Covid-19 Update - Statement

– in the House of Lords at 8:03 pm on 30th November 2020.

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The following Statement was made in the House of Commons on Thursday 26 November.

“With permission, I would like to make a Statement on coronavirus. We are approaching the end of a year where we have asked so much of the British people. In response to this unprecedented threat to lives and to livelihoods, the British people have well and truly risen to the challenge by coming together to slow the spread and support each other. I know how difficult this has been, especially for those areas that have been in restrictions for so long. The national measures have successfully turned the curve and begun to ease pressure on the NHS. Cases are down by 19% from a week ago, and daily hospital admissions have fallen 7% in the last week.

January and February are always difficult months for the NHS, so it is vital that we safeguard the gains we have made. We must protect our NHS this winter. We have invested in expanded capacity, not just in the Nightingales, but in hospitals across the land, and we have welcomed thousands of new staff. This morning’s figures show that the number of nurses in the NHS is up 14,800 compared with just a year ago, so we are well on our way to delivering on our manifesto commitment of 50,000 more nurses. Together, while we invest in our NHS, we must also protect our NHS, so it will always be there for all of us during this pandemic and beyond.

I am so grateful for the resolve that people have shown throughout the crisis. Thanks to this shared sacrifice, we have been able to announce that we will not be renewing our national restrictions in England, and we have been able to announce UK-wide arrangements for Christmas, allowing friends and loved ones to reunite and form a five-day Christmas bubble. I know that this news provides hope for so many, but we must remain vigilant. There are still today 16,570 people in hospital with coronavirus across the UK, and 696 deaths were reported yesterday. That means 696 more families mourning the loss of a loved one, and the House mourns with them.

As tempting as it may be, we cannot simply flick a switch and try to return life straight back to normal, because if we did that, we would undo the hard work of so many and see the NHS overwhelmed, with all that that would entail. We must keep suppressing the virus, while supporting education, the economy and the NHS until a vaccine can make us safe. That is our plan. We will do that by returning to a tiered approach, applying the toughest measures to the parts of the country where cases and pressure on the NHS are highest and allowing greater freedom in areas where prevalence is lower.

While the strategy remains the same, the current epidemiological evidence and clinical advice shows that we must make the tiers tougher than they were before to protect the NHS through the winter and avert another national lockdown. We have looked at each of the tiers afresh and strengthened them, as the Prime Minister set out on Monday. In tier 1, if you can work from home, you should do so. In tier 2, alcohol may only be served in hospitality settings as part of a substantial meal. In tier 3, indoor entertainment, hotels and other accommodation will have to close, along with all forms of hospitality except for delivery and takeaway.

I know that people want certainty about the rules they need to follow in their area. These decisions are not easy, but they are necessary. We have listened to local experts and been guided by the best public health advice, including from the Joint Biosecurity Centre. We set out the criteria in the Covid-19 winter plan, and we publish the data on which the decisions are made. As the winter plan sets out, the five indicators are the case rate in all age groups; in particular, cases among the over-60s; the rate at which cases are rising or falling; the positivity rate; and the pressures on the local NHS.

When setting the boundaries for these tiers, we have looked at not just geographical areas but the human geographies that influence how the virus spreads, such as travel patterns and the epidemiological situation in neighbouring areas. Although all three tiers are less stringent than the national lockdown we are all living in now, to keep people safe and to keep the gains that are being made, more areas than before will be in the top two tiers. That is necessary to protect our NHS and keep the virus under control.

Turning to the tiers specifically, the lowest case rates are in Cornwall, the Isle of Wight and the Isles of Scilly, which will go into tier 1. All three areas have had very low case rates throughout, and I want to thank residents for being so vigilant during the pandemic. I know that many other areas would want to be in tier 1 and understand that.

My constituency of West Suffolk has the lowest case rate for over-60s in the whole country, and I wish to thank Matthew Hicks and John Griffiths, the leaders of Suffolk County Council and West Suffolk Council, and their teams for this achievement. However, despite that, and despite the fact that Suffolk overall has the lowest case rate outside Cornwall and the Isle of Wight, our judgment, looking at all the indicators, and based on the public health advice, is that Suffolk needs to be in tier 2 to get the virus further under control. I hope that Suffolk and so many other parts of the country can get to tier 1 soon, and the more people stick to the rules, the quicker that will happen.

We must make the right judgments, guided by the science. The majority of England will be in tier 2, but I am afraid that a significant number of areas need to be in tier 3 to bring case rates down. I know how tough this is, both for areas that have been under restrictions for a long time, such as Leicester and Greater Manchester, and for areas where cases have risen sharply recently, such as Bristol, the West Midlands and Kent. The full allocations have been published this morning and laid as a Written Ministerial Statement just before this Statement began. I understand the impact that these measures will have, but they are necessary given the scale of the threat we face.

We will review the measures in a fortnight and keep them regularly under review after that. I want to thank everybody who is in the tier 3 areas for the sacrifices they are making to protect not just themselves and their families but their whole community. Regardless of their tier, I ask everyone to think of their own responsibilities to keep the virus under control. We should see these restrictions not as a boundary to push but as a limit on what the public health advice says we can safely do in any area. Frankly, the less any one person passes on the disease, the faster we can get this disease under control together—and that is on all of us.

We must all play our part while we work so hard to deliver the new technologies that will help us get out of this, in particular, vaccines and testing. The past fortnight has been illuminated by news of encouraging clinical trials for vaccines, first from Pfizer-BioNTech, then from Moderna and then, earlier this week, from the Oxford-AstraZeneca team. If these vaccines are approved, the NHS stands ready to roll them out as soon as safely possible.

Alongside vaccines, we have made huge strides in the deployment of testing. Our rollout of community testing has been successful because it means we can identify more people who have the virus but do not have symptoms and help them isolate, breaking the connections that the virus needs to spread. As part of our Covid-19 winter plan, we will use these tests on a regular basis, for instance, to allow visitors safely to see loved ones in care homes, to protect our front-line NHS and social care colleagues and to allow vital industries and public services to keep running safely.

We have seen in Liverpool, where more than 300,000 people have now been tested, how successful this community testing can be. I want to pay tribute to the people of Liverpool, both for following the restrictions and for embracing community testing. It has been a big team effort across the whole city and the result is that in the Liverpool city region the number of cases has fallen by more than two-thirds. In the borough of Liverpool itself, where the mass testing took place, cases have fallen by three-quarters. It has not been easy and, sadly, many people in Liverpool have lost their lives to Covid, but thanks to people sticking to the rules and to the huge effort of community testing, Liverpool’s cases are now low enough for the whole Liverpool city region to go into tier 2. This shows what we can do when we work together. We can beat the virus. I want to pay tribute to the people of Liverpool, NHS Test and Trace, the university, the hospital trust, Mayor Joe Anderson and so many others who have demonstrated such impressive leadership and responsibility, and a true sense of public service.

We are expanding this community testing programme even further to launch a major community testing programme, homing in on the areas with the greatest rates of infection. This programme is open to all local authorities in tier 3 areas in the first instance and offers help to get out of the toughest restrictions as fast as possible. We will work with local authorities on a plan to get tests where they are needed most and how we can get as many people as possible to come forward and get certainty about their condition. The more people who get tested, the quicker a local area can move down through the tiers and get life closer to normal.

Viruses can take a short time to spread but a long time to vanquish. Sadly, there is no quick fix. They call upon our determination to make sacrifices that will bring them to heel and upon our ingenuity to make scientific advances that will get us through. Hope is on the horizon, but we still have further to go, so we must all dig deep. The end is in sight. We must not give up now. We must follow these new rules and make sure that our actions today will save lives in future and help get our country through this. I commend the Statement to the House.”

Photo of Baroness Thornton Baroness Thornton Shadow Spokesperson (Health)

I thank the Minister for taking this Statement, and I look forward to discussing the regulations that will flow from it tomorrow, if they successfully pass through the Commons. Although we can see that cases are going down—and that, of course, is a matter for celebration and relief—we are still seriously in the pandemic. We still seriously stuck in what seems like an endless cycle of lockdowns, which have not been working.

The Government have again wasted the opportunity, over the past few months, to get a handle on testing, tracing, isolating and supporting. Once again the hospitality industry in many parts of the country will be absolutely battered. Once again jobs will be in further jeopardy. Once again our theatres are closed. Once again older people, disabled people and people with learning difficulties remain stranded in care homes without visits from their families. Exactly what will be the difference this time that will make people’s sacrifices yield a reduction in the infection rates? When shall we see testing in care homes, for example?

Reflecting on the debate in the Commons following the Prime Minister’s and the Secretary of State’s announcements last week, we see that all MPs of all parties were desperate for two things. They were desperate to understand the basis on which these decisions were being taken, and they were desperate to understand how their constituents might be able to move from, for example, tier 3 to tier 2, or tier 2 to tier 1.

As my honourable friend Rachel Hopkins MP says:

“The good people of Luton will want to get out of tier 2 as soon as possible, but the current resources provided to Luton Borough Council for the lateral flow rapid testing pilot are insufficient to enable it to provide the level of mass testing that is being described nationally. The contained funding—£8 per person—just will not cover tests for 10% of Luton’s population, as the funding also needs to be used for the wider covid response, including wellbeing support for vulnerable residents.”

She asked the Secretary of State, and I now ask the Minister here, to

“confirm that there are national plans to provide additional support and resources to expand testing if the intention to test close contacts daily is pursued”.—[Official Report, Commons, 26/11/20; col. 1012]

The news about the vaccine is the light at the end of the tunnel, but noble Lords must be well aware that we are still well into the tunnel, and probably will be for months to come. The only sure way to contain the virus is for people to obey personal rules and, most crucially, for us to have an effective and locally controlled test, trace, isolate and support system. We on these Benches have known this and have been asking, if not begging, for the last part of this deal for many months. Despite the Minister’s constant issuing of large numbers one way or the other, it is still not working as it should be. It is not surprising that confidence in the Government’s ability to deal with the pandemic is at a low ebb, much lower than in March and April.

Yesterday I heard the Conservative Rother Valley MP Mr Stafford say on television that he thought we were in trouble with this virus because people had broken the rules—in other words, let us blame the public. He was taken to task firmly by my honourable friend Naz Shah MP, but I have to ask the Minister whether he agrees with his colleague Mr Stafford.

When areas such as Bury and Trafford went into lockdowns in the summer, the Secretary of State promised that MPs would be involved in the decision. Has that commitment now been abandoned? Then Ministers agreed to involve regional leaders but, it has to be said, took exception to being challenged by Andy Burnham. What role do regional leaders now have in these decisions, or is the position really that the Prime Minister imposes from Downing Street restrictions on communities across the Midlands and north that will have huge impacts on the livelihoods of families and small businesses? What are the plans to alleviate the hardship that these rules will create? Leicester, Bury, Leigh and Heywood have been under a form of lockdown for months, with families forced to part and grandparents not seeing their grandchildren. Those families will want to know today what the exit strategy is and what voice they have in that strategy.

The Secretary of State in this Statement has outlined five criteria by which local lockdowns will be judged. Will that be published, with clear, transparent rules for areas entering and leaving tiers and a scorecard for every area, assessing its Covid progress against its criteria so that everyone can judge this in a transparent fashion?

What have the SAGE advisers said to the Minister about the risks which go with the proposed lifting of restrictions for Christmas? The Canadians have a very clear message about this. They say, “Stay home and stay safe”, and the reason they say that is because the worst surge in Covid-19 they have ever experienced followed six weeks after their Canadian Thanksgiving. They have given warning to their southern neighbours—the United States—that they will see an even bigger and more devastating spike following their annual gathering for turkey and gratitude at Thanksgiving. This is a warning that we need to heed. Does the Minister agree?

Photo of Baroness Jolly Baroness Jolly Liberal Democrat

I thank the Minister who is going to respond to this Statement.

The first case of this coronavirus was just over a year ago, on 17 November 2019. Since then, over 1.3 million people have died worldwide and over 50 million people have been infected. The first case here in the UK was on 29 January this year. We watched Italy deal with the cases in late winter, and I am sure that plans were being fetched out of the archives on how we might deal with a pandemic. I know that in 2015 there was a pandemic plan published for an influenza outbreak. Will the Minister tell the House what lessons were learned from that exercise?

I remember walking back to my flat in London on 17 March and my son, who was living with me then, said, “You either go home today, or you stay until this clears”. I went home, and on 23 March lockdown started. Along with many other noble Lords, I stayed away for some considerable time, and Zoom, Teams and virtual working became the new normal.

Hong Kong, which is always waiting for a SARS outbreak, keeps a stock of PPE for all care homes in the event of a pandemic. Is it too early to ask the Minister whether that is something he would now consider for England? I think it was a recommendation of that pandemic preparedness document in 2015.

One area where I would also be grateful for clarification is that of test, track and isolate. At what stage was it decided not to involve the local experts and local authorities? This caused much regional frustration, as this was the biggest public health crisis for many years, and local public health leaders were being sidelined. They know their regions well, and in areas where they did work, it worked well. Let me be clear that in a Lib Dem world, local authorities would test then track those with a positive result and support them practically and emotionally in their isolation.

As the noble Baroness, Lady Thornton, has articulated, many of the public have said that they did not fully understand restrictions. When putting messages together, who did the Government picture they were talking to? From whom did they get their advice? Who did they test their messaging on? This is a case where conversations with the Plain English Campaign, or perhaps the Canadians, would have been helpful.

The last time tiered restrictions were in place, less than half of people in the UCL Covid-19 Social Study said that they fully understood the rules. With changes to the tier system and a five-day relaxation, will the Secretary of State make changes to the Government’s communications strategy to aid compliance?

Some of the Covid economic measures have helped people in the short term, such as the furlough scheme, which our colleagues in the other place fought so hard to get. However, the Government excluded more than 1 million people from Covid support and froze pay for local authority staff, who have also played a vital role in combating this pernicious disease. It is an assault on local authority workers and services.

Nurses too have been hoping for a pay rise. The Chancellor stated:

“Our health emergency is not yet over and our economic emergency has only just begun”.

He explained that the

“immediate priority is to protect people’s lives and livelihoods”, and that the spending review is set to deliver stronger public services. He continued:

“taking account of the pay review bodies’ advice, we will provide a pay rise to over a million nurses, doctors and others working in the NHS.”

He promised

“the 2.1 million public sector workers who earn below the median wage of £24,000” that they

“will be guaranteed a pay rise of at least £250.”—[Official Report, Commons, 25/11/20; cols. 827-28.]

That should include porters, auxiliaries, and other key, low-paid hospital workers.

Countless families are facing serious financial hardship. More than 1 million people have lost their jobs, and the devastating impact of this pandemic will continue to be felt acutely throughout the next year. We are also facing big challenges in deep-seated inequality. We must ensure that no one is left behind. The Government win plaudits for the furlough scheme, but they have failed to provide a serious economic strategy for dealing with unemployment, climate change and inequality. I fear the Government’s Brexit plans will make job losses and business closures much worse. No deal or a bad deal would be a huge blow for businesses and jobs just when we need to be recovering from this crisis.

Although the winter plan broadly outlines the five criteria used for determining the tier system, would the Minister be more transparent about what the exact entry and exit points of the tiers will be? I understand it is not always possible to give exact criteria, but even a rough idea would help the public know what they are aiming for when the Government are asking them to make so many sacrifices.

This has been relentless since the middle of May. At a briefing meeting today, we heard that the acute care sector was at full pelt, and this is before winter sets in. The Minister is rightly proud of the Nightingale units. Do we have staffing for them? Should we need them? Many clinical staff are totally exhausted. Many question whether they want to carry on in the profession. Are the Government making sure that a safety-critical profession can reach safe staffing levels by filling tens of thousands of unfilled nursing jobs?

Children are the most vulnerable to the social impacts of local restrictions and have had formative years of their lives severely affected. With the rule of six being reinstated after national lockdown, will the Minister commit to an exemption from the rule of six for children under 12? It really does make sense.

What is the Minister’s current estimation of the likely length of the restrictions? Being open and transparent on likely timings and not creating false hope are critical to maintaining public support for any public health measures. After all, the PM said earlier this year that we would be back to normal by Christmas, and how wrong he turned out to be.

Photo of Lord Bethell Lord Bethell The Parliamentary Under-Secretary for Health and Social Care

My Lords, I thank the noble Baronesses for their thoughtful and searching questions on an important day’s traffic of announcements from the Government. I would like to try to tackle them as comprehensively as I can, but I assure both noble Baronesses that I will write to them on any points I fail to address in these comments.

The noble Baroness, Lady Thornton, started by saying that she felt the endless cycle of lockdowns had not been working. It is undoubtedly true that we all regret the return to a national lockdown earlier this month, but it is not true they do not work. New infections are down by a third, and that is an enormous achievement by the British public, whose discipline and obedience to the restrictions has yielded a massive dividend.

The noble Baroness said that test and trace was not working. It is undoubtedly true that when prevalence levels are so high, when there are more than half a million infections in the country and when new infections are running at five digits, it is extremely challenging for any national testing and tracing system to keep up with that sort of capacity. I beg the noble Baroness to give some ground and acknowledge the achievement of the huge scaling of the number of tests, the vast number of people who have been asked to isolate, thereby breaking the chain of transmission, and the hard work of those who work on the tracing side of the business, which has dramatically increased its performance and will continue to meet target numbers.

The noble Baroness also talked about care homes being stranded. I remind her that we have come a huge distance. I could reel off a dozen achievements in the care homes strategy, but two stand out. First is the regular testing of staff, which has now become a systematic programme that has massively protected those in care homes. There has also been the recent introduction of testing for visitors, which brings welcome relief for those needing to support and visit those in care homes, a much-valued service that needed a huge amount of work to put into place.

The noble Baroness talked about the role of the public. I have alluded to my respect for and thanks to the public. I will be crystal clear: the challenge that we face as a country is not public apathy but the virus itself. There is an absolutely vicious aspect of the virus, which is its high contagiousness. In a room with a few people together, it is quite unlike most contagious diseases in its infectiousness. When we talk about the challenge of social distancing and the need for lockdowns, it is not one another whom we blame: it is the virus itself. I encourage all those who feel frustrated to remember who the enemy is.

The noble Baroness asked whether the tiering allocations would be done in consultation with local authorities. The brief answer to that question is no. We tried that, but it did not prove a successful experiment. The acrimony and large amount of delays created long-standing problems for the implementation of the policy. Therefore, we will be implementing the tiering on a fortnightly basis from the centre. It is a big yes, however, on the approach to community testing and infection control. We absolutely want to work in partnership with local authorities and local DPHs, which have all the powers that they need to decide whom they seek to target and what incentives they would like to provide for those who need to be attracted to testing. I also say yes—absolutely—to transparency, both in terms of the publication of the numbers and our approach to our collaborations. I put on record our massive thanks to local authorities, particularly those that have been working with us over the last fortnight on our community testing programme, the publication of which earlier today is a really important framework of the local-national partnership of which I have spoken at this Dispatch Box many times. It really brings alive that commitment.

The noble Baroness, Lady Jolly, was entirely right that there was an influenza plan, but it envisaged a completely different type of virus. The lessons from the influenza plan, though relevant for the kind of flu envisaged, were not applicable for the coronavirus. A good example of that is the PPE. Had we followed the possibility of preparing a massive stock of PPE for the kind of flu envisaged in the influenza plan, we would have had the wrong kind of PPE. There was nothing that we could have done about that.

The other big learning was on mortality rates. The mortality rates for Covid-19 and the long-standing effects that it has on people are completely unlike those of the kind of flu that we were envisaging earlier. It has been a grave learning curve to have to change our plans to deal with Covid.

In relation to other learnings or things that we have moved on since then, I reiterate a theme that I have mentioned before: our commitment to national and local test and trace. Quite understandably, the noble Baroness challenges me on that point, but I gently remind her that, in February, local authorities did not have any tests; nobody had any tests. We were doing 2,000 tests a day. Therefore, it is all very well saying that we should have left test and trace to local authorities, but there simply were not the resources there to do that. It took a massive national programme and huge national effort to get us up to half a million tests a day, which is something that the local authorities, even in collaboration, could not possibly have done.

The local authorities also did not have scalable tracing capacity. The PHE capacity was designed for ultra-low prevalence rates—for when you are chasing a few dozen carriers of a disease who, perhaps, have recently arrived from overseas. It was not designed for 20,000 infections a day, which is the kind of infection rate we have been looking at recently. It was only by building the data systems, protocols and guidelines, and having tens of thousands of employees, that we have been able to put that tracing capacity in place.

We also did not have the organisational or analytical capacity to do the kind of surveillance that is done through ONS and REACT or the kind of data management that the JBC has done. Now that we have those components in place—the physical, data and diagnostic frameworks—we are in a position to work as a team, both nationally and locally. The noble Baroness is entirely right that that local insight, intelligence, empathy and leadership are absolutely critical for our success, and I encourage her and all those in the Chamber to read our community testing programme, which was published earlier today and which encapsulates the spirit of the local-national partnership of which the noble Baroness has spoken previously in the Chamber.

The noble Baroness challenges me on communications, and I will not deny that it has been one of the great challenges of the pandemic to try to explain, in a fast-changing and confusing climate, the government imperative and recommendations to the public. One of the key things that we have learned is that, sometimes, the desire to share the delicious complexity of the epidemiology stands in the way of simple communication. Sometimes, trying to find the exemptions that are fair to everyone and cater to every single consultative recommendation stands in the way of simplicity, straightforwardness and tractability.

We have learned that, sometimes, it is more important to be simple, clear and straightforward than to try to accommodate every nuance and exception. This is why we have pursued rules like the rule of six, have gone for a simple and easily understood regional tiering process and applied the 10 pm curfew, although we have updated that to an 11 pm curfew, with a drinking-up time of 10 pm. That kind of consistent messaging is what the public, quite reasonably, respond to, which is why we have moved to it.

In response to the noble Baroness’s question about under-12s, I say that there are both the communication and epidemiological reasons that children are vectors of disease. This is an uncomfortable truth because they very infrequently show any symptoms and it is incredibly inconvenient—I say this as someone with four children, three of whom are under 12. However, it would be epidemiologically irresponsible to try to make an exception in that way, and I certainly will be spending quite a lot of Christmas with my family.

In relation to hardship, the noble Baroness makes the point extremely well, and we are totally sympathetic to her point. It is undoubtedly true that the least advantaged will be the hardest hit by this epidemic. It is true because their jobs are hit hardest, particularly those in casual labour, because the virus often hits those who have the most cramped accommodation or low-quality health and because many of those who live on the borderline of life will be the ones nudged into poverty.

The Government have worked hard, with the furlough scheme in particular, to ensure that a financial safety net is put into place, but I have no doubt that there will be a moment when the economic hardship created by the pandemic will be acute, and I have no doubt that the mental health implications of that for the population will be extremely hard. The Government are extremely aware of that and we are trying our hardest to minimise the impact. One reason why we are hitting the virus hard with these tiers is to ensure that we can get the economy back as quickly as we can, mostly to the advantage of those who are hit the hardest.

The noble Baroness asked me about entry and exit points to the tiers, and I have no easy solution for her. There are very clear considerations which we will be looking at when we consider which regions go into which tier: case detection rates, particularly of those over 60; the rate at which cases are falling; the positivity rate; and pressure on the NHS. But this is an incredibly complex matrix of interdependencies. It is not simple to plop it into the kind of easy algorithm that can churn out an answer at the push of a button; nor is it easy to have one simple metric where we can say, “You’ve hit this and therefore you move this way,” or “You’ve failed and you move that way.” If it were so easy we would publish it. The best advice we can get is that we have to consider all those factors when making those decisions. We will do it in a spirit of transparency, but we will have to make tough decisions. I reassure noble Lords that it will happen every two weeks, as the Prime Minister explained, and we will seek to be as fair and thorough as we possibly can.

Photo of Baroness Morris of Bolton Baroness Morris of Bolton Deputy Chairman of Committees, Deputy Speaker (Lords)

My Lords, we now come to the 30 minutes allocated for Back-Bench questions. I ask that questions and answers be brief so that I can call the maximum number of speakers. I now call the noble Lord, Lord Caine.

Photo of Lord Caine Lord Caine Deputy Chairman of Committees 8:31 pm, 30th November 2020

My Lords, my noble friend will be aware of the great uncertainties facing those who work in the hospitality sector, particularly in those parts of the country that are in tier 3, such as my native West Riding of Yorkshire. What realistic prospect is there of areas moving from tiers 3 to 2 when the next review takes place on 16 December, so that bars and restaurants can at least open their doors for the crucial Christmas period? Rather than grouping together entire regions into tiers, is there not a strong case for more bespoke local arrangements?

Photo of Lord Bethell Lord Bethell The Parliamentary Under-Secretary for Health and Social Care

My noble friend is entirely right about the hospitality sector. It is a sector that we care about greatly and we recognise how hard hit it has been. None the less, we have to be considerate of the fact that the best epidemiological studies suggest that this is an environment where infection hits hard, so we are trying to hit the right balance between the two. As for local areas and trying to be more precise and focused in our tiering, that sounds like a sensible suggestion. However, we experimented with it quite thoroughly during the summer, and I remember standing here at this Dispatch Box week after week running through tweaks to various local tiers, only to find that the virus very quickly leaped from one area to another. It is a frustrating fact that the virus spreads from city to surrounding rural area and from one town to the next with alarming speed. It is also true, as discussed in response to the earlier question, that for communications it is important to keep things simple. For those reasons, we are not envisaging a change to the tiering structure at the moment.

Photo of Lord Bilimoria Lord Bilimoria Crossbench

My Lords, is the Minister aware that just a few minutes ago, before the Statement, a press report questioning the accuracy of lateral flow antigen tests said that 140,000 tests were carried out in the Liverpool City Region, and yet the Statement says that more than 300,000 people were tested in Liverpool and, with the mass testing, cases have fallen by three-quarters and Liverpool has now gone down from tier 3 to tier 2? Why can we not get the communication right so that people can have confidence in mass testing so that it can be rolled out nationally, and show the evidence that it actually works?

Photo of Lord Bethell Lord Bethell The Parliamentary Under-Secretary for Health and Social Care

I am extremely grateful for the opportunity to remind the noble Lord that earlier today we published a fulsome programme of community testing. I would be very glad to send him a copy of it, because it lays out exactly the plan he has just described; I am hopeful that he will celebrate its publication. He is entirely right that infection rates have come down in Liverpool—not just because of mass testing but it has made a contribution—and I pay tribute to the mayor and people of Liverpool for their approach in recent months.

Photo of Lord Brooke of Alverthorpe Lord Brooke of Alverthorpe Labour

My Lords, does the Minister agree that when a country faces a common external threat—to use his phrase, an “enemy”—the best chance of success comes when it is united? If he does, and we are once again seeing splintering and divisions arising quickly after this further Covid Statement, will he speak to his colleague the Prime Minister and seek to persuade him to invite other political parties to get involved in a united approach; to invite Sir Keir Starmer, the leaders of the devolved Parliaments and the leaders of the other political parties so that we can move towards a co-ordinated and co-operative effort while this problem continues to blight the country? As he has demonstrated with Liverpool, there is a very strong case for people working closer together—not permanently, but temporarily—than they have done hitherto. This is required at a national and political level as well.

Photo of Lord Bethell Lord Bethell The Parliamentary Under-Secretary for Health and Social Care

I share completely the noble Lord’s ambition for collaboration and a sense of national unity. I am grateful to the devolved Assemblies and the leaders of the nations for their collaborative approach, and to the leader of the Opposition for his support on a large number of matters. However, right now we need clear, simple, strong government, which is best supplied by the voted-in majority.

Photo of Baroness Walmsley Baroness Walmsley Co-Deputy Leader of the Liberal Democrat Peers

My Lords, at the beginning of the first lockdown in Wales, we were forbidden from going out of our borough or travelling more than five miles for exercise. It worked. Now some Government Back-Benchers are demanding more granularity in the tier areas, with restrictions being eased in boroughs with lower case numbers. If this is to be done, it must be—as the Minister just mentioned—without risking the virus spreading from adjacent high-incidence areas, as it did before. If the Government are inclined to give in to this pressure, will they at least consider imposing travel restrictions in high-incidence areas?

Photo of Lord Bethell Lord Bethell The Parliamentary Under-Secretary for Health and Social Care

The noble Baroness is entirely right. I share her sentiments. We are not inclined to give in to the pressure. There is a temptation for greater granularity, but we have learned the lesson on that one.

Photo of Lord Lansley Lord Lansley Conservative

My Lords, the Faculty of Public Health and the directors of public health have expressed reservations about what they described as the distraction of the mass community testing programme in relation to the requirement to support the vaccination programme. Can my noble friend give them and me some reassurance that the vaccination programme will be an overarching priority for resources and that the testing of symptomatic cases and of essential workers, to which he referred, is a priority for the testing programme? Can he also say whether there is a realistic level of resources to support the community testing programme to which he has twice referred positively?

Photo of Lord Bethell Lord Bethell The Parliamentary Under-Secretary for Health and Social Care

I welcome my noble friend’s challenge. I reassure him that the testing and vaccination programmes will absolutely run alongside each other and that this has already been happening. They are collaborating very closely. The resources being provided for both are generous enough to ensure full delivery of the vaccine. The rollout of the community testing programme is a sign of the success of test and trace, but it will in no way have a negative impact on the deployment of the vaccine programme, which remains a number one priority for the Government.

Photo of Baroness Finlay of Llandaff Baroness Finlay of Llandaff Deputy Chairman of Committees, Deputy Speaker (Lords)

My Lords, given that some people need to go to visit a relative who is dying or otherwise very distressed, will the Government instigate a system whereby these people can register that they will need to travel across boundaries? They may even need to stay over to provide care for some time, to enable a person to be cared for in their own home. Under the current situation, they risk being given a criminal record for breaching rules, and then they may have to try to defend themselves in retrospect after the person has died.

Photo of Lord Bethell Lord Bethell The Parliamentary Under-Secretary for Health and Social Care

I thank the noble Baroness for her characteristically compassionate question. I can reassure her that there are exceptions for essential travel. The kind of scenarios that she just described would seem to me to fit into the definition of exceptional travel. I am happy to look into whether some form of registration process is necessary but, as far as I understand, that has not proved to be the case.

Photo of Baroness Clark of Kilwinning Baroness Clark of Kilwinning Labour

Many scientists are expressing concern that the easing of restrictions at Christmas is going to lead to a surge in cases in January. Given this and the high incidence of Covid among 11 to 16 year-olds, are the Government actively considering extending the Christmas break for secondary school children as a way to try to curb the spread of the virus?

Photo of Lord Bethell Lord Bethell The Parliamentary Under-Secretary for Health and Social Care

The noble Baroness is right that we are concerned about a post-Christmas surge, but the opening of schools is an absolute number one priority. We will do everything we can to keep the schools open, and that includes schools for 11 to 16 year-olds.

Photo of Baroness Harris of Richmond Baroness Harris of Richmond Liberal Democrat

The Minister and the noble Baroness, Lady Walmsley, have already touched on this, but can the Minister tell me how the Government propose to stop people in the different tiers crossing borders? I declare an interest in this because I live in a tourist hot spot, which suffered badly during the first lockdown from people coming from all those neighbouring areas, which are now in tier 3 and surrounding us.

Photo of Lord Bethell Lord Bethell The Parliamentary Under-Secretary for Health and Social Care

My Lords, we rely on the principle of consent. We appeal to the good will of the British public. Analysis of Google and transport statistics suggests that, by and large, the British public have abided by the travel restrictions in the tiering structure, but we do keep them under analysis. It is not our intention to have surveillance and a penalty-fine culture, but we will do whatever is necessary to ensure the effective application of the tiering framework.

Photo of Lord Fairfax of Cameron Lord Fairfax of Cameron Conservative

My Lords, while my noble friend the Minister is of course only responsible for health matters, would he not agree that, with the economic emergency—as the Chancellor had said—just starting, unemployment set to double by next year, and thousands of businesses going to the wall every week, to say nothing of the non-Covid health consequences of its measures, the Government would not be facing possible defeat in the other place tomorrow if they had taken a more balanced and transparent approach, particularly recently, to the Covid crisis?

Photo of Lord Bethell Lord Bethell The Parliamentary Under-Secretary for Health and Social Care

My Lords, although I am only a humble Health Minister, I do believe that the frameworks we are recommending are in the best interests of the economy. If the NHS cannot cope, if trust breaks down in society, if people stay at home and will not shop or go to hospitality, and if people are laid off then the economy suffers. If the pandemic and the presence of Covid, as a driver of behaviour in our society, rolls over for month after month, then we will be the long-term sufferers of economic decline. That is the reason why we believe that the tiering and community testing is essential, and that is why we support these measures.

Photo of Lord Craig of Radley Lord Craig of Radley Crossbench

Can the Minister confirm that the initial advice from the independent committee on vaccinations is that, after NHS and care homes staff, priority should be given to people over 80 in the rest of the population in order of age and risk? That is medically sound advice, but in the wider national interest would it not be preferable that those who contribute to recovery and education are prioritised over the more elderly who successfully kept themselves free from the virus and do not expect to continue to benefit at the expense of working individuals?

Photo of Lord Bethell Lord Bethell The Parliamentary Under-Secretary for Health and Social Care

The noble and gallant Lord makes a fair point. We looked at the very scenario that he describes, but ultimately our priorities are to save life, protect the NHS and keep schools and the economy going. The best way of doing that is to prioritise the elderly because there is a direct correlation between illness from Covid and age. The best way in which we can protect society and the economy is to ensure that those who are oldest get the vaccine first.

Photo of Lord Mackenzie of Framwellgate Lord Mackenzie of Framwellgate Non-affiliated

My Lords, clear messaging by the Government in relation to Covid is crucial. Can the Minister make it clear that three households meeting over five days in one house at Christmas is not compulsory and that it is perfectly acceptable to take the view that it is not worth the risk? Given that a few weeks ago mixing of households was the demon in the piece, does he agree that having Christmas lunch with five others in a Covid-secure restaurant would be far safer than doing so in an excitable family home with minimum PPE security? Plus, of course, it would bring an important additional benefit to the economy.

Photo of Lord Bethell Lord Bethell The Parliamentary Under-Secretary for Health and Social Care

I am grateful to the noble Lord for what I think was his broad point. I did not quite understand the exact scenario in the restaurant that he described, but I think that he was alluding to the difficult but important decision that every family has to make. He is entirely right: we do not all have to go mad over Christmas and see as many people as we can. Some people will make the quite sensible decision to show restraint and to share the holiday with those they love but not necessarily to travel or see a very large number of people. I salute those people and encourage that kind of attitude.

Photo of Baroness Donaghy Baroness Donaghy Chair, EU Services Sub-Committee, Chair, EU Services Sub-Committee

My Lords, perhaps I may come back to of my noble friend Lady Thornton’s question on test and trace. The noble Lord accepted that it was extremely challenging—those were his words—and said that we should accept that there had been a huge scaling up, but we were told that a world-class test and trace system would solve things, and it is far from that. The inconsistencies in results are causing a high degree of scepticism. Can he outline further how the Government will meet that extreme challenge?

Photo of Lord Bethell Lord Bethell The Parliamentary Under-Secretary for Health and Social Care

My Lords, I am not sure that I accept the premise of the question. The scepticism that the noble Baroness describes has not stopped millions of people stepping forward to have tests. Our experience is that those who have direct experience of test and trace—whether they are people who use the app, people who turn up for testing, people who go to hospital and have tests through the NHS or people who are traced—speak of the good service and experience that they have. It is undoubtedly true that test and trace takes a hammering in the press, and its reputation has been hard hit by sceptics who talk down its performance, but, generally speaking, those who actually experience it speak highly of the service.

Photo of Lord Farmer Lord Farmer Conservative

My Lords, just 10 days ago, Professor David Eyre of the University of Oxford reported that, for most people, being infected with Covid-19 protects against reinfection for at least six months. He said:

“This is really good news, because we can be confident that, at least in the short term, most people who get COVID-19 won’t get it again.”

Washington State University research found that just one case out of the multiple millions worldwide suggested that waning antibody levels or a poorly developed immune system to Covid could put people at risk of reinfection. I am aware that studies need to be replicated, but this good news seems to be a very well-kept secret, ignored on the official government web page on the relevance of antibody tests. What would give the Government confidence that potent antibodies linger beyond at least six months in the majority of cases and how small would the tiny minority of proven cases of reinfection have to be in order for them to say that this risk is a price worth paying for society to begin to get back on its feet?

Photo of Lord Bethell Lord Bethell The Parliamentary Under-Secretary for Health and Social Care

My Lords, the Government—and I personally—are extremely interested in this area. Early findings of a study by the Coronavirus Immunology Consortium and Public Health England, which have not been peer reviewed yet, suggest that a strong cellular immune response is likely to be present in the majority of adults six months after infection. At present, there is not enough evidence to rule out people who have positive T cell responses or antibodies to Covid-19 from potentially still playing a role in transmitting the virus to others. However, further research on the level of sterilising immunity provided by natural infection should be available from the SIREN study and the Oxford healthcare workers study before the end of the year. I look forward to the results of those studies very much.

Photo of Lord Bird Lord Bird Crossbench

My Lords, I remind that House that not so long ago the Government put their arms around the homeless and removed them from the streets. They did a highly commendable job because it was the first time that a Government had taken responsibility for rough sleepers en masse. They did not quite finish the job because it was difficult to bring them in. Can we also put our arms around the roughly 200,000 people who, according to the LGA, will fall homeless through eviction? The best thing that we can do is to keep people in their houses. It cuts the cost of poverty and it cuts the cost of homelessness. When people slip into homelessness, the costs double.

Photo of Lord Bethell Lord Bethell The Parliamentary Under-Secretary for Health and Social Care

My Lords, I am enormously grateful to the noble Lord for his very generous comments. I commend him for his advocacy both in the instance of Covid and for his lifelong commitment to standing up for the homeless. He is right that the homeless are undoubtedly super-vulnerable to a pandemic such as Covid and that there is a finance problem for the charities which look after those who live on the streets. He is right that those who have trouble paying their rent and face eviction are in a particularly difficult position. That is why we have put in place a mortgage relief scheme, continue to support the furlough scheme and keep in mind the plight of those who struggle to pay their household bills.

Photo of Baroness Morris of Bolton Baroness Morris of Bolton Deputy Chairman of Committees, Deputy Speaker (Lords)

The noble Lord, Lord Liddle, has scratched, so I now call the noble Lord, Lord Dobbs.

Photo of Lord Dobbs Lord Dobbs Conservative

My Lords, I would like to indulge in a little flight of fantasy by bringing two different elements together. The first is the Oxford vaccine, which appears to be much cheaper and easier to distribute than the other vaccines currently on offer. The second is the pressure on our foreign aid budget. Will my noble friend have a word with his Foreign Office colleagues and see whether it is possible to bring the two together, using the aid programme to distribute the Oxford vaccine as soon as any surplus supply becomes available? Distributing it to our aid recipients to help them with their own battles against Covid will show that Britain is a proud world leader in supplying practical humanitarian support.

Photo of Lord Bethell Lord Bethell The Parliamentary Under-Secretary for Health and Social Care

My noble friend makes a very interesting point. Our priority right now is to vaccinate the British public. He is right that there are many vaccines available and Britain has made a massive investment in vaccines. We are also supporters of the international distribution of vaccines and the fair access of the developing world and those around the world to vaccines. That is why we support COVAX, Gavi and CEPI. He is right that there is an opportunity somewhere, and we are entertaining ways of supporting such a vision.

Photo of Baroness Penn Baroness Penn Baroness in Waiting (HM Household) (Whip)

I think the noble Lord needs to unmute.

Photo of Lord Dubs Lord Dubs Labour

I apologise. Does the Minister have any estimate of the number of people who are currently in self-isolation? Does he agree that if these people were to be given high priority for testing, their period of self-isolation would be shortened and more people would be willing to go into self-isolation because they would not lose so much money if they could be tested quickly and resume their ordinary lives?

Photo of Lord Bethell Lord Bethell The Parliamentary Under-Secretary for Health and Social Care

The noble Lord hits the nail on the head. We have already brought into place a test-to-release programme for foreign visitors and we are looking at ways in which such a principle could be applied elsewhere.

Photo of Baroness Morris of Bolton Baroness Morris of Bolton Deputy Chairman of Committees, Deputy Speaker (Lords)

The noble Baroness, Lady Noakes, has withdrawn. We are not sure whether we have the noble Lord, Lord Rooker. We do not. I now call the noble Lord, Lord Forsyth of Drumlean.

Photo of Lord Forsyth of Drumlean Lord Forsyth of Drumlean Chair, Economic Affairs Committee, Chair, Economic Affairs Committee

My Lords, could my noble friend comment on reports in today’s press that four hospitals only, in the whole of England, are busier than last winter? Could he explain how on Saturday Michael Gove warned that, unless the latest regulations were implemented, every hospital in England risked being overwhelmed by Covid-19 cases? Before our debate tomorrow, could he publish the modelling on which this assertion was based?

Photo of Lord Bethell Lord Bethell The Parliamentary Under-Secretary for Health and Social Care

My Lords, I saw the press reports to which my noble friend refers. I remind him that their suggestion that we should be running our hospital system at 99% capacity during a pandemic is not reasonable. It would put our flexibility to deal with any increase in infections over the winter months in an incredibly precarious state. Running at around 88%, which is the current rate, is pragmatic. It would take very little for the 600,000-plus group of people who carry the Covid infection at the moment to have an impact on those bed numbers before the NHS was overwhelmed. That was the point that the Chancellor of the Duchy of Lancaster made, and I thought he made it very well.

Photo of Baroness Stuart of Edgbaston Baroness Stuart of Edgbaston Non-affiliated

My Lords, it is a matter of regret that it was not possible to reach agreement on the tiering system with local authority leaders. However, local authorities will be crucial to its implementation, not just now but after Christmas. Birmingham City Council has succeeded in recruiting 468 Covid community champions and has regular meetings with faith leaders and public health. Can the Minister assure noble Lords that close co-operation with local communities, authorities and leaders, irrespective of their party allegiance, will continue, because otherwise we will not succeed?

Photo of Lord Bethell Lord Bethell The Parliamentary Under-Secretary for Health and Social Care

I completely endorse the noble Baroness’s points. I know well the very good work that both Birmingham and the entire West Midlands are doing. Recruitment of champions and liaison with faith leaders are exactly the kinds of interventions that local authority leadership can provide. It is absolutely at the heart of our local and national approach. We are providing the kind of support that local authorities need to pursue these plans, which includes military personnel, testing facilities, data and analysis, and financial support, where necessary.

Photo of Baroness Morris of Bolton Baroness Morris of Bolton Deputy Chairman of Committees, Deputy Speaker (Lords)

The noble Lord, Lord Balfe, has withdrawn, so I now call the noble Lord, Lord Moynihan.

Photo of Lord Moynihan Lord Moynihan Conservative

My Lords, I congratulate my noble friend the Minister on the importance that he attaches to the safe return of fans to designated sports events, the reopening of many gyms and sporting activities across England, and the financial package announced last week for key sports in need of urgent financial assistance. Does he agree that we now need to help all clubs, particularly grass-roots clubs, to fulfil the critical role of ensuring that the population is as active and healthy as possible, to provide a strong counter to the Covid virus? Delivering and funding that objective must remain a key priority for the Government.

Photo of Lord Bethell Lord Bethell The Parliamentary Under-Secretary for Health and Social Care

I am grateful to my noble friend for the opportunity to mention sports and to thank him for his advocacy of sports, both national and grass roots, during the epidemic. He is entirely right: if there has been one striking aspect of the pandemic, it has been the way that the British public have missed the elite sports that they follow and support avidly, and have increasingly participated in their personal fitness and sport. I cannot help thinking that this pandemic will be something of an inflection point in the British people’s attitude to sport. I support the department’s campaign to encourage people to do more sport. We are doing an enormous amount to open stadia. I am pleased that we have new guidelines that will enable large stadia to open, albeit with social distancing. But my noble friend is entirely right that we must do more to support the grass roots, and I know that colleagues in the DCMS are doing as much as they can to help.

House adjourned at 8.59 pm.