Baroness Brinton (LD) [V]
My Lords, from our Benches, I thank all the staff and volunteers in the entire health and social care sector, as well as the scientists and other experts, who are still working to keep us all safe as this pandemic continues, because it is clear, especially with omicron BA.2, that it is not over yet.
We are warned that there may yet be more surprises down the line, which is why it is somewhat bemusing that the Statement begins with this phrase:
“Last Thursday, we woke up to a new phase of this pandemic as we returned to plan A.”
That is extraordinary, because the Prime Minister made his Statement with neither the Chief Medical Officer nor the Chief Scientific Adviser by his side. His press conference and this Statement feel like the Government trying to create good news against the constant bad news battle, not least over partygate.
Last summer, and again before Christmas, we warned that the insistence on compulsory vaccination for front-line staff in the social care sector and the NHS would cause severe problems, specifically in terms of staff shortages as staff either left or were sacked. That problem is already evident in social care; a number of care homes have already been taken to court by staff they have had to let go.
The Statement on Monday also talked about cases falling but, frankly, the opposite is happening at the moment, with cases plateauing in some areas and rising in others. Tim Spector of the ZOE Covid study is warning that the numbers are consistently increasing despite many people no longer recording their results. The high level of cases in schools and in the younger adult age groups shows that Covid is still prevalent. Even if omicron BA.1 and BA.2 are less severe than delta—which is, by the way, good news—the number of cases has two consequences. First, there is increased pressure on primary care, especially GPs and hospitals, even if there is less pressure on ICUs. Secondly—the Minister will not be surprised to hear me say this—there are the problems faced by the clinically extremely vulnerable. I will return to this point later.
Yesterday afternoon, the director-general for adult social care wrote to providers of CQC-regulated adult social care activities about the removal of vaccination as a condition of deployment, or VCOD. Extraordinarily, this letter was written as late as on the eve of the date when notices would have to be served to staff in the NHS. Further, the letter refers to a Written Statement being laid before Parliament today but, as at 3.30 pm, it still has not been laid.
The first and second paragraphs of the letter refer to the regulations on VCOD, which relate to care homes and the wider social care sector, but the heading of the letter reads:
“Vaccination as a condition of deployment … in wider social care (social care settings other than care homes)”.
For anyone reading this letter at face value, it clearly excludes care homes from the U-turn on compulsory vaccination. There is no mention of a separate letter for them and the sector is extremely concerned. I know that the department has been dealing with calls on this matter today, but those I have talked to say that they cannot get a straight answer from the department. Can I try to distil this to get a clear answer from the Minister, who I wrote to about this earlier today?
Is the reason that the letter to the social care sector specifically excludes care homes from the compulsory vaccination rule changes because they are covered by regulations that are being revoked and it is not necessary and, if so, why were they not told that in the letter? Or is it because of an error, and they will receive a separate letter that has not gone out yet, despite today being the day that any final employment notices must be served? Or is it because compulsory vaccination rules remain in care homes? Another matter that I have picked up today is that this letter was not sent to hospices. Why was that? I hope the Minister can give your Lordships’ House a precise answer, but there is a wider interest in this so, if he cannot give me that now, I would welcome a written response.
Secondly, can the Minister say whether UKHSA gave formal advice to the Department for Education, in advance of Nadhim Zahawi’s guidance to schools on 20 January, specifically the strong guidance on no face coverings in schools, other than temporarily and only on the advice of their director of public health? Further on in the guidance, on page 12, it says that
“Children and young people previously considered CEV should attend school and should follow the same … guidance as the rest of the population. In some circumstances, a child or young person may have received personal advice from their specialist or clinician on additional precautions to take and they should continue to follow that advice.”
What would the Minister say to the head who, earlier this week, asked all pupils—not just the CEV pupil—to wear masks until further notice, as one pupil has leukaemia and is severely immunocompromised? The family and the school want that pupil in school, if possible. Why have the Government, the Department for Education or the Department of Health—I do not mind which—not given advice to these pupils, their families and their schools?
Finally, the briefing to journalists earlier this week that the Secretary of State for Health wants to stop publishing Covid data in mid-April has rung alarm bells across the medical and scientific community, as well as for those who are CEV and are still following the guidance in place for them. Scientists say it will reduce their ability to look at data to understand the progress locally, regionally and nationally, and doctors need that information too. I hope the Minister can confirm that any such decision is in the hands of the Chief Medical Officer and the Chief Scientific Adviser, as these are scientific, not political, decisions.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
I start by thanking both the noble Baronesses for their questions and the Benches opposite for their support during this difficult time. There was not really much political difference between us. We all recognised that vaccination remained the best defence against the virus and the variants. I also thank them for their support on VCOD.
One of the things we have constantly been doing—for example, over the Christmas break, I was on almost daily calls with other Ministers, the UKHSA and others—is to look at the evidence and the data, as it came in. We were always led by data when it came to making decisions. At the time, we felt that it was right to bring VCOD in for care homes and then to extend it across wider health and social care. You only have to look back to the beginning of Covid when we saw the disproportionate number of deaths in care homes.
Given that Delta has now been replaced, it is not only right but responsible to revisit the balance of risks and opportunities that guided our decision last year. In weighing them up, this was the balance we struck. First, our population as a whole is now better protected against hospitalisation from Covid-19. Secondly, the dominant variant, Omicron, is intrinsically less severe. Taken together, the evidence shows that the risk of presentation to emergency care or hospital with Omicron is approximately half that with Delta. Given these changes, and in conjunction with scientific advice, we have reviewed the policy and decided it is no longer proportionate to require VCOD.
We continue to encourage staff to take up vaccines. It is really important. I know most noble Lords have supported this. The NHS has focused on a targeted approach, particularly among hesitant groups within the health service, but in some ways, those hesitant groups reflect hesitant groups in the wider population. When speaking to my colleague, the Minister Maggie Throup, I have been very impressed by the number of different targeted interventions and consultations there has been, sometimes targeted right at the level of local communities. When I chaired a round table for black and ethnic minority organisations this week, one of the things we looked at was how to roll out antivirals. The question there was do we need to do still more work to convince those who are hesitant in certain communities, sometimes based on ethnicity, sometimes based on geography, sometimes based on income levels. How do we make sure they are vaccinated?
The NHS has continued and will continue with its one-to-one conversations with all unvaccinated staff. This has been associated with an early increase in vaccine uptake by 10%. Even though VCOD, we hope, will be dropped subject to the consultation, we will continue, and I know the NHS will continue, to consult all staff.
On the written advice to those who are about to issue letters today—I have to take responsibility for this—it was waiting for sign-off from me because I was doing lots of meetings for the Bill. I am very sorry; I was juggling two things at once. However, literally just before I came into this Chamber, I gave my sign-off for that letter to go out to give advice that those letters of dismissal should no longer go out.
We know it does not happen immediately, but we want to finish the consultation quickly. We hope to finish the consultation by April, and then we can drop VCOD.
As I said, we are continuing with the wider vaccination programme, and our intention is to be able to revoke it well ahead of 1 April, which is our target date. We want to move as quickly as possible, but as noble Lords will acknowledge, we also have to do a consultation process.
In the care home sector, employees have already been dismissed since 11 November. We know it has been difficult. Care homes were following the laws at the time. There have been conversations about whether some care homes will have those conversations with staff who have left. Will those staff want to go back, or have they got new jobs? This is part of our wider recruitment process to make social care a more attractive vocation and a more attractive career. Some care homes have told us individually that they will probably keep VCOD because it gives more assurance to the relatives of patients in those care homes. So, it is very much not one size fits all.
Some have asked why we are doing this now and whether it is still too dangerous. Others have asked why we have not done this sooner. We have always followed the evidence. We have always balanced the risks, and we now recognise, clearly, that given the rates of transmission, the lower severity of Omicron and the higher percentage of staff that are vaccinated in both the health and social care systems, this was the right time.
I thank the noble Baroness, Lady Brinton, for giving me advanced notice of some of her questions. Unfortunately, I do not have good enough answers at this stage, so I am going to go back to my department and ask for clearer answers, and I will write to her.
Lord Cormack (Con)
My Lords, as my noble friend knows, I have advocated compulsory vaccination since the beginning of last year. I am very disappointed that this decision has been made. Can my noble friend assure me that there will not be another variant breaking out in a few weeks’ time that will be much more dangerous? Of course, he cannot. If he can, we will all be delighted. Would we think of suspending the requirement for a motorist to pass a test and have a licence before driving? A car is a lethal machine. Well, a worker who has this virus can be a lethal instrument within a hospital or care home. Can my noble friend at least give me an absolute assurance that this policy will be under constant review?
Lord Kamall (Con)
I thank my noble friend for his question and for his longer-term engagement with me on this issue. I assure him that we are keeping this under constant review. The evidence changes. We are aware that new variants will arise, as is natural with any virus. Given the replication factor, when the virus replicates, there will be some imperfect replications and so there will be variants. That is just part of the virus spreading. As my noble friend acknowledges, we cannot give an absolute guarantee that there will be no new variants, but we are keeping an eye on all the variants and their continued transmission, along with the tools that we are using to protect workers, staff and everyone, to make sure that we are continuing to protect people as best as possible.
Baroness Tyler of Enfield (LD)
My Lords, I was pleased to hear the Minister say just now that some care homes will choose to keep this as a condition of employment because of the reassurance that it gives to both the relatives and the residents. In this increasingly fractious debate on mandatory vaccinations, one voice entirely missing has been that of patients, social-care users and care home residents on what they want. Could the Minister tell me, first, what consideration in the decision to change the policy was given to the wishes of patients and residents? Secondly, will patient-voice groups or relatives’ groups be included in the consultation referred to by the Minister? Thirdly, what will be the position of patients who, due to their own vulnerabilities, actually do not want to be treated by staff who, despite being given every opportunity, have chosen not to get vaccinated?
Lord Kamall (Con)
I thank the noble Baroness for raising that point. It is really important to note that, when engaging in debates such as this, it is sometimes easy to forget patients, and we should not do that. The health service should be all about patients; it should be patient-centred. I understand the concerns. One of the reasons that we originally introduced VCOD, particularly for care homes and then more widely, was that patients were very concerned and relatives of patients were concerned about their loved ones—they were terrified, given the early outbreaks that we saw in care homes. On the particular consultation, I am afraid that I do not have the information with me, but I will commit to write to the noble Baroness.
Baroness McIntosh of Pickering (Con)
I thank my noble friend for answering questions on the Statement here this afternoon. One thing that struck me when I read through it was that
“Incredibly, over a third of the UK’s total number of covid-19 cases have happened in just the last eight weeks.”—[Official Report, Commons, 31/1/22; col. 71.]
Taken together with the point raised by one of the noble Baronesses on the Front Benches—that the Government are planning to stop publishing the level of Covid infections and deaths, and to stop testing from the end of March—what reassurance can he give us this afternoon that the Government will know where the infection is and what the level of infection is? Against that background, how does my noble friend expect to protect the NHS and care homes at that time?
Lord Kamall (Con)
I thank my noble friend for her question. I will be frank with her: I was not aware that the Government intend to stop publication, so I will have to go back to the department and double-check whether that is indeed true or whether it is a qualified statement. I commit to write to all noble Lords, given that it seems to be what we have heard. Clearly, as we are told, we follow the evidence, and the scientists continue to follow the evidence, so I would expect that data to continue to be collected. The best answer I can give at this stage is that I will go back to the department and investigate, and will write to noble Lords.
Viscount Waverley (CB)
This might be another point that the Minister will wish to write to us about. Beforehand, the selfless manner by which the British people have risen to the challenge represents nothing short of the finest traits of Britishness. Would the Minister care to say a word about the benefits, advisability and practicality of receiving a fourth jab?
Lord Kamall (Con)
I agree with the sentiments expressed by the noble Viscount. Sometimes it takes the worst of times to bring out the best in people. It was an incredible response. It was also a very sad, emotional response. People lost loved ones, friends and relatives, and we were unable to contact people. I still have not seen my mother since January 2019 and my father died in September 2020, and I have not seen his grave. We have all been through incredibly emotional times and lost loved ones. On the fourth jab, we are continuing to review this—for example, we know that Israel has gone for a fourth jab. The briefings I get say that it is too early to tell whether there will be a fourth jab. It depends on whether immunity wanes, and whether the immunity that people now have responds to new variants, for example. In the longer term, if we have to live with this virus, will it almost be like the flu, with people having to take annual jabs? It is too early to give a definitive answer on that, but as soon as the evidence suggests one way or the other, we will notify noble Lords.
Lord Farmer (Con)
My Lords, may I come at this matter from another angle? Dr Steve James, the King’s College Hospital intensive care doctor who defended the principle of bodily autonomy to the Health Secretary, said natural immunity should be taken into account. Healthcare workers like him, especially those who have had Covid, keep topping up their natural immunity with micro exposures. In the omicron rethink, are the Government considering allowing vaccine-hesitant people to use readily available antibody test kit results instead of vaccine status?
Lord Kamall (Con)
First, I thank my noble friend for giving advance notice of the question, enabling me to try to get an answer. While we do intend to revoke the VCOD, subject to consultation in these sectors, we believe that staff still have an important professional responsibility to be vaccinated. The Secretary of State has written to regulators to review their guidance on vaccination for social care providers and the importance of vaccination in supporting the provision of safe care. We believe that vaccination remains important. In conversations I have had—on the daily calls with the UKHSA, for example—I have been told that even if people believe they have natural immunity, vaccination increases immunity by a further percentage. We believe it is worthwhile encouraging people to take vaccines.
Baroness Walmsley (LD)
My Lords, I associate myself with the Minister’s remarks and the Front-Bench contributions about the importance of the professional duty of health and care staff to take the vaccination. However, given the Statement today, it seems we will continue to have unvaccinated staff working in patient-facing roles in hospitals. We do not know about care homes yet, but I look forward to the Minister’s urgent response to my noble friend Lady Brinton’s question about that. What is going to be put in place so that unvaccinated staff and their patients continue to be protected? Will unvaccinated staff be asked to have a negative lateral flow test every day when they are on duty? Can the Minister assure us that they will continue to have appropriate PPE provided for them, for every day that they are working, in every corner of the hospital or care home, and whichever patients they are dealing with?
Lord Kamall (Con)
The noble Baroness raises an important point. I am afraid I do not have detailed answers on patients’ concerns about unvaccinated staff. The main reason for revoking VCOD is that the levels of transmissibility are much lower, with a higher number of people being vaccinated, and cases are less severe. I will have to go back to the department and write to the noble Baroness.
Lord Framlingham (Con)
My Lords, given all the scientific information now available, will the Minister accept that there is absolutely no justification whatever for the wholesale vaccination of children?
Lord Kamall (Con)
The Government continue to review the data, as other countries do. Clearly, we have vaccinated vulnerable children, and there have been moves, particularly with omicron, to look at vaccinating children. We have reduced the age, but we still need more data. Once we have that data, if it is more appropriate, we will vaccinate children, but we have to make sure we have the data because children respond differently.
Baroness Fox of Buckley (Non-Afl)
My Lords, I have always been opposed to this discriminatory policy on principle, so I welcome the Statement, even if it rather defensive. Will the Minister commit to dumping jabs for jobs and not sacking front-line workers? Will the Opposition roll back on the divisive rhetoric, categorising workers under moralistic labels of vaccinated equals virtuous, and traducing the unvaccinated as selfish or neglecting their professional duty? This seems unhelpful, especially as many of the NHS100k campaign are fully vaccinated, vaccine enthusiasts working in the health service, but who believe in choice and freedom of conscience. Is there any likelihood of the estimated 40,000 care workers who have been driven out of their jobs being compensated for the income lost, never mind being reinstated?
Lord Kamall (Con)
I begin by agreeing with the sentiments expressed by the noble Baroness that we should not necessarily be labelling people who decide not to take the vaccine. We should understand individual choice, but with freedom comes responsibility, and we always have to get that balance right. At the same time, I do not think that some of the characterisations that have been given are helpful. Having said that, if people have stopped other people being vaccinated, they should be dealt with by the law. The noble Baroness and I agree on individual choice, but, clearly, this was an emergency and people were dying and it was important that patients going into hospitals and care homes felt confident that they were being treated by staff who would not pass the virus on to them. There is always a difficult balance between liberty and responsibility.
Lord Scriven (LD)
My Lords, I come back to the really important issue raised by my noble friend Lady Brinton about the letter that went out last night to providers of CQC-regulated adult social care activities, except for care homes. My noble friend gave the Minister three hours’ notice of this question because, if care homes do not receive a letter by midnight tonight, under the law they will have to send out notices of termination to staff. Can the Minister give an absolute guarantee that, by midnight, or as early as possible, a letter will go out to stop the confusion whereby many care home providers do not know whether to keep their staff or send out a letter of termination? This is critical.
Lord Kamall (Con)
I hope that the noble Lord will forgive me, but I had a lot of meetings on the Bill today. When the questions came in and I saw the original answer, to be perfectly frank, I was not content with it and I pushed back, which is why I need more time to answer the question.
We are completely clear. We intend to revoke the requirement in its entirety for both care homes and the health and wider care sectors. The care home requirement has been in force since 11 November, but the requirement for health and wider social care was not due to come into force until 1 April. This means that first doses would have been needed by today in order for people to be fully vaccinated by 1 April. We wrote to the sector to clarify how the 3 February deadline would be impacted by the Government’s intention to revoke the regulations. While this particular question was specific to wider social care settings, not care homes, the letter was clear that we intended to revoke them for both care homes and wider social care.
Baroness Finlay of Llandaff (CB)
My Lords, I am most grateful to the Minister for the way in which he has answered these questions, because he has done so in a very nuanced way and this is a difficult topic to deal with. Can he reassure me that there will be no let-up in the effort to understand the fears behind why people are vaccine hesitant, particularly when they are working in these settings, so that they can change their mind without any sense of losing face? Will the general infection control measures that have been put in place, such as handwashing, social distancing and ventilation, be maintained? It is not only Covid that is transmitted from one person to another; there have been thousands and thousands of cases where patients have acquired a nosocomial infection in hospital. One of the most important measures—particularly for something like MRSA—has been handwashing in between treating every patient. Any let-up in these procedures could well mean that we would slip back to the bad old days of multiple wound infections on surgical wards.
Lord Kamall (Con)
As ever, the noble Baroness is absolutely right. Once again, I thank her personally for her frequent advice and questions, based on her years of experience. This gives me the opportunity to be quite clear: just because we are intending to revoke VCOD does not mean that we should let up in the fight against this virus. We need to continue to be vigilant, to wash hands, to respect space, and we hope that many people will continue, as in this Chamber, to wear face masks in crowded places and to ventilate areas, particularly when you are with people that you do not know and do not normally associate with. We should not give up on those; in fact, some of those measures, especially handwashing and others, are good common sense anyway, whether we have a virus or not. We hope that one of the lessons from this whole Covid experience has been the need for better hygiene and for us to be more aware. We cannot yet let up. We may have revoked VCOD, but it is really important that we continue to battle against this virus.
On the first question, about understanding the very real concerns, as the noble Baroness said earlier, I do not think we should simply categorise people as anti-vaxxers or pro-vaccine and virtuous; I think we need to understand their reasons. I had conversations this week when I was chairing the round table with local community organisations and I made the point to them that we want to learn from them. It is all very well for me, as a Lords Minister, to say this, but they understand much better in the community. Sometimes, it is a lack of trust. Sometimes, there are historical trust reasons. Sometimes, it is people’s personal experience. Noble Lords will have heard the recent story about the police, for example: it does not exactly engender trust in figures of authority within certain communities. It just shows the spillover effect of all these issues—discrimination, racism, but also lack of trust—and we have to be quite clear that we understand individual communities. Sometimes, even though they are in the same ethnic community, they may live in different parts of the country and respond in quite different ways. It is very easy to group people and say, “Oh, all BME, all Asians or all disabled people feel this way.” These people are individuals, and we need to understand their concerns.
Baroness Wheatcroft (CB)
My Lords, whatever the reasons people refuse to be vaccinated, the Statement says more than once that it is a professional duty of those working in the health service or in care homes to have the vaccination. Therefore, I rather agree with the noble Lord, Lord Cormack, that it is an unusual situation in which those who breach their professional duty will be allowed to continue in the role. Can the Minister tell us whether what appeared to be a decision taken through thorough research and as a matter of principle has now been changed, not because of principle but because of practicality—we need these people in the health service because of the terrible shortage of staff?
Lord Kamall (Con)
One of the things we have constantly done has been to listen—I had daily calls over the Christmas period, for example—and follow the evidence. Clearly, one of the issues may well have been staffing and warnings of potential shortages, and we had to balance all that up. As the noble Baroness, Lady Finlay, said, these things are nuanced; there are number of different factors we have to consider.
As for professional responsibility, on more than one call I have been on with senior NHS staff, clinicians and senior practitioners, they have told me that in their codes—for example, the GMC code and the nursing code—there is a professional duty to be vaccinated against transmissible diseases. Clearly, that is an issue. The NHS has had to speak to individual clinicians, those who have been reluctant, to try to press that issue, but clearly it came up against freedom of choice. It is difficult and I may not understand it, but we all think differently, which is why we have such great diverse thoughts and debates. It is really important that we understand individuals’ concerns and we can address them, but we are not going to be able to persuade everyone.
Lord Scriven (LD)
My Lords, the Minister is an honourable man and tries his best. The letter that went out yesterday evening has literally caused confusion. People in care homes will be sending letters of resignation. Can he give a guarantee from that Dispatch Box that something is going to go out before midnight tonight, before notices go? It is really important.
Lord Kamall (Con)
I thank the noble Lord for raising this issue and emphasising its importance. As soon as I leave this Chamber, I will go back to the department and ask what is being done and notify him. I thank him for raising it.