Covid-19 Update

Lord Harper Excerpts

Monday 5th July 2021 Commons Chamber

[Sajid Javid]

I do not agree with the hon. Gentleman.

[Mr Mark Harper (Forest of Dean) (Con) [V]]

I apologise for any discourtesy to the House in not being able to be there in person. The Prime Minister has confirmed that there will be contingency measures in place for winter, and even if they are not legal restrictions, they will have an effect on business. Can the Secretary of State confirm what they are, and publish the details so that Members can scrutinise them at the earliest opportunity?

[Sajid Javid]

I believe that my right hon. Friend is referring to our keeping in place contingency measures, particularly for local authorities—the so-called No. 3 regulations—at least until the end of September in case those powers are needed in the event of a local break-out. Of course, there is no intention at this point that those powers will be used, but we believe it is necessary to have powers in place just in case. He will have heard me talking earlier about the risk that still exists from new variants. That is the plan, but I would be happy to discuss that with him further.

Covid-19 Update

Lord Harper Excerpts

Monday 28th June 2021 Commons Chamber

[Sajid Javid]

First, my hon. Friend will know that, in terms of 19 July and the restrictions that will be removed, we are focusing on domestic restrictions. He knows that, separately, we also take very seriously the border controls, the border restrictions and the so-called traffic light system. In terms of making any further decision on that, he will know that it is kept under constant review on a very regular basis, and it is something that I intend to sit down and discuss with my right hon. Friend the Transport Secretary as soon as I can.

[Mr Mark Harper (Forest of Dean) (Con)]

I very much welcome my right hon. Friend’s return to the Front Bench. I know from my experience of dealing with him in Government that he is a man of real integrity, which is an essential quality in a Health Secretary at a time like this, so I welcome his appointment.

I welcome my right hon. Friend’s tone and his intent to get us back to normal, but let me pick up on his earlier answer to our hon. Friend the Member for Runnymede and Weybridge (Dr Spencer). There are those in government, from documents that I have seen, who are preparing the ground for the return of restrictions in the autumn and the winter. Will he rule out the use of lockdowns and restrictions in the winter as a mechanism for managing covid, and look at alternatives to ensure that the NHS is able to deal with us getting back to normal?

[Sajid Javid (Bromsgrove) (Con)]

I thank my right hon. Friend for his kind and warm remarks. I know that he has taken great interest throughout the pandemic in the restrictions in particular, and I absolutely understand why it has been so important to him and others. I am very happy to meet with him to discuss the issues in more detail and listen to his views. He should know that it is my intention, and the Government’s intention, as I have said from day one on this job, to remove all restrictions as quickly as possible.

Coronavirus

Lord Harper Excerpts

Wednesday 16th June 2021 Commons Chamber

[Matt Hancock]

I bring to the House these regulations to change the date of implementation of step 4 of the Government’s road map. On 8 December last year, we fired the starting gun on the race between the vaccine and the virus and started delivering a programme that has allowed us to restore so many of the precious freedoms that we cherish. In the space of just six months, we have now given first doses of coronavirus vaccines to almost four in five adults in the UK, and we have given second doses to over 30 million people. We have made such rapid progress through the cohorts that, today, we are able to extend the offer of a vaccine to anyone aged 21 and over.

Thanks to the protection of the vaccination programme, huge advances in treatments like dexamethasone, which was discovered a year ago today, and the resolve of the British people in following the rules that this House has laid down, we have been able to take the first three steps on our road map, removing restrictions and restoring colour to the nation, but we have always said that we would take each step at a time and look at the data and our four tests before deciding whether to proceed. The regulations before the House today put into effect our decision to pause step 4 on our roadmap until 19 July. Before outlining the regulations that will put this into effect, I would like to set out why we made this difficult but essential decision.

Unfortunately, there has been a significant change since we started on our journey down the road map in February. A new variant has given the virus extra legs, both because it spreads more easily and because there is some evidence that the risk of hospitalisation is higher than for the alpha variant, which was, of course, previously dominant in this country. The delta variant now accounts for 96% of new cases. The number of cases is rising and hospitalisations are starting to rise, too—they are up 48% over the past week. The number of deaths in England is thankfully not rising and remains very low, but, as I told the House on Monday, we do not yet know the extent to which the link between hospitalisations and deaths has been broken, so we propose to give the NHS a few more crucial weeks to get those remaining jabs into the arms of those who need them.

Although we are taking the steps outlined in the regulations today, and I know this is disappointing for many people, we know that science has given us a solution. We must use this time to protect as many people as we can as quickly as we can, because even though the vaccination programme has been going at a blistering pace, there are still people who we must protect.

[Mr Mark Harper (Forest of Dean) (Con)]

Can I just ask my right hon. Friend what we expect to achieve in the four weeks? I think I am right in saying that there are 1.3 million people in priority groups one to nine who have yet to have a second dose of the vaccination. The good point is that that means we have vaccinated 96% of people in those groups, but I just wonder—after four weeks, I doubt that we will get to 100%, so there will still be a significant number of people in those groups not vaccinated with two doses, and at that point, there is still going to be some risk. My worry, and the worry of others, is that we are going to get to this point in four weeks’ time and we will just be back here all over again extending the restrictions. That is what we are concerned about.

[Matt Hancock]

No—on the contrary, that is our view of how far through the vaccination programme we need to get. We are not aiming to eradicate the virus in this country because that is not possible. Indeed, in the parts of the country where it has been tried, it has been found to be not possible. We are aiming to live with this virus like we do with flu. I can give my right hon. Friend an update: as of midnight last night, 1.2 million over-50s and 4.4 million over-40s have had their first jab, but not their second. We seek to get a second jab into a majority—not all, but a majority—of them by 19 July. The estimate is that by taking that pause in this step, we can save thousands of lives. I can tell my right hon. Friend that taking further time and pausing for longer is not estimated to save many more lives, because of the level of protection especially among the over-50s, who are, as we all know, the most likely to die from this disease.

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[Matt Hancock]

No, I do not agree with mandatory vaccination of the public, but for those who have a duty to care, in an environment that includes some of the most vulnerable people in the country, I think this is a sensible and reasonable step in order to save lives.

[Mr Harper]

The Secretary of State will also be aware that staff who provide domiciliary care in people’s homes—they potentially provide care to many people, going to many homes during the day—are also caring and present a similar challenge. It would be preferable, in the first instance, if we could get those vaccination rates up by education and persuasion. I am prepared, if that is not possible, and following the precedent we have in the NHS for those who perform operations and have to be vaccinated against hepatitis, to agree to this matter, but there is a real issue here with the millions of people who provide domiciliary care, who are often employed directly. How is that going to work and provide the level of protection required?

[Matt Hancock]

Yes, we do propose to consult on this point, alongside the consultation on mandatory vaccination as a condition of deployment in the NHS. As my right hon. Friend rightly says, this is a complicated operational matter. The principle of vaccination for those in a caring responsibility is already embedded, as he says; there is a history going back more than a century of vaccination being required in certain circumstances. I think these are reasonable circumstances, so we will go ahead for those who work in care homes and we will consult about those in domiciliary care and those working in the NHS. However, I have no proposals for going, and would not expect us to go, any wider.

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[Jonathan Ashworth]

Well, the Secretary of State needs to explain whether we should or not. Will we be supporting the installation of proper ventilation systems? We have known about the importance of ventilation in dealing with respiratory viruses since the days of Florence Nightingale. Countries such as Belgium are now providing premises and buildings with CO₂ monitors to improve their air quality; will we be doing that?

The other thing about this virus is that, even when we vaccinate people—of course I want to see us meet the various vaccination targets—we know that some people will still be at more severe risk than they would be from flu. There will be people who will develop long covid symptoms. For some people, those symptoms are beyond achiness and tiredness. We have seen people lose hair, lose teeth. In some people it presents as depression, anxiety—even psychosis in some circumstances. So Ministers must explain exactly what “living with this virus like flu” means.

There is something else that they should explain to us. What are we going to do in the winter? It did not come up in the earlier exchanges; I thought that it might. Perhaps the Secretary of State, or the Minister in responding to the debate, can tell us whether the Secretary of State, the Minister or departmental officials are putting together plans for restrictions this winter, and whether the Secretary of State has developed or discussed those plans with any colleagues in Whitehall. I shall be grateful if the Secretary of State or the Minister would tell us about that.

[Mr Harper]

rose—

[Steve Brine]

rose—

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[Jonathan Ashworth]

We do accept it but we do not glibly accept it, because year by year we are looking for improvements in vaccinations, therapeutics and medicines to push infection rates down as low as possible. Even though we are grown-up enough to be aware that sadly some people will die from flu and pneumonia, we do all we can to avoid it. That is what we will have to do with this, but I do not want to see it done by some of the wider restrictions and lockdowns that we have heard about. That is why I would be interested to know whether the Department has developed plans for restrictions this winter and whether the Secretary of State has been discussing that with Whitehall colleagues.

[Mr Harper]

On the point about the restrictions, I know that those discussions are going on because I have seen documents from within Government with very detailed suggestions about what measures may continue. I asked the Secretary of State about this when he was in the Commons earlier this week, and he did not rule out bringing in restrictions this winter. That is partly why some Conservative Members are very concerned and why we are not going to vote for these regulations today. However, I want to take the right hon. Gentleman back to his comments on what Chris Hopson said about the fact that the NHS is very busy at the moment. There is a danger here. I am very sympathetic to colleagues who work in the NHS, who have done a fantastic job, but we cannot get to a point where we restrict and manage society in order to manage NHS waiting lists. That is not the right way round. The NHS is there to serve society. If we need to enable it to do that, we have to think of a way of doing it other than putting restrictions on the rest of society. That is not a sustainable or a desirable position, but it is the logical consequence of what Chris Hopson was saying earlier this month.

[Jonathan Ashworth]

Even though we will find ourselves in different Lobbies this evening, I think there is more in common between us than perhaps one might expect. I do not want restrictions to remain in place for any longer than they need to. I want to move to a system where we are trying to push down covid infection rates by, yes, rolling out vaccination as far and as fast as possible to everybody, but also putting in place the proper framework so that those who are ill or a contact of someone who has been ill with covid is able to isolate themselves.

We still have a culture in this country of soldiering on; the Secretary of State has referred to it in the past. I dare say that it is true of many of us in this Chamber. I have certainly done it in the past 20 years of my working life. I have gone into work with a sore throat or feeling under the weather, thinking I will just have some paracetamol and get on with it. Things like this have got to change, because although that sore throat may well have been fine for me, we now understand in great detail that it could have been very dangerous for others. We have to change our attitudes. However, there will still be a lot of people who have to go to work because they cannot afford to stay at home, so we need decent sick pay sorted out. One of the things that was revealed in this morning’s Politico email was the leak of a Government document that said that the isolation system is still not effective. That is because we still do not pay people proper sick pay. This is going to become more of an issue because presumably Test and Trace is to stay in place for the next year or so, as my hon. Friend the Member for Rhondda (Chris Bryant) indicated. People who have had two jabs and are asked to isolate themselves will ask themselves, not unreasonably, “If I have had two jabs, why do I need to isolate myself?” This is going to become much more of a challenge and we will need proper sick pay in place.

Let me finish dealing with the point made by the hon. Member for Winchester. I want us to control the virus by doing things such as proper sick pay, proper ventilation support, and investing properly in public health systems and local primary care systems. One of the things we know about this virus is that, like flu, it disproportionately hits the poorest and the disadvantaged because they are the people who have to go to work or the people in those communities where significant long-term conditions such as diabetes and chronic obstructive pulmonary disease tend to cluster. That often makes those people more vulnerable to these types of respiratory viruses.

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[Mr Mark Harper (Forest of Dean) (Con)]

I draw the House’s attention to my entry in the Register of Members’ Financial Interests as chair of the Covid Recovery Group.

Before I turn to the matters before us, I would like to put on record my thoughts about the loss of Jo Cox five years ago. Sadly, I remember that day very well. Madam Deputy Speaker, you and I were both in different roles at that time, and it was our joint responsibility—in my case as the Government Chief Whip and in yours as the Opposition Chief Whip—to ensure that the House was able to be recalled for appropriate tributes to the paid to Jo Cox and her memory. I know that, in your position, you are unable to speak often in the House, but it was a great pleasure working with you on that very sad occasion to make sure that a fitting tribute was paid. Sadly, I remember that day very well.

On a happier note, in one sense, I would like to put on record my thanks to Sir Roy Stone for his 44 years of service in the civil service, which will shortly come to an end, although I am told he is not retiring; he is going to turn his attention to other things. He was a fantastic principal private secretary to me when I was Government Chief Whip, and I know that his loss will be felt across Government.

[Mr Steve Baker]

May I take this moment to put on record my apologies to my right hon. Friend, who was Chief Whip during a period when I was leading various rebellions? I also want to offer a great apology to Roy Stone, who will have had to put up with the trouble that I caused my right hon. Friend. I am very grateful for the things that my right hon. Friend has said.

[Mr Harper]

My hon. Friend reminds us all how we can have different roles in this House. It is worth noting that, as a former Government Chief Whip, I do not find not supporting the Government a particularly comfortable place to be. However, as my hon. Friend the Member for Wellingborough (Mr Bone) said, sometimes we have to put what we believe to be the interests of our country first, and that is what I feel I am doing.

I want to draw attention to what my hon. Friend the Member for Bolton West (Chris Green) said, because he is right. There are documents with Government—I am not saying that these have been agreed by Ministers, but certainly this advice is being given to Ministers—that Government should aim to have a very low prevalence of covid. That is not zero covid, but it is not a great distance away. If Ministers were to agree to that strategy, it would mean restrictions going on for the foreseeable future, and that is one of the things that we are very concerned about.

I note, at this point, what my hon. Friend the Member for Wellingborough said: the Labour Benches are somewhat empty—the Back Benches are completely empty— and it is colleagues on the Government side of the House who are holding the Government to account. I accept that the Government may occasionally find that uncomfortable, but it is our role as Members of Parliament.

I always find it helpful to draw attention to the documents actually before us. For those who do not know, we have an explanatory memorandum, which explains what it is we are voting on today. It has been prepared by the Department of Health and Social Care and it will have been approved by a Minister of the Crown. It is very clear, and it is worth reading. Paragraph 7.3, bullet two, makes it clear that the Government will

“likely be able to offer a first dose”

of vaccine

“to all adults…by July, but the vaccinations”

themselves will probably not take place until August “due to supply constraints.” We know that it takes two or three weeks until those vaccinations are effective, so those adults will not actually be protected until later in August, so that means that this delay is therefore pointless, or alternatively, that we are not going to cease these restrictions on 19 July if vaccinating all adults is the goal.

If we then turn to the review dates and whether this is indeed a terminus, paragraphs 7.4 to 7.7 are very interesting. There is a review required by the Secretary of State every 35 days. The first review, according to this, is not due until Monday 19 July. There is no mention here of an earlier review after two weeks—

“the first review due by Monday 19th July 2021.”

It says that

“England will remain at Step 3 for a further 4 weeks (subject to further review).”

It also says that the primary purpose of extending these regulations is

“to gather more evidence that the…tests can be met”—

not that these rules will expire after four weeks never to be reintroduced, but to gather evidence for tests to be met and then for a decision to be taken about whether these restrictions are to continue. The second reason given is to

“allow more people to receive vaccinations…further reducing these risks”,

as Ministers have said, but as I just pointed out, the first doses are not going to be delivered until August, so that makes no sense. Something does not add up here, and we are concerned that these regulations are not going to end on 19 July.

[Chris Green]

In the context of timetables and how things are going to pan out in the near future, it is now the Government’s intention to ensure the vaccination of a very large number of care workers. That is presumably going to take legislation and a period of time for them to have a vaccination, and perhaps a second vaccination, and to deal with all the other problems. If this is a requirement for the Government to be able to deliver an exit from lockdown, how long will that take?

[Mr Harper]

My hon. Friend makes a very good point, and it is part of the reason why we are concerned. If this was genuinely going to be the end of it, that would be one thing. I have listened carefully to the Members who have spoken and a number have said that they will support the Government on this occasion, but this is it. I am afraid that we have heard that before and it has turned out not to be true, and I am afraid, just from reading the documents in front of us, that that is why I have some scepticism.

The final thing I will say—I hope the Minister who will be winding up the debate, who I have a great deal of respect for, can clarify this—is that I am not quite sure what is going to happen at the end. The review of the evidence that has been gathered about whether the tests are met is not due to be done until 19 July, so I am not clear about when Ministers are going to come to Parliament to set out whether those four tests have been met. Is it going to be on 19 July, or is it going to be before 19 July? I am not clear whether they are going to give that one week’s notice—all the way through the road map so far, we have had four weeks, then a week’s notice. I am not quite clear about the timetable, and this is important, because, as has been said, people’s lives will now be reoriented around that new date, including weddings, family events and people’s plans. It is important that our constituents know what to expect. When can they expect a decision? When can they expect to know what their life will look like? It is because of concerns about whether the regulations really are the end that I will, I am afraid, vote against them this evening.

My final point is on the motion about proceedings in this House. It is my strong view that, although it has been welcome that we have been able to have Parliament meet through a pandemic, and thanks should go to all the parliamentary staff who have made that possible, it is, I think, indisputable that this Parliament, in its current form, is not as effective in holding the Government to account and enabling us to do our job as Parliament should be. I think that we should get back to as normal as possible in this House as fast as we can. For that reason I will also vote against the motion to continue these proceedings effectively until we return in September.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I thank the right hon. Gentleman for his kind words about how closely we worked together after the tragic murder of Jo Cox. I much appreciated the work that we did together at that terrible time. I also echo his words about Sir Roy Stone, who I saw this afternoon to say how much I had always valued the advice that he gave to me when I was Opposition Chief Whip.

We now go to Sir John Redwood.

Covid-19 Update

Lord Harper Excerpts

Monday 14th June 2021 Commons Chamber

[Mr Mark Harper (Forest of Dean) (Con)]

Before I ask the Secretary of State my question, I should just say—as a former Government Chief Whip, it does not give me any great pleasure to do so—that I wholly associate myself with your remarks earlier, Mr Speaker. This statement should have been made to this House by the Prime Minister before it was made to the media. I hope that we do not see a recurrence of it and I wish you well in your meeting with him.

The Secretary of State has set out that it is not the Government’s policy to get to zero covid—indeed, that is not possible. Can he say whether it is the Government’s policy to maintain a low prevalence of this virus? If it is not, can he confirm the Prime Minister’s sentiments today that 19 July is a terminus date, and can he rule out bringing back restrictions in the autumn and winter when we see an inevitable rise in what is a respiratory virus?

[Matt Hancock]

Well, it is not inevitable—I do not think it is inevitable. It may happen, but it is not inevitable because we also have the planned booster programme to strengthen further the vaccination response. But it is absolutely clear, based on all the clinical advice that I have seen, that a goal of eradication of this virus is impossible. Indeed, there is one part of this country that tried it for a bit in the summer and found it to be impossible. Therefore, we must learn to live with this virus and we must learn how we can live our normal lives with this virus, so I reflect the Prime Minister’s words, which, of course, I concur with entirely, on 19 July. Our goal is to make sure that we get as much vaccination done between now and then—especially those second doses—to make sure that we can open up safely, even if there is a rise in cases, by protecting people from hospitalisation and especially from dying of this awful disease.

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[Chris Bryant]

On a point of order, Mr Speaker. I completely agree with every single word of your statement earlier, as I guess you knew I would. I want to ask, however, about the provisions for our business from next week. As you know, these things were all timed to change at the same time as the national situation, which has now been changed.

I presume that there will be a knock-on effect on parliamentary business: whether Select Committees will meet in hybrid form or virtually, how we will conduct our parliamentary business in the Chamber and the Division Lobbies, and so on. I know that some of that is your responsibility solely, Mr Speaker, but some of it is the responsibility of the Government and might need changes to the Standing Orders. I wonder whether you have had any notification from the Government that they intend to bring such changes forward or of when we will debate them, when we will ensure we get them right, whether there will be proper debate and whether there will be a business statement to tell us when all that will happen.

[Mr Harper]

Further to that point of order, Mr Speaker. Listening to the Secretary of State, I was struck by what he said about the need to get people vaccinated and about the very important difference that that makes to the level of risk. In the House’s decision making about how we conduct our affairs, would it be relevant to look at the proportion of Members who have been single or double-vaccinated? My judgment would be that if the vast majority of us have been vaccinated, this level of social distancing is simply not necessary and the House could get back to what I know you want, Mr Speaker: much more effective holding of the Government to account.

[Mr Speaker]

I have a lot of sympathy with getting this Chamber absolutely back to normality. What I would say is that it is not just about Members having double doses; it is also about the staff, to whom we have a duty of care. That is why I said, quite a long time ago, “Let’s see if we can’t get our staff and Members inoculated more quickly than we are doing at the moment.”

On the other point of order, we have an important Opposition day tomorrow. Let us see whether the Government bring forward proposals on Wednesday for the House to decide on its own procedures from Monday up to the summer recess. I expect the Leader of the House to consult other parties in the House before the Government bring forward those proposals; I hope and am sure that those conversations will take place, and take place quickly, in order for the House to know where we are going. Because the date is so close to the summer recess, my suggestion is that it would be easier to take it through to then, for the sake of three days, if this House agrees to what is being proposed.

Winterbourne View Hospital and the Transforming Care Programme

Lord Harper Excerpts

Thursday 10th June 2021 Westminster Hall

[Mr Mark Harper (Forest of Dean) (Con)]

Thank you, Ms McVey. First, let me put on the record a declaration of interest: I chair the all-party parliamentary group on learning disability, so that is the context in which I am speaking. Mencap, which provides the secretariat for the APPG, has provided a very helpful briefing for the debate, which it has made available to all Members.

It is a great pleasure to follow the hon. Member for Worsley and Eccles South (Barbara Keeley). I do not propose to repeat everything she said, although I agree with the large bulk of it and the thrust of her remarks. I want to focus on the specific commitments that the Government have made. I am afraid—I say this with no great pleasure as a Government Back Bencher—that the Government have missed commitments on a number of occasions. I want to put on the record some very specific questions for the Minister about what the Government are doing to ensure they hit the revised targets that they have set out. I also want to remind people listening that the Government have now made a clear commitment to introduce proposals to reform social care this year. I know the Minister is well aware, as is the shadow Minister and everyone present, that social care does not just include care for older people; it includes care for people with disabilities.

I say that is because, when the public conversation happens, after about five seconds it immediately turns into a discussion only about older people—usually older people in a residential setting. We tend not to talk about older people who receive domiciliary care that enables them to stay in their homes, and the media do not focus on the fact that, actually—I think it is still the case—the majority of public spending on social care in England is not on older people; it is on people of working age. If we are to introduce social care reforms, they will not be worth having unless they properly encompass people of working age, including people with learning disabilities or autism. They will need to be very different reforms from those that deal with older people, because although many older people, though not all, have assets that enable them to make a contribution—obviously we will have a debate about the appropriate level of contribution—people of working age do not have such assets, particularly if they have been disabled from birth. If we were to have a means test of any description, we would simply build in a new barrier to people of working age with learning disabilities or autism getting into the workplace and working, which is what most of them want to do. Most of them are able to do so if we provide the tools.

I want to focus specifically on some questions for the Minister. I am mindful about what you said about ensuring we can get everyone in, Ms McVey, so I will try not to make my remarks too lengthy. The hon. Member for Worsley and Eccles South set out the various targets that have been missed. As I said, I take no great pleasure in that as a Government Back Bencher, so I will not repeat all the misses. I want to focus on the latest target in NHS England’s long-term plan, which is to deliver a 50% reduction in in-patient beds by March 2024.

First, I want to ask the Minister whether the Government have done any thinking about whether the 50% reduction is ambitious enough. It would be ideal if we did not have anybody in such settings and we were able to support almost everybody in the community. Perhaps the Minister could comment on whether the target remains ambitious enough. Given that the original target was to deliver a 35% to 50% reduction by March 2019, and that another five years has been added on and we are only in 2021, is March 2024 an ambitious enough target to hit the 50% reduction? Given that the previous targets have been missed, I accept that it might seem ridiculously ambitious to talk about introducing the latest target. However, given that we have let it slip by another five years, I want to test whether it is actually the right target.

The second thing is to focus on how we will reach the target. The hon. Member for Worsley and Eccles South rightly said that the only way we can really stop people being in those institutions is to provide proper support in the community. The Government have set out how they will do that with their transforming care plan and objectives about building the right support. I understand that the intention is that a cross-government action plan will be produced, so it will be helpful if the Minister will tell us how that is going and when it will be published. To what extent will the proposals to reform social care that are being worked on improve or transform care in the community for people with learning disabilities and autism? Will the decisions to be taken this year—alongside the comprehensive spending review, I presume—provide an opportunity for a step change in getting this ambitious target delivered on time?

The Minister will be familiar with the fact that the cross-party Joint Committee on Human Rights said in its report that it had no confidence that the Government would hit the target in the NHS long-term plan. It proposed a No. 10 unit with Cabinet-level leadership to ensure reform. I listened carefully to what the hon. Member for Worsley and Eccles South said about a commissioner, but I am slightly traditional and old-fashioned, and I think that accountability in government is held by Ministers. They are elected and accountable to both Houses of Parliament, and political responsibility for delivering on the proposals sits with the Secretary of State and the Minister. I am not keen on having a commissioner as another person who feels that it is their job to chivvy Ministers along, because that is our job, collectively, in Parliament.

I do want to know, however, what mechanisms are in place whereby the Secretary of State for Health and the Minister for Care can monitor what NHS England is doing. At present—this will not be the case under the proposed legislation—NHS England is an arm’s length body with a chief executive, so what are the Secretary of State and the Minister doing, on a regular basis, to hold NHS England to account to ensure that it delivers on this ambitious timetable, and perhaps achieves a more ambitious one?

My experience in government is that if something challenging has not happened in the past, there is only one way to get it done: Ministers making it clear, and saying, that they care about it; and, most importantly, showing that they care about it by focusing on it regularly, asking for information about delivery across the country—Mencap’s report shows that delivery is inconsistent throughout the country—and getting regular updates on progress, putting a bit of stick about when things are not on track. To do that, they need a plan with regular milestones so that progress towards a target can be measured. It would be helpful—there is no reason why it could not be done—if progress towards such milestones were not just shared with the House, but published, so that the families of people who have been badly treated, including those at Winterbourne View, can see that we are making progress.

Before I conclude, I wish to focus on the use of restraint, seclusion and segregation. I understand that a trigger for the Joint Committee on Human Rights inquiry and a CQC investigation was a BBC Radio 4 “File on 4” programme revealing the shocking use of restrictive practices in in-patient units. The CQC report, which was ordered by the Secretary of State, revealed widespread and frequent use of restrictive practices, including physical and chemical restraint, long-term seclusion and segregation. I understand that we are still waiting for the Government’s response to the report, so it would be helpful if the Minister would set out when it will be published so that we can find out what the Government will do as a result.

I hope that the Minister will set out a plan to make sure that we deliver against the new target so that we will not sit here in a few years saying, “The target that was set has been missed and rolled forward again,” with the families who have been subjected to unacceptable care feeling that no one is listening to them, and we are back on the hamster wheel with nothing having been done. If the Minister can focus on that, we will have taken a big step forward.

--- Later in debate ---

[The Minister for Care (Helen Whately)]

It is a pleasure to serve under your chairmanship, Ms McVey. I thank the hon. Member for Worsley and Eccles South (Barbara Keeley) for securing this important debate, for opening the debate and for her committed campaigning for people with learning disabilities and for autistic people. I also thank all Members who have spoken powerfully today, both in the Chamber and virtually, and shown the strength of feeling on the issue among parliamentarians. I particularly thank my hon. Friend the Member for Bexhill and Battle (Huw Merriman), as he has taken on the role of chair of the all-party parliamentary group on autism following, as he said, the very sad death of our right hon. Friend Dame Cheryl Gillan. She is missed so much by all of us, both as a colleague and for her work for autistic people, which has made such a huge difference over the years, although there is clearly much further to go.

The appalling abuse uncovered at Winterbourne View has no place in our society, and I share the shock and anger that hon. Members have expressed today. It was rightly described as heartbreaking and disgusting by my hon. Friend the Member for Broxtowe (Darren Henry), and it should never have happened, as my hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti) said. None of us accepts this kind of cruel and abusive treatment of people with learning disabilities and autistic people, and none of us wants people to be in-patients unnecessarily when they could be better off living in the community. I will use my time to talk about the work of Government, the NHS, the CQC, local authorities, and others we are working with to stop poor and—worse still—abusive care, and to improve care. As part of that, I will talk about what we are doing to reduce the number of people with learning disabilities and autistic people in in-patient units, which we know are rarely the best place for those people to be. As I do so, I will seek to respond to questions raised by right hon. and hon. Members.

First, I will talk about the approach we are taking to stopping abusive care. We are working with the NHS as care commissioners, local authorities, and of course the CQC, which plays a critical part. I fully support the much tougher approach that the CQC is rightly taking through its more robust inspection regime and updated methodology, which includes speaking more to patients and families and really digging into the culture of providers. It is in some of these closed cultures where there has been such concerning treatment of patients, and the CQC is taking a robust enforcement approach, including wasting no time in closing down services when it uncovers unsafe care. The sad truth is that this tougher approach by the CQC has exposed more cases of poor care, and I fully support the CQC in taking very robust action in those cases.

A significant number of people with learning disabilities and autistic people in in-patient units, about 59%, are autistic. As my hon. Friend the Member for Bexhill and Battle said, an in-patient unit is rarely a good environment for someone who is autistic, and can often be a really inappropriate one. I am clear that no one should be in an in-patient unit if it is not to their benefit—if they are not receiving some form of therapeutic treatment that helps them. Even then, their time in an in-patient unit should be as short as possible, and that unit should be as close to home as possible. Our target is to achieve a 50% net reduction in in-patients by 2025, from a base starting in 2015. Back in 2015, there were 2,895 people with learning disabilities and autistic people in in-patient units; that figure has come down to 2,035, which is a 30% reduction. England is divided into 44 transforming care partnership areas, 17 of which are on track to achieve the target, but that means that 27 are not on track. I take that failure very seriously.

My right hon. Friend the Member for Forest of Dean (Mr Harper) asked whether our target of a 50% reduction is ambitious enough, and whether we should be aiming for zero in-patients. That is a question that I have asked myself, and I have also asked it of the NHS and of clinicians. It has been made clear to me that there are times when people with learning disabilities and autism may need to be in an in-patient unit, when they have a mental health condition that could benefit from in-patient treatment. As such, I do not think it would be right to say that it is never appropriate, but it should be rarely considered appropriate, and alternatives should be tried wherever possible. I must also mention to my right hon. Friend that just under 30% of the numbers I am talking about are individuals who are under Ministry of Justice restrictions, so that is another challenge to discharging them. Those are net figures, however, and in the period that we are talking about, there have been more than 10,000 discharges, so it is not a static population. Of course, given that reduction of 30% and more than 10,000 discharges, there have also been a large number of admissions.

When I became the Minister for Care, with this in my portfolio, I straightaway asked the question, right back at the beginning of the pandemic, why are we behind the target? Why have we not made the progress that we should be making? Why is it taking so long? What needs to be done to fix that and to get back on track? We need to have a plan that we can all be confident in—all of us in the Chamber and the families of in-patients.

[Mr Harper]

Before the Minister moves on, may I test her? She said that she asked whether the 50% target was right. After all those conversations and yes, accepting that there might be some need for in-patient units, is the Government’s position that the 50% reduction is the right end state, or is there a different number? If it is 50%, will she publish the analysis that sets out why that is the right number?

[Helen Whately]

I can tell him that achieving the 50% will be hard. I am all for being ambitious, but in fact, from everything I have seen, achieving it will be hard, partly because some are more easily discharged—I pause as I say that, because it has been difficult to discharge many because we have complex situations here. We have seen some people continuing to be in-patients with long lengths of stay, and it has become almost harder and harder to find a way to find the right support for them in the community. Achieving the 50% will not be easy. I will get to the other part of my right hon. Friend’s question.

When I saw the position we were in and that we were not on target, I asked why and how come. Clearly, however, this is a complex system—it involves the NHS and local authorities doing things, and there are questions about housing supply, community schools and in-patient services. I therefore set up the building the right support delivery board, to which my hon. Friend the Member for Bexhill and Battle referred—I thank him for his supportive words. That board’s aim is to bring those involved together, because, much though we all like a clear line of accountability, to point a finger at somebody to say, “Solve this!”, the reality is that solving this involves bringing different organisations and different parts of our system together.

The delivery board has identified six priorities that we need to focus on to overcome the barriers to achieving lower numbers of in-patients: first, identifying the best practice models of care in the community. What does good look like? That may sound obvious, but getting the right answers is not the easiest thing to do. What is the right care for people in the community? First we have to find out what we want to see in all our constituencies that is available for that group of people.

Secondly, we have to focus on improving the transition into adulthood, in particular for autistic young people, because that is a particular problem resulting in in-patient admission. Thirdly, we have to reduce the number of people in in-patient care with judicial restrictions who, as I mentioned, are a significant proportion. Fourthly, we have to address some of the issues with funding flows and potential financial disincentives in the system, which hon. Members have mentioned, including the hon. Member for Worsley and Eccles South. Fifthly, we have to address the lack of available suitable supported housing. Housing is often cited as the most frequent barrier to discharge. Finally, we have to ensure that we have the right workforce.

Those are the priorities. Yes, we are working on a delivery plan, which will include milestones, such as my right hon. Friend the Member for Forest of Dean rightly called for—we all need to be able to see those. Specifically on the NHS role, since the pandemic, I have asked each of the 44 areas in the NHS to review where they are on delivering against our target and to come to me with what their trajectory is. Where will they get to over the coming months and years and, to the extent that they may be below the ambition, what actions will they take to close that gap?

I hope that that addresses my right hon. Friend’s question about my similar commitment to ensuring that we have clear milestones and targets, can see who is doing what, and have a grip on getting this delivered.

[Mr Harper]

Are the milestones in the plans going to be published?

[Helen Whately]

Yes, we plan to publish the delivery plan. We want to have time for the delivery board to feed into it, because we set that up earlier this year. It is complex and cross-government, so it takes a bit of time to bring that together, but broadly yes.

I want to touch on funding, because it was mentioned a number of times as one of the barriers. As part of the NHS England long-term plan, we are investing £40 million this year in improving community support and preventing avoidable admissions. There is an initial £31 million of funding for this issue as part of the NHS mental health covid recovery package. There is £11.35 million specifically to accelerate discharges from mental health hospitals, which includes funding to strengthen advocacy for people with a learning disability and autistic people, and £19.65 million to help prevent crises from occurring and to avoid admissions into in-patient care. There is also the £62 million community discharge grant, which is a fund over three years. The first tranche was issued last year, with a further £21 million to be distributed this year and next. That is particularly to cover some of the double running costs involved when a discharge happens. Someone may need care as an in-patient, but it also has to be set up in the community.

My right hon. Friend the Member for Forest of Dean also asked about the response to the CQC’s “Out of sight” review, which was requested by the Secretary of State for Health and Social Care and which reported back in October last year. It was a review of the use of restraint, seclusion and segregation. My right hon. Friend the Member for Forest of Dean asked when we would respond to it, and I can say that we will do so imminently. I hope he finds that reassuring, even if I cannot give a specific date.

I am mindful of the time, so I will wrap up. I thank all right hon. and hon. Members who have contributed to the debate. I know we are all deeply committed to ensuring that everybody with learning disabilities and autistic people get the care and support that they need. None of this is easy. Some of the individuals we are worried about have really complex needs, but I do not accept that as an excuse for poor or, worse still, abusive care. I will continue to work with the CQC, the NHS, local authorities and other Government Departments, and with the families and user representatives, who play a really important part and are part of the delivery board. I will work together with them to bring an end to this and make sure that autistic people and those with learning disabilities get the care and support that they need, and the support that their families need, to live their lives to the full.

Oral Answers to Questions

Lord Harper Excerpts

Tuesday 8th June 2021 Commons Chamber

[Mr Speaker]

Final question, Mark Harper.

[Mr Mark Harper (Forest of Dean) (Con)]

Mr Speaker, I am very grateful that you could fit me in at the end.

Yesterday during the statement the Secretary of State did not have the information to hand on the efficacy of the covid vaccines in reducing serious disease and hospitalisation. He made a commitment, rightly, to set them out today at Health questions at the Dispatch Box; and I am delighted, with this question, to give him the opportunity to do so.

[Matt Hancock]

First, I can say that a single dose of the Pfizer or AstraZeneca jab offers protection of 75% to 85% against hospitalisation, while data on two doses, which is currently available only for Pfizer, indicates 90% to 95% effectiveness against hospitalisation and 95% to 99% effectiveness at preventing death. However, my right hon. Friend also asked specifically about the delta variant, and I said that I did not have the figure in my head for the reduction in hospitalisations. I do not know whether I should be glad, but I can report to him that the reason is that there is not yet a conclusive figure. This morning I spoke to Dr Mary Ramsay, who runs this research at Public Health England, and she told me that the figure is currently being worked on. The analysis is being done scientifically and should be available in the coming couple of weeks. This is obviously an absolutely critical figure and I will report it to the House as soon as we have it.

Covid-19 Update

Lord Harper Excerpts

Monday 7th June 2021 Commons Chamber

[Matt Hancock]

We are doing work in this area and talking to all the relevant bodies. Aside from some who have not yet understood the full importance of high-quality usage of data in the health system, actually, the vast majority of people, including the BMA, the Royal College of GPs and others, can see the benefit of getting this right. So we are working with them. The goal, though, is really clear—to use data better in the NHS because data saves lives.

[Mr Mark Harper (Forest of Dean) (Con)]

The Secretary of State laid out a number of decisions that will be announced next Monday, and the most significant of those will be on social distancing. If that remains, whatever else changes, we will not have gone anywhere close to back to normal. However, can I press him a bit on vaccine efficacy? The SNP spokesman, the hon. Member for Central Ayrshire (Dr Whitford), said that the first dose was only 30% effective. I believe that that is correct for transmission, but as for what is actually important, which is reducing serious disease and hospitalisation, the first dose is significantly more effective than that. Will the Secretary of State set out to the House his and the Department’s current understanding about the efficacy of the vaccine on the first dose and the second dose against serious disease and hospitalisation?

[Matt Hancock]

My right hon. Friend is absolutely right about the figure for transmissibility reduction from the first dose. The figures for the reduction in serious disease and death are, as he says, higher than that, but since I do not have the precise figures in my head, what I propose to do is set them out tomorrow at the Dispatch Box at Health questions.

Obesity Strategy 2020

Lord Harper Excerpts

Thursday 27th May 2021 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)]

I beg to move,

That this House has considered implementing the 2020 Obesity Strategy.

I congratulate my hon. Friend the Member for South West Bedfordshire (Andrew Selous) on securing this important debate on something I know he is passionate about and about which I have met him on many occasions.

Currently 64% of all adults and 30% of children are classified as overweight or living with obesity. This masks the fact that in some areas the figure is as high as three in four adults. It is a complex issue that has a huge cost not to only the health and wellbeing of the individual but to the NHS and the wider economy. It makes individuals susceptible to a plethora of illnesses. Indeed, my hon. Friend the Minister for Care, who was at the Dispatch Box for the previous debate, commented to me that if we could get the general weight of the population down we would help people with more exercise and a better diet, as well as the health trajectory of those who live with dementia.

Covid has shone a light on why it is more important than ever that we need to get the nation healthy. Obesity is the only modifiable risk factor for covid-19 and a major modifiable risk factor for other diseases such as diabetes, cardiovascular, and some cancers—in point of fact, many. We are therefore at a teachable moment in which we can change attitudes, educate and influence drivers around less than healthy dietary and physical activity, and motivate behaviours so that they change. Helping people to achieve and maintain a healthy weight is one of the most important things we can do to improve our nation’s health, and we all have a role to play in meeting the challenge. It is complex. There is no silver bullet. There is no single source of responsibility. It will take action from all of us to work together to achieve our ambition—from the producer, to the processor, to the retailer, to the customer, with quite a dollop of influencing the environment through actions we in Government and in Parliament take and are taking.

Our strategy to meet the challenge, published last July, is far-reaching in its ambition. It reflects the significant work undertaken over the past four years to halve childhood obesity. Currently two out of every five children who enter primary school are overweight or obese. That number rises in the six years they are at primary school to three out of every five children.

[Mr Mark Harper (Forest of Dean) (Con)]

On the Government’s ambition, the Minister said very clearly, and it says in the strategy, that we want to halve childhood obesity by 2030. The strategy also says,

“reduce the number of adults living with obesity”,

although I looked and could not find a specific target. Is she able to set out what the Government think that trajectory should look like? What I am concerned about—she will see this when I make my remarks later—is that there are lots of practical measures in the strategy, but I am struggling to see how the Government will actually deliver the result, which is fewer people being overweight or obese. Having some milestones on that journey, rather than just waiting until 2030, would be helpful so we can judge whether it is working and make some course corrections.

[Jo Churchill]

I understand why my right hon. Friend is calling for milestones but, although the problem is a national one, there are different numbers for the proportion of the population that is overweight or living with obesity in each area. We can set milestones, but a national mile- stone may mask whether we are achieving what we need to achieve in the areas—often the more deprived areas in our communities—where we need to help, encourage, support and educate people to get them further on this journey. I will listen attentively to his contribution, as I always do, and then I may come back to him in my closing speech.

Three out of five children are overweight or obese by the time they leave primary school. We know that there is a direct correlation between the dietary habits picked up early in life and behaviour later on. We are working to create the right health environment to support people, and I will set out briefly some of the actions we are taking, starting with out-of-home calorie labelling. Restrictions laid in the House on 13 May will require large businesses in England with 250 or more employees, including restaurants, cafés and takeaways, to display calorie information for non-pre-packed food and soft drink items that they sell. Many have already gone some way in doing that. These regulations will support customers to make informed, healthier choices when eating out or purchasing a takeaway.

As I said, many businesses have articulated to me that they understand fully the importance of providing information and being proactive in leading the way. They recognise the demand from their customers for more information so that they can pursue a healthier lifestyle. Smaller businesses currently do not fall within the scope of the regulations.

We have also listened carefully throughout the consultation period to individuals and stakeholders who have the challenge of living with eating disorders. We feel we have been careful and sensitive and have put in reasonable adjustments to help that group. We have also exempted schools from the requirement to display calorie information, given the concern about children in school settings. We have included a provision in the regulations allowing business to provide a menu without calorie information on request.

[Jo Churchill]

If the hon. Lady allows, I will go through the rest of my contribution. I hope she will take away that this is about building blocks. As I said, it is a complex situation, and there is no silver bullet. We must look at the antecedents of both conditions, including the link to mental health for those who suffer from anorexia and certain other eating disorders, and at some of the broader challenges when we are looking at those who are overweight or living with obesity. They need to be taken in the round, but one cannot be cancelled out against the other.

[Mr Harper]

rose—

[Jo Churchill]

I am going to push on just a bit, and then I will of course come back to my right hon. Friend.

We are also taking action to stop the promotion of less healthy products by volume and prominent locations online and in store. We want to support shoppers to purchase healthier options and shift the balance of promotions that way by maximising the availability of healthier products. We still need to eat, and we are not banning anything, but we are trying to educate, encourage and make people aware, so that they have the option of a healthier choice by default.

Last December, we confirmed that we will legislate on the promotion of foods high in fat, salt and sugar in stores and online. This will apply to medium-sized and large businesses—those with more than 50 employees—in England, and it will come into force next year. I would like to congratulate and thank those large retailers that are already taking these steps, because the argument is often put forward that it is unaffordable for a business to do this, yet many of the large retailers are doing it.

[Jo Churchill]

My hon. Friend and I have spoken about Jordans. Indeed, my first job was selling Jordans Crunchy bars at county shows when I was—oh—several decades younger. I will of course be happy to talk to him after this, but I would also gently point out that I have British Sugar, which is also in this food group, in my constituency. I not only meet its representatives on a regular basis, but I also met as lately as yesterday representatives from the British Retail Consortium and the Food and Drink Federation.

[Mr Harper]

The intervention I was going to make when the Minister was dealing with the hon. Member for Bath (Wera Hobhouse) was on the impact assessment for the regulations she mentioned. I have looked very carefully at the evidence, and it seems to me that the best case for these regulations is that we will reduce the number of calories consumed by 80, which is an apple, and the worst case will reduce it by about eight, which is a 10th of an apple. It seems to me that the cost of these regulations simply is not justified by the outcomes.

Because the Minister did not take my intervention at that time, she went on to talk about the legislation for promotions online, and I have looked at this. The Government’s goal for this legislation is that it reduces the calorie consumption by 8 billion calories. That sounds like a lot, but if we look at the number of children in the period that is spread over, it is equivalent to each child eating one fewer Smartie a day. Given that the children who have the most serious obesity problem are consuming up to 500 calories a day, reducing their calorie consumption by three calories a day simply does not do it.

The Government’s ambition is correct, but I just have a real worry that these particular measures simply will not have the effect that the Government and all of us wish to happen.

[Jo Churchill]

I am very glad that my right hon. Friend is joining me in the ambition of wanting to get the weight of the nation down. I would gently push back, and say that I do not recognise those calorie figures. I am sure we can have a longer discussion over where that evidence base is drawn from, and about the fact that there is actually a much greater impact. As I have pointed out on two or three occasions, this is about the building blocks of all these different measures coming together, and they will be monitored and assessed as we go through.

Another element of the environment is advertising. Currently, we are failing to protect children from over-exposure to high-fat, salt and sugar products via advertisements on both television and online platforms. I would gently say that if adverts did not influence people, they would not be used. Therefore, to help tackle the current situation, let us just see more advertising of healthy food. It always strikes me as quite interesting when watching a diet programme on the television that each ad break is often interspersed with adverts for high-fat, salt and sugar products. This does not affect the advertising industry’s revenue, because there is still a need to advertise and people still need to eat, but the foods advertised often do not reflect the balance that we need to enjoy a healthy life.

--- Later in debate ---

[Greg Smith (Buckingham) (Con)]

Obesity is clearly a huge challenge facing our country, and one that absolutely should not be ignored, but I do fear that the state is significantly overreaching in some of the proposals that have come forward as part of the obesity strategy. The approach to foods high in fat, sugar and salt encompasses a perversely broad range of products, including butter, granola, porridge oats, muesli and protein bars, none of which have any particular appeal to or indeed are marketed to children, yet all of which are treated as junk food.

Breakfast cereals were previously heralded for high fibre but are now demonised. No distinction is made for naturally occurring sugars and fats from the dried fruits and nuts that are so often present in those products. If the state is really saying that breakfast cereals are bad, where does that naturally push people? A bacon sandwich? A full English? A pain au chocolat? All are things that I am particularly partial to but that I do not think the public health establishment will be keen to endorse. Perhaps people could have toast? But then we see that butter is on the HFSS naughty list.

Many breakfast cereal producers pay farmers, including in my constituency, a premium for buying their oats, thereby paying for the environmental and wildlife schemes that I am sure we all value. Let us be in no doubt that any policy that reduces cereal-makers’ ability to sell wholegrain cereals will adversely impact on great British farmers.

[Mr Harper]

I was intrigued to listen to my hon. Friend’s list of products. Is not the issue that there is a focus on individual products when, actually, the important thing in getting to a healthy weight is not individual products but a person’s diet as a whole and the balance between individual products across their diet? To demonise individual products is not the way to go.

[Greg Smith]

I absolutely endorse and agree with everything that my right hon. Friend says. It must be about the promotion of a balanced, healthy diet. Some of the things that we all know are not particularly good for us can be part of that balanced, healthy diet, so I absolutely agree.

The restrictions also undermine some alternatives to high-sugar sacks. For example, protein bars are used by many adults who lead highly active lifestyles. Surely the restriction contradicts the ultimate goal of the Government’s strategy: healthier living.

Let me move on briefly to the question of TV advertising. Broadcasters and creative industries throughout the United Kingdom are estimated to be in line to lose some £200 million because of the proposals. With children spending far more time watching online content than traditional TV channels, it is essential, not least for our public service broadcasters, that there is an absolutely clear level playing field between TV broadcast and online. Anything less would be to let down our broadcasters, particularly, as I say, our public service broadcasters.

I would also argue that the 9 pm watershed is equally destined to fail, as research shows that it will lower the calorie intake among children by just 1.7 calories a day, which is simply inconsequential. We need a more proportionate, less interventionist solution that ensures fairness for all. Obesity is a complex problem, but the solution cannot be nannying, ineffective policies.

I certainly did not get into politics to tell people what they should and should not eat, because when people are free to make an informed choice about the way they live, without coercion or state interference, they are much more likely to keep those changes long term, to the benefit of the health of the nation. I urge the Government to rethink the proposals and strip out the nonsensical inclusion of products such as cereals and protein bars. Let us look once more to freedom, choice and personal responsibility.

--- Later in debate ---

[Wera Hobhouse (Bath) (LD)]

I speak today as the chair of the all-party parliamentary group on eating disorders and I want to highlight the anxiety felt by many of those with an eating disorder about one specific aspect of the obesity strategy: calorie labelling on menus. Obesity causes serious health problems and there is no doubt that far too many people in this country do not have a healthy weight. I add my unequivocal support to the Government’s aim of addressing obesity, but obesity has to be considered as one side of our complex relationship with food. It is a form of disordered eating and therefore cannot be separated from other forms of disordered eating and cannot be dealt with in isolation. Calorie labelling on menus will not only be ineffective in tackling obesity, but will actively damage those with an eating disorder.

Studies show that there is only a small body of low-quality evidence supporting the suggestion that calorie counts on menus lead to a reduction in calories purchased. While there is limited evidence that calorie labelling will support the public in losing weight, there is convincing evidence that it would harm people with an eating disorder. About 1.25 million people in the UK have an eating disorder, and the 2019 health survey found that 16% of all adults aged 16 or over screened positive for a possible eating disorder. Over the pandemic, the charity Beat has reported a 173% increase in demand for eating disorder support, and research shows that individuals with anorexia and bulimia are more likely to order food with significantly fewer calories when presented with a menu including calorie counts. Those with binge eating disorder are more likely to order food with significantly more calories.

Many people with eating disorders also live with obesity. Up to 30% of people seeking weight management services would meet the diagnostic criteria for binge eating disorder. Clearly, a reductionist approach to nutrition means that the obesity strategy risks harming some of the very people it is designed to support.

[Mr Harper]

I am sympathetic to the point the hon. Lady is making, and she will know from my intervention that I think the evidence with respect to calories and out-of-home labelling is quite weak. Is labelling on products purchased in supermarkets also a problem for those with eating disorders? I ask that genuinely; I do not know the answer. Can she furnish that information?

[Wera Hobhouse]

I am particularly concerned about calorie labelling in restaurants. People who suffer from eating disorders are isolated and fearful of contact with others because they are thinking continuously about what they are going to eat or drink. Going out to a restaurant gets them through that step, and it is often a significant step towards recovery. As I say, my particular concern is labelling on restaurant menus.

In response to the survey on calorie labelling conducted by Beat, one respondent said:

“My eating disorder thrives off calorie counting and knowing all the calories in everything. I would feel compelled to look at calorie labels”

in restaurants and

“I would feel embarrassed asking for a different menu. Please don’t do it. Please.”

The Mental Health Minister has been extremely generous with her time, listening to the all-party parliamentary group’s concerns about the plan to mandate calorie labelling on menus. The APPG is grateful for her interest in improving early access to eating disorder treatment. However, I must repeat my plea to the Government to look again at this element of the obesity strategy.

Addressing obesity and tackling eating disorders should not be in competition. We must tackle them together. I look forward to working with the Minister to develop an obesity strategy that successfully addresses the obesity epidemic, but does not harm people with other forms of eating disorder.

[Mr Mark Harper (Forest of Dean) (Con)]

As I said in my interventions on the Minister, I very much support the Government’s objective. A situation in which 36% of adults in England are overweight and 28% are obese is not good, and there are many health consequences of it, but my view is that, fundamentally, we need, first, to enable people to understand whether they are overweight or obese. That might sound like a foolish thing to say, but there is some evidence that people do not recognise whether they or those around them are overweight or obese, and are not very good at working that out.

Secondly, we need to make people understand the health consequences of being overweight or obese. The Minister talked about incentives. The real incentive that people should have is that they want to be healthier. Unless individuals themselves want to be healthier and move towards a healthy weight, it seems to me that we will not get very far.

Frankly, getting to a healthy weight means having a healthy diet. It does not mean going on a diet and then going back to unhealthy eating; it means changing diet permanently. In many cases, it means making not dramatic changes but small changes that people stick to, such as reducing portion sizes. It is about reducing treats and things we like, not getting rid of them. When I eat, I like all the bad things, but I have become better as I have got older—I have needed to—and now I am a bit more controlled about how many times I have them. I watch the size of my portions, because as I have got older, I have had to watch what I eat.

It seems to me that it is about diet, not about individual foods. As my hon. Friend the Member for Buckingham (Greg Smith) said, demonising individual foods is not a very successful strategy. There are plenty of things that I like that would individually be very unhealthy, but I just do not eat them very often. That is where we need to get to: people need to understand what a healthy weight is, understand the health consequences and want to get there themselves.

I have a couple of questions for the Minister. She spoke about the evidence for out-of-home labelling. The impact assessment is a rather weighty document of 76 pages, but one of the things that I learned as a Minister is that it is worth plodding through such documents. There is lots of useful information in it, but I did not find any compelling evidence that introducing out-of-home calorie labelling would have any significant impact on the quantity of calories that people consume. Given the concerns that the hon. Member for Bath (Wera Hobhouse) and the charity Beat have rightly set out about those with eating disorders, the case for its successful impact is not very compelling. There is quite a lot of concern that it will not be helpful, so I think the Government ought to think again about their approach.

I also have a question about the soft drinks industry levy. The levy has been successful in reducing the amount of sugar consumed; in my constituency, Suntory Beverage & Food Great Britain and Ireland, which produces Lucozade, Ribena and Orangina, has led the industry in taking more than 50% of sugar out of its products. It has also invested £13 million in new machinery at its Forest of Dean plant to produce those products—I was very proud to launch the new production line. However, although we have reduced the amount of sugar consumed, I have seen no evidence that we have therefore reduced the quantity of calories consumed or made any impact as a result.

[Alun Cairns]

My right hon. Friend is making a very effective, cogent argument. Does he agree that because there is a will to come up with a solution that will have an impact, there is a danger that unless we take account of all the evidence, including his points about the impact of the sugar tax, we might well feel better for doing something, but not quite achieve what we set out to achieve?

[Mr Harper]

That is right. I am very keen that we look at the evidence. I can see that through reformulation we have led the industry—the company that makes Lucozade and Ribena has been successful in doing that—but the real question is whether that has reduced the number of calories consumed, both by adults and by children, and had any impact on the number of people who are overweight or obese. It has clearly been successful in reducing the quantity of sugar consumed, but as my hon. Friend the Member for Buckingham said, sugar in itself is not a bad thing; people need to consume a certain amount of sugar to have a healthy diet. My worry is that we have reduced the amount of sugar in these products, but that will not actually make any difference to whether people have a healthy diet.

All these measures need to be tested. The point that I was making to the Minister earlier is that I do not want us to introduce them, wait nine years until 2030, and then say, “Goodness, it hasn’t worked.” I absolutely accept the Minister’s point that national targets may not make sense, but we need to look, at a local level, at whether the measures are successful. If they are not working, we need to change them and look at what the evidence suggests would be more successful in getting people to a healthy weight so that we all lead a healthier lifestyle.

--- Later in debate ---

[Jim Shannon (Strangford) (DUP)]

I am grateful to be able to speak on this matter. It has been an ongoing issue for the United Kingdom and I appreciate that it is one of our greatest health challenges that affects people of all ages. I want to put on record my thanks to the Minister. I have been involved in many debates where she has responded on the issue of diabetes, which I think she referred to in her introduction. I believe that she is totally committed to bringing together a strategy that we can all endorse and will hopefully bring about a healthier and leaner United Kingdom. I also welcome the commitment to the alcohol strategy.

I am a type 2 diabetic and I have had diabetes for approximately 14 years. I am proud to say that since being diagnosed I have lost almost four stone on what I weighed back in 2008 and 2009. I am not proud of the circumstances that got to me to where I was. I did not even know what diabetes was, to be truthful. I was not even sure what the symptoms were until I met a diabetic maybe the year before. The choices that led me to be diagnosed with type 2 diabetes were ill-judged. I never really gave thought to the health issues that can come along with the foods I was eating. Sweet-and-sour pork and two bottles of Coca-Cola six nights week are not a good thing for anyone, and they certainly were not good for me, as I found out for the worse.

I am now confident and well pleased with how I deal with the issue. It takes self-control. The right hon. Member for Forest of Dean (Mr Harper) referred to self-control, which is very important. Not everybody can do it, but if they can, it is good that they can. Along with the tablets that I take for the diabetes, it seems to be bringing results. There is no place in society for judgment when it comes to the topic of obesity, as the hon. Member for South West Bedfordshire (Andrew Selous) said.

[Mr Harper]

I cannot remember whether I said—as I should have done, when I was talking about people being disciplined—that I accept that it is a simple thing in one sense to reduce one’s calorie intake and take more exercise, but it is not easy for people to do. I did not want to indicate, if I had left that impression, that I thought it was easy. Equally, while there is no alternative, ultimately, to people taking responsibility themselves, I accept that many people require help and support to do so. I am glad that the hon. Gentleman has given me the opportunity to put that on the record

[Jim Shannon]

I am grateful to the right hon. Gentleman for clarifying the matter. I knew that is what he meant, but I thank him.

The health survey for England refers to 1,000 people aged over 16, 277 of whom were obese and 31 were morbidly obese. In Northern Ireland, the figures are replicated; in fact, they are the same everywhere. Childhood obesity is a crucial issue on which much more needs to be done to make youths feel less self-conscious about the issue but at the same time able to do something about it. Obesity affects one in every five children in Northern Ireland. The figures there unfortunately show that there are outstanding problems to be addressed. Obesity exaggerates high blood pressure, diabetes and liver disease. Obesity is one of the three main causes of liver disease, in particular. Obesity also affects many other things, as the Minister said. It is very important to put that on record.

I have met constituents of mine over the years who had a medical condition that meant that they were not obese by choice but because of the circumstances of their own individual bodies. The people I am referring to had to go for bariatric surgery. I know some people who did that and I know it changed their lives. Perhaps the Minister could comment on how such procedures can be looked after within the NHS, because to do it privately costs over £10,000.

This is a serious health problem and it affects thousands of people. I want people to live their lives healthily and happily. I believe children should be taught that support is all around them and that their size is nothing to be ashamed of. There are ways to go about detecting obesity. However, I feel that one of the most important factors in tackling this issue is to reassure people that they will not be judged. Judgment often leads to resentment and failure, and there is no doubt that it is a sensitive issue for those who struggle with weight loss. I therefore urge the Minister to take that into consideration. I also urge others to be kind when it comes to such a topic. I believe that help and support is there for all those who are obese and seek help. I sincerely hope that in the coming years we can work together to bring forward a strategy that will encourage people and not do them down.

--- Later in debate ---

[Jo Churchill]

With the leave of the House, I would also like to thank everyone for the tone of the debate. It is important that we discuss these things and do so in the right way, which is essentially reflected in the comment of my hon. Friend the Member for Northampton South (Andrew Lewer) that he did not come into politics to tell people what to do. Neither did I; I came here to help them, and the crux of this strategy is to inform, to educate and, as my hon. Friend the Member for Stoke-on-Trent Central (Jo Gideon) said, to slowly knit together policies such as the Office for Health Promotion and the healthy start vouchers so that we can start changing lives, and so that children do not end up in front of my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson) as a 12-year-old weighing 9 stone, with the concomitant effect that one in 10 adults over 40 have diabetes and 4.7 million people in this country have diabetes. I have met the hon. Member for Strangford (Jim Shannon) discuss diabetes, the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) to discuss vascular disease—which is, again, completely compounded by carrying weight—and my hon. Friend the Member for Stoke-on-Trent Central to discuss the childhood challenges of poverty. We have often spoken about how particularly challenged Stoke-on-Trent is.

In no particular order, as I just happen to randomly have these figures to hand, I shall state that 8.6% of children in Northampton go into reception classed as obese, but that figure rises to 18.5% when they leave—about a 9.9% uplift. In the Forest of Dean the corresponding figures are 10.3%, with 19.3% of all children in year 6 coming out as obese. In Bedford the figures are 8.9% and 21% of all children, and more than six in 10 adults are overweight or obese.

Actually, I think the time has come to do something, and to help and to assist, because I do not think on our watch we can do nothing. This is about helping people have more quality, healthy life years, and surely that is why we are here. As my hon. Friend the Member for Sleaford and North Hykeham said, when we eat out we consume double the calories; surely it is better that we help inform, because if we were to prepare the food, we would have half the calories.

We are not banning advertising; indeed, we are offering probably the greatest marketing and advertising opportunity as we come out of the covid crisis. It cheered me this week that Kellogg’s has indicated that it will reformulate the amount of fat, salt and sugar in its products, taking out 10% of sugar and 20% of salt. The whole reason that the policy exists is to try to put children and, arguably, all of us on a better trajectory.

All the contributions were excellent, but I listened with some sorrow to my hon. Friend the Member for Buckingham (Greg Smith). I know his county and, indeed, I represent a rural county. I am not demonising breakfast cereals. Kellogg’s is going in the direction that its customers are demanding—I think, as the hon. Member for Nottingham North (Alex Norris) said, that customers are ahead of us in this House on this—and reformulating, which is what we want it to do. A noble Friend in the other place once mentioned porridge and was derided for doing so, but I want to help families and children so that, no matter what they can access and purchase, they are, by default, able to access a healthier choice, so that they are not forced into making the choice of saying, “That, at least, is something to give my children”.

We are not banning butter, so my hon. Friend the Member for Buckingham can rest assured that he will still be able to have his butter on a bit of toast, if that is what he likes. I will not repeat A.A. Milne’s:

“I do like a little bit of butter to my bread!”

However, we are also not putting more than 16 product lines into this, because we have listened to industry, the hon. Member for Bath (Wera Hobhouse) and various others who have noted the challenges. I talk regularly to the Minister for Patient Safety, Suicide Prevention and Mental Health, my hon. Friend the Member for Mid Bedfordshire (Ms Dorries), and we are incredibly cognisant of those who have eating disorders. The road that we travel has to be balanced so that people can make the right, informed choices.

[Mr Harper]

May I press the Minister—

[Jo Churchill]

No, I am terribly sorry, I have only two minutes left, but I am more than happy to talk to my right hon. Friend at considerably more length. He asked me for a bit of evidence on the sugary drinks tax. There is the fact that that, over three years, it has reduced the calories consumed on every occasion that somebody drank a soft drink by 35.2%. The figures on out-of-home calorie labelling show that £5.6 billion will be saved for the economy over 25 years, and that is before we even get to the associated benefits to people’s health.

I am sorry that I am probably not going to answer every point, but we want to achieve the full potential of all people. It is about a joint effort. My hon. Friend the Member for South West Bedfordshire (Andrew Selous) has been a doughty campaigner. I have met members of Bite Back 2030 with him, and those are young people asking us to do something. I am working with colleagues in the Department for Education and the Department for Environment, Food and Rural Affairs to make sure that we are doing that. Indeed, the Under-Secretary of State for Environment, Food and Rural Affairs, my hon. Friend the Member for Banbury (Victoria Prentis), who is on the Front Bench next to me, and I have the food strategy. Part 1 is already out and we are expecting part 2 in short order—that will very much go towards responding to what my hon. Friends the Members for Keighley (Robbie Moore) and for Stoke-on-Trent Central said. That Minister and I have worked together, with the Under-Secretary of State for Education, my hon. Friend the Member for Chelmsford (Vicky Ford), to look at how we can promote healthy eating for children and work across Government to drive these objectives.

I agree with my right hon. Friend the Member for Forest of Dean (Mr Harper), who said that this was about education, changing behaviour, changing the environment and not demonising individual foods. I want everyone to get to where he has, so I can see a future career as a healthy weight consultant, if nothing else. I congratulate Lucozade on what it has done. We will be continually monitoring the situation to make sure that we achieve our ambition on this. Partnership is key, and we are working with local authorities and working to build healthy weight management services. Promoting good health is central to this Government’s health agenda, and we will do that through the new Office for Health Promotion and proactively take the burden of preventable ill health and empower everyone to make the right choice. We would like to see immediate results, but the situation is complex, and we know it will take time. We all have a lot to gain by helping people achieve and maintain a healthy weight, and I look forward to the support of the whole House in doing that.

Question put and agreed to.

Resolved,

That this House has considered implementing the 2020 Obesity Strategy.

Covid-19: Government Handling and Preparedness

Lord Harper Excerpts

Thursday 27th May 2021 Commons Chamber

[Matt Hancock]

It has been an incredibly difficult time for those who have worked in and lived in care homes throughout this pandemic. That has been true across the world, and I pay tribute to the staff in social care who have done so much. It was, of course, a difficult challenge, especially at the start when many characteristics of this virus were unknown. As I have answered many times in this House, we have published full details of the approach that we are taking and that we have taken. We have worked with the care home sector as much as possible to keep people safe and followed the clinical advice on the appropriate way forward.

[Mr Mark Harper (Forest of Dean) (Con)]

May I take the Secretary of State back to what he said in his statement about the B1617.2 variant first discovered in India, which I think will be of the most concern to my constituents and the country in the days and weeks ahead? We are bound to see an increase in cases as we open up; that is inevitable. The important thing is breaking that link between cases, hospitalisations and deaths. My understanding of all the current evidence is that our vaccines are very effective in stopping serious disease, including from that B1617.2 variant. If that remains the case, does he agree that, on 15 June, there would be no reason not to go ahead with opening up fully on 21 June? That is the important question to which we need an answer.

[Matt Hancock]

That is literally the most important question to which we do not yet have a full answer. The data that we have suggest that, in the hotspot areas, around one in 10 of those in hospital are people who have had both jabs. That is a function both of the protection that we get from the vaccine against this variant and also of the age profile of those who are catching the disease. Those who have not been vaccinated include those who are old enough to have been offered the jab and those who have not yet been offered the jab. The fact that 90% of the people in hospital are those who have not yet been double vaccinated gives us a high degree of confidence that the vaccine is highly effective, but the fact that 10% of people in hospital have been double vaccinated shows that the vaccine is not 100% effective. We already knew that, but we are better able to calibrate as we see these data. We will learn more about this over the forthcoming week or two before we make and publish an assessment ahead of 14 June about what the data are saying about taking the step that is pencilled in for not before 21 June.

Covid-19

Lord Harper Excerpts

Tuesday 25th May 2021 Commons Chamber

[Nadhim Zahawi]

I am grateful for the hon. Lady’s question and I discussed this with the Mayor of London this morning. Of course Hounslow is on the list of affected areas and we are turbocharging the vaccination programme, as well as doing the surge testing and the sequencing and isolation. But as I have outlined in response to others, people need to exercise caution and common sense, and travel outside of the area only if it is essential. That is important. The right thing to do is for us to work together to make sure we deliver that message, as I did this morning with the Mayor of London.

[Mr Mark Harper (Forest of Dean) (Con)]

In The Telegraph story this morning about what the rules for self-isolation might be post 21 June, a Government source was quoted as saying, in response to the suggestion that they will not change:

“There is still a risk of getting the virus and spreading it on,”

That is of course true—there is a risk—but of course once people have been vaccinated the risk is much lower and, importantly, the vaccines are very effective at stopping serious disease, hospitalisation and death. So may I say to the Minister that post 21 June it is important not only that legal restrictions and social distancing go, but that all the remaining rules are adjusted to reflect the much lower risk that exists once we have vaccinated the population? Otherwise, we are going to have those rules in place forever.

[Nadhim Zahawi]

It is worth waiting for 14 June, when we will be saying more on this, but suffice it to say two things: first, even if someone has had two doses of either vaccine —I have had this experience in my own family—they can still contract covid and should therefore be isolating and quarantining; secondly, we are also looking at ways in which contacts of people who may have contracted covid can be regularly tested instead of isolating.