MPs hear evidence on Coronavirus: lessons learnt

The witnesses were:

1. Professor Devi Sridhar, Professor of Global Public Health, University of Edinburgh, and Alex Thomas, Programme director at the Institute for Government

2. Rt Hon Matt Hancock, Secretary of State, Department of Health and Social Care

Topics for MDDUS:

• Pressure on doctors - not mentioned
• Burnout pressure - not mentioned
• Indemnity - not mentioned
• Clinical negligence - not mentioned
• Patient safety - not mentioned
• Rollout of the Covid vaccine and the implications for medical professionals - not mentioned

The following is an edited transcript.

Jeremy Hunt: We will be focussing this morning on what are called non pharmaceutical interventions. That is, in a way, everything other than the vaccines that we've all been talking about, but in particular the role of Lockdown's and the effectiveness of public communication that has been so important throughout the pandemic.

Professor Devi Sridhar, From an epidemiological point of view, how do you think the UK government did in combating the virus compared to other countries?

Professor Devi Sridhar: It’s clear to see that we have taken in the UK a much higher level of deaths as well as disability through the stars carry to pandemic than many other countries. And I think this comes down to an early on decision to treat this like a flu like event that would pass through the population an uncontrollable spread that you would try to mitigate through building enough hospitals and medical care so that everyone can get the care they need, rather than treating this like a SARS like event, which is what East Asian countries have done as well as now in the Pacific, Australia and New Zealand, as well as some countries in Europe like Norway, Finland, Denmark, which are a bit interesting for actually diverting from that model and actually trying to keep their numbers as low as possible.

Jeremy Hunt: You have championed very publicly what's called sometimes called a zero covid strategy. And you've also been quite critical of some of the delays to getting test and trace up and running. Now, the government has been talking a lot more about population testing, particularly in Liverpool. Are you reassured that what you've been talking about for many months is now within our grasp?

Professor Devi Sridhar: … this virus will keep spreading as long as you don't have a sustainable suppression strategy.

…on border measures, it does feel like the UK was quite late to use travel restrictions and quarantine measures to try to catch cases.

…on test trace…we still see the numbers being too low.

Carol Monaghan MP:
How do you feel about the prime minister's comments yesterday in his statement that we were going to try and get some Christmas celebrations taking place?

Professor Devi Sridhar: …the virus doesn't care if it's Christmas. We still have a pretty high prevalence across the country. It is risky for people to mix indoors with alcohol, with elderly relatives at this time. By March will be in a fundamentally different position than now.

Mark Logan MP:
Do you believe that the current national restrictions in the UK were inevitable?

Professor Devi Sridhar: No, I don't think they were inevitable, I think, in the summer. We had a period of time where the numbers were crunched, the numbers were really low in Wales, Northern Ireland and Scotland and pretty low in England. And I guess if we go back in time, we could have pushed at that point to really get the numbers low, hold lock down a few more weeks and then put in place really strict border restrictions to say you can't travel.

Barbara Keeley: What impact does the government's emphasis on national contact tracing have on efforts to control the virus?

Professor Devi Sridhar: We know contact tracing is like detective work and it has to be done at local level.

Jeremy Hunt: Alex Thomas, when you look at the pandemic, how effective do you think the British state has been?

Alex Thomas: The pandemic has demonstrated that there are areas of strength and success. One is the initial economic response from the Treasury, but also HMRC and DWP are being able to mobilise that sort of operation rapidly….but the central local balance doesn't to me seem to have been right.

Aaron Bell:…Was there an optimism bias, given that previous scares and scares such as avian flu and foot and mouth hadn't amounted to much?

Alex Thomas: Many of us shared an optimism bias at the beginning, which was explicable. But I do agree with the thrust behind your question that there was a natural optimism bias and maybe some more more pessimistic people in government would have would have helped at the time.

Aaron Bell: Do you agree with the structural changes the government's put in place?

Alex Thomas: Yes, I do. I think the strategy and operations separation makes sense. I think it's clearer and gives a clearer structure of accountabilities than some of the earlier committees where secretaries of state were chairing their own committees.

Dawn Butler: How important is it that those people who are put in those new positions are skilled and experienced in the field that they asked to run?

Alex Thomas: It’s obviously incredibly important that they know what they're doing. But those jobs are as much about leadership and management and logistical jobs as they are about medical interventions.

Sarah Owen: Alex, In 2007, we were drawing up emergency planning for SARS. What happened to those plans?

Alex Thomas: This goes to my point a bit about the contingency planning. I don't know the specific point on the 2007 plans and where they went to. In government there's always a tendency to fight the last battle and not to genuinely scan for risk.

Sarah Owen: Do you think that there would be much more benefit in looking at forward planning in terms of looking at risk and investment in how we better plan for events like this in the future?

Alex Thomas: Yes, I do. I think there are all sorts of lessons that were learnt from this about the capability of the state. One of those is the risk management and contingency planning response.

Sarah Owen: Professor Sridhar, why do you think there is such an unwillingness for this government to learn lessons from countries that have perhaps performed better? And do you think that there is this cultural bias that SARS, swine flu, avian bird flu has affected East Asian countries but not asked before? And do you think that that cultural barrier needs to be looked at for us to really grasp and to learn lessons as as Alex said you?

Professor Sridhar: One of the interesting things to see in February was the complacency across all rich countries, including the United States, about this virus, because the worst thing people could think of is the flu. Whereas if you look at places like West Africa, they redeployed their post Ebola structures because they knew an infectious disease can actually basically run through society, shut down your schools, shut down your hospitals, stop vaccination campaigns and paralyse society for months.

Luke Evans: Professor Sridhar, I'm interested in the behavioural science behind what's going on.

Professor Sridhar: Behavioural science is absolutely massive because you don't need to have state lockdowns and people alter their behaviour on their own through really good guidance. So, for example, if you ask people to avoid crowded settings or you ask them to wear face coverings, you don't need to legislate. If people just understand why it's important you do it.

I think we're seeing fatigue setting. And I think, the countries where there was a zero-covid approach, their populations got a pay-off. New Zealand had a really hard lockdown for three weeks, but they got back to their big rugby games.

Greg Clark: Professor Sridhar, you reflected on the fact that we didn't do some of the things that countries around the world were doing. Have we attempted to have too much of a kind of British exceptionalism approach to this?

Professor Sridhar: I think that's right,

Greg Clark: Alex Thomas, there's a big debate at the moment in parliament about the awarding of contracts and the fast tracking of appointments to key positions such as the person responsible for testing trace and so on. What's your objective view of the rights and wrongs of those decisions?

Alex Thomas: I think it is totally legitimate in the early stages of a crisis, a pandemic to balance off the risk of improper use of money or fraud, as the Treasury did in the income support schemes to get fast action.

There then comes a moment when the crisis becomes the normal when it's really important for public confidence to regularise that. And that applies both to the procurement, the contracts and the National Audit Office report that we saw the other day and to appointments. I think it my
honest view is the government should have been a little bit on the on the slow side on on that.
Panel 2

Matt Hancock, Secretary of State for Health and Social Care
Clara Swinson, Director General of Global and Public Health at DHSC
Dr Jenny Harries, Deputy Chief Medical Officer

Jeremy Hunt
The virus, of course, won't be eradicated by Easter. But if that happens, if all those vulnerable people do get vaccinated by Easter, what will the social distancing look like after Easter?

Matt Hancock: It depends on the impact of the rollout of the vaccine, on the transmission of the disease and on the number of people who have a serious morbidity or indeed die from coronavirus. So the same tools that we use and the same data that we use to judge what should happen to NPIs now are essentially the same measures because they are the things that we're trying to protect against.

There is some evidence in the AstraZeneca trial of protection from transmission and that not only protect yourself from coronavirus, but you reduce the likelihood of you transmitting.

And we've been able to measure that because in the AstraZeneca trial, unlike the other two trials, there was regular testing of some of the participants all the way through. However, you can't know the true impact of that, and you can't calibrate it mathematically until you've seen the impact of having vaccinated a large number of people.

Jeremy Hunt: People watching at home really want to just get a sense. Is it possible that we could be back to normal after Easter?

Matt Hancock: After Easter, we think that we will be getting back to normal. Now, there are some things that are no regrets, right. Washing your hands more and some parts of social distancing are no regrets. But those damaging social distancing interventions that have big downsides, whether economic downsides or social in terms of our wellbeing, I should hope that we can lift those after Easter if these two vaccines are approved by the regulator, which of course, is an independent decision for the MHRA.

Jeremy Hunt: Do you think you've got the right scientific advice at the outset of the pandemic?

Matt Hancock: I always try to say that I was guided by the science. The scientific advice, I think was the best that was available. And it's tough because we started knowing nothing at all about this virus.

Jeremy Hunt: In South Korea, they were modelling test and trace as a strategy right through the pandemic. We didn't get there until the end of April. So, did you get the best scientific advice right at the outset?

Matt Hancock: On testing, it is wrong to say that the advice was to stop testing and we didn't stop testing. We ramp testing up all the time. Stopping community testing was a consequence of having to focus the tests on people in hospital. The big difference was that in South Korea, following their experience of SARS, they moved to NPIs much earlier.

There's absolutely no doubt that we can, we should and we must learn from all of the international examples and from our own experience here about how we can best deal with a pandemic of any sort.

Let me give you one example. Projects Sickness, which is now published. The problem was it was started from the assumption that we were going to have a pandemic flu that was already rampant and widespread because it was an exercise about what you do at the period at which lots of people are already dying. It didn't ask what type of pandemic is most likely? What are the different characteristics of different pandemics like flu or coronavirus being two obvious examples? And can we can we act to stop getting the position that Project Sickness started off at?

The test and trace programme was functioning to reduce transmission enormously. And by the time of the second lockdown, it had already broken the chains of transmission hundreds of thousands of times.

Jeremy Hunt: Why, when you've made this huge investment, £12 billion, massive increases in the amount of testing that's going on, that in September, SAGE would say that all that effort is only having a marginal impact?

Matt Hancock: Well, the thing is that you've got to look at what test and trace how it was doing in totality as opposed to the very specific part that you mentioned. We wouldn't have had the ability to test the people that we did unless we built the capacity. The central point is that test and trace on its own cannot keep the virus under control.

Carol Monaghan: Have you made any attempt to widen the diversity of scientific advice that you're taking.

Matt Hancock: I thought it was a bit strange to say that Sage doesn't have any public health expertise when it's chaired by one of the world's finest epidemiologists in Chris Witty.

Carol Monaghan: Should we have put lockdown measures in place earlier in the pandemic?

Matt Hancock: I'm not sure that putting engineers onto stage would have made any difference to the advice at that juncture. And I think that's something of a red herring. There will be, of course, rightly a debate about what the advice should have been at the time. We put our lockdown measures in earlier within the pandemic curve than other comparable countries in Europe.

Taiwo Owatemi: Why is it that it took the government until April for the government to announce its new testing strategy?

Matt Hancock: Around mid-March, we broadened the responsibility for delivering testing capacity from Public Health England. That became Pillar one. And I took in hand into the department the responsibility for delivering testing capacity. And we built on top of the pillar one, which is the PHE/NHS testing capacity. We introduced Pillar two, which became the Lighthouse Labs programme and Pillars three and four, pillar three for antibody testing and Pillar four for survey and surveillance testing. And and it was then that I was able to really drive the radical increase in capacity for testing that we can see today.

Taiwo Owatemi: What exactly has the government learnt from the delay?

Matt Hancock: We started with a very small diagnostic capacity. Having built this global scale diagnostics capability, we now test more people than any other country in Europe. Having built this, we must hold onto it. And afterwards we must use it not just for coronavirus, but everything. In fact, I want to have a change in the British way of doing things where, if in doubt, get a test doesn't just refer to coronavirus, but refers to any illness that you might have. Why in Britain do we think it's acceptable to soldier on and go into work if you have flu symptoms or a runny nose, thus making your colleagues ill? I think that's something that is going to have to change.

So I want this massive diagnostics capacity to be core and to how we treat people in the NHS so that we help people to stay healthy in the first place rather than just looking after them when they're ill.

Taiwo Owatemi: But given what we have universities and labs which are opened and local authorities wanted to help, did you not think that that was something we should have learnt, something that we should support them and much, much earlier than was done?

Matt Hancock: We brought in the capacity that the universities had and in particular their lab machines. And they were brilliant in helping us to build the lighthouse lab in Milton Keynes, the first one. The challenge around testing, though, isn't just the machines and the lab itself. It's the whole logistics chain from getting a test near to somebody or indeed by post through to getting the results sent to them and digitally into your patient record. The logistics around testing are huge and are in fact far more complicated than the actual testing device itself.

Dawn Butler: What proportion of contract tracing is carried out by local teams?

Matt Hancock: The broad picture is an increasing proportion because because we're getting the contacts to local teams as early as we can. But I'm really pleased that we built the massive central capacity for contact tracing as well, because otherwise we simply couldn't have coped with the scale of contact tracing needed.

Dawn Butler: How much additional resources have been provided to local authorities to help with this rolling out of this?

Matt Hancock: An additional £8 per resident per council has been has been passed over to support this effort.

One of the reasons that the local service can work a lot better is, of course, because the boots on the ground, but it can't do that without the national system taking the big numbers. So what happens is that the national system is the first to get engaged.

Rosie Cooper: We're hearing about potential concessions being made if you test negative several times a week and possibly a major reduction to isolation procedures if you test negative daily. Is there the funding and capability to deliver this across the UK in reality?

Matt Hancock: We can only do this because of the enormous testing capability that we have built. So we do have the test capacity. The challenge is logistical arrangements, identity assurance and making sure that we get the tests to the right people. And this is currently being trialled from this week in Liverpool. And then we'll roll it out to NHS and social care staff. And from that in January, should those pilots go well we'll roll it out nationally. We've got the test kits. The hard part is the logistics. And identity insurance is very, very important because we'll want to know that people are doing the test. Now, the evidence, though, is that when people test positive, they are much, much more likely to isolate. So the isolation figures that the chair referred to earlier don’t distinguish between people who actually have tested positive themselves.

Jenny Harries:

I was going to say that actually none of these are formally used as a national measure at the moment, partly because they are undergoing very stringent evaluation. And the usability and feasibility of using tests in the field is part of understanding the scientific value of those tests. Having said that, they actually look very good. And, for example, when they're being tested in different specific settings, whether it be schools or workplaces, obviously there is a degree of oversight there in a potentially high risk setting or a community focus that allows states to be collected. And all the data from positive tests will be linked back to the national PHE data system. That is a critical point. All of the tests have to comply with the UK standard to ensure that the tests are only those which will deliver the right results. There are numerous electronic devices which have run through initial testing. I think over a hundred and thirty, but only a few, a handful will come out the other end. But actually, particular research has gone on with the London School of Hygiene and Tropical Medicine around the use in health care.

Rosie Cooper: How do we distinguish between reality, what we can deliver on the ground and what is essentially a wish list, and how much of this reliant on the army and external forces.

Jenny Harries: Those issues need to be worked out, which is exactly why the pilots are being run. But so far they have been very successful and I think particularly potentially good use in care home settings as well for testing health care workers there.

Neale Hanvey:

You have stated that the lateral flow tests have a high degree of accuracy. Why do you have such confidence in that?

Matt Hancock: We put lateral flow tests and potential new technologies through a rigorous programme at Portland down, and there have been over 100 new tests that have gone through that programme, but fewer than six at the latest count have been approved. And we publish the results, which is why we can have that confidence.

What matters is the sensitivity and specificity of tests when used in the field. After having tested the new generation tests in Portland, we then put them through a rigorous field testing. So, for instance, we tested 5,000 of the first lateral flow devices alongside 50,00 PCR tests of the same people at the same time in the field. And that gave us confidence in the assessment of the test.

Neale Hanvey: Would you comment on another article from last week when the current strategy was characterised an unevaluated and costly mess?

Matt Hancock: My assessment of that description is that it is wrong.

Neale Hanvey: The actual accuracy of the tests has been published as being as low as 50% Are you giving an accurate representation of the programme to the general public?

Matt Hancock: We only used tests in which we have confidence and to use them for the right purpose. The difference between an assessment of a test whose purpose is to find out if somebody is currently infectious rather than whether they have or have had the disease is important. So a test that is calibrated to find out if somebody is infectious can have an important purpose, especially if it's easier to use in the field. But you wouldn't use it for other purposes where you might want to know if somebody is not yet infectious but may potentially have the disease. So there are different tests that have different use cases.

Jennie Harries: Disease prevalence in different communities is certainly a point of the feasibility testing. These tests vary between 57 percent and around 75 percent, depending whether they are experienced users or not. So where they are used in health care settings, that's absolutely fine. Where they are used systematically, say, for example, for a visitor who continues to visit regularly to a care home, that's likely to be very good as well. The specificity is around 99.5% as opposed to the gold standard of 99.95%.

Sarah Owen: Secretary of State, was Eat Out To Help Out a mistake, especially at a time when Covid-19 cases had already begun to rise?

Matt Hancock: You always have to balance the the needs of all the different considerations, the economy and the hospitality sector in particular with the direct impact of NPIs. Supporting the hospitality industry has been a very important part of trying to get through this. And in particular over the summer when the number of cases was incredibly low and many people could enjoy hospitality outdoors.

Sarah Owen: In places like mine, in Luton north, we actually got the lowest money from Eat Out To Help Out, only £25,000. You've claimed nearly double that in takeaways for your own team. Will you consider publishing risk, impact and possibly transmission assessments for places like restaurants, pubs, gyms, schools and outdoor activities?

Matt Hancock: I haven’t claimed for anything. I reject that accusation. I have absolutely no personal interest in any of this other than saving lives for the nation. We already publish a huge amount of evidence. We we make decisions based on what we think is the best balance in a difficult circumstance where the evidence base is imperfect and maybe Jenny can set out the evidence base that we have.

Jenny Harries: Over the time period since the start of the pandemic, it's become increasingly clear, that aerosol transmission and therefore ventilation is a really important part of managing risk with this infection. So I think whereas at the start of the pandemic, we could make general statements to say that if you are in close proximity to individuals in an environment with poor ventilation, particularly in winter, we now have more evidence accruing over the summer period, which now leads us to recognise particularly that the increased likelihood of aerosol transmission is very much associated with things like singing and speech, which tend to be louder, for example, in social settings, aerobic activity and places where you're not wearing face coverings. So obviously, particularly where you're eating, at the gym, where you're at parties, family gatherings, etc. We must then look at what happened in those tiers, where different interventions have been put in, and we find that in areas of where there have been hospitality interventions, we can see there has been some impact and there is direct epidemiological evidence, which is difficult because you are looking at clusters of disease, people often won't remember precisely where they've been or how many people they've been with.

Right across the world, for example, in Japan, in Hong Kong, in Seoul, we can see the association between hospitality and leisure venues and cases. The gold standard is genomics, when you track the virus backwards, and where that’s been done, broadly the risk ratio is about 2.8 - 3.8 in relation to hospitality settings.

With regards to Eat Out To Help Out, that was during the summer period, which is very different from now from a public health perspective. There are also behavioural and mental health elements, so it’s quite hard to produce a quantitive assessment of it.

Paul Bristow: The Treasury's Chief Economic Adviser has said there are no specific estimates of the economic economic impacts of non pharmaceutical interventions has been made. Is that correct?

Matt Hancock: It would be a matter for the Treasury and I've got no reason to to to think that she's wrong.

I’m 100% confident that the NPIs will be shown to be beneficial overall. We understand the economic impact of the NPIs. It is really hard to quantify the impact. But we, of course, understand the impact and feel it and take it into account. That’s why we tried to run the tiering system for as long as possible until it became obvious that we needed to go to a national lockdown, because if rates are very low in one part of the country and not rising, then I wouldn't want to impose NPIs on that area that are not necessary. And that's one of the insights behind why I came up with the tiering system in the first place was to try to protect some parts of the country from having NPIs that are necessary in other parts of the country, but not there. The new tiers are calibrated to be firmer, especially in tier three, than the previous set, in order to make sure that we do have the tool there to be able to get cases down.

Paul Bristow: You think deaths averted or quality of life years saved are the only factors? Do you not think that unprecedented harm to freedoms and liberties should be considered?

Matt Hancock: Yes, this comes back to the debate we're having at the start of the discussion about following the science versus being guided by the science. The medical science is only part of the equation. Sometime people overestimate the amount of information that there was, especially in the early days. The decisions in terms of impinging freedom weigh heavily on me and certainly on the prime minister. The economic impacts are obvious. I came into politics to try to improve economic chances for people. That was my background that led me here. And now I find myself doing this. But the reason that I can say 100% I think that the NPIs have been necessary is that we also know that if the cases go up, if R is above 1, then ultimately that is exponential and that means that they will go up more and more and more and more sharply. And the inevitable consequence of that is that we will bring in stronger NPIs to bring it down. And that has a bigger economic consequence.

Paul Bristow: I've personally seen quite a lot of anecdotal evidence and even experienced anecdotally that Covid has been recorded as a factor on a precautionary basis and often without proper evidence on death certificates. Are you are you confident that death certificates have always been throughout this pandemic, an accurate basis in assessing prevalence of Covid?

Matt Hancock: I think it's a serious challenge. Over the summer, we got into difficulties over the publication of the deaths measure, because the the original measure included anybody who had tested positive for coronavirus, which was perfectly valid for the start, but by the summer, you had people dying of other things, having previously had and recovered from Coronavirus.

Excess deaths is the one measure that is internationally comparable that you can't avoid.

Dean Russell: Headteachers have been concerned about the fact that they weren't on the priority list of the first 11 around vaccinations. And I think from an economic perspective, schools have helped parents go to work. They've been able to help make sure grandparents weren't looking after young children. I just want to get a sense of why they weren't on that priority list, but also what other support is in place for our incredible teaching force.

Matt Hancock: The prioritisation of vaccines is obviously incredibly important. You need to go in order of clinical priority for two reasons. Firstly, directly to reduce as soon as possible the number of people dying from Covid. Second, this is the best way to recover economically as well, because as you stop people going to hospital and dying from Covid, that's the quickest way to lifting NPIs, which is what will get the economy going. In terms of teachers, they are not any more at risk than the wider population for catching covid. But I also understand the pressures on teachers in particular having to isolate if there are contacts. And I hope that if we manage to get the repeat testing instead of isolation for contacts working, I think that would be a huge benefit to schools.

Clara Swinson, Director General of Global and Public Health at DHSC

Dean Russell asked about the mental health impacts of the pandemic and long covid.

Matt Hancock: There are undoubtedly mental health impacts of lock down. There are also, very sadly, some quite serious mental health impacts of coronavirus itself, because it can be a neurological condition in some way.

Long covid is really serious for some people. And it's a problem that we've got to to support the NHS to address. We're doing that both through funding from the National Institute of Health Research and also the NHS itself has now opened a long covid service. I think there are eight centres already open and we'll have 40 open by the end of the year covering all parts of England. And I know the NHS in Scotland, Wales and Northern Ireland is also working on on this.

Greg Clark: Sage says the policy makers will need to consider analysis of economic impacts and the associated harms alongside this epidemiological assessment, and that the work is currently underway under the auspices of the chief economist. Given you're part of the policymaking team that makes the decisions, have you seen the economic advice?

Matt Hancock: I have seen economic advice which is prepared ahead of those meetings.

Greg Clark: So why can’t we we see the advice? We see Sage papers. It's been very clear that there is a stream of, as it were, pure scientific advice and very important other assessments. Why should they not be published?

Matt Hancock: The cabinet papers are not typically published to protect decision making, but I'd also make a distinction. The Sage papers are the papers that are the result of a discussion of the scientific community on Sage. The CMO and CSA then put their advice in cabinet papers to us as the decision makers in Cabinet or typically Cabinet committees. And those those papers are not published, quite rightly, because ministers need to have the space to make decisions. However, on the economic front, you also need to consider the counterfactual which is even harder to work out than the direct impact of the measures.

I think it's reasonable for Cabinet committees to be able to be served papers by the civil service building, guided by the science on which they make decisions, not fettered by the thought that they may soon be published. It’s a long standing convention of how you run government, that there has to be a protected space for decision making.

Greg Clark: The Prime Minister made a statement yesterday about a new set of tiered restrictions. Have you considered the economic and other impacts of the different tiers that are proposed?

Matt Hancock: Of course, we've considered that. It is critical that we have a tiered system. What we're trying to pull off here is a set of measures that will get R below one that has the minimum damaging economic impact
.
Greg Clark: On 31st of October, Sir Patrick Valance presented a slide that included a scenario in which they would be a peak of 4000 daily deaths. Had you seen that slide before it was presented?

Matt Hancock: I had seen it and I understood it to be what it was, which was one of four different projections.

Greg Clark: But it was out of date, wasn't it?

Matt Hancock: It was clear and it said so on the chart and I took that into account along with everything else.

Greg Clark: Did you question whether it should be presented to the public on that date?

Matt Hancock: I thought it was a reasonable judgement for the CSA, not for me. I thought that presenting a series of options was important because it made it clear and absolutely crystal clear to anybody listening to that presentation that these things are all not certain. We're not dealing in a world of knowing exactly what the consequences of each decision will be. You've got to deal in a world of uncertainty. That's one of the biggest challenges of the whole pandemic.

Greg Clark: It's been useful to see that advice and there's been some scrutiny of it. But we don't have the chance to do that with the economic advice and other assessments. Would you consider making that available to parliament?

Matt Hancock: I will talk to the chancellor about it.

Barbara Keeley: Why has it taken more than a month to begin the pilot of regular testing for care home visiting when vulnerable people with dementia have been denied this test for so long already? And when will we see the roll out of visits to other areas of the country?

Matt Hancock: We those pilots running now, and there hasn't been a delay in this. The debate about visiting in care homes has to take into account both sides of this equation. Sometimes I think the public debate is only about the restrictions against visiting. There's also the vital importance of protecting people who live in care homes. And in the second peak, the proportion of people who've died who live in care homes is lower than first time round. These are some of the lessons that we learn. So we have to act carefully and cautiously. I hope that the rollout will be able to be available to all care homes by Christmas, and that is the goal that we're working to.

Barbara Keeley: Public Health England has recently published data suggesting people with learning disabilities six times more likely to have died from covid-19 than the general population. Yet the response we've seen so far from ministers is that there's going to be a review of that report. What action can we expect on that level of disparity in deaths from covid amongst those people with learning disabilities?

Matt Hancock: Ensuring that we protect people with learning disabilities is obviously absolutely critical. And we look into it in the same way that we look into all of those who are more affected by covid. The the critical part of that analysis before we get to the policy, which will come on to, is to make sure you also take into account co-morbidities, because we know that after age and sex, that obesity is one of the other major factors. However, even taking all those co-morbidities into account, there are there is a higher prevalence of mortality from covid for people with learning disabilities. And of course, we consider that when we are looking at the clinically extremely vulnerable group and the support that we give them.
Jenny Harries: I'm very familiar with the report. I've reviewed it myself. And in fact, the minister for care has asked the same support group to look at both of those reports, which we did, I think it was last Friday. The data is extremely unreliable. That's not to get away from the finding of the report, but it's to say that a key point going forward for learning disabled populations is to ensure that primary care data is really strong on learning disability and particularly on ethnicity as well. And the reason I mention that is because it makes it very difficult to understand the true risk, which is inherent in some of the data that's presented.

Barbara Keeley: In terms of visits, who can check on the care being delivered in those places when there is a blanket ban on visits?

Matt Hancock: The formal responsibility of the system falls to the CQC. But a huge amount of the checking and looking after people in these in these settings is, of course, family and loved ones. And I hope that we'll be able to get them visiting soon.

Jeremy Hunt: On that issue of potential discrimination against people with learning disabilities, the vaccine guidance issued by JCVI says that all older people, including a healthy 65 year old, has to get the vaccine before anyone with learning disabilities under the age of 65. Could you just look into that?

Matt Hancock: Yes. And in fact, I've already asked Professor Van Tam to consider exactly this question.

Laura Trott: When you were last in front of the committee, I asked you about parental access for neonatal units. Bliss, which is a charity which supports premature and sick babies, is still reporting limited access to parents. What's being done to address this?

Matt Hancock: I think this is incredibly important. And we changed the national guidance to the NHS to allow for and encourage visiting. And I think that that guidance should be followed. We need to have a continued drive to open this up and use testing to give people additional assurance that having a partner with you can be done in a safe way.

A testing regime is being considered for parental access to neonatal units and also paediatric wards. We’ll need to make sure that the clinical protocols are signed off to make sure that it's safe. I can't give you a timeframe today, but I'll write to the committee when we've managed to establish one.

Aaron Bell: How far down the priority list do we have to go before we can start to take off MPIs for everybody else?

Matt Hancock: There’s couple of things that make it challenging in practise. The first is, of course, when you say vaccinate, that has to mean both doses and then a short period after the second dose. Once we manage to get the number of hospitalisations down sharply, the data will need to be checked by the MHRA. Then we'll get to the point where we are protecting the most vulnerable

Luke Evans: In terms of legacy, on the role of telemedicine and the referrals to A&Es in particular, that might be something that staying in the future. Could you update us on whether that is likely to be the case?

Matt Hancock: On telemedicine, I absolutely think that we should keep the benefits that we've we've gained. We’ve also made progress on bureaucracy. In fact, I'm publishing a paper today on busting bureaucracy in the NHS, taking forward measures that we've learnt through the crisis are important for helping people to get on and do their job in a safe way.

My strategy team in the department look at all of these things. And of course, I work with the NHS on it. The app, I can tell you now has over 20 million downloads, which is unique downloads, which is absolutely superb. We've also we've built the diagnostic capacity and it's critical that we that we keep that and we have a long term diagnostics industry with that.

As well as telemedicine, which is in a way the most obvious use of digital technology in medicine, actually I want to ensure we accelerate the engagement of the vast majority of citizens with their health care through modern technology.

Regarding the potential of doing the virus drills in care homes, it's a terrific idea and I think I'll give it to my team who take forward ideas like this to see if we should put that into place.

Sir Graham Stringer: Secretary of State, why have you decided when you're imposing different tiers on regions not to negotiate with locally elected representatives?

Matt Hancock: Whilst in most cases, when we negotiated with most areas in the previous tiered arrangement, we had a high quality discussion that led to better outcomes. A case in point is Liverpool, where the case rate has fallen by over two thirds in the last three weeks. Unfortunately, that wasn't the case in all local areas, such as Greater Manchester. So instead, we proposed a set of measures within the tiers which are fixed, also financial support, which is agreed by formula rather than by negotiation. We will, of course, engage with local authorities.

We’ll set out the five indicators that we will look at, but we can't credibly put a set of statistics on those, because when you're looking at five different measures, you've got to take into account the basket. And also because there can be circumstances where where there's an individual case.

We will publish all of the data that underpins the decision that we make.

Sir Graham Stringer: You're going to end up making political decisions. You're not going to negotiate with elected politicians. So how would I be able to tell that you are not just practising arbitrary government?

Matt Hancock: Because we're going to publish the data on which the decisions are made and explain those decisions.

Dawn Butler: Asked about the involved of Topham Guerin, who were were given £3 million to do marketing for the DoH. And they must have done a good job because that contract's now been extended and they've been given another £1.5. I think it is really important that we understand the role that Topham Guerin has played in the department and that you inform the committee what they've done and how they've done it, so that we know that we've we've we've received value for money.

Matt Hancock: Topham Guerin is an excellent organisation and we use all sorts of excellent organisations in the Department for Health and understanding the public's response to the actions that were taken are absolutely critical. All contracts in the department are properly signed off and that that's done by the brilliant civil service to take into account the the conditions at the time.

The National Audit Office report demonstrated that within the department there are sign-off steps that make sure that even though we had to move incredibly fast in order to save lives, all contracts were signed off properly and appropriately within the rules.

Dawn Butler pressed the Secretary of State on the National Audit Office’s report that was apparently critical of contracts. Mr Hancock said all requests went through all of the appropriate stages of procurement.