Covid-19

I beg to move,

That this House has considered covid-19.

This global pandemic calls on us all to make the best judgments that we can on behalf of our nation. This disease attacks us all because we are human, and it is only by coming together as humanity that we can solve it. It is a communitarian disease that passes from person to person among those who are closest to each other, and it is as a community that we must tackle it. The virus raises profound questions for each Member of this House, too, representing our constituencies as we do, to make the best judgments that we can in the face of uncertainty, immense challenge and with great weights on each side of the scales, in the best interests of the nation that we serve.

We have heard today from the Prime Minister of the grave steps on which the House will vote on Wednesday. We know of the real impact that those steps will have on so many lives and livelihoods. We know the hardships that will be faced and the jobs lost, and we cannot save them all, but the alternative of not acting would be so much worse.

When faced with such a deadly adversary, we cannot stand aside and let it spread unchecked through our communities when we know the devastation it would cause, not just to the NHS and not only in the mounting death toll, but I firmly believe the impact on our economy would be worse too. The devastation that the virus would wreak if unchecked would impact the NHS’s ability to treat covid and non-covid patients. For all those who need treatment in the NHS right now, the action we propose will help to ensure that the NHS has what it needs to give them the world-class care that we have all come to expect.

I applaud the congratulations that the Secretary of State has already extended to NHS workers. What message does he have for my constituent, Faye McDonnell, a student nurse? Will she be paid during this crisis? Will my other constituent, Kirsten Doran, a theatre nurse, be given the increase in pay and fair pay that nurses are campaigning for?

Of course the NHS in Northern Ireland is the responsibility of the Administration there. I know of the issues around nurses’ pay, which has been the subject of much interest. I will not go into the individual details, but I recognise the case that the hon. Gentleman rightly makes on behalf of his constituents. We in this House support the staff of the NHS across the UK—in all four nations in all four parts of the NHS.

Across the UK, however, the case is the same. For people who need NHS treatment now, whether it is for covid or any other condition, the best course of action is to suppress the virus. Partly because of that, I believe that the only strategy a responsible Government can take is to suppress the virus and support the economy, education and the NHS as much as possible until science can come to our rescue.

We are undoubtedly in a serious situation, and I am sure that the Secretary of State agrees that we need to take political gamesmanship out of the debate. Considering the measures and the month-long lockdown that have been announced for England, does he share my concern at the actions of some of his colleagues in Wales who have worked the whole situation up into a political frenzy with regard to the ongoing lockdown in my country?

The hon. Gentleman invites me to get involved in political controversy in Wales while rejecting the principle of getting involved in political controversy. Having thought about it, on balance, I am going to sidestep that particular political controversy. As it happens, I strongly think that the public expect us to work together in the national interest, and that is what we propose to do.

A crucial part of that national interest is protecting the most vulnerable. When coronavirus spreads rapidly, it reaches all parts. Many of the most vulnerable can live only with care and support from those outside their home, or live in multigenerational households. We must protect the most vulnerable from the disease, and we will, with renewed shielding advice and support for care homes, but we cannot rely on that alone.

There is no quick fix to this pandemic; there is no silver bullet. What makes this fight so tough is that the virus thrives on all the things that make life worth living, such as the joy of social contact and the communal events that give us so much happiness and fulfilment, but we must persevere together to get it under control.

One of the key things that we will depend on after the lockdown is over—assuming that the House gives its support—is a really effective contact tracing system. The Secretary of State knows as well as I do that, in the last couple of weeks, the system has been reaching only 48% of the contacts of those who have tested positive. The Scientific Advisory Group for Emergencies says that for the system to be effective, it needs to reach 80%. In the 28 days of lockdown, what specific steps will he take to get it to 80%?

My right hon Friend is right; I was going to come on to that issue. Of course the contact tracing system needs to contact as many people as it can. The figures that he refers to include a huge array of different types of contact. I will update the House on the improvements that we have seen in contact tracing, including an increase in the absolute number of people who have been contacted and in the proportion.

We absolutely need the proportion to go up. A critical part of that is people’s engagement with the contact tracing system, as well as the system itself. Some of the proportion who are not reached are not reached because their contact details are not given. It is quite hard to blame the people who work in NHS Test and Trace, who are working so hard on it, for that particular reason. It is important to go into the details of why a particular contact is not made and try to improve all those details. That work is ongoing, but I accept the challenge.

As well as boosting contact tracing rates, which are absolutely critical, I hope the Secretary of State will address the issues with the app that have been revealed this weekend; it has not been contacting people who should have been contacted. Self-isolation is also important. The Prime Minister admitted today—he finally acknowledged—that self-isolation rates are far too low, but we have heard nothing about what steps are to be put in place. We need carrots, not sticks—support and incentives for people to self-isolate. The Secretary of State mentioned multigenerational households; there are many overcrowded households, particularly in inner cities, and therefore high-risk people who cannot self-isolate at home. Has he given any consideration to setting up self-isolation support facilities that those people can go to?

Of course, self-isolation following contact or following a positive test, or in quarantine from abroad, is absolutely critical, and we have brought in measures to improve self-isolation, such as the £500 payment and strengthening the enforcement around it, and we are always looking for what we can do to strengthen self-isolation; the Prime Minister was absolutely right in what he said earlier, and there is a huge amount of work under way on it.

Two weeks ago, I asked the Health Secretary about the button that was meant to be on the app to release a reference code for people to claim the £500. The Health Secretary specifically came to the Dispatch Box to say that they just needed to press that button. That button does not exist—it did not exist then and it still does not exist today—so why did he make that intervention and how is he going to rectify the situation so people can claim that £500?

Yes, the button is coming; it is in development. The hon. Member for Twickenham (Munira Wilson), who made the previous intervention, also spoke about the app. There was an upgrade to the app towards the end of last week, and I want to put on record my thanks to the app team, who have done such a great job in improving the app by, as the hon. Member for Twickenham said, improving the targeting so that more people are targeted and more people get the message. The app is also now getting fewer false positives so people can have more confidence that if they are contacted by the app and told to isolate, they need to do so. The button will come.

People up and down the country made enormous sacrifices during the first lockdown, and they were promised a world-beating contact, test and trace system. Some £12 billion has been spent on Serco to provide that. In areas such as mine with high levels of deprivation, health inequalities and high numbers of vulnerable people, people are already dying, and we do not have an effective testing and tracing system. So, given where we are, may I appeal to the Secretary of State to make resources available to areas where we have the local capacity to do testing and tracing, to help improve the system as quickly as possible in this lockdown?

Yes, as we have discussed many times, that is happening—absolutely—and it is the link between the national and the local that is the solution here. I will come on to testing in more detail later because I have some new things to say about it. In the meantime, the other thing we need to do, of course, is make sure that for this second peak—the second wave—we do all we can to support those institutions that are helping us through it, and first among those is, of course, the NHS.

The NHS is better prepared for this second wave, and I want to thank the NHS and everybody who works in it for their efforts over the past few months to ensure that we are better prepared. We know infinitely more about coronavirus now than we knew as the first wave hit. Our Nightingale hospitals, for instance, stand ready and are being restarted in the parts of the country that need them. The independent sector has stepped up to the mark to help us work through the backlog of the vital elective operations and to help keep going with elective operations, even through this second peak. We have hired more staff, with 13,700 more nurses and 7,800 more doctors. We have provided £3 billion of extra funding across health and social care. Personal protective equipment is widely and freely available, and infection control procedures have been significantly strengthened, based on better understanding of transmission of the virus, including aerosol as well as droplet and fomite transmission.

I am glad to hear that preparations are under way. I have had several emails from constituents in Bosworth who are worried about their routine operations; their follow-up might be lost. They remember what happened in the last lockdown, when they were not able to get that follow-up. Can my right hon. Friend confirm that all NHS appointments will be going ahead as best they can?

Yes, absolutely, and my hon. Friend makes a critical point. If in Bosworth someone is waiting for an operation on the NHS, they are more likely to get it if we keep the virus suppressed—in fact, if we keep it down, they will get that operation and we will get it done. Unfortunately, in the parts of the country where things have got too high, non-urgent, non-cancer elective operations have had to be cancelled. That demonstrates that, both for covid and non-covid health reasons, it is better to keep the virus suppressed.

I was halfway through my long list of the things that the NHS has been doing to prepare over the summer. At the moment, we are delivering 159 A&E upgrades; as far as I know, that is the biggest number of concurrent upgrades to emergency care in the NHS’s history. We have radically expanded telemedicine in primary and outpatient care. We are introducing 111 First, with an expanded 111 service to help people get the care that they need.

The NHS has learned how to treat covid patients better too, of course: not just by discovering treatments such as dexamethasone, in which the NHS played a critical part, but by improving clinical techniques—earlier oxygenation and later ventilation, for instance. As a result, our rate of hospital-acquired infection is down and the number of people who survive covid in hospital is up. We have been able to set an explicit goal that all cancer treatment should continue throughout this second wave, which speaks precisely to the point that my hon. Friend the Member for Bosworth (Dr Evans) made.

But even with this expanded NHS and with the better treatments, the extra investment and the brilliance of the whole NHS team, who have done and learned so much about the virus and worked so hard to prepare—even with all that—and even if the NHS were twice as big as it is now, it could not cope, and no health service could, if the virus continued to grow as it is now. We must control the virus, to protect the NHS and ensure that it is always there, to treat patients with covid and patients with all other conditions.

One of the wonderful things that my right hon. Friend has done is make available so much data. I am looking at the case data for Liverpool, and there it is—daily cases by specimen date. Thank goodness the number is now falling, and on a seven-day basis, again, it is falling. I am just wondering why now anyone in Liverpool would say anything other than that the Government’s previous strategy is now working. Why on earth, then, would people in other areas that are not even as badly off as Liverpool—or indeed Manchester, where the cases seem to be stabilising—want to see an even tighter lockdown?

Unfortunately, in Liverpool the overall case rate includes a very high peak among students. The over-60s case rate, which is also published on the same website, shows a flattening, but a flattening at a very high level, such that Liverpool University Hospitals NHS Foundation Trust has already had to cancel non-urgent, non-cancer elective activity.

The danger of a plateauing at a high level, as the chief medical officer set out, is that if the rate starts to go up again, we are already under significant pressure in the NHS in Liverpool. The same argument goes for Tyneside, where again the overall case rate appears to be coming down, which is good news. The number among the over-60s, however, is flattening, again at a very high level, and in other parts of the country, including areas in tier 3, the numbers were going up.

It is not good enough just to control R and keep it lower than its natural rate; we have to get it below 1 to be able to change from a doubling time to a halving time of this virus. Even I—the most enthusiastic supporter of the tier system—can see that, unfortunately, cases were rising and the cases among the over-60s are rising, including in the areas with tier 3 restrictions. It is important to strip out from those data the outbreak among students. I have talked before about there being two overlapping epidemics: one among students and one among the wider community.