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Lord Janner of Braunstone: My Lords, does my noble friend agree that both hands must clap if there is to be peace in the Middle East? Does she accept that, whatever his perceived faults, Prime Minister Sharon has made it plain that he is prepared to accept—and believes it to be right—that there should be two states living side by side in peace and that he will work on the settlement issue not when terrorism and suicide bombing stops but when there is a visible, real and clear effort to stop them?

In those circumstances, does my noble friend accept that the leaders of all Israel's political parties, most of whom I met last week, wish there to be peace but do not believe that it will be possible while Chairman Arafat has real control? I join in welcoming my noble friend's words about Abu Mazen and the new Cabinet. We wish them well. But does my noble friend accept that only if that Cabinet can sideline Arafat can there be movement towards peace because otherwise it will

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not be acceptable to those who believe that he has been, and is, the creator of the terror and the suicide bombing and the provider of support for both?

Baroness Symons of Vernham Dean: My Lords, I am sorry to say that I cannot agree with all of that. I know that my noble friend's heart is in the right place when he says that both sides must make an effort in this matter—he was clear about that—and that the priority is to stop the violence on both sides. I can agree with that. But I must remind my noble friend that Mr Arafat is the elected leader of his people and that it is not up to us to decide that his role as the president of the Palestinian Authority should end.

I say to my noble friend that it is important to remember that Abu Mazen, the new Prime Minister, is also the Minister of the Interior. He will be supported in that role by Mohammed Dahlan, who is the Minister of State for Internal Security Affairs and, I believe, also enjoys a considerable amount of international confidence. The Minister of the National Economy, Maher Al-Masri, will also have a very important role in shaping the future Palestinian Authority.

Therefore, I hope that we shall not criticise particular individuals and their role in the recent past. I hope that, with the publication of the road map, we can now look to the future and what that may hold for both sides in this extraordinarily damaging and vicious conflict.

Lord Renton: My Lords, do the Government accept that the rebuilding or repair of hospitals and people's homes and workplaces should be regarded as a high priority, although a costly one? Perhaps I may suggest that we should accept responsibility for work at Basra, which we managed to occupy without very great damage. But how else will work be paid for throughout the tremendous area of Baghdad and the other places where such damage has been done?

Baroness Symons of Vernham Dean: My Lords, the immediate priorities are the humanitarian ones. They include ensuring that the people of Iraq obtain sufficient food, which we know has been secured—at least for the next couple of weeks or so; the provision of clean water, which, as the Statement set out, is now well under way; the provision of electricity; and ensuring that proper transport and infrastructure systems are in place. It is also vitally important that the schools and hospitals are open. I was able to tell your Lordships that in the north of the country that is largely the case and that situation is now spreading throughout the rest of Baghdad.

The question of who is to pay for all of that is obviously one that we shall wish to discuss with the United Nations. Let us remember that Iraq is potentially a very rich country. The point is that in the recent past the proceeds of Iraqi oil wealth have not been used for the benefit of the Iraqi people. Our job

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must be to ensure that the huge potential wealth is used for the people as a whole and not, as in the recent past, for a few members of a vicious regime.

Lord Sheldon: My Lords, I am sure my noble friend agrees that the entire situation in the Middle East would be transformed if there were an Israeli/Palestinian settlement. But is she aware that there is concern that the widespread enthusiasm which we all share for such a settlement may not be matched by the necessary actions that have taken place in the United States? Will she take account of the fact that there is justifiable scepticism about the content, the publication and the implementation of such a road map?

Baroness Symons of Vernham Dean: My Lords, I accept that there is a great deal of scepticism. My noble friend says that the enthusiasm may not be matched in all parts of the United States. I point out to him that I do not believe it is necessarily matched in all parts of the Palestinian Authority nor, indeed, in all parts of the Israeli Administration.

The fact is that the President of the United States made a forceful statement on this matter when he was in Northern Ireland with the Prime Minister a couple of weeks ago. The repetition in my right honourable friend's Statement this afternoon of the fact that the President of the United States said that he would pursue the peace process in the Middle East with the same vigour as my right honourable friend the Prime Minister has pursued the peace process in Northern Ireland was very telling. I rest on the position of the President of the United States rather than on that of some other members of the Administration who may not be as enthusiastic as he is. He is the one with the real authority.

SARS

6.57 p.m.

Baroness Andrews: My Lords, with permission, I wish to repeat a Statement made earlier today in another place by my right honourable friend the Secretary of State for Health on severe acute respiratory syndrome—SARS. The Statement is as follows:

    "SARS was first reported to the World Health Organisation from a number of countries in south-east Asia in mid-February this year. Subsequent information from the Chinese authorities suggests it probably started to emerge in southern China during November last year. It presented as an unknown illness causing fever and severe chest symptoms, including pneumonia. Since then, laboratories around the world, including those in the United Kingdom, have been working to pinpoint the precise cause of this serious new illness. At this stage there is neither a test to diagnose SARS nor an antidote to treat it.

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    "SARS has spread to 26 countries but it has been concentrated in a handful of areas, with major outbreaks in Hong Kong, Hanoi, Beijing and other parts of China, Singapore, and Toronto in Canada. According to the most up-to-date information I have received from the WHO this morning, there have been 4,836 probable cases of SARS world-wide and 293 deaths.

    "There are of course understandable public concerns about the impact SARS might have in the United Kingdom. I can confirm to the House that in this country to date there have been just six probable cases of SARS. The last reported case was admitted to hospital on 10th April. All the patients involved were quickly identified and have been successfully looked after by the NHS. All have now returned home and are well. The Chief Medical Officer, Professor Sir Liam Donaldson, has advised that at present SARS poses a low risk for people in this country. So, serious though SARS is, it is important to keep it in perspective.

    "Our approach has been to take a precautionary but proportionate approach. The handling of SARS in this country has been informed—as it must continue to be—by the best scientific and medical advice. In particular the CMO and the new Health Protection Agency, in advising Ministers and the NHS, have been working extremely closely with the World Health Organisation which has the global responsibility for dealing with this disease. Throughout we have followed WHO advice to the letter.

    "It might be helpful if I set out the action taken to date and the further action that we now propose. First, we have provided early, accurate information to both the public and the health service. The CMO contacted all doctors on 14th March and subsequently on 7th April with detailed information on the symptoms and signs of SARS, and what to do if they encountered a possible case. Up-to-date information on SARS is also available to the public on the WHO, HPA and Department of Health websites as well as through the NHS Direct telephone helpline which many members of the public have contacted.

    "Secondly, we have put in place high-quality public health surveillance to enable the disease to be tracked closely. In early March, the Health Protection Agency set up a system for reporting suspect and probable cases.

    "Thirdly, the CMO issued advice to people travelling abroad—on 2nd April, and subsequently on 23rd April—in line with WHO recommendations. He strongly advised against travel to specific SARS-affected areas. That remains his very strong advice.

    "Fourthly, the WHO has advised that screening of passengers should take place at departure from the countries affected. As a further precaution, in line with that WHO guidance, information on SARS has been distributed to the main airports in this country giving advice to returning travellers.

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    "Fifthly, we have laid down, in line with WHO advice, specific requirements through guidance issued by the CMO on 14th March and 7th April for the management of patients within NHS hospitals to reduce the risks of cross-infection.

    "Sixthly, and perhaps most importantly for the long term, we have put our country's considerable scientific expertise to work in helping to identify a causative organism for SARS. The HPA central laboratory in Colindale is a key part of the international collaboration which led to the identification of the likely cause. It is also at the leading edge of work to discover an accurate diagnostic test.

    "Over the past few weeks we have been able to draw on the UK's strength in public health and infectious disease control to deal with the threats posed by SARS. I must stress to the House, however, that this is an evolving situation. We are keeping our plans and policies constantly under review. We are learning lessons where they need to be learned, building on good ideas wherever they are to be found and, particularly, tracking this disease very closely in collaboration with our counterparts in other countries around the world. For example, this week we sent an expert from the HPA to Canada to assist them, but at the same time to learn as much as we can from the unfortunate events in Toronto so that we can build the lessons learned there into our own plans here.

    "So far the approach taken to dealing with SARS in this country has proven effective. There is, however, no room for complacency. My clinical and scientific advisers have stressed that we need to retain flexibility in how we respond. We do not yet fully understand how SARS spreads. We do know that most of the cases have been transmitted between people who are in close contact with one another—for example, between healthcare workers and SARS patients—rather than through normal social contact in the wider population. But we cannot reliably predict whether the SARS virus will maintain its current pattern of attack or whether it could change in infectivity or find new routes of transmission. That is why it is so important to strike a balance in how we respond to it.

    "Some have asked why we do not adopt a policy of screening all entrants to the United Kingdom from countries which have had cases of SARS. The problem is that there is no such test. Screening involves asking people a series of questions about their health to identify any signs or suspicious symptoms. That is being done, according to WHO advice, at airports in the areas most affected.

    "I am advised, however, that the early signs and symptoms of SARS occur commonly in the general population and are found with a cold, cough or minor viral infection. Air travel, with its propensity to induce dry throats and coughs, is also a potential source of a large number of false leads. So trying to identify a genuine case of SARS is, as the CMO has put it, like looking for a needle in a haystack. With 4 million British and other visitors travelling

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    between this country and the most affected areas each year, quarantining all those with such non-specific symptoms is simply impractical. Indeed, I have been advised by our scientific experts that none of the six probable cases of SARS so far identified in this country would have been prevented or detected by screening at points of exit, points of entry or on aircraft themselves. Instead each case was picked up because of the patient's awareness of SARS and because of the high level of awareness among NHS staff.

    "Fortunately, the evidence so far is that SARS is transmitted by people only once they have symptoms of the disease and not before. With a disease incubation period of up to 10 days, successful identification and treatment of SARS sufferers so far has been achieved by concentrating public health expertise on those who have returned to this country and developed the disease in the succeeding days. However, this is a changing situation globally. If our experts advise changes to our approach, we will not hesitate to introduce new measures.

    "Others have asked why we do not make SARS a notifiable disease. In this early and important stage of the SARS outbreak it is vitally important that we find out about all cases of the disease through rapid notification of cases rather than through the slow and bureaucratic processes associated with the notifiable disease regime. Unfortunately it has become associated with significant under-reporting of disease.

    "It is in any case extraordinarily unusual for a person in this country suffering from an infectious disease to refuse treatment, to reject advice and persuasion, and to necessitate the police being called to detain them compulsorily. We do not foresee this power being necessary in detaining people who fall ill with SARS at this stage. For the benefit of the House, however, I should mention that the Public Health (Aircraft) Regulations 1979 provide the power to detain for examination any person leaving an aircraft where there are "reasonable grounds" for suspecting that they are suffering from or have been exposed to infection. There is a similar provision in the Public Health (Ships) Regulations. I can tell the House that should the CMO advise me that wider powers are necessary, then SARS will be made notifiable. If necessary, I am advised that we could do so within 48 hours.

    "We remain vigilant to the threat posed by SARS to public health in our country. So I can also tell the House that I am taking further action following advice from the CMO. First, following emerging evidence from the main affected areas that SARS spreads through poor cross-infection control measures, all chief executives of NHS organisations are being reminded to ensure that rigorous controls are in place when treating a patient with possible SARS. This communication will also include an instruction to defer the start date of appointments of any foreign recruits to the NHS from SARS-affected areas.

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    "Secondly, I am taking steps to check that the exit screening from ports of departure is robust. The UK is sending observers to those areas this week to ensure that passengers are being screened in line with WHO guidance. Where we have doubts that that is the case, we will consider screening passengers on specific flights on entry to Britain, including asking them to make a signed declaration that they have not been in close contact with SARS cases or have symptoms themselves.

    "Thirdly, I intend with my right honourable friend the Secretary of State for Transport to ask airlines returning passengers from SARS-affected areas to distribute information along with boarding cards. We also intend to discuss with the airlines other means of informing passengers about SARS on all long-haul flights from affected areas.

    "Fourthly, I will be reminding all airlines of their obligations to provide a declaration of health when a plane arrives in the UK. Fifthly, next month, at the World Health Assembly in Geneva, I will be meeting other health ministers to discuss whether there are any further measures above and beyond those already taken which could be put in place at a European or international level.

    "The whole House will want to pay tribute to staff in the NHS for their prompt, effective and successful action in responding to SARS. The best advice I have is that the UK, alongside many other countries who have experienced a very low incidence of SARS to date, may see further cases over the months ahead. Given the importance and ease of global travel, we cannot isolate ourselves from the rest of the world. Given the complexity of detection, the test of success of our disease control policy rests on keeping to an absolute minimum the spread of the disease and successfully treating those affected.

    "To date the NHS has met that challenge because of the precautionary but proportionate approach taken. We will continue to be vigilant. We will take whatever means are necessary to safeguard the public health of our people. And we will continue working with the international community to tackle and, in time, defeat this serious disease".

My Lords, that completes the Statement.

7.10 p.m.

Earl Howe: My Lords, I begin by thanking the Minister for repeating the Statement and by saying that I very much welcome both the fact that the Statement has been made today and, in broad terms at least, its contents. I say "in broad terms" only because, as the Minister might expect, there are several questions that arise from what she has said, which I hope she can answer. I will not take long over them.

One of the phrases that perhaps caused me to raise an eyebrow very slightly was the statement that SARS poses a low risk for people in this country. Based on the number of cases that we have so far experienced in the UK, that might be taken as a fair judgement. However, as the Minister herself said, the disease is a serious one and there is so much about it that we do not

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know that I should have thought that it was not yet possible to quantify the extent of the risk. We read only today of new precautions being taken in Taiwan, South Korea and the Philippines, and the Minister will I am sure confirm that the spread of SARS is far from being under control in many parts of the Far East.

I recognise that the Government have acted in accordance with advice from the WHO and the measures that they have taken are sensible and in the main reassuring. It is worth saying that we owe a great debt to the professionalism of the NHS staff who have successfully prevented the six SARS patients in this country from infecting anyone else. Nevertheless, I was always brought up to believe that within reasonable limits, and unless there is a good reason to the contrary, governments should adopt the precautionary principle in dealing with any threat whose cause is not fully understood and where the risk is for practical purposes unquantifiable.

The Minister said that the Government had decided not to make SARS a notifiable disease, at least for the time being. I am no more in favour of bureaucracy than she is, but the 1984 Act is there for a purpose. It is there to enable the authorities to act quickly should they need to protect public health. The value of making SARS notifiable is, as I suggested the other day when we debated this topic, that it would enable the authorities compulsorily to detain those suspected of incubating the disease at port of entry or indeed anywhere else.

The 1979 regulations do not, as I understand them, give the authorities more than a limited scope to examine a person, and then only in certain situations. That might not be sufficient in some circumstances. I take the point she made that most people do not refuse treatment when offered it. Nevertheless that is a proposition which takes a lot for granted when we consider someone who presents with a high fever and all the symptoms of SARS. Does such a person act rationally? Is an infected asylum seeker susceptible to polite requests to go to hospital? If the Government's argument was valid, there would be no need to make any disease notifiable, since everyone with a dangerous and infectious condition would always willingly submit themselves for quarantine and treatment when asked to do so. Frankly, I find it hard to understand why the Government do not take the necessary powers now, as a precautionary measure, to ensure that those powers could be used immediately if required. It is a simple parliamentary process which we on this side of the House would totally back.

Screening people by means of a questionnaire is a good idea but it is not of course guaranteed to yield substantive information, because people do not necessarily know if they have been in contact with someone infected with SARS. Similarly, exit screening at ports of departure abroad is welcome; but we have no means of knowing how efficiently or effectively it is being carried out. I am glad that observers are being sent to the relevant areas of the world to ascertain just that point.

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The Minister correctly mentioned that there is no test to diagnose SARS. Nevertheless, I wonder whether the Government have considered using the Actin Serum screening test which, though non-specific, acts as an early marker for infection when a disease is being incubated. If they have not, I should be grateful if the Minister would look into this idea and let me know what conclusion has been reached.

I welcome the precautionary approach taken to the admission of foreign recruits into the NHS and that the start-date of such appointments from SARS affected areas is to be deferred. Can the Minister say how long the deferral will last? The Minister mentioned that confirmed UK cases of SARS have so far numbered six. Can she confirm that there are no other suspected SARS cases currently being treated in NHS hospitals?

Reverting to the situation in China, can the Minister confirm that the Chinese authorities are now co-operating fully with officials from the WHO as regards up to date information on the SARS outbreak? Have WHO officials been allowed to visit Guandong province to speak to doctors and nurses on the ground?

The key to the future, as the Statement emphasised, will be vigilance and flexibility. There is just a chance that a global pandemic can be avoided if governments across the world take the right measures in a timely fashion. I am pleased and reassured our own Government have taken the measures described today. However, as I have indicated, ideally I should like to see them going a little further.

7.15 p.m.

Lord Clement-Jones: My Lords, I join the noble Earl, Lord Howe, in thanking the Minister for repeating the Statement made in another place. I do not believe that any of us, when commenting on the Government's Statement, underestimates the seriousness of SARS. It is a matter of great concern. It is a major issue, not only with huge potential public health consequences, but as has been seen, huge economic consequences as well. In that context I welcome the Statement. It deals with many points of public concern and seems to be soundly grounded in both WHO and domestic advice from the Chief Medical Officer and the new health protection authority. We on these Benches believe that crises such as this do not lead to political point scoring or that politicians start second-guessing public health professionals.

I pay tribute not only to NHS staff, who, as the noble Earl, Lord Howe, pointed out, detected the six cases, but to the new public health authority. As the Minister knows, I have had my doubts about the nature of the reorganisation, but I have great confidence in our public health professionals—particularly in Colindale's particular expertise. I am pleased that they have taken a full part in international collaboration.

It is important in such major crises for Ministers to provide reassurance and the reasoning behind the decisions that are made, and to be seen to be taking responsibility. It is particularly important in that

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context, because information is an important antidote to panic—to public concern. It is a pity that the Secretary of State did not have a press conference during the Easter Recess when Parliament was not able to have a Statement from him. There are circumstances when political visibility is important.

However, we on these Benches believe that the Chief Medical Officer and the World Health Organisation have struck the right balance. For instance, we do not yet see the need for enforced quarantine; that is, isolating people who are symptom-free. We also understand the good, practical reasons against compulsory notification, but I want later to raise a caveat in that respect.

That said, I want to take the opportunity to ask the Government a number of questions. First, in the view of the Chief Medical Officer, at what point does the need to notify in terms of the seriousness of SARS outweigh the bureaucracy involved in the 1984 Act? Secondly, have the Government assessed whether adequate resources are available for infection control teams? Clearly, those teams will be of great importance to prevent the spread of infection of SARS.

Thirdly, will the Government consider giving much more comprehensive information to travellers not only about health issues, but also about the rights of cancellation and the complicated matters which arise from insurance? The advice currently being given by agencies, tour companies and airlines varies widely and that is a matter of concern to travellers.

Furthermore, I hope that the Minister will take the opportunity to comment on the demand of the Conservative Party for health checks for each and every immigrant. The noble Earl, Lord Howe, did not mention that, but as the Minister will have seen from today's Evening Standard, that is a wholly opportunistic demand. It admits that they would not reduce the spread of SARS. Is it not the case that health checks should depend on where you come from and not who you are?

Will the Minister explain what advice has come from the Chief Medical Officer regarding the declarations which might be requested in the case of certain flights from certain destinations? What is the legal basis for that? For instance, can passengers be forced to sign the forms or are they purely voluntary in the circumstances?

Finally, regarding bureaucracy and returning to the 1984 Act, does not our public health legislation need an overhaul? Could not that bureaucracy be counter-productive if powers are not taken to have compulsory notification in these circumstances? Cannot the new health Bill, which begins its passage through another place, be used to update our law so that it will be fit for the purpose in pandemics such as we are now facing?

7.22 p.m.

Baroness Andrews: My Lords, I am grateful to both noble Lords for the support they have given the Statement and government policy and for the confidence they have expressed for the excellent work being done by all parts of the health service involved in

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fighting the epidemic: the researchers at Colindale; the health staff who worked with the six cases to isolate and treat; and the doctors and public health networks involved in surveillance. They are doing a magnificent job and we should give all credit to them.

The noble Earl, Lord Howe, began by asking why we were so confident that we could say that the NHS was a low risk. Perhaps I may add the caveat that there is no room for complacency in our response and in our language. But the point is that the public health surveillance system is being tested. It proved itself to be very robust in the past and it is proving itself to be very robust and effective at present. We have responded quickly and comprehensively and we have also responded proportionately to the challenge. We believe that we have the best scientific and medical advice and that the situation is well in hand. We are doing all we can to control the spread. The six "probable" cases is the best evidence that we have of that.

The noble Earl also asked about the powers of the 1979 regulations and whether we ought to move immediately towards notification. First, we believe that the 1979 regulations give us sufficient powers, but that pro-active surveillance, which is working, is a better response than a reactive notification system. However, I stress that if we receive advice from the Chief Medical Officer that we should move to notification because we need extra powers to enforce isolation where people are not prepared to commit themselves to voluntary isolation, we will consider that most carefully. At the moment, out best advice is that we are making the right response. It is appropriate and we will continue to monitor it.

In terms of exit screening, we are sending our HPA experts, or qualified people, to examine screening in countries where SARS is active. The problem for us as a receiving country is that we do not have a screening test. No test works and it may be some time before we can develop one. In the absence of that, we are left with questionnaires, which some countries are using, to invite people to provide information about any potential contact or symptoms. We will monitor the situation and if it is necessary for us to take that step, we will certainly consider it.

The noble Earl also asked about the start date of NHS staff coming from infected areas and whether I could give him a timeframe. They will be given a breathing space of 14 days before starting work.

The noble Earl asked about prospective cases. Our best evidence is that we have six probable cases who are doing well and have left hospital. A further 50 suspected cases are under investigation and we will follow them with interest. Of course, there may be further suspected cases but all the evidence suggests that the surveillance system is picking them up and they are being treated immediately. Furthermore, the Chinese authority is co-operating with the WHO.

I turn to the points raised by the noble Lord, Lord Clement-Jones. I am pleased that he recognised that the Government have been open. Since the beginning of the epidemic, we have made a serious attempt to make available as widely as possible

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accurate information. That is so not only in terms of the political discourse but also information from scientists at Colindale, the practitioners and the Chief Medical Officer. There has been a legion of interviews, reports and exchanges and if one listens to the "Today" programme on a regular basis, one realises that we are well-informed about how the public health faculties and researches consider things are going.

The noble Lord asked about the balance between changing bureaucracy and notification. Again, we must be advised by the scientific and medical experts. When they tell us that there is a case for notification irrespective of the potential delay we can move fairly fast. But we will be guided by them and are listening carefully to them.

In terms of resources for infection control teams, all appropriate and necessary resources must be provided. In relation to the information to travellers, the noble Lord will know that information leaflets and posters have been placed in all our international airports. They are being distributed in different ways. We are examining the possibility of providing information leaflets on planes and the best way of doing that. The noble Lord made an interesting suggestion that we might look further at advising travellers about, for instance, rights of cancellation and insurance. I shall take that back to the department for investigation. I agree with his comments about the Conservative Party and immigration, and I also agree that the crucial question is where people come from and not their status or condition. SARS is essentially a disease of contact and the critical advice is that that is in those countries where SARS is spreading.

In terms of the advice from the CMOs on the form of the declaration, we are in the process of considering how that could best be effected if we had to make that decision. I would have thought that, given the seriousness of the disease, most incoming passengers would not have a problem in filling out that declaration. Clearly, we need to consider the possibility that there might be some who refuse. I do not have an answer to that at present. The noble Lord's final question concerned the overhaul of the 1984 Act. Getting Ahead of the Curve, the famous document on communicable disease, pledged that we would consider the Act and that still stands.

I thank noble Lords on the Front Benches for the temperate and thoughtful way in which they have responded to the Statement.

7.31 p.m.

Lord Chan: My Lords, I welcome the Statement. However, there are two issues which have not been specifically discussed. The first concerns the quarantine of students from South East Asia who arrive here. In schools in Knutsford and the Isle of Wight Chinese students have been put into quarantine. What is the advice regarding that? The Chinese community are also practising that as regards people who come from the countries identified. In other words, anyone who comes from such areas is not

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welcomed in homes, restaurants, and so forth. Can the Minister give any advice as regards that issue? Associated with that is the issue of whether we welcome people coming for conferences from such parts of the world.


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