Vaccination: Condition of Deployment

Baroness Brinton Excerpts

Thursday 3rd February 2022 Lords Chamber

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

My Lords, the noble Baroness, Lady Brinton, is taking part remotely. I invite her to make her comments.

[Baroness Brinton (LD) [V]]

My Lords, from our Benches, I thank all the staff and volunteers in the entire health and social care sector, as well as the scientists and other experts, who are still working to keep us all safe as this pandemic continues, because it is clear, especially with omicron BA.2, that it is not over yet.

We are warned that there may yet be more surprises down the line, which is why it is somewhat bemusing that the Statement begins with this phrase:

“Last Thursday, we woke up to a new phase of this pandemic as we returned to plan A.”


That is extraordinary, because the Prime Minister made his Statement with neither the Chief Medical Officer nor the Chief Scientific Adviser by his side. His press conference and this Statement feel like the Government trying to create good news against the constant bad news battle, not least over partygate.

Last summer, and again before Christmas, we warned that the insistence on compulsory vaccination for front-line staff in the social care sector and the NHS would cause severe problems, specifically in terms of staff shortages as staff either left or were sacked. That problem is already evident in social care; a number of care homes have already been taken to court by staff they have had to let go.

The Statement on Monday also talked about cases falling but, frankly, the opposite is happening at the moment, with cases plateauing in some areas and rising in others. Tim Spector of the ZOE Covid study is warning that the numbers are consistently increasing despite many people no longer recording their results. The high level of cases in schools and in the younger adult age groups shows that Covid is still prevalent. Even if omicron BA.1 and BA.2 are less severe than delta—which is, by the way, good news—the number of cases has two consequences. First, there is increased pressure on primary care, especially GPs and hospitals, even if there is less pressure on ICUs. Secondly—the Minister will not be surprised to hear me say this—there are the problems faced by the clinically extremely vulnerable. I will return to this point later.

Yesterday afternoon, the director-general for adult social care wrote to providers of CQC-regulated adult social care activities about the removal of vaccination as a condition of deployment, or VCOD. Extraordinarily, this letter was written as late as on the eve of the date when notices would have to be served to staff in the NHS. Further, the letter refers to a Written Statement being laid before Parliament today but, as at 3.30 pm, it still has not been laid.

The first and second paragraphs of the letter refer to the regulations on VCOD, which relate to care homes and the wider social care sector, but the heading of the letter reads:

“Vaccination as a condition of deployment … in wider social care (social care settings other than care homes)”.

For anyone reading this letter at face value, it clearly excludes care homes from the U-turn on compulsory vaccination. There is no mention of a separate letter for them and the sector is extremely concerned. I know that the department has been dealing with calls on this matter today, but those I have talked to say that they cannot get a straight answer from the department. Can I try to distil this to get a clear answer from the Minister, who I wrote to about this earlier today?

Is the reason that the letter to the social care sector specifically excludes care homes from the compulsory vaccination rule changes because they are covered by regulations that are being revoked and it is not necessary and, if so, why were they not told that in the letter? Or is it because of an error, and they will receive a separate letter that has not gone out yet, despite today being the day that any final employment notices must be served? Or is it because compulsory vaccination rules remain in care homes? Another matter that I have picked up today is that this letter was not sent to hospices. Why was that? I hope the Minister can give your Lordships’ House a precise answer, but there is a wider interest in this so, if he cannot give me that now, I would welcome a written response.

Secondly, can the Minister say whether UKHSA gave formal advice to the Department for Education, in advance of Nadhim Zahawi’s guidance to schools on 20 January, specifically the strong guidance on no face coverings in schools, other than temporarily and only on the advice of their director of public health? Further on in the guidance, on page 12, it says that

“Children and young people previously considered CEV should attend school and should follow the same … guidance as the rest of the population. In some circumstances, a child or young person may have received personal advice from their specialist or clinician on additional precautions to take and they should continue to follow that advice.”


What would the Minister say to the head who, earlier this week, asked all pupils—not just the CEV pupil—to wear masks until further notice, as one pupil has leukaemia and is severely immunocompromised? The family and the school want that pupil in school, if possible. Why have the Government, the Department for Education or the Department of Health—I do not mind which—not given advice to these pupils, their families and their schools?

Finally, the briefing to journalists earlier this week that the Secretary of State for Health wants to stop publishing Covid data in mid-April has rung alarm bells across the medical and scientific community, as well as for those who are CEV and are still following the guidance in place for them. Scientists say it will reduce their ability to look at data to understand the progress locally, regionally and nationally, and doctors need that information too. I hope the Minister can confirm that any such decision is in the hands of the Chief Medical Officer and the Chief Scientific Adviser, as these are scientific, not political, decisions.

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

I start by thanking both the noble Baronesses for their questions and the Benches opposite for their support during this difficult time. There was not really much political difference between us. We all recognised that vaccination remained the best defence against the virus and the variants. I also thank them for their support on VCOD.

One of the things we have constantly been doing—for example, over the Christmas break, I was on almost daily calls with other Ministers, the UKHSA and others—is to look at the evidence and the data, as it came in. We were always led by data when it came to making decisions. At the time, we felt that it was right to bring VCOD in for care homes and then to extend it across wider health and social care. You only have to look back to the beginning of Covid when we saw the disproportionate number of deaths in care homes.

Given that Delta has now been replaced, it is not only right but responsible to revisit the balance of risks and opportunities that guided our decision last year. In weighing them up, this was the balance we struck. First, our population as a whole is now better protected against hospitalisation from Covid-19. Secondly, the dominant variant, Omicron, is intrinsically less severe. Taken together, the evidence shows that the risk of presentation to emergency care or hospital with Omicron is approximately half that with Delta. Given these changes, and in conjunction with scientific advice, we have reviewed the policy and decided it is no longer proportionate to require VCOD.

We continue to encourage staff to take up vaccines. It is really important. I know most noble Lords have supported this. The NHS has focused on a targeted approach, particularly among hesitant groups within the health service, but in some ways, those hesitant groups reflect hesitant groups in the wider population. When speaking to my colleague, the Minister Maggie Throup, I have been very impressed by the number of different targeted interventions and consultations there has been, sometimes targeted right at the level of local communities. When I chaired a round table for black and ethnic minority organisations this week, one of the things we looked at was how to roll out antivirals. The question there was do we need to do still more work to convince those who are hesitant in certain communities, sometimes based on ethnicity, sometimes based on geography, sometimes based on income levels. How do we make sure they are vaccinated?

The NHS has continued and will continue with its one-to-one conversations with all unvaccinated staff. This has been associated with an early increase in vaccine uptake by 10%. Even though VCOD, we hope, will be dropped subject to the consultation, we will continue, and I know the NHS will continue, to consult all staff.

On the written advice to those who are about to issue letters today—I have to take responsibility for this—it was waiting for sign-off from me because I was doing lots of meetings for the Bill. I am very sorry; I was juggling two things at once. However, literally just before I came into this Chamber, I gave my sign-off for that letter to go out to give advice that those letters of dismissal should no longer go out.

We know it does not happen immediately, but we want to finish the consultation quickly. We hope to finish the consultation by April, and then we can drop VCOD.

As I said, we are continuing with the wider vaccination programme, and our intention is to be able to revoke it well ahead of 1 April, which is our target date. We want to move as quickly as possible, but as noble Lords will acknowledge, we also have to do a consultation process.

In the care home sector, employees have already been dismissed since 11 November. We know it has been difficult. Care homes were following the laws at the time. There have been conversations about whether some care homes will have those conversations with staff who have left. Will those staff want to go back, or have they got new jobs? This is part of our wider recruitment process to make social care a more attractive vocation and a more attractive career. Some care homes have told us individually that they will probably keep VCOD because it gives more assurance to the relatives of patients in those care homes. So, it is very much not one size fits all.

Some have asked why we are doing this now and whether it is still too dangerous. Others have asked why we have not done this sooner. We have always followed the evidence. We have always balanced the risks, and we now recognise, clearly, that given the rates of transmission, the lower severity of Omicron and the higher percentage of staff that are vaccinated in both the health and social care systems, this was the right time.

I thank the noble Baroness, Lady Brinton, for giving me advanced notice of some of her questions. Unfortunately, I do not have good enough answers at this stage, so I am going to go back to my department and ask for clearer answers, and I will write to her.