Baroness Brinton (LD) [V]
My Lords, the publication of the 33-page Covid Autumn and Winter Plan, including plans A and B, rightly talks about the need to resume life as normally as is possible while Covid is still around, but to move into restrictions faster if cases surge and the NHS is pressured. The World Health Organization’s special envoy on Covid, Dr David Nabarro, has said that the UK is right to find a way to live with the virus. However, he added:
“Speed is of the essence. We’ve been through this before and we know, as a result of past experience, that acting quickly and acting quite robustly is the way you get on top of this virus, then life can go on. Whereas if you’re a bit slower, then it can build up and become very heavy and hospitals fill up, and then you have to take all sorts of emergency action.”
Why does the Statement talk about the vital importance of mitigations, such as meeting outdoors where possible, ensuring ventilation if inside and wearing face coverings? Why are there no clearer, repeated messages for the general public about all these vital interventions, especially what we can all do now to slow down the increase in cases and hospital admissions?
At the No. 10 press conference on Monday, Professor Chris Whitty said:
“Anybody who believes that the big risk of Covid is all in the past and it’s too late to make a difference has not understood where we are going to head as we go into autumn and winter.”
He is right to be concerned. The seven-day rolling figure for daily hospital admissions is now around 1,000, with an average of 8,400 Covid patients in hospital beds. These numbers are considerably greater than they were this time last year. SAGE is very concerned that, as rules are further relaxed and people start coming back into work, the number of Covid patients going into hospital is set to increase substantially. This would put the NHS under real pressure, with perhaps as many as 7,000 admissions a day in six or so weeks, so it says.
The Statement announces the final decision on the booster scheme for those aged over 50, healthcare staff and the clinically extremely vulnerable, following the third dose for the half a million people who are severely clinically vulnerable. We welcome this. However, the World Health Organization reminded us that we should also be providing doses for low-income countries, but I see that the Government are planning only 100 million doses over the next few months. That is a drop in the ocean given that only 2% of the populations of low-income countries have been vaccinated. Will the Government agree to review and increase this number?
We on these Benches welcome the news on 12 to 15 year-olds getting vaccines. We accept that this was a difficult and complex decision, but we are pleased that there finally is one. There was an excellent slot on the “Today” programme this morning, with a group of 12 year-olds asking a paediatrician some questions; he had to look one answer up on Google. I hope that all parents and children will be able to access this sort of information because we know that it makes all the difference in coming to a decision.
However, as the noble Baroness, Lady Thornton, said, anti-vaxxers are causing serious problems. Good on Chris Whitty for what he said about one celebrity who attacked the idea of 12 to 15 year-olds having vaccines. However, today, yet another celebrity attacked him on social media, saying that he should be hanged. That is disgraceful. What are the Government doing about public servants like Professor Whitty being threatened in this way? As importantly, what will the Government do about the disinformation that people are now spreading at school gates, including leaflets with the NHS logo on them?
Ten days ago, Dr Jenny Harries announced that all clinically extremely vulnerable children in England—even those still on chemotherapy—would be removed from the CEV list and expected to return to school as term was starting, regardless of their underlying condition or the fact that there are no masks, bubbles or even, in many schools, proper ventilation. Although it is really important to have all children back in school, this cohort of children is at particular risk. Their consultants and GPs are as bemused as their parents, so why is Jenny Harries’s letter to the parents of these children, explaining why they are being removed from the CEV list, not on either the NHS or UKHSA website? Will the Minister write to me to explain this decision? We are hearing confusion from parents and medics alike.
Finally, last week, I commented on the continuing farce of Ministers U-turning daily on the use of vaccine passports for clubs. It is confusing to keep up with the U-turns on U-turns; I note that the Statement is trying to have it both ways. I suspect that Ministers could do with some new flip-flops.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
I thank the noble Baronesses, Lady Thornton and Lady Brinton, for such thoughtful questions. I am very pleased to be here to answer questions on both these Statements, and I thank the noble Baroness, Lady Thornton, for her kind remarks earlier.
I too welcome the decision to bring forward the vaccination of children. I reassure the noble Baroness, Lady Thornton, that it will be done in the same way that a large number of other vaccinations are run through the school process. As I am sure she knows, vaccinations for things such as HPV and flu have been done at primary school for some time and there are extremely well-established and thoughtful protocols for handling them. They are handled not by school nurses but by nurses employed by the local authority or on contract by the local CCG to deliver the vaccinations, and the consent forms are handled directly with the parents. There is an extremely well-established process for the very rare occasions where there is a difference of opinion between the child and the parents. It is important that we get that right. I reassure the Chamber that this process for vaccinations has been handled for years. The professionals who deal with such disagreements are extremely well trained and the Gillick principles, which are extremely well known, will be applied to the Covid vaccination. I think all noble Lords agree that that is entirely right. Children aged between 12 and 15 will be provided with information, usually in the form of a leaflet, for their use. The school- age immunisation provider will, prior to vaccination, seek consent for all the vaccination programmes.
The noble Baroness, Lady Thornton, quite rightly raised the question of children being pressured into taking or not taking the vaccine. I reassure her that the school-age vaccination programme and the clinicians involved are very well equipped and are well versed in dealing with vaccines in schools; this will not be a new thing for the schools or professionals involved. Their ability to gain consent and to communicate exactly why the Chief Medical Officer has gone ahead is an important element of the decision to accept the recommendation from the CMO on the back of the JCVI recommendation. The four CMOs have said that it is essential that children and young people aged 12 to 15 and their parents are supported in their decisions, whatever decisions they take, and are not stigmatised for accepting or not accepting the vaccination offer. Individual choice will be respected.
The rollout is starting immediately, at the beginning of next week, and we expect that it will end in schools by the end of November. The advice from Dr June Raine of the MHRA is that the flu and Covid vaccinations can happen contemporaneously—studies have supported that—but that will not necessarily happen in every case. The practicalities of the supply of Covid and flu vaccines are, as noble Lords know, extremely complex, and we do not want to make a complicated situation any worse by trying to force a combination if it is not possible.
The noble Baroness, Lady Thornton, asked about our arrangements for the current winter period and particularly about mandatory masks. I completely understand the concern of noble Lords in the Chamber about making masks mandatory. The noble Baroness, Lady Thornton, referred to it as “light touch”, but our feeling is that it is not light touch to mandate the wearing of masks; in fact, it is an intrusion into people’s life in the most intimate way. That is not to say that it should not happen at all, but we are at a stage of the pandemic where we are trying to move the responsibility for individual choices, such as wearing masks, on to people to take it for themselves. Of course, if the worst happens and we have to move into plan B, we have the legal and influential role to be able to mandate masks, but at this stage it feels proportionate to try to use persuasion rather than mandation.
I remind noble Lords that the messaging around the pandemic is not the only thing we are trying to do right now. In response to the remarks of the noble Baroness, Lady Brinton, about public messaging, I reassure her that I am the Minister who signs off the marketing around Covid and other health messaging. We are currently spending a substantial sum communicating our messages on Covid. The fact that she thinks they do not exist is an example of the public exhaustion that is an inevitable result of 18 months of relentless campaigning on Covid. We have to recognise that the public can hear us only so many times before they start tuning out the message.
There are other very important messages that we have to get through to the public, the most important of which is for those who show symptoms of other diseases to step forward to get their tests, so that we can catch people who are ill with non-Covid diseases. We have a massive backlog of diagnostics; the NHS figure on the expected numbers of people who have diseases such as cancer, and need to be seen by GPs and specialists, is huge. We need to get those messages across to people as well and, while it is not a zero-sum game, to be aware that these messages compete with each other. We are using this moment where there is a pause in the Covid epidemic to try to get people back into the GP surgeries and the diagnostic hubs—back into hospital—to try to catch diseases and reduce the lists. That fightback is extremely important and is one of the reasons why we are focused on the “Help us to help you” messaging.
The noble Baroness, Lady Thornton, asked about testing in schools. I reassure her that we have not only put a huge effort into the double supervised testing which, as she knows, kicked off the school term but are sustaining the support for school testing. There will be a review at the end of September but there are no current plans to end regular testing in schools. We have to ensure that there is value for money and that the testing is effective, but it is extremely well supported by schools. I believe it has made a serious impact on the spread of disease within schools and pay tribute to teachers, headmasters, parents and pupils for the high rates of uptake in schools. Around one-third of all positive cases are tracked down through asymptomatic testing, which is a really good indication of how effective it is at breaking the chains of transmission.
There is a review of our border arrangements in play, and I believe the Secretary of State for Transport will be making a Statement tomorrow. However, I reassure the noble Baroness that we take border control extremely seriously. We are very conscious of the threat from variants of concern. At the same time, however, we have to recognise that vaccination makes a big difference and be proportionate in our border arrangements. We are conscious that although travel is regarded as a voluntary matter, people may have strong family roots or good business reasons. Being able to travel is one of the great joys and loves of people’s lives, so we are seeking to be proportionate and reasonable in our travel arrangements. The Secretary of State will make further announcements on that tomorrow.
On the point made by the noble Baroness, Lady Brinton, on public servants, I could not agree more. The rhetoric that has been directed at public servants such as Chris Whitty and JVT sometimes leaves one feeling quite cold and disappointed at the British public. As she probably knows, we have made arrangements to put a big arm around those people who have been threatened and improve the security arrangements for them. I call on everyone to express support for our public servants, who have a very tough job. They are often communicating unpalatable, difficult truths to the public and challenging some of the assumptions and preconceptions of those who would like life to be slightly different from what it really is.
In particular, I noted the physical attack on the MHRA headquarters in Canary Wharf 10 days ago. Videos of that attack really disturbed me; it was brutal, nasty and ferocious. I pay tribute to the Metropolitan Police, who responded extremely quickly and emphatically, and to professionals at the MHRA who had steady nerves on that Friday afternoon. We cannot operate in a society where differences of opinion about public health policy lead to physical violence on the streets of London. I absolutely condemn those who participate in physical attacks of that nature, along with the kind of violent extremism that calls for people to be hanged. This is no time for that kind of extremism. Those who participate in it are trying to divide society. They really need to move on and find something else to do.
I am extremely pleased to hear what I think was the implicit support of the noble Baroness, Lady Brinton, for the principle of vaccine passports. It is right that we hold such an intimate and strong measure in reserve in case we need it for plan B. The technical and regulatory arrangements for the measures have been put in place but we have held off the implementation because it is not felt that it is needed right now. However, should it be needed either to break the chains of infection and restrain the spread of the virus or to encourage vaccine uptake, which is one of the benefits of such a measure, we will turn to it as part of our plan B measures. That is a proportionate treatment of that potent but very heavy state intervention.
Baroness Watkins of Tavistock (CB)
My Lords, I join other noble Lords in congratulating the Government on the last two Statements and the decision to encourage vaccination in 12 to 16 year-olds. However, some teachers who have been very involved in assisting pupils with swabbing are concerned that there might be an expectation that they do inoculations. Can the Minister confirm that that will not be expected of teaching staff? I think he implied that it will not be in his discussion of nurses.
Will the Government seriously consider alternatives to quarantining in hotels by giving individuals the choice to be tagged and remain in one centre if they travel back to the UK? This is particularly important for British citizens working abroad who have been doubly vaccinated.
Lord Bethell (Con)
My Lords, I absolutely reassure the noble Baroness that teachers will not be involved in the vaccination programme. I pay tribute to the work that teachers have done in organising pupils and, on occasion, administering the swabs themselves. It has been an impactful programme and we are enormously grateful. There is an established vaccination programme that, as I mentioned, makes use of professional nurses. That is the route we will take in this instance.
When it comes to the MQS programme, the bottom line is that hotel quarantine is extremely effective. It really does stop the spread of the disease as it comes into the country. That is absolutely relevant when we have the threat of variants of concern. We keep the question of tagging in sight. It is a very intrusive measure and we are not convinced that it will necessarily be, in current terms, as effective as hotels, but I take the point the noble Baroness made and will continue to look into it further.
Lord Faulkner of Worcester (Lab)
My Lords, there is a great deal in the Minister’s answers and the initial Statements with which I totally agree, particularly his statement about the threats to leading medical figures and leaders of the vaccine movement. Anti-vaxxers are a vile section of our community and I hope everything can be done to stop their activities. I also strongly welcome, as the grandfather of a teenage girl, the decision to vaccinate schoolchildren. She is delighted by that. It means she can go on holiday properly with her parents. It will make a great deal of difference to her and I know she will support it.
However, the aspect of the Minister’s answer with which I was not happy—he will know what I am going to say because I have raised this before, although not for a while in the Chamber—is the wearing of face coverings. The message is confused and the advice being given to the public is not clear. It is not made easier by photographs appearing in the press of the Cabinet sitting around a table close together with not a single face covering in sight, and pictures of at least half the Chamber in the House of Commons where virtually all the Members are unmasked. It is not the same in this House: face coverings are being worn by the great majority on all sides of the Chamber when we are not speaking. We do this not just for our own benefit and that of our immediate neighbours but for the benefit of the staff who work here. That perhaps deserves rather higher consideration in the House of Commons.
The advice being given to travellers is very difficult. Again, I would have liked earlier, much stronger advice. At present, it is mandatory if you are travelling on a Transport for London conveyance—a Tube, tram or bus—to wear a mask, but on other forms of transport, it is advisory. There is great confusion, and it gives rise to resentment among people following what they think is government advice to wear a face covering. Can we have from the Government a bit more clarity on when they believe face coverings should be worn, because I think the public are not clear about it at all?
Lord Bethell (Con)
My Lords, I hear the noble Lord’s points loud and clear. We are seeking to balance the epidemiological, public health practicalities of trying to limit the spread of the disease through mask wearing with accepting the benefits of the vaccine and the limit that puts on hospitalisations and death and trying to restore confidence in the public that we live in a safe environment.
We will be debating in months to come the challenge of trying to get the country back to work and back to economic activity, to get people back into society and back into their communities. It is not that stage right now—we are going into the winter, so naturally our concerns are about hospitalisations and a possible rise in pressure on the NHS—but we must have sight of the exit from this disease. If we have a society where the Government mandate very intimate parts of people’s everyday life and where the impression given to the entire population is that a deadly disease is an imminent threat to them, I am afraid we will run into a problem in trying to get the economy moving and to get society back again.
What we are seeking to do right now is to get that balance right, and it is proportionate. I acknowledge that mask wearing is down, but people are broadly responsible, as the noble Lord rightly pointed out. Central government cannot make every decision in all of society for all time. We need transport providers to make their own decisions, which does mean that it is complicated and that TfL and overground are different. However, it feels like the right approach for right now.
Baroness Tyler of Enfield (LD)
My Lords, I make no apology for pursuing the issue of wearing masks and face coverings, because I feel so strongly about it. My personal experience this morning when coming in on the Tube was that more than 50% of people were not wearing a mask; they were close to me. One man actually took his mask off and sneezed over me. The whole experience made me feel very uncomfortable and very anxious.
I contrast this experience with a recent train journey to Scotland. As soon as we crossed the border, there was an announcement making it quite clear that wearing masks was compulsory on the train. Absolutely every person was wearing a mask, and I felt so much more confident.
I do not really understand the explanation that the Minister has given; I listened to it very carefully. I think he said that it is not a light-touch measure, but, to me, it seems extremely light-touch. It costs very little; it protects others; it does not harm the economy, and ultimately it can save lives, so I genuinely do not understand what the problem is. I think it is about being considerate to others and, frankly and bluntly, not being selfish.
I would certainly add my voice to the comments of the noble Lord, Lord Faulkner. By not wearing masks in the Commons Chamber yesterday, many MPs were sending mixed messages and setting an appalling example to the country.
I want to end by asking the Minister a question asked also by my noble friend Lady Brinton about children who are clinically extremely vulnerable being taken out of that category. Can he explain why that is and what is going to happen to those children, and perhaps write to me and my noble friend on it?
Lord Bethell (Con)
My Lords, I absolutely applaud the sentiments that the noble Baroness articulated: her sense of responsibility and commitment to the community are generally exactly what we are trying to inculcate in a lot of people. But I just do not agree with her or with the noble Lord, Lord Faulkner, that having a state-mandated direction—accompanied, presumably, by fines and, therefore, court appearances for some—could possibly be described as light touch. It is the most intrusive and intimate of measures. If the circumstances require it, we are prepared to do it. We have done it, and, if necessary, we will do it again. But noble Lords really are missing the mood of the nation if they think that the vast majority of the country is in the same place.
I am afraid to say that this is a question of personal choice at the end of the day. The public health judgment—these decisions were made in participation with public health officials—does not support mandatory mask-wearing for the entire country. I agree that visiting Scotland is a completely different experience; there, policymakers have made a different decision, as they have in some other countries. But when we lifted mandatory mask-wearing on 19 July we saw a very large change in the public’s habit. Why? Because some people find it extremely intrusive and not comfortable at all, and they do not like it or are not prepared to do it. Therefore, at this stage of the pandemic it feels proportionate and right to rely on guidance and inspiration and on the leadership of both our national and civic leaders. If necessary, in plan B we will come back to the mandating of those kinds of measures. At this stage it really does not feel proportionate.
Baroness Andrews (Lab)
My Lords, if I may pursue this with the noble Lord, he has used the term “proportionate” on several occasions and has now said that the Government will be prepared to come back to this if they feel that the circumstances require it. It is worth reminding the House that the term “light touch” was not used by my noble friend Lady Thornton but by Sir Patrick Vallance.
I have several questions for the Minister. First, when will the circumstances be such that the Government will agree that “proportionate” is no longer the key and that action will need to be taken to require masks to be mandatory and people to stay at home? That is what the SAGE advice is suggesting. Secondly, exactly why have the Government not taken the advice of their own advisers in this respect, given the circumstances, which have been well described across the Chamber, of increases in the number of hospitalisations and the number of infections? Thirdly, what does the Minister think is likely to be the worst-case scenario this winter and the key risks, given that the Government have, on two or three occasions over the last 18 months, not followed the advice to act swiftly and urgently and according to the advice that they have been given? Why is it so difficult to take that advice and act on it now? It appears that we have not learned the lessons about the necessity for early intervention to stop things getting worse.
Lord Bethell (Con)
I am very grateful for the questions and I will take them one at a time. I am enormously grateful for the advice of SAGE; the work it does is invaluable. However, it is not regarded as the key medical adviser to the Government—that is the role of the CMO, who advises the Government on medical matters.
On the circumstances for moving to plan B, that is a reasonable question. We do not have a specific formula or algorithm, because it is extremely uncertain how things will play out. Undoubtedly, pressure on the NHS is one of the biggest drivers of that decision, and if we were to see a spike in hospitalisations, severe disease and deaths, and beds being used up and capacity being drawn down to an extreme level, that would be one of the key drivers. But we have to also look at variants of concern, other diseases and the state of the NHS in the fightback, as well as at the flu epidemic that may or may not come. Therefore, I cannot give an easy and simple answer to that question—there is not a “four tests” type of answer to it—but we are looking at it extremely carefully.
On the criticism on speed, I remind the noble Baroness that, at the beginning of this year, the Government laid out a very clear steps process, whereby we left the last round of regulations. That was extremely well considered; there were at least five weeks between each step, and it was done in a proportionate and empirically based manner, and I think noble Lords would recognise that it was a thoughtful and reasonable way of doing things. To characterise the Government’s approach this year as being behind the curve is not reasonable. As I said, we are trying to accept the risks that we have in front of us, and Covid is only one of them: there are other pressures on the NHS, including the huge catch-up that we need to do, and the possibility of flu and other epidemics on the horizon. We cannot just focus entirely on this.
Viscount Waverley (CB)
My Lords, quite rightly the Minister is in popular demand this evening. This is nothing against Boots the Chemists, which by the by does an excellent job, but with not shy of 2,000 eligible candidates on the parliamentary estate, could not the testing facilities on the estate be designated as official testing areas for flying purposes and for any other reason that tests are required? Furthermore, notwithstanding the announcement to which the Minister referred, which may or may not address this point, why, oh why, do we need day 2 testing, having had a valid test 48 hours prior to arrival in the UK from, for example, the continent?
If the Minister is minded, given that I do not think that another noble Lord is going to ask a question, could he possibly also say a word about the issue of mixing and matching booster vaccination types? Can the flu jab, to which the Minister referred, be taken at booster stage?
Lord Bethell (Con)
Like the noble Viscount, I pay tribute not just to Boots—an excellent chemist—but all the other pharmacies, which have contributed so much in this epidemic in looking after the communities that they serve, not only in trying to provide essential services during lockdown but in their contribution to the vaccine rollout programme. It really has been a demonstration of the enormous amount of value in big and small chains and community pharmacists across the board.
As for the testing provisions here on the estate, those are of course LFD asymptomatic testing provisions, and for flying purposes you need a PCR test, so I am not quite sure whether it would necessarily read across directly.
Viscount Waverley (CB)
My Lords, just from first-hand experience— Sorry, I apologise for intervening.
Lord Bethell (Con)
It is an interesting and creative idea, and certainly one that would be worth looking at.
On day 2 testing, I recognise that it is inconvenient to do the follow-up testing if you are travelling but, for the protection of this country, it is an important part of our border public health measures.
The pre-flight testing regime is helpful; it catches some disease, but in no way could it be thought of as a reliable barrier to infection into the country. I am afraid that there is simply, as I am sure noble Lords know, too much variance in the quality of that testing regime, to put it politely. Our estimate is that it catches between 10% and 20% of disease, but we know from our own testing in this country that it certainly does not catch all of it. In fact, most people will not travel if they are blazingly ill, so almost all travel infection is asymptomatic. That is why we look to day 2 testing, because it has the benefit of catching those people who might either have asymptomatic disease or are incubating the disease and would not be caught even by a PCR test.
The day 2 test is an effective way of catching those with the disease; it is an essential part of our surveillance. We would not know how much disease was coming into the country, what VOCs were coming into the country or which countries had disease, because so few have sophisticated testing, let alone genomic sequencing. It is literally the only way we know what is coming into this country and where the threats are from around the world. That is why it has played such an important part in our testing regime to date. The Secretary of State for Transport will be making announcements tomorrow and I look forward to his update on that.
On mixing and matching, one of a great many surprising medical outcomes from this disease is the idea that you might have one vaccine one day and another one three months later. When that was first posited to me, and when I first made that suggestion in this House, it was greeted with surprise and with some concern, but actually they somehow provoke different parts of the immune system, they somehow complement each other and there is strong and growing evidence that this is a very effective and complementary way of administering programmes. They work for different types of people in different ways, and different mixes and matches complement each other in a strange Rubik’s cube of complicated arithmetic. I would have to leave it to JVT, the deputy CMO, to explain it in more detail if noble Lords would like more information on that.