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Covid-19 Update

Volume 805: debated on Monday 21 September 2020

Statement

The following Statement was made in the House of Commons on Thursday 17 September.

“With permission, Mr Speaker, I would like to make a Statement on coronavirus and about our plans to put us in the strongest possible position for this winter. Like many other countries around the world, we are continuing to see a concerning rise in cases, with 3,991 new cases recorded yesterday, and this week the number of patients in mechanical ventilator beds has risen above 100 for the first time since July. The battle against coronavirus is not over, and while we strain every sinew to spring free of its clutches, with winter on the horizon we must prepare, bolster our defences and come together once again against this common foe.

One of our vital lines of defence has been taking targeted action at a local level. We have seen local action work well in some parts of the country, and now we must take further action. We have seen concerning rates of infection in parts of the north-east. Sunderland, for example, now has an incidence rate of 103 positive cases per 100,000 of population, and in South Tyneside, Gateshead and Newcastle the figures are all above 70 per 100,000. As a result, local authorities wrote to me earlier this week asking for tighter restrictions, and we have taken swift action to put them in place. From tomorrow, in Northumberland, North Tyneside, South Tyneside, Newcastle-upon-Tyne, Gateshead, Sunderland and County Durham, residents should not socialise with other people outside their own households or support bubble; hospitality for food and drink will be restricted to table service only; and late-night restrictions of operating hours will be introduced, so leisure and entertainment venues must close between 10 pm and 5 am.

I know, as the whole House does, that these decisions have a real impact on families, on businesses and on local communities. I can tell everyone affected that we do not take these decisions lightly. We agree with local councils that we must follow the data and act, and the data says that we must act now so that we can control this deadly virus and keep people safe. I know that the people of the north-east will come together to defeat this virus, as defeat it we must.

We are working to bolster our health and care system too. Winter is always a stretching time for health and for care, but this winter presents particular challenges. People will be spending more time indoors than they did in summer, where we know the virus is more likely to spread, and we know that we will need to deal with coronavirus along with the usual pressures that the season will bring. So today I want to set out our plans to support the NHS and social care this winter.

Turning first to the NHS, I can tell the House that we have allocated a further £2.7 billion to the NHS to support it during the winter months. This funding, in addition to the extra funding for personal protective equipment and testing, will help the NHS with the vital task of operating safely in a world in which Covid is still at large and the critical task of working through the backlog of elective work that was inevitably caused by the first peak.

Our emergency departments are on the front line of the fight for life in the NHS. Today, I am delighted to announce a series of measures to support our urgent and emergency care system this winter and beyond. I want to thank and pay tribute to Katherine Henderson, the president of the Royal College of Emergency Medicine, with whom I have worked closely to develop these proposals. I want to thank her, and, through her, all those who work in emergency care for their service in the face of adversity. I saw this again this morning at the St Thomas’ Hospital accident and emergency department, and I know that all of us support the work of those who work in our emergency facilities, right across the country. I very much hope that yours, Mr Speaker, will be opening soon in Chorley.

We will make our emergency departments bigger. Many are simply too small—that was true even before the pandemic, but it is even more acute now. So we are investing to expand capacity in urgent and emergency care, so that hospitals have the space to continue treating patients safely in the coming months. In August, we confirmed £300 million for emergency upgrades across 117 trusts, and I can today announce a further £150 million to expand 25 more emergency departments, including some of the most constrained in the country, such as those in Worcester and at the Royal Shrewsbury. This extra funding will put us in the strongest possible position for this winter, and boost the crucial work to accelerate non-Covid care.

It is not just about the space, but about the service, so we are working to get patients the right care in the right place, by expanding the role of NHS 111. During the peak of this pandemic, we saw millions of people using NHS 111, on the phone or online, to get the best possible advice on coronavirus, helping them to stay safe and, where possible, to stay out of hospital, where they could have unknowingly spread the virus. It is crucial that, ahead of winter, we use this window of opportunity to seek out what worked and build on it, so we provide a better service for patients and protect the NHS. Of course, no one will ever be turned away from our emergency departments in the most serious of cases; however, we have worked with the royal colleges, the NHS and others to develop a better, quicker and more clinically appropriate service for patients by using NHS 111 first.

This is how it works. We will invest £24 million to increase call-handling capacity and to make sure there are more clinicians on hand to provide expert advice and guidance, and we will build on our trials to make NHS 111 a gateway to the emergency care system, providing a first port of call for patients. In future, rather than having to queue in an emergency ward, we are testing that people should call NHS 111 first to book an appointment with whoever can give them the most appropriate care, whether it is a GP, a specialist consultant, a pharmacist, a nurse or community services. Of course, if they need to go to the emergency department, NHS 111 will be able to book them into an appropriate time slot. We want to see this approach lead to shorter waiting times and better availability of appointments for patients. We will consult on how its performance is best measured, and, with successful pilots, we will roll out NHS 111 First to all trusts from December.

Finally, I want briefly to update the House on our work to protect care homes. One of the worst things that we know about this virus is that it reserves its greatest impact for those who are physically weakest, especially the elderly, so we must do everything in our power to protect residents in social care. In May, we introduced the adult social care infection control fund, which has helped adult social care providers reduce the rate of transmission. This was used to fund important measures such as improving infection prevention and paying staff to self-isolate. I can now inform the House that we will extend this fund for six months and provide over £540 million of extra funding for providers. That brings our total funding for infection control measures in social care to over £1 billion. We will also shortly be bringing forward our adult social care winter plan, because we will do whatever is humanly possible to protect our care homes from this virus so that they are a place of sanctuary this winter.

We will soon be facing winter in this fight and, whether on our NHS emergency care wards or in our care homes, we will strain every sinew to give them what they need, so they are well equipped for this pandemic and, indeed, for the years ahead. I commend this Statement to the House.”

Like everyone here, I watched the briefing by the Chief Scientific Officer and the Chief Medical Officer today, and very sobering it was too. It was followed by a very informed discussion on the BBC. It feels that we are playing catch-up again, although I realise that that is almost inevitable. Today we have had another Statement since this one and I gather that the Prime Minister will make a further Statement tomorrow.

Last week, when we discussed the then Statement which was already three days old, I said that I thought that we had come to a critical moment when some very serious decisions would need to be taken, and clearly that was correct. The words “tipping point” and “perilous moment” were used in the Commons today during the debate on the Statement. As we have said all along, clarity of messaging is totally vital. The country has become increasingly confused about what people should do to protect themselves and those around them, so perhaps this break point is really important.

A few weeks ago, the Prime Minister was setting out his stall to review the outstanding restrictions and allow a more significant return to normality, possibly in time for Christmas. Now the Prime Minister has admitted that we face a further six months of very difficult lockdown restrictions while the CSO, Sir Patrick Vallance, said that the UK faces 50,000 Covid cases a day by mid-October if the current infection rate is not halted. My first question for the Minister is: are we now at level 4? I ask because the Joint Biosecurity Centre has recommended that the Covid-19 alert level for the UK should be increased to level 4, meaning that transmission of the virus is high or rising exponentially. It has been at level 3, meaning that the Covid-19 epidemic is in general circulation, for several months, but the Chief Medical Officers of England, Wales, Scotland and Northern Ireland said in a joint statement this evening:

“After a period of lower Covid cases and deaths, the numbers of cases are now rising rapidly and probably exponentially in significant parts of all four nations.”

Given that, are we going to move to level 4?

Can the Minister confirm that the Government intend to bring forward further restrictions in London? What are the next steps nationally? This morning, Chris Whitty, the CMO, said that people should

“break unnecessary links between households to stop coronavirus spreading out of control.”

Has the advice about return to work changed? Can the Minister confirm whether the reported two-week circuit-breaker lockdown is indeed going to happen?

It is deeply concerning that the Statement last Thursday contained scant reference to testing. As my right honourable friend the shadow health Secretary said, under this Government test and trace is actually trace a test. When will that be resolved? Giving evidence to the Science and Technology Committee on Thursday, the noble Baroness, Lady Harding, told MPs:

“I do not think anybody expected to see the really sizeable increase in demand that we have seen over the course of the last few weeks.”

This is simply not true. Can the Minister confirm that SAGE warned the Government that the UK faced an inevitable increase in community transmission and cases after the summer and needed a fully functional and trusted test and trace system put in place?

I feel that I need to talk about the “moonshot”, because it is an emerging story on the i that the moonshot test for Covid-19 that will allow people to resume normal life will not be available on the NHS—as the Government’s testing tsar, the noble Baroness, Lady Harding, suggested. She said that individuals and companies would have to pay to access the proposed test and that it would not be part of the normal NHS test and tracing scheme that she heads, which will continue to concentrate on swab tests. So the question I need to ask the Minister is: are we now looking at an A and a B test and trace system or an A and B test system where people who can afford to pay for a test can get one immediately and those who cannot—the majority of us—will not?

Given these issues, tests now seem to be rationed, with health and social care prioritised. Could the Minister reflect on reports that care homes worst hit in the first wave could be tested for coronavirus less often, as the Government believe there will be higher levels of immunity and that they are less likely to pass on the virus? This is deeply worrying, given the high percentage of staff turnover and the vulnerability of residents.

Can the Minister confirm reports that evidence shows that 20% of people who have been told to self-isolate are still leaving their homes, and will that information be published? That is presumably what is leading to the much more aggressive fines. The Government say that the £10,000 maximum fine will act as a deterrent to testing positive and not self-isolating. Does the Minister share my concern that this actually may deter people with symptoms from getting a test at all? For many people, ignorance may also be the only legitimate option, as they are unable to get a test and self-isolation is financially non-viable.

The Minister will be aware that the Joint Committee on Human Rights said it was unacceptable that many thousands of people were receiving fixed-penalty notices despite evidence that the police do not fully understand their powers. They highlight enforcement as having a disproportionate impact on young men from black, Asian and minority ethnic backgrounds. Currently there is no way for people to challenge the fixed-penalty notices easily, so does the Minister share my concern that this will invariably lead to injustice, as members of the public who have been unfairly treated with a fixed-penalty notice have no means of redress?

It ought to be straightforward for a member of the public to find out what the current law is, nationally and in their local area, without having to trawl—as the rest of us are doing—through countless confusingly named regulations. Will the Government publish a website where people can enter their postcode and be told in plain English what restrictions currently apply where they live?

My Lords, I thank the Minister for dealing with this Statement, which comes hot on the news that we are at level 4 as regards the pandemic. Therefore, I want to touch on two or three points in this Statement. The first is the Government’s intention to invest £24 million in increasing call-handling capacity through NHS 111, to make it into a gateway to emergency care, providing the first port of call for patients. I must say to the Minister that it is a bit late to be doing that, and most of us should be somewhat alarmed at the news in the Statement that the Government intend to conduct pilots and will roll out NHS 111 First to all trusts from December. I understand the need to run pilots, but does he not think that time is against us?

On 17 September, six council leaders, cross-party, from across Yorkshire and Humber, wrote to the Minister. It is worth paying attention to what they said in their letter. They said: “It would be worth exploring the protocols and policies that might increase demand for what might be considered lower-value testing in a time of capacity constraint. This would include working with NHS 111 and reviewing their protocols. It seems that any childhood illness may result in a Covid test—that is what GPs are constantly telling us—while the Royal College of Paediatrics and Child Health have produced helpful guidance around that.” I ask the Minister if his department has seen that guidance and whether it will pay any attention to it.

Secondly, back to care homes and the ring of steel that never was. It is very welcome that there is going to be further investment in PPE and coverage for staff who have to take time off. However, there is a real danger in this, and there always has been, because social care is much more than care homes. Only 15% of people aged 85 or over are in a care home—most people who receive care are not. It is not uncommon for domiciliary care workers to visit 10 to 15 different homes in a shift. This Statement is silent on this matter which, given that the advisers are telling us they now know more about the transmission rate, is somewhat surprising. I wonder whether the Minister could talk about that.

The big issue in the last few days is the increasing confusion among members of the public as to who should be tested. Even in areas that are on the watchlist, people do not know whether they should be tested only if they are symptomatic or if they are asymptomatic. Some authorities have been given the power to do asymptomatic testing. Going back to that letter of 17 September, I note that the local authority says that it would be happy to have discussions locally but accepts the need for a co-ordinated approach with the Government. There needs to be a public discussion that provides urgently needed clarification from the department on how long these capacity issues are going to be around and what contingencies are going to be in place to manage them, particularly in high-risk areas.

This is not endless carping but a genuine concern for public health, and I therefore look forward to some detailed answers from the Minister.

My Lords, the noble Baroness, Lady Thornton, hit exactly the right note: we are at a sober moment and it is clear from the medical authorities that we are at some sort of tipping point. It is not too grand to say that the British nation faces something of a choice about how we approach the months ahead.

I confirm, as the noble Baroness, Lady Barker, has already done, that we are at level 4. The CMO has confirmed that he has taken the advice of the Joint Biosecurity Centre, and this is an indication of the seriousness of the situation. I acknowledge that there is widespread discussion of further restrictions and, as the noble Baroness, Lady Thornton, alluded to, that the Mayor of London, Sadiq Khan, has grave concerns for London. The CMO and the Chief Scientific Adviser have made their grave concerns crystal clear in their briefing this morning, and the graph showing the potential exponential growth in the case rate is extremely daunting.

I acknowledge that there are people who are concerned that we should put further restrictions in place, but I cannot confirm any of those arrangements. There will be a COBRA meeting tomorrow morning, which will be followed by a Cabinet meeting. The Prime Minister will make a Statement in the House of Commons tomorrow afternoon; how it will be repeated here is being discussed in the usual channels.

The expectations are very gruelling. The noble Baroness, Lady Thornton, queried why we did not see this coming, saying that, surely, SAGE and others had predicted this. The situation a month ago was quite different: when you looked at the dashboard, it was not clear that this sudden spike would turn up. However, the example of France—in cities like Marseilles—the hospitals in Spain and countries such as Israel has been extremely challenging and we are therefore moving quickly.

We completely acknowledge the concerns of parents and teachers in schools and the demands that they have put on the testing regime; we are absolutely determined to do whatever we can to keep schools open. We acknowledge the concerns of those with loved ones in social care, and we continue to pledge a very large amount—half of our testing capacity—to put protection in place for those in social care homes, who work with those in social care and who are in domestic care.

The noble Baroness, Lady Thornton, asked about Moonshot, and she is entirely right. The Moonshot project is adjacent to and parallel to our existing testing capacity, which uses the Rolls-Royce PCR test, which is extremely accurate in terms both of sensitivity and prevalence. Those tests take time to turn around, are costly and are best placed one after another in machines in an industrial process.

We are therefore looking at a much more flexible type of testing capacity, which may not need to be quite as scientific in its approach and may have different use cases. Principally, it would enable people to do the things they seek to do: to be in places where social distancing is more challenging, whether that is a place or work or leisure, or a family context. In answer to the noble Baroness, Lady Thornton, we absolutely apply the inclusionary principle, but there may well be a role for owners of venues such as football clubs and theatres to take advantage of these interesting, dynamic and innovative technologies in order to bring back some of the economic, social and cultural parts of the country that we all love, and that many depend on.

The noble Baroness, Lady Thornton, asked about self-isolation and quarantine. She is entirely right: these are critical components of our first-line defence against Covid. The only reason for having a test and trace programme is that people then isolate. If they do not isolate, there is no point in having that programme. We are absolutely focused on doing whatever we can to ensure that those who have been asked to isolate, because they have been in a risky situation or because they have had a positive test, do indeed do that. The fines we brought in at the weekend, or are set to bring in, are evidence of our determination to double up on the isolation principle. We have also brought in economic support for those who are isolating in certain target areas. As I have said at the Dispatch Box previously, those systems remain under review. If there is more that we can do to support those who are isolating, we will consider doing it.

The same is true of quarantine. The concerns of those in this House who would like to see our airports reopened and airlines and international travel restarted have been heard loud and clear. However, quarantining is essential to breaking the chain of transmission and to protecting this country. Until we have quarantine protocols that we can rely on, we have to live with what we have got.

The noble Baroness, Lady Thornton, also asked whether there was a better way for those in a particular place to understand what restrictions they are living under. I entirely agree. The pace at which some local lockdowns have been enforced or changed is extremely difficult to keep up with, even if you live in one area. That is why the app, which will be released on Thursday, will have a postcode checker. You can put in any post- code in the country and it will give you an indication of the lockdown principles and alert level in that area. That is a helpful device which will put many people’s minds at rest.

The noble Baroness, Lady Barker, asked about call handling and 111. I remember that, not long ago, the very existence of 111 was questioned by many. There were those who thought that closing it down might have been a good idea. During the Covid epidemic, 111 has been a phenomenal success. We have put in more resources, more call handlers, more training and more technology in order to make it more successful. It has proven its value in a massive way.

What we are doing with the trials alluded to by the noble Baroness, Lady Barker, is introducing a pilot so that those going to the emergency services in a hospital can phone 111 to check which services they should attend and, on occasion, book their slot in the emergency services. This is a system that patients have been asking for for a long time. It will help us massively with our load management as well as our Covid hygiene principles in emergency services. The pilots are starting in half a dozen locations, including Cornwall and Warrington, and we have put £24 million and a marketing campaign behind them. My expectation is that this service will prove extremely popular and will change the way in which people engage with hospitals. It will mean that the concerns and treatment of patients will be handled much more efficiently, and patients will go to the place that can best look after their treatment.

The noble Baroness asked about the protection that we are providing for care homes. The winter plan for social care, published last month, is an extremely detailed document that addresses many of the concerns that I have heard here in the Chamber. It is a thoughtful, well-financed and highly detailed plan for how we are going to protect those who are most vulnerable during the winter months. It is backed by an enormous financial commitment, a large number of tests and new guidelines to handle, for instance—as the noble Baroness rightly pointed out—the very difficult challenge of itinerant workers who may work for several different patients all at once; we are providing the financial resources and the new protocols in order to ensure that they do not become vectors of infection.

The noble Baroness, Lady Barker, asked about testing and who should be tested, and addressed in particular the question of asymptomatic testing and public discussion. We are massively engaged in a huge national conversation at the moment with local authorities, civic groups, employers, scientists and every single stakeholder that you could possibly imagine in the testing arena. Every day at the Department of Health we have round tables, webinars and all manner of engagement to understand how best we can serve schools, families, the economy and all the aspects of British life that depend on getting testing right.

One aspect of testing that is being generated by the exciting innovations that I mentioned in my answer to the noble Baroness, Lady Thornton, is the testing of asymptomatic people. That is not possible at the current levels of testing, even at 250,000 per day. We have to be extremely careful, as everyone here knows, to use every test that we have to its most effective use. When there are very large numbers of tests that can be cheaply and quickly delivered, and which are user-friendly by using things such as saliva or even breath tests, that could inaugurate a revolution in the way that we use testing and it may provide a system where those who are seeking to go outside, to go into areas where social distancing is challenging, can check whether they have the virus that morning and, at least for a day or two, have evidence that they will not be vectors of infection. That is potentially a transformative technology and it is the focus of our Moonshot ambitions. The progress that we are making is extremely encouraging and I look forward to updating the House on future days.

My Lords, 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.

My Lords, I want to pick up on what the noble Baroness, Lady Thornton, said about the clarity of messages. Enough has been said about test, track and isolate, and I will not go there, but I want to pick up on the comment made by the Chief Medical Officer in the presentation this morning about how people’s changing behaviour may help reduce or suppress the transmission of the virus significantly. The Government’s slogan “Hands, Face, Space” is apt. The Government were quite clear at the beginning of the pandemic about handwashing but less clear about face masks or face coverings and space. In future, as we are facing a serious problem, what message does the Minister wish to give to citizens when it comes to the use of face masks and space?

Our message remains clear and the same as when we started this epidemic. There is no other better alternative than the three principles articulated by the noble Lord, Lord Patel: clean hands, clean face, and social distancing. That mixture of hygiene and social distancing is the only thing that can beat this virus; that is our first line of defence. Test, trace, and isolate is our second line of defence. Face masks—in situations where social distancing is a challenge—can provide some secondary back-up, but they are not our primary form of defence.

My Lords, the statement by the CMO and CSO today fired a shot across the bows of Government and demands action now to prevent the second wave getting out of hand. The message is sobering. As noted by my noble friend, we could see 50,000 cases a day by mid-October if no action is taken, leading to 200 deaths per day by mid-November. They refer to transmissions at home and in social settings. This should direct our attention to pubs and restaurants and whether they should remain open as potential vectors of infection.

We have learned many lessons from the first wave, particularly that there may have been a reluctance on the part of hospitals to refer patients to the Nightingale hospitals, lest this be seen as a sign of failure. This is a war on a pernicious virus, and we need leadership and central direction to ensure that we use these facilities more effectively. I welcome the £450 million earmarked to upgrade and expand A&E units, but we need a plan for the following points. One, triage patients to Nightingale hospitals once capacity in NHS hospitals exceeds 60%. Two, A&E holding bays for suspected Covid patients, who are transferred to Nightingale hospitals if they test positive. Three, a point of care test, be it the new flexible test the Minister mentioned earlier, to ensure we get quick results. The purpose of the Nightingale hospitals must be to enable the wider NHS to fulfil its obligations to maintain elective and emergency services. Can my noble friend the Minister confirm whether this is the Government’s strategy?

It is a war, that is why we are focused on how we manage extra resources such as the Nightingales. We have put in new systems and artificial intelligence for algorithms to help us with our triage. We have invested £450 million in A&Es, which will include building new holding bays. As my noble friend rightly points out, these need development. We have invested in 5,000 DnaNudges and other point-of-care devices to give front-line care workers the diagnostic help they need.

My Lords, I welcome the statement from the Minister, but to be candid, when I hear talk about Moonshot, I will believe it when I see it. What members of the public want is the ability to access Covid tests in places such as Bagshot, or Aldershot, or any other testing centre. The reports we get are that they cannot get appointments. Schools are closing because they cannot get test results, classes are being sent back; therefore, it is not just the number of tests, it is how long they are taking to turn around. To say we are surprised by the surge, when we were opening schools, does surprise me.

I have two other points on which I would welcome a response from the Minister. One, raised by noble Baroness, Lady Barker, is about domiciliary care. It is essential that PPE is available. It must be the right quality; we have had examples where large batches have been ordered from Turkey and China and they have been no good. We want quality PPE that is available.

I am addressing all these questions to the Minister. My last point is this: will there be testing capacity in general practice surgery?

My Lords, we are introducing a new scheme for bringing testing capacity straight to the desks of general practice, and the results from that initiative are promising.

My Lords, I welcome the further £2.7 billion for the NHS to prepare for winter and the further £150 million to expand emergency departments in England. However, as a resident of Wales, where health is devolved, I ask the Minister whether the Government have provided a proportionate sum to the devolved Administrations, to ensure that their residents can benefit from these improvements too? Furthermore, will the changes to NHS 111 be available in Wales, Scotland and Northern Ireland?

My Lords, the noble Baroness raises an important point about the rollout in the devolved Administrations. I do not have the details in my brief but I would be glad to write to her with them.

My Lords, I draw the House’s attention to my registered interests. The Minister has alluded to the strategy, announced by Her Majesty’s Government earlier this month, of moving to mass population testing for citizens, regardless of symptoms. This is clearly predicated on having capacity for high-frequency testing, rapid reporting of results and a minimum threshold of accuracy for the test used. What assessment have the Government made of the threshold of accuracy in relation to sensitivity and specificity required to ensure that the mass testing strategy is successful—which is essential if we are to not only implement public health measures but save our economy?

My Lords, the user cases for different tests are being drafted and interrogated as we speak. The user case, for example, of an anaesthetist going into a delicate operation would be very different from the asymptomatic testing of a large school, or of people thinking about going to the pub in the evening. Matching the tests with the user cases is an important and necessary step. Once that is agreed with all relevant scientific committees, we will publish those user cases so that manufacturers can make the tests according to the required dimensions and specifications.

My Lords, I am sure my noble friend will agree that at this serious and critical moment it is imperative that all the rules are observed. It is, however, important that the rules are seen to be practical and workable. I urge my noble friend, therefore, to reconsider in the near future the current decision to include children under 12 in the rule of six. Will the Minister also confirm that no woman will have to give birth alone?

My Lords, the rule of six treatment of children under 12 is extremely heartbreaking. I have three children under 12 and I find it very awkward. The CMO’s view, however, is crystal clear: children, whether under 12 or not, can be vectors of infection, and if a whole generation of children is infected with the disease it will roll through the generations to those who are older or vulnerable, as sure as night follows day. For that reason, we are holding the rule as it is.

I thank the Minister for his Statement and for confirming that the alert level is now at 4. If I heard him correctly, he mentioned that COBRA would meet tomorrow. On Friday I asked why COBRA had not met for four months, and he indicated that it had given way to COVID-O and Covid Gold. I looked these up on the government website; deep into page 15 it announced the names of the operational and strategic committees and their membership. I am anxious that there should be clarity and co-ordination of decision-making, proper consideration of spending public money and accountability in contracting. Can the noble Lord give me an assurance that there will now be better co-ordination at national level and better reporting of decision-making?

I pay tribute to colleagues and officials at Downing Street and the Cabinet Office who have organised an extremely detailed, flexible and fast-moving decision-making arrangement through the COVID-O and Covid Gold process. That has proven, as has often been discussed in this Chamber, incredibly quick at responding to events. In terms of spending, I pay tribute to my noble friend Lord Agnew in the Cabinet Office, who is leading the fraud and financial scrutiny efforts to ensure that the money spent on taxpayers’ behalf goes to the right places.

Does the Minister agree that we cannot afford to destroy the economy again and that it would be immoral to destroy the educational future of our children? That implies that people must curtail their social opportunities. It is also incumbent on Government to recognise that education and the economy working will lead to increased cases. Do the Government not therefore need to step up and reintroduce the targeted work on those most vulnerable to this disease, as we know who they are?

My Lords, I entirely agree with the noble Lord’s sentiments. The economy and education are critical. I reiterate the Government’s commitment to ensuring that the economy survives in the best possible way and that our children get the education they need. However, it is not quite as binary as he describes. If the public abide by the behaviours recommended in the guidelines, we can enjoy a far greater range of activities than would be the case under a major lockdown. Either way, we are committed to protecting the most vulnerable. I point to the substantial financial investment in protecting those who are shielded and in social care.

My Lords, I declare my role in the Distance Aware programme in Wales, intended to help people coming out of shielding. We must focus on breaking the chain of transmission. Oxford University reports that the Isle of Wight Test and Trace pilot with the NHSX app broke transmission rates from among the worst in the UK to zero in three weeks. That app was withdrawn. Now the Google/Apple app trial on the island and in Newham is failing to stop R rising after five weeks. As the NHSX app is the only intervention shown to break the chain of transmission, will the Government now urgently roll it out nationwide?

My Lords, the noble Baroness is correct inasmuch as the statistics published for the original app would suggest. However, new statistics about the new app will be published after its launch on Thursday. I reassure her that the circumstances between then and now have changed considerably. The impact of an app that is widely downloaded and implemented across the country can be profound. We are extremely optimistic about its impact.

My Lords, it was announced in Stormont this afternoon that Covid-19 restrictions are to be extended across all Northern Ireland from 6 pm tomorrow. However, given that the Prime Minister is to make his own set of announcements tomorrow, can the Minister offer some clarity on whether the changes in Northern Ireland could be overwritten by Mr Johnson? Can he also offer some insight into what work is going on to try to achieve more consistency of messaging across all four nations of the United Kingdom? It is obvious that the differences are causing profound confusion among the public and putting more lives at risk.

My Lords, I note the move by Northern Ireland, which has taken a sincere and thoughtful approach. It is true that there have been some small differences between the different countries, but the vast majority of guidelines, restrictions and lockdown arrangements are shared by all the countries of the United Kingdom. I commend the huge amount of collaboration between all the DAs in working together to fight this horrible disease.

Has the Minister ever read his own department’s weekly statistics paper for test and trace? On page 8 of that for the latest week, from 3 to 9 September, there is a chart and figures for people tested from May. There is not a single day when the number of people tested exceeded 100,000, even when tests under pillar 1 are added to tests under pillar 2. The average for the latest week is 82,000 people tested. Could he ask the Secretary of State to stop playing fast and loose with the figures, especially in interviews where the interviewer is not briefed properly, as on “The Andrew Marr Show” on Sunday? He himself used the figure a few minutes ago of over 200,000, implying that was the number of people—it is not. There have never been 100,000 people tested on any single day.

My Lords, I would be glad to talk about the weekly statistics with the noble Lord in detail, if he would like. The number of tests per day is frequently over 200,000. The number of people includes a huge amount of duplication, because some people have had more than one test. Those people are often in social care or hospitals. If a person is tested in March and goes on to be tested 20 more times, they are counted once in March and not again. That is why the number he is looking at is quite different from the daily “tested” figure.

My Lords, another statistic we seem to forget is that some 20,000 Covid-related deaths have occurred in care homes to date. Yet, as we face another massive surge, there is no guarantee that we have learned any lessons from them. I welcome the resources spent on PPE, and I hope the Minister will guarantee that no patients will be dumped into care homes as they were earlier in the year. Unless we can protect the 1.2 million social care workers, 465,000 of whom work in care homes, the same will happen again. Last Friday, as reported by the York Evening Press, a care home in York waited over seven days for 100 test results to be returned—seven days when people got more ill and faced the prospect of an early death. Unless the Minister can guarantee at the meeting tomorrow that all tests in care homes will be offered on a weekly basis and returned within 24 hours, we will be putting our whole care home sector in peril.

My Lords, the noble Lord, Lord Willis, does the care home sector, the NHS and those who work in them a massive disservice. There are hundreds of ways in which we have learned to deal with this disease better, such as how we use therapeutic drugs; how we store and use PPE; how we manage and protect our workforce; how we handle mental health and the entertainment of those who live in care; how we use modern technology, including television and diagnostic devices; how we transfer patients in and out of hospitals; and how we use testing. I could continue, but I think I have made my point.

My Lords, Lord Sumption and others say older people should be allowed to take their chances with the virus if they prefer that to cutting off contact with family and friends. Does the Minister agree that senior citizens—I am 91—should be allowed to take responsibility for their own safeguarding, rather than face their remaining years in perpetual lockdowns and feeling guilty that their protection is at the expense of younger, working people and the economy?

My Lords, I do not like telling anyone what to do. I do not like telling anyone that they should lock themselves up or stay away from the people they love—of course I do not—but in this epidemic we have learned that my health affects your health and your health affects my health. If you wander around catching the disease and giving it to other people, the impact on the whole of society is enormous. We all have to get used to this fundamental public health truism.

My Lords, we know that Covid attacks the most vulnerable in society so, while I sympathise with the noble and gallant Lord, Lord Craig, I wonder whether the Minister sees merit in sending a clear message to those over 70 or with underlying conditions that they should consider isolating. This message would not be simply to protect them but to protect the NHS and allow the country to keep its schools and economy working.

My Lords, a clear message could not have been more emphatically sent to those over 70 about the dangers of this disease. The problem we have today is not one of irresponsible over-70s; it is a problem of prevalence among the young. We need to think thoroughly about how we address the issue of young people, who rarely get symptoms or even know they have the disease, transporting that disease in a dangerous way to those who are more vulnerable.

My Lords, the Minister has emphasised that targeted action in local areas is essential and that the Government are listening to local authorities. Will he confirm that local authorities will now truly have a powerful presence in fighting this pandemic and will be given adequate funding appropriate to their needs? Will he also assure us that we have moved away from empty boasts about UK initiatives being world beating and are now approaching this pandemic with greater insight and maturity? For example, what can we learn from Europe and other countries about the pandemic and how they plan, and how will we take note of that? Tracing and testing would be a good example.

The noble Baroness is right to point to the lessons we can learn from other countries, and we spend a huge amount of time on the telephone in round tables with those in other countries who have much to teach us. We have spoken at length and continue to speak to those in Asia, including in Taiwan, Japan and South Korea, which have pioneered different ways of doing things, and we note the work of the civic authorities in Antwerp, which recently brought in local measures that massively reduced a runaway situation. They are an inspiration to us all.

My Lords, will the Minister give us some idea of the advice the Government are giving to institutions such as amateur sports clubs about how they are supposed to function in the changing environment? There has been some activity, and they will presumably have to pull down in certain places. Also, is there any government strategy for making sure that these clubs and groups can still survive if we have to go through another six months of this isolation?

My Lords, I pay tribute to amateur sports clubs, which have jumped through enormous hoops to keep operating and to provide important leisure and fitness to the country during an incredibly difficult period. They have been extremely disciplined and entrepreneurial in the way they have applied hygienic protocols. On Sunday I went to three amateur sports clubs, taking one of my children to each. The warning the noble Lord, Lord Addington, gives about the financial future of these clubs is extremely well made. The Department for Digital, Culture, Media and Sport is looking at ways in which it can provide both the financial and infrastructure support for those clubs and will work hard to ensure that they survive.

My Lords, the Minister has touched on critical countrywide issues but, as regards those who have crossed the channel, does automatic Covid testing take place for migrants detained by the UK border agency on the Kent coast, for example?

My Lords, all those resident in local authority hostels or accommodation will be tested regularly to prevent the transmission of this disease.

My Lords, will the Minister commit Her Majesty’s Government not only to an independent inquiry into their handling of Covid-19 but to a public inquiry? The Government need to look at the massive human cost of the pandemic as well as the financial one. Have the many billions of pounds spent on the pandemic been spent wisely?

My Lords, I am afraid that any decision about an inquiry is way beyond my pay scale, but the noble Lord is entirely right: there will clearly be massive lessons that we need to learn about the ways in which we do government, and health, and manage our public health. Those lessons should certainly include the economy since the impact of this disease on it has been profound. We will be living with those consequences for some time to come. We need to learn how to protect the economic future of our children when dealing with these kinds of national epidemics.

My Lords, one of the most public failures of communication has been the refusal of the Prime Minister to talk to his counterparts in the devolved nations. Yesterday, they had the privilege of a conversation with Mr Gove. The Prime Minister has still not spoken to them since May. I find that extraordinary. I have never seen Mark Drakeford so angry. Does the Minister agree that unilateral decisions taken in England can have a perverse impact, particularly on Wales, as many people live in Wales but work in England? Will the Prime Minister now engage? Will those devolved Ministers be at the COBRA meeting tomorrow, for example? When will the Prime Minister set up the regular, reliable meetings with his counterparts for which they have been asking for months?

My Lords, the noble Baroness makes a powerful point but it is at odds with my own experience. I deal with my counterparts in the devolved authorities on a very regular basis. We have extremely strong bilateral relations and I pay tribute to the collaborative spirit in which they go into those conversations. All I can say is that I am extremely grateful to those in the devolved authorities who have worked so closely with us in a four-nations response to this epidemic.

My Lords, 50,000 is a frightening enough number but SAGE has made public pronouncements that, as we approach the winter, up to 500,000 people or more may display Covid and flu symptoms. With schools and universities returned, there is nationwide concern about this increasing exponentially, as the Minister has said. We have heard that some schools and universities are already facing partial closure. What specific advice has been issued to NHS front-line staff, including GPs, so that they are vigilant and adequately prepared to respond to the needs of teachers and families—particularly those within ethnic minority communities—who are deemed at higher risk of being affected by this dangerous disease? Regarding the Help Us to Help You campaign, is the Minister working closely with ethnic minority communities in particular? They have obviously been disproportionately affected, and we want to avoid that continuing, at all costs.

My Lords, the noble Baroness is quite right to raise the question of the Help Us to Help You campaign and the work that is being focused on hard-to-reach communities, whether BAME communities or other communities where we struggle to get some of our health messages through. I reassure her that there is an enormous focus on getting these important messages through to those who are particularly vulnerable to the effects of Covid, and who we have to work harder to reach.

House adjourned at 7.24 pm.