlog in cancer care, waiting for screening, further tests or treatment. That can change only if the staff doing the cancer care, treatment and testing are being tested very frequently, even those without symptoms.

It is very concerning that the Government are refusing to publish information about the reproduction rate per region, the viability of home test kits, the number of people tested daily, and the number of people contacted under the new contact tracing system, to list a few examples. Furthermore, the data that the Government have published has been decried as highly misleading by the head of the UK Statistics Authority. Will the Minister commit to urgently publishing these figures to ensure openness, transparency and public confidence in the Government’s approach?

Does the Minister share the concerns of scientists, including members of SAGE, and public health leaders that the Government’s NHS Test and Trace system was not yet robust enough to quash any resurgence of the virus and should have been “fully working” before lockdown measures were eased? A final comment on “test, track and trace” is that the Cummings saga was bad enough, but we now have the chairman of the UK Statistics Authority making very robust suggestions that government presentation may not be what it seems. Sir David Norgrove has pulled no punches and makes it abundantly clear that he thinks the presentation of testing numbers in England is unacceptable.

On shielding, it is remarkable that the announcement to lift shielding was made during the night at the weekend. There was no notification to GPs, public health officials or those who most recently had been told to shield until the end of June. Can the Minister please tell us what the scientific justification is for that? Apparently, according to my noble friend Lady Armstrong, department officials met many organisations representing patients with long-term conditions last Thursday. There was no mention then that anything would be lifted on Saturday, even though they discussed experiences of lockdown and talked about the way forward. That suggests to me that it was a politically motivated announcement, without any involvement of the relevant clinicians or patient groups. Can the Minister say which clinical groups had supported the announcement on Saturday evening? What preparations were the NHS able to make before the announcement was made? At the beginning of lockdown, shielded people got daily emails from the NHS about how to behave but, since Saturday, I understand that they have received nothing. I think many may feel abandoned —some are our colleagues in the Commons.

We must not make the same mistakes with our shielded citizens as were made with care homes, ignoring the risks to those most vulnerable. The arguments about discharging patients into care homes without them being tested has not abated. What information does the Minister have about current and regular routine testing of care home staff, and even daily tests? There is emerging evidence of higher death rates among those with learning disabilities—yet another emerging tragedy. Does the Minister think that was avoidable? Was a strong shield wrapped around them from the start? I do not think that it was, but maybe the Minister can give us his view.

Finally, we must start thinking about what kind of NHS will emerge after the pandemic is really under control, whenever that might be. How will the system deal with the huge backlogs, such as those for cancer patients and cancelled surgery? I do not expect an answer from the Minister right now, of course, but we need a debate and a discussion. Can we expect a Statement on these matters? If we truly are now going through the worst, can we start planning for the future?

My Lords, I too thank the Minister for the Statement. From these Benches, we send our condolences to the family of Lord Rea; he will be missed. I also repeat the support from the Liberal Democrat Benches for everyone working hard to help contain and reduce Covid-19, from the magnificent front-line staff in the NHS and the care sector to all key workers, whether visible to us or not: we know that you have given your all. We also send our condolences to all those who have seen the death of families and friends over the last four months.

The World Health Organization has insisted repeatedly that no country should start to lift lockdown until Covid-19 is no longer in the community. With the noble Baroness, Lady Harding, confirming that there are still over 8,000 new cases per day, clearly it is still in the community, and WHO also says that lockdown should not be lifted until a full test, trace and isolate process is in competent operation across the country, which it is not.

Can the Minister explain why Ministers took the decision to start the process of lifting lockdown even though the Chief Medical Officer refused to allow the threat level to reduce from four to three? Unlike other European countries, which started lifting lockdown only when the daily death rates were below 10, today the department reports a total of 359 people died in the UK in the last 24 hours. Why was the shielding advice changed over the weekend, and why was no guidance sent out to GPs, care homes and clinical groups? I can confirm, as someone who is shielding, that I still have had no advice, by text, by letter or by telephone, on what I should be doing now that the advice appears to have changed. What can the Minister do to reassure people who are shielding that this is safe advice?

What steps are the Government taking to prepare for flare-ups of cases in our communities, and, worse, an early second wave? Will the care sector be involved in that preparation, given that they appear to have been left to hang out to dry in order to protect the NHS? I understand that unlike hospitals, the care sector has not been approached at all yet.

In the Statement, the Secretary of State refers to the publication of the Public Health England report on disparities and the risks and outcomes of Covid-19. The Runnymede Trust summarised the problems with the report, saying that there were not

“any recommendations on how to save BAME lives.”

What specific guidance is being provided to the NHS and care sectors to protect BAME staff in high-risk Covid-19 areas? Can the Minister comment on the report from the Western General Hospital that BAME locums were disproportionately placed on rotas in coronavirus-intense wards, and that the hospital has experienced a recent and very large spate of cases?

Yesterday, the Office for National Statistics wrote its second letter in four weeks to the Secretary of State, challenging him in the bluntest terms and accusing him of obfuscation and confusion on the number of daily tests carried out. Can the Minister give the House a date when we will be able to see real and consistent data on testing, approved by the ONS, back- dated and adjusted, so that there is no room for any misunderstanding?

I return to the issue I have raised repeatedly with the Minister: the care sector. At the weekly APPG on Adult Social Care update today, we heard again from across the sector that it still faces a number of problems, some of which the noble Baroness, Lady Thornton, outlined. To be clear—before the Minister responds again, saying that this is just anecdotal evidence—we were told that this is happening in a large number of care homes and settings in wide areas right across England. This is not a one-off.

First, a number of CCGs are still pushing care homes to take block-bookings of patients coming out of hospital without having had Covid tests. The Prime Minister and Secretary of State have repeatedly said that this has never happened. It has happened and is still happening. When will it stop?

Secondly, on PPE, the care sector says that the Clipper system is finally starting to be rolled out across the country—a mere eight weeks after your Lordships’ House was told that it was only a handful of days away. However, care homes report that deliveries are still only a portion of their original orders, meaning homes still have to make decisions about rationing. Can the Minister provide a date by which the care sector will receive all the PPE it orders and needs?

Thirdly, the Minister told us that all care homes would be offered tests by 6 June. I repeat my question from two weeks ago as to why some homes are excluded from the portal so that they cannot access tests. These are homes for learning-disabled adults and disabled people under 65. Given the worrying comments on the inequalities data in the PHE report, when will this change?

Fourthly and finally, I echo the points made by the noble Baroness, Lady Thornton, about it being essential for all health sector staff to be able to access repeat testing to keep people safe. While it is true that it is happening for NHS staff, it is not true that our care homes or staff working in the community are able to access regular testing. Can the Minister please provide a date by which staff in care settings will have regular testing? This is vital because there are so many asymptomatic cases. They need parity with the NHS.

I recognise that I have asked a large number of specific questions and hope that, even if the Minister cannot answer them now, he will be able to write to me and others taking part in the Statement. Perhaps he could also answer any of the questions from the noble Baroness, Lady Thornton, if he cannot answer them now, in the same way.

My Lords, I start by echoing the words of both noble Baronesses and give thanks for the contribution of Lord Rea to the House. I did not know him well but have read the many testaments to his work. He clearly lived a full life and made a massive contribution to the House, for which we should all be thankful.

I echo the noble Baronesses and give a moment of thought to all those who have had deaths in their family and among their friends. I have lost both an aunt and a godfather to Covid in the last few weeks; my family has not been untouched, and I think—

Yes, I am back. I apologise for my broadband. I was addressing the question of the Prime Minister’s words. I have no doubt that there will be a judgment of history on whether the Government have made every decision correctly and whether every call we have made was right. There will have been mistakes, for which I am happy to put my hand up. But I am proud of the response to Covid, not just from the Government but from everyone involved.

With the leave of the House, I will single out five things. I am proud of the Lighthouse Labs. I am proud of the Nightingale hospitals. I am proud of the fact that the NHS stood up under relentless pressure when so many people thought it would fall over. I am proud of the fact that we ducked the worst effects of the epidemic, which many people forecast might lead to deaths of up to 400,000 people; everything that we know about the disease suggests that those forecasts were quite right and utterly realistic. Of course, the death rate is far too high. I have reiterated my thoughts for anyone who has lost someone and I feel very sad about the number of people who have died. And I am very proud of the scientific response, particularly by our vaccine researchers, who are world-leading in all this.

There has been an amazing collaborative effort by all parts of society, from the SAS to returning nurses, from front-line NHS workers to the private sector. It makes me profoundly sad when I hear people talk so negatively and so angrily about the way this country has responded. I totally put my hands up as a member of the Government for any mistakes that we may have made in our decision-making, but I ask noble Lords to speak a little more positively about this incredibly impressive effort and to remember that, when they speak in a negative way about the response to Covid, they are addressing not just the Government and the Government’s response. They are addressing everyone from postal workers to shop workers, the NHS and everyone who has been involved in this response. Having worked very much at the centre of things, I feel genuine pride in this effort.

The noble Baroness, Lady Thornton, asked about the PHE report. It is important, but it is preliminary research. It does not answer every single question about the complex issue of the differential rates of infection and mortality from this disease. It remains a mystery why some groups are much more profoundly hit, and it is not clear whether the differences are behavioural, social or genetic.

I say to the noble Baroness, Lady Thornton, that it appears that those areas of the NHS with the highest prevalence of infection are not those involving the front-line workers, where the use of PPE has actually protected workers from the worst effects of Covid. It has been among other parts of the hospital—in the canteens, among the porters and among back-room staff—that the prevalence has been highest. That is because infection has often happened where workers have touched each other or socialised. I mention this just to put paid to the idea that there has in any way been an irresponsible attitude, or that the NHS has in any way inadvertently put those with vulnerabilities in harm’s way.

I am not quite sure if I completely understood or heard the precise reference, but I did hear the phrase “structural racism” in the NHS. I react very sceptically towards that phrase and, to be honest, with a profound sense of anger. The NHS is not a racist organisation. This has been raised in previous debates and I reject it wholeheartedly at every level. If I have misunderstood the remarks of the noble Baroness, Lady Thornton, I hope that she will clarify them, but I want to make a clear stand on that point. There is clearly work to be done to understand better why some groups—older people, BAME groups and those who are overweight—have been hit so hard by the disease; that work is ongoing.

The noble Baroness, Lady Thornton, asked about test and trace. I want to be clear about a few things. As my noble friend Lady Harding said at its launch, this is a huge project which has been put together at pace and not every part of it is working immaculately. I admit that there are ragged edges but in essence it is working incredibly well. The people involved are working extremely hard. It is a coherent, thoughtful and, I believe, in many ways a world-beating outfit. I would like to ask anyone who is interested in finding out more about it to let me know and I will be glad to talk them through it or to invite my noble friend Lady Harding to go over the work of the test and trace programme. I genuinely believe that anyone who finds out about its workings cannot help but be impressed by it. I want to make a special testament to the private contractors who have made a contribution to it. I do not agree with people who denigrate those who work in the private sector for doing so—quite the opposite. My experience of working with private contractors who have contributed to the response to Covid has left me extremely proud of them and impressed by the results.

On local engagement, if it was the case that directors of public health, local environmental officers and local infection directors were not engaged, that is no longer true. The joint biosecurity initiative has done a fantastic job of briefing and tying in the local response. Tom Riordan from Leeds, who will be known to many noble Lords, is leading the charge on this. He is doing a fantastic job of working with local groups. Our response to Covid is now more local at every level and, as a result, is much better than it was.

The turnaround time for tests is important and is the focus of the operational priorities of the test and trace programme. Some 85% of the tests carried out through the drive-in centres are now done within 24 hours. The data is shared with GPs, although it is very hard work to tie in the test and trace computer program with the GP computer program, and more work needs to be done on this. I do not hide the fact that we are working extremely hard to bottom out and make more secure the operational arrangements of the test and trace programme. It was a huge infrastructure project which was thrown together very quickly, but I pay my thanks to those who are making extremely rapid progress on it. Perhaps I may share a point with noble Lords. Last weekend, I took a “secret shopper” test. I booked it at 6 pm on Saturday. I took the test at 11 am on Sunday at the Wroughton centre on the edge of Swindon, and I got the result at 6 pm on Monday showing that I had tested negative, of course. It was an extremely easy process. It took me 10 minutes on Saturday and 10 minutes on Sunday. The text I got was very clearly marked as being from the NHS, as it was, and it was a thoroughly professional and easy-to-handle experience. I invite all parties to try to support this important national project rather than denigrating it, because it relies on public trust and we really need the public to believe in it. They will do so only if our leaders support it.

I utterly agree with both noble Baronesses that people need to be able to understand the data—it is a really important project—but perhaps I may share a genuine and honest dilemma. We have sought to publish data as promptly and in as much quantity as we humanly can. The result of that, though, is that it is not all audited and checked and therefore it is often revised. That creates the kind of problems which David Norgrove has quite rightly identified. We are working extremely closely with David to try to close the gap. We are working closely with the Office for National Statistics to ensure that all future data is fully audited, but it is usual in peacetime to take months to iron out these processes before the publication of official data, and data is not published on a daily basis for exactly the reasons identified by both noble Baronesses. We have real and consistent data published by the ONS which is properly audited. That is completely robust data and we try our hardest to make right the data that goes into the daily updates. However, there is a tension between being prompt and being procedural, and we have sought hard to try to hit the right combination of the two.

The noble Baroness, Lady Thornton, asked about shielding. I reassure her that in no way are these announcements made for politically motivated reasons. We have been asked by many groups to address inconsistencies in the shielding arrangements. It is entirely reasonable for the Government to lift the shielding arrangements; that was done at speed and we are working extremely hard to ensure that those who were shielded are informed properly and that GPs and the NHS are part of that process.

Both noble Baronesses, Lady Thornton and Lady Brinton, asked about care homes. I reassure them both that 60,000 tests are carried out per day, and all those homes with outbreaks are being tested and retested. It is too early to tell exactly, but we are well on the way to hitting our 6 June target, and the amount of testing going on in care homes is extremely high.

As regards the anecdotes concerning CCGs being under pressure, as I understand it, to accept elderly people who are coming from hospitals into care homes, I would be very grateful if the noble Baroness, Lady Brinton, would write to me with those examples, because they are shocking, if they are true, and are completely against government policy and the agreed procedures of the NHS. I would be very happy to take up the case if she could give me chapter and verse.

On the future of the NHS, the noble Baroness, Lady Thornton, quite rightly asked what kinds of lessons we have learned. I will share two. First, one of the good things that has come out of the Covid epidemic is that the social care sector, the NHS and the public health sector have worked much more closely together than they have for a long time. We need to learn the lessons of that and figure out ways to ensure that they work even closer than they do right now. As regards the backlog, the Government completely acknowledge the challenge of catching up with the massive amount of procedures and medical work that will need to be done once Covid is under control. We have already made a full and clear commitment to funding the catch-up in that backlog, and we are putting in place the necessary preparations to staff and facilitate the catch-up process.

The noble Baroness, Lady Brinton, asked about the decision on lifting lockdown. It was the right decision and it was entirely consistent with advice from the CMO. The numerical threat level, which is organised by the CMO, is completely independently arranged, and I regard it as a testimony that it has been held at a high level, which shows the scientific independence of that process.

On preventing future flare-ups, I will flag two very important developments. First, I have already mentioned the joint biosecurity centre, which is currently being organised by Tom Hurd, and which is proving to be a really important development in arranging local responses to local flare-ups. These flare-ups may be anything from a school, a business or even, in the Weston case, a whole hospital. Being able to mobilise both the expertise and the analysis, support and data in order to jump on these flare-ups is an essential part of keeping a lid on the epidemic, and I pay tribute to the work of the biosecurity centre.

Secondly, we are working extremely hard to stockpile the necessary medicines and supplies for the winter. Our focus is very much on preparing for the winter in every possible way to prepare the NHS, social care and our public health response. We are using the summer months to mend the roof and ensure that we are in good shape. We very much hope to avoid a second spike, but we are fully aware of and preparing for the threat.

I remind both noble Baronesses that many European countries had more than 50% of their deaths in the social care sector. In fact, a low proportion of deaths in Britain have been in the social care sector, relative to other European countries. I appreciate completely that that is of no interest or value to those who have lost loved ones in the social care sector; I mention it only so that we have a sense of perspective.

On our response to and actions on the threat to BAME workers in the NHS, clear guidance has been sent from the top of the NHS to trusts, asking them to put in local measures that each trust regards as appropriate to protect BAME staff. This is entirely the right response to encourage and allow local trusts and the social care sector to make their own arrangements in their response. We continue to analyse the numbers to understand this problem more fully.

We now come to the 30 minutes allocated for Back-Bench questions. I ask that questions and answers be brief so that I can call the maximum number of speakers. I will now pass the chair over to the noble Lord, Lord Haskel.

I thank my noble friend profoundly for all that he and his health colleagues—and so many people everywhere, as he said—are doing to tackle this frightful disease, but I have a concern. I believe that the move to impose quarantine on arrivals from overseas is a real own goal. By all means, quarantine arrivals from countries that pose a particular health risk, but an indiscriminate prohibition will cut the legs off struggling sectors such as aviation, tourism and our itinerant financial and business services. This could contribute to the millions of unemployed people now expected later this year. Can the Minister please urge his colleagues to rethink?

My noble friend makes an incredibly valuable point and I completely share her concerns, but I will share two important points, if I may. First, we cannot avoid the fact that this disease has a 14-day incubation period. It is extremely tough to protect our borders from infection by a disease that may not be detectable, even at our borders, during that period. Secondly, while the peak is raging, additional infection from foreign visitors makes only a marginal difference, whereas at this stage, when we have worked so hard to get the prevalence down and reduce infectiousness, the threat of new infection from foreign visitors is higher. That is an irony that the CMO is fully aware of, but it is entirely right that we have brought in these measures. They are constantly under review. The impact on tourism and other industries is hugely regretted, but to rid the country of Covid they are proportionate.

My Lords, I thank the Minister for repeating the Statement. Before I ask my question, let me say this: with the greatest respect to the Minister, if he thinks that no degree of racism exists in the NHS, I suggest that he speaks to those people from ethnic minorities who work in the NHS and see how they feel. I accept his comment that examination of what has happened hitherto is for another day, but we have to examine the current strategy for suppressing the virus, which we have not done successfully. In this regard, the latest initiative is the Government’s test and trace scheme. A great degree of transparency and trust will be required to make this a success. Can I ask the Minister: what matrix will the Government use to demonstrate the success of the project?

My Lords, I bow to the experience and wisdom of the noble Lord, Lord Patel, particularly in the matter of racism in the NHS. I would not for a moment suggest that there is no racism at all in the NHS—or any large organisation—and I deeply regret any bad experiences he may have had. The accusation, however, was of structural racism in the NHS, and that is what I push back against. The NHS as an organisation is not racist, and I reject the suggestion that it is.

As for the matrix of success, that is an extremely perceptive question, and a bloody tough one—exactly the kind I would expect from the noble Lord. To summarise, it is to reduce R: if we can get a lid on R0 and stop the index case from spreading the disease to more people, then Test and Trace will have succeeded.

My Lords, like the Minister I too went to have my Covid test recently. There was hardly anyone there—lots of testing stations but no customers and no queues. I was in and out in five minutes. I was not surprised, therefore, that while 200,000 tests a day are available, many fewer are being taken up. I ask the noble Lord, therefore, whether the Government will open testing to the wider public and not restrict it to those with symptoms. There are many asymptomatic carriers and we need to know who they are and where they are.

I also reiterate the question about how soon test results will be available in hours rather than days. We can do it, but when will it be rolled out?

I can reassure the noble Lord, Lord Turnberg, that all people, of all ages, are currently eligible for testing. I accept that communication about this has not got through to everyone, and we are working very hard to communicate the information widely. A very large marketing campaign to make it clear began earlier today—I saw the adverts when I drove in on the M4 this morning.

I can also tell the noble Lord that because the infection and prevalence rates are so low, we have a machine with spare capacity. That is being used for surveillance and to cleanse the social care sector and the NHS sector through asymptomatic testing. The machine is on standby for the winter, and, as we lift lockdown, to protect society from any rise in the infection rate. The turnaround times are already getting much tighter and in many cases are less than 12 hours.

My Lords, the Minister said that the review of disparities in Covid had revealed what we already knew: that those most at risk include minority communities, particularly BAME people. We also already knew that the guidelines for people with inequalities replicate existing inequalities. I am sure that public health directors up and down the country have known about these inequalities, and have published reports about them, for many years. The Minister says that it is a great mystery, but really the report just touches on the inequalities.

Does the Minister understand that those from BAME communities, who disproportionately work in front-line services and the jobs he mentioned, are being hit? They are extremely worried, and very angry at this response. I understand that there cannot be a huge raft of recommendations, but there needs to be more guidance on protecting people, not just in the health service but more generally for those who employ people from BAME communities.

I will give an example from my own community. The Turkish and Turkish-Cypriot communities in this country are around only half a million. We have lost somewhere in the region of 250 people; we have all been touched by this, myself and my community. In Germany, there are 3.5 million Turks, and they have had about 50 deaths. The figures are stark.

On 19 May, I asked the Minister whether he would consider meeting campaigners and health professionals to put in place a proper Covid race equality strategy, for now and beyond. Will he please take that back and agree to meet us, and others, who are determined that we will have a proper response to this terrible virus that is disproportionately impacting on our BAME communities?

The noble Baroness is entirely right. These diseases always hit hardest those who are most vulnerable, and the most vulnerable often include those who are poorest, who have existing morbidities and who are vulnerable in some way. She is right that this is an age-old truth; it is as old as history itself.

I was referring to the scientific links between the disease and the death rate. To clear up the point, if I may, the mystery that we do not understand is the biological explanation of why the disease appears to hit some people harder than others. That mystery is being unravelled, but I cannot pretend that we fully understand it at the moment.

As to the noble Baroness’s invitation to meet groups, I remember it well and would be very glad to take it up. I will ask my private office to be in touch to make those arrangements.

My Lords, I want to go back to the testing centres question. I also had a test, but I had to drive to Stansted from Cambridge. Many people in our community do not have cars and do not drive. What is the Minister doing to make it possible for all major towns to have testing facilities that can be reached either by public transport or on foot?

My second point is more doubtful. Many people do not seem to realise when they should be tested, or, for that matter, how often. If you are tested at the beginning of June, when do you need to be tested again, if at all? What does the test prove, apart from the fact that you do not have the virus? It does not prove that you have had it or will not get it. Will the Minister step up the publicity campaign he just mentioned, so that people can be better informed?

I deeply regret that my noble friend had to drive from Cambridge to Stansted. We are working hard to address that and are looking at alternatives. We have now put up more than 100 sites, and I hope very much indeed that there would now be a site nearer him. We have also pioneered at-home testing, which we believe will address his key point, and we are trialling walk-in centres for city centres such as Cambridge.

My noble friend’s last point is entirely right. You should have a test when you show symptoms, but defining the symptoms of any disease, and in particular this disease, is very difficult. We do miss some people who do not show any symptoms, and some people who think that they have the symptoms actually have the symptoms of something else. It is a real dilemma and part of the battle we face against Covid.

My Lords, the Statement does not address yesterday’s report from the CQC showing more than double the expected number of deaths of people with learning disabilities during lockdown—something we were warned to expect by colleagues in Italy. Will the noble Lord explain what is being done to better protect everyone in this group, including those living in residential care, but also people made vulnerable because of visits by support staff, who often visit more than one person living in the community?

I thank the noble Baroness for her question, which I think I understood. If I understand correctly, she is asking about those who live in social care and residential care. I commend the work of Helen Whately, the Social Care Minister, who has been an amazing champion for social and residential care. She holds our feet to the flames daily to ensure that more work is being done. Testing is one area where we have made huge progress. The provision of PPE, raised by the noble Baroness, Lady Brinton, is another, despite everything noble Lords might have read. I pay tribute to my noble friend Lord Deighton, who has brought about a huge amount of manufacturing in the UK. There is, however, more that we can do and we are working as hard as we can.

Could the Minister explain what changed between 12 May, when I asked him what advice could be given to those shielding and was told that they must remain inside until at least the end of June, and last Saturday evening, 30 May, when the advice suddenly changed with no warning and the clinically extremely vulnerable were told that they could go out?

The noble Baroness asks a good question. One thing that changed was that there was a large amount of representation from those being shielded that the mental health consequences of their isolation were having a profound effect. There were very touching and moving stories, and the scientific analysis of that was extremely persuasive. We have sought to be flexible, but the advice remains very clear: those who are clinically vulnerable have to take extremely good care of themselves. Even though the prevalence is lower, they have to be aware of the consequences of this awful disease.

My Lords, earlier today, a former Prime Minister, Mrs May, intervened at Prime Minister’s Questions to ask about the security of data, including medical data, if there was a no-deal Brexit. The Prime Minister’s reply was the usual “It’ll be all right on the night”. Does the Minister agree that it would be an enormous betrayal if proper systems were not put in place well before the deadline for any departure? The medical and other data that we receive from Europe are an integral part of fighting this disease and should not be put at risk for ideological reasons.

I completely agree with the noble Lord. The Prime Minister said that it was down to the negotiating table to sort out this important matter. I will leave it to the negotiators.

I understand that we have to wait for the data to come through that addresses what underlying health conditions and comorbidities might impact on BME critical care and death rates from Covid, but, to reassure the community while we are waiting for further information, I wonder whether the Minister’s publicity campaign could be very directly targeted at those vulnerable groups to make it very clear that they should avail themselves of the testing capacity available—indeed, that they might even get priority—so that they have some reassurance that, should they have any of the symptoms, they will be seen to as soon as possible?

The noble Baroness makes a powerful point. The frustrating truth is that many in the groups and communities of which she speaks take the fewest number of tests. Getting through to these groups is extremely important, so they can seek the clinical help they need if they are suffering from Covid. We have worked extremely hard with our marketing department to ensure that hard-to-reach communities get the marketing messages that will be effective. The noble Baroness provides a really reasonable reminder and I will redouble my efforts to ensure that those marketing messages are focused on the right communities.

My Lords, I appreciate that “test, trace and isolate” is in its embryonic phase and that we have yet to learn the lessons of the pilot on the Isle of Wight, but at the height of the pandemic Sir Paul Nurse and other academic researchers offered, in the spirit of Dunkirk, to assist the Government with their “little boats”. Sadly, this approach failed to find favour, with a central approach then being used. Will my noble friend assure me that, as we head to a national rollout of “test, trace and isolate”, the Government will remain open to offers of help from those in the security and medical fields?

In addition, the PHE report identifies worrying outcomes from BAMEs who contracted Covid-19, as others have said, but the analyses did not cover comorbidities such as hypertension, which is common in the Asian and African populations, diabetes or obesity, which was mentioned in 21% of Covid-19 death certificates. Can my noble friend say when these factors will be considered, in order to provide a clearer picture for BAMEs who are at risk of contracting Covid-19 now and when the next wave comes in the winter?

My noble friend makes an incredibly perceptive point on the BAME research. He is entirely right that this important aspect of our understanding in relating the ethnic, social and behavioural elements of the response to the disease is essential. The report has not covered all the ground yet: that work is being done at the moment, as I mentioned earlier. Frankly, only when all those elements are linked together will we get a full picture.

Regarding the “little boats”, we absolutely celebrate them. In order to get the industrial-level testing numbers up, it was correct to back big laboratories that could do the automation necessary to achieve that. I am a huge admirer of Sir Paul Nurse and have spoken to him often. The role of laboratories such as his is in connection with their local NHS trusts. Many local laboratories are doing extremely good work with local NHS trusts and we are putting measures in place to facilitate and encourage such connections.

My question concerns the “track and trace” system. I declare an interest as a county councillor in Cumbria, where we have had severe outbreaks of the virus. A world-beating system was supposed to be in place on 1 June and we were given, as I understand it, less than two weeks’ notice of what the local government involvement in this “track and trace” arrangement would be. Does the Minister think that this has been handled adequately? How does he see the relationship between what is done by local authorities and what is done nationally by the Serco system that is being recruited?

I completely understand the noble Lord’s frustration, but I remind him that in Covid time, two weeks is ages. We have been moving so quickly to cover the ground that we have had to stand up very big programmes within a fortnight. He speaks with frustration that there seems hardly enough time to get things organised, but that is the pace at which we have had to move. The prevalence rate is down and the infection rate is down—that is not say we are complacent, but now is the moment when we are bedding in our operations.

The noble Lord is entirely right that our focus and our investment of time is in stitching together the local response, which is, as many noble Peers have said in these discussions, an essential part of our response. As I said earlier, the work of the Serco call centres, of the directors of public health, of Tom Riordan, of local authorities—all these need to be stitched together. It is extremely complex, but that is what the team of my noble friend Lady Harding is doing at the moment.

Following a previous response by the Minister that touched on politics, will he clarify an issue that is exercising the country at large? Is the response by government to corona led by science or by taking note of science? If the latter, what are examples of choices by government that differ from that of scientific advice?

The noble Viscount asks an incredibly broad question, upon which many a treatise could be written. I can best answer by giving my personal experience, which is of being in meetings where the scientists absolutely lead our thinking, where their clinical judgment takes precedence over any lay opinion and where we have been advised by unbelievably impressive and experienced clinicians, epidemiologists and scientists from different groups. My experience is that those voices have been the ones that prevailed in almost every debate. However, not everything can be answered by scientists and there are political decisions to be made. Ultimately, major decisions such as on lockdown, on the strategy for test and trace and on how to run a vaccine strategy are informed by scientists, but politicians have to make big calls. That is the same in every single major national project. I think we have got the balance right. We have tried to put the science, quite rightly, at the heart of the decision-making, and sometimes we have been led into quite politically awkward situations by the good judgment of our scientists. I pay tribute to them and their judgment. My personal experience is that we have listened to and been led by them wherever necessary.

My Lords, I remind the Minister that holding the Government to account for their decisions in no way undermines front-line workers, whose jobs have sometimes been made harder by their decisions. As the Government say that we are moving to local flare-ups, which body has full responsibility and legal powers—now, today—to implement and control a local lockdown?

The arrangements for local lockdowns are not fully in place. In fact, the policy around them is in development and a full decision has not been made on what arrangements we will make for lockdowns. The joint biosecurity centre will be absolutely central to those arrangements. It is the hub into which the intelligence on prevalence and infectiousness comes and which pushes that information out into the local area to help advise directors of public health, local authorities and other local services on local arrangements. I believe that it will develop the expertise and the co-ordination role which the noble Lord asks about.

My Lords, in answering the question of the noble Lord, Lord Turnberg, the Minister said that a test is available to anyone who wants one, and that this is being advertised on the M4. I am looking right now at the website page headed “Ask for a test to check if you have coronavirus”. Highlighted on that page, it says:

“Please help the NHS by only asking for tests for people who have coronavirus symptoms now.”

Can the Minister explain that? Also on that page, it lists the three symptoms for which it suggests we should have a test. Yet when I go to the Centers for Disease Control and Prevention website—the US body—it lists 11 lots of symptoms, including: fatigue; muscle ache; headache; sore throat; congestion; nausea or vomiting; and diarrhoea. Have the Government considered expanding the list of symptoms, and if they have not, why not?

If I was not clear, I hope the noble Baroness will forgive me. The test is open to anyone in the population. It is not restricted to key workers or those who are over five, as it once was. However, the clinical advice is that you should seek a test only if you show symptoms, partly because the test will not necessarily work if you do not have symptoms. That remains the case.

With regard to expanding the list of symptoms, we changed the symptoms about two weeks ago. We have done a huge amount of work to understand the best way of recommending symptoms. This is an amazingly complicated area. A lay person like me would think it was not too difficult to define symptoms for an important disease, but actually it is an extremely contested area. We have broadened it, we keep it under review, and if what we have done is not working well enough, we will update it again.

Does my noble friend not agree that where there are densely populated communities and a greater risk of spreading the coronavirus, testing should take place through booked appointments with their regular GP surgeries? Many of those communities do not know how to access online appointments and come from larger families. They could then also be asked about how they were following the guidelines set down by the Government. My worry is that many communities are not being communicated to and are falling through the gaps. I urge the Minister to take that on board.

I agree with my noble friend. It is a grave concern that key communities, particularly those to which she alludes, are not hearing the message and do not have the available resources for booking tests. We are working hard on that. In particular, we are working with GPs to ensure that they have the ability to book tests. They can of course do so on the portal like anyone else, but we are working to create a special prioritised facility for GPs to be able to book tests for their patients. I completely agree with my noble friend’s assessment that in many communities GPs play a trusted role. A practical issue is that many GP surgeries are currently closed, but I welcome the fact that many are now reopening.

My Lords, the time allotted for the Statement is now up. The day’s Virtual Proceedings are now complete and are adjourned.

Virtual Proceeding adjourned at 6.37 pm.