Public Health
Helen Whately Excerpts(3 years, 6 months ago)
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The Minister for Care (Helen Whately)
I beg to move,
That the Health Protection (Coronavirus, Restrictions) (No. 2) (England) (Amendment) (No. 4) Regulations 2020 (S.I., 2020, No. 986), dated 13 September 2020, a copy of which was laid before this House on 14 September, be approved.
I will start with a short summary of the social distancing regulations, as context to this debate. The Health Protection (Coronavirus, Restrictions) (England) Regulations 2020—the major lockdown regulations—were introduced on March 26. Those regulations outlined restrictions on gathering and required a number of businesses to close. The regulations were amended four times as we opened up the economy and allowed for technical clarifications. They were then revoked and replaced by the Health Protection (Coronavirus, Restrictions) (No. 2) (England) Regulations 2020. Those regulations had been amended three times prior to 13 September to allow more businesses to reopen, as the transmission of the virus was falling or stabilising. Unfortunately, as winter approaches, the picture has changed and we now need to introduce tighter restrictions to control the virus, protect the NHS and save lives.
Mr Mark Harper (Forest of Dean) (Con)
The regulations were obviously made and brought into force ahead of the commitment that the Secretary of State made to the House last week. Given that the regulations that we are debating today cover the whole of England and are obviously of very great significance, will the Minister confirm that regulations of this nature would in future be covered by the Secretary of State’s commitment and would be brought for debate and decision in this House before they came into force? Would that also apply to, for example, the self-isolation regulations, which have not yet been debated by this House and which are also significant? I want to ensure that we are following through on the commitments that the Government made last week, and that this House will get to debate measures that cover the whole country and are of great significance.
Helen Whately
I thank my right hon. Friend for his point. Indeed, the Secretary of State has made a commitment that for future changes to restrictions that would have national effect, we will do our very best to bring them to the House to a vote, although obviously we have to bear in mind that there are circumstances in which we need to act very quickly, because, as we have seen, things can move very quickly with the infection rate and the consequences of the pandemic.
The regulations that we are debating today amend the Health Protection (Coronavirus, Restrictions) (No. 2) (England) Regulations 2020 so that people may not participate in social gatherings in groups of more than six unless they are members of the same household or support bubble, or exemptions apply. The regulations were made under the emergency procedure in order to respond quickly to the serious and imminent threat to public health posed by coronavirus.
Steve Brine (Winchester) (Con)
I think the Minister knows what I am going to ask. I asked it last Monday in the general debate and her colleague, the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), chose not to respond in the wind-up, so I will ask it again: what is the rationale for including children under the age of those who have to wear masks in the rule of six? I am asking not about the fact that it is happening, but the rationale.
Helen Whately
If my hon. Friend allows me to make a little progress, I will pick up on that point during the course of what I will say.
I appreciate that these national regulations have caused real disruption to people’s lives, placing restrictions on who people can see and what they can do. However, the evidence indicated that the covid-19 infection rate was rising across the country. It was therefore vital that the Government took decisive action to limit and slow the spread, to protect public health and to reduce the likelihood of a further national lockdown of the type that was necessary earlier this year.
Madam Deputy Speaker, I am aware that you, Mr Speaker and a number of Members have raised concerns about parliamentary scrutiny. As the Secretary of State for Health and Social Care outlined to the House last week, for significant national measures with an effect on the whole of England or UK-wide, the Government will consult the House of Commons wherever possible and hold votes before such regulations come into force.
Mr Harper
I am grateful to my hon. Friend for indulging me a second time. The point of our arguing for that was insisting that Ministers had to set out their arguments and the evidence. I understand that one of the key ways of transmitting the virus is social contact, and that as the regulations have been in force for three weeks, they would lapse if this House did not debate and vote on them in the next four days, but what evidence is there that the measures are actually having an effect on reducing the rise in cases of the virus? Having looked at the data, I do not see any evidence that they are having any practical effect. We want to see action—yes—but we want the right action to be taken which will have the effect that we all wish to see.
Helen Whately
I will answer the question that my right hon. Friend asked in a moment, if he lets me continue.
As the Health Secretary set out in his statement to the House on 1 October, this virus spreads through social contact, so we are having to take difficult decisions to suppress the virus while allowing people to socialise safely. The regulations we are debating today brought previous guidance into law while tightening and simplifying it. The rule of six means that people can now gather only in groups of six both indoors and outdoors. There are exceptions to that rule for households or support bubbles that are larger than six, as well as for areas including work, schools, weddings and organised sports activities.
The regulations also gave the police the powers to enforce those legal limits, including issuing fines of £100, doubling for further breaches up to a maximum of £3,200. The vast majority of the general public will do the right things and follow the rules, but to protect public health, it is important that the police have appropriate powers to deal with those who flout the rules. As the Prime Minister announced, these measures were not a second national lockdown but are aimed at preventing the need for one.
Sir Desmond Swayne (New Forest West) (Con)
Do the police have powers of entry into a private dwelling to enforce these rules?
Helen Whately
I would not want to say anything incorrect at the Dispatch Box, so let me make sure that I get back to my right hon. Friend with a detailed answer to that question.
After a period of reducing or stabilising the transmission of the virus, we have been seeing daily case numbers rise rapidly across most parts of the country. That is why the Government chief medical officer and chief scientific adviser jointly agreed the changes that we announced. We know from the science of what has sadly happened in other countries that are experiencing a second wave that an increase in infections will lead to increases in hospitalisations and deaths until we take action.
In introducing the changes, we noted that clear and easily understood information about the virus and how it spreads was likely to increase adherence to public health advice. Although the majority of people report that they understand social distancing rules, feedback from the public and Members of this House indicate that people would value simpler messaging. That is why we have moved to the rule of six—one number for all settings—and have tightened the regulations so that they exactly reflect the guidance rather than there being one set of numbers in the guidance and another set of numbers in the legal framework. The rules were simplified and strengthened, so that they were easier to understand and so that the police could identify and disperse illegal gatherings.
We have acted to get the virus under control and, in doing that, we want in due course to be able to make changes and, clearly, to be able to lift the restrictions. My hon. Friend the Member for Winchester (Steve Brine) asked specifically about children. The position on this is, as I have said, the need for a clear steer. We needed the guidance to be simple and absolutely clear to everybody. We wanted, on the one hand, to enable a level of socialising for the sake of people’s quality of life, while on the other hand to take steps to control the virus. That is why we took the position that the rule of six achieved that balance. I appreciate that colleagues would like a different position to have been taken, but that is the position based on the—
Several hon. Members rose—
Helen Whately
At that specific moment, I was doing my very best to answer the point made by my hon. Friend the Member for Winchester. I think I should make some progress, but I am happy, of course, to come back to this point if colleagues feel that they have not had all the answers that they need.
As I was asked about this a moment ago, I wish to move on to the impact of these measures. I note that they have been in place for only just over three weeks. We know that, because of the incubation period of the virus, it takes at least a couple of weeks for us to see the measures take effect. When social distancing measures were first introduced, we saw high understanding, high awareness and lots of concern about covid and high adherence to the rules. What we have seen over time, with an easing of restrictions and perhaps lower levels of public concern, is that people’s social contacts have increased. Since the introduction of this rule, levels of socialising have begun to decrease again, including specifically socialising in larger gatherings—we know that, sometimes, larger gatherings have been a factor in some outbreaks. Clearly, we are keeping a close eye on infection rates and absolute case numbers across the country.
I will now briefly talk through some further changes that have come into effect since the regulations were made.
Mr Harper
I am grateful to the Minister for what she has said. What she seemed to be saying was that it is too soon to tell. It is very clear from the test and trace data that the primary location for infection is in people’s households and among visitors to households. Clearly, the rule of six may have an impact on visitors to households. May I ask her to make sure that the Government publish the data as they track it out each week?
The Minister also talked about compliance. The Government keep referring to how well people are complying with regulations—or not. They do not publish any data on that. Will the Government publish the compliance data to which they have access, so that we can all see the extent to which people are complying with the rules? There is no point making rules if no one is following them. That is an important matter for this House to be aware of when it is assenting to them.
Helen Whately
My right hon. Friend makes two important points. He will be aware that the Government are publishing a large amount of data and seeking to be as transparent as possible with colleagues and, clearly, with the public, and we will continue to publish what we can. I will take away his specific requests for even further publication.
Several hon. Members rose—
Helen Whately
I will just move on as I am conscious that I have taken quite a number of interventions—
Sir Graham Brady
I am very grateful to the Minister for giving way. We are three weeks in and we know that a different model is being applied in Scotland. At what point would she expect to be able to form a judgment as to whether the Scottish approach, excluding young children from the rule of six, is less effective, as effective, or more effective than that in England?
Helen Whately
I have a personal perspective, as I have a household of five and am therefore well aware that the rule of six can make socialising quite difficult for families. For instance, my own family now cannot get together either with both my parents or my husband’s parents. I very much appreciate the difficulty of this restriction, although the majority of households are slightly smaller and are not finding it as difficult as my own or other larger households. We are keeping this and all measures under review. The Government clearly do not want to introduce restrictions if we do not need to do so. What is crucial is that restrictions are effective, so we are looking at all the evidence, including where and how the virus is being transmitted—whether that is in households, in people’s own homes, through meeting up with other households or in hospitality settings—and we will continue to do so. But in answer to my hon. Friend’s question, I cannot give a date or a specific “This will be the moment at which it would happen.”
Helen Whately
I feel I have taken quite a number of interventions, so it is time that I moved on, if that is all right.
Let me talk through some further changes that have come into effect since the regulations were made. On 21 September, following the advice of the four chief medical officers, the UK’s covid alert level was raised from 3 to 4, which is the second most serious stage, meaning that transmission is high or rising exponentially. The Prime Minister outlined to Parliament on 22 September that we were at a “perilous turning point”, and needed to act to save lives, protect the NHS and the most vulnerable, and shelter the economy from far sterner and more costly measures that would inevitably become necessary.
As a result, further restrictions came into effect from 24 September. These included: rules on the closure of certain businesses selling food or drink between 10 pm and 5 am; measures to require hospitality venues to provide food and drink for consumption on the premises by table service only; the doubling of initial fines for individual breaches of the above measures; and new fines for businesses that do not adhere to the new requirements, starting at £1,000, up to a maximum of £10,000 for repeated breaches. The rules also change the exemptions to the six-person gathering limit to restrict attendance at wedding ceremonies, receptions and support groups to 15, and remove the exemption for stand-alone religious or belief-based lifecycle ceremonies and adult indoor sports apart from indoor disabled sports. We are working through the normal channels to schedule debates for these regulations as soon as possible.
I recognise that people have had to make significant sacrifices to suppress the first wave, and these restrictions are not measures that any Government would want to introduce, but the threat of the virus very much remains. With winter approaching, we must do whatever it takes to keep it under control and protect the NHS so that it can, in turn, look after us.
Helen Whately
I am sorry but I was closing my speech, not taking an intervention. That was the end of my speech. [Interruption.]
Madam Deputy Speaker (Dame Rosie Winterton)
Order. The Minister has completed her speech. She is due to come back at the end of the debate, although hon. and right hon. Members who wish to speak must bear that in mind if they wish her to speak again, because this is just a 90-minute debate.
Helen Whately
I thank all colleagues who have spoken in this debate, because I have been grateful for the thoughtful approach that many of them have taken. Just as I do in my role, Members have drawn on experiences from their own lives and of course from what they hear from constituents. The backdrop to this debate is the fact that the country is in the grip of a global pandemic. We are battling a highly infections and deadly disease, facing a challenge that this country has not faced since the second world war. As we have seen, this virus can spread through the population at an exponential rate, killing people as it goes. Only because of that have the Government brought in such restrictions to people’s lives, ones that clearly no Government would wish to bring in. The alternative—just allowing the virus to let rip—simply cannot be the right thing to do.
Mr Steve Baker
Nobody is suggesting that we let the virus rip; radical as I may be, I cited some supportive passages in my remarks. The Minister says that the virus is deadly. We all accept it is deadly for people who have prior risk factors, which raise the infection fatality rate, but is it not the truth that for a great many people who are younger and without prior conditions this is not an especially deadly disease? We knew that at the beginning; we know it today. It is deadly for a certain section of our society, and it is them we are looking after. Can we please be honest about that?
Helen Whately
I appreciate that my hon. Friend did not take the “let rip” position, but some have done so. The majority of those who have spoken this evening have absolutely supported the fact that we need to have restrictions in place, which is good to hear.
Helen Whately
May I just finish responding to my the point made by my hon. Friend the Member for Wycombe (Mr Baker)? He says that for the vast majority this is a mild illness and that the deaths have particularly been among those with underlying health conditions. It is true to say that the majority of those who have died were older and with underlying health conditions, but, sadly, some have died who did not have known underlying health conditions and were younger. I well remember reading about a nurse not far from my constituency, in Kent, who had three young children and was only slightly younger than me but who died early in the pandemic. So it is not true to say that this affects only older and unwell people, although we should also mourn the older people whose lives have been taken before their time, many of whom were in receipt of care.
The other point is that among those who have had mild illness we are seeing increasing evidence of the condition known as “long covid”, where, sadly, there are long-term health consequences of covid. We are learning about those all the time; they are making it materially difficult for people to lead their lives some weeks and even months after they had the illness, even if they had it mildly in the first place.
Several hon. Members rose—
Helen Whately
I will make progress, as colleagues made a large number of points during their speeches that I am keen to respond to. I will take further interventions if there is time.
Mr Harper
I just wanted to challenge the Minister on this let it rip point, as the Secretary of State has done that as well. I ask the Minister to take it from me that we all want the Government to be successful, but if every time somebody asks a question or posits a different strategy, we are accused of wanting to “let it rip” and kill tens of thousands of people, this debate will not remain good tempered. Please accept that we are all trying to get this right. We are all willing to be generous, because, as the hon. Member for Westmorland and Lonsdale (Tim Farron) said, this is difficult, but I ask the Minister please not to say that Members of this House who suggest a different strategy in order to be successful want to let the disease rip and kills tens of thousands of people. We do not, and we will not be pleased if that is what we are accused of doing.
Helen Whately
I absolutely hear my right hon. Friend’s point. I reiterate the response that I just gave, which is that I very much appreciate the support of colleagues in general for taking action to suppress the virus, and I think it is extremely valuable for us to be debating some of the measures, as we are this evening.
Helen Whately
If my hon. Friend would allow me, I would like to make a little bit of progress, otherwise I will have remarkably little time left.
We have a clear strategy, which is to control and suppress the virus while doing all we can to protect the economy, people’s work, schools and the NHS, so that it, in turn, can care for us.
Let me turn to some of the points made by hon. Members. Various reasons have been suggested for the rapid introduction of the regulations. In fact, the shadow Minister made some suggestions. The Government have had to act fast. When we see the rates of increase—particularly when we take away the average across the country, and look at specific areas and parts of the population where the doubling rate can be going up really quickly—it is clear that we need to act fast. The alternative is to act slowly—and if we did that for several days, it would be inaction. That just means that the virus would be left to spread further and faster.
Colleagues have asked for further information about the impact and effectiveness of measures. I get the sense that some Members would like to hear, “If you do x, you get y,” in a very mathematical way. We are dealing with a new disease that simply is not known to the level of “A leads to B exactly.” We look at a huge amount of evidence, including at what is happening overseas, the difference made by local lockdowns and evidence from the test and trace system. All that evidence informs the decisions that are made. We know that social contact is a particular cause of the spread, so we must reduce social contact.
Helen Whately
I am really sorry, but I have so little time.
We have seen reduced levels of socialising since introducing the rule of six, but that is against a backdrop of rates rising in particular parts of the country, which are now under further restrictions. We will continue to look at the evidence and ensure that we are putting in place effective interventions.
The measures that we are debating today are clearly coupled with the vital rules such as hands, face and space. We all have our part to play. We will continue to assess the effectiveness of the measures, but we need restrictions in place until covid rates come down.
Helen Whately
I have only three minutes left, so I am keen to cover a few more points that have been made in the debate.
Colleagues have spoken about children and the rule of six. As I have said, I am acutely mindful of this point as I have a family of five. I am well aware that Wales and Scotland, where health is devolved, have made their own decisions, including a slightly different decision on this issue. Of course, we will learn from the other parts of the United Kingdom. There are regular conversations between the devolved authorities and the UK Government.
On the matter of extended families and larger households, there is an exemption for larger households—clearly, they can gather—but in some areas there has been a particularly rapid spread when larger households of extended families come together. That can be a particular source of the spread, so it is much harder for larger households wanting to socialise. This is a difficult balance to strike, but we want to ensure that we are suppressing the virus because it is such a cruel thing.
Let me turn to policing. The police approach is one of engage, explain, encourage and enforce. I can confirm that they do not have power of entry, but my understanding of the feedback that we have received from the police is that they feel that they do not need further powers to enforce these measures.
I would like to reiterate the Government’s commitment to working with Parliament and to debating regulations such as these and others. I should say that we absolutely recognise the impact of these restrictions on people’s lives, and that it is with great reluctance that we bring them in. None the less, as I have said, the alternative is not suppressing the rate of the virus, and, as I have mentioned, it is not always a mild illness. We are seeing cases of long covid. There is also a health impact on our hospitals: if they become too full treating people with covid, they will struggle to treat people with other illnesses. That has its own health implications, and cannot be the right strategy. The strategy has to be to control this virus and to suppress it with the rule of six and all the other things that we as individuals can do, including our own compliance with the social distancing measures. We must take this approach, and I thank everybody for all that they are doing. I know that the public face the implications of these restrictions day in, day out, as we do ourselves, but we must do it, because it is the way that we get back to normal as soon as possible.
Question put.
Adult Social Care Winter Plan
Helen Whately Excerpts(3 years, 7 months ago)
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The Minister for Care (Helen Whately)
I would like to update the House on the Government comprehensive adult social care covid-19 strategy and its publication of the “Adult Social Care Winter Plan”. A copy of the plan will be deposited in the Libraries of both Houses. The coronavirus pandemic has created unprecedented challenges in the United Kingdom and around the world.
This has resulted in an equally unprecedented, but not unexpected, response from the social care sector and its dedicated workforce of 1.5 million people, who alongside the 5.4 million plus women, men and young people who provide unpaid care, have made an invaluable contribution to the national effort and our gratitude to them all is immense.
Together, they have been working tirelessly to support people who need care, especially those who are older or already living with underlying health conditions making them more vulnerable to infection.
Alongside extensive efforts at local level, national Government have provided enhanced support to the sector, working with and through local leaders. This support was set out in the “Adult Social Care Action Plan” and “Care Home Support Plan”. It included £3.7 billion of emergency grant funding to local authorities to address the pressures on local services caused by the pandemic and a £600 million infection control fund to support providers to reduce the rate of transmission of covid-19.
Meanwhile, the adult social care covid-19 support taskforce, set up and chaired by David Pearson—social care covid-19 lead for the NHS and past president of the Association of Directors of Adult Social Services—formed part of the Government overall commitment to the sector.
It would be wise to assume that coronavirus, in addition to anticipated service demand, will place unique pressures on the health and care system this winter. Covid-19 will be co-circulating with seasonal flu and other viruses, and transmission may well increase over the winter period.
It is therefore essential that we—national Government and local partners—work closely together to make sure we are prepared for these additional pressures, particularly a resurgence of covid-19 cases. We must have robust plans in place to respond to challenging events and protect people who need care and the workforce supporting them.
The adult social care covid-19 support taskforce concluded at the end of August, and its recommendations have shaped our approach to tackling covid-19 in the adult social care sector and, in particular, the plans we have put in place for winter.
As we approach these colder months, the Government will play a key role in driving and supporting improved performance of the system, working with local authorities and the CQC to strengthen their monitoring and regulation role to ensure infection prevention and control procedures are taking place. The key elements of our plan for social care this winter are:
Providing an additional £546 million infection control fund to support infection control measures.
Continuing to engage with local authorities, care providers, people with care and support needs, and their families and carers to understand their needs and provide support.
Leading and co-ordinating the national response to covid-19 and providing support to local areas as set out in the contain framework.
Continuing to develop and publish guidance which is relevant and accessible, and update policies and guidance in line with the latest evidence. We will work to proactively communicate vital updates to our winter plan and other guidance.
Working relentlessly to ensure sufficient testing capacity and continuing to deliver and review the social care testing strategy in line with the latest evidence and scientific advice. We will also improve the flow of testing data to everyone who needs it.
Providing free PPE for covid-19 needs in line with current guidance to care home and domiciliary care providers via the PPE portal until March 2021.
Providing free PPE—for covid-19 needs—in line with current guidance to local resilience forums (LRFs) who wish to continue PPE distribution, and to local authorities in other areas, to distribute to social care providers ineligible for supply via the PPE portal until March 2021.
Making the flu vaccine available for free to all health and care staff, personal assistants, and unpaid carers.
Introducing tightened measures around visiting. We recognise that visits are important for the wellbeing of residents and loved ones, but with higher rates of covid-19 in the community, extra precautions will be needed. We have set these out in revised guidance. Infection control is paramount and in designated “areas of intervention” visiting will be stopped except in exceptional circumstances, such as end-of-life.
Stopping all but essential movement of staff between care settings to stop the virus spreading. We know that the majority of care homes have already done this—now we are taking this restriction further and will enforce this through regulation.
Working with the CQC to ensure that all places that receive people discharged from hospital are safe and have the highest levels of infection control measures in place.
Supporting providers to ensure that staff who are isolating in line with Government guidance receive their normal wages while doing do.
Publishing the new “Adult Social Care Dashboard”, bringing together data from the capacity tracker and other sources, meaning that critical data can be viewed in real time at national, regional and local level by national and local government.
Publishing information about effective local and regional protocols and operational procedures based on what we have learnt from so far, to support local outbreaks in the event of increased community transmission.
This does not diminish the need for a long-term plan for social care. Putting social care on a sustainable footing, where everyone is treated with dignity and respect, is one of the biggest challenges our society faces.
There are complex questions to address, to which we want to give our full consideration in light of current circumstances.
Successive Governments have failed to “fix” social care, but this Government have been clear that this must change. Right now, the Government No. 1 focus for adult social care is for everyone to receive the care they need throughout this pandemic.
This crisis, awful though it has been and continues to be, for so many people, may yet be the catalyst for a new kind of social care; services that reflect, adapt and future proof the health and wellbeing of all of us—now and for many generations to come.
[HCWS458]
Axial Spondyloarthritis
Helen Whately Excerpts(3 years, 7 months ago)
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The Minister for Care (Helen Whately)
I congratulate my hon. Friend the Member for Gedling (Tom Randall) on securing this debate and on bringing the House’s attention to the need for earlier diagnosis of axial spondyloarthritis. May I say how important it is that he has brought his personal experience to the debate? The House should appreciate the courage he has shown to speak up about his own condition—something that cannot be easy, but that is an example. I feel strongly that all of us bring our own experiences to our work. That is one of the reasons it is important to have a diverse House of Commons. He has brought his own extremely painful experience to bear. I am confident that simply by doing so, he will make a difference for many others who suffer from this painful condition or who may do so in the future.
My hon. Friend rightly highlighted how critical it is for those with axial spondyloarthritis to get the right diagnosis and get it quickly, and to have their symptoms taken seriously by all healthcare professionals. It is clearly incredibly important to ensure that people can access the right sort of care at the right time, as it can prevent the potentially devastating impact of the condition on quality of life. I very much appreciate from his account and from others I have read how the condition affects people and their loved ones. We must do all we can to reduce the impact on people’s physical and mental health, and I want to do so.
As my hon. Friend said, axial spondyloarthritis, which may also be referred to as axial SpA or AS, is a form of inflammatory arthritis that most commonly affects the spine. It is a painful long-term condition that currently has no cure. As well as affecting the joints in the spine, it can affect the chest, the pelvis and other joints, ligaments and tendons. Unfortunately, AS is often misdiagnosed as mechanical lower back pain or diagnosed late, leading to delays in access to effective treatments. It is estimated that approximately 220,000 people, or one in 200 of the adult population in the UK, have the condition.
As my hon. Friend said, the average age of onset is relatively young at 24, with patients having to wait on average eight and a half years before diagnosis at an average age of 32. That is clearly far too long to be waiting for a diagnosis, because left untreated the condition can lead to irreversible spinal fusion, causing severe disability. That makes a rapid referral to specialist care for those with any signs or symptoms crucial to treatment and to preventing those kinds of outcomes.
I recognise that AS can have a devastating effect on the quality of life of people who sadly go undiagnosed or misdiagnosed for far too long. This must get better. It is clear to me that early diagnosis and treatment are the key to preventing the development of other serious conditions further down the line and to improving the quality of life of those who suffer from this condition.
We recognise that one major reason for the delays in diagnosing axial SpA is a lack of awareness of the condition among healthcare professionals and the general public. That can take many forms: a lack of awareness of different types of arthritis; a lack of knowledge about the differences between inflammatory and mechanical back pain; or misunderstanding that AS affects similar numbers of men and women. Educational interventions to improve the level of awareness should lead to improvements in earlier diagnosis, and a range of materials are being produced to this effect. For example, an online training module on AS for GPs has been produced by the Royal College of General Practitioners.
In June this year, the National Institute for Health and Clinical Excellence published its managing spondyloarthritis in adults pathway, which has been well received by patient groups and charities. This set out recommendations for healthcare professionals in diagnosing and managing axial SpA in adults. It describes how to improve the quality of care being provided or commissioned in this area, both through guidance and via an associated quality standard. I completely agree that we would expect providers and commissioners to be following the guidance and recommendations in this area so that we can improve the overall rate of earlier diagnosis. It is not only important that we have this guidance but that it will be within the pathway that the APPG and my hon. Friend have argued should be put into place in practice.
Munira Wilson
While I welcome the guidance and the pathway, what does the Minister suggest can be done to tackle the clinical conservatism that we quite often find among specialists even once the diagnosis is made? In my husband’s case, the rheumatologists said to him, “You are far too young for us to move you on to the more advanced treatments”, so he was living with huge amounts of pain on just very mild painkillers and steroids. It was only because we happen to live in London that we got him re-referred to a world-leading specialist in the field who then put him on anti-TNFs. He is now able to be the primary carer of our two very young, active children, which he could not do otherwise. Not everybody has that luxury, especially if they live in a rural area.
Helen Whately
The hon. Member makes a really important point, again drawing from her own personal and family experience, about the importance of awareness of what is the best treatment for this condition. If she would like me to do so, I am happy to take away her specific point and look into how we can address the need for improvement in the treatment, as well as her general point about needing a better pathway. I am also happy to meet my hon. Friend the Member for Gedling, as he requested, to talk further about how we can make more progress on the right treatment for this condition, and awareness of it.
Coming back to the overall points about what we can do to improve the treatment, the NHS long-term plan set out our plans to improve healthcare for people with long-term conditions, including axial SpA. That includes making sure that everybody should have direct access to a musculoskeletal first-contact practitioner, expanding the number of physiotherapists working in primary care networks, and improving diagnosis by enabling people to access these services without first needing a GP referral—in fact, going directly to speak to somebody with particular expertise in the area of musculoskeletal conditions. The hon. Member for York Central (Rachael Maskell) intervened to make a point about the demands on physiotherapists. I have asked to be kept updated on progress on delivering the expansion of the number of physiotherapists in primary care networks and, more broadly, on the implementation of the NHS long-term plan. We do indeed need to make sure that we have sufficient physiotherapists to be able to deliver on that. I anticipate that that should have a positive impact on the problem of delayed diagnosis for a range of conditions, and particularly for this specific condition.
While better education and awareness of AS should improve the situation, there is clearly more that we can and must do to understand the condition. The National Institute for Health Research is funding a wide range of studies on musculoskeletal conditions, including AS specifically. That research covers both earlier diagnosis and treatment options for the condition, so that we continue to build our understanding of good practice and improve both the treatment and the outcomes for those who have the condition.
In conclusion, I want to pick up on my hon. Friend’s point about the importance of awareness and the call for an awareness campaign by the APPG, and I should of course commend the National Axial Spondyloarthritis Society for its work in this area. My hon. Friend mentioned that there is clearly a huge amount of public health messaging going out at the moment, but I hope the time will come when we can gain more airtime for this particular condition. However, the fact that we are having this conversation in the Chamber is in itself a step towards raising awareness of the condition, and so, too, is all the work that is going on; that is important as well, because along with having the policy and the pathway, we must make sure it is put into practice.
I congratulate my hon. Friend again on bringing this subject to the attention of the House and on the work he is doing and the effect that this will have. I truly want to support him and to do our best for all who suffer from this condition and may suffer from it in future, to ensure that we achieve much earlier diagnosis and treatment and better outcomes for those with the condition.
Madam Deputy Speaker (Dame Eleanor Laing)
I commend the hon. Member for Gedling (Tom Randall) on his courage in bringing such a personal and difficult matter before the House. Many people will not appreciate that that is a difficult thing to do, and I am sure that he will have made a difference to many by what he has done today. [Hon. Members: “Hear, hear.”] I am pleased that those in the Chamber are in agreement.
Question put and agreed to.
HEALTH PROTECTION (CORONAVIRUS, RESTRICTIONS) (NO. 2) (ENGLAND) (AMENDMENT) (NO. 2) REGULATIONS 2020
Helen Whately Excerpts(3 years, 7 months ago)
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The Minister for Care (Helen Whately)
I beg to move,
That the Committee has considered the Health Protection (Coronavirus, Restrictions) (No. 2) (England) (Amendment) (No. 2) Regulations 2020 (S.I. 2020, No.788).
It is a pleasure to serve under your chairmanship, Ms Fovargue. I will start by summarising the changes to the regulations. The Health Protection (Coronavirus, Restrictions) (No.2) (England) Regulations 2020, which I will refer to as the national regulations, came into force on 4 July. There have been five changes to the national regulations, the first of which was debated in and approved by both Houses before recess. The focus of this debate is the second amendment to the regulations.
These amendments permitted from 25 July the reopening of the following businesses and venues: indoor swimming pools, including water parks; indoor fitness and dance studios; and indoor gyms, sports courts and facilities. Alongside those changes, the Government produced supporting guidance advising that the most high-risk activities within those businesses and venues, such as saunas and steam rooms, should not reopen. Those easings did not apply to the city of Leicester boundaries and the borough of Oadby and Wigston.
We have needed to use the emergency power to amend these regulations so that we can respond quickly to the serious and imminent threat to public health posed by coronavirus. I know that these national regulations have caused real disruption to people’s lives. They have placed restrictions on who people can see, what they can do and where they can work. Just as the Secretary of State has the legal obligation to protect public health, he is also obligated to ease restrictions as soon as it is safe to do so.
The first three changes to the regulations opened businesses and venues that had been required to close, and covid-secure guidance was developed with industry and medical advice to ensure that they opened safely. That means that now only nightclubs, dancehalls, discotheques, sexual entertainment venues and hostess bars are required to remain closed, as they are considered to pose a high risk of transmission because of the close proximity of members of staff and customers. That shows the Government’s commitment to ensuring that restrictions are in place only as long as necessary, and an evolution in our understanding and approach to tackling the virus.
Over the summer recess, we have combined the tightening of restrictions in areas where there are outbreaks with the easing of business restrictions nationally. We have given local authorities powers to act quickly in response to local outbreaks by closing specific premises, shutting public outdoor spaces and cancelling events. We asked all councils to develop dedicated local outbreak plans, and we gave them £300 million of new funding to support that. We published the contain framework, providing further guidance on managing local outbreaks.
Where regulations have been required, the Government have worked with local partners to develop tailored and proportionate restrictions based on the best scientific evidence available, in areas varying from a single factory to an entire region, such as the north of England. These interventions have been underpinned by scientific advice and local data provided by a combination of Public Heath England, the Joint Biosecurity Centre and NHS Test and Trace.
Colleagues will have seen that today the rule of six comes into effect. This change brought the gathering policy from guidance into regulation, mandating that people can only gather in groups of six, and it applies both indoors and outdoors. Single households or support bubbles of more than six are still able to gather together, and there are a small number of exemptions, such as for work, schools, weddings and organised sports activities. People should continue to follow social distancing rules with those outside their household or support bubble. As the Prime Minister announced last week, these measures are not a second national lockdown but are aimed at preventing the need for one.
It is thanks to the public and their continued effort that we have been able to slow the spread of the virus and have started cautiously to return to life as normal. Now, with winter approaching and covid rates rising again, we must keep doing whatever it takes to keep it under control, guided by our ever-increasing knowledge of how covid is spreading and what interventions are effective.
I am grateful to colleagues from across the House for their valuable contributions to these debates and for continuing to challenge us to do better in this vital area of public policy. I believe that we have met the bar set for us. These regulations are a proportionate and necessary use of the powers that Parliament has asked us to use, and I commend them to the Committee.
Helen Whately
I thank the hon. Member for Ellesmere Port and Neston for his response, some of which, as he mentioned, he has said before. I will address his comments head-on.
The hon. Gentleman said that he would like us to have debated these regulations sooner, and we absolutely recognise that timely scrutiny is important. There is substantial scrutiny of the Government’s decisions. For instance, there have been multiple oral statements, and numerous urgent questions have been responded to by Government Ministers. There is a great deal of challenge to decisions that are made.
However, throughout the pandemic and up to the present, we continue to need to act rapidly. We need to take rapid decisions to make restrictions to people’s normal way of living, unfortunately, when we see growing risks of the spread of the disease. We also want to be able to take rapid decisions to reduce those restrictions, recognising the difficulties that they cause for people going about their lives, whether in their family relationships, social relationships or livelihoods.
The hon. Gentleman has said that we are now at a different time, and things are different now. Yes, we have done a huge amount to bring the virus under control since the peak in the spring, and we now have a vast quantity of testing relative to the amount we had earlier on, although I fully recognise that its capacity is challenged at the moment because of the great deal of demand for it. However, we are continuing to learn all the time from the greater data we now have about how people are catching the virus—how it is spreading, but also how it is not spreading—so it is still the case that we need to be able to move quickly.
The hon. Gentleman asked about the scientific context for this, and whether because time has moved on, these easements are still the right thing to do. The restrictions are continuously reviewed, looking at what new restrictions may be appropriate and what easements might need to be introduced. As he has acknowledged, in some areas where there have been local outbreaks, restrictions have either not been lifted or have been reintroduced. We are able to do that because, thanks to the operation of Test and Trace and the Joint Biosecurity Centre, we have much more data about how the virus is spreading. For instance, we know that the virus is largely spreading through people’s social interactions. For the most part, it is not spreading in workplaces, and the risk for children in schools is very low, but we have a particular challenge with social contact. Therefore, we are, in general, able to maintain the easements that have been brought in, but are introducing the rule of six today to limit the social contact through which covid is spreading.
In some areas of the country where there are greater rates of covid, there are greater restrictions on household gatherings and even on the rule of six, because we have evidence that in some places, it is particularly spreading through households mingling in a home setting. The whole point is that having greater data and scientific insight, and following scientific advice, means that the restrictions we now have in place can be more tightly targeted, and can avoid restricting people’s lives in ways that are not essential while targeting the ways in which we know the virus is being spread. I assure the hon. Gentleman that we will continue to review the situation, including whether we need to impose further restrictions. Clearly, that would be done with great reluctance, but we cannot get to a situation that is the same as the one we were in earlier in the year. We must continue to be vigilant.
Justin Madders
I am grateful to the Minister for explaining in a little more detail some of the work that is taking place to understand how the virus is spreading. Is it the case that the relaxations we have talked about today are not contributing to an increase in transmission?
Helen Whately
As I said, the work that is carried out by the Joint Biosecurity Centre, drawing on the information from NHS Test and Trace and other sources of data, looks at the main sources of spread. We know that the main source of spread is through social contact, rather than in more controlled settings. In business settings, we are seeing, for the most part, businesses taking great care to ensure their setting is covid secure, for which they should be commended.
I feel that this is the moment to bring the debate to a conclusion, and I commend the regulations to the Committee.
Question put and agreed to.
Oral Answers to Questions
Helen Whately Excerpts(3 years, 7 months ago)
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Patrick Grady (Glasgow North) (SNP)
The Minister for Care (Helen Whately)
We recognise that there will be increased pressures on the NHS and social care during winter, and substantial preparations have been and are being made. The NHS has already published its winter plan, and we will shortly publish the winter plan for social care.
Patrick Grady
That is exactly why there is a need for significant additional funding to prepare for a surge this winter, and that has to include a fully funded pay rise for health and care staff. At the height of the crisis, the Secretary of State was saying, “Now is not the time to consider a pay rise.” When will the time be? Is it now or some time in the future?
Helen Whately
As I expect the hon. Gentleman knows, we have announced £3 billion of additional NHS funding for the winter and are continually looking at additional funding needs for social care.
Dr Rosena Allin-Khan (Tooting) (Lab)
There is a looming mental health crisis this winter, and as such it is vital to meet with experts. I know the Secretary of State believes that that is important, so I asked him several parliamentary questions wanting to know how many mental health trusts and organisations he had met during the first three months of lockdown. I was told that he “holds these meetings regularly”, but a freedom of information request revealed that he and the Mental Health Minister organised only two meetings with mental health trusts and organisations during that entire period. Can the Secretary of State confirm that he did not attend either of those two meetings? Does he think that is an acceptable track record?
Helen Whately
The Secretary of State has regular meetings with stakeholders about the future of mental health.
Sir David Amess (Southend West) (Con)
The Minister for Care (Helen Whately)
We know that those who receive social care are among the most vulnerable in our society. The Department of Health and Social Care has strived to support the sector throughout this pandemic, providing it with a sense of guidance, extra funding, and emergency supplies of personal protective equipment, and prioritising access to testing.
Mark Menzies
May I express my very sincere thanks for all the help that social care services have provided throughout this ongoing crisis, but can the Minister assure me that we have learned all the lessons from the shielding programme and that the social care sector is adequately prepared for the coming winter months?
Helen Whately
I join my hon. Friend in thanking all those who work in social care for their commitment and compassion since the start of the pandemic. We have indeed carried out work to understand the impact of shielding on people’s health and we will shortly be publishing our winter plan for adult social care, setting out our preparations for the winter and in the event of a second wave.
John Howell
Can my hon. Friend confirm that every care home in England has either received a coronavirus test or is about to receive one?
Helen Whately
Yes, I can confirm that. Every Care Quality Commission-registered care home in England has been offered testing. Care homes for those who are over 65 and with dementia have been offered repeat testing. We have now opened up repeat testing to care homes for working age adults.
Liz Kendall (Leicester West) (Lab)
Following on from that question, Ministers initially promised weekly testing for care home staff by 6 July. They then abandoned that pledge and said that routine tests would not happen until 7 September. With more than 15,000 deaths from covid-19 in care homes so far and with winter and the flu season fast approaching, regular weekly testing of care home staff is critical. Will the Minister now guarantee that every care home will have weekly testing for their staff by Monday to help all of our loved ones in residential care keep safe?
Helen Whately
We are indeed determined to support social care, and particularly the care homes, with repeat, regular testing. As the hon. Member knows, because we have spoken about it, there has been a delay with our repeat testing of care homes because of a particular issue with some of the test kits. That was communicated to her and to the sector. As I said in my previous answer, we have now been able to offer repeat testing to all care homes for older people, to open up the portal to those care homes with working age adults as residents, and to initiate our second round of repeat testing for the older sector.
Martin Vickers (Cleethorpes) (Con)
Angela Richardson (Guildford) (Con)
The Minister for Care (Helen Whately)
We will deliver 50,000 more nurses for our NHS. We are increasing the number of student nursing places on degree courses and improving the experience of working in the NHS so fewer nurses leave, and we will also add to our home-grown nurses through international recruitment. I am happy to report that we now have 13,840 more nurses in the NHS than a year ago.
Mrs Wheeler
I thank my hon. Friend for her answer. Does she agree that the changes made by Project 2000 in 1986 led to a large group of caring people being excluded from training to be nurses? If we are to recruit many more nurses, this approach should be rethought, with recruits once again being able to learn on the job, as they did prior to 1986. This would bring nurses’ education much more in line with the Government’s recognition that university is not for all children and fulfil our objective to have apprenticeships in all walks of life.
Helen Whately
My hon. Friend makes an extremely good point. We want all those with the capability and aspiration to become nurses to be able to do so. That is why we are supporting multiple routes to becoming a nurse. While the majority of new nurses take the university route, another option is the degree apprenticeship, which enables students to earn while they learn. Last month, we announced a £172 million funding package to double the number of nursing apprenticeships.
Angela Richardson
I am delighted to hear that we are successfully recruiting into the nursing profession. Does my hon. Friend agree that it is not just school leavers, but dedicated and caring people of all ages and diverse working backgrounds who have the transferable skills needed to start nursing qualifications? Will she outline what steps her Department is taking to engage with these individuals and encourage them to consider nursing as a vocation?
Helen Whately
I completely agree that nursing should be open to all men and women from diverse backgrounds. Our £5,000 grant to all nursing degree students, starting this autumn, will help students with the cost of that degree course. In addition to the apprenticeships route that I just mentioned, in January we are launching an online blended nursing degree to give another route into nursing.
Jim Shannon (Strangford) (DUP)
NHS Pay Review Body: Government Response
Helen Whately Excerpts(3 years, 9 months ago)
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The Minister for Care (Helen Whately)
I am responding on behalf of my right hon. Friend the Prime Minister to the 33rd report of the NHS Pay Review Body (NHSPRB). The report has been laid before Parliament today (Cm260). Copies of the report are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
As this is the third and final year of the three-year Agenda for Change pay and contract reform deal (2018-19 to 2020-21), the NHSPRB did not make any pay recommendations for 2020-21.
This multi-year deal has delivered year-on-year pay increases for our much valued NHS staff, and as part of this we have increased the starting salary for a newly qualified nurse by over 12% and increased the lowest starting salary within the NHS by over 16%.
The Government welcome the 33rd report of the NHSPRB and are grateful to the chair and members for all their work and helpful observations at what is a challenging time for our NHS. The report rightly recognises the hard work and dedication of our NHS staff in responding to the covid-19 pandemic, and makes helpful observations on effective workforce planning and how best to support the development of the NHS workforce.
The upcoming People Plan will seek to address many of the observations made by the NHSPRB, and the Government remain committed to delivering on their manifesto commitment to deliver 50,000 more nurses in the NHS by 2025.
[HCWS409]
Doctors and Dentists Remuneration Body: Government Response
Helen Whately Excerpts(3 years, 9 months ago)
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The Minister for Care (Helen Whately)
I am responding on behalf of my right hon. Friend the Prime Minister to the 48th report of the Review Body on Doctors’ and Dentists’ Renumeration (DDRB). The report has been laid before Parliament today (Cm259). I am grateful to the chair and members of the DDRB for their report.
This report has been produced during what is an incredibly challenging time for our NHS and the DDRB report rightly recognises the tremendous effort of all of our clinical staff on the frontline of the covid-19 response. They have shown true resolve, professionalism and dedication throughout this challenging time for our NHS.
Thanks to the Government’s investment in the NHS and the certainty provided in the long-term funding settlement, the Government are pleased to accept the DDRB’s recommendations in full, providing a much deserved pay rise for our doctors and dentists working across the NHS.
The Government greatly value and appreciate the role public sector workers have in delivering essential public services, and we are delivering a real-terms pay increase to show that we mean it. The hard work and dedication of our public servants are something we do not take for granted.
We are conscious that public sector pay awards must deliver value for money for the taxpayer. Covid-19 is having a very significant impact on the economy and the fiscal position, and the Government will need to continue to take this into account in agreeing public sector pay awards. It is important that public sector pay is fair to both public sector workers and the taxpayer. Around a quarter of all public spending is spent on pay and we need to ensure that our public services remain affordable for the future.
Today’s pay award is worth on basic pay:
Between £2,200 and £3,000 for consultants
Between £1,100 and £2,100 for specialty doctors
Between £1,500 and £2,600 for associate specialists
This Government have invested heavily in our NHS and its workforce. We have backed the NHS by passing the NHS Funding Act which enshrines in law the largest cash settlement in NHS history as well as clearing billions of pounds worth of debt for NHS trusts. We also pledged that all public services would get whatever financial support they needed to deal with the covid-19 pandemic and we are working at pace to ensure the supply of vital funding and resources continues. We have also delivered on a manifesto commitment to address the tax issue in doctors’ pensions by listening closely to the concerns of senior clinicians. The Chancellor confirmed at Budget that both annual allowance taper thresholds will be increased by £90,000 from 6 April 2020, removing anyone with income below £200,000 from the scope of the tapered annual allowance. The incentive to take on extra NHS work is now restored, and clinicians can earn an additional £90,000 before reaching the new taper threshold. These measures will take up to 96% of GPs and 98% of NHS consultants outside the scope of the taper based on their NHS income.
The DDRB was asked not to make a pay recommendation for contractor general medical practitioners (GMPs) or doctors and dentists in training as both groups are moving into the second year of their respective multi-year deals. The significant investment in GMP core practice funding, as part of the five-year contract, provided greater certainty for GMPs to forward plan. The contract as agreed in 2019, and via further amendments in 2020, has also set out significant additional investment in a new state-backed indemnity scheme, the introduction of primary care networks and reimbursement for additional staff. For doctors and dentists in training the multi-year deal will mean all junior doctor pay scales will have increased by 8.2% by the end of the deal, and in addition circa £90 million is being invested to reform the contract, including to create a new, higher pay point to recognise the most experienced doctors in training.
Affordability has to be a consideration of Government when responding to the DDRB. Accepting the DDRB’s recommendations will require difficult trade-offs and reprioritisation of spending within the wider context of the original financial plan set out in the NHS long-term plan. However, the Government deem accepting the DDRB’s recommendations as important to reward and retain valued NHS staff.
In addition to retaining existing staff, the Government are committed to increasing workforce supply. That is why by September this year we will have opened five new medical schools in England so that we can continue to grow our domestic medical workforce. The new schools will help to deliver a 25% increase in the number of available places and by September we expect there will be an extra 1,500 medical students entering training each year, compared to 2017.
The Government’s response to the recommendations is as follows:
Accept the recommendation for a uniform 2.8% uplift in pay across the whole of the DDRB’s remit group with the exception of those already in multi-year deals. This includes uplifting the value of the GMP trainers grant, the GMP appraisers’ grant and the minimum and maximum of the pay range for salaried GMPs.
To accept the recommendation to freeze the value of national and local clinical excellence awards (CEAs), commitment awards, distinction awards and discretionary points.
Salaried GMPs
For salaried GMPs the minimum and maximum pay range will be uplifted. As self-employed contractors, it is largely up to GP practices how they distribute pay to their employees. Employers have the flexibility to offer enhanced terms and conditions—for example, to aid recruitment and retention.
Specialty doctors (new grade 2008) and associate specialists (closed grade)
For specialty doctors and associate specialists (SAS doctors) the Government take note of the DDRB’s comments on the need for improved recognition and career development. Negotiations on a multi-year pay agreement, incorporating contract reform, for this group of doctors are progressing and we hope to reach agreement in time for the next pay year.
Clinical excellence awards
The Government also acknowledge the DDRB’s comments on clinical excellence awards and its reasons for not recommending an increase in their value. With this in mind, we will progress our plans to reform these awards with a view to introducing new arrangements from 2022.
General dental practitioners
A 2.8% general uplift in the pay element of their contract backdated to April 2020.
The Government have also fully acknowledged the DDRB’s comments on the lack of progress on the dental contract reform and we appreciate the frustration with the pace of reform. NHS England and the Department of Health and Social Care need to be confident that the prototype contract, which has been tested, has proven that it has the ability to maintain or increase access, improve oral health, and is affordable for the NHS while also being sustainable for dental practices, before taking decisions on wider national implementation.
[HCWS407]
Health Protection (Coronavirus, Restrictions) (No. 2) (England) (Amendment) Regulations 2020
Helen Whately Excerpts(3 years, 9 months ago)
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The Minister for Care (Helen Whately)
I beg to move,
That the Committee has considered the Health Protection (Coronavirus, Restrictions) (No. 2) (England) (Amendment) Regulations 2020 (S.I., 2020, No.719).
It is a pleasure to serve under your chairmanship, Ms Elliott.
The regulations were made by the Secretary of State for Health and Social Care on 9 July and came into force on 11 and 13 July. I thank the House for being so flexible in scheduling this debate to allow for timely parliamentary scrutiny. I note that, because of that flexibility, we are debating this statutory instrument before it has been formally cleared by the Joint Committee on Statutory Instruments.
Thanks to an immense national effort to slow the spread of the virus, we have been able to restore some of the freedoms that are cherished by us all. The regulations made on 3 July allow us to do that. They were debated on 16 July, and they committed several sectors to reopen, including hospitality and leisure. They also require some businesses to remain closed, owing to increased transmission risk from covid. However, we continue to ease remaining restrictions as the Government work with the relevant sectors to develop covid-safe practices.
As set out in the Health Secretary’s statement to the House on 16 July, we are moving from blanket national measures to targeted local measures, supported by our NHS test and trace system. Those measures may be implemented on a small scale, such as relating to an individual farm or a factory, but when needed, we may also act on a broader basis, as we did in Leicester. To allow that shift from national to local action, we have provided local authorities with new powers to enable those authorities to put in place local restrictions on individual premises, organised events and access to defined outdoor public spaces under the regulations that came into effect on Saturday. That includes the ability to require premises, events or public spaces to close.
The amendments we are debating allow outdoor facilities at water parks and outdoor swimming pools to reopen from 11 July, and allow the following close-contact services to open from 13 July: nail bars, tanning booths and salons, massage parlours, tattoo parlours, body and skin piercing services, and spas and beauty salons. Guidance has been published for those sectors, outlining how they may open safely. For example, they set out that face treatments should not be offered, although those will be allowed from 1 August, and that indoor pools and gyms within a spa should not open.
Along with the changes to regulations, guidance has been issued on how organised outdoor grassroots team sports and participation events may begin again, and how outdoor performances with an audience may take place. This is an important milestone for our performing artists, who have been waiting patiently in the wings since March.
As the Committee is aware, we have announced plans for future changes. The Secretary of State for Digital, Culture, Media and Sport announced that we plan for fitness and dance studios, indoor gyms and sports venue facilities, and indoor swimming pools and water parks to be able to open from 25 July. People will be able to get back to their gyms, indoor swimming pools and leisure centres, and to jump on a spin bike or treadmill for the first time in months.
In addition, the Prime Minister set out that from 1 August, subject to prevalence remaining around or below current levels, we will reopen most remaining leisure settings, namely bowling, skating rinks and casinos, provided they follow covid-secure guidance; enable all close-contact services to resume, including treatments on the face, such as eyebrow threading and make-up applications; restart indoor performances to a live audience, subject to the success of pilots; pilot larger gatherings in venues with a range of sizes of crowds, including in sports stadiums and business events, with a view to a wider reopening later in the autumn; allow exhibition halls and conference centres to reopen; allow small wedding receptions of no more than 30 people; give employers more discretion on how they ensure that employees may work safely; and confirm that the clinically extremely vulnerable will no longer need to follow the advice on shielding. Those are all positive developments.
We continue to follow the science when making those changes so that we ensure that any remaining measures are both proportionate and necessary. That is why some businesses will still need to remain closed from 1 August. They are nightclubs, dancehalls, discotheques and other similar venues; sexual entertainment venues and hostess bars; and indoor play areas, including soft play areas. Those venues are unable to open at this time as they pose an increased risk of transmission, but we continue to work with those sectors to develop and agree safe ways for them to reopen.
As a nation we have made huge strides in getting the virus, which has brought grief to so many, under control. These regulations will help us to keep the virus cornered and to enjoy the summer safely. I am grateful to all parliamentarians for their valuable scrutiny and I commend the regulations to the Committee.
Helen Whately
It is a pleasure to debate the regulations with colleagues, including the hon. Member for Ellesmere Port and Neston. I appreciate the tone that he brings to these conversations. I shall respond to some of his points, before bringing my remarks to a conclusion.
I note the hon. Gentleman’s concerns about the process, and particularly its sequencing. However, I will say that I know he also appreciates the importance of our moving cautiously but also quickly to reduce the restrictions on people’s lives—restrictions that limit economic activity and people’s freedoms..
Secondly, the hon. Gentleman talked about the impact of local lockdowns through the demands they may place on local authorities and the impact on local businesses. The Government are mindful of both those things and are working closely with local authorities in places such as Leicester, where a local lockdown has been imposed. Both the Ministry of Housing, Communities and Local Government and the Treasury are also mindful of, and keep under review, what support may be required for local authorities and businesses in those areas that may be affected.
Thirdly, coming to the hon. Gentleman’s point about clarity of messaging and the concerns expressed by the hon. Member for Warwick and Leamington that things might be moving too fast for businesses, I will say that certainly businesses in my constituency that have lobbied me as a constituency MP have wanted things to move forward. For instance, I had conversations with the pub sector, which very much wanted to be able to reopen and welcomed when things moved as swiftly as possible on that.
Clearly, there is some balance to be struck between not wanting to issue too much guidance too quickly or change things too quickly and, when it is safe for businesses and activities to restart, moving quickly to enable that to happen, which is in the interests of those businesses and the general public.
Matt Western
It was not so much the speed, but the sequencing of it, as my hon. Friend the Member for Ellesmere Port and Neston has said, and the consistency of some of the policies announced. That is why he has been trying to make those points over recent weeks. It is through a more open, collaborative approach, with scrutiny from all sides, that things such as the inconsistencies of barbers versus beauty salons would be addressed, and that would be in the best interests of businesses.
Helen Whately
I hear the hon. Gentleman’s point. To address the specific example he gave of barbers versus beauty salons, there were indeed some conversations with colleagues about that, including female colleagues who said, “Hold on, what’s going on here?” The fact is that we know there are additional risks in activities that involve close face-to-face contact for an extended period of time. That was the reason there was sequencing of the easing of restrictions from one to the other. There was a rationale behind those things.
Moving on, the hon. Member for Ellesmere Port and Neston brought up questions about wanting to have more access to the scientific guidance and the connection between that and transmission risks. It is absolutely clear that there is indeed some increased risk of transmission as people are able to do more things and are more likely to come into contact with each other. That is the reason why the reduction and easing of restrictions is a step-by-step and cautious process.
Therefore, all these decisions draw on the scientific advice about the risks involved. Overall, there is a cautious approach, because we know we must keep the transmission rates down. That goes hand in hand with careful monitoring across the country of what is happening in each local area so that, should we need to take local action, we are able to do so.
The hon. Gentleman mentioned the concern about whether there might be a second peak. I am acutely mindful of the challenges we will face come winter when, in addition to potentially having coronavirus around, we will also have the usual coughs and sneezes and flu, and it will be much harder to tell who might have what, along with people being less likely to be in well-ventilated areas. That is why there is extensive winter planning going on across health and social care to be ready for what comes our way, and also why it is essential that we have effective tracking and monitoring and the ongoing NHS test and trace system running, so that we can limit any onward transmission of the virus and keep it under control. That is essential.
In conclusion, I restate the Government’s commitment to working with Parliament on this. We appreciate that the restrictions have placed a significant strain on individuals. The Government will only continue to impose restrictions that are necessary to protect the public from the spread of coronavirus. We will only make changes when we are confident it is safe to do so, and we remain prepared to reimpose stricter measures should that become necessary. It is a pleasure to serve under your chairmanship, Ms Elliott, and I commend these regulations to the Committee.
Question put and agreed to.
Liberty Protection Safeguards
Helen Whately Excerpts(3 years, 9 months ago)
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The Minister for Care (Helen Whately)
This statement provides an update on the implementation of liberty protection safeguards (LPS). The Mental Capacity (Amendment) Act 2019, which received Royal Assent in May 2019, introduced LPS to replace deprivation of liberty safeguards (DoLS).
LPS will authorise deprivation of liberty in order to provide care or treatment to an individual who lacks capacity to consent to their arrangements, in England and Wales. It will replace a system that many agree is overly bureaucratic and complicated.
It is paramount that implementation of LPS is successful so that the new system provides the safeguards needed. The intention to date, subject to the Department for Health and Social Care’s work with stakeholders and delivery partners, was for LPS to come into force on 1 October 2020.
It is now clear that successful implementation is not possible by this October. We now aim for full implementation of LPS by April 2022. Some provisions, covering new roles and training, will come into force ahead of that date. I will continue to update the sector and stakeholders on timings.
The Government will undertake a public consultation on the draft regulations and code of practice for LPS. That will run for 12 weeks, allowing sufficient time for those that are affected, including those with learning disabilities, to engage properly.
The sector will need time following the publication of the final code to prepare for implementation. We will give the sector sufficient time to prepare for the new system to ensure successful implementation. I am considering a period of approximately six months for this.
After we have considered responses to the consultation, the updated code and regulations will need to be laid in Parliament to allow for proper scrutiny. This needs to happen well in advance of the target implementation date, first to allow for that scrutiny and second because some of the regulations need to come into force earlier.
Health and social care has been at the frontline of the nation’s response to covid-19, with social care providers looking after many of the most vulnerable in society. We have received representations from public and private bodies from across the sector over the last few months, outlining the pressures they face if they were to implement by October 2020.
My overall objective remains to ensure implementation of an effective system in particular for those whose lives will be most affected by this legislation.
The forthcoming draft code of practice and regulations will also offer more detailed information about how LPS will operate in practice. I will provide a further update on the progress of implementation in due course. I hope that the additional time announced today provides reassurance to the sector.
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Learning Disabilities Mortality Review: Fourth Annual Report
Helen Whately Excerpts(3 years, 9 months ago)
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The Minister for Care (Helen Whately)
I am announcing today the publication of the fourth annual report of the learning disabilities mortality review programme (LeDeR). A copy will be deposited in the Libraries of both Houses.
Addressing the persistent health inequalities faced by people with learning disabilities is a priority for this Government and this report is an important contribution towards that.
The LeDeR programme was established in June 2015 to help reduce early deaths and health inequalities for people with a learning disability by supporting local areas in England to review the deaths of people with a learning disability and to ensure that the learning from these reviews lead to improved health and care services. The programme is led by the University of Bristol and commissioned by NHS England and NHS Improvement.
As in previous years, the report makes a number of recommendations for Government and its system partners to improve the care of people with a learning disability which does not always meet the high standard we would expect for each and every individual. We must carefully consider these recommendations to better support those who need care and take the right action as soon as possible.
Earlier this year, we provided an update on action being taken in response to the third LeDeR report and any ongoing actions highlighted in previous years’ reports. This week, NHS England has also published its “Action from Learning Report” alongside the fourth LeDeR report, which sets out a range of work taking place to improve the safety and quality of care to reduce early deaths and health inequalities.
The fourth annual LeDeR report covers the period 1 July 2016 up to 31 December 2019, with a particular focus on deaths in 2019. This means the report will not include reference to deaths from covid-19, as the reviews it includes, and the analysis of them, were completed before the pandemic. From 1 July 2016 to 31 December 2019, 7,145 deaths were notified to the LeDeR programme. Some 3,450 of these were notified in 2019. In 122 of the cases reviewed, people received care that fell so far short of expected good practice that it significantly impacted on their well-being or directly contributed to their cause of death.
Based on the evidence from completed LeDeR reviews, the report makes 10 recommendations for the health and care system, as follows:
A continued focus on the deaths of adults and children from BAME groups is required.
For the Department of Health and Social Care to work with the chief coroner to identify the proportion of deaths of people with learning disabilities referred to a coroner in England and Wales.
The standards against which the Care Quality Commission inspects should explicitly incorporate compliance with the Mental Capacity Act as a core requirement.
Establish and agree a programme of work to implement the from the “Best practice in care co-ordination for people with a learning disability and long term conditions” (March 2019) report and liaise with the National Institute for Health Research regarding the importance of commissioning a programme of work that develops, pilots and evaluates different models of care co-ordination for adults and children with learning disabilities.
Adapt (and then adopt) the national early warning score 2 regionally to ensure it captures baseline and soft signs of acute deterioration in physical health for people with learning disabilities.
Consider developing, piloting and introducing: Specialist physicians for people with learning disabilities who would work within the specialist multi-disciplinary teams; a diploma in learning disabilities medicine; and making “learning disabilities” a physician speciality of the Royal College of Physicians.
Consider the need for timely, NICE evidence-based guidance that is inclusive of prevention, diagnosis and management of aspiration pneumonia.
Right Care to provide a toolkit to support systems to improve outcomes for adults and children at risk of aspiration pneumonia.
Safety of people with epilepsy to be prioritised. The forthcoming revision of the NICE guideline “Epilepsies in children, young people and adults” to include guidance on the safety of people with epilepsy, and safety measures to be verified in Care Quality Commission inspections.
For a national clinical audit of adults and children admitted to hospital for a condition related to chronic constipation.
The inappropriate use of do not attempt cardio-pulmonary resuscitation (DNACPR) decisions is highlighted in this fourth report, as it has been previously. DNACPRs should never be used in a blanket way and this has been reiterated during the covid-19 crisis through letters from the NHSE, including the NHSE medical director on 7 April 2020, and by the Secretary of State for Health and Social Care on 15 April 2020.
I am clear that we must tackle the issues raised in the LeDeR report to ensure the care that each individual deserves is provided. We will consider the report and its recommendations in more detail in the coming weeks, in order to determine the action that must be taken.
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