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Covid-19: Response

Volume 805: debated on Monday 27 July 2020


The following Statement was made on Monday 20 July in the House of Commons.

“With permission, Mr Deputy Speaker, I would like to make a Statement on our action against coronavirus.

Thanks to the perseverance of the British people and the hard work of those on the front line, this virus is on the back foot. For over three weeks now, the number of new cases each day has been below 1,000, and daily hospital admissions are down to 142. Because of this success in slowing the spread of the virus, on Friday, the Prime Minister was able to set out a conditional timetable for the further easings of the restrictions.

Throughout the reopening, we have acted carefully and cautiously, always vigilant, and we have been able to deliver on our plan. We have protected the NHS. We have cautiously replaced the national lockdown with local action. Thanks to our action against hundreds of local outbreaks, and thanks to NHS test and trace working well, NHS test and trace has now asked 180,000 people to self-isolate—that is up to 180,000 potential chains of transmission broken by this brilliant new service. What is more, in the hundreds of thousands of tests it delivers every single day, the vast—vast—majority test negative. That provides assurance to hundreds of thousands of people who can go back to work and sleep easy.

NHS test and trace is a brand new service. Putting together a massive service of this kind, at this pace, has been a remarkable job—almost unprecedented. I would like to thank the remarkable leadership of Baroness Harding for spearheading the programme and Tom Riordan, who has driven our vital work with local authorities. Everybody in this country who loves freedom should join me in thanking all those who work in NHS test and trace, in Public Health England, and in local public health operations for successfully delivering on our plan of moving from a national lockdown to local action. The plan is working.

I would like, if I may, to set out the next stages in this plan. We refuse to be complacent about the threat posed by the virus, and we will not hesitate to put the brakes on if we need to. Our goal is that this should be done through as targeted local action as possible, like we did in Leicester, where we can now start to ease the restrictions. On Friday, we published our framework for containing and controlling future outbreaks in England. From Saturday, local authorities have had new powers in their areas so that they can act with more vigour in response to outbreaks. They can now close specific premises, shut outdoor public spaces, and cancel events. Later this week, we will publish indicative draft regulations that clearly set out the suite of legislative powers that Ministers may need to use to intervene at a local level.

As I pledged to the House on Thursday, we are publishing more data and sharing more data with local bodies. I bow to no one in my enthusiasm for the good use of data in decision-making. Properly used, data is one of the best epidemiological weapons that we have. From last month, local directors of public health have had postcode-level data about outbreaks in their area. From today, as I committed to the House last week, we are going further and putting enhanced levels of data in the hands of local directors of public health too. Of course, high-quality testing is the main source of our data, and having set targets radically to expand testing over the past few months—which have had exactly the desired effect, as each one has been met—so we are now setting the target for the nation of half a million antigen tests a day by the end of October, ahead of winter. I am sure that, as a nation, we will meet this challenge too.

The need for extra testing is not, of course, the only challenge that winter will bring. We know that the NHS will face the usual annual winter pressures, and on top of that, we do not yet know how the virus will interact with the cold weather. So we will make sure that the NHS has the support it needs. We have massively increased the number of ventilators available to patients across the UK, up from 9,000 before the pandemic to nearly 30,000 now; we have now had an agreed supply of 30 billion pieces of personal protective equipment; and we will be rolling out the biggest ever flu vaccination programme in our country’s history.

To support this, I have agreed with the Chancellor of the Exchequer the funding necessary to protect the NHS this winter too. We have already announced £30 billion for health and social care, and we will now provide a further £3 billion on top of the £1.5 billion capital funding announced a fortnight ago. This applies to the NHS in England. Those in Scotland, Wales and Northern Ireland will also receive extra funding. This means that the NHS can keep using the extra hospital capacity in the independent sector and that we can maintain the Nightingale hospitals, which have provided so much reassurance throughout the pandemic, at least until the end of March. We have protected the NHS through this crisis, and that support will help us to protect it in the months ahead.

We all know that in the long term, the best solution to this crisis would be a vaccine, and I am delighted to say that Britain continues to lead the world on that. Two leading vaccine developments are taking place in this country, at Oxford and Imperial, and both are supported by government funding and the British life science industry. Today, Oxford published an encouraging report in the Lancet, showing that its phase 1 and 2 trials are proceeding well. The trial shows that the Oxford vaccine produces a strong immunity response in patients, in both antibody production and T-cell responses, and that no safety concerns have been identified. That promising news takes us one step closer to finding a vaccine that could save lives around the world.

The UK is not just developing world-leading vaccines; we are also putting more money into the global work for a vaccine than any other country. With like-minded partners, we are working to ensure that whoever’s vaccine is approved first, the whole world can have access. We reject narrow nationalism. We support a global effort, because this virus respects no borders, and we are all on the same side.

This morning I held a global conference call with other health leaders, including from Germany, Australia, Canada, Switzerland, the United States, and others, to discuss the need for global licensing access for any successful vaccine. Here at home, as well as our investment in research, we are working hard to build a portfolio of the most promising new vaccines, no matter where they are from. We have already secured 100 million doses of the Oxford vaccine, if it succeeds, and today I can tell the House that the Government have secured early access to 90 million further vaccine doses—30 million from an agreement between BioNTech and Pfizer, and 60 million from Valneva. We are getting the deals in place, so that once we know a vaccine is safe and effective, we can make it available for British citizens as soon as humanly possible.

Another long-term solution to eliminating this virus and its negative effects is through developing effective treatments, and it was British scientists, backed by UK Government funding, who led the first robust clinical trial to find a treatment that was proved to reduce the risk of dying from Covid: dexamethasone. We now have preliminary results from a clinical trial of another treatment known as SNG001, which was created by the Southampton-based biotech firm Synairgen. Initial findings based on a small cohort suggest that SNG001 may substantially reduce the chance of someone developing severe disease, and it could cut hospital admission time by a third. The data still need to be peer reviewed, and we are supporting a further large-scale trial, but the preliminary results are a positive sign.

In the fight against this virus, our world-renowned universities, researchers and scientists are indispensable, so that we can develop the vaccines and treatments that will tackle this virus for the long term. We have a plan, our plan is working, and the measures I have set out today will help to protect the NHS, support our treatments and vaccines, and take our country forward together. I commend this Statement to the House.”

My Lords, I gave the Minister notice on Friday that, because we had not taken a Statement about Covid for three weeks, I will need to address the three Statements that are outstanding.

Parliament entrusted this Government with huge powers to deal with Covid-19 when we put the emergency powers on the statute book in March. Certainly, in this House, at the time of the passage of the emergency legislation we sought and received undertakings from the Minister and the Government about the need for effective scrutiny, timely debate, consultation and trust. So how will accountability be achieved during the Recess and the autumn in this fast-moving world? All three Statements raised vital issues that deserve more time and scrutiny than we were able to give them, and I am grateful for the extra time that the usual channels have found for Back-Bench colleagues.

Before I address these Statements, I want to ask the Minister about the sudden announcement this weekend of quarantine measures for those returning from Spain. These Benches have made it clear that we support evidence-based protective measures at the border. We have long called for the scientific evidence to be made public and for track, trace and isolate systems to be in place, to avoid the need for the blunt tool of 14-day quarantine. Does the Minister agree that the latest decision-making process regarding Spain and the short notice for travellers have created a sense of panic and suggest a loss of control? Will he agree that proper contingency plans should be in place to support people coming home where there is no guarantee that their employers will allow them 14 days of work flexibility? Why do the measures apply to the whole of Spain? As my honourable friend Jon Ashworth MP said yesterday, “We’ve got an outbreak here in Leicester, but the whole of Leicestershire is not locked down and the whole of the East Midlands is not locked down, so why are the Balearics and the Canaries included when their infection rate is so low?”

On the announcement on 14 July about face masks and shopping—a month after it became mandatory to wear masks on public transport—why did it take so long and why was the messaging so confusing? We have long known about airborne transmission. The Secretary of State warned long ago about asymptomatic transmission. The Secretary of State’s own advice published on 11 May advised in favour of wearing face masks, so it is a shame that it took two months to make that advice mandatory; it came into force last Friday. How will it be enforced? As a former member of USDAW, I am very concerned for shop workers. USDAW says:

“We are also deeply concerned that enforcing the wearing of face coverings could present a further flashpoint for abuse against our retail members.”

It makes the point that full government guidance was released only hours before the changes came into effect, so how were employers to have adequate time to put the policy in place to support their staff during these changes?

On the Leicester lockdown announced on 16 July, the people of Leicester are now in the 17th week of lockdown. We will discuss that issue on Wednesday, but will the Minister confirm what lessons the Government have learned from what they did and did not do in Leicester, for when they face other local flare-ups? Will the Minister guarantee—I would like a yes or no answer—that local authorities will now get the specific data that can facilitate action, that it will be timely and in the form of person-identifiable data, not just postcodes, and that it will include not just positive but negative results so that they can understand the overall infection prevalence? Will they receive the contact tracing data so that they will know who has been asked to isolate by test and trace and can follow them up? Will they receive the data on a daily basis? Once a week is not good enough. The virus does not wait a week, so why should local directors of public health have to wait a week?

Moving on, the financial Statement said that £10 billion had been allocated to test and trace. It would be helpful if the Minister could itemise what that £10 billion has been spent on and with whom. A letter to me lodged in the Library would probably suffice for that question. On 20 July last week, the Secretary of State made a comprehensive Statement—a sort of end-of-term report; I can pick out only one or two important matters and hope that other noble Lords will cover the rest. The news about vaccine progress was very welcome and exciting, but will the Government ensure that there is equitable access to a vaccine when it is developed? The Minister knows that we stand shoulder to shoulder with the Government in taking on poisonous anti-vax propaganda. However, if a vaccine does not become available, what scenario planning is taking place right now, should we be confronted with that awful prospect? Will the Minister take this opportunity to update the House on R? Are we still below 1? Which parts of the country are not?

On social care, we welcome the fact that families are now able to visit their loved ones in care homes and we also welcome the extra funding for the NHS announced by the Prime Minister. But there was no extra funding for social care. Will social care get any more resources this winter? This is underlined by the Government’s failure to reimburse care homes properly for PPE and testing costs during the pandemic. They will actively have to meet the additional costs of ensuring that care homes stay safe for residents, staff and visitors. It must be cost-effective that they do so. The Local Government Association has today called for a social care reset after reflection on the Prime Minister’s pledge to fix social care a year ago. That representative body has urged the Government to publish their timetable for social care reform prior to Parliament’s return from the Summer Recess in September. Will the Minister tell the House whether that is possible?

My Lords, from these Liberal Democrat Benches, I thank and congratulate all the millions of people, whether paid staff or volunteers, who have worked tirelessly over the last five months to combat this pandemic, serving people and providing support during what is the most extraordinary health crisis in 100 years. As the noble Baroness, Lady Thornton, outlined, it is very disappointing that the Government Whips’ Office has resisted giving your Lordships’ House the opportunity to have a timely discussion on each of the three Covid Statements, on 14, 16 and 20 July. Each covered different, urgent and serious matters for our country that should be scrutinised by your Lordships’ House, so I too will use all three Statements as the basis for my questions to the Minister today.

First, given that the report of 20 July has a strategic and end-of-term report feel, we have an overarching concern about the Government’s repeated mantra in Statements about protecting the NHS at all costs, including the preparations for a second wave. Unfortunately, it appears that lessons have not been learned from the consequences of that single priority, not least those from throwing our care sector to the wolves without adequate testing, PPE or financial support for its massively increased costs. So I ask the Minister again: do all parts of the care sector now have repeat and regular testing, the PPE they need to practise new standards of infection control and continuing financial support for the consequences of both?

As I mentioned on Friday in the debate on the coronavirus regulations, a further group feel they have been left high and dry: people who shield, whether they are disabled, elderly or have serious underlying conditions. So I again ask: will the Minister explain why the letter to shielders dated 22 June insists that shielders lose all the support for shielding from 1 August? The letter instructs recipients to follow strict social distancing at all times and to stay at home where possible but, in complete contradiction to that, also instructs people to return to work if it is Covid-safe and removes access to furlough pay and sick pay, so if it is not safe to return to work and shielders cannot work from home, they are now at high risk of losing their jobs. Blood Cancer UK is extremely concerned about this risk for people who have been shielding as from August they will face an impossible choice between returning to work and risking their health or staying at home and risking unemployment. It asked the Government to extend the furlough scheme for the small number of people involved for up to three months or to provide alternative financial support to protect them from life-threatening ill health, and we agree. Will the Minister undertake to raise this with the Chancellor of the Exchequer as a matter of urgency and write to me?

Lifting the lockdown also brings into sharp relief how much real progress has been made by the Government on testing, tracing and isolating as a key tool to manage outbreaks. To that we must again add quarantine arrangements. On the news today, following the Spain quarantine regulations, we heard the Government say that they will not be monitoring any quarantine arrangements. They are still experimenting with temperature screening at airports and are not routinely testing people as they arrive in the country. If we are serious about having a proper system for people arriving in this country and quarantining safely, when will that be put in place?

We also hear that testing capacity will shortly reach 500,000 a day, which is welcome, but there seems to be no routine to test that capacity to the full. It is still not universal, despite repeated requests, regularly to test NHS and care staff to keep them safe. We hear that many local testing centres are closing down and that the test at home system is to stop. Can the Minister reassure your Lordships’ House that a full test, trace, isolate and quarantine policy is in operation, not least to test the larger-scale, effective system that we will need in the event of a second wave? How many people were tested on Friday?

Finally—the Minister can probably recite my next question as I have asked it so often, but I will be grateful if he could answer my actual question, not repeat the usual mantra because just saying that local authorities are being given more data at postcode level is not enough—when will all local authorities and directors of public health get the full data that they have requested and signed data protection releases for on a daily basis and at a more granular level than postcode, without which they cannot effectively tackle spikes in cases swiftly? The Minister saying that he is giving them more data is not enough. It must be the data that they need and for which they have already signed data protection releases.

My Lords, I thank the noble Baronesses, Lady Thornton and Lady Brinton, for their detailed questions, which I will go through as speedily and thoroughly as I can.

On accountability during the Recess, there are long-standing precedents on this and we will obey them, as is normal.

On the arrangements for Spain, I reassure the noble Baroness, Lady Thornton, that there is a very thorough system of regular meetings to assess the exemptions on travel. This is done at several levels of government and detailed intelligence from the front line is provided to those meetings. However, the situation in many countries is fast changing, and the Spanish situation is a good example. The information we had at the beginning of last week was quite different from the information we had by the end of the week. Fast turnaround decisions are not a sign of panic or weakness; they are a sign that the system works and is working well. We are trying to be as flexible as we can and we respect the country’s desire to travel, but when the infection rate in overseas countries moves, we have to move quickly as well. Within individual countries, there is no way for us to control intra-country transport. It is therefore very difficult and challenging to have a regional exemption list. That is why we have not been able to give exemptions to the Balearics, and I say that with a personal interest in the matter.

Our guidance on face masks is based on trust. There is no compulsion and they are not mandatory. In some countries they are mandatory, but not in this country. That is why the science is so important to us, and it is one reason why we may have moved behind some other countries. The guidance we now have on face masks is extremely clear. I pay tribute to the large and growing number of people wearing them. I believe this country is moving in the right direction.

We are concerned about shopworkers. USDAW makes a good case for the need to protect shopworkers who may be put in an awkward situation. That is why we work closely with the police to ensure that the right protections are in place.

I say a profound thank you to the people of Leicester, who have done an incredible amount in a difficult situation. The signs are that the prevalence of the disease has come down a long way in Leicester thanks to their commitment. The lessons we have learned include some of the most obvious lessons you could learn, but there is no replacement for local contacts and the involvement of local communities. However, there are hard-to-reach communities where our message has not got through and we need to do more to reach them. In particular, I am grateful to faith leaders in Leicester who are working with us on preparing for Eid and ensuring that the message on social distancing gets through in time for that important celebration.

Full details of the budget for NHS Test and Trace will be published when the time is right, and when that time arrives I will be glad to place a copy in the Library as requested.

I completely agree with the noble Baroness. Having an equitable distribution of the vaccine in this country and overseas is key to the Government’s policy. That is why we are working hard with the World Health Organization, GAVI and others to ensure that vaccines are shared as a global resource. We hope that a vaccine can be found, and the indications from Oxford are encouraging, but we recognise that vaccines for coronaviruses, particularly those affecting the respiratory system, are difficult. That is why we are making a massive investment in the test and trace programme and in therapeutics and why we remain vigilant over local lockdowns—to rid this country of this horrible disease.

Both noble Baronesses spoke about social care. I do not recognise the phrase used by the noble Baroness, Lady Brinton, that the care sector has been “thrown to the wolves”. I find that an unhelpful characterisation. I say yes to regular testing, yes to PPE and yes to financial support—we have given £3.7 billion to local authorities to help them pay for the cost of Covid-19, and on 2 July we gave a further £500 million to the social care sector. We remain vigilant with regard to the financial resilience of the social care system and we are working very closely with social care providers on the ongoing costs of both testing and PPE, as well as the financial resilience of the entire sector.

On shielders, the noble Baroness, Lady Brinton, makes a very good case. The handling of those who need shielding is one of the most delicate challenges that we face. Those who through no fault of their own are particularly vulnerable to the effects of the disease are put in an invidious situation, and we are extremely grateful to all those who have gone through the hardship of extreme shielding during this long and difficult time. I take on board all her comments and extend my profound thanks to all those concerned. I will look into the question of the parcels that she raised in the debate last week. My inquiries are ongoing on that, and I will respond to her, as I promised to last week.

On the arrangements for travel, it is true that the current medical advice is that we are currently sceptical whether temperature testing is effective and therefore we have not imposed it.

On testing, it is a frustrating but unavoidable truth that a test today does not necessarily mean that you do not have Covid and that you may not display both the symptoms and contagiousness of Covid in the days ahead. That is why snap testing at airports cannot be a sure-fire and safe route for protecting the country, which is why we have to look at isolation as a way of protecting the country.

On the mandation of isolation, as in other matters to do with Covid, we apply a voluntary principle because we believe that trust is the best way to keep the public on side, and we have neither the legal nor the other resources necessary to impose mandation.

On the questions from the noble Baroness, Lady Brinton, about the state of the testing programme, I reassure her that testing at home is not stopping and that NHS staff are regularly tested. There is a very clear plan, that plan is heavily resourced and we are continuing to invest in it with innovation, manpower and legal support where necessary.

We now come to the 40 minutes allocated for Back-Bench questions. I ask that both questions and answers be brief so that I can call the maximum number of speakers.

My Lords, as the management of Covid-19 moves to localised decision-making, good will is going to be more important than ever to ensure that people observe the restrictions placed on them. I use my own circumstances as an example. I am currently living under, and fully complying with, extra restrictions because of the outbreak in the centre of Blackburn, yet I have a Bolton address, a Bolton telephone number and I live in Bolton. For me, as for hundreds of others, a random line drawn on a map places us on the far boundaries of Blackburn with Darwen. This geographical disconnect, which will be replicated across the country, risks undermining co-operation. I would be most grateful if the Minister could assure the House that, should local authorities have to take the difficult decision to impose extra restrictions or lockdown, they will be charged to do everything in their power to make them as narrowly focused as possible to ensure that the necessary element of good will remains.

The noble Baroness is entirely right that these local outbreaks create invidious choices for local authorities, and the fine tuning of the boundaries is an important part of the lockdown process. We saw that in Leicester, where the boundaries of the lockdown were changed for the very reasons that she outlines, both to preserve trust and in order to be effective. However, I remind the noble Baroness that the movements of people within areas mean that the disease can spread. Therefore, the lockdowns do not necessarily apply only to those areas with high prevalence in any one period, and sometimes buffers need to be put around the infection area, which is why these areas can seem to be either unfair or overextended.

My Lords, Amnesty has reported that the UK has had 540 deaths among health and care workers, second only to Russia. Compare that to Spain, which has had 63 deaths. Have the Government carried out a root-cause analysis to find out the causes of these deaths, and will they publish the results? If the Government have not carried out such an analysis, will the Minister agree that one should be carried out with some urgency in case there is a second wave of infection?

My Lords, local trusts have been urged for many months now to undertake a profound risk assessment of workers, particularly BAME workers, in order to understand where infection may have come from. Infection control teams in individual trusts are charged with the responsibility for delivering infection control plans. It is at that level that we can understand the detailed causes of infection because in each trust those causes can be quite different.

My Lords, may I, for the second time in three days, press the Minister on what information is given or not given to local authorities during this pandemic? Is he aware that in the borough of Sandwell last week there were nearly 100 new cases of Covid-19, of which no fewer than 28 were confirmed at a single workplace in West Bromwich? Is he further aware that these 28 cases were discovered not by notification through the Government’s track and trace system but by a telephone call from the relative of one of those infected to Sandwell council’s public health department? Does the Minister agree that workplace addresses must be included in the information given to local authorities nationwide so that councils can act immediately to tackle the problem? Will he ensure that that is done in future?

My Lords, local authorities have had daily Covid-19 containment dashboards, which include 111, 119, online triage information and positive case information at UTLA and LSOA levels, for more than two weeks. Data for directors of public health who have signed the data-sharing agreement requires data-sharing agreements as personally identifiable information, and is mostly for their teams. That data includes much more granular data, including sex, age, postcode, ethnicity, occupation, test date, pillar and test location type. This question of data is one that concerns us enormously. We have moved a phenomenal amount in recent weeks, and it is my genuine belief that those in local authorities, directors of public of health and local infection teams have all the data that they need to do the job.

My Lords, social care has barely been mentioned in the last three Statements. Could the Minister clarify, in the event of a second wave of coronavirus, who in the Department of Health and Social Care is now leading on preparations with the care sector, and who from the care sector is leading in those discussions? How frequently do they meet?

My Lords, I pay tribute to my colleague Helen Whately, the Minister for Social Care. She has worked incredibly hard and tirelessly on this area, which is her ultimate responsibility. There is a social care team which handles those negotiations, and I thank all those in the social care industry who are engaged. The social care industry is highly fragmented so engaging with the entire industry is a massive challenge. That is why we have put in place new structures, new dialogues, new guidelines and new ways of working to ensure that we are match-fit for the winter.

My Lords, a number of countries, including Hong Kong and Austria, undertake testing at ports of entry. Under certain circumstances, that can limit the time that people have to spend in quarantine. Will the Government offer such testing at UK ports and airports?

My Lords, that is not in the current guidelines. The noble Lord is entirely right that it is incredibly time-consuming and not currently practicable. For the reasons I outlined in answer to an earlier question, a test today does not guarantee that someone will not be infectious either tomorrow or the next day. That is why we have not focused on testing at ports, but we remain open to suggestions. We assess a large number of options and, as evidence and trials emerge that may demonstrate the efficacy of different policies, we will of course consider them and remain open-minded.

My Lords, the Statement is clear that the intention is to mass-vaccinate the population once we have a vaccine that is safe and effective. Can the Minister inform us of Her Majesty’s Government’s plans to achieve this, in the light of concerns among general practitioners that they will be overwhelmed, and given that as many as one in six people in a recent survey said that they would not take up the vaccine if it was available? Do the Government intend, for example, to deploy the many nurses and doctors who volunteered to assist earlier this year to deliver vaccinations for both flu and Covid-19? Will they engage faith leaders in encouraging the uptake of vaccinations through proper explanation of the benefits to individuals and to society as a whole of so doing?

The noble Baroness raises an incredibly important issue and I pay tribute to Kate Bingham, who is running the Vaccine Taskforce. She is tackling exactly the issue that the noble Baroness raised. GPs are right to be concerned about capacity, which is why we are looking at ways of massively increasing the capacity to deliver such a vaccine. We will definitely look at resources such as returnees, pharmacists and other sources of people power to deliver the vaccine into the arms of the nation. On the anti-vaxxer groups, the fake news and wrong stories around vaccines are an area of deep concern. We are working with faith groups and other civic leaders to put right the arguments for a vaccine because, at the end of the day, any vaccine requires the participation of a large proportion of the country in order for it to be truly effective. It will cause huge disruption and personal suffering if trust is not maintained in the efficacy of such a vaccine.

Where does the Minister think the greatest risks of a second wave of Covid-19 now lie? What specifically needs to be achieved by early autumn to prevent that, and what extra support will be provided specifically for care homes?

The noble Baroness invites speculation; I wish that I knew the precise answer to that key question. We are extremely vigilant in a large number of areas, including the measures to release a degree of social distancing and on foreign travel, as she knows. We know that if the country remains committed to the basic principles—hand washing and hygiene; social distance; and isolation when necessary—those three principal pillars will be the ones that defend us from the spread of the disease. We are doing everything we can to shore up those pillars, and that is particularly true in social care, where we have massively boosted testing for both staff and patients and brought in hygiene control, particularly around PPE. We will continue to support the sector financially to ensure that agency workers can be used as little as possible.

My Lords, there are still issues about the length of time it takes for test results to be returned and contacts traced. Is the Minister aware that a four-week pilot scheme for the OptiGene saliva test in Southampton was completed a week ago? This test takes only 20 minutes to process. Since it does not rely on throat and nose swabs, there are less likely to be false negatives because of faulty swabbing. Can the Minister give the House the results of the pilot, which was referred to by a witness to the Science and Technology Committee as a potential game-changer? Are there plans to make the new test more widely available? In light of the latest news about travellers from Spain, will the test be given at the airport to all passengers returning from non-exempt countries so that they can be followed up quickly at the address they have given on the passenger locator form, and should they not have another test a few days later?

My Lords, I pay tribute to colleagues at Southampton, who have been managing this exciting trial of saliva-based LAMP testing. The LAMP process is extremely exciting, as it removes the time-consuming RNA extraction process from the testing; turnaround times are therefore dramatically reduced. Saliva is a much more accessible vector for the virus than swabbing and therefore has potential for mass appeal. We are extremely interested in the pilot of the OptiGene technology. It is, though, at an early stage. I would not want to raise expectations too quickly on this, but it remains one of a great many similar exciting technologies that our innovations and partnership team is looking at. I am extremely optimistic about the speed and scale of innovation in our test and trace programme, and I believe that we can move more quickly, at bigger scale and with more accuracy than we ever have before in the very near term.

My Lords, does the Minister accept that confusion arises in the UK and overseas because England and the devolved Administrations’ Covid announcements often differ in content and timing, and may lack distinction between guidance and statute? Such announcements will continue for months, so can a structured and less confusing scheme be adopted for all regions—for example, including agreed regular days and time across the UK—for making or updating announcements?

It may appear from the outside that there are differences between the devolved nations and England, but my experience is that the four-nations approach to combating Covid has been extremely united and effective, and that we have worked extremely well together. It is true that we move at a different pace on some subjects, but we are generally moving to the same destination and in the same direction, and for that I pay tribute to my colleagues in the devolved nations.

My Lords, the United Kingdom has spent 30% more than any other EU country on PPE. Of the UK’s PPE contracts, 73% went through without any competition at all, compared with 61% in Europe. The Department of Health had 137 contracts totalling more than £1.9 billion, none of which was subject to competition, according to Spend Network. The Department of Health has told today’s Financial Times:

“We have a robust process in place to ensure that orders are of a high standard and meet commercial due diligence.”

Which of those two statements is correct—that from Spend Network, or that from the Department of Health?

Anyone who has stood at the Dispatch Box to answer questions on PPE, as I have done, will feel extremely proud of the fact that we have managed to purchase a very large amount of it under very difficult circumstances. We have also responded well to the challenge of a global collapse in the PPE supply chain. Despite appearances, we have substantial stockpiles of both near-term seven-day and further-term 90-day PPE resources; by that, I am very pleased. Competition does not necessarily guarantee either quality or delivery. I pay tribute to colleagues in the NHS, in the Cabinet Office and at DH who have, under extremely difficult circumstances, thoroughly checked out the delivery and bona fides of the contracts we have signed while working closely with the NSA to avoid fraud. We continue to work closely with both domestic and overseas suppliers, which I would argue has delivered a valuable result for the country.

I will follow on from the question posed by the noble Baroness, Lady Watkins of Tavistock. Have the Government worked out an order of priority in which people might receive a vaccine? Would it be front-line workers, the elderly or even—perhaps—government Ministers?

My Lords, the Cabinet Office is charged with the role of deciding the order of priority. There are precedents for this; it is a well-established list that is decided at a level outside the DH. I do not know if Cabinet Ministers are given priority, but I slightly suspect that junior Ministers are not.

My Lords, I will ask about the poorest of our fellow citizens. According to the ONS report last Friday, in the four months March to June this year, the mortality rate for Covid-19 in the most deprived areas of England was 140 deaths per 100,000 people. This was more than double the mortality rate—63 deaths per 100,000 of population—in the best-off areas. In fact, it was 120% above. Even worse, in June the mortality rate in the most deprived areas was 137.5% higher. In short, it is getting worse. Why was there no mention of any of these in the Statements that have been laid before us? What measures are the Government taking to address this particular problem?

The noble Lord touches on a subject that is extremely sensitive—it makes me feel emotional to think about it—but he is entirely right that those who are least advantaged in society are hardest hit by this disease and lots of other diseases. There are behavioural reasons for this: the decisions that people make about social distancing and their own health. There are also environmental reasons: the living conditions and the places in which they live. Neither of these detract from the fact that this is a very sad and upsetting truth. However, we are extremely conscious of the challenge, as we are of all health inequalities. The particular lever that we are focused on is trying to get our message out to hard-to-reach communities, who may not have heard the important messages on hygiene, social distancing and isolation. We have in place a programme of marketing in order to reach these communities to communicate these important messages.

My Lords, the noble Baroness, Lady Falkner of Margravine, raised the issue of the procurement of PPE. Can I press the Minister on the procurement of vaccines? According to the Statement, the Government appear to have secured 190 million doses of vaccine—if they succeed. Could he tell us what procedures have been undertaken to procure the vaccines and reassure the House that the country will not lose money if the vaccines do not, in fact, succeed?

I am not quite sure of the 190 million number. I think that is possibly an aggregate number of different vaccines. However, the practicalities of vaccine research are extremely expensive, and there are eight, nine or 10 potential runners and riders in the global vaccine market. It is the practice for countries to contribute to those research costs up front in order to have access to the vaccine should it be successful. That is the practice for medical research of many kinds, and these are the practical costs of trying to break the difficult mystery of the disease and providing security for ourselves and for our children.

My Lords, I pay tribute to the Minister for the way he answers all our endless questions. I want to raise two issues of huge importance. I understand that the system of track and trace, in the absence of an app, will not be sufficient to prevent a second national wave of Covid-19. Can the Minister tell the House when we will introduce the Google/Apple app? Secondly, have the Government assessed the cost of full regular community testing, which would involve the entire population being tested weekly? This would certainly be costly, but surely it will be infinitely less costly than a second national wave of Covid-19—in terms of the demolition of the economy—particularly if we can use the Southampton saliva test.

The noble Baroness is entirely right that track and trace on its own, with or without an app, is not enough to prevent a second wave. The only thing that can do that is the behaviours of the British people themselves. Commitment to hygiene, distancing and isolation is the best bulwark we have against this horrible disease. In terms of community testing, given the current level of technology, mass testing of the entire nation on a weekly basis is beyond the resources of our technology, testing capabilities and, frankly, the tolerance of the British people. However, as I said in answer to an earlier question, the technology is moving incredibly quickly. It has already moved a long way in the last few months, and I am hopeful that technologies such as—but not only—the OptiGene technology may offer new opportunities. However, they have to be validated, invested in and developed: they are not on the near-term horizon.

My Lords, I am sure my noble friend is well aware of the importance of the use of language in Statements and careful use of language. Given the importance of the working relationships between national and local authorities, will my noble friend expand on the assertion that the new powers delivered last Saturday will enable local authorities to “act with more vigour”? It seems a strange phrase to me, and I would welcome some expansion on how those relationships are going.

My Lords, the relationship with local authorities is extremely good, and I recommend that noble Lords do not believe everything they read on this subject. I completely commend those who work closely with PHE, the test and trace programme, the joint biosecurity team and all the sectoral parts of government that reach out to local authorities, DPHs and local infection teams. A very strong bond is forming, and we have a very large number of outbreaks up and down the country that you never read or hear about, and which are not celebrated either for being good or bad because that partnership works well. The intelligence and data are put into the hands of the people who need them, and the teams move quickly and effectively to deal with the outbreak. I am extremely grateful for this; a huge amount of progress has already been made, and we continue to invest in those relationships.

My Lords, it is clearly good to hear that the relationship with local government is on a good level, as the Minister has said. However, why is it that directors of public health have been complaining for weeks about the lack of information? The Minister says that they are getting all the information they need, but this has occurred only in the last few weeks. If it is a question of data protection legislation, why was emergency legislation not put through in the spring to enable local authorities to have all the information they clearly need?

My Lords, it is put to me week in, week out that our relationship with directors of public health is in some way troubled. I reassure noble Lords that, every single day of the week, we are in contact with dozens of directors of public health in amicable, constructive dialogues that lead to concrete action, local interventions and sharing of data. These conversations happen in a cordial and friendly fashion. The message may have got through to some noble Lords that there is some huge acrimony and difficulty between us, but that is not the perspective that I have. The data has got through. It is a hell of a thing to have put up a huge track and trace system in a few months. That we can get such detailed data to a large number of people within the envelope of reasonable data security legislation is nothing short of a miracle. I am extremely proud and pay tribute to those involved.

My Lords, I want to follow the noble Lord, Lord Reid of Cardowan, in pointing to ONS data, this time data showing that 60% of all deaths from Covid-19 have been among those living with disabilities. A recent report from Oxford University and the Bonavero Institute of Human Rights found a failure of government to embed social and human rights models of disability in its response to the pandemic, and a failure to support people with disabilities to make the adjustments required to comply with fast-changing regulations and to continue to live flourishing lives. Will the Government commit to an immediate review of the impact on disabled people of legislation passed during the coronavirus crisis, and will they put in place a disability-inclusive Covid-19 response and recovery action plan which involves people with lived experience of disabilities in decisions on economic and social recovery as well as ongoing healthcare guidance?

My Lords, it is a horrible truth that this disease hits hardest those with vulnerabilities. We have put in place a massive national programme to seek to protect the most vulnerable, and those with disabilities have been very much the focus of our attention. I cannot make the commitments that I know the noble Baroness wants me to make, but I reassure her that those with disabilities are the focus of what we are trying to do.

My Lords, the London Nightingale hospital was mothballed in mid-May and remains at standby for a second wave of Covid-19, having treated just 54 patients since it opened on 3 April. In a recent report of 19 July, Harrogate Borough Council questioned how the 500-bed field hospital based in Harrogate Convention Centre would be deployed. Given that £3 billion has been allocated to maintain the seven Nightingale hospitals until the end of March 2021, and noting that the Harrogate centre has not treated a single patient since it opened, can my noble friend the Minister say what the strategy is for those hospitals? Should they not be designated Covid centres to which all local hospitals can refer their patients, thereby allowing the NHS to resume its routine work and centres such as the London Nightingale hospital, which could reopen in six days with 250 beds, to provide assisted ventilation, hemofiltration and dialysis to support seriously ill Covid patients?

My Lords, the Nightingale hospitals have been a huge success in helping us to protect the NHS at a time when our needs were greatest. Since then, when prevalence rates were lower, we reallocated resource into restarting the NHS to gain ground during the summer months on our backlog of business-as-usual work. Those resources are needed in the hospitals where people usually work. The mothballing of the Nightingale hospitals allows us to use that capacity for what is most needed right now.

My Lords, evidence suggests that obesity doubles a patient’s chance of being hospitalised with the virus, hence the Government have put forward a strategy for reducing obesity, which I welcome. However, they could have introduced a sugar tax 10 years ago, which might have resulted in fewer obese Britons now. Is that policy under consideration?

My Lords, the obesity package that the Prime Minister announced today is one of the most ambitious, impactful and thoughtful of any Government in recent history. We will see how it plays out and consider new measures when the time is right.

Covid-19 and obesity are so often a fatal combination, and it explains the high mortality in the UK, with its dense population and the fact that two-thirds of people are either overweight or obese. Is it not therefore time for those strangers to the truth in the media and in politics to stop demoralising the public with their repeated false news, including blaming the Government for the high death rate? Should we not expect the media and politicians to use their power to support the country and the Prime Minister’s campaign to reduce obesity and its complications, in order to minimise the number of deaths from the next pandemic?

My Lords, it is not the feeling in the Government that we should duck hard questions about performance, and we embrace those who ask difficult questions about how things have gone. None the less, the noble Lord is entirely right that the country has a difficult challenge that it needs to face up to: that of obesity. It has had a profound effect on the health of the nation for a generation and we have been caught out by Covid, as obesity has undoubtedly had an impact on our total death rate. It is a point that the Prime Minister made powerfully in his video earlier today. That is why we have put together the package that we have, and we look to all civic leaders and the media to support us.

My Lords, we are all aware that more than 45,000 people have died as a result of Covid-19, and the number is still rising. Is any statistical analysis by gender available, and how will the Government support the Covid widows who have may lost the breadwinner in their family?

My Lords, PHE publishes detailed statistics which give a gender breakdown. I recommend that the noble Lord has a look at the data. We express our sadness and regret for all those who have passed away and our support for all those mourning them.

The rail industry is keen to introduce a flexible form of season ticket to support a return to rail travel for those who have been working from home so that they may in future work flexibly. Will the Minister seek on my behalf assurances from his colleagues in the Department for Transport that they are treating this matter with urgency and not obstructing it? If he could write to me about that, I would be grateful. Will he also acknowledge the health benefits of getting people out walking, cycling and using public transport again, instead of relying solely on their cars, which lead to more congestion, more pollution and little or no exercise on the part of drivers? Further government encouragement would be welcome in bringing that about.

The noble Lord is entirely right that Covid will lead to changes both subtle and profound in the way we do many things in our life, including patterns of commuting, and a renewed commitment to modes of transport that support our health, particularly cycling and walking. Local authorities such as TfL already have strong bicycling and walking plans. Those will undoubtedly be enhanced, and the Government entirely support them.

My Lords, with an eye to its impact on any autumn resurgence, I hark back to questions asked on 11 March by the noble Lord, Lord Kennedy of Southwark, and my noble friend Lord Forsyth, about deep cleansing. My experience of countries in Asia, such as Singapore and Korea, which also pioneered mask use, is that they appear to be much better than us at cleansing medical facilities and other risky premises. They use mists and sprays, applied aggressively in the hands of cleaning professionals, rather than relying on the random impact of risk assessments, NHS and care home cleaners and controllers, and personal hygiene routines, which the Minister emphasised. What does the latest guidance say about cleaning and cleansing? Can we do better?

My Lords, we can undoubtedly do better in the area of hygiene. The guidance is very clear on what types of detergents work and how they should best be administered. I pay tribute to the cleaning staff in the NHS, who have worked incredibly hard during the epidemic, putting themselves at risk; they have done a very good job. None the less, our view is that the greatest challenge is to change the behaviours of the British public. Work still needs to be done to persuade all of us to wash our hands more and to maintain cleaner personal hygiene. Transmission of the disease happens most often through manual contact—touching the face and shaking hands. That can only be challenged by washing hands.

My Lords, Public Health England has been including in its death totals those who once had Covid, recovered, but have since died from other causes. So, if you once had the virus but no longer have it, and get hit by a bus, you still get listed as a Covid casualty. How can Ministers and others reach sensible policy decisions when the basic statistics provided to them seem so flawed? Has this bizarre practice now stopped? Have Public Health England offered any justification for it?

The Secretary of State has asked Public Health England to review the logging of death statistics; we await the review’s results.

My Lords, on three occasions today the Minister has said that, if you have a Covid test today, you are not guaranteed to not have the disease tomorrow. In that case, what on earth is the purpose of having the test system at all? Secondly, the NHS is not functioning properly. Bearing in mind the precedents of my noble friends Lord Deighton and Lady Harding, would it be a good idea for the Minister’s department to appoint a specific person to get the NHS up and running again, as foreseen by my noble friend Lord Ribeiro in his perceptive question?

My Lords, we use the tests we have got because they are the tests we have got. The way in which the disease manifests itself is not, I am afraid, something that I can negotiate with. We do what we can, but I emphasise that an unfortunate feature of this disease—and many others—is that it harbours itself silently in our bodies and manifests itself both to infect and be diagnosed only when it is ready. That is a simple fact of life. However, the testing regime has a profound impact on the spread of the disease by identifying those who have some form of symptom, even if it is a quiet one. I pay tribute to Sir Simon Stevens, who is working hard to get the NHS back to business as usual and is having a profound impact on the issue.

My Lords, the time allowed for this business has now elapsed. I apologise to the four speakers who did not have time to put their questions.

Sitting suspended.