Part of the debate – in the House of Commons at 5:14 pm on 11th November 2020.

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Photo of Justin Madders Justin Madders Shadow Minister (Health and Social Care) 5:14 pm, 11th November 2020

I thank the hon. Member for her intervention. The recent developments in rapid testing give us the ideal opportunity to allow relatives of those in care homes to get in and see them and give them the support that they have been so sadly lacking in recent months. None of us could fail to be moved by the many representations we have had from family members who have been unable to see their loved ones for many months.

On the health and social care workforce, we know, sadly, that over 600 staff have lost their lives so far to covid-19. They have paid the ultimate price just for doing their job. It is important that lessons are learnt about how we stop transmission, and it is right that the Government opened up their life assurance scheme to all health and social care staff, but over half of all families who have lost someone to the virus have still not received their payment, so we need the Government to be much more proactive in making sure that everyone who is entitled to that payment receives it.

Let us support the staff, but let us not forget the impact on patients as well. We know that the NHS could cope with the first wave only because so many planned operations were cancelled. We know that the need to operate in a covid-secure environment presents additional challenges to the NHS in reaching previous levels of activity. We know that before the pandemic started, waiting lists were already climbing to record levels. Covid-19 has accelerated that increase so that by August this year, over 100,000 patients were waiting over a year just to start treatment. Cancer Research UK estimates that around 3 million people are waiting for breast, bowel or cervical screening, and there were over 1.2 million patients waiting for a key diagnostic test at the end of August. We need to hear what the plans will be to address these spiralling waiting lists, and we need a cast-iron guarantee that no patient will be discharged from hospital into a care home if they have tested positive for covid-19.

I turn to what awaits us in a few weeks’ time, because we all hope that the current lockdown will end on 2 December as planned, and as promised, I believe, by the Prime Minister. If it does end on that date, it seems likely that we will still have some system of tiered restrictions moving forward. That is another area where we need to see improvements, because the Government’s approach to restrictions to date has at times been contradictory, muddled and rushed. I accept that the Government have had on occasions to move quickly, sometimes because of a rapidly changing picture—but sometimes, regrettably, because of leaks to the press too. Of course, we would not expect things in this kind of situation to be perfect, but they can be better than they have been.

The time that this lockdown buys us should be used not just to fix test and trace, to prepare for a roll-out of the vaccine and to fine-tune the mass testing pilots, but to set out a clear and consistent framework for determining and implementing future restrictions. The Minister and his colleagues have spent many Monday afternoons in Committee Rooms with me and others going through increasingly convoluted and amended statutory instruments dealing with each new restriction, often published only hours before they became law and always debated weeks after they came into force. We cannot go back to that style of governing. Public trust is eroded when decisions are not made in a transparent and timely manner, so when the Government decide what their exit strategy to the lockdown will be, they also need to consider what the process will be for making and communicating those decisions. It is critical that individuals and businesses get sufficient advance warning in future to enable them to prepare properly for whatever comes next. This point is as much about process as it is about substance, but the process matters, because restrictions need to be tested in this place; if they do not stand up to scrutiny here, we cannot expect them to stand up to scrutiny out there.

I want to say a few words about test, trace and isolate. The Serco side of the system is underperforming badly, and the decision to place responsibility for mass testing into the hands of local directors of public health is a welcome one. It recognises, perhaps belatedly, where the real expertise lies. The latest figures for the national test and trace system are frankly shocking, with 26% of test results received within 24 hours. We should not forget that the Prime Minister said we would have all results turned around in that timescale by the end of June, yet the figures have been getting worse in recent weeks, not better. We know how important it is for results to be turned around quickly if we are ever to get test and trace playing the part it was meant to play in controlling the spread of the virus. Ministers can boast about record capacity, but capacity is meaningless if the results are not coming back quickly enough to be effective.

Let me turn to the contact tracing system itself. In the most recent weeks for which figures are available, 40% of close contacts were not reached and asked to self-isolate, amounting to more than 130,000 people in one week. That is a failure. When every one of us in here has those difficult and distressing conversations with our constituents about the restrictions that we currently face, we need to reflect on that failure and question not only why these unproven private providers have been given the task in the first place, but why they continue to be responsible for a system that they are clearly not delivering on. Every scientific adviser said that relaxing lockdown measures would work only if we had an effective test and trace system in place, yet on just about every measure the system is going backwards. How much longer will Ministers tolerate this failure? However, whoever is doing the contact tracing, that is only half the story. Without people adhering to the rules of self-isolation thereafter, the success of the entire system is in doubt.

Yesterday Baroness Harding gave evidence to the joint inquiry of the Science and Technology Committee, and Health and Social Care Committee, where she made the important point that the reason that people were not self-isolating was that they could not afford the loss of income, not because of a refusal to comply. She also made the rather remarkable claim that the surge in cases that we have seen in the last couple of months was not anticipated, which I thought was an incredible admission.

The Committees also heard from Professor Sir John Bell, who said that the self-isolation system was “massively ineffective” and spoke about using the increased testing capacity perhaps to cut short the self-isolation period for negative cases. No doubt the Government are actively considering that, but we are still left with the need to do more to encourage people who test positive to self-isolate.

In September a report for the Scientific Advisory Group for Emergencies concluded that self-isolation rates would be improved if additional financial support were available, ensuring that those required to self-isolate—let us not forget that these are people who are doing the right thing—are not penalised and do not experience financial hardship when doing so. This survey found that only 18% of people with symptoms self-isolated, and that figure went down to just 11% of those told to self-isolate by Test and Trace after coming into contact with a confirmed case. I know that these are preliminary figures and that other studies have suggested slightly higher levels of compliance, but no study that I have seen has shown levels anywhere near close enough to where they need to be for us to have an effective system.

The entitlement to a self-isolation payment is tied to being in receipt of certain benefits, which means that a significant number of people do not qualify, although those not in receipt of those benefits and those who do not receive contractual sick pay can also receive statutory sick pay or employment and support allowance. But that is frankly not good enough. SSP is far below the rate set for a self-isolation payment. The Secretary of State famously said that he could not live on such an amount, so we should not be surprised when we see low rates of compliance, because asking those who are not eligible for a self-isolation payment to accept a significant drop in their pay for a fortnight inevitably causes hardship and discourages compliance. I urge the Government seriously to consider doing more to encourage people to self-isolate.

It is a massive oversight that those notified through the app are not entitled to the payment. I understand that the Government are actively looking at this, but given that it is over six months since we started hearing talk about the world-beating app, it is staggering that we are only now looking at how properly to tie it in with support for self-isolation. Action on that issue cannot come soon enough.

There has been newspaper speculation that the actual period of self-isolation might be cut, with a suggestion that it could end at 10 days following a negative test. A report in The Guardian on Monday says that a compromise was “cooked up” to placate Dominic Cummings. Frankly, he ought to be the last person in government to be determining the self-isolation rules, given that he has found it impossible to follow them himself. Any change to this period should be based on medical advice, so I do hope that we get clarity from the Government during the wind-ups that any decisions on shortening the self-isolation period will be based on advice from the chief medical officer, rather than any Dom, Dick or Harry who happens to be in the Prime Minister’s office.

I hope that those on the Government Benches have been listening today and considered the issues and the suggestions that I have made, as none of us wants to be back here in another month or two debating another lockdown because the time this lockdown has bought was wasted. We do not want to be here talking about how the second wave saw us with one of the highest death rates in the world again, and we do not want to be here in a few months’ time seeing cases rising again because demand was not anticipated. We all want to hear that cases are falling, that hospital admissions are reducing, and that other NHS patients are getting their treatments quicker. Human endeavour has given us the opportunity to get to that place. While reaching that destination is not entirely within the Government’s gift, it would be inexcusable if we failed to get there because of incompetence or neglect on the Government’s part. The people would never forgive that, and nor should they.