Lord Kamall
That the Grand Committee takes note of the temporary provisions of the Coronavirus Act 2020.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
My Lords, we shall also consider the Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) (Amendment) (No. 3) Regulations 2021.
Moving to step 4 of the Government’s road map and easing the vast majority of restrictions in England was a major landmark in our fight against the virus. It is testament to the hard work and sacrifices of many people up and down the country. We are in a better position compared with this time last year and we are all conscious of how hard the pandemic has been for so many people.
On 14 September, we published the COVID-19 Response: Autumn and Winter Plan, which sets out how we will build on the progress made and prepare the country for future challenges, while ensuring that our system of healthcare does not come under unsustainable pressure. In recent weeks, we have seen an increase in the number of cases, hospitalisations and, very sadly, deaths. The pandemic is far from over. We must continue to stay vigilant and be ready for all eventualities.
The vaccination programme continues to provide a vital line of defence against the virus. We have vaccinated more than 86% of people over 12 years old in the UK with at least one dose. We are carrying out the largest-ever seasonal flu vaccination programme, alongside Covid-19 booster vaccines for priority groups. We have also secured 730,000 patient courses of antivirals for UK patients: 480,000 courses of Molnupiravir from Merck Sharp & Dohme; and 250,000 courses of PF-07321332 from Pfizer. I shall be testing noble Lords on these in future. These antivirals can be taken at home to target early Covid-19 infection. Should these antivirals receive MHRA approval, we will prioritise antivirals to protect the clinically vulnerable most at risk this winter.
As well as the vaccine and the booster programme, we are taking a number of measures to prepare for the months ahead. The NHS will receive an extra £5.4 billion over the next six months to support its response to Covid-19. This includes an extra £1billion to tackle the treatment backlog caused by Covid-19. These are just some of the actions we are taking to protect the public over the coming months, while trying to achieve the appropriate balance for any legislation and restrictions in place.
As part of the autumn and winter plan, the Government reviewed the remaining regulations and decided, subject to agreement from Parliament, to extend the No. 3 regulations and the self-isolation regulations. The Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) (Amendment) (No. 3) Regulations 2021 extend these regulations to 24 March 2022. The test, trace and self-isolate system continues to be one of the key ways to control the virus and protect the nation. Under the self-isolation regulations, if you are notified that you have tested positive for Covid-19, or that you have been in close contact with someone who has tested positive, you must self-isolate unless exempt. Information about the legal requirements is available on GOV.UK.
The recently published Canna model concluded that, between August 2020 and April 2021, we saw a reduction of between 10% and 28% in virus transmission as a result of test, trace and self-isolation, and that, at key periods, self-isolation made a significant contribution to bringing down the reproduction number of the virus, also known as the R number. The Canna model estimates that test, trace and self-isolation has prevented 1.2 million to 2 million secondary coronavirus cases.
The technical amendments to the self-isolation regulations that we are debating today mean that, if you are a close contact of a positive case who has received doses of two different types of vaccine in the UK, you are not required to self-isolate. This ensures that those who have received doses of two different vaccines are treated in the same way as those who have received a full course of a single vaccine. The amendments also clarify that if someone in your household tests positive, you do not need to self-isolate if you received your second dose of the vaccine more than 14 days before the positive case in your household first experienced symptoms or tested positive.
In addition, the amendments clarify the requirements for those taking part in workplace daily contact testing schemes. These schemes offer daily lateral flow testing as an alternative to self-isolation for unvaccinated close contacts. If a person on one of those schemes tests positive with an assisted lateral flow test, but subsequently receives a negative result from a confirmatory PCR test, they must continue with daily testing, or self-isolate for the remainder of their original self-isolation period. These amendments, and extending the self-isolation requirements to March next year, are important to protect the public from this virus.
The No. 3 regulations, which we are also discussing today, are another important tool for managing the virus and protecting the public. The regulations equip local authorities with the powers to respond swiftly to local outbreaks. Local authorities have powers through these regulations to restrict, prohibit and close individual premises and outdoor public spaces and cancel events where there is a serious and imminent threat to public health. The powers have been used 330 times since the regulations came into force in July 2020. Local authorities play a critical role in public health protection, emergency response and infectious disease control. Covid-19 has been no different, with local authorities leading the responses in their communities. Extending the No 3 regulations will help ensure they have the tools to do their job.
We are all aware of the monumental challenge that Covid-19 has posed over the last 18 months and more. It was clear at the beginning of the pandemic that additional tools and powers were needed to enable a full-scale and wide-reaching response to save lives and livelihoods. We acted decisively to put in place the legislation needed to achieve this.
As noble Lords are aware, the Coronavirus Act 2020 came into force by Royal Assent in March 2020. It has been critical to our country’s response to this awful and devastating virus, giving the Government powers to take the appropriate action to respond to the challenge. I acknowledge the many concerns about how some of the powers in the Act have been used and assure the Committee that the Government have sought to use them in an appropriate and proportionate way, with arrangements to ensure accountability to Parliament. These include two-monthly reports to Parliament and six-monthly reviews, combined with confirmatory votes, without which the temporary provisions cannot continue. On each occasion, the House of Commons has confirmed that it is content for certain provisions to continue. The Government have also committed to expire provisions as soon as they are no longer needed. I will go into more detail on this shortly.
The Act has given us the temporary powers to ensure that the NHS and social care services have had the capacity to deal with the peak of the virus by allowing the temporary registration of over 28,000 nurses and other healthcare professionals and social workers. It has protected critical societal functions and ensured that they were able to continue—for example, enabling courts to use video technology in a wider range of circumstances. It has helped provide support packages for people and businesses; this includes the Coronavirus Job Retention Scheme, which has protected more than 11.7 million unique jobs—equivalent to over a third of the entire workforce—and the Self-employment Income Support Scheme grants, which have supported nearly 3 million self-employed people throughout the pandemic.
The Act has also shone a light on where public services can be improved in the longer term, such as allowing more virtual court hearings, and the Government will aim to secure these useful powers in alternative primary legislation.
The course of the pandemic continues to change, partly because of the strong defences we have built. It is right that we again reassess the legislative powers that are in place to deal with this pandemic and support the country. The third six-month review of the Coronavirus Act, which scrutinised its remaining 27 non-devolved temporary provisions, was published on 22 September 2021.
We have identified a further seven provisions in the Act as suitable for full expiry. Once that happens, Parliament will have been able to expire half of the original 40 temporary, non-devolved powers ahead of schedule. This includes removing some of the more controversial sections of the Coronavirus Act, such as powers to detain infectious people under Schedule 21 and issuing directions in relation to events, gatherings and premises under Schedule 22. These powers were taken at a time when the course and severity of the virus were unclear; we now recognise that they are no longer needed and should be expired.
We also propose suspending the remaining powers in Section 58, which cover provisions to ensure that, in the event of a very significant number of deaths, we can continue to deal with the deceased in a respectful and dignified way. Suspension rather than expiry of these powers is seen to be part of sensible contingency planning, since it allows them to be revived quickly if the public health situation requires it.
We will lay regulations as soon as possible to expire these provisions. Once expired, 20 temporary provisions will remain in the Act, three of which will be suspended. There are good reasons for retaining each of them. They continue to support the NHS, individuals and businesses throughout the potentially challenging winter months by allowing the temporary registration of healthcare professionals and statutory sick pay to be claimed on day 1 of self-isolation, but we hope they will help protect the progress we have made so far in beginning to recover from this awful pandemic. The legislation and regulations we are debating today help ensure that we have proportionate powers to help protect our public services, individuals and businesses.
This virus has presented the greatest public health threat to the United Kingdom in recent history, requiring a heroic response from everyone across the country, including our doctors, nurses, carers and other healthcare staff but also other key workers including transport, postal and delivery workers, who delivered much-needed food and items during lockdown.
We owe it to every person and organisation that has made sacrifices to protect themselves and others during this difficult time not to allow ourselves to fall at the final hurdle and to ensure that we emerge in the spring with the worst of the pandemic well and truly behind us.
Lastly, please allow me to repeat and highlight the simple things each and every one of us can to do to help limit the spread of Covid-19. First and foremost, get vaccinated. There are still around 4.7 million unvaccinated adults in England, and I welcome the advice I have been given by noble Lords across the House about how we can target some of the demographics that have not come forward for vaccines in line with the rest of the population. Let us all urge everyone who can have the vaccine to come forward.
If it has been more than six months and one week since your second jab and your GP has not contacted you, you can register at the NHS booking service online or call 119 to book your booster. Some noble Lords have told me about problems in this area. I am assured that these have been resolved but, if you come across anyone who is still experiencing issues getting through to either of those, please let me know and I will forward it to the appropriate person and make sure that we can target and tackle this.
Let us also urge people to take a flu jab when offered it. Please self-isolate and get tested if you have symptoms of Covid-19. Anyone who is told by NHS Test and Trace that they have tested positive or been in close contact with someone who has tested positive should follow the public health advice and self-isolate where required. Even if we are well, we can wear face coverings, meet outdoors or in well-ventilated rooms indoors, regularly wash our hands, and, where possible, makerapid tests part of our weekly routine.
I look forward to noble Lords’ continued scrutiny and valuable contributions to this debate.
Lord Kamall (Con)
My Lords—apologies while I remove my mask—I thank all noble Lords for their valuable contributions to this important debate, and for the range of views expressed in the best tradition of our debates. The Government see extending the No. 3 and self-isolation regulations until 24 March next year as vital to allow local authorities to respond to serious and imminent threats from Covid-19, but also to ensure that the self-isolation system continues to protect the public during the challenging winter ahead. I have listened to and have taken on board—and will take on board—many of the concerns raised here today.
The Government believe that the Coronavirus Act continues to be a critical part of our country’s response to this awful virus, which has touched every corner of our society. In terms of parliamentary scrutiny, I understand the points that have been made by many civil libertarians here today. The Government believe that the Coronavirus Act has enabled them to provide help and support to people, businesses and our public services, and to boost the healthcare workforce at a critical time of need. I assure noble Lords that we will continue to review every aspect of coronavirus legislation, but we are now able to expire seven provisions and part of a further power in the Coronavirus Act. I hope this demonstrates the Government’s commitment to, and progress towards, winding down the emergency powers.
The Government see themselves as taking only those powers that are critical to our response and recovery—for example, powers that help make sure that the NHS is properly resourced and that statutory sick pay is available to those who are self-isolating. It is always a very difficult balance; we heard from the noble Baroness, Lady Merron, that she would have preferred us to keep some of the other emergency provisions. The Government’s autumn and winter plan sets out how we hope to sustain and bolster the progress that we have made thus far.
I turn to some of the specific points made by noble Lords; I hope I will have the time to respond to as many as possible. If I do not respond to every point, I will make sure that I write to noble Lords in answer to their specific questions. The noble Lord, Lord Hunt, asked when an SI would be laid. He also talked about unlawful convictions and incorrect charges, as many other noble Lords spoke eloquently about. I thank them for their contributions about the incorrect charging decisions under Schedule 21 to the Act. Of course it is regrettable that 295 incorrect charging decisions have been made under the Coronavirus Act. The primary issue that the Crown Prosecution Service has identified is that individuals were erroneously charged under Schedule 21 rather than under other legislation such as various health protection regulations. Since April 2020, the CPS has agreed to review all prosecutions made under the Coronavirus Act and it continues to do so. I hope, in some ways, that that reassures the noble Lord.
The noble Lords, Lord Hunt and Lord Scriven, my noble friend Lady Foster, and the noble Baronesses, Lady Fox and Lady Brinton, asked about parliamentary scrutiny. I know that this is an issue of concern to many noble Lords. The Government are confident that they have upheld their promise to allow for proper scrutiny and accountability of the powers in the Act. Many criticisms were levelled, which I understand, and I hope that noble Lords will continue to hold us to account on accountability. Maybe I can have some conversations offline with some noble Lords to make sure we do this as much as possible.
My noble friend Lord Balfe talked about living in the same street as former MEPs and doctors. He then went on to say that the doctors were his friends, but he did not say anything about whether the former MEPs were also his friends. I hope so, but I assure him that he still remains my noble friend.
On occasion, it has been necessary to introduce urgent measures to protect the NHS and save lives. The Government have committed to debates in advance of regulations coming into force wherever possible for measures of national significance. This included Parliament being recalled to debate the national lockdown in January, and debates and votes on regulations covering the tiers system; the steps regulations in March, which set the path for implementing the Government’s road map out of lockdown; and, in June, pausing the move to the next step of the road map.
The noble Baroness, Lady Fox, talked about impact assessments. On the evidence for decision-making, a full regulatory impact assessment was not prepared for many coronavirus regulations, as they fell under the civil contingencies exclusions of the better regulation framework. The Better Regulation Executive will not seek to enforce the current administrative requirement for validating impacts for temporary coronavirus legislation in advance of the wider reform of the better regulation framework.
The noble Baroness, Lady Brinton, and the noble Lords, Lord Hunt and Lord Scriven, accused us of ignoring the scientific advice by not implementing plan B now and asked who is advising us and what the trigger points are. Our approach has always been informed by scientific and medical evidence, and by the latest data. We take evidence from the Chief Scientific Adviser, the Chief Medical Officer, SAGE, of course, as part of that, the UK Health Security Agency, the NHS and others. They remain valuable when we balance the evidence of scientific opinion. Scientific experts have contributed directly to ministerial discussions.
As we have heard in this debate, many noble Lords have contested the science or referenced certain reports. It shows that, even around this area, science is contestable. That has been revealed in the way the Government assess all these trade-offs. What is also interesting is that many people in other parts of the health sector are concerned about some of the provisions, such as the impact on mental health and other unintended consequences. All these have to be balanced. The Government have benefited from the expertise of their science and medical advisers through the pandemic and remain deeply grateful for the role they have played in saving lives and protecting the NHS.
In our debate on Thursday last, I mentioned the work of Professor Mark Pennington, professor of political economy at King’s College London, who talked about the response to the pandemic via decision-making. He talked about the situation being almost a Hayekian, complex system, with many individuals having incomplete knowledge or, as Hayek said, the conceit of knowledge. That expresses and shows the difference of opinion. This is a case where we have to weigh up many different views, particularly among the scientific community, and, in addition, some of the papers referenced today by many noble Lords.
Noble Lords have asked what the set threshold is. The Government and our scientific advisers monitor a wide range of Covid-19 health data, including on cases, immunity, the ratio of cases to hospitalisations, the proportion of admissions due to infection, the rate of growth in cases and hospital admissions in the over-65s, vaccine efficacy and the global distribution and characteristics of variants of concern. In assessing the risks to the NHS, the key metrics include: hospital occupancy for Covid-19 and non-Covid-19 patients; intensive care unit capacity; admissions of vaccinated individuals; and the rate of growth of admissions. The Government also track the economic and societal impacts of the virus to ensure that any response takes those wider effects—that is, socioeconomic effects as well as those in the medical and scientific professions—into account and assesses that range of views. It is not necessarily a binary decision but a range of views that must be considered and weighed up. Noble Lords have expressed eloquently in this debate the range of scientific views and papers on Covid.
A number of noble Lords, including the noble Lord, Lord Hunt, and the noble Baroness, Lady Brinton —forgive me if I do not remember the others—asked how regularly SAGE meets. Throughout the pandemic, SAGE has been a vital source of co-ordinated scientific advice and technical support to help guide the Government’s response. However, as I have said previously, we also consider other bits of scientific advice. Committee members utilise the latest scientific research, insight and analysis from across government, academia and industry. As new evidence or data emerges, SAGE updates its advice accordingly. As Covid-19 was completely unknown to us less than two years ago, this means that some of the guidance provided in the earlier stages of the pandemic has now been superseded or amended to reflect our ever-evolving understanding of the virus.
The noble Lord, Lord Scriven, asked about face coverings—
Lord Hunt of Kings Heath (Lab)
I am grateful to the Minister for explaining the Government’s approach to SAGE, but I have to say that it is rather confusing since SAGE clearly encompasses a wide range of scientific views. The Minister seems to be saying that it has been given a subordinated role, meeting only monthly, and, in essence, the Government are looking for other bits of scientific advice. I would like clarification on this because, for me at least, this is clearly a significant change in policy and practice.
Lord Kamall (Con)
I thank the noble Lord for that question. As I laid out earlier and have said formerly, the Government listen to a range of scientific advice, including from SAGE but also from the Chief Scientific Adviser, the Chief Medical Officer, the NHS and a range of other views.
Lord Hunt of Kings Heath (Lab)
I am sorry to pursue this but it seems to me that the Minister has made a very significant statement because all those people are on SAGE, as far as I am aware from looking at the minutes. I do not think that the Government can get away with simply saying, “We listen to a whole range of advice, including from SAGE”. Surely SAGE is the primary place from which the Government get advice.
Lord Kamall (Con)
I can only repeat what I have said previously but I will look at this in more detail and respond to the noble Lord if he is not satisfied with my response. I will try to make sure that I send a satisfactory response.
A number of noble Lords talked about the evidence around face coverings. Some noble Lords said that they definitely work. Others said, “No, there is no evidence that they work”. Others said, “Actually, they are useful as part of an overall package of other measures”. If the data suggests that the NHS is likely to come under unsustainable pressure, the Government will implement their prepared plan B. That is why we have explained it in advance: so that we cannot be accused of doing things at the last minute. Plan B would include legally mandating face coverings in certain settings, but we are not yet at that stage. The continued efforts of the public in practising safe behaviours and getting fully vaccinated will be critical to ensuring that the NHS does not come under unsustainable pressure.
Lord Scriven (LD)
This is an important issue that goes back to what the noble Lord, Lord Hunt, said. We keep hearing the phrase “when the time is right, we will implement plan B, if required”. Who will the Government take that advice from? Will it be SAGE, which, until now, has given the Government clear scientific advice that the Government have acted on—sometimes belatedly but they have done so? What are the criteria and who will give the advice on determining when the time is right within normal government business, if SAGE is no longer seen as having the primary role in advising, since its remit is during times of emergency?
Lord Kamall (Con)
Before I answer that in more detail, perhaps I may say that we are not putting SAGE into a subordinate role. It is independent and we rely on its advice. However, as I mentioned, we also rely on the Chief Scientific Adviser, the Chief Medical Officer, the UK Health Security Agency, the NHS and others, and balance up views within the scientific and medical professions. I hope I have also laid out the range of data that is examined. The decisions are data-led. We look at immunity, the ratio of cases to hospitalisations, proportional admissions and so on to see whether the data suggests that the NHS will be overwhelmed. That is what leads to the difficult decision-making and balancing up whether the time is right.
One noble Lord—I think my noble friend Lord Ridley —and many others referred to the research of the London School of Hygiene & Tropical Medicine showing the range of views. Some scientists are saying that the virus will grow while others are saying that if we keep doing what we are doing and rely on the booster vaccines, the numbers will drop off. As one can imagine, there is a range of views but I reassure the noble Lord, Lord Hunt, that we have not relegated SAGE. It is independent and we listen to its advice, as we listen to the advice of others.
On face coverings, the point made by my noble friend Lord Robathan was interesting regarding people who say they are in favour of face coverings but, as he sees when he travels on public transport, a smaller percentage wear them. That shows some of the difficulties in polling, whereby there are stated preferences but also revealed preferences. Although many people say that they will do things, one should judge them by their behaviour. I note that my noble friends Lady Foster and Lord Ridley also raised concerns about the efficacy of wearing face masks.
SAGE evidence states that face coverings, if they are worn correctly and of suitable quality, are likely to be most effective, at least in the short to medium term, in reducing transmission indoors where social distancing is not feasible. Reviews by the UK Health Security Agency in June 2020 and January 2021 found evidence that the use of face coverings in the community helped to reduce transmission. Once again, we have a range of views on the efficacy of face masks.
My noble friend Lord Robathan talked about schools, universities and transmission. In universities, there have been low case numbers among students since the end of the 2020-21 academic year, although there have been slight increases in recent weeks.
My noble friends Lady Foster and Lord Ridley asked why the Act was not being repealed. Correct me if I am wrong, but I believe the noble Baroness, Lady Fox, also asked that. Throughout the pandemic, the Government have been clear that the measures will not be in place any longer than absolutely necessary. That is why we are expiring a number of powers in the Act and intend to expire even more when, we hope, there will be a significant landmark in our progress. The two-year lifespan of the temporary provisions of the Act was chosen to ensure that powers remain available for an appropriate length of time and can be extended by the relevant national authority.
My noble friend Lord Balfe asked about test and trace, and the cost. We have released £280 million in funding thus far, which is broken down as follows: £114 million to cover the costs of the main test and trace support system, £116 million for discretionary payments, and £50 million for administrative costs.
My noble friend Lord Naseby asked about minority vaccine uptake. He asked what the Government were doing to drive uptake among ethnic minority communities. We are well aware of this issue and a lot of work is being done with a number of local community associations to work out the best way to reach them. Only yesterday, I asked the noble Baroness, Lady Benjamin, about how we could tackle particular demographics and got some very valuable advice from her on how we could focus. I fed that into the department, so hopefully that will be part of our strategy. What we have seen is pop-up temporary vaccination sites at many places of worship and community locations. One of the things we have been advised is to go to where the unvaccinated are and to see how we can pursue a targeted campaign.
The noble Baroness, Lady Brinton, asked whether there would be a charge for lateral flow tests. Anyone in England can continue to order free lateral flow tests. I am afraid that I am going to run out of time, so I will write to noble Lords.
Baroness Foster of Oxton (Con)
May I just make a point? My noble friend obviously spent a lot of time on certain aspects of this debate, but he tended to skip a little bit past the issue of whether plan B would be introduced. My question is—because I think it is very key—what exactly the benchmark would be to introduce something such as plan B. The NHS has been overwhelmed every year that I can remember during the winter for the last however many decades. At the moment, fewer than 5% of hospital beds are currently occupied by patients with Covid. I appreciate it is under pressure—we might have more flu cases, et cetera—but I would like a little bit of clarification on what the Government would see as that benchmark, because this is a big decision that I would not actually support.
Lord Kamall (Con)
I thank my noble friend for that question. One of the difficult things about answering it—believe me, it frustrates me as much as it does the noble Baroness—is that there is no set indicator, no one silver bullet or trigger point. There is a range of indicators that we will balance up to measure how they will affect the NHS and whether the NHS will be overwhelmed.
I know it has been a difficult 18 months, and people across the UK have risen to the challenge of Covid-19. We hope that the Government’s support package has helped to safeguard jobs, businesses and public services. With continued perseverance during the autumn and winter months, supported by only those essential powers remaining in place, subject to the scrutiny of noble Lords, I hope that we will get through this. I thank noble Lords for their contributions to this debate and previous debates: their expertise and the range of views expressed are hugely appreciated. I also thank everyone across the UK for the sacrifices that they have made over the period.
I end by repeating my earlier plea to everyone to do their bit. As my right honourable friend the Secretary of State for Health and Social Care made clear, quite small changes can make a big difference. Both my noble friend Lord Naseby and the noble Baroness, Lady Merron, mentioned messaging. We all have a role to play in combating this virus, especially during winter, which we know will be a challenging period. We can all do our bit by washing our hands regularly, continuing to wear masks in crowds and on public transport, testing regularly where appropriate, staying at home when we feel unwell, and, most importantly, getting fully vaccinated against both coronavirus and flu—and urging friends and family to do so. By remaining vigilant together, we can help limit the spread of the virus in the months ahead. I commend the regulations to the Committee.