The Minister for Care (Helen Whately)

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Community asymptomatic testing is an important tool in the fight against covid-19. We have delivered more than 5 million lateral flow tests to the 117 local authorities that have already gone live with testing their communities, and we are rapidly expanding the programme to all remaining local authorities in England, as well as working with devolved Administrations on their plans.

Helen Whately

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It is great to hear about the work of the Rotherham CCG and my hon. Friend’s primary care network, which are clearly on the front foot in this vital work of vaccinating people who are at high risk in his community. As he may have heard from the Secretary of State earlier, we are making sure that everybody is able to access community testing as they need it and has a vaccination centre within reach.

Helen Whately

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I join my hon. Friend in welcoming the opening of community testing centres in Swadlincote. Asymptomatic testing enables us to pick up cases in high prevalence areas that otherwise would go undetected, which means that we can break chains of transmission. There has been extensive clinical evaluation from Public Health England and Oxford University, which shows that lateral flow tests are appropriate for that use. They identify over two thirds of all people who have covid-19 but often do not have symptoms and, importantly, they catch the vast majority with a high viral load.

Helen Whately

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I can assure my hon. Friend that most secondary schools and colleges have already set up testing sites and have begun weekly testing, using lateral flow devices for staff currently in school. Staff could also participate in daily contact testing on site, and primary schools will shortly be receiving test kits for weekly staff testing and also for daily contact testing.

Helen Whately

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We absolutely recognise not only the importance of self-isolation, which is critical in breaking the chains of transmission, but that it is not always easy for people to do. We recognise, for instance, the cost of self-isolation, and that is why we introduced a payment of £500 for those who are on low incomes and unable to work from home while isolating. We will continue to make sure that people have the support they need to self-isolate.

The Minister for Care (Helen Whately)

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I am pleased to report that the strong recent performance of the contact tracing service has been maintained, even with the significant growth in cases. The latest weekly data show that the service made contact with almost 700,000 people: 85% of positive cases were reached and provided details of their close contacts, and 92% of those close contacts—that is almost half a million people—were then reached and told to self-isolate.

Helen Whately

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The hon. Member has described, in fact, what is a really important partnership working between the national NHS Test and Trace system and local partners such as local authorities, as indeed is happening in his own area of Sheffield, where it is that combined working that enables us to contact the maximum number of people and therefore to get more people to self-isolate and break these chains of transmission.

The Minister for Care (Helen Whately)

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indicated dissent.

The Minister for Care (Helen Whately)

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The regulations before us set out measures that none of us wants to take, yet we must take them if we are to control this new and aggressively infectious variant of coronavirus, which is spreading rapidly across the country. As we heard from the Prime Minister and the Secretary of State for Health, we are up against it, in a race of vaccine versus virus. We are vaccinating faster than any comparable country but, even as we do so, each day we have a relentless rise in the number of new infections, hospital admissions and, sadly, deaths. We now have more than 30,000 people in our hospitals with covid.

Earlier this week, the UK’s chief medical officer’s advice was that we should move to alert level 5, meaning that if action is not taken, NHS capacity might be overwhelmed within 21 days. The consequences of that and the decisions that it could lead to are not decisions that we want our doctors to have to take. Therefore, I say to hon. Members, that is why we must adopt the measures before us. Just as we do not want to impose the restrictions on people, we must of course be ready to lift them too, as soon as we are in a position to do so. Lockdowns come at huge cost, economic and social, and in particular to the many thousands of children who are no longer going to school.

Helen Whately

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I thank my hon. Friend for his intervention. Many other hon. Members have also asked about the duration of the restrictions and ongoing parliamentary scrutiny. I can say that the regulations provide for the restrictions until 31 March 2021 not because we expect the full national lockdown to continue until then, but to allow a steady, controlled and evidence-led move down through the tiers on a local basis. The restrictions will, of course, be kept under continuous review. We have a statutory requirement to review them every two weeks and a legal obligation to remove them when they are no longer necessary to control the virus.

I also reassure my hon. Friend the Member for Altrincham and Sale West (Sir Graham Brady), my right hon. Friends the Members for Chesham and Amersham (Dame Cheryl Gillan) and for Forest of Dean (Mr Harper) and others that we absolutely do not want to continue the restrictions longer than necessary. Most particularly, we do not want to keep children at home and being home-schooled. I say that as a parent with three children who have spent the day, I hope, being home schooled—my husband has been in charge of that today. We do not want that to be the situation any longer than it has to be. Schools were the last to close, and the Prime Minister has said that we want them to be the first to open. Of course, they are still open for the children of critical workers, and that should include—to pick up on a point made by my hon. Friend the Member for Bridgwater and West Somerset (Mr Liddell-Grainger)—those involved in the construction of critical national infrastructure, such as the Hinkley Point power station.

While with great reluctance we have had to keep most children out of school, we have also had to require outdoor sports facilities, such as golf courses, to close. Several hon. Members have challenged that, and I want to tackle it head on. I say to hon. Members who have raised this issue that if we made an exemption for golf, we would also have to make an exemption for other outdoor activities, such as tennis, outdoor bowling, climbing walls, riding centres, dry ski slopes and go-karting—I could go on. People would then say, “I’m being told to stay at home but I can go and do all those things, so you don’t really mean that I should stay at home.” Quite apart from the fact that people congregate in those outdoor settings, we need to be really clear that the message now is, “Stay at home.”

Helen Whately

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I do not believe that my hon. Friend is as he describes himself, but what I do think is quite clear. We are saying that people should stay at home, unless their reason for leaving home is on the very clear list of essential reasons for doing so. That covers the eligibility of the children of critical workers to be in school, healthcare appointments and, indeed, exercise. We really need to make sure that it is absolutely clear that, other than for those specific reasons, people should stay at home. That is what we need to do in order to control this raging virus. That is the message that all of us need to convey to our constituents.

Helen Whately

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I have very little time and want to cover more of the points that have been raised, including by my hon. Friend.

As hon. Members have said, this national lockdown is different from previous lockdowns because we have the vaccine and the end is in sight. We have already vaccinated more than 1.3 million people. That includes the nearly one in four of those over 80 who have had their first jab. By the middle of February, we expect to have offered the first vaccine dose to everyone in the top four priority group identified by JCVI—namely, care home residents and staff; people over 70; all frontline NHS and care staff; and the clinically extremely vulnerable. That answers the question posed by the shadow Health Secretary as to when NHS frontline staff will have the opportunity to be vaccinated, as they, together with social care staff, are in the group to be offered the vaccination by mid-February.

The Opposition spokesman, the hon. Member for Nottingham North (Alex Norris), asked how the vaccine will be offered. He will know that vaccination is not mandatory. We are educating, encouraging and informing people of the important reasons why they should step forward and have the vaccine. That is the way in which we are going about it.

My hon. Friend the Member for Middlesbrough South and East Cleveland (Mr Clarke) rightly said that we should stop at nothing to get people vaccinated, and I could not agree more. That is why my hon. Friend the vaccination deployment Minister is working with the NHS on getting millions of people vaccinated in just a matter of weeks, involving hospitals, GPs, community pharmacies and a workforce that includes thousands of volunteers, including health professionals returning to the frontline to play their part. As the Health Secretary confirmed earlier, we have already acted to reduce some of the bureaucracy and, in particular, some of the training models required for those NHS returners, so that we are ready to vaccinate as fast as the vaccine can be supplied.

I have heard several hon. Members call for more data on the vaccination roll-out. I assure them that weekly data will be published tomorrow, and the publication of daily data will start next week. That data will show our accelerating vaccination programme protecting more people day by day, so that in time we will be able to lift many of the restrictions before the House today.

In conclusion, there are difficult weeks ahead for all of us—especially for those working on the frontline in health and social care, whom we cannot thank enough—but we are on the final stretch with the end in sight, so we must keep our resolve and get behind these restrictions, which are needed to control the virus until the vaccine has reached those that it needs to. I commend the regulations to the House.

Question put.

The Minister for Care (Helen Whately)

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I beg to move,

That the Health Protection (Coronavirus, Restrictions) (Self-Isolation and Linked Households) (England) Regulations 2020 (S.I., 2020, No. 1518), dated 11 December 2020, a copy of which was laid before this House on 11 December, be approved.

Helen Whately

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Before I say anything else, I want to say thank you to all our health and social care workers who have been working day and night through Christmas, Boxing day and the bank holiday. I know that every single one of them is feeling the strain and that they are not just tired but exhausted, having gone not just the extra mile but miles and miles of extra miles. I would also like to thank everyone across the country who has forgone the joy of sharing Christmas with family or friends. We have all missed those precious moments, and I know that this has been particularly painful for those facing what may be the last chance to spend Christmas with a loved one nearing the end of their life. That is why I say thank you to them from the bottom of my heart for what they have done, not so much for their own sake but to protect others.

I would like to take a moment to celebrate the good news of the authorisation of the Oxford-AstraZeneca vaccine for use. Although the development of vaccines is an international collaboration, we should recognise the contribution of the British life sciences sector, which offers the UK a way out of this disease and will make a huge impact on the global response.

Helen Whately

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My hon. Friend may well have heard the statement by the Secretary of State for Health and Social Care, after which he answered a large number of questions about the vaccine. As he said, we will be rolling out the vaccine as rapidly as possible, we are poised and ready to start rolling out that particular vaccine as of next week, and it is all about getting the supply of the vaccine in to enable us to do that.

There is light at the end of the tunnel, but we are not there yet. We are here today to debate regulations that increased the restrictions on parts of the country before Christmas, but we also heard the Health Secretary’s statement earlier and know the seriousness of the situation we face despite those greater restrictions. We know that we have just had the highest number of new cases in one day—over 53,000—and in many parts of the country, our hospitals are stretched to the limit. We know we are facing a new variant of covid that is more infectious and spreading rapidly in many parts of the country, so I am in no doubt that we were right to introduce further restrictions when we did.

Before going into the details of the regulations, I will give a brief overview of the measures we are debating. On 2 December, a revised tiering system was introduced following approval of the all-tiers regulations in both Houses. Those have been amended four times. On 14 and 16 December, the all-tiers regulations were amended to move some local authority areas between tiers. Those changes came into force on 16 and 19 December respectively. On 20 December, the all-tiers regulations were amended to introduce a further level of restrictions—tier 4—and to move some local authority areas into that tier and to exclude tier 4 from the Christmas easements. Finally, on 24 December, the all-tiers regulations were amended to move some local authority areas into higher tiers, and some amendments were made to the measures in tier 4.

In addition to those four amendments to the all-tiers regulations, we are debating the Health Protection (Coronavirus, Restrictions) (Self-Isolation and Linked Households) (England) Regulations 2020, which reduce the self-isolation period for household and non-household contacts from 14 days to 10, based on evidence showing that the likelihood of being infectious as a contact after 10 days is low. That decision was made following advice from UK chief medical officers. To bring English policy in line with other nations in the UK, we now count the start date of this period from the day after exposure, onset of symptoms or a test. Those with covid-19 should continue to self-isolate for 10 days, as per Government guidelines. We have brought the wait time for those switching support or childcare bubbles down to 10 days, in line with those changes.

I know that some hon. Members have previously raised concerns about parliamentary scrutiny, and some may be disappointed that those amendments were made in advance of this debate. However, I am sure hon. Members will also appreciate that this virus does not wait for parliamentary procedure. The situation we faced in the run-up to Christmas, as we identified that the cause of the rapid rise in infections was the new variant, meant that we had to act, and act fast.

Helen Whately

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I hear my hon. Friend’s point, and I share his view that throughout this pandemic the vast majority of people have behaved with great responsibility. I know that people in tiers other than tier 4 thought very hard about whether they should gather with relatives, even within the easing that was allowed during the Christmas period, and rightly so. We must all play our part in controlling the virus and stopping its spread.

Helen Whately

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I will make some progress.

At the time of these provisions we were seeing an exponential rise in cases in London, Kent, and some other parts of the south-east, and it was clear that the tier 3 restrictions were not sufficient. We identified the existence of a new variant in those areas, and further analysis showed us that the new variant was driving the steep trajectory of infections. The new and emerging respiratory virus threats advisory group—NERVTAG—tells us that the new variant demonstrates a substantial increase in transmissibility, compared with other variants, and that the R value appears to be significantly higher, with initial estimates suggesting an increase of between 0.4 and 0.9.

There is no evidence to suggest that the new variant of the virus is more likely to cause more serious disease, but increased infections lead to increased hospital admissions and, sadly, increased loss of life. These winter months already pose great challenges for our NHS. That is why we had to take the action that we took before Christmas, and the further steps announced today to control the relentless spread of the virus. However, it is not all bad news.

Helen Whately

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I am making some progress and I am mindful that many Members want to speak this evening.

The roll-out of the Pfizer vaccine is happening at pace, with more than 600,000 people receiving it between 8 and 20 December. Vaccinations in care homes started on 16 December, and the NHS has already been getting the vaccine to those who are most vulnerable, and the care workers who look after them. Now, the Oxford-AstraZeneca vaccine has been approved, and it is much easier to get out to people and into arms. There is every reason for optimism, but we are not there yet. We must suppress the virus now and in the weeks ahead.

On the specific measures in these regulations, in response to the greatly increased risk, the addition of tier 4 stay-at-home measures will be familiar to people from the November national restrictions. Tier 4 involves minor changes to those national restrictions. As of November, people in tier 4 areas must stay at home and not travel out of tier 4. They may only leave for a limited number of reasons such as work, education, or caring purposes. We are advising that clinically extremely vulnerable people in tier 4 areas should do as they did in November and stay at home as much as possible, except to go outdoors for exercise or to attend health appointments. The regulations contain the same exemptions as other tiers for childcare and support bubbles. We advise that people elsewhere avoid travelling into a tier 4 area, unless they need to do so for work, education or health purposes.

Helen Whately

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One thing that I will do when I have finished speaking is see whether I can look up the specific data for the hon. Member’s constituency. In general, however, the announcements made today, just as with previous announcements, are based on the data that we are seeing, which includes rapidly rising rates of infection in certain areas, the level of new infections, the trajectory and hospital pressures.

The tier 4 regulations require all non-essential retail, indoor entertainment, hairdressers and other personal care services to close. International travel is also restricted to business trips only. However, we have listened to hon. Members and the public about what is most important to people in their daily lives so, unlike in the November restrictions, communal worship and a wider range of outdoor recreation are still permitted. We also recognise the restrictions’ impact on businesses and continue to provide them with ongoing support to help get through the crisis.

We know that these measures are hard. We know that they keep families and friends apart, yet we also know that they are necessary for us to get through this situation and to prevent the loss of lives as we do so. This virus thrives on the things that make life worth living, such as social contact, but that means we can all play our part in stopping the spread—as I said, if not for ourselves, then for others. The end is in sight, but for now it is our duty here in Parliament to put in place these restrictions—onerous though they are—to control this virus. I commend the regulations to the House.

Helen Whately

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I thank hon. Members from across the House and those who have contributed virtually for the many truly thoughtful contributions in what has been a really wide-ranging debate this evening. In a moment, I will respond, as far as I can in the time that I have, to many of the points and questions that have been raised.

As I stated at the outset, although we have the truly welcome news of the MHRA approval of the Oxford/AstraZeneca vaccine for use, right now we face a very serious situation. We face rapid rates of covid transmission and new cases of the new variant of the virus. We began to see that before Christmas, when we brought in the measures and the introduction of tier 4, which we are debating today. No Government would want to do what we are having to do, which is to put such restrictions on people’s lives, but, as many hon. Members have recognised in their speeches, we see the pressures on the NHS and know that rises in infections and rises in hospital admissions very sadly lead to loss of life. We also know the implications of those pressures on the NHS not only for those with covid, but for those needing treatment for other illnesses. The alternative to taking measures to suppress the virus is unthinkable. These decisions are not easy to make, but the data is clear, including on the additional infectiousness of the new variant.

Some hon. Friends asked why their constituencies had been moved up tiers either in the past couple of weeks or today and sometimes moving at some pace from a low tier to as far up as tier 4.

The reason is that a combination of the epidemiological evidence and hospital pressures, looking at the five criteria that we have set out, makes it clear that that is what needs to happen. I remind my hon. Friends of the five criteria. We look at the case rates for all ages, the case rates for over-60s—which particularly translate into hospital admissions—the change in the case rate, the positivity rate and pressures on hospitals such as occupancy rates and the trajectory of those. Looking at that dataset, it is clear when action is needed.

Helen Whately

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Something that I can say to give my right hon. Friend some extra insight is that, for instance in introducing the latest measures, one of the things that we saw was a rapidly changing situation. During the national lockdown and the weeks following that, there was some puzzling about what was going on. We were seeing a large increase in the case rate in the south-east, especially in Kent and part of my constituency. What we came to investigate and understand was the new variant playing its part in that. It is the data that tells us that we need to make an urgent change, for instance in the tier that an area is in.

I have one very specific example that I want to give, not in relation to my right hon. Friend’s constituency but in response to the question that my hon. Friend the Member for Christchurch (Sir Christopher Chope) asked about why his constituency had changed tier and what had happened in the period that we are talking about. I can tell my hon. Friend the Member for Christchurch—he is not in his place, but I hope that he is listening remotely—that we saw a 68% increase in the case rate in his area of the country between 17 and 23 December, as well as a rapidly rising rate in the over-60s and a rising positivity rate. That is the kind of story that tells us that we need to take rapid action.

My right hon. Friend the Member for New Forest West (Sir Desmond Swayne) also questioned the timing of the introduction of the new measures, and I can tell him that we saw the number of cases increasing fast—both cases and hospital admissions. There was quite simply no time to waste. The analysis was clear that that was driven by the new variant.

Some hon. Members have questioned the effectiveness of the measures. My hon. Friend the Member for Thurrock (Jackie Doyle-Price) spoke about her area now having the highest case rate in the country—something I can relate to because part of my constituency previously had the highest case rate in the country—and it is not a reason why you want your area to be famous.

In the parts of Kent that were hit hardest with the new variant a few weeks ago, we are now seeing some stabilisation in rates. I should warn that that is at a relatively high level. It is also very soon after the introduction of tier 4—just 10 days ago—for us to see its full effect. We and everyone living in those areas can play their part in making sure that the restrictions work. My hon. Friend the Member for Aylesbury (Rob Butler) said to us on the screen that he had one simple message, which was to follow the rules. The virus thrives on social contact and the restrictions reduce that, and the Government will of course continue to keep these measures and their effectiveness under review.

Many hon. Members spoke up for businesses in their constituencies, and I absolutely recognise the huge challenges that the pandemic has placed on many businesses in some sectors such as hospitality and tourism and travel in particular. We have, of course, sought to protect livelihoods as well as lives. We have spent over £280 billion this year to support businesses and individuals. That includes extra support for higher tiers, recognising the extra costs incurred in those areas. I have no doubt that my honourable colleagues in the Treasury will be taking note of many of the arguments made by colleagues today.

Helen Whately

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May I make a little progress? I did take an intervention from my right hon. Friend a moment ago, and I am trying to respond to the many points made in the debate.

My right hon. Friend the Member for South West Wiltshire (Dr Murrison) rightly referred to the unpredictability of this virus, and to how it does not follow due process, as we have seen with the new variant. Unlike many mutations, which are normal things that occur with a virus, this variant has changed the behaviour of the virus. As my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer) said, thanks to the UK’s world-leading virus surveillance capability, we were able to detect and analyse the spread of this new strain. We know that it is most evident in the areas with exponential rises in cases at the moment, and those are the areas that have been placed in tier 4, either before Christmas or with the announcements today.

Many hon. Members spoke about the vaccination programme, and they welcomed the good news about the Oxford/AstraZeneca vaccine. Some hon. Friends even sought to change the way we describe the vaccine, by claiming it for their own constituencies. The hon. Member for Strangford (Jim Shannon) said that the vaccine has put a spring or a skip in his step, which I know that Members around the House will welcome.

The NHS has done a brilliant job of already vaccinating more than 600,000 people with the Pfizer-BioNTech vaccine, and with the opportunity to now bring into play the Oxford/AstraZeneca vaccine, we are driven and committed to its rapid roll-out. We have secured 100 million doses, and the NHS stands ready to deploy them from next week. We have an infrastructure of hospital hubs, GPs, vaccination centres and pharmacies ready to play their part and, as my right hon. Friend the Member for South West Wiltshire said, they will be drawing on a workforce that includes volunteers from among our fabulous NHS returners, who stepped forward to offer their help to the NHS during the pandemic.

Helen Whately

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I do not think that now is the moment for me to hold a remote debate on that with the deputy chief medical officer, and my right hon. Friend also asks me to see into the future regarding the roll-out of the vaccine. I can say, however, that we are following the prioritisation as set out by Joint Committee on Vaccination and Immunisation. That is first and foremost to vaccinate those who are at greatest risk of losing their lives to covid, and that is why we are starting with residents in care homes, which have been so hard hit by the pandemic, as well as care home workers. The next priority category is those who are over 80 and broader health and social care workers, and it then moves down the ages. Our approach follows the JCVI prioritisation to put the vaccine to that crucial and important effect of saving people’s lives from this cruel disease.

The hon. Member for Nottingham North (Alex Norris) asked about the publication of JCVI advice on the use of the vaccine. I can tell him that it has already been published and is available on gov.uk.

Helen Whately

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I am being counselled not to respond to my hon. Friend’s description of himself. I do not think I should be drawn into speculation on the roll-out and what we face ahead of us. He will have heard the good news from the Secretary of State earlier that we have an additional vaccine that we can use and that the NHS is ready and poised to roll out at great pace. We are determined to do so. That is so important, as it means that we have hope as we go through this very difficult time.

It was very good to hear so many hon. Members recognise and thank not only NHS staff but those working in social care. Care home workers in particular were mentioned by my hon. Friend the Member for Thurrock, as were the social care workforce more widely. The hon. Member for Twickenham (Munira Wilson) mentioned the mental health of the NHS and social care workforce—something about which I care a great deal. I assure her and others who are concerned about this matter that we have put in place extra mental health support for frontline NHS and social care workers, including specialist helplines that are available 24/7 so that there is always someone they can call.

In conclusion, as we go about our lives under these restrictions, we must remember the pressure the pandemic puts on that workforce. I once again thank the public for all playing their part and for the sacrifices they are making for themselves, but especially for others. The end is in sight, but we have a way to go and we must take the steps necessary to suppress the virus here and now.

Question put and agreed to.

Resolved,

That the Health Protection (Coronavirus, Restrictions) (Self-Isolation and Linked Households) (England) Regulations 2020 (S.I., 2020, No. 1518), dated 11 December 2020, a copy of which was laid before this House on 11 December, be approved.

Public Health

Resolved,

That the Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) Regulations 2020 (S.I., 2020, No. 1533), dated 14 December 2020, a copy of which was laid before this House on 14 December, be approved.—(Rebecca Harris.)

Resolved,

That the Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) (No. 2) Regulations 2020 (S.I., 2020, No. 1572), dated 17 December 2020, a copy of which was laid before this House on 17 December, be approved.—(Rebecca Harris.)

Resolved,

That the Health Protection (Coronavirus, Restrictions) (All Tiers and Obligations of Undertakings) (England) (Amendment) Regulations 2020 (S.I., 2020, No. 1611), dated 20 December 2020, a copy of which were laid before this House on 21 December, be approved.—(Rebecca Harris.)

Resolved,

That the Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) (No. 3) Regulations 2020 (S.I., 2020, No. 1646), dated 24 December 2020, a copy of which were laid before this House on 29 December, be approved.—(Rebecca Harris.)

The Minister for Care (Helen Whately)

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It is a pleasure to serve under your chairmanship, Ms Ghani. I thank the hon. Member for City of Chester (Christian Matheson) for securing a debate on this very important topic.

The pandemic has impacted everybody, but many of those with learning disabilities have been particularly hard hit. I know how difficult it has been for them, their carers and loved ones to continue to be supported to live fulfilling lives during the pandemic. Wherever possible, we have made exemptions and reasonable adjustments to the restrictions for disabled people, while balancing that with the need to keep people safe. Sadly, we know that some of those with a learning disability have suffered the worst effects of covid-19 and passed away. I send my deepest condolences to their families and friends.

The hon. Member for Bethnal Green and Bow (Rushanara Ali) asked me to talk about what we are doing about the high mortality from covid of those with learning disabilities. We commissioned Public Health England to analyse the information about deaths for people with learning disabilities in order to understand the impact of covid-19 and ensure that we could take every possible step to protect people. As hon. Members have said, its report estimated that, in the first wave, people with learning disabilities had a mortality rate from covid-19 that was between 4.1 and 6.3 times higher than the general population. We know that some of the difference is associated with having other health conditions such as Down’s syndrome and with place of residence.

The University of Bristol recently published a LeDeR—Learning Disabilities Mortality Review—report setting out findings from reviews of deaths from covid-19 of people with learning disabilities, which adds to our understanding. The findings of those reports are very concerning. I want to reassure hon. Members that we did not wait for the publication of those reports to take action. Rather, we have worked continuously to protect people throughout the pandemic, and I will briefly set out some of the actions we have taken.

From the adult social care action plan back in April to the adult social care winter plan published in November, we have worked to ensure that people who need care, including those with learning disabilities, are protected as much as possible from the worst outcomes of covid-19. That has included introducing the infection control fund, now totalling £1.1 billion, to ensure that care settings, including day services, are covid-secure. We are providing free PPE for adult social care providers until March 2021. That includes domiciliary care and personal assistance, as well as residential care homes. As testing capacity has increased, we have extended asymptomatic testing not only across care homes but to domiciliary care staff. Following the roll-out of the single round of national testing to the most high-risk extra care and supported living settings, we have launched regular retesting for those settings.

The hon. Member for City of Chester spoke about DNACPRs and the concern about their inappropriate recording in patient records. When I heard about that, I too was very concerned and shocked. The blanket application of DNACPRs to any group of people is completely unacceptable, and I want that message to be said as many times as it needs to be to ensure that that practice does not continue. When we heard that it was happening, a series of communications went out from the Department, the Secretary of State and NHS England to say that there needed to be an immediate stop to that practice. As has been said, the Care Quality Commission is looking into that. The 2021 general medical services quality and outcome framework was updated in September, and it requires GPs to review all DNACPR decisions for people with learning disabilities to make sure they are appropriate.

The hon. Gentleman also spoke about the need for training to ensure healthcare staff have the skill and understanding they need to care for people with learning disabilities. I completely agree with that, which is why I am working with Health Education England and Skills for Care to develop the Oliver McGowan mandatory training to ensure that all staff have the skills and understanding they need.

Several Members asked about remote consultations. The NHS medical director of primary care wrote to GPs in September, asking them to continue to ensure that patients who need to can access face-to-face care.

I am sure that, like me, hon. Members welcomed the incredible news that a vaccine against covid has been approved. They will know that the Joint Committee on Vaccination and Immunisation, the independent body responsible for identifying priority groups for vaccinations, has published its advice on prioritisation. In advance of that process, we shared with the JCVI the latest evidence on people with learning disabilities and covid—including the Public Health England work that I referred to—to inform their approach and ensure that those with learning disabilities would be considered alongside older people, for instance, for whom the risks are very well known. The JCVI’s advice, published in December, stated that people on the clinically extremely vulnerable list, including those with Down’s syndrome, should be in priority group four for vaccination, and that people with a severe or profound learning disability should be in priority group six.

Helen Whately

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We will continue to scrutinise all possible evidence and data we can get to understand the impact of the steps we are taking. For instance, as I have set out, we have supported residential care settings and other carers to ensure that they have the PPE and infection control support they need. Sadly, we still see that care homes are experiencing outbreaks of covid. It is incredibly hard to stop the disease getting into these places when it is prevalent in the community. We know that the most important thing we can all do to keep those who are most vulnerable to covid safe is to take steps to reduce the spread of covid in the wider community. I assure the hon. Member that we are continually looking at the evidence and at what more is possible to do to keep people safe.

In fact—I was coming to this exact point—I have asked the Scientific Advisory Group for Emergencies care working group to consider the findings in the Public Health England and LeDeR reports to help us develop further targeted actions. The Department has commissioned research to better understand the impact of the pandemic on the wellbeing and lives of people with a learning disability. That is being led by the University of Warwick and Manchester Metropolitan University. The insights from this research will help us to further mitigate and reduce harm from covid-19, including tackling isolation and loneliness. We will keep the evidence under review.

I come now more broadly to restrictions, which I know have been particularly hard for people with learning disabilities. In particular, visiting loved ones for those who are in residential care settings has been incredibly difficult for families, friends and the individual themselves. On 1 December, we published updated guidance on visiting care homes. We advised care homes to use the rapid tests that we are providing, together with PPE and other infection control measures, to enable safer visiting. There is also guidance on visiting in-patient healthcare settings. That was updated in October, and NHS England and NHS Improvement wrote to mental health learning disability and autism in-patient providers to remind them that they must take all possible steps to enable safe regular visits.

The hon. Member for Warrington North (Charlotte Nichols) asked about the visiting out guidance for those of working age. An enormous amount of care was taken over that to try and establish the right balance to enable people to go and see their family if that is what they normally do while they live in a residential care setting, while recognising that they may well be in a setting where others in that care home, for instance, may be extremely clinically vulnerable to covid. As I have said, we know that once covid gets into a residential setting, it is really hard to stop it spreading. That is why the clinical advice is very strong on saying that those returning to a care setting after a visit out should quarantine for 14 days. I am really aware that that is a very difficult thing to ask people to do, but the reason it is in there is because that setting may well have people who are clinically extremely vulnerable, and there is such a risk. It is not just about the one individual visiting out; we must bear in mind the risk to the whole group of residents. That is why the guidance is as it is.

Before I conclude my remarks, I will talk about the restrictions on the day-to-day activities, which all of us have been complying with. We have made exceptions and reasonable adjustments wherever possible, for example by excluding support groups such as day services from the rule of six, setting out clear exemptions to mandatory face coverings, including where a person cannot wear one due to a disability, and working to ensure that that is communicated. There has been some debate about this and whether the ban should be much more strongly enforced, but I have personally worked really hard to communicate the importance of there being exemptions.

We have also, wherever possible, produced guidance in accessible formats, such as easy-read. We continue to work with stakeholder groups and organisations such as Mencap, which has rightly been mentioned during the debate, to ensure that we get input on the potential implications of restrictions on people with a learning disability, and how we can best mitigate those implications.

To conclude, I thank all hon. Members for their contributions on this important topic. We are all deeply committed to helping protect people with a learning disability from the worst effects of covid-19, and I hope that what I have set out today does assure Members that the Government are working tirelessly to make that happen.

The Minister for Care (Helen Whately)

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The speeches we have heard this evening remind us just what hard times we live in, when we have had to do things that would have been unimaginable just a year ago. There are the things we have done to save lives, but sadly, even so, many lives have been lost. As my right hon. Friend the Secretary of State set out in his statement to this House earlier today and the Minister for prevention, public health and primary care, the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), reminded us in her opening remarks, this is not over yet.

I know that people in the places moving into tier 3 on Wednesday morning will feel a real sense of disappointment, especially as we get closer to Christmas. We have heard today some powerful contributions from across this House about how our constituents have been affected. For instance, my hon. Friend the Member for Bolsover (Mark Fletcher) spoke about the impact of the restrictions on mental health, with the loss of routine, loss of social contact and loss of opportunities to pursue passions and activities that make life worth living—ice skating, as we have heard, but also dance classes. I should add to that the loss of livelihoods. Many colleagues have spoken about the impact on hospitality, and particularly pubs. Believe me, I really appreciate that, with a brewery as the largest employer in my constituency.

I also welcome the recognition and the tributes paid by hon. Members not only to the NHS and its workforce, but to care homes and care workers, who have indeed been there for the people they care for day in, day out throughout this pandemic. They are rightly prioritised for testing. I will pick up on a comment made by my hon. Friend the Member for Redcar (Jacob Young) and say that care agency staff absolutely should be tested regularly, using tests distributed to the care homes that they work at.

Helen Whately

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It will probably be helpful if we pursue the specific case outside the Chamber. I just wanted to reiterate the importance of care agency staff being tested in care homes. Tests are being distributed to care homes for that purpose.

Whenever the Government have to take difficult decisions, such as the ones we have taken today, the impact of those decisions on people across the country is always at the front of our mind. With a 14% rise in average daily cases last week and a 13% rise in daily hospital admissions, we had no option but to act today, even ahead of the formal review point on Wednesday. As the Secretary of State reminded us earlier, Germany had to introduce tougher restrictions over the weekend, and Sweden is seeing real pressures on intensive care beds. As we set out in our winter plan, our strategy has always been to suppress the virus and prevent our NHS from becoming overwhelmed until the vaccine can make us safe.

I know that hon. Members will share my sense of optimism that, just as many other parts of the country have done so magnificently, the areas now facing rising rates can turn this around. They are getting the support they need to do that, right where it is needed most, including through the provision of community testing, with millions of newly invented tests targeted at the areas that need that support. I know that the Members representing those areas will want to play their part in this effort, so I can say that today we published a guide for Members so that colleagues can promote, support and champion local community testing and contact tracing in their areas.

I am grateful to my hon. Friend the Member for South Thanet (Craig Mackinlay), who spoke about how he had seen people become more careful in his area as they saw rates rise locally. He saw their behaviour change through the increased wearing of face masks, for instance, as people took the extra steps to keep themselves and others safe. That is a reminder that ultimately, all our efforts must be underpinned by a sense of personal responsibility. Our national effort begins with every one of us.

We all know what a difficult year it has been, yet that does not make those important public health messages any less true. As several hon. Members have reminded us this evening, we must continue to wash our hands, cover our face and make space. We must continue to self-isolate when we are asked to, for the 10 days now required. Perhaps even more challenging than that, though, we must be unafraid to ask ourselves difficult questions about who we are meeting, their vulnerability and whether that is a risk worth taking. Time and again, the common sense of the British people has prevailed, and it must continue to do so.

Finally, our vaccine deployment continues apace, because we know that vaccines represent our best route out of these difficult times. It is such a relief to be able to say about vaccination not if, but when. Tens of thousands of people have already been vaccinated, and GP roll-out started today in hundreds of parts of the country, so many more will be vaccinated this week, like the relatives my hon. Friends the Members for Stoke-on-Trent South (Jack Brereton) and for South Thanet mentioned.

Helen Whately

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I know that a huge amount of work is going on to ensure that we have the boots on the ground needed to vaccinate people. Indeed, that is one of the things that those who have volunteered—particularly those with healthcare experience who are returning to the NHS—are stepping forward to help with.

We will vaccinate in care homes by Christmas, and that process has already begun in Scotland. Most of us who are eligible can expect to receive our vaccine in the next few months, which is truly heartening, but we must all stay on our guard through Christmas and into the new year. This is not the time to ease up—quite the opposite, in fact, because this is the busiest time of year for our NHS and for the doctors, nurses and other health and social care workers who have already done so much for us in this pandemic. Along with many colleagues today, I thank our health and social care workers.

This is a moment to stand firm against this deadly virus and to redouble our efforts to keep one another safe. This is one of the toughest things we have ever had to do as a country and one of the toughest things that anyone has had to endure personally, but the end is in sight. We must steel ourselves and do the right thing, if not for our own sake then for others’, and we will get through this together.

Question put and agreed to.

Resolved,

That this House has considered covid-19.

The Minister for Care (Helen Whately)

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It is a pleasure to serve under your chairmanship, Ms Eagle. I congratulate the hon. Member for Rhondda (Chris Bryant) and thank him for securing a debate on this important matter. I give him so much credit and pay tribute to his passion and his huge knowledge of this subject—I know that he has debated it at length with other Ministers—which he has brought to this debate and other debates on the matter. I also pay tribute to his commitment to this cause and the tireless work that he does. Of course, I know that he speaks on this subject from direct personal experience. I pay a huge tribute to him for all that he brings to these debates.

It is also good to have the hon. Member for Blaydon (Liz Twist) here. I thank her for the work she is doing with the APPG and the hon. Member for Rhondda to campaign for those with acquired brain injury.

I recognise the vital work of charitable organisations such as Headway, the United Kingdom Acquired Brain Injury Forum and the Disabilities Trust. Their work is invaluable not only in raising awareness but in providing hands-on help and support to patients, families and carers. I am aware that acquired brain injury affects not only an individual’s health but their family, work, relationships and education, in the case of children, so it has a huge impact on people’s lives.

I have met people with brain injuries. Shortly after I was elected, I visited Kent and Canterbury Hospital, which has a neurorehabilitation unit, and I spoke to staff and patients and saw the really impressive work that they were doing. I appreciate the points that the hon. Gentleman makes about the importance of effective neurorehabilitation.

As the hon. Gentleman set out, the pandemic has had a real impact on the care and treatment of people with acquired brain injuries. As he said, staff have been redeployed on to frontline covid work, and that has affected people’s care. For instance, some consultations have been moved online, and services are not what we would want them to be. Face-to-face neurology rehabilitation services are being restarted as quickly as possible. Guidance has gone out from NHS England and NHS Improvement and the Association of British Neurologists, and every effort is being made to catch up on delayed care. I will look into the point that the hon. Gentleman made about his concern that services are not yet up and running. I recognise that the pandemic has been a really difficult time for those affected by ABI across a range of areas, not simply access to healthcare services.

This debate and previous debates owe a debt to the all-party parliamentary group and the hon. Gentleman’s leadership. I want to flag the wide-ranging inquiry into the causes, impact and treatment of ABI, culminating in the report published in October 2018, which set out a host of things that we need to address across Government. As he knows, my Department worked with officials across Whitehall to give a response in February 2019. I welcome the fact that the APPG, along with UKABIF, continues to drive the “Time for Change” agenda, most recently in an online summit held on 16 November.

One of the key issues highlighted in the report, as the hon. Gentleman said, is the importance of better Government co-ordination. I absolutely take his point. He mentioned a conversation with the Chancellor of the Duchy of Lancaster. I speak directly for Health, but I am very aware that brain injury cuts across almost all aspects of an individual’s life, from education to work and welfare, and sadly sometimes the justice system, so we need to work on this across Government. I will work with my officials to drive stronger co-ordination for ABI across Government.

On the services available to patients with ABI, the hon. Gentleman will know that since 2012 we have had 22 regional trauma networks across England, and those major trauma centres can provide the specialist care needed by patients with major trauma, including brain injury. Alongside that, timely and appropriate neurorehabilitation is a critical part of care. As the hon. Gentleman set out, that is absolutely crucial for improving the outcomes for people with brain injury. For patients with the most complex need, NHS England commissions specialised rehabilitation services nationally. Trauma unit teams then work to assess and develop a rehabilitation prescription for brain injured patients. RPs are rightly regarded as very important for rehabilitation, as they reflect an assessment of the needs of the patient in the round. That approach is showing results. As the hon. Gentleman knows, the latest data shows that 94% of patients accessing specialist rehabilitation have evidence of functional improvement.

The hon. Gentleman spoke about local commissioning and the differences across the country. The majority of rehabilitation is commissioned locally. To support that, NHS England has produced guidance setting out what good rehabilitation looks like and what services people should expect. Community services clearly play a crucial role.

Helen Whately

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I absolutely take the hon. Gentleman’s point, and I have heard the argument made about the service we are discussing and other services that are commissioned locally. There is the holy grail—people want a locally responsive health service to respond to what the community needs, but on the other hand they want consistency. Achieving both of those is hard and, arguably, not entirely possible, because the mere fact of having something locally responsive will involve some variation. However, I will also take away the hon. Gentleman’s point that there are ways to try to achieve a higher overall standard and more consistency without necessarily going all the way and saying that it must be done in exactly that way everywhere. Oversight is one way of doing that, so I shall see whether there is further we can go with regard to the point that he made.

I want to pick up on the list of questions—or the wish list, as we are approaching Christmas—

Helen Whately

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In that case, demands: I shall see which of them I can answer. One was about a national neurorehabilitation lead. During the period of covid-19 there is indeed a national lead. Suzanne Rastrick has been designated the national clinical director for rehabilitation, co-ordinating clinical advice and leadership in that area. That is for the period of covid. I appreciate that the hon. Gentleman’s demand is that it should go beyond the period of the covid pandemic.

As to whether all neurorehabilitation services will be restored after covid, I have no reason to believe that they will not, but I shall, again, take the matter away, and make sure that we see that happening. The hon. Gentleman asked whether neurorehabilitation is one of the 12 specialties that are protected during covid, and I can broadly answer yes. NHS England has made a specific provision for a subset of services, to ensure that they are protected, and complex rehabilitation services are included in that. I hope that answers the hon. Gentleman, at least on that issue. I shall look at his ask on a national neurorehabilitation strategy and consider whether it is something we can do. It is a clear request.

Helen Whately

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I was just about to conclude, and I believe that the hon. Gentleman has a couple of minutes at the end.

Helen Whately

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In that case, I shall take his intervention.

Helen Whately

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The hon. Gentleman makes a good point, and I shall, as I say, take that matter away, as the Chancellor of the Duchy of Lancaster has done as well. In conclusion, I take the matter absolutely seriously. Clearly, covid has put huge pressure on the Department, Ministers and the whole health service, but the hon. Gentleman raises a really important point about how seriously we must take the care, treatment and rehabilitation of those with acquired brain injuries. I thank him again for all that he is doing to campaign on it, and for the impact that he has in doing so.

Question put and agreed to.

The Minister for Care (Helen Whately)

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Visits from loved ones are what makes life worth living for many care home residents, yet, sadly, these have been too few over the last few months. Unlike the first lockdown, during this period of national restrictions, we want visits to be able to continue. That is why we published new guidance on 5 November advising care homes of the steps that they can take to allow safe visiting while there are high rates of covid in the community. Yesterday, we launched our visitor testing trial and plan to offer visitor testing to care homes across the country by Christmas.

Helen Whately

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We have been testing and have prioritised testing in care homes going back as far as May, and we have been carrying out whole care home testing. We are now testing over 500,000 staff and residents in care homes every week. Now, as testing capacity increases, we are launching the visitor testing trial with 20 care homes across Hampshire, Devon and Cornwall. We will use the lessons from that trial to roll out testing more widely across the country as fast as we possibly can.

Helen Whately

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I absolutely want to enable relatives to go and visit their loved ones in care homes, but we have to remember that we are against a backdrop where covid is incredibly cruel to those living in care homes. We have seen outbreaks that have gone from one resident across to almost all residents within a few days, with staff also affected, so we have to get the balance right. We have to make sure that we do this in a way that is safe to residents and staff. That is why we are carrying out the trial to learn the lessons, so that we do it right and so we can then safely roll out testing and more visiting across the whole country.

The Minister for Care (Helen Whately)

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Sadly, covid is cruel to care home residents, and outbreaks are hard to prevent and control, especially when covid rates are high in the surrounding community. As we set out in our winter plan for adult social care, we have a regime of regular testing for staff and residents, we are supplying personal protective equipment to care homes, we have been offering training in infection prevention and control, backed up by Care Quality Commission inspections, and we are providing £1.1 billion to social care specifically to go towards the cost of infection prevention and control.

Helen Whately

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My hon. Friend is a great advocate for the care sector—for those who receive care and for the workforce—in Southend West. Yesterday we launched a trial of visitor testing, and we plan to offer this to care homes across the country during December. On his question about flu vaccinations, this year we are carrying out the biggest ever flu vaccination programme. So far, the majority of care home residents have been vaccinated, but there is further to go for care staff, and I urge any careworker who has yet to have their flu jab to ensure that they get it over the next few weeks.

The Minister for Care (Helen Whately)

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Our winter plan sets out what we are doing to support adult social care during the second wave of the pandemic, including supplying free PPE to meet social care’s covid needs across domiciliary care, day care services and personal assistance as well as in care homes, and includes a further £546 million of funding for the infection control fund, bringing the total we have provided to social care for infection control to £1.1 billion.

Helen Whately

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The answer to my hon. Friend’s question is yes. Adult social care has already been at the front of the queue for testing. Care homes in Stourbridge and across the country have had whole care home testing since May. We have now sent out more than 13 million test kits to care homes. Every week we are testing more than half a million staff and residents, with nearly 90% of results back within 72 hours. I will continue to make sure that social care is a priority, going beyond care homes to include domiciliary care and supported living as we increase testing capacity.

The Minister for Care (Helen Whately)

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I thank the hon. Members for Oldham East and Saddleworth (Debbie Abrahams) and for Strangford (Jim Shannon) for securing this important debate. I commend the many personal and powerful contributions from hon. Members, but I pay particular tribute to the work of the hon. Member for Oldham East and Saddleworth, who is the co-chair of the all-party group on dementia, and to the charities that she and I both work with, such as the Alzheimer’s Society.

It has not been easy to listen to hon. Members’ stories today. They are painful to hear, let alone for those who have lived them. Hon. Members have brought great knowledge to the debate, from the clinical challenges of diagnosing covid in those with dementia to the understanding of what makes a difference for those living with dementia, from physical contact to music. Hon. Members have brought to the debate a real understanding of the burden borne by informal carers across our constituencies. If anyone needed reminding about how lives are being blighted by the cruel combination of covid and dementia, they have been reminded. Even before the pandemic, people with dementia were some of the most vulnerable in our society; they were usually older and living with other health conditions alongside this terrible progressive disease, for which we still have no cure. Dementia was already the No. 1 cause of death in this country and, tragically, more than 12,000 people with dementia have lost their lives to covid—people who still had life left to live.

Many of my conversations over the past few months have been about how much worse the pandemic has made life for people with dementia, their families and their carers. For instance, restrictions that are hard for us can make life almost impossible for them. People with dementia can find it really hard to follow instructions or the rules and guidance on social distancing and hand washing. Being made to stay at home means that they may lose the independence that they used to have, and which they might never get back. For those living in care homes, there is confusion about why their families no longer come to see them. Although the care staff are often wonderful, how can they know someone’s needs as well as their partner, son or daughter, who perhaps used to visit several times a week or even every day?

Equally heartbreaking has been the experience of families who have been unable to see the person they love for many weeks, knowing that that person might be confused and lonely, and then, tragically, finding out that their health has declined. For carers, it has been extra tough without the usual support and respite care. I thank families and carers for their incredible resilience and for what they have done, day in and day out, for the people who so need their love and care. There are more than 5.4 million informal carers in England, from children to older people who themselves might be in need of support. That is why, as we bear down on coronavirus, the Government are doing all they can to support those who are living with the consequences of this cruel disease. I will briefly set out some of those things now. As I do so, I will pick up on the questions that hon. Members have asked during the debate.

First, I will outline the overall support that we are providing, as set out in the adult social care winter plan, which specifically drew on the expertise of those who are involved in dementia care. It sets out the Government’s commitments and our expectations of local authorities, the NHS and care providers. It includes our commitments to PPE for social care, to testing and to an investment of more than £546 million, bringing our funding for infection control in social care to £1.1 billion.

The hon. Member for Oldham East and Saddleworth asked me about parity of PPE and testing between social care and the NHS. We are now providing PPE for social care to meet all its covid PPE needs. Like the NHS, social care is getting the PPE that it needs for covid. In addition, we are providing regular testing—weekly for care home staff and every 28 days for residents—and social care has been at the front of the queue. We have also learned from and adjusted some of the restrictions from the first lockdown to take account of the difficulties for those with dementia and their carers. The hon. Member for Bradford South (Judith Cummins) asked, on behalf of her constituent Tracy, if an adult caring for another adult can form a support bubble with another household. As she probably knows, an adult can form a support bubble with another household as long as that household is a single person. The restrictions allow somebody entry into the house of a person who requires care to give care, and to give the carer respite. I will take away the question of a larger bubble—I have been asked about it by other colleagues, and she and I have spoken about it—and whether I can do anything further to help on that.

The hon. Member for Leicester West (Liz Kendall) spoke about day services. I know how important they are, particularly for people with dementia and those who care for them. That is why I worked with the Social Care Institute for Excellence to provide guidance to services on how they can operate in a covid-secure way. I have said that the infection control fund can be used to help with extra costs for day services, and I have urged them to reopen in a covid-secure way. I have also been working with the Local Government Association and the Association of Directors of Adult Social Services to find out about the provision of day services—how much provision is there, where are the gaps and what more can be done to increase it?

Many hon. Members spoke about visiting in care homes. I want people to be able safely to visit their loved ones in care homes, but this is hard. Covid has taken the lives of 15,400 people living in care homes, and we know that when covid gets into a care home, particularly one that is looking after people with dementia, it is hard to control. Anyone can bring it in, particularly since many people have covid without any symptoms, so they do not know they have it. That is why we have advised care homes to restrict visiting, particularly during this national lockdown when covid rates are high in much of the country; in some areas, as many as one in four people have covid.

I did not want care homes to be closed up again during this lockdown, as they were in the first time around. We are advising care homes to do things that many have already put in place, such as allowing visits through screens and windows, but I know that that is not the answer, particularly for those with advanced dementia. That is why we are launching our trial of visitor testing on 16 November in 30 care homes. We are trialling both PCR and lateral flow tests to find the best way of doing this, with the intention of rolling out testing for visitors across the country as fast we can in December. I want people to be able to touch, hold hands and hug again. I cannot say when that will be possible, but, believe me, I want to make it possible again.

I turn briefly to access to diagnosis. At the start of the pandemic, many memory assessment services were closed and dementia diagnosis rates fell below our national ambition for the first time in four years. While we have supported remote or virtual memory assessment services, I recognise their shortcomings. I want to see in-person services fully functional as soon as possible, because a diagnosis can make such a difference so that people can access the treatment and support they need. I know the hon. Member for Leicester West, who raised this point, will understand.

I want briefly to mention the important role of charities such as the Alzheimer’s Society and the Race Equality Foundation, which are doing particular work to support black, Asian and minority ethnic people with dementia. We have supported those charities with extra funding, but I know they have gone above and beyond in their work during this pandemic.

I conclude by saying that as we navigate these challenging times, we must never lose sight of what is important. Our efforts must not just be to save lives, but also to make life worth living for everyone—thinking hardest and trying hardest for those who live with the greatest of challenges. That means doing our utmost for those with dementia and their families.

The Minister for Care (Helen Whately)

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It is a pleasure to serve under your chairmanship, Ms McVey. I congratulate and sincerely thank my hon. Friend the Member for Beaconsfield (Joy Morrissey) for securing this debate. My thanks also go to all those who have come here today and made such powerful speeches, talking about the really difficult situation of visiting restrictions in care homes. My hon. Friend spoke extremely powerfully on behalf of Jamie, acting as his advocate in this tragic situation. I thank her for discussing this with me in advance of the debate; I am looking into that case.

As many hon. Members have said this afternoon, and as Minister for Care I strongly agree, visiting is incredibly important for those living in care homes. It is hard to put into words how paramount, how crucial, contact with their loved ones is for residents in care homes, but let me offer three reasons. First, for the individual in residential care, it can be what makes life worth living. The chance to see a loved one—a husband, wife, son, daughter, grandchildren or oldest friend—these visits are things to look forward to.

Secondly, visits to see their loved ones are important for family members. I have recently heard about a couple, both in their 90s; the wife is living in a care home and her husband always used to go to see her, but he has not been able to do so for months. This is actually affecting him more than it is his wife, who sadly has much less awareness of the situation due to her advanced dementia. It is affecting him because he is not able to see her. So the visits are important for the family who want to visit as well.

The third reason is the role that families and visitors play in making sure their loved one living in the care home is safe and well—the role they play in their care, in fact. Hon. Members have spoken today about the problem of residents, especially those with dementia, who are deteriorating without the visits they are used to. The advocacy role is also important, as my hon. Friend mentioned.

To step back a moment, the Government’s overall aim is to keep people in care homes safe and well—as safe and well as possible in the extremely difficult circumstances of a pandemic of a virus that is so cruel in in how it affects the old and most vulnerable. As the hon. Member for North Ayrshire and Arran (Patricia Gibson) said, it is an incredibly hard balance to strike, and I appreciate the way she spoke about that. On the one hand we want to enable visits to care homes, to enable people to have the things that make life worth living, but on the other hand, we know that when covid has got into care homes, when there have been outbreaks, it has been extremely hard for care homes to control it. That we have seen so many deaths of people in care homes is tragic. The hon. Lady is absolutely right; it is a cause of sleepless nights for me and others who are trying to make the right decisions.

In my remarks, I intend to speak first about what has happened, then say where we are now, and finally look ahead. I will do my best to pick up some of the questions and comments from colleagues.

When the pandemic hit us, it is true to say that visits were stopped, other than in exceptional circumstances such as end of life. The problem was so bad and there seemed to be such a risk for care homes that visits were stopped. During that period, I spoke to care workers who really went the extra mile to support care home residents through that time—to try to make their lives still worth living and to have positive moments, and to use technology to keep people in touch.

I am not naïve—I know that having a screen is not the answer to the problem of visiting, but for some people in some circumstances it has enabled more contact between those living in residential care and their families. It certainly does not work for everybody. It is not the whole answer.

That is one reason why, as covid rates came down during the summer, new guidance was published on 22 July to encourage the opening up of care homes and to enable more visiting. It supported local discretion; the director of public health and the local authority would work with care homes to agree a reasonable level of safe visiting, using PPE and social distancing and so on. I was very keen to see care homes opening again. Many people did have the chance to see their family members in care homes during that period. Unfortunately, not every care home managed to open its doors at that point and, as the hon. Member for Halifax (Holly Lynch) mentioned, those in tier 2 or tier 3 high-risk areas still maintained strict restrictions on visiting.

As the hon. Member for York Central (Rachael Maskell) mentioned, there is a real problem of closed environments. One of the things that visitors do is raise a concern if there is a situation in a care home. She and I have spoken about an issue in her constituency a while ago, which was of great concern. That is why, when we went into the current lockdown, I was determined that we should not return to the situation of the first lockdown, where care homes were closed. I was determined that we should continue what visiting we could safely allow, and continue to have the Care Quality Commission crossing the threshold of care homes to identify and investigate where concerns had been raised. That is why the current visiting guidance is to encourage care homes to enable covid-secure visits, using screens, windows, visiting pods and so on.

Some care homes have been incredibly creative and innovative. My hon. Friend the Member for Warrington South (Andy Carter) had a great example of a care home in his constituency. The guidance draws on methods that we have seen care homes using over the last few months, with the aim of getting others to follow suit. It is supported by being able to draw on the infection control fund. We have put £1.1 billion into funding to support care homes with the extra costs of providing covid-secure care.

I absolutely hear the message. This is not where we want to be. I want people to be able to hold hands again, hug again and have the physical contact we all need, which is particularly important for those with dementia and those for whom this whole situation is confusing or frightening. We know it has been bad for their health and wellbeing. Right now, however, to allow such contact goes strongly against the clinical advice I have received.

I have been advised that every single additional person going into a care home takes with them the risk of taking covid into that setting. In some parts of the country, one in 40 people have covid. If there is a care home with 40 beds and each person has a visitor, one of those visitors may well be carrying covid into that care home, unbeknownst to them, because they may well have no symptoms. When it gets in, it can be extremely hard to control. That is why we have taken a cautious approach, but I absolutely want to open up care homes to allow for the kind of visiting that people want. I am looking ahead.

Hon. Members have asked about testing, which will be so helpful in reducing the risk that someone going into a care home is taking covid with them. We have a huge testing programme in place in care homes for staff and residents. Staff are tested weekly, and the vast majority of staff are now undergoing that. That is really valuable in catching covid outbreaks early. Residents are tested every 28 days, and the next step is testing for visitors. A trial will be launched this month in four local authorities in areas of lower prevalence, where the risk is lower. That will launch on 16 November in a range of 30 different care homes both to assess the practicalities of testing and to make sure that we are confident in its safety. That will trial both the polymerase chain reaction—PCR—test that has been used for some time and the newly introduced lateral flow test that can be turned around quickly.

Trialling both will enable us to see which is the best to enable visiting, and we then plan to roll that out more widely across the country in December to see how many visits testing will enable. I am optimistic that that, combined with the lower covid rates that our national self-discipline during the lockdown should achieve, will make it much more feasible to enable more testing. Looking ahead, the prospect of a vaccine that may be effective against covid, alongside testing and a supply of PPE, should put us in a much better position to achieve the level of visiting that we all want.

Helen Whately

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I am happy to do that, because I have been looking into that issue as well. The guidance I have been given is that Public Health England and those running the trial want it to take place first in the 30 care homes, which I mentioned. That will enable us to have confidence that those who have had a lateral flow test will be able to visit. There is sequencing to be done, but the issue is at the top of my mind. Lateral flows tests are already being used, and we should make the most of that to enable visiting. I hope to be able to put that more formally in writing in due course.

In the time available, I wish to pick up on a few of the other points that were made in the debate. The hon. Member for St Albans (Daisy Cooper) referred to the 30-minute time limit. I believe that that must be something that the care home in question has chosen to put in place. Our guidance advises that one should book a visit with a care home, but does not stipulate a 30-minute limit.

My hon. Friend the Member for Bexhill and Battle (Huw Merriman) set out an excellent list of things for me to take forward. Many of them are indeed in train, such as testing and work on the vaccine. The Joint Committee on Vaccination and Immunisation has proposed that care home staff and residents should be at the top of the list for that. He mentioned a reporting mechanism, which I am also taking forward.

The hon. Member for Liverpool, Walton (Dan Carden) referred to the lottery of visits. On the one hand, we responded to local authorities and care homes when they asked for more discretion and a local say in how we respond to the pandemic; on the other, we can find that in one area there is far more access than in another, so we need to combine allowing local discretion with being able to investigate whether somewhere is not being so supportive of visits. We need to ask what is going on and how can we bring this about.

My hon. Friend the Member for Beaconsfield focused on the situation of those of working age living in a residential care home. As she said, they have been talked about less during the pandemic than those of an older age, but the people of working age living in residential care are absolutely at the top my mind. As we have seen during the pandemic, those with learning disabilities might be at greater risk if they catch covid, and, like those of an older age with dementia, they need family visits and the support, love and advocacy of a family member.

As my hon. Friend also said, the pandemic has shone a light on some of the problems that existed in our social care system before the pandemic. Yes, the pandemic has been hard for social care, but there were problems before. Although the vast majority of care homes have provided wonderful supportive care—indeed, loving care—for those who live in their buildings, some have sadly let down those they care for. We must continue to identify, intervene and prevent cases where there is neglect or, worse, the abuse of those living in residential care.

We are in the thick of a pandemic that has made life so hard for those living and working in the social care sector. We have to step forward, get on the front foot and really achieve the social care reform that everyone has been crying out for, for so long. This is an, “If not now, when?” moment. We will seize this moment not only to support social care through the pandemic, but to bring about a system of social care where we can hold our heads up high and be happy for the care of our loved ones, our friends and family, or indeed for ourselves, should the time come when we need it.

The Minister for Care (Helen Whately)

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I would like to thank the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) for securing this debate on this important topic, and also for her work as chair of the all-party parliamentary disability group. Thanks to her, we are marking Down Syndrome Awareness Month here in the House with this debate today, and I am truly pleased that we have this opportunity to celebrate the brilliant contribution that people with Down’s syndrome make to our society, and also all the work of the many people and organisations who support those with Down’s syndrome to live their lives to the full.

Today, the hon. Member has outlined some fantastic stories about the achievements of people with Down’s syndrome, and also their hopes and dreams. I would like to share Michael’s story with the House. Michael has Down’s syndrome, a visual impairment and the muscle condition hypotonia. Despite his family being warned by doctors that he would probably need a wheelchair for the whole of his life, Michael has represented Wales and Great Britain in the Special Olympics and he has won more than 60 medals, which is an incredible achievement. He has not let the pandemic stop his plans. Earlier this month, he ran his first marathon in support of Mencap. He ran through rain, wind and mud to complete the virtual route around his local area in Wales. I want to take this opportunity to extend my congratulations to Michael on such an outstanding achievement.

While Michael’s achievements stand out as an inspiration to us all, I also want to celebrate the everyday achievements and contributions that people with Down’s syndrome make to their families and our communities, and the contribution they make to employment through participation and through love, friendship and laughter, enriching all our lives. That said, people with Down’s syndrome still face too many challenges and barriers. I want to see a society that works for everyone, where everyone can participate fully, feel included and be free to be themselves, so I want to talk briefly about some of the work we are doing to ensure that disabled people, including those with Down’s syndrome, are enabled to live full and rewarding lives.

First, in education, our ambition is for every child, no matter what challenges they face, to have access to a world-class education that sets them up for life, and that absolutely includes children and young people with Down’s syndrome. Supporting children, young people and adults with special educational needs is a particular need for us at this time, and our aim, even during the pandemic, is that education, health and care continue as far as possible, so that children and young people with SEND get the provision and support they need to fulfil their potential and achieve their ambitions.

The hon. Member spoke about work and employment in her excellent speech. We want everybody to have the opportunity to participate in meaningful and rewarding work and to gain the life skills and rewards that come from doing that. I am sure she knows from her work on the APPG that the Government have several programmes in place to support disabled people. An example is the Access to Work grant, which enables employers to buy personalised and tailored support to help disabled people to move into and retain employment. I should also say that, during the pandemic, Access to Work has particularly strengthened its support by making greater use of assistive technology and supporting the transport of assistive technology from workplaces to homes to enable more disabled people to work from home.

There is also the intensive personalised employment support programme, which helps disabled people with complex needs who want to work but require specialist support to do so, and the Disability Confident scheme, which supports employers to have the confidence to recruit and retain disabled people. However, I will take away the hon. Member’s question about what specific support is available through the kickstart scheme for people with disabilities, and also her point about particular schemes for those with disabilities to start their own businesses.

I also want to talk about health inequalities. We had a brief exchange about the improved life expectancy for people with disabilities, particularly those with Down’s syndrome, but despite the increase in life expectancy, there are still health inequalities facing those with Down’s syndrome and also those with learning disabilities. For instance, they are more likely to experience premature mortality. The recent Learning Disability Mortality Review report stated that the life expectancy gap for those with learning disabilities is 22 years for men and 27 years for women. That is absolutely not right.

Helen Whately

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I completely agree with my hon. Friend. I do know that those with Down’s syndrome are in employment, but let us continue to support that as one of the rewarding things for everybody to experience in life. As he said, life expectancy has indeed improved enormously, but I am ambitious and determined that we go further and make sure that we reduce health inequalities for people with disabilities.

Helen Whately

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The hon. Member makes a really important point. It is clearly a very difficult and sensitive topic, but it is absolutely the case that if, during pregnancy, any abnormality is detected or suspected there should at no stage be any bias towards abortion, which is what, as I understand it, she is referring to. I want to make that absolutely clear. It must be the case that all health and care staff involved in the care of a woman or a couple who might be considering the termination of a pregnancy must adopt a non-directive, non-judgmental and supportive approach. That absolutely should be the case throughout our health system. Should anyone experience anything different and find that that is not the case, they should raise it, because women and couples should be supported in a positive way so that they can make the right choice for them. I am choosing my words carefully given that this is a very sensitive topic.

While I have the opportunity, I want to talk briefly about the importance of the Oliver McGowan mandatory training in learning disability and autism, which the Government have committed to rolling out to make sure that all health and social care staff receive training in learning disabilities and autism. That is really important to make sure that people with those conditions get the right and appropriate care when they are in the health and care system, including, I should say, for end-of-life care, making sure that do not attempt CPR—cardiopulmonary resuscitation—orders are used appropriately.

In the light of the pandemic, one thing that has been raised with me, particularly for those who are caring for those with disabilities, is the importance of day services and respite services. I have been working really hard, including with the Social Care Institute for Excellence, on guidance to support the reopening of day services and to encourage local authorities to make sure that those are reopened.

To conclude before we are out of time, I am so glad that we have had this debate and been able to talk about the contribution that those with Down’s syndrome make to our society, and, to use a phrase from the excellent speech by the hon. Member for East Kilbride, Strathaven and Lesmahagow, to have made our contribution to changing the narrative. It is crucial that we should celebrate the achievements and contributions of those with Down’s syndrome to our society, so we have been and are taking action to support those with disabilities, including Down’s syndrome, but I believe that we can always do more and go further. So I say, let’s do that. Let’s do more and go further to support people with Down’s syndrome to achieve their dreams.

Question put and agreed to.

The Minister for Care (Helen Whately)

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I beg to move,

That the Health Protection (Coronavirus, Restrictions) (North of England and North East and North West of England etc.) (Amendment) Regulations 2020 (S.I., 2020, No. 1074), dated 1 October 2020, a copy of which was laid before this House on 2 October, be approved.

These regulations came into force on Saturday 3 October. They were introduced, based on the latest epidemiological data and local insights. The data showed rapidly rising rates of covid-19 infections in Merseyside, Halton, Warrington, Hartlepool and Middlesbrough, indicating an urgent need for further steps to control the outbreak. The regulations also introduced an easing of restrictions for Bolton, based on the stabilisation situation compared with the rapid growth in case numbers a few weeks previously.

These regulations represent targeted measures designed to reduce transmission in areas where incidence rates are high. We do not want to, and will not, impose regulations where they are clearly unnecessary, but where we do, while public health is our priority, we are balancing the need to impose measures to tackle the transmission of the virus with protecting our economy and education.

Helen Whately

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My hon. Friend makes a really important point. In making these decisions, we look at multiple factors. We look at the incidence rate per 100,000, for instance. We look at the positivity rate—the percentage of tests that are positive—and we keep a close eye on hospital admissions. All those factors are important. The good thing about the data from our testing systems is that they give more leading indicators of things that may follow on. All of those are an important part of the information that goes into the decisions that are made.

Incidence rates across Merseyside, Halton and Warrington over the seven-day period 17 to 23 September 2020 range from 163.3 per 100,000 people in St Helens to 257.7 per 100,000 people in Liverpool. Test positivity was high too, ranging from 10.5% in the Wirral to 15.7% in Liverpool in the same period. With those levels of infection, including growing infection rates in people aged 60 and over, for whom we know the risks of complications are greater, action was clearly necessary. By contrast, in Bolton, which until the regulations were introduced was under greater restrictions and interventions than nearby areas, infection rates have stabilised, although they are still high, at 241.8 per 100,000 people, with a test positivity rate of 12.3%.

Many areas across the north of England have been subject to extra restrictions, in some cases, for weeks. I know that that is really hard for people, day in, day out, and for many businesses. The regulations do not introduce any new measures, but they amend existing legislation.

Helen Whately

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I thank my right hon. Friend for his intervention. I will come on to the impact and detail of the rationale for the interventions.

Helen Whately

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The hon. Lady makes an important point about the impact of restrictions on people’s livelihoods as well as their lives. However, she is asking me to stray beyond my brief as a Health Minister to talk about the financial support, although she will be aware that the furlough has supported huge numbers of people during the period of lockdown and since, and the Chancellor has introduced further measures to support people in the months ahead.

Helen Whately

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I will make a little more progress and then I will take further interventions.

I will now run through each of the regulations that were amended. The first was the Health Protection (Coronavirus, Restrictions) (North of England) Regulations 2020—SI 2020/1057—which changed the geographic areas covered by the north of England regulations. Halton, Knowsley, Liverpool, Sefton, St Helens, Warrington and the Wirral were removed. These local authority areas were then added to the north-east and north-west regulations—SI 2020/1010. Two new areas were also added to the same protected area, Hartlepool and Middlesbrough. For each of these, this was the first time that local restrictions had been implemented. People living in these areas are prohibited from mixing with people from different households in each other’s homes and gardens, and in any indoor public venue.

Next, these regulations added Bolton to the geographic area covered by the north of England regulations, rejoining the other local authorities that make up Greater Manchester. This amendment meant that the takeaway-only restriction affecting hospitality was removed, so businesses in Bolton have been once again able to serve food and alcohol with table service. Due to Bolton being added to the north of England regulations, the Health Protection (Coronavirus, Restrictions) (Bolton) Regulations 2020—SI 2020/974—were revoked.

The final regulations amended by these regulations is the Health Protection (Coronavirus, Restrictions) (Obligations of Undertakings) (England) Regulations 2020—SI 2020/1008—which were incorrectly amended before. This amendment ensures that the right exemptions apply to the requirement on pub, café, restaurant or bar managers in the protected area of the north-east and north-west regs to take all reasonable measures to stop groups of six in areas where only national restrictions apply, or members of the same household in the north-east and north-west protected area from singing on the premises.

To come to the decisions behind these regulations in more detail, given the urgency of the situation and the rapidly increasing numbers of people testing positive for covid in Merseyside, Halton, Warrington, Hartlepool and Middlesbrough, we consulted local leaders last week on the potential next steps. Similarly, we consulted local leaders in Bolton.

Helen Whately

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I thank my hon. Friend for his comment. We are trying to get the balance right between wanting to target restrictions and not impose them on areas where they might not be needed, while being mindful that if every area has its own local variant specifically, it does get more and more confusing, so there is a clear balance to strike in being targeted but also trying to keep things simple.

Helen Whately

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Let me just come to Bolton. I was saying that we had consulted local leaders in Bolton and we used the emergency procedure to make the present set of regulations as soon as we could. Recognising the concern about the time that it can take for Parliament to debate these statutory instruments and given the pace of the pandemic, I hope that hon. Members acknowledge that we are debating today measures that came into force just this Saturday.

As I mentioned, for the implementation of these measures, existing legislation was amended rather than bringing in new Acts. We reviewed the impact of existing regulations and considered where they needed to be more robust or could be eased. We took into account the existing measures in place elsewhere and assessments of the impact that those measures were having. The complexity of local restrictions has been highlighted recently, so the decision was made to impose regulations already in place rather than to develop new ones.

There is extremely serious concern about the outbreak in the north of England, the north-east and the north-west, both at the point the decisions were made to introduce further restrictions and ongoing. Engagement with local public health teams and local leaders has been extensive. I would like to thank the local council leaders, local authorities more broadly and the local resilience forums, as well as Public Health England, the Joint Biosecurity Centre, and the local and regional directors of public health for all their engagement and all the work they are doing. All the local councils involved have engaged sensibly at chief executive and other levels, and I know they have also been doing a huge amount locally—for instance, working to increase compliance, supporting increased access to testing, working with care homes and supporting the most vulnerable. We will only succeed in suppressing this virus by working together at every level.

Helen Whately

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My hon. Friend invites me to stray somewhat from the subject of this SI and the updates to the regulations, but clearly from what he said, he is well aware of all the work that is going on for us to have a vaccine. He is also well aware that the priority at the moment is that we absolutely have to suppress this virus because the alternative does not bear thinking about.

Helen Whately

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Again, my hon. Friend is asking me to stray beyond the scope of the SI, but what I will say is that, in the decisions that are made about interventions and policies more generally, clearly we are always looking at what is going on and what the transmission rate is. Something we saw during the period when there was eat out to help out was that that was a period when, in general, we had lower rates of infection. It gave great support to the hospitality sector, which had been clearly having a really difficult time. We are now very much seeing a second wave, particularly in much of the north of England, and therefore it is absolutely appropriate that there are, in general, greater restrictions. We absolutely must suppresses this virus and one place where we know that infection goes on is through hospitality, where there is social contact.

I will return to the job in hand, Madam Deputy Speaker. Guidance has been updated for people living in protected areas to make it clear what they can and cannot do under the restrictions. Again, I know local authorities are working hard on communications as these measures only work if people know about them, understand them and comply. These regulations, as with the other local regulations we have debated already, demonstrate that we will take action where we need to. In mirroring the restrictions that have been used in other parts of the country, we are drawing on and learning from experience. We will, of course, use continued experience of these measures to inform and help us develop our responses to ongoing local outbreaks.

I reiterate to the House that, for significant national measures with effect in the whole of England or UK-wide, we will consult Parliament and, wherever possible, we will hold votes before such regulations come into force, though of course responding to the virus means that the Government must act with speed when required, and we cannot hold up urgent regulations that are needed to control the virus and save lives. I am sure that no Member of this House would want to limit the Government’s ability to take emergency action in the national interest, as we did in March, but we will continue to involve the House in scrutinising our decisions in the way my right hon. Friend the Prime Minister set out last week. This will be through regular statements and debates, and providing opportunities for Members to question the Government’s scientific advisers more regularly. I am grateful to all Members for their continued engagement in this challenging process.

Helen Whately

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I am just wrapping up, and I have taken many interventions. I am very sorry, but I am not going to take a further intervention at this point, as there are people waiting to speak.

I particularly thank people in the protected area in the north of England, who are restricting social contact and forgoing many of the things that make life worth living. In so doing, they are playing their part in supressing the virus and protecting those whose lives are at risk.

Helen Whately

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I thank colleagues for the contributions that have been made today, which I have listened to very carefully. There have been some extremely heartfelt speeches on all sides of the House that clearly reflect the enormously difficult time we face right now in this country for all our constituencies and all our constituents. They are facing restrictions and things that affect their day-to-day life—their livelihoods, the businesses they may run or work in, or, for instance, visiting relatives in care homes; we want to do everything we can to make sure that can be done safely.

But this does all reflect that we are truly facing a global pandemic and, as I said yesterday, for those who were in the Chamber for the debate yesterday, the greatest crisis or the greatest challenge that our country has faced since the second world war. That means that, however we want things to be, at the moment there is no way they will be as we want them to be. I am sure hon. Members on all sides of the House recognise that everybody, whatever role they are in, is doing their very best to make things as least bad as they possibly can be.

The reality is that we are fighting this truly invisible, deadly enemy that is spreading through our communities—and we know, sadly, killing as it goes—and we must suppress it, but do so with this incredibly difficult balance. Colleagues have talked about the impact on businesses and the local economy in their constituencies. We must do so while doing our utmost to protect the economy and, of course, keep kids in school and support those in university and other forms of education. As has been said, if the pandemic spreads faster and further, that in its own right also has impacts on the economy—not just the restrictions, but the impact of the pandemic itself and more people getting covid.

As the Government have responded over the weeks that have passed, we have been constantly learning, listening, adapting—learning from those overseas, as well as from the data that we have built up ourselves—and working closely with those in local areas, because the only way we will win against this virus is, indeed, by working together, fighting together and defeating it together.

I now come to some of the comments from honourable colleagues. One thing that came up several times is: why are we seeing different action in different areas? What I will say is that numerous factors are looked at—the incidence rate, the positivity rate, hospitalisations, intensive care units and, of course, taking into account local views. That absolutely has been taken into account in the regulations that we are debating today. As for the impact—in fact, one colleague asked: are they still necessary?—some areas have come out of some restrictions and seen easements. We do know that it takes time for there to be an impact, but we need to continue to take the steps that are necessary because, as we know, the real exit from this is for us to see rates come down.

We are clearly working flat out for a vaccine, and we are continuing to build up the capacity of our test and trace system. I want to pick up one particular concern that there might have been some problem in that there was not the right data because of the technical problem last week. What I will say is that actually the data on which these decisions were made, or the data that did not feed through was too recent to affect these decisions, but it will feed into future decisions—very much so. What I will say, and ask colleagues to remember, is that we have built up the capacity of our testing system from testing 2,000 people a day to being able to test well over 200,000 people a day, which is not to be sniffed at, and working up to 500,000 day by the end this month.

Members have asked about local test and trace. Absolutely, the systems work together. The national system does work with local tracers and is working with local teams, although what I will say to those who want their local public health to be running the whole thing is that I am hearing from local public health teams that they are really maxed out with a huge number of responsibilities at the moment. We should continue to work together, because the local and national complement each other.

There are no easy answers. Some colleagues have said that they want restrictions that are easier to live with. Restrictions on our social contact will be hard to live with. I would like to say a huge thank you to all our constituents across the country who are playing their part in following these restrictions, as we must do ourselves. I commend these regulations to the House.

Question put and agreed to.

Resolved,

That the Health Protection (Coronavirus, Restrictions) (North of England and North East and North West of England etc.) (Amendment) Regulations 2020 (S.I., 2020, No. 1074), dated 1 October 2020, a copy of which was laid before this House on 2 October, be approved.

The Minister for Care (Helen Whately)

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NHS Test and Trace launched in May. Four months later, more than 150,000 people who have tested positive for covid-19 have been contacted, and 450,000 of their contacts have been reached so that they can self-isolate. We have tested more than 7 million people at least once and many, such as care home workers, more than once. Rapid expansion brings with it challenges. Working with local authorities, we will continue to improve test and trace, as it is an important part of our armoury to defeat this virus.

Helen Whately

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I thank the hon. Member for her question and for the work that she does with the APPG, which I joined recently for a very valuable conversation. Supporting care homes through the pandemic and in the months ahead is absolutely our, and my, priority. One part of that is ensuring that they have the testing that they need. We are getting regular repeat testing to care homes. I acknowledge that the turnaround times have not been what we would have liked them to be, but those turnaround times are coming down and we are seeing a rapid improvement in performance.

Helen Whately

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I thank the hon. Member for her question. I am sure she will know that local authorities received £400 million to support them with local outbreak management. It is really important to have this coming together of the national system and the local system, where local authorities are indeed playing an important part, using their local knowledge to follow up with contact tracing, particularly for some of the contacts that are proving harder to reach.

Helen Whately

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There was quite a lot in that question. One thing I will say on schools is that enabling our children to continue to go to school is very much part of the whole strategy that we are using to tackle and suppress coronavirus, because education is so important. On the specific test and trace system to which the hon. Member refers, the Secretary of State spent an hour and a half in the Chamber yesterday answering colleagues’ questions about the performance of that system.

Helen Whately

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Well, it is very good to hear of the set-up in York that the hon. Member describes, and what I can do is take away from here and follow up to ensure that there is joint working, which we know is a really effective way to bring together national resources with the local resources, expertise and knowledge that are so important in tackling this virus.

Helen Whately

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The context is the huge increase in the testing capacity of our system that we have already seen, going from in the order of 2,000 tests a day back in March to well over 200,000 tests a day now and building up to 500,000 tests by the end of this month. I recognise also that there is both the Lighthouse labs—what is known as pillar 2 testing system—and the important part that NHS testing facilities play in the pandemic. And of course the hon. Member will know that a huge amount of money has been and is going into the NHS to support its response to covid.

Helen Whately

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It may be helpful to say that, since the NHS Test and Trace system started, it has contacted 78.5% of those who have tested positive, and then 77% of their contacts have been reached. There is an important part of the system where the national contact tracers are handing over to local authority contact tracers who are able to access the same system and are supported in contact tracing but, critically, are also using their local knowledge of the local area to increase the success rate. It is really important that people are reached wherever possible and advised to self-isolate.

May I also say how much I appreciate and thank all those who are doing the right thing by self-isolating, both those with symptoms and those who have been contacted by contact tracers?

Helen Whately

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I do not recognise the hon. Gentleman’s suggestion that there could be a two-tier system. What we have in place is a universal system where everybody who has symptoms is able to access a test. As he well knows, where we know there are particular risks, such as for those in care home settings, there are also tests for those who do not have symptoms so that we can pick up outbreaks early. A huge amount of resource and investment is going into developing new technologies for testing—easier testing, quicker tests and tests that can be done at greater scale—because this is all part of building up our testing capacity, so we can suppress this horrid virus.

The Minister for Care (Helen Whately)

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Education, health and care plans identify the support needs of children and young people across those three areas. Local authorities and health bodies are required to jointly commission the services. The Government are currently undertaking a review of the special educational needs and disability system, and I am working on this with my ministerial counterpart in the Department for Education.

Helen Whately

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My hon. Friend makes an important point about how we need to see children and young people getting in place, as soon as possible, the support that can help them and about how there are waiting times for these plans. There are two things I can say in response. First, in the context of covid, NHS England has made it clear to NHS organisations that they must restart and restore services that support children and young people with EHC plans and in the assessments for those plans. Secondly, in the review of the SEND system, we are indeed looking at how we can address some of the problems in the system and achieve better integration across health, care and education.

The Minister for Care (Helen Whately)

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Universities have a duty of care to support students who are required to self-isolate. The Department for Education is working with universities to make sure that where an outbreak occurs, support is in place. That includes ensuring that students with cystic fibrosis and other long-term health conditions who are self-isolating have access to the food, medicine and medical care they may need.

Helen Whately

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The hon. Lady asks a really important question. Clearly, it is a difficult time for students starting university now, but particularly for those with long-term health conditions such as cystic fibrosis. Overall, as she knows, the context is that we are prioritising education. We do not want students to put their life on hold, but we do want them to be supported by their university, particularly if it is harder for them to self-isolate because of health conditions. I am in regular contact with the Minister for Universities and will take up with her the specific questions about support for students with cystic fibrosis and access to supermarket deliveries. If the hon. Lady would like to raise any specific case with me, she should let me know and I will take that up with the Minister for Universities to address the specific issues.

The Minister for Care (Helen Whately)

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We have sweated blood and tears to support the sector through this pandemic. Last month, we launched the adult social care winter plan, with regular testing for care home staff and residents, free personal protective equipment and mandatory infection prevention and control measures for care providers, supported by £546 million of Government funding. I am enormously grateful to all those on the frontline in social care. I recognise the challenges that they have faced and how many feel daunted by the winter ahead. I say to care workers: “I cannot thank you enough for what you do and I am with you every step of the way.”

Helen Whately

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My hon. Friend makes an important point about the importance of visiting both to the individuals living in care homes, and to their family and friends. Achieving the balance between protecting care home residents from the risk that covid might be brought into the care home, where it is so hard to control, and giving them access to visitors, has been one of the hardest areas to get right over the past few months. That is why in the summer we issued guidance on safe visiting and gave more freedom on the decisions about visiting to local authorities, with directors of public health working with care homes. I want us to continue to support and enable safe visiting for care homes.

Helen Whately

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The infection control fund is being distributed in two equal instalments, the first of which has already been paid to local authorities. My hon. Friend’s local authority, Cheshire East Council, will be receiving £4.7 million in total, so it should already have received £2.35 million to go towards the extra costs for care providers and others in infection prevention and control.

Helen Whately

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I thank my hon. Friend for his comments, but most of the credit should go to those working in social care, who have been looking after some of the most vulnerable people in our society in such difficult circumstances. He is right that it is really important that we ensure that there is no transmission between one care home and another, which is why we are requiring care homes to make sure that their staff work in only one setting and are providing additional funding to enable them to do this.

Helen Whately

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First, may I congratulate my hon. Friend on his recent report on levelling up our communities? As he said, care homes have indeed been the focus of our social care response to the pandemic, but I would not want anyone to think that that was the limit of our support for social care during the pandemic; the winter plan also includes support for domiciliary care, supported living and others. I agree with him that as we look to the future, we should support the aspiration that most people have to live independently, with their own front door, well into their old age. There are no plans to create a national care service run from Whitehall.

Helen Whately

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The hon. Member makes an important point, as did my hon. Friend the Member for Derbyshire Dales (Miss Dines) a moment ago, about the importance of visiting for those in care homes, and for their relatives and loved ones. We are striking the difficult balance between protecting those in care homes and ensuring that they have visits wherever possible, but these visits must be done safely. I have heard from the sector about the aspiration for some family members to be treated as care workers—for instance, if they visit the care home regularly. As we expand testing, I very much intend that we should test some visitors—and am making the case for doing so—but it is all part of how we expand and use our testing resources.

The Minister for Care (Helen Whately)

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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.

Helen Whately

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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.

Helen Whately

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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.

Helen Whately

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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.

Helen Whately

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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—

Helen Whately

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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.

Helen Whately

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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.

Helen Whately

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I will just move on as I am conscious that I have taken quite a number of interventions—

Helen Whately

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Okay then.

Helen Whately

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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

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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

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I am sorry but I was closing my speech, not taking an intervention. That was the end of my speech. [Interruption.]

Helen Whately

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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.

Helen Whately

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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

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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.

Helen Whately

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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.

Helen Whately

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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

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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

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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

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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.