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Long Covid

Volume 825: debated on Thursday 17 November 2022

Motion to Take Note

Moved by

My Lords, I think the first thing I need to say is that Covid is not over. People are still catching Covid; some are still being very ill; some end up with long Covid. Our NHS is still battling with Covid itself and the terrible effect it has had on the whole of the NHS’s ability to do its job and catch up with the backlog which Covid produced, on top of the waiting lists which already existed and were growing in 2019 before the pandemic. This is the background of our discussion today

Given the number of speakers across the House for this debate, I am very pleased that so many agree it is about time we reflected on the emerging short and long-term challenges of long Covid. I thank the Library, the British Medical Association, Nuffield Health and many others who provided us with such large quantities of briefing.

I thank all the speakers who will follow me, and I anticipate a well-informed debate which will no doubt be challenging for the Minister, not least because, although this is designated a health debate, I think if 2.1 million—and I have seen lower and higher figures—of our fellow citizens are reporting experiences of some or many of the range of symptoms of long Covid, then this has wider societal implications. It affects the workplace, incomes, families and our mental health and social care services. It raises questions about defining a disabling condition, which will affect treatment, support, insurance, pensions, income support, careers, jobs and the reasonable adjustments which need to be made, and how we will support children who may get long Covid.

Part of the challenge is that it seems there is yet no internationally agreed clinical definition of long Covid, and the evidence base on what constitutes long Covid, in terms of range and length of symptoms, is still emerging. In October 2021, the World Health Organization defined “post-Covid-19 condition” as occurring

“in individuals with a history of probable or confirmed SARS CoV-2 infection, usually 3 months from the onset of COVID-19 with symptoms and that last for at least 2 months and cannot be explained by an alternative diagnosis.”

More recently, the NICE guidance on managing the long-term effects of Covid-19 covers care for

“people who have signs and symptoms that develop during or after an infection consistent with COVID-19, continue for more than four weeks and are not explained by an alternative diagnosis.”

As noble Lords will be aware, common symptoms include fatigue, shortness of breath, chest pain, problems with memory, heart palpitations, dizziness, joint pain and many others.

To advance our understanding of long Covid, it is crucial that prevalence data is collected, and this is my first substantive point for the Minister. Government commitments have been made; for example, in June 2021, NHS England committed to setting up a long Covid registry to collect long Covid activity data. However, to date, data is not collected accurately and consistently across the UK, meaning the UK Government are still relying on ONS self-reported data. When will this important data collection happen in a consistent fashion?

There are currently a lot of unknowns when it comes to treating long Covid. Despite recent investment, more research is needed to increase the understanding of the condition, including psychological aspects, and to develop more effective treatments. In October 2020, NHS England and NHS Improvement set out a five-point plan for long Covid support, which included a commitment of £50 million to fund research. The Government said that £20 million of the £50 million previously committed to research would go into 15 UK-based research studies, through the NIHR, the National Institute for Health Research, to better understand the condition, improve diagnosis and find new treatments. As part of this investment, various studies are investigating whether there might be potential pharmaceutical treatments that would be effective in treating long Covid.

Long Covid is a focus for researchers globally, with the European Commission announcing it would accelerate its research into long Covid and develop treatments, while the United States is also running clinical trials. I would like to ask the Minister whether we are participating in these research programmes, and, if so, what are the outcomes?

Similarly, major pharmaceutical companies have demonstrated an interest in developing targeted new treatments or repurposing existing ones. Although researchers have been surveying the broad spectrum of symptoms associated with long Covid, it has to be said they have not found one biological explanation. It is likely there are various mechanisms involved. Similarities between long Covid and other post-infection syndromes need to be considered, and I am confident this will be raised during the debate today.

Despite the investment into research for treatments for long Covid, much of the research is in its early stages, resulting in a lack of evidence on effective treatments. In terms of resources, of the million or more who are reporting with long Covid, only 60,000 patients can access treatment. This means that hundreds of thousands of people with long Covid are feeling isolated and frustrated in their search for treatment, and as a result sometimes live in poverty and despair. I would like to commend the patient groups that have been doing a great job in mutual support and campaigning.

Let us look at the research, of which there must be much more. It is true the Government agreed to invest £50 million in research, although I think there are some blockages, which I would like to raise with the Minister, such as approvals to facilitate research pathways, and through developing pathways support more rapid implementation of promising findings in relation to the diagnosis, assessment, and treatment of long Covid. It would seem, despite the increased funding in research, the UK Government need to increase the infrastructure to meet the scale of the problem. While the MHRA, through the Innovative Licensing and Access Pathway, aims to accelerate the time it takes to get treatments to market, there may need to be some changes to clinical trials research legislation to enable this to be carried out. Is that the case, and are the Government considering it, and what should happen next, because it is vital that if the research is there and the pharmaceutical industry wants to bring forward treatments, we should make sure the pathway is completely clear of any obstacles.

There are huge challenges concerning work and long Covid. The first is the need to support the post-pandemic return to work, which we have discussed before in this House. Since the pandemic, there has been a marked increase in the number of workers aged 50 to 64 who have left employment. Recent labour market statistics from the ONS found that the number of people in this age group classified as “economically inactive” stood at 374,000-plus from June to August this year, compared with 37,000 in the first three months of 2020, as Covid-19 took hold. A recent analysis by the ONS found that 51% of people in this age category who had left work since the pandemic and had not gone back had reported a physical or mental health condition or illness, including long Covid. Apart from anything else, this points to the fact that people need extra support from employers to prevent them being squeezed out of the workplace. It seems to me that guidelines for employers are required—are they available? Are they being planned?

There are health and social care workers who have been particularly exposed during the pandemic. Of course, long Covid makes it even more difficult for the NHS to function as it should, to say nothing of the lives being wrecked and the families suffering terribly. The Industrial Injuries Advisory Council has made its recommendations to the Secretary of State regarding the circumstances in which long Covid should be prescribed as an occupational disease. Why have the Government not acted on this? Covid special leave provisions ended across the UK by 1 September 2022. The British Medical Association has repeatedly called for enhanced Covid-19 sickness pay provisions to continue until a long-term strategy for dealing with Covid-19 is in place. I need to know why the Government have not put a sufficient compensation scheme in place for healthcare workers who are developing long Covid.

Further to this, the Secretary of State for Work and Pensions published the Industrial Injuries Advisory Council report on Covid-19 and its occupational impacts. This report was provided to the Secretary of State and was laid before Parliament yesterday; I thank the Minister for making it available to this House. The council argues that there is sufficient evidence to recommend prescription for health and social care workers whose work brings them into frequent proximity to patients and clients where there is a significantly increased risk of infection, subsequent illness and death. Now that the Government have that report, and it has been made public, will they act upon it?

We need to address the issue of preventing long Covid in children. Will the Government develop a campaign with more consistent messaging about long Covid and clear information and guidance for parents regarding the benefits of vaccination for children and how it can protect children from long Covid?

Clearly, there needs to be more support for health professionals to identify and treat long Covid. All health professionals should be supported and equipped with up-to-date information to ensure that they understand the variable symptoms of long Covid and are aware of the available support and how to refer people to it. In terms of the funding and resources to establish multidisciplinary services, pathways for long Covid should focus on addressing patients’ multisystem symptoms and rehabilitation needs and provide individualised care plans accordingly. There also needs to be a more consistent provision of long Covid clinics, including for children, so that there is less variation in waiting times for treatment. Increased funding and independent workforce planning are key to the success of these services. How many more multidisciplinary centres are planned, and by when?

Turning to improved financial and wider support for people unable to work due to long Covid, the Government need urgently to provide employers with better guidance on how to support employees with long Covid. Perhaps the Government should set up a task force to review the UK’s statutory sick pay allowance system and whether it should be increased so that it is in line with other OECD countries. Does the Minister accept that the decision to end special Covid leave for NHS staff has put patients and healthcare workers at risk? Why do the Government not reinstate this scheme until a longer-term compensation scheme to support staff is in place?

At the end of this debate, I would welcome an acknowledgement by the Minister that the Government recognise that long Covid is having a major impact on productivity, employment and wider society, as well as our health services. I would like the Minister to tell me that they have a plan for this to be tackled in a comprehensive fashion across government. I beg to move.

My Lords, I start by thanking the noble Baroness, Lady Thornton, for bringing about this important debate. She has held the Government’s feet to the fire—in fact, she held my feet to the fire—on this issue, and I absolutely commend her persistence.

Rehabilitation in general and post-viral syndromes in particular have a long history of being horribly overlooked in this country. I am afraid that this regrettable neglect has contributed darkly to the long-term poor health of many in this nation. However, before I speak about the consequences of this on long Covid, I will take a moment to recognise that Britain has done more than almost any other country to address long Covid. Professor Chris Whitty and the CMO’s office prioritised NIHR research, with £50 million going into 19 projects, giving a clear signal for other research. The NHS, and in particular the noble Lord, Lord Stevens of Birmingham, launched a welcome five-point plan, as the noble Baroness mentioned, and Amanda Pritchard has rolled out excellent long-term long Covid clinics. Treatments such as monoclonal antibodies and pulmonary rehabilitation are emerging as a result. I pay tribute to Dr Harry Brünjes, who pioneered the Breathe programme at the English National Opera, which is a fantastic example of social prescribing that has produced some very promising clinical trial results. I thank the noble Lord, Lord Darzi, who kicked off the important REACT programme at Imperial College which has generated hefty longitudinal population studies. Lastly, I pay tribute to the patient groups, who are both vocal and thoughtful in their responses, for their testimony.

Despite these considerable collective efforts, I am sad to say that the long Covid story has become a parable for how the UK health system fails to protect people’s freedom from disease and illness. It fails to properly rehabilitate our sick, and we are paying a horrible economic price as a result. The scale of long Covid is enormous, as the noble Baroness rightly pointed out, but the clinical response I referred to is sadly inadequate. The ONS says that there are 1.5 million sufferers, yet the long Covid clinics can see only 60,000 patients per year. Patient groups are frustrated that, when they do get seen, clinicians do not have the latest pathways that might lead to positive outcomes. The NIHR agrees with patients that there are a lot of unanswered questions.

We are familiar in this country with the rationing of scarce health resources and the uneven distribution of the latest research—uncomfortable though that is—but I will focus a few words on the profound economic effects of this troubling British healthcare strategy. ONS data reports that 500,000 people have left the workforce over the last 18 months, and 75,000 of those are economically inactive due to long Covid. The Institute for Fiscal Studies has a slightly different figure of 110,000, and it says that the cost is almost £1.5 billion in lost earnings a year. Another IFS study suggests that there is an average of 2.5 hours of sick leave per worker being taken due to those who have long Covid. Either way, the OBR has recognised that Covid in the round could cost around £2.7 billion in welfare benefits such as incapacity and housing. That is an absolutely staggering sum.

My point is that we cannot shrug our shoulders about the impact of conditions like long Covid on the economy. We have to take on the challenge of making this country healthier and pivot towards prevention. Andrew Haldane, chief executive of the Royal Society of Arts, put it well in his recent speech:

“We’re in a situation for the first time, probably since the Industrial Revolution, where health and wellbeing are in retreat … Having been an accelerator of wellbeing for the last 200 years, health is now serving as a brake in the rise of growth and wellbeing of our citizens.”

Yesterday, Andrew Bailey, the Governor of the Bank of England, told the House of Commons Treasury Committee that part of the reason the country was being held back was the sharp decline in the size of the workforce since Covid.

Despite this, the Treasury plan for living with Covid makes no mention of investment in rehabilitation or major initiatives for getting the workforce back to work. Finances in the UK Health Security Agency and the Office for Health Improvement and Disparities, the main legacy public health organisations—

Will the noble Lord give way, please? Does he agree there is a growing concern about the serious side-effects that the booster vaccinations can have? Does he agree with me that the Government should look at this very carefully?

My Lords, the vaccine programme has been an astonishing success, and the uptake of those vaccines has shown the enormous public confidence in them. I will speak on another date about the profound impact this has had on the health of the nation.

My point here is that, at this moment when we are feeling the effects of Covid heavily on our workforce and economy, the finances at the UKHSA and OHID are under huge pressure. The public health infrastructure built over the pandemic has largely been dismantled. At the same time, we have an NHS straining to look after the sick and a workforce many of whom are too sick to work.

It is time that we work towards a new political settlement that prioritises the health of the nation and not just the treatment of the sick; and that we make the operational decision in health and care to move towards prevention.

My Lords, I thank the noble Baroness, Lady Thornton, for bringing this important subject to the House. I have a very close relative who has had ME for a number of years, and I have seen at first hand how debilitating and life changing it can be. I have become the vice-chair of the APPG for ME and I have talked to hundreds of ME patients who have had their condition ignored or ridiculed. They have been subject to inappropriate and sometimes dangerous medical intervention, and they are struggling with an employment and benefits system that simply does not acknowledge the realities of their condition. Those 250,000 ME patients are now, in effect, being joined by over 2 million long Covid sufferers.

It is worth starting by pointing out that debilitating post-infection syndromes such as long Covid are not new clinical entities. In American medical literature, ME-like symptoms are described as far back as 1934. When ME was first noticed in this country it was described as “yuppie flu”, but in fact these syndromes affect millions of people suffering from a range of viruses, including those living in poor, third-world countries.

The Institute for Fiscal Studies estimates that one in 10 people with long Covid have given up work, with “persistent labour market effects”. This month’s Lancet said that

“post-acute infection syndromes could pose a substantial public health burden in the near future if appropriate measures are not … taken”.

Despite the huge economic cost they inflict, as the noble Lord, Lord Bethell, said, post-viral illnesses have been neglected, dismissed and under-researched for far too long. We still have no diagnostic blood tests for either long Covid or ME.

As well as the breathlessness, chest pains and loss of taste or smell which characterise long Covid, patients exhibit a cluster of symptoms such as the debilitating fatigue, post-exertional malaise, cognitive dysfunction, PoTS and sleep disturbances that are also diagnostic of ME and other post-infection syndromes. While all the funding for research into long Covid must be welcomed, it is disappointing that some researchers are still ignoring or are not aware of what has already been learned about what may be causing ME and how this could help us to understand the causes of long Covid.

Almost 40 clinical trials into possible treatments for long Covid have been registered, some involving interventions that have already been assessed in ME. Some of these treatment trials have small sample sizes or no control groups. The lessons do not appear to have been learned from the use of poor-quality methodology in many clinical trials involving ME. Some health professionals who are managing people with long Covid are unaware of or ignoring what we have learned about the management of ME and other post-infection syndromes, on activity and energy management particularly. The ME charity sector produces excellent information on symptom and energy management, as does the new NICE guideline, but people with long Covid are often simply unaware of this information, as are many health workers.

Another important lesson that needs to be learned from ME is that misdiagnosis can occur when people with chronic fatigue are not properly assessed and are labelled as having a post-viral syndrome. There are some very disturbing cases being reported of people having long Covid when, in fact, they have another medical condition. A Suffolk councillor recently featured in the news when, it turned out, her long-standing diagnosis of long Covid actually proved to be lung cancer.

Research into the cause and diagnosis of, and effective treatments for, long Covid could help those with ME. The ME Association has requested that clinical trials for long Covid treatments include a group with ME. What has been learned about the management of ME can help many people with long Covid.

Harlan Krumholz, a cardiologist at Yale, said:

“No one wanted the pandemic, but sometimes a jolt to the system can create innovation in ways that wouldn’t have occurred otherwise”.

That should be our guiding principle.

My Lords, I thank my noble friend Lady Thornton for initiating this debate. I am concerned about the low level of awareness of something that affects up to 2 million people. One person said to me on Monday, “Does that mean they’re still contagious?” I am also concerned about the economic implications, particularly for the health service, whose staff were on the front line throughout the worst period. My third concern, which my noble friend Lady Thornton already raised, is about continuing government funding for research into long Covid.

On public awareness, are the Government satisfied that they are doing enough to raise the profile of the devastating effect of long Covid? Now that the newspapers and media appear to have moved on from covering Covid, the sufferers must feel like the disappeared.

I chair the mesothelioma oversight committee, which ensures that payments are made speedily and efficiently to some of the 3,000 people a year who are dying from mesothelioma. It has a low profile, but at least those diagnosed have the satisfaction of knowing that they and their families will have financial support—thanks to the noble Lord, Lord Freud, when he was the Minister.

Of course, I do not claim that long Covid is a terminal illness for most sufferers. I am grateful to and thank the noble Baroness, Lady Scott of Needham Market, for using the parallel cases of ME sufferers. Awareness, financial support and funded research are vital in all these health areas. What plans do the Government have to raise awareness and enable families to feel supported?

Secondly, on the economic and employment implications, I am aware that the National Institute for Health and Care Research is doing some research into economic evaluation, but does the noble Lord have more information about the impact on health workers? How many are affected, and in what areas? Given the number of vacancies in the health service, surely a focus on the recovery of these workers as speedily as possible would pay dividends.

The BMA said that doctors who had contracted long Covid had been let down by the Government’s failure to provide adequate support, with staff faced with a premature return to work—assuming they are physically able to—or with being unable to pay their mortgages. We know that 2,100 health and care workers lost their lives due to Covid-19, and at least 199,000 NHS workers are living with long Covid. They are seven times more likely to have had severe Covid than other workers, and much of this took place with no or inadequate PPE.

Temporary staff or locums have already lost their jobs because they did not have job security. Does the Minister know how many formal absence procedures have been initiated in the health service, and how many people have been dismissed due to long Covid? We still do not appear to know the extent of the loss to the labour market. The noble Lord, Lord Bethell, also broached this. The Resolution Foundation stated that it could be 600,000. The Institute for Fiscal Studies estimated that it was one in 10. It is clear that the majority are not getting enough help. NHS England data suggested that, up to August 2022, only 60,000 people suffering from long Covid had been assessed by an NHS specialist. If the 600,000 figure is correct, the gap is concerning.

This brings us back to the questions of awareness and profile. The patient does not know that they can get help, and the GP does not recognise the symptoms. Either way, there is a huge job to do. What role do the Government have in improving the position?

The Chief Executive of NHS England, Amanda Pritchard, said recently:

“The NHS faces the toughest winter of my career and potentially the toughest winter in its history.”

This does not sound like someone expecting adequate support from the Government.

In the paper, Our Plan for Patients, published by the DHSC in September, the then Secretary of State, Thérèse Coffey, said that

“this Government will be on your side when you need care the most.”

This sounds fine, but there is no reference to long Covid in that paper.

Finally, what assurances can the Minister give about the Government’s continuing funding for research? I am aware that the NIHR is conducting 19 studies. Ten years ago, I was an independent member of one of its sub-committees, but I no longer have that link. Many of these pieces of research are still in progress, but some themes are emerging. Mesothelioma was underresearched for decades. Will the Minister guarantee that this will not happen with long Covid?

My Lords, I join other noble Lords in thanking the noble Baroness, Lady Thornton, for having secured this important debate and for the very thoughtful way in which she introduced it. I declare my own interests as chair of King’s Health Partners, chairman of UK Biobank and an active researcher in the field of thrombosis, a particular pathophysiology that has both impacted acutely on Covid and may have some role in long Covid symptoms.

We have heard that some 2.1 million people—some 3.3% of our population—have self-reported, as part of the ONS data collection programme, symptoms attributable to long Covid. It is striking that some 500,000 of those individuals reported having had Covid some two years previously. This represents a substantial, ongoing, chronic burden of disease. We should all be conscious of its potential impact on the way in which we are able to deliver healthcare through the National Health Service.

As we have heard, little is known about the etiology of long Covid. There is a suggestion that part of it may be attributable in some individuals to a failure to properly clear the virus from their bodies. It is also possible that there are genetic determinants that drive individual immune response and that this dysfunction is part of the explanation for long Covid symptoms. There is a now well-established phenomenon of dysfunction in the microvascular and endothelial cells that line blood vessels, which may be responsible for some of the long Covid symptoms. Indeed, a profound hypercoagulable state—a tendency to a risk of thrombosis and blood clots—manifests itself in an important number of long Covid patients.

We have heard of the importance of research in trying to understand more about the etiology of long Covid and to better understand its history. This is critically important if we are to be able not only to research and develop new therapies but to address the question of long Covid through the mechanisms underlying its development and sustained impact. This research is also critically important in understanding how we should properly develop services to manage patients. At the moment, His Majesty’s Government have committed some £194 million to the provision of clinics and services to manage Covid patients—some £90 million of which is to be spent in the financial year 2022-23. However, when one looks at the burden, this resource is only able to provide services for some 5,000 patients a month. The substantial demographic of long Covid is running into many hundreds of thousands, if not millions, of people. We clearly need to understand from prospective research not only what volume of services is needed but how those services should be constructed, based on our knowledge of the natural history of the disease, in order to adequately and properly manage the requirements of those patients beyond symptom control.

Is the Minister content that the approach to research is sufficient? As we have heard, some £50 million has been committed by the Chief Medical Officer to a variety of research programmes. Is he able to address the question, raised by the noble Baroness, Lady Thornton, of why a national cohort has not been established to allow us to marshal the current clinical burden of long Covid in our country and then to apply an appropriate methodology and protocols to the evaluation of these individuals? Research undertaken in this systematic fashion is not only highly efficient but provides the best opportunity for us rapidly to understand and start addressing the questions that need to be addressed if we are to be able to develop these new therapies and organise and deliver services in the most appropriate way for these patients.

Beyond the financial commitment to the development of a long Covid research cohort, there is also the need to ensure that the data collected through routine exposure of these patients to NHS services can be marshalled to inform the research effort. Those data should be able to link with other datasets whose huge value in addressing acute Covid and in the post-infection period has been established. I reiterate my interest as chairman of UK Biobank, which has been used in this regard. It is a unique resource, available to the country, where half a million of our fellow citizens have provided their biological material. The genome in those individuals has now been mapped and the opportunity exists to interrogate the dataset, using that biological material, to assess novel biomarkers and the prevalence of disease. The deep phenotyping and repeat imaging give the capacity to understand structural end organ dysfunction in Covid. All this requires an approach from His Majesty’s Government with regard to data sharing, within and across datasets, between researchers in different institutions and, as we have heard, with those outside the public sector wishing to support this research. Is the Minister able to provide some reassurance on this?

My Lords, I too thank the noble Baroness, Lady Thornton, for securing this important and timely debate.

I will focus my remarks on the rural dimension of long Covid, which is having an impact on many people in Devon where I am privileged to serve. I am concerned about rural sustainability and the need to ensure that the Government’s levelling-up agenda is not focused exclusively on urban deprivation. Rural poverty may not show up on government statistics because it is dispersed in pockets, but it is just as real. Research suggests that structural inequalities, including poverty, are important in the development and course of Covid-19 and may form an important context for long Covid.

As far as Devon is concerned, the picture postcard view of my county beloved by holidaymakers is only half the story. The best information we have is that there are currently around 16,000 people living with long Covid in Devon and, as I am sure the noble Baroness, Lady Watkins of Tavistock, will corroborate, it is impacting on the economic life of our county.

As in other parts of the United Kingdom, we know that the groups most likely to be affected by long Covid are people between the ages of 35 and 69; women; people living in more deprived areas; those in care; those with a high body mass index; those working in close-contact professions; and those living with long-term health conditions. Of the 16,000 people in Devon living with long Covid, only around 70% have been referred to long Covid treatment services. Research has revealed that children, older people, men and those living in deprived areas are less likely to seek help and be referred.

The pandemic has impacted people’s health and self-confidence, well-being and the demand for services. It has had an adverse effect on mental health, with higher levels of mental health anxiety and loneliness. For those suffering from long Covid, unsurprisingly, research has revealed that they have lower levels of life satisfaction and happiness, and some have lost hope of change or improvement. Overall, the pandemic has had a greater impact on those groups already suffering from greater disadvantage and higher health inequities than average across the county. In Devon, service providers have reported increased demand for mental health, domestic violence, and drug and alcohol support services. There have also been increased concerns over the safety of children, young people, and vulnerable adults.

Sadly, young people in Devon reflect the national picture, with a significant rise in child obesity during or after the lockdowns, especially among boys and those living in the most deprived communities. The noble Lord, Lord Dubs, highlighted that in his Question this morning.

The picture is not all negative. I am immensely proud of my county and the resilience of many rural communities, much of it, I am proud to say, fostered and supported by local churches.

However, one particular concern in Devon is the impact of long Covid on the workforce. National research shows that before contracting Covid-19 and then developing long Covid, two-thirds of respondents had been working in front-line jobs such as hospitality, schools, care homes, childcare, emergency services, retail, transport and delivery. Most respondents believed that they had almost certainly, 41%, or very likely, 18%, caught Covid-19 at work, pointing to the lack of PPE and the direct contact with Covid-positive patients. As one researcher commented:

“Key Workers are overwhelmingly paying the price of workplace Covid-19 exposure with loss of health, loss of employment and loss of income.”

As we move into winter, this is really serious.

This national picture is exacerbated in rural counties such as Devon. One of the problems facing the countryside post Brexit has been the shortage of workers, both in the care sector and agriculture. Not only is there a smaller population in rural areas from which workers are drawn but, on average, they have to spend more time travelling to and from their jobs or, in some cases, between jobs. Because long Covid disproportionately impacts lower-paid women in front-line roles, this has made it more difficult to recruit suitable staff in the countryside. This shortage is now being seen in many rural businesses in Devon, especially in the hospitality sector, which are closing for the winter period due to lack of staff and higher energy bills.

In conclusion, therefore, I ask the Minister: what research is being undertaken to assist the medium and long-term effects of long Covid, specifically in rural communities?

It is a pleasure to follow the right reverend Prelate the Bishop of Exeter, whom I know well and whose speech I completely concur with. Happily, mine does not completely reflect it. I also acknowledge the work of the noble Baroness, Lady Thornton, in getting this debate for us to consider today.

I will particularly highlight the challenges of long Covid on mental health services, healthcare staff and children’s education and health, and therefore need to declare my interests as a registered nurse and president of the Florence Nightingale Foundation.

I note that the lack of consistency on the definition of long Covid makes it difficult to measure and analyse the emerging evidence. Despite this, the NIHR estimates that 1.8 million people in the UK—as others have said, 3% of the population—are experiencing symptoms of long Covid. Its studies published in 2021 showed that up to one in three people who have had Covid-19 report long Covid symptoms, and up to one in seven children. The scale of chronic ill health and disability after Covid-19 has been described as the next big global health challenge. I am not sure that it is the next big one; I think it is the immediate one.

According to the NIHR’s survey of 3,286 people with long Covid, 71% said it was affecting family life and 80% reported that it affected their ability to work. The Ulster University survey of 3,499 healthcare staff demonstrated that 49.3% felt overwhelmed by pressures of the pandemic, with social work and nursing the most impacted.

NHS Check, a study by King’s College London—where I must declare I have a visiting chair—looked at 18 partner NHS trusts and found high levels of distress and symptoms of anxiety in staff working in healthcare. A concerning finding was that there was a high prevalence of PTSD symptoms and self-harm. This has caused long-term absence of staff due to Covid-related sickness, resulting in people at work carrying out jobs out of their skill set and/or being overworked. It is reported that these issues have directly impacted the quality of care and waiting times and, in extreme situations, have led to unsafe practices. Dissatisfied patients have resulted in increased abuse towards healthcare workers, exacerbating their exhaustion and anxiety levels. Those on long-term sick-leave have suffered isolation and financial difficulties, intensified by the recent soaring cost of living, leading to further distress and longer absences from work, and some healthcare workers have lost their jobs due to long Covid.

The impact of staff shortages from long Covid has also led to a breach in some patients’ human rights: namely, the illegal detention of patients. Last week, the Independent reported that mental health patients were being held “unlawfully” in A&Es due to shortage of staff to undertake timely mental health assessments. I must stress that I believe that that has been to protect their safety, but none the less it is a severe problem.

The effects on our children are highlighted in Ofsted’s second report on the impact of the pandemic and school closures. It demonstrates that children have regressed in basic skills, physical fitness and learning, particularly those whose parents were unable to work flexibly—including, of course, health workers. Children were found to show increased signs of mental distress, including a rise in eating disorders and self-harm.

Social isolation and greater exposure to family conflicts have added to children’s mental ill health, leading to an increase in the number of referrals to CAMHS, which has not been matched by an increase in investment in children’s services. A large study by the NHS in 2020 found that mental health conditions among children had risen by 50% compared to three years earlier. I think that will be even higher in the next piece of work on that issue. It is sad that Baroness Sally Greengross is not here to argue for intergenerational fairness on this issue.

These academic studies have shown major organisational changes across the NHS, with substantial physical and mental health challenges for NHS staff and other care workers during the pandemic. Results also indicate the importance to support staff so that they can contribute to service recovery. Therefore, can the Minister explain the Government’s position regarding the implementation of the proposed 10-year mental health and well-being plan for NHS staff and, in particular, the investment to support staff with long Covid?

Will the Government make further contributions to NIHR for global collaborative research to increase our understanding of long Covid and its impact and, in particular, to generate evidence-based interventions that may enable the health recovery and mental resilience of staff impacted by long Covid and support them to return to work, thus ensuring their retention in healthcare practice?

My Lords, I thank my noble friend Lady Thornton for having secured the debate, to which I am very pleased to make a short contribution. There will be many tens, if not hundreds, of thousands of people and their families up and down the country who will be grateful to her for having given them the opportunity to have their experiences of what we call long Covid both explored and legitimised. Many interesting points have been made in the debate. I was struck by the reference of the noble Lord, Lord Bethell, to the economic impact, which is staggering and a point to which I will return. The House may know that there was a debate in the other place about long Covid six months ago, so it is high time that we had our own debate here today.

My first main point is that the outcome of the debate will be, I hope, that we agree on the need: for more research into all aspects of Covid, including long Covid; and to explore the link that may exist between long Covid and the recent exit from the UK workforce of so many people. I remind the House that it was the brilliance of scientific research, including research conducted in this country, that enabled the vaccines to be developed from which we have all benefited. Now we have the challenge of long Covid. One way of thinking about it is to say that it is the persistence of symptoms in those who have had, and thought that they had recovered from, Covid. It is interesting that the majority of people with long Covid are PCR-negative, which indicates microbiological recovery, although the chronic symptoms extend beyond 12 weeks. In other words, long Covid is the time lag between the microbiological recovery and the clinical recovery.

By May or June last year, some of the most commonly reported symptoms included the following: fatigue, cough, chest tightness, breathlessness, palpitations, myalgia, and a difficulty to focus. I will illustrate that with some direct evidence that I have received from long Covid sufferers. A person who fell ill with Covid in the first wave in 2020 wrote:

“I was knocked sideways by it. I have never been so ill.”

They were

“bed-bound for 2 weeks, coughing badly for 2-3 months thereafter. Feeling weak and frail.”

Now I want to introduce your Lordships to the concept of brain fog. Let me again use the words of another sufferer:

“Brain fog came on insidiously after an initial period of recovery. Unaware of it at first, but slowly it engulfed me.”


“had no name for what was happening … for a long time”,

and it was a

“relief when others started naming it and talking about it”.

This is where today’s debate comes in. It will be very helpful for people to know that their symptoms are being recognised. I have received a long list of some of the symptoms, which I am sure that many of your Lordships will recognise: the inability to write or concentrate; a short attention span, forgetfulness, memory loss, word lapses, sleep problems, eye problems, balance problems; a terrible sense of brain congestion, of which one person wrote that it felt

“sometimes as if my head would split”;

exhaustion, weariness, and others. Someone said:

“My vocation is gone and I am unable to write. As though a door has shut in my brain and I cannot work.”

Another mentioned:

“A desire to flee from company and crowds. I now avoid outings where possible. I am de-coupling from life.”

It is worth noting that many of those who suffered from long Covid did have vaccinations and boosters.

I understand that some people have taken private action to secure the drug ivermectin and that it had a beneficial effect in some cases, albeit for a short time. I mention that because I tabled Questions to the Minister’s department earlier this year about that drug, and I would be grateful to know what the department and Minister’s current views are about it.

This is not the debate in which to refer to the cuts in public expenditure announced by the Chancellor in another place while we have been sitting here, but of course cutting back on science research would fatally undermine research efforts. I hope that the Minister will be able to reassure the House today that the Government will protect the £50 million that is being invested in long Covid, as set out by the National Institute for Health and Care Research. As I understand it—I am grateful to the Library for this information—the NIHR has published its latest themed review, entitled Researching Long Covid: Addressing a New Global Health Challenge, in which it refers to: three studies considering who gets it and why; two studies looking at the biological causes; three studies looking at the diagnosis; four studies evaluating treatments; three studies considering recovery and rehabilitation; one study looking at the impact of vaccination; and two studies looking at how health services can treat the condition and the health and economic costs of the disease.

That brings me to my second major point, which I will have to truncate. What is the link between long Covid and the people who have left the workforce? As has been referred to, the Office for National Statistics has published several articles. Time does not permit me to give all the details, but it is clear that a huge proportion of those in the age bracket of 60 to 65 are unlikely to return to work, and the pandemic has affected decisions to leave the labour market. The report published in July 2021 by the ONS listed some of the major reasons that workers cited for not returning. Research by the Health Foundation indicates that economic inactivity in the UK has increased by about 700,000 people since before the pandemic. That is an absolutely enormous number, and the cost to the UK will be very great. It seems as though we are living through a pandemic of inactivity, as it were. The Health Foundation report concludes that

“these contributing factors are exacerbating a pre-pandemic trend of the increasing prevalence of poor health as a reason for inactivity”.

I will end there. We certainly need more research, and I hope that this debate might have what I might call a catalytic effect both on the discussion of long Covid and on the reply from the Minister.

My Lords, I am glad that the noble Baroness, Lady Thornton, asked for this debate, and I applaud her comprehensive introduction. When I asked an Oral Question on this topic on 23 May, I cited a figure of

“1.1 million sufferers of long Covid in the UK … unable properly to undertake day-to-day activities as a result of their condition.”—[Official Report, 23/5/22; col. 656.]

That ONS figure now stands at 1.6 million—the figure is in the excellent Library briefing—and a total of over 1.1 million have been suffering for more than a year, so this is a growing problem. Even though we may be over the worst of Covid as a life-threatening disease, at least for now, a significant minority of those who contract Covid continue to develop long Covid. It is a debilitating illness for the individuals concerned, and its extent represents a wider social problem that the Government need to take seriously.

Many of us know people suffering from this condition, professionally or as friends or relatives. My concern in this debate is what can be done better for those who are suffering, from their own point of view. I thank those with long Covid to whom I have talked about their situation. One friend—under 60 with no discernible underlying conditions, and living in rural Hampshire—contracted Covid in September last year. As symptoms persisted, the GP said that she would be referred to a long Covid clinic in two to three weeks, but that happened only 10 months later, with nothing happening in between. Hers is by no means an isolated case. As the Minister will appreciate, this is not just about the waiting time to get to a clinic, crucial though that is; it is also about what happens up to that point. So I ask him: what is being done to help upskill all GPs, and what can be done as soon as a patient contacts a surgery? What can be done to better signpost the support that a patient requires at an early stage? Indeed, what can be done to ensure that those who have long Covid or suspected long Covid contact a GP in the first place?

My friend tells me that, ideally, the GP should have said, “Stop work completely. I’ll fill in a sick note. Come back in four weeks and we’ll keep an eye on you”. This is with hindsight, of course. She believes that, if she had been set on the right road and been monitored from the off, she would be much further down the road to recovery. She would also have missed much less work. As it is, over a year later, she can still do at most only two days of work a week.

Her main symptom is fatigue, in line with 70% of the 1.6 million that I have cited. This is not just about not being able to climb a hill; it is about not having any energy to do anything for a period of time. Of course, many people’s stock reaction to this, sufferers and non-sufferers alike, is “Carry on regardless, try to take more exercise”—one very good reason why long Covid should be treated professionally as quickly as possible.

Additionally, addressing these concerns will avoid in toto a significant loss to the economy, as others have pointed out. The Government need to take a significant note of that. There must be faster access to long Covid clinics, as the noble Baroness, Lady Thornton, said. Clearly there is still a postcode lottery about referral. Many more clinics need to be put in place across the whole of the UK, to decrease waiting times and to ensure that everyone has the same level of access, which continues to vary hugely across the country.

Fortunately, my friend now has a case manager, a qualified physiotherapist who can refer her to different services according to the symptoms displayed. We know that a multitude of symptoms are exhibited by sufferers, so there is the respiratory team, the occupational therapy team and so on. The problems do not stop there, though, in terms of delivery, because there are also difficulties in accessing those services, as has been pointed out. Can that be looked at, as well as the priorities over access and the funding involved for long Covid patients? One good thing in my friend’s case is that meetings with her case manager are through Zoom. Travelling is very difficult for long Covid patients.

Such is the demand for treatment and the slowness of NHS provision that there are now heavily subscribed private online programmes of treatment. People are desperate but there is a question over whether these services are a substitute for those services referred through the NHS as part of what, ideally, should be a complete and integrated programme of recovery. I say this as an open question.

In an informative video on YouTube, one sufferer, Gez Medinger, sums up what many sufferers experience when he says, “It takes every aspect of your life and pretty much crushes it”. The Government need to do as much as possible to support those with long Covid, as well as putting money into research to beat this condition.

My Lords, I am grateful to my noble friend Lady Thornton for a masterly introduction to this debate. I speak with a little trepidation because I am no authority in this area, but I recognised very quickly what the noble Lord, Lord Kakkar, had to say. His request to the Government about the need for a national cohort is very important indeed, and if the Government do nothing more today, I hope they will at least respond to that.

I approach this from an unusual angle. When Covid started, noble Lords may recall that every day, on the BBC, we saw photographs of the people who were dying. They were mainly old. There was a preponderance of men rather than women. A disproportionately high number came from the UK’s BAME population and 50% of those dying were overweight. My noble friend Lady Thornton knows that I have laboured on this subject for a long time. I and others noticed this. The research findings then bore out that there was a categorisation in this form—the research backed it up. The Government then decided that they had to do something about obesity and very quickly produced their 2021 strategy, as these underlying causes were substantial contributory factors.

We had higher death rates in the UK than the rest of Europe. Our numbers led the field for a period. Put me right if I am wrong, but I think we have performed particularly poorly. We did extraordinarily well with the vaccines, but the death rate was very high indeed. We are generally seen as one of the unhealthiest nations in Europe, part of which goes back to obesity, again linked with Covid. I have not read Covid-19 and Occupational Impacts, only glanced at it, but some important information there relates to the BAME community and sheds light on the problem there. However, I cannot find out whether there are any common factors on a substantial scale that can be identified within people with long Covid.

For example, I know people who have got long Covid who are overweight. They were overweight before, so they had an underlying cause and they were at risk. They continue with long Covid, yet they have a continuing problem with their weight. This is a difficult subject but we must address it honestly and straightforwardly. If there are continuing underlying factors not dissimilar from the problem in the first instance, we must acknowledge them, look at them, give support and assistance in those areas, and not run away from some of the difficulties that may be around. In this country these days, we run away so much from some of our underlying problems. It is too difficult politically and too sensitive to address them on head-on.

I am speaking marginally out of tone with the rest of the debate. I have just as much compassion, but it is important to have a frank and honest debate on this topic. I express my gratitude again to my noble friend for the opportunity to speak up and fully debate the topic before us. It is a very big one, which may be repeated elsewhere with other issues that come along later. I would be grateful if the Minister could tell us whether we are performing badly compared with the rest of Europe—whether we are getting more cases of long Covid than elsewhere. Are we doing better or less research than elsewhere in Europe? I pick up from the noble Lord, Lord Bethell, that the evidence indicates that we are leading the field in the research, which is good.

Fundamentally, we must keep coming back to prevention in the first instance. Until we make our country healthier, we will not be in a position to meet all the problems that will come with climate change, new diseases and unforeseen issues. If we are healthier in the ill to come, as we face it, we stand a much better chance of doing better next time round, with fewer people left with a continuing illness than we have at the moment.

My Lords, I apologise for having to be virtual this week. I thank the noble Baroness, Lady Thornton, for this debate, with a very special “thank you”.

I am a member of the All-Party Group on Coronavirus. On several occasions we have taken evidence on long Covid. On the last occasion, three ladies gave us evidence—a doctor, a teacher, and a train driver. All would like to be working, but it was impossible. Long Covid had struck them so badly that they were unable to leave their houses and fatigue and brain fog had taken over their lives. One of the ladies said, “We are the forgotten”. I said, “No, you are not forgotten”. That is why my “thank you” to the noble Baroness, Lady Thornton, for having this debate, is so special.

Recently, I met a doctor at a BMA dinner who is doing research on long Covid in Birmingham. I asked him how he found long Covid, and he wrote to me, stating:

“I have been reflecting on the challenges I am facing in both my roles as a clinician and researcher in long Covid. One of the biggest issues for me personally is the definition of long Covid. It is necessarily broad, given that we do not fully understand it, but it includes such a heterogenous group of patients that the diagnosis has limited use for patients. As a result, it is also very difficult to design studies to understand it better. Funding for specific research to address this would benefit the community greatly.

Pragmatically, my experience of the long Covid services has been good, though I should emphasise I only have experience with one centre, and I am fully aware that across the country services are patchy. We have been fortunate locally to have rehabilitation experts who have joined the team and made a positive contribution”.

Services are patchy across the country in respect of so many health issues. People living in rural areas should not be forgotten, as the right reverend Prelate the Bishop of Exeter said. The key messages from the APPG on coronavirus are that long Covid is having and will continue to have a significant impact on both the UK’s health and economy, that Covid-19 must be recognised as an occupational disease, that a compensation scheme must be put in place for key workers living with long Covid, and that a comprehensive long Covid care system must be established to tackle the significant burden that it will continue to place on the NHS.

Long Covid impacts significantly on the UK population and will continue to do so, including on the UK workforce in both public and private sectors. Many of those living with the acute health challenges presented by long Covid were initially infected as a result of work they did during the pandemic on the front line—caring for patients, educating children and continuing to provide vital transport services—yet support from employers and indeed the state is hugely variable.

The APPG has heard of long Covid’s devastating impact on children. Long Covid can have a significant impact on children’s education as a result of lost learning, and the level of support offered by schools to pupils and to parents of pupils living with long Covid is extremely variable. The APPG has heard that

“children experience a wide range of Long Covid symptoms, and that these symptoms can differ from those displayed in adults”,

yet there remains little research into treatment or specific care pathways for children. Without such research, long Covid will continue to impact the health and education of those children living with it.

There should be government guidance on long Covid across the country for GPs, employers, private and public services and the public at large. Some GP surgeries do not want to be involved, but patients only want to know where to go for help.

I am just about to finish. They need directions—not to feel forgotten and not worth advising. Does the Minister agree?

We need compassion at this difficult time across the country. We need to solve the mystery of why some people develop long Covid and others recover without complications, and to take any similarities into consideration.

My Lords, I thank my noble friend Lady Thornton not just for making this debate available to us but for her having demonstrated stamina beyond the normal in the way that she has fronted for this side of the House—indeed, I think she has spoken for Members across the House—during the entire troubles that we have been through with Covid. Covid may have a long form, but those who speak about it and remind us of its importance can also have a long form, and I thank her for that. I also pay tribute to our friends in the Library for their briefing note, which is truly extraordinary and has been mined by many of us in the speeches that have been made.

The noble Baroness, Lady Scott of Needham Market, has drawn attention to the way that ME played out through chapters of misapprehension and wicked neglect through its course, until we got on to more certain ground. I might add dyslexia as another condition that suffered from not having adequate analysis or forensic understanding, which led to its own misapprehensions.

All that leads me to focus my intervention on the first of my noble friend Lady Thornton’s points: the need for data—the need for an adequate basis from which to draw empirical and helpful conclusions. In pressing the Government, and my noble friend is certainly not the only one who has done this, we must almost insist, if that is within the bounds of the conventions of this House, that the Government really give us an answer on that one: how do we get the evidential basis upon which we can draw reasonable conclusions? I heard from the noble Lord, Lord Kakkar, who is not in his place at the moment, a suggestion that concrete ways of responding were available, although they might need to be enriched and all the rest of it. It is urgent that we have that evidential base, for this is something that we must know more about scientifically.

I have a son who went down with all the symptoms that my noble friend Lord Stansgate mentioned, and was laid flat out for months. He has made a good recovery so that is a possibility, but I have to say that his family live with the possibility that it may recur. Again, that emphasises the need to understand this disease better than we do currently. I have to say—and a father would only want to do this—that in my son’s recovery he played a key role in the way that the funeral of the late Queen played out. He works for Westminster City Council, responsible for their street management. He resourced the queues and cleaned the streets once the horses had left their hallmark, and did all the things that were unseen.

However, I have another son who has not had Covid but Covid has had him. He has a small business that collapsed the day that lockdown started, and he is reinventing himself all the time. Long Covid, in an economic and personal way, is not related to the disease in the bloodstream or whatever it is but is playing itself out in as insidious a way, and the economic outcomes have to be borne in mind. Meanwhile the marriage of my daughter—who lives in France—did not manage to survive lockdown. Once again, those things happened as a result of Covid, and there is an ongoing realisation that we have to cope and deal with it as best we can. Long Covid in its clinical phase of operation and understanding, together with its outcomes in personal and economic life, all need to be held together.

One thing is certain in my mind as I draw my remarks to a close. The noble Baroness began by saying that Covid is still with us, and the worry is that it might recur when we thought we had cracked it. On a lighter note, I have to say that I went down with it once. The symptoms were mild but it was on my significant birthday when I could not finish my salmon steak or my glass of wine. So I have a real grudge against Covid, and I hope that will be taken into consideration.

My Lords, I applaud the noble Baroness, Lady Thornton, for bringing forward this incredibly important debate and for her outstanding introduction to it.

Long Covid is undoubtedly a serious challenge for the NHS and, as the noble Lord, Lord Bethell, said, for the economy, and a devastation for about 1.5 million people across the country. My principal reason for speaking in this debate is a concern that, for reasons that I simply do not understand, the chronic fatigue syndrome that too often results from the Covid virus is not linked in doctors’ minds, or indeed in many other minds, to the chronic fatigue syndrome that can be triggered by other viruses, and from which more than 1.5 million people suffer and have suffered for many years.

The principal symptom of chronic fatigue syndrome, as we know, whether it is triggered by Covid or by some of the virus, is extreme physical and mental tiredness that does not go away with rest or sleep. Sufferers find it difficult to carry out everyday tasks and activities and, as others have mentioned, too often they cannot work. This applies to the 1.5 million or more people with chronic fatigue who have had it for however long—for years, in many cases—and to those with chronic fatigue from Covid. They are exactly the same.

Other symptoms, as other noble Lords have mentioned, may or may not include muscle and joint pain, headaches, flu-like symptoms or feeling dizzy or sick. Covid-triggered chronic fatigue may also include a loss of taste and smell, and that is a slightly misleading piece of the jigsaw. In the main, chronic fatigue triggered by Covid and chronic fatigue triggered by another virus are indistinguishable other than by this rather weird issue of the loss of taste and smell. Does the Minister have any evidence to suggest that these two chronic fatigues that I have mentioned are in any way distinct, other than in this little piece, which I think is just a separate element of the consequences of Covid?

As someone who will have asthma for the rest of my life as a result of Covid, I also experienced a complete loss of taste and smell for several months after Covid. I am not just being self-indulgent; there is a point to bringing this in. It seems clear that the loss of taste and smell following Covid should be regarded as separate from chronic fatigue and separate from asthma or any other post-Covid illness. The fact that post-Covid chronic fatigue sufferers may lose their taste and smell should not suggest that it is in any way different from other post-viral chronic fatigue syndromes. They are surely identical, and medical treatment and research should focus on all types of chronic fatigue syndrome, including Covid related CFS. We know there has been a lot of money devoted to research because of long Covid; it is crazy for that money and research not to include other causes of chronic fatigue. It just cannot be right.

I very strongly welcome the focus of the noble Lord, Lord Bethell, on the alarming economic consequences of long Covid. Again, the economic consequences of chronic fatigue, whether triggered by Covid or any other virus, are eye-wateringly large. Urgent attention, both medical and in research, should be given to the prevention and treatment of chronic fatigue, however it is triggered.

I raise this issue in part because in the past chronic fatigue sufferers have experienced the most unpleasant stigma from doctors and others who tended to take the view that chronic fatigue was in no sense a physical illness, just something in the mind. Clearly, post-Covid chronic fatigue syndrome is acknowledged to be a physical response to Covid with a deeply unpleasant set of symptoms. It would be very helpful if the same understanding were applied to CFS triggered by other viruses or events. I will be grateful if the Minister can respond to this point, and to the important economic concern raised by the noble Lord, Lord Bethell, in his summing up.

My Lords, I join those who have congratulated my noble friend on, and thanked her for, introducing this debate. I am sure that she is very pleased with the expertise we have had in the House today, which shows the kinds of contributions we can make to furthering issues of this kind. I am not an expert on health matters in any way, but it has been striking how significant the big picture of the problems facing everyone is, and we should all be aware of the difficulties that are being created.

The estimates we have heard about are of 2 million cases or more, because it is self-reporting. It means that this is a very significant problem both for individuals who are affected but also for society and, as the noble Lord, Lord Bethell, was saying, for the economy as a whole. Long Covid affects the individual, but it also affects their family, friends, employment, society as a whole and the economy, as we have heard. The cases we have heard about show the extent and range of problems that are involved. I was struck by the BBC today talking about a young girl in the north-east who had missed virtually two years of education because of long Covid, which obviously affected the whole of her family.

We have heard today about key workers in particular who have had their lives turned upside down. It has been difficult for them as individuals and for their families, but it is also a great loss for all of us if they are not in the National Health Service participating as key workers. The fact that many are not able to return to work is a very significant problem for us all. I listened to what was said about medical research. I think we were all very struck by what the noble Lord, Lord Kakkar, said, and I hope the Minster can accept that that is a particular way forward.

Regarding the impact on the economy and society, I want to pick up what my noble friend Lady Thornton said about the need for employers to have better guidance on how they should react. I would like to know more about what is happening here, because we are suffering very significant skills shortages in many areas, which is holding back our economic progress. The fact that individuals vary in how they are affected by long Covid needs to be more widely understood. Somebody may be okay one day but not the next, which is not easy for employers to deal with. The need for greater flexibility on employment is important, but we also need co-ordination across government.

Turning to the impact on individuals, the situation seems to be extremely varied. Early on, there was probably a lack of understanding by medics and others, but many people who suffer from long Covid, as was being said on other illnesses, find that doctors and medics generally vary in their understanding. Some people feel that it is very difficult to be taken seriously for problems of this kind. The idea of a post-Covid assessment service is clearly very welcome, but it is concerning to hear that over a third of the people who need that service must wait for several months—and that is not months since they first got Covid but months since they first realised that there was a longer-term problem. So we need to get a grip on that difficulty.

The right reverend Prelate referred to issues in his area, where only 17% of people were getting access. The issue of a postcode lottery in any area of health is a problem—and it certainly is here—as is the difficulty that sometimes arises with statutory sick pay. Not all people are entitled to it, and people tend to go back to work because they have no option and need the money, which can lead to longer-term problems in the end. So we need some better co-ordination on the part of government to ensure that everybody is covered.

I will raise two particular points with the Minister. The first is the fact that Covid is not over, and I worry about complacency settling in on this issue. Mention was made that, in the early days, it was in the media all the time, but now it is hardly ever mentioned. People are not coming forward for vaccinations as much as they should. We do not know what the next variant will be or when it will hit us, and the Government must be prepared to step up their game to make sure that we do not become too complacent.

Secondly, the current Chancellor of the Exchequer was chair of the Health Select Committee and, if the Minister looks up the tweets and statements made by Jeremy Hunt when he had that role, he will find many quotes that the department can use to get leverage for extra funding in this area. So I recommend that he does his homework on the present Chancellor of the Exchequer; his department might find that very useful.

My Lords, I declare my interests as chair of University College London Hospitals NHS Foundation Trust, chair of Whittington Health NHS Trust and a member of the North Central London Integrated Care Board, as well as other interests stated on the register. I am most grateful to the noble Baroness, Lady Thornton, a wonderful fellow non-executive director at Whittington Health, for securing this debate. I too am very grateful to the Library, which has been hugely helpful, and I am enormously grateful to all other speakers, because most have said most of what I was going to say.

I have a very specific point. At UCLH, we a run a well-known and much-admired long Covid service, which is led by the remarkable Melissa Heightman, who is also a national specialty adviser for NHS England and the co-chief investigator for the STIMULATE-ICP study, the largest long Covid trial to date. We know that the service is desperately needed; we have heard that all around the House. Those who run this particular service are working night and day; it does not have the resources to do what is needed, to the extent that those who run it are begging for bits of resource from elsewhere, mostly for people. So short is the service of staff that they recently asked UCLH Charity to fund an extra consultant for two years, which it has agreed to. I am well aware, as we all are, that today is the day of the Autumn Statement and that times are tough, but it is really serious when an NHS trust with a £1 billion turnover has to ask its charity to support an on-the-ground service led by the national lead, even for a limited period of time—particularly for a service designed to help other NHS staff across London.

Worse still, as other noble Lords have said, some 10% to 14% of reported cases are NHS staff. Although we all know that, it is not generally known among the population—but it is not really surprising, given the higher exposure to the virus that they all had. What a difference getting them well and back to work would make to the cash-strapped NHS and to the challenge over staff numbers. We have real trouble in recruiting and, as others have said, we have people leaving the service.

Can I personally endorse what the noble Baroness just said, in particular her testimony on Melissa Heightman and the team at UCLH? I had extensive dealings with them as a Minister, and their work is absolutely first class. I am heartbroken to hear that they are having to reach to charity for financial support.

I am extremely grateful to the noble Lord, and I shall make sure that Melissa knows about that.

Meanwhile, we have all the figures that everybody has cited, and the ONS has reported that long Covid has adversely affected the day-to-day activities of 1.6 million people—that is absolutely huge, and other noble Lords have mentioned that fact. The NHS has tried to help with that ongoing issue but, unfortunately, not enough. I want to go through that, because I think that it is relevant.

In October 2020, NHS England announced a five-point plan to support long Covid patients; it commissioned NICE to develop new guidance and established designated long Covid clinics to provide

“joined up care for physical and mental health”.

It also created the NHS long Covid task force to guide the NHS’s national approach on long Covid, and it funded NIHR research on long Covid better to understand the condition. In July 2021, NHS England published its long Covid plan for 2021-22, which included investing £70 million to expand long Covid services and £30 million in the rollout of an enhanced service for general practice, to support patients in primary care. But when NHS England published its updated plan in July this year, the previously enhanced service funding was not continued, so primary care no longer receives any ring-fenced funding for this condition—yet, as we know, it affects nearly 2 million people.

The problem is both insufficient resources to do all the work that is needed and insufficient forward planning to enable those services that do exist to build up capacity, engage in research, recruit, train, educate, and care for patients, including, importantly, the large number of NHS staff who appear to have been affected. We have a major health problem here that is likely to run for many years. Treatment is uneven across the country and research, which will need a lot of funding, is in its early days. This is an additional burden on an already very stretched NHS, both with patients with long Covid and with the large numbers of staff who have it.

What we really need is a properly NHSE-commissioned service to be put in place now, with secure funding for the next several years, even in these cash-strapped times. It feels like a hand-to-mouth, temporarily funded arrangement, so it is really hard to build a resilient service for the longer term. Can the Minister assure this House that such long-term commissioning will now be put in place, given the recent evidence of the numbers of people away from work with long Covid, the huge proportion of NHS staff affected, making other NHS backlog issues worse, the general impact on the UK economy, which others have mentioned, and of course the sheer suffering that long Covid is causing?

I offer warm congratulations to my noble friend on securing this debate and on the way in which she introduced it. She and other noble Lords will know that, by the time you get to this stage of a debate, there is not much new to say. However, I have been listening very carefully, and there is no doubt that there is a great deal of agreement about the fact that long Covid provides a new challenge for an already much-challenged health sector. In listening to the excellent speeches that have been made, I see three main problems about long Covid. There is the issue of recognition and awareness, the issue of treatment, and the issue of its impact.

The first problem seems to be knowing whether you have long Covid or not. The same could be said of Covid itself. When I tested positive for Covid last year, no one was more surprised than I; I thought I had a little head cold, and was astonished to find when I was tested here at your Lordships’ House that I was positive. I know many people have had the same experience. This very uncertainty of knowing whether you have long Covid adds to the anxiety of sufferers. Just this morning, I was speaking to a young man in his 30s who had such awful brain fog, as he called it, after getting long Covid, that he thought that he had senile dementia coming on. I am glad to say that he is now recovering.

This also applies to treatment. There seems to be no agreed accepted programme of treatment for long Covid sufferers and availability of treatment is patchy in the extreme. In many areas, it seems to depend on the chance of finding a sympathetic doctor or nurse. If you have had symptoms for more than four weeks that is supposed to be an indicator, but it is not always accepted that these are the same symptoms and that they are always present, as we have heard many noble Lords mention. There does not seem to be any agreement about that and we are all reminded of the experience of those with ME, which noble Baronesses have brought to our attention. Many people suffered for many years with what was called “yuppie flu”, and it was seen as the last resort of malingers, causing much distress to sufferers.

That brings me to the impact of long Covid. Much has been said about its effect on the labour and employment market. The Institute for Fiscal Studies has been mentioned by many. It said that

“long COVID shows some persistent labour market effects, with impacts being felt at least three months after infection”—

I emphasise “at least”. I remind your Lordships that we must consider these possible effects on the ability to work in the light of the terrible workforce problems that many noble Lords have mentioned, particularly in the health and social care sector. There are nearly 170,000 vacancies in social care alone already, and so many people are burned out and leaving the workforce. If long Covid further affects these shortages, as seems likely, we must be fearful of the ability of the NHS and social care to provide even the minimum care which citizens have a right to expect. As others have said, the need for further research and for action as a result of research already commissioned is urgent.

I must draw noble Lords’ attention to the particular problems faced by unpaid carers in this regard. We all know that many carers have been extremely careful with the possibility of catching Covid and have been shielding for much longer than the general population so that they do not pass it on to the person they care for. From a benefits perspective, people with a new illness, such as long Covid, who are of state pension age, must have evidenced health needs for six months before they can even claim attendance allowance. The cost of being impaired by long Covid will not be offset for this group or for their carer. As one carer said: “My husband may not be able to return to work due to long Covid, so the loss of half the monthly income, coupled with the rise of everything from fuel to heating costs and a new baby, will be devastating for us as a household”. One carer who themselves had long Covid said: “I am a carer who has long Covid and I am on a long waiting list to get help. I have been told that I will most likely have to wait for nine or 10 months before my initial appointment. I asked for my situation as a carer to be taken into consideration but I was told this was not considered as a circumstance that would merit any special consideration.” This is not acceptable.

There is no doubt that long Covid is having a negative impact on our nation, especially on the most vulnerable. We must take it seriously. We must give support in the benefits system, in practical support and in long-term policy around how this is going to affect us in the future. I hope the Minister will be able to confirm that the Government are committed to many of the things that have been called for today—better diagnosis, better collection of data, more consistent messaging and, above all, an understanding of the wide-ranging impact of long Covid on the health, both physical and mental, of our whole nation.

My Lords, I declare my interest as a vice-chair of the All-Party Parliamentary Group on Coronavirus. I add my congratulations to the noble Baroness, Lady Thornton, on securing this important debate. She and I have spent most of the last 30 months in the parliamentary trenches of emergency Covid legislation, Statements and Questions, along with the noble Lord, Lord Bethell, and, more recently, the noble Lord, Lord Kamall. The noble Lord, Lord Markham, does not know how lucky he is to have missed those times.

The speech by the noble Baroness, Lady Thornton, eloquently set out the issues. I thank the organisations, including the Library, that have sent briefings. I also thank everyone who has spoken so far in the debate; there have been many powerful contributions from all around the House. Despite the worry of the noble Baroness, Lady Pitkeathley, that there was nothing left to say, she certainly said many things, including different things, and it is a pleasure to follow her.

I start by taking us back 100 years. The excellent book Pale Rider by Laura Spinney—which both the noble Baroness, Lady Thornton, and the noble Lord, Lord Bethell, have heard me quote repeatedly—shows evidence of excess deaths throughout the late-1920s and 1930s, after everyone thought the Spanish flu epidemic was over. But no one made the connection; all they knew was that there was excess death from cardiac and respiratory disease over a decade. Now, we understand more, of course. I have a key question for the Minister. It is already evident to me that parts of the NHS and many parts of government want to put Covid behind them. Will he undertake to make sure that we do not repeat history and stop learning from Covid, because it is not yet over, as others have said?

The authoritative and expert contribution of the noble Lord, Lord Kakkar, was really helpful. The scientific world is now publishing papers that show the consequences of Covid after that initial infection period. One in 22 will have a major cardiac event within 12 months of having caught Covid and one in five will get long Covid—as we have heard, that is over 2 million people to date. Covid damages the brain. A friend of mine in his 70s and his wife thought that he had very bad rapid onset dementia; last week, he discovered after an MRI scan that it was not dementia at all, but many micro clots in his brain, which were definitely affecting his capacity to think, speak and do physical things. That will be with him now for the rest of his life. Covid also damages the vascular system and the immune system. Variants mean that herd immunity and even one course of vaccines are no long-term solution.

Among the studies published recently is one from Washington University in St Louis. One American commentator, a scientist, says:

“We don’t know everything about long COVID yet, but what we do know is downright terrifying. But you’d never know it if you don’t seek out that information yourself … This pandemic is a mass killing AND a mass disabling event. Long COVID is going to be a defining issue of our times.”

The Americans have a reference system. The US veterans’ association provides a longitudinal study for Covid, and an article in Nature, published in May, showed that, after breakthrough SARS-Covid infection, there is considerable evidence of further and long-term problems. And the more you get Covid, the more likely you are to get long Covid or other serious consequences.

The right reverend Prelate referred to health inequalities in rural areas, and the noble Lord, Lord Brooke, referred to health inequalities for people catching Covid. Interestingly, this was also a major problem in the Spanish flu pandemic 100 years ago. We have that long tail—100 years—but have learned nothing.

My noble friend Lady Scott of Needham Market made a strong and impassioned argument for not falling into the trap of assuming that long Covid is about weakness or psychology. There are still no blood tests to identify long Covid or ME. She and the noble Baroness, Lady Meacher, made the vital connection with other post-viral conditions. Researchers this week are seeking volunteers with long Covid to take part in a study that looks at psychological factors, full stop. After all the evidence that we have heard this morning, that is breathtaking.

If noble Lords have not seen it already, Rowland Manthorpe, the excellent technology correspondent of Sky News, has a long article on the Sky website about his two-year journey with long Covid. It is very moving, including people saying that he just needed to start doing things gently and build up—not the answer. The noble Earl, Lord Clancarty, spoke of the difficulties in accessing appropriate support with GPs. At this point, the questions others have asked about definitive research become really important, but it is not just research; it is ensuring that the training for all our front-line healthcare and clinical staff understands that and they do not stick by the old thoughts.

The noble Lord, Lord Brooke of Alverthorpe, spoke about the high number of deaths in the UK. This was thought to be principally due to late lockdown in the first big wave, if we look at excess deaths, and comorbidities were key. It was not just about obesity, but obesity was among them. Significantly, people with high blood pressure, a history of heart problems or asthma also faced high death rates.

Long Covid definitely affects children too. My noble friend Lady Harris of Richmond, who cannot be in her place today, has spoken often in your Lordships House about the devastating effect that long Covid can have on children, from familial experience. The noble Baroness, Lady Taylor, referred to a young girl from the north-east and her two-year experience of long Covid. Yesterday, Hayden from Elvington in Kent, a previously fit and healthy 15 year-old, told the BBC how his life completely changed after he caught Covid in December 2020. He used to swim and play judo, but now has to use a wheelchair and is largely bed-ridden with, among other things, extreme and severe fatigue.

The noble Viscount, Lord Stansgate, referred to ivermectin. That is a longer debate for another day, but I strongly recommend he reads the one-pager that he can find online where a scientist explains why it should not be used in humans at all—in vitro, possibly; possibly even in cows; but not in humans.

The employment issues are vital. The right reverend Prelate referred to employment stats in Devon and the All-Party Group on Coronavirus also found statistics. The big issues that seemed to affect employees were that Covid-19 was often first contracted in the workplace, especially, as we heard, in professions deemed key and essential workers. As the noble Baroness, Lady Neuberger, said, 10% of those are in healthcare, so it is really shocking that the NHS is now sacking staff with long Covid and when those staff say, “But I caught it at work”, the NHS says, “You cannot prove it, end of case”. That happened to a friend of mine who was a senior midwife and it is appalling that she is now lost to the profession.

The all-party group has received many examples of healthcare professionals who were forced to work with Covid-19-positive patients with inadequate PPE. We have also heard of employers forcing them to work in unsafe conditions and offering no support for return to work, and a growing trend that those with long Covid feel physically and mentally unable to challenge dismissals or wrong PIP allocations. That is a real problem, because it means they are not getting benefits to which they are entitled.

The noble Baroness, Lady Thornton, set out the medical problems. I want to raise another issue. A number of Education Secretaries over the last 30 months have continued not to take account of Covid and long Covid in schools. That is why we have so many children with long Covid, so why are we not following the example of America, where all children are eligible for the vaccine? A colleague of mine, Councillor Oliver Patrick in Somerset, has devised a very cheap ventilator for children’s classrooms. You need only one and it costs about £100 to create, but schools are not getting support to do that and the word is certainly not getting around. So, when we have the next wave, expected in January and February, schools will once again act as a vector for Covid, and arising out of that will be long Covid.

I finish by asking the Minister some questions, some of which have already been asked. We need guidelines for employers, in both the private and public sectors, about how to manage employees who have had Covid. Will the Government undertake a compensation scheme, available to all front-line key workers who have Covid? Will the Minister look at the care system, as the noble Baroness, Lady Pitkeathley, outlined? Will the Government look at measuring, reporting and monitoring the number of people, including children, with long Covid in the UK? Finally, as the noble Baronesses, Lady Watkins and Lady Taylor, said, long Covid is a key part of Covid. Until the long Covid tail is over, Covid is not over. Will the Minister undertake to make sure that the Government act by that?

My Lords, I refer to my entry in the register of interests. I thank the noble Baroness, Lady Thornton, for securing this important debate and all noble Lords across the Chamber for their thoughtful and considered contributions. I will try to do their points justice in my response; where I do not, I promise to follow up in writing.

The pandemic has tested us all in many ways, as I am sure noble Lords agree. Governments and healthcare systems around the world are all facing the same set of challenges in tackling long Covid. Although I am to some extent still “the new guy”, I am under no illusions about how these add to the existing challenges facing the NHS, some of which have already been debated in the Chamber. We have done much already, but I shall not pretend that we have got it all right. We must do more, as was well put by my former colleague, my noble friend Lord Bethell, and many others.

Today’s debate has been wide-ranging, and I will do my best to respond to the issues raised. I will set out what the Government are doing on the serious challenges of long Covid, such as NHS healthcare, research, employment and social support. However, with the presence in this House of so many of the key players in the fight against Covid—my noble friend Lord Bethell and the noble Lords, Lord Darzi and Lord Stevens—it is only right that we first recognise the critical role they all played and the support they gave in the unprecedented global challenge we faced. The country acted decisively and, I think we broadly agree, got the big calls right. We were the first country to administer an approved vaccine and the first to administer a bivalent vaccine for the original strain and omicron, and we had the fastest booster programme across Europe. I pay tribute to my predecessor and all other colleagues for the tireless work they did in that area.

As mentioned by many noble Lords, including my noble friend Lord Bethell, we all agree that prevention is better than cure. It is the best defence. Not only have vaccines been proven to stop serious illness, but—I accept, more anecdotally—they are thought to reduce the risk of long Covid. As we all know, we have administered 139 million vaccine doses, 40 million boosters and a world-class programme. On the point made by the noble Lord, Lord Brooke, rather than being one of the worst in Europe, in terms of excess deaths, which is the internationally recognised definition, we are one of the best. However, I agree with my noble friend Lord Bethell that we need to bring what we have done on Covid prevention into our research on long Covid prevention.

The point was very well made by many noble Lords that it is not just about research into Covid but, as the noble Baronesses, Lady Scott and Lady Meacher, said, linking how long Covid might connect with ME, chronic fatigue syndrome and other similar areas. As we know, it is a complex area. Various speakers, including the noble Baroness, Lady Masham, and the noble Viscount, Lord Stansgate, mentioned how complex this is. We need to make sure that our research digs into all these areas. Some 220 different symptoms are included, I believe. The research we have done, such as the REACT study from Imperial, in which the noble Lord, Lord Darzi, has been so involved, and the UCL research on brain fog, mentioned by the noble Viscount, Lord Stansgate, and to which I am sure the noble Baroness, Lady Neuberger, is connected through her UCH connections, is vital. There are honest debates around this; there is also research into weight management and its impact on long Covid, as brought up by the noble Lord, Lord Brooke. We all agree that there must be an honest debate to really understand the drivers behind it. We need to be clear about that.

I can commit that the £50 million for research is protected. As the noble Baroness, Lady Brinton, said during her excellent history lesson—I will look up Pale Rider—there are many lessons to learn from Spanish flu. I agree that Covid is not over, unfortunately, so she has from me a commitment to that research.

In answer to the point made by the noble Lord, Lord Brooke, about the levels of investment, the £50 million we are investing in research is, I believe, second only to the USA, so we are very much among the leaders. This is in addition to the £108 million spent on Covid research to date. To answer the point made by the noble Baroness, Lady Thornton, we are fully committed to international research, and making sure it is a two-way process in which we share our findings and commit our data.

Regarding data, some excellent points were made by the noble Baroness, Lady Thornton, and the noble Lords, Lord Kakkar and Lord Griffiths. Noble Lords have heard me say before that I am a bit of a data anorak, so I totally understand its value in this space. I will make sure that noble Lords have a detailed answer on this, but it is something I very much support and believe we need to be doing.

I say in response to the noble Baronesses, Lady Scott and Lady Meacher, who spoke about trying to understand how long Covid might interact with, or have similarities to, ME and chronic fatigue, that funding is still available. The right reverend Prelate the Bishop of Exeter spoke about the rural impact, and I would say there is scope there. The noble Lord, Lord Kakkar, asked if we need to do more. Funds are still available within that £50 million, but it is something we believe in, and as we know from short Covid—if that is the right term for it—our research was vital and we remain committed to playing a leading role on the world stage.

We all know that research is only of any use or has any point if it actually creates treatments we can use within the NHS. As many speakers have said, only if these are substituted into services will they really help. The UK was one of the first countries to recognise and respond to long Covid, and we set up the national long covid commission guidance with new care pathways. As part of that, as mentioned by many speakers, including the noble Earl, Lord Clancarty, access to information and education for doctors is key. The Royal College of GPs and the HEE have put out information, but to judge from some of the examples given today, it has clearly not been disseminated widely enough.

I appreciate the tips from the noble Baroness, Lady Taylor, about getting extra funding from the Chancellor. As many of us might have seen, extra funding was announced in the other House earlier, but I appreciate the tips and, believe me, I will be using them. I assure the noble Baroness, Lady Neuberger, that the £224 million we have already invested is a commitment, and it has helped set to up 100 specialist treatment centres, many in rural areas. I had a chance to look up the figures, and I think I counted seven in Devon, but I will confirm that, because it is not just an inner-city issue but a whole-country issue. There is also the question of the impact on young people and children, a point made by the noble Baronesses, Lady Watkins and Lady Masham. Fourteen of those 100 centres specialise in treating children and are therefore helping to deal with this issue.

The point that these measures are only any good if we are making people aware of them all was very well made by the noble Baronesses, Lady Donaghy and Lady Pitkeathley, and the noble Earl, Lord Clancarty. I am proud of what we have managed to achieve on the Your COVID Recovery web app: we have had 12 million visits from people looking at advice on how they can recover. However, I am by no means complacent about the need to make sure that there is advice everywhere.

I will get back to the noble Viscount, Lord Stansgate, on ivermectin, as I need to get some detailed advice on that. However, as the noble Earl, Lord Clancarty, talked about people feeling the need to go to private centres and often try unproven medicines, generally I would caution against that, as I am sure many of us would. While this is a complex area and we are still learning about it, I advise people to stick to the proven methods we are trying to adopt through our own NICE guidelines and our own centres. That is what we are trying to do right now through the NHS, but as the noble Baroness, Lady Brinton, and others mentioned, this is not a one-and-done matter. This is a long-run thing, so these services will need to evolve over time, and we will need to keep up.

As we all know, looking at what we are doing health-wise is only part of the picture. The noble Lord, Lord Bethell, started the discussion on this point very well, and a number of noble Lords contributed to it, speaking about the whole impact on employment, work and schools, and—as was well said by the noble Lord, Lord Griffiths—on a personal basis. The impact of long Covid is much wider than just on health, and I very much recognise its impact on employment and work. As many noble Lords will know, I was the lead NED of the Department for Work and Pensions before I came into this role, so I am very aware of the 2.5 million people out of work due to long-term sickness, towards which we now know that long Covid is contributing. Action in this area to help those people is vital not only to their health but to the health of the economy. I know that this is a priority of colleagues at the DWP, and it is part of the £1.3 billion investment to support the long-term sick into work.

I totally accept the point made by a number of noble Lords, including the noble Baronesses, Lady Donaghy, Lady Watkins, Lady Masham, Lady Neuberger and Lady Brinton, about the impact of long Covid on our own NHS staff. We need to make sure that we are supporting them through this. I have done a bit of research on whether long Covid can be defined as an occupational disease, as was mentioned. This is a complex area, because, as we mentioned before, there are 220 different symptoms connected with it. However, the DWP is being advised by the independent Industrial Injuries Advisory Council on this. It has recently published a paper prescribing five complications following Covid which should be considered in awarding personal independence payments. I am sure this will be an evolving picture, but my DWP colleagues are looking at it.

Of course, this issue is much wider than the NHS; it should be embraced by all employers. I am very pleased that I have an opportunity to speak at the CBI conference shortly about health in the workplace. This is something that I plan to bring up then, because it is important that all our employers recognise that health is everyone’s business, as was said in a consultation document that recently went out, to which we will respond shortly. Clearly, the role of employers is key to all that.

Personally, I would like to see the sort of approach taken in Japan, in which employers take on a big role in the health of their workforce and very much look at prevention. As my noble friend Lord Bethell said, it should not just be our health service looking at prevention methods; we need to be giving people over 50 health MoTs, and looking at cardiovascular impacts as well as how employers can help in that space.

I hope I have answered many of the points raised today. I commit to cover any I have missed in a detailed response. I finish by again thanking the noble Baroness, Lady Thornton, and all the speakers. I found this a very informative debate. We can all say that we have much more to learn about long Covid and that we continue to be guided by the science. But the virus has definitely not gone away and, unfortunately, as many noble Lords mentioned, we will have to live with Covid and long Covid for a long time to come. We must continue to be proactive to prevent through our vaccine programmes, to treat through NHS services, to research to continually improve understanding, and to support people to get back into work. I thank noble Lords.

My Lords, I thank the Minister for that reply and the noble Baroness, Lady Neuberger, for outing me, because I did not declare my interest as a non-executive director of the Whittington; she is my boss there. I will just use these last few minutes to say that this was an excellent debate and I hope it has the kind of impact that most speakers said they would like. I will just mention a few of them.

I thank the noble Lord, Lord Bethell, for a wonderful contribution. There was a time when he and I felt that we saw more of each other than we did of our partners. I should include the noble Baroness, Lady Brinton, in that comment.

The noble Baronesses, Lady Scott and Lady Meacher, were correct to make the links they did and to raise issues such as there being no diagnostic blood tests for ME and CFS, even now. My noble friend Lady Donaghy was also completely right about the need to raise awareness.

The noble Lord, Lord Kakkar, is always concise and I am always grateful for the medical exposition he gives, which I would never dare attempt. I was hoping he would do so and indeed he did. I wish I had thought of the words “national protocol”, and I hope the Minister takes the opportunity to look at what he said about how data could be used. I do not wish to bring the two together, because I am sure they know each other, but I thought that his offer was very pertinent.

The right reverend Prelate the Bishop of Exeter and the noble Baroness, Lady Watkins, brought to our attention the problems in rural areas and with mental health. I am very grateful to my noble friend Lord Stansgate because he and other noble Lords, such as the noble Earl, Lord Clancarty, and the noble Baroness, Lady Masham, talked about the personal experiences of long Covid of people they had spoken to. It is very important that we give voice to those experiences in this Chamber. Many noble Lords did that and I had hoped they would, because I knew I would not be able to in my opening remarks.

I am very grateful to my noble friend Lord Griffiths for his extremely kind words and for reminding us, as he often does, about the human costs of the pandemic—not just the medical costs. My noble friend Lady Taylor talked about the significance of long Covid for society, and I was very struck by the noble Baroness, Lady Brinton, who again reminded me of a book that I still have to read. I promise her that I will now read it because, as she says, history has things to teach us and we need to hear those words—and the Minister does too.

My noble friend Lady Pitkeathley quite rightly talked about carers and unpaid carers. I thank her too for her expert round-up.

I thought that the Minister did the best he could—I have been in his place; there are so many experts in this House, and as a Minister you can only do your best with them—but I think the noble Lord needs to go through this debate. I asked about eight or nine specific questions, some of which he answered and some of which he did not. For example, he did not address the question of the Industrial Injuries Advisory Council. It is very important for our NHS staff to know the answer. I should be grateful if the Minister and his officials could go through this debate, pick out those questions and write to everybody who took part in this debate, putting the answers in the Library, so that we can see and take this forward as we know we will need to do.

Motion agreed.