Covid-19 Update
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Lord Kamall (Con)
There clearly are concerns. These were expressed in the stakeholder engagement that occurred with both the social care sector and other sectors that will need to bring this in from March next year—we are bringing it in now but with a grace period until next March. A lot of this engagement and consultation discussed how we can support staff who are unwilling to be vaccinated as well as understanding their concerns and whether employers see these as legitimate.
Thinking back to the beginning of the crisis, one of the reasons this was called for in care homes as quickly as possible was the data from the early part of the pandemic, when there were a disproportionate number of deaths in care homes. A number of people, including patient groups and families of patients, were quite adamant that if their relatives were in a care home, they wanted to make sure that they were being looked after by staff who had been vaccinated.
There is another vaccine that is a condition of deployment, that for hepatitis B. I have asked medical staff whether they are concerned about this and a number have said no, because they are already compelled to have the vaccine for hepatitis B. That is a condition of deployment and staff see this vaccine as just as essential. That assuaged some of the concerns I had over compulsion. These are difficult, unprecedented times. We would not ordinarily want to go with compulsion, but the health of the nation is at risk and many people want to feel much more reassured that they, or their family members who are receiving care, are looked after by people who have been vaccinated.
Lord Scriven (LD)
Evidence-based policy is really important on this. Statistics from the Nuffield Trust show that, with the mitigations that healthcare and hospitals are putting in place, hospital-acquired Covid rates have been coming down since the middle of the year, while rates in the community have been rising. The reason for that is that the mitigation includes face-covering measures which, as the NHS Chief Nursing Officer, Ruth May, said in July,
“will remain in place across healthcare settings so that the most vulnerable people can continue to safely attend hospital”.
If that is the case, why was the Prime Minister not wearing a face covering when in a hospital this week?
Lord Kamall (Con)
I thank the noble Lord for that question and other noble Lords for their questions. I am not the Prime Minister’s keeper; it is as simple as that. We all decide for ourselves. I wear a mask whenever I can and when I talk to different people, I make sure that we are seen to be wearing masks. I thank noble Lords across the House who are leading by example by wearing a mask.
Lord Kamall (Con)
In consultation with the social care sector and the wider NHS, including trusts, discussions have looked at the impact and what would happen, but also how to make the message more positive, how to encourage staff to take up vaccines and how to listen to their concerns. In some cases, employers have said that they do not feel that staff have given a legitimate reason for not taking up the vaccine, but they are also under pressure from patients’ families to make sure that they employ care staff who have been vaccinated. They are trying all the different areas of persuasion, including targeted campaigns and one-to-one conversations in some cases, to encourage them as much as possible. At the end of the day, even before the introduction of vaccinations as a condition of deployment, many care homes were already trying to push their staff to take vaccinations because they are concerned about their patients.
Lord Scriven (LD)
As we have time, the Minister has just said from the Dispatch Box that the Prime Minister was following the rules of the trust he visited. That trust says on its website that you must
“wear a face covering when you enter the hospital until you leave”,
and adds:
“You must ensure that you wear your covering or mask throughout your visit and you must not remove your face covering/mask or kiss your loved one.”
By not wearing a mask, in either a clinical or non-clinical area, how was the Prime Minister carrying out the policy of that trust to try to save vulnerable people from being contaminated with Covid-19?
Lord Kamall (Con)
Whenever I have visited hospitals during the lockdowns or restrictions, we have sought advice from the staff around us. We have asked what measures are appropriate and whether we should keep face coverings on at all times. There have been times when they have said that, in particular areas, you can take your mask off. I was not at the visit yesterday, as I am sure the noble Lord will acknowledge—in fact, I was here answering questions—so I cannot go into detail. However, having visited hospitals myself, I am aware that you go in wearing a mask by default, but there are times when staff say, “In this area, you can take it off”.
Covid-19 Vaccinations
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Baroness Uddin (Non-Afl)
I really find this offensive; I am trying to make a point. I am about to get to my question. Many Members of the Lords do this, but I find that specific Members are always prevented from speaking out. I want to finish my point, which is to say that the health inequalities remain a deep scar among many communities and many sections of the community, where the constant bombardment of information has long since died. Will the Minister agree that we need to continue to mandate masks and ensure that there are meaningful—
Baroness Uddin (Non-Afl)
My Lords, will the Minister agree that incredibly important environmental safeguards continue to be required to prevent children catching Covid and to empower parents with sufficient information so that they can make informed choices?
Lord Kamall (Con)
I thank the noble Baroness for her question, I think. To be fair, she has made a number of points, especially about disparities and inequalities. It is quite sad that there is low uptake of the vaccine in a number of communities. I know that the noble Baroness has done a lot of good work in the past in Tower Hamlets and other areas with minority communities.
The most important way we can tackle this issue is to encourage people to be vaccinated. We want to roll out the booster as quickly as possible and, sadly, too many people have still not taken their first and second vaccines yet. I know that noble Lords across the House have many contacts in many communities, so it is important, please, to come to me with suggestions and ideas. I have spoken to a number of noble Lords across the House about how to tackle this and how best to reach people who are hesitant and who may not trust authority, and encourage them to take the vaccine. I thank the noble Baroness for her question.
Public Health Grant to Local Authorities
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Lord Scriven
To ask Her Majesty’s Government by what percentage the public health grant to local authorities has (1) increased, or (2) decreased, since 2016.
Lord Scriven (LD)
My Lords, in begging leave to ask the Question standing in my name on the Order Paper, I declare my interest as a vice-president of the Local Government Association.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
Since 2016, the local authority public health grant has decreased by 2% in cash terms, but we increased the grant in 2020-21, and in 2021-22, and it now stands at over £3.3 billion. We are maintaining the grant in real terms over the next three years to enable local authorities to deliver preventive and front-line health services which will improve the health and well-being of their communities.
Lord Scriven (LD)
My Lords, even with the recent cash increases, the public health grant has been cut in money terms since 2016 by £1 billion, curtailing services such as smoking cessation, healthy families, and sexual health clinics. If the Government really are committed to preventing poor health, why did the Chancellor not restore in the Budget the £1 billion to improve public heath, rather than prioritising giving banks a £4 billion tax break?
Health Incentives Scheme
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Baroness Merron (Lab)
My Lords, I thank the Minister for answering questions on the Statement, which was first made on Friday, before the Government began press releasing new—and some not so new—spending commitments, and eventually published their full Budget yesterday. I must admit to having been somewhat bemused when I read this Statement. It felt like being taken on something of a gentle canter around the issues. To put it mildly, it is more than unusual to see the announcement of an app and wrist-worn devices making the grade for the substance of a parliamentary Statement presented to both Houses.
I make this point because it is important to say that, on any measure, the Government have decimated the budgets necessary to tackle the underlying causes of poor health and the inequalities that arise from and contribute to its incidence and effects. As we know, poor health has many costs—social, economic and personal—and I regret that the Statement is a fig leaf for inaction. Although the Prime Minister and the Secretary of State have acknowledged that stark health disparities exist, the Government repeatedly fail to face the target, let alone hit it.
The pandemic has highlighted just how important it is to have a healthy and resilient nation. Preventing and treating disease is vital for reducing further unnecessary deaths from disease and lessening the burden on the NHS as it contends with the enormous backlog in healthcare caused by the pandemic. However, the Budget presented contradictions, as funding will be mostly focused on a curative rather than preventive approach, which would have prevented obesity and non-communicable diseases happening in the first place. Public health experts and practitioners alike agree that investment in the prevention of disease could make the single biggest difference to the nation’s resilience and health, so can the Minister explain the reason for this omission from the Budget? Does he agree that failure to invest in public health will harm the Government’s levelling-up agenda?
Specifically, we were disappointed not to see any further public health funding in the Budget to allow local authorities to deliver key prevention services, such as smoking cessation and weight management. It is well documented that locally provided public health services are highly effective and cost effective. Can the Minister tell your Lordships’ House why this was ignored?
We on these Benches have campaigned for many years against this Government’s short-sighted cuts to public health funding. A reduction in spending of a quarter in this area has led to growing obesity in our population, loss of smoking cessation services, a ticking time bomb of poor sexual health, and overburdened drugs and alcohol services. Of course, any savings made by those cuts has been hoovered up by the impact on the rest of the health service.
Obesity is at a crisis level in this country. Two-thirds of adults are above a healthy weight; half are obese. A new IPPR report says that multiple disadvantages were “conspiring” to drive down health outcomes and prevent life expectancy from growing across parts of England. Hundreds of thousands of children in England are growing up overweight or obese because of widening health disparities across the country. Their excess weight means that they will face a higher risk of serious conditions, such as type 2 diabetes, heart disease or cancer, later in life. The IPPR analysis found that as many as one in 12 cases could be avoided if health outcomes in the worst parts of England were improved to match the best. This does not make pretty reading.
We are of course not going to argue against measures that attempt to help the public improve their health, but like the obesity strategy that precedes it, the latest pilot announced in the Statement is tinkering around the edges. We need to acknowledge that tackling obesity is about tackling poverty. People in the poorest communities are twice as likely to be obese as those in the best off. This scheme is about encouraging people to make healthy choices, but the cost of living crisis will make that even harder for too many people. How is someone supposed to make healthy choices if they simply cannot afford to?
According to a report by Broken Plate, the poorest fifth of UK households would need to spend 40% of their disposable income on food to meet Eatwell Guide costs, as opposed to just 7% for the richest fifth. Therefore, if poverty limits someone’s food choices, their exercise choices and their time, can the Minister tell the House why this does not feature in the heart of the Government’s plan to tackle this scourge?
Whatever this pilot achieves, and whatever their obesity strategy achieves, it will be completely undermined by the £20 a week cut to universal credit, which, despite yesterday’s announcement, will push millions on to cheaper, less healthy alternatives. Can the Minister tell the House what will happen to the health of adults and our children? Will those who are invited to join this pilot come from the communities that will benefit most? They are the people who have suffered most from the cuts to public health. Will the Minister commit that this scheme and the obesity strategy will be followed by the restoration of moneys cut from the public health grant?
Lord Scriven (LD)
My Lords, from these Benches I thank the Minister for coming to answer questions on the Statement. These Benches welcome anything, including innovation, that targets the poor health and loss of life years that obesity brings. However, this is really the emperor’s new clothes, because it has to be set in the wider context of the detriment of poor health, public health budgets and poverty. Public health budgets have been decimated, so that many issues connected to the determinants of health cannot be dealt with. Low pay has become the norm for so many in our country. School budgets for extra activities, such as physical activity, and timetabling have caused problems, and food and drinks industry standards also have to be addressed. Tackling obesity is about tackling the lack of opportunity and tackling poverty. Innovation with a wristband is like asking somebody to learn the Green Cross Code they have a motorway to get across. It is not going to be successful.
As a country, we have to start early: we have the second-largest child obesity problem in the whole of Europe. So what are the Government doing to ensure that daily sport as an activity is available in every state school, so that every child has some daily activity? What is the Government’s response to the report by the Association for Physical Education with regard to children’s health and, in particular, with regard to swimming?
Diet at home and in school is important. The Jamie Oliver Foundation Bite Back report basically found that healthy options in schools were more expensive. What are the Government doing to ensure that fresh, healthy food is available at an affordable price in every school in the country? How are the pilots being chosen? The correct areas are the areas of deprivation, because that is where the highest incidences of obesity are. What are the criteria? How are they being selected? How are areas being offered the chance to become part of the pilot? This must be seen as a healthy eating and exercise approach, and not a weight-loss problem. There are far too many citizens in our country who suffer with eating disorder issues. So what are the Government doing to ensure that it is this framework of healthy eating and healthy lifestyles, rather than being seen purely as weight loss?
With regard to the wristband and the data, who will have access to the data? Where will it be stored? What precisely will the data be used for? Will any private sector organisation have access to the data and its interpretation, and, if so, what conditions are in place to ensure that we do not have the problem that we had with DeepMind, where it was used for purposes over and above what was anticipated?
Finally, talking of the private sector, HeadUp Systems is noted in the Statement. This is a company that has a £30,000 turnover and made an £11,000 loss last year. So how, and on what criteria, was HeadUp Systems chosen? What role will it have? Which other private sector organisations were asked to provide the support that HeadUp Systems is doing? What Ministers or officials did members of HeadUp Systems approach or have access to? If there is a contract, what is its value and on what basis was it given to HeadUp Systems?
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
My Lords, I start by thanking the noble Baroness and the noble Lord for their questions. This is a good story in terms of how we tackle health in the modern day. The noble Baroness mentioned the IPPR. I am not sure how well the name “Tony Blair” goes down on the Benches opposite these days—
Lord Kamall (Con)
I thank my noble friend for those important questions, which are exactly those that I would have asked—and, in fact, did ask the briefing team when I was getting more details on this matter.
Of course, one of the most obvious things that we have to ask is: how do people game the system? Often, when one analyses a scheme, sometimes there are unintended consequences whereby people are able to game it. Someone asked me—I think and hope that it was in jest—“If I ate 75 cream cakes and blamed my metabolism, would I be able to get on to the scheme?” We have to make sure that our data is robust. The pilot will include robust anti-fraud measures in relation to users’ activity and access to incentives.
What is interesting about the scheme is that it is voluntary, but it will also make sure that the users input the data. There has been a lot of research around that, because it has seemed to be a potential weakness, if users were inputting the data, regarding whether they can game the system. We have been assured that measures have been put in place to avoid that sort of gaming but, once again, the evidence will tell. That is why the system is not national but is a pilot to test all these questions to the limit.
The noble Lord mentioned weight loss and obesity, which I shall come to. One of the things that we want to make clear is that the health incentives scheme is not a weight-loss programme; it is a programme for healthy living. It uses an innovative approach to rewards and incentives to help participants to adopt healthier behaviours for physical activity and diet. Of course, it will help those who are overweight. I have been on two diets in my life—no, really I have. What is interesting about this is that, when one looks at these issues, it is not just a question of consuming less but about burning off calories. That is why we want to encourage healthy living as opposed to purely tackling obesity. That is very important.
The other day, I met a young lady who was very slim. She said, “Why do you keep going on about obesity and type-2 diabetes? I am slim and I have type-2 diabetes”. So sometimes we have to make sure that we are clear about these connections.
Lord Kamall (Con)
Oh I see. I bow to the superior expertise in this House of the noble Lord, Lord Scriven, and I will sit down.
Health Care and Adult Social Care
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Lord Kamall (Con)
The noble Baroness raises an important point but before I answer that specifically, I reassure her that I am a Liverpool fan, as well as an Enfield Town fan. It so happens that my middle name is Salah. I think that I can wear that name on the back of my shirt with pride. I assure noble Lords that I did not line that question up. One reason why the Office for Health Improvement and Disparities was set up in the first place was to look at disparities across a wide range of issues, not only in social care but in relation to gender inequalities, ethnic minority inequalities and some of the other inequalities and disparities between various areas. As the noble Baroness rightly says, sometimes one can find some of the poorest communities right next to the some of the wealthiest. We are hoping to address those issues through the work of the Office for Health Improvement and Disparities, by first identifying where disparities are and then addressing them.
Lord Scriven (LD)
My Lords, with more than 105,000 vacancies in social care, we have a bit of a crisis. Which job would the Minister advise a low-paid worker to take when offered one of these three full-time jobs, all advertised today: a delivery driver at £11 an hour, a supermarket shelf stacker at £10 an hour or a senior care assistant at £9.25 an hour?
Lord Kamall (Con)
I do not see myself as someone who is able to offer jobs advice or careers advice. But the points made by the noble Lord help to explain in many ways some of the pressures that care home providers are facing when recruiting in a competitive market. The Government have looked at funding and how we can work with care providers, particularly as many are in the private sector, as I said earlier. They are not directly controlled by the Government and we can therefore work with local authorities and care providers on how to make sure that they pay a competitive salary to attract care workers to work in the social care system, as opposed to some of the more competitive sectors that the noble Lord mentioned.
NHS England Funding: Announcement to Media
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Lord Kamall (Con)
My noble friend makes a valuable point. It is important that we are accountable to Parliament, and we will continue to be so. I hope that the fact I am here today shows a willingness to be accountable to Parliament.
Lord Scriven (LD)
The Minister has just said in a previous answer that, to deal with the social care crisis, a Bill will be coming forward. The crisis is now. Care homes are not able to take people and are turning them away because of the lack of staff. You will not clear hospitals while social care cannot hope. What will the Government do now to deal with the social care crisis in this country?
Lord Kamall (Con)
The money that has been announced is for April 2022 onwards, for three years. In dealing with the specific issue now, believe me, we are having conversations within the department and elsewhere about how we address some of the issues that people are raising with us.
Coronavirus Act 2020
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Lord Scriven (LD)
My Lords, I have so far not had a chance to welcome the Minister to his new role. I wish him well. I think he has already found out that it is going to be a very busy portfolio, and, with the present climate we find ourselves in, quite rightly so.
Before the Minister was in post, many statutory instruments were laid before Parliament after they had come into operation, as the noble Lord, Lord Hunt of Kings Heath, just said. This has continued to be a worrying trend, because it is a way of getting round normal parliamentary scrutiny. It becomes ministerial diktat and law by the scribbling of a Minister’s pen.
The statutory instrument says:
“These Regulations are made in response to the serious and imminent threat to public health”.
Paragraph 6.7 of the Explanatory Memorandum says:
“In accordance with section 45R of the 1984 Act, the Secretary of State is of the opinion that, by reason of urgency, it is necessary to make this instrument without a draft having been laid before, and approved by a resolution of, each House of Parliament.”
We are talking not about something that puts somebody into isolation to stop the spread of coronavirus but about relaxing when people can come out of self-isolation. It is not an imminent threat; it is not an emergency. The Government knew that 27 September was coming and could have planned for it so that normal legislation could have gone before Parliament, rather than this emergency approach of ministerial diktat, which affects millions of people in this country. It has to stop. There are times when emergency legislation for public health use is appropriate but, like others, this one is not appropriate.
What stopped the department and Ministers knowing that 27 September was coming? This did not have to be emergency legislation if they had planned ahead. This statutory instrument was laid five days before the planned date of extinction of the previous regulation. It is either poor planning or legislation to try to bounce Parliament. Either way, it is not acceptable.
I declare an interest as a vice-president of the Local Government Association, as set out in the register. The other part of this is about the powers to local authorities. I have believed right from beginning, as other noble Lords did, that local authorities should play a large part in this, rather than having national responses. Some national responses were needed, but so was a more local response.
Back in March 2020, I tabled an amendment to the original Bill with a power of general competence for local authorities to be able to act, which would be debated through normal legislation without statutory instruments having to keep coming with powers for local authorities. We were told that that was not required, so why do statutory instruments need to keep coming with powers for local authorities? Why did the department not listen at the time and grant a power of general competence in an amendment to the Bill, which could have been dealt with in the normal way rather than in emergency legislation? It has to stop. I want to talk about some interventions that might be required based on where we are at present as a nation.
I am clear that we will need interventions over and above those in place, but the Government are not listening to public health experts, people who work in the NHS or the epidemiologists who say that further action on Covid is required now, not just to deal with the potential crisis in the NHS but to stop future lockdowns that harm the economy and people’s livelihoods. They are saying it is a step to stop lockdowns, so I would like to understand from the Minister why that advice has not been taken. What assurance do the Government have that if action is not taken now and cases continue to rise, as well as the pressures on the NHS, either local or national lockdowns will not at some point be required? What modelling exists at present to prove that point?
I want to look at the rates per 1,000 population. On a seven-day rolling average from yesterday’s figures, the UK has 488.5 cases. France has 54.9 cases, Portugal has 51.9 and Spain has 28.3. Even taking into account testing variations, the UK is a significant outlier there. I know what the Minister will say: “Oh, there’s a lower death rate—that’s why. It’s not just cases. We have to look at the death rate”. Let us look at the death rates in those countries. On the rolling average for the last seven days, Spain has a death rate per million people from Covid-related disease of 2.87. Portugal has a death rate of 3.12 per million; France has a death rate of 1.88 per million; and the UK has one of 10.7 per million. In terms of both cases and deaths, the UK is an outlier.
I suggest that the reason why the UK is an outlier is that those other countries, rightly, are vaccinating—in some cases, they have now increased their vaccination rate above that of the UK—but have not put all their eggs in one basket. They are taking mitigation and vaccination as a way to deal with a public health crisis, because this is not a political or philosophical discussion. It is not an argument of libertarians versus those who believe in a more restrictive approach to the state. This is about public health and trying to keep people alive and healthy. It is about taking lessons from what is happening abroad and using them as good practice. If experts are not being listened to, I suggest that people look at what is happening abroad and learn the lessons there: mitigation and vaccination combined are a way of dealing with this. It is about having not draconian lockdowns but simple mitigations, so let us look at some of the issues within those mitigations.
Some politicians are worried that the public just will not buy some of the issues. A UK YouGov poll from today clearly shows that the public are becoming worried and starting to get ahead of the Government: 81% support having face coverings on public transport and 76% are for them in shops and restaurants. Meanwhile, 67% support social distancing in pubs and restaurants—but there is no majority for lockdowns. We have become a country obsessed with having plan A or plan B. It does not have to be such a binary choice. We could take steps to deal with the threat to public health as we come into winter. We could look at what happens abroad and bring about the use of mandatory face coverings, which have no economic impact. If you are a libertarian, their use restricts freedoms very little but helps reduce cases, along with other issues. We could ask for face coverings on public transport and in shops.
Some noble Lords opposite are shaking their heads. I am not basing my facts on some theoretical study; I am basing them on what is happening in France, Portugal and Spain. That is the evidence, not an academic study. Mitigation, along with vaccination, works. If not, noble Lords will have to explain when they get up why those countries have fewer cases and deaths. It is because they are not just jabbing but asking for face coverings.
Now, there are other, much wider things in plan B that I do not support. For example, I do not support the use of Covid vaccination certificates—not as a matter of political philosophy but because, although someone may have a certificate saying that they are double-jabbed, we know that 30% of people who are double-jabbed also get the virus and could be asymptomatic. It gives a false sense of security. That person may go out thinking, “I’m jabbed, I’m okay, I’ve got my vaccination certificate”, but they could be one of the 30% of people out there who are asymptomatic and helping to spread the virus. So, the reason why I believe that vaccination certification is not worth introducing is practical, not philosophical.
We are at a severe crossroads in this public health crisis. If we go one way, the country will go into lockdown and there will be harder economic and social consequences. That road means continuing as we are, putting all our eggs in the vaccination basket and not taking extra action now. Or there is another way we could turn: phasing in some simple mitigation requirements, such as face coverings and potentially looking at social distancing. These are not like the draconian “Stay at home to work” order or lockdowns.
I believe that we need to take a different course. To avoid lockdown and the harm we have seen, we need to do something extra beyond just talking about vaccinations. European countries that have taken those measures show that it can be done. They will not eradicate the virus, but they will mean we manage it better, helping the NHS and the economy and doing something that we need to do: take our advice and approach from public health, not political philosophy.
Lord Kamall (Con)
I can only repeat what I have said previously but I will look at this in more detail and respond to the noble Lord if he is not satisfied with my response. I will try to make sure that I send a satisfactory response.
A number of noble Lords talked about the evidence around face coverings. Some noble Lords said that they definitely work. Others said, “No, there is no evidence that they work”. Others said, “Actually, they are useful as part of an overall package of other measures”. If the data suggests that the NHS is likely to come under unsustainable pressure, the Government will implement their prepared plan B. That is why we have explained it in advance: so that we cannot be accused of doing things at the last minute. Plan B would include legally mandating face coverings in certain settings, but we are not yet at that stage. The continued efforts of the public in practising safe behaviours and getting fully vaccinated will be critical to ensuring that the NHS does not come under unsustainable pressure.
Lord Scriven (LD)
This is an important issue that goes back to what the noble Lord, Lord Hunt, said. We keep hearing the phrase “when the time is right, we will implement plan B, if required”. Who will the Government take that advice from? Will it be SAGE, which, until now, has given the Government clear scientific advice that the Government have acted on—sometimes belatedly but they have done so? What are the criteria and who will give the advice on determining when the time is right within normal government business, if SAGE is no longer seen as having the primary role in advising, since its remit is during times of emergency?
Lord Kamall (Con)
Before I answer that in more detail, perhaps I may say that we are not putting SAGE into a subordinate role. It is independent and we rely on its advice. However, as I mentioned, we also rely on the Chief Scientific Adviser, the Chief Medical Officer, the UK Health Security Agency, the NHS and others, and balance up views within the scientific and medical professions. I hope I have also laid out the range of data that is examined. The decisions are data-led. We look at immunity, the ratio of cases to hospitalisations, proportional admissions and so on to see whether the data suggests that the NHS will be overwhelmed. That is what leads to the difficult decision-making and balancing up whether the time is right.
One noble Lord—I think my noble friend Lord Ridley —and many others referred to the research of the London School of Hygiene & Tropical Medicine showing the range of views. Some scientists are saying that the virus will grow while others are saying that if we keep doing what we are doing and rely on the booster vaccines, the numbers will drop off. As one can imagine, there is a range of views but I reassure the noble Lord, Lord Hunt, that we have not relegated SAGE. It is independent and we listen to its advice, as we listen to the advice of others.
On face coverings, the point made by my noble friend Lord Robathan was interesting regarding people who say they are in favour of face coverings but, as he sees when he travels on public transport, a smaller percentage wear them. That shows some of the difficulties in polling, whereby there are stated preferences but also revealed preferences. Although many people say that they will do things, one should judge them by their behaviour. I note that my noble friends Lady Foster and Lord Ridley also raised concerns about the efficacy of wearing face masks.
SAGE evidence states that face coverings, if they are worn correctly and of suitable quality, are likely to be most effective, at least in the short to medium term, in reducing transmission indoors where social distancing is not feasible. Reviews by the UK Health Security Agency in June 2020 and January 2021 found evidence that the use of face coverings in the community helped to reduce transmission. Once again, we have a range of views on the efficacy of face masks.
My noble friend Lord Robathan talked about schools, universities and transmission. In universities, there have been low case numbers among students since the end of the 2020-21 academic year, although there have been slight increases in recent weeks.
My noble friends Lady Foster and Lord Ridley asked why the Act was not being repealed. Correct me if I am wrong, but I believe the noble Baroness, Lady Fox, also asked that. Throughout the pandemic, the Government have been clear that the measures will not be in place any longer than absolutely necessary. That is why we are expiring a number of powers in the Act and intend to expire even more when, we hope, there will be a significant landmark in our progress. The two-year lifespan of the temporary provisions of the Act was chosen to ensure that powers remain available for an appropriate length of time and can be extended by the relevant national authority.
My noble friend Lord Balfe asked about test and trace, and the cost. We have released £280 million in funding thus far, which is broken down as follows: £114 million to cover the costs of the main test and trace support system, £116 million for discretionary payments, and £50 million for administrative costs.
My noble friend Lord Naseby asked about minority vaccine uptake. He asked what the Government were doing to drive uptake among ethnic minority communities. We are well aware of this issue and a lot of work is being done with a number of local community associations to work out the best way to reach them. Only yesterday, I asked the noble Baroness, Lady Benjamin, about how we could tackle particular demographics and got some very valuable advice from her on how we could focus. I fed that into the department, so hopefully that will be part of our strategy. What we have seen is pop-up temporary vaccination sites at many places of worship and community locations. One of the things we have been advised is to go to where the unvaccinated are and to see how we can pursue a targeted campaign.
The noble Baroness, Lady Brinton, asked whether there would be a charge for lateral flow tests. Anyone in England can continue to order free lateral flow tests. I am afraid that I am going to run out of time, so I will write to noble Lords.
Men’s Health Strategy
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Lord Kamall (Con)
I thank the noble Lord for the advice that he has given me to date on many issues relating to this portfolio. In terms of a specific men’s health strategy, it was quite clear that we needed a women’s health strategy because for many years women’s health had not been given the consideration that it needed, including on a whole range of issues such as clinical trials and data, for example. On male life expectancy, the issues that men face are quite disparate, so we target particular issues such as systemic heart disease, cancers, particularly prostate cancer, the fact that more men than women die from suicide, alcohol-related deaths, drug-poisoning, smoking and obesity. We look at those and target them specifically, rather than putting them into an overall men’s strategy.
Lord Scriven (LD)
My Lords, we should not look at men as one homogenous blob. There is more than a nine-year life expectancy difference between men in the top income bracket and those in the bottom 10, which is more than the life expectancy difference between men and women in those brackets. What will the Government do to ensure equity and fairness to tackle this deep-rooted health inequality for some men?
Lord Kamall (Con)
The Government have launched the Office for Health Improvement and Disparities and part of its remit is to make sure that we look at inequalities within the health system, particularly gender inequalities or those to do with income strata, and at how people in different income brackets are affected differently. That is why the word “disparity” is in the name of the office.
Covid-19 Update
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Baroness Wheeler (Lab)
My Lords, I thank the Minister for reading the Statement.
Yesterday, the Secretary of State said that the pressures on the NHS due to Covid-19 are “sustainable”. Today, we have the Commons Statement desperately trying to reinforce this message when, in reality, we see ambulances backed up outside hospitals, patients waiting hour upon hour in A&E, cancer operations cancelled and NHS staff worn out and exhausted. Yet still, as we head into winter, the Government refuse to trigger plan B or tell us what the criterion is for doing so. Can the Minister spell out exactly what evidence and criteria will be used?
The British Medical Association is the latest front-line body to call for plan B’s immediate implementation. Why can we not just make the wearing of masks on public transport, for instance, mandatory now? We must remember that SAGE, the Government’s scientific advisers, called for plan B-type measures when the Government’s autumn and winter plan was first launched, with Sir Patrick Vallance stressing the importance of going early with measures to stop rising cases.
Once again, the Government have failed to learn the lessons of the early stages of the pandemic. This hesitation to follow advice will lead to more cases, more hospitalisations and more deaths. The Secretary of State’s warning that cases could rise to 100,000 is chilling. Today, we have the sobering update from the Government’s own Covid dashboard showing 52,009 new coronavirus cases—the highest daily total and the first time the daily tally has topped 50,000 since 17 July.
It is obvious that plan A just is not working. The vaccination programme is stalling, particularly given the very late vaccinations for 12 to 15 year-olds and the mixed messages and worryingly low uptake of booster jabs. Ministers cannot blame the public when 2 million people have not even been invited for a booster jab, and on current trends the booster programme will not be completed until March 2022. Currently, there are just 165,000 jabs a day. Will the Government commit to 500,000 booster jabs a day and ensure that the programme is completed by Christmas, as it needs to be, particularly given the growing evidence of waning vaccination protection among double-vaccinated older and more vulnerable people? We learned from leaked data yesterday that only a quarter of care home residents have received a booster vaccination. Can the Minister confirm that this is correct and tell the House what urgent action the Government are taking to address this?
On children, where the highest rate of infections is concentrated and infections are running at 10,000 a day, only 17% of children have been vaccinated. This is a stuttering and wholly inadequate rollout of the children’s vaccination programme. Does the Minister recognise that this slowness exposes the folly of the drastic cuts over the past decade in the number of school nurses and health visitors who support these immunisation programmes in our communities? Will retired medics and school nurses be mobilised to return to schools and carry out vaccinations?
As the winter crisis looms, the rollout of flub jabs is also crucial to bringing down hospital admissions and ensuring that the NHS can cope, but it is also painfully slow. Only 6% of over-65s have been vaccinated, and across the country we hear stories of cancelled flu jabs at GP surgeries and of pharmacists running out of supplies. Why are supplies apparently running so low, with infections, meanwhile, running so high? What are the Government doing to ensure adequate stocks at GP surgeries and chemists to meet the demand? Can the Government guarantee a flu jab to all those that need it by December? We must get ahead of this virus, because otherwise it gets ahead of us.
Can the Minister also comment on reports in today’s media that as well as plan B, there is now active consideration of a plan C: no household mixing—in other words,
“a lockdown by the back door”,
as the shadow Secretary of State, Jonathan Ashworth, has called it. Can the Minister tell the House what is actually under “active consideration”, in the words of the Health Minister on Radio 4 this morning? No household mixing would be deeply concerning for many people who were prevented from seeing their loved ones for months at a time during the first and second waves of lockdown.
I am sure noble Lords will have much to say on mask wearing, as they did during yesterday’s PNQ. Ministers continue to sow confusion, including among themselves, with the Secretary of State’s comments in the Commons yesterday that politicians should “set an example” and wear masks in crowded spaces—yet the Leader of the House subsequently told MPs that there was no such advice for workplaces. Can the Minister explain what is going on?
The Statement also refers to the agreement with Pfizer and MSD on two new antiviral drugs, which we of course welcome, as they play a vital role in stopping a mild disease from becoming serious. Can the Minister tell the House about the expected timetable for MHRA approval and any provisional details on availability and rollout?
Finally, on social care funding, as usual we welcome the announcement at the end of the Statement of additional funding for local authorities to support staffing and care work through the winter, assuming that the £162.5 million workforce retention and recruitment fund is actually new money and not part of previous repackaged funding. Could the Minister confirm this? Can he provide more details as to how and when this money is to be available and how it will be allocated to local authorities?
Lord Scriven (LD)
My Lords, I too welcome the Minister’s reading the Statement from yesterday. We are discussing this on the day when more than 50,000 Covid cases have been recorded in the UK for the first time since 17 July. There have been over 52,000 cases and 115 deaths; 8,142 people are in hospital with Covid, and 870 of those are on a ventilated bed. We are discussing this just hours after the Royal Cornwall Hospitals NHS Trust has declared a critical incident because of the pressures it is under serving the people of Cornwall.
That shows why this Statement is not a master class in providing a range of effective public health measures to tackle a virus that spreads at speed, and more a master class in trying to keep the libertarian wing of the Conservative Party happy. The “jab, jab, jab” message is important but, when some people go on to the booking system now, they are not able to book. They are told to ring 119, as my honourable friend in the other place, the Member for St Albans, Daisy Cooper, said early today; when they ring 119, operators tell them that they cannot override the system. I ask the Minister what is going on with the booking system and how soon it will be repaired. The “jab, jab, jab” message is important, but it is not, in itself, going to deal with the severity of the public health crisis we face. As Professor Adam Finn, a member of the JCVI, said yesterday, vaccinations in themselves are not going to stop us falling off the edge of the Covid cliff.
I want the Minister to explain these different rates, if plan A, of vaccination, is working. The seven-day rolling averages for Covid-19 cases per 100,000 of the population are: in the UK, just under 500, and rising sharply; in France, approximately 60, and falling; and in Spain, approximately 50, and falling. Even considering the variation in testing rates, the UK is clearly an outlier. Take a look at three months ago, when the Government removed all mandatory mitigation measures. The picture tells you the true story of why “jab, jab, jab”, as a public health strategy, is not enough to deal with the Covid-19 problems. Then, the UK had approximately 300 cases per 100,000, and it now has 500; France had approximately 220, and it now has 60; and Spain had approximately 350, and it now has 50. It is because France and Spain, as well as other countries, have jabbed, jabbed, jabbed but also mitigated, mitigated, mitigated. Indecision is our greatest enemy in the fight against this disease.
Let us be clear: those of us who ask for extra mitigation measures, such as the use of mandatory face coverings, do so to stop the crippling lockdowns that have come before. The Government, as the Health and Social Care Select Committee has reported, have acted too little too late before when dealing with this virus. This means that the damage, both to public health and the economy, is greater than it would have been if the Government had listened to the expert advice and acted sooner.
On one very important mitigation measure we could take, the mandatory use of face coverings, the Minister said yesterday, answering a PNQ:
“Personally, I do believe that many people should be wearing masks and that there is evidence for this.”—[Official Report, 20/10/21; col. 145.]
If good evidence exists that wearing face masks helps to reduce the transmission of Covid-19, why have the Government stopped their mandatory use in indoor settings? Could the Minister please enlighten the House on what evidence the Government have that asking people to use self-judgment on wearing a face covering in certain indoor settings is more effective than making them mandatory? I am sure that evidence will be at the Minister’s fingertips, as it is official government policy. They would not make up such an important policy to ditch a mitigation measure that could save lives without the use of good evidence—would they?
Furthermore, can the Minister explain why, at Prime Minister’s Question Time yesterday, hardly any Tory MP sat on the green Benches had a face covering on, and why, today, a Minister sat on the government Front Bench in this House wore a mask below his chin, with both his nose and mouth exposed? Whose evidence are they following? What leadership and example does it set to the nation if the Government are, on the one hand, asking us to use our self-judgment to wear a face covering, but government Ministers and MPs in the House of Commons do not?
The evidence of experts in public health and epidemiology, and figures from Europe, show that a mixture of vaccination and mandatory mitigation measures is required, if the spread of the virus is to be contained to manageable levels, so that later in winter we do not have to slam on the brakes and have yet another lockdown.
Can the Minister clarify something that he said yesterday during a PNQ? When asked whether the Government still had confidence in SAGE and its workings, the Minister replied:
“May I write to my noble friend on that?”—[Official Report, 20/10/21; col. 146.]
I know that the Minister is new and that he did not have all the details to hand, so I am giving him a second chance. Can he confirm from the Dispatch Box that the Government do have confidence in SAGE and the advice that it gives?
It is time to be clear that the message on vaccination take-up and extra mitigation on issues such as mandatory face coverings are required. Otherwise, we will be left in a situation where, unfortunately, more people will die than is necessary, the Government will be behind the curve in dealing with the virus and much more draconian measures will have to be taken. Now is the time for plan B, not for dithering and not taking the measures that are required.
Covid-19: Plan B
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Lord Scriven
To ask Her Majesty’s Government, further to the rising number of Covid-19 cases and comments made by the NHS Confederation regarding the reintroduction of certain restrictions, what criteria they have put in place as the triggers to implement their Covid-19 “Plan B”.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
I thank the noble Lord for the very important Question. As set out in the Government’s comprehensive Covid-19 Response: Autumn and Winter Plan 2021, if the data suggests that the NHS is likely to come under unsustainable pressure, the Government have prepared plan B contingency measures. We monitor a wide range of Covid-19 data closely, so we can act if there is a substantial likelihood of this happening. We also track the economic and societal impacts of coronavirus to ensure that any response takes into account those wider effects in a balanced way.
Lord Scriven (LD)
My Lords, Professor Stephen Reicher, a member of SAGE’s sub-committee, said yesterday:
“I don’t want lockdown … The danger is if you do nothing … in terms of infections, in terms of long Covid, in terms of hospitalisations … they will be left with no alternative.”
Based on what the Minister has just said, what evidence do the Government have of why scientists such as Professor Reicher are wrong in seeking mitigation measures now to deal with the worrying number of viral transmissions as a way of stopping future lockdowns?