Covid-19 Update

Andrew Murrison Excerpts

Monday 6th December 2021 Commons Chamber

[Sajid Javid]

It is important that there is easy access for everyone to get vaccinated. The hon. Lady has given a really good demonstration of why that is so critical for every part of our community. If it is helpful, the Vaccines Minister will be pleased to meet her, as chair of the APPG, to see what more we can do.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

Vaccines are clearly our way out of this, but does the Secretary of State agree that treatments are also important, and they have come on in leaps and bounds? Sotrovimab reduces the incidence of death or hospitalisation by 80% and molnupiravir got its approval last week. Does he agree that while we are very good at R&D we are less good at rolling out these extraordinary therapeutics? Will he do everything in his power to make sure that the NHS has access to those drugs as soon as possible since they reduce considerably the problem that covid and its associates will pose in terms of mortality and serious illness?

[Sajid Javid]

Yes. I know my right hon. Friend speaks with experience and I agree with him absolutely.

Adult Social Care

Andrew Murrison Excerpts

Wednesday 1st December 2021 Commons Chamber

[Gillian Keegan]

Thank you, Madam Deputy Speaker.

The hon. Gentleman has asked a good question. Dealing with covid is very challenging for many workforces, which is one of the reasons for our taking the difficult step of making vaccination a condition of deployment in this sector, and also offering the third dose—the booster—which many of those people have now had. It reduces the likelihood of transmitting or contracting covid, although it does not eliminate it altogether. The hon. Gentleman is right about the pressures on the workforce, which are increased by the need to manage covid in the case of residents and also people who are in their own homes. We have invested £162.5 million to help with those pressures in the short term.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

I congratulate the Minister on getting a grip on an issue that consecutive Governments have simply ignored since the 1940s, but does she accept that there is a certain irony in our having two White Papers to deal with a matter involving integration?

Will the Minister say a little about how what she has announced today may help to resolve the crying shame of elderly, vulnerable people languishing in acute hospital beds for weeks on end when there is no active medical management plan for them, often at the end of their lives, when they should be being cared for appropriately in homely settings in the community? Will she recognise that until we deal with that, and the huge pressures that it puts on them, their families and our NHS, we will make no progress whatsoever?

[Gillian Keegan]

My right hon. Friend is absolutely right. People are in expensive hospital beds when they would rather be at home because of a lack of services, or a lack of joined-up service, and that affects hospitals throughout the country. It is a large element of the current pressures, and it happens every winter. It happened every winter when I was a hospital governor. This integration, and the Health and Care Bill which the Minister for Health, my hon. Friend the Member for Charnwood (Edward Argar), steered through the House so ably, will help to solve the problem.

Public Health

Andrew Murrison Excerpts

Tuesday 30th November 2021 Commons Chamber

[Maggie Throup]

Today, we are debating some travel restrictions about self-isolation, but the other restrictions are covered by different legislation and therefore they are not relevant to this debate.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

The Minister mentioned hand hygiene. Is she aware of a study published in The BMJ on 20 November that showed that hand hygiene was as effective as mask wearing? Does she agree that anything we do here needs to be firmly evidence-based? Can she say why we have focused on mask wearing in the regulations and not, for example, if our aim is to improve public health, mandating for alcohol gels in hospitality venues?

[Maggie Throup]

My right hon. Friend, with his medical background, makes a good point that I will take away and look into further.

I will return to my speech. Accordingly, our scientists are investigating omicron to determine, among other things, how quickly it is likely to spread and what the impact may be on the immunity that many of us have acquired through vaccination.

--- Later in debate ---

[Daisy Cooper]

rose—

[Dr Murrison]

rose—

[Maggie Throup]

I give way to the hon. Lady, who has been trying to intervene.

[Maggie Throup]

As I said earlier, we are mandating the use of face coverings. I think we are in a different situation now with regards to that.

[Dr Murrison]

Will the Minister give way?

[Maggie Throup]

I will allow one more intervention and then I will move on.

[Dr Murrison]

The Minister is really being most generous and I thank her very much indeed. Our right hon. Friend the Member for Forest of Dean (Mr Harper) is absolutely right and I fear that, inadvertently, she has not given the fullest answer that she might have done to this. The fact is that motion 3 on the Order Paper expires on 20 December, yet motion 4 expires on 24 March 2022. Can she explain the logicality of that? I also observe that, given the extraordinary restriction on liberty that this potentially offers, most Members of this House would be more than delighted to return after the House rises for the Christmas recess in order to reaffirm our support for the measures that she has put before the House today.

--- Later in debate ---

[Alex Norris]

The hon. Member goes slightly further than I did in saying that ventilation should be rolled out immediately across all schools. Of course, that would have significant financial implications. It would also, of course, be very good for British business. We are saying that, as has been clear throughout the pandemic, better ventilation in public buildings should be a significant part of building regulations in general. What I seek from the Minister is a sense that any of that, never mind all of it, has been done at all.

[Dr Murrison]

Can the shadow Minister cast his mind back to the debates we had on smoking in public places? If he is suggesting properly engineered extraction ventilation, we dismissed that during those debates—although many of us would have liked to have seen it as an alternative to an outright ban—because of the sheer engineering cost of doing it. Or is he proposing simply opening windows? What exactly is he proposing when he says we need to improve ventilation? At one extreme it is going to be murderously expensive and virtually impossible, and at the other it is simply opening the window.

[Alex Norris]

I cannot cast my mind back to that debate—I believe I had just started secondary school when it took place—but I can foresee the issues that were raised. I would not do down the idea of opening windows; that would be a good thing to do in and of itself, and I would support that. What I am saying is that there are certain places where that will work less effectively, and we ought to have some sense, certainly building by building, of what might be an effective measure. As I said, I do not think this is something that we can just click our fingers and do easily, but I would like to get a sense that we have tried to do any of it at all, and I have yet to get that. I hope the Minister will disabuse me of that.

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[Sir Graham Brady]

Absolutely. As a former Chief Whip, my right hon. Friend knows very well that there is always parliamentary time available when the Government want to do something; it is only when they are reluctant to do something that parliamentary time becomes elusive.

There is a further question as to why only one of the instruments before us has an expiry date in the regulations. Surely it would have been better to put an expiry date in place, which would have required some positive action to renew or extend the regulations if that was deemed necessary.

There are also serious concerns about the efficacy of what is proposed. We know enough about covid by now that we can see which interventions are ineffective. We can see that even full lockdowns possibly delay the spread of covid but do not eliminate it. In this instance, I am intrigued to know from the Minister exactly what action the Government propose if their research finds that this new variant is effective in evading the vaccines. Surely they do not propose to return to a full lockdown, knowing that that would simply defer the problem for a period of days, weeks or months.

[Dr Murrison]

If my hon. Friend recalls, the reason for lockdown was to reduce a potential impact on the national health service. Does he agree with me and everyone who has opined on the subject that there is no conceivable way in which our NHS is going to be overwhelmed by this? That would be a remarkable thing, since 90% of us have antibodies right now. Therefore, a justification for a lockdown falls away completely.

[Sir Graham Brady]

I am grateful to my medically qualified right hon. Friend for that intervention. He is of course right that that is unlikely. There would have to be some evidence of a very different kind of variant of covid for it to pose any kind of threat of that sort. He is also right to point out that when we first went into a lockdown, it was intended to protect the NHS for long enough for us to increase capacity in the service for a three-week period. The first lockdown then spread into three months. That is the most important thing the House should be guarding against: the mission creep that allows Governments simply to introduce restrictions and further restrictions, and then extend them, getting into the habit of regulating what we do. That is my most important concern of all.

In the summer of 2020, the Prime Minister said that it was time to move on and time to start to trust people to make decisions for themselves. I rejoiced at that and thought what a wonderful thing it was that we were moving to a point where we would advise people, inform people and make sure they had the best evidence to make decisions in their own lives. Now, however, we see the first instinct of the Government when we do not even have any evidence that the omicron variant is worse in its effects. There is some suggestion from South Africa that it might be less severe, but the Government’s first instinct is to introduce further compulsory measures and regulations relating to self-isolation and to face coverings in some settings but only until 20 December, plus measures that affect the travel industry, particularly the move back to PCR tests on day two.

--- Later in debate ---

[Daisy Cooper]

I take that point. We know that many of these measures often result in a lose-lose situation. A real problem over the past 18 months has been the way in which people have tried to frame this as public health versus the economy, because for me, having a strong and healthy workforce and a strong and healthy economy are two sides of the same coin. Notwithstanding that, I am encouraging the Government to ask people to work from home where they can, in order to strike the right balance that would reduce levels of transmission. I am not suggesting a blanket mandate for everybody to stay at home; I am suggesting encouraging people to work at home where they can, in a balanced way.

[Dr Murrison]

I am listening carefully to what the hon. Member has to say. Does she agree that the group in society that has really borne the brunt in the past 18 months is young people? They have been particularly affected by so-called work from home, and their mental health in particular—which I know her party takes a close interest in—has in many cases been devastated. I commend to her the best available evidence as published last week. As the hon. Member for Central Ayrshire (Dr Whitford) pointed out, that evidence suggests that two interventions—that is to say, mask wearing and cleaning our hands properly—may well have some impact, but to be honest the evidence for social distancing is pretty thin. Would the hon. Member for St Albans (Daisy Cooper) perhaps like to reconsider the sort of swingeing measures that she appears to be recommending?

[Daisy Cooper]

I thank the right hon. Member for his intervention, but I respectfully disagree with him. What we have learned over the past few months, from public health directors in particular, is that the more measures we take, the better protection we have. It is not an either/or. If we wear a mask, wash our hands and limit the amount of time spent in close proximity to someone else, we limit our overall chances of either catching covid or passing it on. The more measures we can take, the better. Notwithstanding that, when I was talking about working from home, I was not referring to children studying at home. I was talking about the working population. I recognise that there have been enormous impacts—

[Dr Murrison]

I was talking about university students.

[Daisy Cooper]

Ah, okay. I thought the right hon. Gentleman was talking about schools and young people. Of course there have been major issues for young people, but when I was talking about working from home, I was talking about the working population. On the question of students at universities, of course there needs to be a balance. Many universities got it wrong during the pandemic, and I said so at the time. I was utterly appalled when some universities put railings around the student accommodation. We need to strike a balance. This is about reducing our contacts to reduce transmission. There is nothing to prevent university students from going in to study, if that is the point that the right hon. Gentleman was trying to make.

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[Dr Murrison]

How on earth does the hon. Lady think that we can mandate or suggest that people work from home but then expect students to tip up? University is about being taught, and being taught requires people to go to work. Or have I missed something?

[Daisy Cooper]

Something appears to have been lost in translation here. I am not entirely sure whether the right hon. Member is referring to students or to the academics who teach them. I am talking about encouraging people to work from home where they can. There are of course examples where people will need to go into work, and they can change the ways in which they work, but working from home has been proven to reduce levels of transmission.

I am concerned that we are talking solely about the new variant, and that the mantra around putting in place restrictions to protect the NHS appears to have stopped. I worry that the Government appear to have lost their tongue. Ambulance services across the whole of England are at their highest alert level: level 4, or code black. That means that there are people in the back of ambulances who cannot get into hospitals. The NHS 111 line has had more than 1 million calls abandoned after 30 seconds this year, when they should be answered within 20 seconds. We have GPs who are reducing their hours or resigning because of the workload and the abuse. Some of them are really worried and saying that they will not to take on the contracts to deliver the booster jabs because of the expectation that they will still have to do the same amount of work seeing their patients and that if they are required to do the booster jabs as well, that will mean longer waits for other appointments. They are not getting the support they need in that regard, and I hope that the Minister will respond to this point. We have record backlogs—

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[Dr Andrew Murrison (South West Wiltshire) (Con)]

I record my interest as a practising doctor. I agree with my hon. Friend the Member for Isle of Wight (Bob Seely) that there appears to be a problem with the availability of slots for vaccinations, and that was before the Government announced this week that we were to expedite the booster programme. I am concerned about that, and I hope the Minister, who has commented briefly on that already, can confirm she has a cunning plan to ensure that people who need to be vaccinated are vaccinated and in particular that those vaccines reach the elderly and the vulnerable. At the moment, I have severe concerns about the availability of those slots, if not the vaccines themselves.

I will be supporting SI No. 1340 today on face coverings. I am mindful that we have to rely on the best available evidence. The evidence for a lot of these non-pharmaceutical interventions is more common-sense than actual. It seems to me to be a minor imposition to ask people to wear a face mask, particularly given the evidence published by The BMJ last week on this matter, which we have referred to already. The hon. Member for Central Ayrshire (Dr Whitford) in particular spoke about it.

I am more concerned about SI No. 1338 for two reasons. While SI No. 1340 expires on 20 December—or, at least, Ministers can decide whether to continue it on that date—there is no such luxury contained within SI No. 1338. That seems to be illogical. When pressed earlier, I regret to say that the Minister, who was very good at taking interventions from hon. and right hon. Members, did not address that point. She needs to explain to my satisfaction, and that of other Members, why 20 December stands in SI No. 1340, but it is 24 March for SI No. 1338. It seems that there is an appetite in the House to return here, if necessary, to reconfirm or refute the need for these measures to continue into the new year. I hope that the Minister has heard that loud and clear.

I for one would be more than happy to be here well past the time at which we rise, and right up to Christmas if necessary, and the reason for that is this: the things we have been discussing today touch heavily on the liberties and livelihoods of our constituents. These things are not trivial; they are of vital importance, and all actions have consequences. I am worried about things like this because of the messaging it gives off. It will be very difficult for businesses deciding whether to invest. They will look at SI No. 1338 and think, “Good gracious me, this will go on and on and on.” While they have been happy to go along with some of the impositions that we have had over the past 18 months, they are now coming to the point where they are thinking, “This could basically be the new normal. This will go on and on, and on what basis will we continue to invest in our businesses if every few months we have these kinds of things and goodness knows what else that may follow?” I am worried about that.

I am also deeply worried, as other hon. and right hon. Members have pointed out, about this “suspected of” bit. That seems to me to be rather clumsy and I am not comfortable with it. Presumably, anybody showing any coronavirus symptoms could be “suspected of” having the omicron variant.

The World Health Organisation touched on a potential solution to that at the weekend, which is the Thermo Fisher PCR test. I assume that it relies on the detection of the S-gene dropout that has been referred to, which could expedite the diagnosis of omicron as opposed to straightforward coronavirus. I wonder whether the Minister could reflect on that and say whether her understanding is that such a test would be the basis on which we would decide whether somebody was suspected of having it, because that could shorten the length of time that people are required to be out of action and might make No. 1338 slightly more palatable for those of us who have concerns about it.

I disagree with some hon. Members about what will change in three weeks’ time, because I think a great deal will change, as a number of international authorities have made clear. Indeed, the doctor who first found the variant, Angelique Coetzee, seemed to be of that view in her upbeat assessment of how it is affecting her patients, as is Dr Anthony Fauci, the adviser to the President of the United States. Many international authorities are saying that in two weeks’ time, we should be a lot further along the journey of understanding how the variant behaves.

That makes sense because, in two weeks’ time, if the variant is a problem, we will presumably see an uptick in hospitalisation at least among the vulnerable population. It is wrong to suggest that everybody in South Africa is young and vibrant; of course it has its fair share of elderly, vulnerable and frail people and of people with comorbidities. In two weeks, I expect there will be at least some indication of whether it will be a problem. We should also keep in mind that it might be part of the salvation, rather than the problem, because we do not know how the virus will behave. Some viruses mutate downwards and others mutate upwards. We must hope for the former not the latter, but at the moment we simply do not know, which is the basis of my support for No. 1340.

There is an assumption that perhaps southern Africa is not sophisticated in healthcare terms, but I gently make the point that the Republic of South Africa certainly is sophisticated. It has been the victim of its own generosity in having invested heavily in sequencing. It is a bit like the UK in relation the Kent variant: if we look, we will find. We need to be careful about suggesting that other healthcare economies are not up to spec, because I do not think that is necessarily the case for South Africa.

I also observe that yesterday, 25 deaths were attributed to covid-19 in South Africa and the seven day average is 35 deaths. Many of us are captivated by the covid graphs; I check them daily. I confess that I do not generally obsess about South Africa, but recent events have made one focus on its graph, which is bumping along the bottom. We are in no way seeing a wave as yet, although we may yet do so, but we need to be careful about suggesting it will be a major problem, as Angelique Coetzee and others have been.

The Government are right to be cautious—of course they are—but we also need a sense of proportion. We need to understand that everything we do in this place with regard to regulation has a consequence for liberty and livelihoods, for the economy in general and for young people in particular. I made that point in connection with the apparent suggestion of the hon. Member for St Albans (Daisy Cooper) that it was a no-cost measure. We need to be careful about the impact that it all has on young people and especially on mental health.

[Bob Seely]

Does my right hon. Friend share my frustration that we have all these charts about covid, but we have never had them in context—how many people are born, how many people die, how many people die of flu, how many people die of other illnesses—so we have become fixated by something when there are many other causes of death in this country that, frankly, claim many more people, and by taking this out of context we create unnecessary fear?

[Dr Murrison]

Yes, I absolutely agree with my hon. Friend. The point about that is of course that the national health service at the moment is running very fast to catch up because for the past 18 months, necessarily, it has not been doing a lot of the elective work in particular that it would have wanted to do. That is actually going to be a problem, I think, for years to come. What I would say is that there seems to me to be very little likelihood of our NHS being overwhelmed this winter. There are always pressures at this time of the year, and an overwhelmed NHS was the absolute cornerstone of Government policy towards this particular public health emergency at the start. Those things are not there now, and I think that we just need to contextualise a lot of what is going on.

Of course we need to reduce the number of admissions to the NHS, particularly to ITUs, for covid-19. It is a huge burden for the NHS, and it prevents us from doing other things, but we are certainly not in the position now that we were in this time last year. So while I will certainly be supporting No. 1340, I am afraid that I will not be able to support the Government in respect of No. 1338, because of the lack of a sunset provision similar to that enjoyed by No. 1340 and also because I am very concerned about “suspected of” and what that might mean in terms of a chilling effect on schooling, the economy, liberty and livelihood.

Health and Care Bill

Andrew Murrison Excerpts

Report stage
Tuesday 23rd November 2021 Commons Chamber

[Edward Argar]

I set out the commissioning of the 15-year framework to look at need. Within that, the House will be regularly updated, as happens now—not least in oral questions, as we saw in the session preceding this debate—with plenty of opportunities for Members to challenge the Government and to see updates. There is also the regular publication of figures and workforce statistics, which will continue. Once we have that 15-year framework back and see what HEE says, we will be able to look at how best that might be interrogated by Members of the House and the wider public. I am hopeful that it will report back in the spring, and I suspect that that may well occasion a debate in this House. If not, I suspect that it may well occasion an urgent question from the hon. Lady or the hon. Member for Ellesmere Port and Neston.

Let me turn to new clause 29, which also addresses the issue of workforce planning. This new clause would place a duty on the Secretary of State to report on workforce planning and safe staffing. I have just elaborated at some length on the substantial work that my Department is doing to improve workforce planning. It remains the responsibility of local clinical and other leaders to ensure safe staffing, supported by guidance and regulated by the Care Quality Commission. The ultimate outcome of good-quality care is influenced by a far greater range of issues than how many of each particular staff group are on any particular shift at any one time, even though that is clearly important, which is why the Government are committed to growing the health workforce. It is also important that local clinical leads can make decisions based on the circumstances in their own particular clinical setting, utilising their expertise and knowledge.

The amendment would also require the report to contain a review of lessons learnt. In the last decade, the Government have introduced significant measures to support the NHS to learn from things that go wrong, reduce patient harm and improve the response to harmed patients, such as: a regulated duty of candour that requires trusts to tell patients if their safety has been compromised and apologise; protections for whistleblowers when they raise safety concerns; the Healthcare Safety Investigation Branch, which we are building on and establishing as a separate statutory body through the Bill; and the first-ever NHS patient safety strategy, with substantial programmes planned and under way to create a safety and learning culture in the NHS.

I hope I have given the House some reassurance that we are doing substantive work to improve safe staffing and workforce planning. Again, I encourage the shadow Minister—perhaps it will be unsuccessful, but it is always worth trying—to consider withdrawing his amendment.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

New clause 29(2)(d) has merits, as I am sure the Minister will accept, in that we need to incentivise people to join health and care, and, crucially, to be retained with the system. Will he give some consideration to this, particularly given that, for example, somebody working in the care system can work for years and years and still be in the same place when it comes to applying for a training place in a profession allied to medicine as somebody who simply has a couple of A-levels? That seems to be wrong. Does he agree that we need to complete the structure so that there is some prospect of progression with health and care and to try to break down the barriers between the two?

[Edward Argar]

As ever, my right hon. Friend—my friend—makes his point well, and, as ever, I will commit to taking it away and reflecting on it very carefully. He is always very considered in the points he makes in this House, so I am happy to look at it.

I turn to Government amendment 127, which I bring forward with support of the Welsh Government. Clause 127 on professional regulation provides additional powers that will widen the scope of section 60 of the Health Act 1999 and enable the Privy Council to make additional changes through secondary legislation. One of the powers within this clause is to enable the regulation of groups of workers concerned with physical and mental health, whether or not they are generally regarded as a profession. This element of the clause falls within the legislative competence of the Senedd. When the section 60 powers are used, they are subject to the existing statutory requirements in schedule 3 of the Health Act 1999— namely, consultation and the affirmative parliamentary procedure. When legislation made using section 60 powers also falls within areas of devolved competence, it will be developed in collaboration with the devolved Administrations. Orders may require the approval of the Scottish Parliament where they concern professions brought into regulation after the Scotland Act 1998, or of the Welsh Assembly where the order concerns social care workers. In Northern Ireland, where the regulation of healthcare professions is a transferred matter, the UK Government will continue to seek the agreement of the Northern Ireland Executive when legislating on matters that effect regulation in its territory.

The amendment introduces a requirement to obtain the consent of Welsh Ministers before an Order in Council can be made under section 60 of the Health Act 1999 when it contains a provision that would be within the legislative competence of the Senedd. It would apply if we were seeking to bring into regulation in Wales a group of workers who are concerned with physical or mental health of individuals but who are not generally regarded as a profession. The UK Government recognise the competence of the Welsh Government regarding this provision and are respecting the relevant devolution settlement in making this amendment. For these reasons, I ask hon. Members to support the amendment.

Finally, I turn to the amendments related to part 4 of the Bill on the health services safety investigations body. These are the most significant set of provisions found within this Bill to enhance patient safety. The establishment of an independent healthcare body focused on learning from mistakes to improve safety and quality is a world first. For the health service safety investigations body to be able to perform this “no-blame” role, the integrity of safe space is paramount. Without it, health and care staff will not have confidence to come forward, and potential learning will be lost. This principle runs throughout the drafting of these clauses. We have made a small number of exceptions in the Bill—for example, to ensure that coroners can continue to perform their vital functions as judicial office holders and effectively as part of the judiciary. We have also provided for a regulation-making power to ensure that safe space can evolve in line with innovation in technology or medical practice. However, nothing in the Bill can or will undermine the imperative that the HSSIB is an independent organisation or the fundamental importance of safe space to the effective working of that organisation.

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[Justin Madders]

I thank the hon. Member for her intervention. Indeed, this actually covers some of the debate we had in Committee. There has been a rhetoric coming out of Government in recent months that managers are somehow a cost burden and that administrative staff do not actually help deliver the services. Of course, as the hon. Member has just pointed out, they are a vital source of support for those on the frontline.

[Dr Murrison]

The hon. Member is being generous in giving way. Would he avoid the temptation to suggest that productivity is in some way simply a demand for hard-pressed people in health and social care to work harder? It is not that at all. It is just doing what they want to do, which is to work smarter and thus get more out of the system, which I think is what the hon. Member for Central Ayrshire (Dr Whitford) has just said.

[Justin Madders]

I accept what the right hon. Member has said. There has been a gap in investment in IT and other things that make people’s jobs easier and more efficient, and that has been a characteristic of NHS spending over the last decade.

With your permission, Madam Deputy Speaker, I will try to make some progress, but it is important, as we have talked about the staff, that we pay tribute to all those who make the NHS what it is today. On Nursing Support Worker Day, I pay tribute to all those who work in wards, clinics and community settings to support our nurses and provide that essential hands-on care to patients.

Our care system does indeed face a crisis—over waiting times, over recovery—but as with all other crises, the root cause is inadequate funding. The most visible and significant symptom is an inadequate workforce, plus the scandal of social care provision. There is no plan at the moment; it is just a plan for a plan. When we talk about a workforce crisis, that cannot be in any way a reflection on the huge value and contribution of the workforce we have now.

There are particular positive aspects to amendment 10 to which I would like to draw attention. Explicit recognition of the need to consult with the workforce through trade unions is very welcome. The planning covers health and social care, which is also absolutely essential. Given the scope of the review, the timescale is about right—every two years is demanding, but not too onerous—but a regular update each year might be preferable. However, the main point, which I have made already, is to compel a regular report and review of demand. The central role is that the Secretary of State has a duty to get planning done, and we hope that will be a crucial lever for the change we need to see.

If the amendment has a weakness, it is probably the one we have touched on already, which is that it does not ensure that the plan is feasible or delivered. A plan that shows the gap is not a plan unless it has a credible funding solution alongside it. Even if that is not explicit in the amendment, we assume that funding would follow any such assessment and plan that is set out. Our suggestion would be that any such financial projections in a plan are subject to the same level of independent expert verification as we see with the Office for Budget Responsibility. Since all the various think-tanks are going to do an assessment anyway, we may as well have a built-in process for verification.

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[Jeremy Hunt]

I absolutely agree with the hon. Lady, who knows about acute services. I also point to recent evidence from Norway that shows the same for general practice: patients who see the same GP over and over again go to A&E departments less than patients who see different GPs.

[Dr Murrison]

The hon. Member for Central Ayrshire (Dr Whitford) is absolutely right about acute safety; I speak from personal experience. My right hon. Friend is right about general practice, but the issues are different. In general practice, the issue is chronic long-term care: patients need to know that practitioners have a view of their condition that spans a long period—sometimes generations. The issues are very different in acute and primary care, but they come to the same thing.

Does my right hon. Friend agree that part of the problem with the workforce is not recruitment, but retention, particularly the retention of senior doctors in their mid-50s? It pains me to say it in this consensual debate, but the root cause is the GP contract and the consultant contract brought in by the last Labour Government. Those contracts incentivise people—in my demographic, as it happens—to leave, potentially leaving the service short of 10% of their entire career.

[Jeremy Hunt]

My right hon. Friend is right that there are problems with the GP contract. I do not want to get into too many discussions about doctors’ contracts in this very consensual debate, but Conservative Members have to take responsibility for not having remedied the pensions anomaly, which gives people an incentive to retire much earlier than we would want. We have to address that issue.

Lots of people might reasonably ask whether I did enough to address the issues in the nearly six years that I was Health Secretary. The answer is that I set up five new medical schools and increased by 25% the number of doctors, nurses and midwives we train. However, that decision was taken five years ago and it takes seven years to train a doctor, so not a single extra doctor has yet joined the workforce as a result.

That is the nub of the problem: the number of doctors, nurses and other professionals we train depends on the priorities of the current Secretary of State and Chancellor. As a result, we have ended up with a very haphazard system that means that although we spend about the average in western Europe on health, as a proportion of GDP, we have one of the lowest numbers of doctors per head—lower than any European country except Sweden.

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[Sajid Javid]

My hon. Friend makes a very important point and he speaks with deep experience. What I can tell him is that we will shortly be publishing an integration White Paper, which, given what he has just said, I am sure he will welcome.

[Dr Murrison]

I declare an interest similar to that of my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter). Does the Secretary of State agree that there is an opportunity with integrated care boards and panels to ensure the end of the awful spectacle of people at end of life and frail elderly people coming towards the end of their days being expected to live out those days in an acute hospital ward, when they should be looked after in more homely settings in the community? That has gone on for too long and consecutive pieces of legislation have failed to address it. We have an opportunity here, probably with the help of the other place, to sculpt the measure we are considering today to ensure that stops. It must stop now, so that our frail elderly can have a future that does not involve an end as grisly and as sad as so many are forced to endure.

[Sajid Javid]

I absolutely agree with my right hon. Friend, who also speaks with deep experience. I very much agree with what he has just shared with the House.

On bureaucracy, we are removing the rules and regulations that make sensible decision making harder. On accountability, our healthcare must be accountable to democratically elected Members of this House. We spend well over £140 billion pounds of taxpayers’ money on our healthcare system, so it is right that there is more accountability to this place.

In closing, the unprecedented challenges of the pandemic have only deepened our affection for everyone working in health and care. They have been the very best of us. It is on us in this place, and on everyone who can make a difference, to give them the best possible foundation to work together to meet the challenges of the future. The Bill does that and a lot, lot more.

Tobacco Control Plan

Andrew Murrison Excerpts

Tuesday 16th November 2021 Westminster Hall

[Bob Blackman (Harrow East) (Con)]

I beg to move,

That this House has considered the delivery of a new Tobacco Control Plan.

It is a pleasure to serve under your chairmanship, Mr Bone—I believe for the first time in this place. I speak as, and declare an interest as, the chairman of the all-party parliamentary group on smoking and health. We welcomed the Government’s announcement of the new tobacco control plan, and we welcomed that it would be published this year, to deliver the Government’s smoke-free by 2030 ambition. I do not want to put any pressure on my hon. Friend the Minister, but she does not have long to achieve the first ambition. The Government’s ambition to reduce smoking rates to 5% or below, making smoking obsolete, is one that all of us in the all-party parliamentary group share. I believe that will be endorsed on an all-party basis this morning, because it is clearly a great way to ensure the health of the nation.

For me, this is deeply personal. Both of my parents died of cancer caused by smoking. My late mother was only 47 when she died of lung and throat cancer, as she was a very heavy smoker for most of her life. I do not want to see families go through what my family had to go through during those terrible days. For me, it is a lifetime ambition to ensure that people understand the risks of smoking, the damage to their health and the damage to their families.

The all-party parliamentary group is keen to support the delivery of the ambition of a smoke-free Britain, which is why, in June this year, we published a report setting out our recommendations for the tobacco control plan for England. Those recommendations were endorsed by more than 50 organisations, including the Royal College of Physicians, Cancer Research UK and the British Heart Foundation. On behalf of the APPG, I am pleased to welcome my hon. Friend the Public Health Minister to her new post, and indeed to welcome her opposite number; to put our recommendations on the record; and to give the Minister the chance to respond to those views.

The APPG has a long-term track record of acting as a critical friend to the Government on the tobacco control agenda. I am confident that this collaborative and constructive relationship will continue. Although smoking rates in my constituency are lower than the English average, there is no room for complacency. In Harrow, more than one in 10 people still smoke and smoking kills around 250 people a year. That is obviously far too many. In 2018-19, there were 1,566 smoking-attributable hospital admissions and 370 emergency admissions for chronic respiratory disease, which is caused almost entirely by smoking. That is in one constituency, so imagine what smoking does to the national health service up and down the country.

Research presented to the all-party parliamentary group shows that, on average, smokers are likely to need social care a decade earlier than non-smokers, and particularly never-smokers. Smoking-related disease and disability make it hard to carry out normal daily activities such as getting dressed, walking across a room and making a meal. Most of us take these things for granted, but we should not.

The importance of the smoke-free 2030 ambition is clear. As the Minister herself stated recently,

“tobacco continues to account for the biggest share of avoidable premature death in this country. It contributes half the difference in life expectancy between richest and poorest.”—[Official Report, 1 November 2021; Vol. 702, c. 621.]

More than 70,000 people died from smoking last year in England alone. For every person killed by smoking, at least another 30 are living with serious smoking-related illnesses.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

I warmly congratulate my hon. Friend on bringing forward this debate. On the point about the 70,000 deaths, is it not important to understand that that is year after year after year? Would he set that in contrast with the awful toll we have had from covid and the terrible restrictions that we have necessarily placed upon the population of this country, and agree with me that getting rid of this horrible substance would be far less of an intrusion on people’s liberties than the sort of things we have seen over the past 18 months? Over time, that would have a far greater impact on health, wellbeing and people’s ability to go about their daily lives. It would reduce the burden on the national health service very substantially indeed, and address the health inequalities that sadly mean the life expectancy of the richest and poorest in this country are currently separated by upwards of 10 years.

[Bob Blackman]

I could not have put it better myself. My right hon. Friend quite clearly makes the comparison between covid-19 and smoking. People cannot help catching covid, but when they smoke they make the choice as to whether they inflict life-changing circumstances on themselves.

Covid-19 Update

Andrew Murrison Excerpts

Monday 15th November 2021 Commons Chamber

[Sajid Javid]

I listened carefully to what the hon. Lady said and I will take that away, but let me give her some reassurances. We work very carefully on the vaccination programme with GPs, local authorities and others. Obviously it is vital to ensure that costs and payments are covered, and we keep that constantly under review.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

Pandemics are by definition international, and the UK—along with France, Germany and the World Health Organisation—has rightly called for an international pandemic treaty. Can my right hon. Friend say what form that treaty will take, and within what sort of timeframe? Will it cover, for instance, the availability of personal protective equipment in a timely fashion to those who need it, and the avoidance of the use of vaccines to exert diplomatic leverage, which we have seen in the case of AstraZeneca and the threatened use of article 16 of the Northern Ireland protocol?

Covid-19 Update

Andrew Murrison Excerpts

Tuesday 9th November 2021 Commons Chamber

[Sajid Javid]

I gently say to the hon. Lady that she really should not try to play politics with the story that she is perpetuating about the Prime Minister on a hospital visit yesterday. As the hospital trust said, and as I am sure she knows, the Prime Minister and his team followed all the rules that they were required to follow, whether they were about face masks or otherwise, in that hospital. Something tells me that she knows that, but sadly she has decided that she wants to play politics with such an important issue.

As for information on vaccination rates in Bristol, the hon. Lady knows that every region of England has a director of public health. She probably knows who hers is, and they will be able to supply a lot of information. If she is having any difficulty getting that information, I will certainly help her in any way that I can.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

I declare my interest as a vaccinator. I support the Government’s position, but will my right hon. Friend the Secretary of State tell us what assessment he has made of the risk of transmission of coronavirus from an apparently healthy person to a vulnerable person? As with hepatitis B, the only justification for the measure must be that there is a significant risk of transmission.

Furthermore, will he reassess his position on flu following the comments of his two predecessors, which I support? Will he ensure that we do nothing to trespass on the rights of individuals unless it is absolutely essential to keep vulnerable people safe? Finally, will he say why he has gone for 1 April? If this has to be done, it is better to do it quickly. By the spring, we will clearly be past the winter pressures that we are all concerned about.

[Sajid Javid]

I thank my right hon. Friend for his support. On the assessments that we have done, I have shared some information with the House, and there will be an impact statement followed by an impact assessment that will give him more information. It may be helpful for him to know that studies already in the public domain show that against the delta variant, the AstraZeneca vaccine is 65% effective and the Pfizer vaccine is 85% effective in preventing infection. The fewer people who are infected in these settings, the less spread there will be.

I think I have set out the Government’s thinking on flu, but it remains under review. There are many reasons why we have focused on the 1 April date, but the main one is to give those in the NHS who have not yet had a single jab—there are 100,000 of them—to make the positive decision to get vaccinated.

Covid-19: Government Response

Andrew Murrison Excerpts

Thursday 21st October 2021 Commons Chamber

[Maggie Throup]

We laid before the House our autumn and winter plan, which outlines the non-pharmaceutical interventions on which people can make their own decisions, because we believe people can make informed choices. As people see the levels rising, they will look at the guidance again and perhaps make the decision to wear a face covering in more venues.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

Will the Minister ensure that an obsession with non-pharmaceutical interventions, such as mask wearing, does not obscure the central message that the way out of this is through the continuation of the UK’s excellent vaccination programme? Will she ensure that the wind is not taken out of the sails of that vaccination programme as we enter a perilous part of this cycle in the winter months? And will she ensure that the evidence that monoclonal antibodies and antivirals given to test-positive vulnerable people before hospitalisation reduces their mortality is rolled out into recommendations so that such people can receive interventions that stand every chance of reducing their mortality and ensuring their recovery, thus reducing the burden on the national health service?

[Maggie Throup]

My right hon. Friend makes a very good point that our vaccination programme is the best wall of defence we can have. That is why, once again, I have made the call for everybody to have their first jab, if they have not had it, and their booster jab when they are eligible, and for 12 to 15-year-olds to have their jab when they can. As he rightly says, and he has much knowledge of this subject, monoclonal antibodies and antivirals will make big inroads into protecting the most vulnerable and the immunosuppressed. We welcome the antivirals that were announced yesterday, and over the coming months we hope they will be recognised by the Medicines and Healthcare products Regulatory Agency.

Coronavirus Act 2020 (Review of Temporary Provisions) (No. 3)

Andrew Murrison Excerpts

Tuesday 19th October 2021 Commons Chamber

[Sajid Javid]

In our response to the pandemic, we have set out clearly our plan for the autumn and winter; I have certainly done so in the House. We certainly expect more pressure as we head into winter. We have been very open about that; it is why the covid vaccination booster programme and the flu vaccination programme both remain important. However, there are provisions in the Act that I believe are still necessary and proportionate to help with the pressure that my hon. Friend refers to, such as the registration of healthcare and social care workers and the power to discontinue healthcare assessments for people being discharged from the NHS. I think that it is wise—especially as we head into the winter, when we do not know just how significant the pressures will be—to have that flexibility.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

Would my right hon. Friend go a little further? As a medical support worker, I can tell him that there has been very little effort to follow through on a programme begun last year to encourage people to return to being patient-facing. They need to remain engaged; the Act is a good start in that process, but it does not appear to have been developed in any way. I agree absolutely that my right hon. Friend needs to keep those provisions in the Act, but he needs to develop them more than has been done so far—particularly because if we face a bad winter and possibly the resurgence of this or another virus, we will need those people. They need to remain engaged.

[Sajid Javid]

My right hon. Friend is right to draw attention to that point. We need to keep working on it, but it might be helpful to know that under section 2 of the Act, the Nursing and Midwifery Council has been able to register temporarily some 14,000 nurses, midwives and nursing associates in England, and the Health and Care Professions Council has been able to register more than 21,000 temporary paramedics, operating department practitioners, radiographers and other professionals. That has certainly helped the NHS and the care system.

We have already allowed 13 of the 40 temporary non-devolved provisions in the Coronavirus Act to expire, and at the most recent six-month review we deemed a further seven provisions and part of an eighth suitable for expiry. Last month, as we published our autumn and winter plan, I came to the House to set those out.

Some of the provisions that we are recommending for expiry are some of the most stringent aspects of the Coronavirus Act. They include section 51, which relates to potentially infectious persons and which has been used only 10 times and not since October 2020; section 52, which gave powers to issue directions relating to events, gatherings and premises, and which has never been used; section 23, which relates to time limits for urgent warrants under the Investigatory Powers Act 2016 and which is no longer proportionate to this stage of the pandemic; and section 37, which allowed for the disruption of education for children and young people with special educational needs and disabilities, and which continues to be unused.[Official Report, 22 October 2021, Vol. 701, c. 8MC.]

--- Later in debate ---

[Jonathan Ashworth]

The hon. Gentleman tempts me. I can understand that if the Act fell, there would be time for alternative provisions to be put in place, but I am afraid I do not have confidence in the continuation of this particular Treasury, which is keen to find savings in the public finances, to provide statutory sick pay from day one. Voting down the Act today would be voting down statutory sick pay from day one, and I do not want to see the Government revert to providing it from day four. That is why, although I have sympathy with the hon. Gentleman’s point, I am not prepared to vote down the Act.

[Dr Murrison]

I always listen to the right hon. Gentleman’s comments with the greatest of interest. He is concerned that there is not sufficient scrutiny. Will he compare and contrast the attendance in this short debate on the Government Benches with that on the Labour Benches? I count three of his Back-Bench colleagues at the moment.

[Jonathan Ashworth]

The right hon. Gentleman is better than that, with respect. He is very experienced, and he knows full well that right hon. and hon. Members have various responsibilities as Members of Parliament. Come on! That was akin to those ridiculous tweets that we sometimes see going around, saying that an important issue is being debated in Parliament and asking why the Benches are empty and so on, when it is an evening Adjournment debate.

--- Later in debate ---

[Dr Murrison]

When the hon. Gentleman says vaccination, I hope he also means vaccination against seasonal flu, which is currently at the front of my mind as this morning I had my jab in the Attlee Room in Portcullis House. Seasonal flu will potentially cause more of a problem this winter than covid. It is important to get that message across. Does the hon. Gentleman share my concern that we are currently not where we really ought to be in vaccinating people against flu?

[Martyn Day]

I thank the right hon. Gentleman for his comments, and I do indeed agree. I wonder whether he has seen an advance copy of my notes, because I was coming to that very point. We are still witnessing too many infections and I worry that, when they are combined with flu, we could yet have a very difficult winter ahead for our health services—a “twindemic”, if you like. The successful roll-out of vaccinations and the protection of the most vulnerable remain essential, so I thank the right hon. Gentleman for that point.

As I have said, the SNP welcomes the four-nations approach to tackling the coronavirus pandemic. However, the UK Government would do well to match Scotland’s science and public health-first approach for the remainder of the pandemic. The Scottish Government have followed the science and done what they can within their power, which is why Scotland retains stronger rules on face masks, for example. As we head into what will likely be a difficult winter, the UK Government must be willing to follow the examples set by the devolved nations and be prepared to introduce measures such as face masks in shops and on transport, to protect people from both coronavirus and flu this winter.

--- Later in debate ---

[Maggie Throup]

I reassure my right hon. Friend that there are ongoing talks across all the devolved nations and the interoperability of the devices are being looked into; work is under way on that.

[Dr Murrison]

Will my hon. Friend also scrutinise the Bill, as a number of colleagues have mentioned this afternoon, to find those bits that were inserted as expedients but probably need to be refined a little and perhaps given a different statutory basis, such as the certificates in section 19, which for many years have been a nice little money-earner for members of my profession but a burden on the deceased’s estate and which really are not necessary?

[Maggie Throup]

Of course we keep every aspect of the Act under review and will continue to do so.

Members have made a number of compelling points and I would like to address them and respond to some of the questions raised. The shadow spokesman raised the issue of vaccinations and I am pleased to report that 3.6 million booster jabs have been delivered to date over a very short time period. This week sees the launch of a communications campaign on the importance of flu jabs. As my right hon. Friend the Secretary of State announced earlier, the national booking service will open for vaccination bookings for young people shortly and letters will be sent to parents and guardians of children aged 12 to 15 over coming weeks inviting them to book the vaccine online or by calling 119. Jabs will continue to be delivered in schools and if the child has already been invited through their school they do not need to act on their invite unless the parents wish to do so. This is a further option for parents to get their children vaccinated.

In response to my right hon. Friend the Member for Forest of Dean (Mr Harper), on 23 September, the Government laid out their plans for parliamentary scrutiny should there be a need for vaccine certification. The Government recognise the vital importance of parliamentary scrutiny. In addition, there was a call for evidence, which closed on 11 October. I trust that my right hon. Friend was able to contribute to that.

My hon. Friend the Member for Bolton West (Chris Green) raised the issue of care workers. My father was in a care home for seven years. I know from personal experience that care workers become part of the family and play a really important role.

Covid-19 Update

Andrew Murrison Excerpts

Monday 6th September 2021 Commons Chamber

[Nadhim Zahawi]

I have grateful for the hon. Lady’s words, including those about the issue of vaccine certification, on which I agree with her. No one in this Government, and certainly not this Prime Minister—as I said at the weekend, it goes against his DNA—wants to curtail people’s freedoms, so we will not do this lightly at the end of September. As for her question about the funding, let me try and give her some more details.

The £5.4 billion cash injection over the next six months in response to covid-19 includes £1 billion to help tackle the backlog, delivering routine surgery and treatments for patients. As I said in my statement, the total Government support for the health service is £34 billion in this year alone. The funding will go towards helping the NHS to manage the immediate pressure of the pandemic. As I have said, it includes an extra £1 billion to help tackle the backlog, along with £2.8 billion to cover related costs such as those of the enhanced infection control measures that are so important to keep staff and patients safe from the virus, and £478 million to continue the hospital discharge programme, freeing up beds.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

Six years ago we lost 28,000 people to seasonal flu. Can the Minister assure me that we will not prioritise the jabbing of 12 to 15-year-olds over the seasonal flu programme, given that the number of children whom we would lose to covid would be vanishingly small in any event? Can he also assure me that in his planning he has considered not only the 15-minute wait that the Pfizer jab requires, but the extra time and effort that are required to get truly informed consent from children whose motivation cannot be clinical, must be altruistic, and may be subject to peer pressure?

[Nadhim Zahawi]

Let me try to unpack my hon. Friend’s question. First, no decision has been made on vaccinating 12 to 15-year-olds who are healthy. We are vaccinating those who are vulnerable. We will not pre-empt the important work that the chief medical officers are doing and on which they are experts. Operationally, we have the infrastructure to be able to deal with both programmes.

The flu and covid booster campaigns are the largest endeavours. As I said earlier, in some weeks we will probably break the record that we set in the original covid vaccination programme. The flu vaccine is traditionally delivered through the brilliant work of GPs and, of course, community pharmacies, and they are doing that again. They have raised their ambition and ordered more than they did last year—which was a record-breaking year—and we have procured centrally as well. I can reassure my hon. Friend that that is our priority. I worry very much about a bad flu season this year, which is why we have been so much more ambitious in that regard, as well as on the covid booster campaign.