(3 years, 4 months ago)
Commons ChamberI normally thank the Minister politely at this point in the day, but I really do thank the Minister for what he has just said on this particular occasion.
On a point of order, Madam Deputy Speaker. Earlier, you announced the excellent, historic victory of England over Germany. How can I record my congratulations to the English team on behalf of all the people of Northern Ireland, not just in my constituency of Strangford but across from Newry to Londonderry and from Portrush to Enniskillen, where the Union flags are flying? I have one flying at the end of my farm lane. It could be that those flags are flying in celebration of the forthcoming 12 July celebrations, but I believe that they are flying to support England, so how can we send our support from Northern Ireland and wish England well for the quarter finals and for this competition? Our team, England, are playing in the quarter finals, and that has got to be good news.
(3 years, 4 months ago)
Commons ChamberI thank my hon. Friend for raising that issue about his local hospital. As a constituency MP, I absolutely understand the importance of local hospitals and having that support in the local community. This hospital in particular has done a great job with vaccinations, and it continues to do a fantastic job. I think that is a very good sign of the contribution that it can potentially continue to make for the local community, and I would very happily meet him.
I thank the Secretary of State for his statement and, as the Democratic Unionist party health spokesperson in this place, I wish him well, on behalf of my party, in his new role. I have absolutely no doubt that he will do an excellent job.
If we are aiming for progression and moving away from restrictions such as the wearing of masks, may I ask when people will be able to attend worship and sit in churches self-distanced, without wearing a mask, just as diners can sit in a restaurant self-distanced without a mask? If we are going to have parity, then I believe that churches should have parity with restaurants.
I thank the hon. Gentleman for his remarks. I agree with him that as we move towards removing restrictions and step 4, we should take seriously into account what he said about people attending churches and the restrictions that they currently face. That is certainly my intention.
(3 years, 5 months ago)
Commons ChamberIn winding up the last debate, the Minister for the Armed Forces referred to volunteering a mucker for the guardroom. I hope that my entire speech does not sound like that to the Secretary of State; it is not intended to.
Every couple of years, Whitehall, like an overexcited teenager expecting a new mobile phone, becomes fixated with data. Most recently, it has been about the power of big data mining, and I am sure that that is not just because of the influence of Mr Dominic Cummings. The Department of Health and Social Care wants to open our GP medical records—55 million datasets or thereabouts—to pharmaceutical companies, universities and researchers.
Managed properly, that data could transform, innovate and help to overcome the great challenges of our time, such as cancer, dementia and diabetes. Those are proper and worthwhile ambitions in the national interest, and I have little doubt that that was the Government’s aim, but that data is incredibly personal, full of facts that might harm or embarrass the patient if they were leaked or misused. Psychiatric conditions, history of drug or alcohol abuse, sexually transmitted infections, pregnancy terminations—the list is extensive. Revealing that data may not be embarrassing for everyone, but it could be life-destroying for someone.
Unfortunately, in keeping with the Department’s long history of IT failures, the roll-out of the programme has been something of a shambles. The Government have failed to explain exactly how they will use the data, have failed to say who will use it and—most importantly—have failed to say how they will safeguard this treasure trove of information. They describe the data as “pseudonymised” because it is impossible to fully anonymise medical records, a fact that is well understood by experts in the field.
Even pseudonymised, anyone can be identified if someone tries hard enough. Take Tony Blair, who was widely known to have developed a heart condition, supraventricular tachycardia, in October 2003. He was first admitted to Stoke Mandeville and then rushed to Hammersmith. One year later, in September 2004, he visited Hammersmith again for a corrective operation. Even the name of the cardiologist is in the public record. A competent researcher would make very short work of finding such individual records in a mass database. That cannot be for the public good. Moreover, the Government seem to intend to keep hold of the keys to unlock the entire system and identify an individual if the state feels the need to do so.
I congratulate the right hon. Gentleman on securing the debate; I have been inundated with the same concerns from many of my constituents. Does he agree that a system that allows a diversion from the court-appointed warrant to collect information is a dangerous precedent in terms of judicial due process? We must ensure that anyone who opts out is completely opted out, as is promised.
(3 years, 5 months ago)
Commons ChamberUrgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
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My hon. Friend is clearly having conversations in his constituency, and he makes an important point about the scale and number of people who have involvement in the care system. There are over 1.4 million people who receive care, over 1.6 million people in the care workforce, and over 5 million unpaid or family carers. The scale is huge and is growing as more people need care. My hon. Friend is absolutely right that this is not a party political issue; we need to come together and build a consensus across Parliament, but also across society as a whole—and, yes, we will bring forward proposals for reform later this year.
I thank the Minister for her statement today on social care reform. An issue close to my heart is support for carers in the form of respite; in particular we have generations of young carers who need a break after the isolation of the pandemic. Will the Minister commit to making funding available specifically to provide respite overnights for carers who carry out their activities 24/7 and need support more than ever right now?
The hon. Gentleman makes a really important point about respite for carers. Being a carer is hard and back-up support and respite services help make it more possible, but frustratingly, during the pandemic many of those services have not been able to function as normal. I am currently working with Ministry of Housing, Communities and Local Government Ministers to help local authorities across England ensure that day services and respite care are fully restarted as that is very important, and I would like to see that across the whole of the UK.
(3 years, 5 months ago)
Commons ChamberI would like to thank Mr Speaker, through you, Madam Deputy Speaker, for allowing parliamentary time on this important topic in this Adjournment debate on miscarriage. I wanted to bring to the Chamber’s attention the recent series of papers published in The Lancet entitled “Miscarriage matters” and the petition by Tommy’s on support for women after miscarriages. The petition currently has over 170,000 signatories.
I know that this topic is often one that is difficult to talk about, but I hope that by giving the Chamber an opportunity to hear some of the experiences and latest research, this debate can act as a catalyst for change for miscarriage services in the upcoming women’s health strategy. For too long, miscarriage has been a taboo, and I was disappointed that while the press release on the women’s health strategy call for evidence mentioned breaking taboos, it did not mention miscarriages directly—only pregnancy-related issues.
I am so pleased that prominent women, like Meghan Markle and Myleene Klass, have been brave enough to speak and break the taboo about their experiences. Miscarriage is little spoken about but incredibly common. One in four pregnancies is thought to end in miscarriage. The research suggests that 15% of recognised pregnancies around the world end in miscarriage—that is 23 million a year or 44 miscarriages a minute. Black mothers face a 40% higher relative risk than white mothers and the risk of miscarriages is lowest between the ages of 20 and 29, but goes up threefold by 40 and fivefold by 45. Unfortunately, I think that this commonality and the well-known challenges in women’s health have meant that services are not always set up in the best interests of women. Miscarriages are often a symptom of an underlying health condition. They should not just be seen as a fact of life, and I am concerned that this attitude speaks to wider gendered inequalities in our society.
I shared my own experience in a Westminster Hall debate last year and I have been overwhelmed by families contacting me to share their experiences. I have heard from women who have never told anyone but their partners that they have experienced a miscarriage and women who have experienced this 30 years ago still carrying the hurt, and now, some are seeing their children going through exactly the same issues. Although I spoke of my loss to highlight the impact of the pandemic, what is clear to me is that, covid or not, there are some huge holes—sometimes voids—in the care provided. Some people are lucky enough to have access to fantastic services and early pregnancy units. Others attend their GPs and others end up at A&E. Unfortunately, some attitudes seem to be very, very prevalent both in society and in some health services.
May I just say how moved I was—the hon. Lady knows this—by her contribution in Westminster Hall on that day? It moved me to tears. I congratulate her on securing this debate. We should change the way we handle support for miscarriages as a result of that debate. Does she not agree that the threshold of three miscarriages in a row for NHS investigation must change, as every miscarriage is devastating and the estimation of an acceptable level of loss is abhorrent?
I absolutely agree and I will come on to the issue of how care is provided later in the debate.
There seems to be a general lack of understanding that while miscarriage is common it is also incredibly traumatic and can lead to mental health problems. The Lancet research series highlights that anxiety, depression and even suicide are strongly associated with going through a miscarriage. Partners are also likely to be affected and previous reports have highlighted links with post-traumatic stress disorder. Despite that, the loss associated with miscarriage can often be minimised with phrases such as, “It’s okay, you can just try again,” or “It just wasn’t meant to be this time.” After my miscarriage, I got into a cycle of blaming myself and obsessing over what went wrong—if I ate the wrong thing, lifted something too heavy and so many other ridiculous thoughts. I have had to have counselling to deal with my trauma, but it was not offered. It was something that I had to seek out myself.
The same cycle has been described back to me again and again and again by people who have experienced miscarriages. My brave constituent Lauren, who has allowed me to share her story today, has sadly suffered three miscarriages. She has never ever been offered any mental health support through the miscarriage pathway. In fact, even after she requested it, her miscarriages were not even recorded on her medical notes, leaving her to explain to five different healthcare professionals about her three miscarriages. On one occasion, a member of staff asked her when she had had her first child. That is clearly incredibly distressing, and why I support calls for better data collection and patient recording of miscarriages.
Women have also told me about suffering three, four and five miscarriages. The reasons found for them were underlying health conditions, such as blood clotting disorders, autoimmune diseases and thyroid disease. Since my miscarriage, I ended up in hospital again and was diagnosed with diabetes, an issue that may have been picked up if testing had been carried out at the time of my miscarriage. The information I have received since my diagnosis of diabetes about pregnancy has been very informative and helpful, and a really stark contrast to those who have to get information about miscarriage.
There are some excellent examples and many, many committed staff who often share the frustrations about the system, which has a hard cut-off of 24 weeks for some support services. We have seen a huge number of organisations stepping forward to fill the gaps in support and advice: Tommy’s, Sands, the Miscarriage Association and, locally in Sheffield, the Sheffield Maternity Cooperative. I spoke with Phoebe from the Cooperative, an experienced midwife who herself has gone through a miscarriage. She works with individuals and families across the city to provide timely, appropriate and sensitive care, after her own experiences were, unfortunately, the exact opposite of that.
So what shall we do? I hope today the Minister will respond to the key findings of The Lancet series and to these key asks. The first is that the three-miscarriages rule has to end. The large number of people who signed the Tommy’s petition shows the strength of feeling on that. We would not expect someone to go through three heart attacks before we tried to find out what was wrong and treat them, so why do we expect women to go through three—in some cases preventable—losses before they are offered the answers and treatments they need? Instead, the research recommends a graded support system where people get information and support after their first miscarriage—we should not phrase it like that, though—tests after the second, and consultant-led care after the third.
The second key ask is 24/7 care and support being available. That care should be standardised to avoid a postcode lottery or the patchy provision currently available, and it should include follow-up mental health support to help to reduce mental illness post miscarriage.
Finally, we need to acknowledge that miscarriage matters and start collecting data on miscarriage, stillbirth and pre-term rates. I was shocked to find that no central data existed on the statistics and these estimates are based on very many different sources. We must break the taboo on miscarriage. I know from personal experience, and from many people who have contacted me, that we could do so, so much better. Will the Minister today commit to take forward these proposals and take a stand for women, individuals and families the system is failing? And will she meet me and campaigners to discuss this issue further?
(3 years, 5 months ago)
Westminster HallWestminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
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I beg to move,
That this House has considered the value of vitamin D as a defence against covid-19 infection.
It is a pleasure to serve under your chairmanship, Mrs Murray. As so often happens, this is one of the debates that I applied for ages ago, and then they all come. I have a debate next Tuesday as well, which has been around for some time, but it is always a pleasure to speak in Westminster Hall. I love Westminster Hall. I love this place and I love speaking in the Chamber. I love the ritual, the tradition, the history, and how things are done. It is great to be a part of it and I feel very privileged. I know other Members feel that as well.
I am pleased to see all my friends here. I have many friends in this place—at least, I hope I have. It is always good to see the Scottish National party and the Labour party’s shadow spokespersons in their place. The hon. Member for Nottingham North (Alex Norris) and I often debate here together. It is wonderful to see you in your place as well, Mrs Murray. I look forward to a constructive and good time.
I am pleased, as always, to see the Minister in her place. I say that every day, but that is not to say that I mean it any less. I genuinely look forward to her response and to what we can do. Other Members who I had hoped would be here have various other things to do, perhaps something to do with the by-election in Chesham and Amersham or whatever. People who perhaps had hoped to be here, unfortunately, are not, and we have to accept that and move ahead.
On this debate on vitamin D, other right hon. and hon. Members have a greater knowledge than I do, and perhaps if they had been available today their contributions would have greatly enhanced the debate and the conversation.
Vitamin D could well play a role in the immune response to respiratory viruses and could potentially mitigate the inflammatory response. I want to put that on the record at the beginning. I also want to declare an interest as chair of the all-party parliamentary group for respiratory health, which I have a particular interest in. I have chaired it for some time and we did an inquiry last year. Hugh McKinney does the admin and helps me greatly in the job that I do and the role that I play in the inquiry, and in the launch of its results and conclusions. I look forward to the year ahead.
I also want to place on the record my thanks to the Backbench Business Committee for granting time for this debate. I also thank those who have met with me and written to me in recent months on this subject, all motivated by deep concern about the shocking toll that covid-19 has had on so many families, my own included. Right hon. and hon. Members will know that I lost my mother-in-law in October last year to covid-19. It came very quickly. I think very few families have not been touched by covid-19 and have not lost family members as a result. It has been in every corner of this great United Kingdom of Great Britain and Northern Ireland.
The covid-19 pandemic sent shockwaves through societies around the world. As we gradually move towards life in a post-pandemic society, many questions will be asked as we consider the impacts of the disease on our communities and economies. Last night, I personally voted with the Government on the two motions that came before the House, because I believe—we have this saying, as I am sure you do, Mrs Murray—it is better to be safe than sorry. I think it is better for us to be more cautious and take the extra four weeks, and then I hope we can relax some of the regulations on 19 July and move out from there.
Some of the questions that will be asked will be difficult. What made the world so vulnerable, and why were so many people ill-prepared? I say people, but it was probably Governments that were ill-prepared. Predictability is one factor that was missing from this pandemic, and I understand that only too well. With previous outbreaks of swine and avian influenzas, there were key links to the ecologies of poultry and pig farming in certain nations, but nobody predicted the Ebola outbreak in west Africa in 2013 or indeed the Zika virus outbreak in South America in 2015.
I believe it can be said that covid-19 was the major global pandemic that the world expected to happen at some stage, and yet no country was prepared, ready or equipped to fight it as perhaps they could have been. I am ever mindful of the fact that this time last year—indeed, as far back as March last year—it was hard to know what was the right thing to do because of the uncertainty over how covid-19 would react and the number of people who were being diagnosed with, and dying from, the disease. It is always very difficult to find a strategy right away, but I think perhaps we should have been a wee bit more prepared to respond in a good way.
Many lessons have been learned, and I know that we are all learning. I am a great believer in the saying, “I learn something new every day.” Anyone who is of an inquisitive nature, as of course I am, wants to learn things so they can use them in the life they lead, as I do here as an MP, or when I deal with constituents back home in the office. Covid-19 first emerged from Wuhan in 2019, but it is important that we now focus on what needs to change in order to mitigate future harms, especially with respect to the most vulnerable, who have paid the biggest price in this pandemic.
I am greatly encouraged by the vaccine roll-out and the number of people who have taken advantage of it. It has been an absolute success story for our Government and for our Minister for Covid Vaccine Deployment, the hon. Member for Stratford-on-Avon (Nadhim Zahawi). Every region of the United Kingdom of Great Britain and Northern Ireland has benefited from the vaccine roll-out, and in Northern Ireland we are taking vast steps towards the inoculation of almost all the adult population with both doses. I had my last one in May, and my wife has had hers. My sons are 32, 30 and 28, and they and their wives have had theirs, so we are moving down into the younger category.
Robin Swann, the Northern Ireland Assembly Health Minister, is doing an absolutely superb job. The Secretary of State for Health often refers to the meetings that he has once, twice or three times a week with Robin Swann, and to their very close working relationship. I think we, as a nation, owe a debt to our Secretary of State for Health and to the Health Minister in Northern Ireland. There has also been co-operation with Scotland and Wales. We are better today because we have co-operated. I do not say that in a political way, but it really does show how the great United Kingdom of Great Britain and Northern Ireland can work better together to deliver for everyone equally, wherever they may be.
Compared with February 2020, where we stand today with the treatment of covid-19 has completely changed thanks to fast-developing treatments resulting from the incredible work of scientific researchers who successfully uncovered the viral sequence of SARS-CoV-2 during the early stages of the outbreak in January 2020. Every one of us is overawed by our scientists’ ability to find a vaccine. They worked hard at that, and our Government committed to buying the vaccine even before we knew it was going to be successful. That was visionary of the Government, and I am greatly impressed by their commitment. While the rest of Europe dallied and were not sure what to do, our Minister and our Government here were getting the vaccine and preparing for it.
Fewer people who go into hospital with the virus today are guaranteed to end up in an intensive care unit or on ventilation. The largest vaccination distribution programme in medical and scientific history has been developed in just one year. What a feat that has been for our scientists, the health service and the Government and Ministers here and across all the regions. That was no mean feat, when we consider that it took four years to develop the mumps vaccine. At that time, four years was considered a speedy process. That happened in my lifetime, and that was how long it took to make it happen. This vaccine was developed in six months—wow! Is that not an incredible feat of medical science? The scientists were able to do that, and our Government and Ministers worked alongside them, close together in partnership, to make it happen.
I pay tribute to all the scientists who began working on the vaccine as far back as February 2020, before the virus became a global pandemic, and to the clinical trial volunteers, who risked their own health—they were not sure—to take something that was only experimental for the benefit of others. I also pay tribute to our Government officials, who negotiated around the usual years-long red tape and bureaucratic processes involved with vaccine development to fast-track this life-saving vaccine without compromising public safety. I admire the people who became the guinea pigs—perhaps that is the way to put it—for the vaccine. They enabled us to receive it in the knowledge that it was safe. They have all shaped science in just over one year. That is an incredible result, for which we should give thanks.
We are gradually moving towards the post-pandemic world, but we know we are not completely in the clear yet, and it will take a while to get there. While the vaccine works its wonders around the world, we still rely on treatments for covid-19 that help to reduce the need for hospital admission and make the stay in hospital sooner and shorter for those who need to be admitted.
I believe in what the Minister, the vaccines Minister and the Prime Minister have said: we are not all safe until everyone has had the vaccine. The Government’s duty is to our own people and our country, but they also have the duty to ensure vaccines are spread across the world. The Prime Minister said that yesterday at Prime Minister’s questions, and the Government have committed to billions of vaccines. The G7 gave us an opportunity to reinforce that. I have no doubt that many other countries across the world, including the United States and other countries in Europe and the western world are committed to doing that.
The use of remdesivir and corticosteroids— dexamethasone and hydrocortisone—has become part of the standard treatment across the world and continues to improve patient recovery, but, as I have said, we need to mitigate future harms. One of the ways to do that could be through the use of vitamin D—as the title of this debate suggests—against the virus, and I want to raise awareness of that. Many of the people I have spoken to are clear that vitamin D could have a role. The right hon. Member for Haltemprice and Howden (Mr Davis) has been clear in his commitment to the plusses of vitamin D, and I think that is good.
At the start of this pandemic, a good friend of mine who has a nutritional degree warned staff in the office to start taking vitamin D, and I conveyed that to my own staff in my office. “Build yourselves up,” he told us, “to give your body the chance to fight at its fittest,” and he has been proven to be absolutely right. Vitamin D has several very important functions, the most vital of which is facilitating a normal and healthy immune system and resistance to certain diseases. Vitamin D was found by one particular study to be effective in regulating the mood and decreasing levels of anxiety and depression. We have had a very difficult year. The Minister responded to a debate yesterday, which I participated in as well, about the mental health of children and young people. She spoke very well in summing up. I think every one of us realises that high levels of anxiety and depression are prevalent among not just adults but children. Can vitamin D help with that? There is some evidence that it can, which is something that we should pursue.
The study found that people suffering from depression noted an improvement in their symptoms by taking vitamin D supplements, so it is easy to understand why it is often called the sunshine drug. It is not because the sun shines, but because it perhaps lifts the mood. Many of us feel that wee bit better every day when the sun shines. It gives our spirits a lift. By the looks of yourself, Mrs Murray, you have been getting a bit of sun down in your neck of the woods, and you will feel better for it.
As with any vitamin, however, it works most effectively when there is a deficiency. We get the most out of a vitamin if our body is deprived of it, and we will see the changes fairly early if we really need it, so if our body responds positively to vitamin D it is clearly of benefit. I was once told, “If your cup is full of tea and more tea is poured in, that isn’t useful as the tea will of course pour over the edges.” It is all about balance, and vitamin D gives that to those who need it, and gives them a lift.
Vitamin D deficiency is affecting an increasing number of people, mostly due to lifestyle and increased time spent indoors. My goodness, I am one of those who is not entirely convinced whether working from home is always the best. It is an opinion, and I try not to impress any of my opinions or thoughts upon other people, but I give that as an observation. The routine that we all need of going to work is probably good. If someone sits in a house all day that cannot be good. There is also the use of sunscreens, living in larger cities where sunlight is blocked, and having darker skin, because the higher the level of melanin the less vitamin D can be absorbed. I am very fortunate that I have lived in the countryside or small villages all my life. I have never had to live in the city. I do not mean this offensively to anybody who lives in London, but I have no wish to live in London or any of the big cities. I am very happy to be where I am.
Given our lifestyle over the past year, it would not be surprising to discover that a good number of us lost some level of vitamin D from our system, because if we do those things our vitamin D levels will be down and we will need to enhance them. We spent months living a very abnormal lifestyle as we heeded the message to stay at home and stay indoors, allowed only one session of exercise a day at the peak of the pandemic. Think back to those weeks and months between March and July last year and recall the empty streets, parks and beaches during the day because everyone was staying inside or around their house—our elderly folk in care homes even more so.
Our nature is to want to talk to each other; we are elected representatives because we want to engage with people, and we do so better when we are as close as we are now, or even closer over a cup of coffee, than when we are in a Zoom meeting. Zoom meetings had a role to play. They helped us to connect with people over the past 12 months in a way that I certainly never had before. Technologically I have probably advanced, but certainly not as far as my grandchildren, who are young. My level of capability is not very high. Zoom played its part, but it did not do all that we wanted.
Let us think back to those weeks and months between March and July last year. We all agree that that was not a normal way for us to live for any period of time, let alone for months. Because vitamin D is produced in the skin through exposure to the sun, it adds weight to the case that levels of anxiety and depression rose among people not just because of the impact of the pandemic in other areas of our lives, but simply because we were spending so much time indoors, out of the sunlight, for such a long period of time.
Some people, like myself, were fortunate to live in the countryside, where they were able to go for a walk every night. We were lucky because we had some of the best weather we have had for such a long time between March and July.
Most of us have heard of the condition seasonal affective disorder, better known as SAD, where, during the winter months, reduced sunlight can lower our levels of serum 25(OH)D, causing depression-like symptoms in some people. Various studies have shown that taking vitamin D supplements can improve the symptoms of that disorder.
Some foresight was lacking at the beginning of lockdown in 2020. In hindsight, it would have been a good idea back then to suggest that people got as much sunlight as possible, whether that was sitting by an open window or out in the garden where possible, or took vitamin D supplements if those options were not available.
Although the National Institute for Health and Care Excellence reported that there was insufficient data to recommend the use of vitamin D or calcifediol as a defence against or treatment for covid-19 infection, several recent studies have produced evidence that offer more hopeful results. I want to give some of the evidential base today.
An observational study carried out from March to May 2020 at Hospital del Mar in Barcelona tested 838 patients admitted with covid-19, of which 447 were given 530 micrograms of vitamin D on day one and 266 micrograms on days three, seven, 15 and 30. The other 391 patients were not given that treatment on admission. Of the 447 patients treated with vitamin D when they were admitted to hospital, just 20 needed assistance from ICU, compared with 82 of the non-treated 391 patients. The findings go further, and report that just 21 out of 447 patients treated with vitamin D died from covid-19, compared with 62 of the 391 non-treated patients. I suggest that we have an evidential base, from the trials and tests that were done at Hospital del Mar in Barcelona, that proves the benefit of vitamin D. When patients with covid-19 infections were treated with vitamin D on admission, it significantly reduced the need for ICU admission and more of them survived.
Other research has shown that those who experienced acute respiratory failure with covid-19 had high rates of vitamin D deficiency. I am particularly interested in the subject. As chair of the all-party parliamentary group on respiratory health, I take a deep interest in these issues. Although these are small, randomised studies, they provide a credible level of data and evidence showing that the lack of vitamin D is a factor in rates of ICU admission and mortalities. We need to look further for evidence that vitamin D deficiency plays a role in the mortality rate from covid-19 infection and consider sensitively why this virus has been so devastating for our black and minority ethnic communities here in this great United Kingdom of Great Britain and Northern Ireland.
A peer-reviewed article published in 2018 in BMC Pediatrics reported that vitamin D deficiency was on the rise almost exclusively among black, Asian and minority ethnic groups. A clear section of the community need help and support, and awareness needs to be raised on the need to take vitamin D.
The University of Birmingham supported the study, also reporting that the national diet and nutrition survey concluded that nearly half the UK’s population were vitamin D-deficient, with BAME groups in Britain and throughout northern Europe observed to be most at risk due to the fact that darker skins produce far less vitamin D. Also—I say this most respectfully—the observance of cultural traditions that require the wearing of clothing from head to foot results in a lack of skin exposure to sunlight on a daily basis.
In Northern Ireland, and maybe in Scotland as well—the hon. Member for Glasgow East (David Linden) will speak shortly—we do not get much of the sun, and when it does come, we tend to take advantage of it to the point where we burn. The point I am making is that those with ginger hair might find that they are unable to accept the sun. We have the first grandchild I am aware of in our family who has ginger hair. I am not sure if any family member has been ginger-haired before, but we have one now, so we will have to protect Max more from the sunshine than the rest of us. It is always good to be ready.
I made the previous point out of sensitivity. If we are to recognise this health matter, it must be taken into account. The most important source of vitamin D is sunlight, because so little is contained in food. I am not sure whether this is something that can be done—I am sure we will understand that from the Minister’s response—but it might be something to consider. The lack of vitamin D has a severe impact on children’s growth, so will she acknowledge the findings of the national diet and nutritional survey, perhaps in conjunction with the Department for Education, and ensure that our children and adolescents receive vitamin D supplements every day?
One thing I remember from school—I remember many things, although it is quite a long time ago—is that we had a bottle of milk every morning when we were at school. That goes back to the ’60s in my case. I remember it because it was important for us at that time to have the supplementation and the goodness that came in milk. Times have changed a wee bit, so we might now get the goodness, nourishment and benefit that comes out of vitamin D.
Where vitamin D is concerned, our supplementation policies and implementation strategies need to be updated urgently, especially now that rates of covid-19 infection have begun to increase with the delta variant. In yesterday evening’s debate, the Minister for Health, the hon. Member for Charnwood (Edward Argar), said that
“we must learn to live with this disease”.—[Official Report, 16 June 2021; Vol. 697, c. 388.]
That is my opinion as well. I get the flu jab every September or October, because I am a diabetic, which is one of the chronic diseases. I will probably get the covid-19 booster jab at the same time as that next year. We have got to learn to live with such things. Over the next four weeks or so, with the delay to the relaxation moving to 19 July, we will see how well that works.
Vitamin D supplementation must be adopted through an evidence-based strategy, and we have sound evidence-based findings from the University College London Institute of Health Informatics. The information confirmed that the death rate from covid-19 was about two to three times higher for BAME groups in England than for the general population. We have a really big job to do to look after that section of the community. We must raise awareness, perhaps with a strategy, and sometimes we need to involve community leaders, whether those be leaders of churches or community groups. There are many good people out there who want to help. I believe that if we can get them all together, we can do something.
With those tragic figures to which the University of London referred, we can see the sense in vitamin D being an effective way to mitigate future harm to our BAME communities from covid-19 infection. Can we prevent further loss of life on such a scale by prescribing for those who have been most vulnerable to the virus a simple but effective programme of vitamin D supplementation? That might sound simplistic, but there is an evidential base for the benefit that could be gained.
If that is something that can be done at small cost, with great benefits—as I believe them to be—it should be done. Will the Minister who is present today look—as I know she has—at the evidential base and the research? Will her Department be prepared to look at raising awareness among those in the community, and the BAME community in particular, across the whole of the United Kingdom, where responsibility lies, and perhaps to commit to new funding or investment, or talking in partnership with those who are involved in further research into unlocking the benefits of vitamin D as a defence against covid-19 infection?
I will conclude by saying that I believe this research is necessary—indeed, absolutely crucial—if we are to determine whether vitamin D can play an effective role in the prevention and even the treatment of covid-19 infection on a broader scale. I say that because the Government have proven, working alongside all the regional Administrations across our United Kingdom of Great Britain and Northern Ireland, that if we work together, we can, first, be stronger together and, secondly, be effective together. As I say, when it comes to looking at the treatment of covid-19 infection on a broader scale, we need to do that. We should also be very aware of the issue of vitamin D deficiency in the community, and the consequences for those who are vulnerable.
I believe that my job, and the job of all of us as elected representatives, is to represent our people well. I believe that every MP does that job well and we have a responsibility to do it well. One of the things that I have always been willing to do, all my life, is to help people, and I am very fortunate that I have had some 35 or 36 years to do that. Although we are able to pull off some great things sometimes and have some wonderful success stories, there are some times that may not be as easy. However, I believe that here we have an example of what we can do to do things better, and it is something that we can do better together.
It is an absolute pleasure to serve under your chairmanship, Mrs Murray, I think for the first time. I offer my warm congratulations to the hon. Member for Strangford (Jim Shannon) on securing the debate. I am sure if he had not secured it, he would have contributed to another debate in here this afternoon. I intended to say this yesterday, but I did not get the chance: I would like to send my warm and best wishes to the hon. Gentleman’s mother. He will know why I am saying that. It is a delight to be here today to respond to him.
I will try to respond directly to all the points that were made today, if not specifically then more broadly, but I am always here if hon. Members want to ask me for more specific details. We consistently review the data and the latest information as it emerges on covid-19. Our objectives are to ensure that people are not made adversely ill by covid-19 and that as many people as possible stay out of hospital, off ventilators and improve as quickly as possible.
That includes the progress we have seen in treatments for those suffering with the virus, including longer-term preventive measures, such as our strategy to reduce obesity, which we know is one of the few modifiable factors of covid-19, and the implementation of the vaccination programme.
Some 78.9% of adults in the UK have now received the first dose of the covid-19 vaccine, and 56.6% have received the second dose. Everyone who has spoken, including the shadow Minister, the hon. Member for Nottingham North (Alex Norris), and the SNP spokesman, the hon. Member for Glasgow East (David Linden), has congratulated volunteers and those who have run and operated the vaccine programme across the UK, and I add my congratulations. It has been phenomenal, and we have much to be thankful for. I am sure that everyone will join me in acknowledging the dedication of volunteers who have answered the clarion call and turned up. I think the hon. Member for Glasgow East said—it may have been yesterday—that they have donned the vest and got out there, and they are still doing those jobs. That is just amazing.
Since the start of the pandemic, there have been reports that vitamin D may reduce the risk of coronavirus. I have to sound a note of caution here because, when looking at the data and the evidence, we cannot cherry-pick the odd report here and there. I am not accusing anyone of doing that, but we have to take a more robust view of the data and look at it in the round.
I will pick up on the points that the hon. Member for Strangford made about BAME communities. To date, the UK Biobank’s most robust data on covid, vitamin D and ethnicity has not found a link between vitamin D concentration and ethnicity that could reduce covid-19 infections. There was no link, sadly. It would really be encouraging for us if the data showed that vitamin D prevented people from catching covid—that would be quite amazing—and we are certainly working on and searching for that data, but we do not have it yet.
On 14 January, the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), responded to a debate on this matter, in which the hon. Member for Strangford also participated. I welcome the opportunity to debate it further and set out the measures that we are delivering. As my hon. Friend said:
“Several nutrients are involved in the normal functioning of the immune system; however, there is currently insufficient evidence that taking vitamin D will mitigate the effects of covid-19.”—[Official Report, 14 January 2021; Vol. 687, c. 597.]
Last December, the National Institute for Health and Care Excellence, the Scientific Advisory Committee on Nutrition, and Public Health England published rapid guidance in response to the queries that the hon. Member for Strangford and others have raised on vitamin D in relation to covid-19. The data was reviewed by an expert panel and included the best available scientific evidence published to date, including both randomised controlled trials and observational studies. The expert panel supported existing Government advice and the recommendation for everyone to take 10 mcg of vitamin D supplement throughout the autumn and winter to protect their bone and muscle health. However, the panel concluded that there is currently not enough evidence available to support taking vitamin D to prevent or treat covid-19.
There are still significant gaps in the current evidence, as was the case in January. To date, studies have not reached the high level of data quality required to revise the guidance. The current evidence base is mixed and dominated by low-quality studies, with substantial concerns around bias and confounding evidence. There are lots of studies out there, but some of them do not have the quality and the robustness of data and evidence that are required.
Currently, studies are unable to demonstrate a causal relationship between vitamin D and covid-19 for anyone. That is because many of the risk factors for severe covid-19 outcomes are the same as the risk factors for low vitamin D status. Owing to the lack of reliable evidence, the NICE guidance recommends that more research be conducted on the subject. Government guidance continues to stress the use of high-quality randomised control trials in future studies.
At present, more than 90 trials that are looking at the efficacy of vitamin D as an intervention for covid-19 across all stages of the disease are either under way or due to publish, either in the UK or internationally. Given that 90 trials are currently under way, possibly—hopefully—the evidence and data that we require will come our way soon. I would be really disappointed if those 90 trials do not give us the evidence we want. Let us hope that they do.
Some of the trials are of the high quality that we require to produce the data, and will answer key questions. NICE, PHE and the Scientific Advisory Committee on Nutrition are monitoring new evidence from trials as it becomes available.
The long-standing Government advice is that, every year, between October and early March, everyone is advised to take a supplement containing 10 mcg—400 international units—of vitamin D a day. Vitamin D helps to regulate the amount of calcium and phosphate in the body and to protect bone and muscle health. In April and autumn 2020, PHE reiterated the advice and also ran a public awareness campaign throughout December 2020. That had a specific focus on BAME communities, where vitamin D supplementation is important.
Vitamin D is made in the skin when exposed to sunlight during the spring and summer months and the PHE advice to continue taking vitamin D supplements is therefore particularly important for those who were shielding, care home residents and prisoners, as well as those who choose to cover most of their skin when outdoors, as these groups are likely to have reduced sunlight exposure. Importantly, individuals with dark skin are more at risk of not having enough vitamin D and are advised to take the 10 mcg of vitamin D supplements all year round.
We have actively supported the uptake of the PHE recommendations. Over winter 2020-21, the Government provided a free four-month supply of daily vitamin D supplements to adults on the clinically extremely vulnerable list who had opted to receive the supplements, all residents in residential and nursing care homes in England, and the prison population, where Her Majesty’s Prison and Probation Service made supplements available across England and Wales.
The Government prioritised groups that were asked to stay indoors more than usual over spring and summer 2020 due to national restrictions. The supplements were provided to help support their general health and, in particular, bone and muscle health.
Recipients of the Healthy Start scheme are also offered supplements containing vitamin D by the Government. Guidance on vitamin D can be found online, and we encourage individuals to buy 10 mcg vitamin D supplements from retailers such as supermarkets, chemists and health food shops.
As research continues on the impact of vitamin D on covid-19, we will continue to monitor evidence as it is published. We have committed to keeping this under review and, as I have said, we are committed to keeping the 90 trials that are under way under review, some of which are high quality, producing robust information.
Does the Minister have any indication of when the trials will be completed and when the evidence will be sought and got?
I want to thank all those who took part in the debate. First, I thank the hon. Member for Glasgow East (David Linden) for his contribution. Many things that the Scottish Parliament does on health issues interest me. He knows this, because I have said it to a health spokesperson for his party. I always listen intently to everyone, but in particular to the Scottish Members about how Scotland has done things, because it has done many things that I believe we could replicate across the whole United Kingdom.
One of the great things about these debates is that we can learn from one another and then, hopefully, take some of the good things from elsewhere and bring them in where we are, in the same way as we have done in Northern Ireland. The hon. Member for Glasgow East referred to what the Scottish Parliament is doing on vitamin D and to taking it all year round. It is perhaps a step ahead of us, so I thank him for describing that.
I am very pleased, as always, to have the hon. Member for Nottingham North (Alex Norris) here. My apologies to his wife; she can have him for the rest of the day—is that the way to put it? He has responsibilities here and has done well; I thank him for that. I also thank him for making, as always, an in-depth contribution, which lets us know where the Opposition, in the form of the Labour party, are and what they are doing.
We can probably all agree—I think the Minister is absolutely right, by the way—that we are here to support each other and the Minister. She outlined a very robust strategy for health—
I want to let the hon. Gentleman know that I have received a response on when the trials are due to conclude. Most are due to conclude this year.
Now, that was a quick answer! How many people get an answer to a question they asked 15 minutes ago? That is brilliant. That reinforces my comments about the strategy that the Minister referred to—the restrictions on adverts before 9 pm, the obesity and covid-19 death connection, and all the things the Minister referred to. Hopefully, some of the 90 trials—I never realised that there were that many trials going on—will produce high-quality data, which is what the Government needs to act upon.
I am hopeful, and I thank everyone for their participation. In particular, I thank the Minister for her excellent response and for reassuring me, the shadow Minister, the hon. Member for Glasgow East and those who were not able to come today but are watching the debate and would have wished to participate. Today, we have hope for the strategy. If the high-quality data is there, this can be a reality. I genuinely believe in my heart that this can benefit people, but we need the data to prove it. Our job, and the Minister’s job, is to receive that data and work on it. We have had that commitment. If the data is correct, we will have that.
Thank you for your chairmanship, Mrs Murray, as always. We do not always say that to the Chair, but thank you for chairing the debate well, as you always do. I also thank the staff, who work away in the background behind the screens. If we did not have them, this would not work at all.
Question put and agreed to.
Resolved,
That this House has considered the value of vitamin D as a defence against covid-19 infection.
(3 years, 5 months ago)
Commons ChamberMr Deputy Speaker, I would be very happy for the hon. Member for Wellingborough (Mr Bone) to come over here and join us on our side if he wishes to do so. I know that we are together in many things anyway.
I believe that we have to live with covid-19. Just as I get a flu jab every September or October because I am a diabetic and that is the way it is, in the same way we will get a covid-19 jab come that time as well. It has been a long, hard road to recovery and I want to place on the record very clearly my thanks to the Government, and to the Health Minister Matt Hancock, and to the Northern Ireland Health Minister Robin Swann, for all that they have done to keep us safe over this period of time. It is important to put that on the record.
I understand that weddings are an issue for many; they certainly are for me, and for my constituents in the hospitality sector. Wedding attendance is calculated based on the risk assessment of the said venue. Self-distancing is absolutely critical to making that happen. So many wedding venues can accommodate extra numbers because of their scope for self-distancing. Weddings are the most significant day for couples and there is nothing more heartwarming than seeing one’s guests smile with joy. Self-distancing has made that happen.
May I make a plea to the Minister for churches? I do that because I am a regular church attender, but also for everybody else who attends church or would like to do so. We know that we must self-distance and wear a mask in church, and we understand that. However, are we getting to the stage where we can attend church and do not have to wear a mask, while adhering to social distancing? When we go to a restaurant, we do not have to wear a mask, and perhaps the same rules should apply for churches. I request easement for weddings in churches as well. I understand that not every church has the capacity for self-distancing to have a wedding, but there are many that would, and I believe there is a way forward to do that.
Tourism is a crucial sector for our economy where the restrictions are blurred and many are left confused. I again request the Government to address the issue of tests and passenger location forms discouraging people from booking holidays, not to mention the fact that Portugal was taken off the green list. I do not say that as a criticism, but just to make the point that perhaps we need more clarity in relation to that. The focus needs to be on making travel more accessible and efficient to encourage those who travel, even if it is within the United Kingdom.
A constituent of mine recently left for work in the EU, where he was charged £85 for a PCR test, not to mention the test requirements when he comes home. Is it possible to review this approach to allow the lateral flow tests that are acceptable in our schools to be acceptable for travellers? This would instil more efficient travel where travellers can save money and travel with less hassle. I also make a plea for tour operators and buses. We know all the problems with buses. People cannot self-distance on a bus and so these services cannot be viable. If we are going to have this for another few weeks, as we are, can we make sure that those businesses are protected and that jobs are secured?
Live music is crucial to many aspects of life for us personally but also for venues, for the hospitality sector, for weddings and for concerts. I appreciate that there is always a risk in singing. When I sing, the rain usually comes on. The Bible says, “Sing, make a joyful noise”. When I make a joyful noise, it is never melodious but it is always joyful. It is always loud as well. I would love to able to sing in church again, but it is not happening and it is not likely to happen in the near future. I understand that for those who are involved in this, there is a real need to have it.
I make the plea that as we move forward together over the next four weeks, we can ensure that these businesses can be protected and have the support that is needed through the furlough. I understand that the vaccine roll-out is a part of any moving forward, and I support that. I welcome younger people getting the vaccine. To me, this signals being able to move forward safely, which is what we need to do.
I fully appreciate that the Prime Minister and the Government are being careful and cautious, and I support that. To use a saying that we often use in Northern Ireland, it is better to be safe than sorry, and it is better to be safe than sorry today. I will support the Government in both votes on what they are putting forward because I believe that it is right: we can do this for another four weeks and that will be the end of it. As there are more people with the vaccine, confidence will be restored, and if confidence is restored, then we must all be in a better place. I know that is not the opinion of some, but it is certainly my opinion and that of others in my party as well. I want to ensure that the Government are supported and I will support them tonight.
(3 years, 5 months ago)
Westminster HallWestminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
It is a pleasure to speak in this debate, Sir Gary. I thank the hon. Member for Twickenham (Munira Wilson) for setting the scene so well. She obviously has a passion for the subject. I love to engage with the debates that she is involved in, because I usually find I am on the same page, so I thank her for securing this debate.
I like quotations, and John F Kennedy had one that is appropriate for this debate. He once said:
“Children are the living messages we send to a time we will not see.”
I think that sentence captures this debate. The years march on, and for those of us of a certain vintage, they march terribly quickly—at least, they seem to. But that’s the way it is. I understand these things more than ever. My mum is 89 years old. In four weeks’ time, almost to the day, she will be 90, and she is very fit in mind and body. She reads the Minister’s novels, by the way—the Minister knows that—and she finds them very enjoyable. That is the sort of mind she has, but she is the first to tell me that she does not know how young people are coping at present. Long gone are the very simple times. Our children live in an age where the world is at their fingers, which sounds great. It also means that when they are at home, in a place that should be safe from the world, the cyber-bullies are still at play, information is still at hand, and the anxieties of the world are never too far away.
I am always amazed when I look at my two oldest grandchildren—Katie, who is 12, and Mia, who is seven. They are so active and so capable on their iPads and laptops. Their grandfather, unfortunately, has not caught up with them at all. I am thankful for the wonders of the internet and all the possibility it brings, yet it also brings a world of uncertainty and fear. Information is truly available, but so too is information that is false and that could really harm, corrupt and do a great deal to the health of our young people.
During home schooling, we told our children to access school online and do more on the iPad and the computer than ever before. At the same time, young children were scared and frightened by the seismic shift in their lives because of covid, watching informational programming that was not designed for them and that caused fear and upset. We were isolating them from their support systems at school, from their friends at church and even from their neighbours. Little wonder our young ones are struggling now, fearful of this bug and not sure what that normal is any more. I am not sure what the normal is any more either—it might be what we used to have.
YoungMinds, a charity that the hon. Member for Blaydon (Liz Twist) and others referred to, is doing tremendous work. In its recent survey, which I quote for the record and to focus our minds, 75% of respondents agreed that they found the current lockdown harder to cope with than the previous ones, with 44% saying it was much harder, while 14% said it was easier and 11% said it was the same. Some 67% believed that the pandemic will have a long-term negative effect on their mental health. That includes young people who have been bereaved or who have undergone traumatic experiences during the pandemic, who were concerned whether friendships would recover or who were worried about the loss of education or their prospects of finding work. Some 19% neither agreed nor disagreed, and 14% disagreed, but the figures we need to focus on are the 67%, the 75% and the 44%. Some 79% of respondents agreed that their mental health would start to improve when most of the restrictions were lifted, but some expressed caution about restrictions being lifted too quickly and about the prospect of future lockdowns.
The statistics speak volumes, yet the issue is the silent, solemn children who carry burdens that their wee shoulders were never designed to carry. How heartbreaking it is to imagine that one of my precious grandchildren could be feeling that; it is a feeling felt by too many children. I know that from speaking to parents, teachers and ministers back home in Northern Ireland. The question on our lips is, what can we do?
As a grandparent, I know that Katie and Mia are old enough to understand much of this. They have perhaps observed loss and watched their parents and grandparents grieve. As a Christian—I always say this if I get the opportunity, and I know it is something that resonates with you, Sir Gary—I will be seeking that the perfect peace that comes from God descends on our young people. But as a parliamentarian, I ask my Minister and my Government to put in place funding to enhance the counselling available, to encourage schools to carry out Mental Health Day events, and to work with churches to enable them to signpost children to help. We must act, lest the message that we send to the future be nothing other than an apology for our failings.
(3 years, 5 months ago)
Commons ChamberI am glad that the hon. Gentleman raised that, because he is talking about the Government’s own failure. Last summer, the shadow Transport Secretary, my hon. Friend the Member for Oldham West and Royton (Jim McMahon), and I were speaking about the fact that 14-day quarantining was unnecessary if we had testing up and running. We could have had a test and release system with release after 10 days. We were highlighting the complete failure of the Government on testing, so I am pleased that the hon. Gentleman gave me the chance to make that point.
I give Ministers another warning. As we speak, countries with large numbers of delta variant cases are on the amber list, which has been proven clearly not to work in stopping infections reaching the UK. Thailand and Vietnam are on the amber list, despite having rocketing cases and, potentially, yet another new variant that has already entered the country. Thousands more are on flights coming and going from holiday destinations across the world. Again, we put the Government on notice: put in place proper covid protection at the border to end the culture of failure that has been their record so far.
That is why, today, we are forcing a vote again on securing our borders. The Government must take clear steps to avoid the disastrous mistakes of the past: scrap the amber list and move it on to the red list with the proper hotel quarantine system; continue to have the green list, which can grow safely over time; work with our international partners to introduce a universal, worldwide, standardised international vaccine passport; and introduce the long-awaited sector support deal for the aviation sector, called for many times by my hon. Friend the shadow Transport Secretary, saving jobs and ensuring environmental protection.
Stobart Air, which has connectivity between Belfast City and many cities across the UK mainland, is on the edge of collapse—indeed, that will happen. Does the right hon. Gentleman feel that it is important to give the aviation sector the help that it needs to ensure, when we come back, that there will be something that we can build upon?
The hon. Gentleman is absolutely right. We need to see a proper ambitious support package, with the money properly targeted to meet its aims.
Appalling hire-and-rehire tactics should be outlawed—that practice has no place in our country—and we need staff salaries protected, with a clear commitment to workers’ right. Let us also see a commitment to cleaner fuels, UK-based suppliers, tax paid here in the UK and compliance with consumer rights regulations. Inaction—continuing inaction—is not the answer. Those are steps that could be taken right now. They would reduce the risk of yet more variants reaching the UK.
When people are working so hard to contain the delta variant at home, this Government run the risk of bringing in yet more from abroad. The irresponsibility has to stop. Up and down the country, people have done their bit. They have given up their freedoms, queued up for the vaccine, given up precious time with loved ones, abandoned planned family events and sacrificed attendance at funerals. They have done all they can to protect the country; the least they can expect in return is that Members of Parliament will do the same by supporting our motion to ensure that we can secure our borders from covid variants, allowing lives to return to normal in the near future.
(3 years, 5 months ago)
Commons ChamberYes, I work very closely with the Culture Secretary on making sure that these events pilots can go ahead. We are working very closely with F1. I am delighted that we will be able to see the Wimbledon finals go ahead, on a pilot basis, with 100% capacity. It is fantastic to see the crowds at Wembley. We are making progress, and these freedoms have returned. We are not yet able to make the full step 4, but we are making the progress that we can.
I thank the Secretary of State for his statement. We can all understand the difficulties that have been presented for those who are waiting to get married, have put off their weddings and have lost deposits, and who have been holding on and hoping against hope that their special day will come. Does the Secretary of State not agree that the importance of a wedding celebration is equal at least to the importance of a football match or a summit, and that if there is to be a delay, consideration must be given to those getting married in July and August? Will the Secretary of State task a working group of experts to outline the safest way to allow these family events to take place, and then ensure that those decisions will be discussed with and conveyed to the Northern Ireland Health Minister?
Yes. The weddings taskforce has worked very hard on ensuring that there are covid-secure ways of progressing, including opening up weddings, removing the cap on numbers and doing this with social distancing. I hope that that will allow lots of the thousands of weddings planned over the coming weeks to happen in a way that is consistent with social distancing. I am very happy to talk to my opposite number in Northern Ireland, Robin Swann, who does an exemplary job. I know that he looks at these things very carefully, and I have no doubt we can have a conversation about that.