Part of the debate – in the House of Commons at 2:44 pm on 22nd October 2020.

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Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health and Social Care 2:44 pm, 22nd October 2020

I am truly grateful for that reassurance, because the Secretary of State will understand that many people in those areas will be concerned and Members will want to get their points of view on the record on that front.

The virus has caused a pandemic because it exploits ambivalence and takes advantage of our human vulnerabilities. It undermines our biological defences and spreads through human social behaviour and clustering. We know that people with long-term chronic conditions in particular are vulnerable, and we know that there is a greater burden of illness in our more disadvantaged areas, which covid cruelly exaggerates. We know that as we entered this crisis, we had less resilience as a society. We entered with life expectancy falling for some of the poorest and stalling nationwide, and life expectancy is a summary of our overall health.

In the past 10 years, the amount of life in good health has decreased for men and women. Our child mortality rates are some of the worst in Europe, and poor health and chronic illness leave communities acutely vulnerable to disease, so it should come as no surprise to any of us that some of the boroughs currently fighting the most virulent fires are some of the very poorest in our country, with the very worst life expectancy.

I welcome the progress being made on diagnostics, therapeutics and vaccinations, which the Secretary of State has updated us on today. We welcome the expanding of mass testing, including the saliva testing and the lateral flow testing. I hope, by the way, that the Secretary of State will invest in our great universities, which are developing some of this saliva-based testing, because they will need the equipment and the labs to process it. He will probably need to invest in robotics and artificial intelligence to do some of that, because there are not enough staff to do it at the moment, and I hope that is part of his agenda. As well as all that, because the virus is now endemic, we will need a health inequalities strategy to get on top of this virus for the long term.

In the immediate term, we also need to adjust our behaviours to bring infection rates down, which is why I have supported the difficult restrictions that the Secretary of State has had to impose, and it is why we are saying we need clarity all the time from Government. But people also want to know that there is light at the end of the tunnel, because it is still not clear to families in Bury, Heywood and Penistone and all those other places that have been put under lockdown in recent days how they will escape it.

We still do not know whether the restrictions across the north will be lifted when the national R falls below 1 or when local regionalised R values fall below 1. We still do not know whether restrictions will be lifted across the north when hospital admissions stabilise. Yesterday, the Prime Minister said that decisions are

“based on a number of things including the R—also, of course, rates of infection, rates of admission to hospital and other data.”—[Official Report, 21 October 2020; Vol. 682, c. 1053.]

He did not tell us what that other data is. Perhaps the Minister responding to the debate can outline how an area in the north in tier 3 gets out of those restrictions. I know that the areas will be reviewed every four weeks, but what are the criteria to inform those reviews?

I represent Leicester, where we are in tier 2, but we have been in a version of restrictions for 114 days. We went directly from national lockdown to local lockdown. In fact, we endured tougher restrictions than those currently designated for tier 3. Our hospitality closed, our non-essential retail closed and—I did not agree with this—our schools closed as well. All those measures together did help to bring infections down in Leicester to about 55 per 100,000—to be frank, many Members would bite your hand off for 55 per 100,000 now—and even at 55 per 100,000 we remained in a version of lockdown.

Now, months later, after all the sacrifice we took in Leicester—after months with our businesses closed, with the mental health impact of people not being able to see their loved ones and families denied the opportunity to visit a care home to see their grandmother or mother—our infection rates in Leicester are 219 per 100,000. The Secretary of State will therefore have to forgive me when I express some scepticism that his approach will work and suppress the virus to the levels sufficient to bring the R value down, because although the early restrictions in Leicester did have an impact, after months we are still under restrictions with infection rates over 200 per 100,000.

The Secretary of State updated us on the situation we are in. He has been good at updating the House repeatedly; I have no criticism of him at all on that front. The growth rate in the virus is slower than in March—it is more muted, thanks to the great sacrifices of the British people, with hand hygiene, social distancing and everything we are doing—but it is not plateauing. We are dealing with an autumn resurgence, and for all the heat and fallout we have had across the House this week, the truth is that the virus is at worrying levels everywhere. The national R is between 1.3 and 1.5. The R across the south-east is between 1.3 and 1.5, across the south-west between 1.3 and 1.6, and across the east of England between 1.3 and 1.5.

Of course, admissions to critical care are currently concentrated in the north and the midlands, but while at this stage in the first wave those admissions to critical care were beginning to come down, they are continuing to go up. It is right that improvements in care mean that people are less likely to die. That is a good thing, and we all celebrate that, but general and acute beds are filling up with covid patients across the north and across the midlands.

We know that the Prime Minister has rejected a circuit break for now—he does not rule it out indefinitely. We think he should have taken advantage of next week’s half term. He decided not to do that. But we should remind ourselves that SAGE advised the circuit break on 21 September. A month later, on 21 October, we had these grim statistics: 191 deaths; 996 hospital admissions; 6,431 in hospital; 629 on ventilation; 26,688 tested positive; and 249,978 cases in the past 14 days. Many will ask how much of that could have been avoided, had the Prime Minister gone along with SAGE’s advice a month ago.

Today, the Chancellor said in his statement that we have to find a balance between saving lives and protecting livelihoods, but I do not believe that the two are in conflict. It is not a trade-off. Actually, I do not believe the Secretary of State thinks it is a trade off—the tone of his remarks was very different from that of the Chancellor earlier. Saving lives and protecting livelihoods go hand in hand. I worry that the approach the Government are currently taking—while understandable, because nobody wants to be in a lockdown, and none of these decisions are easy or do not have negative consequences; I think we are all mature enough across the House to appreciate and understand that—means that there will, by necessity, have to be tougher, deeper action in the weeks to come, not only in autumn. Winter has not hit us yet.

Professor John Edmunds of the London School of Hygiene said yesterday in one of the Select Committees that

“there’s no way we come out of this wave now without counting our deaths in the tens of thousands…I think we are looking at quite a bleak situation unless we take action…I don’t think we should be taking action just specifically in the highest risk areas, but I think we need to take action everywhere”.

A similar sentiment was expressed by Sir Jeremy Farrar, who is also on SAGE. For balance, Professor Van-Tam said at the press conference this week that he disagreed, but also that

“we may have to push on the pedal a little harder” to get it under control.

I know the Secretary of State is a decent man. He has been very good throughout this crisis in talking to me privately; one would expect a Secretary of State and a shadow Secretary of State to have those discussions. Whenever I have asked for briefings, all the way back to January, he has ensured that the chief medical officer would give me confidential briefings, as I am sure that every Member across the House would understand and appreciate. So I know he is a decent man. I know he is not playing games or anything like that. I know that these are difficult judgment calls of extraordinary gravity. I know there is no easy solution. Everything has trade-offs; everything has negative consequences. But we also know that unless we take decisive action, the consequences could be even worse. No one should pretend to the House that that is not the case. There is a worry that by not taking action now, we will, in the words of Professor David Hunter, an epidemiologist at Oxford,

“all wind up in tier 3 eventually.”

According to Times Radio yesterday, Government sources were telling it that the Government are now planning a three-week circuit break next month across all tier 2 and tier 3 areas. If that is the case, then the Government should probably level with us so that we can all start preparing for it.

This is not just about minimising harm and deaths from covid. As the Secretary of State said in responding to questions from my hon. Friends, we have a huge responsibility and duty to minimise harm and deaths from non-covid conditions as well. We have to avoid the situation that we were in in the spring, when the immense lockdown, which was actually a number of different interventions all at once, meant that to build surge capacity in the national health service, we had to cancel elective operations to free up general and acute beds, and much important diagnostics work and treatment got delayed. That has left us with a situation today where 110,000 people are waiting beyond 12 months for treatment, compared with just 1,600 in January; 3 million people are waiting for breast, bowel or cervical screening, and more people are waiting for treatment.

My worry is that we will end up building a greater backlog in treatment if we do not act. General and acute beds are filling up. We have a number of hospitals cancelling electives already. Bradford has just suspended non-urgent surgery. Birmingham is talking about suspending non-urgent surgery. It is happening in Nottingham. We know that Merseyside is under considerable pressure; the Secretary of State outlined it. It has just been revealed in the Health Service Journal that we are heading into this winter with 2,000 fewer beds than we had last winter. Today the Royal College of Emergency Medicine has warned that over half of A&Es across the country are caring for patients in corridors due to the lack of beds—and we are not even in winter yet. Our overcrowded A&Es are not ideal at the best of times, but during a covid pandemic it is obviously highly dangerous to be treating patients in corridors of A&Es. The president of the royal college, Katherine Henderson, has pointed out that this situation

“will put more lives at risk than it ever did before.”

If the Government really want to drive down infections, suppress the virus and ensure that general and acute beds are not overwhelmed and more operations are not cancelled, then they have to seriously consider what steps they need to take to go further. Unless the Secretary of State or the Minister is going to get up at the end of this debate and say, “Actually, we’re going to do a circuit breaker over half-term next week”, I accept that the Government have probably missed that window of opportunity now, but at some point they will have to take further action.

We could have avoided much of this if test and trace had been more effective. The Secretary of State is spending £12 billion on this programme. Twelve billion pounds is a colossal amount of money. Some of it is going on consultants who earn £7,000 a day, but where on earth is the rest going? We are throwing around figures in this covid debate, and we are becoming quite complacent and relaxed about them, but £12 billion is an extraordinary amount of money; we could probably run the NHS for a month or so on that. We learn today that the system is contacting only 59.6% of contacts, which is the equivalent of failing to contact 101,000 people. That is not world beating; it is a world-beating shambles. I really hope that the Government look at stripping all the failing private outsourcing firms, such as Serco, of these contracts and putting local public health teams in charge. That would be much more effective.