Patients with Heart Failure

Justin Madders Excerpts

Thursday 11th March 2021 Westminster Hall

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

It is a pleasure to see you in the Chair this afternoon, Mr Mundell. I want to add my congratulations to those offered to the hon. Member for Strangford (Jim Shannon), on securing the debate and on his persistence in getting it almost a year after he first requested it. It is important to discuss the quality of life for patients with heart failure. I thank the hon. Gentleman for his excellent introduction, and for raising many issues, many of which are similar to those that I want to talk about. I add my thanks to those he expressed to people working in the NHS, for the wonderful care that they provide.

I also thank my hon. Friend the Member for Birmingham, Selly Oak (Steve McCabe) for his contribution and congratulate him on the formation of the new all-party parliamentary group on heart valve disease. He spoke about the initiative for 100,000 conversations, which sounds like an excellent way of drawing attention to the issue. Indeed, he brought his own experiences to the fore, which can only help in drawing more attention to the matter.

It is important to discuss heart failure. It is a progressive, potentially life-limiting condition, and there are a number of potential causes; coronary heart disease, high blood pressure and diabetes can all contribute. It can manifest in a number of different ways, including, as we heard, shortness of breath, fatigue and sometimes swelling of the lower limbs. It can occur at any age and the example that the hon. Member for Strangford gave from his constituency was of someone at the lower end of the age bracket. However, heart failure is of course more common in older groups.

As we have heard, there are currently an estimated 920,000 people living with heart failure in the UK, with around 200,000 new diagnoses every year. That is a significant number of people, by any calculation. Nearly all of those people—98%—will also have at least one other long-term health condition. Sadly, about half of all people diagnosed with heart failure die within five years of their diagnosis. Heart failure is a common cause of unplanned hospital admissions, with more than 110,000 of those each year. The rate of such admissions increased by nearly a third in the past five years, and now nearly one in 17 hospital visits in England can include a heart failure diagnosis as either a cause or a contributing factor.

That of course means that the issue puts a considerable burden on the NHS. The Lancet reports that

“the burden of heart failure in the UK…is now similar to the four most common causes of cancer combined.”

It accounts for 2% of the total NHS budget, and around 70% of those costs are due to hospitalisation. I should add the caveat that that clearly does not include covid, which we hope will not be something we must deal with on an annual basis at the level we have had to for the past 12 months.

The British Heart Foundation says that, despite improvements in heart failure therapies over the last two decades, the risk of mortality for patients with heart failure remains high, with the inequalities that we have heard about linked to age, ethnicity, gender, socio-economic status and geographical location. Those inequalities can affect the entire patient pathway, from how quickly someone is diagnosed, which of course, as we have discussed, has an impact on the severity of their condition, to the number of times they are readmitted to hospital and whether they receive the correct support in the community following their discharge from hospital.

For example, while the National Institute for Health and Care Excellence reports the average age of diagnosis as 77, according to the British Heart Foundation it falls to the age of 69 for people from black and minority ethnic groups, and to the low 60s for people from the most economically and socially deprived backgrounds. In 2021, that is simply unacceptable.

Looking more closely at diagnosis, as with many serious health conditions, early diagnosis can of course save lives, yet sadly it is still too often the case that patients are diagnosed late. In a hospital setting, that means they are more likely to have advanced disease, and therefore face poorer outcomes. Research from Imperial College shows that eight in 10 diagnoses of heart failure in England are actually made in hospital—for example, when a patient is admitted with a life-threatening episode of breathlessness—despite four in 10 people presenting with potential symptoms, such as fluid retention or breathlessness, to their own GP. That could have triggered an early assessment or diagnosis in a different care setting.

NICE guidelines for diagnosis and management have been in place for over a decade now, but the British Heart Foundation reports that they have not been universally implemented, meaning that heart failure services remain variable across the country. When there are national guidelines in place, it really should not be something that we have to address, and we need to do better.

Moving on to admission, we know that specialist input during admission is vital to ensuring that patients receive the care that they need. It leads to fewer deaths in hospital and fewer deaths after discharge. Heart failure cannot be cured, but there are treatments that can keep symptoms under control, such as healthy lifestyle changes, medication or devices implanted in a person’s chest. Those treatments not only prolong life, as we have heard, but can improve quality of life, relieving symptoms and improving overall enjoyment and participation in life. Some of the most common symptoms of heart failure—breathlessness, fatigue and fluid retention—really matter on a day-to-day basis for people’s quality of life.

Some treatments can limit physical function, leading to withdrawal from activities and social contact. They can cause psychological problems. Being aware of our own mortality obviously can have an impact, leading to sleep disturbance, depression and anxiety. Many things flow from such a diagnosis that cannot be underestimated. It is therefore vital that we look at all of the pathway in terms of a patient’s journey, so that they receive the best possible specialist care and treatment throughout, to ensure that their quality of life can get better following a diagnosis.

We know from the heart failure audit carried out by the National Institute for Cardiovascular Outcomes Research in 2018-19 that the percentage of patients seen by a specialist ranges from as little as 40% in some hospitals to 100% in others. That can continue following discharge, when many patients are unable to access or are not offered the care and support, such as rehabilitation and relevant recovery and support services in primary care in the community, that they need in order to continue to live well.

Again, unfortunately that is particularly true for those in socially and economically deprived groups, who have consistently worse outcomes than those in more affluent groups and are 20% more likely to be hospitalised. According to a population-based study by The Lancet, that has not changed in decades. We should be ashamed that we are still talking about it today.

This is before we even start to consider the impact that covid has had on such vital services, which, as we would expect, has been significant. NHS England data shows that during the first wave of the pandemic the number of echocardiograms fell by around two thirds in April and May of last year, compared with February 2020, and it has since struggled to return to pre-pandemic levels. During the second wave, the number of people presenting to hospital with heart failure also fell dramatically—by some 41% from the beginning of October to mid-November.

We should be worried about that, because we know that late diagnosis has long-term implications for health and quality of life, but also because we do not know whether these missing patients have accessed care and support during this period or whether they have simply fallen through the cracks. Then there are the indirect effects on patients who are already in the system who face reduced access or delays because their care has struggled to meet what we would normally expect in a non-pandemic situation.

We know the reasons for that: staff had been redeployed; there is a need to maintain social distancing in clinical settings; there have been changes to the way services operate; and a significant amount of routine care and treatment for heart failure patients has been postponed, including routine appointments just to review their condition and their treatment or medication to ensure that they are able to live well. The backlog has come about for a number of reasons. We know that services across the board were already severely strained before covid-19 hit us. The shutdown of non-covid services, combined with drastic changes in patient behaviour, means the NHS is now facing a large backlog of non-covid-19 cases.

We also know that stricter infection control measures mean that, as we hopefully move out of the pandemic, there will still be a reduction in the number of patients able to go through hospital. That backlog could actually take longer to work through than we would otherwise expect it to. All this matters because we know that diagnosing people with heart failure earlier and getting them into the specialist care as soon as possible not only cuts emergency admissions, but relieves overall pressure on the NHS. It also improves the quality of those individuals’ lives, giving them the opportunity to live well for longer.

We are thankfully past the peak of the virus, we hope, although we know the pressure that the NHS is still under. We know the number of patients in England waiting over a year for routine hospital care is now 130 times higher than before the pandemic, and there are now 4.5 million people waiting for NHS treatment. This could take years to address, and of course, as we have discussed many times in the past few weeks, our healthcare workers are exhausted. They are struggling with the long-term consequences of giving care during the pandemic, with one in four doctors having sought mental health support during the pandemic. The staff survey that was released today gave some alarming statistics about how our NHS workforce are feeling at the moment.

It is vital that we come up with a realistic plan to tackle the backlog in non-covid care, which is something we have called for. I hope the Minister can set out how the NHS, and heart failure services in particular, will be able to recover from the pandemic, now that hospitalisations for covid are beginning to decrease. We know that the long-term plan already identifies cardiovascular disease as a clinical priority and commits to supporting people with heart failure better through improved rapid access to heart failure nurses, so that more patients with heart failure who are not on a cardiology ward will receive specialist care and advice. It is welcome that the Minister has confirmed that these are priorities from the number of written questions we have seen her answer recently.

We know that there are shortages across the NHS workforce. The 2018 audit of heart failure nurses showed that the biggest concern was the significant case load that they are having to manage, with demand on services increasing without further resources being provided. Can I ask the Minister to set out in her response what steps she will take to increase the number of heart failure nurses to meet this commitment? Could she also update us on the number of heart failure patients who actually have access to a specialist heart failure nurse?

The Minister will be aware that a report from the Public Accounts Committee in September was highly critical of the Government’s approach, finding that a long-term plan was not supported by a detailed workforce plan to ensure the numbers and types of nurses that are needed across the board. It also found that the removal of the NHS bursary in 2017 failed to see the increase in student numbers that we would have liked to see and that the Government had said would occur.

We are also still waiting for publication of the substantive long-term workforce plan, which we all want to see deliver a lasting solution to recruitment and retention in the workforce, ensuring that there are enough skilled staff to provide the care that we all want to see. Again, I would be grateful if the Minister updated us on when we might see that plan. The long-term plan also commits to greater access to echocardiography in primary care to improve early detection. Will the Minister update us on what steps have been taken to improve that access?

I will say a few words on data, which the hon. Member for Strangford mentioned. The only nationally available mandated dataset for heart failure is the heart failure audit, which collects data about hospital admissions, symptoms, demographics, access to diagnostics, specialist input, types of treatment, and mortality. Unfortunately, that data is not linked to primary community data, and local systems struggle to get their own data back out of the audit to inform their local decision making. We need a comprehensive dataset that is accessible and useable for clinicians in a timely manner. It should include the comprehensive demographic data that we need to understand inequalities in access to care and in outcomes, as well as an expanded range of data to include primary community care, allowing clinicians and system leaders to get hold of the analysis that I think we all want to have. Will the Minister tell us a little more about what is happening on the adequacy of data collection, and whether there are any plans to expand the collection of data across primary community care settings?

As we know, many medical research charities have made dramatic cuts to their research budgets because of fundraising shortfalls in the last year. The Minister will be aware that the medical research charities reacted with some disappointment to the comprehensive spending review, which committed to £14.6 billion in research funding, but failed to ring-fence any of that for medical research charities and did not provide any long-term assurances of funding for the sector. The British Heart Foundation, whose research all Members appreciate and rely on, has had to reduce its spending by half in the last year. Are there plans to support those medical research charities in meeting the shortfall that they will have to find after the last 12 months?

Oral Answers to Questions

Justin Madders Excerpts

Tuesday 23rd February 2021 Commons Chamber

[Mr Speaker]

Let us head up to Bolton, to Yasmin Qureshi. [Interruption.] No, we cannot, so we will go first to shadow Minister Justin Madders.

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

The Government’s road map yesterday said:

“While self-isolation is critically important to halting the spread of the disease, it is never easy for those affected.”

We agree with that. We have been making that point for months, along with most of the expert advisers in the Government, which is why creating a scheme that only one in eight people qualify for was never going to work. Will the Minister tell us why, despite yesterday’s announcement, it is still the case that only one in eight people who test positive will actually qualify for a self-isolation payment?

[Jo Churchill]

I thank the hon. Gentleman for his question. It is important that we have targeted support and that we support the people who need assistance, so that they can self-isolate. It is, exactly as I outlined in my first answer, what we have been doing, and as my right hon. Friend the Prime Minister said yesterday, we will continue to look after people through the pandemic. Our undertaking is to make sure that we protect people, whether they are self-isolating or unable to work for other reasons, such as shielding, throughout the duration of the pandemic. The hon. Gentleman will be hearing much more about that from the Chancellor next week during the Budget.

Covid-19

Justin Madders Excerpts

Monday 22nd February 2021 Commons Chamber

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

As we know, we are now a year into this pandemic. It has been a year unlike any we have experienced before, and it certainly was not the one we would have hoped for. The virus has turned the world as we know it upside down. We have seen the very best of many: our frontline health and social care workers who have selflessly looked after us, our key workers who have kept our vital services running and our country going, and our communities who have come together to support one another, especially those in need. But it has also been the very worst of times for many: families kept apart for months, individuals and businesses left with no support and, of course, the grim milestone of more than 120,000 deaths from coronavirus, which was reached this weekend. We know that each life lost is a tragedy that leaves behind devastated family and friends, and that death toll does need explaining. I will return to that issue later, but I would like to start on a more positive note.

As the Minister referred to in his opening remarks, more than 17.5 million people in the UK have received their first dose of the covid-19 vaccine. I echo his congratulations to everyone who has been involved in that roll-out. From the scientists to the NHS to the volunteers, it has been nothing short of brilliant, and it is something for us all to celebrate. While we are on the subject, we should also extend our congratulations to Mark Drakeford and the Welsh Government for becoming the first country in the UK to get through the first four priority groups.

I am sure that all of us have breathed a sigh of relief or even shed a tear when a parent or vulnerable family member or friend has received their first vaccine dose. Yesterday’s news that all adults in the UK will have been offered their first dose by the end of July is very positive indeed, but can more be done? When Simon Stevens says that the NHS could deliver double the number of vaccines it currently is, we will all be asking, why is that not happening? With research showing that some minority groups are well behind the general population in terms of take-up, another question that I am sure Members will want to raise about the roll-out is: what can the Government do to vaccinate more people in hard-to-reach communities?

I am sure that many Members will have been moved by the story of Jo Whiley and her sister, Frances. She has talked about the anxiety shared by many families across the country. We know that people with learning disabilities are much more likely to die from coronavirus than the general population, with the death rate in England up to six times higher during the first wave of the pandemic, but currently only people with severe learning disabilities have been prioritised for the vaccine. I am sure the Minister is aware that over the weekend, at least one clinical commissioning group announced that it will be offering the vaccine to all patients on the learning disability register as part of priority group 6. I would be grateful if the Minister updated us on whether there are any plans to consider that issue again.

I have one last question regarding the vaccine. We have asked a number of times for the Government to publish figures on how many health and social care staff have been vaccinated. The Secretary of State said last week that a third of social care staff had still not been vaccinated, so I hope that when the Minister responds to the debate, she will be able to update us on those figures and on what more we can do to improve take-up in that group. It is vital that we look after the people who look after us in social care and the NHS. Our NHS rightly deserves huge congratulations on its impressive and speedy vaccine roll-out, but despite its incredible efforts, it will still take many months before the vaccine offers us widespread protection. With the emergence of new variants, increasing pressures on our health service and continuing high rates of transmission, it is vital that Ministers do everything possible to ensure that frontline health and care workers, who are more exposed to the virus, are fully protected.

Healthcare staff deaths are now estimated to be approaching 1,000. That is tragic. We know that our frontline workers face higher risk. During the surge in cases last month, the British Medical Association reported that more than 46,000 hospital staff were off sick with covid-19 or self-isolating. A survey conducted by the Nursing Times during the last two weeks of January found that 94% of nurses who work shifts reported that they were short-staffed due to similar absences. We support calls from the BMA and the Royal College of Nursing to urgently review PPE guidance and increase stockpiles of high-grade PPE such as FFP3 masks for all frontline NHS employees. I hope the Minister can update us on what plans the Government have to ensure that health and social care staff are fully protected.

Finally, we need a plan for staff to address what comes next. Just as the nation needs a recovery plan, the NHS workforce needs one too. We must not forget that we entered this crisis with a record 100,000 vacancies in the NHS. What I hear from staff, who have now been working flat out for a year, is that they desperately need a break, and they need a tangible demonstration that their efforts are truly valued. The NHS rightly has a special place in the hearts of the people of this country, but without the staff, the NHS ceases to exist. That is why we need to recognise that we cannot keep dipping into that well of good will, and that at some point, NHS workers need cherishing as much as the institution itself.

I cannot mention PPE without briefly addressing last week’s High Court ruling that the Government had acted unlawfully by failing to publish details of covid-related contracts. Why has the Secretary of State not come to Parliament to explain himself? Is breaking the law such a common occurrence in Government nowadays that it does not warrant an explanation from those responsible? The Government’s approach to procurement during the pandemic has been marred by a toxic mix of misspending and cronyism. We all understand that the Department was and is dealing with many pressing issues, but transparency is important, and accountability matters. Of course, we need to remember why there was such a rush to get PPE in the first place—it was because the Government had ignored the warnings and allowed stockpiles to run down. The pandemic has been used too often as an excuse for standards to slip, but it really should not need saying that transparency goes hand in hand with good government.

Another area where we need greater transparency is the Government’s general response to the pandemic to date. With the highest number of deaths in Europe, those in power now need to answer why that has been the case, because such a grim death toll was not inevitable. If it is the right time to undergo an expensive and disruptive reorganisation of the NHS, it is also the right time to have the inquiry into covid that the Prime Minister promised more than six months ago. The families of the deceased deserve answers, and we all need to know that lessons have been learned and that the same mistakes will not be made again. If we look at what has happened so far, we can see that there has been a tragic failure to learn the right lessons. That is why what we have heard from the Prime Minister today matters, because we are not out of the woods yet. Infection rates, though they are reducing, remain high; there are more people in hospital now than there were at the start of the second lockdown; and there are still more than 1,000 people being admitted to hospital every single day. So, what we do next, when we do it and how we do it remains critical.

The Opposition have been clear all along about the importance of following the science. We know where not following the science takes us: it leads to the worst death rate and the deepest recession in Europe. It leads to the farce of the Prime Minister refusing to cancel Christmas plans, only to U-turn three days later, and it leads to the shambles of children returning to school for one day, only to find it closed the next. We know that the virus thrives on delay and dither. As we approach a year of life under restrictions, any ambiguity over when, where, why and how the restrictions will be eased in the coming weeks and months is just as big a threat as the virus itself.

Before I conclude, I just want to say a bit about test and trace. We did not hear anything new from the Prime Minister on that today, but it nevertheless remains a vital part of the pandemic response. We need to remind ourselves that the number of new cases is still above 10,000 each day, and that every day thousands more people are required to self-isolate. For this lockdown truly to be the last, we need to continue to cut transmission chains and the spread of the virus, so this continuing blind spot when it comes to supporting people to self-isolate is as baffling as it is wrong.

When we first came out of lockdown, the scientific advice repeatedly stated that the easing of restrictions would work only if there was a fully functioning test and trace system in place. That was true last year and it is still true today. We still do not have all test results back within 24 hours, as the Prime Minister promised would happen last June, but perhaps most important are the continued low compliance rates with self-isolation. The Government have known for many months that the lack of financial support to those self-isolating has resulted in extremely low adherence rates. Surveys between March and August last year found that only 11% of people in the UK notified as having been in recent close contact with a confirmed case did not leave their home. That figure has improved a little recently, but it is still well below where it needs to be.

Around a quarter of employers will only pay statutory sick pay for such an absence. The Secretary of State has previously said that he could not survive on statutory sick pay, so we should not be surprised when others cannot do so either. We also know that seven in 10 applicants are not receiving self-isolation payments from councils, with one in four councils rejecting 90% of applications. They are rejecting them not because there is no need but because the rules have been so tightly drawn that seven out of eight people do not qualify for a payment under Government rules. When Dido Harding herself says that people are not self-isolating because they find it very difficult, a huge question needs to be answered about why the Government have still not acted to rectify this.

Last month, the Government announced more cash for councils for self-isolation payments, but that was to last until the end of March, and actually the amount handed out was the equivalent to one day’s-worth of people testing positive. That is clearly not enough, and what about after March? We need confirmation of how much support will continue to enable people to self-isolate after that date. Following reports in The Independent late last week that some people working for the NHS through private contractors, such as cleaners, porters and kitchen staff, were being denied full sick pay for covid-related absences because of the removal of supply relief, we need a commitment that this will be investigated urgently and that the direction of travel will be reversed so that everyone in the NHS is properly supported. The Government should be setting an example here, not leading a race to the bottom. On wider financial support, where is the road map for businesses that will still be operating under restrictions for many months to come? We know that the Budget is next week, but they need clarity and support now.

In conclusion, what the Prime Minister announced today has to be the last time the word “lockdown” passes his lips. There must be no more false dawns and no more boom and bust. With this road map, relaxations should now be clear and notified to the affected parties in advance, but also approved by this place in advance. There should be no more muddle between guidance and laws; no more regulations published minutes before they become law; no more businesses having to throw away thousands of pounds-worth of stock because decisions are reversed at a moment’s notice; no more of the stop-go cycle; and no more hopeless optimism followed by a hasty retreat. This time really has to be the last time. The vaccine has given us hope. It has given us a route out of this. With a year’s experience of the virus and with multiple vaccines on the way, there can be no excuse for failure this time. The Prime Minister has said that he wants the road map to be a one-way ticket. I hope he is right. We all want him to be right, but if he gets it wrong, he should expect nothing less than a one-way ticket to the jobcentre.

HEALTH PROTECTION (CORONAVIRUS, RESTRICTIONS) (ALL TIERS) (ENGLAND) (AMENDMENT) REGULATIONS 2021 HEALTH PROTECTION (CORONAVIRUS, RESTRICTIONS) (ALL TIERS AND SELF-ISOLATION) (ENGLAND) (AMENDMENT) REGULATIONS 2021

Justin Madders Excerpts

Monday 8th February 2021 General Committees

[The Chair]

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

[Mr Harper]

--- Later in debate ---

[Ms Dorries]

[Justin Madders]

[Ms Dorries]

--- Later in debate ---

[Ms Dorries]

[Justin Madders]

[Ms Dorries]

[Justin Madders]

[Ms Dorries]

[Ms Dorries]

[Justin Madders]

[Ms Dorries]

HEALTH PROTECTION (CORONAVIRUS, RESTRICTIONS) (ALL TIERS) (ENGLAND) (AMENDMENT) REGULATIONS 2021 HEALTH PROTECTION (CORONAVIRUS, RESTRICTIONS) (ALL TIERS AND SELF-ISOLATION) (ENGLAND) (AMENDMENT) REGULATIONS 2021

Justin Madders Excerpts

Monday 8th February 2021 General Committees

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

It is a pleasure to serve under your chairmanship, Sir David. No room is gloomy when you are in it.

I thank the Minister for her introduction, and I pay tribute to our NHS and social care staff, and indeed all key workers, who have done so much, and continue to do so much, to fight through this incredibly difficult period for our nation. As we know, we have sadly passed the tragic milestone of 100,000 people having died from covid-19. As of yesterday, 111,634 people have died, over a third of them since the start of this year. Those truly shocking figures show us how far we still have to go in this fight. We have the highest number of covid deaths in Europe, and every step should be taken to fight the virus.

We are here to discuss two sets of regulations, as the Minister set out. The first set came into force several weeks ago on 20 January. As we heard from the Minister, they make minor amendments and corrections to the all tiers regulations to clarify that the exemption to leave home to collect goods from businesses operating click and collect also applies to libraries; that elite sports competitions are permitted; that cafés and canteens in all post-16 education and training settings can remain open; and that marriages and conversions under the Marriage (Same Sex Couples) Act 2013 are permitted.

The Opposition do not oppose these regulations, but I have some observations and questions for the Minister. As I have said many times, we are once again retrospectively approving legislation, particularly regulations that have a dramatic impact on individuals’ liberty, as well as an economic impact. We have discussed these issues many times. These regulations should not be approved after the event, and I thought that there had been a commitment given that regulations of national significance would be debated in advance. Although it could be argued that the first set of regulations, which primarily make corrections, is not within the ambit of that promise, the second set of regulations certainly is, so will the Minister set out why that commitment has not been honoured on this occasion?

The first set of regulations deals with errors and oversights from earlier regulations. This is not the first time that we have had to address this. Of course, we are in a rapidly evolving situation, but we are on the third lockdown, so one would expect enough experience to have been gathered for there not to be a need to come back and make such corrections. The instrument states that it

“is being issued free of charge to all known recipients of those Regulations.”

Will the Minister tell us how many organisations that is, and what the cost of this error is to the taxpayer? What is the legal position of people who were fined for attending the premises concerned before the regulations came into force? Does the Minister know whether anyone has been erroneously fined as a result of the drafting error? And what about the businesses that have been affected? Have any indicated that they have lost profit or income for that period when they were erroneously told they could not operate? Mistakes have consequences, and there have been too many. A proper explanation ought to be forthcoming about why we are having to deal with these things after the event. They should not be dealt with in this way when people’s lives and livelihoods are involved.

I will move on to the second set of regulations that came into effect on 29 January. They concern self-isolation requirements and, as we have heard, gatherings of more than 15 people in a private dwelling, in educational accommodation, or at an indoor rave. I thank the Minister for Care for writing to me regarding this instrument to outline what the amendments primarily concern, particularly in terms of the enforcement of offences and allowing police to receive additional information, as the Minister said, so that they can verify those individuals who are under a legal duty to self-isolate.

The right hon. Member for Forest of Dean (Mr Harper) made an interesting point about whether the regulation covers those who have been advised by an individual in their household that they have a duty to self-isolate. That has had a dramatic impact on the performance figures for Test and Trace, but it raises a series of difficult questions about enforcement. I hope the Minister can clarify whether those notified outside the system, so to speak, are also covered by the regulations. I suspect that they will not be, and I think the issue of how a person is notified will cause all sorts of evidential difficulties, particularly if they are not in a household that is a family unit. It would certainly make for awkward dinner conversations if such issues arose.

In her letter to me, the Minister for Care stated that

“sharing this additional information is both necessary and proportionate in order to give the police the information they need to effectively enforce the law.”

That may well be the case, but it begs the question why, a year into this pandemic, that has only just been acted on.

As we have heard, the statutory instrument increases the fixed penalty notice for those caught attending illegal gatherings, such as house parties, of more than 15 people. Unlike the fines for gatherings of more than 30, this fine applies to both organisers and attendees, although one assumes that attendees and organisers of gatherings of more than 30 would be covered, given that that is more than 15. I would be grateful if the Minister could confirm that.

Considering the fines first, it is fair to say that the announcement was met with a little bit of scepticism. Most of the debate that I saw was about why gatherings of 14 would not attract fines. I do not know if this is an unintended boost for unauthorised seven-a-side football matches, but it looks like 15 has been chosen arbitrarily. I am not sure that was the message the Government were hoping to send. Of course, the most important thing is the message that people should stay at home and not organise gatherings of any nature. That message on compliance is absolutely critical to our getting through this.

However, in order for that message to be most effective, we need to hear very clearly why 15 is the magic number. When the policy was announced, the Home Secretary said, “The science is clear”, but is it? There is clear scientific evidence on the impact of indoor gatherings on transmission, but not having seen the scientific modelling for this particular set of regulations, I would be grateful if the Minister could explain why the regulations set the number of people at 15. We had similar debates over why the rule of six was six and whether children were included. Will the Minister advise whether children are included within the 15? However, what we really want to know is why it is 15.

We also want to know why this is so urgent. Surely the time to have looked at this would have been over the Christmas and new year period, when one would have naturally expected there to have been a greater risk of large gatherings taking place. I hope I am not being overly cynical when I say it appears to me that the regulations seem to have been introduced in response to that period of the year and the number of illegal gatherings that took place, rather than being part of a strategic approach to the issue.

The timing is interesting, because the statutory instrument was laid before Parliament at 11 am on 29 January 2021 and then came into force at 5 pm—the same day. Why was it rushed so quickly on the same day? Was there a specific reason why it needed to be introduced on 29 January? There have been many instances of regulations being published and then introduced at incredibly short notice, and while there have been occasions when that could be justified, I simply do not see why such speed and such disregard for parliamentary scrutiny were necessary on this occasion. The Minister referred to the critical situation that we were in in January, with the number of infections and hospitalisations, but by 29 January we were clearly on a downward trend. Anything the Minister could say to clarify why this had to be rushed through on 29 January would be appreciated.

We agree with Martin Hewitt, chair of the National Police Chiefs’ Council, that increased fines will act as a disincentive for people thinking of attending or organising such events. Was there specific intelligence about 29 January? Was there something on that date to suggest that groups of 15 people or more would gather more? I hope that the response justifies the need for speed on this occasion.

I will now turn to the sharing of data, on which I have several questions. We all know that the self-isolation regulations impose certain requirements on individuals to self-isolate. As the Minister outlined, the statutory instrument amends the information that needs to be disclosed. Of course we can see why sharing that information might be helpful, particularly for the police in verifying an individual and helping to carry out self-isolation enforcement, but I have a few questions. Lord Bethell, a Health Minister, said that the police are accessing

“isolation information, not health information.”—[Official Report, House of Lords, 20 October 2020; Vol. 806, c. 1418.]

There is concern that that is not the case, because whether an individual is required to self-isolate is, to all intents and purposes, health information. I hope the Minister can see that a rather fine distinction is being made. I draw attention to that because health data is highly sensitive and therefore falls under a special category of data under the general data protection regulation rules. Concerns have been raised about that. Given that medical privacy is the bedrock of a functioning public health system, its disclosure should be subject to full parliamentary scrutiny before it is enacted.

There are also concerns that the broad definition of who the information can be shared with means that it can be provided not only to the police, but to anyone else the Government enlist to uphold the rules. We do not have any particular concerns about public health officials, but we need clarity about who can receive this information and who is entitled to see it under the regulations. It could be the covid marshals we used to talk about a lot but do not hear so much about anymore. If the Minister can advise us who exactly is entitled to receive this information, that would be helpful.

There are also concerns about whether the police are permitted to use this information for the purposes of these regulations. Some people have expressed concerns that it could be used for other investigations that they are conducting. I have had the benefit of visiting my local police station, as I am sure many Members have, and seeing how access to personal information has been used to aid their investigations, but the police have done that with very clear safeguards in place. In order to ensure confidence in the uptake of the test and trace system, it is important that we have confirmation that that information will be used only for the purposes of these regulations.

I turn briefly to the app. Can the Minister advise us whether those notified by the app to self-isolate will be covered by these regulations? They were not covered by the original self-isolation regulations, which in my opinion was a huge oversight. If that has not been rectified, why not?

How will the police powers that have been provided under these regulations be resourced? Last month, John Apter, chairman of the Police Federation of England and Wales, said that some forces in England have as many as 15% of staff off. Since these regulations came into force at the end of last month, we have heard that the police will be expected to play a role in the enforcement of hotel quarantine. Our police officers have worked incredibly hard throughout this pandemic, and they face very difficult circumstances. Can we have some assurances from the Minister that they will be adequately resourced to take on the additional responsibilities that they have been given?

On the subject of public confidence, there is concern about the lack of transparency over the memorandum of understanding between the police and the Department. In a Delegated Legislation Committee on 19 October 2020, the right hon. Member for Forest of Dean asked the Minister for Care about the memorandum of understanding, and she said:

“It has not been yet, but it will be.”—[Official Report, Fourth Delegated Legislation Committee, 19 October 2020; c. 25.]

Hon. Members can see a clearer response from the Minister for Care in Hansard, but we still have not seen that memorandum of understanding. I understand that a freedom of information request for sight of the memorandum was refused on 15 December, on the basis that it was intended for future publication. I ask the Minister what is going on here. Can she confirm when exactly we will see the memorandum? Why has there been a delay in its publication? Can she also confirm whether these regulations have led to a new memorandum of understanding and whether that will be available for public scrutiny?

At the heart of this is a question of public trust. We need assurances that sensitive health data will be kept private. Many people could be unwilling to take a coronavirus test or engage with the Department’s contact tracers, particularly if there is a threat of harsh punishment, if they are not given those assurances. Many public figures have raised concerns along those lines. The British Medical Association says it is concerned that some people are deterred from being tested because they are anxious about a loss of income should they need to self-isolate, and it is worried that police involvement will add to that.

Professor Chris Whitty has also expressed concerns. Professor Susan Michie, the Scientific Advisory Group for Emergencies’ behavioural science adviser, has said that the move could cause further distrust in the Government, which is a massive problem for adherence to the regulations. Those are serious concerns from very respected people. Can the Minister give us an assurance that the data-sharing arrangements will not deter people from giving information to contact tracers or, indeed, giving their own information? These are all essential to combatting the spread of the virus.

We know that compliance rates for self-isolation are already low, so everything must be done to ensure that the message and the practical help is there, to encourage as many people to self-isolate when they are required to do so. We want to get as high a compliance rate as possible. Anything the Minister can say to address those concerns would be appreciated.

There are practical steps that the Department can take too. The Government have known for many months that rates of self-isolation remain too low and there is a gaping hole in the system, because not everyone can work at home or comfortably isolate themselves. The system still expects families to go hungry to stop spreading the infection. We have seen the serious side effects of this at the weekend, with evidence that the rates at which cases of covid-19 have fallen since the start of the year are dramatically lower in some of the UK’s poorest regions when compared with wealthier areas.

Figures show that the number of cases of covid-19 infections per 100,000 people remained markedly higher in the last full week of January in many poorer parliamentary constituencies than in more affluent ones. For example, in Preston, infection rates fell by just 9% in January, and in Bradford they fell by just 14%, but in more affluent areas, such as Oxford West and Abingdon, and Saffron Walden, cases declined by 72%. Does the Minister agree that these stark differences demonstrate the serious consequences of the failure to offer financial support to help people on lower incomes with the self-isolation requirements?

The Government have been too slow to address this. Even Baroness Harding recognised last week that there was a big flaw in the Government’s approach to self-isolation support. She said that 20,000 people a day were not self-isolating when they should be. That is simply an unsustainable figure, if we are ever going to see some of the relaxations of current measures that we all wish to see.

On self-isolation, these regulations deal with the stick, but they do not address the deficiencies in the carrot. I again urge the Government to fix the payments regime so that it does not act as a disincentive to people who want to do the right thing and self-isolate. We have said this many times before, but I will make no apology for saying it again: the £500 test and trace support payment is not reaching enough people. Seven out of eight people do not qualify for it. Rejection rates in councils are over 70%. At the time it was announced, the amount given by the Government to councils to continue the fund for a further two months would only have been enough to cover everyone who tested positive on one day. That is not good enough.

In conclusion, we are in our third lockdown. This is extremely difficult. The British people have done their part, staying at home and helping to keep the virus under control. But it is incumbent on the Government to do the right thing by them as well, by ensuring that support for self-isolation and for test and trace genuinely supports people, as well as by dealing with those who do not comply.

--- Later in debate ---

[Ms Dorries]

That was a large number of questions covering a number of points. I know that officials are furiously trying to group them at the moment. I will do my best to answer them as well as I can. If there are any that I do not answer, I give the hon. Member for Ellesmere Port and Neston and my right hon. Friend the Member for Forest of Dean absolute assurance that they will be written to quickly with more detailed answers.

The first point raised by the hon. Gentleman was about why the regulations have come in after the event. Public health underpins what we are doing today. My right hon. Friend’s last question was about this being a public health initiative, and not a stick or a means of taking away people’s freedoms for the sake of it. That is absolutely not what the regulations are about; they are very much a response to the South African variant. We need to do what we can to ensure that people self-isolate when they are supposed to, that they are deterred from gathering in groups and that we do as much as we possibly can, using the instrument of the law, to protect the health of the nation.

Coronavirus is a brand-new virus, and we knew nothing of its biology or pathology when it landed on our shores this time last year. One thing that I have learned since then as a Health Minister is that when the virus mutates—there have so far been more than 10,000 mutations—the figures go in only one direction when they start to rise. They do not rise to small numbers and then suddenly drop off and disappear without very restrictive action, such as that taken in China and other countries where there is a much stronger social contract with the population.

We move very quickly, but the virus moves faster. It would be wrong of us, as a Government, to see a variant such as the South African one and not look at what further public health measures we can put in place now to protect the health of the nation and stop the variant rising.

[Justin Madders]

I am grateful for the Minister’s answer. I only wish that such action had been extended to quarantining international arrivals for the South African variant. Does that explanation also apply to the question of gatherings? Does anything about that variant apply to large gatherings and explain why the regulations were brought in as they were?

--- Later in debate ---

[Ms Dorries]

Our police are very responsible individuals. If they receive a report that somebody is believed to be breaking regulations, or breaking isolation, they will not automatically ask Test and Trace for the individual’s information before they have carried out an assessment of the situation. They would need to clarify for themselves whether a breach was actually taking place, such as a breach of the numbers—for example, if it was not a single-household individual mixing within their bubble. They would have to assess the situation and see if the regulations were being broken. If they were being broken, the police would have the right to revert to Test and Trace to ask for clarification on the individual’s details.

Both my right hon. Friend and the hon. Gentleman are pursuing a definition—as my right hon. Friend knows well—in legal terms within the legislation. I will need to seek legal clarification and write to both of them with the details on that point.

[Justin Madders]

I appreciate the Minister’s valiant efforts to explain how this all works in practice. I think that the answer, as the right hon. Member for Forest of Dean said, is to publish the memorandum of understanding. That is the way that we will all gain clarity on how this all works—I hope.

I will just go back to what the Minister’s colleague, the Minister for Care, said on 19 October last year. When asked if the memorandum of understanding would be published, she said, “It will be.” The Minister seemed to be backtracking a little from that tonight. Can she confirm whether we will actually get sight of it?

[Ms Dorries]

I am aware that it exists as a working understanding, as I said, between DHSC and policing. Obviously I will consider both points about transparency and take them both on board. However, I need to seek further clarification—if, why, legally, and how?—around the memorandum of understanding. The hon. Gentleman’s points have been well made today and have been noted. I will take the process further and explore the options, then get back to him with an answer.

[Justin Madders]

I am sorry to press the point, but one of the Minister’s colleagues said on the record that it will be published and she is now saying that that is not, or might not be, the case. That is not acceptable. We must have things said by Ministers on the record adhered to.

[Ms Dorries]

I completely agree. I have just been informed, in the form of our old notes, that the memorandum of understanding is currently being updated to reflect feedback from the Information Commissioner’s Office and the recent changes made by this SI.

--- Later in debate ---

[Justin Madders]

I am grateful for the Minister’s explanation. It seems that, as we would expect, this decision is based on scientific advice. Would the Minister be able to publish that, so that we can see it in full?

[Ms Dorries]

I am sure that the hon. Gentleman’s request has been listened to—he knows that publishing the advice from SAGE is above my pay grade.

As I said, fixed penalty notices for those caught attending illegal gatherings, such as house parties, of more than 15 people will double for each successive offence, up to a maximum of £6,400. These amendments to the all tiers and self-isolation regulations will provide the police with the enhanced powers that they need to tackle egregious breaches of the law.

Unfortunately, covid-19 has forced us to balance the increasing social contact restrictions with the protection of public health. These decisions are not easy ones to make, but with alarming epidemiological evidence suggesting that the new variant is much more transmissible, urgent action has become appropriate. We will continue to work alongside scientific and medical experts to ensure we have decision making appropriate to the circumstance at each stage of this crisis, and we will review the regulations regularly, assessing them in the light of the latest science and other data. I commend the regulations to the Committee.

Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) (No. 4) Regulations 2020

Justin Madders Excerpts

Monday 25th January 2021 General Committees

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

It is a pleasure to serve under your chairmanship, Mr Pritchard —for, I think, the first time, as the Minister said. I declare an interest, in that my wife is a member of Cheshire West and Chester Council, one of the local authorities mentioned in the regulations; I do not think that requires any further expansion, but it needs to be stated for the record.

I thank the Minister for his introduction, and his acknowledgment of the issue to do with the timing of these regulations—a matter that we have debated on many occasions over the past 12 months. I echo his tribute to NHS and social care staff, and indeed all key workers, who continue to do this country proud and see us through this incredibly difficult time.

As we debate these regulations, we must recognise the scale of the challenge we still face. The situation is as serious as it has ever been. We have lost 98,000 people so far to the virus; as we know, the Office for National Statistics shows more than 110,000 excess deaths; and as of yesterday, there were 38,000 people in hospital, some 4,000 of them on ventilation. Those figures are significantly higher than those in the height of the first wave of the pandemic. The climbing, record death rate is a tragic reminder of how devastating the virus is, and behind every statistic is a grieving family. We must therefore leave no stone unturned in our efforts to prevent further loss.

We have come together to discuss these regulations, following their introduction on 30 December, even though, as the Minister says, they have largely been superseded by the national lockdown. As I have said many times, retrospectively approving legislation—in particular, regulations that have a dramatic impact on individual liberty, as well as an economic impact, which we have discussed many times—is no way to go about things.

I will not labour the point, because it has been made many times, but it is worth noting that on the day these regulations were introduced, the House was already debating a number of previous instruments, most of which were also significantly out of date. I know this is a rapidly changing situation, and in December things perhaps changed more quickly than at most other times, but is there any particular reason why these regulations could not have been dealt with at the same time as those others debated on 30 December?

As we heard, today’s instrument amends the “All Tiers” regulations for the fourth time—quite a record, given the latest tier system was in place for one month. Even though we are again in lockdown, as the Minister has said, we will be moving back to a tiered system as restrictions are eased, so it is important that we review the effectiveness of the tiered system when looking at this instrument. Given that the past two attempts at a tiered system ended in lockdowns within a matter of weeks, we need to be confident, and to hear from the Minister about his confidence, that the situation will not repeat itself.

Although whether the tiers proved effective is of fundamental concern, there is little evidence to date to suggest that, on the whole, most of them were working. Another problem with the regulations, and all the regulations that we have dealt with on this matter, is that we are presented with a list of places, which tells us who can do what and where they can do it, but does not tell us why. Of course, at a macro level, we know why, but what we are missing is why one area is in one tier and another area is in another.

We know what the Secretary of State told us about the criteria, which the Minister repeated today, and they are set out in the explanatory memorandum, but they have never been explicitly spelled out in the regulations. Nor, crucially, is there any detail on the point at which those criteria take us from one tier to another. No doubt the Minister will say that it is not as black and white as that, and I am sure that there is some merit in that answer, but there has to be some yardstick and some analysis of the data that matters; otherwise, the process would be entirely random, which it clearly is not.

Although most of that information is publicly available, it is disparate and often not released at the same time. What would make debates such as today’s rather more meaningful is if there were full disclosure of all the information at the time the decisions were made, and the debates took place at the time of those decisions, so that Members on both sides of the room could say to their constituents that there was clarity, and could say that the reason why one area was in one tier and another was in another was debated when the regulations were introduced.

That is particularly relevant to today’s regulations, as it seems that the primary reason for areas moving up tiers this time probably relates to only one of the criteria: NHS occupancy and projected occupancy. That is apparent to us all now, given the figures that we have alluded to, but it probably was not as clear to everyone at the time the regulations were introduced. Moving forward, I ask the Government to, as far as possible, set out in the regulations the data applicable to each area, so that we can objectively judge, when the regulations are introduced and debated, whether the Government have got it right. I think that is what all Members want.

I understand that the measures are presented on a “take it or leave it” basis, and that sometimes events mean that scrutiny lags behind the original decisions, but that should be a reason for more transparency and more debate—not for simply providing us with a list of councils that are moving tiers. The regulations are all concerned with moving areas up to higher tiers, rather than down, albeit for a matter of days before the next lockdown came in. We therefore need to ask, irrespective of whether there is a new variant, whether the tiers have ever been, or will be, effective.

We have asked time and again for the Government to provide us with evidence of what measures work. Some areas have been in a form of lockdown since last summer, as the Minister is well aware from his constituency. There has been plenty of time to gather data on the subject, even if it is to conclude that local restrictions are insufficient. As the Minister will know, last year the Secondary Legislation Scrutiny Committee also highlighted a need for that information to be public, reminding the Government that it is customary, when a scheme is changed after it has been operating for a while, to explain what has worked well and what has been amended because the performance has not always achieved the desired effect.

The Liverpool city region is often cited as an example of an area in the then highest tier—tier 3—where there was a successful attempt to reduce transmission. That was largely attributed to the mass testing regime undertaken there, but infection levels were dropping before that scheme was introduced, and it relied on significant input from the Army that I do not think it would be physically possible to replicate elsewhere. Is that the plan, moving forward, for the highest tiers? We need realistic and resourced plans for such areas because, the tier system having effectively collapsed over Christmas and the new year, people need confidence that any new tier system will work, and that infection rates will not spiral out of control again.

I am sure that the Minister agrees that this lockdown needs to be the last. The Government need to demonstrate that they finally have a grip on localised restrictions that not only enables areas to reduce transmission, but gives areas with low transmission rates the tools to keep them low. To date, that has palpably not been the case. We will not oppose today’s regulations, but we need assurances that when we return to another system of tiers once we exit the national lockdown, they will finally work. We must see, in real time and in full, the advice that the Secretary of State and the Government receive from the Scientific Advisory Group for Emergencies on the restrictions needed before we are asked to make judgments on those decisions.

Thus far, we have seen a tragic failure by the Government to learn from mistakes. That must now change. We must not repeat that with the roll-out of the vaccine. It is widely acknowledged that that is our only way out of this situation. The task is clear. The Government must deliver the vaccine quickly and as safely as possible. We want to see round-the-clock vaccine programmes, 24 hours a day, seven days a week, in every village, town, high street, GP surgery and pharmacy—everywhere possible that we can use to roll out the vaccine.

That goes hand in hand with measures to supress the virus. Not everyone can work at home or comfortably isolate themselves. The system still expects families to go hungry to stop spreading the infection. Again, I urge the Government to fix sick pay and ensure everyone is supported to self-isolate. The Health Secretary, as was mentioned many times, has admitted that he could not live on statutory sick pay, but that is what we still expect hundreds of thousands of people to do each week.

The Government have known for many months that rates of self-isolation compliance are low. That is the gaping hole in the system. I was disappointed that rumours at the end of last week that the Government were due to extend the scope of the £500 self-isolation payment were just that: rumours. I urge the Government to consider extending the payment to all low-income parents self-isolating with children, and to ensure that councils can give discretionary payments to all who need them. When even Baroness Harding recognises that this is a big flaw in the Government’s approach, we need to act.

We know how difficult this lockdown is for millions of families. We are being asked to stay at home for a third time, to help get the virus under control. In return, the Government must not only deliver the vaccine, but ensure that people can self-isolate when required to. The decisions made will be significantly influenced by how quickly people can be vaccinated. Of course, we want roll-out to proceed as soon as possible. Being the first country to approve the vaccine, we should be the first country to roll it out successfully.

I hope that in his closing remarks, the Minister will update us on how the Government plan to reach those communities that are hard to reach. We know that the crisis has had a disproportionate impact on black, Asian and ethnic minority communities, so it is important that the vaccine roll-out does not leave those communities behind. We need to understand how the roll-out relates to the implementation and continuation of the tier system. The Secretary of State has said of easing lockdown measures that there will need to be no more major new variants of covid-19, that hospitalisations must fall, that the daily death rates must fall, and that the vaccination programme should work.

On new variants, the need to secure our borders is clear. I suspect decisions of that nature are above the Minister’s pay grade, though maybe not for long; who knows? Perhaps one day. I hope he will convey our concerns about the daily scenes at our airports, and about the clear need for more robust systems. Lockdown, with the incredible sacrifice that it involves, is a decision that I know weighs heavily on every Member, but to ask our citizens to submit to that while, because of holes in our defences, people enter the country and potentially spread new, dangerous variants is unforgivable. That must be addressed as a matter of urgency.

Two of the criteria are the same as those in the tier system. I want to raise a few points about the vaccination process and how that will relate to the tier system. It seems, as a matter of logic, that if these criteria apply to the lockdown, they will also apply to the tier system. This is the one thing that the Government can control and direct, so it is important that we have transparency about how this will happen

We know how many people daily, by region, receive their first and second dose of vaccine. Those figures are now further broken down to those for each sustainability and transformation partnership footprint, but that does not give us the data that we need to identify whether progress is even, or how that will impact tier systems. For example, the latest data, up to 17 January 2021, tells us that 114,000 people over 80 have received the first dose of the vaccine in Cumbria and the north-east. That is undoubtedly good news, but we do not know the proportion of over-80s, or how those people are spread across the region. Are some parts of the region doing better than others?

I hope the Minister accepts that the public are getting only a partial picture. Moving forward, as we look to adjust the tiers, I suggest that that information needs to be disseminated at local authority level, consistent with the tiers contained within these regulations. For example, Cumbria County Council is described in the regulations as being in the north-west, but in terms of the vaccination process it is in the north-east. We also need to know what percentage of each vulnerable category has been vaccinated and, crucially, how much vaccine has been supplied to each local authority area, ideally expressed as a proportion of the total vulnerable categories.

To date, despite questioning on the subject, we have no specific information about how much vaccine has been supplied to each area. We are only getting information about when it has reached the arm of the patient. That is the most important data, but if one of the criteria used to allocate tiers is progress with the roll-out, we will need to know if there is equity in supply as well. I am sure the Minister will not want to end up in arguments about whether tiers are being decided on the basis of whether the vaccine has been fairly distributed. In the spirit of being helpful, I suggest to him that the best way to avoid getting into those arguments is through total transparency on the numbers and proportions distributed to each area.

Finally, there has been a lot of debate today about schools and the continuing uncertainty about when they may be able to reopen. I am sure we all share the same aim and we want them fully reopened as soon as possible. That begs the question about the possibility that education settings could be treated differently, depending on which tier they are in. Is that being looked at on an area by area basis? There was a spike in September when schools and universities returned. Can that be better contained by more localised decision making in the new tier system?

In conclusion, we believe that there is an awful lot more to be done to demonstrate that tiers are effective, that areas are placed in tiers on a transparent basis, that areas are given sufficient support to reduce transmission of the virus or to prevent it from increasing, and that there is sufficient support for business, recognising that each tier brings with it a different set of challenges, both trading within the tier or having to close the business altogether.

--- Later in debate ---

[Justin Madders]

I pay tribute to all those involved in the vaccine roll-out. I had the pleasure of visiting my local centre a couple of weeks ago, and it was very well organised. I was trying to gain some understanding from the Minister about whether the vaccine roll-out will be applied to tier decisions, or whether the national picture will be part of the decision. I do not expect him to say, “This number of people receiving a dose is going to mean x, y or z relaxations,” but will that be considered at national or local level?

[Edward Argar]

I am grateful to the shadow Minister for his clarification. If I am being honest, I think it is probably premature at this point for us to speculate about things at that level of detail, but he makes his point well and it is on the record. I will relay it to the Secretary of State as we look at when the time is right for us to start easing the national regulations and potentially move towards a tiering model again. At that point, those sorts of question are of course pertinent, and I will ensure that the Secretary of State is aware of the hon. Gentleman’s comments.

The hon. Gentleman’s final point was, in the context of vaccines, infection rates and hospital pressure, about the need for information to be as local and granular as we can get it. Vaccinations started in earnest in early to mid-December, and we have ramped up at a huge rate the number of people being vaccinated each day. In parallel with that, we have continued to try to increase the amount and granularity of information that we publish on gov.uk and on the dashboard about vaccinations by region, area and volume. In parallel with actually getting the vaccine in people’s arms, the team continues to look at what more they can do to be as transparent as possible about how that is going, so that people in a local area can understand a bit more about what it means for them.

I hope I have addressed if not all then as many as I can recall of the hon. Gentleman’s questions and points. I commend the regulations to the Committee.

Question put and agreed to.

Resolved,

That the Committee has considered the Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) (No. 4) Regulations 2020 (S.I. 2020, No. 1654).

Oral Answers to Questions

Justin Madders Excerpts

Tuesday 12th January 2021 Commons Chamber

[Helen Whately]

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

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

We can have all the testing in the world, but it will not be effective if people do not self-isolate after a positive result. We have repeatedly said that compliance with self-isolation rules is not good enough; with only one in eight people qualifying for the self-isolation payment, that is not surprising. Can the Minister ensure that everyone is properly supported to self-isolate from now on and explain why those who test positive after a lateral flow test cannot apply for a payment and do not even enter the national test and trace system?

[Helen Whately]

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

Covid-19

Justin Madders Excerpts

Tuesday 12th January 2021 Commons Chamber

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

We have had another well-subscribed debate, and Members’ contributions have been short as a result but no less effective for it. On the Opposition Benches, we have heard from my hon. Friend the Member for Leeds East (Richard Burgon), who expressed concern that the current lockdown rules are inadequate and that the Government’s response is to blame the public for non-compliance. My hon. Friend the Member for Birkenhead (Mick Whitley) talked about the heroes who have kept this country going, and I join him in paying tribute to them. He said that they are the “very best of humanity” but are often among the lowest paid.

My hon. Friend the Member for West Ham (Ms Brown) gave a typically passionate speech. She described NHS staff as exhausted, stressed and traumatised, and she asked the right question: if the Nightingales are reopening, how can they be staffed when NHS staff are already at breaking point? She was outraged, as many of us are, at the paltry offering that our nation’s children have been told is enough to feed them for a week. My hon. Friend the Member for Newport East (Jessica Morden) paid tribute to the work of the Welsh Assembly and made the fair point that, when it has made decisions to lock down, financial support from Westminster has not always followed automatically.

My hon. Friend the Member for Hornsey and Wood Green (Catherine West) expressed regret that the Government did not formally review their actions after the first wave, because if they had, mistakes might not have been repeated. My hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy) was, as always, a powerful advocate for her city, and she spoke about how businesses and individuals have suffered during the last year. My hon. Friends the Members for Coventry North East (Colleen Fletcher) and for Brentford and Isleworth (Ruth Cadbury) drew attention to the widening health inequalities in the past decade that have now been exacerbated by the pandemic. My hon. Friend the Member for Weaver Vale (Mike Amesbury) spoke about the patchiness of vaccine supply in his constituency. As his neighbour, I recognise those concerns, as many Members do, and we hope to see great progress on that in the coming weeks.

Finally, in a powerful speech, my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) reminded us that the link between covid cases and poverty is a stark one. She made a strong case for why more support is needed to enable people to self-isolate. In fact, just about every single Opposition Member raised that in one way or another. We have been making this case since the start of the pandemic, so why has it not happened?

We are in the darkest hour yet, but we still see the same failings again and again that have led us to this place. More people have been infected this year already than in the whole of October, when, let us not forget, things got so bad that we had to have another lockdown. Worse still, more people have died this month already than died in July, August and September put together. Every death is a tragedy. Every death leaves behind a grieving family, and while not every death is avoidable, not every one was inevitable.

The Government follow the same pattern every time, waiting until the last possible moment—until a decision becomes unavoidable. It is an ongoing cycle of bluster and denial, losing valuable time through delaying the inevitable and then running to catch up but never quite getting there. We can trace that pattern right back to even before the start of the pandemic, when warnings about preparations were ignored and the Prime Minister missed five Cobra meetings when our initial response to this threat was drawn up.

The Government have repeatedly been too slow to act. They were too slow to lock down the first time, and the second and the third. Ignoring the scientific advice from SAGE on a circuit breaker lockdown for six weeks was unforgivable. The Government certainly were not following the science then, nor were they when they said they would not change the Christmas relaxation rules because it was too late to do so, only to then do it three days later. They then told teachers, parents and children that it was safe to return to school one day, only to close them the next.

The Government ignored the World Health Organisation’s advice to test, test, test and stopped contact tracing altogether in March. As my hon. Friend the Member for Leicester East (Claudia Webbe) set out, the Government’s failings in social care are many, the most serious of which was allowing patients to be discharged into care homes without testing them for covid. We also had people being sent hundreds of miles just to get a covid test, all the while people were still coming into the UK without any checks at all. That still is not going to be corrected until the end of this week. The promise of all test results being returned within 24 hours has never materialised. Even now, the vast majority of tests take far longer than that to return.

They also delayed the roll-out of routine testing for care home staff but failed to anticipate the increase in testing capacity that would be needed when people returned to schools and workplaces, and they missed thousands of new cases because the spreadsheet was full. They set up a covid hotline that missed thousands of calls because of a failure to anticipate demand, again. On contact tracing, they developed the famous app and then could not get it to work. It was scrapped. They started again and finally delivered it four months’ late. Then, when it arrived, a notification to self-isolate from it did not count for claiming the self-isolation payment.

Worst of all, they handed massive sums of money to private companies with no record of contact tracing to deal with test and trace, repeatedly ignoring the evidence that locally led teams consistently delivered better results. The consequences of that were that thousands of people every day were not contacted quickly enough or were not contacted at all, meaning they continued to unwittingly spread the virus. They also did not require those private testing companies to report their results back to local public health bodies, meaning that opportunities for early action on local outbreaks were missed.

On PPE, where do we start? Stockpiles were allowed to run down. The Government allowed desperately needed PPE to be exported abroad, while our own health and social care staff were having to scrabble around or rely on homemade items. They signed £10 billion-worth of contracts on covid procurement without following the usual rules, including handing multimillion pound contracts to companies with no record of PPE production, some of whom supplied PPE that did not meet the required standards or, worse still, did not provide anything at all.

As we have said, they failed and are still failing to support people to self-isolate, bringing in a scheme of support that only one in eight people qualified for, with the unsurprising consequence that many people cannot afford to self-isolate. This is one of the first things we brought up at the start of the pandemic almost a year ago and it is unbelievable that it has still not been resolved.

Finally, the Government introduced a tier system that did not work and then another tier system that experts told them from the start would not work, so they had to introduce yet another tier system that did not work before finally creating extra tiers to the tier system that also did not work. They have over-promised and under-delivered every step of the way. There is a tragic failure to learn from mistakes. That must not be allowed to happen with the roll-out of the vaccine. It is, after all, our only way out of the situation.

It is, of course, a source of great national pride that we were the first country to approve a vaccine for distribution and that our own scientists were integral to the development of the second vaccine that was approved. So it would be a huge failing if we then did not become the first country to mass vaccinate our population. For the families forced to part, for the businesses facing bankruptcy and for the NHS staff exhausted by the relentless pressure that the virus has created, we all want the quickest possible route out of this.

The vaccines Minister said yesterday that the limiting factor to the vaccine roll-out at the moment is the volume of vaccines available, but has provided little detail on future supply. Where has it gone? AstraZeneca promised 30 million doses by September. That went down to 4 million by the end of year and clearly much less has actually been delivered on the ground. All the best laid plans will not matter if the supply is not there, so I hope the Minister can set out a detailed schedule of how many doses have been received to date, how many are expected each week and what the weekly projections are for delivery moving forward. Once we have got that sorted, let us go for 24-hour delivery. I can assure the House that there is an appetite for that.

On the vaccination of NHS staff, the latest estimate is that there are now some 46,000 staff off ill with covid, so it is vital that all NHS staff receive their first dose as soon as possible. Will the Minister commit today not just to delivering them as soon as possible, but to ensuring that they all get their vaccines within the next two weeks? We very much welcome the vaccines data that will be published each day from Thursday, but will she also commit to publishing the daily total of health and social care staff vaccinated so we can see progress there, too. We absolutely need the NHS to be protected. In that regard, one way to relieve pressure is to ensure that discharges into the social care sector are managed. Can the Minister update us on when the 500 covid-secure care homes will finally be on stream?

I just want to say a few words on the current lockdown. As we have heard, there has been much debate, both in here and in the media, about whether the current measures in place are sufficient. Once again, we hear at second hand from media briefings that Ministers are considering introducing new measures. Can the Minister update us in here, today, on whether any further measures will be introduced? Advice in December called for the Government to reconsider the 1 metre-plus rule, and we hear that SAGE has urged the Prime Minister to go further and increase 2 metres to 3 metres. We cannot be too late on that as well, so can the Government set out today what their position is on the social distancing rules and whether they need to change?

We know that the Government have also been advised to reinforce the importance of face coverings, including in settings where they are not currently mandated, such as workplaces and outdoor spaces. There was a two-month delay in advice on face coverings moving from just being guidance to becoming law. We cannot wait another two months for a change again if that is needed.

We all know why we need to look at extra measures, but to reinforce just how important that is, I want to conclude with a message that I received this morning from a constituent, who is an ICU nurse. She told me:

“I work full time plus extra, as we’re so, so busy. It’s horrendous. I am exhausted. I am still awake after a night shift, as I can’t switch off. I had four patients last night, I should only have had two. Then on my days off, I’m having to home-school as my husband, who is a store manager, is having to go to work and do click and collect. He says there are huge queues. It’s an absolute joke. This is not a proper lockdown.”

We need to listen to her. Our own eyes should tell us that this lockdown is not as strict as the first one, yet we have a more transmissible variant of the virus in circulation. Let us not delay again making the difficult but necessary decisions. Let us not put more pressure on an NHS already at breaking point. Let us not make those same mistakes again.

Covid-19 Vaccination Roll-out

Justin Madders Excerpts

Monday 11th January 2021 Westminster Hall

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

It is a pleasure to see you in the Chair, Sir David. I want to start by thanking my hon. Friend the Member for Gower (Tonia Antoniazzi) for her comprehensive and compelling introduction to this subject. She raised a whole series of questions, dilemmas and judgments that follow on from the very clear objective that we all share: we want as many people as possible to be vaccinated as quickly as possible.

My hon. Friend the Member for Gower clearly set out that lots of people in the country have been discussing this issue, as we would expect, but this forum is the right place in a democracy for us to be discussing those ideas, exchanging views and doing so in a way that is respectful and tolerant of other opinions. She set out clearly, as did other Members, the consequences of missing school, particularly in terms of the widening attainment gap and the digital divide, and she explained why it really has to be a priority to get children back into school as soon as possible. It was so disappointing, if not sadly inevitable, that we had to make the decision to restrict attendance at school. It is also very regrettable that the decision was taken without a proper back-up plan to allow children to learn remotely. I agree with her that teachers inspire, build confidence and impart knowledge, and they do that best of all when they teach in person in the classroom.

We also heard from my hon. Friend the Member for Leeds North West (Alex Sobel), who talked about the overwhelming sense of fatigue that we all feel in dealing with this virus—I think we can all understand that. He described the vaccine as the way out of this situation and said that the wonders of human ingenuity have allowed the vaccines to be developed and made ready in such a short space of time. He gave a very good plug for our party’s campaign on the vaccination programme, and he raised the important point that it would be very helpful if employers gave paid time off for people to go and receive the vaccine.

My hon. Friend the Member for Leeds North West also raised an important question, which I hope the Minister answers, about whether hospice staff should be included in the priority group for vaccination. He talked about a 24/7 vaccination programme and told us that the Prime Minister had apparently said there is no appetite for it. After talking to Members present and to members of the public, I have to say that there is an appetite for that. Every minute, every hour and every day that we can vaccinate people is another step closer to the freedom that we all want to return to. Let us not miss any opportunity to get to that point as quickly as possible. As my hon. Friend the Member for Cardiff South and Penarth (Stephen Doughty) said, the 24/7 approach should apply not just to delivering the vaccine but to the production of it.

My hon. Friend was also right to talk about the importance of getting information out there, because everyone wants to know where we are up to with this. Certainly, my constituency office has had many phone calls and emails asking about the vaccination programme. He also spoke about the excellent work undertaken in Wales to roll out the vaccine. He made the fair point that this is not an easy choice—these are not easy options for anyone—but it is important that we take the best professional and scientific advice available when we take these decisions.

It is, of course, a source of great national pride that we were the first country to approve a vaccine for distribution and that our own scientists were integral to the development of the second vaccine, which is now beginning to be rolled out across the country. Having found ourselves in this good position, it would be very disappointing if we did not become the first country to mass vaccinate its population. For the grandparents who have not seen their grandchildren, for the businesses that have not traded properly for a year and are facing bankruptcy, and for the NHS staff exhausted by the relentless pressure that this virus has created, we all want the quickest route possible out of this.

To date, as we have discussed, the lockdown strategy has been our most effective weapon against the spread of the virus, but we all know that that has created another set of extremely tough challenges and that there are concerns that even that may not be enough to halt the spread of the new strain. Therefore, as has always been the case, mass vaccination is the key to ending the nightmare, which is why no stone should be left unturned and no component of the state left unutilised, and every member of society who wants to contribute should be engaged in some way so that we all play our part to get as many people vaccinated as possible, as soon as possible. We all share that ambition, but the Government have displayed a pattern in this pandemic of being too slow and of over-promising and under-delivering.

[Jim Shannon]

Does the hon. Gentleman share my concern—I suspect the Minister does—that the roll-out of the vaccine has been halted in parts of the United Kingdom because supplies are running out? Is there not a logistical issue to be addressed as well, to ensure that that does not happen?

[Justin Madders]

The hon. Gentleman predicts the journey I am about to embark on. I will talk about that very legitimate point, which hon. Members have raised. AstraZeneca promised 30 million doses by September, but that went down to 4 million by the end of the year and, clearly, much less has been delivered on the ground. All the best plans possible will not matter if the supply is not there. Various Members have raised this issue, so when he responds, I hope the Minister will set out the exact position in terms of supply. How many doses have been received to date from each manufacturer? How many are expected each week? What are the weekly projections for delivery?

I will give the Minister a local example. My vaccination centre in Ellesmere Port is due to open sometime this week, but nobody knows exactly when because nobody knows when the first delivery will arrive. One thing this country is not short of is logistics experts. The Vaccine Taskforce is supposed to have been addressing this for months, so those on the frontline should not have been put in the position of not knowing when the vaccine is going to arrive. No vaccine should be left on the shelves, in warehouses or stuck at a factory gate waiting to be delivered. Greater transparency would be much appreciated. As my hon. Friend the Member for Leeds North West said, we could do with a performance dashboard covering not just the total figures published each week, but the proportionate numbers in each category of the priority list, including NHS staff—at clinical commissioning group level as well as nationally—so that everyone can see what progress is being made. There are references to that in the document that was produced today.

Turning to the subject matter of the petition, we know from what SAGE has said that schools are making a significant contribution to the R rate and that, with infections running out of control, the closure of schools—except for vulnerable children and the children of key workers—was, sadly, inevitable. As we have said, however, there are multiple reasons why reopening them has to be a priority, not least the importance of getting children back into the classroom. Although we could not go against the JCVI priority list—indeed, it is likely that a change now would be counterproductive—we believe that, as with the change to the period between the first and second doses, serious consideration needs to be given to the order in which the vaccine should be distributed after the initial phase. Indeed, I think Sir Simon Stevens has said as much today.

Of course, it is worth pointing out that the most clinically vulnerable adults who work in education will receive the vaccine shortly anyway, and we believe that the priority should be to increase the number of people who have received the first dose, so that debates over prioritisation become obsolete. However, if that is not possible, we believe that it is more than reasonable to look not only at the risk posed by particular workplaces but at the wider societal benefits of vaccinating particular groups of workers.

I hope that we have sufficient supplies and delivery networks so that we do not end up in a position where particular groups of workers are pitted against one another, but clearly there is a strong case for priority to be given to those working in education settings. At this point, may I thank everyone who works in education for their contribution? I know how hard many of them worked over the Christmas period to prepare for the mass testing regimes, and we could all hear their exasperation when they were asked to revert to remote working at 24 hours’ notice. I am afraid that some of that exasperation actually turned to anger when the Education Secretary delivered his warning that Ofsted could become involved if online learning was not up to scratch. If ever there was a sentence that summed up how he is not listening to the education world, that was it.

When I talk about education, I mean education in the widest sense. As various Members have said today, that includes all those who come into close contact with others as part of their job in an educational setting. For example, if we look at those in special educational needs settings, we see that they are often in much closer contact with others than most people. It is not just teachers whom we must consider but classroom assistants, cleaners, cooks and probably just about everyone who works in a school. We are not only talking about schools; as my hon. Friend the Member for Leeds North West said, nurseries and other childcare settings should be looked at. However, for reasons that are not entirely clear, they remain open at this time. I think we can all see how, in those settings, it can be very difficult to avoid close contact with others.

[Tonia Antoniazzi]

Just to reiterate, everyone in an educational setting should be prioritised for vaccination. Also, what about student teachers? Does my hon. Friend agree that they need to be prioritised too?

[Justin Madders]

Yes. I think we have to look at the actual work that they do and the risk on the ground, but clearly student teachers would be part of that process.

There are strong arguments for those in other essential services to be given additional priority. There has been much talk of the police and their role in enforcing covid rules; if 20,000 police officers had not been cut in the past decade, the police might not be in such a difficult place to do that. We should remember that when the police go about their duties, they engage with the public and so, by definition, they put themselves at risk of infection.

Similar arguments could be made for those involved in the vaccination process—not just NHS staff but those who are volunteering. In relation to that, can the Minister update us on how many retired NHS staff have now passed all the requirements in this regard, so that they can assist in the vaccination process? We have all heard the stories about the fire safety training modules that have to be taken; although such requirements are worthy in their own right, it cannot be mission-critical at the moment for those tests to be undertaken. I can put it no better than the retired consultant who contacted me and said:

“This is actually more than I was required to do when I was a full-time NHS consultant. It is grossly excessive, unnecessary and burdensome.”

On the vaccination of NHS staff, we know the unprecedented pressures they are facing at the moment; the latest estimate is that there are some 46,000 NHS staff off sick with covid, and that is before we even consider those who are required to self-isolate. The need for a full complement of NHS staff to be available to work cannot be clearer, so we want to see all NHS staff receiving their first dose of the vaccine as soon as possible. There is also a concern about whether those people who are not directly employed by the NHS and instead may be self-employed are being picked up by the system.

In conclusion, we know that at the moment the vaccine programme rightly prioritises the most vulnerable and is designed to protect life. However, as that group of people receives that protection, it is right that we consider where priorities lie next. The nation’s key workers have literally kept the country going in the last 12 months—those in education and in transport, council workers, and many, many others who have gone to work day in and day out, knowing that they risk contracting a deadly virus. They do not deserve to be thanked with a pay freeze. At the very least, they deserve serious consideration for prioritisation in the next phase of the roll-out. Proper recognition of their contribution and of the wider societal benefits of their work demand no less.

Breast Cancer Screening

Justin Madders Excerpts

Wednesday 16th December 2020 Westminster Hall

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

It is a pleasure to see you in the Chair this afternoon, Sir Edward. I thank the hon. Member for High Peak (Robert Largan) for securing this important debate and for his introductory speech. It is clear that he feels very passionately about improving access to breast cancer screening for his constituents. He was right that tremendous progress has been made in tackling this awful disease in recent years, but there is still an awful long way to go, as we have heard today.

The hon. Gentleman mentioned the importance of screening, as most Members did. I was very sorry to hear that the mobile screening service in his constituency has been temporarily halted. I hope it is a temporary halt and the Minister is able to give us some good news when she responds. It is particularly disappointing because the hon. Member spoke very highly of that service in the last debate we had on this matter, only last month. He certainly set out very clearly why moving to the system that we have at the moment is presenting a particular challenge to his constituents. He also gave some very personal testimony about the consequences of a delay in screening, showing why, of course, access is important.

We have heard some other excellent contributions this afternoon. The hon. Member for West Bromwich East (Nicola Richards) cited her local area’s statistics to point out that the figure for screening appointments in her constituency was lower than the national average; clearly, such a situation is something that all Members can play a role in remedying. She was right to say that the key to all this is being proactive and encouraging people to seek screening and early diagnosis. She gave a very personal example of how that approach had made a real difference to someone very close to her.

The hon. Member for Westmorland and Lonsdale (Tim Farron) extrapolated from his local statistics to state that about one in six people who would ordinarily have received treatment this year are not receiving it. He mentioned his work as the chair of the all-party parliamentary group on radiotherapy and I commend him for his consistent work in that particular forum. He referred, quite rightly, to the 15% drop in the use of radiotherapy treatment, which is of particular concern. He said that he does not believe that there were good medical reasons for that reduction, so there is a challenge for the Minister to go back to trusts to see whether there are reasons beyond medical reasons why these treatments are not taking place. He described the situation as a crisis on the scale of covid and said that it needs a Government response on that scale to tackle the issues that we have discussed today.

Those sentiments were also expressed by the hon. Member for Strangford (Jim Shannon), who gave a typically passionate and well-informed speech. I am sure that we all agreed with him when he said that he would like to read out a different set of statistics in a debate on this issue next year. Like all the hon. Members who have spoken today, he very clearly set out the importance of screening. He also raised a number of other issues, which I will touch on in my remarks.

This is the second Westminster Hall debate on breast cancer in as many months, which reflects the importance of this subject. On both occasions, it has been evident from the testimonies of Members how many people have had their own lives touched by breast cancer. Debates such as this one are important because, as many Members have mentioned, the various statistics out there show that there are very few people whose lives are not touched by this issue in some way. As we have heard from many Members, one in seven women in the UK will develop breast cancer during their lifetime—on average, that is 55,000 women, as well as 370 men, every year. Around 600,000 people in the UK are living with or beyond breast cancer, and, sadly, around 35,000 people have incurable secondary breast cancer.

As the hon. Members for High Peak and for Strangford both said, almost 1,000 women die from breast cancer in the UK every month, almost all of them from secondary breast cancer. The hon. Member for Strangford put things very well when he reminded us that these statistics are about real people and real homes, which may never recover from such a tragic loss. We must never forget the human tragedy behind these figures when we read them out in debates such as this one.

This very important issue affects so many people, but there are also many people who are united in their desire to do all they can to beat this disease. I pay tribute to all the dedicated campaigners, ambassadors and charities, who all do their bit to make life a little bit easier for those suffering with cancer. We must, of course, pay tribute to the NHS staff for everything that they do, not just this year—the most difficult of years—but every year, in the fight against cancer. I also thank Breast Cancer Now for its continuing support for all politicians from all parties in the House and, most importantly, the support it gives to those living with or affected by breast cancer, because, as we have heard, more women, thankfully, are now surviving breast cancer than ever before.

As many Members have already said, the key to that is screening, because we know that the earlier a cancer is diagnosed, the more likely it is that treatment will be successful. We also know that currently around 95% of women diagnosed will survive for more than one year and more than 80% for more than five years.

In the debate on this issue last month, I touched on the impact of coronavirus on early diagnosis, as most Members have today. Cancer Research UK estimates that around 3 million people are waiting for breast, bowel or cervical screening, and Macmillan estimates that there are currently around 50,000 missing diagnoses from this year compared to last year. This is the biggest crisis that cancer has faced in decades.

Breast Cancer Now estimates a significant backlog of nearly 1 million women requiring screening has built up during this year. Among the women still waiting for their screening, we know from the statistics that there will be around 8,600 who do have breast cancer, but it remains undetected. As Members have set out, the reasons for that backlog are numerous. Social distancing and infection control means that many cancer services can operate only at about 60% of their capacity. As the hon. Member for Westmorland and Lonsdale pointed out, that means the situation might get worse rather than better. Services were already under severe strain during the first few months of this year, and we know about the unprecedented steps that the NHS has had to take to deal with the large influx of covid-19 patients, which has led to an effective pausing of breast screening in England.

Of course, not only the screening programme was affected. Breast Cancer Now has also reported that the number of people referred to see a specialist with suspected cancer declined dramatically during the peak of the coronavirus outbreak in April. It estimates that across the UK there are likely to be nearly 107,000 fewer breast cancer referrals. Some of those women could be living with undetected breast cancer, and with every month that passes more women will be missing that early diagnosis that we have all heard today is the key to preventing death.

Although screening programmes have now restarted, we have heard that that has happened more quickly in some parts of the country. Breast cancer charities have raised concerns about the current strategy that has been adopted to clear the backlog, with the plan to send women open invitations to call and make an appointment from September this year to the end of March. As the hon. Member for West Bromwich East said, research has shown that the number of women who make appointments is sometimes lower than the number of women who actually attend for a timed appointment.

Breast Cancer Now fears the strategy could worsen the persistent decline that we have seen in the uptake of screening in recent years. It has also raised concerns, as did the hon. Member for West Bromwich East, about the impact on groups, among which uptake is already low, such as those who live in deprived areas and those from black and minority ethnic groups. This is particularly important at a time when surveys have shown that people are reluctant to come forward with symptoms due to concerns about catching coronavirus and giving it to the family, and putting pressure on an already very busy NHS. When the Minister responds, will she tell us a little more about what steps the Government can take to ensure that the women who have received open invitations for screening are able to take those up in the coming months?

It is very welcome that October’s NHS breast cancer waiting times showed an increase in referrals for people with potential symptoms of breast cancer to see a specialist. However, the crucial targets for women to be seen within two weeks was missed. There are immense pressures on our health service at the moment, but before the pandemic the breast imaging and diagnostic work was already overstretched and under severe pressure because of increased demand on their services—and that of course has been compounded, as many Members have referred to, by the shortages and vacancies in the workforce.

As the hon. Member for High Peak mentioned, Public Health England has previously reported a vacancy rate of 15% for mammography staff. About half of all mammographers are aged 50 or over and therefore likely to retire in the next 10 to 15 years. That is very concerning, given the importance of mammograms in detecting breast cancer.

Of equal concern is what Breast Cancer Now tells us: only 18% of breast screening units are adequately resourced with radiography staff in line with breast screening uptake demand in their area, and one in four trusts and health boards across the UK has at least one vacant consultant breast radiologist post. Sadly, that situation is unlikely to improve any time soon as vacancies are set to increase with about a quarter of breast radiologists forecast to retire over the next five years.

A recent analysis of NHS trust risk registers showed that 83% of trusts surveyed reported a workforce risk, including not having enough staff to manage cancer care, showing the NHS entering the pandemic with huge holes in the workforce.

The Government commissioned reviews that have highlighted some concerns. We heard from the hon. Member for High Peak and various other Members about the independent review of adult screening programmes in England, which found that such programmes are constrained by the size and nature of their workforce and by the equipment and facilities available to them. As we heard, Professor Sir Mike Richards’s review, which was commissioned by Sir Simon Stevens, found that significant investment in facilities, equipment and workforce was needed. That means replacing outdated testing machines and expanding the imaging workforce by about 2,000 additional radiologists and 4,000 radiographers, as well as support staff.

In September, a Public Accounts Committee report called on the Government urgently to prioritise publication of the long-term workforce plan. Unfortunately, that exposed the lack of long-term thinking in the current approach to the NHS workforce. Such thinking is vital if we are to see the NHS perform at the level we all want it to. We need to see a full five-year people plan, with costed actions within it.

The pandemic has shown, as other Members said, just how valuable and appreciated NHS staff are, but it has also highlighted the unaddressed long-term issues of excessive workload, burn-out and the inequalities experienced by staff. The rhetoric on support for our NHS staff needs to be matched by action. As we have heard today, that commitment is vital to ensuring that breast cancer services can safely continue to give all those affected by breast cancer the very best chances of survival. I hope that we will hear from the Minister about how that ambition, which we all share, will be delivered.