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Written evidence submitted by the Petitions Committee (GRC0001)

Petitions Committee

The Government’s response to coronavirus

25 March 2020

Catherine McKinnell MP (Chair (Petitions Committee))

Very grateful that you're able to join us today and that this session is able to go ahead. I'm Catherine McKinnell. I'm Chair of the Petitions Committee, and we're very grateful to be having this session because it comes out of a huge level of public interest clearly in Coronavirus and the Government's response to it and the public's response to it as well. We've had 50 e-petitions tabled on a whole variety of aspects in relation to this issue, and (they've been) signed by over 2 million people. So the public interest in being able to present, not those petitions themselves because we are not able to hold debates in Parliament, but to raise the concerns that are highlighted by those petitions, and also in the public engagement that we have undertaken, since those petitions have been tabled. We have had over 60,000 questions submitted by members of the public. We're not going to ask you 60,000 questions, but we are going to try and collate all the issues that are being raised into and hopefully questions that you can answer today to give clarity and reassurance to members of the public and on the concerns that have been raised.

So this is obviously a bit of a first for our committee, of many, many committees, holding it in this forum – it's clearly got to be the best way that we can get answers for the public and enable the public to hear directly from you whilst not having to travel and be able to do it from our from our homes or our offices in a socially distanced way. So thank you very much everybody, for and partaking in this.

So my first question is actually in relation to the advice that's been issued by government to date on what people do need to be doing to protect themselves and others. And the advice which, although there are some elements that are absolutely clear and have been clear from the start There are other aspects of the advice that are changing on a daily basis, which has presented challenges for many people who are still uncertain about what they should be doing. First of all, do you accept that there has been a lack of clarity for the public on some of the guidance that's been issued? And what would you say now that people should be doing to limit the risk of infection to themselves and others? Shall I come to you first Jenny. Is it okay, if I call you Jenny, or your full title?

Dr Jenny Harries OBE (Deputy Chief Medical Officer) 

That's absolutely fine. Thank you. And obviously, I too am getting used to this communication. So can I just check that you can hear me okay, before I start?

Catherine McKinnell MP (Chair, Petitions Committee)

I can hear you really well.

Dr Jenny Harries OBE (Deputy Chief Medical Officer) 

Excellent. And so I'll start off but then obviously, if you want to, I'm sure if you want to ask me supplementary questions. I'll start at the high level and then you can go into whatever you'd like to. I think the important thing to say right at the start, as we all know, and simply because of the way we're communicating now, this is an unprecedented event, certainly in most people's lifetimes now, we have not had a pandemic like this in the UK. And we have different communication tools at our fingertips now, which is excellent. But that also presents a challenge in terms of pace and the flow of information, much of which is not owned by government at all. And I think so these are ways of doing things. And I literally, we have tried to exploit all those different channels in communicating with the public. And my final starter is as a public health doctor, in training, thought that if you have a public health incident, that can be either there is a public health issue or there could be a public health incident because the public think there is an issue and both of those apply in these circumstances. So, the behavioural elements are really, really important and they are important in managing the risk of the incident itself. Because if people misunderstand or become anxious at different points in the incident response that in itself can have a negative impact on health. So, I think what we have tried to do with communication to through a strategy is explain the outbreak to population as best we can, try and keep confidence in the Government's in the NHS response to that incident and clearly fundamentally minimize the risk of infection in the population and therefore, the subsequent health impacts and the possible cases in the population as we go forward. And we started off very early on with a very basic, what I would call infrastructure message. Now, to the public, washing your hands frequently, I think has perhaps seemed a very simple message, although people I think are increasingly understanding that this is a building block for building the resilience in the population we need. So we started off with a marketing campaign which involved behavioural scientists trying to encourage people to minimize the risk of infection both through hand washing predominantly and through the "Cough, catch it, bin it, kill it  variation of the campaign. That campaign was launched in what was called the pain phase at right at the start of February, I think the Second of February, and it it coincided with isolation of people returning from Wuhan, when we were trying to very much ensure that we for as long as we could contain people. So included what individuals could do on a general basis, but equally what individual returning travellers could and should do as they came back from the other countries. So that was effectively our contain phase. Then as the transmission increased in the community, tell people to stay at home if they if they've had illness, and also trying to build safety in our systems by directing people not to go GPs and not  to go to hospitals, but use online 111 or telephone systems for that.

As cases rise and we move into the delay phase we have very clearly set out a Coronavirus action plan. And that also has been communicated. And although I think from a public perspective, that may be seen more as a government decision. Nevertheless, it's designed to contribute to the consistent messaging and update the public on the plan to follow through based on science and responding to the changes in the epidemic as we go through.  Just on channels of communication, we've used lots of those, which I'm happy to go into but radio I know the public now will be very aware of the black fluorescent campaign which started with the wash your hands message, and is now translated through to don't go out, only go for essential exercise,  That goes through platform and key influencers. A direct contact, or, for example, working with the Department of Culture, Media and Sport with charity group and organisations. All of these link out to the public either direct or through other parties, so I'll pause there and then you can ask some questions.

Catherine McKinnell MP (Chair, Petitions Committee)

I mean, one of the aspects of the Government's advice that a number of petitioners have got in touch to convey concerns about is that initially, the Government's advice was that they were, well, I don't know whether the word comfortable but they were not concerned about large numbers of the public contracting the virus on the basis that that was actually required in order to build immunity. And then now clearly, the advice has changed. And we want to try and minimize the spread of the virus. Can you just clarify and how that has changed? And why that changed?

Dr Jenny Harries OBE (Deputy Chief Medical Officer) 

So I don't think it has changed. And I think it's really important. I recognize that different people, there's a message and there's a there's a giving of a message and the receiving of the message, and I recognize that some people have perceived information in one way, but for absolute clarity, the herd immunity messaging, which people heard, this is not a government approach, strategy, plan in any way whatsoever, it never has been put forward that way. Herd immunity is a natural by-product if you have a population as we have currently in the world, where people have not seen this infection before with quite a few people with antibodies go forward and more people become infected, we will have millions. But that is the biology of the outbreak. It has nothing to do with a plan. And the Government has always made it clear that we would try to minimize the number of infections, but particularly how many fatalities, the number of deaths, with this incident. If you have a pandemic, where the transmission unlike something for example, like Ebola, which is very direct contact transmission, if you have a pandemic of a respiratory nature, like Coronavirus, it's not a change of policy. It is almost a recognized inevitability that we will have a large number of cases, which is why we have always had a very clear plan of contain delay and mitigate.

Catherine McKinnell MP (Chair, Petitions Committee)

Okay, and I mean in terms of how the Government is able to track the spread of the virus, the World Health Organization has given a very clear message: "test, test, test". Countries such as South Korea and Singapore, have managed to flatten their curve, got ahead of the spread of the virus, through extensive contact tracing and isolation. And the UK test rates do not compare favourably with the vast majority of other European countries in particular, the countries that are managing to flatten the incidence of the virus. Why do you think this is and what do we need to do to get better at testing?

Dr Jenny Harries OBE (Deputy Chief Medical Officer) 

So it's really really important to understand what different countries are doing, that there are - there's a preamble for me here which is the we will not be able to be clear what interventions have been successful in the UK or even in places like Singapore or South Korea, until a long way ahead. And the reason for that is that the way different countries are reporting a testing basis is very different. So for example, in China, the early cases that were reported and probably the case definition involved you to have had a sample at the start, so clearly the case numbers are very different to if you're reporting and equally -

Catherine McKinnell MP (Chair, Petitions Committee)

So are you confident that we are doing enough?

Dr Jenny Harries OBE (Deputy Chief Medical Officer) 

I'm very confident we are what I'm trying to get. There is a plan and if you look at countries, so if we actually go to China data today, where people have been reporting early success, we need to be very cautious. I think I don't have the data in front of me, but I think they reported another 78 cases - though that may be inconsequential or not. The point is that where  the plan in the UK has always been to manage so we can support all of the people who need care through our hospitals, we do not want to push it too far forward into the next winter. And we definitely don't want to, if we don't avoid it, have a second wave. And where countries, the modelling showed so first of all where countries suppressed very hard, and without clear plans to do it, there was a very high peak happening when we perhaps did all of ours. So I'm very content that we have. You raised testing, and there is a huge amount were contested. So within about three or four weeks, we will have 5000 tests per day capacity within the NHS. So this is for the people who are needing care. And that will be for our frontline health and care workers. But simultaneously to that there is a program of work currently being tested to separately, outside, so it's not interfering with the work of the NHS, do hundreds of thousands of tests in force for as a starting point, again, our health and care workers, but equally then moving on and rolling out to the public. And that's in an advanced form. But clearly, they have to be good tests, they have to be sensitive and specific, and so we should not be rolling them out until they're fully evaluated.

Catherine McKinnell MP (Chair, Petitions Committee)

So without extensive testing, which, as you say, we can't compare to other countries. So how are we measuring our success at controlling the virus?

Dr Jenny Harries OBE (Deputy Chief Medical Officer) 

So we won't know just yet, the reason the Prime Minister said earlier in the week that we will review in three weeks is because we will start hopefully to see a change in the shape of our epidemic curve. If people have complied with the new rules properly, we will see that going in about two to three weeks. So that is one way we will do it. But besides the testing, we have the genomics program setting off as well. And we will have antibody testing. So it's quite complex, there's the have I got it now test, there's the have I had it test. And then there's a genomic investigation to see what we can see about the movement, if you like, of the different types of virus around the country. Both of those tests added to the genomics will give us much stronger information about the spread through the population, and will give us an indication on a representative proportion of the population, how many may have had it without having many symptoms, if there's really good evidence then to say how we manage the data part of the epidemic in the UK And what interventions we put in or whether we can take some off?

Catherine McKinnell MP (Chair, Petitions Committee)

Okay, can you understand that the public might find that quite an anxious time waiting three weeks to know whether we've done enough to control the virus, but also, in the meantime, watching the capacity of our NHS, whether it's enough and in terms of the testing, whether we're doing enough to test our NHS stuff, so that they are not spreading the virus and also, they know that they can go to work because even if they might have some symptoms, which are gone in one or two days of a common flu, they can go back to work and do their job and support those people who are suffering from the virus. What's the Government doing to make sure all of the NHS are getting tested?

Dr Jenny Harries OBE (Deputy Chief Medical Officer) 

So, I absolutely support that. We recognise it and I mean, just going straight back. There is a plan that's underlying all the actions. It is scientifically driven. The key people stay right at the front of this, actually it's not just the health care workers. So for example, somebody's working in the laundry at the hospital is a key person for continuing the care of people who will be coming through. The army for now helping for testing at logistics, PPE distribution and all of those sorts of things. So, these key workers are the ones that we do want to test also to ensure that the very, the most vulnerable, those most at risk of the disease have care workers attending them who have had the disease. We know they will be safe too. In terms of that testing, ramping up to workers within the NHS will start support and there is some testing going now. The layers of health care colleagues, but equally the end to end service outside of hospitals currently being tested and evaluated. is the one which is mostly to support our health and care stuff. It's in the public's interest the health and care workers' interests and the Government's interest. We all recognize it is the most important.

Catherine McKinnell MP (Chair, Petitions Committee)

Okay, so I'm going to bring in Theresa Villiers now who wants to ask about public transport and other issues as well. So, Theresa.

Theresa Villiers MP (Petitions Committee) 

Thank you for letting me come in here. I think there is some confusion about the advice relating to public transport and people going to work. Now my understanding of the public health advice and then the rules of social distancing is that for individuals who cannot do their job at home, they are permitted to go to their place of work, to do their job, so long as you take appropriate steps at that workplace to observe a two metre distance, as much as possible, between themselves and their colleagues or customers. But on London Underground, the message coming across the public address system is that you should not be on the public transport system, unless you are a key worker doing a job which is relevant to supporting people through this crisis. So, it'd be really good to get your thoughts on what the public health advice really is about people working, where they can't do it from home, how they get to work.

Dr Jenny Harries OBE (Deputy Chief Medical Officer) 

So I think I'm obviously a medical advisor and I'm going to provide the health element for that, and the advice that we have given to the Government. But there is in all of this - go right back to the stuff they really brought from population assessment, if you like, because asking people to stay in their homes for protracted periods of time is a very balanced and new requirement. We definitely need to reduce our social interactions and that is the basis the social distancing policy but equally to create unsafe and by doing that, where the risk for an individual or a family unit may be greater than the in totals and the total population risk from coronavirus. So, these are perhaps they are I think they are clear messages and i'll come on to them but I think we just need to keep them At the back of our mind, there will be some circumstances which have been highlighted in the guidance. So for example, a very vulnerable highly at-risk individual who is dependent on care, might do better theoretically from having no interactions. But actually, that individual most certainly might have four or five different carers with whom they are very familiar, coming into their home on a regular basis. And that is their lifeline for survival. So we need to keep a really clear balance on this.

But your point about work - so we have said, people should work from home where they can and it's surprising, as we are demonstrating, just how much work you can do in a different way from the home environment. So that's the first one. If you can't work from home, then you can go to work but perhaps adapt how you work or what you're doing. So it may be that different roles can be changed, or 'I am currently in a work environment as a key worker, but I also know that there is a lot of space created, because many of my colleagues are working from home so I can social distance very successfully in the work environment'. And then there will be other people who, as you've noted, there are key workers who needs to be out working. I know there has been a lot of noise about construction workers, and I'm not intending on a professional basis to comment on the sort of political angle for that. On the scientific perspective, there are two points that are probably relevant people working outdoors where they can space themselves effectively, the virus doesn't survive as well outdoors as it might do on a hard internal surface. So that risk element is reduced.

And then the issue about transport is - absolutely ideally, you'd have seen the things you know 'wash your hands' because you may pick it up if somebody coughed or sneezed, and then wiped it on any hard surface, it might be at work, it might be on transport, that could be a potential problem, but the mitigation there is to keep washing your hands. But equally, actually, the modelling does not suggest - and we have done this all very much on scientific modelling and taken the biggest interventions that are going to have the most impact for us - the transport one is not actually a significant intervention. If it had been, if it was the one at the top of the list, that's the one that we would have followed from the science to start with. But it doesn't actually seem to deliver much impact. The one that does really deliver is reducing our total overall social interactions. So somebody who's going to work may still actually managed to reduce very significantly their service interactions now because they're not going to the pub, they're not going out for the weekend, they're not doing all sorts of things. So we're still likely to be successful as long as everybody follows the guidance.

Theresa Villiers MP (Petitions Committee) 

Thank you for that clarification. I mean, it seems to me that there's clearly a mismatch between the Government's public health advice and the message that's been put out by the Mayor of London and Transport for London. And I would urge you and your colleagues at Public Health England to try and engage with the Mayor to see if we can resolve that, because the very strong message coming out of the London Transport System is that you should not be on it as a key worker and that is inconsistent with the advice that you're giving - that if people can't work at home, they are still permitted to go to their place of work, as long as they can observe social distancing.

Can I ask about the public health advice that people are permitted to exercise once a day? Now, many people aren't lucky enough to live around the corner from a park, or have their own garden. And so they will need, if they want to do this exercise in the open air, they would want to get on the public transport network or get in their car to go somewhere where they can exercise. And my understanding is that in some places people have discouraged from doing that or indeed by the police. So again, it would be useful to have you're clarification that if the advice is that people are allowed to exercise, albeit individually or with members of their household, then they should also be permitted to use public transport or your car to get to a safe location to carry out exercise.

Dr Jenny Harries OBE (Deputy Chief Medical Officer) 

So again, I'm going to take us back to principles around this. So I think as you've highlighted it, we cannot reasonably say 'everybody go into their garden' because we're absolutely well aware that a number of people will have no facility to go into a private space. And that is actually one reason why the exception, if you like, around exercise is there, because if we're asking people to comply with this for all of our benefits, including theirs, we need to ensure that it is manageable and gives the impact to population health that we need. And people will be less inclined to do that if we have created rules which are simply not manageable. And if you are in a small flat in London with several small children, and have no private space to go back to yourself, that is virtually an unmanageable task over a significant period of time. But then I think we also need to be clear what we mean by exercising - walking along the street is exercise. Walking fast along the street is just as good as lycra-clad bicycling in the park. It's really good for you. So I think this isn't about having to go somewhere to do exercise. That's not what it's about. It's about giving people safe permission and opportunity for their mental and physical wellbeing. But importantly for the maintenance of this reduction in social interaction, giving them that opportunity to go out, so they do not generally need to be going off somewhere in a car or on a bus to something. In fact, we would prefer that they weren't, as you've said, that will imply that people are piling into vehicles in groups and heading off somewhere. Actually, what we want them to do is just take some exercise and some air safely at a distance two metres apart, unless you are in a family group. So obviously, if you're a mum with a couple of toddlers, you need to hang on to your toddlers, I've been there, and take them down the street. But if it's strangers, if it's a different household unit, you need to keep apart and ideally you do that on your own and at a distance.

So I think some of these, I recognize it's important that people have the opportunity to ask questions and explain. And what I'm personally and I know colleagues are trying to do is explain the principles of this, because it is not possible to write into guidance, every single permutation of a job or a family unit or a housing condition, which means that everybody can instantly identify a rule for them. So I think it's about taking fresh air and having the ability to go out and take some exercise. But ideally, we definitely do not want the scenes that we had last weekend of people accumulating in groups in parks. That's not what we want it for. That's quite dangerous.

Theresa Villiers MP (Petitions Committee) 

Can I ask about the over-70s and using the transport system. The public health advice is that the over-70s should self-isolate for the next 12 weeks or avoid going out together, isn't it? But that, as far as I understand it, is not now part of law, it's not compulsory, it's advisedly. So if, if a 70 year old is fit and healthy, and again, feels the need to continue going to work, are they breaking the law or if they if they own the train or get a car to go to work? My understanding is that they can still do that if they want to, and that the 12-week isolation period is just advisory, it's not a legal requirement?

Jenny Harries (DCMO) 

So, so if people are behaving in a way which impacts negatively on risk, there's people around them or the populations, there is a legal framework behind that to prevent it. So currently in the current pandemic, if people are accumulating, for example, in crowds in a park, that is a dangerous public health thing to do, and there is legislation sitting behind it and the capacity to ensure that that is discontinued. But I think just going back to what we call the vulnerable groups, if I've missed the first part, but I just because the transmission on the phone wasn't quite so good.

But I think what we were discussing were potentially two different things. So there are what I'm going to call a general vulnerable group, in whom we have identified that there is a risk potentially of having a more significant illness if they catch the virus. And then there is a very high-risk vulnerable group which are (what) I'm going to call the 12 week group just for simplicity. Now, if I take that very high-risk group, these are the individuals who will have been receiving texts and letters. They are, although it's a large group in numbers, quite a small proportion of the population. These are people who may well already know that they have a very high risk of perhaps contracting the infection or not being able to handle it well if they get it. So, for example, somebody who has recently had a transplant, or somebody who is actively receiving chemotherapy for cancer, we know that their immune systems won't work, they will almost certainly have been advised or ready to ensure that they are not in an environment that heightens the risk to their life. Now, to those individuals we're saying 'it's advisory that you should, for your own protection, stay right away from everybody for 12 weeks. Don't go out on public transport. Don't go to the shops. Get people to help or get the system to help deliver your medicines. Let the health service know because we can get them in different health systems the safe way if that's necessary. And if you have a private piece of ground or something which you can safely go to which is away from your neighbours, then that's okay. But don't otherwise go out, though this is a really vulnerable group.

But for a 70 year-old, who might be thought of as vulnerable just by virtue of their age, but is otherwise well, that may not handle the illness quite so well, what we're saying is to take extra precautions. Really work hard at reducing the number of social contacts you have. So I wouldn't suggest that they couldn't, for example, take their dog for a walk, but I would suggest they did it very carefully, they might go out when it's less busy and be very, very careful to keep a distance away. And ideally, if they don't feel the need to they would not do that at all. So keep in as much as possible.

And just on the compulsory bit, I mean, there is another side to this. If I was very elderly with terminal cancer with a limited life period, and I just really wanted to spend time with my family, I might actually feel there was a calculated risk and say, at this time in life, this is more important to me. And I understand that if I get Coronavirus actually it might severely limit my life expectancy, and that's ok. We have specifically said that for people who are nearing the end, we recognize they may choose not to stick strictly to this. And so it's important that that is not something which is so specific.

Catherine McKinnell MP (Chair, Petitions Committee)

Thank you very much. And it is really helpful to get clarity because, particularly on the public transport issue, because I know for parts of the country, the experience is very different and for those people who still want to travel in Newcastle, for example, the public transport is very quiet at the moment. And it's probably, you know, safe to do so and keep social distancing. I think there is a big challenge in London with the numbers of people that still need to travel round. And the capacity of the transport system, given a number of the drivers themselves or those running the transport system are having to self-isolate, what do you think is the optimum solution? Because we can't be asking people to self-isolate and then cramming people into public transport. We need to be able to keep that social distancing in the workplace, and on the way there. So if we're not able to do that, surely the Government needs to issue clearer advice that less people should be travelling?

Dr Jenny Harries OBE (Deputy Chief Medical Officer) 

So yeah, I mean, as I said, I'm going to provide the scientific and medical element, because that is my role rather than policy decisions. But nevertheless, all of my decisions have been based on the science and the evidence. And I think the action which arose at the press briefing yesterday with the Secretary of State for Health, and I think it is back to these principles, and it's both government and individual, this pandemic is not something the Government could solve, actually. It can do everything it can to support people through the Health Service, but at the end of the day, this will depend or not on whether people do heed the reduction in social interactions, that is the bottom end of it.

Catherine McKinnell MP (Chair, Petitions Committee)

Can I just bring in the Health Minister there? Actually, sorry, no, we haven't got Health Minister. Okay, well, it can't be left to individuals to use their discretion, and I think that's how we got to the point where the Government has had to become much clearer about the advice because different people have different emergencies in their own lives. Those who are self-employed that can't otherwise support themselves feel they have to get on that public transport and go to work, even if they are not a key worker. So the lack of clarity is something that has to come into the science, because it can't be solved by individuals making these decisions for themselves.

Dr Jenny Harries OBE (Deputy Chief Medical Officer) 

Yeah, I would say it needs clear guidance and I might just highlight the guidance that's there, but it also depends on individual interpretations of what is said, and in the example I've just used about the very vulnerable people, we all do have very different starting points for these and very different perceptions. I think what the Government and the guidance - the advice that we give on medical side - we try to consider were the balance of this is, but at the end of the day, we are putting out very, very strong advice now, because of the point that we are in the epidemic curve that people should adhere to this. It is dangerous for all of us if they do not. There is a time - a short timeframe - for people to settle into new patterns. These are really big changes to their lives that we're asking people to make, and in fact, is there is increasing science as we go forward which is good. So I think, obviously, we don't want the scenes that we had in the parks at the weekend. I think many of those who have stopped and we don't want people crowding together on public transport, but that is the case in all parts of the country. I think the more the messages go out, the more compliance we are getting and if we continue to get the support of the public, we will be successful in managing to (flattened) the epidemic peak. We'll see that change in the use of public transport. I mean, the one thing I would say is I realise it won't work for everybody, but there are always...and if you're allowed out, if you like, one time a day to do some exercise, it becomes very exciting, so we could actually improve people health.

Catherine McKinnell MP (Chair, Petitions Committee)

Okay, I'm going to bring in Selaine who's got some questions about the NHS.

Selaine Saxby MP (Work and Pensions Committee) 

Excellent. Thank you. And obviously last night, we had the announcement of the Nightingale Hospital. And obviously, there's been a lot of planning going into increasing capacity for the NHS. And I just wondered, I actually represent a very rural constituency myself with a very small hospital, what steps have been taken outside perhaps of the capital where we've already seen what steps have been taken, to ensure that enough capacity for other cities but also for rural populations.

Dr Jenny Harries OBE (Deputy Chief Medical Officer) 

So, all of the planning, there's a huge planning framework behind all of the work that we do both now in this pandemic, but I think more importantly, sitting right behind it. So for example, I used to be a Director of Public Health in Norfolk, that has very, very rural populations. And there is always a pandemic framework sitting behind of mutual support across health, public health and other responding systems. So I think it's not possible...no country has hospitals in rural areas, for example, set up to deal with this sort of thing. It would be quite impractical. We are not unusual in this. We have high-consequence infectious disease centres, and then we have a network of infectious disease units. And then we have a network of critical care and emergency care systems. So inevitably, if you're in a rural area, and I think none of us expect to have a critical care unit on our doorstep, but we do expect to...we hope that there will be capacity if we need it at some distance away, and the whole of the NHS planning is geared to ensure that the rural areas and the capacity for that population is planned for on geographical footprints.

And the one thing I would say for this, and you would have heard in the news I'm sure if you haven't experienced it yourself, but the Secretary of State also saying yes, it is really important, we do not want for example, we saw the crowds in the parks at the weekend. We do not want the crowds on the beaches either. And one of the key reasons for that is the first one, obviously, is that they're too close together and there'll be transmitting infection. So (they're) not doing social distancing. But the second point about it is, in general, rural areas plan for their population as it stands and have capacity for that, and then in some areas like a seaside resort, they will plan for an increased upturn in some conditions during summer months. So you expect to have lots of families with cuts and bruises and broken ankles in the summer on a seaside resort and you manage that and plan for it. You do not expect to have crowds turning up from London, for example to Cumbria and then requiring all sorts of acute care, which is why we are asking people to stay in the areas that they normally are because that's how our planning system works.

Selaine Saxby MP (Work and Pensions Committee) 

And sort of following on from that slightly rural coastal theme, a question that I'm getting a lot from my locals - I think a lot of our tourists hopefully have now gone home and aren't coming to our beaches, but the people that live there all year round do have different behaviour patterns to those that we're being asked to change in the big cities. And a lot of people there perhaps go to the beach for a swim, drive to the beach and go surfing, drive and walk their dog on the beach, and we are coming up against resistance actually from the Police that people shouldn't be driving to the beach or a large open area for exercise. And I just wondered what the health advice on that was because for a lot of people they see exercising in the sea as actually a very safe thing to be doing. And so it would be good to be clear to understand the guidance.

Dr Jenny Harries OBE (Deputy Chief Medical Officer) 

So again, going back to first principles, obviously, we're all in very different individual circumstances. The virus itself doesn't last a while outside. So the outside environment generally is, just on pure viral transmission route on your own, probably a slightly safer route in general than somewhere with lots of hard surfaces where it can be harboured. But I think that there are two elements to this one is, you know, for want of a better phrase, we're all in it together - this pandemic will be managed because we all do the right thing to help all of us. And if we keep stepping out of line in different places or have exceptions, actually that's very, very difficult messaging. So I think most people are being really responsible. They're getting the message now, how serious it is. And I'm sure most people in rural areas, and others are trying to do the right thing. So setting an example wherever we're living, I think is a really important thing to do.

Having said that, if in the same way that we're saying, you know, if you live in a flat in London, you want to walk down the street because we recognize you need to exercise and you do so safely, we've said that is allowable - that is the balance on the mental and physical health elements and managing the risk of transmission. So the equivalent might be if you go to the seaside, once in the morning when it's quiet, nobody's around, you're walking two metres away from everybody else, and you have your swim and go back home and that's it, that probably is fine as well. So it's a different form of exercise in a different place carried out just safely balancing the need to reduce the social interactions and transmission of the virus in the population, but also the needs of the individual to be able to stay in their homes going forward and feel that's okay as well.

Selaine Saxby MP (Work and Pensions Committee) 

Thank you and sort of leading on from that, we've talked briefly about some tests and vaccines, do you have any update on what progress has been made towards the vaccine and when that might be available?

Dr Jenny Harries OBE (Deputy Chief Medical Officer) 

I think there's a tale of two parts here. So very, very early on, there was a huge callout to research, industry, and on the international front, and significant funding has gone in to support international development of potential new vaccines and that is under exploration now. That's the positive bit. The other side to it is, despite most of the sort of stories you'll hear every now and again...I mean, a vaccine would be just perfect, because if we had one and we knew it worked and we knew it was safe - a critical point - then we could deploy it and that would be a great way to end a pandemic. The reality is, to develop and then safely test and use the vaccine is absolute minimum about 12 months, more likely 18 to 24. And in this particular circumstance, when it was Ebola, for example, in West Africa, some vaccine was used quite early on, but the mortality rate in that outbreak was somewhere around 60 to 70%. So on average, if you've got the disease, you are far more likely to die than not. Now, for this disease, it's difficult because so many people are becoming infected and because we are completely...it's completely new to us. But on an individual basis, over all the population, 99% of us will get better. And so that balance of risk in testing a new vaccine, and using it, is in a completely different sort of sphere. And so we have to be really sure that...when we have a vaccine, if we have one, that when we use it, we use it safely and we're not creating more harm in doing that than good. So a quite a long way away.

Selaine Saxby MP (Work and Pensions Committee) 

Thank you. I don't have any other questions. Thank you, Catherine.

Stephen Timms MP (Chair, Work and Pensions Committee) 

A couple of questions for Justin largely. The biggest petition here was the one signed by over 600,000 people calling for statutory sick pay to be extended to self-employed people. And I wonder, Justin, if you're able to comment on whether that's been considered as a possibility for this package of support for self-employed people that we're now expecting to hear about tomorrow?

Justin Tomlinson MP (Minister of State, Department for Work and Pensions) 

I mean, I'm not Treasury, so I can only try and make educated guesses. I'd be surprised, because statutory sick pay is a minimum requirement that employers can pay to employees. And so if you're self-employed, you in effect can't pay yourself. So I would be surprised if that was one of the announcements. I think there will be significant additional announcements to support people who are self-employed. And I think we've all seen the request in our individual inboxes, but on the wider point of statutory sick pay, I do welcome the fact that that's now available from day one - we made that decision very quickly. And also that we extended it, not just to those who were actually sick and away from work, but those who following government guidance were then self-isolating. And we also made it that for any business under 250 employees, they could then reclaim the money up to 14 days for any employees who are then eligible for statutory sick pay. I must also stress that is the minimum legal requirement, and from surveys done, it's around about 68% of employees actually get more than the statutory sick pay. In many cases, they will just carry on getting paid as normal, depending on those business circumstances. That is the minimum requirement that a business can pay.

Stephen Timms MP (Chair, Work and Pensions Committee) 

There's quite a head of steam behind the argument that statutory sick pay should be paid at a higher rate - just £94 a week at the moment. A minister attracted a good deal of attention the other day by saying he couldn't live on £94 a week. Is that something that's being looked at - the possibility of increasing the rate at which it's paid?

Justin Tomlinson MP (Minister of State, Department for Work and Pensions) 

I think part of the cause of that, and I did the opposition day debate on this, was some Members drew comparisons to other countries. But to an extent it is comparing apples and pears because underlying this we have a welfare system and statutory sick pay is the minimum legal requirement that employers would have to pay, but depending on individual circumstances, they could also in addition to statutory sick pay, be eligible for welfare support. So it does depend on individual circumstances and that can the rate of that will then depend on if you have children, dependents, their housing costs, etc, etc. So it can't just be taken in isolation that, if you are on low income, you wouldn't just be left with £94 if you are eligible for additional support through the welfare system. So we have a more joined-up approach - a more comprehensive welfare net - but it is based on individual circumstances if either of us two were to find ourselves on statutory sick pay because of the earnings that we have and things, we wouldn't then be eligible for that additional support. But for the people in genuine need, that's what we do - we target support, and I welcome that. I know there's going to be more announcements. You know, we're seeing this on a daily basis. There's only been about £6.5 billion of additional support during this temporary period that the Department of Work and Pensions (DWP) is distributing to those most in need in society. And I like everybody else will welcome further announcements for self-employed people that we expect in the coming days.

Stephen Timms MP (Chair, Work and Pensions Committee) 

We'd love to ask you what might be in that package, but I'll resist that temptation.

Justin Tomlinson MP (Minister of State, Department for Work and Pensions) 

I'd love to be able to tell you!

Stephen Timms MP (Chair, Work and Pensions Committee) 

Would you accept that it will need to address in lots of freelancers, for example? But there's also a worry about people on zero-hours contracts who probably aren't going to benefit from the 80% wage subsidy offer but will need support of some kind if they have to self-isolate, if they have to give up their work for any reason.

Justin Tomlinson MP (Minister of State, Department for Work and Pensions) 

Okay, yeah, so specifically around the individual Zero Hour contracts, we've made a couple of changes already. So in terms of their eligibility to various different things, you will look at the average earnings over an eight week period, not just in the one week where perhaps those hours have been reduced due to the impact of the virus - it is over an eight week period. But actually bearing in mind...

Stephen Timms MP (Chair, Work and Pensions Committee) 

Is that Universal Credit?

Justin Tomlinson MP (Minister of State, Department for Work and Pensions) 

Yes, that would be with Universal Credit. But bearing in mind with zero-hour contracts, your income then is taken into account as part of that welfare net. So if for whatever reason an employer wasn't doing what we would hope they would do, and I do recognize that there are times to challenge employers and there are some employers that have been highlighted by the media who haven't been acting in I think the spirit will expect them to, there will also be some businesses having to make very difficult decisions, because their cash flow has been impacted so much. That is then where the welfare net would then kick in. Many of those people on zero-hour contracts will already be in the system. And if not, then they will be able to then register for the UC system straight away.

Stephen Timms MP (Chair, Work and Pensions Committee) 

I think it is very likely whatever is said tomorrow, that Universal Credit is going to be carrying quite a big part of the load of supporting people over the next few weeks. We've seen half a million applications, I think, new applications in the last week for Universal Credit. The Secretary of State was at the Work and Pensions Select Committee this morning talking about that. Is there a chance here to look at some of the problems with Universal Credit? You know, there's, I think, a really big problem about the fact you have to wait five weeks after applying for your first regular benefit payment. I think it's going to be terribly difficult if we're saying to employed people that your 80% wage subsidy kicks in straight away, but to self-employed people "you've got to wait five weeks before your first regular payment".

And another issue that's been raised about Universal Credit, particularly if it does have to support more formally self-employed people is that it stops at the moment once you've got £16,000 in savings. And you know, there'll be lots of self-employed people who are not well off but do have more than £6,000 and perhaps more than £16,000 in savings and I think we'd all want to see Universal Credit supporting them properly, which it won't do if those caps stay in place.

Justin Tomlinson MP (Minister of State, Department for Work and Pensions) 

Yeah. Well I'm now straying very much into the Minister for Welfare Delivery's territory on Universal Credit, but I'll answer broadly on behalf of the DWP. Anybody who applies for Universal Credit can get support straight away through the advance payments. What that in effect means is you would get 13 payments over the year rather than 12 payments over the year, so though anybody in immediate need can access that. We've obviously removed the need to have a face-to-face conversation about accessing advanced loans as part of minimizing direct contact with individuals. You are right to talk about those numbers. We've processed a record 105,000 in the last 24 hours, it's just over half a million in the last nine days. We anecdotally suspect a proportion of that will be self-employed people who perhaps, and I don't know what the details will be when they are announced, but when they are announced soon, maybe that you see, isn't then actually the area of support they will need to do but at the moment, that is the advice - that if they don't have direct income, then use the welfare system, which obviously, is predominantly Universal Credit, but for some of them, it could be the new style ESA, if they've made the right amount of contributions to the National Insurance system. So, you know, it's a moving brief. We fed in, we all support. You know, I am encouraged as an individual MP that by and large, this has been done on a cross party package.

I don't envy the Chancellor finding the most effective way to target the support for self-employed people, everybody agrees we've got to do it. How you do it is a lot more complicated than the 80% minimum support provided to people on PAYE where it's very black-and-white, how much people earn. Then, in terms of the points about the £16,000, the welfare net is there to target support at the most vulnerable in society. Normal rules dictate that if you've got, remember it's a household benefit so if you have somebody who's earning, you know, different levels of money, and then also with that £16,000, that's there, then those wouldn't be eligible at that time. But obviously, as circumstances change, then they can then enter into the system when they are in that point that's deemed to be of most need. I don't think that will change, is my view, the £16,000. I could be wrong. As I said, I'm not I'm not party to the advanced notice from the Treasury, but I'd be surprised if that's how they were doing it because they'll want to target the money at those most in need at that particular point.

Stephen Timms MP (Chair, Work and Pensions Committee) 

A final point, Catherine, if I may. I mean, it does all depend on how much Universal Credit is expected to support a large number of self-employed people over the next few weeks. That's a different job from the job of supporting the most vulnerable, which Universal Credit has been designed for. Can I just ask you - your point about "you can get an advance that means you'll get 13 payments over 12 months", I didn't quite understand. I mean, the problem is, of course, that your advance, you have to pay it back in the subsequent payments and therefore that reduces the amount that you see subsequently and - this is something a number of feel quite strongly about - that does mean I think that Universal Credit for many people is a pretty unattractive offer as things stand.

Justin Tomlinson MP (Minister of State, Department for Work and Pensions) 

Okay, so the easiest way to explain this is: over a 12-month period, whether you have an advance payment or don't have an advance payment, you will be given the same amount of money based on your individual circumstances. If you choose to have an advance payment, you'll have that first payment day one or any point during the five week wait that you need it and request it, and that will then reduce your following 12 payments. But at the end of the 12 month cycle you would have had exactly the same money, so if you were entitled to £5000 support over the year for example, you will have £5000 at the end of the 12 month period, but it would have been paid in 13 payments. The first payment would have been sooner, your following 12 payments would have been a little bit less but at the end of that 12 month cycle you would have got to £5000. If you choose to not take the advance payment, and many choose not to, then you will still get £5000 at the end of the year, but you'll wait for your first payment. That's the easiest way to explain it. That's why we say it's not a loan. It's an advance payment, it's your money, we're giving you advance access to that as part of your money that you're entitled to over a 12-month period. Now moving forward, that's obviously as you know, will be extended to 16 months, and then again, if I remember rightly, that's been extended again, but that's some way off before that's implemented.

Also we've strengthened the bits about hardship payments, that is £500 million has been given to local authorities so that, again, we're targeting support at the most vulnerable of people who need it straight away. There's more discretion in the system that we can deliver it locally. I personally support that. Whenever we sort of bid for money to Treasury as a department and we have to decide which of the bits to do. I'm a big supporter of where possible, providing discretionary money at local areas. Maybe I'm a bit biased because I spent 10 years as a councillor in Swindon before I became an MP. But I do think we all represent very, very different areas - rural, urban, different types of employment challenges - and therefore wherever possible, devolving discretionary funding to support vulnerable people, I'm a big supporter of. But that's me speaking as an individual rather than necessarily the corporate line.

Catherine McKinnell MP (Chair, Petitions Committee)

Thank you. I think Stephen raised the point that there are two challenges here, one supporting the vulnerable, the other supporting the effort, which is to stop the spread of the virus. And I think there isn't that, and I know hopefully this will be resolved tomorrow, when further measures are announced to support self-employed people. But at the moment, far too many people are being put in the position of not being able to do what they would like to in terms of not spreading the virus, because they will be left in too much financial hardship if they do not go to work, which is why the public transport in London is still very busy. Which is why too many people are still going out to work even though they would rather stay at home for the safety of them and their families. Is that something, is that a concern that you share?

Justin Tomlinson MP (Minister of State, Department for Work and Pensions) 

We all want to get the support for self-employed people brought forward as quickly as possible. To be fair to the Treasury, they have already made very helpful announcements around the deferral of self-assessment payments, made very clear that HMRC will be very sympathetic with people who are due to make payments or need to change their arrangements. Some self-employed people and businesses will be eligible for the grants, the loans that have been put into place. Many local authorities through the additional money they've been given are also putting additional packages in place. But I think we all agree as quickly as possible that Treasury can get the additional support into place. I have every sympathy with the Chancellor on this because it's so complex. I ran my own business for 10 years. To be able to any point in that 10 years tell you accurately what my earnings are or aren't going to be in the coming days in normal times was nigh-on impossible. They've got to find a way. I know they're working at pace. I know all of the business organizations - the FSB and CBI - they're all feeding in, we're all feeding in with the suggestions that we're getting. It's complex. It will make a big difference, I think, when that's confirmed, because, you know, people have to make decisions about how they're going to have the money to carry on. In the short term, Universal Credit is an option and we're working at pace as I said, we processed 105,000 claims alone over the last 24 hours. We will keep doing our bit. But I suspect once those announcements are made, some of the traffic coming towards Universal Credit will probably new look at the other forms that will be announced.

Catherine McKinnell MP (Chair, Petitions Committee)

Okay, thank you. I was gonna bring Katherine in now and give you a bit of a break Justin, because Katherine was going to ask about education

Katherine Fletcher MP (Petitions Committee) 

Greetings. So an another one similarly to Stephen, which got to the 600,000 signature mark was about a petition for schools to close. What that figure tells you is that the British public and parents especially were really concerned in the early stages about infection risk for schools. I would be really interested if I can just understand the thinking on the timing of the school's closure announcement. Is it because the British wants them closed or is it more to do with the medical advice?

Nick Gibb MP (Minister of State, Department for Education) 

The decision to close schools was led by advice from the Scientific Advisory Group on Emergencies, the CMO and the Deputy CMO. It was purely based on the science as we move from the contain phase to the delay phase, so it's a closure of all schools but of course, we want the schools also to be open for the most vulnerable children and also the children of critical workers, unless of course they can't do that work from home which is our preference, so they can look after their children at home if they have children.

Katherine Fletcher MP (Petitions Committee) 

Understood, yes thank you. So the medical advice was very much what was driving the schools closure. We've got lots of questions. Perhaps you could talk through the petitioners' concerns about exams and exam grades, especially for those key transition stages into those who want to go into the technical college or further education at university?

Nick Gibb MP (Minister of State, Department for Education) 

No exams will be held in schools. We considered that decision very carefully. We looked at all the options, and there was an option of saying "well look, let's let Year 11s come in and take their exams and then go away again and put desks two metres apart, and the same for Year 13s. But there are a whole host of reasons why that would not be fair. For example, if large numbers of students opted for the alternative, which I'll come to in a second, and some went for the exam. So in the end, we took the decision, I think it is the right decision, that there will be no exams for secondary and no tests, no SATs at the end of primary schools, which means also there'll be no performance tables this year, either for GCSEs and A-levels nor of SATs for primary schools. So what's happening as an alternative, we're working with Ofqual and the exam boards to publish detailed guidance about what will happen, but in broad terms grades for A-levels and GCSEs will be based on teacher assessment, which itself will be based on the work of children over the two years of a course, on mock results and predicted grades. It will also be based on the prior attainment of pupils as a particular school. And of course, the progress that pupils at that school have made in previous years. Because we want this system to be fair, or as fair as possible, not just between pupils of this current academic year but of course, between pupils of previous academic years and subsequent academic years, because these are children of roughly the same age and they will be competing in the future for the same jobs. So we need to make sure that all those years are comparable. And the work that has been carried out so far by Ofqual and the exam boards I think is very rigorous and it is the best possible sort of facsimile of real grades and the grades that are awarded to candidates this year will be as valid as grades awarded to candidates who actually took the exam.

Katherine Fletcher MP (Petitions Committee) 

Wonderful, thank you. Another question that petitioners are raising is just understanding what measures are in place to support vulnerable children's schools, and those who are eating free school meals, but also what measures are in place to make sure that teaching staff and teaching assistants who are in school at the moment looking after children are safe as well?

Nick Gibb MP (Minister of State, Department for Education) 

So the definition of vulnerable children for this purpose is children that either have an EHCP plan - an Education Health and Care Plan - or they are supported by a social worker. It is not the general population of children eligible for free school meals, which is a significantly larger group of young people. And for those young people, there are measures in place for schools to provide vouchers to those children.

We are also in the process of creating a national voucher scheme, but at the moment, many schools are issuing vouchers to their free school meal children, to use at their local Tescos, their local supermarkets, and also on some occasions, providing food packages to those young people. The very vulnerable - those who have the support of a social worker or have an EHCP plan - we are encouraging to come into school because for those children, the safest place for them may well be the school. Now, some families will say no, they're actually safer at home with us, they might be on an EHCP plan but we believe that they are safe at home, and that is a valid decision. Where children are being supported by a social worker, there is a difference of opinion about where they can be most safely looked after, then that will be discussed between the school, the parents and the social worker. It is important that we do everything we can, it is a priority of the Government to make sure that the most vulnerable children are safe during this crisis.

Katherine Fletcher MP (Petitions Committee) 

And the teaching staff and teaching assistants?

Nick Gibb MP (Minister of State, Department for Education) 

Significantly fewer pupils are attending school as a consequence of the messaging that we want children to not come to school unless they're in those categories, and because they should be at home and that's the best way to save lives and protect the NHS. We have issued, last night, some guidance about social distancing in the school. So we want teachers to be at least two metres away from their class, from their desks, to be at least two meters away from each other. So both the pupils are protected from the social distancing, and also the teachers and staff are also protected and that's what that guidance sets out. We'll be issuing more guidance in addition to the guidance we issued last night, giving more details on sector-specific mixes.

Katherine Fletcher MP (Petitions Committee) 

Understood, and I'm not sure that this is one for you, Nick, or whether it's for Dr. Harries, but can we give parents any timescales at all about how long the schools are going to be closed?

Nick Gibb MP (Minister of State, Department for Education) 

No that is absolutely a scientific...I'm not even sure whether Dr Harries will be able to answer that question either, but it is absolutely based on the science. In terms of our policy in the Department for Education, it is led wholly by the scientific advice.

Catherine McKinnell MP (Chair, Petitions Committee)

Dr Harries?

Dr Jenny Harries OBE (Deputy Chief Medical Officer) 

So, yes, just to comment to that. I mean, I think the really important thing is, there is a perception of the risk of the school, and if schools were dangerous places for disease transmission early on, that would have been at the top of our list to close them. And I think, again, it's a difficult concept to get across. But the reason the advice was to close them at the point that it was, was to do with the rate of rise in our epidemic curve, and the fact that it is another opportunity for social interaction, if you like. But it's not because it's some sort of hotbed of transmission, I think that's an important thing. If it was, those children would not have been there and it would have been our first point of advice to close. But what our modelling did show was that it made a little bit of difference. It adds on an additional benefits in terms of overall reduction, so that's why it was brought in. But equally, our modelling suggests that you need to do it for quite a significant length of time, which is why we have not been keen to try and promote something with a very small impact very early on, only when it's absolutely necessary. So yeah, exactly right. I can't actually give you the precise date either. But certainly, what I can assure you is as we watch the curve, and we watch the epidemiology of the cases around the country over time, then we will be looking to try and manage the rise to make sure it's safe for the whole population, but certainly not keep children out of school any longer than we need to.

Katherine Fletcher MP (Petitions Committee) 

Understood, thank you. Just a final one. So there was a tweet yesterday from a comedian that said he was considering expulsions from his home school on day one. Can we reassure the parents and petitioners that, you know, there is additional support and help coming, because they can't hope to take over from the teaching profession at these times, but are we going to support them to do as much as we can?

Nick Gibb MP (Minister of State, Department for Education) 

Yes, all schools are giving children work, either worksheets and so on or on the internet. And we are currently working with the BBC to see how much help they can give in order to put lessons onto television. But also there are a huge number of private companies that do provide educational material online, and we are about to produce quite detailed guidance for schools about how to navigate that particularly complex marketplace of provision.

Katherine Fletcher MP (Petitions Committee) 

Thank you very much.

Catherine McKinnell MP (Chair, Petitions Committee)

Could I just say, as a mother of three myself who is juggling working from home with children, what an amazing job our teachers do, and how grateful we all will be for them when the children can go back to school. But also thank you to the schools for all the hard work they put in, to providing packs and information so that we can do our best to socially isolate during this period. I just wanted to put that on record. But the other question that I had and it might be a scientific one - it comes down to the personal protective equipment (PPE) issue, which I know you mentioned Jenny, that is getting distributed by the army now. But we do hear far too many reports from the NHS that still don't have them, and there are also many other frontline workers where the public are concerned that, you know, should they have protective clothing as well? And it comes down to this issue of viral load and whether those who are more exposed to, perhaps, even those that are carrying the virus but may not be showing symptoms, whether they are more at-risk and whether we should be doing more in terms of protecting all our workers on the front line from that exposure to the virus? Is there something that you can explain to us about that and give us some reassurance on that front?

Dr Jenny Harries OBE (Deputy Chief Medical Officer)

Yes, I am very acutely aware of the number of different services including frontline responders, not just the health and care sector. So for example, I personally try and join the police chiefs call on a weekly or twice weekly basis, because I'm very aware of things like Post Office staff or home office, prison handling, that sort of thing. Each of those sectors has had some guidance on personal protective equipment. I think there's probably still some noise in the system for two reasons. One is around people's perception of what they need, and one about an understanding of what that PP does or doesn't do. And both of those, I think we have done a lot of work to address but we are actually continuing to do so. For example, the care sector. So this isn't just a residential care unit, actually, it's about people, probably three or four different people going into an elderly person's home to have very close contact and supporting them on daily living, bathing, washing, lots of things that we have issued guidance on. And for most people, you do not need a significant amount of PPE. So if the individual you're caring for is well and is asymptomatic, you wouldn't normally be requiring any PPE. What I am very passionate about personally, and colleagues know this, is that this is a risk-based assessment. So it doesn't matter where you are, whether you're a policeman or an ambulance or wherever it might be, there has to be...what we propose in terms of what your risk exposure is. And that is what the basis of all of our guidance is. There's been a lot of noise, I think, recently in the media around suggesting that it differs from the World Health Organization guidance, actually this is not really the case. We currently have a higher specification for some of our masks, our FFP3 masks. And we have different approaches to the gowns and aprons that we use because of the underlying way that in the health service we have tackled anti-microbial infection control. So there is usually a very strong rationale behind this, but I think what we are working on now and will help is getting a simple message. Public Health England has just revised some infographics to try and make that simpler to translate through, particularly to our health service staff. And we're looking across each of the different sectors to try and ensure that we can get the same clear information out.

Catherine McKinnell MP (Chair, Petitions Committee)

Martyn, are you happy to come in now on your questions?

Martyn Day MP (Petitions Committee)

Yeah, happy. I just wonder if I could perhaps follow up on the one you just asked on PPE – just to ask what assurances we can we can have that the country will have enough PPE equipment for the essential workers that do need it? Because I know that's a question that people have been contacting myself about.

Dr Jenny Harries OBE (Deputy Chief Medical Officer)

Yeah. So I think there are different things here: one is people understanding what it is that is needed and what the guidance is. The second one is: have we got it? And the third one is: is it in the right places when people need it? So at the moment, currently, we have sufficient PPE across the country to manage all our needs. Part of the reason for that is because actually, we have what we call the pandemic flu stockpile. We have always had a plan in the country for managing a pandemic of a respiratory virus and we have pulled heavily on that, as our cases and numbers have risen. That is part of our long-term planning so that's a really good part of the resilience across the UK. There were some issues: the way the PPE was ordered and distributed—or how it is normally done on a routine basis. If I just sort of describe it: a hospital, for example, would routinely order PPE a bit in the same way it might order its stationery or its paperclips –it just got supplied. Now, of course, when you have an unprecedented event like this, and you suddenly have a very steep rise in demands, that system needs to be a much more refined system in order to make sure that the essential PPE gets to the right place at the right time. So I think we've acknowledged that in that very rapid rise there were a few disconnects in terms of where it was arriving/ at what time, and that was both in numbers to hospital trusts, but equally to some of the other sectors that we've just talked about: the care sector, for example. But over the last few days, well, weeks actually, we have revised that completely. There is a special section setup to take all of that PPE ordering and distribution completely out of any other framework for ordering. It's linked up with the army logistics distribution and those deliveries have been going on through the night in fact. I know hospital trusts have been warned to say you'll definitely get it but don't be surprised if it arrives in the night and that's in order to ensure that it arrives to the right place at the right time. I know there were some final deliveries, for example, going into the care sector today which will have finished a one-off distribution. There have been letters sent out to all of the acute trusts and all of the care sector cascaded from the Minister for care. So I think that is in a much better place.

Where we go forward, I think one area is, as I referred to earlier, just about getting a shared understanding, particularly with my medical colleagues about what the underlying risks and appropriate PPE is and we will be working on that with the CMO and with the different Royal Medical Colleges. But equally as we go forward, we do have to recognise that the whole world is pulling on PPE supplies. We're in a really good position, but much of our PPE stock comes from China, and clearly a lot of the Chinese facilities have been out of action or are just coming back into action.  The government has worked really hard to secure all available stock very early on and I know it won't be evident to colleagues or members of the public, but it has been a huge process of work and I can assure you that's continuing. But we will be needing to look – and we have a group established now – to check the use of the PPE against the epidemiology and against what we have available. So it's a big piece of work, but I think some staff should be feeling that that has improved now.

Martyn Day MP (Petitions Committee)

I'm aware that a number of manufacturers of PPE equipment in the UK have been exporting products; I’d just like to know if we got to a dire situation that we'd be taking steps to stop anything leaving the country if we needed it ourselves.

Dr Jenny Harries OBE (Deputy Chief Medical Officer)

Yeah, I mean, I'm probably not in a personal position to comment on all the individual suppliers. But I am very aware that there's been a call to arms if you like to the suppliers, and looking to see whether individual manufacturers of items in this country can actually switch to products or PPE in the same way that there has been for respirators and things and there's a lot of very positive discussion ongoing. So all of those avenues have been and are continuing to be explored.

Martyn Day MP (Petitions Committee)

Okay, thank you. The questions I was coming to were about communication and information going out. I’d just like to say at the start, I thought the text message that went to just about everybody I know was a brilliant stroke, although I was a little self conscious about clicking on the link, but brilliant idea/ thing to do. How are we making sure that messages get to everybody as not everyone has a smartphone or access to the internet?

Dr Jenny Harries OBE (Deputy Chief Medical Officer)

No, so that's why we've had multimedia channels. So you will have seen we just kicked off yesterday – with brand new stepped up advice – a TV advert which features the Chief Medical Officer. We're using social media influencers so that will pick up many of the younger people. It's out in print media as well. We’ve also tried a number of different routes and we're very cognisant that a number of—probably the majority of –our most vulnerable individuals will not be those who use smart technology. This is always a communication issue. So, for example, where we have identified by digital roots the 900,000 in the very high risk vulnerable group, we know we have – surprisingly – electronic communication reach about 70% of them, and we have used it in the same way that if you've had a text message for this, they will have had a text message about their vulnerable condition. But equally the mainstay of that is through letters. And obviously, many of these individuals will be communicating with their own GP. So we're doing a little bit of overkill in a way I think, but for the very good reason that we want to make sure that those people who need to understand what the risks are are fully informed.

Martyn Day MP (Petitions Committee)

I’ve seen a number of the broadcasts from the press conferences with signers. Do we have all of them now being signed? And are the messages reaching people were learning difficulties as well?

Dr Jenny Harries OBE (Deputy Chief Medical Officer)

Yes, I would have to get back to you to check on the number of conferences that have been signed I'm sorry, I don't have that information but I’m very happy to provide that. I do know though that some of the other communication – so for example, we have different guidance for people with learning disabilities. So it has a very simple graded messaging which is checked externally and then a picture to try and get across to individuals the importance of the message but also without frightening them and being very attentive to how they might perceive this risk. And then alongside that there is guidance for parents and for carers of individuals, particularly children who have learning disabilities or who have, for example, autism, so that they understand the sorts of triggers and reactions that children might have, not just in verbal terms, but actually the sort of physical reaction they might have if they become particularly frightened, and then some links to support systems to help them help their child through this time. Because for many, even as an adult, it's quite it's an unusual event. If you see the media – because we want people to be aware and take action – but equally, we do not want to be frightening people because that tends to move into a position where they're not taking sensible actions. So it's a difficult balance. We hope we have tried to think of all those different avenues. But certainly I will ask our communications teams about signing.

Catherine McKinnell MP (Chair, Petitions Committee)

Thank you very much. So I just had a couple of questions that haven't managed to get covered either for technological reasons, or because they've just appeared in the news. One is about the the new test that has been mentioned that will be available as early as next week. This is a question probably for you, Jenny – the 15 minute home test – and I presume this is the antibodies test – could you give us an update on on what that test is, when it's likely to be available and what impact it's going to have?

Dr Jenny Harries OBE (Deputy Chief Medical Officer)

Yeah, so there are there are a number of moving channels on the test. So without seeing the particular reference it's difficult, but there are two which are in a very near development phase. So one is the antigen test: that is the hear and now test, the one I referred to earlier, which is likely to be a drive through – let’s call this the drive through pregnancy test just for simplicity. So the drive through here and now test, that is being evaluated at the moment and obviously, we need to be cautious about how quickly that can expand because again, all of these tests, need supplies, reagents and various other things, but that is currently being evaluated and that one will be very helpful in helping our health care staff understand whether they need to be off work or not, and keeping that system going. And there is an antibody test and there are two elements to that if you like, that test is to say have you had it? which equally is very good for health care staff but it would be more like a sort of pregnancy test to do it at home. But that is still very much in early development.

I think the Secretary of State referenced yesterday that the UK had brought a significant number of tests, but we do need – before it is launched in the public for obvious reasons – we need to be sure that it is properly evaluated against our own gold standards that Public Health England run, and that is an important first step. What we do not want is to find that we are using a test which doesn't help inform us. It is quite likely that, if suppose a healthcare worker, for example, had that test, it would be really helpful because then we would know, if it was me say, I would know that I had had this illness and I was very unlikely to get it again in the short term. I could safely be working on the wards and equally, I may be less worried about what PPE I was wearing, because I've had the disease and it's not so important whether I have exposure to it. So I mean, those are quite difficult things but I think that one we do need to check. So we've brought into testing and the theory, but we do need, before it's rolled out that widely, to make sure it's right and I think if somebody had a positive test on that, certainly on an initial base, we will be wanting to do a serology test – a blood test as well to check that the two conspire.

Why that's going to be really important is one is because of our health care staff and our first responders and knowing that they're safe to be working on the front line and that they've had it but the second one is that this one about understanding the spread of the disease and so although the WHO message has been “test test test” that messaging is, or WHO messaging is, going out to every country across the world. So much of that is focused at lower middle income countries where they may not know they have a problem yet, and their infrastructure for infectious disease is not as solid as it is here. What we have done is had a controlled movement, if you like from the early containment phase where we did “test test test”, to a movement where we are managing through delay and into mitigation, the important clinical patients that we need to manage. There is no point in sending out clinical staff that we need on the front line to test people in their homes, where it's going to make no difference to our management. So this is a sensible and proportionate testing process. But that antibody test in due course, will allow us to understand where the disease is in the country, for example, it will give us more information about children and how many of them have had the disease and have had very mild symptoms and to understand the past for the disease, and we'll be able to do that through genomics as well. So very important looking forward and very important for managing the tail end of the of the outbreak.

Catherine McKinnell MP (Chair, Petitions Committee)

Could I just say, though, that I absolutely agree with everything that you've said, I think what the public find difficult to understand, and to have full confidence in, is how you even know now how many people may or may not have the symptoms, because you're not even supposed to phone 111 unless you cannot cope with your own symptoms. So really, the only measure you have for how far the virus is spread is how many people are hospitalised, and in reality, the real figure we have and the one that's published every day, which is really awful, but it's the figure that we have is the death rate, but the death rate is only really a measure of how far our health system is able to treat these people and how many ventilators we have. So could you just explain that because I know that's a big concern for the public. We may get some nasty shocks because we don't actually know how many people there are, who have the symptoms.

Dr Jenny Harries OBE (Deputy Chief Medical Officer)

Okay, so just on that last point though, I do just want to come back on that. So the death rate – we currently have full capacity to manage people coming through the health service. There isn't a vaccine and there aren't specific treatments – although we are looking at some potential treatments and have done so right from the start of the outbreak and there are trials planned that we can safely use anything which looks to have had a positive outcome – but where people are very sadly passing away from coronavirus now, this is not for lack of facilities in the NHS. It is because they have the disease which they have succumbed to despite the best efforts and despite the facilities in the NHS. We will never be able to save everybody from this in the same way that even though we have antibiotics for pneumonia, currently people die from pneumonia. So I just think its really important people don't think that our current deaths are in any way linked to a lack of capacity in the NHS, it is simply because all of the treatments have been applied and very sadly, that individual has passed away. So I think that's one thing. But your point on the testing and the numbers is important one, because I don't think we are saying that we know every case, and in fact, we've said quite the opposite: we have said that we are very sure there are more cases, far more cases, thousands more cases if you like out in the community.

The important thing at this point is most individuals get better. And we're pretty confident for a number of different epidemiological reasons that the 1% figure on the infection fatality rates for the number of people who are dying for those that have it is right. It's much easier to see how many people have died than it is to count right across. We could spend huge amounts of time looking for people with very mild symptoms, and we're not going to treat them any differently. We want to focus on our health service. So when we get the antibody tests in due course – this time next year I'm sure will have great data—but at the moment we are counting what we are counting, and we're not suggesting we're counting every individual mild case, but we are still very confident on our current epidemiology that the 1% is right. And very sadly that is the figure which comes onto people's screens, and it's really important that we manage that so everybody takes the right actions and does the social distancing so that that 1% represents people who we could not have helped in any way, not that we have managed to get such a big rise in our health system that those people are not able to be helped.

Catherine McKinnell MP (Chair, Petitions Committee)

That's actually really helpful to understand. Thank you. I think Katherine wants to come in on this subject as well.

Katherine Fletcher MP (Petitions Committee)

Yeah. And thank you very much, Chair. And so I wear two hats today, because I'm also a member of the Science and Technology Select Committee. And there was some very interesting new news on testing kits from Public Health England this morning. And the Professor very kindly outlined the fact that, you know, volumes of tests, antibody tests, so the test that says, have you had it, are being ordered in the millions, there's a protocol where they want to just check that they're working. And then she was talking about, you know, days, not months, in terms of being able to roll those outs as a priority to NHS workers. And I know I was just wondering if you had any update or whether it's PHE leading on the rollout of those tests, because I think that's a game changer for the public perception.

Dr Jenny Harries OBE (Deputy Chief Medical Officer)

So, we're both talking about the same thing, in fact, so the 3.5 million, which the Secretary of State mentioned yesterday, and I'm presuming I'm guessing it was Sharon Peacock, who was talking at –yeah. So that probably is good evidence that we are all entirely joined up. And in fact, Sharon is one of the key clinical professionals. So we have a clinical group which is chaired by the CMO includes all of the UK CMOs across the different devolved administration's myself, my DCMO colleagues, and then colleagues from PHE Public Health England and NHS England and NHS digital. So all of this is joined up and we are working on it.

So it's exactly it's the same testing that I'm talking about that you're describing, and the Secretary of State has announced and it will be a game changer as I say my only caution, which sounds like she was doing the same thing is we don't want to roll out something which we can't see works. We are excited to be doing this and we absolutely recognise the importance of it in relation to our health staff. And we know, you know, we're one of them: she and I are both doctors we want to know, in the same way they do, are we safe? Can we be managing patients safely? And that actually significantly effects our planning and our understanding of the resilience of the NHS, because if it turns out that a large number of us have had it, it means that we don't have to be quite so anxious about for example, workforce absences going forward, and that adds to our confidence and the resilience and our management of the peak.

Catherine McKinnell MP (Chair, Petitions Committee)

Thank you so much. Unless anybody has any final questions they want to ask in which case wave your hand and I will let our three witnesses go because I know how incredibly busy you are working on behalf of the Government and the public to deliver on the things that we know, our petitioners are very concerned about. So, and I thank you very much for your time today and the thoroughness of your responses and we very much look forward to tomorrow to receiving an update on the situation for self-employed people, because that is a huge, huge concern for a huge number of petitioners. I just wanted to end this well by saying that, and we know that parliament is going into recess, but the petitions don't stop, and the concerns of the petitioners don't stop. So I do hope that in this new world of technology – and hopefully our trial today will be considered a success and we will hope to be able to get a transcript of it and be able to circulate the responses – but that we will be able to continue this dialogue and find ways to be able to provide petitioners with answers to those questions, even if we can't do it in the usual way, that we have done today in Parliament. Hopefully, it will not only add to the public debate, but will add to the strength of our democracy and democratic engagement as well. So thank you very much indeed to all of the committee members that contributed today and to our three witnesses, Justin, Nick and Jenny as well. Thank you very much.

March 2020