Cigarette Stick Health Warnings Bill [HL]

Lord Kamall Excerpts

2nd reading
Friday 3rd December 2021 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

My Lords, I add my congratulations to my noble friend on progressing his Private Member’s Bill to this stage and on securing this important debate.

Over the past two decades the UK has introduced a range of public health interventions and a strong regulatory framework to help smokers quit, and to protect future generations from using tobacco. Thanks to these, smoking rates in England are down to a record low of 13.9%, from 19.8% in 2011. If we go back even further, we see that the smoking rate was at 45% in the 1970s. As the noble Baroness, Lady Merron, has said, these reductions have been cross-party; Governments of all colours have tried to tackle this issue.

Those reductions are something we should be very proud of but not complacent about. While we celebrate this success, we recognise that there are still 6 million smokers in England, with smoking remaining one of the biggest causes of preventable mortality and, as a number of noble Lords have acknowledged, one of the largest drivers of health disparities. One of the reasons why I am very pleased that we now have the Office for Health Improvement and Disparities is that there will be a laser-like approach in the attempt to tackle these disparities.

Smoking rates still range from 23.4% in Blackpool to 8% in Richmond upon Thames. In addition, smoking rates vary significantly among certain groups. Nearly one in 10 pregnant women still smoke, increasing the risk of health problems for their babies. The Government are determined to reduce smoking rates in groups that smoke disproportionately, as well as across the board—so, work is going on not just in respect of pregnant women but elsewhere. For example, we know that 23% of routine and manual workers smoke, while the rate among people with long-term mental health conditions is nearly 26%. That is why there is so much to do. We have to make sure that we understand those parts of communities where we can, laser-like, focus our action. That is why the Government have set the bold ambition for England to be smoke free by 2030.

The Government recognise the good intentions behind the Bill. I pay tribute to my noble friend Lord Young of Cookham not only for the Bill but for his long-standing commitment to encouraging smokers to quit. My noble friend himself has told me about his work in the 1970s but also as a Health Minister in the 1980s. Let no one be in any doubt that the Government are clear that we strongly support measures to stop people smoking but also to educate current smokers of its dangers. We have already introduced a number of measures, such as graphic health warnings on tobacco packaging and information on packs giving further advice on how to quit.

While we sympathise with the aims of the Bill, we believe that policy should be evidence-led. It is therefore vital that we conduct further research to build up a strong evidence base to support measures before bringing them forward. To date, sadly, no country has introduced such a measure so there is very little evidence so far on its impact in supporting smokers to quit, compared with other measures we are looking at. Several other measures have been tried in other countries—for example, warnings inside the pack as well as outside—and there are a number of other issues we are examining.

The Government are in the process of developing a new tobacco control plan that will include an even sharper focus on tackling health disparities and will support the Government’s levelling-up agenda. We want to explore a broad range of new regulatory measures to support our ambition to be smoke free by 2030. So, I reassure noble Lords that we will be reviewing this proposal as part of that work.

I turn to some of the specific questions that were asked. A number of noble Lords asked about the tobacco control plan. Rather than implementing blanket measures that may not always reach some of the communities that need to be reached, we want to ensure that the plan has an even sharper focus on disparities and that it supports the Government’s levelling-up agenda. We need bold but impactful proposals. With the establishment of the Office for Health Improvement and Disparities, we are going to draw on its advice on how to address the high levels of smoking among some of these groups, and harness that advice to develop robust and effective proposals that will ensure that our plan delivers the smoke-free 2030 that this country deserves.

We are developing policy for the tobacco control plan and intend to publish it next year. There is a current tobacco control plan, which runs until 2022. We hope to include a number of measures that focus on health disparities and groups where smoking rates are not falling fast enough. I have already mentioned pregnant smokers and smokers with mental health conditions, but that also includes smokers in many deprived parts of the country.

We were asked about the amendments to the Health and Care Bill. We were grateful for the suggested amendments, which show support for strong tobacco control, but once again we need to see the evidence and make sure that such measures are targeted at groups we want to encourage, as well as more generally. At this stage we do not believe we should accept the amendments but, as I have said, next year we will be publishing our new tobacco control plan, since the current one runs until 2022.

Some of these examples include stop smoking services, which we have found produce high quit rates of 59% after four weeks. Since 2000, they have helped nearly 5 million people to quit. We have also protected a public health grant over the course of the spending review to ensure that local authorities can continue to invest in stop smoking services, because they have been seen to be successful. As long as they are successful, they will continue to be part of our armoury.

The noble Lord, Lord Moylan, asked about evidence. The Office for Health Improvement and Disparities continues to monitor developments in tobacco control across the world. We share our knowledge with international partners and draw on their evidence-led experiences to make sure that we are introducing effective measures, rather than just introducing measures we feel might work without evidence.

The noble Lord, Lord Rennard, talked about youth smoking. He is absolutely right, but youth smoking rates continue to decline, and they are currently at their lowest rate on record. In 2018, 5% of 15-year olds were regular smokers, 2% of 11 to 15 year-olds were regular smokers, and 16% had never smoked. While the youth rates are declining, we should not be complacent. We know that smoking remains an addiction largely taken up in childhood, with the majority of smokers starting as teenagers and then becoming addicted. We want to build on that recent success and protect young people from harmful tobacco, and we have an area of focus targeted at that.

My noble friend Lord Naseby talked about the tobacco levy. We recognise that the tobacco industry is already required to make a contribution to the public finances through tobacco duty, VAT and corporation tax—in many ways, it pays our wages. The department will continue to work with HMT regarding tobacco taxation and revenue funding. This includes reviewing options such as the future levy, but we want to make sure that it is an effective way to raise additional funds to support stop smoking services.

The noble Baroness, Lady Uddin, was very honest in her appraisal of her ability to stop smoking in her family. But she made some interesting points, not only about having failed to prevent her family smoking but about whether young people will read the warnings on the cigarettes. I think that is a point we have to look at. Will they be dismissed, just as the effectiveness of the warnings on the outside has waned over time? Will the same thing happen here?

[Lord Naseby (Con)]

As I mentioned, I spent 20-odd years in advertising. The Bill says that the warning has to be in red on blank white paper—quite frankly, that will be very difficult to read. If my noble friend is serious about this, I suggest he takes advice from those who know a little more about printing.

[Lord Kamall (Con)]

I thank my noble friend Lord Naseby for that intervention; I will take account of his advice. In fact, I want to thank him for his advice, given the number of years he spent in the advertising industry. Something we are looking at generally in the public health approach in this country are those experts from the advertising industry who have looked at behavioural studies and behavioural economics to encourage people to buy their products or to smoke, and to attract a number of them—as poachers turned gamekeepers—to help us understand the skills they use to attract smokers and people eating high-fat food, and to turn that around to discourage people from taking up smoking and eating food that might cause obesity.

The noble Baroness, Lady Uddin, also talked about smoking in pregnancy, and we recognise this problem. It is sad that 10% of pregnant women still smoke, and they are not falling in line with other groups. Therefore, we are looking at how we address that at prenatal and neonatal clinics, but also during that whole experience. How do we reach those mothers, and would that really be effective?

One of the questions asked was about a number of different ideas that came up. Basically, we want to follow the evidence. That is really important. There is a tobacco plan already in progress, which will end in 2022. Next year, in 2022, we will publish the new tobacco plan, and we are looking at evidence from around the world and at what works. But we also want to see how we can work across government. For example, we are working closely with the Department for Education to ensure that the harms of smoking are in the curriculum, but many of us will remember being at school and receiving education on a number of different issues related to lifestyle. A number of my friends would say, “I’m never going to smoke or drink”, and two years later, I would see them at parties, smoking and drinking.

Therefore, we have to understand how effective these messages are, how long they work for, and how we can make sure that they continue to work. We understand and accept that we need to continue to take action; we must not be complacent. We want to look at the evidence: some 64,000 people still die each year from smoking; two-thirds of long-term smokers will die from it; it is one of the greatest drivers of health disparities and, as many noble Lords have said, it causes a great, heavy financial burden. In fact, each year smoking costs society £12.5 billion, with a cost to the NHS of around £2.5 billion. We believe that making smoking obsolete would free up £15 billion per year, benefiting especially the most disadvantaged families and the most deprived communities.

Given the lack of evidence and the other measures being considered, the Government do not feel that the Bill is appropriate at this point in time. However, the Bill’s requirements will be considered as part of the wider range of regulatory proposals to support our smoke-free 2030 ambition. We want to see evidence-based, targeted proposals and to make sure that they are effective.

I once again thank my noble friend Lord Young of Cookham for this important debate and encourage him to continue pressing the Government. I also thank noble Lords for their insightful contributions.

Adult Social Care

Lord Kamall Excerpts

Thursday 2nd December 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, I thank the Minister for the Statement. It is no exaggeration to say that we on these Benches, along with many other noble Lords, have been repeatedly pushing Ministers to publish this White Paper for years. It is now two and a half years since the Prime Minister announced from the steps of 10 Downing Street:

“My job is to protect you or your parents or grandparents from the fear of having to sell your home to pay for the costs of care. And so I am announcing now—on the steps of Downing Street—that we will fix the crisis in social care once and for all with a clear plan we have prepared to give every older person the dignity and security they deserve … that is the work that begins immediately behind that black door.”


We were pushing because it was evident even then that adult social care was already in crisis. High levels of staffing vacancies, and cuts to local government meant that fewer people who had been entitled to state support would receive it, as the criteria for eligibility were repeatedly tightened. Even then, it was common knowledge that private patients were having to subsidise those funded by the state, as the amount given to local authorities did not match the actual costs of that care.

Even allowing for the inevitable delays caused by the pandemic, this Government have insisted on continuing with their structural reforms, rushing through the Health and Care Bill—which NHS leaders are now asking to be delayed because of the continuation of coronavirus and its pressure on all NHS services—as well as the health and social care levy, rushed through your Lordships’ House in one day, six weeks ago, which now requires amendment in the Health and Care Bill, which will mean that house owners outside the greater south-east will end up paying a higher percentage of their assets than those in the greater south-east. So much for protecting them from the fear of having to sell your home to pay for the costs of care—yet another broken promise from this Prime Minister.

In setting the scene, we and others have pushed for the publication of the White Paper prior to the Bill starting its journey in the Lords, because we cannot understand how any Government could restructure integrated care services between the NHS and the care sector without knowing what plans they have for the future of the adult social care sector. Yesterday’s paper was deeply disappointing—but I think the Government know that, which is why Ministers announced yet another White Paper next year on integration. But hang on: was that not why this White Paper was due to be published? If there is to be another White Paper, the timing is important. Can the Minister say when this new White Paper will be published? This one certainly is not the answer.

Allocating some money to developing the workforce in five years’ time will not even start to address the current crisis in social care: with well over 100,000 vacancies; with social care providers still having to pay for expensive PPE that is provided free to the NHS; and with providers handing back state-funded payments to their local authorities because they cannot provide a safe service for those patients. It does not address the current practice, caused by lack of funding, of domiciliary care workers not being paid as they travel between clients. It does nothing to change the experience of unpaid carers. There are lots of great ideas about following best practice and getting people to talk together, but there is no real offer of funding for regular respite care or other benefits and support.

Reading the full White Paper, the truth about the promises in the Statement begin to be revealed. The Minister knows that, from these Benches, we have repeatedly emphasised the importance of housing in relation to care and support for adults of all ages. It was, therefore, perhaps encouraging to read the recurring phrase

“Making every decision about care a decision about housing”,

but closer examination of the funding for disabled facilities grants increases shows that there will be £570 million a year in 2022–23, 2023-24 and 2024–25. The current budget for this year is already £537 million. Although continued funding is welcome news, this is only a £33 million—or 6%—increase, which, given rising costs of labour and materials, will barely keep up with inflation. It is not the transformative grant that the Statement trumpets. On the funding for

“a new service to make minor repairs and changes in peoples’ homes, to help people remain independent and safe”,

for which most authorities are able to offer only £1,000 to £2,000 per person before they have to look at their assets, no cash amount is specified, but it is hoped that this will give a boost to handyperson services that are so highly valued by older people and provide such a great return on investment.

It is impossible to transform way our social care provision works, keeping people in their homes, unless this White Paper demonstrates the practical support that the Government can give to make that happen. The real difficulty we face is that staff in the sector, providers, the NHS and, above all, the users and their families are severely let down by the White Paper. The word “dignity” is used repeatedly in the Statement. The reality is the opposite: no vision, no real reform and, worst of all, no attempt to deal with the current crisis.

[Lord Kamall (Con)]

My Lords, I thank the noble Baronesses for the points they raise. But let us be clear that for many years—not just five, 10, 15 or 20 years; some noble Lords have said that we knew this issue was coming after the war, in the 1950s—the demographics of the country meant that we were going to have an ageing population, and successive Governments of all colours have not grasped the nettle. They have commissioned a report, it has gathered dust on the shelf and another report has come along. Many noble Lords, including my noble friend Lord Lilley and others, have written papers for various think tanks, but those also gathered dust and nothing has been done. When I have spoken to friends of all political colours, they have said that, frankly, it was too difficult and there were other priorities. So the Government should be given some credit for finally grasping the nettle.

We have set out a vision. Before you set out a strategy, you have to set out a vision, and we have done so. This is a 10-year vision, and we have committed to the first three years. Throughout the White Paper, we have said that we will continue to consult the sector—experts, carers, both paid and unpaid, local authorities and nursing or care home providers—to make sure that we get the right balance and understand the issues. As technology develops—medical technology, information technology and other technology that enables people to live in their own homes—we will see how the vision might adapt, rather than laying out everything from day one. We have laid out the vision and the spending for the first three years, but we will continue to consult to ensure that we are adapting to the changing technology and circumstances.

Compared to the current system, more people will be supported with their social care costs and have greater certainty over what they pay and receive higher-quality care. We think the plans announced represent the best value proposals. As many noble Lords will appreciate, that means balancing many issues: how many people are supported; how much they are supported; and the cost to taxpayers of offering that support. We believe that the plan sets out an appropriate level for the cap and balances that with people’s personal responsibility for planning for their later years. A number of experts have written recently asking why financial advisers advise people to build up ever-larger sums of money but they then leave it to their children at the end of their lives, rather than depleting their assets as they get older to look after themselves. We were clear that the £86,000 would be the amount individuals will need to pay towards the cost of their care, and the amendment to the Health and Social Care Bill reflects the changes. We believe the new system is necessary, fair and responsible.

We admit that the Care Act 2014 was landmark legislation informed by a range of partners, and we want to build on those strong foundations, rather than reinvent the wheel. Many of the provisions in that Bill act as a platform for better, even more joined-up health and social care in future. We are the first Government to announce that we are going to integrate health and social care, and that we will have a system of healthcare all the way through—not social care as a bolt-on afterwards—from your birth all the way through your life.

The Health and Social Care Bill contains several provisions built on the Care Act 2014. We have looked at assurance, with a new duty on the Care Quality Commission, and we have looked at data, to make sure we have the appropriate data on adult social care. People should pass from hospital to social care with no delay and as seamlessly as possible. We have looked at provider payments and the better care fund. The Bill also proposes to put integrated care systems on a statutory footing, which will make sure that, in each area, working with local authorities, account is taken of the needs of social care, joined up with the other parts of the healthcare system.

On 3 November, we published the adult social care winter plan, because we recognise that this is a long-term plan, but we have constantly been listening to stakeholders and have drawn up recommendations with a number of people, including Sir David Pearson, who reviewed last year’s adult social care plan, advisers from SAGE and UKHSA. So we have listened carefully to make sure that we meet some of the short-term issues that we are facing. We have looked at how we can increase spending, where relevant, to make sure that we tackle some of those issues.

Across the House, noble Lords will want to pay tribute to social care workers, both paid and unpaid. We have a track record of responding to workforce pressures—for example, the £162.5 million workforce recruitment and retention fund and the £388 infection control and testing fund. We will continue to keep this situation under control. We are also increasing the rate of the national living wage, which means that many of the lowest-paid care workers will benefit from pay rises. We are also investing at least £0.5 billion in the way we support the development and well-being of our social care workforce—an investment in knowledge, skills, health and well-being, and how we drive the retention of existing staff and boost recruitment. This will set the conditions for professionalisation over a longer period, giving carers recognition. When we look at the social care workforce and how much they are valued, one of the great issues has to be recognition of their skills and giving them a professional development pathway.

In the longer term, as set out in the White Paper, we remain interested in working with commissioners and providers to make that sure care workers have the best terms and conditions possible, including being paid for all the hours possible. This is already set out in our existing market-shaping and commissioning guidance. We will also explore how we can champion best practice and support local authorities, including through the new CQC assurance framework. We acknowledge the prevalence of zero-hours contracts in the social care sector and we are interested in working with commissioners, providers and care workers to understand how those contracts impact this sector.

Chapter 6 of the White Paper sets out three key aims for the workforce strategy over the next three years, backed up by £500 million of investment. We want to create a workforce that is well-trained and well-developed, healthy and supported, sustainable and recognised. We want to make sure that social care is seen as a rewarding career—that it is not only heart- warming but has professional recognition. I should stop there and take some more questions at this point.

[Baroness Thomas of Winchester (LD) [V]]

My Lords, could the Minister say exactly what the Government are doing right now to recruit more carers, in view of the huge shortfall in the workforce? Are they largely leaving it to hard-pressed local authorities?

[Lord Kamall (Con)]

The Government are in conversation with local authorities at the moment to look at the short-term issues. That is why we have announced increases in funding, particularly as part of the winter plan. The White Paper we are talking about today looks at the longer term, but we have also recognised the short-term issues, which is why we have announced these increases in spending.

[Baroness Pitkeathley (Lab)]

My Lords, we have been waiting for four years—sometimes I think I have been waiting 40 years—for a White Paper that contained a vision for social care that would, once and for all, rescue it from its Cinderella role in public services. I did not get that, but I am a glass-half-full person and am relieved by how many times unpaid carers are mentioned and how many warm words there are about identifying, recognising and involving carers. I thank the Government for that.

But family carers are at breaking point now. As my noble friend said, most have not had a single break since the start of the pandemic. They need immediate help, so will the Minister tell the House how the proposals in the White Paper will help stressed carers now? My second question is about integration between health and social care services, which is the only hope for real reform. It is frequently referred to in the White Paper, but there is no vision for how it will be delivered. We understand that another White Paper about integration is being prepared; I wonder why that is necessary when it could have been tackled in this one. Could the Minister update the House on progress and assure me that carers will be consulted as that paper on integration is written?

[Lord Kamall (Con)]

First, I pay tribute to the work that the noble Baroness has done for carers over many years. She has personally raised with me issues with carers, both paid and unpaid, as well. The White Paper clearly raises issues of professionalising, training and recognising carers to help make this a rewarding career for many. At the same time, it looks at unpaid carers and understands that, for a number of reasons, they are not all similar. Sometimes they are school-age children. We have looked at young carers and at elderly carers—for example my mother, who, in her 70s, looks after an 80 year-old sister who suffers from dementia. They have different needs.

We are first trying to look at how we can help make their task easier, for example through technology freeing up time. We are also looking at respite and how we can make sure they have breaks. We hope that those conversations will be had at the local level, between ICSs and health professionals having meetings directly with the individuals concerned to make sure that unpaid carers have the appropriate support.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I feel torn on this. On the one hand, it is irritating that the White Paper has come out but everybody wants to bash it, when I am relieved that somebody has suggested something. On the other hand, it is not satisfactory. To ask some immediate questions, the crisis of care staff has already been referred to, but I am concerned that the White Paper is being used to avoid talking about the real crisis now. There are genuine problems in care homes in the aftermath of Covid. It is not just about staff, but the fact that relatives are still being denied face-to-face visits. There is still a climate of risk aversion and fear from some managements, with lots of people with dementia being locked in their rooms. All sorts of terrible things are happening and people do not know what to do. I do not want this White Paper to be used to bat things away.

That was the first thing. Secondly, in the longer term, can the White Paper create that vision and be used as a platform? To be honest, I think it is visionless and technocratic. We need to get talking and involve the nation in developing the vision we need. Everybody has an investment in improving this.

--- Later in debate ---

[Lord Kamall (Con)]

The noble Baroness, Lady Fox, makes a valid point: we have to look at not only the long-term vision but the short-term issues raised. This is why, on 3 November, we announced the adult social care winter plan for 2021-22. This was developed in conjunction with the NHS and social care stakeholders. We drew on the recommendations of the review of last year’s adult social care winter plan and listened to a number of different stakeholders in setting out the short-term issues.

As the noble Baroness acknowledges, we are the first Government to set out a long-term vision, not just from one electoral cycle to another but for 10 years. We have set out a vision with three years of commitment to specific spending, some of which is a discovery process, because we still have to know what will and will not work, and how to use and integrate technology. By doing that, we have laid down the gauntlet to whatever Government come after us, of whatever political colour, for them to continue to fulfil this vision. It is a vision against which this and future Governments will be measured.

Other politicians from other parties have known about this for many years. The noble Baroness, Lady Pitkeathley, mentioned waiting for 40 years and others have known about our post-war demographic challenge. We have finally grasped the nettle. We are not going to get everything right, which is why we have not laid out a detailed, prescriptive plan for 10 years. We have laid out a vision of integration, making sure that we use the best technology to support people in their own homes, as much as possible. At the same time, we have committed for the next three years. After that, the challenge is for us to work with all stakeholders to deliver that vision.

[Baroness Watkins of Tavistock (CB)]

My Lords, I am particularly delighted to see this White Paper and congratulate the Government on publishing it in this timeframe. However, we need to look closely at workforce needs, at the same time as we look at workforce needs for the Health and Care Bill, because there is a real mismatch between the vision we now have and the staffing for that vision. I welcome this opportunity to hear how the Government think we can tackle that and give young unemployed people good opportunities to come into a proper caring profession.

[Lord Kamall (Con)]

I thank the noble Baroness for the conversations that we have had about this, and a number of other issues, as I got to grips with my brief. She makes a very important point. We have to make sure that social care is seen as an attractive career path and not just something unskilled; we know that there are skills involved, such as empathy. There will also be an increased need for digital skills, and people management skills will be handy in other areas. For far too long, social care has been seen as the poor relation of other parts of the health system. By bringing health and social care together, we are sending a signal that our vision is to put them on an equal footing. We are also explaining how we intend to spend over the next three years. We challenge everyone—stakeholders, local authorities, everyone—to come forward and help us develop that vision for the long term, and to hold future Governments to account against that vision.

[Baroness Walmsley (LD)]

I wish the Minister good luck with his nettle grasping—I think he is going to need it. He will know that the right housing is key to enabling people to remain safely and happily in their home, yet only £300 million, a very small amount, is being promised in the White Paper to integrate housing into health and care strategies. Take, as an example, the so-called extra care units, where people can live in a flat with appropriate on-site support; that will mean only about 3,000 such units across England. Can the Minister say over what period that money is being offered? Is it three years or a different period? How many units of supported housing can be provided for that amount of money?

[Lord Kamall (Con)]

I thank the noble Baroness for raising this issue. We want to ensure that people can live in their own home for longer. We have committed a sum of money and been quite clear that practical changes can be made, such as installing stairlifts, level-access showers, wet rooms, sensors, et cetera. New technology is constantly being developed to meet people’s needs in their own home. To this end, we have committed a further £573 million per year to the disabled facilities grant, from 2022-23 to 2024-25. We are also talking to local authorities and others, looking at whether we need to increase the subsidy amount per adaptation and reconsider funding allocation to better align with local needs, as well as funding a new service to enable minor repairs and changes to people’s homes. We need to know what needs to be done, and local authorities and others can come back to us on the adaptations that they need and the best way to achieve them. We must look at best practice to make sure that, as technology develops, people can stay in their own home for longer.

[Lord Dubs (Lab)]

My Lords, I declare an interest; my daughter-in-law is a full-time unpaid carer. First, the report says that unpaid carers’ money will go up to £69.70 a week. That is fine if you also have a job, but quite a few unpaid carers have given up their jobs to be unpaid carers, so that is all that they have got, other than the benefit that the person they are caring for may get. That is a pretty tough situation. Secondly, unpaid carers get very few breaks—some get no breaks at all. We must devise a way of looking after the 10 million or 11 million people who keep everything going. Although there are aspirations in this document, I would like to see them translated into something absolutely practical, so that I can go to an unpaid carer and say, “You’re full time, and something will happen to help you and take off the pressure.” It is a lonely business working full time, on virtually no money, looking after somebody. If the paid carers who come in the mornings or evenings do not turn up, it is the unpaid carers who keep things going. I hope that the Minister will pay attention to that. There is a whole agenda there which many of us will be pushing very hard on.

[Lord Kamall (Con)]

I know that the noble Lord has been a champion in this area. We have been quite clear that, as we go forward, a number of issues have to be understood. For example, you cannot say that all unpaid carers are the same. They all have different needs: some can work and some cannot work; some can spend a couple of hours working and share their care duties with others; there are sole carers; some are elderly and some are younger. We want all the different partners to come together to discuss individual needs—including respite for carers, to rest and recharge—and to look at their financial situations. We have laid out that those who are not working may be eligible for other benefits on top of the care allowance that they get. We are exploring this. It is a process of discovery and we want to ensure that it works. We have therefore set out the vision and the three-year commitment.

[Baroness Tyler of Enfield (LD)]

My Lords, I would like to pursue the points that were raised a minute ago by the noble Baronesses, Lady Fox and Lady Watkins. Despite the welcome long-term aspirations in the White Paper, the reality is that the chronic workforce shortages in social care are getting worse, with uncompetitive pay being the main culprit. If Covid surges this winter because of the new variant, these workforce problems will be magnified, with potentially disastrous consequences. There are similar concerns with unpaid carers, as the noble Lord, Lord Dubs, has just said. With no new resources from the new levy coming on stream until October 2023, and all the fragilities that I have just described, what are the Government going to do to address the pay and retention issues now, over this winter?

[Lord Kamall (Con)]

The Government have been listening to the workforce and understand its pressures. We recognise that this is the vision, and that we need to look also at the short-term issues. We announced £162.5 million for the workforce recruitment retention fund, and the new Made with Care scheme to recruit social workers and to send a message that social work can be a rewarding career. We are talking to different bodies, including the Department for Education, about how we increase professionalisation. We have also increased the national living wage, meaning that many of the lowest-paid workers will be paid more. We are investing at least half a billion pounds in supporting the development and well-being of the social care workforce, including an investment in knowledge, skills, and well-being. We will work with partners to set the conditions for the professionalisation over a longer period. We cannot do this immediately; we want to consult the education sector and care and social care experts, to give recognition. That will be a precursor to making progress on pay.

[Lord Lilley (Con)]

Does my noble friend agree that the primary obligation of a Government is to provide decent care for those who cannot finance their own care, and that the lowest priority is to provide taxpayers’ funds to enable those who own valuable assets to pass them on to their offspring? If it is possible to enable people to insure against the risk of having to use the value of their home to pay for their own social care, possibly through a state-aided scheme, would that not be desirable? Is he not astonished that the Labour Party, normally the champion of public sector provision and the enemy of channelling public money to the rich, should advocate channelling money to the rich and not a state-funded insurance scheme?

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[Lord Kamall (Con)]

I thank my noble friend for his question and pay tribute to him as one of the authors of a paper on funding social care, which had a number of interesting ideas. I am also very grateful to noble Lords across the House who have approached me with different ideas, including from the Labour Benches, these Benches and the Cross Benches. The Government have looked at a number of plans and have decided on this, but we are in conversation with the private insurance industry, including the ABI and others, to discuss what financial products it can offer in response to the changes. Some people are quite happy to take out insurance policies, but it depends on individual wealth levels and circumstances, and a number of different matters. We hope that there will be a development of the private market, and we are in conversations with the insurance industry. It has told this and successive Governments that, at the moment, there is no private sector solution for social care insurance. I regret that and wish that there was. My noble friend’s idea of the state underwriting it is interesting, but many reports have been written. I know that the noble Baroness, Lady Walmsley, will writhe in pain at this, but we have drafted that letter. Whatever we do, we will be criticised for it, but we will do this. We have set the vision for the first three years and have set the challenge for all of us to come together to provide the best possible social care for the future.

[Lord Desai (Non-Afl)]

My Lords, I want to reinforce something that the noble Lord, Lord Dubs, said: the distinction between unpaid and paid care workers is very unfair because people who have to care do not have a choice whether to do so—they just do not get paid. The noble Lord mentioned his mother looking after her sister—there is no choice in that matter. Something ought to be done to redefine the category of unpaid social worker, perhaps by making such people part of universal credit so that they will get a statutory payment as of right—because they are relieving the state of some expenditure on care and, of course, performing a very useful social function.

[Lord Kamall (Con)]

The noble Lord makes the very important point that unpaid carers save the state billions of pounds a year with all the work that they do and the love and attention that they give. Sometimes, they do have a choice, but they choose to be carers because they are worried about putting their relative into a home and are not quite sure about that—I understand that. But the fact is that, if they are unpaid, we are looking at how we can support them better. Unpaid carers are very different, and you cannot lump them all into one group: they have different needs and are at different stages of their lives. I emphasise the importance of making sure that we understand how we can personalise that journey for everyone—the cared- for person and the carer. But, if you have given up work, a range of other benefits may be available, and we want to make sure that unpaid carers are equally valued and not penalised for looking after a loved one.

[Lord Hamilton of Epsom (Con)]

My Lords, following on from my noble friend Lord Lilley’s remark, what percentage of people in need of care will be covered by the £86,000 cap?

--- Later in debate ---

[Lord Kamall (Con)]

I am afraid that I do not have the details of that, but I will write to my noble friend.

Ambulance Response Times

Lord Kamall Excerpts

Wednesday 1st December 2021 Lords Chamber

[Baroness Brinton]

To ask Her Majesty’s Government what assessment they have made of current ambulance response times; and what steps they are taking to reduce them.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

We recognise the unprecedented pressures that the ambulance service is facing, and strong support is in place. A £55 million investment by NHS England and NHS Improvement will provide 700 additional staff in control rooms and on the front line to improve response times. This is alongside £4.4 million to keep an additional 154 ambulances on the road this winter. NHS 111 is recruiting an additional 1,100 staff, alongside a £250 million winter GP capacity fund to avoid unnecessary ambulance calls and visits to A&E.

[Baroness Brinton (LD) [V]]

Last week, the BBC reported that Shropshire had run out of ambulances, as every ambulance was queueing outside hospitals. Yesterday, the Shropshire Star reported that the West Midlands Ambulance Service had apologised that ambulance-hospital handover times were now four hours. This is happening all over the country, and people are dying waiting for paramedics. This is before the expected winter surge starts, so what is the Government’s emergency plan right now?

[Lord Kamall (Con)]

The Government understand that the reason for a number of these waits is related to the Covid pandemic and increased callouts, and we have stats for that. Ministers are in regular contact with NHS England and NHS Improvement about the performance of the emergency service care system, including the ambulance service. One Minister of State has meetings that track the improvement effort at all times, including in ambulance trusts. In addition, there is investment of £55 million to boost ambulance staff by more than 700 and £4.4 million to keep an additional 154 ambulances on the road. Also, we are looking at ways to stop people calling out an ambulance when they do not need to—when their calls could be handled without the need to call out an ambulance.

[Baroness Thornton (Lab)]

My Lords, it seems clear that the problem is a symptom of system pressures and will require a whole-system approach to resolve it once and for all—Covid, social care packages to help with discharges and local factors, and the fragility of the NHS infrastructure going in to the pandemic. The Minister has explained some of the short-term emergency plans literally to save lives, but in the absence of an NHS workforce strategy, how will the Government produce a system-wide resolution of this matter?

[Lord Kamall (Con)]

The noble Baroness makes a very important point: we should be looking at this in a systemic way. In fact, I did my PhD in a department of system science, where you look at problems in a holistic way—rather than analysing individual problems, you look at the whole system. We found odd unintended consequences. For example, a friend forgot his inhaler, could not get one from the chemist, could not get one from the A&E and, in the end, had to call out an ambulance. There are a number of times when ambulances are called out needlessly, and that is on top of the pressures we are already facing due to Covid. We are tackling the backlog, which, hopefully, will also reduce ambulance waiting times.

[Baroness Walmsley (LD)]

My Lords, is the Minister aware that every ambulance service in the country is currently on black alert? The problem goes both upstream, into the community, and downstream, into the hospitals and social care. What are the Government doing to decrease the number of older people being blue-lighted into A&E because they cannot get the social care services to keep them safe in their own homes?

[Lord Kamall (Con)]

The noble Baroness makes a very important point. We are all aware of the difficulties in different parts of the system. We have invested £450 million to upgrade A&E facilities in more than 120 separate NHS hospitals ahead of last winter, and this is being used to boost the physical capacity of A&E through expanded waiting areas, increasing the number of treatment cubicles, reducing overcrowding, et cetera. This is alongside an additional £1.8 million to place more hospital ambulance liaison officers at the most challenging acute trusts to help address the long delays, to reduce ambulance queueing and to get crews back on the road quickly.

[Lord Rogan (UUP)]

My Lords, the Northern Ireland Ambulance Service and its personnel hold a special place in the hearts of the people there because of their bravery, selflessness and professionalism during 30 years of terrorist violence. With Northern Ireland currently registering the highest Covid infection rate in the UK, the ambulance service is now facing a new challenge, with waiting times trebling and some patients having to wait for up to six hours outside emergency departments to be admitted to hospital. What assurance can the Minister offer the people of Northern Ireland that Her Majesty’s Government are aware of this problem and will offer all possible support to local Ministers to help solve it?

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[Lord Kamall (Con)]

I thank the noble Lord for raising that point and making people aware of the challenges in Northern Ireland. As he will be aware, health is a devolved issue, but we are very much aware of the challenges in all four of the devolved Administrations. If he would write to me with extra information, I should be happy to pass it on.

[Baroness Tyler of Enfield (LD)]

My Lords, it is estimated that nationally, a quarter of patients in beds are clinically ready to leave hospital but cannot do so due to problems of discharge—particularly a lack of available care in the community. With fewer available beds, ambulances cannot discharge patients to a bed, leading to a lack of ambulances and paramedics available to deal with other emergencies. What plans do the Government have to deal urgently with the problem of discharge to help the NHS get through the winter?

[Lord Kamall (Con)]

All noble Lords have raised important points about the pressures on different parts of the system. In taking a systemic overall view, the Secretary of State is holding regular “pressure” meetings and looking at the key metrics in getting those pressures down. He is also looking at how we can tackle things systemically from within, including discharge issues. We are looking at how to improve on discharges to make sure that there is enough space, thereby continuing to ensure not only that elderly patients are back in their homes as quickly as possible, but that we reduce the length of time that others have to wait for ambulances.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, that concludes Oral Questions for today.

HIV and AIDS

Lord Kamall Excerpts

Wednesday 1st December 2021 Lords Chamber

[Lord Fowler (CB)]

My Lords, I beg leave to ask a Question of which I have given private notice. I declare my interest as an ambassador for UNAIDS.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

Perhaps I may start by paying tribute to the noble Lord, Lord Fowler, for his work as the ambassador for UNAIDS and for following this issue ever since the 1980s, when he was Secretary of State. We should recognise his commitment to this issue.

We believe that the UK can be proud of its efforts. Since last World AIDS Day, the UK signed up to the progressive and ambitious political declaration at the UN high-level meeting in June and declared our commitment to delivering a new global AIDS strategy so that the world has the best chance of meeting the 2030 goal of ending AIDS altogether. Noble Lords will be aware that, domestically, we have published a new HIV action plan.

[Lord Fowler (CB)]

My Lords, this is World AIDS Day and the international position is anything but encouraging. Has the Minister seen the reports of the serious setbacks in the fight against AIDS over the past year, with testing figures down by 40% and an annual death toll of over 660,000? Will he join me in paying tribute to the many non-governmental organisations and volunteers around the world whose efforts have prevented the toll from AIDS becoming even more catastrophic?

[Lord Kamall (Con)]

I am sure that all noble Lords would like to join the noble Lord, Lord Fowler, in celebrating the work of the NGOs. A lot of aid is government to government, which can sometimes be a barrier in reaching those it needs to help, especially in countries where the people who are suffering from HIV are discriminated against or stigmatised. Often, the best way to reach them is not via government but via those NGOs, so of course, I pay tribute to them, as I am sure all noble Lords do.

[Lord Cashman (Non-Afl)]

My Lords, the Global Fund to Fight AIDS, Tuberculosis and Malaria has saved 44 million lives since being founded 20 years ago. It is estimated that more than 3 million of those were thanks to UK aid. Therefore, will the Minister confirm that continued close partnership with the Global Fund will remain a central pillar of the UK Government’s planned international development and global health strategies?

[Lord Kamall (Con)]

I thank the noble Lord for his question and pay tribute to his work during our many years together in the European Parliament, where he was probably one of the strongest champions for LGBTQ+ issues, and AIDS and HIV awareness. My only regret is that I was not able to champion as strongly as I wanted to on ethnic diversity and the lack of it in the EU. Of course, we remain committed to the Global Fund and to other partners, including UNAIDS and the global financing facility. It is important that we all work together on this issue, not only in our own countries but particularly in countries where the situation is difficult and people have challenging health systems, and in countries where, unfortunately, gay people or those suffering from HIV are discriminated against or even stigmatised. One of the things that we can be proud of in the UK is that we stand up for those people.

[Baroness Barker (LD)]

My Lords, over the past 40 years, this country has led the international efforts to overcome HIV and AIDS. We have done so by leveraging our contributions to international funds. Unfortunately, in 2021, those were significantly cut, jeopardising world-leading research at a point when we were very close to some game-changing treatments and diagnostics. Will the FCDO review look, as a matter of urgency, at restoring the funding for UNAIDS and Unitaid?

[Lord Kamall (Con)]

I am sure that noble Lords understand the reasons for some of those cuts in terms of the pandemic and needing to redirect resources, but we are committed to continuing with funding and working at an international level. In fact, this issue has come up at a number of G7 international health meetings attended by UK representatives. The UK is seen on the diplomatic circuit as one of the leaders standing up for the rights of both gay people and people with HIV/AIDS.

[Lord Lexden (Con)]

Does the Government’s welcome new commitment, announced today, to ensure that home testing is available throughout the country mean that anyone who wants a test will be able to get one throughout the year?

[Lord Kamall (Con)]

I thank my noble friend for his question. I am pretty sure that the answer is yes.

[Baroness Chakrabarti (Lab)]

My Lords, generic drugs were crucial to the global response to HIV/AIDS; I see the Minister nodding. In that case, will we learn that lesson for this pandemic and stop blocking the TRIPS waiver so that we can better vaccinate the global south and protect ourselves from new variants?

[Lord Kamall (Con)]

One of the best ways to help to vaccinate people across the world is through multilateral, bilateral and plurilateral partnerships. We will have donated 100 million coronavirus vaccine doses by next June. We are committed to working internationally. This issue comes up at the G7 where, once again, we are seen as leaders on the COVAX programme and other such programmes. It is important that we focus on what is effective and how we can get vaccines to those who really need them.

[Baroness Bennett of Manor Castle (GP)]

My Lords, following on from the noble Baroness’s question, the UK Government played a leading role in establishing the Medicines Patent Pool, which is a means of simplifying and accelerating the generic production of HIV medicines by sharing patents. Does the Minister agree that a global pooling mechanism for Covid-19 would support countries’ ability to access the vaccine and the drugs required to control Covid-19 infections? Will the Government give their full support to the Covid-19 Technology Access Pool and encourage UK pharmaceutical companies to license through it?

[Lord Kamall (Con)]

In tackling coronavirus and helping those who cannot access even a first dose of the vaccine while people in this country are now going for their third—even fourth—injection, it is really important that we act internationally. This issue comes up at international meetings. We are seen to be leaders in co-ordinating; we are doing much of that via the international COVAX programme and by talking to pharmaceutical companies about what more they can do.

[Baroness Manzoor (Con)]

My Lords, more than 40% of people who are diagnosed are diagnosed later in life. Can my noble friend say what the Government are doing in relation to this so that the stigma is removed and people come for testing much earlier? I welcome the government strategy as it currently stands.

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[Lord Kamall (Con)]

I thank my noble friend for making that point. I am afraid that I do not have specific details on the older population, but I will make sure that I write to her.

[Lord Collins of Highbury (Lab)]

My Lords, the Minister mentioned stigmatised communities. UK civil society organisations have raised concerns that previous global health strategies have failed to address the gender-specific aspects of HIV, in particular the priorities of marginalised women. Can the Minister tell us how the FCDO’s planned global health strategy will address the underlying structural inequalities that contribute to the vulnerability of girls and women?

[Lord Kamall (Con)]

The Government have made more money available for the funds, particularly in helping young girls and young ladies in different countries. At the same time, we must work out what we can do, as donors or as an international community, to help address some of the structural inequalities in particular countries. We can name it, we can draw awareness to it, but how much deeper can we go? Quite often, one of the best ways to do this is to support the NGOs who are right at the heart of the community, understanding these issues and understanding the structural inequalities on a daily basis.

[Lord Hayward (Con)]

My Lords, following on from the question asked by the noble Lord, Lord Collins, but bringing it to this country, there is still a general perception that HIV/AIDS is a gay disease. There is a growing proportion of the population that are infected who are heterosexual. Can my noble friend ensure that the messaging is directed at heterosexuals as well as the gay community?

[Lord Kamall (Con)]

I thank my noble friend for making that very important point and for stressing that this should be seen not just as a gay disease but as a disease that heterosexual and other people also suffer from. One of the issues in the HIV plan has been to ensure that those communities which maybe have a macho approach to a number of these issues are addressed, particularly at the local community level. It is very difficult, and we have to tread carefully, particularly with some of the ethnic minority communities, so that we are not seen to be stigmatising that community or blaming them but getting the right balance. The fundamental point that my noble friend makes is very important and we should repeat it: HIV does not affect only gay people—it also affects heterosexual people and younger communities.

[Lord Laming (CB)]

When coronavirus struck us, within a year, remarkably, a number of vaccines had been produced, to huge effect. Does that not stand in marked contrast to what has happened with HIV/AIDS? Is it not amazing that 20 years after the noble Lord, Lord Fowler, did so much to establish a proper response to HIV/AIDS, we still have do not have the medical support that we need for it? Can the Minister take this back to the department and see what more can be done to improve the situation?

--- Later in debate ---

[Lord Kamall (Con)]

The noble Lord makes an incredible point. Not many people are aware that there is no cure as such yet. It is about ensuring that you reduce the risk of transmission and that those who contract HIV can live longer, as opposed to the beginning of the 1980s, when this epidemic hit us, and sadly many people lost friends, loved ones and others prematurely. On looking for a cure, I assure the noble Lord that the department is very aware of that. In my briefing for this I asked how come we still do not have a cure after so long—a question that continues to be asked. Let us pay credit to the pharmaceutical industry and the medical profession. They have tried.

[Lord Brooke of Alverthorpe (Lab)]

What steps are being taken with those members of the Commonwealth who have difficulties accepting or supporting the gay community?

[Lord Kamall (Con)]

The noble Lord makes a very important point that we should be aware of and address. We are aware of certain countries—I have been warned not to name and shame them, sadly—which stigmatise, discriminate, or have some other explanation. One of the best ways to deal with this sometimes is not via government-to-government help but by ensuring that we get to NGOs that are working with people on the ground. Also, at the macro level, in international forums, we can raise this issue. The UK, to its credit, is seen as a world leader when raising these issues at different diplomatic forums.

[Baroness Hussein-Ece (LD)]

My Lords, we heard earlier that HIV/AIDS has always been perceived as a gay problem, which is of course a fallacy; it is also perceived as something that young people are more likely to contract. The facts show that the over-50s have, for the past decade, been the fastest growing group contracting HIV/AIDS and living with it to quite a senior age. What is being done to target that particular group? It is not just young people who are affected by this, but they should also be vigilant in protecting themselves against HIV/AIDS.

[Lord Kamall (Con)]

The noble Baroness makes a very important point of which we should all be aware. It is great that we are all living longer and, as I am sure noble Lords agree, that we are being sexually active for longer. The HIV plan sets out how we look at different—for want of a better word—segments or parts of different communities where there are issues, and how we target messaging there. That is the most important thing, rather than trying to have a one size fits all that others could ignore.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, there has been a huge amount of progress in the last 30 years since—I think I may say my noble friend—my noble friend Lord Fowler did his good work. But there is still work to do in this country. I noted that the Minister proudly referred to there being perhaps less stigma in this country than elsewhere. It is true that we have no room for complacency in this regard and that this is still one of the main reasons why people who should be tested are not being tested. Can the Minister tell the House the Government’s current assessment of the infected but untested rate of HIV/AIDS in this country?

[Lord Kamall (Con)]

I am afraid I do not have a specific figure for the noble Baroness, but the action plan sets out how we are going to increase access to and scale up HIV testing, by focusing on populations and settings where testing rates have not been high to ensure that we tackle them, that new infections are identified rapidly and that people receive the necessary treatment faster to prevent complications. We will operate the annual HIV Testing Week between 7 and 11 February 2022, and the campaign will be called “It starts with me”. During that week we will open self-sampling HIV testing services for all residents of England, and we want to make sure that lots of different programmes are raising awareness. I know that a number of noble Lords across the House take this issue seriously and I would welcome their advice.

Health Protection (Coronavirus, Wearing of Face Coverings) (England) Regulations 2021

Lord Kamall Excerpts

Wednesday 1st December 2021 Lords Chamber

Moved by

[Lord Kamall]

That the Regulations laid before the House on 29 November be approved.

Relevant documents: 22nd Report from the Secondary Legislation Scrutiny Committee. Instrument not yet reported by the Joint Committee on Statutory Instruments.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

My Lords, in moving these regulations, I will also speak to the Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) (Amendment) (No. 4) Regulations 2021.

We have always known that a worrying new variant could pose a threat to the progress that we have made as a nation. On Friday 26 November, the World Health Organization designated variant B.1.1.529, now known as omicron, as a variant of concern. I thank the Government of South Africa for their rapid identification of this variant and exemplary transparency in alerting the world. Yesterday, the Secretary of State spoke with Minister Phaahla to convey this unanimous message from G7 Health Ministers and reaffirm our commitment to working together to address the global impact of the omicron variant.

Some 22 cases have been confirmed in England and Scotland, but we expect that number to rise over the coming days. Omicron has been spreading across numerous countries. Early indications show that it may be more transmissible than the delta variant, and that current vaccines may be less effective against it. It may also have an impact on the effectiveness of one of our major treatments, Ronapreve. We are therefore concerned that omicron may pose a substantial risk to public health. That is why we are taking decisive action against it to buy ourselves time and strengthen our defences while our world-leading scientists learn more about this potential threat.

Our test, trace and self-isolate system continues to be one of the key ways in which we can manage and contain the virus and protect the nation. The self-isolation regulations that we are debating today were introduced to provide a legal requirement to self-isolate for individuals who have been notified that they have tested positive for Covid-19 or are a close contact of a positive case. On 16 August, thanks to the success of the vaccine rollout, we were able to introduce a number of exemptions to self-isolation for close contacts, including for those who are fully vaccinated or under the age of 18.

Given the greater threat that may be posed by the omicron variant, we have reviewed the application of these exemptions. This latest amendment to the self-isolation regulations is targeted at helping to slow its spread. Since 4 am yesterday, all individuals notified by NHS Test and Trace or a public health official that they are a close contact of a confirmed or suspected case of the Covid-19 omicron variant will be legally required to self-isolate, regardless of their age or vaccination status. Anyone who has been notified as testing positive for Covid-19, regardless of the variant, will continue to be legally required to self-isolate.

We have also reintroduced the requirement to wear face coverings in shops, including supermarkets, banks, and close contact services such as hairdressers, on public transport, and in transport hubs. Some noble Lords may ask why face coverings are not required in hospitality venues such as cafes and pubs. I would respond that this is part of a targeted and proportionate intervention. We recognise that not everyone is able to wear a face covering. That is why health and disability exemptions will continue to apply. However, those who are able to must continue to follow the rules so that we might slow the spread of this new variant.

I stress that these measures are temporary and precautionary, and will be reviewed in three weeks, which is the period scientists say is required before it is known how the variant impacts on the effectiveness of vaccines. Ultimately, the vaccination programme, and the test, trace and isolate system continue to be our most effective way of reducing transmission, along with continuing to practise good hygiene, keeping spaces well ventilated, and wearing a face covering in enclosed or crowded spaces.

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[Baroness Chisholm of Owlpen (Con)]

No, let the Minister finish first.

[Lord Kamall (Con)]

The UK Health Security Agency continues to monitor the situation closely in partnership with scientific and public health organisations across the world. Covid-19 is not going away and so we are likely to keep seeing new variants emerge. If we want to learn to live with the virus, we must follow the scientific evidence and advice and act in a proportionate and responsible way if a variant has the potential to thwart our progress. As we do this, we are taking a well-rounded view, looking not just at the impact of these measures on the virus, but on the economy, education, and non-Covid health, especially mental health. I am confident that the responses we set out today are balanced and responsible steps that are proportionate to the threat we face.

[The Deputy Speaker (Lord Brougham and Vaux) (Con)]

I call the noble Baroness, Lady Brinton. No? I call the noble Baroness, Lady Thornton.

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[Noble Lords]

You’re on!

[Lord Kamall (Con)]

I apologise to noble Lords— I was looking forward to so many more contributions. I hope noble Lords will forgive me for enjoying the debate rather too much. I apologise to my noble friend Lord Greenhalgh, who has been waiting for ages, and to my noble friend behind me who says he has to go to the theatre. I hope he will wear his mask when he goes to the theatre.

I thank all noble Lords for their contributions to today’s debate. What is really important and what it shows is that we are still debating issues and contesting the science. Clearly there is a range of views across the House on the issues raised. There is no consensus on this. That is really interesting in the way it shows that we can debate these issues and question the statistics. I will turn to some of the points noble Lords made, particularly about some of the statistics but also on the regulations.

I hope noble Lords will forgive me if I do not answer every single question and refer to every single noble Lord who asked them—unless noble Lords want to stay here a bit longer and my noble friend Lord Greenhalgh can go and have another teacake or something while he is waiting.

[Lord Robathan (Con)]

That’s a bit much!

[Lord Kamall (Con)]

Sorry, was that offensive? I apologise for any offence caused to my noble friend. I just assumed that because I like teacakes, my noble friend also does.

I will start with some of the questions. On the question of how many people have been helped by some of these financial services, as of 17 November 2021, local authorities have reported 362,573 successful claims since the start of the scheme, totalling £181 million in test and trace support systems.

Despite the easing of the restrictions at step 4 of the road map, the Government have continued to recommend that face coverings are worn in crowded and enclosed spaces. We accept that there is wide support for reintroducing mandatory face coverings, but we have always tried to balance these issues. As I said in previous debates, we look at a number of factors, not only medical but economic and social. Also, within health itself, many mental health experts are very concerned that we might go for more lockdowns and about some of the measures that a number of noble Lords have mentioned.

As we saw in the debate, there are noble Lords who believe that we have gone too far and noble Lords who feel that we have not gone far enough unless we effectively enter a second lockdown. That shows the range of views here and the difficulty, as my noble friend, Lady Altmann, said, that the Government are damned if they do, damned if they do not, but we accept that.

So, do face masks actually work? This is where there is still a debate. I thank my noble friend Lady Noakes for pointing out the article by Professor Simon Wood, who is professor of statistics at the University of Edinburgh, in which he analysed the BMJ paper. It is in effect a meta-analysis. A number of newspapers have taken a line saying that wearing a mask cuts Covid by 53%. I encourage noble Lords to read the article, in which he takes apart the statistics as a statistician and looks at, as those who have done statistics will understand, whether we have a significant number of samples to make it statistically sound. In addition, Professor Naismith of Oxford University has been quoted as saying that

“the Scottish and English approach to masking, although formally different since July, has made no meaningful difference to delta.”

Once again we see that there is a whole range of views, but we have listened to those views. Because we do not yet know enough about this variant, we will continue to review the data. For example, some say that it is very mild in South Africa so we should not be overly concerned about it, but we also have to remember that South Africa has a different demographic in terms of younger people. We know that when the virus first struck it disproportionately affected older people—as my noble friend Lord Robathan said, people aged over 85. On the balance of the data at the moment, we believe that wearing face masks works but we have always been very careful to make sure that it is proportionate where we do it.

On the expiry of some of these measures, as the Prime Minister said on Saturday, all the provisions that have been voted on will be reviewed in three weeks. They are necessary and proportionate while we learn more. I refer to the economics Nobel laureate Friedrich Hayek, who talked about humans having limited knowledge. He talked about the conceit of knowledge. The way to understand a lot of complex problems is to allow the discovery process to take hold and to look at what we can learn from that process. We should be very careful not to imagine that we have total knowledge. What we have to do is assess it proportionately.

It is our hope that these regulations will no longer be necessary in three weeks’ time and that we can return to the system that we lived under last week, but in the event that we need more time to understand the effect of the variant, or that the data shows that we need to take a different approach that requires new regulations, the House will return to Parliament ahead of the Christmas Recess for a debate and vote on the regulations ahead of their coming into force.

On regulations expiring, the international travel regulations will expire at the end of 16 May 2022. The face covering regulations will expire, unless extended, at the end of 20 December 2021. The self-isolation regulations at the moment expire at the end of 24 March 2022, but we will continue to review the data. Almost daily the data is being reviewed and conversations are going on. We will also continue to review the data on the new variant and we hope to update Parliament on the review in the week commencing 13 December.

A number of noble Lords asked about facilities. We are told that setting up dedicated testing facilities at border entry points such as airports is logistically difficult at the moment, and risks delays to passenger journeys and operations. Given the turnaround for a PCR test, passengers would still have to travel to their home or the place they are staying and isolate there before receiving a result. The Government are taking a measured and proportionate response. We want to try to protect the UK from omicron while allowing continued safe travel.

A number of references were made to points made by Dr Jenny Harries. As the Prime Minster said, the guidance remains the same as the measures that were in place to fight delta. We have now brought in tougher measures, but we continue to take advice from a number of experts. Individual experts are free to give their viewpoint but we look at the balance—some of it medical, some of it clinical, but also economic and social factors—and getting that proportionate.

[Baroness Thornton (Lab)]

I need to ask the Minister about the fact that our most senior adviser on these matters gave advice that was then completely denied by No. 10 and the Government. That will at least cause confusion. It is not a question of balancing this and that; Jenny Harries was very clear in her advice about what she thought should happen. It was quite the opposite to what the Prime Minister said should happen. The Minister needs to acknowledge that that will cause confusion.

[Lord Kamall (Con)]

I thank the noble Baroness for raising the point, but it depends on how it is reported. The real issue here is that a number of different experts are advising. Of course, you can pick and choose which expert you decide to listen to. A few weeks ago, noble Lords were picking up on comments made by the NHS Confederation. That is not a scientific body, but noble Lords claimed that it showed that we need to lock down. It is very easy to pick and choose your experts, but we continue to listen to a wide range of experts.

One of the great things about science that we should remember is that there is no such thing as “the science says”. Science should remain contestable. Can you imagine if science was not contestable? We would still be saying, “You can’t challenge the notion that the solar system revolves around the earth.” Scientists challenged that, and that is how we advance knowledge. It is really important that we continue to contest. Scepticism is one of the most important factors in science to make sure we make progress. We will listen to a range of experts.

I ask those noble Lords who really want to lock down more, and who say that we not only have not done enough but should do more and lock people down, to look at the impact that has on people’s mental health and on our economy. I ask them to think about the wider impact and to remember that we are not in the same place we were a year ago. We have been absolutely clear that vaccines work and that the best thing we can do to get through this is to get vaccinated. It is not too late to get your first or second vaccine. I am grateful to noble Lords who have asked questions—

[Baroness Thornton (Lab)]

The Minister is now saying that there is absolutely no doubt about the science behind vaccinations. That is not a matter of opinion; there is no doubt about the need for vaccinations. He is straying into dangerous territory when he says that there is science on this side and science on that, because the Government have rightly said that vaccination is the way forward.

[Lord Kamall (Con)]

I thank the noble Baroness for agreeing with the Government’s line that vaccination is the most important way forward.

[Baroness Thornton (Lab)]

The Minister is being patronising. We have always—always—supported the Government on vaccination; I am sorry that the Minister feels he needs to be sarcastic about that.

[Lord Kamall (Con)]

I apologise to the noble Baroness if I came across as sarcastic.

In terms of hospitality settings, quite rightly, as a number of noble Lords have said, even though we have mandated it in certain settings, it is being left to settings to decide. This is in line with property rights, but also something that people have been asking for—a number of noble Lords have asked “Why not just let the establishments themselves decide, so people can make a decision whether they go to somewhere where masks are mandated or somewhere where they are not mandated?” We are looking really hard at this and we want to make sure that we are proportionate. It could be that we find out that omicron is not that dangerous, but we have to make sure that we have the data and that we sequence it all. It could be that it affects us more in the UK that it would in South Africa because of the change in demographics. That is a really important point.

In terms of who is responsible for enforcement, the police and Transport for London officers have powers to issue fixed penalty notices for non-compliance with the regulations. They are using the four E’s in a proportionate way: engaging, explaining and encouraging before enforcement, just to remind people, if they can, to make sure that they wear a face mask.

The Health Secretary has also asked the JCVI to consider giving boosters to as wide a range of people as possible. If you are boosted, your response is likely to be stronger, so it is more vital than ever that we get our jabs.

On helping the rest of the world, the UK remains committed to donating 100 million doses by mid-2022. We are also extremely grateful to the South African Government; we have been talking to a number of partners, including South Africa directly, to make sure that we do not disincentivise other countries for doing the right thing by reporting the outbreak in the first place. We are doing all that we can.

I am trying to make sure that I answer all the questions; I apologise if I am not able to. My noble friend Lady Neville-Rolfe asked about exemptions for children under the age of 11 and those unable to wear a face covering due to health, age, equality or disability reasons. In terms of the impact to the economy, we do not know the extent to which the variant escapes the vaccine, but as soon as we do, we will be able to make a better measure. We do not at the moment expect there to be significant economic disruption. We have said that we believe face coverings are effective at reducing transmission indoors. The recent UKHSA study suggests that all types of face coverings are, to some extent, effective, but we also welcome challenges to that data. The advice remains the same: we believe that, on balance, it is better to wear a face mask. Many noble Lords have agreed and disagreed with that, but we have to balance these things.

Proportionate measures remain in place in schools. Face coverings should now be worn in communal areas by older students and teachers. The Department for Education is looking at how we make sure that there are clear guidelines on that. We advise staff, visitors and pupils to wear face coverings in communal areas.

I turn to the point from the noble Baroness, Lady Tyler, and that very personal case; it highlights—this should sober us up—those very powerful words that this is not over. We have said that consistently. It is not over. If we believed it was over, we would have removed all restrictions. It is highly likely, but not definite, that we may have to continue to get boosters. Just as we have an annual flu vaccine, we may in the future end up with an annual Covid vaccine, including looking at other strains.

We have said who is responsible. In answer to a point made by my noble friend Lord Cormack, may I suggest that he takes his point about continuous committees up with the Lord Speaker? That is not really in my remit as Minister for Health. My initial reaction is that it seems a good idea, but let us see what the Lord Speaker says.

I again thank all noble Lords for their contributions and for continuing to challenge. That is really important. I can assure my noble friend Lord Cormack that today I asked my department for a list of potential or forthcoming regulations so that we can lay them as early as possible, as my noble friend and other noble Lords suggested. I am grateful for the acknowledgement that we laid these regulations as quickly as we could, and I pledge that we will try to improve that as much as we can, I too, believe very strongly in procedure and the Government and the Executive being held to account. It is really important.

[Baroness Neville-Rolfe (Con)]

Before my noble friend sits down, I thank him for mentioning the economy. His assessment is that the impact on the economy should not be great, but of course there has already been an impact on the economy from this new strain. I think I mentioned in particular the transport industry, which has been affected. Would he be able to come back to me on this business of economic assessment—in fact, not only economic, as I am also worried about the impact of the measures being taken on things like cancer deaths. There is no time to discuss that now, but I would really like to have a further discussion, perhaps bilaterally. We will of course have my noble friend Lady’s Noakes’s regret amendment in due course, but that may be months away. It really is very important to understand the implications of what we are doing. We are doing it for the right reason, but it has a wider impact.

[Lord Kamall (Con)]

My noble friend raises an important point. We also have to clear about unintended consequences and the costs of what we have been doing. I read an interesting article from the leading behavioural economist Paul Ormerod, who asked where have all the economists been when it came to this debate, as economics is about considering trade-offs.

I again thank the Government of South Africa for their rapid identification of the variant and their transparency in alerting the global community. I commend our scientific and public health experts who continue to monitor the situation closely alongside our scientific and public health partnership organisations across the world. We are continuing to collaborate in order to understand the virus, including the data and the different demographics that our countries have and whether a study in one place is relevant to a study in another place.

I also thank the House for its valuable scrutiny today. The Government hope that the temporary and precautionary measures laid in these regulations will enable us to slow down the spread of the omicron variant while we gather more information on how best to deal with it and how infectious it is. The Secretary of State assured Members in the other place that if it emerges that the omicron variant is no more dangerous than the delta variant, we will not keep these measures in place for a day longer than is necessary. I hope that that is the case, but we must take precautions and act decisively until we have a fuller understanding of the omicron variant. I commend these regulations to the House.

Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) (Amendment) (No. 4) Regulations 2021

Lord Kamall Excerpts

Wednesday 1st December 2021 Lords Chamber

Moved by

[Lord Kamall]

That the Regulations laid before the House on 29 November be approved.

Relevant documents: 22nd Report from the Secondary Legislation Scrutiny Committee. Instrument not yet reported by the Joint Committee on Statutory Instruments

Motion agreed.

Coronavirus Act 2020 (Early Expiry) (No. 2) Regulations 2021

Lord Kamall Excerpts

Tuesday 30th November 2021 Grand Committee

Moved by

[Lord Kamall]

That the Grand Committee do consider the Coronavirus Act 2020 (Early Expiry) (No. 2) Regulations 2021.

[The Deputy Chairman of Committees (Lord McNicol of West Kilbride) (Lab)]

Before I call the Minister, I must inform the Committee that the noble Baroness, Lady Brinton, will take part remotely so I will call the Lib Dem response at the appropriate time.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

My Lords, the Coronavirus Act has been a central part of the Government’s response to Covid-19. It includes powers to bolster the health and social care workforce through the temporary registration of practitioners. More than 13,000 social workers and 28,000 nurses, midwives, paramedics, operating department practitioners, radiographers and other professionals have joined the temporary registers. This continues to provide extra resilience for our health and social care sector during these uncertain times. It also demonstrates the commitment and determination of our fantastic health and social care professionals.

The Act includes powers to ensure that critical functions in society are able to continue throughout the pandemic. For example, it has allowed virtual court hearings to take place in a wider range of circumstances. The Government plan to secure some of these powers in alternative primary legislation. The Act also includes powers that have enabled the Government to provide vital support to people and businesses, including provisions for statutory sick pay for Covid-19-related absences; the Coronavirus Job Retention Scheme, which has supported 11.7 million jobs; and the Self-employment Income Support Scheme, which supported almost 3 million self-employed individuals.

The Coronavirus Act has been a critical part of the Government’s response to the pandemic, but I acknowledge that some noble Lords are concerned about some of the powers in it. I assure them that the Government have sought to use the powers in an appropriate and proportionate way. There are arrangements in place to ensure accountability, including regular opportunities for parliamentary scrutiny; this accountability is vital. I am grateful to noble Lords, my honourable friends in the other place and the Joint Committee on Statutory Instruments, whose welcome review of our draft instruments continues to ensure their accuracy.

We will continue to review the powers in the Act and are committed to ensuring that emergency powers remain in place for only as long as they are necessary. The most recent six-month review of the Act in September identified seven provisions, and parts of an eighth, that could be expired. Once approved, Parliament will have expired half of the original 40 temporary, non-devolved powers in the Act ahead of schedule.

The regulations that we are debating today expire some of the most controversial provisions in the Act, including the powers under Schedule 21, relating to potentially infectious persons, and Schedule 22, giving powers “to issue directions relating to events, gatherings and premises”. The regulations also expire other powers that are no longer needed, such as those under Section 23 enabling the variation of “Time limits in relation to urgent warrants” under the Investigatory Powers Act and Section 56 powers related to “Live links in magistrates’ court appeals” in certain situations, as well as powers under Section 37 and parts of Section 38 relating to the education and childcare sectors. We are also expiring Sections 77 and 78, which were time-limited powers in the Act, and a further provision on behalf of Northern Ireland.

Expiring these provisions is an important milestone. It is possible only because of the significant progress that we have made so far in our fight against the virus, but we have continued to be clear that the pandemic is not yet over. The Government believe that the remaining provisions in the Act are important to continue to support the response to Covid- 19 over the coming months. Everyone should continue to do their bit to keep themselves and others safe as we tackle the winter months ahead, so let us encourage everyone to get their first, second and booster doses, when eligible. It is not too late for those who have not yet received their first or second doses to get them and we urge them to come forward. We also urge everyone to continue to wash their hands, to ventilate indoor spaces, to wear masks where mandated—but even where not mandated, if appropriate—and to stay home when they feel unwell.

We are conscious of how hard the pandemic has been for so many people and we are grateful to everyone who has made sacrifices. We are grateful for the dedication and determination of individuals and communities across our great nation and to all those who have worked so hard in the fight against Covid-19.

--- Later in debate ---

The Explanatory Note suggests that the uprating of benefits was linked to supporting people at a time of unprecedented circumstances. However, one thing that the pandemic highlighted is that those most in need are struggling with incomes that are simply too low, pandemic or no, and it is this that needs addressing. The regulations may turn off the power to increase levels of benefit payment, but they cannot turn off the reality that many will go back to being unable to make ends meet, with all the inequalities that follow from that. I look forward to the Minister’s response to these points.

[Lord Kamall (Con)]

I start by thanking all noble Lords for their contributions to this important debate and for continuing to ask questions to hold us to account. The Coronavirus Act has been fundamental to facilitating the Government’s response to the pandemic, supporting individuals, our healthcare, our public services and our businesses. We see expiring a further seven provisions of the Act as a significant milestone towards winding down the emergency powers. To be clear, the Government retain only those powers seen as critical to the ongoing response and recovery, and I thank noble Lords for their general support for that principle, but we will continue to review every aspect of coronavirus legislation.

I now turn to some of the points made by noble Lords this afternoon. First, why are we making some of these changes now, given what happened over the weekend? In reality, a thorough, in-depth review of all the provisions was conducted in September. The provisions we expire today are seen as no longer needed, as we have explained. The provisions that give the Secretary of State the power to prohibit or restrict events and gatherings have been dropped, but most legal restrictions to date have been achieved under the Public Health (Control of Disease) Act 1984. Some of these additional powers are not required because the Government assess them as appropriate to expire, but they can also respond under that Act to increase our vigilance and restrictions in response to coronavirus and any possible variants.

A number of noble Lords raised concerns about the expiry of Section 77 on the uprating of working tax credits. Throughout the crisis, the Government have sought to protect people’s jobs and livelihoods, and to support businesses and public services. The Government have always been clear that the £20 increase was a temporary measure to support the households most affected, that it was time-limited and that it can no longer be used because it related to the 2020-21 tax year.

During the recent Budget, the Chancellor announced that, since the restrictions have been lifted, economic growth has exceeded expectations and the labour market is recovering strongly. The Government are now focusing on supporting people to move into and progress back to work, including the Plan for Jobs to help people move into employment so that they can get a regular wage. Also, workers leaving the furlough scheme and unemployed people over the age of 50 will be helped back into work as part of the more than £500 million expansion of the Government’s Plan for Jobs. Those on the lowest wages will also be helped to progress their careers, and existing schemes targeting young people will be extended into next year. On balance, it was considered appropriate to try to help those who genuinely want to get back to work.

Also, one of the struggles for any temporary government measure is, as I think Ronald Reagan once said, that there is nothing more permanent than a temporary government measure. We have to be aware that, whatever you do temporarily, there will be concerns when a temporary measure comes to an end. Frankly, I expect we will see that in a couple of years’ time when we reassign the uplift back to social care, given that we have given it to the NHS temporarily to help tackle the backlog. I imagine that in a few years’ time the Government will be accused of making cuts, even though we made it clear that it was temporary to help the backlog. We want to focus it mostly on social care.

A number of noble Lords raised points about Covid-19 vaccines. As many noble Lords will recognise, we stepped up yesterday in response to the variant. So far, the NHS has administered more than 17.5 million booster or third doses in the UK. Almost 51 million over-12s in the UK have now received at least one vaccine dose and 46 million have had at least two doses. The line that we continue to say is that it is important that people get jabbed.

Yesterday, the Joint Committee on Vaccination and Immunisation updated its guidance, which the Government accepted, that booster vaccination eligibility should be extended to all adults aged 18 to 39 years, as well as to severely immunosuppressed individuals who have received three primary doses. We will continue to ask and to campaign. The general campaign reaches lots of the people who have already had their vaccines, but we are looking at more targeted ways to make sure that people recognise that it is never too late. If you have not had your first or second jab, do not think that it is too late. You can still do so. There is plenty of opportunity to do so. Do not feel that you have been ignored. We are also working with a number of civil society organisations at a local community level. I thank noble Lords across the Committee who have given advice on how we can reach some of those hard- to-reach demographics. In some ways, it is a more targeted approach to spend that effort making sure that people are vaccinated, rather than on a message that reaches lots of people, many of whom say, “Why is that aimed at me? I’ve already been vaccinated and I’ve told my family”.

Local authority meetings were raised by a number of noble Lords. The Department for Levelling Up, Housing and Communities launched a call for evidence on 25 March to gather views and inform a longer-term decision about whether to make express provision for councils to meet remotely on a permanent basis. That consultation has closed and the department is considering responses to it. I hear and understand the point very strongly that these decisions really should be left to local authorities. I will definitely take that back, because it is important when we are talking about devolving power to the most local level. I hear that message strongly and understand the concerns.

There are many other meetings which are not main meetings where councillors have been able to participate virtually as well as in person. Not all decisions are taken in full council or in local authority committees. A lot are delegated. The problem is that any permanent change would require primary legislation. The Department for Levelling Up, Housing and Communities is looking at this.

I was asked why the changes are expiring now, given what happened over the weekend. We think that the powers that have been retained are sufficient to ensure that we can respond, for example, to omicron and other variants. Some civil libertarians would say that these powers are still too much. The other powers which are expiring are not necessary for us to be able to continue to respond.

I thank the noble Baroness, Lady Brinton, for giving me notice of her question about people who are waiting for lateral flow tests to come back. I immediately raised that in my department. I have been trying to get an answer as quickly as possible. I had hoped to have it in time for this afternoon’s debate. I apologise that I do not have it yet. I will write to the noble Baroness on that specific issue. As she said, it is urgent to get this information as quickly as possible. I have impressed that on my department.

The noble Baroness also raised the issue of doctors who are kept hanging around for months. I note what she said and will raise it within my department. It is always helpful when noble Lords raise issues with me. They enable me to take them back to the department. If noble Lords raise an issue that has previously been raised, it emphasises its importance.

There were a number of questions about face coverings. Many noble Lords clearly feel that they make a difference. I wear one, partly because I think we should be sending this message anyway, but also because it is not too much of an imposition. It is not too much to ask. I do not see that my individual liberties are being impinged or affected by wearing a face mask in public. The advice we receive from a range of scientists balances political, social and economic needs with health care. With some of the restrictions we introduced previously, there have been concerns about their impact on mental health. We always try to keep a balance. We listen to a range of experts. I have listed a number of them in the past, including the UKHSA and others. Some have chosen to express their own view, but we have always been clear that we listen to a range of views.

There are issues about masks in indoor spaces. It is quite right that they should be worn on public transport and in shops. I asked a few experts today about why they should not be worn in restaurants. The answer was that, in a restaurant, you are continually taking off and putting on your mask. There was a concern that, touching it and having breathed on it, it could lead to a greater chance of transmission. In a shop, the situation is fairly constant. You go in with the mask on, keep it on and come out. In a restaurant, you are taking it off and putting it on. One of the other concerns was about balancing social mixing and economic impact. It is still up to individual establishments. Noble Lords will be aware that some establishments have decided that they will continue to insist that their customers wear masks. Frankly, in some ways, that is an appropriate level. It is about property rights. It is up to them whom they let in. It is a difficult balance. Given that some people think that continually taking a mask on and off and walking around may make things worse, on balance, it has been decided not to extend mask-wearing to restaurants. We continue to review all the advice.

I know noble Lords were asking for more restrictions and for face masks to be used more earlier on. We never ruled that out; what we said was that there was sufficient evidence to suggest it, or there was sufficient consensus among all our advisers, we would move that way. There is clearly quite a lot of consensus on face masks in shops and on public transport, but not yet in other places. This is why we have been clear.

I am trying to think if I have missed any of the questions. If I have, I apologise to noble Lords. I will make sure that we go through the transcript—

--- Later in debate ---

[Lord Kamall (Con)]

Thank you. I appreciate it.

[Baroness Merron (Lab)]

Before we go off the issue of face masks, I appreciate the explanation about restaurants, but my question was about large gatherings—for example, cinemas, theatres and conferences, to name but a few. The explanation about restaurants does not apply there. I hope the Minister will take this back as it is simply a question of where is the logic regarding the venue. It seems to make no difference; it is about the fact of there being a number of people.

The real point I would re-put to the Minister, which links with that, is my question about the comments of Dr Jenny Harries on Radio 4. She said that we should decrease our social contacts, whereas the spokesperson for the Prime Minister says that we will not be doing that. I am very concerned about mixed messaging, as I am sure the Minister is—I know he is from what he has said. It would be extremely helpful to put on the record where we are on whether decreasing social contact makes a difference.

[Lord Kamall (Con)]

I apologise if I was not clearer before. I thank the noble Baroness for taking advantage of the opportunity to ask that question and finding the urge to do so irresistible. On theatres and cinemas, one of the things that was put to us was that in a restaurant, you are constantly taking a mask on and off, whereas in a cinema or theatre you are not really eating that much. Okay, you might well go to buy your ice cream—I do not know whether they still sell ice cream and jelly babies in theatres, or whatever it used to be; this will look very odd in Hansard when someone reads it—but you are not constantly doing and you are more or less constantly wearing your mask. However, I will take that back. It is a fair point, and one thing that I do when I am being briefed is to challenge because I know that noble Lords will rightly challenge me on this issue.

In response to the comments by Jenny Harries, I hope I have been clear that we take advice from a range of advisers and there is not yet consensus, but we have been relying not just on making mask mandatory when necessary as a precaution, but at the same time on people’s individual behaviour and them acting responsibly. It is about getting that balance right. We listen to Dr Jenny Harries, but she is one of a number of experts whom we listen to. We weigh up the different views; it is as simple as that. As we have been clear, there is no one trigger for any of these measures. We always consider a range of measures, including capacity in the NHS, the trends et cetera. I have listed them in previous debates. It is not one person whom we listen to. We listen to a range of experts.

[Baroness McIntosh of Pickering (Con)]

Will my noble friend undertake to write to me about waiting facilities in GP waiting rooms? That would be helpful. I am also prompted by a question that I do not think he responded to from the noble Baroness, Lady Brinton, on the welfare aspects of staff shortages in meat-processing plants and the massive cull of pigs. While I appreciate it might not be the direct responsibility of his department, this is an animal welfare disaster about to happen.

One thing that I did not like to raise—I am sure it will go no further than the Grand Committee, which is why I feel confident to raise it now—is that my noble friend will be aware that there is PPE equipment which was deemed not fit for use, but it is in the system and is, to a certain extent, clogging up the supply chain by taking space which should be used for other goods. Will he undertake to use his good offices to look into this? Perhaps we could have a word about it afterwards because it is contributing to shortages and delays in the supply chain, particularly in storage terms.

[Lord Kamall (Con)]

First, I apologise for missing that point earlier. Regarding the supply chain provision, an SI was laid under the draft affirmative procedure on 21 April 2021. It was debated and approved by both Houses, came into force on 16 July and expired the provision. As the noble Baroness rightly acknowledged, some of her questioning was not within the scope of these regulations. However, given that she has asked a question, I will endeavour to find out the answer. Clearly, that will include going across departments, so I hope that she will be patient as I try to get that answer as quickly as possible.

On GP access, we recognise the pressure that general practitioners are under, especially in the upcoming and challenging winter period. We are investing £250 million in the winter access fund to improve GPs’ practice capacity. I will take the noble Baroness’s specific question about square metres and areas back to be answered; I hope she understands that I do not have those facts to mind.

The issue of measures was also raised. We must remember that one of the counterpoints put is that the country is in a very different position to the one it was in last year, due to the vaccination programme. Some of the restrictions that might have seemed appropriate last year are not as appropriate this year because we have reduced the link between cases and hospitalisations, as well as between hospitalisations and deaths. Clearly, we have the vaccine. I am sorry if I sound like a broken record but we continue to push the vaccine because it helps to break that link; it is part of the reason why we will not have to go back to some of the restrictions—those similar to last year’s—that many noble Lords are pushing for.

All I will say is that the Government’s autumn and winter plan set out how we will sustain and strengthen some of the progress made so far. We all know that winter will be a challenging period, but more so over the next few months. We all have a role to play in fighting the virus. There is much that government can do but sometimes, even when we mandate things, we know that there will be people who do not obey, so we must get the balance right and decide how to get the appropriate enforcement. Together, we believe that we can protect the progress that we have made, protect the NHS in the months ahead and help friends, loved ones and ourselves by being vaccinated against Covid-19, getting a flu jab if eligible and sticking to the advice on how to keep safe.

I thank noble Lords for their contributions to this debate and previous ones on the Coronavirus Act; I also thank them in advance for future contributions. I welcome noble Lords’ expertise and contributions, and I commend the regulations to the Committee.

Motion agreed.

Covid-19 Update

Lord Kamall Excerpts

Monday 29th November 2021 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

My Lords, I shall now repeat a Statement made in another place. The Statement is as follows:

“Mr Speaker, with permission, I would like to make a Statement on the omicron variant and the steps we are taking to keep our country safe. We have always known that a worrying new variant could be a threat to the progress that we have made as a nation. We are entering the winter in a strong position, thanks to the decisions we made in the summer and the defences we have built. Our vaccination programme has been moving at a blistering pace and this weekend we reached the milestone of 17 million boosters across the UK. This means that even though cases have been rising, hospital admissions have fallen a further 11% in the past week and deaths have fallen by another 17%. But, just as the vaccination programme has shifted the odds in our favour, a harmful new variant has always had the opportunity to shift them back.

Last week, I was alerted to what is now known as the omicron variant, now designated a variant of concern by the World Health Organization. We are learning more about this new variant all the time, but the latest indication is that it spreads very rapidly. It may impact the effectiveness of one of our major treatments for Covid-19, Ronapreve, and, as the Chief Medical Officer said this weekend, there is a reasonable chance that our current vaccines may be impacted. I can update the House that there have now been five confirmed cases in England, and also six confirmed cases in Scotland, and we expect cases to rise over the coming days.

The new variant has also been spreading across the world. Confirmed cases have been reported in many more countries, including Austria, Belgium, the Czech Republic, Denmark, Germany, Italy, the Netherlands and Portugal. In this race between the vaccines and the virus, the new variant may have given the virus extra legs. So, our strategy is to buy ourselves time and strengthen our defences while our world-leading scientists learn more about its potential threat.

On Friday, I updated the House about the measures that we have put in place, including how, within hours, we had placed six countries in southern Africa on the red list. Today, I would like to update the House on the more balanced and proportionate steps that we are taking. First, measures at the border to slow the incursion of the variant from abroad. On Saturday, in line with updated advice from the UK Health Security Agency, we acted quickly to add another four countries to the travel red list: Angola, Mozambique, Malawi and Zambia. This means that anyone who is not a UK or Irish national or resident who has been in any of these countries for the previous 10 days will be refused entry; and those who are must isolate in a Government-approved facility for 10 days.

Beyond this red list, we are also going further to put in place a proportionate testing regime for arrivals from all across the world. So we will require anyone who enters the UK to take a PCR test by the end of the second day after they arrive and to self-isolate until they have received a negative result. The regulations for this have been laid before the House today and will come into force at 4 am tomorrow.

Secondly, we have announced measures to slow the spread of the virus here in the UK. We are making changes to our rules on self-isolation for close contacts in England to reflect the greater threat that may be posed by this new variant. So close contacts of anyone who tests positive with a suspected case of omicron must self-isolate for 10 days, regardless of whether or not they have been vaccinated. Face coverings will also be made compulsory in shops and on public transport in England, unless an individual has a medical exemption.

The regulations for self-isolation and face coverings have been laid before the House today and will come into force at 4 am tomorrow. I can confirm to the House that there will be debates and votes on these two measures to give the House the opportunity to have its say and perform valuable scrutiny. My right honourable friend the Leader of the House will set out more details shortly and we will review all the measures that I have set out today after three weeks to see whether they are still necessary.

Thirdly, we are strengthening the defences that we have built against this virus. We are already in a stronger position than we were when we faced the delta variant. We have a much greater capacity for testing, enhanced ability for sequencing and the collective protection offered by 114 million jabs in arms.

I will update the House on our Covid-19 vaccination programme, which has been a national success story. We have delivered more booster doses than anywhere in Europe, and we have given top-up jabs to over one in three people over the age of 18 across the UK. I pay tribute to the NHS, the volunteers, the Armed Forces and everyone else who has been involved in this life-saving work. Our vaccines remain our best line of defence against this virus, in whatever form it takes. There is a lot that we do not know about how our vaccines respond to the omicron variant, but although it is possible that they may be less effective, it is unlikely that they will have no effectiveness. So it is really important that we get as many jabs in arms as possible.

We were already planning to do 6 million booster jabs in England alone over the next few weeks, but, against the backdrop of this new variant, we want to go further and faster. So I asked the JCVI—the Government’s independent expert advisers on vaccinations—to urgently review how we can expand the programme and whether we should reduce the gap between second doses and boosters. The JCVI published its advice in the last hour. First, it advised that the minimum dose interval for booster jabs should be halved, from six to three months. Secondly, it advised that the booster programme should be expanded to include all remaining adults aged 18 and above. Thirdly, it advised that these boosters should be offered by age group in descending order to protect those who are most vulnerable to the virus. Priority will be given to older adults and people over 16 who are at risk. Fourthly, it advised that severely immunosuppressed people aged 16 or above who have received three primary doses should now also be offered a booster dose. Finally, it advised that children aged between 12 and 15 should be given a second dose, 12 weeks from the first dose. I have accepted this advice in full. With this new variant on the offensive, these measures will protect more people more quickly and make us better protected as a nation. This represents a huge step for our vaccination programme.

I will update the House on the part that the UK is playing. We currently hold the presidency of the G7, and, earlier today, I convened an urgent meeting of the G7 Health Ministers to co-ordinate the international response. We were unanimous in our praise for the leadership shown by South Africa, which was so open and transparent about this new variant, and we were resolute in our commitment to working closely with each other, the World Health Organization and the wider international community to tackle this common threat.

Our experience of fighting this virus has shown us that it is best to act decisively and swiftly when we see a potential threat, which is why we are building our defences and putting these measures in place without delay. Scientists are working at speed, at home and abroad, to determine whether this variant is more dangerous. I assure the House that, if it emerges that this variant is no more dangerous than the delta variant, we will not keep measures in place for a day longer than is necessary.

Covid-19 is not going away, so we will keep seeing new variants emerge. If we want to live with the virus for the long term, we must follow the evidence and act in a proportionate and responsible way if a variant has the potential to thwart our progress. As we do this, we are taking a well-rounded view, looking at the impact of these measures not just on the virus but on the economy, education and non-Covid health, such as mental health. I am confident that these balanced and responsible steps are proportionate to the threat that we face.

This year, our nation has come so far down our road to recovery, but we always knew that there would be bumps in the road. But this is not a time to waver; it is a time to be vigilant and think about what each and every one of us can do to slow the spread of the new variant: getting a jab when the time comes, following the rules that we have put in place and getting rapid, regular tests. If we all come together once again, we can keep this virus at bay and protect the progress that we have made. I commend this Statement to the House.”

--- Later in debate ---

[Baroness Brinton (LD) [V]]

My Lords, I thank the Minister for repeating today’s Statement. The World Health Organization and many globally respected scientists and doctors have been warning us that variants of Covid-19 might pose a serious risk, especially when a Government think that we are winning the war against the virus and that we can all afford to relax. Omicron reminds us that the battle is not won until it is won across the world. From these Benches, we also thank the South African scientists for their genome sequencing that has alerted the world, and I hope that the UK and the other G7 countries will offer them not just gratitude but countries in southern Africa more practical support.

I echo the comments of the noble Baroness, Lady Thornton, about arrangements for international travel and test and trace. I also support her request for a briefing for Peers. For some bizarre reason, the Liberal Democrat MPs were not included in the MPs’ briefing. Please could the Minister make sure that we are included in any such meeting in the Lords.

In April, before the Minister was appointed, we warned Ministers that the Government were responding far too late to the reports of the delta variant in India. So we warn again. While the face mask mandate in shops and on public transport is welcome and well overdue, we are absolutely bemused that it excludes hospitality and that the advice to schools excludes classrooms. Professor Chris Whitty said in Saturday’s No. 10 press conference that when there is a risk we should go in hard, so can the Minister explain how the virus will be kept at bay in those indoor settings where masks are not required? Why is there no encouragement for people to work from home where possible? Trains and buses are crowded and unventilated. Risks will remain there too, even if lessened with masks.

I have said before that I am in the clinically extremely vulnerable group. I have had my third dose of the vaccine and now look forward to my fourth, or booster, dose. But many of those who should be getting the third dose still face a series of problems in the NHS about who should get it, as opposed to a booster, and how it is recorded. Indeed, today, in response to a Written Question to my honourable friend Daisy Cooper about the recording of a third dose, the Minister, Maggie Throup MP, replied:

“Work to assess the need to include boosters in the NHS COVID Pass is ongoing and we will provide a further update in due course”,


so even the records cannot distinguish. Can the Minister say when “in due course” is? I am afraid this is symptomatic of the way the clinically extremely vulnerable have been ignored and left to fend for themselves.

I will ask a question that I have asked the Minister’s predecessor repeatedly since June of this year. In May 2021, Jenny Harries left Public Health England to set up the UKHSA. For the preceding 12 months she had specific responsibility for co-ordinating all the different elements of Covid issues for the CEV and for shielding. When she left, no one was given that responsibility, and it was noticeable that all communications with CEV people and the different parts of the NHS on Covid just stopped when shielding stopped. Can the Minister tell us which senior person in the NHS has that managerial responsibility? It has been five months since I first asked and there are 3.7 million worried people still waiting for answers. It would be good to know which Minister has the responsibility to co-ordinate all Covid matters for the CEV or former shielders. This is important, because the last letter from the Secretary of State tells the CEV not to go into any environment where people have not been double-jabbed. There is no mention of boosters, and obviously no mention yet of omicron.

Is there a confirmed register that distinguishes between the CEV and the severely CEV? Unlike in Scotland, hospital consultants in England do not have access to individual patient records that GPs use or even to the Covid app data. Can the Minister say how NHS England will be able to communicate directly with eligible people if they do not have a register? Is there a specific communications plan to ensure that primary care, secondary care and the 119 vaccine helpline are fully aware of plans and processes for this group? Reports are coming back of blood cancer patients being told at vaccine centres that they do only boosters—there is no knowledge or understanding of the third dose.

I recognise that I am asking the Minister a large number of questions on the immunocompromised. I really do not expect answers to them today—written answers are always very welcome—but please will he agree to meet with me, Blood Cancer UK and the Anthony Nolan Trust to discuss these key questions, not least because we are now in a different situation, with the 3.7 million, which is 5% of the country, left in limbo?

As the noble Baroness, Lady Thornton, said, it is too early to say whether omicron is more dangerous than delta or beta, or whether treatments such as Ronapreve and the current vaccines might not be as effective. The Government are right to be cautious. I echo her comments about Clive Dix, the former head of the Government’s Vaccine Taskforce. What plans are in place for vaccine development for an escape variant?

At a time when manufacturing is one of the key issues slowing down the delivery of vaccines worldwide, why is the Vaccine Manufacturing and Innovation Centre at Harwell, which has received in excess of £200 million of public funding via UK research and development, now up for sale, long before the pandemic is over? We still need its expertise. Selling off a publicly funded, not-for-profit organisation during the pandemic, if at all, seems, frankly, bizarre.

Finally, the Statement has a passing reference to test and trace domestically. It says:

“We have a much greater capacity for testing, enhanced ability for sequencing”.


Genome sequencing in the UK has been a real strength of UK science and has undoubtedly helped us considerably in this pandemic. But, in recent weeks, with the Government’s determination to open up and return to normality, test and trace has been scaled back, with reduced centres and reduced hours for those that remain open. Can the Minister say what plans there are to increase these back as needed? Are directors of public health and their local resilience forums receiving funding for the current omicron problem? It also appears that there is no Covid funding for them next year at the moment. If omicron is a viable variant, we must plan to fund them to keep these safety nets of test and trace in place, because without an effective test, trace and isolate system, including proper payments to those who need to isolate, we will not manage, let alone control, this virus. Defences are not defences when there are large holes in them.

[Lord Kamall (Con)]

I thank both noble Baronesses for their questions. I will try to answer as many as I can.

On the first issue of face coverings and why not all places, we are taking temporary, targeted and proportionate action as a precaution while we learn more about this new variant. Face coverings have been introduced as part of the temporary measures being put in place to slow the spread of the omicron variant. We know that face coverings are effective at reducing transmission indoors when people are likely to come together—for example, on public transport or in shops—while having a low impact on our daily lives. We continue to encourage everyone to wear face coverings in settings that are crowded or where they meet or come into contact with people they do not normally meet, but we are also guided by the advice of our scientific and medical experts. We are constantly keeping these under review.

One of the reasons why our advice is not the same for hospitality venues is that the advice has been that it is not seen as practical for people to wear a face covering when eating or drinking. It is not recommended that face coverings are worn when undertaking strenuous activity, including exercising and dancing. That is the advice we have had to date on that one.

Questions were asked about NHS capacity. The NHS can respond to local surges in demand in several ways, including through expanding surge capacity in existing NHS hospitals, mutual aid between hospitals, and making use of independent sector capacity and accelerated discharge schemes. The NHS is the Government’s key spending priority. That is why we committed to the historic settlement of the cash increase of £33.9 billion a year by 2023-24, and other investments we have made to make sure we have that capacity.

The booster vaccine will be offered in order of descending age groups, with priority given to older adults. This will probably be the most complex phase of the NHS vaccination programme so far, but the NHS is working through updated guidance and will set out how this will be operationalised shortly. It will contact you when you need to act and book in for your life-saving vaccination.

On helping the rest of the world, the UK remains committed to donating 100 million doses by mid-2022. We will have donated more than 30 million vaccines by the end of 2021 and we have announced plans for 70 million doses in total so far. We will continue to work to ensure that any vaccine that the UK does not need is reallocated to other nations that require it, wherever possible.

On future preparedness for variants and future pandemics, as noble Lords will know, the UK Health Security Agency, which focuses on health protection, became fully operational on 1 October 2021. It will operate as an integral part of our health system and utilise state-of-the-art technologies and ground-breaking capabilities in data analytics, including genomic surveillance, as acknowledged by the noble Baronesses. The UKHSA will play a critical role in the route to developing vaccines that are effective against new and emerging variants. In the longer term, to make sure we learn the lessons, we will build on the infrastructure developed for Covid-19 to tackle and prevent other infectious diseases and external health threats. This work will include a strong focus on the life sciences, strengthening relationships with academia, research organisations and industries that have developed and grown through the pandemic, in which there are now several centres of expertise.

We are delighted to see students back at schools and higher education settings, but to reduce transmission we are keeping some sensible measures in place across education and care settings. These include access to twice-weekly testing in secondary schools and the provision of CO₂ monitors to all schools. We have said that education settings must continue to comply with health and safety law, and we are working between the Department of Health and the Department for Education to make sure we have the right and appropriate response in our education settings.

The noble Baroness, Lady Brinton, asked about severely immunosuppressed individuals—I thank her for the acknowledgement that I will not be able to answer all the questions in detail and that it probably would be better if I write to her in more detail. So far, however, the individuals who have completed their primary course of three doses should be offered a fourth booster dose with a minimum of three months between the third primary and fourth booster dose. If they have not yet received their third dose, they should have that now to avoid further delay.

The other point I will make is that it is not too late for anyone who has not yet had their first or second dose. Please do not think that, because we are advertising for boosters, it means that you have missed the boat. In fact, we are working very hard—and I have received a lot of advice from noble Lords across the House—on how to address the low take-up of vaccines among certain communities and demographics. I am grateful to noble Lords for that. I also reiterate the point that it is not over. I humbly disagree with the statement that we have given the impression that it is over. We have been quite clear that it is not and that we must continue to be vigilant.

In terms of briefings, I will commit to giving a briefing to all Peers. I thank the noble Baroness for that suggestion. I have apologised for not being more proactive on that—maybe I should have done so on Sunday afternoon or evening after the Secretary of State. To the noble Baroness, Lady Brinton, I can only apologise for not having an answer sooner to the questions she has asked in the past. The best way to resolve this is for me to commit to the meeting that she has requested so that we can try to answer the questions that she has outstanding. I apologise to her for those questions not being answered previously.

[Baroness Masham of Ilton (CB) [V]]

My Lords, it is very difficult to find out why many people are hesitant about having a booster jab having had two vaccinations. Does the Minister think that, if something went wrong and left a person seriously disabled from the vaccine, but if they knew they would have adequate compensation, they might be more willing to have the booster?

[Lord Kamall (Con)]

I thank the noble Baroness for raising that important point. We have made the point that it is not over, but one thing that we have seen, sadly, with the uptake of the booster vaccine is that a number of people felt that because they had had the first and second doses, they could almost return to normal. Maybe we could have been stronger with the message that it is not over, but we continue to say that we should be ever vigilant. The important point is that, if you have not had the booster, we ask you to come forward, just as we ask all those who have not had their first or second vaccine to come forward. We are trying to work with all those in different communities to make sure that they come forward. We are, for example, working with interfaith communities and local groups.

[Viscount Hailsham (Con)]

My Lords, I welcome the Statement, but may I express the hope that the requirement to wear masks in shops and on public transport is not relaxed prematurely? Is there not a case for continuing those requirements while the pandemic is prevalent?

[Lord Kamall (Con)]

My noble friend will be aware of the constant debate that there has been in the public sphere about the effectiveness of masks, when they are effective and who is affected. Therefore, we have always followed scientific advice on the wearing of masks and where would be most appropriate. We know that many noble Lords and others have called on us literally not to let the masks slip, as it were, and to make sure that people continue to wear masks. There have been others, however, asking why people still need to wear masks. We have always been vigilant, and the fact that we now have this new variant means we are taking a precautionary approach. We will continue to review it and it could well be that, in three weeks’ time, we will see how dangerous it has been and how effective mask wearing has been in the places that we have specified.

[Lord Davies of Brixton (Lab)]

My Lords, it is now recognised widely that none of us is safe until we are all safe, leading to the conclusion that we need a worldwide vaccination programme. However, there is mounting evidence that populations that are immunocompromised, especially people living with HIV, provide a particularly ideal environment for the mutation of the virus. Does the Minister accept that we must therefore contemplate the possibility of having a global programme of antiretroviral medicine as part of our response to Covid?

[Lord Kamall (Con)]

I thank the noble Lord for the point he just made. If he will allow me, I will take that back and try to get an answer for him.

[Baroness Watkins of Tavistock (CB)]

My Lords, I hear from colleagues in South Africa that nasal swabs alone are not as effective at picking up the new variant and that there have been many false negatives reported. I would welcome the Minister’s comment on that, as we are moving to more nasal swabs. I also suggest that it would be more sensible to encourage the use of face coverings in offices and to encourage people to work from home wherever it is feasible in terms of employers, so that the next two weeks can be used by scientists to really identify other problems that might be associated. This would help to safeguard NHS clinical staff as well as hospitals. If people are getting false negatives and then being admitted to hospital, it puts the very staff we need to keep at work at risk.

--- Later in debate ---

[Lord Kamall (Con)]

As the noble Baroness, Lady Watkins, will be aware, our scientific medical advice and the data are constantly reviewed. We are currently conducting thorough tests to review both LFT and PCR efficacy when it comes to the omicron variant. The advice that I have been given is that we must wait for the data and take a cautious, proportionate approach as scientists work urgently to better understand the variant. In terms of the question on more restrictions in terms of where face masks should be worn, the advice at the moment is still on public transport and in shops, and to continue to encourage people to work either from home or in offices, as appropriate.

[Lord Lansley (Con)]

My Lords, in my noble friend’s repeat of the Statement, he said that

“our strategy is to buy ourselves time and strengthen our defences”.

May I ask him about our border controls? Given our testing capacity, would it not make sense for us, for example, to test everybody who comes into our airports at the airport itself so that we have certainty that, where they are positive, we know who they are and are able to conduct the contact tracing required?

[Lord Kamall (Con)]

I thank my noble friend for giving me notice of the question; I appreciate it. The answer that I have been given in response is that we have built a thriving private diagnostic market to meet the demand of the international travellers and day 2 PCR testing for travellers is provided by these private providers. Based on forecast modelling, we are confident that the market has sufficient capacity to meet the rise in demand that omicron may pose.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, I thank the Minister for his Statement, in which he indicated that he was chairing a meeting of G7 members to deal with this specific issue. Will that meeting deal with the rollout of excess vaccines to the rest of the world, particularly those countries in southern Africa? I can only think of what my right honourable friend the former Prime Minister Gordon Brown said at the weekend, which was also reaffirmed in the leader column in yesterday’s Sunday Times: that nobody is safe in this world until everybody is safe. So is there a strategic plan to deal with excess vaccines to ensure that they are all used up, and particularly that they are used in those countries in the developing world that need them most?

[Lord Kamall (Con)]

I believe all noble Lords will agree with the points made by the noble Baroness on making sure that as many people in the world as possible have access to the vaccines. Someone said to me today that we are talking about third and fourth doses in the UK, but there are people in many parts of the world who have not yet had their first dose. I am sure noble Lords are aware of that. There is an analogy with when you are on an aircraft and the oxygen masks fall; do you protect yourself before you protect others? There is clearly a debate on this.

The UK remains committed to donating 100 million doses by the middle of 2022. We will have donated more than 30 million vaccines by the end of 2021 and have announced plans for 70 million doses in total so far. We will continue to ensure that any vaccines that the UK does not need are reallocated to other nations which require them wherever possible. Having sat in one of those G7 meetings with Health Ministers and joint G7 meetings with Health and Transports Ministers, I can assure noble Lords that one of the issues that comes up constantly is how we can help the rest of the world, particularly those countries which have not had access to even first doses of the vaccine.

[Lord Patel (CB)]

My Lords, on whether LFT swabs should be nasal or nasal plus throat, it is more important that the test is carried out properly; we know that LFTs have low specificity, as opposed to sensitivity, compared to PCRs. Those who test positive with the new variant and their contacts must isolate for 10 days. If a traveller arrives on these shores and tests positive for the new variant, will the whole of the aeroplane have to isolate for 10 days or only close contacts? If only close contacts, who counts as a close contact? What risk assessment have the Government made on the transmissibility of the new variant in superspreader events such as clubs and sporting events?

[Lord Kamall (Con)]

The noble Lord raises an important point. I will double-check the details as I do not wish to mislead him or the House. Given that this is a fast-moving situation, in which the data is very new, changing constantly and constantly being reviewed, it would be more appropriate if I double-check before I answer.

[Baroness Tyler of Enfield (LD)]

The new requirements are for all travellers arriving in the country to take a PCR test on or before day two and to self-isolate until they have received a negative test. However, on the government website today, it says that if someone has tested positive with a PCR, they should not be tested again using either a PCR or lateral flow test for 90 days, unless they have developed new symptoms. What are returning travellers who have tested positive in the last 90 days meant to do? Who is cross-checking the existing guidance against new regulations?

[Lord Kamall (Con)]

All I can do is thank the noble Baroness for her question. I will have to double-check; as she will imagine, I do not have all the answers at the moment. Throughout the day, as I was preparing for this, the advice was changing constantly, and things were being swapped in. Advisers from the Department of Health and Social Care were saying, “This is the latest advice”, but it was changing literally hourly. I will try to get the latest advice and share this with noble Lords.

[Lord Naseby (Con)]

In light of the overall success of the vaccination programme, is it now a condition of employment that every new recruit to the NHS, at every level, must be vaccinated against Covid and agree to accept any future recommendations on protection against it?

[Lord Kamall (Con)]

As my noble friend will be aware, vaccination as a condition of deployment has been brought in for the social care sector. It will be brought in for the wider NHS, but there is a grace period in certain cases. Management are being encouraged to meet with staff to encourage them, particularly staff who are vaccine-hesitant. There is a grace period to see us through the winter period; it runs up to April next year. However, we are encouraging as many members of NHS staff as possible to get vaccinated and we have a high rate of vaccination so far.

[Baroness Bennett of Manor Castle (GP)]

My Lords, the Minister referred to a thriving diagnostic market in PCR tests. When these were previously commonly required, there were huge problems with misleading advertising about costs and people being misled about the services and timings on offer. Have the Government solved these problems and are they looking at how much money these companies are making out of this thriving market?

[Lord Kamall (Con)]

The important thing for us is to make sure that PCR tests are available and that there is sufficient supply and capacity to deliver them. Frankly, as much as we want to make sure there are enough PCR tests, we want to make sure that supplies come to the market. But, as the noble Baroness will be aware, my right honourable friend the Secretary of State has raised concerns about the cost of some of the PCR tests and has been quite public about that.

[Lord Robathan (Con)]

My Lords, first, did the Minister see the interview with Dr Coetzee, the South African doctor who first identified the omicron variant, on “The Andrew Marr Show” yesterday? She said that the British Government were overreacting and, when asked, specifically agreed that they were panicking. Secondly, could he identify and publish for the benefit of everyone the studies that have shown that wearing these flimsy, non-surgical face masks is effective in preventing transmission? I refer to the excellent research which my noble friend Lord Ridley detailed in the Grand Committee on 26 October, which is in column 123 of Hansard. So far, no proper study has shown that wearing a face mask is effective.

[Lord Kamall (Con)]

I thank my noble friend for those points. On the comments made by the South African expert, I raised these issues with officials and experts today; one of the points made was that there are different demographics of who has been affected. We want to make sure that we are being cautious and proportionate. Therefore, we have taken these measures as a precaution. On the efficacy of face masks, the point my noble friend makes shows that there is a debate, but we have decided to err on the side of caution to make sure that we are prepared.

[Baroness Hoey (Non-Afl)]

My Lords, what is the position with aeroplanes coming into Dublin Airport? Have the Irish Government followed the United Kingdom Government? Otherwise, what will happen to people who have come into Dublin and then come across a border where there is obviously no restriction into the United Kingdom?

[Lord Kamall (Con)]

The noble Baroness makes a good point. Health issues are devolved to Northern Ireland, but I will double-check this point and write to her.

[Viscount Waverley (CB)]

My Lords, I too generally find the GOV.UK website wanting in the detail. Frankly, it is very confusing and is never kept accurate enough in a timely manner; I encourage the Minister to pay regard to that. May I drill into one particular issue on a point which other Peers have touched on? What is the rationale for the emphasis on testing after arrival into the UK, rather than catching those with Covid before departure?

[Lord Kamall (Con)]

The noble Viscount raises a good question; I am afraid that I will have to double-check the answer.

[Viscount Stansgate (Lab)]

My Lords, the Government’s Statement says that close contacts of anyone who tests positive with a suspected case of the omicron variant must self-isolate for 10 days, regardless of whether they have been vaccinated. Can the Minister tell the House what specific scientific advice has been received in the recent past to support that? Or are the Government being excessively precautionary? If so, is this a permanent or a temporary provision?

[Lord Kamall (Con)]

The Government have taken these measures as a precaution and we will constantly review them as we get more data. We have already committed to reviewing the measures after three weeks. If the data becomes available and we are clear about whether or not this is effective, we may well have an announcement before then, but we have committed to reviewing this within three weeks.

[Lord Hope of Craighead (CB)]

My Lords, can the Minister say what steps will be taken to enforce the regulations being made? I ask the question because Transport for London has been saying for weeks that the wearing of masks is required on London transport. I am a regular passenger on the London Underground, and something like a quarter or even a third of passengers are not wearing masks. It is all very well making regulations, but they need to be enforced.

[Lord Kamall (Con)]

The noble and learned Lord makes a valuable point. One of the points I made previously about enforcement on public transport is that it puts staff in a difficult position. We therefore have to be careful about how we do this. When giving advice, you assume that some people will not follow the advice, whatever you do. It has been found that most people will wait until it is mandated on public transport, sadly, rather than doing it of their own volition. The police and police community support officers can take measures if members of the public do not comply, and I am sure the noble and learned Lord will have seen a number of police and community officers.

We are clear that face coverings reduce the risk, and until now we have followed scientific advice. We are now adopting a precautionary approach and taking precautions. Some may argue that it is overly precautious, but we feel that it is the right balance. None of these things is binary, and we want to make sure we balance the steps we take with the data we receive.

[Lord Oates (LD)]

My Lords, what signal does the Minister think it sends to the world about doing the right thing when the consequence of South Africa’s excellent science and exemplary transparency is a total flight ban, with potentially devastating consequences for its economy and that of the region, with no apparent mitigating support package from the rich world? What conversations can he have with his friends in the Treasury so that they act to give some support to South Africa and the region?

[Lord Kamall (Con)]

The noble Lord makes a valuable point: we should pay tribute to the openness of the South African Government, in real comparison with the openness of the Chinese Government at the beginning of the whole pandemic. It is clear that they have been transparent. It is important to recognise that one of the things about the WHO is that it relies on experts in certain countries to report early signs. I will have a conversation internally and see what can be done; otherwise, it almost acts as a disincentive to report to the WHO. We have to make sure we are not disincentivising others who may wish to report similar cases in future.

[The Deputy Speaker (Lord McNicol of West Kilbride) (Lab)]

My Lords, the time allocated for supplementary questions has now been fulfilled.

NHS: Primary Care Surgeries

Lord Kamall Excerpts

Wednesday 24th November 2021 Lords Chamber

[Baroness Bakewell]

To ask Her Majesty’s Government what steps they are taking to prevent the takeover of National Health Service primary care surgeries in the United Kingdom by American health insurance companies.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

The Government are clear that the NHS is not and never will be for sale to the private sector, whether overseas or domestic. Regardless of whether a service is run by an individual, a partnership or any other organisation, all providers of NHS core medical services are subject to the same requirements, regulations and standards. Patients will continue to receive high-quality care, free at the point of use.

[Baroness Bakewell (Lab)]

I thank the noble Lord for that Answer. I have two points to make. Once they know what is happening, NHS staff and the public increasingly oppose this move. A group action by Islington patients is going to court to challenge the change of control to an American profit-making company. First, will the Minister respond to such a groundswell and urge the Government to stop the encroaching control of the NHS by American health insurance companies? Secondly—

[Baroness Bakewell (Lab)]

Centene has a bad reputation across America. Since 2000, it has paid many millions of dollars in fines for 174 contract-related offences across the States, so will Her Majesty’s Government forbid the appointment of Centene-related staff and former staff to NHS CCG boards and their sub-committees?

[Lord Kamall (Con)]

I thank the noble Baroness for her speech. In answering, as this is for judicial review, I am sure she understands that I cannot comment on it. But I saw an interesting documentary over the weekend, so let me just read some words from it:

“Yes the NHS is a public service but how it spends its vast procurement budget, how it uses IT, how it fashions new processes and pathways for patients, plainly benefit from private sector experience.”


I admit I have plagiarised these words from Tony Blair, the last Labour Prime Minister to win an election.

[Baroness Pitkeathley (Lab)]

Is the Minister familiar with the research that shows that the longer the relationship between a patient and a GP, the less likely the patient is to need out-of-hours care or emergency hospital treatment, or to die, within 12 months? Are patients not right to be afraid that profit-making will interfere with those important relationships?

[Lord Kamall (Con)]

The standards of care that CCGs expect are clear in the contracts that they sign with GPs. However it is provided, patients should continue to expect the same standards of care.

[Baroness Brinton (LD) [V]]

My Lords, one of the concerns is the transparency of agreements between clinical commissioning groups and these private companies. Are CCGs required to make absolutely transparent any arrangements they have made with these private companies?

[Lord Kamall (Con)]

The noble Baroness will understand that it is not for the Government to intervene in the decisions of CCGs. All who believe in devolution and decisions being made as close to the people as possible believe that we should not be interfering. These decisions are made by CCGs and it is not for the Government to interfere.

[Lord Bethell (Con)]

My Lords, I entirely welcome the Minister’s assertion that much of what is great about the NHS is the collaboration with international partners and the private sector. During the pandemic, many things that went well, including the vaccine, relied on that. With a special session of the World Health Assembly next week to discuss new global agreements on pandemic preparedness, what steps will the department be taking to foster international and business collaboration?

[Lord Kamall (Con)]

I thank my noble friend for that important question. International engagement remains crucial to tackling the pandemic and ensuring future resilience. In my first few weeks in the job, I have had a number of meetings, at bilateral, G7 and other levels, to make sure that we are fostering international health partnerships. “It is also really important that we understand the contribution the private sector can make towards making the NHS better for all of us.” Those are the words of Alan Milburn, also a former Labour politician.

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare that I am a fellow of the Royal College of General Practitioners. Do the Government recognise that, with an increasing number of GPs working salaried and part-time, it is essential that they have security in their contracts? There is a tension when commercial providers need to provide profits to their shareholders, which can work in the opposite direction to the needs of the community, as the medical staff should be working as a co-operative to improve services locally.

[Lord Kamall (Con)]

I am sure that we all want to pay tribute to the work of GPs, who are at the front line and, quite often, are the gateway to many services across the NHS and the wider healthcare system. It is important that we recognise some of the pressures they are under, but also work out how to help them and, indeed, patients. As I have said in the past, I will be a champion of patients and it is important that patients have access to their GPs, as a gateway to further services.

[Baroness Thornton (Lab)]

Notwithstanding the fact that the Minister says that the NHS is not up for sale, would he care to speculate what would motivate an American health insurance company to buy into a UK primary care GP market? Was this procurement carried out under the Covid relaxation that allowed contracts to be awarded without competition, or the usual procurement regime?

[Lord Kamall (Con)]

I wish I could read the minds of those who bid to run these services, but I am afraid I will have to admit that I cannot. The contracts are awarded at the local level by CCGs. It is their decision and it would be inappropriate for the Government to intervene.

[Lord Jones of Cheltenham (LD) [V]]

My Lords, my local GP, who has been extraordinarily busy during this pandemic, tells me that he just wants to get on with treating people who are ill and preventing others from becoming ill. He is not interested in fighting off unwanted backdoor interference from Americans or any other predators. Will the Government give proper support to our NHS, without which some of us might not be around to pass on these views from the front line?

[Lord Kamall (Con)]

We all understand the importance of the role that GPs play in our NHS. I remind noble Lords that, when the NHS was created, once the state had seized the voluntary hospitals and hospitals from churches, it left GPs independent. It has been left up to them how to run their services. What is important is that we expect all GP services to offer the best-quality care, despite the business model they use.

[Lord Adonis (Lab)]

My Lords, I commend the Minister for congratulating Tony Blair, who, of course, led the best Government of modern times in this country. The Blair Government trebled health spending in real terms—three times the rate of growth under this Government. I encourage the Minister to learn further lessons from Tony Blair, in particular to significantly increase health spending and leave the National Health Service in a better condition than he found it, rather than, as is now happening, in a worse condition.

[Lord Kamall (Con)]

I pay tribute to the noble Lord on his contributions to the Blair-Brown documentary, which I am sure a number of noble Lords enjoyed watching and learning from. It is important that we learn the right lessons from whichever political party, so when Tony Blair, a former Labour Prime Minister, says that we should encourage the private sector to be more involved in partnership with the public sector, we will take that advice.

[Lord Rogan (UUP)]

My Lords, I have great respect for GPs, but with general practices paid for the number of patients registered with the practice, profit-driven services might carry the risk of some GPs choosing to register younger and fitter patients, who will need to be seen less often than older patients. Would the Minister really be comfortable if that situation played out?

[Lord Kamall (Con)]

I am sure that noble Lords agree that it is appropriate that GPs register as many patients as they are able to see, and that their patients, whatever their needs, can access our great system of healthcare in this country. I would indeed be concerned if there were barriers to accessing GP services.

[Lord Clark of Windermere (Lab)]

My Lords, the cost of locum doctors to the NHS is £6 billion a year, much of it in primary care surgeries. Does the Minister feel that this is good value? What are the Government doing to try to get back to having regular doctors?

[Lord Kamall (Con)]

The Government recognise that it is important that people can see GPs and, as much as possible, invest in making sure that there are more full-time equivalent GPs. We have done that and we will continue to do so.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, the time allowed for this Question has elapsed.

Food (Promotion and Placement) (England) Regulations 2021

Lord Kamall Excerpts

Wednesday 24th November 2021 Lords Chamber

Moved by

[Lord Kamall]

That the draft Regulations laid before the House on 21 July be approved.

Relevant document: 12th Report from the Secondary Legislation Scrutiny Committee. Considered in Grand Committee on 23 November.

Motion agreed.