Covid-19 Vaccine: Take-up Rates in London

Christopher Chope Excerpts

Tuesday 9th March 2021 Westminster Hall

[Sir Christopher Chope (in the Chair)]

Welcome to this version of Westminster Hall. May I thank all the people involved in facilitating this important development in our democracy? There have been some changes, which I will set out briefly. One is that we start five minutes earlier, so that we can finish this debate at five minutes to 11. I remind hon. Members participating, both physically and virtually, that they must arrive at the start of the debate and they are expected, under the instructions of the Deputy Speaker, to remain for the duration of the entire debate. If Members attending virtually have any technical problems, they should email the Westminster Hall Clerks’ email address. We ask that Members attending physically clean their spaces before using them and before leaving the room, so that those spaces can be used by others later. Without further ado, I call Andy Slaughter to move the motion.

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[Ms Karen Buck (Westminster North) (Lab) [V]]

I congratulate my hon. Friend the Member for Hammersmith (Andy Slaughter) on introducing this very welcome and extremely timely debate. He has set out the arguments very comprehensively and I shall endeavour not to repeat too many of the key points.

I will repeat, and I am sure that everyone speaking this morning will also repeat, our grateful thanks to NHS and public health staff who are working so hard to deliver this vaccine. It has been a national success story; there is no doubt of that whatever. It is an extraordinary logistical achievement, of which the NHS can be extremely proud. I had my vaccine on Saturday at St Charles’ Hospital and it was an extraordinary, professional operation; swift and effective. I think everyone should be very proud of what they have done.

Of course, that does not mean that that we should not be able to focus on some of the outstanding questions that arise regarding the delivery of the vaccine in London. As has been stated, London as a city, as a region, is not achieving the same figures as other parts of the country, which should be a cause for concern. My particular concern is my own borough, my own constituency area, Westminster North. It is apparently the second-worst performing borough in the country with just 69% coverage of 65-plus. City of London and Westminster South are also performing very poorly.

This does matter very greatly, for reasons we all understand. It matters in terms of individuals and in terms of the public health of the borough, but I would also suggest to the Minister that it is a particular concern because the central London economy is so critical to our national economic revival. Therefore, being confident that we have good coverage in central London seems, to me, to have a significance even over and above the pure public health considerations.

I want to focus on two particular themes, the first of which I am afraid is going back to the question of data. For the reasons that my hon. Friend the Member for Hammersmith has outlined, inner London generally has a highly complex set of population characteristics. We need to understand the particularity of those circumstances to be effective in delivering to those populations. While it is useful, indeed, to have the national and regional—north-west London, in my instance—and some of the borough data, we need to be able to look at local data, understand it and know that it is accurate.

I have yet to see the information that is provided to the directors of public health. As of this point, the middle of March, nearly three months into the vaccination programme, it has not yet been shared with me. The fact that it has not been shared with me by my local authority reflects its concerns that the data is not accurate. The Minister will have heard, no doubt, from many other people, that there is a concern that building up from the basis of the local data to a larger picture and then expanding it out to a national picture will give different results, and people will start looking at variations in that data and asking questions about it. I understand that point and can see that it is indeed difficult to get those statistics all squared off. On the other hand, I am absolutely clear that unless we understand the difference between what is in happening in, for example, the Mozart estate area in the Queens Park ward, and in Belgravia and Knightsbridge, we will not get a proper understanding of where the priorities should be.

My local authority has told me that part of its anxiety is that there is a variance between the use of the Office for National Statistics data and the national immunisation management system data, which has led to a significant national population variant of, I believe, as high as 5 million. As my hon. Friend outlined, there is good reason to believe that the percentage variance will be greater in central London than anywhere else in the country. We have seen that in terms of the census and the population figures. I had a debate on the 2001 census because of my concerns about accurate recording of population. However, it is unclear to me, from discussions with people working in the local health service, what population denominators are being used locally. It is unclear who is using what data, and as a consequence it is unclear whether such local data as exists is even remotely accurate.

The question is: does that matter? I would say that it does, because if we are spending time trying to find people who are simply not present, to raise the vaccination rate, for good reasons, we are wasting time and effort on them, whereas at the same time—both phenomena are, I think, true simultaneously—there are wards, estates and communities in my constituency, as there will be in others, where we are failing to make contact with people who need to be contacted, because they are extremely hard-to-reach populations. My hon. Friend outlined some of the reasons for that. There is a high relative proportion of single people who will not necessarily have ties to communities, and links so that we can use the normal channels of communication. There is a high proportion of people with mental health problems, again, often living singly. There is the largest private rented sector in the country, with a high degree of population churn, which means that when talking to someone it is often unclear whether they are the same person who was living there six months before. Unless and until we can be sure of the granular data and understand the baseline population statistics on which it is based, we have a problem.

A secondary data problem concerns ethnicity and understanding some of the issues around both the take-up of the vaccine and vaccine reluctance, which are different components. The issue is that, in central London, we have the largest Arabic-speaking populations, a very diverse set of communities, but these are being recorded under “ethnic—other”, and therefore it is difficult for us to be able to focus in on those communities, which are important, in terms of delivery.

I have written to the Minister with some of these questions, but even since I wrote to him there has been new information from the local authority and from the clinical commissioning groups that raise questions for me about the data. We need to know whether the population that we are chasing is there, whether we are chasing hard-to-reach people or whether we need to focus in on people who have vaccine reluctance. I was told last week—

[Sir Christopher Chope (in the Chair)]

Order. I am sorry, but if the hon. Lady were participating physically, I would by now have been staring her down, because a lot more people wish to participate in the debate. I hope that she will bring her remarks to a swift close so that I can call the next speaker.

[Ms Buck]

Many apologies. I will conclude on that. I have concerns about the data and the investment in support for reaching hard-to-reach populations, and I hope the Minister will address those. My sincere apologies.

[Bob Blackman (Harrow East) (Con) [V]]

It is a pleasure to serve under your chairmanship once again, Sir Christopher, albeit for the first time virtually. I congratulate the hon. Member for Hammersmith (Andy Slaughter) on securing the debate, which is important for all Londoners. It is a pleasure to follow the hon. Member for Westminster North (Ms Buck).

In the London Borough of Harrow, we have had an outstanding performance on vaccination rates. We received congratulations from the Secretary of State for Health and Social Care on that performance, and I put on the record my appreciation and thanks to the fantastic team—both from the NHS and the volunteers—who made this possible. To set it in context, more than 70,000 people in Harrow have had their first vaccination, out of an adult population of just under 200,000, which is a remarkable performance, at the Hive centre, which opened in December, and at Byron Hall and Tithe Farm, which opened in January. To get to this stage so quickly has been remarkably good.

That has to be set against the fact that Harrow is the most ethnically diverse borough in London. Others have a higher number of different sections of population, but we literally have someone from every country on the planet and various different communities, so it is a direct challenge to reach all those different communities and to encourage them to come forward to get their vaccinations. This fantastic effort also has to be set against the position that, at the beginning of the pandemic, Northwick Park Hospital came very close to being overwhelmed by the number of covid cases. Sadly, we have had a very high death rate, and at one stage Harrow had the highest covid transmission rate in London, so achieving this vaccination rate has been vital.

More than 35,000 people have had their first vaccination at the Hive since the middle of December, and the Prime Minister visited the site to see at first hand the excellent work that is being done. However, we are experiencing problems, and I will relay some of those for the Minister. There is reluctance among the Afro-Caribbean, Bangladeshi and Pakistani communities, who are hard to reach. There have been real difficulties in getting them to come forward; there is a reluctance to have the vaccine. Among the white British, Irish and Indian population, there have been no such problems—they have come forward in their droves to receive their vaccinations, which is good news.

The supply problems are really serious. To give the Minister an example—I hope he will be able to answer this—the capacity at each of our vaccination centres is roughly 860 doses a day, yet this week, our centres will only receive 400 doses. That is less than half a day’s work, so the lack of supply is holding us back from achieving even faster vaccination rates.

The real problem that emanates from that is that we are having particular difficulties in contacting younger people who have underlying health conditions. They are among the most reluctant to come forward, because of the myths and legends about what the vaccine does to people’s bodies. I am pleased that we now have a myth-buster to combat this unfortunate propaganda, which is spreading very widely among different communities. An excellent video has also been put together by different community leaders, coming together irrespective of race, religion, colour or creed to say why it is important that people have the vaccination, to encourage people to do so, and to try to combat some of this insidious propaganda.

Also on the issue of vaccine supply, my centres complain that they get notified only a day in advance of the vaccine arriving, which of course means that it is very difficult to schedule people in to get their vaccinations. Can we have a better plan for supply of vaccine, which is vitally important? Equally, allowing flexibility to GPs undertaking vaccinations at GP surgeries would help considerably. It would reach those harder-to-reach groups, because people trust their GPs in the way that they do not necessarily trust going to a large vaccination centre.

I will end my remarks by saying that in Harrow, certainly, we have achieved remarkably well, but we can do better provided that we get the supply, that we have better notice, and that the facilities continue to arrive. At the end of April, two of our mass vaccination centres will close, and there will be the potential for complete chaos when we come to the second doses, because everyone will be invited to attend one centre in Harrow to get their second dose. I predict that is going to be quite chaotic, so I would ask that we look at potentially keeping those centres open for a further period to ensure that every adult gets their opportunity for at least the first dose by the end of July, as per the plan that the Minister has.

Thank you, Sir Christopher, and I look forward to listening to what other colleagues have to say.

[Sir Christopher Chope (in the Chair)]

As there are still eight more speakers and we start the wind-ups at 10.33, I am afraid that I now have to impose a four-minute maximum time limit.

[Dr Rupa Huq (Ealing Central and Acton) (Lab) [V]]

We are now in the second year of coronavirus, and we have all experienced highs and lows throughout this period. At the beginning, we were told that this is a great leveller, given that Prince Charles and the Prime Minister had it. Rather than the “we are all in it together” narrative, it is maybe more fair to say that we are all in the same storm, but in different boats. Nowhere have we seen that differential impact more clearly than in the vaccine roll-out in London.

We all remember the pictures of the memorably named William Shakespeare having his jab early in December, but it took a good 10 days for the vaccine to reach the magnificent gothic splendour of Ealing town hall, and sadly the supply in London has lagged behind other parts of the country. It has been a magnificent effort. We have all seen the brilliant statistic that a third of the population have been done, but again, there is room for improvement here. We remember the highs and lows—the 50,000 fatalities figure came just before the miracle of the vaccine at Christmas that has given everyone hope—but that maxim of differential impact is one we have to look at.

There are two things that will take us to the other side of this: vaccine uptake among the population and the hesitancy that people talk about, and supply. London has nudging 10 million people—some 12% of the population. My own borough has 360,000 people. Initially, we had the town hall, then we had a second venue in Southall— in the west of the borough. Both those were closed last week. The latter did a record 1,200, I think, before shutting its doors until further notice. There has been a magnificent effort from volunteers and NHS staff, and everyone was poised. I have heard nothing but praise about the efficiency of the operation, but then they were all stood down.

There are old divides between the inner city and the leafy suburbs, but my seat has both: Ealing is known as “queen of the suburbs”, but there are wards of deprivation in Acton, where there has been no vaccination centre; it is a bit of a vaccination black spot. I hope the Minister will help me to address that issue. Acton is big enough to have a tube or rail station with every compass point on several different lines—Central, District, and Piccadilly—but there is no vaccination centre. Given the characteristics of its population, the Acton-shaped hole makes the issue even more urgent.

As a whole, London—our nation’s capital—sometimes seems to have experienced this over-promising, and this moonshot rhetoric. Not that long ago, we were promised 24-hour vaccinations in the capital. That was being said in January. The experience of our centres last week was far from that.

We are waiting for the second dose and hopefully there will be a big surge, but it concerns me that there seems to be a bit of anti-London rhetoric from the Government at times. That stretches to the fact that we have a towns fund with new bungs bringing in prosperity and opportunity—but not in London, which has been completely excluded in favour of red wall locations. I would caution the Government not to let that apply to vaccination supply. London is not immune from deprivation, poor housing and overcrowding: I have those in my wards in Acton. Localised need should drive allocation, not centralised supply.

[Sir Christopher Chope (in the Chair)]

Order. I am sorry to interrupt, but you have gone beyond your time limit. I do not know whether it is because you cannot see the clock. My job is to try to ensure that everybody is able to speak. I call Feryal Clark.

[Dr Huq]

Apologies; I did not see a clock.

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[Rushanara Ali (Bethnal Green and Bow) (Lab) [V]]

It is a pleasure to join this very important debate, Sir Christopher, and I congratulate my hon. Friend the Member for Hammersmith (Andy Slaughter) on securing it.

The speed of the roll-out of the vaccination programme is a great source of hope for all of us. Those of us who have lost loved ones are particularly grateful to the NHS, to the scientists and to so many people who have come together to produce this vaccine, because we all know how important it is to protect our constituents, and our friends and family.

Locally, I pay tribute to my local authority, which has set up a helpline that is proactively contacting people who have not been vaccinated, and addressing and answering their questions. Government resources will make a big difference to other local authorities to help support that effort, and we need that back-up from Ministers.

I also thank the Royal London Hospital, Queen Mary University, GPs’ surgeries, the London Muslim Centre and other partners who have been helping with the vaccination effort in my constituency. Many people will be aware that in the first wave Tower Hamlets had the fourth-highest age-standardised death rate in the country. Although we are a young population, relatively speaking, there are huge health inequalities and huge issues with deprivation, severe overcrowding, intergenerational households and many other factors that, as other colleagues have said, make inner London extremely vulnerable to this pandemic.

In the second wave, we saw that the spread of the virus caused more deaths, which is why it is vital that we get to those who have not yet been vaccinated and those who have underlying health conditions by increasing the supply of the AstraZeneca vaccine, and that we get to those who did not take up the vaccine when they were offered it, for a number of complicated reasons, as other colleagues have mentioned. In some cases, it is about reticence, but it is also about practicalities and about deprivation. It is not just ethnic minority communities who are affected, although we have seen big differentials; it is also those from white disadvantaged backgrounds and from working-class backgrounds who have been disproportionately affected, both in terms of death rates and in lower take-up of vaccines.

What we need to do now is make sure that the vaccines are in the right places. The centralised hubs are, of course, useful and important, but it is also vital that we get vaccines to local GP surgeries. As I have said to the Minister time and again, it is vital that we get more vaccines to pharmacies and that pop-up clinics get up and running. The ones that we have are very good and very helpful, but the unpredictability of supply, the inability to plan and the lack of local flexibility are all leading to sub-optimal outcomes, when we could have better outcomes.

So today I call on the Minister, once again, to get the vaccines to the local providers and to provide local authorities with additional support, so that they can do the chasing, as is the case in my local authority. What we have seen is that when GPs are responsible for getting vulnerable patients, including homebound patients, vaccinated in my borough, 95% of those patients have been vaccinated. So this is not rocket science; we can address the gaps.

I am grateful to the Minister for the work that he has done so far and I appreciate that in him we have a listening ear. I hope that he listens to the arguments that have been made—not just by Members in my party, but by Members in his own: we have to get the supplies in. Going forward, as other colleagues have pointed out, we also need to address some of the deeper underlying conditions and to make sure that people’s vulnerabilities are addressed.

There is one final issue. Ramadan is coming, so we are in a race against time to vaccinate vulnerable constituents from the Muslim community in our city, because if we do not vaccinate them there will be even greater risks. So I hope the Minister will address that point, as well as the importance of getting more supplies into London—

[Sir Christopher Chope (in the Chair)]

Order. I call Fleur Anderson.

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[Siobhain McDonagh (Mitcham and Morden) (Lab)]

May I begin by making it clear that I am not here to raise criticism for criticism’s sake? I am here because I understand how imperative it is that the vaccine programme is successful. Although I welcome the scale of the programme and the number of vaccinations delivered, I am extremely concerned about the vaccination take-up in my constituency, and the inconceivable decision to open the two new vaccination centres miles away from the NHS declared low take-up wards of concern.

Let me briefly explain the geography. The borough of Merton is split in two: Mitcham and Morden, and Wimbledon. Merton’s inequalities in health are stark, with an eight-year difference in life expectancy between parts of Mitcham and parts of Wimbledon. The Minister will be aware of Tudor Hart’s inverse care law—that the areas in the greatest health are then statistically more likely to receive better health services.

Look no further than Merton. When the state-of-the-art Nelson health centre was opened in one of the wealthiest, richest wards of Wimbledon, Mitcham received the “Wilson portacabin”. When lateral flow testing was introduced at community pharmacies, they were opened everywhere but Mitcham. When a decision was made to relocate acute hospital services—guess what? The proposals moved them miles further away from the most deprived areas, with the statistically worst health. While many of these decisions are baked into decades of inequality, the location of a vaccination centre is a decision for here and now.

Here is the state of play: there are two centres in Merton; one in Wimbledon and one in Mitcham. However, take-up of the vaccine across the borough has varied significantly and, as ever, the devil is in the detail. Merton has 25 middle and lower layer super output areas. Of the 12 with the highest vaccination take-up rates, 11 are in Wimbledon. In all 12 Wimbledon areas, over 93% of over-70s have received their first dose. Compare that with Mitcham and Morden, where seven of the 13 areas are still below 90%, and Mitcham West, where the vaccination take-up was just 81%. That means that one in five residents have been offered, but not accepted, the vaccine.

I recognise the breadth of factors as to why this could be, and that accessibility of the vaccination centre is only one. However, it is a significant one, particularly given that, of the two new large-scale vaccination centres that are set to open in Merton, both are in Wimbledon—two centres, miles away from the wards with the lowest take-up areas, which also have statistically lower levels of car ownership. Are we not supposed to be breaking down barriers, rather than throwing up even more?

I am not calling for Wimbledon to lose their services, but the Minister must surely see the absurdity of this decision.

[Sir Christopher Chope (in the Chair)]

I will have to limit the last two speakers to three minutes each. If they have not seen it, there should be a countdown clock at the top of their screens to help them keep to the time limit.

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[Andy Slaughter]

Thank you, Sir Christopher, for your stewardship of our proceedings this morning. I am grateful to colleagues from north, south, east and west London for speaking on behalf of their unique constituencies but also identifying some common problems; to the shadow Minister, who has shown, as always, the support and solidarity that London MPs can expect from northern colleagues; and to the Minister himself. The Minister will be able to judge whether he has satisfied us on every point raised today by how many people turn up to his Friday briefing this week.

If there is one takeaway for the Minister from this debate, it is the need, in the laudable rush to hit overall targets, not to forget those left behind. That could be people of certain ethnicities. I draw his attention to the Royal College of Nursing’s work on this issue, which shows that even among nursing staff there is a disparity between different ethnicities. There are also those who fall through the net. I have a 68-year-old constituent who, because of her good health for 20 years, lost her NHS number and now is told that she has to wait eight weeks before she can get the vaccine. There are people who simply fall through the net, and it is partly our job to ensure that that does not happen.

On the hesitancy issue, I ask the Minister to look at the work that we are doing in Hammersmith and in north-west London. It is really good stuff. It is good practice that perhaps can be reflected elsewhere. He might even, after having seen it, want to go away and fund it.

Question put and agreed to.

Resolved,

That this House has considered covid-19 vaccine take-up rates in London.

[Sir Christopher Chope (in the Chair)]

The sitting will be suspended until 11 o’clock. May I ask those who have participated in this excellent debate to leave as quickly as possible?