Covid-19: Government Response
Jonathan Ashworth Excerpts(3 years, 1 month ago)
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Urgent 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.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
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Jonathan Ashworth (Leicester South) (Lab/Co-op)
(Urgent Question): To ask the Secretary of State for Health and Social Care, if he will make a statement on the Government’s response to covid-19.
The Parliamentary Under-Secretary of State for Health and Social Care (Maggie Throup)
I am grateful to the right hon. Member for his question and for the opportunity to answer questions from across the House in addition to my oral statement later this morning. Before I do so, I want to underline our commitment to keeping the House informed.
Yesterday’s announcement on the procurement of new antiviral treatments was made to Parliament via a written ministerial statement. The purpose of the Secretary of State’s press conference was to appeal directly to the public to come forward for their vaccines, including the 4.7 million people over the age of 18 in England who have not accepted the vaccine. We need those who are eligible to do so to take up the offer of a booster jab as we pursue plan A to its full extent.
Jonathan Ashworth
I thank the Minister for that answer.
Yesterday the Secretary of State said that the pressures on the NHS were sustainable, but we are seeing ambulances backed up outside hospitals, patients waiting hour upon hour in A&E, cancer operations cancelled, and NHS staff exhausted. Has there ever been, in the history of the NHS, a more complacent attitude on the part of a Secretary of State as we head into winter? Yesterday the Secretary of State refused to trigger plan B. Can the Minister tell us what is the criterion for triggering it?
Newspapers report today that a plan C—no household mixing—is being considered: a lockdown by the back door. When the Business Secretary ruled out a lockdown yesterday, was that just another example of his making things up as he goes along in interviews? The Minister for Health, the hon. Member for Charnwood (Edward Argar), said on the radio today that that plan was not
“something that is being actively considered.”
Members should note the qualifying adverb “actively”. We do not want a return to the dark days of lockdown; nor do we want to see regional lockdowns, or local lockdowns like those that we saw in Leicester, Bolton and Burnley. Can the Minister rule out such lockdowns?
Is the truth not that we are in this situation because the vaccination programme is now stalling? Ministers cannot blame the public when 2 million people have not even been invited for a booster jab, and on current trends we will not complete the booster programme until March 2022. There are currently just 165,000 jabs a day; will the Minister make a commitment to 500,000 a day, and ensure that the programme is completed by Christmas?
The Minister will know that the highest concentration of infections is among children, but only 17% of children have been vaccinated. This is a stuttering roll-out of the children’s vaccination programme—and does it not expose the folly of cutting the number of school nurses and health visitors who support these immunisation programmes in our communities?
Only 36% of over-65s have been vaccinated against flu. We hear stories of cancelled flu jabs at GPs’ surgeries, and of pharmacists saying that they do not have enough supplies. Why are supplies apparently running so low? With infections, meanwhile, running so high, Ministers need to stop vacillating and get vaccinating.
The wall of defence is crumbling. We know that we have to get ahead of this virus, because otherwise it gets ahead of us. How will the Minister fix this stalling vaccination programme?
Maggie Throup
Let me first thank the right hon. Gentleman for his co-operation throughout the pandemic. However, I am a bit disappointed with his tone today. What we are seeing is the Government carrying out the plans that have been laid before Parliament—the autumn and winter plans involving plan A and plan B—and as the Secretary of State rightly said yesterday, plan A is still what we are working to.
Our vaccines have created a wall of defence. It is incredible how many people have taken up the offer, not just for the first jab but for the second, and are now coming forward for their boosters. In fact, at the start of the week 5.4 million people were eligible for their booster jabs, and 4 million people had taken up that opportunity: 4 million arms had been jabbed.
The right hon. Gentleman talked about 12 to 15-year-olds. We are now able to offer more choice to parents wanting to take their children to vaccination centres. I am sure the right hon. Gentleman will agree that it is important for the choice of where children get their jabs to be as wide as possible to ensure that everyone has that opportunity. It is also important to ensure that the 4.7 million people who have not yet taken up the offer of the first jab are encouraged to come forward, because, as the right hon. Gentleman said, the vaccines are our wall of defence.
The flu vaccine programme, too, is extremely important, and people are now being called forward for the flu jab that is helping to protect us throughout the winter months. My message is this: if you receive a call for a flu jab, do not wait to receive a call for your booster jab, and vice versa. Get whichever jab you are invited for first, and that will help to protect you, your family and the people around you.
Covid-19 Update
Jonathan Ashworth Excerpts(3 years, 1 month ago)
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Jonathan Ashworth (Leicester South) (Lab/Co-op)
I often have a sense of déjà vu when responding to these covid statements, but I feel it particularly acutely today. I thank the Minister for advance sight of her statement. She, of course, has had advance sight of my questions. May I put to her again some of the questions that she did not have—or perhaps did not take—the opportunity to answer earlier? Perhaps she can tell the House the answers now.
Are Ministers ruling out a so-called plan C, where household mixing is banned? Are they ruling out lockdowns such as those we saw in Leicester, Bolton and so on? And are they ruling out a return to regional tiers? Is the Department looking at plans to introduce regional tiers? Will she also now tell us the criteria that trigger plan B? We did not get an answer to that question earlier either. Why not just make mask wearing—on public transport, for example—mandatory now? Yesterday, the Secretary of State talked about the importance of mask wearing. Why do we not just get on with it?
I am afraid that the vaccination programme is stalling. On current trends, the booster programme will not be completed until March next year. At one point back in the spring, we were doing about 800,000 vaccines a day. Why does the Minister not now set a target of 500,000 booster jabs a day so that we can complete the programme by Christmas? We are currently only doing about 165,000 jabs a day. Instead of blaming people for not coming forward, will she not only make sure that everyone eligible is invited and has a letter, but allow those who need a booster—or, indeed, the immunosuppressed who need the third dose—to go to a walk-in centre or a pop-up centre, rather than making them book online as they have to at the moment?
Children’s vaccination rates are also low, at only about 17%. Of course, we have seen years of cuts to numbers of school nurses and health visitors, who help with the children’s vaccination programme. The rate of infection among children is running at about 10,000 a day. Will the Minister mobilise retired medics and school nurses to return to schools and carry out vaccinations?
The Minister talked about the importance of the flu jab, but people’s flu jabs are getting cancelled. Will she guarantee a flu jab to all those who need and want one before December?
Let me put a question to the Minister that I did not put to her earlier. About 20% of covid patients in hospital—or one in six, actually, on the latest figures—are unvaccinated pregnant women. Will she guarantee a helpline so that expectant mothers can access proper advice? Will she deal with some of the anti-vax nonsense that we sometimes see spread on social media? Will she establish a target for driving up vaccination rates, including priority access for expectant mothers?
Ministers can have plan A, they can have plan B and they can have plans C, D, E and F, but infectious people cannot afford to isolate and transmission will not be broken until we fix sick pay as well. Indeed, there will be those who will fear that getting their booster or their second or third dose could lead to a couple of days of feeling unwell because of the side effects and will not take it because they will not be able to afford two or three days off work as a consequence. We really need to fix sick pay as we go into this next stage of dealing with covid.
There we have it: those were six straightforward questions for the Minister, and I am looking forward to six straightforward answers—because the wall of defence, I am afraid, is crumbling; vaccination is stalling; and we are heading into a winter of misery. This vaccination programme needs fixing now.
Maggie Throup
I would like to reassure the House and anybody who is listening that our wall of defence is extremely strong. I am really proud of all the scientists who developed the vaccines that helped to build our wall of defence, and all the NHS workers and volunteers who have helped to deliver it and are continuing to develop it.
The right hon. Gentleman talked about whether people can access booster jabs. Comparing the number of community pharmacies, for example, there were 1,032 in phase 1 and there are now 1,049 taking part in our activities to provide the booster jab. It is a bit disingenuous of him to say that we are not going fast enough, as there are actually plenty of opportunities for people to get their booster jab.
The right hon. Gentleman asked what would trigger plan B. As I said earlier, we are on plan A. There are numerous factors that we could go into about triggering plan B, but we are still on plan A, and we can still go further with plan A.
The right hon. Gentleman rightly mentions the importance of pregnant women getting the jab. Only last week there was a big push from the NHS to get the message out that it is extremely safe for pregnant women to get a covid vaccine—encouraging them to do that, because it is protecting them from getting this deadly disease. There has been a high rate of hospitalisation for those who are pregnant and have not been vaccinated, and we need to encourage more pregnant women to get the jab.
The right hon. Gentleman mentions plan C. I saw that story earlier and checked it out, and it does not have any foundation. We are always open to alternatives, and quite rightly so, because as a Government it would be irresponsible of us not to be looking at every alternative. I hope he is reassured that, as I said earlier, we are still on plan A. By encouraging everybody who has not already had their booster jab to come forward, we want plan A to be successful.
The right hon. Gentleman mentioned statutory sick pay. I am extremely proud that this Government, through the Coronavirus Act 2020, introduced statutory sick pay throughout this emergency from day one, alongside many other measures that were put in place to support people, whether businesses or individuals, throughout this global pandemic.
Oral Answers to Questions
Jonathan Ashworth Excerpts(3 years, 1 month ago)
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Jonathan Ashworth (Leicester South) (Lab/Co-op)
If I may, Mr Speaker, I will, with your indulgence, take a moment to express my deep sadness at the loss of James and David and my utter shock at what we saw this weekend, but also to remember David as someone who was always smiling, who always encouraged me, particularly as a rookie MP when my office was just down the corridor from his, who always asked after my children and who always gave me tips. I sometimes get in a bit of trouble for being friends with Tories, but I will hugely miss David and James and send my condolences and sympathies to their friends and families.
I also welcome the new Ministers to the Treasury Bench. In recent weeks we have seen a patient at Preston wait over 40 hours for a bed, we have seen a child with mental health problems wait nearly 48 hours for a bed at Ipswich A&E, we have seen ambulances backed up outside hospitals—in Norfolk a patient died of a heart attack waiting in the back of an ambulance—and we have seen ever more patients, who cannot bear the wait for surgery, paying for operations. This is an NHS not just under pressure, but under water. What is the Secretary of State personally going to do to avert a winter crisis of misery for patients?
Sajid Javid
I agree with every word the right hon. Gentleman said about our friends and colleagues, James and David, but I hope his friendship with me will not get him into trouble—I hope I have not given that away. He is right to ask about the huge pressure the NHS is facing, and all our constituents are seeing that wherever they live. It is picking up over the winter. Winters can usually be tough for the NHS but this winter will be particularly tough and the Government have set out the reasons why: the pandemic is still ongoing; and this flu season will, I think, be particularly tough, which is why we are having the largest flu vaccination programme alongside the covid programme this year. We are doing a lot alongside the vaccination programmes, especially in terms of resources. We have put an extra £34 billion into the NHS and care for this year, including much more funding for diagnostics such as the community diagnostics hubs that I announced a couple of weeks ago, in which we invested 350 million. We will very shortly set out with the NHS a detailed programme for the winter and how we can better deal with the pressures.
Jonathan Ashworth
The Secretary of State mentioned the pandemic, but he must surely be concerned that yesterday we recorded close to 50,000 infections, and on every single day of the last three weeks 10,000 children have been diagnosed with covid. The booster programme is stalling with charities describing it as a “chaotic failure”, and only about 13% of children have been vaccinated. His wall of defence is falling down at just the point that vaccination is waning, so may I suggest that he ditches the complacency and fixes the vaccination programme now?
Coronavirus Act 2020 (Review of Temporary Provisions) (No. 3)
Jonathan Ashworth Excerpts(3 years, 1 month ago)
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Jonathan Ashworth (Leicester South) (Lab/Co-op)
We do not oppose the renewal of the Act and we will not oppose its renewal in the Division Lobby, but I do have huge sympathy with the Members who have raised concerns about the way in which the Act is scrutinised and asked questions about whether there are alternative means of putting this legislation on the statute book. The main reason we will not oppose the Act is the provision of statutory sick pay from day one and not day four, which was the case before the Act received Royal Assent. Given that we have a Chancellor who has been very keen to cut back universal credit, I am not convinced that if the Act fell today the Chancellor would carry on paying statutory sick pay from day one, and would find time to introduce an appropriate Bill. However, I urge Ministers to try to find a better way for the Act to be scrutinised.
Let us think back to March 2020—and I remember it well. A deathly silence was falling upon our streets, as we knew that a deadly pandemic was set to spread with ferocity. We knew that the House had to act with urgency and haste. Indeed, I, as shadow Health Secretary, was invited to Downing Street to meet the Prime Minister, to meet Dominic Cummings and to meet various officials, to discuss in principle agreeing to this Act on a cross-party basis. The then Health Secretary invited me to the Department of Health and Social Care on numerous occasions to sit down with him and his officials to discuss the content of the Act. We proceeded on a cross-party basis because we understood the gravity of the crisis that we were facing.
Measures were put in the Act that we had asked for, such as the provision of statutory sick pay from day one, but other measures were put in the Act that we had not asked for, although in the circumstances we were prepared to go along with them. One of the things that we asked of the Government, working with the right hon. Member for Haltemprice and Howden (Mr Davis) and other Members, was a renewal of the Act every six months, on a regular basis. From memory, I think we may have asked for a renewal every three months, but we will have to double-check with Hansard on that front. We also asked for the ability for various aspects of the Act to be expired.
Perhaps I am naive, but I did not anticipate that 18 months later the Act would be renewed again on the basis of a 90-minute debate not allowing Members to scrutinise this properly—and given the way in which the House has decided to debate it, Members cannot even table amendments and have their point of view expressed on the Order Paper. I strongly encourage the Government —the Executive who control the business of the House—to try to find a more satisfactory way in which the Act can be properly scrutinised, particularly if the Government are minded to renew it again in six months’ time rather than expire it, as was originally intended.
Jonathan Ashworth
The hon. Gentleman tempts me. I can understand that if the Act fell, there would be time for alternative provisions to be put in place, but I am afraid I do not have confidence in the continuation of this particular Treasury, which is keen to find savings in the public finances, to provide statutory sick pay from day one. Voting down the Act today would be voting down statutory sick pay from day one, and I do not want to see the Government revert to providing it from day four. That is why, although I have sympathy with the hon. Gentleman’s point, I am not prepared to vote down the Act.
Dr Murrison
I always listen to the right hon. Gentleman’s comments with the greatest of interest. He is concerned that there is not sufficient scrutiny. Will he compare and contrast the attendance in this short debate on the Government Benches with that on the Labour Benches? I count three of his Back-Bench colleagues at the moment.
Jonathan Ashworth
The right hon. Gentleman is better than that, with respect. He is very experienced, and he knows full well that right hon. and hon. Members have various responsibilities as Members of Parliament. Come on! That was akin to those ridiculous tweets that we sometimes see going around, saying that an important issue is being debated in Parliament and asking why the Benches are empty and so on, when it is an evening Adjournment debate.
Richard Fuller
I have a great deal of sympathy with what the right hon. Gentleman has just said, but there is an underlying point. On many occasions since March 2020, the Opposition have absented themselves from providing effective voting opposition to measures that the Government have proposed, often affecting the rights and liberties of individuals. If the right hon. Gentleman is saying that he is balancing all the issues involved in the restrictions that result from the continuation of the Act with the single purpose of continuing statutory sick pay for three days, and that because he is not prepared to test the willingness on the Government Benches to support him in any measure he would turn down this whole measure, I think that what he is handing us is giving him a little bit short of what he might expect.
Jonathan Ashworth
The hon. Gentleman knows full well that if the Government wanted to bring forward a separate Bill to pay statutory sick pay from day one—and to increase the level of statutory sick pay, which is not currently at a satisfactory level—that would of course have our support. However, that would have to come from the Executive. It is unlikely to come from Back Benchers, although I am confident that, should such an opportunity present itself, the hon. Gentleman would find himself in the same Lobby as me on the question of paying enhanced statutory sick pay.
A number of provisions have been taken out of the Act that restricted liberties and freedoms. We raised concerns about those provisions six months ago and 12 months ago, and we are pleased that they have been lifted from the Act, particularly those sections that gave the power to detain potentially infectious persons, which have been used for a number of prosecutions, every one of which was found to be unlawful by the Crown Prosecution Service. Hon. Members from both sides of the House made that point in the six-month debate and in the original debate 12 months ago, so we are pleased that the Government have listened to those Members and to the Joint Committee on Human Rights, which said that those powers ought to be repealed. They have now been removed from the Act.
There are some sections whose removal from the Act we would question. A lot of my local government colleagues have asked why the powers that enable local authorities to meet remotely have been removed from the Act. Would it not be better to allow local authorities to come to their own decisions on whether they want to continue to hold online meetings in the next few months? I am not quite sure why we need to remove that provision from the Act.
Of course we would not want to lose statutory sick pay from day one, but the Secretary of State also referred to the emergency legislation covering healthcare workers. This is important because it means that we can get recently retired workers back on their licences and back onto the frontline. We would not want to lose that from the Act. The Act continues to allow remote participation in court proceedings to take place, which we believe is needed in the current circumstances.
The Act was not the legislation that brought in the lockdowns, including the local lockdowns for my home city of Leicester and areas such as Burnley, Bolton and Calderdale, which, sadly, were put into localised lockdown in the past year or so. None of us wants to see those lockdowns ever again. Nobody wants to see a national lockdown, and nobody wants to see local lockdowns. I understand that the Government have quite rightly ruled out further lockdowns, but the public health crisis is not over. That is why we still need some of the provisions in the Act. Covid has not gone away. We can learn to live with the virus, but that is not the same as pretending the virus no longer exists. Yesterday, we recorded close to 50,000 infections, more than 7,000 people were in hospital—with nearly 800 in ICU—and every day on average 100 of our fellow citizens sadly die from this disease. A decision on vaccination in schools by the appropriate committee was delayed, but record numbers of children are now infected. In the past three weeks, we have seen an average of 10,000 new covid infections every day in schools and thousands are missing school as a consequence.
The ongoing pandemic is making existing inequalities worse and worse, so we need some of these provisions to stay on the statute book. However, we need to go further as well. As I have said, I never want to see another lockdown again, either locally in my home city of Leicester or nationally. There are a couple of things that I hope the Government will consider in order to avoid further lockdowns and to avoid needing some of the most draconian measures in the Act to return.
First, we need to fund public health properly in the spending review. The virus thrives on health inequalities. The Secretary of State rightly referred to health disparities and stalling life expectancy in Blackpool, but his Government have presided over public health cuts of £43 per person per year across Blackpool, which are some of the largest in the country. Secondly, we need substantial investment in ventilation support for businesses, public spaces and schools. Better ventilation has been proven, time and again, to reduce the transmission of covid. In addition, it brings other health benefits.
We know that vaccination is waning and that parts of the programme are stalling. The wall of defence is crumbling, so we need to encourage those retired clinicians who helped with the initial vaccination programme to help again. We also need to encourage those retired clinicians who did not help out last time to consider playing their part. That is why the clauses in the Act on the emergency registration of healthcare workers need to remain on the statute book.
We also need to fix the booster programme. As of Friday, only half of eligible over-80s had received their booster jab. Charities including Blood Cancer UK and Kidney Care UK are warning that the third-dose programme for the immunosuppressed has been a “chaotic failure”, with between 55% and 60% yet to be invited to get a third dose, as of Friday. What are the Government going to do to scale up third jabs and boosters? Will the Government consider pop-up clinics, for example? They were successful in the previous round of vaccinations.
Our case rates are concentrated among the young, but only around 30% of children have been vaccinated. One problem in getting vaccinations out to children is that there are not enough staff, which is another reason why we need the emergency registration provisions to stay on the statute book to try to encourage more retired clinicians to join the children’s vaccination programme.
The Secretary of State is now allowing children to book a vaccination in a walk-in centre for half-term, but it is half-term this week in some parts of the country, including in Leicester, so can that part of the programme start today rather than waiting for next week?
There are still parts of the country, including Leicester and many London boroughs such as Brent, Lambeth and Tower Hamlets, as well as parts of the country that were in lockdown last time such as Blackburn and Pendle, where second-dose rates are still below the national average. What will we do to drive up vaccination rates in those parts of the country that were in lockdown last time and where vaccination rates are still too low? Will the Secretary of State consider guaranteeing mandated paid time off for vaccination and mandated sick pay for people who need to take a couple of days off due to side effects or due to feeling unwell, as people sometimes do following a vaccination?
We will support the Government in renewing this Act, although we want them to find a better way of scrutinising its provisions. We are concerned about the infection rates we are seeing. The embers are burning bright again and, because we were world leading on vaccination, we could be world leading again on the waning of vaccination. We need a plan to drive up boosters, to drive up third doses and to drive up second doses for those who have not had them. This disease remains lethal, especially to the frail, to those with underlying health conditions and, obviously, to those who are unvaccinated.
Let us strengthen the vaccination programme, let us pay proper sick pay, let us ensure fresh, clean air in public buildings and let us properly fund public health. Remember that the Select Committee reported last week that the Government’s handling was one of the worst public health failures in British history. This is no time for complacency, and I hope Ministers act now.
Several hon. Members rose—
Covid-19 Update
Jonathan Ashworth Excerpts(3 years, 2 months ago)
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Jonathan Ashworth (Leicester South) (Lab/Co-op)
I thank the Secretary of State for advance sight of his statement. Like him, I want to send my condolences to the Prime Minister and the wider Johnson family at this difficult time.
Infection levels today are actually higher than they were at this time last year, so the test of the Secretary of State’s plan A and plan B is whether we push infections down, minimise sickness and save lives, keep schools open, protect care homes, maintain access to all care in the national health service, and avoid a winter lockdown. He has talked about a plan B. Can he tell us what level of infection and hospitalisation would trigger plan B? Yesterday, Downing Street briefed about a lockdown as a last resort. What, then, is the first resort in combating the virus to avoid a winter lockdown? Will the Secretary of State rule out today local and regional lockdowns like we saw in my city of Leicester, in Bolton and in parts of West Yorkshire last year?
On vaccination, last night we had confirmation of a vaccine programme for children. We welcome and support that. The Secretary of State has now confirmed a booster jab as well. Again, we welcome and support that. But how will he boost vaccination in those areas of the country where vaccine take-up remains relatively low? For example, in Bradford, second doses are running at about 65%, in Wolverhampton at 65%, in Burnley at 69%, and in my own city of Leicester at 61%. What support will be made available to those areas, or others, so that they can boost vaccine take-up?
Vaccinating children is often justified, in my view wrongly, on the basis of its impact on adults and wider transmission. But children and young people would actually benefit further if vaccination rates were increased among adults. Among younger adults—25 to 30-year-olds—it is running at about 55% on a second dose, and among 30 to 35-year-olds at 68%. So what is the Secretary of State going to do to vaccinate more younger adults? What campaign is he going to run to get those vaccination rates up?
What is the plan for those who are immune-suppressed and have shielded throughout this crisis? For example, 1 million cancer patients cannot produce an immune response to vaccines. Will they be offered the prophylactic antibody treatments that are now available, or will they be expected to shield further throughout the winter?
The Secretary of State is right to raise flu and seasonal viruses, but he will know that the Australian flu season has been minimal. That is good for Australia, obviously, but it impacts the ability to collect samples to make an appropriate vaccine for the strain that might hit us. Is he confident of the effectiveness of the flu vaccine to match this year’s strain?
On Test and Trace and wider diagnostics, we are likely to see more flu and RSV—respiratory syncytial virus—and more common colds and coughs. These are viruses with overlapping symptoms to covid, and an increasing range of symptoms is associated with covid as well. Will he look at multiplex testing, which as well as diagnosing whether someone is covid positive also diagnoses flu and RSV? The Academy of Medical Sciences has recommended this.
The Secretary of State said that PCR testing will continue free of charge through autumn and winter. I think that is the first time that a timeframe has been put on free PCR testing. Is he suggesting that we will move to a different system for PCR testing from next spring and summer, where perhaps people will be expected to pay for a test? Could he clarify the Government’s thinking on testing next spring and summer and the rest of the year?
Isolation rules have changed, understandably, but we still need tracing systems. So will local authorities get the resources they need to do contact tracing? For those who need to isolate still, will local authorities have more money in their funds to pay isolation payments? We know that it is such a struggle for those who are low-paid, on zero-hours contracts and so on to isolate.
The Secretary of State has talked about mask wearing and working from home, but he has not talked about ventilation so much. We know that the virus is airborne. We know that workplaces have legal standards about the quantity of fresh air and purified air that is appropriate, so what will he do to drive up ventilation in workplaces and to support public buildings to install the relevant air purification kits, so that people are not effectively breathing in contaminated air?
The Secretary of State did not mention social care. One of the most devastating consequences of failing to protect care homes or to put that protective ring around them was the tragic number of deaths in care homes. The infection control fund ends on 30 September for social care. Will it be extended?
On vaccine passports, will the Secretary of State clarify what exactly the Government’s position is now? What are the Government actually proposing? What will they ask the House to decide? On Sky, he said he was not ruling vaccine passports out. On the BBC, he said he was ruling the idea out. He is now saying they will keep it in reserve. Yesterday, Downing Street said that vaccine passports are a “first-line defence” against a winter wave. What exactly is the position? Rather than zig-zagging all over the place on vaccine passports, can we just get clarity and can the House make a final decision on whether or not we think they are an appropriate intervention?
Sajid Javid
The right hon. Gentleman asked a number of questions, so I will quickly plough through them. We have made clear that plan A is absolutely our focus. It is the situation we are in. Vaccines remain a critical part of it, as do testing and surveillance. I thank him for his support for our vaccine programme, including his comments yesterday. He also asked me about plan B. It is absolutely right that the Government have a contingency plan, and the trigger, so to speak, for plan B, as I mentioned in my statement, would be to look carefully at the pressures on the NHS. If at any point we deemed them to be unsustainable—if there was a significant rise in hospitalisations and we thought it was unsustainable—we would look carefully at whether we needed to take any of those plan B measures. That would be informed by the data, and of course we would come to the House at the time and make the appropriate response.
It is really important to emphasise, as we cannot do enough, the importance of vaccines. We now know from data just yesterday from the Office for National Statistics that, in the first half of this year, 99% of those who died from covid-19 sadly were not vaccinated. That highlights the importance of vaccination.
The right hon. Gentleman asked about people who are immuno-suppressed. He will see that we set out more details on that in the plan we have published today, including treatments that either are currently available or may soon be available. I have mentioned the antivirals taskforce, which is doing great work. There are a number of possible new treatments, and it is something in which the UK is very engaged. He will know that, for those immuno-suppressed people who can take the vaccine, just last week, we announced a third dose as part of the primary treatment. That again is a reminder of the action we are taking. Our advisers are constantly looking to see what more we can do.
The right hon. Gentleman asked about the flu risk. It is a significant risk this year, not least because, for reasons we are all familiar with, there was not much flu last year. There is a lot less natural immunity around in our communities, and the flu vaccine, which is being deployed not only in the UK, but across Europe, has less efficacy than normal, but it is still effective and a worthwhile vaccine, and that is why we will be trying to maximise uptake with the biggest roll-out programme and communications programme that this country has ever seen for the flu vaccine.
On diagnosis, the right hon. Gentleman made a good point, and it is something that we are looking at with covid and flu jointly. On testing arrangements, I think I have set them out clearly in the statement. We have no plans to change the current arrangements, but of course we keep that constantly under review. However, as long as those tests are needed available free for the public, that will be the case. But as I say we will keep that under review.
In terms of infection control in social care settings, a substantial amount of funding is available. We have already made available for this financial year some £34 billion of funding in total for the NHS and the care system for a lot of these extra measures. That is a huge amount of funding. Much of it is going to essential work, such as infection control, and we will ensure that what is needed is there.
The right hon. Gentleman’s last question was about vaccine certification. I think I have made the Government’s position clear. It is not something we are implementing. We are not going ahead with any plans for that. For any Government to do something like that, it would be such a big decision, and it would have to be backed up by the evidence and the data. That evidence is not there, and I hope that we will never be in the situation that it is. To keep it in reserve is the right thing to do.
Covid-19 Vaccinations: 12 to 15-year-olds
Jonathan Ashworth Excerpts(3 years, 2 months ago)
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Jonathan Ashworth (Leicester South) (Lab/Co-op)
I am grateful to the Minister for advance sight of his statement. On behalf of the Opposition, I welcome the guidance today from the chief medical officers and the response of the Government tonight.
Children may not have been the face of this crisis but they have been among its biggest victims. Children have lost months in in-person learning, and have spent weeks cut off from friends and family. We still do not fully understand the long-term mental health implications of this, especially in poorer areas where deprivation already has widespread consequences for the health and wellbeing of our children. Being in school is not just about learning; children often access health services through school as well. I therefore particularly welcome the CMOs’ recognition of the importance of avoiding the disruption of being out of school in making this decision. We are also pleased that the Government have now made the decision, given that other nations have been vaccinating children for some months.
But many of our constituents will rightly have questions. Will the Minister explain to the House what the next stage in the children’s vaccination programme will look like? By what date does he anticipate that children will be vaccinated? On the roll-out, he will know that, for TB, HPV and children’s flu vaccinations in primary schools, it is often school nurses, health visitors and specialist vaccination teams who go to schools directly and vaccinate. Will that model be used in this case, or will children instead be asked to go to the vaccine hubs run by primary care because it is the Pfizer vaccine? Will it be the responsibility of the parents to arrange their child’s vaccination, or will the local NHS arrange it with schools, year group by year group, or class by class? Will the flu vaccine that is to be expanded to secondary school children this year be delivered at the same time as the covid vaccine, or at a separate time?
The Minister rightly said that vaccinating children is a benefit to those children but will also reduce transmission, and in that respect it is a benefit to wider society, but children and young people, and society itself, will in turn benefit if we drive up vaccination rates among adults. In the most deprived areas, fewer than 70% of the adult population are vaccinated; in the least deprived areas it is more than 90%. Among 25 to 30-year-olds, 55% are on their second dose; among 30 to 35-year-olds, 68% are on their second dose; and among 35 to 39-year-olds, 75% are on their second dose. What will he do to drive up vaccination rates among adults, because that is key to pushing down overall infection rates?
Of course, parents will want information. In the past, the Minister has suggested that this vaccination will not go ahead without the consent of parents, but he will know that the Gillick competence principle suggests that a child under 16 can consent to their treatment if the child is believed to have the understanding and intelligence to appreciate what is involved. Can he confirm what the Government’s position is in rolling out this vaccination and whether the consent of parents is necessary? In the past, he has said that it is necessary, as has the Secretary of State for Education; the CMOs seemed to suggest something else today at the press briefing.
There is nothing more precious for a parent than their child. We therefore support the approach of the Government today and welcome the advice and the recommendations of the chief medical officers. However, I hope the Minister will understand that parents, in coming to this decision, will want all the information they can possibly get hold of, and I hope the Government provide it.
Nadhim Zahawi
I am grateful to the right hon. Gentleman for his support, for his points about guidance to the parents and of course to the children, and for his points about the long-term mental health consequences of this pandemic for school-age children.
I can confirm to the right hon. Gentleman that the NHS—it is incredibly efficient and well-equipped, because it has been running the school age vaccination programme for many, many years for other vaccines—will be the primary vaccination infrastructure that we will use to deliver this vaccine. If there are schools where that is unable to be delivered, we will use the rest of the covid vaccine infrastructure, including vaccination centres, to deliver that in a safe and appropriate way. My point is to reassure him and parents up and down the country that it will be the school age vaccination programme that has run in schools. Teachers and parents are well-versed in that process.
The right hon. Gentleman asked about vaccine uptake. He will recall that I said at this Dispatch Box on 13 February, in launching the vaccine uptake programme, that the NHS continued to put effort and resource into making vaccines available and easily accessible to the most deprived communities and to all ethnic groups. We will continue to redouble our efforts, including with the booster programme, which will come later this month. We have had the interim advice from the JCVI on boosting for flu and covid. The uptake of both should increase the uptake in those communities. We have spent a lot of time looking at that.
The right hon. Gentleman asked an important question about the consent process, and I want to spend a little time on that. As with all vaccinations for children, parental consent will be sought. The consent process will be handled by each school in its usual way and will provide sufficient time for parents to provide their consent. Children aged 12 to 15 will also be provided with information, usually in the form of a leaflet for their own use and to share and discuss with their parents prior to the date of immunisation and the scheduled time for it. Parental, guardian or carer consent will be sought by the school age immunisation providers prior to vaccination, in line with other school vaccination programmes.
In the rare event that a parent does not consent, but the teenager wants to have the vaccine, there is a process by which the school age vaccination clinicians discuss this with initially the parent and the child to see whether they can reach consensus. If not, and the child is deemed to be Gillick competent, the vaccine will take place. That is very rare, but on the whole this is something that the NHS is very well versed in delivering for other vaccination programmes.
Covid-19 Update
Jonathan Ashworth Excerpts(3 years, 2 months ago)
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Jonathan Ashworth (Leicester South) (Lab/Co-op)
I thank the Minister for advance sight of his statement. Like him, I praise all our NHS staff. I particularly want to associate myself with the remarks about the safety of the vaccine for pregnant women.
Children’s health and wellbeing has always been a driving priority of mine. Children may not have been the face of this pandemic, but they have certainly been among its biggest victims. The record will show that I have been asking in this House about the vaccination of adolescents for some months. I of course understand the position of the JCVI and welcome the review on the wider implications for children’s wellbeing by the chief medical officers. Should vaccination be recommended and the chief medical officers do recommend vaccination, that will command our full support on the Labour Benches. If the chief medical officers recommend vaccination, will the Minister guarantee that our public health workforce, our health visitors and our school nurses, as well as primary care, will have the resources they need to roll out that vaccination?
Children are back to school. In Leicester, children have been back in school for two weeks. In Scotland, children have been back in school for some weeks also, putting upward pressure on infection rates. If the chief medical officers recommend vaccination, how long does the Minister think it will take to roll out that vaccination? Are we talking months? Are we talking weeks? Are we talking days? If he could give us an indication, I am sure we would all be grateful. The Education Secretary has removed many of the infection control mitigations in schools. We urged Ministers to use the summer holidays to install ventilation, air filtration units and carbon dioxide monitors in schools. How many schools have now had those systems installed?
The hon. Member for Stratford-on-Avon (Nadhim Zahawi) is the Minister for vaccines. Primary and secondary school children are due to receive a flu vaccine, yet not only is the NHS apparently running out of blood test tubes, with certain vital tests delayed, but we are now told that flu vaccination will be delayed, because deliveries are delayed by two weeks, and GPs are cancelling flu vaccination appointments. This is before we head into what could be one of the most difficult winters in living memory. What will the Minister do to get a grip of this situation and avoid a flu crisis this winter? If there is a delay in flu vaccines, does he expect that to knock on to any booster jab campaign? Less than a month ago, the Health Secretary said he wanted booster jabs to be given at the same time as flu jabs and he said that they would start this month.
Finally, we of course welcome the new funding for the second half of the financial year and we welcome that it would appear that Ministers have listened to our calls for the discharge to assess funding to be extended, but I think the whole House would agree that surely one of the most heartbreaking, and in my view frankly unforgivable, episodes in the pandemic was the failure to protect care homes and to put that protective ring around care homes as we were promised. If covid has taught us anything, it is that a long-term plan for social care is long overdue and that it should be funded in a fair way. The Minister, along with every Conservative Member, was elected on a manifesto that promised a social care plan and promised no rise in national insurance. The Prime Minister guaranteed no rise in national insurance, but we are told to expect, tomorrow, a rise in national insurance—a tax on workers to pay for a regressive social care policy that simply will not improve the care that people need and deserve. In this House, the Minister used to call national insurance a “tax on jobs”. What would he call a manifesto-breaking national insurance rise now?
Nadhim Zahawi
I am grateful to the right hon. Member for his support and his words on the vaccination of pregnant women and the protection that the vaccine offers them.
On the right hon. Member’s question about the JCVI advice on 12 to 15-year-olds, the JCVI looked at the very narrow impact of the vaccine on 12 to 15-year-olds, because that is very much its remit. It also advised that the chief medical officers should take a wider look. That is what they are doing as we speak. Panels of experts from local public health as well as other experts are looking at the impact of the vaccine on mental health and the disruption to education specifically for 12 to 15-year-olds. They will come back with recommendations. The JCVI is observing those panels and is very much in the room, as far as that is concerned.
It is also worth reminding the House that the Medicines and Healthcare Products Regulatory Agency has looked at the Pfizer and Moderna vaccines and has approved both vaccines as safe and eligible to be administered to 12 to 15-year-olds. It is not worth our pre-empting the report of the chief medical officers of England, Wales, Scotland and Northern Ireland. Throughout the pandemic, we have operationalised the vaccine programme; we prepare early and we prepare well. To give the right hon. Member a direct answer to his question, the NHS is prepared to administer a vaccine within five working days of any recommendation. That does not pre-empt any recommendation. We did the same when none of the vaccines was approved. Some colleagues will recall Brigadier Phil Prosser explaining at the press conference that we had built the equivalent of the infrastructure of a national supermarket chain and were growing it by 20% every week. We have done the same thing when it comes to all outcomes of the deliberations at the JCVI and what it will ultimately recommend.
On education, the Secretary of State for Education addressed many of the issues on the mitigation and controls in schools, as well as testing and the very successful adult vaccination programme that we have delivered, which is now also delivering protection for 16 and 17-year-olds.
I really want to address the point about flu and I hope that we can have a sensible discussion on it. We are being very ambitious on flu. The interim advice from the JCVI is wherever possible to co-administer flu and covid vaccines. Traditionally, flu vaccination begins earlier—it begins now. One of the suppliers, Seqirus, has had a border issue with its Spanish fill-and-finish factory, which it has used for many, many years. This is the first time that it has had this issue. It is meeting the Spanish regulator to see what the issue is. It is being very careful and estimating a one or two-week delay. This will not delay the overall flu vaccination programme at all. Its German and Belgian supply chain has been flowing normally. It is one of the suppliers, so I urge the right hon. Gentleman not to, as a knee-jerk reaction, talk about flu vaccine shortages. We are being incredibly ambitious on flu vaccines—including procuring centrally as well as the traditional procurement through GPs and pharmacies—with a big, big programme.
Wherever possible, we will co-administer. The only caveat I would place on that is that the JCVI has given us only its interim advice on covid. We are not yet there with the cov-boost data, which it will look at. It will give us its final advice on covid. If it chooses a vaccine that requires, for example, a 15-minute observation period, we have a very different challenge in co-administration, but nevertheless, wherever possible, we will co-administer. We have made it possible for vaccinated volunteers to administer flu and covid vaccines.
Finally, on funding, I am glad that the right hon. Member agrees that the £5.4 billion announced today is a good thing. I urge him not to speculate on how we will pay for social care and to wait for the announcement; I am sure that we can then discuss it in this place and in the media.
Covid-19 Update
Jonathan Ashworth Excerpts(3 years, 4 months ago)
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Jonathan Ashworth (Leicester South) (Lab/Co-op) [V]
I thank the Minister for advance sight of his statement. Let us be frank: it was a shambles yesterday. It was an insult to the House and a let-down for health and care staff.
Ministers have been dragged kicking and screaming to this 3% settlement. Can the Minister accept—and does he accept—that it is not an NHS-wide settlement, as it does not cover the health and care workforce who do not fall under the pay review body? For example, it does not cover our junior doctors who have had an intense year caring for sick patients on ventilators, who have been redeployed to other sites across the NHS and who have seen their training disrupted. Will the junior doctors get a pay rise, especially given that the pay review body, in paragraph 10.6 of its report, urges the Government to recognise the role of doctors who are out of scope? Will all health staff who work in public health receive the settlement? Care workers are obviously not covered by the pay review, and we know how valuable they are, so will care workers finally get the real living wage that they deserve?
How will the pay settlement be funded? NHS trusts do not even know what their budget will be beyond September. The Health Secretary has said that the pay settlement costs £2.2 billion, so where is that £2.2 billion coming from? Is he expecting trusts and general practice to find it from their existing budgets? At a time when the NHS is in a summer crisis, with covid admissions increasing and more patients on ventilators in hospitals, with operations being cancelled again and waiting times growing because of the pressures the NHS is under, rather than getting a funded settlement for the NHS we have seen this week briefing and counter-briefing from the Health Secretary, the Chancellor and Downing Street about what may or may not be coming for health and social care.
The NHS needs more investment now to cope with the pressures that it is under. Will the Minister confirm that the Government will break their manifesto pledge to increase national insurance, or is the Business Secretary correct in what he said this morning? He said:
“I don’t see how we could increase national insurance”.
The Prime Minister promised, on the steps of Downing Street two years ago this Saturday, that he would have a social care plan, but this is not a plan for health and social care; it is a Government in disarray.
That brings me on to the so-called pingdemic, with the problems of isolation. The problems of isolation that we are seeing are a symptom of what happens when Ministers allow infections to get out of control. The Government are apparently U-turning today and agreeing a list of workers who could be exempt from isolation, based on a negative PCR test. With infections running at more than 50,000 a day, and possibly on the way up to 100,000 a day, can the Minister absolutely guarantee that PCR testing capacity will be available to cope with the inevitable increased demand this summer?
If the Minister wants to avoid shutting society down, he needs to bring infections down, so why have the Government ruled out extending statutory sick pay to the lowest-paid, and what is he doing to drive up the vaccination rate among younger adults? He knows that allowing infections to rise among that cohort sets his vaccination programme back, given that somebody has to wait 28 days post-infection for vaccination.
Today the Minister has repeated his support for vaccine passports. Can he explain why he thinks it is safe to go out clubbing into the early hours this Friday, but in September it is only safe to go out clubbing if everybody is double-jabbed? Can he confirm when the relevant statutory instrument will be laid, and when the vote will be on introducing those passports?
The Minister has a proposal for nightclubs in September, but does he have a proposal for schools in September? A million children have been off school recently, so, as we asked him on Monday, will he use this summer to install air filtration units in schools in time for September, and is he considering bringing mask-wearing back in schools?
Finally, Mr Speaker, may I, like the Minister and others across the House, thank you, and all the staff especially, for the extraordinary work that you have put in, in these last 12 months, to ensure the smooth running of Parliament in these most unprecedented of circumstances? I hope you are all able to have a suitable rest over the summer recess.
Nadhim Zahawi
The right hon. Gentleman asks who is included in the 3% pay rise recommended by the independent NHS Pay Review Body. They are the 1 million NHS staff, including nurses, paramedics, consultants and, of course, salaried GPs. The junior doctors he mentions have a separate, multi-year pay rise over three years, amounting to 8%.
The right hon. Gentleman asks about the capacity for testing. I looked at that before coming to the House, and the capacity currently for PCR tests is not 600,000 but 640,000 a day, according to the latest data that I looked at. He asks about schools. There will be two supervised tests for schools. He knows that in Monday’s statement we announced our acceptance of the JCVI guidelines on vaccinating vulnerable children, vaccinating children who live with vulnerable adults, and vaccinating those who are 17 but within three months of their 18th birthday. The JCVI will keep under review the vaccination of healthy children as more data becomes available from countries such as the United States of America and Israel.
The right hon. Gentleman asked a question around the covid vaccination pass and nightclubs, other crowded unstructured indoor settings such as music venues, large unstructured outdoor events such as business events and festivals, and very large structured events, such as business events, music and spectator sport events. They are the ones that we are most concerned about. We have seen other countries, whether it is Holland or Italy, opening nightclubs and having to reverse that decision rapidly. What we are attempting to do, and the reason we have the covid vaccination pass in place, is to work with industry while we give people over the age of 18 the chance to become double-vaccinated. It would be hugely unfair to bring in that policy immediately. Giving people until the end of September is the right thing to do, while at the same time allowing businesses to open safely, using the app now—because the app went live and the industry is very much engaging with it.
There are no easy decisions on anything to do with this virus. That is the one thing we have learned. The most effective tool we have against the virus is, of course, the vaccine programme, followed by the tool of self-isolation. If we want to get back to normal and get our lives back, we need to transition this virus from pandemic to endemic—from pandemic to manageable menace—as quickly and as safely as possible. If we release all restrictions now, including self-isolation, which I am sure a number of colleagues will ask about today, we risk the number of infections, which the shadow Secretary of State worries about as I do, rising rapidly. That could risk the transition of this virus.
We are working flat out with industry. I commend companies such as Lidl, which knows it is under pressure but will work through it with us. We will allow critical, frontline and key workers and health and social care workers to get back to work if they take a negative test, as I announced on Monday. By 16 August, everyone who is double-vaccinated will be able to do that.
Covid-19 Update
Jonathan Ashworth Excerpts(3 years, 4 months ago)
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Jonathan Ashworth (Leicester South) (Lab/Co-op)
I thank the Minister for advance sight of his statement.
Of course people have the right to protest against a lockdown that no longer exists, but will he join me in condemning the ugly scenes of harassment, thuggishness, throwing of objects, pushing and intimidation directed at police officers outside on Parliament Square earlier?
The Minister has said that a number of teenagers will be vaccinated. Can he tell us how many and by when? The Medicines and Healthcare Products Regulatory Agency has approved the Pfizer jab for all 12 to 18-year-olds. Indeed, countries such as the United States, Canada, Israel, France, Austria, Spain, Hong Kong and others have started vaccinating, or soon will be, 12 to 18-year-olds, so why are we not?
The Minister rightly said that the risk of death to children from covid is mercifully very low, but children can become very sick and they can develop long-term conditions and long covid. Indeed, according to the Office for National Statistics, 14.5% of children aged 12 to 16 have symptoms lasting longer than five weeks, so will he spell out in detail the clinical basis for why the JCVI has made this decision? Will he publish all its analysis and documents in the same way that the Scientific Advisory Group for Emergencies publishes its analysis—not just the advice—and can he guarantee that this decision was made on medical grounds and not on grounds of vaccine supply?
The Minister talked about infection among children being disruptive, and we know that infection among children is highly disruptive for learning—we have seen hundreds of thousands of children out of school. If we are not vaccinating all adolescents, can he tell us what the Government’s plan is for September, when children return to school? For example, will he consider using this summer to install air filtration units in every classroom or in every school?
Testing is already stretched, with turnaround times lengthening. Can the Minister guarantee that through the summer—and especially once contacts can be released from isolation on the back of a negative PCR test in August—and into September, when schools return, there will be sufficient PCR testing capacity to meet demand? As we move into autumn and winter, we anticipate more flu and respiratory viruses. Those are illnesses with symptoms that often overlap with covid, so will he also now invest in our testing capacity, so that alongside a covid test we can test for flu and respiratory syncytial virus this winter? We need multi-pathogen testing going forward.
Three weeks ago, the Health Secretary told us that unlocking would make us healthier, and he promised us that it would be irreversible, but today we have some of the highest infection case rates in the world, and the mayor from “Jaws” has decided to reopen the beaches, recklessly throwing off all the restrictions with no safety precautions in place, such as mandatory mask wearing. It risks reimposing new restrictions in the future, and it means that the NHS is facing a summer crisis. Already, admissions for covid are running at around 550 a day, and hospitals are cancelling cancer surgery. Liver transplant operations were cancelled in Birmingham last week.
Throwing off all restrictions like this will see thousands suffer serious long-term illness. The clinically vulnerable and scared are feeling shut out of society, and selection pressure could see a new variant emerging that evades the success of the vaccine programme, setting us back and snatching defeat from the jaws of victory. It is reckless, and it does not have our support.
More infections means more isolation. The NHS staff who will be released from isolation if double-jabbed will still want protection for themselves and their patients, so will the Minister ensure that the standard of masks worn in NHS settings is upgraded to the FFP3 requirement, as NHS staff have called for? What is his plan for keeping the economy and public services functioning throughout the summer as more and more people are asked to isolate?
We know that the Prime Minister’s and the Chancellor’s plan was to dodge isolation, so can the Minister tell us how this “random” clinical trial, which so helpfully selected the Prime Minister, the Chancellor and the Chancellor of the Duchy of Lancaster, was set up? Will he tell us what exactly happened between 8 am and 10.38 am on Sunday that persuaded the Prime Minister and the Chancellor to withdraw from this presumably valuable and random clinical study? Can he tell us how many other Ministers have participated in the trial? Did he participate? How many Government Departments and officials were involved, and why? If he cannot answer these questions sufficiently, our constituents will rightly conclude that it is one rule for Tory Ministers and another for the rest of us.
Nadhim Zahawi
The right hon. Gentleman began well but ended with petty politics. However, I will address the issue of the testing trials over a number of days, which began, I think, around December. It was not just the Cabinet Office and No. 10 that participated; organisations such as Transport for London, Heathrow airport and others would have participated as well. The Government make thousands of decisions every day, every week, which is not something that the Opposition are used to doing—certainly not their leader, anyway. Nevertheless, I shall refrain from engaging in petty politics and try to address some of his more substantive questions.
On the harassment and thuggish misbehaviour, I join him in condemning such behaviour outside the Houses of Parliament against our police officers.
On vaccinating 12 to 15-year-olds, the right hon. Gentleman asked about the number for England. Approximately 370,000 children will receive that protection. We are currently not following the United States of America, Israel or other countries in vaccinating all children, although the JCVI is continuing to review the data and is waiting for more data on second doses. Millions of children in the US have already received a first dose but there is a time lag for second doses and that is being kept under review. We publish the JCVI advice accordingly.
On testing, the United Kingdom now has the capacity for over 600,000 PCR tests and many millions of lateral flow tests. I myself am not on the trial that the right hon. Gentleman spoke about, but I do take the lateral flow test and I tested negative earlier today, as I did on Thursday and Friday.
I am happy to have the right hon. Gentleman’s support on the JCVI advice on protecting the most vulnerable children, and of course asking it to make sure that it reviews the data on all children. I reassure him that the decision was not in any way made taking into consideration volumes of vaccine. We have plenty of vaccine available for the vaccination of all children that is necessary. We have ordered more of the Pfizer-BioNTech vaccine, which is the vaccine that was approved. The decision was made by the JCVI based on looking at the data from other countries, and that is the decision that we will implement.
Health and Care Bill
Jonathan Ashworth ExcerptsWednesday 14th July 2021
(3 years, 4 months ago)
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Sajid Javid
The right hon. Gentleman has raised an important matter. There are issues surrounding the cosmetic surgery industry, and I know that he has spoken eloquently about them in the House before. I do not necessarily agree that this Bill has to be the vehicle for any change, but if he wishes to discuss the matter further, I should be happy to meet him in due course, because it is important and it does require a fresh look.
Whenever the NHS is subject to change, it is tempting for some, who should actually know better, to claim that it is the beginning of the end of public provision. We know that that is complete nonsense, and they know it is nonsense, but they say it anyway. So let me very clear: our integrated care boards will be made up of public sector bodies and those with a social purpose. They will not be driven by any private interests, and will constantly make use of the most innovative potential of non-NHS bodies.
The spirit of this Bill is about holding on to what is best about the NHS and removing what is holding it back. That is something that we all want, and I am looking forward to a mature debate—[Laughter.] Perhaps that is too much to ask in this Chamber with this Opposition Front Bench, but I hope for, and I think the public expect, a mature debate on the Bill and on how we can achieve these sensible changes together.
In that spirit, the second theme of the Bill is cutting bureaucracy. As we have been tested during these past months, we have looked at the rules and regulations through new eyes. It has become increasingly clear which of them are the cornerstone of safe, high-quality care, and which are stifling innovation and damaging morale. It is that second group of rules and regulations that the Bill strips away, removing the existing procurement regime and improving the way in which healthcare services are arranged. Yes, this is about how we deliver better value for the taxpayer, but fundamentally it is about how we can free up NHS colleagues to deliver better care. We know that patients are better served when experts are free to innovate unencumbered by unnecessary bureaucratic processes. That is why the Bill will repeal section 75 of the Health and Social Care Act 2012, giving the NHS the flexibility for which it has been asking. I know that this is a point of agreement with the Labour party—
Jonathan Ashworth (Leicester South) (Lab/Co-op)
We said it 10 years ago.
Sajid Javid
The Labour party said it not just 10 years ago but in 2015, 2017 and 2019—in all those manifestos—so I am sure that its members agree with this direction. [Interruption.]
Jonathan Ashworth (Leicester South) (Lab/Co-op)
I beg to move an amendment, to leave out from “That” to the end of the Question and add:
“this House declines to give a Second Reading to the Health and Care Bill, notwithstanding the need for a plan for greater integration between health services and social care services and for restrictions on junk food advertising to improve population health outcomes, because the Bill represents a top down reorganisation in a pandemic leading to a loss of local accountability, fails to reform social care, allows further outsourcing permitting the private sector to sit on local boards and fails to reinstate the NHS as the default provider, fails to introduce a plan to bring down waiting lists for routine NHS treatment or tackle the growing backlog of care, fails to put forward plans to increase the size of the NHS workforce and see them better supported, and fails to put forward a plan that would give the NHS the resources it needs to invest in modern equipment, repair the crumbling NHS estate or ensure comprehensive, quality healthcare.”
Well, the Secretary of State talked a lot, but he did not say very much. Look at the context of where we are. Yesterday, we recorded 36,000 covid infections. Hospital admissions have increased to over 500 a day, up 50% in a week. Waiting lists are at the highest level on record, currently at 5.3 million. Some 336,733 people have been waiting over a year for treatment, over 76,583 people are waiting over 18 months, and over 7,000 people are waiting over two years. Some 25,889 people are waiting more than two weeks from urgent referral to a first consultant appointment for cancer. Emergency care is grappling with some of the highest summer demands ever seen. Two hundred and fifty thousand people are waiting for social care. NHS staff are exhausted, facing burnout. We went into this pandemic with 100,000 vacancies across the NHS and a further 112,000 vacancies across social care.
The answer from the Secretary of State is to embark on a top-down reorganisation when we are not even through the pandemic—a reorganisation that will not deliver the integration needed, because reforms to social care are delayed again; a reorganisation that will not deliver more care but in fact, in periods of stretched health funding, could well deliver less care; and a reorganisation that is, in effect, a Trojan horse to hide a power grab by the Secretary of State.
Let us be clear why this reorganisation is taking place. The Government have come forward with this Bill because of the mess of the last reorganisation—the mess that the Secretary of State supported and voted for, and the mess that he spoke out for in this House, saying that it would modernise the NHS and that the
“concept of GP commissioning has been widely supported by politicians from all parties for many years. May I urge my right hon. Friend to keep putting patients first by increasing GP involvement in the NHS?”—[Official Report, 4 April 2011; Vol. 526, c. 773.]
Why, if he believed that then, has he U-turned now? And it was a mess that we warned of. My hon. Friend the Member for Leicester West (Liz Kendall), who opposed that Bill in this House, warned the Government that it would increase bureaucracy and increase the fragmentation that the Secretary of State has just complained about from the Dispatch Box.
Ministers said that that reorganisation under Lord Lansley would reduce bureaucracy, and Back Benchers told us that it would reduce bureaucracy, but what ended up happening? Billions were wasted and thousands of NHS staff were made redundant. That was the Government’s priority then, and now they are asking us to clean up their mess today. They also told us that that reorganisation would improve cancer survival rates, and where are we today? We are still lagging behind other countries on cancer survival rates. Perhaps the Secretary of State could have come to the Dispatch Box and apologised for that Lansley reorganisation and 10 wasted years.
The Secretary of State talked about NHS leaders, but the truth is that NHS leaders asked for a simple Bill to get rid of the worst of the Lansley restructuring and instead re-embed a sense of equity, collaboration and social justice in our NHS structures. That is not what this Bill is. Of course, the Secretary of State secretly agrees with me. According to The Times, he wrote to the Prime Minister saying that there were “significant areas of contention” that were yet to be resolved with the Bill, and that he wanted to delay it. The Secretary of State was only back five minutes and already Downing Street was overruling him. When it overrules him on his choice of spin doctors, he walks; when it overrules him on the future of the NHS, he puts his career first and stays in the Cabinet.
I listened carefully to the case made by the Secretary of State. He talked of the need for greater integration between health and social care and the need to provide better co-ordinated care, and he referred to an ageing population.
To be frank, that was a speech that Health Secretaries and their predecessor Social Services Secretaries have been making more or less since 1968, when Richard Crossman proposed the first set of NHS reorganisations. Indeed, there were echoes of the Secretary of State’s speech in that made by his predecessor Keith Joseph, when he came to this House in 1972 to set up the area health authorities, bringing together hospitals and community care and working more closely with local authorities because we needed seamless care. Those authorities were of such a size that, within a year, they were rearranged again into district health authorities. Given the size of some of the integrated care systems that the Secretary of State is proposing, I suspect that the seeds of the next reorganisation are being sown today.
Yesterday, the Secretary of State told the House that his
“three pressing priorities for these critical…months”
were
“getting us…out of this pandemic…busting the backlog”
of non-covid care, and
“putting social care on a sustainable footing for the future.”—[Official Report, 13 July 2021; Vol. 699, c. 163.]
But absent from his speech was any credible explanation of how this reorganisation will meet his objectives that he outlined to the House yesterday. In fact, in the last 30 years, we have seen around 20 reorganisations of the NHS. Have any of them delivered the outcomes that Health Secretaries have promised from the Dispatch Box? Well, not according to analysis in The BMJ, which observes:
“Past reorganisations have delivered little benefit”.
Why should this one be any different?
The question for me is: how will the 85-year-old with multiple care needs experience better whole-person care as a result of the restructuring that the Secretary of State is embarking upon? How will waiting times for elective surgery for cancer and mental health be improved by this reorganisation? How will health inequalities that have widened and life expectancy advances that have stalled be corrected by this reorganisation? To those questions, the Secretary of State had no answer today: the Bill fails those tests because it is a badly drafted Bill and could in fact even worsen health outcomes.
Let me outline our specific concerns. On the proposed integrated care boards, the Bill collapses the remaining 100 or so clinical commissioning groups into 32 integrated care systems differing in geographical size and with some covering populations up to 3 million or 4 million. In some parts of the country, the ICSs are not based on the NHS agreed boundaries, but currently on centrally drawn-up boundaries for political reasons. We know that Cheshire will be combined with Merseyside. Glossop is cut off from Greater Manchester and allocated to Derbyshire. Frimley is split up, leading the former Prime Minister, the right hon. Member for Maidenhead (Mrs May), to complain in an Adjournment debate recently:
“Do not break up Frimley ICS. Just for once, let common sense prevail.”—[Official Report, 29 June 2021; Vol. 698, c. 238.]
These boundaries and the way in which they were proposed by the previous Secretary of State, the right hon. Member for West Suffolk (Matt Hancock), prompted NHS Providers to warn that the disruption could lead to
“a worsening of patient care”.
And then, of course, we have the design of the integrated care system, split across two committees—a partnership board containing people from local authorities, the third sector and others, and then an NHS board responsible for spending the money, for commissioning. The Secretary of State has moved away from GP commissioning, of course; he wants the NHS board to commission now. Those two boards will probably have different chairs, but the NHS board only has to have “regard” to the partnership board strategy. Nor is it clear how local authority seats—the one local authority seat—will be decided when they cover more than one council and possibly even councils of different political persuasions, so we will see how a consensus can be built then.
Other important voices are left out. Mental illness accounts for roughly a quarter of the total burden of illness, yet there is no guarantee that mental health providers will get the seats on these boards, when we know that mental health services are under pressure and the Secretary of State tells us that the mental health backlog is one of his personal priorities. The pandemic has also reminded us that the health and wellbeing of our community is not just in the hands of large hospitals or general practice. It is also in the hands of our directors of public health, who have shown exceptional local leadership throughout this crisis, standing on the shoulders of their forebears, who in the past confronted diseases such as cholera, smallpox and diphtheria. Test and Trace would have been far safer in their hands from the outset, by the way, and what is their reward? They are sidelined. Public health, again, should be properly represented on the NHS boards and we will table amendments to that effect.
Mr Kevan Jones
Does my right hon. Friend agree that it is not just about their being sidelined; it is actually about the budgets for public health, which have been pushed off into the autumn? If the consultation paper that went out last year is anything to go by, County Durham would lose 19% of its budget. How can we effect these changes without its being divorced from what will be provided in terms of cash?
Jonathan Ashworth
My right hon. Friend is absolutely right. I will come to the financial flows in a few moments. But how on earth can we have a triple aim of trying to improve health outcomes for a population and not even give public health a voice and a seat on the decision-making body that decides health plans for an area?
The Secretary of State talks about integrating health and social care. There is no seat for directors of adult social services on these committees, either. And what about patients? Patients were not mentioned very often by the Secretary of State in his speech. Patients will always come first for the Opposition. They have no mandated institutional representation, either—no guaranteed patient voice—so we have yet another reorganisation of the NHS whereby patients are treated like ghosts in the machine. It is utterly unacceptable. This is fragmentation, not integration, with a continued sidelining of social care.
There is a loss of local accountability as well, because there is no explicit requirement that the boards meet in public or publish their board papers. Although NHS England has stated that that is its preference, it is not required; nor is there any commitment, despite the wide geographical spread of some ICSs, for meetings to be made accessible online. But, of course, the White Paper did indicate that the independent sector could have a seat on an ICS, and the explanatory notes to the Bill state that
“local areas will have the flexibility to determine any further representation.”
Kevin Hollinrake
The right hon. Gentleman talks about solutions to social care. Will he come on to his own solutions to social care? Will they potentially include the recommendations of the Select Committees about that German-style social care premium—recommendations made by members of his own party who were elected by his party to serve on those Committees? Is that something that he is now willing to explore? He has ruled it out time and again on the Floor of the House.
Jonathan Ashworth
I have. The hon. Gentleman is a dogged advocate for that proposal for social care, and he is quite right: he always raises it with me. I am unpersuaded but I am more than happy to sit down with the Secretary of State and with my hon. Friend the Member for Leicester West to discuss a solution to social care. We keep being told that there are going to be cross-party talks, but I think I missed the Zoom link, because they have not happened so far.
As I was saying, these committees do permit a seat, if the committees want it, for the independent sector. In Bath, in Somerset, we have seen Virgin Care get a seat on the shadow ICS. The Opposition think that is unacceptable and we shall table amendments to prohibit it.
I welcome the removal of the section 75 competition and procurement rules, finally scraping the remnants of the Lansley competition rules off the boots of the NHS. We did warn him and others that this compulsory competitive tendering would lead to billions going to the private sector, would be wasteful and bureaucratic, and would be distracting—and it even led to the NHS getting sued by Virgin Care when it did not win a contract. But this is not the end of contracting with the private sector. Without clauses to make the NHS the default provider, it would be possible for ICBs to award and extend contracts for healthcare services of unlimited value without advertising, including to private companies. Given the past year, when huge multibillion-pound contracts have been handed out for duff personal protective equipment and testing, we naturally have concerns about that and will seek safeguards in Committee. We are worried about further cronyism.
We are particularly concerned about the Bill because of the power grab clauses for the Secretary of State. He is creating 138 new powers, including seven allowing him in effect to rewrite the law through secondary legislation, to transfer functions between arm’s length bodies without any proper scrutiny. He has not explained why he needs these powers or given any guidance on how he expects to use them. These powers also include a requirement that Ministers be informed of every single service change, every single reconfiguration, and the Secretary of State will then decide whether or not to call them in for ministerial decision. Are you sure you want that power, Secretary of State?
The Government have gone from wanting to liberate the NHS under Lansley to now listening out for the clang of every dropped bedpan echoing through Whitehall. This is not a plan for service modernisation; it is a “Back to the Future” plan and it will mean more inertia. Instead of powers to interfere at every level, resetting the mandate for the NHS within years, we instead would want the duties on the Health Secretary, and therefore on the 42 ICSs to which he delegates those responsibilities, to continue the promotion in England of a comprehensive health service, as per the National Health Service Act 2006, to be fully reinstated and made explicit.
Steve Brine (Winchester) (Con)
As ever, I have listened carefully to the right hon. Gentleman. If this is the “Back to the Future” Bill, presumably it puts right what once went wrong. Does he support the clauses on foods that are high in fat, salt and sugar, and the watershed proposals for advertising?
Jonathan Ashworth
Yes, although I am disappointed that they are in this particular Bill. I think they should be part of a stand-alone Bill. In my concluding remarks, I will make a point or two about other public health interventions, which I imagine and hope that the hon. Member, as a great champion of public health, would support.
It is crucial that the Secretary of State’s duty to provide comprehensive healthcare is reinstated, rather than the duty to meddle in the NHS at any time he wants, because there is a lack of clarity about how the funding flows work in this system. The talk is of moving to capitated budgets for an area to provide holistic care to meet the complicated care needs of individual. But when waiting lists are increasing at the current rate, and when cancer waits and mental health referrals are going up, how is an area going to fund the episodic care for each unit of extra care that is needed—often care that is expensive and more complicated because it needs to be done in the acute sector?
We have worries. Clauses 21 to 24 on the financial duties on ICS boards, NHS trusts and NHS foundation trusts are alarming, because they put in place a duty to ensure financial balance across the ICS area, but there is no clarification of how that balance should be achieved and enforced. Local health budgets have been stretched to breaking point after years of underfunding, so what does this duty mean for existing deficits? At the moment, trusts have a combined deficit of £910 million. King’s has a deficit of £111 million. Worcestershire has a deficit of £81 million. University Hospitals of Leicester NHS Trust has a deficit of £80 million. Will the ICBs need to fill this £900 million black hole before they are even up and running How exactly will trust and ICS board deficits be dealt with at the end of each financial year?
This could well be a return to the days that we saw in the ’80s, which some Members in the House may recall, when health authorities would close beds and put off paying bills from January onwards in order to hit financial balance. If health authorities have to hit this financial balance year by year, will it result in a postcode lottery of more rationing and an even longer list of treatments being removed from the NHS through the decisions of ICBs because they have to hit balance, effectively forcing patients either to go private or go without? I hope that the Minister, in summing up, can clarify what the situation will be.
If a set of providers, trusts and an ICB feel that the financial settlement they have been given by NHS England will not allow them to deliver the levels of care to bring down the waiting lists, which the Secretary of State said is one of his top priorities, or to improve mental health outcomes, which he has also said is one of his top priorities, what is their appeal process? How will the arbitration process work on an area’s financial settlement under the current plans to bring together NHS England and NHS Improvement, not split them out?
The Bill is spun as an attempt to integrate health and social care, but there is nothing in it actually to integrate health and social care, because there is nothing in it to fix social care. If it is about integrating health and social care, where is the long-promised Bill to reform social care? The Bill will repeal provisions in the Care Act 2014 that require patients to be assessed for their social care needs before they are discharged from hospital. Without long-term funding in place, that could mean a patient being sent home, left out without support and waiting for an assessment. Will the Secretary of State, or the Minister who responds to the debate, guarantee that that will not be the case? Will they put in place the necessary funding alongside the Bill?
A number of royal colleges and health bodies have said today that the biggest challenge facing the NHS is workforce. The Bill proposes a duty on the Secretary of State to report on workforce once every five years. That is simply not good enough. We need a solution to workforce now; we need a solution to recruitment now; staff need a fair pay rise now; we need more investment in training and professional development budgets now; and we need safe staffing legislation now. We will therefore look to amend the Bill, hopefully on a cross-party basis and perhaps working with others who put forward proposals to improve the workforce sections of the Bill.
As my hon. Friend the Member for York Central (Rachael Maskell) asked the Secretary of State, what does the Bill mean for “Agenda for Change”? The Bill suggests that an integrated care system will be able to change “Agenda for Change” terms; we disagree with that.
Finally, on public health, the Bill introduces restrictions on the advertising of less healthy food and drink. We welcome this step—it, too, was in our 2017 manifesto, which the Secretary of State has been reading—but we would go further. Why can we not have more restrictions on the advertising of unhealthy food around schools? Our public health crisis is about not just obesity but smoking and alcohol, so why are there no provisions in the Bill on smoking services and to ensure alcohol calorie labelling? We will table amendments on those issues in Committee.
This is the wrong Bill at the wrong time. Will the person with learning difficulties or the older person who needs social care experience improved care? No. Will social care be brought back in from the wilderness? No. Will the cancer backlog be tackled more effectively? No. Will health inequalities be narrowed? No. Will parity of esteem for mental health be delivered? No.
Instead of this being a simple Bill to end competition and foster local collaboration, NHS staff will be left trying to second-guess where the Secretary of State will interfere next in the safe running of their local NHS with his in-year changing mandate. The rules on funding could result in more rationing and cuts, so we cannot possibly support the Bill. We have championed integrated care for many years, but the Bill does not deliver it and we urge the House to accept our reasoned amendment.