Health Protection (Coronavirus, Wearing of Face Coverings in a Relevant Place and on Public Transport) (England) (Amendment) (No. 2) Regulations 2020
(Limited Text - Ministerial Extracts only)
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Lord Bethell
That the Regulations laid before the House on 22 September be approved.
Relevant document: 28th Report from the Secondary Legislation Scrutiny Committee
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, we are all aware of the rising rate of infection, particularly after this morning’s candid briefings, and the risks this poses. Therefore, noble Lords will understand the importance of taking the necessary steps to keep members of the public safe, while continuing to keep the economy running, the schools open and heading off the need for a second lockdown.
We know that some of the rules put in place have become increasingly complex and difficult to enforce. That is why the Prime Minister has set out today how we will further simplify and standardise local rules by introducing a three-tier system of local Covid alert levels in England. This is not the subject of the debate today, nor does it change the legal requirement to wear a face covering, but it should reassure noble Lords that we continue to work with local leaders to tackle outbreaks with more targeted restrictions that are simple and constructive.
The regulations being debated today introduce the requirement that members of the public should wear a face covering in taxis and private hire vehicles. In addition, they should also be worn when inside a premises that provides hospitality—such as a bar, pub or restaurant—except when eating or drinking, for which they must be seated. This means that people must wear a face covering when entering, leaving and moving around inside these premises. Additionally, staff working in certain retail and hospitality settings should wear a face covering if they are in areas that are open to members of the public and are therefore likely to come into contact with members of the public.
I will now set out why this is a necessary measure, and how we have seen public behaviour change since the introduction of the first set of face covering regulations. A review of recent clinical research published in the Lancet in August suggested that face covering usage
“in community settings with reduced physical distancing might be justified.”
But despite this, the paper concluded that for Covid-19 this evidence is of
“low or very low certainty”
due to the nature of the data collection.
Studies published in the journal Nature have shown different degrees of support for face coverings. In an article at the end of September, the publication concluded that the effectiveness of cloth face coverings is not as well established as that for PPE in a clinical setting. This article recognised that face coverings are intended to protect the public from exhaled virus-containing particles, but points out that
“few studies have examined particle emission by mask-wearers into the surrounding air.”
In a news feature a fortnight later, Nature quoted studies suggesting that face coverings might have the capacity to save lives, but the article outlined the difficulty of establishing definitive proof. The BMJ pointed out on 7 September:
“There are large gaps in our knowledge and without clear evidence on the use of cloth masks in the community we may be wearing false reassurance.”
PHE conducted a rapid review in June of 28 studies into face coverings for community usage. At the time it concluded:
“There is weak evidence”
in these studies
“that mask wearing in the community may contribute to reducing the spread of COVID-19”.
There is, however, stronger evidence that the
“beneficial effects of wearing masks may be increased when combined with other non-pharmaceutical interventions, such as hand washing and social distancing.”
SAGE has advised that using cloth masks as a precautionary measure could be at least partially effective in enclosed spaces where social distancing is not always possible.
This is the scientific context for these measures. The Government have mandated the use of face coverings in places where social distancing is difficult and where there is closely shared space. We are not increasing high levels of acceptance that face coverings are gaining among the public. We need to be clear that face coverings are not a panacea; they are not a substitute for the key measures. Face coverings alone will not stop the chain of virus transmission, but to do so we must continue to maintain good hygiene, including when putting on and taking off face coverings, and follow social distancing guidelines and safe self-isolation advice.
As the WHO pointed out this summer, due to the limited evidence of the efficacy of homemade masks,
“their use should always be accompanied by frequent hand hygiene and physical distancing.”
With this in mind, noble Lords may have seen the recommendations published by the BMA this weekend about extending the use of face coverings in more settings, including outdoors.
We know that people are responding positively to these regulations, as it is reflected in data published by the ONS. On 11 May the Government advised the public to wear face coverings in enclosed spaces, and on 5 June ONS data suggested that only 32% of people reported that they had worn a face covering outside of the house. Fast forward to now, and ONS figures published on 9 October show that 98% of people had reported wearing a face covering when they leave the house. YouGov polls from the start of October provide further support for these findings. Data collected for the DHSC on health behaviours also show that since new regulations came into force on 24 September, 84% had worn a face covering in a restaurant, café or pub on some occasion, a rise of 22%.
This instrument is already benefiting members of the public and workers alike. I am enormously grateful to noble Lords for their continued engagement on this challenging process in the scrutiny of these regulations. We will, of course, reflect on this in the debate to come. I beg to move.
The Deputy Speaker (Lord Russell of Liverpool) (CB)
Just for the benefit of noble Lords, let me say that the noble Baroness, Lady Thornton, will not be speaking next; she will be winding up for the Opposition. The noble Lord, Lord Campbell-Savours, will be relieved that he is not winding up for the Opposition, and I call him next.
Lord Bethell (Con)
My Lords, I endorse the words of the noble Baroness, Lady Uddin, in thanking the Lord Speaker and noting his words on masks in the House. Who would have believed in February that a Lord Speaker would be sending an email recommending wearing masks in the corridors of the House of Lords? We have indeed come a very long way. I thank the noble Baroness, Lady Finlay, and the noble Lord, Lord Campbell-Savours, for their insight on the wearing of masks. They have both clearly taken deep dives into the scientific evidence, as I have, and have thought to synthesise from the raw data an understanding of how masks and face coverings may or may not protect the wearer and the society around them. The upshot is that it is not always crystal clear, as they both acknowledged, but there is interesting advice there for everyone.
The noble Baroness, Lady Jones, had in some ways the most interesting insight—at least to me. Out of the science comes a very human and important public health observation, which coronavirus has struck us all with: my health is important not only to me but to those who share my space and my health service. If I have coronavirus, it is not just of interest to me but to anyone standing near me. A communicable disease is just that. The clue is in the name. It is shareable with our neighbours. That is why the wearing of masks and face coverings is not only about protecting ourselves, but about protecting our community, our neighbour and our health system.
I take from this debate a real sense of optimism that public attitudes in the UK have massively changed. I note, in response to the noble Baroness, Lady Thornton, the huge endorsement of the wearing of masks: according to recent ONS figures, 98% of people say that they have worn a mask in the last few weeks. The scientific evidence on masks would endorse that spirit. A simple hand-made or cloth mask is a public service rather than a source of self-protection and it is all the more poignant and important for that reason.
We have come a long way since February and March when there was a serious and understandable concern about cannibalisation. As I said in the previous debate, we have tens of millions of items of PPE from hundreds of suppliers covering months of health needs ahead, so cannibalisation is no longer a fear. The example of south-east Asia is important. I note and echo those who observe the role of face coverings and masks in countries that have much to teach us about public health concerns. However, I reiterate some of the practicalities and concerns about inappropriate—and overreliance on—face mask wearing. It can be a displacement activity. For some people, it can be a way of channelling concerns and can lead to unnecessary risk-taking, particularly for those who are seeking to avoid social distancing. For some, it can be a distraction from the important regimens of hygiene. As I said in my opening words, it is absolutely imperative that those wearing masks are conscious of and abide by hygiene protocols—a badly treated face covering, reused over days, can become a vector for infection and a source of contagion.
These are the concerns of the CMO and why we have moved thoughtfully and not rushed into this. As the evidence base builds and public attitudes change, we are putting more and more store in this important area, particularly in those instances where social distancing is difficult and where masks can helpfully control or minimise contagion. There is also an important question of public trust. We do not want to be in a position where we highly recommend something that we cannot quite prove is effective. There are those who say, “Well if it doesn’t hurt, why not give it a go?” It can hurt, however, because if the public suspect that we are not relying on clear scientific evidence, that has an enormous impact on our trust figures.
The noble Baroness, Lady Finlay, mentioned the environment and asked about the measures we are taking to minimise the ecological impact. This is challenging. The best practice for masks is, frankly, to use them frequently. In south-east Asia, pupils bring three masks to school each day—one for the morning, once for lunchtime, one for the afternoon—and each one is thrown away after use. That is an enormous consumption of environmentally damaging disposable goods. I pay tribute to the Keep Britain Tidy campaign, which has done an enormous amount to try to think through the disposal of masks; work is being done to figure out ways of either reusing or recycling them.
I will answer some specific points. I absolutely, categorically and 100% reassure the noble Baroness, Lady Ritchie, that there is no herd immunity strategy. It is not the Government’s strategy and we have no plans to move in that direction. To the noble Earl, Lord Clancarty, I explain that masks are recommended for indoor areas in schools, particularly in places such as corridors where social distancing is impossible. It is up to headmasters to provide specific guidance but this is all explained in the guidelines. The noble Lords, Lord Greaves, and Lord Oates, and my noble friend Lady Wheatcroft spoke about shops. This is a challenging area but we are loath to put shopkeepers and shop workers in the firing line; it is not appropriate or fair to ask someone working behind a counter to police the wearing of masks. However, we are very serious about enforcement. In response to the noble Lord, Lord Oates, I pay tribute to Transport for London. Some 102,856 people were stopped between 4 July and 1 October. Of those, 1,753 were removed from public transport and 430 fixed penalty notices were issued.
The question from the noble Baroness, Lady Thornton, on Barking and Dagenham was very interesting. I do not know the full answer. I will seek it and write to her with whatever answer I can find. The noble Lord, Lord Greaves, asked where the transmission of disease comes from. He was right to say that there are different types of transmission in different categories. As we discussed in the earlier debate, households are where it all ends up. Household contagion is extremely high. Many households will originally be infected from the community, by their neighbours or in places where they socially congregate. The disease is introduced into communities from various distances. That is why we often look at ways of restricting transport, whether within a lockdown area or internationally. Finally, in answer to the noble Earl, Lord Clancarty, visors are not enough to cover mouths and noses; that is why they are not a substitute for a face covering.
Looking to the future, I have said enough on our desire to bring a more regular scrutiny to these kinds of statutory instruments; I completely endorse the words of the noble Baroness, Lady Thornton, on this. I remind noble Lords that it is up to the usual channels to schedule the business of the House. On the Joint Committee on Statutory Instruments corrections, I take note of the noble Baroness’s remarks. I have little to say in mitigation, other than to balance her well-meaning and frank remarks by paying testimony to the legal teams who do this work. I know that the noble Baroness would join me in thanking the legal teams who have the unenviable task of drafting these regulations, often late at night and at the weekend. I can tell noble Lords that this weekend was particularly tough for the legal team, who are doing their best under difficult circumstances. As I said, I pay tribute to their work. With that in mind, I beg to move.