One of the main reasons given for the national lockdown earlier this year was to get the NHS ready to handle a wave of CV19 cases. They expanded the Intensive Care capacity substantially, putting in new Nightingale hospitals as part of the answer, increasing intensive care beds in existing hospitals and buying more ventilators.

To increase capacity further they cancelled all non urgent operations in main hospitals, took over the capacity of the private sector hospitals to undertake some non CV 19 work for them and were keen to move patients out of hospital as soon as possible after treatment.

Today some people are still worrying about NHS capacity. Of course we all pay tribute and say thanks to the dedicated staff who bore the brunt of the first wave of CV 19 in hospitals, gave diligent care and pioneered treatments to respond. By now I assume more have been trained to handle CV 19, and we see the good news that there are better treatments with the death rate falling substantially as a result

Today I would like to ask a crucial question.

What is now happening to NHS output for non CV 19 conditions? Ministers tell me the NHS is operating again as before for non pandemic conditions. Is it? What is your experience of access to non urgent treatments, and to treatments for serious conditions like heart attacks and cancer .

The NHS England/DHSS budget for 2020/21 was £148bn at the start of the year, up from £140bn the previous year by £8bn or 5.7%. The NHS had been offered an increase of £33bn by 2023/24 as part of a five year settlement to allow growth and improvement. Special money to handle CV 19 has now added an additional £31.9bn to this year’s total to provide protective clothing, to introduce Test and Trace, to buy in private sector capacity, increase ventilators and provide extra facilities in the Nightingales.

I am seeking information from government about how output in the NHS now compares with this time last year. We know there was a large dip in activity during the intense period of the CV 19 crisis in the spring. It would be good to know we are more than back to normal, given the backlog and the resource now being committed. It would also be good to know when we can stop paying for the private sector capacity as well.

The UK passenger railway had a big business running commuters into and out of cities for their work five days a week. Even after allowing for the discount element of the season ticket, these travellers were made to pay premium prices for their travel, as there was little by way of alternative for most of them. The roads were jammed and there were too few car parks at work to make the car an alternative for many.

The railway always complained that it was very costly having to provide so much rolling stock and so many staff for a couple of peak hours in the morning and another couple of peak hours in the evening. It was that peak volume which the railways said justified the high fares. In an attempt to fill the rolling stock the rest of the time and to pay staff wages for more than four hours a day the railway adopted heavily discounted fares to persuade people to undertake leisure, shopping and entertainment trips by train to use the empty carriages.

Today we still see a pattern of dear tickets at peak times, and cheap tickets at off peak across the network. If we take some longer journeys as examples we see

Standard single ticket London to Manchester off peak £33 peak £157

Standard single ticket London to Birmingham off peak £15.50 peak £74

The peak fare is around five times the off peak.

Today the talk is of a major change of future working even assuming an end to special CV 19 lock downs. Office workers look forward to going to the office two or three times a week instead of five times, and want to be offered flexible hours so they can switch to the old off peak. Many have discovered how much better off they are working from home and saving all that money on rail travel and expensive coffees.

If some of this comes to pass it requires revolution on the railways. It means a substantial reduction in numbers of travellers and a bigger reduction in fares revenue if charging policies are unaltered. The railway managements are talking about how their leisure business has picked up but this is largely heavily discounted tickets that come nowhere near paying the high fixed costs of the amount of rail travel beign offered. They say it is very green, but creating more journeys on trains that otherwise would not have happened is not green but the opposite.Trying to run a railway around heavily discounted leisure use will leave a huge hole in railway finances. We cannot carry on for much longer with the current system of running 90% of pre pandemic services for Maybe a third of the passenger numbers. It is unaffordable for taxpayers. When will the rail experts tell us what Level of demand they think they can recapture anD what fares they can charge in this new world.

There are three government models for tackling the pandemic.

The first is to give priority in all policy matters to curbing the spread and reducing the death rate from the virus through strong national action. The UK and most other governments tried this in the spring. The problem with this approach is that as soon as governments relax the virus spreads again, leading to pressures to shut down more of the economy for a second or successive times. The concentration of resources is difficult to sustain for long periods, leads to unwelcome deaths from other conditions that can go untreated or may be exacerbated by the policy, and merely delays the spread of the pandemic itself.

The second is to see the problem of public health as one for local government. Patterns of infection and pressures on health services vary widely within the same country, so why not have a menu of possible actions for local government to adopt as they see fit? This is the US model, where State Governors led the responses to the virus, drawing on Federal resource and law where needed. The UK has also been moving more to this model in recent weeks with a three tier approach to lock down.

The third is to trust people and free institutions within a democracy to make their own decisions about how and whether to protect themselves from possible transmission. Government sets out the dangers and passes on national and international knowledge about the threat and the spread. Government also provides support for those who wish to shield themselves, offering the ability to work from home, to have home deliveries and help with technology to switch more of their lives to on line. Governments can message that people need to keep their distance from possible infection, wash their hands and reduce their risk through their choice of travel and work patterns.

Forming hybrids of these approaches is complex. Devolved and local governments often want a say but do not want to take full responsibility. They may wish to lock down, but see it as an opportunity to demand other policy initiatives and resources from central government. Some wish to play politics with it, to try to shift blame onto national government and cast them in a poor light.

My advice is to keep working away on a wide range of actions that can tame the virus and make living with it less dangerous. The medical teams are now coming up with a wider range of drugs to treat the severe forms of the disease, and the death rate in intensive care is dropping. More can be expected from improved understanding of the disease and from trials of better treatments. More knowledge and communication about how the disease spreads should lead to more people opting to take precautions voluntarily, to reduce the risks to themselves, which should help.

It is difficult to see a Test and Trace scheme which can guarantee success as democratic governments hope. Delays in testing and getting results, imperfect recoding of who was present in an infected location, false results from tests, and reluctance by some to self isolate owing to the difficulties it poses for their lives mean it is not the silver bullet some seek.

Sir John Redwood MP (Wokingham) (Con): Does the Minister accept that paying people from the local labour force better, and paying for their training, is a much cheaper solution than building lots of houses to invite migrants in, and a much more popular one?

The Parliamentary Under-Secretary of State for the Home Department (Mr Kevin Foster): My right hon. Friend points out that in a time when we have large numbers of people affected by the current economic situation, we need to focus on our own UK-based workforce when it comes to filling needs.

Sir John Redwood MP (Wokingham) (Con): Has my right hon. Friend seen how much popular and excellent quality fresh food there is in our supermarkets with the Union flag on the packaging? Will he confirm that if the EU insists on high tariffs on food trade, where it sells us massively more than we sell it, that would be a huge opportunity for our farmers to grow and rear more for the domestic market and get back the huge amounts of market share stolen from them under the common agricultural policy?

Chancellor of the Duchy of Lancaster and Minister for the Cabinet Office (Mr Michael Gove): My right hon. Friend makes three very important points. The first thing is that UK producers are doing a fantastic job in increasing production in a sustainable way. Championing the quality of UK produce is something that we should all do and recognise, whether it is Orkney cheddar or Welsh lamb, that the UK flag is a symbol that connects quality not just to our consumers but worldwide.

The second point that he makes, which is absolutely right, is that the common agricultural policy has been harmful, and our escape from it will ensure both that our farmers can prosper and that our environment can improve. His third point is that we should be confident not just that we can sell more excellent produce here in the UK but that, as we emerge into the world as a global free-trading nation, new opportunities to sell our excellent produce are available to our farmers, and he is absolutely right to be optimistic.