Covid-19 Update

With permission, Mr Speaker, I would like to make a statement on coronavirus and about our plans to put us in the strongest possible position for this winter. Like many other countries around the world, we are continuing to see a concerning rise in cases, with 3,991 new cases recorded yesterday, and this week the number of patients in mechanical ventilator beds has risen above 100 for the first time since July. The battle against coronavirus is not over, and while we strain every sinew to spring free of its clutches, with winter on the horizon we must prepare, bolster our defences and come together once again against this common foe.

One of our vital lines of defence has been taking targeted action at a local level. We have seen local action work well in some parts of the country, and now we must take further action. We have seen concerning rates of infection in parts of the north-east. Sunderland, for example, now has an incidence rate of 103 positive cases per 100,000 of population, and in South Tyneside, Gateshead and Newcastle the figures are all above 70 per 100,000. As a result, local authorities wrote to me earlier this week asking for tighter restrictions, and we have taken swift action to put them into place. From tomorrow, in Northumberland, North Tyneside, South Tyneside, Newcastle-upon-Tyne, Gateshead, Sunderland and County Durham, residents should not socialise with other people outside their own households or support bubble; hospitality for food and drink will be restricted to table service only; and late-night restrictions of operating hours will be introduced, so leisure and entertainment venues must close between 10 pm and 5 am.

I know, as the whole House does, that these decisions have a real impact on families, on businesses and on local communities. I can tell everyone affected that we do not take these decisions lightly. We agree with the local councils that we must follow the data and act, and the data says that we must act now so that we can control this deadly virus and keep people safe. I know that the people of the north-east will come together to defeat this virus, as defeat it we must.

We are working to bolster our health and care system too. Winter is always a stretching time for health and for care, but this winter presents particular challenges. People will be spending more time indoors than they did in summer, where we know the virus is more likely to spread, and we know that we will need to deal with coronavirus along with the usual pressures that the season will bring. So today I want to set out our plans to support the NHS and social care this winter.

Turning first to the NHS, I can tell the House that we have allocated a further £2.7 billion to the NHS to support it during the winter months. This funding, in addition to the extra funding for personal protective equipment and testing, will help the NHS with the vital task of operating safely in a world in which covid is still at large and the critical task of working through the backlog of elective work that was inevitably caused by the first peak.

Our emergency departments are on the frontline of the fight for life in the NHS. Today, I am delighted to announce a series of measures to support our urgent and emergency care system this winter and beyond. I want to thank and pay tribute to Katherine Henderson, the president of the Royal College of Emergency Medicine, with whom I have worked closely to develop these proposals. I want to thank her, and, through her, all those who work in emergency care for their service in the face of adversity. I saw this again this morning at the St Thomas’ Hospital accident and emergency department, and I know that all of us support the work of those who work in our emergency facilities, right across the country. I very much hope that yours, Mr Speaker, will be opening soon in Chorley.

We will make our emergency departments bigger. Many are simply too small—that was true even before the pandemic, but it is even more acute now. So we are investing to expand capacity in urgent and emergency care, so that hospitals have the space to continue treating patients safely in the coming months. In August, we confirmed £300 million for emergency upgrades across 117 trusts, and I can today announce a further £150 million to expand 25 more emergency departments, including some of the most constrained in the country, such as those in Worcester and at the Royal Shrewsbury. This extra funding will put us in the strongest possible position for this winter, and boost the crucial work to accelerate non-covid care.

It is not just about the space, but about the service, so we are working to get patients the right care in the right place, by expanding the role of NHS 111. During the peak of this pandemic, we saw millions of people using NHS 111, on the phone or online, to get the best possible advice on coronavirus, helping them to stay safe and, where possible, to stay out of hospital, where they could have unknowingly spread the virus. It is crucial that, ahead of winter, we use this window of opportunity to seek out what worked and build on it, so we provide a better service for patients and protect the NHS. Of course, no one will ever be turned away from our emergency departments in the most serious of cases; however, we have worked with the royal colleges, the NHS and others to develop a better, quicker and more clinically appropriate service for patients by using NHS 111 first.

This is how it works. We will invest £24 million to increase call-handling capacity and to make sure there are more clinicians on hand to provide expert advice and guidance, and we will build on our trials to make NHS 111 a gateway to the emergency care system, providing a first port of call for patients. In future, rather than having to queue in an emergency ward, we are testing that people should call NHS 111 first to book an appointment with whoever can give them the most appropriate care, whether it is a GP, a specialist consultant, a pharmacist, a nurse or community services. Of course if they need to go to the emergency department, NHS 111 will be able to book them into an appropriate time slot. We want to see this approach lead to shorter waiting times and better availability of appointments for patients. We will consult on how its performance is best measured, and, with successful pilots, we will roll out NHS 111 First to all trusts from December.

Finally, I want briefly to update the House on our work to protect care homes. One of the worst things that we know about this virus is that it reserves its greatest impact for those who are physically weakest, especially the elderly, so we must do everything in our power to protect residents in social care. In May, we introduced the adult social care infection control fund, which has helped adult social care providers reduce the rate of transmission. This was used to fund important measures such as improving infection prevention and paying staff to self-isolate. I can now inform the House that we will extend this fund for six months and provide over £540 million of extra funding for providers. That brings our total funding for infection control measures in social care to over £1 billion. We will also shortly be bringing forward our adult social care winter plan, because we will do whatever is humanly possible to protect our care homes from this virus so that they are a place of sanctuary this winter.

We will soon be facing winter in this fight and, whether on our NHS emergency care wards or in our care homes, we will strain every sinew to give them what they need, so they are well equipped for this pandemic and, indeed, for the years ahead. I commend this statement to the House.

I thank the Secretary of State for advance sight of his remarks.

The capital investment for 25 A&Es will be welcome. On the piloting of the 111 triage ahead of A&E, given inequalities in accessing healthcare for the poorest and disadvantaged, how will the Secretary of State ensure that it does not worsen health inequalities? If it leads to greater demands on primary care, will GPs be given extra resources as a consequence?

The NHS is facing a likely second spike, winter pressures and a monumental backlog in non-covid care. The Chancellor promised to give the NHS “whatever it needs”. Does that promise still stand, and will the NHS get the funding it now needs to tackle the growing backlog in non-covid care?

On social care, can the Secretary of State guarantee that care homes will not face the same personal protective equipment shortages they faced at the start of the pandemic? Does he also accept that restrictions on family visits cause huge harm to residents? Does he rule out re-imposing nationwide restrictions on family visits?

The Secretary of State said little about testing this afternoon. Back in May he stood at the Dispatch Box and told 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”—[Official Report, 18 May 2020; Vol. 676, c. 380.]

“We have”, in his words, “now got testing for all”.

Yet, four months later, for the British people, it has become not so much “test and trace” as “trace a test”. Just when many fear we are on the cusp of a second deadly spike, the Prime Minister admits we do not have enough capacity. Rather than fixing the testing, the Secretary of State is restricting it. In the exchanges on Tuesday, 33 Members from across the House raised issues around testing in their constituencies. He responded with the local figures—it was a very good debating trick, and well done to the specialist adviser for producing the briefing—but that will have been no comfort to constituents advised to travel hundreds of miles for a test when ill. It will have been no comfort to parents with a poorly child and themselves sick with worry and unable to get a test. It will have been no comfort to those turned away from walk-in centres and now presenting at A&E asking for a test. It will have been no comfort to the 25,000 teaching staff not in schools teaching our children because they cannot get a test. People want to know when the Secretary of State will fix testing and deliver on his promise to make testing available to everyone.

To respond to the constructive questions that the hon. Gentleman raised, I welcome his comments on the use of 111 First. The purpose of 111 First is to improve access, including in terms of inequalities in the NHS, by ensuring that people get the right treatment in the right place and easier access if they do need to go to an emergency department, because the emergency department will know that they are coming. It is commonplace now in almost every part of our life to let people know that we are coming. If we are going to do something as important as visit an emergency department, it will help both the patient seeking treatment and the NHS to let them know that they are coming first. That is the principle behind 111 First. It sits alongside 999, which anybody should call in a serious incident.

The hon. Gentleman asked about the need for extra funding for the NHS, both for winter and for testing. I have just announced £2.7 billion of extra funding for the NHS, and he might have done better to welcome it. He talked about tackling the backlog of cases that inevitably built up in the first peak. The good news is that we are making progress on tackling that backlog and reducing it. Of course, there is an awful lot of work to do, and part of this extra funding will go towards that, alongside the funding to expand our emergency departments, the funding for PPE and the funding for testing that I mentioned in my statement.

The hon. Gentleman asked about PPE for care homes. We have a huge plan to ensure that care homes can get PPE, and the details will be set out shortly in the social care winter plan. He asked about family visits. The challenge of visits to those living in care homes is incredibly difficult, because nobody wants to spread coronavirus, but we also need to ensure that those who live in care homes get the support that they need and deserve.

The hon. Gentleman asked about testing. Of course there is a challenge in testing. The central point is that, contrary to what he said, capacity is at record levels and has increased week on week. The challenge is that demand has gone up faster—[Hon. Members: “No, it’s not.”] Those on the Opposition Benches can say, “No, it’s not,” but they cannot defy the facts. The most important thing for everybody across the country to hear from their elected representatives, if they are interested in helping the country get through this pandemic, is: if you have symptoms, get a test, and if you do not have symptoms, please do not come forward to get a test unless you are specifically asked to. That is what colleagues on both sides of the House need to be repeating to their constituents.

Today is World Patient Safety Day, which I had the privilege of launching virtually with Dr Tedros of the World Health Organisation this morning. The changes that the Health Secretary is announcing to A&Es are about patient safety. As Dr Katherine Henderson told the Health Committee, if we go back to crowded A&E waiting rooms, patients will die, so I welcome these changes. May I ask my right hon. Friend specifically about sepsis? Our A&Es have made huge progress in testing people who need to be tested quickly for sepsis when they arrive at A&E. If that is now to be done on the phone—if that is the first point of contact—it is absolutely vital that 111 call handlers are properly trained and their algorithms adjusted to ensure that we ask the right questions on sepsis. Will he undertake to do that?

I wholeheartedly support the points that my right hon. Friend has made. I pay tribute to him for his work in establishing World Patient Safety Day and thank him for his ongoing work in the international arena, both representing our country and driving forward this agenda globally. I entirely agree with his comments about 111 First. It is absolutely critical that both the online and phone systems act to ensure that sepsis is recognised, wherever that is feasible, to ensure that people get the best and safest route to care. I will ensure that that point is registered. We have put in the extra funding, which I have just announced, for 111 to ensure more clinical support for people accessing the service through NHS 111 First. Indeed, I pay tribute to him for introducing 111 in the first place. There is an awful lot of work to do here, but it will undoubtedly help patients to get a better service and help the NHS to deal with the multitude of cases that come its way.

While personal behaviour and local measures are critical, so is a functioning test, trace and isolate system. Last week the Prime Minister claimed that there was capacity for 350,000 covid tests a day, but I am sure the Secretary of State is well aware that a third of that capacity is antibody testing, which becomes positive only after the infection and is therefore of little use in diagnosing cases or managing outbreaks. Why have the Government not published the daily diagnostic testing capacity since last Thursday? The Secretary of State has promised that there will be 500,000 diagnostic tests a day by the end of next month. Can he confirm that that definitely refers to diagnostic antigen testing, and is he confident that it will be delivered on time?

The current problem appears to be a shortage of laboratory capacity, with the Government now cutting test appointments in many parts of the UK. Does the Secretary of State accept that that causes a danger of new outbreaks not being detected at an early enough stage? With the rationing of test slots, there are multiple reports of people being advised to enter an Aberdeen postcode to obtain authorisation for a test, even though the test will be carried out in the south of England. Does he accept that that will undermine Scotland’s contact tracing system and that incorrect data could give the false impression of a local outbreak in Scotland that does not exist? How does he plan to stop that practice?

Finally, the Secretary of State has previously talked about his moonshot testing project, based on millions of people testing themselves for covid every morning. Can he clarify whether he is planning for such tests to be provided on the NHS, or would individuals be paying for them? If they are on the NHS, given the enormous price tag and the fact that the technology does not even exist yet, should he not focus funding and efforts on getting the current diagnostic testing system working in the here and now?

Taking those points in reverse order, of course investing in the next generation of technologies is important here and now, because if we do not push forward those technologies that allow us to expand testing, we will always be stuck with the current one. The idea that there is a dichotomy between the two is completely wrong.

On the hon. Lady’s point about an Aberdeen postcode, we already have in place a system to ensure that if someone puts in one postcode but then turns up at the wrong drive-through centre, that will be indicated to the people there, so that problem has been resolved—indeed, it had been resolved before it was first raised in the House.

I hope that, like the Scottish Government, the hon. Lady will reiterate the point that people should come forward for a test when they have symptoms or have been told to do so by a public health professional, and they should not come forward if they do not have symptoms. Working together across the UK is undoubtedly the only way to solve this crisis, to the benefit of all our constituents.

That brings me to the point about testing in Scotland. More tests are being done in Scotland—through drive-through centres, local testing sites and mobile testing centres—than across the rest of the UK per head of population. We over-index the number of tests through those routes that we put into Scotland. Indeed, in the Scottish NHS there is spare capacity that needs to be used. I am working closely with the Scottish Government to ensure that that spare capacity is used, given the enormous demand for tests right across this country. I think that tone of working together is what we need to hear.

Earlier this month, Tameside and Glossop clinical commissioning group was reporting the highest rate of covid death of anywhere in the country. I want to put on the record my thanks to Ministers, Public Health England and NHS staff for working so hard to try to tackle this worrying situation, but it is very concerning that my constituents are still sometimes being asked to travel over 150 miles to get a test. Can the Secretary of State reassure me that the Government are doing everything they can to ramp up testing and laboratory capacity as a matter of urgency?

Yes, of course. There are of course challenges, which we are working incredibly hard to address, both in Derbyshire and nearby in Greater Manchester. Across Derbyshire as a whole, in the past week almost 4,000 tests have been done, so the testing capacity is there The challenge is that there is also this increase in demand. We have to ensure that the people getting the tests that are available are the people who need them most. That is the principle behind prioritisation, and it is a principle that everyone here should support.

A constituent wrote to me yesterday:

“My child started at primary school last week. Inevitably, she’s picked up a cold. That cold includes a slight temperature. She’s not allowed back to school until she’s had a negative Covid test result. Nor are my wife and I allowed to go to work. No tests are available.”

That scenario is being repeated in thousands of households across the country, with children who have already been out of school for six months facing further weeks at home because they cannot get a test. The heroic efforts of teachers to enable the full reopening of schools are being undermined by the chaos of the testing system. When will schoolchildren, teachers and support staff have reliable and rapid access to testing and results so that covid cases can be swiftly identified and isolated, and disruption to education minimised?

Those are the challenges that we are working so hard to address. The message to the hon. Lady’s constituent and others is that there are thousands of tests available in her part of London, and it is incredibly important that those with symptoms come forward and those without symptoms—[Interruption.] I know that her constituent had symptoms. The critical thing is that all of us have the same message: those with symptoms do come forward, but those without do not. That huge spike in demand is the challenge. It is as simple as that.

Testing capacity is a finite resource, and it is right to consider prioritising care homes, hospitals and key workers. Will my right hon. Friend ask his Department also to consider the issue of testing very young children, who frequently experience raised temperatures, coughs and colds? Some parents are taking very young children for multiple tests, but those in that age group are unlikely to be out in the community spreading the virus. People want to do the right thing and nobody wants to overwhelm the system, so will he continue to do all he can to ensure that the testing system is operating efficiently?

Yes. I thank my hon. Friend for that question, which captures the challenges we face. It is absolutely true that children under the age of 16 are very unlikely to get ill with coronavirus; indeed, the proportion of under-16s testing positive is extremely low and is flat, whereas it is rising in many other age groups. She raises a clear point: the prioritisation we have is about getting the tests that we have—record capacity—to the people who need them most. That is why it is an important principle.

Over the next few days, tens of thousands of students will be arriving in Nottingham. Our universities have spent months planning for a safe return, but there is a real danger that their hard work will be undermined, as Nottingham schools’ incredible efforts have been undermined, by the inability to get tests and results promptly. The University of Nottingham has repeatedly requested access to a small stock of pre-distributed pillar 2 swab test kits, which would enable faster and safer testing for symptomatic students and take the pressure off local community testing facilities. Will the Secretary of State work with and listen to universities such as the University of Nottingham to help to improve the efficiency of the national testing programme, and will he authorise the allocation of those kits to the university and others who request them?

I will absolutely look into that. That is exactly the approach we have taken with schools, and many universities’ labs are an important part of getting test results back. I am very happy to work with all of the 106 universities that are doing so much to ensure that the return of university is covid-secure, and I will look into the precise point the hon. Lady raises.

I have also had a number of Carshalton and Wallington residents get in touch with me about testing, some of whom are being sent down to the south coast to places such as Portsmouth and Southampton. May I ask my right hon. Friend what more the Government are doing not only to ensure that drive-through centres such as those in Chessington, which is nearby, are able to continue to process those tests, but to bring in more testing capacity into boroughs such as Sutton?

We are looking to get more testing capacity right across the board, as my hon. Friend well knows. The Chessington drive-through centre, which was one of the first that we put in place, has done an amazing job over the entirety of this pandemic. The good news is that, as I mentioned to the House on Tuesday, the average distance, as the crow flies, that people have to go to get a test has fallen from more than 6 miles to less than 6 miles. The message is that there are thousands of tests available and the average distance is low. The critical thing is that the people who come forward to get a test are the people who are eligible for a test, not people who do not have symptoms.