Social Care Reform

Philippa Whitford Excerpts

Thursday 18th March 2021 Westminster Hall

[Dr Philippa Whitford (Central Ayrshire) (SNP) [V]]

Thank you very much, Dr Huq. I pay tribute to social care staff for all they have done during the pandemic and recognise that they, too, suffered bereavement when they lost residents to covid who they had been looking after for a long time. Instead of sympathy, they often faced criticism and attack in the media.

Like the NHS, social care has faced huge pressures during the covid pandemic, so it was shocking that it was not mentioned at all in the Budget. While the Chancellor claimed the UK was in good shape when covid hit due to the Government’s management of public finances, it actually came at the end of a decade of austerity, with the NHS on its knees and an £8 billion social care funding gap in England alone. Service cuts had led to under-provision, with Age UK identifying that almost 1.5 million people do not get the support they need. While most think of frail, elderly people when they talk about social care, it is also critical to allow those facing end of life to be at home if they wish, and to ensure that younger people with a disability can participate fully in society.

The Government’s Green Paper, first announced in 2017, has been postponed yet again, despite the Prime Minister boasting in the 2019 election that he had a plan for social care that was ready to go. Perhaps he was mixing it up with his oven-ready Brexit plan.

More recently, we have been told the delay is due to cross-party discussions, but I certainly have not seen anything, nor apparently has the shadow Minister for Care. Several MPs in this debate have suggested that the Government should propose an insurance-based model, and Germany and Japan are often held up as examples. However, closer examination shows that both systems have increasing shortfalls and that co-payments are, therefore, growing markedly. Taxation still provides the greatest solidarity and security. The Secretary of State has announced plans to reverse some of the most damaging aspects of the Health and Social Care Act 2012 and promote integration of health and social care. Of course, the devil is in the detail, and there was very little of that about social care in the White Paper.

Scotland faces exactly the same issues as the rest of the UK: an ageing population, a growing need for social care support, and the challenge of retaining and recruiting care staff, particularly with new visa requirements increasing the difficulty in recruiting from the EU. However, there are significant differences in both the provision and structure of health and social care in Scotland. After devolution more than two decades ago, the structures of the healthcare market, including hospital and primary care trusts and the purchaser/provider split, were reversed and the Scottish NHS returned to being a single public body with local services provided by geographical health boards. Since 2014, Scotland has been working on integrating the NHS with social care through the establishment of integrated joint boards. They manage half of the total Scottish healthcare budget for the provision of all community services.

Of course, covid highlighted how much further we have to go, as social care is a much more fragmented landscape. The pandemic, however, stimulated a lot of close working, including projects I was part of during the first wave. One involved colleagues from acute medicine, geriatrics and the local hospice holding online meetings with care home staff to discuss difficult cases and provide advice and training in symptom management and end of life care. The other was to try and identify unpaid carers, who often grow into the role so gradually that they do not recognise the part they play. The aim is to reach out to them when they attend their local community pharmacy and encourage them to make contact with our local carers’ hubs, where they can access support, benefit advice, PPE or even just have a chat. Due to their pivotal role, unpaid carers are now being invited to receive the vaccine.

Having been involved in redesign projects over many years as a breast cancer surgeon, it was fantastic to see the usual barriers to innovation simply collapse, and the relationships formed during the pandemic will definitely accelerate integration going forward. Due to its size and rural nature, Scotland already had significant digital health infrastructure, and video consultation systems, such as Near Me, were extended to all areas. Care homes were provided with devices and digital support to connect staff and residents to their families and, when needed, to the NHS. The Scottish Government underwrote sick pay to ensure that staff could isolate if necessary. As well as providing PPE to local social care providers, health boards offered access to NHS locum banks to reduce the need for agency staff and ensure safe workforce levels.

Scotland is unique among the four nations in having provided free personal care to those over 65 since 2002, with the provision increased in 2011 and the age threshold removed in April 2019 by Frank’s Law—named after the footballer, Frank Kopel, who developed early onset dementia. Such provision encourages people to stay at home, which most of us would prefer. Two thirds of social care is provided in people’s own homes. That means there is a need for a strong home care sector as well as residential and nursing care homes.

It is important to remember that social care is delivered by people for people, so it is critical to recognise the importance of relationships and the need for continuity, dignity and respect. Social care staff also need respect for their skill and dedication, and for what they do for those we love. Part of that recognition should be paying care staff properly for a tough job that most of us could not do.

The Scottish Government have funded the real living wage for care staff since 2017. They fund overnight sleepovers at the full rate, and they provided a 3% pay rise last year. Social care staff in Scotland have also received the same £500 thank-you payment as their NHS colleagues this month. Unfortunately, the UK Government refuse to exempt it from tax or benefit deductions.

Care staff should not be described as unskilled workers, which we hear from the Home Office, just because they are paid too little. That fails to recognise the difference between wealth and worth. As many MPs have said this afternoon, caring needs to become a career and not be a low-paid stopgap before someone gets a better job on the checkout at Tesco’s. However, this is not just about basic pay rates; it is also about overall terms and conditions and the ability to take pride in one’s work through having an ongoing, satisfying relationship with the person receiving care, not just a rushed, 15-minute transaction.

Last autumn, the Scottish Government commissioned an independent review of adult care in Scotland. The Feeley report has now been published. It proposes the creation of a national care service, with national contracts, clinical standards, training and terms and conditions, to ensure greater equity and consistency across Scotland. It promotes a human-rights-based approach for the care recipient, with the principle of seeing social care as an investment rather than just a financial burden; it should allow everyone to participate fully in society. One recommendation is that all non-residential services should be provided free, in the same way as healthcare is.

We will be the next generation of care users, whether as a recipient of care or as an unpaid carer seeking respite for a loved one. We therefore have a vested interest in reform of the structure and provision of social care in all four nations of the UK and in how the people who deliver it are trained and have access to career development, but also how they are valued. To improve the quality of social care, we must invest in those who deliver that care. Caring needs to become a profession, and a profession that is respected.

NHS Staff Pay

Philippa Whitford Excerpts

Monday 8th March 2021 Commons Chamber

[Helen Whately]

I thank my right hon. Friend for his question. He mentions the 2.1% increase within the long-term plan. That figure covers not only this pay rise for the NHS workforce, but the pay deals that have been agreed for staff in other multi-year pay deals, pay progression, and other investment in the workforce. As for his question on funding for the broader extra covid costs, that is not in the main NHS budget. Just as we had £63 billion invested in those costs throughout this year, there is an extra £22 billion set aside for covid costs outside the NHS budget and also £3 billion specifically for recovery and bringing down waiting lists.

[Dr Philippa Whitford (Central Ayrshire) (SNP) [V]]

The proposal for a mere 1% pay rise suggests this Government do not value the risks taken and sacrifices made by health and care staff throughout the pandemic, nor the challenge that they will face to clear the backlog. Like their initial refusal to extend free school meals, it also shows the Government are out of touch with the public.

With a workforce crisis before the pandemic, does the Minister really believe that such a mean award will help recruit and retain healthcare staff? Senior band 5 nurses in England already earn up to £1,000 less than their Scottish counterparts, while the removal of the nursing bursary and imposition of tuition fees has saddled recently qualified nurses with up to £50,000 of debt. I am sure the Minister knows that shops do not accept claps instead of cash. Will this Government not give health and social care staff a decent pay rise and consider a one-off thank you payment, as in Scotland?

[Helen Whately]

I am somewhat surprised by the language the hon. Lady used around 1%, because a 1% pay rise for this large number of staff will cost around three quarters of a billion pounds. She should remember that this all has to be paid for in the context of, sadly, around three quarters of a million people losing their jobs through the pandemic, while others are seeing pay cuts or reduced hours. We are in a time of huge economic uncertainty, but while much of the public sector is going to have a pay freeze, the NHS workforce is going to have a pay rise.

Covid-19 Update

Philippa Whitford Excerpts

Tuesday 2nd March 2021 Commons Chamber

[Matt Hancock]

Transparency has played a vital role in our approach to responding to this virus, and I think that is an important lesson from it that should be heeded globally. In terms of the future of the NHS arranged around the ICSs, that transparency will be important, too. There will be a crucial role for the Care Quality Commission, which currently rates hospitals according to, as my right hon. Friend put it, an Ofsted-style rating. It is vital that the CQC has a similar role when it comes to ICSs, and I look forward to working with him and other members of his Committee to make sure that we get the details of that right.

[Dr Philippa Whitford (Central Ayrshire) (SNP) [V]]

Although the number of cases of the Brazilian variant is thankfully small, it is a warning that being tested in advance does not rule out travellers carrying covid. The South African variant is resistant to antibodies in previous covid patients, and there is concern that both variants may be resistant to vaccine-induced immunity and could therefore undermine the success of the vaccination programme.

The Brazilian variant has already been identified outside South America, and the South African strain is present in 35 countries not on the red list. The arrival of the Brazilian strain via both Switzerland and Paris demonstrates the various routes to the UK from high-risk countries and shows how a traveller can avoid the current hotel quarantine system by separating the legs of their journey. Those infected spent several hours in close quarters with other travellers, who would not be subject to hotel quarantine even now.

I assume that the Government are tracing the passengers from the flights, but with genomics taking some time, the window for worrying variants to get a foothold in the UK before they are discovered is significant. The situation would not have arisen with comprehensive hotel quarantine, as advised by SAGE, so why did the Secretary of State agree to such an inadequate system? Can he tell us the view of the Joint Biosecurity Centre? Does he recognise that quarantining just 1% of international arrivals does not protect the UK from these variants, or protect it from those that may evolve in other parts of the world? Will the Government now review their hotel quarantine policy and make it fit for purpose?

[Matt Hancock]

The hon. Lady is completely wrong, and she knows it. Quarantine is in place for 100% of passenger arrivals in this country. In fact, this episode, in which all those we have successfully contacted—all five—have fully isolated and quarantined at home as required, demonstrates that the policy is working. We have further strengthened it and introduced hotel quarantine, and that will no doubt give further reassurance. The hon. Lady’s characterisation is wrong, and some of the descriptions of the organisations involved are wrong as well. I am happy to ensure that she gets a private briefing so that she can understand the situation in future.

Oral Answers to Questions

Philippa Whitford Excerpts

Tuesday 23rd February 2021 Commons Chamber

[Matt Hancock]

My hon. Friend is absolutely right to make this link, because not only are the vaccines important to keep each individual safe—we saw wonderful data yesterday about how effective they are at reducing hospitalisations and deaths—but the vaccination programme is crucial to the road map out of this pandemic. It is only because of the success of the vaccine programme that we are able to set out the road map in this way. The vaccine is good for the individual, but it is also good for all of us, because by taking a vaccine people are helping to protect themselves and helping all of us to get out of this pandemic situation.

[Dr Philippa Whitford (Central Ayrshire) (SNP) [V]]

The provision of insufficient doses for care home staff to be vaccinated at the same time as elderly residents may have contributed to the fact that only two thirds have been immunised. As well as the convenience, the solidarity of being vaccinated with colleagues has helped to encourage uptake of 94% in Scotland. Will the Secretary of State ensure that staff can get vaccinated when second doses are delivered to care homes?

[Matt Hancock]

Yes, when the vaccination programme goes to a care home, vaccines are offered both to residents and to staff, of course. We want to support the ability of more and more people to access the vaccine, and that includes care home staff. People who work in a care home can now go on to the national vaccination site and book themselves an appointment. Alternatively, when we go to give the second dose to residents, any staff who have not yet taken up the opportunity of a vaccine will have the offer of getting going on the programme. I hope that care home staff and NHS staff across the board will listen to the words of the chief medical officer, who said that it is the “professional responsibility” of people who work in care settings to get vaccinated. It is the right thing to do.

[Dr Whitford]

More vaccine-resistant strains, such as the South African variant, could risk undermining the UK’s vaccine programme. As they could come via any country, does the Secretary of State not agree that all travellers should undergo strict quarantine?

[Matt Hancock]

Yes, I do. All those who arrive in this country as passengers need to undergo quarantine, and we have both the hotel quarantine and home quarantine; all need to be tested; and all the positive test results are sent for sequencing so that we can spot any new variants. This is a critical part of our national defences. The good news is that we can see from the data that the number of new variants in the country is falling and is much lower than it was last month. We obviously keep a very close eye on that, because making sure that we do not have a new variant that cannot be beaten by the vaccine is a critical part of the road map, as set out by the Prime Minister yesterday.

Covid-19

Philippa Whitford Excerpts

Monday 22nd February 2021 Commons Chamber

[Dr Philippa Whitford (Central Ayrshire) (SNP) [V]]

As we move into the second year of covid, and despite still being in lockdown, there are key positives to be celebrated. The vaccine roll-out is progressing quickly, and staff in all four national health services should be congratulated, along with the Army, who have provided logistical expertise, and the thousands of volunteers who have helped to ensure the safety and organisation of vaccination centres. Vaccine uptake has been way above expectations and, with the hope that vaccination will prevent viral transmission as well as protecting the recipient, everyone who rolls up their sleeve is contributing to the fight against the pandemic. However, concerns remain about lower vaccine uptake among certain groups, including some who are particularly vulnerable to covid, such as BAME communities. Anyone offered the vaccine should take up their appointment. If they have questions, there is information on the NHS websites, or they can ask their local GP practice.

Until now, any increase in covid cases has led to an inevitable rise in hospitalisation and deaths just a few weeks later, but as more vulnerable groups are vaccinated, that is starting to change. We are already seeing the benefit to those who were vaccinated first in Scotland. An analysis of over 1 million vaccine recipients by Public Health Scotland has today revealed a reduction in hospitalisation of between 85% and 94% for the two vaccines. Owing to its integrated structure, Scotland’s NHS was able to get permission from the Medicines and Healthcare Products Regulatory Agency to deliver the Pfizer vaccine to all elderly care homes from 13 December. That has led to a 62% drop in deaths among residents throughout January. That dramatic fall will, we hope, be replicated in data across the rest of the UK in just the coming weeks.

As the Prime Minister has highlighted, one possible threat to the success of the vaccination programme would be the importation of a more vaccine-resistant variant, such as that which has arisen in South Africa and has already been shown to be resistant to antibodies from those who have recovered from covid. This threat makes it inexplicable that when the UK Government have finally decided to set up monitored border quarantine, it is on such a limited basis—so much for following the science! There should be mandatory quarantine for arrivals from all countries, as there is nothing to prevent someone from travelling from South Africa or Brazil via a third country. The South African variant is already present in at least 35 other countries and new variants could be evolving as we speak. The Government’s suggestion that people will be able to travel abroad for summer holidays seems to be courting danger, as many countries will not be vaccinated and therefore pose an increased risk that holidaymakers would bring back new variants; surely this is a sacrifice we could all accept if it allowed children to be in school and our domestic economy to open up. This measure must, however, be combined with support for the aviation, aerospace and international tourism sectors.

On the Prime Minister’s road map out of lockdown, I welcomed the suggestion that decisions that would be based on data rather than dates, but he then proceeded to announce a whole list of dates. Although it is good to see cases falling so dramatically across the UK, from almost 60,000 a day to just over 11,000 a day, case levels are still more than double what they were when SAGE called for a lockdown on 21 September. The number of covid patients in hospital is 10 times what it was last September and only just dropped below the peak of the first wave last week.

While Scotland has maintained lower case levels throughout the second and third waves, progress in all four nations is slowing, and this is thought to be due to the greater infectiousness of the B117 Kent variant. Thankfully, this variant appears to be just as sensitive to the immune response induced by current vaccines, but every time the virus spreads and replicates itself, there is an opportunity for mutation and the risk of a problematic domestic variant emerging, including one that might be resistant to our current vaccines. The UK has already faced three waves of covid and three lockdowns, and it is important that current restrictions remain until case levels have been driven low enough to give the vaccine programme a chance to succeed and health services time to recover. It is not a matter of setting the economy against public health; it is through stopping community spread that we would be able to get our domestic economy and society back up and running.

Once covid levels have been brought down, it is critical to have an effective system to test, trace and isolate those who could be carrying the virus, in order to keep control of the outbreak. Unfortunately, one in eight cases are still not being reached by NHS Test and Trace, and surveys suggest that as few as one in three people are isolating when required. The commonest reason is that they cannot afford to lose their income, yet more than half of those applying for the Government’s support payment are being turned down, which makes it very unlikely that they would then isolate. The Government need to widen the eligibility criteria and review the level of payment, which is less than the minimum wage. It is in everyone’s interest to ensure that those who could be carrying the virus isolate so we avoid onward spread. All these measures carry a cost, but when we see the flourishing domestic economies of the countries that acted quickly and stringently last year, we can see the cost of not taking action, both in lives and in economic damage.

Future of Health and Care

Philippa Whitford Excerpts

Thursday 11th February 2021 Commons Chamber

[Matt Hancock]

I pay tribute to my predecessor’s work setting up integrated care systems in the first place. In a way, this legislation builds on the foundations that he laid when he was in my job, and I look forward to working with the Health and Social Care Committee on the legislation as it proceeds. We have already had discussions, and I am grateful for the Select Committee’s work so far and the insights it has provided.

The question my right hon. Friend raises about the accountability of ICSs is absolutely central, not just to accountability for the use of taxpayers’ money, but to driving up both the quality of care for patients and the health of the population the ICSs serve. It is critical that we ensure the correct combination of high levels of transparency, the role of the CQC as inspector, and accountability up from the ICS, through NHS England, to Ministers and therefore Parliament, and through our democratic processes to taxpayers. The White Paper sets out at high levels how that accountability will work. The details will be a matter for the Bill. The combination of transparency and clear lines of accountability are vital to make sure that while we use the integration provided for in the Bill to empower frontline staff to deliver care better, they are held to account for the delivery of that care and, critically, the outcomes for the population as a whole whom we serve.

[Dr Philippa Whitford (Central Ayrshire) (SNP) [V]]

Health and social care staff always do their best for their patients and residents, regardless of legislative systems, but I welcome the Government’s recognition of the damage caused to the NHS in England by the Health and Social Care Act 2012, and the proposal to reverse some of its most obstructive and expensive aspects, particularly section 75, which forced the outsourcing of services, promoted competition instead of collaboration, and made pathways more disjointed and confusing for patients, especially those with complex conditions. The devil, however, will indeed be in the detail.

Which model of integrated care is the Secretary of State proposing? Will he merge organisations, including commissioning groups, or, as the NHS would prefer, create new public NHS bodies, similar to the health boards we have in Scotland? When sustainability and transformation partnerships were created, their transformation budgets were quickly used up in covering debts caused by the bureaucracy of the healthcare market, so what additional funding is he committing to bring about this reorganisation? Given the pressure of covid, the backlog of urgent cases, and extensive staff vacancies, how does he plan to create the capacity for staff to carry out such service change? Covid has highlighted the vulnerability of the care system, so what plans are there to integrate health and social care?

Finally, the Secretary of State has highlighted health inequalities, but poverty is the biggest driver of ill health. What discussions has he had with the Secretary of State for Work and Pensions and other Cabinet colleagues about promoting the prioritisation of health in all policy decisions?

[Matt Hancock]

Of course health is an important consideration in all policy decisions. The overall response to the pandemic has demonstrated that.

The hon. Lady is right to raise the issue of integration and to ask what plans there are for the integration of health and social care. Indeed, that is at the core of the proposals, as I set out clearly in my statement, and at the core of the White Paper. The integration of health and social care has improved significantly this year as a result of people having to work together in the pandemic. Fundamentally, social care is accountable to local authorities, which pay for it, and therefore to the local taxpayer, whereas the NHS is accountable to Ministers and central Government. The combination of these two vital public services is a challenge that I think can be addressed through the integrated care systems. We have been working very closely with the Local Government Association in England and the NHS to try to effect that integration as much as possible.

The hon. Lady raises the issue of funding. Of course, the NHS has record funding right now, and rightly so, but these reforms are about spending that money better to improve the health of the population, to allow new technology to be embraced, and to remove bureaucracy. It is not about having to spend more money on a reform; it is about reforming in order to spend money as well as possible.

Covid-19 Update

Philippa Whitford Excerpts

Tuesday 2nd February 2021 Commons Chamber

[Matt Hancock]

My right hon. Friend knows that we set out in our manifesto, committed in the manifesto and were elected on a manifesto to resolve the long-standing problems in social care. The Prime Minister has set out to the Liaison Committee, of which my right hon. Friend is a member, the timetable on which he hopes that we are able to deliver that commitment. Alongside dealing with this pandemic, we are working to deliver our manifesto commitments, whether on social care or the 40 new hospitals or the 50,000 more nurses. I look forward to being held to account by the Select Committee on Health and Social Care on those commitments.

[Dr Philippa Whitford (Central Ayrshire) (SNP) [V]]

I associate myself with the Secretary of State’s comments on HIV test week, but it is concerning to hear that over 100 cases of the South African variant have been detected in the UK, particularly as they do not represent a single outbreak, but are widely scattered across England. The concern, of course, is that while current vaccines will still give a significant degree of protection, this variant’s resistance to some covid antibodies could reduce their effectiveness, so does he plan to tighten internal travel restrictions to avoid it spreading across the UK as happened with the Kent variant?

Will there be increased random genomic testing of PCR specimens outwith those areas to identify just how widespread it already is? Unfortunately, this is shutting the barn door after the horse has bolted. The Government have been aware of the concern about this variant for some time, and the SAGE advisory group warned that limited travel bans would not be enough to keep out new covid variants and that the only way to stop them would be mandatory quarantine for all arrivals, so why did the Government choose not to follow that advice? This variant is already present in many countries and new, more resistant covid variants could evolve anywhere in the world, so will the Government reconsider their very minimal quarantine plan and extend it to all incoming travellers? As new strains brought in through holiday travel last year contributed to the second wave of covid, is the Prime Minister seriously suggesting that people should go abroad on holiday this summer?

Covid-19

Philippa Whitford Excerpts

Tuesday 12th January 2021 Commons Chamber

[Dr Philippa Whitford (Central Ayrshire) (SNP) [V]]

Thank you, Mr Deputy Speaker. First, I wish to pay tribute to all NHS and social care staff across the UK for the incredible role they have played in this crisis and to all the key workers who have helped to maintain food or energy supplies, and kept our public services operating. I echo the Minister in saying that the best way for all of us to express our gratitude is to stick to the rules and stay at home.

With the novel coronavirus emerging just a year ago, all Governments have had to find their way. There are many aspects of the UK Government’s covid response that can be criticised, especially being too slow to lock down in March, September and yet again in December, or outsourcing testing and contact tracing to companies with no previous experience, such as Deloitte and Serco, instead of using NHS and public health expertise. I am sure that many of the issues will be well-aired in this debate, so I will focus on where we are now and on what options should be considered for the next steps.

The first thing is to recognise that it is a false dichotomy to set public health against the economy, lives against livelihoods. People will simply not engage with the economy if they do not feel safe. The countries that have suffered the least economic harm are those with previous experience of SARS. Last February, they quickly acted on their learning from the epidemic of 2002. They initially closed their borders and have since maintained tight border control with testing and strict quarantine of all arrivals. They drove down early outbreaks and then worked to eliminate community spread. Those countries, such as Taiwan, New Zealand and Singapore, all now have domestic economies that are fully open and societies that are engaged in the pleasures of sporting events, dining out or simply having a few friends round, or, as the shadow Minister said, being able to give a loved one a hug.

So what is the strategy? First, let us avoid importing any more dangerous covid variants by tightly controlling the external borders of the UK, and, through co-operation with the devolved nations and the Republic of Ireland, try to make the whole common travel area covid-secure. I welcome the plan to require pre-travel tests for those coming to the UK, but they should be PCR tests, not lateral flow devices that miss more than half of those carrying the virus. We could learn from Pacific countries that enforce strict quarantine for incoming travellers, either in hotels or through digital monitoring at home. Such a strict approach would avoid importing the South African strain or other more concerning mutations that we do not even know about yet. If it contributed to getting the domestic economy fully open, the Government would then be able to focus their financial support on the industries involved in international travel, such as aviation and aerospace.

To avoid creating more mutations within the UK, it is critical to drive down the current rate of infection. It is simply a numbers game. More spread means more viral replication and leads to more mutations. All of this increases the risk of developing an even more problematic variant. The big advance, of course, compared with last March is that vaccines are now available and all four health services across the UK are working as fast as possible to deliver them to those at highest risk of covid. This is the light at the end of the tunnel, but, with just over 3% of the population vaccinated and hospitals in London at risk of being overwhelmed within weeks, it is simply not possible to vaccinate our way out of this current surge, so this lockdown is absolutely necessary.

The Minister mentioned those who undermine the rules by not taking covid seriously. A comparison of the first SARS epidemic and covid-19 highlights the fact that infectiousness is a greater danger than virulence. SARS had 10 times the mortality rate of covid, but only infected about 8,000 people and killed fewer than 800 worldwide. In contrast, despite appearing to be a much milder condition, covid-19 has infected more than 90 million people and already killed almost 2 million. As the new variant is estimated to be 70% more infectious than the original virus, uncontrollable spread is the real threat.

Therefore, rather than already discussing arbitrary end dates for this lockdown, it needs to be maintained long enough to fully suppress the current outbreak. We all know that lockdown is really difficult, but with approximately 55,000 new cases every day that will take time, and if it is relaxed too quickly, cases will simply rebound as they did in the autumn. Thereafter, the aim is that the test, trace and isolate system should detect and deal with sporadic cases and shut down minor outbreaks so that they do not get out of control. Instead of planning to spend eye-watering sums on lateral flow tests with poor sensitivity and a danger of giving people false reassurance, it would make more sense to fund an expansion of NHS labs to increase capacity and provide quicker turnaround times for PCR tests. It has been good to see an improvement in contact tracing with the greater involvement of local public health teams, as has been the case in the devolved nations since the start. However, the most important aspect of test, trace and isolate is the isolation of those carrying the virus. Only isolation stops the onward spread of the virus. No amount of testing or tracing will control the epidemic unless we get people isolating when required. The £500 isolation payment is welcome, but it is less than the minimum wage. It is important to clarify what happens to those whose applications are refused, and also to assess the need for practical support, such as the delivery of shopping or medicines. It is well worth providing such support if it helps stop the onward spread of the virus.

The fourth part of the strategy should be to make indoor settings—such as hospitality, offices and schools—safer by improving ventilation and air purification systems. A Government taskforce could assess the various new technologies available. Removing VAT or providing grants would help hard-hit sectors such as hospitality to reduce the risk of being repeatedly shut down in the future.

Finally, it is important to get the communication strategy right. Public health messaging should be clear, simple and honest, instead of undermining trust by constantly over-promising. Whether it is claims of world-beating apps and systems, or just repeatedly saying that the crisis will be over by a certain date, it is not helpful to have a trail of broken promises. I know from more than 30 years of having to speak and break bad news to cancer patients that honesty is always the best policy. Treat the public like grown-ups and share information openly, whether good or bad.

There was no handbook on covid at the start of the pandemic a year ago, but there are lessons we should have learned by now from research and experience, from our own mistakes or the successes of others. The Government need to make this lockdown count and ensure a systematic approach to covid in 2021.

Oral Answers to Questions

Philippa Whitford Excerpts

Tuesday 12th January 2021 Commons Chamber

[Matt Hancock]

There are very significant pressures on the NHS. On the specific question about oxygen supplies, the limitation is not the supply of oxygen itself; it is the ability to get the oxygen through the physical oxygen supply systems in hospitals. That essentially becomes a constraint on an individual hospital’s ability to take more covid patients, because the supply of oxygen is obviously central to the treatment of people with covid in hospital. As we have a national health service, if a hospital cannot put more pressure on its oxygen system, we take people to a different hospital. I assure the hon. Gentleman that there is no constraint that we are anywhere near on the national availability of oxygen—oxygenated beds. As he knows and as we have seen reported, sometimes patients have to be moved to a different location—as local as possible, but occasionally across the country—to ensure that they get the treatment that they need.

[Dr Philippa Whitford (Central Ayrshire) (SNP) [V]]

Yesterday, the Secretary of State revealed that only a quarter of care home residents in England had been vaccinated against covid, despite being the No. 1 priority group. Can he explain why they were not the first cohort to receive the Pfizer vaccine in December, as was the case in Scotland?

[Matt Hancock]

That is not quite right. I am glad to report that care home residents have been receiving the Pfizer jab. That is harder—logistically more difficult. Looking at the total roll-out of the programme, I am delighted that, as the hon. Lady says, over a quarter of people who are residents in care homes are now able to get the jab, and that number is rising sharply.

--- Later in debate ---

[Mr Speaker]

We are going back to Scotland for the second question from Dr Whitford, to be answered by the Secretary of State.

[Dr Whitford]

As the Secretary of State highlighted earlier, primary care networks will play a major role in rolling out the vaccine in England, but we have heard previously from MPs that not all areas are covered by such networks. How does he plan to avoid a postcode lottery and ensure equitable access, with outreach into vulnerable ethnic or deprived communities?

[Matt Hancock]

Some 99% of GP surgeries are members of primary care networks. The very small minority that are not are being dealt with to ensure that we have fair access to vaccines, and they will of course be covered by invitations to the large vaccination sites as well.

I agree strongly with the hon. Lady that it is vital that we reach into and support those communities who may be more distant and harder to reach both geographically and, in some cases, culturally. The NHS is very well placed to do that and is one of the most trusted public services in encouraging those from all backgrounds to take the jab. Pharmacists, too, will play a vital role in the outreach programme.

Covid-19: Vaccinations

Philippa Whitford Excerpts

Monday 11th January 2021 Commons Chamber

[Nadhim Zahawi]

I am grateful for my right hon. Friend’s compliment and this is only the start. I hope that, as we progress in the weeks and months to come, the focus and the rate of output will continue to rise.

My right hon. Friend raises an important point around the critical workforce for the economy, like teachers. The Joint Committee on Vaccination and Immunisation looked at all these issues and has come out very clearly in favour of us vaccinating the nine cohorts that are most vulnerable to dying from covid-19, hence why that is absolutely our focus.

We are absolutely committed to making sure that people get two doses, so if they have received their Pfizer first dose, they will get their Pfizer second dose within 12 weeks of the first dose. Similarly, if they have had their AstraZeneca first dose, they will get their AstraZeneca second dose within 12 weeks. So those people whom we will begin to reach in March, where we have to deliver their second dose, will absolutely get their second dose. But to my right hon. Friend’s point, the more vaccine volumes that will come, and we have tens of millions that will come through beyond February and into March, the faster we can begin to protect those nine categories in phase 1. The moment we have done that, then it is absolutely right that we should begin to look at categories like teachers and police officers—those who may be exposed in their workplace to the risks of this virus.

Of course, it is worth reminding the House that it is two weeks after the first dose, and three weeks after the first dose with AstraZeneca, that people begin to get that protection, not the moment they are jabbed, so there is that lag time as well. But my right hon. Friend’s point is well made: we need to make sure, as we protect greater and greater numbers of people in those nine categories, that we then move very quickly to the next dose.

[Dr Philippa Whitford (Central Ayrshire) (SNP) [V]]

The Joint Committee on Vaccination and Immunisation was very clear that those who live in care homes were the top priority for vaccination against covid-19. Due to integration of health and social care, Scottish health boards were able to deliver the Pfizer vaccine into care homes in December, and well over 70% of such residents have already been vaccinated across Scotland. In my own health board, the phase is almost complete. So can the Minister explain why in England care home residents were not the first cohort to receive the Pfizer vaccine in December, and as only a quarter have received their first dose, when does he expect all such residents to have been vaccinated?

People over 80 years are now being offered vaccination, but there are only 1,200 sites to cover the whole of England—a similar number to Scotland, which has less than 10% of the population. This means elderly people are being asked to travel long distances, despite their age and the fact that many will be also shielding. As the letter does not offer the option to wait and have their vaccine at a local GP surgery, does the Minister recognise that many are now feeling pressurised into travelling, despite the current dangers? So will he take this opportunity to clarify that the vaccines will gradually be made available through all GP surgeries and that elderly patients who cannot travel long distances will be offered a further opportunity closer to home?

The Minister will be well aware of the public concern about the decision to delay the second dose of each vaccine so as to ensure more people receive the first dose more quickly. With the current surge in covid cases, I totally understand the rationale for this approach. So can he explain why there have been more than 300,000 additional second doses given over the last week, despite the JCVI announcement on 31 December, and can he guarantee that sufficient quantities of the Pfizer vaccine will be available by the end of February to ensure those given their first dose in early December will receive their booster on time?

[Nadhim Zahawi]

There is a lot to unpack there; let me try to take the points in reverse. We can guarantee that those who have had their Pfizer vaccine will get their booster within the prescribed period of up to 12 weeks. The hon. Lady asked about those who have had a second jab already. Information went out to primary care networks and hospital hubs, saying that those who have an appointment up to 4 January should be able to have their appointment honoured. Beyond that, they have been working very closely with the NHS England team centrally, which we have been supporting with resources and actually phoning to postpone those appointments further; hence why we have protected many more people.

It is worth reminding the House that for every 250 people from the most vulnerable cohorts that we protect, we save a life. For every 20 people in care homes that we vaccinate, we save a life. The focus is therefore now very much on care homes. We began with the Pfizer vaccine into care homes. Of course, last week—on 4 January—we started to roll out the AstraZeneca vaccine, which is much easier to administer into care homes, especially for the roving teams. It had to spend two days in hospitals before it was released to primary care networks, but the moment it was released, it went into care homes and now some areas in England. We have about 10,000 care homes where we have to vaccinate residents and, of course, those who look after them. Some have done their care homes already; others are beginning to do the same thing. All will be done by the end of the month.

The hon. Lady talked about people having to travel long distances. I mentioned in my opening statement about the strategy that there will be 2,700 vaccination sites. I think she may have been confused about the figure of 1,200, which is the number of primary care networks, hospital hubs and large vaccination centres, but there will be 2,700 vaccination sites. By the end of the month, no one will be more than 10 miles away from a vaccination site.