The following Statement was made on Monday 18 May in the House of Commons.
“With permission, Mr Speaker, I will make a Statement on coronavirus. This is the most serious public health emergency in 100 years, but through the combined efforts of the whole nation, we have got through the peak. Let us not forget what, together, has been achieved. We flattened the curve, and now the number of people in hospital with coronavirus is half what it was at the peak. We protected the NHS, and the number of patients in critical care is down by two-thirds. Mercifully, the number of deaths across all settings is falling.
This Mental Health Awareness Week is an important reminder that we need to look after ourselves, as well as each other. If someone needs support with their mental health, the NHS is there for them. This is particularly important for front-line staff, and we have supported all NHS trusts to develop 24/7 mental health helplines.
Our plan throughout this crisis has been to slow the spread and protect the NHS. Thanks to the resolve of the British people, the plan is working, and we are now in the second phase of this fight. I will update the House on the next steps that we are taking as part of that plan. First, we are protecting the nation’s care homes, with a further £600 million available directly to care homes in England. We have prioritised testing for care homes throughout, we made sure that every care home has a named NHS clinical lead and we are requiring local authorities to conduct daily reviews of the situation on the ground, so that every care home gets the support it needs each and every day. All this amounts to an unprecedented level of scrutiny and support for the social care system, and a level of integration with the NHS that is long overdue.
Secondly, the four UK chief medical officers have today updated the case definition to include a new symptom. Throughout this pandemic, we have said that someone who develops a new continuous cough or fever should immediately self-isolate. From today, we are including anosmia—losing one’s sense of smell or experiencing a change in the normal sense of smell or taste—which can be a symptom of coronavirus, even where the other symptoms are not present. So, from today, anyone who develops a continuous cough or fever or anosmia should immediately self-isolate for at least seven days, in line with the guidelines. Members of their household should self-isolate for 14 days. By updating the case definition in line with the latest science, we can more easily recognise the presence of the virus and more effectively fight it.
Thirdly, we are expanding eligibility for testing further than ever before. Over the past six weeks, this country has taken a small, specialised diagnostics industry and scaled it at breathtaking pace into a global champion. Yesterday, we conducted 100,678 tests. Every day, we create more capacity, which means that more people can be tested and the virus has fewer places to hide.
Today, I can announce to the House that everyone aged five and over with symptoms is now eligible for a test. That applies right across the UK, in all four nations, from now. Anyone with a new continuous cough, a high temperature or a loss of, or change in, their sense of taste or smell can book a test by visiting nhs.uk/coronavirus. Anyone who is eligible for a test but does not have internet access can call 119 in England and Wales or, in Scotland and Northern Ireland, 0300 303 2713. We will continue to prioritise access to tests for NHS and social care, patients, residents and staff, and as testing ramps up towards our new goal of a total capacity of 200,000 tests a day, ever more people will have the confidence and certainty that comes with an accurate test result.
Fourthly, I want to update the House on building our army of contact tracers. I can confirm that we have recruited more than 21,000 contact tracers in England. That includes 7,500 healthcare professionals who will provide our call handlers with expert clinical advice. They will help to manually trace the contacts of anyone who has had a positive test, and advise them on whether they need to isolate. They have rigorous training, with detailed procedures designed by our experts at Public Health England. They have stepped up to serve their country in its hour of need and I thank them in advance for the life-saving work that they are about to do.
The work of those 21,000 people will be supported by the NHS Covid-19 app, which we are piloting on the Isle of Wight at the moment and will then roll out across the rest of the country. Taken together, that means that we now have the elements that we need to roll out our national test and trace service: the testing capacity, the tracing capability and the technology.
Building that system is incredibly important, but so too are the basics. We need everyone to self-isolate if they or someone in their household has symptoms. We need everyone to keep washing their hands and follow the social distancing rules. We need everyone to stay alert, because this is a national effort and everyone has a part to play. The goal is to protect life and allow us, carefully and cautiously, to get back to doing more of the things that make life worth living. That is our goal and we are making progress towards it. I commend this Statement to the House.”
The Statement was considered in a Virtual Proceeding via video call.
My Lords, I thank the Minister for not repeating the Statement, which I have read.
First, I want to ask about these Covid-19 symptoms: lack of taste and smell. The Minister will know that many healthcare specialists and the World Health Organization were making these warnings eight weeks ago, so can he explain why there has been a time lag in updating the definition?
I start by referring back to the question, on testing and tracing and the NHSX app, which I posed to the Minister yesterday and which he did not answer. I asked him whether it was true that in a Downing Street briefing that morning it was announced that the rollout of the app has been delayed until June. Is that true? When can we expect the rollout? Indeed, will we see the rollout of this app at all? If the Government will not use the app any time soon, does that mean that testing, tracking and isolating have to work smoothly and effectively at local level? That raises many questions.
We on these Benches welcome the wider rollout of testing, of course. Can the Minister update the House on whether the screening of all healthcare workers, whether they are symptomatic or not, has been successfully rolled out? What proportion of healthcare workers have been tested so far? Will they be tested every week? If not, how often? This is important, because it has been reported that 20% of hospital patients got Covid-19 while in hospital for another illness or treatment. So if routine NHS work is to be restarted, patients must be confident that they are in a Covid-free environment.
Can the Minister inform the House of the progress on antibody testing? Are these tests now widely available? If so, for whom? If they are not yet available, when will they be available? I gather from a widely available advertisement that I could have what is said to be a PHE-approved antibody test right now for about 100 quid. Would the results of that test be acceptable if I wished to use it to prove to an employer that I could got to work, go to school or teach at school?
My Lords, I thank the Minister for the Statement. The ONS statistics this morning showed that over 44,000 people have lost their lives, with the Financial Times estimating that the total figure is now well over 60,000 when a percentage of excess deaths is taken into account. From these Benches, we send our sympathies to all bereaved families and friends, and our thanks and support to the amazing front-line staff in the NHS, social care and community sector, and to others in key roles working to save lives and keep people safe.
The Secretary of State began his Statement by talking about flattening the curve, but yesterday an article in the British Medical Journal said:
“What is clear is that the UK’s response so far has neither been well prepared nor remotely adequate … Above all, the response to covid-19 is not about flattening epidemic curves, modelling, or epidemiology. It is about protecting lives and communities most obviously at risk in our unequal society.”
We agree.
I echo the points made by the noble Baroness, Lady Thornton, about the acceptance, at last, by the Government of a third symptom, anosmia, but many other countries have more symptoms. France says that you should self-isolate if you have any symptom on a list of 10. Why do our Government still refuse to increase that list?
The Secretary of State has repeated his claim that he has prioritised testing in care homes, yet he still repeats that testing for everyone in care homes, whether staff or residents, will be only “offered” by 6 June. The Adult Social Care APPG is still hearing of care homes waiting for that “offer” of tests, and of others that have had tests but results still going astray or taking 10 to 14 days to be returned. On that basis, if Ministers are really prioritising care homes, why does the Statement announce testing for members of the public over the age of five now while people at the heart of the firestorm of Covid in care homes still have to wait up to two weeks before being offered a test?
My Lords, I thank the noble Baronesses for their penetrating and searching questions. I will go through them systematically.
First, I want to say a few words, partly in response to the appeal for transparency from the noble Baroness, Lady Thornton, and partly in response to some of the suggestions about the performance of the Government in their response to Covid. I assure the House that the Government approach this epidemic in a spirit of openness and transparency, and we would like to work in partnership with other parties. I simply reject the suggestion, consistent in some of the questions, that the projects undertaken by the Government have in any way been characterised by failure or disappointment.
I bear testimony to the huge achievements of those who have worked extremely hard to throw up remarkable schemes which have been enormously successful and massively mitigated the effect of this disease. The testing network, the ventilators, the Lighthouse labs and the Nightingale hospitals were all hugely ambitious ventures, greeted with scepticism when launched and accompanied by complaints while being thrown up. But their achievements have been enormous: they have had a huge impact.
I would therefore like to turn around the tone of this debate, to be a little more positive, and celebrate the huge achievements of those who have thrown their heart and soul into the response to coronavirus. I pay tribute to their achievements and to the personal sacrifices many of them have made by giving up their time, and even putting their lives at risk, to conduct these important roles.
Quite reasonably, both noble Baronesses asked whether the Government regard isolation as part of the programme. I can reassure them that isolation is absolutely the key point. The way to stop transmission is for those who have symptoms, and especially those who have tested positive, to shield themselves from the rest of society in order to prevent the spread of the disease. Everything that we do in the test and trace programme is ultimately to promote good behaviours by the British public, so that people who have symptoms will distance themselves from the rest of society, putting a brake on the disease. It is absolutely imperative, and at the heart of all our communications.
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.
My Lords, I thank the Minister for the Statement, which I read. I also listened with great interest to the discussion this morning about the devastating impact that Covid-19 is having on members of black, Asian and minority ethnic communities, particularly those who work in hospitals and care homes. From that discussion, I reiterate the ask from the noble Baroness, Lady Hussein-Ece, to the Minister to meet with black and minority ethnic leaders to discuss a government Covid-19 race equality strategy. It is not just the immediacy of the life and death matters that we are confronting; we face an economic downturn the likes of which we have not seen for 300 years. Unless we have an action plan and acknowledge the challenges, those communities, which are already at a disadvantage, could face a further penalty and devastation, and that must not happen.
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On tracing, we on these Benches have long argued that the safe way to transition out of the lockdown is by having a test, trace and isolation strategy in place. Can the Minister tell us the current median time for test results to be received by someone when the test is carried out by Deloitte and other private sector testing facilities? More crucially, how soon do directors of public health and GPs receive the results of those tests?
Is that how it works: that the test is nationally organised and carried out, and the results are fed back locally? Who are they fed back to, and are those people responsible for tracking and tracing? Are those people the experienced local public health tracers or are they some of the 21,000 tracers who, we are informed, have been recruited? To whom are any or all of them accountable for tracking down people who are infected? As the Minister knows, we on these Benches believe that the Government should have made better use of local public health services. Who will inform people who have been in touch with a person with Covid-19 to isolate? Who is responsible for what happens to those people who must isolate, and for whether their families are supported in doing so? Where does the national call centre delivered by Serco fit in to this system? Can the Minister tell us by what date tracing and tracking services will be operational? Will they be operational by 1 June? I have raised with the Minister the issue of isolation. Why is that not mentioned as one of the key elements of the test-and-trace strategy?
Turning to care homes, I note what the Secretary of State said about social care last week: that he had thrown a “protective ring” around care homes. What constitutes a protective ring? The spread of coronavirus in care homes has become a crisis within a crisis. It was reported by the Guardian on 13 May that during the period coronavirus has been spreading in the UK, there have been as many as 19,938 excess deaths in care homes, well above the figure attributed to coronavirus by the ONS, leaving an urgent question about the causes of these deaths. None of this suggests anything remotely protective.
The reality is that there was no early lockdown of care homes, which was needed, and no early testing of people transferring from hospitals to care homes until mid-April. Prior to 15 April, the Government’s care home advice said:
“Negative tests are not required prior to transfers/admissions into the care home”.
That was not rescinded until mid-April, when the Government eventually issued their care homes strategy. Today, the CQC report says that 36% of care homes have Covid-19. That seems to be a greater proportion than that being admitted by the Government. Weeks later, do we yet have full testing of all residents and care home staff? No wonder Age UK say that this is “too little, too late”. When will they all be routinely tested? What is the date for that?
Turning to the R number, can the Minister guarantee that every easing of restrictions—such as asking children to return to school—is accompanied by a government statement on the expected impact on the R number and the underlying prevalence of the infection? If the R number rises to be greater than one in a region or local area, how will the Government deal with that?
Finally, I want to be clear that we on these Benches are desperate for the Government to succeed in beating this virus. We will support and have supported the Government. In return, we expect transparency, as everyone does. Let us see the science. Give us clarity about what people are expected to do, truthfulness when things go wrong, as they inevitably will, accurate communication on all occasions and regular accountability to Parliament. We deserve no less.
Still on testing, can the Minister tell us the percentage breakdown of PCR testing results versus antibody testing results? If not, can he tell the House when this information will be publicly available? We need as many PCR tests as possible as part of an effective test, trace and isolate programme. How many of those carrying out testing are paid roles versus volunteers? A couple of weeks ago, the Minister told your Lordships’ House that testing would be extended through, among other things, a deal with Boots. Five days ago, Boots had an advertisement seeking volunteer testers taken down after public outrage that a company that had been given a commercial contract with the Government was relying on volunteers to carry out the work. Was using volunteers part of its tender to government? If so, does the Minister approve of companies using volunteers while pocketing public money in a contract?
On tracing, it is encouraging to hear that more than 21,000 tracers have been recruited, but today there are reports of people recruited receiving multiple emails congratulating them on being successful or attending online training that has completely fallen over and failed technically. Can the Minister say what percentage of those 21,000 have received full training and are now working as tracers? Last week, the Secretary of State said that local tracers would be used, whether local health or environmental health tracers, as well as central ones. Can the Minister say how many local tracers—that is, not Serco call-centre tracers or central NHS tracers—there will be from the 21,000?
The Statement asserts that the Government now have all the elements to roll out their scheme of test, track and trace, but I repeat that there is no focus on isolation for those who have to quarantine. Test, trace and isolate is used not just by the WHO but by many countries. What plans are in place to support people isolating, whether at home or in a quarantine unit, once lockdown is lifted? They will feel much more vulnerable at that point, when everyone else is moving back into their normal lives. Experience from Taiwan, Germany and South Korea shows that community health support for those in quarantine is more likely to make it successful. Again, countries that have been successful in containing the virus all had fully operational test, trace and isolate programmes up and running from day one. Given that each new venture the Government have undertaken during this crisis, as outlined in the BMJ article—from expanding PCR tests from a low base to manufacturing ventilators, supplying PPE and now the tracer app—has had a very problematic start, to put it kindly, are the Government starting to run full contact tracing now, using new staff in an area that has sufficient cases of coronavirus, before lockdown starts to be lifted but particularly by 1 June? It would be inappropriate for schools to return and people further to return to work without such a system in place.
I pay tribute to the British public, who have made huge personal sacrifices during this lockdown. The culture of isolation will be an essential part of keeping a lid on the disease. The Government are committed to providing mental health support, and practical and cultural support, for those who are in a state of isolation. I thank both noble Baronesses for throwing a spotlight on that.
I want to convey to the House the enormous complexity of identifying the key symptoms of this disease. By any common sense, it would seem incredibly obvious how to spot Covid, but I have sat in numerous meetings running through the data and know how difficult it is to have a consistent set of symptoms that can be understood clearly and communicated simply to the public. The data on this disease is extremely complex. As I have said to the House before, this disease is a very difficult adversary, as characterised by the way in which symptom checking is so difficult. We have moved to a new and upgraded set of symptoms, and we may well have to move again. However, we are seeking to encourage absolutely anyone who has any symptoms to declare them and seek a test.
Perhaps I may move quickly through the questions put by the noble Baroness, Lady Thornton. I reassure her that the NHSX app is very much part of our plans. The Isle of Wight programme has been enormously successful and take-up rates have been huge. But it did teach us one important lesson: that people wanted to engage with human contact tracing first, and quite reasonably regarded the app as a supplementary and additional automated means of contact tracing. We have therefore changed the emphasis of our communications and plans to put human contact tracing at the beginning of our plans and to regard the app as something that will come later in support.
I reassure the noble Baroness that the testing of NHS and care staff is an absolute priority. Testing by the NHS of both groups is well under way. As announced by the Secretary of State, we are looking carefully at bringing in antibody testing to answer the question from staff who may query whether they have had the disease in the past, and to understand better what the role of immunity might be. The science is not firm; the lessons are not clear; but we need to understand the role of antibody testing and find out how it can help us combat this disease.
I advise the noble Baroness, Lady Thornton, to be very wary of private tests. They vary enormously in quality, as I know through my own experience. The time after having the disease when you take the test impacts enormously on the test and the assumptions one can make about a positive test are not proven. You cannot currently share with an employer any impression that you might have immunity, on the basis of a test.
I reassure both the noble Baronesses that our involvement with local groups in the tracing operation is being energetically promoted. We have appointed Tom Riordan, the chief executive of Leeds City Council, to lead this part of the programme. He is running an excellent programme to work with local authorities, directors of public health, environmental health officers and local resilience forums to ensure that our tracing system is as local as it possibly can be. It cannot all be done locally: some of it is better done digitally, and the highly automated routines of the app are very good. Some of it must be done at scale on a national basis by the massive call centres that we are throwing up, but some of it is best done by local groups. Those processes are being put in place energetically and I thank GPs, local directors of public health and all those who are engaged in them. We will be putting together local Covid plans that will be implemented by the relevant local authorities. These will form an important part of keeping a lid on this contagion.
I also pay tribute to those who are helping to organise the major test centres, including Serco, and those who have stepped up to take roles as contact tracers. They are going through complex training at the moment; it is a challenging task. No one wants to hit the phone and tell someone that they have to isolate; it is a tough message to have to deliver. I have no doubt that there will be problems with this complex and difficult task, but I pay tribute to those involved and express my gratitude to those running the programme.
On care homes, as the noble Baroness, Lady Thornton, rightly described, every death is a source of great sadness. However, I pay tribute to all those who have put their safety on the line by delivering tests in care homes. I reassure the noble Baroness, Lady Brinton, that there is a website where any care home that wants a test can register their interest and get a response promptly. Any care home worker who wants an individual test can access a site where, as a key worker, their test will be prioritised. There should be no reason why any care home or care home worker should wait two weeks, as suggested in the question.
I put my hand up and explained that mistakes were made 10 days ago when, due to problems with our Northern Irish test laboratory, some care home tests were either delayed or voided. That was an enormously regrettable situation, but, when you put together an operation of this scale at such pace, some mistakes will be made. We have done an enormous amount to rectify those mistakes. Bringing in the noble Baroness, Lady Harding, to run the operational side of our testing regime is a great step forward.
I will also say a word in defence of the volunteers who are working at our drive-in test centres. These are often furloughed workers who do not need paid employment, but they are spending their time usefully and are often committed and have a sense of public service. I bridle at the thought that they would be sneered at or in any way insulted. The role of Boots in recruiting them is entirely honourable, legal and appropriate for the times we are in, and I very much thank those volunteers who have dedicated their time and risked their personal safety to do this difficult and possibly risky job. It is not appropriate to suggest that there has been public outrage at this arrangement—quite the opposite. The British public support this kind of individual public service.
The recruitment of tracers is going extremely well indeed: 21,000 have been put in place, which is way beyond our initial expectations, and the training is going well.
This programme is developing very quickly. We will seek to make announcements about it later this week and there will be a further rollout next week. I am extremely proud of the achievements that we have made, and I thank everyone who is involved very much indeed.