Health Protection (Coronavirus, Restrictions) (Steps etc.) (England) (Revocation and Amendment) Regulations 2021

Baroness Barker Excerpts

Tuesday 14th September 2021 Grand Committee

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am very glad to follow the noble Lord and to speak to these regulations. They were laid two months ago and, once again, we are debating regulations that in a sense have been superseded by the various announcements made over the last 24 hours. I realise that this week we will probably debate at least two of the Statements, as well as looking forward to a lot of activity when we return.

I will focus on the instruments. At the time they were brought into force, the Government stated:

“The vaccine deployment programme continues successfully … Evidence shows vaccines are sufficiently effective in reducing hospitalisations and deaths in those vaccinated”


and that confidence in vaccine effectiveness against the delta variant has increased significantly. I hope the Minister can update us on that.

Can he confirm the number of adults who have not yet been vaccinated? I think there are figures in the winter plan that I have just seen. Does he agree that, while one should applaud all the efforts of those who have made the vaccination programme possible, it is still striking that so many adults have irresponsibly decided not to vaccinate? I know we will debate the issue of children aged 12 to 15 later this week, but I for one feel very uncomfortable that, even with just one jab, there will be a small risk to those taking it— particularly some boys—partly because of the selfishness of adults in not taking the vaccine. I personally think there are some ethical issues and am not surprised that the JCVI found this a very difficult decision. What else does the Minister think can be done to encourage adults to take up the vaccine?

Could the Minister also say a little about the unknown risks of vaccine effectiveness in high-prevalence environments where transmission pressures are high? I will also ask about the relationship between the booster jabs, which I think the Chief Medical Officer recently announced are to happen, and the flu vaccine programme. I understand that there is concern that immunity to the virus is low, leading to fear that flu, together with other winter viruses, could put the NHS under extreme pressure. Could he also comment on the likely effectiveness of the flu vaccine, which I gather is pretty low?

May I also ask about face coverings? These regulations remove the requirement for people to wear face coverings when using public transport services and in relevant indoor settings. The rationale for that was that the success of the vaccination programme meant we could move away from strict legal restrictions towards personal responsibility and informed judgment. Last week we debated this to an extent and the Minister pointed to data that his department had showing that this had not had much impact on people’s behaviour. From talking to noble Lords, I note that there is some surprise about this, because to the visible eye mask-wearing has dropped off considerably, particularly among men. I wonder about the extent to which this is being monitored and whether we need to step up some programmes about why it is still to be encouraged.

Finally, I will ask about local authority powers. These regulations enable local authorities to take action where an outbreak or risk of outbreak is linked to premises or an event, with local authorities retaining powers to respond to local serious and imminent public health threats. That is a very sensible provision. The Government then describe those regulations as continuing

“to act as an important public health tool for local authorities”.

Could he update me on the use of these regulations since they were passed?

[Baroness Barker (LD)]

My Lords, I am speaking in this debate because my noble friend Lady Brinton cannot be in her place to take part. We have the technology to enable remote participation in debates in the Moses Room, but the House authorities have not yet permitted that for contributions in Grand Committee, so virtual participation in these proceedings is unfortunately not possible, even though we have seen in this last week that the very few participants who need to take part remotely can be managed very effectively without recourse to extensive speakers’ lists.

It is also a loss to the Committee, because my noble friend Lady Brinton cannot take part for one very important reason, about which she has been quite public: she is clinically vulnerable, and one thing she cannot do is travel on public transport, which she cannot do because people are not wearing masks. Of all people, she should have been able to be here to make that point.

Yet again, these SIs were tabled very late. They came in just before the recess in late July, so yet again we are back to debating things that are long in the past. We have repeatedly asked the Government to respect the House and timetable SIs when they are not genuinely urgent. However, these are, as the noble Lord, Lord Hunt of Kings Heath, said, quite pertinent in view of the Statements being made this week.

This statutory instrument mostly deals with the revocation of statutory instruments on 21 July, which confirmed a number of the changes in the Prime Minister’s so-called freedom day. However, there is one extension, in Regulation 4, to the expiry date of the Health Protection (Coronavirus, Restrictions) (England) (No. 3) Regulations, which are now to end on 27 September. The Explanatory Memorandum says that this

“will ensure that local authorities retain powers to respond to local serious and imminent public health threats as a result of the spread of coronavirus. The No. 3 Regulations will continue to act as an important public health tool for local authorities in their local coronavirus outbreak management, compliance and enforcement activities. This is particularly important in light of the revocation of the other restrictions mentioned above”.

As we have said all the way through this pandemic, it is important that local authorities have the power to manage local outbreaks. Simply extending that power in law, but not making sure that they have the resources, will not work. As epidemiologists have said to us in terms, there will inevitably be points when it is important to close all the pubs in a certain area, simply because an outbreak has to be contained. While we welcome that, it behoves the Minister to say something about local authorities such as Croydon, which is insolvent, and how it will have the resources to manage this significant and enduring public health problem.

We regret the removal of face coverings on public transport and other crowded venues. I can say, as somebody who travels on the London Underground every working day, that fewer and fewer people are wearing masks and, as more and more people are on the Tube, I am certain we will see a spike in infections as a result. I also point out to noble Lords that the bad messaging on this does not help. There is genuine confusion. One of my colleagues was on a train to Scotland in the summer and, when it got to the border, there was an announcement that the law now required everybody on that train to wear a mask, and they did, as they should have done all the way.

It is now clear that the Government, and in particular the Prime Minister, have been so desperate to place emphasis on the vaccination programme as our primary defence that they have forgotten to look at the role of other mitigations against the disease. Although we support the passing of these regulations, we need to make the messaging clearer as a matter of urgency, so we can avoid the confusion that is now prevalent among people in England.

[Baroness McIntosh of Pickering (Con)]

My Lords, I welcome the regulations and congratulate my noble friend on bringing them before us. To a certain extent, my comments echo those that have already been made by previous speakers. I was fortunate enough to visit my family in Denmark and Scotland this summer, and the guidance in each place was much clearer. Speaking as an older person, I prefer to keep my mask on, on all forms of public transport. I am sure my noble friend will recognise that one of the reasons why there was not a high incidence of flu last year was, in large measure, because we followed the example of the Asians after the SARS epidemic in the late 2000s of masking up. Even the common cold was kept under control.

I understand the Department of Health and Social Care’s concern about a high incidence of flu this year, but I am sure we can encourage people to mask up, particularly in areas of close proximity. The noble Baroness, Lady Barker, mentioned the Tube. I am still reluctant to go on the Tube at busy times, but even the trains on the east coast main line are incredibly busy now, and you can find yourself next to someone who you are not normally accustomed to seeing.

To me, wearing a mask is not an infringement of my liberty; it is my passport to health and keeping safe. I hope that it will keep others safe as well. Does my noble friend imagine that the guidance will be revisited? It is in stark contrast to what has applied in Denmark and in Scotland.

Residential Social Care: Staff

Baroness Barker Excerpts

Monday 6th September 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, the noble Lord is right that taxes have to be spread across the whole country, but I remind him that the national living wage has risen by 2.2% in the last year, which benefits everyone across the population.

[Baroness Barker (LD)]

My Lords, a number of local authorities, including Croydon, are insolvent. Have the Government or the Minister’s department made an assessment of the impact of that on the viability of care providers and the capacity of people who need social care, and are entitled to it under the Care Act, to get the services that they need?

[Lord Bethell (Con)]

My Lords, I acknowledge the pressure that local authorities are under. We do indeed keep in very close contact with local authorities that have financial pressure; I assure the noble Baroness that we will not be in a position where we breach the Care Act and that we keep very close tabs on the financial support that social care needs.

Covid-19

Baroness Barker Excerpts

Wednesday 21st July 2021 Lords Chamber

[Lord Bethell (Con) [V]]

My Lords, the take-up of vaccine will at some point begin to tail off among some demographics. We are redoubling our efforts with our marketing and the availability of the vaccine, particularly among younger groups. The introduction of domestic certification for major events and pubs and clubs, if that is brought about, will create a strong incentive. These are the kinds of measures that we are putting in place to see through the strategy which, as I said at the beginning, is to get the vaccination levels to such a rate that R is below 1.

In terms of social care, as I mentioned earlier, we are looking to consult on domiciliary care and other forms of the healthcare system. On booster jabs, the noble Baroness makes me want to check my notes. In my briefing it says emphatically that flu and Covid jabs can be taken together, but I will take the opportunity of her additional question to offer to write confirming that point in case I have got it wrong.

[Baroness Barker (LD)]

My Lords, throughout the pandemic, epidemiologists have been clearly telling us that when restrictions are eased, there will inevitably be further outbreaks, some of them localised. For the past 15 months, test, trace and isolate has been a shambles. Can the Minister explain what will be done over the summer to improve test, trace and isolate and improve the information going, in real time, to local authorities and to other parts of the NHS, in order that we can move swiftly, as necessary, to very localised lockdowns when that proves necessary for public health?

[Lord Bethell (Con) [V]]

I completely agree that the post-lockdown wave is a well-known phenomenon, and we are living through the pain of it right now. I do not agree that test, trace and isolate is a shambles, and if the noble Baroness really still feels that way, I would be glad to arrange a briefing for her. As for what more we can do, we are investing heavily in the system and we will continue to improve things, as we have done already.

Health: Dementia

Baroness Barker Excerpts

Monday 5th July 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, the focus on diagnosis is critically important. That is why Challenge on Dementia 2020 set a target of two-thirds of people living with dementia receiving a formal diagnosis. At the end of May 2021, DDRs were 68.8%, compared with 61.7% at the end of April. We are working hard to get these numbers back up, and the £17 million fund which I referred to is one contribution to that. But the noble Baroness is entirely right that this is an important area, and we are focused on it.

[Baroness Barker (LD)]

My Lords, during Pride month, the Alzheimer’s Society and Opening Doors London did a lot to highlight the experiences of LGBT people with dementia. Does the Minister agree that when the Secretary of State for Health insists on wearing a rainbow badge, it is unacceptable for people to turn up to services only to be misgendered or to have their family relationships ignored or undermined, and that there should be a process of sorting out training for staff so that people are dealt with appropriately?

[Lord Bethell (Con)]

My Lords, I take seriously the testimony of the noble Baroness. I am not aware of the specific concerns that she describes, nor am I completely up to speed on the precise arrangements of the training, but I would be glad to correspond with her on this matter.

Social Care and the Role of Carers

Baroness Barker Excerpts

Thursday 24th June 2021 Lords Chamber

[Baroness Barker (LD)]

My Lords, I salute the noble Baroness, Lady Jolly, as she makes her way off to her new defence portfolio. I want to follow the noble Baroness, Lady Donaghy, in turning the House’s attention to the often forgotten part of social care: mental health social care.

I put it to the Minister that, as we sit here watching, as we have done for the past year, an unfolding mental health crisis with an unprecedented level of mental health problems in the general population, and waiting for the legislation following Sir Simon Wessely’s review and the Government’s response to it, now is the time, with popular support, to change radically the way in which we fund and devise mental health support. We need to ensure that adults of working age have access to skilled mental health support, to enable them to remain in work. We also need to do what my colleagues in Sutton local authority have done: find the money to support mental health staff in schools so that children can get through this challenging period with some resilience.

In mental health, it is often said that the NHS gets lots of resources and local authorities get lots of responsibilities. They do. They have huge responsibilities for commissioning mental health social care. At the moment, they are running those on resources that are pretty well exhausted. We need a system whereby people have quick access to emergency preventive support and to crisis support of the kind that we provide very well when we have resources; and whereby, when people have had episodes of acute care in hospital, their Section 117 aftercare, to which they are entitled, is actually there, and they are supported back into work. If we do not have that, we will simply have a generation of people who are not earning the capital to fund their future care needs when they are older.

I also want to do one thing that I do not think we have done today: acknowledge that communities of people of colour and LGBT communities are disproportionately hit by all this, as they have been disproportionately affected by Covid.

I finish by asking the Minister two specific questions. First, what assessment have the Government made of his department’s convened Mental Health and Wellbeing Advisory Group’s recommendation that we need £1.1 billion of investment in mental health social care budgets? Secondly, when will the Government publish their response to that group’s recommendations, after committing to review them in a mental health winter plan? If we leave this, it will become more than urgent; it will become an acute and endemic problem. We need to seize the time now to deal with it radically.

Covid-19: Vaccines and Pregnancy

Baroness Barker Excerpts

Monday 14th June 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, the JCVI has a clear set of prioritisation protocols, which we are sticking to. The fact of being pregnant does not seem to have a direct impact in terms of severe disease or death, so there is no clear evidence at the moment for putting in or changing the prioritisation of pregnant women. However, we constantly review that and we are naturally concerned to protect both the mother and the child.

[Baroness Barker (LD)]

The Minister referred to women who do not know that they are pregnant. The place where women go to find out whether they might be is a pharmacy. What are the Government doing to make sure that pharmacies are places where women can access accurate information and guidance?

[Lord Bethell (Con)]

The noble Baroness is entirely right. Pharmacies have played an absolutely critical role in the vaccine rollout, and we owe them huge thanks for their contribution. Pharmacists have undertaken a huge amount of training in both the delivery and explanation of the vaccine. I attribute some of the success of the vaccine programme to the extremely effective communication from pharmacists on all aspects of the vaccine, including relating to pregnancy.

National Health Service (Charges and Pharmaceutical and Local Pharmaceutical Services) (Coronavirus) (Amendment) Regulations 2021

Baroness Barker Excerpts

Monday 26th April 2021 Lords Chamber

[Baroness Barker (LD)]

My Lords, I thank the noble Lord, Lord Hunt of Kings Heath, for introducing this debate. It is a most timely and important one. As I sat down to prepare my speech for today, I thought back to a year ago, and two places. One was the relatively affluent suburb of south London where I live. It is very fortunate. It has a major teaching hospital, a number of excellent primary care facilities and, if anything, an oversupply of pharmacies, both chain and independent. Contrast that to a small place up in Lancashire, where there is a district general hospital but where the GP services have not had any permanent staff for the whole population of a small town in over 15 years. The high street chain pharmacies there have bailed out and just one or two community pharmacies remain, and they are struggling.

From watching people at that time when it was not possible either to go to hospital or to a GP, I saw people visiting their local pharmacy services and relying on them. In south London they were very well served; up in Lancashire they were not. That is the important thing for the Government to recognise. We are talking about a sector that is both a key part of the front-line delivery of healthcare services but also, in part, part of the retail sector, which we know was under severe stress even before the events of the last year. It behoves the Government to take a strategic view of services for the public and to begin to work out exactly how we make sure that the population as a whole has access to this most important of services.

I am no Pollyanna about the pandemic. I do not take the view that there are any great silver linings. It was terrible. However, the pandemic has highlighted those things that are contributing factors to health inequalities as well as new ways of working for the NHS which we need to—and have shown in the last year that sometimes we can—adapt and accelerate at pace.

The important thing to understand is the unique role of high street pharmacies. They are not on the web. They are physical presences where people can go as a walk-in and talk to trained professionals. That, I believe, makes pharmacies a very significant part of the overall pattern of health provision, which I think may change. I think the way in which people will access GP services in future may change. However, we have to have some consistency and some understanding on the part of the public, who, by now, after a year, are very well versed in understanding how we best use the resources of the NHS and do not waste them but who really want to be sure that they can use pharmacy services and can rely on them to be there.

The all-party parliamentary group held an inquiry in 2020. We have known since 2016 that we have lost about 400 pharmacies, disproportionately in those poorest communities. In 2020 we found that the cost of staying open and offering services when other NHS services were under the cosh has had a disproportionate effect on pharmacies. Some 95% of independent pharmacies believe that they are under financial pressure. We really should not allow that to continue.

I also want to talk about the distinction between community pharmacies and the chains. Chain pharmacies have a difference that arises from their ability to operate at scale and that is very valuable. It is now the case that the majority of people with eye problems go to their opticians. I know that in this last year GPs were signposting people to go to opticians if they had minor eye problems; so, too, with audiology services and other services which are primarily being done in pharmacies rather than in the NHS. If that works effectively and efficiently for people, we should make sure that it remains.

I am the co-chair of the All-Party Parliamentary Group on Sexual and Reproductive Health. One of the biggest changes that we have witnessed during the pandemic is the change to telemedicine for women seeking abortion and access to contraceptive services. Data that has been subject to two different reviews—in Scotland and England—shows that that move has been extremely beneficial to patients. It has cut waiting times. It has enabled women to be seen much more quickly than they would otherwise have been. It has beneficial health outcomes. I know the Government are in the middle of a consultation but I hope that they will make that move permanent simply because it is in the best interests of the health of women and girls. I also hope that the Government will come through on the suggestion that we should make access to contraception much easier and allow young women to go to pharmacists and for that to be the primary route for accessing oral contraception but that the oral contraception should be free. We should not be cost shifting as we do that.

I want to make one other point. It has always seemed to me that one of the biggest barriers to integrated healthcare care at whatever level—acute, primary, community—is that of information and data sharing. I believe that if we are to make more progress on that—as I think has been hinted at or has been mentioned in passing in the White Paper—we need to come back to how data is shared responsibly across different providers so that we can enable people to have access to services without any leaking of their private data. I believe it is safer for people to have their data shared with NHS-approved pharmacists than it would be for them to seek other services on the web from unlicensed providers.

I want to echo the views of the noble Lord, Lord Hunt of Kings Heath: pharmacies have played a tremendous role this last year, but they cannot sustain it and continue to provide the services that they have. If we imagine that, this time next year, the NHS is again having to deliver a vaccination programme on the scale that it is now, it is impossible to think that pharmacies could continue to bring up the slack. So in the meantime, I back the noble Lord, Lord Hunt, in his request that pharmacies are not asked to return the £370 million that was put in on an emergency basis, and that, secondly, as a matter of urgency, we have a plan for integrating pharmacy services in a clear and thought-out way, proactively taking part in prevention and also enabling people to deliver emergency front-line telemedicine services to people who need acute access.

Covid-19: One Year Report

Baroness Barker Excerpts

Thursday 25th March 2021 Lords Chamber

[Baroness Barker (LD)]

My Lords, a year ago, when little was known about the virus, the Government, through the legislation whose renewal we are debating today, assumed unto themselves unprecedented powers, with little accountability or scrutiny. One year on, when much more is known about the virus, the Government are at it again in the renewal of this legislation.

A year ago, we on these Benches said three things. First, the way to minimise the impact of this virus would be through local public services, with professionals, such as environmental health officers knowledgeable and skilled at managing public health emergencies, and trading standards officers accustomed to managing premises and businesses from a health point of view. We also pointed out that local authorities’ budgets had been hollowed out by 40%. Since 2012, the public health budget has had £800 million removed from it. We called for the resources to be put into locally led Covid responses, supported by national initiatives, and the Government completely ignored that. They set up centralised systems that were vastly expensive and did not work.

A year on, the Government have finally got the message. I understand that the track-and-trace system will now be turned over to local authorities. I specifically ask the Minister this: of the £37 billion that was allocated to track and trace, how much is left at the moment and how much will be given to people in local government who, for years, will be picking up the pieces from the impact of this on local communities?

The second thing we said was that the Government’s key responsibility in the pandemic was to be open with people about the basis upon which they would legislate to restrict people’s liberty. We said that clear communication would be essential to ensure compliance and trust, as was an understanding that the rules would be applied fairly to everybody. For months, they were not because of two words: Barnard Castle.

The same is being done again with this legislation. As my noble friend Lady Brinton pointed out, it is not legal for somebody to go abroad to tend to a sick or dying relative, but it is legal for them to attend to a holiday home. That is unacceptable, as is the extension of the existing legislation that enables police forces to determine which, if any, protests they will permit and police. That is not the way to maintain the confidence of the public, who have been remarkably forbearing and compliant in this last year. We need people to continue to have faith in the public health messages that they are being given, because this is not over and will not be for several years.

A year ago, we said that the renewal of this legislation should not be on a “take it or leave it” basis. We said that some government forecasts would inevitably be accurate, and some would not. Therefore, we would need to be prepared for what happens. A year ago, we said that having an effective vaccine would be a game-changer and that a lot of the legislation would no longer be necessary. It stands to reason that renewing the draconian powers to detain people is not necessary now.

The country now needs a legislative framework that is based on the lessons that have been learned over the last 12 months, which assumes that there will be localised outbreaks and recurrences of the virus, because that is what the epidemiologists tell us will happen. We need to equip local authorities to manage them to safeguard the health and well-being of communities and businesses, as they come out of this.

Finally, the treatment of care homes and those who live and work in them is the most shameful aspect of this pandemic. At the moment, the Government appear hesitant to say that there should be a requirement for people who either work in or are resident in care homes to be vaccinated. Yesterday, I listened with great care to the spokesperson for Barchester Healthcare, one of the biggest providers of care homes in the country, who basically said that businesses are implementing policies because both their customers and their staff want them to. I suggest to the noble Lord that it should not henceforth be permissible for companies or providers of care home services to require new staff to be vaccinated. The Government should work with providers of residential care, particularly that which is publicly funded, to ensure an increased uptake by staff over the next year, so that we make sure that the people who continue to need care can do so safely.

Covid-19: Over-75s

Baroness Barker Excerpts

Tuesday 9th February 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, my noble friend is entirely right about the massive mental health challenge and, if not the challenge to mental health, that of the isolation and loneliness felt by many who are shielding or isolated. Seven hundred and eighty thousand individuals over 70 are considered clinically extremely vulnerable. We have changed the terms of the shielding arrangements to give them more flexibility, and we have published the well-being and mental health support plan relating to Covid-19, which sets out steps to strengthen the support available for those who are struggling. But my noble friend is entirely right: we must do more to support and help voluntary organisations, which play a critical role, as do local authorities.

[Baroness Barker (LD)]

Another wave of Covid is hitting care homes at the moment. Therefore, there is an urgent need for hand-held rapid testing kits that deliver accurate and swift results. What investment is being made in biotech companies and care staff to develop a rapid testing system that works at scale?

[Lord Bethell (Con)]

My Lords, the innovation and partnerships team at NHS Test and Trace has an enormous programme on this. The lateral flow devices are a huge development but, as the noble Baroness undoubtedly knows, the sensitivity of a lateral flow device means that it is not necessarily appropriate for the user case that she described. We have invested in DnaNudge and other small point-of-care devices, but having a fast-turnaround device that can be rolled out in mass numbers is a challenge, and we continue to search for the ideal format.

Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) Regulations 2021

Baroness Barker Excerpts

Monday 8th February 2021 Grand Committee

[Baroness Barker (LD)]

My Lords, following on from the noble Lord, Lord Winston, it is important to stress that, for political leaders at this time, there is one overriding job to be done: to ensure that the relief sensed by everybody that the vaccines are coming is not misplaced into a false sense of security. We need to understand that over the next year or so we must continue the important social distancing measures that we have become used to. I believe the Government have one priority at the moment: to enable the country to emerge from lockdown to a situation which is sustainable in terms of social and economic health and well-being.

Key to that will be the opening of schools of colleges. I say that, but schools and colleges are open and people are working; they are just not physically present. It is important that as many schools as possible open as soon as possible. I urge the Government to move away from central fiats announced at short notice towards a culture of working more co-operatively with teachers and local authorities to work out what resources are needed in different areas to enable schools to open safely.

I draw to the Minister’s attention one issue that requires urgent attention. He will know that to open legally any children’s service has to have staff with up-to-date first aid qualifications. He will also know that first aid training cannot be completed online. Last March, the Health and Safety Executive announced an extension in the grace period for renewal of a certificate from one month to six. The HSE’s current advice is that all training will have to be renewed by 31 March and there will be no extension. That means that staff—and, incidentally, staff of training providers—are being told on the one hand that to get their training certificates renewed they have to go out to a training course, but on the other that they have to observe lockdown. Does the Minister realise that this potentially is a very big problem for schools, colleges and preschools? Does he also realise that this kind of mixed messaging is the last thing that professionals working at a local level to try and give some hope to their communities need?

I understand that it is being reported that test and trace is getting rid of staff. I and many others have been deeply critical of the poor performance of the test and trace operation, particularly the lack of support for isolation. Can the Minister say whether, as we go into this current phase, resources will be diverted to local authorities and local resilience forums so that we can continue to make sure that people are given supported, practical help to isolate? We can then have much more localised efforts to reverse trace so that we can find out where different variants have come from and how they have been transmitted among the population.

I have two final points. First, it is evident that mental health is becoming the big issue of this pandemic for schools and colleges. Are the Government now starting to plan to have emergency first aid mental health services for schools and colleges, exhausted public health staff such as doctors and nurses, and self-employed people who have not been eligible for any government support? Finally, on care homes, nursing homes and domiciliary care workers, when will the Government stop reporting the number of vaccinations that have been offered and start reporting the number that have been completed?