PARLIAMENTARY DEBATE
Covid-19 Update - 15 October 2020 (Commons/Commons Chamber)

With permission, Mr Speaker, I would like to make a statement on coronavirus.

The threat remains grave and serious. In Europe, positive cases are up 40% from one week ago, and in Italy, Belgium and the Netherlands, they have doubled in the last fortnight. Here, we sadly saw the highest figure for daily deaths since early June. Let us be under no illusions about the danger posed by this virus. Coronavirus is deadly and it is now spreading exponentially in the UK. We must act to prevent more hospitalisations, more deaths and more economic damage. We know from recent history that when this virus keeps growing, unless we act together to get it under control, this is the result.

Our strategy is to suppress the virus, supporting the economy, education and the NHS. Local action is at the centre of our response. The virus is not spread evenly, and the situation is particularly severe in some parts of the country. Through the Joint Biosecurity Centre and NHS Test and Trace, we have built up a detailed picture of where and how the virus is spreading. This week’s NHS Test and Trace statistics show that testing capacity is up, testing turnaround times are down, and the distance travelled for tests is down too. Thanks to this capacity and analysis, we have been able to take a more targeted approach, keeping a close eye on the situation in local areas, bearing down hard through restrictions on a local level where they are necessary.

I know that these restrictions are difficult for people. I hate the fact that we have to bring them in, but it is essential that we do bring them in, both to keep people safe and to prevent greater economic damage in the future. When a virus is moving fast, we cannot stay still. We know that if we act collectively, we can control the virus, because we have done it before. I believe in the people of this country. I believe—in fact, I know—that the people of this country want to control the virus, to protect their loved ones, their lives and their livelihoods, and I believe from the bottom of my heart that, acting together, we can.

We must take firm and balanced decisions to keep this virus under control. This is the only way to protect lives and livelihoods, and we must act now. Delayed action means more deaths from covid, it means more non-covid deaths, and it means more economic pain later, because the virus comes down slower than it goes up. We should stop it going up in the first place. Unless we suppress the virus, we cannot return to the economy we had; unless we suppress the virus, we cannot keep non-covid NHS services going; and unless we suppress the virus, we cannot keep the elderly and the vulnerable safe and secure.

I did not come into politics to put restrictions on people’s lives. I want people to have as much freedom as possible, subject to not harming others. But the nature of this virus means that any one of us can inadvertently pass it on without even knowing. That is the liberal case for action. I believe that the British people get that, but I want that action to be as targeted as possible. Local action is one of the best weapons that we have, and we have seen how local action can flatten the curve, for example in Leicester and Bolton. That is the principle that sits behind our new, simpler system of local covid alert levels. I am pleased that the House approved those measures earlier this week.

Yesterday, I chaired a meeting of the Local Action Committee gold command, which brings together the best data and the best clinical and public health expertise to look at how the virus is spreading. Turning first to parts of the country where prevalence of the virus is highest, discussions are ongoing with local leaders on moving from high to very high. These are areas where transmission is rising at the sharpest rate and where we see a very real risk to the local NHS.

The Liverpool city region moved into the very high level yesterday, and I thank the local leadership for their public service and cross-party teamwork in the face of this virus. We have developed a substantial package of support for areas that enter that third tier, including more support for local test and trace, and more funding for local enforcement and the job support scheme of course, alongside the offer of help from the armed services. In other areas currently in the second tier where discussions are ongoing, no further decisions have yet been made, but we need to make rapid progress.

Turning to other areas of the country currently in the medium level where rates are rising fast, in London infection rates are on a steep upward path, with the number of cases doubling every 10 days. The seven-day average case rate stands today at 97, rising sharply. We know from the first peak that the infection can spread fast and put huge pressures on the NHS, so we must act now to prevent the need for tougher measures later on. Working closely with the Mayor, cross-party council leadership, local public health officials and the national team, we have together agreed that London needs to move to local covid alert level high. I want to take a moment to thank all those involved for their exemplary hard work, the collegiate nature of decision making, the collaborative approach and the constructive work, all focused on the public health and economic wellbeing of our citizens.

To Londoners, and all who work in our great capital, I want to say: “Thank you for what you have done to suppress the virus once. We now all need to play our part in getting the virus under control once again.” I know the sacrifices that that means, but if we work together we can defeat this. Working with local leaders in Essex and Elmbridge, we are also moving them into local alert level high. I pay tribute to the leadership of Essex County Council and in Elmbridge, where they have been working so hard to suppress the virus.

Infection rates are also rising sharply in Barrow-in-Furness, York, North-East Derbyshire, Erewash and Chesterfield. In all of those places, cases are doubling in less than a fortnight. For all the areas entering the high alert level, the change will come into effect at one minute past midnight on Saturday morning. That includes Barrow-in-Furness, York, North-East Derbyshire, Erewash and Chesterfield. The central change is that people cannot now meet other households socially indoors. That applies in any setting, at home or in a restaurant or any other venue. The rule of six still applies in any outdoor setting. Although people may continue to travel to open venues, they should reduce the number of journeys where possible.

I know that those measures are not easy, but I also know that they are vital. Responding to this unprecedented pandemic requires difficult choices—some of the most difficult choices that any Government have had to make in peacetime. We make these decisions with a heavy heart, and with the sole aim of steering our nation through troubled waters. Things will get worse before they get better, but I know that there are brighter skies and calmer seas ahead—that the ingenuity of science will find a way through. Until then, we must come together, because we all have a part to play in defeating this dreadful disease. I commend this statement to the House.

I thank the Secretary of State for advance sight of his statement. Given what we know about the rising prevalence of the virus and rising admissions to critical care, I totally understand why he has had to make difficult decisions today on tier 2 restrictions for London and other areas, including Erewash, Essex, Barrow and Chesterfield. I hope he will agree that decisions like these are most effective when made in tandem with local leaders. On that point, can he update us on the current position with respect to Greater Manchester and Lancashire? Should we anticipate further announcements later today?

While I do not quibble with or object to the public health interventions that the Secretary of State is making, I am afraid that they are still not backed up by the financial package needed to mitigate their impact on jobs and livelihoods. More people will fall into poverty and destitution. Families across Bury and Bolton and small businesses across Burnley, Hyndburn and London have been failed by the Chancellor, so I urge the Government to introduce a stronger package of financial support for areas in tier 2 and tier 3.

The British people have a made tremendous sacrifice already, and we are heading into the bleakest of winters. Much of this could have been avoided if the misfiring £12 billion test and trace system had been fixed over the summer. Today, new figures show just 62% of contacts being reached. That is the equivalent of 81,000 people not reached circulating in society, even though they have been exposed to the virus. That is another record low. Yesterday, we learnt that consultants working on test and trace are being paid more than £6,000 a day to run this failing service. In a single week, the Government are paying those senior consultants more than they pay an experienced nurse in a year. Can the Secretary of State explain why such huge sums of money are being paid to consultants to run a service that is only getting worse?

The Prime Minister said yesterday that these new restrictions will bring the R rate below 1, but while the virus growth has accelerated in northern regions, the embers are burning bright nationwide. Let me repeat to the House—Tory party staff are welcome to clip me again for Twitter; it will save my staff the trouble—that a full national lockdown stretching for weeks and weeks, like the one that we had throughout April, May and June, would be disastrous for society. We are urging the Secretary of State to adopt a short, time-limited two to three-week circuit break, to take back control of the virus, to reboot and fix test and trace, to protect the NHS and to save lives.

SAGE has recommended a circuit break. NHS Providers is

“urging politicians to listen to the scientific advice and move as fast and as decisively as possible”.

The SPI-M sub-group of SAGE says that a circuit break of two weeks will save almost 8,000 lives. For all the ponderous blustering and carping from the Prime Minister yesterday, he told the House—with some haste, as if he did not want his Back Benchers to hear it—“I rule out nothing” with respect to a circuit break. The Prime Minister has not ruled it out, which we welcome, so what are the Government’s criteria for a national circuit break? How many hospital admissions? How much non-covid care delayed? Dare I say, how many more deaths?

Action is needed now. Plans need to be put in place today. Everyone accepts that the Government were too slow in the spring. How certain is the Secretary of State that his Government are not making the same mistakes again with more catastrophic consequences? This is a moment in history—look around, Health Secretary, and explain why there should not be a circuit break now, because if we do this in a few weeks’ or a few months’ time, more lives and livelihoods will be lost. In the national interest, I offer to work constructively with him today to deliver the circuit break that is now needed.

As I said in my statement, discussions with local leaders in Greater Manchester, Lancashire and elsewhere continue, and I do not want to pre-empt them. Those discussions do, of course, include what financial support is needed, but I remind the House that we have put in place unprecedented financial support for those who are affected.

The hon. Gentleman mentioned the test and trace system. The figures this morning in fact show that a record high number of people have been contacted by NHS Test and Trace, and the system has been reaching more people and testing more people faster than at any other point. He might have seen yesterday that, internationally, this was commented on as an area where we have done well here in the UK. Of course, we want to make sure that we do things even faster and that we have an even greater testing capacity, but I think he would do better to reflect on the progress that has been made.

Finally, the hon. Gentleman talks about the national circuit break idea that the Labour party put forward, at least on Wednesday this week. I gently say to him that here in the House, Labour calls for a national circuit break, but we take the view that we should do everything we can to control this virus where it is rising fastest and take a more targeted approach. The Labour party cannot even get its Mayors in other parts of the country, where the cases are going up, to come out and support the proposals that are made from the Opposition Dispatch Box. What I would say is that we need to work together. We need to pull together. Everybody should come together, and that is the best way to defeat the virus.

I support today’s measures, but is not the biggest issue that we face as a country now uncertainty—uncertainty about our health and uncertainty about the future of the economy? Given my right hon. Friend’s tremendous success in expanding our testing capacity, is now not the time to announce a date—whether it is February, March, April of next year—by when every single person in the population will be tested every week, so that, irrespective of progress on a vaccine, irrespective of the success of local lockdowns and irrespective of other uncertainties, we have a date by when we know we will get the virus under control and we know we have some prospect of returning to normality?

My right hon. Friend and I share a passion for an expansion of testing capacity in this country. He has long tried to persuade me to set yet more goals for the expansion of testing capacity. I am very glad to say that we have hit every single one that we have put in place, such as the 100,000 in the spring, and we are on track to meet the 500,000 by the end of this month. After that, I very much hope that we can continue to expand testing capacity, and I will look at the idea that he proposes very carefully.

I recognise the need for this action, but it is critical that those called on to isolate, whether as individuals or through a lockdown, receive the financial support to do so. Avoiding the social and economic impact of repeated local lockdowns depends on driving down community transmission through testing and tracing every single case and finding and isolating their contacts in the short window before they, too, become infectious.

Tracing systems based on local public health teams, such as those, in Scotland, Wales and, now some parts of England, have all outperformed the centralised Serco system, which has reached barely three quarters of cases and well under two thirds of contacts. I welcome the news that local public health teams will now be directly involved in contact tracing in areas of high covid spread, but will the Secretary of State now have them lead contact tracing in all areas across England to help to get the test, trace and isolate system working effectively? Will he ensure that appropriate financial resources are moved to local authorities to fund this?

Unfortunately, the hospitality industry is being hit particularly hard, both by the virus itself and by the restrictions to control it. As we now know, covid is spread by airborne particles as well as droplets, and it has become clear that ventilation is key to reducing viral spread indoors. Will the Secretary of State ask the Chancellor to promote the installation of filtered ventilation units by removing VAT and making them tax deductible? In that way, the Government could help the hospitality industry to make its premises more covid secure, rather than having repeatedly to shut it down every time cases surge.

The hon. Lady talks about the testing system, and the UK-wide testing system is an example of the whole country working together to keep people safe. The UK system provides the majority of tests in Scotland, and it works very closely with the NHS in Scotland, which also provides important testing capacity. That is an example of the local system in Scotland and the UK system nationwide working together for the people of Scotland.

The hon. Lady mentions isolation payments, and I strongly agree with her about their importance. Again, this is a proposal that we have worked on together, with the UK Government providing the funding that is being delivered across England, Scotland, Wales and Northern Ireland. I think the best approach to tackling this pandemic is for people across the whole country to come together, and for the UK Government and the Scottish Government to work together, as we do, where an issue is devolved to deliver for the people of Scotland.

First, may I tell the Secretary of State that no one wants to let the virus rip, and that such language is unhelpful? Secondly, as I understand it, the Government’s intention is to continue shutting down our country’s economy to a greater or lesser extent, destroying the lives and livelihoods of millions of people in the process, until a vaccine is found. That might never happen, and even if it does, there is no guarantee that it will work. We need a plan B, and I would be grateful if my right hon. Friend could tell the House what that is.

The plan is that, as my hon. Friend and I agree, we cannot let the virus rip, and therefore we must act to suppress it. Suppressing it through local action, in the first instance, is our best tool while we work with the scientists on technology that can help us to do that better. I put it to him that not only is that best for health outcomes, although that is undoubtedly true for both covid and non-covid health outcomes, but it is best for economic outcomes. Even though the restrictions have their impacts—I understand that, and I feel that—they are better than the consequences of the action that would have to be taken to keep the virus under control were it to get out of hand once again.

I have just finished a call with Greater Manchester colleagues and the Minister for Care, the hon. Member for Faversham and Mid Kent (Helen Whately), about the moving of Greater Manchester into tier 3, which has been widely speculated about. There was unanimous fury during that call about the process, the evidence base and the economic support packages that are on the table.

We want action, but it has to be the right action. We have lived in tier 2 for nearly three months, and it has not worked. The chief medical officer says that the measures in tier 3 will not make a material difference to the infection rate, yet they will cause widespread economic damage to our region, costing tens of thousands of jobs and thousands of businesses. It is not good enough that meaningful conversations began only this morning, so will the Secretary of State ensure that they reach a conclusion so we can get infection rates down while protecting livelihoods and businesses?

I urge the hon. Lady to work together with others for the best outcome for the people of Greater Manchester, and of course those conversations with the local leadership in Manchester have been going on for some time. I also urge her to look carefully at what the chief medical officer said, because it was not as she quoted. I point out that across Greater Manchester, cases are rising and they are already high. To ensure that we support the NHS across Greater Manchester and get the situation under control, action is needed fast.

I welcome my hon. Friend’s thoughtful approach to the action that is needed in Elmbridge. Of course Elmbridge’s connection to Greater London is very intense, and the travel-to-work patterns mean that, like him, a huge number of people who live in his constituency work in the centre of London. His council has worked closely with the national team to make this decision.

The expansion of NHS capacity is, of course, critical, as is controlling the virus—both of them. In London, we have not yet had to stand up the NHS Nightingale again, which is at the ExCeL centre. We stand ready to do so if necessary. We now have a huge quantity of ventilators; we have the Nightingale hospitals for bed capacity; we have brought more people back into the NHS over the past six months; and we have retired NHS staff on standby. It is the combination of the three—the kit, the physical space and the staff—that we need in order to expand capacity. Unlike in Manchester, where we are having to stand up the Nightingale hospital again already, we are not yet at the point where we need to that in London. I really hope that, in pulling together and following the level 2 rules, the people of London and Elmbridge can avoid that in the future.

Many staff have put themselves on the frontline to protect the most vulnerable, but have tragically lost their lives, leaving their families absolutely devastated. Alongside support, appropriate tribute must be paid to their sacrifice. As chair of the all-party parliamentary health group, I wrote to the Prime Minister a number of months ago, asking for a memorial to be commissioned in their honour, but as yet I have heard nothing back. Will the Secretary of State support bereaved families who have given their all and, at this time, take this issue forward across Government?

Yes, of course, we have done a huge amount to support bereaved families. It is an issue that is very close to my heart, as the hon. Lady can imagine, so I would be very happy to talk to her about how we can take this forward.

My right hon. Friend will, I am sure, be aware that the World Health Organisation has recently praised Hertfordshire health authorities for measuring the pulse and the feelings of our community through an online platform, and for adjusting service provision accordingly. Does he agree that good local data could enable a district-wide approach rather than a county-wide approach in Hertfordshire in the event that the tier levels have to be reassessed?

Yes, of course we look at a district-by-district approach, as the decision in Elmbridge attests. I mentioned Leicester and Bolton as areas where local action has brought the virus under control. Of course, that is also absolutely true in Hertfordshire. There was quite a serious outbreak a month or so ago that was brought under control by a combination of the district councils, the county council and the central team all working well together crucially supported and effectively delivered by the people of Hertfordshire.

In March, the Government were advised by SAGE to lock down. The Government delayed that by a week, and senior scientists estimate that the delay cost tens of thousands of lives. I fear that the same mistakes are being made again. Three weeks ago, SAGE advised a circuit-breaker lockdown. In Coventry, we have seen cases rise rapidly, with more than 100 new cases in 24 hours. Before it is too late and there are tens of thousands more avoidable deaths, I urge the Secretary of State to impose a circuit-breaker lockdown and bring in the economic support that will get us through this crisis.

That is not an accurate description of history, but if that is how the hon. Lady feels about Coventry, she may like to know that we are working with the leadership of Coventry City Council, and if she were to talk to them as well I would be very happy to ensure that she was part of that conversation.

I have been contacted by a Derbyshire Dales constituent, Sarah Peet, whose grandfather was sadly taken into a care home in May. He has been married nearly 70 years. Sadly, because of covid, he cannot see his wife, with whom he has lived for 70 years, or his family. Will my right hon. Friend please update the House on what is being done on rapid testing to stop the scourge of loneliness in our care homes?

Yes, I was working on the issue of how we can safely allow visiting—especially by people who have been married for 70 years, which is an extraordinary achievement in and of itself—in a way that is safe, according to the risk level and the background rate of infection. Of course, testing can be part of the solution, as can the proper use of personal protective equipment. We have more nuanced rules in place now than during the first peak, and I would be happy to work with my hon. Friend to try to ensure that we get this right.

I welcome the Secretary of State’s greater attention on York, as announced today, but although we are in tier 1, I am concerned that there are areas of the country in tier 3 with a lower infection rate. Certainly, I do not believe that the measures in tier 2 will be sufficient to stop the spread of infections in our city, which, as he will know, are rising incredibly sharply, including in the older population. York experiences real challenges every winter because of the capacity issues in our hospital, and I am concerned that, without taking more acute action now, we will be in serious difficulty in just a few weeks’ time.

We are expanding capacity at the hospital in York. Of course, in York there are two overlapping epidemics, one among students and one among the general population. As the hon. Lady says, though, the spread is increasing among the older population, who are of course the most at risk from covid. The number of cases increased by 60% in York over the last week, so I welcome her support for the measures that we are taking, and I am happy to continue to talk to her about what more might be needed, because this is best done on a cross-party, cross-community basis. My message to everybody in York, a city I know and love, is that it is very important that all of us abide by these rules and reduce social contact. That way we can start to get the increase in the number of cases in York coming down.

I draw the House’s attention to my declaration in the Register of Members’ Financial Interests as a practising NHS doctor, who has been practising on the frontline during the pandemic.

The Secretary of State is right to introduce these measures today, and he is right to see a full national lockdown as the very last resort. May I bring him back to the issue of testing? Tremendous strides have been made in expanding national testing capacity to many hundreds of thousands a day from a standing start, but a number of hospitals still face challenges in getting NHS staff tested. I am aware of some hospitals that are being offered only 15 tests a day for their staff. Will he please look into this matter urgently? It is vital that the NHS has the staff available to treat patients, particularly given the second wave that we are now facing.

Absolutely. We are making significant progress in this area. My hon. Friend will have seen the announcement by the NHS on Monday that we are expanding the asymptomatic testing of members of NHS staff in tier 3 areas, and we are also expanding the capacity for covid tests within the NHS itself. He is absolutely right to raise this issue, and we are making a lot of progress.

We know that case rates are rising in Greater Manchester, but, as the chief medical officer has made clear, imposing new restrictions on its own will not be enough to turn this situation around. Instead, we need people to be supported to do the right thing and we need to use appropriate enforcement powers when they do not.

What we need from the Government is additional financial support for businesses and local authorities in tier 2 and tier 3 areas so that they can support employees to follow the rules. We also need to expand the staffing and resources of our excellent local contact tracing services rather than continuing to pump billions into a national system that is less and less effective at contact tracing.

We are putting in more support and if any area goes into the third level, into tier 3, it gets further support. We are putting more into local test and trace, although on its own that will not work as effectively as the partnership, which is, as I know from the figures, improving and expanding all the time. I welcome the fact that the hon. Lady recognises the sharp rise in cases in Greater Manchester and the need to act. I very much hope that we can act on a cross-party basis, but act we must.

A lot of weight is being shouldered by the Joint Biosecurity Centre, which is engaged in decisions that are having big consequences for millions of people across the country. It is concerning that there was nothing in the Secretary of State’s statement about the criteria for exiting these measures.

When the Joint Biosecurity Centre was created on 20 May, SAGE was told that it would

“pursue a reputation as an organisation that the public can trust. This will require them to be an exemplar in terms of honesty, openness, competence and independence.”

Yet nearly five months on, it has not disclosed the minutes of any of its meetings, the papers that it has drawn on or even who sits on its boards, despite a commitment on its own website to do so. If it is to be the exemplar that it has been billed to be and if the public are to have trust in it, given the importance of these decisions, will the Secretary of State order that openness without delay?

In fact, very shortly the Joint Biosecurity Centre will be making further details of its analysis public. It works within the Department and its officials are civil servants, so it is different from SAGE, which is made up of independently employed scientists. Nevertheless, my right hon. Friend makes an important point, on which we are acting.

As a London MP, may I start by saying thank you for the briefing call that London MPs had with the Care Minister and officials this morning about today’s announcement? A number of questions, however, remain unaddressed by both that call and today’s statement. Will the Secretary of State advise the House about what the evidence is behind the measures he is implementing in London? What modelling has been done on their impact, and how long does he expect these restrictions to last?

We are seeking to publish further evidence on the impact of measures. For instance, I have often mentioned Leicester and Bolton—in Bolton the curve was flattened, and in Leicester we brought it down with a much stricter intervention than the one we are proposing in London. We are proposing to publish further information on the analysis of the impact of such measures.

The fundamental science is really simple: the more people congregate, the more the virus is passed from one to another. That is why the restriction of social activity between households indoors is an important part of restricting the spread of the virus. All those areas in level 2 are reviewed fortnightly. Of course, if we can bring any area, including London, out of level 2 faster, that will be even better. I am working with the cross-party London councils and the Mayor on setting out more details about how London can exit these measures and get down to level 1. Ultimately, of course, and as soon as possible, we all want to get to level zero, which is normal life.

Will the Secretary of State please explain what formal and detailed assessment his Department has made of the long-term health cost that a second blanket lockdown would have on the physical and mental—not just covid-related—health of the population, and whether he believes that that is an acceptable trade-off?

I have looked into this in great detail, as my hon. Friend will imagine, as she is experienced in these areas. The result of what I have looked at is that there is no trade-off. If covid gets out of hand, that increases non-covid ill health and non-covid deaths too. When it comes to mental health, I was talking only yesterday to the Royal College of Psychiatrists, who are clear that a second peak getting out of hand is bad for mental health, not least because of the mental health impacts of long covid for people who survive covid but for whom the condition lasts for months and months, which is an issue very close to my heart. A proposition has been put forward that there is some trade-off between covid health and non-covid health, but I have looked into it in great detail and it is false. The best way to improve the non-covid health of the nation is to ensure that covid says under control.

During our coronavirus briefing for Members on Monday, the deputy chief medical officer, Jonathan Van-Tam, said of the pandemic that it was very easy to lose control and very much harder to gain it. Only yesterday, the Department of Health and Social Care released figures stating that 19,724 people had tested positive for the virus. With positive cases of hospital admissions increasing across the country, death rates are sadly rising, and on the admission of the Secretary of State’s own scientific advisers, there are many more to come. Does he believe that more can be done to regain control and stop the spread of this deadly disease, does he believe that proper financial support is in place for people in need in these high-risk and very high-risk areas?

Yes, I do think more action is needed, and that is why we are taking it today.

The Prime Minister has been very clear about the risk of obesity for those who get coronavirus, in that people who are obese have a more severe disease course than those who are slimmer. In tier 3 areas, however, many gyms are being closed and many sporting activities are being restricted. What are the Secretary of State and the Department doing to ensure that we can encourage activity among people in those areas? Perhaps we could have a work out to help out scheme, with free online activities targeted to each age group and each physical ability.

I love the idea of work out to help out. It is undoubtedly true, from the science that I have seen, that obesity contributes to a worse impact for those who catch coronavirus. This is something the Prime Minister has spoken about with great passion, and it is something we want to tackle, so I will absolutely look into that idea. I would also say that we have changed the proposals for people who are shielding, even in the highest risk, in tier 3 areas. They should always be clear that outdoor exercise is a good thing.

My constituents are being denied routine blood tests because the Swiss company, Roche, that supplies the labs in Bedford is having supply chain issues. If one company with one supply chain problem can cause a national shortage of medical components that are vital to patient care for at least three weeks, is the Secretary of State as concerned as I am about the disruption to medical supply chains during a pandemic when we leave the EU in just over two months?

We have prepared for years to ensure that we have the supplies that are needed, and I have of course been in contact with Roche over this distribution issue. It is actually an issue about distribution from a warehouse in England, and these distribution issues do happen from time to time in very large organisations such as the NHS. We are working closely with Roche, and I thank it for all its efforts to solve this technical problem.

I agree with the local approach that my right hon. Friend is taking. He has to make a judgment based on balancing what the science is telling us, what the economy is telling us and the sustainability of public consent.

I am concerned about care homes. My care home managers tell me that their staff are knackered. They are exhausted from covering extra shifts when other staff are isolating or have childcare challenges. They are also exhausted from dealing with online GP appointments because GPs will not visit those homes, and from dealing with angry relatives, particularly those of elderly mentally infirm residents, because they cannot visit them face to face. What can we do to help sustain those care home staff and, in particular, to approve volunteers from the massive register that we have, in order to help to share the load?

I would be very happy to take up my hon. Friend’s suggestion about the volunteers. I commend to him the social care winter plan, which sets out how we will balance the very difficult issues that he mentions.

In my constituency, schools are already closing due to confirmed cases of coronavirus. What conversations has the Secretary of State had on routine testing in schools? Will he publish the science behind the decision not to introduce routine testing for teachers and tell us why schools have been issued with only 10 testing kits each?

We have a testing prioritisation board which takes into account the order of priorities within testing. Of course, as testing expands it means we will be able to use it for more things, including in schools. I look forward to being able to make that progress just as soon as we make the expansion even bigger.

London as a whole is going into tier 2 as a result of the infection rate being at an average level of 97 per 100,000, but, as my right hon. Friend will be well aware, the actual levels of transmission in different London boroughs are widely different. Will he set out what criteria will now be used for London to go from tier 2 to tier 1? Will it be the case that every London borough has to come down below a given rate before that can happen? Otherwise, we will have the position whereby this short-term period could extend for many months. Will he therefore set out what criteria will be used to get us down to tier 1?

I want the time that London is in tier 2 to be as short as possible. The best way we can achieve that is by all pulling together and following the level 2 rules. In terms of exiting from level 2, the cross-party London group set out a very clear set of criteria on the need to go up a level, including reaching 100 per 100,000 cases on average across London, which we are just about to breach. It is now working with us on what the exit might look like. I totally agree with my hon. Friend on the importance of setting that out to give people the motivation that, if we all pull together and sort this out, we will get out of these measures and people can live their normal lives a bit more.

Scotland made use of a summer of lower cases to get its public health-based contact tracing system up and running. It is reaching over 90% of cases and contacts. Can the Secretary of State tell us by when the UK Government hope their Serco track and trace will reach even 70% of community contacts?

The way we do it in England is that the national system and the local systems work together. The first proportion, the majority of cases, are dealt with by the national system and then the local systems come into action. Between them, they reach a very high proportion of cases. It is that teamwork that is the best way forward.

Today, there are thousands of people working in hundreds of private businesses contributing to the testing endeavour. Will the Secretary of State pay tribute to them, and does he agree with me that they are key workers in every respect?

Yes, I do. In contrast to some of the comments from the Opposition, although sotto voce now, it is about teamwork between people in private businesses and people in the public sector working together in the national endeavour to defeat this disease. It is a big team effort and let us not divide people where they should be brought together.

Serco is at the heart of an outsourced tracing system that is failing to contact one third of all the close contacts of those with coronavirus. That is clearly helping the virus to spread out of control. There is widespread public concern that the Government are in hock to giant outsourcing companies, and concern that Serco and the like are not just ripping off the public but putting lives in danger. Does the Secretary of State think that the public should be reassured or worried by the fact that Serco’s former chief spin doctor is now his Minister for Health?

I do not think the hon. Gentleman was listening. I pointed out just previously not only that the national system in the last week has more than doubled the number of contacts that it has reached—I pay tribute to it for that—but that it is teamwork between the national and local systems that works best. It is the combination of the large-scale private organisations and the public sector—people working together—that is able to deliver, and to deliver a better service. I will tell the hon. Gentleman this: there was a time in the last few days when we had requests from local systems to bring some of the contact tracing back into the national Serco system so that it could help to reach more people. That sort of teamwork is what I look for, instead of the negative, derisory, divisive approach of the hon. Gentleman up there.

Would my right hon. Friend care to reflect that a number of us in London regard it as neither targeted, nor proportionate, nor appropriate to use a London-wide average in so large a metropolitan area where so little commuting is now taking place? Will he reflect on that in the future, and will he speak today to the Chancellor of the Exchequer to see what support can be given to hospitality businesses in the London suburbs that are suffering as of now as a direct consequence of his decision?

Of course, across London there is a huge amount of travelling to work. Although of course in different boroughs the rates are different—my hon. Friend is absolutely right about that—and in his patch they are lower than the London average, nevertheless, unfortunately, they are rising sharply. We considered a borough-by-borough approach, but because of the integrated nature of London and because, unfortunately, cases are rising fast across London, we decided that the best approach was for the whole of London to go into level 2 together.

I have to ask the Secretary of State, as another Member of Parliament who, in his words, is “up there”: does he understand that people in Greater Manchester fear that an indefinite period in tier 3 would mean the pauperisation of our people and the destruction, at least in the short and medium term, of our economic capacity, with no certainty—unless he really does get test, track and trace not just improving but working well—that we would come out of it any better than we went in?

By “up there” I meant on the screens at the top of the Chamber rather than anywhere geographically. What I would say to the hon. Gentleman is that the best way to avoid the outcome that he seeks to avoid is for everybody to pull together across party lines, across communities, to get the public health message out that we need to work together to deliver for the people of Greater Manchester and all other areas of the country.

I thank the Secretary of State for his statement. As a Member representing a constituency in the north-west of England, may I also say thank you to him for his continued engagement and that of the Department? He does speak on a regular basis to Members in the north-west. I can say that hand on heart because I regularly speak to him about the issues in my constituency. He will know that hospital admissions in my constituency continue to rise and that there is pressure on the health service there. We have moved from 40 in-patients a week ago to 80 today. What support is he giving to Warrington Hospital so that normal NHS treatment can continue uninterrupted?

As a Cheshire boy myself, of course I talk to my hon. Friend, as I do to colleagues right across the country. Warrington is close to my heart; my grandfather used to live next to the golf course in Warrington. The hospital there is a very good hospital, but it is under strain. We are making sure that the whole region supports the hospitals that are under strain with covid admissions, which I am sure my hon. Friend would welcome and which is, of course, one of the advantages of having our great NHS.

The whole country knows the perilous situation facing the city of Liverpool and the north-west region. People out there are very worried—not least the people who were officially shielding previously. Will the Secretary of State say what the latest scientific advice is, and may I call on him to reintroduce that advice and, with it, financial support?

Yes. On Tuesday this week, we set out the details of the approach we take to clinically extremely vulnerable people in this second phase. I will write to the hon. Gentleman with the details of that, and he might want to take up the offer that I can make to him of a meeting with the deputy chief medical officer, Jenny Harries, who leads on that programme.

I thank my right hon. Friend for his support for my campaign to ensure that all women have partners for scans and labour, and I am grateful that NHS trusts have seen a significant reduction in unnecessary measures, but today I ask for clarity: should pregnant women in their third trimester be shielding given their much higher vulnerability to covid-19? Does he agree that employers must take account of the higher risks and support women to work from home or in jobs that are not on the frontline?

Of course employers should have a duty of care towards their employees who are pregnant. When it comes to the formal shielding advice, maybe my hon. Friend can join the hon. Member for Liverpool, Walton (Dan Carden), who spoke just a moment ago, in a briefing with Jenny Harries. I will also send my hon. Friend the updated guidance to make sure that we get this exactly right for people in the third trimester of pregnancy.

At the first joint Select Committee meeting of the covid inquiry this week, we heard evidence from a care home manager that a member of her staff had to wait nine days for her results. If I were in charge of that shambles, I would struggle to look at myself in the mirror, let alone get up at the Dispatch Box and have the gall to tell the public that testing is anything but a failure. When will the Government get a grip on testing?

The turnaround times for tests have come down very significantly, including for care homes, over the past few weeks, and we work incredibly hard to get them down. Even while there was the most acute pressure on testing capacity, we kept the weekly testing for care staff, and I think the whole House can unite behind that.

While it is clear that the measures taken in the spring helped to slow the spread of the first outbreak, at the end of what was supposed then to be a three-week lockdown, daily cases had trebled and daily deaths were up 750%. If there were to be a so-called circuit-breaker national lockdown, how would it be possible to judge after two or three weeks whether it was safe to lift those restrictions?

We are trying to have as local an approach as possible, partly because we have to ensure that we take measures that are proportionate. There are some areas of the country, including Dudley, where case numbers are lower than even their close neighbours—in my hon. Friend’s case, across the west midlands. That is the reason, as the Prime Minister set out on Monday, that we are taking the tiers approach, which I think helps public understanding, because it is really simple but allows us to take action where that is necessary.

We have lost Rosie Cooper as the connection has gone down, so we will go to Selaine Saxby in the south-west.

Thank you, Mr Speaker.

Does my right hon. Friend agree that the Opposition should not play politics with people’s lives and livelihoods? A national circuit-break lockdown is not the answer, particularly for areas such as my North Devon constituency, where covid cases per 100,000 are still fewer than 40.

My hon. Friend sets out why, with case rates like that, we are focusing our attention on the parts of the country with the most serious problem. Throughout this, we try to ensure that we take action that is necessary but proportionate, in order to slow and suppress this disease.

Communication for shielding people has been poor in the past. Now as we sadly return to further restrictions, communication remains poor, with news being fed to the press before updating the country in a clear way. That really is not good enough. The Government have had seven months to get it right. When letters are sent to shielding people, will the Secretary of State ensure that they are in accessible formats, especially since many potentially are disabled people? Will he let them know what extra support they will be entitled to?

This is a very sensitive issue and it is very important for those who are shielded. I invite the hon. Lady to the briefing with the deputy chief medical officer so that she can ask any questions that she has.

Since March, the Government’s top policy priority has been to save lives by preventing the NHS from becoming overwhelmed. Given that, the Government have rightly been preparing for this winter by significantly expanding free flu vaccinations. Given that parts of High Peak, including Glossopdale where I live, have just gone into tier 2 restrictions, may I urge the Secretary of State to do everything that he can to make certain that sufficient flu vaccination doses are available in High Peak and other areas with extra restrictions?

Absolutely—not least because there is evidence that if someone has flu and catches covid it is even worse. The flu programme this winter is incredibly important—even more important than it always is. I will look into the roll-out in High Peak and ensure that it goes well. I am very glad to say that the uptake of the flu vaccine is much higher this year than it has been in previous years, and we have a record amount—more than 30 million doses available. Everybody on the priority list in High Peak who wants a flu vaccine can get one. They will be available over the forthcoming 10 weeks between now and Christmas, and I am very happy to work with my hon. Friend to ensure that that happens for his constituents.

We have found Rosie Cooper, so we are going up to Lancashire.

Thank you, Mr Speaker. Four British teenagers in Sicily continue to test positive after two weeks of isolation. In Britain, they would be back in the community spreading the virus, so does the Secretary of State recognise that a test, trace and retest system is needed to protect us? When could it be implemented? Also, what action can be taken to protect my West Lancashire constituents who have been alerted via social media to the fact that supporters who want to watch the Liverpool versus Everton match this Saturday intend to travel from nearby tier 3 areas into pubs in West Lancashire? This could be a super-spreading event leading to a public health disaster.

I will write to the hon. Lady on the first point. It is a very important point, but the proportion of people who are still infectious after two weeks if they do not have symptoms is thought to be very low. I cannot remember the figure off the top of my head, but it is very low. I will write to her and perhaps publish the letter to explain that scientific fact in full detail.

On the second point, I strongly agree with the hon. Lady. The principle behind the levels is that, if someone is resident in an area on a very high local covid alert level, that level applies to them wherever they are. If someone lives in a lower alert level area and they travel to a higher alert level area, the rules of the higher level apply if that is where they are. People who live in the Liverpool city region should not travel to West Lancs because the pubs are open there. That contravenes the regulations, and I look forward to working with her to try to ensure that that does not happen.

Operation Moonshot was the UK Government’s latest world-beating covid intervention, but it seems that it has perhaps missed its target and is heading off into deep space. The public did not ask for world-beating; they asked for competent, and they deserve availability. Can the Secretary of State advise us on whether there are any positive signals from Operation Moonshot? When will it be rolled out nationally, or is it another testing failure?

It is going pretty well, actually, and it is going to benefit the people of Scotland as well as people right across this united land.

What advantage is there to be had from accommodating non-intubated covid cases in Nightingale hospitals, and if there is an advantage what additional facilities would need to be provided?

Some of the Nightingale hospitals can take non-intubated patients—not ones who need full intensive care, if they have multiple organ failure—but not all of them can because of the way that they are set up. We need the ventilators, the space and the staff to ensure that the Nightingale hospitals can be expanded as much as possible.

Yesterday I received an email from my constituent Anna Shipman, who is really concerned about test, track and trace. She has a friend who is on a vaccine trial and has a routine test every Wednesday. At the beginning of the trial, he would normally get his test results the next day. Anna is pregnant. She told me that her friend met her on Friday and then, on Saturday, he met his elderly mum, who is 75. On Saturday and Sunday, he went back to work as a full-time carer, exposing extremely vulnerable adults. He did not receive his test results until Sunday. This system is a shambles. Will the Secretary of State say when we will protect vulnerable people from being infected by people who do not know because they are not getting results on time?

No, the turnaround times are reducing. While I absolutely pay tribute to the hon. Lady for raising this individual case, it is very important to look at the system as a whole, where the number of tests is at a record level and the turnaround times are, I am glad to say, reducing.

Is the Secretary of State currently having discussions with West Yorkshire leaders about our covid alert status? Does he anticipate any change to our current status of “high” in West Yorkshire this weekend? Will he continue to be guided by the localised data?

The localised data is very important so that we take the action that is needed as locally as possible, as we have in Kirklees over the past few months of the crisis. We are in constant dialogue with the leaders in West Yorkshire, but no decisions have been taken.

Tower Hamlets faced one of the highest death rates in the country in the first wave of the pandemic, including for those in black, Asian and minority ethnic communities. For weeks, the borough has been given the lowest testing capacity in the capital despite high incidences of positivity. Will the Secretary of State focus on the specifics and explain when he will get a grip on testing and tracing and localised resources for it; when he will get local authorities, businesses and communities the resources they need; and what action he will take to produce the action plan that was promised months ago after the disparities report was published by his Government?

Yes, absolutely. The hon. Lady rightly raises the issues in Tower Hamlets. The good news is that the testing being delivered in Tower Hamlets is going up. The bad news is that both the number of people testing positive and the positivity are also going up. Because of today’s decision on putting London into level 2, further resources will be available for local test and trace.

Thank you, Mr Speaker, for allowing me to get in at the last minute, because this is a London statement. When a Minister gets a collection of London MPs together, it would be great if they could actually be allowed in to ask a question for a long enough time to save them having to scrabble into the House of Commons.

I want to follow on from the comments of my hon. Friend the Member for Bromley and Chislehurst (Sir Robert Neill). London is huge. Whether people like it or not, it is very diverse, and many of the boroughs are bigger than most of the towns in the rest of the UK. Surely we need to look again at the London-wide nature of this tier 2 position. Even regional areas could be taken out. There are big disparities. I ask that we please think again. Otherwise people will say, like one constituent who rang me today, “Is this in fact a London-wide tier 2 to stop the north-south divide argument running?”

On the last point, absolutely not. This decision has been taken on the basis of the data across London. We did consider the borough-by-borough approach that my right hon. Friend understandably advocates, but the decision that we came to was that because cases are rising throughout the capital, it was right for the capital to move as a whole. That was supported by the cross-party team who are working on this at a London level.

Cases in Ealing have shot up, doubling in the past week and making it now the capital’s coronavirus capital. May I therefore commend the Secretary of State’s approach to the London-wide situation, given its fluidity and that of our city? Will he resist the siren voices on the Conservative Benches saying otherwise? Will he look at additional funding for areas like mine, and other interventions that could help? He knows my position on vitamin D. Has he considered that that could be a high-impact, low-risk, virtually cost-free thing that would make him a hero? What is he waiting for?

On the first point, I will say that I will listen to all voices. The voice of my right hon. Friend the Member for Chingford and Woodford Green (Sir Iain Duncan Smith) is far from siren. It is thoughtful, considered and represents his constituents. I will listen to and consider him, my hon. Friend the Member for Bromley and Chislehurst (Sir Robert Neill) and the hon. Lady in trying to get the best public policy outcome, taking into account the health, economic and social consequences of these decisions and choices that we are unfortunately faced with. We should try to carry on that approach of listening to all considered voices.

On the point about vitamin D, I have asked the scientists to look once again at its impact on resistance and immunity. Some updated evidence has come to light in the past few weeks, and I want to ensure that it is fully taken into account. I can also tell the hon. Lady that we will be increasing the public messaging on vitamin D to make sure that people get the message that it can help with broad health and there is no downside to taking it, and therefore people should consider that.

Thank you for squeezing me in, Mr Speaker. I thank my right hon. Friend for his statement, and I also thank him for his response to my hon. Friend the Member for Harrow East (Bob Blackman) earlier. It is so vital that we have a pathway and an exit plan to take London back to tier 1 as soon as possible.

I am concerned about the impact on local people and businesses in my constituency in central London, particularly in terms of the mental health issues we are facing. I met a businesswoman on Friday in the City of London—a beautician who is now on antidepressants because her business is failing. Will my right hon. Friend please assure me that funding for mental health services will be available as we go further into this crisis?

My hon. Friend is right to raise those issues, and these are difficult choices that we face. She has raised with me previously the need for a plan for exit so that we can motivate people to do what is needed to get the disease under control in London. In her constituency, almost more than any other, decisions to restrict social life have a significant direct impact. On economic and health grounds, getting this virus under control helps on both counts, particularly if we take into account, for instance, the mental health impacts. Having spoken to the Royal College of Psychiatrists, I think it is clear that the mental health impacts if the virus gets out of control are worse than the mental health impacts of the measures necessary to keep it in control, but nevertheless we have to ensure that the services are there to support people.

I wrote to the Secretary of State on 16 September about the inadequacies of track and trace, and I acknowledge what he has said today about the need for local and national teamwork, but I need to be further reassured that he will get track and trace right, because that is central to dealing with the covid-19 pandemic. London is now in tier 2, and we have seen Manchester go from tier 2 to tier 3. We need to have a national circuit break for that to work, because otherwise we will have tier 2 going piecemeal to tier 3, and that is not a plan.

First, yes, we want to work more closely with Ealing to make sure we get that national and local link-up in the test and trace system—I can give the hon. Gentleman that assurance. [Interruption.] And with Enfield as well. Just to be clear, no decisions have yet been taken on Greater Manchester, and I want to reassure colleagues from Greater Manchester who are in the Chamber of that. Finally, this targeted approach is clear for people to understand. There are three levels. Everyone knows what is in each of the three levels, and it is very easy for someone to know which level their area is in.

I bring news from Greater Manchester, where the impossible has been achieved: all the Members of Parliament, the leaders of the councils and indeed the Mayor are surprisingly in agreement with one another; but the meeting that we had earlier today was entirely pointless. I might as well have been talking to the wall. When are we going to be properly consulted, and learn about measures through the right channels rather than via the media?

May I put to the Secretary of State a question that I posed to the Prime Minister? The closure of hospitality will drive people into private dwellings, where they will mix. We do not, thank goodness, live in a police state, which would be the only way to police it. Will they please listen to common sense and think again?

Some of the evidence for the approach that we are taking is not only because we see that approach in other countries in the world, but because even within Greater Manchester, in Bolton, where cases were rising sharply, they were flattened when hospitality was closed except for takeaways; albeit that they have started to go up again since that measure was relaxed. So, although I understand my hon. Friend’s urge for a consultation—I am happy to talk to him about these issues at any moment of the day or night—we are seeking to work with the local area and with all the elected representatives to get a solution that we can commend to the people of Greater Manchester. But a solution we must have. We cannot see cases inexorably rising, because we know the consequences that that brings.

I am slightly confused. On Monday the Secretary of State gave up his valuable time to Greater Manchester MPs and confirmed tier 2 with a four-week review. He had unanimous support, cross-party, from Greater Manchester. As the hon. Member for Hazel Grove (Mr Wragg) said, every day it has been briefed in the press that we were moving to tier 3. So I am grateful to the Secretary of State that the Minister for Care, the hon. Member for Faversham and Mid Kent (Helen Whately), has today announced that the Department will undertake a leak inquiry. Today, again, there was full unanimity about tier 2 in Greater Manchester. Come on, Minister: just confirm it and you will have our wholehearted support across the conurbation.

Not quite, because even in this statement there have been Members speaking from Greater Manchester who have urged more action. [Interruption.] What I would say to the hon. Gentleman is that I have started a leak inquiry into the leaks of some of the information around Greater Manchester. That will, of course, have to cover both national and local government. There is a more important thing, though, which is the need for people to come together to take the action that is necessary to get this virus under control, because unfortunately, in Greater Manchester there continues to be a rise in the number of cases—[Interruption.]

Order. Just a second. Mr Kane, I gave you the privilege of having the final question when you were not on the list; please do not abuse it. I also need to hear what is said because it affects my constituency.

Very sadly, across Lancashire and across Greater Manchester, the number of cases of coronavirus continues to rise. The number of cases among the over-60s continues to rise. The number of hospitalisations continues to rise. Further action is therefore necessary. I very much hope that we can reach the sort of cross-party agreement that we have had in London, and that the local leadership in Manchester can work with us to find a solution, because it is critical that we get this virus under control.

In order to allow the safe exit of hon. Members participating in this item of business and the safe arrival of those participating in the next, I suspend the House for a few minutes.