19:19 - The House divided: - Ayes: 319 / Noes: 246 - Question accordingly agreed to.
The Minister for Care (Helen Whately)
I beg to move,
That the draft Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) Regulations 2021, which were laid before this House on 22 June, be approved.
As we head towards a winter where care homes may have to battle with covid and flu, the question we should ask ourselves is this: what more can we do? Over the last year and a half, covid-19 has sadly taken many thousands of lives, particularly the lives of older people and those with underlying health conditions, and particularly the lives of those who need the kind of care received in a care home. There have been more than 40,000 deaths among care home residents. They were mothers and fathers, grans and grandads, brothers and sisters, sons and daughters. Sadly, we have lost some of our dedicated care workers, too: despite all the efforts that have been made by care homes and their staff, local authorities and by us in Government to keep covid out, despite personal protective equipment, despite testing, despite isolation. Throughout the second wave, care homes used 26 million tests and—
Sir Christopher Chope (Christchurch) (Con)
On a point of order, Mr Deputy Speaker. I raised a point of order earlier this afternoon about the lack of an impact assessment before the House, despite it having been referred to on 22 June as having been made available. I was informed during the course of that point of order that pressure was going to be put on the Government to explain why there was no impact assessment. It is therefore a source of great disappointment that the Minister has not started off her speech with such an apology and explanation.
Mr Deputy Speaker (Mr Nigel Evans)
Thank you for that point of order, Sir Christopher. The Minister is on her feet and she looks as if she may respond to that point of order herself, as it is not a point for the Chair.
Helen Whately
Thank you very much, Mr Deputy Speaker. I was indeed intending to come to that point. I was commencing my speech by giving some further context, but I can respond to the specific point made by my hon. Friend. The impact assessment is being worked on. I will be clear with hon. Members. One of the challenges is that there is significant uncertainty about the level of behavioural change we may see in the weeks ahead from this and other measures, for instance the requirement for vaccination to travel to some countries, which we anticipate will lead to further vaccination uptake.
Mr William Wragg (Hazel Grove) (Con)
Will the Minister give way?
Helen Whately
If my hon. Friend will let me, I will cover his exact point.
I know that some hon. Members may wish to delay this debate, because they wish to review—
Mr Wragg
On a point of order, Mr Deputy Speaker. It states in the explanatory notes:
“A full Impact Assessment has been prepared”.
If it has been prepared, it cannot currently be in preparation. So where is it?
Mr Deputy Speaker (Mr Nigel Evans)
That is not a point of order for me, but it could have been an intervention upon the Minister, so let us allow the Minister to give the full response to the points that have been made and perhaps she can include that one from William Wragg.
Helen Whately
As I said, the impact assessment is being worked on. That is the current situation. I was explaining one of the challenges in coming to an impact assessment that we can share with colleagues to inform them accurately. I really hear that hon. Members want to have the full set of information for this debate. We face a dilemma: the clock is ticking and each day we are moving closer to winter. I am going to come on to it in the detail of my speech, but one important feature of this proposed legislation is that it gives staff a grace period in which to get vaccinated. The longer we take on this, the more risk there is to having that grace period.
Mr Mark Harper (Forest of Dean) (Con)
Will the Minister give way on that point?
Helen Whately
In one moment. One thing I can share is evidence that we have on how this kind of policy is working in practice from a large care home provider that is already implementing a requirement for its staff to be vaccinated. It has seen the vast majority of staff get vaccinated, with less than 1% of its workforce choosing not to be vaccinated. We have committed—and the Minister for Covid Vaccine Deployment, my hon. Friend the Member for Stratford-on-Avon (Nadhim Zahawi) committed to this earlier to the Lords Secondary Legislation Scrutiny Committee—to publishing an impact statement setting out the evidence we have in advance of the Lords debate.
Several hon. Members rose—
Helen Whately
If my hon. Friends would allow to make a little more progress, I will absolutely take more interventions. However, I am conscious of wanting to set out the context and thinking behind this piece of legislation.
Helen Whately
I may well answer many of my hon. Friends’ questions as I proceed, so I ask my right hon. Friend to let me make a little progress and I assure him I will take interventions.
As I was saying, throughout the second wave care homes used 26 million tests and 1.2 billion items of personal protective equipment, yet still we saw outbreaks in many care homes during the winter and 14,000 deaths from covid among care home residents. But there is one thing now making a huge and crucial difference, a major advance that is unequivocally saving the lives of care home residents and staff from this cruel and pernicious virus, and that is vaccination. I have spoken to residents who were in tears of joy and relief as they were vaccinated, as they at last had their own defence against this virus. So far, the vaccine roll-out to residents and staff in care homes has been a big success story. The Joint Committee on Vaccination and Immunisation made residents and staff in older age care homes the highest priority as soon as vaccines were available, and the NHS hit its target of offering the first dose to all care homes by the end of January, which was a fantastic effort.
Helen Whately
In one moment. Vaccination teams have made multiple visits to care homes since then and as a result 96% of those living in older age care homes have had their first dose and 93% have had their second dose. Some 92% of residents living in working age care homes have had their first dose and 87% have had their second dose. Take-up among staff has also been strong, with 86% of staff in older age care homes having had their first dose and 75% having had their second dose, and 83% of staff in working age care homes having had their first dose and 72% having had their second dose. Our vaccination teams have gone to great lengths to support and encourage those who have been worried about the vaccination, along with care home managers and care colleagues. I am sure that Members will join me in thanking everyone in the NHS, local authorities and care homes who have worked so hard together to achieve such levels of vaccination.
Several hon. Members rose—
Helen Whately
I will take an intervention from my right hon. Friend the Member for Forest of Dean (Mr Harper).
Mr Harper
I come back to the point about the impact assessment. The document prepared for the House says that a full impact assessment has been prepared. Ministers need to give accurate information to the House, so if that is not correct and is misleading, it should be corrected immediately. It is not good enough to say that something will come along afterwards; we are being asked to vote on these regulations today. There is no urgency—the regulations do not come into force for 16 weeks, until November—so it is perfectly reasonable for them to be taken away and for the impact assessment that has been prepared to be published. If there is uncertainty, share the uncertainty with the House. It is not good enough to expect us to vote on something that is difficult, controversial and complicated and not share with the House the information that the Minister has at her disposal. It is an abuse. It is not good enough.
Helen Whately
During the course of this speech, I will share as much information as I can with my right hon. Friend on the rationale behind this, but let me address his point about the timing. He says that it could be done later, but the problem is that, if we do it later, will we suggesting that it is too late for care home staff who have not yet been vaccinated? The point is to give care home staff the time between this being legislated upon and its being implemented in time for the winter, when we know that there is a greater risk of a combination of covid and flu, to get vaccinated, in the knowledge that we are generally seeing an eight-week period between doses.
Sir Desmond Swayne (New Forest West) (Con)
The Minister will appreciate that the provisions before us extend well beyond the care home staff. With respect to the 1% of those staff of whom she spoke, in the absence of the impact assessment, if their failure to be vaccinated results in dismissal, who will be responsible for the compensation?
Helen Whately
My right hon. Friend asks an important question about how things would work in practice, although I think he is presuming that there is a question of compensation. I expect to see care homes being able to follow a process, and so long as they follow a fair process, there should be no need for the compensation that my right hon. Friend suggests. We will set out guidance, but the point is that there is a fair process in which, for instance, a care home can discuss vaccination with its staff member and, indeed, look at whether there might be an alternative role for an individual if they really do not want to be vaccinated, although I am realistic that there are not that many roles for staff in care homes that do not involve being in the care home. After that, if the situation is still that the staff member does not wish to be vaccinated, the care home must follow a notice period and make sure that it follows a fair process.
Rachael Maskell (York Central) (Lab/Co-op)
I want to help the Minister. We are having to make a decision this evening on the balance of risk, but we have not been given the data because the impact assessment has not come forward. The Minister is, in effect, asking us to make a decision on information that we have not yet been able to see. Would it not therefore be more sensible to withdraw this statutory instrument and ensure that we have the right data in front of us, so that we can then make an informed choice?
Helen Whately
We live in an uncertain world, but we know that covid is a killer for people living in care homes and we know that the winter ahead of us is going to be challenging both because of the ongoing circulation of covid and because of flu. The question we should put to ourselves today is: what are the steps that we can take to make people safer in the months ahead? This time last year—last summer—infection rates were low, but we did not sit back and say, “In that case, it’s going to be okay for the winter.” We in Government, working with local authorities and care homes, made preparations for the winter ahead. Thank goodness we did make those preparations. Although sadly there were many deaths, had we not put in place the personal protective equipment distribution system, had we not had the level of regular testing that went on in care homes throughout the winter, and had we not had the support with infection prevention and control, I fear that last winter would have been much worse. We know that the winter ahead is going to be another challenging one and we must prepare for it.
Helen Whately
I will make some progress. As the Prime Minister and our chief medical officer have said, even when we are no longer in a pandemic, the virus will remain in some shape or form and we will have to learn to live with it. It will continue to circulate and potentially evolve into new variants, and there is a serious risk of a resurgence of flu and other seasonal infections. A combination of covid and flu may be unpleasant for many of us, but it will be life threatening for those who are most vulnerable.
Helen Whately
We must ask ourselves: what more can we do to protect those who will be most vulnerable?
Mr Deputy Speaker (Mr Nigel Evans)
Again, this is not a matter for the Chair, but it is certainly a point for the Minister to address. I think it would be helpful if the Minister could directly address that particular issue, which many Members are now raising.
Helen Whately
Thank you, Mr Deputy Speaker. There is not a great deal more that I can say on that point. As I have said, the impact assessment is being worked on and we will share it with colleagues as soon as we can. That is all I can say on that particular point.
Sir Christopher Chope
Further to that point of order, Mr Deputy Speaker. Yesterday, I asked the House of Commons Library to inquire of the Department where this impact assessment was, and the Department informed the Library that it was about to present the impact assessment. It did not say that the assessment was still under preparation. The implication was that it was ready to be given to the House and it was just a matter of time—they said they would do it as soon as possible.
Mr Deputy Speaker
Again, I can only say what I have heard during the debate and apparently the impact assessment is simply not available. This is clearly not the best situation. We can see exactly what it is, but it is what it is.
Helen Whately
Thank you, Mr Deputy Speaker.
The Scientific Advisory Group for Emergencies recommends that 80% of staff and 90% of residents should be vaccinated in any care home, at a minimum, to provide protection against outbreaks of covid. While the majority of care home workers have now been vaccinated, our most recent data has told us that only 65% of older-age care homes in England were meeting that safe minimum level, and the figure fell to 44% in London. That is why the instrument is being put forward today. It means that, by November, subject to parliamentary approval and a subsequent 16-week grace period, anyone entering a Care Quality Commission-registered care home in England must be vaccinated unless an exemption applies. That will apply to all workers employed by the care home, those employed by an agency and volunteers in the care home. Those entering care homes to undertake other work, for example, healthcare workers, tradespeople, hairdressers and CQC inspectors, will all have to follow the regulations.
The introduction of this policy has not been taken lightly. We have consulted extensively, including with a wide range of valued stakeholders, and used their feedback to inform this legislation. We recognise that some people feel that workers should have freedom of choice about vaccination, while others do it as a duty of care to protect the people most at risk. I know from speaking directly to people who receive care and to those who have relatives living in care homes that, although they might not be sure about requiring all care workers to be vaccinated, they are sure that they, individually, want to be cared for by someone who has been fully vaccinated. Many people have little choice about who cares for them.
Helen Whately
We have reviewed the huge number of responses to the consultation. Not everybody who responded supported the proposal—as my hon. Friend says, 57% did not—but it was interesting that the picture in care homes was fairly even between those who supported it and those who were concerned.
One thing that we are already seeing is that some care homes are bringing in the policy themselves.
Mark Jenkinson (Workington) (Con)
Will the Minister give way?
Helen Whately
I may pre-empt my hon. Friend’s point. I know that hon. Friends have asked why the Government need to bring in the policy if some care homes are doing it themselves. The problem is that we could risk a situation in which someone fortunate enough to be living in a care home that has required vaccination for its workers is highly protected against the virus, but someone less fortunate, in a care home in which far fewer staff are vaccinated, is unfortunately at much greater risk. That is not an inequality that any of us should be comfortable with.
Jim Shannon (Strangford) (DUP)
If we take a vote tonight, it will set a trend, set down a marker and point the direction not just for this place, but for the whole United Kingdom; I mention Northern Ireland in particular. Before we make the decision, may I ask whether the Minister has had any opportunity to talk to the regional, devolved Minister, Robin Swann, to gauge his opinion on how the legislation will affect us?
Helen Whately
The hon. Member is right: I know that other parts of the United Kingdom are watching what we are doing here in England. There are regular conversations between the Department of Health and Social Care in England and the other Administrations. Also relevant is the international situation: other countries have either done what we are doing or are looking very hard at it. In fact, France has just announced that it will require vaccination for health and social care workers on a faster timeline than the one we propose.
Never again do we want to be back in the situation of having covid outbreaks across hundreds of care homes, with those who live and work in them losing their lives to this virus. Vaccination is a safe and effective way of preventing the spread of covid. The majority of care home workers have already taken up the vaccine, and it is essential that all care home workers who can have the vaccine do so in order to protect those in their care.
The original scope proposed in the consultation was to apply the policy only to care homes that look after older people, but following the consultation it became clear that there was a compelling case to extend the obligation to all care homes that provide care to the most vulnerable, for example young adults with learning disabilities. There was also significant support for broadening the scope of the policy to include all those who come into contact with residents, and there was support for including all those who enter care home residences in any capacity.
Sir Graham Brady (Altrincham and Sale West) (Con)
Will the Minister give way on that point?
Helen Whately
I will proceed, and I may answer my hon. Friend’s question as I go.
We listened to the responses and made the decision to apply the policy to all people working inside care homes, unless they have a medical exemption or are not eligible for vaccination—under-18s, for instance. There are further exemptions, including people providing emergency assistance or undertaking urgent maintenance work, and family or friends visiting. Guidance will be published that gives more detail about the exemptions, which will reflect the green book on immunisation and clinical advice from the JCVI.
Sir Graham Brady
Can the Minister explain why the draft regulations do not distinguish between those workers who actually come into contact with residents and those who do not?
Helen Whately
My hon. Friend asks a reasonable question. We consulted on exactly that point. There are two reasons relevant to the breadth of the policy, which covers not only care workers, but others coming into the care home, such as hairdressers, health professionals and tradespeople.
When somebody, including a tradesperson, comes into a care home, they might spend significant time in the care home, move around and move from room to room, so they might be a significant infection risk to the care home. They might also move between one care home and another, particularly if they are a specialist who serves multiple care homes. We know there is a risk when individuals are moving between care homes, so there is a clinical case for the regulations.
We also heard from providers responding to the consultation that they want a consistent approach for people who enter a care home to work, and these regulations will make it more straightforward for them to implement that.
Dr Luke Evans (Bosworth) (Con)
I am grateful to the Minister for giving way. On making sure there is equity, where does she believe the duty of care falls, given these regulations?
Helen Whately
My hon. Friend makes a really important point. Throughout the pandemic, the Government and I have felt our responsibility to protect those living in care homes from covid as best we can. We can try to do that by extending to them the protection of being cared for by people who are doubly vaccinated, knowing as we do now, from the increasing evidence, that being vaccinated not only protects the individual but reduces the risk of transmission.
Several hon. Members rose—
Helen Whately
I will sum up, as I know other colleagues wish to makes speeches.
I put on record my sincere thanks to care workers across the country, not just for their work throughout the pandemic but for all they bring to our health and care services. People working in care homes have played an incredibly important role in caring for those most at risk from this terrible virus. The vaccine is working, with more than 14,000 lives saved so far. It is only right that we take every possible step to protect those most at risk.
As I said at the outset, we must all ask ourselves what more we can do to protect care home residents, and these regulations are what we can do.
Mark Jenkinson
On a point of order, Madam Deputy Speaker. I seek your advice on whether the vaccination figures cited by the Minister, which are more than a month out of date, might have inadvertently misled the House. Her earlier figures on the vaccination status of care home staff and residents suggest it simply is not possible for the figures both to have reached the SAGE threshold and to be as low as the House was informed.
Helen Whately
I thank hon. Members for their contributions and the questions they have put to me during this debate. I welcome the consensus on the importance of protecting care home residents. This debate is about how best we do that and the level of evidence needed in order for us to take the steps to best protect those vulnerable residents. The problem we face is that the clock is ticking towards winter, and to a potential combination of covid and flu to which we know care home residents will be extremely vulnerable. The problem with inaction and waiting for more time is that inaction costs lives.
I have heard—I assure my hon. Friends on this—the strength of feeling about the impact assessment, and may I say that I apologise to my hon. Friends for the error, particularly in the explanatory notes to the regulations? I have done my utmost, as I did in my opening speech, to set out for hon. Members the situation with the impact assessment, and there is nothing further I can say on that now.
Mr Harper
I do not know what other colleagues feel, but I find it offensive that, because we have expressed concerns about these regulations, it is somehow implied that we want to do away with or risk the lives of people in care homes. These regulations do not come into force for 16 weeks. There is ample time to take them away, review them, publish the impact assessment and get this House to make a decision, and protect people before the onset of winter. To suggest that Members want to do otherwise and that we are suggesting inaction that would put their lives at risk is offensive, and I urge the Minister to withdraw it.
Helen Whately
No offence was meant on my part. The problem with what my right hon. Friend is suggesting is that, if there is a substantial delay—for instance, in the autumn—in bringing through this legislation, that leaves care workers who have not yet been vaccinated with very little time in which to get vaccinated, and that is why we are bringing this forward now.
Helen Whately
I am sorry, but I am conscious of the time left.
Several hon. Members have argued that we should continue the current approach to increasing uptake and indeed do more. Of course, we will continue to support care workers to take up the vaccine, but, as flagged by my hon. Friend the Member for Winchester (Steve Brine), the question is: how long do we give that? The vaccination of care home workers in England began in December last year, about eight months ago. We did take a similar approach to that in Scotland mentioned by the hon. Member for Central Ayrshire (Dr Whitford), where staff were vaccinated alongside residents in care homes. NHS teams went into care homes multiple times to offer the vaccination to staff. Indeed, we saw that that was effective and more staff took up the vaccination on subsequent visits. We also opened the national booking system to care home staff early on, before there was wider availability to everybody. We have worked with communities who have been particularly concerned and hesitant about vaccination. There have been materials in multiple languages. We have worked with faith groups. Local authorities have worked closely with care homes, alongside NHS vaccination teams, particularly care homes that have had lower vaccination rates. A huge amount has been done to raise the levels of uptake among care home staff.
We then have to ask ourselves the question: what more can we do? The No. 1 reason care home staff have given us for not yet being vaccinated is that they want some more time. Well, this gives them some more time through the summer in which to get vaccinated. Some care homes, as I have mentioned, are already doing this. One example is the Barchester care home group, which has over 16,000 staff. The vast majority, over 99%, have chosen to be vaccinated. Fewer than 0.5% have chosen not to be vaccinated. But the problem, if we leave it to care homes that are on the front foot to do this, is that others will be left behind and we will see inequality, where some residents are fortunate to be cared for in a care home where all the staff are vaccinated, and others will not be so safe. That leaves us with inequality for those care home residents, who will remain at greater risk. We know that the vaccination not only protects individuals, but reduces the risk of transmission.
Some hon. Members have raised the concern that care workers are being singled out in some way. That is not the case at all. This is about the setting of care homes, where we know there is the greatest risk and the greatest vulnerability to covid. This is about protecting individual residents in those care homes by requiring the vaccination of people who enter those care homes to work—so not only care home staff but NHS staff who enter care homes. This is about protecting residents in those care homes. Fortunately, at the moment, the rates are lower than they have been during peak times, but even in some of the recent outbreaks we have seen in care homes, the index case has been an unvaccinated staff member. That just emphasises the importance of us having high levels of vaccination among staff.
My hon. Friend the Member for Workington (Mark Jenkinson) asked me about the data I referred to earlier, the SAGE data on minimum levels and the extent to which that is being achieved by care homes. I shared the most recent data that I have. What we do know is that there are still hundreds of care homes that have not yet met that safe threshold, which is a minimum threshold for avoiding outbreaks in care homes.
I say to my hon. Friends that the question before us is: what more can we do to protect those who are vulnerable in care homes? This is what we can do and I commend the regulations to the House.
Sir Charles Walker (Broxbourne) (Con)
On a point of order, Mr Deputy Speaker.