Health Protection (Coronavirus, Restrictions) (No. 2) (England) Regulations 2020

Justin Madders Excerpts

Thursday 16th July 2020 General Committees

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to see you in the Chair, Mrs Murray. I hope that your début is memorable for all the right reasons.

I thank the Minister for her introduction. As we know, this is the fifth iteration of the lockdown restrictions, although it is only the fourth time that we are actually debating them. In that lies a tale, which highlights the far from satisfactory approach to parliamentary scrutiny that has been a feature of the Government’s response to the pandemic.

[Maria Eagle]

Is my hon. Friend content that we are discussing today a set of regulations that have already come into force and that have since been changed? However one describes scrutiny, that is a strange definition.

[Justin Madders]

I will be expanding at length on the unsatisfactory nature of the way these regulations have been dealt with from the start. I think it is fair to say that at the start of the pandemic we understood why it was not possible to debate the regulations straightaway, but there is no longer any reason why regulations cannot now be debated in an orderly fashion, before they are formally made law.

Nearly a fortnight ago we saw the reopening of pubs, restaurants and hairdressers, among other businesses. I am sure that many of us were very pleased to be able to support those businesses in our constituencies, but I am sure that we are all equally concerned at the scenes we now regularly see where social distancing appears to have gone out the window. The chairman of the Police Federation, John Apter, commented that it was “crystal clear” that

“drunk people can’t/won’t socially distance.”

That rather begs the question of what consultation was going on before the regulations came into force. On the face of it, they are creating additional risks.

To be clear, none of the regulations has ever stopped people from being closer than 2 metres. That has never been a law that could be enforced, but it is an important element of the guidance designed to help stop the spread of the virus, so changes to the regulations should always consider whether they make social distancing easier or harder to adhere to.

Unfortunately, the Government do not seem to have learned from their experience, because we know that the police were not consulted on the face mask announcement that was made on Tuesday either. That is just one reason why it is frankly ridiculous that we are not debating the regulations before they are introduced.

The Minister was gracious enough to acknowledge the concerns that we have raised on every occasion about the timing of these debates; when we debate the regulations is getting a little bit closer to the due date—next week we will get even closer—but the fact is that we are debating changes that came into effect nearly two weeks ago, and a new set of regulations have already been introduced. That makes a mockery of the parliamentary process for approving legislation.

That brings me to the previous amendment to the regulations, which we were due to debate last Monday—well after they were first introduced, of course. In the end, we did not actually get to debate them at all, because a few hours before the Committee was due to meet, we were told that the sitting had been cancelled—the reason being, apparently, that the regulations had already been superseded and there was no need to debate them. Well, I respectfully disagree with that analysis.

Parliamentary scrutiny is not something that can be ditched because it is inconvenient or the dates do not match. It is why we are here and why we have parliamentary debates, especially for regulations that have huge ramifications. It is not only right but essential that we debate them in Committee. I believe that we should find the time and make it a priority. These issues are too important not to be debated; they demand timely and full parliamentary scrutiny. I make the plea to the Minister, as I have done on previous occasions, that whoever timetables parliamentary business should be made absolutely aware that the Opposition believe that contempt is being shown towards parliamentary scrutiny.

The fact that we were not able to debate the last set of regulations matters because they included what can only be described as a most remarkable and disorderly U-turn, as they enabled outdoor areas, aquariums, visitor farms, zoos and safari parks, as well as drive-in cinemas, to reopen. Members may well wonder why that is a particularly memorable U-turn, given that we have seen quite a few of them in recent weeks. It is because the last set of these regulations that we debated included laws to close those places down. The debate on those regulations took place on the same day that the next set of regulations came into force to open those places up again. We ended up debating one set of laws that had been expunged by another set of laws that Parliament was not debating. If that is democracy, it is a farce. It was all the more remarkable that at no point during the debate did anyone on the Government Benches point out that that was happening.

Even if the Government are not making it up as they go along, they are doing a very good job of creating the impression that they are. As I have said previously, of course we accept that the initial regulations had to be hurriedly introduced in response to the rising number of infections, but since that time the House has been up and running for more than two months and Members on both sides and in the other place have expressed concern about time not being provided to ensure that future changes are debated before they are made. I see no good reason for the Government to continue in this way.

Paragraph 3.1 of the explanatory memorandum states:

“It is the opinion of the Secretary of State that, by reason of urgency, it is necessary to make the regulations without a draft being so laid and approved so that public health measures can be taken in response to the serious and imminent threat to public health which is posed by the incidence and spread of severe acute respiratory syndrome coronavirus 2”.

I think that was a perfectly reasonable thing to say at the start of the crisis, but we are now four months on and it really ought to be possible for there to be a little more formality and order to these things.

The regulations require there to be a review at regular intervals—it was every three weeks, but it is now every four weeks. That is because the Secretary of State has a duty to terminate any regulations that are not necessary or proportionate to control the transmission of the virus. That also means that, from the introduction of the first set of regulations, we have had a clear timetable for when new regulations might be created, and therefore a clear opportunity to factor in parliamentary time for their scrutiny. There is therefore no excuse for us to debate the measures late once again, and neither is it acceptable for us to debate them without the full extent of the information upon which the Government have based their decisions.

[Matt Western (Warwick and Leamington) (Lab)]

My hon. Friend, as always, is making some extremely important points. To go back to his point about the frustration with the enforcement of the regulations as laws, the difficulty for businesses and members of the public is not just in keeping up to date with the laws, but in trying to understand if they will be enforced and how seriously. As he said, the police are totally frustrated by these pieces of legislation because they do not really know what their powers are. Likewise, local authorities do not know what they should be doing. If they do not know, there is no chance of anyone taking this seriously.

[Justin Madders]

My hon. Friend is absolutely right about the blurring of the lines between what is guidance, and therefore advisory, and what is the law. It is important that people do not act unlawfully or, indeed, against the guidance. The police do not enforce issues in which there is only guidance, rather than law.

For example, we know that it was advised that face masks should be worn on public transport back on 11 May, but that only became a legal requirement approximately one month later. The police have been clear that they do not see it as their role to enforce that, which poses the question of who exactly will enforce such rules. We will see the same issues with face masks in shops. It is important not only to have clear sight of what is lawful or not, but that the bodies charged with enforcing the rules and laws have the necessary resources and power to ensure that they are adhered to.

In a previous debate, I asked the Minister to commit to the review of 25 June and the introduction of more relaxations being debated before implementation. Obviously, as we can see from the fact that we are in Committee today, that was not possible. I am grateful that the Minister acknowledges the concern, but it really should not be happening. In previous debates, I asked the Minister why the legally required reviews of 16 April, 7 May and 28 May have not been published. I ask the same question again in respect of the review of 25 June, which again we have not seen.

It is not only me who thinks that that is a problem. On 25 June, the Secondary Legislation Scrutiny Committee specifically expressed concerns about the Government’s refusal to publish reviews, stating that

“it would assist the House and the Committee if the Explanatory Memorandum in such cases included specific information about how and where the outcome of any review is to be promulgated and… We expect Government departments to ensure that in future this information is always provided.”

We have no review and all we have published alongside the regulations is an explanatory note telling us that no consultation has been carried out, no regulatory impact assessment has been undertaken and, worryingly, this time, no declaration that scientific advisers agree that the changes are likely to have an acceptably small impact on transmission rates. That is important, because there are no SAGE minutes to state that such matters have been considered.

In fact, not only do the regulations not state that they will have an acceptably small impact on transmission rates; they actually state that there is recognition that the changes may lead to an increase in transmission rates and will continue to be kept under review. As we have not seen the scientific evidence, will the Minister please give us more detail on that important statement? Is she able to provide clarity about which measures, individually or collectively, are considered likely to lead to an increase in transmission rates? That, above anything else that she says today, has to be the most important thing for us to hear from the Government Benches on this piece of legislation.

It would be better if the review of the regulations were published in full, alongside the full scientific evidence and a full impact assessment, but unfortunately we have none of that. I hope that the Minister will be able to come back to us on some of those concerns before the end of the Committee.

As we heard yesterday, the Imperial College research data commissioned by the Government showed that lockdown significantly reduced the rate of coronavirus infection in the community. The study did not cover care homes or hospital places, which is where we know there has been a significant issue with transmission throughout. Will the Minister confirm when the findings for June—when we saw the easing of lockdown restrictions—will be available? Have those findings been taken into account as part of the consideration in the review of the regulations today?

That is particularly important for public confidence, given that a whole raft of new measures are included in the regulations, as outlined by the Minister. As we have heard, they allow for the reopening of indoor and outdoor public houses, restaurants, cafés and bars, hairdressers, barbers, holiday accommodation, and several leisure and recreational attractions.

The regulations also impose restrictions that require certain businesses to remain closed, including night clubs, dance halls, discothèques, sexual entertainment venues, hostess bars, casinos, nail bars, tanning booths, spas, beauty salons, massage and tattoo parlours, and piercing services. Certain leisure and recreational facilities must also remain closed, including indoor skating rinks, indoor and outdoor swimming pools, water parks, indoor play areas and soft play areas, indoor fitness and dance studios, indoor gyms and sports courts and facilities, and bowling alleys. Conference centres and exhibition halls must also remain closed to external bookings.

As we have already touched on, Members will notice that that list is now out of date, following the amendments to the restrictions that came into effect on 11 and 13 July: those now allow swimming pools and water parks, nail bars, tanning booths, spas, beauty salons, massage and tattoo parlours, and skin piercing services to reopen. That re-emphasises the point about the confusion and lack of clarity about what is and is not permissible. We will be back here on Monday to debate those changes, so I will not go into more detail now, except to reinforce the point that it is wrong for us to be debating regulations to be brought into law to close these places down after they have already reopened.

The regulations significantly change the rules around gatherings. They prohibit gatherings of more than 30 people in private dwellings or on a ship or boat, other than for public transport, or in unmanaged outdoor spaces, save for a small number of exceptions. There is prohibition on indoor raves involving more than 30 individuals. Gatherings of more than 30 people are permitted where reasonably necessary for work, for voluntary or charitable services to provide emergency assistance, to avoid injury or illness, to escape from harm, for education or childcare, or to fulfil a person’s legal obligations.

These are now the only restrictions on people gathering together. Gone completely are the regulations about who people can meet, where and when. Those rules have now become guidance. The guidance on seeing friends and family is still that people should only be socialising in groups of up to two households indoors or up to six people from different households outdoors, but it is only against the law for gatherings of more than 30 people to take place in private homes. I am not sure everyone could fit that many people in their homes anyway, but there is clearly a difference between what the law says and what the guidance says.

It is particularly unfortunate that the Government website that lists what people can and cannot do has not been updated since 9 July, despite the new regulations coming into force on 11 and 13 July. We need clear and consistent messaging from Government on the rules, the laws and the changes that lie ahead. The confusion we have seen this week around face masks proves that there is still some way to go on consistent and clear public messaging.

With regards to compliance, following the scenes of overcrowding and poor social distancing on Bournemouth beach and at other locations, I note that these regulations also provide the Secretary of State with the power to restrict or prohibit access to a specified public outdoor place or public outdoor places of a specified description, in order to prevent, protect against, control or provide a public health response to the incidence or spread of covid-19. I am sure local authorities will welcome that support as we enter the summer holiday period, but they may also be wondering why on earth this was not put in place prior to the easing of lockdown restrictions last month. Can the Minister set out what procedure and consultation will take place with local councils and police forces before such decisions are taken? Presumably, they will be the ones tasked with enforcing the measures.

Finally, as with previous regulations, these regulations provide that fixed-penalty notices may be issued by authorised persons to persons over 18 whom they reasonably believe have committed an offence under the regulations. I have some questions about that, too, as there is a lack of transparency in those situations where fines are issued for a breach of the regulations.

I understand that the Crown Prosecution Service is doing a monthly review of every charge, sentence and conviction under emergency powers in England and Wales, during which it has found that eight wrongful charges were brought under the regulations in May. That figure is proportionately worse than the previous month, with a 10% rate of unlawful charges, increasing from 6% in April. Those failures included the charging of four homeless people and two people in England who were charged under the Welsh regulations. The lack of any appeals process means that the risk of miscarriages of justice is greater.

It is a concern that the regulations appear to be disproportionately impacting the BAME community. Some 12% of fixed-penalty notices were issued to those identifying as Asian, who represent 7.8% of the population in England, and 35% of the fixed-penalty notices were issued to those identifying as black, despite the fact that they represent 3.5% of the population in England. Analysis by Liberty Investigates and the Guardian found that BAME people were 54% more likely to be fined than white people. What are the Government doing to deal with regulations that appear to be being applied in a discriminatory manner?

We will not oppose the regulations today, because we want people to be able to get back to work and to see their families and loved ones; we also want children back at school and the economy to reopen. However, that does not mean that we do not have concerns. Relaxation must be carefully planned and clearly communicated. The country cannot afford for the Government to get this process wrong, but what we have seen through these regulations from the start is an alarming lack of clarity and a disorderly approach to changing the rules.

We also know that an essential component of the successful relaxation of the lockdown will be a fully functioning test, track and trace system. However, instead of the “world-beating” system that the Prime Minister promised on 1 June, we have a system that still has a long way to go because the Government have got the planning wrong and have been too slow in putting matters right.

We have serious questions about these measures that the Minister needs to answer. Why, for example, are a quarter of people still not being contacted by the test and trace system? Why is the current system not reaching about two thirds of those who are suspected of having covid-19? Why are more than a quarter of people who are being tested at regional testing stations waiting more than 24 hours to get their results back? Home tests are even worse, with virtually everyone who takes one waiting longer than 24 hours for their results.

We have also heard today about the problems with the Randox tests. Can the Minister please set out, if possible, what the issue is? The risks around this process are too great to be underestimated. The risks associated with a failure to develop an app in time can be highlighted by the fact that about half of those who have had close contact with someone who has tested positive are not being reached. That is an awful lot of people who will potentially go on to infect others.

These are not minor points; they are integral to developing an effective system to combat the spread of the virus. We need greater candour about the problems in meeting the targets and a little more detail about what is being done to put matters right.

Finally, I hope that the Government will implement as a matter of urgency all the recommendations in the Academy of Medical Sciences report, which was discussed at Prime Minister’s questions yesterday. The report stressed the importance of an effective test and trace system. When the Minister responds, I hope that she will be able to confirm that that report and all its recommendations will be implemented in full as a matter of priority.

--- Later in debate ---

[Justin Madders]

The Minister will be aware that some 3 million tests are unaccounted for. Is she able to advise what the understanding is on where those have gone?

[Jo Churchill]

As the shadow Minister well knows, some of the tests that are sent out are counted on the out and we do not have the ability to ensure that the test is used and sent back to us. As I said, I will write to him with full and comprehensive details on testing.

The hon. Gentleman may or may not be aware that in the Leicester local lockdown, we are going door-to-door in order to ensure that asymptomatic testing and testing throughout Leicester is ramped up. We are also using translation services, both on the doorstep and on some of the phone lines.

This has been an unprecedented situation. We are dealing with a new virus and we have ensured that each time we have taken the learning and tried to deliver an enhanced service. It is well recognised that the numbers we are testing have grown. It was a stretching target and we have matched it. We are now providing one of the most comprehensive testing systems—across mobile testing, satellite testing, the Lighthouse testing, home testing, testing in care homes and hospitals, which now stretches out into asymptomatic as well as symptomatic testing—ensuring that anyone is now able to ring and get a test.

On testing information, pillar 2 is being fed back into local areas so that they have a much clearer idea of what their locality looks like, as per the number of tests.

[Justin Madders]

It is indisputable that the number of tests has significantly increased, but what has happened to the false negative rate? We heard earlier on that it was about 30%. Is it still in that area?

[Jo Churchill]

If the hon. Gentleman will forgive me, I have said that I will write to him on testing. I fear that we are straying slightly from the point of today’s debate on the regulations. I thank everyone for their contribution—

[Justin Madders]

The Minister is about to finish, but it is really important that we hear from her about the statement in paragraph 7.4 of the explanatory notes, which says:

“There is recognition that these changes may lead to an increase in transmission rates”.

What is the scientific advice in relation to that risk? How is the Minister going to be able to report back and monitor that, particularly in terms of parliamentary scrutiny?

[Jo Churchill]

As far as the R rate is concerned, as the hon. Gentleman knows, the Secretary of State meets regularly with the chief scientific adviser and the chief medical officer, plus SAGE, the new and emerging respiratory virus threats advisory group—NERVTAG—and the Joint Biosecurity Council. All that information is fed back into the decisions that are then made in and around the R number. If he will forgive me, I am going to push on, because I feel we are straying off into areas away from the regulations.

We will continue to keep the restrictions placed on individuals, businesses and society under continual review over the coming weeks and months. The new regulations debated here today have been a major step in the gradual return to normality for individuals, businesses and society as a whole, and, as we have heard, that is something we welcome.

I am pleased that, as of 10 July, we have continued to take those steps and have made further amendments to reduce restrictions in a safe way. We appreciate that restrictions have placed a significant strain on individuals. The Government will only continue to impose restrictions that are necessary and proportionate, but we remain prepared to impose further restrictions should that become necessary.

Today’s debate has provided an opportunity for hon. Members to debate the range of activity that the Government have undertaken in response to coronavirus. I commend the regulations to the Committee.

Question put and agreed to.

Resolved,

That the Committee has considered the Health Protection (Coronavirus, Restrictions) (No. 2) (England) Regulations 2020 (S.I., 2020, No. 684).

Draft NHS Counter Fraud Authority (Establishment, Constitution, and Staff and Other Transfer Provisions) (Amendment) Order 2020

Justin Madders Excerpts

Wednesday 8th July 2020 General Committees

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to see you in the Chair, Mr Mundell.

As we have heard, this statutory instrument extends the abolition date of the NHS Counter Fraud Authority from 31 October 2020 to 30 October 2023. As the Minister set out, any order for a new special health authority established after 1 April 2013 must include provision for the abolition of that authority within three years of its establishment, pursuant to section 28A of the 2006 Act. The 2006 Act also provides that the abolition date can be varied or changed by order within that three-year period to a later date, beginning with the day on which the authority would have been abolished. Of course, that is why we are here today, because, as the Minister said, we clearly need an authority to deal with fraud in the NHS.

I think that this is the first time that we have had an opportunity to discuss the NHSCFA since the statutory instrument that brought it into force was laid in 2017. I think that came in under the negative procedure, which meant that it did not require approval by resolutions of both Houses, so there has been no discussion of the NHSCFA’s remit and performance.

As the Minister said, the Secretary of State’s function to protect the health service from fraud has been carried out by a number of organisations since 1998. Obviously, the NHSCFA was established on 1 November 2017 to identify, investigate and prevent fraud, bribery and corruption across the national health service in England. That responsibility was previously held by NHS Protect, which was a division within the NHS Business Services Authority. NHS Protect’s staff, property and liabilities were transferred to the new authority.

The estimate of fraud in the NHS from the most recent NHSCFA annual report—that is for 2018-19, and I hope that when the Minister speaks at the end of the debate she will tell us when the 2019-20 report will be available—will be of concern to most people. The sum that we are talking about—the estimated fraud in the NHS—is £1.27 billion each year. We often talk about the issue of NHS workforce shortages; we know that there are more than 40,000 vacancies for nurses. When I say that £1.27 billion would pay for those 40,000 nurses, 5,000 frontline ambulances or 116,000 hip operations, we can be in no doubt that it is extremely important that we counter fraud as much as we can, and that this authority is needed to prevent fraud, bribery, corruption and any illegal acts or any financial gain at the expense of the NHS and, of course, as the Minister said, the taxpayer.

It is important to remember that, although we are talking about significant sums, those who commit fraud are the minority. However, their actions take resources away from the NHS, staff and patients and have an impact on us all. As the Minister said, at this time in particular, the NHS is under additional pressure with coronavirus, so it is vital that every penny intended for the NHS stays within it. The scale of the challenge is clear. It is welcome that the most recent annual strategic intelligence assessment highlighted a reduction of £90 million in patient fraud, but it is fair to say that there is still an awful long way to go.

The explanatory memorandum that accompanied the instrument that created the NHS Counter Fraud Authority stated:

“The establishment of a special health authority focused entirely on counter fraud activities is intended to provide the independence and practical accountability that is required to deliver effective anti-fraud services across the health service.”

It also stated:

“The Secretary of State has statutory responsibility for health service security management functions under the 2006 Act”,

and that security management is most effective when tailored to local circumstances. It concluded that local NHS bodies were best placed to develop and apply security management policies and practices, in order for them to take account of local circumstances and deal with security matters. We need to establish whether that has, in fact, turned out to be correct. Concerns about those powers being transferred were raised by Members of both Houses at the time, in 2017.

The Government stopped collecting data on assaults against NHS staff in 2016, but following freedom of information requests from all NHS trusts in England in 2016-17, the Health Service Journal reported that physical assaults on NHS hospital staff had risen 9.7% since the previous year. Those figures suggest that, on average, there were just over 200 reported violent attacks on NHS workers every day. As alarmingly high as those figures are, Unison believes that many incidents go unreported, and estimates that there were 56,435 physical assaults on NHS staff in 2016-17.

In January this year, The Independent reported that the Health and Safety Executive found that 25 NHS trusts were in breach of rules designed to make sure that they manage risks to their staff from violent patients or members of the public, following 38 inspections by the regulator since April 2018. These inspections were prompted by increasing numbers of assaults on staff, including three killings by patients in the last five years. Figures show that between 2015 and 2018 the number of violent attacks on health and social care staff was three times as high as in other industries. We can see that the disbanding of NHS Protect has had some impact, but without national data it is difficult to determine the true scale of the problem. Can the Minister tell us whether the Government have any plans to resume the collection of national data? If she cannot advise us of that today, could she possibly write to me?

The protection of staff should of course be an absolute priority, and the Government did promise an anti-violence strategy in 2018. Will the Minister update us on where that is, and on the seven trusts that were issued notices of improvement in terms of how they manage the risks of violence and aggression? What action are they taking to reduce violence against NHS staff across all settings, and what training and support is available? We know from the annual staff survey that 14.5% of staff said they had experienced physical violence from patients, their relatives or the public. The figures for the most recent survey are not yet available. Will the Minister update us on whether we can expect to see those latest figures?

Can the Minister advise us whether she believes that the uncoupling of security and fraud aspects, per the statutory instrument creating the Counter Fraud Authority, has been a cause of this increase in violence, or whether there are other factors in play? It is important that we try to get to the bottom that.

To return to the Counter Fraud Authority, I mentioned that the most recent annual report identified a number of challenges and potential barriers that affect its ability to tackle fraud against the NHS. It highlights the fact that the

“level of understanding of the nature of fraud in the NHS continues to be uneven across the health system.”

There is under-reporting of fraud and suspicious activity, which is a continuing concern. There is also inconsistent recording of local counter-fraud work, which is another concern. The report highlights a

“fragmented approach in the NHS to sharing lessons learned and limited cross-NHS working, resulting in lost opportunities to identify and prevent fraud.”

Can the Minister advise us on what the NHSCFA intends to do to improve cross-NHS working?

The report also draws attention to a number of initiatives, including an e-learning programme to train counter-fraud champions and improving access to large datasets, which was due to be rolled out in the last financial year. We have not seen that yet, so can the Minister update us on its progress? I also note that last year’s annual report says the authority’s

“approach to counter fraud work is detailed in our 2017-2020 strategy document ‘Leading the fight against NHS fraud’”,

which is obviously due to expire this year. Can the Minister advise us on when we will see an updated strategy document?

We will not be opposing the order. It is clearly important that we continue to have the Counter Fraud Authority, but if it continues for three further years, we need assurances from the Minister that she is holding it to account for its performance. We need to have confidence that greater success in reducing fraud will be part of the story for the following three years.

[Helen Whately]

I welcome the helpful and constructive comments from the shadow Minister, who shares the perspective of the Government on the important role of the NHSCFA and the importance of preventing and tackling fraud in the NHS. I want to reiterate that never before has a counter-fraud response to protect the Government’s investment in the NHS been so important, and that only a national organisation such as the NHSCFA can gather and process the information and intelligence arising from the huge range of threats to the NHS.

I should reiterate that the vast majority of people do not commit fraud in their interactions with the NHS; the problem is very much from a minority. The NHSCFA carries out the Secretary of State’s counter-fraud functions in respect of the health service in England, and it has the crucial ability to distil data and enable a focus on prevention in its counter-fraud response.

The shadow Minister asked about cross-NHS working. The NHSCFA is working hard to build and develop capability across the NHS and among NHS organisations, to extend consistent principles, national standards and best practice to all parts of the NHS, and to drive a national, co-ordinated and cross-organisational response. The focus is on prevention, because we know that preventing loss is more cost-effective than prosecuting suspects and recovering funds that have already been lost.

The shadow Minister asked about a revised strategy for the CFA, and I can assure him that it is being drafted and will be published soon.

[Justin Madders]

On the updated strategy, we have talked a lot about personal protective equipment in the last few months, and it is fair to say there are some unusual entrants into that market. Will the updated strategy look at how PPE is procured moving forward?

[Helen Whately]

The shadow Minister makes an important point about PPE. Clearly, the Government have had to move very rapidly to increase the procurement of PPE to meet the needs of the NHS and social care during the pandemic. PPE procurement for covid-19 is centrally managed, not managed by NHS trusts, and therefore falls outside the remit of the NHSCFA. It is being investigated by the DHSC anti-fraud unit, but that is being supported by the NHSCFA. No doubt lessons learned from the covid experience will be used by the NHSCFA in developing its processes and the strategy that we have been referring to.

Extending the current model will provide the opportunity for the NHSCFA to continue its work and consolidate its organisational design, which it has been working on over the last three years. The Department will continue to oversee the function of the NHSCFA, in its sponsorship role, to ensure that it remains fit for purpose. The draft order is an important and integral piece of secondary legislation to allow the NHSCFA’s independent and crucial remit to continue. I urge all hon. Members to approve it.

Question put and agreed to.

Health and Social Care Workers: Recognition and Reward

Justin Madders Excerpts

Thursday 25th June 2020 Commons Chamber

[Justin Madders (Ellesmere Port and Neston) (Lab)]

I congratulate my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell), the Chair of the Petitions Committee, on introducing the debate and brilliantly articulating the many issues relating to the recognition and reward of health and social care workers. I thank all those who have signed the four petitions, which have so far amassed some 290,000 signatures between them. By doing so, they have brought this very important debate to Parliament today.

This debate comes at a particularly poignant time, when health and social care workers have been at the heart of the fight against coronavirus, working day and night to protect the NHS and save lives. They, and all the key workers who keep this country going, are the very best of us. I want to take this opportunity to once again pay tribute to the hundreds of NHS and social care staff who have lost their lives to the virus. I hope that when this is over, we can find an appropriate way to remember the frontline staff who gave their lives in the line of duty.

This was a heavily subscribed debate, and it was clear from every Member who spoke that the gratitude the whole country feels for our health and social care workers is replicated in this place. We had some superb speeches from Opposition Members, with good representation from Wales. My hon. Friend the Member for Merthyr Tydfil and Rhymney (Gerald Jones) spoke with typical eloquence and highlighted the wise decision of the Welsh Government to recognise the contribution of care workers. I hope that the Minister will be able to respond positively to my hon. Friend’s request, or at the very least confirm that she is making strong representations to the Treasury about the tax treatment of that payment. We heard a similar point from my hon. Friend the Member for Pontypridd (Alex Davies-Jones), who also reminded us of NHS Direct, which was a great innovation from the last Labour Government.

My hon. Friend the Member for Bethnal Green and Bow (Rushanara Ali) rightly said that staff need to be rewarded with more than just applause, and she drew attention through her strong speech to the sorry record we have seen over the last 10 years on the NHS. My hon. Friend the Member for Coventry South (Zarah Sultana) spoke with great passion and listed a whole series of ways in which the health workforce is hit with extra burdens in the course of their duties.

My hon. Friend the Member for Erith and Thamesmead (Abena Oppong-Asare) drew attention to the scandal of nurses being forced to use food banks. That should shame us all. We also heard from my hon. Friend the Member for Hackney South and Shoreditch (Meg Hillier), who made the powerful point that medals do not put food on the table. She brilliantly highlighted how insecure work is a blight on the NHS and a systemic problem that needs addressing once and for all.

As we heard, even before the pandemic our frontline health and social care staff were working in overstretched and under-resourced settings. We must acknowledge that many of our frontline careworkers have been in extremely stressful and sometimes traumatic situations as a result of covid-19—situations that those of us who have not been on the frontline cannot even begin to imagine. Working in these uncertain times, dealing with a new and emerging disease, often without adequate protection, while coping with losing patients and worrying about getting ill themselves or taking the virus home to their loved ones are all contributing factors to staff burn-out and poor mental health. It is vital that we keep them all safe in the event of a second wave.

Yesterday, following the Prime Minister’s announcement of the relaxation of the 2-metre rule and sweeping changes to the lockdown in England, health leaders called for a rapid and forward-looking assessment of how prepared the UK is for a new outbreak of the virus. Those health leaders from the Royal Colleges of Surgeons, of Nursing, of Physicians and of GPs say:

“the available evidence indicates that local flare-ups are increasingly likely and a second wave a real risk.”

They also point out:

“Many elements of the infrastructure needed to contain the virus are beginning to be put in place, but substantial challenges remain”,

and they call on the Government to focus on

“areas of weakness where action is needed urgently to prevent further loss of life”.

We cannot have any failures in preparation this time.

We may no longer be gathering outside our homes on a Thursday night to clap for our carers, but our admiration remains. It has been incredible to see the effort from staff in the last three months—staff who, too often, get very little in return. We hope that they are recognised for their true worth now.

[Jamie Stone]

Will the hon. Member give way?

[Justin Madders]

I am sorry, I will not have time to give way.

Many of our NHS and care staff are exhausted and fearing burn-out. They need our support now, which means safe staffing ratios, adequate PPE and decent fair pay, because for them the hard work is not over—it is only just beginning. They will continue to give their all as they begin to tackle the backlog in non-covid care. The millions of routine operations, screening tests, treatments and therapies that were suspended or cancelled during the pandemic will now have to restart. Those challenges cannot be met without the staff.

As we know, there are well over 100,000 vacancies in the social care sector, and systemic insecure work and low pay are not the answer to resolving that issue. We know that prior to the covid-19 outbreak there were also 106,000 vacancies across the NHS, including 44,000 nurse vacancies. Those vacancies matter. They mean that NHS services were already under extreme pressure due to the ongoing staff shortages, before being further stretched by more shortages due to sickness or caring responsibilities during the pandemic. That, in turn, has put all healthcare staff under intolerable and unsustainable levels of pressure.

On top of those staff shortages, healthcare staff have had to work in unfamiliar circumstances or in clinical areas outside their usual practice, and of course they have had to work in very difficult circumstances. A survey by the Royal College of Nursing found that half of nursing staff felt under pressure to work without the levels of protective equipment set out in official guidance, and a survey by the British Medical Association of 7,000 doctors found that 45% were experiencing stress, exhaustion and burn-out. We need to listen to what the staff are telling us.

Just last week, we learned that student nurses who joined the frontline six months ago as part of the coronavirus effort are seeing their paid placement schemes terminated early, leaving them with no income and no guarantee that they will not face extra costs for completing their studies. That is no way to treat student nursing staff who have put their studies on hold to join the fight against coronavirus, and who are at the start of what we hope will be a long career in the NHS. They deserve better.

The Government still have not quite resolved the issue of the immigration health surcharge, where NHS and social care staff coming from abroad and working on our frontline are required to pay a surcharge of hundreds and sometimes thousands of pounds just to use the NHS themselves. It was welcome that, after considerable pressure, the Government announced last month that the surcharge would be abolished, but, as we have heard, there are still reports of people being charged. I would like an update from the Minister about what is happening in respect of that.

In conclusion, no one hearing this debate would be in any doubt that our health and social care workers are appreciated, admired and respected, but warm words are not enough. A clap on Thursday night is not enough. It is time for action, and for the Government to finally recognise the monumental contribution that health and social care workers make. No more poverty pay. No more “work until you drop”. No more sending people into work inadequately protected from exposure to a deadly virus. That cannot happen again.

The Government were too slow to recognise the need for PPE, too slow to protect the social care sector, and now they are too slow to properly reward our brave health and social care workers, who have literally put their lives on the line for us all. It is time we put that right.

Oral Answers to Questions

Justin Madders Excerpts

Tuesday 23rd June 2020 Commons Chamber

[Matt Hancock]

It is very strange taking these questions from the SNP spokesman, given that I am working with the SNP Government on resolving exactly these problems in Scotland, and maybe the SNP would do better to focus there. In response to the second question, honestly, we have put £300 million of support into local directors of public health to tackle this pandemic, and I know that her colleagues in the Scottish Government are working hard with local authorities in Scotland as well in exactly the same way.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

The Prime Minister promised that 100,000 people a day would be tested by the end of April, so since that date, on how many occasions have more than 100,000 people been tested on any single day?

Social Distancing: 2 Metre Rule

Justin Madders Excerpts

Monday 15th June 2020 Commons Chamber

[Edward Argar]

I am grateful to my right hon. Friend. I can reassure him that his kind words about me are reciprocated; I of course have huge respect for him, not only for what he did in his previous roles in Government but for the work he is doing now as Chair of the Science and Technology Committee.

My right hon. Friend is absolutely right to highlight the importance of striking the right balance—and it is a balance—between protecting public health outcomes and public health, and understanding the impact that the restrictions are having every day on businesses. I am entirely seized of the difficulties of striking that balance.

My right hon. Friend asks whether the review will take into account the wider impact on society through the impact on business. I can reassure him that, given that economists are a key group in putting together this review, that is exactly one of the things that we will look at—scientific and medical evidence, but economic evidence too.

The work is already under way. My right hon. Friend highlighted the importance of timescales. Work has been ongoing for some time within SAGE, constantly to review and consider the impact and appropriateness of the 2 metre rule, but I hear exactly what he says about how important it is that businesses that are getting ready to reopen get guidance as early as possible to enable them to prepare.

My right hon. Friend the Prime Minister is clear that the review must report within a matter of weeks. I will of course reflect to him the feeling, which I suspect my right hon. Friend the Member for Tunbridge Wells (Greg Clark) will not be the only Member to convey, that it is important that this is done as quickly, efficiently and rigorously as possible to give businesses as much certainty as we can.

My right hon. Friend touched on the differences between the distances in different countries. The UK, Canada, Estonia and Spain, for example, have a 2 metre rule in place; the USA has 1.8 metres; Belgium, Australia, Germany and Italy have 1.5 metres; South Korea has 1.4 metres, and France and other countries have a 1 metre rule. The reality is that there is not a fixed science and there continues to be a scientific debate about what is the most effective distance.

One of the reasons that we have a 2 metre distance in place at present is that the scientific evidence from SAGE is that a reduction from 2 metres to 1 metre would carry somewhere between a twofold and a tenfold increased risk of transmission. That is why we have the present guidance, but we are very clear that the review will give us the basis to make considered decisions on the most appropriate way forward in striking the balance between public health and economic impact.

As ever, advisers advise—we have some of the best scientific advisers in the world, but we will of course look at the scientific advice from around the world—but ultimately Ministers decide, and Ministers will decide on the basis of the review and the evidence.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

I congratulate the Chair of the Science and Technology Committee, the right hon. Member for Tunbridge Wells (Greg Clark), on securing the urgent question. We all want society to reopen, but we need to know the basis on which any changes will be made and by when they will be made.

I say that because, as we heard, a review was promised by the Prime Minister on 27 May, and he said at the time that we would get the results before 15 June and the reopening of non-essential retail. It is now 15 June and that review is nowhere to be seen, so what confidence can we have that this latest review will be published on time? The hospitality sector could reopen in England on 4 July, the date this review is due, but as we heard, even if it comes out on time, it will still be too late for businesses to put in place effective systems for reopening on that date. What about all those businesses that have already gone to great expense to reorganise on the basis of 2 metres? Will they receive financial support if the guidelines change?

As we heard, we know that if we change the rules on social distancing, we change the risk, so it is not only critical that the Government follow the science; they also need to be honest with the public about the level of risk that they consider acceptable. What evidence will be made available, particularly to those most at risk, in the event that we do see a change to this rule?

It is important that the review is not undertaken in isolation. The Government’s own scientific adviser and the World Health Organisation have said that measures should be eased only when there is a fully operational testing and tracing system in place. Will the review consider the robustness of that system, and can the Minister tell us when we will have a fully functioning system, with an app, in place?

Finally, since 11 May the Government advice has been to wear face-coverings where social distancing is not possible. That advice only became compulsory on public transport today. Can the Minister say why it took a month to make that advice compulsory? The Government were too slow on that, and have been too slow one PPE, on testing and on social care. We cannot afford to be too slow on this as well.

[Edward Argar]

I am grateful to the shadow Minister, as always, for his remarks and for, as ever, the constructive tone that he adopts on these occasions. I share his view that we do want to see the United Kingdom reopening for business, but we want to see it do so in a way that is safe for those going out and shopping—and I encourage people to go out and frequent their shops from today. I also want to ensure that when we are able to safely open hospitality again, we get it going and do so in a safe way based upon the evidence.

On timescales, as my right hon. Friend the Member for Tunbridge Wells (Greg Clark), the Chair of the Select Committee, and the shadow Minister have said, we recognise the importance of getting this information and this decision out there as swiftly as possible, because it is important to give businesses all the time we can to prepare for it. Equally, however, the shadow Minister would not expect me to set a particular deadline while the work is being done. I have said that that will be within a matter of weeks and that we recognise the urgency for business, but it is important that those conducting the review can do so properly and rigorously, so that it is useful for the decision we have to make. Once that review has reported and the Prime Minister has had the opportunity to consider it, I would, of course, expect the findings to be made public.

On the WHO’s comments, the hon. Gentleman is absolutely right to highlight that the 2 metre distance is only one part of the measures—only part of the complex package that is in place to reduce risk and to protect public health. As we have seen, different countries around the world have adopted different approaches, such as on whether to reduce the distance and have imposed different requirements on the wearing of face masks. Therefore, there is, in a sense, a menu of different options all of which can reduce risk, and the question is how to come up with the most appropriate balance between reducing risk while also opening up business. On the Committee we see economists and clinical and scientific expertise feeding into that balance-picture. As the Chancellor said at the weekend, it is not binary; we must consider this in the round, considering all relevant factors.

The hon. Gentleman mentioned test and trace. It is a hugely important part of the armoury of options to chase down this disease and allow our economy to reopen. As he will have seen last week, we made a very good start in the first week of the operation of the new test and trace system. We also saw a very, very high willingness on behalf of members of the public to self-isolate when asked to do so, and I pay tribute to everyone who has done that and thank them for doing so.

Finally, I say to the hon. Gentleman that I believe that throughout this pandemic we have been learning every day about how the disease behaves, about what is needed to tackle it and what steps are most effective, and I am confident that we have done the right thing at the right time throughout. However, like any responsible Government, of course there will be lessons to learn and it is important that we are willing to learn them.

Public Health

Justin Madders Excerpts

Monday 15th June 2020 Commons Chamber

[Justin Madders (Ellesmere Port and Neston) (Lab)]

Today marks 12 weeks since the country went into lockdown and we saw the biggest peacetime restrictions ever. Over the past 12 weeks, the public have made huge sacrifices. The vast majority of them supported and adhered to the lockdown, and it is right that we take a moment to acknowledge the sacrifices they have made in the interests of public health—the business that faces an uncertain future, the child who has missed out on crucial social and educational opportunities, and the grandparents who just want to give their grandchildren a hug. We know it has been hard, and we thank them for doing their bit.

We also thank those in the NHS and other parts of the public sector, in social care and of course the millions of other people who have made their own contributions in the collective fight against the virus. When we have seen over the weekend images that represent the worst of this country, let us not forget that many, many more have in recent months shown us what the very best of this country can look like.

It is also right to take a moment to remember the more than 41,000 lives that have been lost to the virus, each one a tragic loss. We mourn them all.

We are here today to consider the third iteration of the regulations, just as further relaxations come into force to allow non-essential shops to open for the first time. Those measures are probably the single largest relaxation since lockdown was introduced—but we are not here to debate those changes. In our view, we ought to be, but instead we are here to debate the changes that came into force two weeks ago, on 1 June, and the interventions on the Minister that we have heard demonstrate why there is some anxiety.

Changes should be debated and have democratic consent before they are introduced. I thank the Minister for acknowledging Opposition concern in respect of that, and I understand why urgent action is needed, but it should be perfectly possible for us to debate regulations at short notice. We in the Opposition stand ready to co-operate with whatever is necessary to make that happen.

[Peter Kyle (Hove) (Lab)]

Considering that Government have one job, and one job alone right now, which is keeping us safe and preparing for the days ahead, is it not inexcusable that they are not able to keep Parliament up to date at the same speed as they announce things to the media?

[Justin Madders]

I will come on to the discourteous way in which the Prime Minister has been announcing these things to press conferences instead of this Chamber.

It is important that this Chamber has a role because these are not minor or consequential changes that can be nodded through without debate. They affect millions of people’s lives, and we know that if we get it wrong, the consequences will be devastating. Debating them weeks after the event, and in some cases when they have been superseded by the next set of regulations, demeans parliamentary democracy. Changes such as these should always be accompanied by a statement to Parliament, not just showcased at Downing Street press conferences. We are not merely a rubber-stamping exercise to create the veneer of a democratic process. We should not be debating these measures late, and we should not be debating them without seeing the full extent of the information on which the Government based their decisions. We know that the next review of the regulations must take place on or before 25 June. If that review leads to further relaxations, will the Minister commit today that any regulations introduced off the back of that will be debated here before they are implemented and not retrospectively?

The reviews, which are legally required to happen under the regulations, took place on 16 April, 7 May and 28 May. I ask the Minister: where are they? In a written question, I asked the Secretary of State whether he would publish those reviews. I received a reply last week stating that the Department of Health and Social Care had indicated that it would not be possible to answer the question within the usual time period. Why on earth not? If the Government have conducted these reviews, why are they not in a position to disclose them? I find this absolutely incredible. Here we have the most far-reaching impositions into everyday life in this country, yet we have no idea what the Government’s own reviews of them say. These are reviews that are required under legislation.

[Sir Charles Walker]

They are far-reaching, and it is a pretty poor reflection on this Chamber that it is empty. It is probably only a third full, even with the social distancing rules in place. Where are our colleagues getting upset about the removal of people’s civil liberties? Neither side here has a great story to tell.

[Justin Madders]

If these regulations were actually going to be changed as a result of what we said here, we might see a better attendance, but the Government have shown the contempt in which they hold this place by introducing them way after the event. The question is: where are the reviews? What is it that we cannot see in them? This betrays a cavalier attitude to transparency, and it does absolutely nothing to engender confidence that the decisions that are being taken are the right ones.

[Peter Kyle]

We have to get this on to the record. My right hon. Friends the Members for Barking (Dame Margaret Hodge) and for Derby South (Margaret Beckett) want to be here engaging in the debate, but they are unable to be here because the virtual Parliament has been closed down for debates such as these, and they have to shield. The Government are telling them not to be here. That is the reason they are not here. Is that not correct?

[Justin Madders]

My hon. Friend is absolutely right, and I am sure there are many Members who cannot be here for good reasons but who would like to take part in the debate. They are following the Government’s advice, which is to work from home wherever possible. This just shows how confused the approach is sometimes, and it really is an affront to democracy that those Members cannot take part in important debates such as these.

[Mr Harper]

For the benefit of the House, I understand that that particular point about participation in legislative debates is currently being considered by the Procedure Committee. I think the Government have indicated that if the Procedure Committee can come up with a sensible way of including colleagues who need to participate remotely in legislative debate, that is something that the Government will look at favourably. I hope that is helpful to the House.

[Justin Madders]

I thank the former Chief Whip for his intervention. I would certainly welcome that development. I have not heard anything from the current Leader of the House to explain why we can take part remotely in some debates but not in others. I will not take any more interventions, because I know we are up against time.

Turning to the regulations themselves, they include, as the Minister outlined, some relaxations including the reopening of some outdoor retail as well as various outdoor sporting activities. They also make provision for elite athletes in anticipation of the return of professional sport, including the Premier League later this week. I am sure we are all looking forward to that, although anyone who has witnessed the Arsenal back four this season may consider the definition of an elite athlete to be a triumph of hope over reality.

It is not all one way, however, and for the first time, the regulations include a list of venues that must now close. I fail to see any logic, coherence or consistency in respect of the Government’s approach to these venues and, critically, there has been no impact assessment on those venues. The first set of regulations, despite their sweeping nature, had no impact assessment at all. We understand, of course, why that was not possible in the first instance, but we have made it clear that we do not want that to become the norm, because we know that the impact of these regulations will be huge. We are now on the third set of regulations, 12 weeks after the lockdown started, and we have still had no impact assessment. How can the Government continue to issue new laws with such sweeping powers when they cannot tell us what their impact is?

Is there a document the Minister can point us to that sets out the Government’s own assessment of whether they have met the five tests they set themselves for relaxing the lockdown? Certainly, there is concern that the threshold for relaxation has not yet been met. Only yesterday, the World Health Organisation expressed concern that we may be coming out of lockdown too early. According to a recent University of Oxford study on each country’s level of readiness for easing lockdown, we are now fourth from bottom in the entire world.

The questioning comes not just from outside bodies but the Government’s own joint biosecurity centre, which has not reduced the threat level—still level 4—and says very clearly that only when the threat reduces to level 3 can there be any relaxation of restrictions. I implore the Minister to set out exactly why the Government feel they can depart from the opinion of their own joint biosecurity centre.

All these concerns matter not only because of the enormous impact of the regulations but, frankly, because the Government appear to be winging it in respect of which regulations they choose to apply. Take the new category of venues to be closed in schedule 2—model villages, zoos, safari parks, aquariums and so on. Clearly, that was an oversight in the original regulations, but we have seen a rapid U-turn on parts of the regulations so that, as I understand it, zoos and safari parks are no longer required to close. How have the Government got themselves into such a mess that we are debating on the Floor of the House regulations that they do not fully support? How can it possibly be consistent with the rule of law for the Government to present us with regulations and say, “Actually, we’re going to pretend that bits of this are not there”? It is an absolute shambles. To preserve the rule of law, it is vital that people do not act outside the law, but how can we expect it to be enforced properly if the Government say that bits of the regulations do not need to be followed? The changes come to us late, without any assessment of their impact, and after some of them have been pulled. That does not inspire confidence that the Government are in control of the situation or following any kind of plan.

As we know, the WHO, the Association of Directors of Public Health and some of the Government’s own scientific advisers have said that the easing of lockdown should not occur until the testing and tracing system is proven to be more robust, but the reality is that the system is in chaos. The Government have not been able to publish the number of people tested each day for more than three weeks now. How can testing and tracing work properly if we do not know how many people are tested each day? A third set of data from the test and trace system shows that it needs a lot more work. Just over 8,000 people were tested, but only two thirds of them were contacted. Missing out a third is not what I would call an effective and robust system.

And what of the app? It seems that the world-leading, game-changing, virus-busting app is not as important as it once was. That is a fate that probably awaits us all in here, but the app has suffered a downgrade before it has even been launched. Last month, the Secretary of State said it would be crucial and that downloading the app would be a public duty. Now we are told that it is not vital; it is more of a cherry on the cake. Which is it? Will the Minister explain how it is safe to open non-essential retail if people who might come across someone who is infected cannot be traced because there is no working app in place?

The Government have been too slow on testing, too slow on social care, too slow on personal protective equipment, and too slow on the lockdown, and now it seems they are too slow on tracing. The Prime Minister promised a world-beating system by 1 June, but that date is long gone. Newspaper reports suggest that we may not get a fully operational system until September. When pressed in debate on the last set of regulations, the Minister could not give us a date when it will be ready.

This matters because the restrictions are being lifted now. The Government must demonstrate that they have got a grip of the testing and tracing strategy in order to restore public confidence in their handling of the pandemic and to ensure that we do not risk another catastrophic spike of infection that will lead to a second lockdown, with all the damage that will bring. The Government have taken the decision to lift the restrictions. It is for them to demonstrate that they are listening to the experts and publish the full scientific evidence behind the decisions that have been taken.

We want the Government to succeed and remain committed to working constructively with them, but that is a two-way street. I have now spoken three times on these regulations. On each occasion I have stressed the importance of the Government operating within the rule of law, following due process and providing us with a full evidence base supporting the decisions they take. On each occasion the Government have failed to listen to those concerns. They have failed to demonstrate that they are following the science, they have failed to show that they are assessing the impact of their decisions, and they have failed to show that they grasp the importance of accountability. This Parliament and this country deserve the full picture, so I hope next time we debate these issues we get just that.

--- Later in debate ---

[Jo Churchill]

I would argue that this is a dynamic situation. For example, with zoos, scientific evidence indicates quite clearly that open spaces are much safer for people to be in, so a degree of logic applies. It is very difficult to argue that we do not want things opened, while at the same time requesting that businesses and so on are opened. There has to be a degree of walking slowly, and I hope to come on to that. Several Members raised the fact that there appear to be inconsistencies, but I would argue that the Government are maintaining only the restrictions that are necessary and appropriate at any given time.

[Justin Madders]

I want to come in on the point made by my hon. Friend the Member for Hove (Peter Kyle). Paragraph 23C of schedule 2 deals with aquariums and zoos, including safari parks, and we just need to be clear about the Government’s position on that. Are they now saying that that paragraph is no longer going to be applicable, or are zoos part of this? I would be grateful if the Minister could clarify that, please.

[Jo Churchill]

Zoos have been closed as a consequence of the restrictions since they came into force on 26 March. Until 1 June, zoos were in effect closed as a consequence of regulation 6, which required people not to be outside their homes other than for a reasonable excuse. I think we would all agree that that does not include visiting a zoo. Aligned with the scientific advice on 12 June, the regulations were signed to permit outdoor areas of zoos to open, but obviously not the inside areas.

The debate today has provided an opportunity for the Government to hear the concerns of a wide range of society through the contributions made by right hon. and hon. Members, and I now turn specifically to the debate. First, I would like to say that I have heard the frustrations. Regulations have to be made urgently, given the impact they have on individual rights and to respond to the latest possible evidence. Debates are organised and scheduled through the usual channels, which, I would just say, are not always as fleet of foot as others.

In response to the hon. Member for Ellesmere Port and Neston (Justin Madders) and my right hon. Friend the Member for Forest of Dean (Mr Harper), the Secretary of State keeps the restrictions and requirements under constant consideration throughout the 28 days. It is a continuous cycle, rather than a fixed point in time for a review. If I understood the argument of my right hon. Friend the Member for Forest of Dean correctly and we took it to a logical conclusion, it would mean that as we lifted restrictions, it would actually take longer were we to be iterative over those 28 days, rather than processing easing as we currently are.

[Justin Madders]

Will the Minister give way?

[Jo Churchill]

Yes, finally, although I am sure the House would appreciate it if we just pushed on.

[Justin Madders]

I appreciate the Minister’s tolerance in letting me intervene again. Can we be clear on the reviews? I appreciate why the Secretary of State will be doing that on an ongoing basis, but the Opposition would like to see those reviews in some documented form so that we can understand the basis on which restrictions are eased and implemented.

[Jo Churchill]

To that point, I will address the comments that the hon. Gentleman made about transparency. In recognition of these unprecedented times, SAGE has been publishing statements and the accompanying evidence it has reviewed to demonstrate how the scientific underpinning and understanding of covid has continued to evolve. As new data emerges, SAGE’s advice quickly adapts to new findings and reflects the situations.

I would like to turn to the impact assessments.

Health Protection (Coronavirus, Restrictions) (England) (Amendment) (No. 2) Regulations 2020

Justin Madders Excerpts

Wednesday 10th June 2020 General Committees

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to see you in the Chair, Mr Mundell.

We are here today to consider these regulations during yet another critical phase in the fight against coronavirus, and of course we all wish that they were not necessary, but sadly we know that these restrictions are required due to the ongoing and serious threat to public health that we face. The virus has not gone away and it is right that we take all necessary steps to protect our citizens.

Of course we want the Government to succeed in defeating this virus and in minimising the impact that it has on our lives and on the country, so we will continue to be supportive where that is appropriate. Equally, however, in wanting the Government to get this right, where we have concerns we will continue to raise them, and it is right to say that we have concerns.

First of all, we are having the right debate, but we are having it at the wrong time. I want to place on the record our concerns about the procedure for considering these regulations. As the Minister said, these regulations were created and signed into law on 14 May. It is now 10 June. It is far too late for anything that we say to make any difference to these regulations.

The Minister has said that it is right that the rule of law be maintained, and of course we agree with that, but I fear that by debating these regulations retrospectively, we are treading on the wrong side of that. Of course we accept that the initial regulations had to be hurriedly introduced, in response to the rising number of infections. However, as I stated when we debated those initial regulations back on 4 May—some six weeks after they had been introduced—given that Parliament was up and running again by that time, there should have been sufficient time to ensure that future changes were debated and had democratic consent before they were introduced. Debating them weeks after the event, and when in fact they have already been superseded, as we have heard today, is frankly an insult.

There is no excuse for this situation now. As we have heard, the regulations require there to be a review every three weeks, as the Secretary of State has a duty to terminate any regulations that are not necessary or proportionate to control the transmission of the virus. That means that all along we have had a clear timetable and sight for when new regulations might be created, which should have allowed plenty of opportunity for parliamentary scrutiny of those regulations.

Yet here we are again today, debating regulations that came into effect weeks ago. That is not good enough. I want to ask the Minister this: what would happen if the Committee voted against these regulations today? Would all the fines issued under them have to be repaid? I imagine that would be a minimum step, but the Minister will be pleased to hear that, at this stage, that is a hypothetical question, because we are not going to vote against these regulations. However, this is the issue—it is the way that these regulations continually come to us late. Moving forwards, we cannot carry on in this way and the Government accept our indolence at their peril.

That is because we are not only debating these regulations too late but, as we have heard, we are debating them when they have been superseded, as the next set of regulations has been introduced. As we heard, the review that took place on 28 May, with regulations being laid on 31 May, came into law on 1 June, and a debate on those regulations is set to take place on Monday—again, long after the event. Does the Minister agree that debating regulations when they are already out of date makes a mockery of the process?

As we know, and as the Minister told us, the regulations have changed the requirement for a review to take place from every 21 days to every 28 days. Given that the next review must take place before 25 June, if that review does envisage an introduction of more relaxations, can the Minister commit today that those new regulations—any introduced off the back of that review—will be debated before they are implemented, and not retrospectively, as has been the case today?

The Minister went on to say that the regulations are, in fact, constantly reviewed; I should be grateful if she would clarify exactly what she means by that. Is there a formal process by which that is taking place, or are there, in fact, just the three-weekly reviews that have been set out in the regulations?

As for those reviews, where are they? In a written question that I put to the Secretary of State for Health and Social Care, I asked if he would publish the reviews carried out on 16 April, 7 May and 28 May pursuant to these regulations. I received a reply to that question at half-past 9 last night, which said:

“The Department of Health and Social Care has indicated that it will not be possible to answer the question within the usual time period.”

I find that absolutely incredible, and, regrettably, the failure of the Department to provide me with an answer to what I would have thought was a pretty important and obvious question leads me to one inevitable and damning conclusion: there has been no proper review.

Here we have the most far-reaching impositions on the life of this country in peacetime—necessary actions, but ones that have had unparalleled and far-reaching economic and social impacts—and the Government have not, as required by law, conducted any review of those regulations that we can actually see; or if they have, they have decided that we do not deserve to see them, which is equally reprehensible.

I understand, from what the Minister said in her introduction, that there were several more reviews on 22 April and 7 May. Again, if the Minister had not been good enough to tell us today about those reviews, we would never have known that they had taken place. We need far more transparency than we are seeing at the moment. We cannot go on like this. If we are to defeat the virus and carry with us public confidence and trust that the tough decisions being made are the right ones, the Government must be transparent and open and let us see the outcome of the reviews as a matter of urgency.

It is because of their wide-ranging effect that these measures demand full parliamentary scrutiny. I am sure that many hon. Members agree that a 90-minute debate by a small parliamentary Committee, weeks after the fact, cannot possibly be sufficient to provide the level of examination and scrutiny that such important laws require. As we have seen, great efforts have been made by staff to get Parliament up and running again. We should not demean those efforts by turning these debates into a procedural formality, a rubber-stamping exercise to create the veneer of a democratic process. We should be better than that. We should not be debating the measures late and without the full extent of the information on which the Government have made their decisions.

When it comes to the regulations themselves, not only has the legally required review of them not been disclosed to date; they have not had any kind of impact assessment carried out. Again, to be fair to the Government, we understand why, in the first instance, that was not possible. However, we did make it very clear, the last time the regulations were debated, that we did not want that to become the norm, especially for regulations such as these, where we know that the impact will have been huge. The second and third set of regulations have apparently had no impact assessment, either.

How can the Government continue to issue new laws with such sweeping powers as these when they cannot tell us what their impact is? As the time between reviews and updated regulations extends, will the Minister commit to undertaking impact assessments for future regulations and publishing them alongside the regular reviews of the regulations that they undertake?

The public have made huge sacrifices. Like us, they have supported the lockdown. It is right that we take a moment to acknowledge the sacrifices that they have made in the interests of public health and to thank them for that. However, it is simply unacceptable for the Government to continue to issue regulations but then to make no attempt to measure their impact.

We have always argued that restrictions need to be eased gradually and in a safe way. Of course we want to see society reopen, but that has to happen safely. We need a structured approach to easing and tightening restrictions, which needs to be done in an open way, backed by the science and alongside a published impact assessment. That is the way to take people with you.

The Government have confirmed that all the proposed easings of restrictions have been modelled and that that showed that the R value remained below 1, but we of course have not seen that modelling. We still see thousands of new infections each week. Indeed, I understand that we still have the second highest infection rate in Europe. We need to see all the scientific evidence for the decisions that have been taken. Any easing of restrictions should be accompanied by publication of the Government’s full scientific evidence and should involve advance warning, to allow adequate time for planning. It should be done in conjunction with all nations, regions, local authorities and elected Mayors. The decision at 5 pm last Friday night suddenly to announce that everyone in hospitals should wear face masks was a classic example of a headline-driven agenda that fails to acknowledge that decisions need to be taken in consultation with those who will have to deliver on them.

The Government should be clear that they would rapidly reintroduce targeted restrictions where necessary should infections increase and the R rate increase above 1 in the whole or in parts of the country. They should also spell out how they would do that. That is essential to ensure that we maintain public confidence and safety. We have heard talk of localised lockdowns, but the Government have not spelt out how that will work in practice. Who will make those decisions? Who will monitor and enforce the lockdown? And who will be responsible for dealing with the economic fallout from such decisions?

Will the Minister commit to publishing written guidance on defining what a “local lockdown” is, how it will be enforced and what resources and powers local authorities and other agencies will be able to draw on in enforcing it? We know from what Ministers have said that they are looking at the scientific advice across the board, but we do not know what that science is, because we have not seen it. What we have seen in recent weeks is various members of the SAGE committee popping up on TV to raise their concerns, while at the same time those experts have mysteriously disappeared from the nightly Downing Street briefings. Is it any wonder, in those circumstances, that we might want to have some more detail about the basis on which decisions are being made? I hope the Minister will take the opportunity today to reiterate the Government’s commitment to following the science. Of course, the simplest way to show that commitment would be to publish it all.

We also consistently hear concerns about the Government’s strategy in communication from the royal colleges, membership bodies and NHS bodies. Only last weekend, the chairman of the Royal College of General Practitioners called for a strategy for test and trace, for PPE, for the use of technology, for maintaining covid services and opening up non-covid services, saying that

“there’s no sense of direction as to where we’re heading.”

Those are not small concerns. Senior clinicians, frontline NHS staff and public health experts are not convinced that there is a plan to deal with a potential second wave of covid-19 infections, more than 80 days since lockdown began. That is about as serious as it gets. The Government say they have met their own five tests for the easing of lockdown rules, but as I have set out, there are considerable concerns from people on the frontline that we are woefully underprepared to deal with a spike in cases. Can the Minister point to a document that sets out the Government’s assessment of the five tests? Can she explain why the relaxations have already happened when the joint biosecurity centre has not reduced the threat level?

I come to the substance of the regulations. As we have heard from the Minister, the regulations further amend the original lockdown regulations and give further reasons why a person can leave their home. The explanatory memorandum describes them as

“a number of small relaxations”.

I would not dissent from that description, nor will I recite them all here, but I will draw attention to the new permission that has been granted by amending regulation 6(2) of the Health Protection (Coronavirus, Restrictions) (England) Regulations 2020 to include sub-paragraph (n)—namely, the ability to visit a waste or recycling centre. I mention that because when we debated the first set of regulations, I contrasted the permitted reasons to leave home at that stage with the statements made by the Secretary of State for Housing, Communities and Local Government, who had said in April that people were permitted to leave their homes to visit waste or recycling centres. Clearly, he should have said at the time that he meant that people could do that after 13 May.

On fines, the regulations significantly increase—from £60 to £100—the amount that can be charged as a fixed penalty notice for people over 18 who breach the lockdown restrictions. What is the reason for that increase? What evidence has the Minister had to suggest that there needs to be a higher level of punishment? Is a greater deterrent needed? Will she also provide an update on the representations that the Secretary of State for Health and Social Care made to the Treasury on the fines issued to people whose childcare issues may have been why they breached the rules?

In the context of public compliance with the rules, it would be remiss of me not to raise concerns that the actions of Government in recent weeks have negatively impacted on public confidence in such measures. The Government have allowed the public health message to be undermined because the Prime Minister, for reasons best known to himself, would not take firm action against his senior adviser for breaking the lockdown. No one wants to feel as though there is one rule for them and another for those is power. That should not be the case. We want to keep the public on board and adhering to social distancing, to keep everyone safe. It is vital that Ministers rebuild trust in their strategy and that ministerial statements in the media are without bias and reflect the rules and official guidance.

There are concerns about the issuing of fixed penalty notices. We have seen some worrying data showing that black, Asian and minority ethnic people in England are 54% more likely to be fined under the regulations than white people. According to 2016 population figures, BAME people account for 15.5% of the population in England. However, according to National Police Chiefs Council data from 15 May, they have received at least 22% of the coronavirus lockdown fines. Will the Minister confirm that she is aware of this issue? What steps are the Government taking to address the disproportionality?

We also know that racial and health inequalities amplify the risks of covid-19 and that people in the poorest households and those of colour are disproportionately affected, with black, Asian and minority ethnic people more likely to die from covid and more likely to be admitted to intensive care. However, the Public Health England review published last week made no recommendations on how to reduce the impact of covid-19 on BAME communities. As the lockdown is eased, will the Minister confirm what steps the Government are taking to mitigate the risks faced by such communities and to protect them, in order to ensure that no further lives are lost?

One message that has been coming through clearly from the experts is that the key to easing lockdown safely is a properly functioning testing and tracing strategy. The Opposition have concerns about that: we have been too slow on testing, and now it seems we are too slow on tracing. The Prime Minster promised a “world-beating” system by 1 June, but that date has come and gone, and we are now told that it may not be fully operational until September. We do not know the numbers of people tested each day or the numbers of contacts traced. We do not know whether mailed tests are completed and we do not know how many care home residents, care staff or NHS staff have been routinely tested, or whether they are symptomatic or not.

We take no pleasure from the fact that the system is in chaos and that the UK Statistics Authority has been forced to intervene over concerns about testing data, or that the Association of Directors of Public Health has called on the Government to delay easing lockdown until the tracing system has been proved to be more robust and there can be confidence about what the impact will be on continuing trends in infection rates. I raise those issues because we want to get things right. If we do not, we will risk another spike in the number of infections, with a second lockdown, costing many more lives and causing untold damage. We must do everything we can to ensure that that is not allowed to happen.

I hope that the Minister will be able to confirm when we will have a fully functioning, effective test, trace and tracking system, with a fully functioning app. I hope that she will commit to introducing a covid test guarantee, so that no one will have to wait more than 24 hours to receive a test, and then no more than 24 hours to receive the results—for all tests, without exception and with immediate effect. I hope that she will also commit to delivering a working app that will enable councils to contact everyone at risk, with a cast-iron guarantee to the public that they can feel secure that their information will not be disclosed to third parties.

None of us wants a sharp rise in infections or the R rate. We are at a critical moment. The Government must demonstrate that they have got a grip of the testing and tracing strategy, to restore public confidence in their handling of the pandemic. The Government have taken the decision to lift the restrictions. It is for them to demonstrate that they are listening to experts and publish the full scientific evidence and the rationale behind the decisions that they have taken. We want society to reopen, but that must happen safely and in a way that follows the science. We remain committed to working constructively with the Government. That requires them to work constructively and openly with us and others. We hope that the Government will confirm that that is their intention on those important issues, because only with constructive working, where the Government listen and respond to concerns, can we all beat the virus together.

[Matt Western (Warwick and Leamington) (Lab)]

On a point of order, Mr Mundell. I should be interested to know the reason for certain sittings being broadcast and others, like this, not being broadcast. Is there a reason?

--- Later in debate ---

[Helen Whately]

In summing up, I want to restate the Government’s commitment to working with Parliament in developing the policies that find expression in the legislation that we debate in the House. I appreciate the tone of the comments made by the hon. Member for Ellesmere Port and Neston, and particularly his opening remarks about wanting to support the Government in the measures we are taking and, overall, our drive to succeed in crushing coronavirus. There were many questions in his speech, and I shall do my utmost to cover them in my response, but as he spoke at pace I might not manage 100% to do that. I will do my best.

I think his first point could be encapsulated as a preference for us to debate regulations and amendments sooner. I appreciate that point, but he and other hon. Members will appreciate the situation that we are in, with a global pandemic hitting us and other countries with extraordinary aggression. That has required extremely rapid action to protect people’s lives. The hon. Gentleman also knows that we must act as quickly as we can to protect people’s livelihoods and wellbeing. That means looking to move promptly, albeit cautiously, towards easing some of the restrictions when the science indicates that it is possible for us to do so.

The hon. Gentleman asked me about what happens with the review process. It is conducted by the Secretary of State for Health and Social Care following discussion with other Ministers. It is guided by officials and experts, and SAGE provides scientific evidence and advice. Overall, the process is to ensure that the measures are necessary and proportionate.

The hon. Gentleman asked about impact assessments. We acknowledge that the impact of the restrictions is hard. It is tough on many individuals and hard for businesses, but it is variable: it is harder on some than on others. In my role as Care Minister, I talk to carers looking after people with learning disabilities, autism and a range of other health conditions. That group has been hit particularly hard by the restrictions and the loss of services, given that it is not considered safe to access them. I am mindful of the variable impact.

[Justin Madders]

I am grateful to the Minister for giving way, and I hope she will answer all the questions. I take it from what she has said that there is not actually a formal impact assessment but reviews are undertaken. Will she explain why the Department has not issued copies of them, following my written question?

[Helen Whately]

What I do know is that there is a huge volume of inquires coming into the Department at the moment. I am personally handling a large number of questions and letters from colleagues, so there is huge demand on the Department to respond to inquiries.

The Government absolutely are considering the impact on businesses and individuals—the economic, personal, physical and mental health impact, including on those with protected characteristics. We take those impacts very seriously, and we want to provide as much support as possible to mitigate the negative impacts on people.

The hon. Gentleman asked about transparency and the publication of, for instance, SAGE documents. I am sure he is aware that a suite of documents from SAGE has been published online.

The hon. Gentleman also asked about fines and the reason for their increase in the instrument. The reason for the increased fixed penalties is to act as a greater deterrent to those who might break the rules.

The hon. Gentleman made a very important point about whether fines have had a disproportionate impact on people from BAME communities. That is clearly a very serious concern. We are working with policing partners to analyse the data, to determine whether there has been a detrimental impact on those from BAME backgrounds. Let me make it absolutely clear that no one should be subject to police enforcement on the basis of their race.

The hon. Gentleman asked a number of questions about testing. There has been a phenomenal ramping up of the volume of testing that has been carried out. I have seen the enormous efforts that have taken place to increase the volume of testing available to the care sector, and particularly to care homes. We are getting testing kits directly out to care homes so it is easy for them to access tests. The team that did that has done a truly phenomenal job, at pace. I absolutely appreciate the hon. Gentleman’s desire for data on the testing programme—both the numbers and what they tell us. However, as he said, it is really important that we share accurate data that is supported by the UK Statistics Authority, and we are working with it to make sure that we share reliable, robust, informative data on the testing programme.

--- Later in debate ---

[Helen Whately]

I have already given my answer. I have nothing further to give on that point.

[Justin Madders]

We have talked about the importance of the reviews of the regulations. Can we have a commitment that those will now be published?

[Helen Whately]

I have set out the process that is taking place and I am not going to give the hon. Gentleman the commitment that he asks for, but he has made it clear that that is what he would like to see.

To sum up, these amendments are an important and cautious step towards returning to normal life. We have listened to the public and to the scientific evidence and we are taking the steps to ease the restrictions over the coming weeks and months. We understand the burden that restrictions place not only on individuals but on society as a whole. We maintain only the restrictions that are necessary and proportionate at any given time. There will be many occasions over the coming weeks and months when we will be able to debate these questions further. As I said, the changes brought in on 1 June will be brought to the House for debate on 15 June.

I end by paying tribute to the NHS and care workforce, to whom we all owe the greatest respect for the work they do each and every day, and to the people of the United Kingdom for their patience and strength in helping to combat this pandemic. The steps we have been able to take towards normal life are a testament to the people of the UK and their fortitude in tackling this outbreak. As a Government, we will play our part by making sure that the burden is no more onerous than it absolutely needs to be. These regulations ensure that that remains the case.

Question put and agreed to.

Resolved,

That the Committee has considered the Health Protection (Coronavirus, Restrictions) (England) (Amendment) (No. 2) Regulations 2020 (S.I. 2020, No. 500).

Public Health

Justin Madders Excerpts

Monday 4th May 2020 Commons Chamber

[Justin Madders (Ellesmere Port and Neston) (Lab)]

We all wish that these regulations were not necessary, but we are all absolutely clear that, given the threat we face, they are required. Before we get into the substance of the regulations, I want to say a little bit about the process, because whether we support these measures or not, given that they represent the biggest peacetime restrictions that this country has ever seen, they do demand full parliamentary scrutiny. I do not intend this to be a criticism of the Minister or anyone else, because we all know the efforts that have been made to get this place up and running again, but a couple of hours’ debate weeks after the regulations were introduced cannot in future be sufficient to provide the level of examination and scrutiny that such sweeping laws require.

We all know the damage that this virus is doing to our society, and we all know that these measures are needed to limit that damage, but we should not forget their impact—the business shut down overnight with no idea if or when it might trade again; the child who cannot understand why they cannot see their friends any more; the grandparents cut off from their family, missing out on their grandchildren growing up. Everyone is facing their own challenges. The physical and mental toll is huge, yet virtually everyone is adhering to these rules in a way that is a testament to the resolve and determination of the British people. So we say thank you to everyone who has played their part in slowing the spread of the virus.

We acknowledge that this is incredibly difficult, and we do not want these measures to be in place for a day longer than is absolutely necessary. The first duty of any Government is to protect its citizens, and if it is necessary to curtail basic freedoms—freedoms for which people have fought and died—to protect them, reality dictates that that is what has to happen. That reality must be accompanied by openness, accountability and scrutiny at a greater level than we would ordinarily see. We accept that the regulations had to be introduced hurriedly in response to the rising number of infections, but there is now a new rhythm to life, and there ought to be time and space to ensure that any future changes have democratic consent before they are introduced.

The regulations require a review every three weeks—as the Minister said, one is due in the next few days. The Secretary of State is legally required to terminate any regulations that are not necessary or proportionate to control the transmission of the virus. A statement in the House following the review will provide a helpful examination of that requirement. I hope that when the Minister responds he will commit to that and to an oral statement after each subsequent review. If that review envisages some relaxation of the measures, we hope that any new regulations on the back of that are debated here before they are implemented and, most importantly, that they follow a wider conversation with Opposition parties, employers, trade unions and, of course, the public.

There are reports that that has begun to happen, but it needs to be done in a structured, open way, not through media briefings or leaks. I do not say that to make a political point, but because I believe that consent for an application of the rules will be better after full and transparent dialogue than it would be without that. We need only to look at the way in which some of those rules were interpreted and applied in the early days to know that there was confusion about their exact meaning. Again, that is not intended as a criticism—no law, let alone one that is completely unprecedented in its reach in modern times could be implemented without areas where there is ambiguity, and clarification is required.

Much of that was most likely due to the unusual and sudden nature of the regulations, but even recently we have seen a divergence between ministerial pronouncements and what the law actually allows. For example, the Secretary of State for Housing, Communities and Local Government has recently said on a number of occasions that tips should be able to reopen. Regulation 6 does not state that such a visit is a reasonable excuse for leaving home.

That leads to my next point—the current rules, sweeping as they are, are not numerous. If the next phase is likely to contain a longer list of reasonable excuses to leave home, it is even more important that those rules are clear and consistent. The rules need to be harmonised with advice, guidelines and all forms of official communication. We do not want people to imply legal authority where there is none, or to act outside the law. That is vital to preserve the rule of law. We know that the lockdown was a blunt tool—effective nevertheless—and one that will change by definition as restrictions ease. There will be a measure of nuance, distinction and variation that requires careful explanation and policing. People will inevitably ask why one set of businesses can reopen, but not another. We believe that full disclosure not just of the names of the attendees of the Scientific Group for Emergencies but of all the scientific evidence and advice that has been provided is required to give the public confidence and reassurance on any changes to the rules.

It is in the area of transparency that we need a change from what have seen so far. To take people with us, and for the morale of the nation, any changes to the rules must be viewed in the context of a published exit strategy. We need clear sight of the proposed areas where restrictions will be eased, and a robust plan to protect workers and the public alongside a published impact assessment. So far, there has been no impact assessment—again, we understand why that was not possible in the circumstances, but we do not want that to become the norm, especially for regulations such as this. We see the impact every day and we know that it is not distributed equally.

I should like the Minister to provide assurances that there will be adequate personal protective equipment for all those working on the frontline and facing exposure to the virus. I should like to put on the record our thanks for the extraordinary bravery and dedication demonstrated by NHS staff and other public servants. Our thoughts are with those who have lost loved ones to the virus, and we hear the concerns from many royal colleges and trade unions in the NHS and social care sectors about the availability of PPE. That matters going forward. If, for example, any changes to the lockdown rules involve the wearing of masks in public what steps will the Government take to ensure that everyone can access them consistently and securely?

Will the Minister also address the question of what resources will be devoted to helping businesses make physical changes to ensure safe working and to increase capacity for the official enforcement of safe working practices? The Health and Safety Executive has experienced significant cuts to its budget over the past decade, and demands on it will be higher as questions inevitably arise about safety. What extra funding will be available to meet that demand?

Will the Minister provide clarity on the status of the 2-metre social distancing rule? It is probably the most effective tool in helping to stop the spread of the virus, yet it does not appear in the regulations. Does it appear elsewhere? Is it actually enforceable? On the question of enforceability, the comments today from the TUC about the lack of enforceability of the proposed guidelines that it has seen are extremely troubling. We cannot allow people back into work unless there is confidence that a robust and enforceable system is in place to guarantee their safety.

Finally, we require clarification on the list of vulnerable people in schedule 1 of the first set of regulations. For example, motor neurone disease appears in the schedule as an underlying medical condition for those in the vulnerable category, but it is not among the high-risk category of patients on the NHS shielding list. This may well be another example of where there needs to be greater harmony between the regulations and other guidance.

In conclusion, we will not oppose the regulations but, given that they represent the most severe restrictions imposed on British liberty in modern history, it is critical that they are subject to continual comprehensive and transparent scrutiny. Democracy demands no less.

[Madam Deputy Speaker (Dame Eleanor Laing)]

We now have a formal time limit of five minutes.

Alcohol Harm

Justin Madders Excerpts

Tuesday 17th March 2020 Westminster Hall

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Paisley, and I congratulate the hon. Member for Congleton (Fiona Bruce) on having secured this debate. It is always a pleasure to hear from a fellow Cheshire MP, and she introduced the subject extremely well. She was right to say that this is an extraordinary time, but when we hopefully get through the current crisis, the issue of alcohol harm will still need to be tackled. She was also right to say that as we face this crisis, there is an increased risk that long periods of self-isolation will lead to excessive drinking. I know there is tremendous pressure on the Department at the moment, but I hope that important point will be considered. The hon. Lady has also described the importance of integrating the loneliness and social prescribing agenda into alcohol support strategies.

We also heard from the hon. Member for East Lothian (Kenny MacAskill), who brought his own experience to bear on this matter. He was clear that affordability, availability and advertising are the key ways in which to tackle this issue, and that education on its own is not enough; he was also right to identify off-sales as a trend that needs looking at. The hon. Member for Henley (John Howell) made some interesting points about drink-drive limits and also raised the issue of drinking before conception—before the period of pregnancy—which we do not talk enough about at the moment. As always, we heard from the hon. Member for Strangford (Jim Shannon), who discussed in detail the history of his eating habits, raising an important point about moderation and controlling temptation that can be applied equally to this area. He also clearly highlighted the social difficulties caused by excessive alcohol consumption.

We also heard from my hon. Friend the Member for Blaydon (Liz Twist), who spoke mainly about minimum unit pricing. She talked about the benefits that the University of Sheffield’s study demonstrated such pricing could create, and made the interesting point that 48% of publicans support minimum unit pricing, which we do not always appreciate. She was also right that a holistic approach needs to be taken to alcohol harm, which is a point that most Members touched on to some extent.

Every year, thousands of people die because of alcohol consumption and many more people are harmed. This is an issue that goes beyond the individual and affects the whole of society, including their family and their whole community. The statistics we have heard this morning are shocking, and I make no apologies for repeating some of them, because they are worth repeating. Alcohol is the leading risk factor for death for 15 to 49-year-olds in England, and eight people die every day due to alcohol. Alcohol-related hospital admissions are at a record high, having risen by 44% over the past decade. In 2018, there were 1.1 million admissions to hospital related to alcohol use. Every day, 33 people are diagnosed with one of seven types of alcohol-related cancer, and liver disease is a major and increasing cause of death. It causes about 2% of all deaths in the UK every year, having increased by a shocking 400% since 1970.

Those numbers come at a high cost. Alcohol costs NHS England £3.5 billion annually, and 25% of A&E workers’ time is spent dealing with alcohol-related incidents. It is also reckoned to cost the economy £1.2 billion to £1.4 billion annually. In total, over 10 million in the UK consume more than the recommended levels of alcohol.

As we heard, 2 million people have an alcohol-dependent parent; at least 200,000 children live with at least one alcohol-dependent adult. According to the Children’s Society, parental alcohol abuse damages the lives of 700,000 teenagers across the UK. More than 4,000 children a year contact Childline with concerns about their parents’ alcohol use—it is the most common reason for children to call about their parents. We know from previous debates about the adverse childhood experiences of growing up with a parent with alcohol or substance misuse, which can have lasting, and sometimes devastating, impacts on children. We hear about them having to fend for themselves, when they have no option but to take on as best they can the adult responsibilities foisted upon them.

Children themselves may get into a similar spiral. One in three diagnosed mental health conditions in adults is known to directly relate to adverse childhood experiences. The World Health Organisation outlines a cycle of violence, because alcohol and substance misuse impacts on children’s lives, with a devastating impact on their adulthood.

My hon. Friend the Member for Leicester South (Jonathan Ashworth) has campaigned passionately on these issues; he is clear that alcohol addiction is a public health issue and is strongly linked to health inequalities in England. The rate of alcohol-specific deaths is more than double in the most deprived areas compared with the least. Tackling alcohol harm is a key route to increase the health of our nation, to reduce health inequalities and to reduce pressure on our public services. That means investment in those services, focus on prevention and challenging the wider circumstances and social determinants of ill health, including addiction. We struggle with that at the moment, because alcohol services continue to be cut because of public health spending reductions of around £700 million, including addiction services cut by £162 million. That has an impact; we heard from my hon. Friend the Member for Blaydon that local authorities still do not know their public health allocation for next year, despite it coming into force in two weeks’ time.

We must fund alcohol treatment services fully; the hon. Member for Congleton highlighted that 88% of those who need services in Cheshire East are not getting that support. Unless we take this issue seriously, that figure will not improve.

I want to say a few words about workforce. Whenever we talk about health issues, there are always workforce implications. The number of training posts in addiction psychiatry has decreased by 60% since 2006. In 2017, the Royal College of Psychiatrists census found that the NHS had 20% fewer consultant addiction psychiatrist posts than four years previously. Obviously, that has an impact on frontline staff, and there is less one-to-one client contact, which is vital. We must improve co-ordination and partnership working with mental health services. Too many people who experience addiction problems also experience mental health conditions such as depression, anxiety or schizophrenia. Yet just one in four people with a diagnosed mental health problem in substance treatment also receives mental health treatment. We have talked many times about the need for mental health to get parity of esteem.

The Government’s alcohol strategy in 2012 devoted just two paragraphs to recognising the link between co-morbidities of alcohol problems and mental health. That simply is not good enough. Dual diagnosis must be the expectation, not the exception. Just as we need to do more to improve recovery and addiction services, we need to be bolder on prevention and population health interventions. We have a proud record on bringing down smoking rates, because we have taken decisive action. We need to do the same with alcohol abuse; it must be at the heart of the prevention agenda.

There are three areas that should be included—transparency on alcohol labelling, pricing, and prevention and marketing. Unfortunately, there is not time to go through all those in much detail, but I know that the Government committed to a new prevention Green Paper and updated alcohol strategy. While I appreciate that the Department has huge pressures on it at the moment, it would be helpful if the Minister gave us an indication of when we might expect to see that, if she is able to, because that will be the key to making progress on those issues in the future.

Income tax (charge)

Justin Madders Excerpts

Monday 16th March 2020 Commons Chamber

[Justin Madders (Ellesmere Port and Neston) (Lab)]

First, I welcome the Minister back to his place after his period of self-isolation. I am sure that all parts of the House will agree that the current coronavirus crisis has demonstrated beyond all doubt just how important our public services are. We all know that this is a very serious time and that our constituents will be concerned. I know many are frightened by the way the crisis has escalated over the past week or so, so I start by sending our condolences to all those who have already lost a loved one including, sadly, one gentleman in my constituency. I also send our gratitude to those who are already working flat out to do their best to limit the impact of coronavirus, whether they are in the NHS, the rest of the public sector or the private and voluntary sectors, which are making a vital contribution as well.

As the Minister will know, we are supportive of the national effort to contain and delay the spread of the virus, and it would be irresponsible of us as an Opposition to make any attempt to exploit the pandemic for party political gain. I thank the Minister for his kind words in that respect. Equally, it would be irresponsible of us to ignore the concerns being raised by the public, the scientific community and the sector more widely. It is critical that we ask important questions on their behalf, especially when the limits of public service will be tested like they have never been tested before.

We know that many aspects of life will have to change or stop altogether, albeit temporarily, but it is hoped that accountability, transparency and the ability of Opposition parties to scrutinise Government decisions will continue. We are under no illusions that, at this time, our ability to do that comes with a particular responsibility, so I hope the House will understand that I will focus mainly on the challenges of the immediate crisis facing us and ask some of the many important questions that have been raised. I appreciate that there will be a statement later, and I will understand if the Minister refers some responses to that, but we will have slightly more time in this debate to discuss important concerns that have been raised with us by many in the country.

Let me turn to the Budget, as this is a financial debate. We have previously acknowledged the extra funding announced in the Budget for the NHS and social care as part of the covid-19 response. That is something we have long called for, but there remain unanswered questions about how that funding will be precisely allocated. Can the Minister tell us exactly how the extra funding will be allocated and what will happen once the money is depleted? The NHS said last week that it needs to scale up intensive care beds sevenfold. That new pot of money is going to run out at some point, and it will need topping up. Will another Budget be necessary then, and what will the process be for determining resources at that point?

While we welcome the extra funding, we are aware that it is in the context of the NHS already facing extreme pressure, as usually happens over a busy winter period. We know from the last NHS winter report two weeks ago that 80% of critical care beds were occupied and that 93% of general and acute beds were also occupied. We know that the proportion of people being seen within four hours at A&E is the lowest on record, and the target has not been met since July 2015—the best part of five years. We know that the number of people on waiting lists in England is the highest it has ever been—nearly 4.5 million people are on a waiting list for treatment—and the waiting list target has not been met for nearly four years. Sadly, some cancer targets have not been met for over six years.

Those figures should tell us that the NHS is already stretched to capacity and that we are not starting from the optimum position. But it also tells us why the Government’s strategy of delay is one that has to be supported. Even if we take at face value the Government’s insistence that they have provided enough NHS resources to deliver the commitments in the long-term plan, we must surely all accept that the covid-19 outbreak will lead to an increased demand on trusts, meaning that resources in the system will have to be reallocated. Should trusts be expending time and resources on working on control totals and end-of-year accounts at this precise moment?

Will beds from the private sector be made available to covid-19 patients, and at what cost? What will the process be for trusts that have particularly large outbreaks and increased demand? Is any audit being undertaken of disused hospitals or other public sector facilities that may be required at some point? For example, is there any way that the brand new Royal Liverpool Hospital building could be brought on stream more quickly? Are the Government sourcing more ventilators, and when can we expect to see those available? Many manufacturers export all around the world. Will steps be taken to ensure that the NHS is at the front of the queue when those goods are produced?

I want to say a few words about the workforce. We know that, before we entered the crisis, the NHS was already short of over 100,000 staff, including 43,000 nurses and 10,000 doctors. The impact of staffing shortfalls manifests itself across the whole spectrum of NHS performance, as I have just outlined. It is therefore more critical than ever that those people who work in the NHS and whose good will we rely on already get adequate protection. It is evident that, in order for patients to have the best care possible, the NHS must support its staff to ensure that they stay well and can provide that vital care. That means a continuous supply of the right equipment and facilities. Personal protective equipment is vital in that respect. I hope we will hear, either in the Minister’s response or the statement later today, about what is being done to secure supplies of equipment and whether there is enough capacity in the system to ensure continued supply.

We would also be grateful for more information on the plans mooted to get retired staff back into the health service. Will some of the money announced in the Budget be used to deal with the anticipated increase in the wage bill that that would mean? Can we have an explanation as to how those people would be protected given that, by definition, the majority of them are likely to be over 70? What oversight will be put in place to ensure that they are delivering safe care if the revalidation process is to be suspended for retired returnees? Those on the frontline who I have spoken to are concerned about identifying the point at which an individual has been away from practice so long that it becomes impractical to reintegrate them in a safe and effective way. Will guidance be issued on what that point might be? What consideration has been given to those in the existing workforce who might be in a more vulnerable category because of their age or an underlying health condition?

A major concern is the lack of clarity about when people should be tested. We are hearing of many frontline NHS staff displaying symptoms but not being tested. What does that do for morale, if nothing else? The World Health Organisation has said that we should be continuing to test and contact-trace those suspected of having the virus. As a matter of importance, we should have a full explanation of exactly why we are currently diverging from WHO advice. It has been reported that labs are overwhelmed and tests are now taking several days to come back with results. Is the current ambiguity on testing policy a question of capacity rather than anything else? Will the Government be putting more resources into those labs, and if so, when will this materialise? It seems to us that continued testing is vital not only to stop the spread of the disease, but to understand when its peak has been reached. It may also be that efficient and accurate testing means fewer people having to self-isolate unnecessarily, which of course has an unnecessary economic knock-on effect.

[Mike Amesbury]

A GP has been in touch with me today to say that they were in close proximity to a patient who is likely to have coronavirus and have been sent home to self-isolate, but they have not been tested. How on earth will they know, when they do return to work, that they are not a risk to others? Surely testing should be extended to such vital GPs.

[Justin Madders]

My hon. Friend makes very well the point that I was making. It is evident that if that particular GP does not have the virus, it would be better for us all if they know that sooner rather than later, so they can get back in and treat patients. It is also worth restating at this point that people who have suspected symptoms should not be turning up at their GP practice because that is one of the ways, unfortunately, that we will spread the virus.

[Jim McMahon]

The case that has been outlined is very important, but we also need to remember that social careworkers, who will be visiting all the people in their care in their homes, are also placing their patients at high risk, but at the moment there are no plans I have heard about to test those social careworkers. I should say, by the way, that many of them are paid just over the minimum wage, and there is a real question here. We say that we value the NHS and that we value these community workers, but I am not sure a lot of them feel that way at the moment.

[Justin Madders]

I will be dealing with the concerns about the social care sector in a little while, but the points my hon. Friend makes are absolutely valid and they certainly require a Government response.

We should think about protecting NHS staff not just in terms of the doctors, nurses and other frontline staff, but in terms of the cleaners, porters and all the other essential staff who are needed to keep a hospital running and who also play a vital part in infection control. We often hear about the importance of data, and it seems to me that this is a particularly clear example of where data have a huge role to play. If the data are not collected on a regular and consistent basis, surely we will not be in the best position to take the right action.

Yesterday, it was announced that UK medical schools have been urged to fast-track final year students to help fight coronavirus. Can we have an explanation of how this will work, and how will we ensure that graduates still face rigorous testing to make sure they provide the best quality care for patients? There is certainly a role for them to play, but trusts need clarity about its limits so that they can plan ahead. Are staff on maternity and paternity leave being encouraged to return to work early, and would they be able to do so without losing any untaken leave?

[Stephen Doughty]

Does my hon. Friend agree with me—I asked Defence Ministers this question—that we should be calling up full-time reserve service members of the Royal Army Medical Corps and the medical corps of the other armed services, if they are not already NHS workers in their civilian lives? There are people with excellent training and excellent skills, and they and their facilities should be brought into use as soon as possible.

[Justin Madders]

My hon. Friend makes a very important point. I think it shows the spirit of this place at the moment that we are all coming up with very important suggestions. No stone should be left unturned in using all the resources at our disposal to tackle this virus.

As we move to the later stages of the Government’s plan, do we expect to see the cancellation of elective surgery, which will only make those record waiting lists grow further? It is fair to say that that would not be a surprise, but a reduction in elective surgery will have a knock-on impact on trust finances in the longer term. I would be grateful for some clarity about what contingencies will be put in place to help trusts financially in these difficult times, especially when they are collectively in deficit to the tune of almost £1 billion already. Is there also a case to defer loan repayments that are currently made by trusts back to the Department for a period of time?

There was a great deal of surprise and disappointment at seeing no mention of public health in the Budget. Public health directors are currently preparing local responses to covid-19. They need to expend significant sums of money on that, yet they do not know what the public health allocation will be for the next financial year, which starts in just over two weeks. I am sure the Government understand what an invidious position that puts them in, and we urgently need those allocations to be published. Will the Minister say when that will happen? Will he assure the House that the funds will be sufficient to help local authorities deal with these issues?

Has any assessment been made of the extra demands placed on public health budgets regarding preparatory work? It is likely that the knock-on economic effect will severely impact on council finances. Fewer people will use services that they currently pay for, such as leisure facilities, and it is likely that council tax collection rates will drop. There will almost certainly be unanticipated expenditure from covering staff sickness, and that is before we get to social care.

[Geraint Davies]

Is my hon. Friend aware of whether the Government are continuing to pursue the idea of herd immunity—namely letting the virus transmit almost unchecked through the population, which would put overwhelming strain on beds, social services, and so on, or are they trying to minimise transmission by asking people to move and assemble less, and then get resources and testing in place? I am worried that they are still attached to the social services model, rather than to evidence-based experience from China, and elsewhere, regarding ways to control this virus.

[Justin Madders]

That is a perfect question to put to the Secretary of State—he will be here shortly—and my hon. Friend raises an important point about the messages being put out. All sorts of stories are coming out in the press, not all of which are necessarily accurate, and it is important that we do our utmost to ensure a clear and consistent message across the board. I am not sure whether or not herd immunity is a Government policy, but I am sure the Secretary of State will take the opportunity, if he is so minded, to put that matter straight once and for all.

[Emma Hardy]

On confusing messages coming from Government, will my hon. Friend help me seek clarity on advice for people who self-isolate? Can they still go for walks outside? Can they go outside to walk family pets if they go on their own, or are they to be contained within their property? There seems to be a mixed message about what constitutes self-isolation.

--- Later in debate ---

[Justin Madders]

Again, we need a definitive answer on that from the Secretary of State. I appreciate that things are evolving rapidly, and sometimes what was considered best practice a few weeks ago might have changed in light of the evidence. It is incumbent on us to hear the advice directly from the Secretary of State, and then we can send the same message to our constituents, so that there is no more confusion and ambiguity.

[Ruth Cadbury]

My hon. Friend was excellently covering council income, but one area I am concerned about, and have heard nothing about, is council rents. Many council tenants are at risk of losing work or being forced into self-isolation, and they might not get paid. I appreciate the Government’s work on statutory sick pay, but that will not be enough to pay council or housing association rents. Does my hon. Friend share my concern that many people could be at risk of arrears unless the Government support councils in addressing that issue?

[Justin Madders]

My hon. Friend is right: a whole raft of issues will have an effect over the coming months, and although housing revenue accounts are separate to main council budgets, we still need to have that balance. Over the past decade, as a consequence of welfare reform, we have seen how councils and housing associations have adopted policies to deal with that loss of income from a number of changes to the welfare and benefits system, and we must keep that dialogue open over the next few months. We certainly could not expect full collection rates at this time, and we must work with people to understand the limitations of that. We will talk to the Government regarding any legislation that comes forward in due course.

[Jim McMahon]

I thank my hon. Friend for giving way; he is being extremely generous. Does he share my concern that, beyond rent, many households are just a payday away from poverty, so people will be sent into debt that they may never get out of in their adult lives? Surely, the Government need to do far more to help households that are really on the edge.

[Justin Madders]

That is a very fair point. We are only beginning to understand just how precarious a lot of people’s household incomes are in this economy. It is going to take concerted Government effort to support people, but it is also going to take everyone in the private sector who has a debt with an individual holding off enforcing that debt while this crisis comes through. Again, that is something we need to work on. I am afraid I will not be able to take any more interventions.

Social care has been mentioned a couple of times already. Unfortunately, once again, we have a Budget in which social care is not addressed. Local authorities have had £8 billion cut from their adult social care budgets over the past decade, leaving people struggling without any care at all. Our social care system is already at breaking point, and it is likely that the spread of coronavirus will test it even further. Without proper measures to protect people in care homes and those who receive care in their own home, there could be tragic consequences. It is crucial that social care receives the same attention from the Department as the NHS. We expect to see a plan to advise people in social care along the lines we have discussed.

As my hon. Friend the Member for Cardiff South and Penarth (Stephen Doughty) mentioned, those in the social care sector have raised particular concerns about the availability of personal protective equipment. That equipment, which is crucial to protect staff and patients, is just as necessary in social care settings as in the NHS. I have heard from local care companies about difficulties sourcing hand sanitiser, to name but one example. As equipment runs low, how will care staff, including those who are self-employed, have the equipment they need to continue to keep patients safe?

However, the biggest concern for the social care sector is whether it will have the staff it needs to deal with this crisis. As we know, there are already 122,000 vacancies across the sector, leaving staff feeling under immense pressure. We know they already feel pressure, due to staff shortages, to come into work when they feel unwell, but in this case it is vital that they stay at home if they feel unwell. How will the Government ensure that there are enough staff to care for patients when we have far more people in the care sector who are unwell and self-isolating?

A quarter of social care staff and almost half of all home carers are on zero-hours contracts. For some care staff, there is no guarantee that they will be entitled to sick pay, despite today’s announcement. That is particularly true of those who work for multiple agencies or work irregular hours. It is vital that those staff, as a key part of the workforce, feel fully supported if they become unwell. We need a guarantee that all social care staff will receive statutory sick pay. All workers need reassurance from the Government that they will receive sick pay if they are unable to work.

Over the past few days, a number of nursing homes and care homes have made the difficult decision to close their doors to visitors. They made that decision themselves, in the absence of clear guidance. Families are now unable to see their loved ones, and they will want reassurance from the Government that that is the safest call. Will there be guidance on that issue for the care sector?

Inevitably, social care providers will face difficult choices over the next few months. Many will face higher costs. Last year, more than half of social care providers handed contracts back to local authorities because of financial pressures. That causes immense pressure on councils and, of course, worries for the families of people receiving care. It seems inevitable that we will face that situation again soon. Will local authorities and care providers get the financial support they need if cost pressures become too much to deliver safe care? At this difficult time, we must ensure that care services continue to provide the vital support that people need.

What about those who provide care for a loved one outside the system? Inevitably, there will be people who are not able to provide care for a period. The state has no official role to play in that situation, but those people will still need help and support. How will that be addressed?

In conclusion, providing well-resourced and well-funded public services is vital to tackle the spread of this disease, but of course that is not the whole picture. Every member of society will have to play their part. We will all have to recognise that the impact could be felt for many years to come, but we should take heart from the fact that we have a truly national health service and the capacity to rise to whatever challenges we face, so we are better positioned than many to take on this challenge. That will only be true, however, if we can be confident that the services people will rely on in the coming months are robust enough to deal with the storms ahead.

A decade of underfunding has not left us in as strong a position as we would like, but it seems that in the hour of need that may change. We will support the Government in any attempt to boost funding across the board, but we will not be afraid to point out when we believe measures are not enough. Beyond funding, we want messages from the Government about the action they are taking to be clear, consistent and quick. We all have a responsibility in this place to get that message across. Her Majesty’s official Opposition stand ready to give that message as well.

[Several hon. Members rose—]