Ockenden Review

Justin Madders Excerpts

Thursday 10th December 2020 Commons Chamber

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

I thank the Minister for advance sight of her statement and the personal commitment she has shown on this issue. I too thank Donna Ockenden and her team for their work to date.

Sadly, the report is not the first of its nature, and it is unlikely to be the last. We need to get ourselves into a place, sooner rather than later, where these systemic, almost cultural, failings become a thing of the past. The families have suffered unimaginable pain, and it must not be exacerbated by closed and defensive responses to the tragedies they have experienced.

Today’s statement comes only a fortnight after another damning report on maternity safety—Bill Kirkup’s report “The Life and Death of Elizabeth Dixon”. This is the latest in a long line of reports that show that, across large parts of the NHS, there is still a long way to go before we have the openness and transparency that patients deserve. That is not to do down the hundreds of thousands of staff who do a fantastic job day in, day out, but the report points to the wider problem—it is not a new problem—that when things go wrong, there is too little candour, too much defensiveness and a lack of leadership at the top of trusts; the leadership do not take personal responsibility and put right what has gone wrong.

Once again, we have got to this point only because of the persistence and resilience of the grieving families who have suffered such personal tragedy and refused to accept that what they were told was the end of the matter. I want to put on the record my appreciation of the courage and strength that they have shown throughout, but we really should not expect light to be shone on these issues only because individual families do not accept what they are told.

Senior leadership within trusts has to be much more candid and challenging with itself when faced with these concerns.  These families just want answers and an assurance that nobody else will have to go through what they did, but, too often, they do not get them. The fact that we are now looking at more than 800 cases over a 40-year period, when the original investigation was tasked to look at just 23, must surely tell us that, for a very long time, those grieving families were not being listened to and the necessary lessons were not being learned. That in itself is as much a failure as the individual incidents. With so many more families coming forward and having to relive some of the most difficult experiences in their lives, it is vital that support is offered to them to deal with the consequences of that, so can the Minister assure us that appropriate support is available to all those who need it?

So that we will all be clear now, the Ockenden review will be far larger and take far longer than was originally intended. Can the Minister assure the House that the review has the resources necessary to complete the final report as soon as possible? I understand that the trust has not waited until today to take action, but, inevitably, further recommendations will emerge from the final report. There are also actions for the whole NHS, and a number of specific actions that can be taken across the board now, which the Minister indicated are in fact urgent. I would be grateful if she indicated whether she intends to set a deadline for implementation of the system-wide recommendations and whether she will provide regular updates to the House on their progress.

Strong leadership, challenging poor workplace culture and ring-fencing maternity funding are all key to improving safety. On tackling the poor workplace culture that exists in some trusts, it is clear that there is still a long way to go. It is concerning to see a report this morning that the review into bullying at West Suffolk Hospital, which was originally due to be published last April, is now not due until next spring. It is also clear that there is a pressing need to reinstate the NHS maternity safety training fund. That money was vital for safety and makes a big difference to care, so can the Minister commit to reinstating that training fund?

Can the Minister also advise what action is being taken to ensure that we have enough staff in all maternity units, and will the Government commit to legislating for safe staffing levels? More widely, can she set out what is being done to tackle the estimated 3,000 midwife vacancies that we currently have? We cannot ignore the fact that some of the problems created by this culture will be exacerbated and will continue if we do not solve the staffing and resourcing crisis in the NHS, and these issues will continue to compromise patient safety.

Finally, it is understandable if families who are currently receiving care at the trust are anxious. Can the Minister provide them with some reassurance today that they will be safe and well looked after?

[Ms Dorries]

I thank the hon. Member for Ellesmere Port and Neston (Justin Madders) for his, as always, constructive and reasonable tone in his response. Yes, I can assure him that the resources are in place, and have been guaranteed to be in place. As for the deadline, it is 2021. I cannot give an exact month. It was really important to me—I believe that Donna Ockenden has mentioned this in her report a number of times— that the first 250 cases were evaluated so that we could take the learning from those cases and introduce it as quickly as possible. In that way, we could identify what had gone wrong so that we could prevent it from happening again in the future. That is why we have produced the report in two stages. We know the findings of this interim report and the recommendations that have been identified by Donna and her team can be put in place. The second stage of the report will appear before the end of next year—certainly in 2021. I will, as the hon. Gentleman requests, and personally if he requires it, update the House on what is happening with the report.

With regard to the maternity safety training fund, we secured £9.4 million in the spending review. It cannot be underestimated, in this time of covid, what a huge achievement that was. The money will not go into the old format of the maternity safety training fund, because we do not believe that that worked as well as it should have done. Much of that money was used to backfill the staff, who then, unfortunately, did not attend training. We did not get the best results—the biggest bang for the buck.

What we, as a Department, are doing now is directing that £9.4 million to where it is needed most and to where it can be spent in the most effective manner to produce results in maternity safety. That work is ongoing now in the Department, and I hope to be able to update the House and the hon. Gentleman very soon on how that money is being spent and what results we expect to see in return for the expenditure.

I did not anticipate the hon. Gentleman’s question about midwives. I do not have the exact number, because the figure rises every day. None the less, we are recruiting new nurses—I think the figure was 12,000 when I last gave a statement to the House—some of whom will be recruited to become midwives. So, yes, work is under way on the workforce and on nurse recruitment.

DHSC Answers to Written Questions

Justin Madders Excerpts

Thursday 19th November 2020 Commons Chamber

[Edward Argar]

I am grateful to my hon. Friend. As he will be aware, other Departments, while they have heavy workloads, are not leading the response to the pandemic. In response to his final point, he will not be surprised that I do not characterise it in that way. Instead, I would characterise it as the Department of Health being in the lead in saving lives and protecting the NHS in this country.

My hon. Friend asked two other substantive questions. I think his language was a little intemperate in respect of the serious efforts that officials undertake every day to try to provide accurate and timely answers. There is no suggestion that they seek to stonewall or to avoid responding. They do their best, but it is difficult and the situation changes day by day. Where answers are deemed to be inadequate, hon. Members often revert to me directly or table their questions again, and we endeavour to fulfil our obligation to provide accurate answers.

On my hon. Friend’s question about recovery, we have set a trajectory for each month in order to recover performance over the coming months. Of course, that depends to a degree on the workload of officials in responding to the pandemic, as well as in providing answers, but I do not see it as an either/or; we intend to recover performance in parallel with tackling the pandemic.

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

I thank the Minister for his response and for the hard work he and his Department put in. However, as he acknowledges, the performance here, like in so many other areas, is just not good enough. We know it is tough, but there comes a point when it begins to look like departmental scrutiny is being used as a cover for evading giving answers.

This morning, I looked at the Department’s response times to my own written questions over the past six months. I have had to wait over one month for an answer 29 times, over two months 11 times and over three months four times. I was actually thinking of putting in a question asking for the average response times to questions, but then I thought I would just be waiting a long time for that answer as well. I have even had to wait five months for the answer to what I thought was a pretty simple question asking what tests for covid-19 had been used. One hundred and sixty-eight days later, I received the utterly unrevealing answer:

“A large number of different tests have been used throughout the programme.”

I was lucky; my hon. Friend the Member for Sheffield, Brightside and Hillsborough (Gill Furniss) waited 18 weeks for an answer to a question on tests, only to be told:

“The information is not held in the format requested.”

Why did it take so long just to say that? Do Ministers even read the answers that they sign off?

This is not just about the time; the quality of the answers that we get back also needs improving. On dozens of occasions, I have been told that the Department does not hold the data, or no real attempt is made to answer the question that was asked. I accept that sometimes that information may not be easily acquired, but too often it looks as though the Department wants to keep us in the dark. I remind the House that the ministerial code requires Ministers to be

“as open as possible with Parliament”,

even when that may be inconvenient to them. In the spirit of openness, will the Minister also look at restarting NHS England and NHS Digital publications?

In conclusion, we all understand that the Department is dealing with many pressing issues, but scrutiny is important. Accountability matters, and if the pandemic is used too often as an excuse for standards to slip, that is how we go from questions not being answered to major policy changes being announced by media leaks, until we end up with the shameful spectacle of spivs and cronies pocketing millions from PPE contracts. Government must do better.

[Edward Argar]

I was going to say that, as ever, I was grateful to the hon. Gentleman for his tone, right up to almost the end of his remarks. On his substantive points, when it comes to accountability to this House, he will know from our regular double acts at this Dispatch Box and in Committee that I and fellow Ministers do not shy away from our accountability to this House in all its forms.

On volume, as I have said, during the same period last year we received 4,000 written questions; this year, the figure has been 8,000. That cannot be addressed by increasing administrative resource alone, because the technical expertise of policy experts is required to provide accuracy in the answers that the hon. Gentleman and other hon. Members seek. The same policy officials are dealing, day to day, with all aspects of the response to the pandemic.

The hon. Gentleman talked about accuracy, and he is right about the importance of accurate and timely answers. Given that we have answered 8,000 parliamentary questions between March and, I believe, October, some may, sadly, not live up to his expectations. I know that he will hold me and other Ministers to account when that is the case.

In answer to another of the hon. Gentleman’s question, yes, I and other Ministers read not only the answers and the questions, but the background to those questions. If we do not, we will quite rightly end up at the Dispatch Box, being asked those questions again and being challenged on the Floor of the House. In view of that, and in view of our obligations to the public and under the ministerial code, it is absolutely right that we take the answering of written parliamentary questions very seriously.

On the hon. Gentleman’s final point about NHS Digital and the publication of data and so on, I am happy to take that away and look at it for him.

Oral Answers to Questions

Justin Madders Excerpts

Tuesday 17th November 2020 Commons Chamber

[Edward Argar]

I am delighted that my hon. Friend’s constituents will benefit from £3 million to increase capacity at Russells Hall Hospital in Dudley as part of the investment to upgrade A&Es ahead of winter. Future NHS capital spending will, of course, be determined at the upcoming spending review, but once our settlement has been confirmed with the Treasury, we will consider carefully how projects are prioritised within it. In the meantime, I encourage the Dudley Group NHS Foundation Trust to discuss its proposals with NHS England and NHS Improvement. I would be happy to meet my hon. Friend to discuss this, because I know how hard he campaigns on this issue, and I would be delighted to take him up on the offer of a visit when I am able to.

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

The NHS will only survive the winter if its workforce are valued and supported. The evidence from the British Medical Association to the Health and Social Care Committee this morning was stark. So does the Minister understand how demoralising it is for staff to hear reports that they may face yet another two-year pay freeze? I asked those on the Government Benches to rule this out last week. I got no answer, so I ask them again today: will they rule out a pay freeze for NHS staff?

[Edward Argar]

I am grateful to the hon. Gentleman. He is quite right to highlight the amazing work that our NHS and social care workforce have done throughout this pandemic, as they do every year, and I pay tribute to them for that. As he will know, the NHS agrees with its staff multi-year pay deals set by independent recommendations, and we continue with that process.

Breast Cancer Diagnosis and Services: Covid-19

Justin Madders Excerpts

Thursday 12th November 2020 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr McCabe. I start by thanking the hon. Member for North Warwickshire (Craig Tracey) for securing this important and timely debate and for his excellent introductory speech. He made a number of important points, some of which I hope to return to, and I hope he gets a positive response to his very helpful suggestion on the gathering of data. I also thank all the other hon. Members for their contributions today, and I will go through some of the highlights of those.

My hon. Friend the Member for Barnsley East (Stephanie Peacock) spoke about the need for a cancer recovery plan, which I think we all agree on, and addressed the important point about widening health inequalities and the startling differences in the availability of screening depending on where people live. I agree with her that improvements to the cancer outcomes datasets are an important part of beginning to understand how those disparities work out.

We heard from my hon. Friend the Member for Easington (Grahame Morris); I pay tribute to the work he does on the all-party parliamentary groups in this area. He mentioned the Catch Up With Cancer campaign and drew attention to the backlog, which, of course, many hon. Members have raised today. He also raised the availability of radiotherapy, which, in his own words, he bangs the drum on consistently in this place, and we pay tribute to his persistence.

The hon. Member for High Peak (Robert Largan) made an important point about the availability of mobile screening units and the hon. Member for Strangford (Jim Shannon) , who always speaks with such knowledge on this subject, made some important points about clinical trials and charities, which I hope to be able to return to if time allows.

It was a pleasure to see the hon. Member for Southend West (Sir David Amess) find his spiritual home at last; it is the equivalent of Gary Neville turning out to play for Liverpool, but he is welcome all the same. We have a vacancy in the shadow health team for a Parliamentary Private Secretary at the moment and, if he shows the promise that he demonstrated in his speech today, I think we may be able to find a role for him on this side of the House.

The hon. Gentleman made, as my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes) did, an important point about some of the people who are not here today, including the hon. Member for Chatham and Aylesford (Tracey Crouch), who we heard this morning in business questions speaking about her frustration at not being able to participate in this debate. I am sure it would have been enhanced by her presence, given her current battle, alongside the former Member—still our friend—for Dewsbury, Paula Sherriff. I am sure the whole House sends both of them our very best wishes.

I want to speak about the impact the pandemic has had on the early diagnosis of cancer in general, as many Members have referred to already. We know how important early diagnosis is to improving chances of survival and in successful treatment. As we heard, Cancer Research UK estimates around 3 million people are waiting for breast, bowel or cervical screening, and there were over 1.2 million patients waiting for a key diagnostic test by the end of August this year. As my hon. Friend the Member for Easington mentioned, we know from Macmillan’s latest report that there are currently around 50,000 missing diagnoses; that compares to a similar timeframe for this time last year, and means 50,000 fewer people have potentially not been diagnosed with cancer.

We know significant amounts of capacity had to be created during this pandemic, and that meant the cancelling of planned operations, large numbers of patients being discharged back into the community, and staff and patients having to be protected from the transmission of covid-19. What those changes also meant is that, thankfully, intensive care did not have to be rationed so that only covid-19 patients were treated. However, it also caused the shutdown or reduction in many other non-covid services, which, combined with drastic changes in patient behaviour, has led to us facing this huge backlog today. We know that stricter infection control measures—which are absolutely necessary—mean that the backlog of care will probably take much longer to clear than we would like.

My hon. Friend the Member for Dulwich and West Norwood and other hon. Members referred to the Breast Cancer Now report, and how the number of people referred to see a specialist declined dramatically from April. There is an estimate that across the UK, there have been 107,000 fewer breast cancer referrals, and a backlog of almost 1 million women requiring screening has built up during this time. Some of those women may well have been living with undetected breast cancer, and some may still be. Every month that that situation continues, more women could be missing out on the best chance of getting an early diagnosis and the best chance of beating the disease. It is vital—and something that we have been pushing for for a long time—that we get a clear sense of how we are going to tackle that backlog, because it is so important.

The hon. Members for Wakefield (Imran Ahmad Khan) and for Crewe and Nantwich (Dr Mullan) mentioned the importance of mammograms. As we know, they are a key tool in early detection. There is a plan to send open invitations for screening from September to March of next year. That has caused some concern among cancer charities, because some of the research shows that the number of women who make appointments is significantly lower than those who actually attend timed appointments. There is a fear, sadly, that this could actually worsen the persistent decline we have seen in recent years of the uptake of breast cancer screening. We are particularly concerned about the impact that will have on some groups where uptake is already low, such as those living in deprived communities and some BAME groups. We heard a little bit about the impact on BAME groups from my hon. Friend the Member for Dulwich and West Norwood, and both she and the hon. Member for Winchester (Steve Brine) very powerfully put into words the additional mental toll that this disease has during this time, on top of everything else that people ordinarily face when they have received such a diagnosis.

Several hon. Members mentioned the impact of covid-19 on secondary breast cancer patients. It is still, sadly, the case that around 11,500 people—women, mainly—die from breast cancer each year. Most of those are to do with secondary breast cancer, and as we have heard, it is not something that there is a cure for at the moment. It is estimated that around 35,000 people in the UK are living with secondary breast cancer. As the general population ages and people live longer, numbers will continue to increase, so it is really important that we get a better understanding and response to secondary breast cancer. We also need to look at this issue from the patient’s perspective.

I want to mention my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams), who wanted to speak in today’s debate but could not. She wanted to pay tribute to one of her constituents, Jo Taylor, and to METUP UK, which focuses on making positive changes for everyone with metastatic breast cancer. Its “busy living with mets” campaign calls for increased awareness of secondary breast cancer, because catching it earlier leads to better outcomes. It is also campaigning for better access to drugs, clinical trials, radiotherapies and surgical pathways.

As the hon. Member for North Warwickshire mentioned in his opening comments, the national cancer patient experience survey tells us that the experiences of patients with secondary cancer differ greatly. It has identified gaps through the taskforce in the support and services offered to people, including variation in access to clinical nurse specialists, patchy provision of information, patients’ psycho-social needs not being met, and a lack of prompt and timely access to palliative care services.

As we have heard from several hon. Members, clinical nurse specialists play a critical role in co-ordinating care, providing information and helping people to manage their diagnosis and treatment better. In fact, Breast Cancer Now reports that the support of a clinical nurse specialist is the single most important contributing factor to people’s positive experience of care. That is particularly important for secondary cancer patients, who are often on lifelong treatments and have complex needs as a result. Its importance was acknowledged in the long-term plan, with a commitment that by 2021—it is only six weeks away now—all patients, including those with secondary cancers, will have access to a clinical nurse specialist or support worker.

It is very important that we get to a point where everyone is able to take advantage of the expertise that a clinical nurse specialist provides. Prior to the pandemic, the workforce was already overstretched and under pressure due to increased demand and persistent shortages across the workforce. A report by the Public Accounts Committee was highly critical of the Government’s approach to the workforce, finding that the long-term plan was not supported by a detailed workforce plan. Of course, the removal of the NHS bursary in 2017

“signally failed to achieve its ambition to increase student nursing numbers.”

Before I conclude, I want to echo what the hon. Member for Strangford said about the importance of charities in this sector. We know there is a great deal of concern in the sector. I know that some support was announced by the Government back in April, but it falls well short of what was suggested by the associations involved, and only a few have been able to benefit from it. I hope the Government will listen to the sector and look again at what additional financial support can be provided, because we know that clinical trials provide a vital opportunity for patients to access new treatments, which are always in development. We know it is particularly important for patients with secondary breast cancer. We hope that is something the Minister can take on board today, and I look forward to hearing her response.

Covid-19

Justin Madders Excerpts

Wednesday 11th November 2020 Commons Chamber

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

It is now 293 days since the Secretary of State first came to this House and spoke about the emerging threat of covid-19. Since then, thousands of lives have been lost, both directly and indirectly, and billions of pounds have been spent. There has been great personal sacrifice, and we have all heard so many stories of individual courage and dedication that have been an inspiration, but there is no doubt that people are now weary. Not one corner of this isle or one aspect of our lives has been immune to the impact of this virus, so the news this week that there may be a way out of this nightmare has given people hope, and we all need hope at this difficult time.

However, that hope should not obscure the truth that we are in the midst of a second wave, so we must be sure to maintain vigilance. As we heard from the Minister, as of yesterday there were 20,000 new infections; more than 13,000 people are in hospital in England, with more patients in hospital in the north of England than there were at the peak of the first wave; and sadly, there were another 532 deaths yesterday, the highest number in one day for approximately six months. That is another 532 families who have lost a loved one, and among the huge numbers we talk about, we should never lose sight of the fact that each one of those numbers is a person. With the news today that we have now passed 50,000 deaths since the start of the pandemic, we know that the scale of human loss has been immense.

Those figures remind us that we still have a long way to go. Hope for the future is important, but it is not guaranteed, and neither is the end likely to be reached before we enter the difficult winter months, during which it is sadly likely that more people will catch the virus and more will die. It is right that plans are now being made for the roll-out of the vaccine, but that should not mean we take our eye off the ball when it comes to the immediate and pressing challenges that this virus presents. I know that time is at a premium today, so I will not detain the House for too long, but I want to say a few words about some of those immediate challenges.

Every challenge in the NHS is faced, first and foremost, by its workforce, so I will start by paying tribute—as the Minister did—to everyone in the NHS: the doctors, the nurses, the many allied health professionals, the porters, and everyone who has gone above and beyond over these past nine months to keep the NHS going. We know that working in the NHS is never easy, but the pressure, the workload and the trauma this year are of a scale and intensity we have never seen before. Not only must we show our gratitude to those who have given their all, we must demonstrate that we are listening to them by addressing their well-documented and legitimate concerns. That has to be more than a clap or a badge: there has to be tangible recognition that there are only so many times people can go to the well before they become physically and mentally exhausted. It is clear that burn-out is a real risk, as 14 health unions and royal colleges have warned in their letter to the Prime Minister earlier this week. They say that asking staff to carry on at this level of intensity is “increasingly unrealistic”. We have to listen to that warning.

Addressing workforce fatigue is not just the right thing to do: it is the only thing to do if we want the NHS to continue to be the jewel in this nation’s crown. I hope that the rumours of another two-year pay freeze for NHS staff are just that—rumours—because if that were true, it would send the most appalling message about the value this Government place on the NHS workforce. When the Minister winds up the debate, I will be delighted if she could put that particular rumour to bed.

Of course, NHS staff should be properly rewarded for the work they do, but they also need to be properly supported when doing the job. We cannot have a repeat of the obscenity of doctors and nurses bringing in home-made PPE while UK manufacturers are selling it overseas. I know that general practice is particularly concerned about the availability of PPE this coming winter, and while many of these debates have rightly focused on the hospital-based issues that covid presents, we should not underestimate the demand there has been on GPs this year. We know it is always the case that, when general practice struggles, the impact is felt elsewhere in the NHS. It is not yet clear what role GPs will play in the roll-out of any vaccine, but any additional demands placed on them in that respect must be matched by additional support.

We welcome the news that at last, many months after we first suggested it, there will be routine testing of frontline NHS staff. The Healthcare Safety Investigation Branch report on the transmission of covid in hospital settings, which came out last month, stressed the importance of increasing pillar 1 testing capacity, and it is a matter of deep regret that we are only just starting to see that now. Let us hope that that pledge does not face the same problems with availability that we had in the social care sector.

[Carla Lockhart (Upper Bann) (DUP)]

I had hoped to speak in this debate but, unfortunately, there are limited flights to Belfast. Does the hon. Member agree that there needs to be additional testing in the care home sector, particularly for family members who could be designated as care workers? I know that the Minister brought forward a pilot scheme. Does the shadow Minister agree that that should be rolled out right across the United Kingdom and that loved ones should get access to their family members in the care home setting?

[Justin Madders]

I thank the hon. Member for her intervention. The recent developments in rapid testing give us the ideal opportunity to allow relatives of those in care homes to get in and see them and give them the support that they have been so sadly lacking in recent months. None of us could fail to be moved by the many representations we have had from family members who have been unable to see their loved ones for many months.

On the health and social care workforce, we know, sadly, that over 600 staff have lost their lives so far to covid-19. They have paid the ultimate price just for doing their job. It is important that lessons are learnt about how we stop transmission, and it is right that the Government opened up their life assurance scheme to all health and social care staff, but over half of all families who have lost someone to the virus have still not received their payment, so we need the Government to be much more proactive in making sure that everyone who is entitled to that payment receives it.

Let us support the staff, but let us not forget the impact on patients as well. We know that the NHS could cope with the first wave only because so many planned operations were cancelled. We know that the need to operate in a covid-secure environment presents additional challenges to the NHS in reaching previous levels of activity. We know that before the pandemic started, waiting lists were already climbing to record levels. Covid-19 has accelerated that increase so that by August this year, over 100,000 patients were waiting over a year just to start treatment. Cancer Research UK estimates that around 3 million people are waiting for breast, bowel or cervical screening, and there were over 1.2 million patients waiting for a key diagnostic test at the end of August. We need to hear what the plans will be to address these spiralling waiting lists, and we need a cast-iron guarantee that no patient will be discharged from hospital into a care home if they have tested positive for covid-19.

I turn to what awaits us in a few weeks’ time, because we all hope that the current lockdown will end on 2 December as planned, and as promised, I believe, by the Prime Minister. If it does end on that date, it seems likely that we will still have some system of tiered restrictions moving forward. That is another area where we need to see improvements, because the Government’s approach to restrictions to date has at times been contradictory, muddled and rushed. I accept that the Government have had on occasions to move quickly, sometimes because of a rapidly changing picture—but sometimes, regrettably, because of leaks to the press too. Of course, we would not expect things in this kind of situation to be perfect, but they can be better than they have been.

The time that this lockdown buys us should be used not just to fix test and trace, to prepare for a roll-out of the vaccine and to fine-tune the mass testing pilots, but to set out a clear and consistent framework for determining and implementing future restrictions. The Minister and his colleagues have spent many Monday afternoons in Committee Rooms with me and others going through increasingly convoluted and amended statutory instruments dealing with each new restriction, often published only hours before they became law and always debated weeks after they came into force. We cannot go back to that style of governing. Public trust is eroded when decisions are not made in a transparent and timely manner, so when the Government decide what their exit strategy to the lockdown will be, they also need to consider what the process will be for making and communicating those decisions. It is critical that individuals and businesses get sufficient advance warning in future to enable them to prepare properly for whatever comes next. This point is as much about process as it is about substance, but the process matters, because restrictions need to be tested in this place; if they do not stand up to scrutiny here, we cannot expect them to stand up to scrutiny out there.

I want to say a few words about test, trace and isolate. The Serco side of the system is underperforming badly, and the decision to place responsibility for mass testing into the hands of local directors of public health is a welcome one. It recognises, perhaps belatedly, where the real expertise lies. The latest figures for the national test and trace system are frankly shocking, with 26% of test results received within 24 hours. We should not forget that the Prime Minister said we would have all results turned around in that timescale by the end of June, yet the figures have been getting worse in recent weeks, not better. We know how important it is for results to be turned around quickly if we are ever to get test and trace playing the part it was meant to play in controlling the spread of the virus. Ministers can boast about record capacity, but capacity is meaningless if the results are not coming back quickly enough to be effective.

Let me turn to the contact tracing system itself. In the most recent weeks for which figures are available, 40% of close contacts were not reached and asked to self-isolate, amounting to more than 130,000 people in one week. That is a failure. When every one of us in here has those difficult and distressing conversations with our constituents about the restrictions that we currently face, we need to reflect on that failure and question not only why these unproven private providers have been given the task in the first place, but why they continue to be responsible for a system that they are clearly not delivering on. Every scientific adviser said that relaxing lockdown measures would work only if we had an effective test and trace system in place, yet on just about every measure the system is going backwards. How much longer will Ministers tolerate this failure? However, whoever is doing the contact tracing, that is only half the story. Without people adhering to the rules of self-isolation thereafter, the success of the entire system is in doubt.

Yesterday Baroness Harding gave evidence to the joint inquiry of the Science and Technology Committee, and Health and Social Care Committee, where she made the important point that the reason that people were not self-isolating was that they could not afford the loss of income, not because of a refusal to comply. She also made the rather remarkable claim that the surge in cases that we have seen in the last couple of months was not anticipated, which I thought was an incredible admission.

The Committees also heard from Professor Sir John Bell, who said that the self-isolation system was “massively ineffective” and spoke about using the increased testing capacity perhaps to cut short the self-isolation period for negative cases. No doubt the Government are actively considering that, but we are still left with the need to do more to encourage people who test positive to self-isolate.

In September a report for the Scientific Advisory Group for Emergencies concluded that self-isolation rates would be improved if additional financial support were available, ensuring that those required to self-isolate—let us not forget that these are people who are doing the right thing—are not penalised and do not experience financial hardship when doing so. This survey found that only 18% of people with symptoms self-isolated, and that figure went down to just 11% of those told to self-isolate by Test and Trace after coming into contact with a confirmed case. I know that these are preliminary figures and that other studies have suggested slightly higher levels of compliance, but no study that I have seen has shown levels anywhere near close enough to where they need to be for us to have an effective system.

The entitlement to a self-isolation payment is tied to being in receipt of certain benefits, which means that a significant number of people do not qualify, although those not in receipt of those benefits and those who do not receive contractual sick pay can also receive statutory sick pay or employment and support allowance. But that is frankly not good enough. SSP is far below the rate set for a self-isolation payment. The Secretary of State famously said that he could not live on such an amount, so we should not be surprised when we see low rates of compliance, because asking those who are not eligible for a self-isolation payment to accept a significant drop in their pay for a fortnight inevitably causes hardship and discourages compliance. I urge the Government seriously to consider doing more to encourage people to self-isolate.

It is a massive oversight that those notified through the app are not entitled to the payment. I understand that the Government are actively looking at this, but given that it is over six months since we started hearing talk about the world-beating app, it is staggering that we are only now looking at how properly to tie it in with support for self-isolation. Action on that issue cannot come soon enough.

There has been newspaper speculation that the actual period of self-isolation might be cut, with a suggestion that it could end at 10 days following a negative test. A report in The Guardian on Monday says that a compromise was “cooked up” to placate Dominic Cummings. Frankly, he ought to be the last person in government to be determining the self-isolation rules, given that he has found it impossible to follow them himself. Any change to this period should be based on medical advice, so I do hope that we get clarity from the Government during the wind-ups that any decisions on shortening the self-isolation period will be based on advice from the chief medical officer, rather than any Dom, Dick or Harry who happens to be in the Prime Minister’s office.

I hope that those on the Government Benches have been listening today and considered the issues and the suggestions that I have made, as none of us wants to be back here in another month or two debating another lockdown because the time this lockdown has bought was wasted. We do not want to be here talking about how the second wave saw us with one of the highest death rates in the world again, and we do not want to be here in a few months’ time seeing cases rising again because demand was not anticipated. We all want to hear that cases are falling, that hospital admissions are reducing, and that other NHS patients are getting their treatments quicker. Human endeavour has given us the opportunity to get to that place. While reaching that destination is not entirely within the Government’s gift, it would be inexcusable if we failed to get there because of incompetence or neglect on the Government’s part. The people would never forgive that, and nor should they.

Exiting the European Union (Agriculture)

Justin Madders Excerpts

Tuesday 10th November 2020 Commons Chamber

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

I thank the Minister for his brief but informative introduction —I would like to say it was entertaining, but that might be pushing the boat out a bit, because it is a very technical piece of legislation, as he outlined. The instrument is primarily being made to reflect the Northern Ireland protocol in the field of food safety and hygiene.

As we know, the instrument amends or revokes 16 of the 17 EU exit statutory instruments that were hurried through in the weeks ahead of the original 29 March 2019 Brexit deadline. As the Minister said, the intention is to avoid disruption to food controls, which is critical for the approximately 220,000 businesses active in the agrifood sector. As such, we will not be opposing the regulations today. We have a number of questions, however, because we have been clear that any future changes to regulatory controls after the UK leaves the EU should provide at least the same, or even an improved, level of consumer protection. That applies to food hygiene and safety standards as much as anything else.

As the Minister briefly outlined, there was a public consultation. The explanatory memorandum sets out that that was completed by the Food Standards Agency in respect of the amendments made to this instrument, which is welcome. I note, however, that the initial consultation, which was carried out in September and October 2018, received 50 responses from interested parties across a wide range of sectors. The consultation that we are talking about today, which was carried out in August and September of this year, received only seven responses. That is a concerning drop-off, even though many other issues have clearly been occupying people’s attention this year. Will he confirm that the recent consultation was as widely publicised and drawn to the attention of stakeholders as the previous one? Does he have a view on why there was such a drop-off in responses?

Although we can view the consultation document itself, a summary of the responses has not yet been published, so is not available for proper scrutiny. That is especially concerning as the explanatory memorandum states that 29% of replies had “mixed comments” and that further analysis of them will be undertaken. The phrase “mixed comments” could, of course, be classic civil service speak for major concerns being flagged, or equally, those concerns could have been addressed in the regulations. We do not know because we have not seen them. Although 29% amounts to only two responses in this consultation, that does not make them any less valid, given the small number of responses that we had.

The Minister knows that I am keen on transparency and full disclosure, so I hope that he will be able to shed some light on the nature of those mixed comments, the concerns that were raised, and what further analysis of the instrument was undertaken following that response. Given the low level of response, I wonder whether he can be confident that the consultation process was sufficiently robust.

Will the Minister update us on the progress of the provisional framework on food and feed safety and hygiene that will create a joint risk analysis process across the UK from the end of the transition period? I note that the chief executive of the Food Standards Agency gave a written response to some questions raised by the Common Frameworks Scrutiny Committee last week, which indicated that the provisional framework will continue to be reviewed into early December.

As that is a matter of public safety, it is imperative that any changes are communicated clearly and in a timely manner to ensure that the industry can remain in line with current legislation. Can the Minister assure us that it will be possible to do that within those timescales? What assessment has been undertaken of the readiness and capability of the FSA and Food Standards Scotland to take on those responsibilities from day one?

Finally, the explanatory memorandum states that guidance is not required for this instrument as it generally maintains existing regulations and does not introduce new requirements. Given that this regulation was spread across 17 instruments previously, it presumably covered 17 different sets of guidelines. This concern was raised by the Local Government Association in the initial consultation, which suggested that the FSA or other organisations, such as relevant professional bodies, may wish to consider how clear guidance and assurance for councils on the new regulations could be provided.

The Proprietary Association of Great Britain has also expressed concerns about the FSA’s assertion that there would only be minimal, one-off familiarisation costs to local authorities and port health authorities, stating that cuts to local authority funding are such that some authorities do not have any full-time food and feed officers and that the time required for officers to read and understand the proposed regulations will impact on the already limited time that trading standards, environmental health and port health authority officers have to undertake enforcement activity. We know local authorities are already under intense pressure due to the covid-19 response, so will the Minister confirm whether he has spoken with colleagues in the Ministry of Housing, Communities and Local Government about whether councils do have sufficient capacity to carry out their duties in this important area? On that note, I will end my speech.

HEALTH PROTECTION (CORONAVIRUS, RESTRICTIONS) (SELF-ISOLATION) (ENGLAND) REGULATIONS 2020 HEALTH PROTECTION (CORONAVIRUS, RESTRICTIONS) (NORTH OF ENGLAND, NORTH EAST AND NORTH WEST OF ENGLAND AND OBLIGATIONS OF UNDERTAKINGS (ENGLAND) ETC.) (AMENDMENT) REGULATIONS 2020

Justin Madders Excerpts

Monday 19th October 2020 General Committees

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

It is a pleasure to see you in the Chair, Ms Fovargue.

I thank the Minister for her opening remarks. As she noted, today we are debating two SIs. The first numerically, No.1045, came into force on 28 September, and strengthens the duties on those who are required to self-isolate and increases penalties for non-compliance. The second SI, No. 1057, makes changes to the restrictions on the protected areas throughout the north of England.

In common with the Minister, for the purposes of today’s debate I will largely focus on self-isolation issues. But, first, I must refer again to the timing of the introduction of multiple SIs, particularly No. 1057. The Minister will be aware that my colleagues and I have consistently raised concerns about the way in which regulations are introduced. It is the view of the Opposition and of Members on both sides of the House that the regulations are too important not to be debated before they become law, and that full parliamentary scrutiny should be required. It will not have escaped anyone’s notice that we saw some progress on that last week when the new regulations on medium, high and very high tiers of restriction were debated in the Chamber before they came into force. After arguing in this room and others along the Corridor week after week for such debate, it would be churlish not to acknowledge the improvement in such scrutiny.

The SIs before us today are back to the old ways and bad habits, I am afraid. Last week, when we debated multiple SIs that related to face covering regulations, I noted that the Secondary Legislation Scrutiny Committee had pointed out that it is not helpful to have the law scattered across so many different SIs. That is exactly the case with regulation No. 1057. Although it has now been superseded, it actually amended four different SIs. That practice adds to the confusion about what is or is not lawful under health protection regulations at any given time. When we are asking people to comply with measures that are needed to protect public health, it is really important that we make that process as helpful as possible.

Because, once again, we are debating regulations several weeks down the line, much of the legislation is already out of date. The accompanying explanatory memorandum is also out of date, having been written before the new three-tier approach was introduced. I found it of little value to my understanding of what is still relevant for the purposes of today’s debate. I think the Minister has put me out of my misery by confirming what part of the regulations are still live. Regulation 3, however, which relates to restrictions on indoor gatherings and exceptions to that, has been superseded by the tiered approach that was introduced last week. I believe that regulation 4 on obligations of venues when taking bookings is still a live requirement.

[Catherine McKinnell]

On the point about clarity, everybody appreciates that this is an unprecedented situation that is difficult to manage, but the Government have to do better at communicating the decisions and changes that affect people’s everyday lives, because that is the only way that people will know how to best combat this virus. For example, three different sets of regulations for the north-east have been announced to us in three weeks. I have such admiration for the people of the north-east; they are erring on the side of caution and doing what they think is best. However, it is difficult to understand exactly what the requirements are, because we have the national rule of six, then we had local restrictions and now we have the tiers. I do not want to add to the confusion, but the Government really need to do better if they are to get the best results from any measures put in place.

[Justin Madders]

I thank my hon. Friend for her intervention, which was made in the right spirit for this critical time. It is difficult to understand exactly what is and is not in force at any one time. Our businesses, in the main, want to comply with the law. In fact, they would be foolish not to, given the level of penalty applied for breaking some of these regulations. I talked to some local publicans over the weekend, and they are petrified of asking the wrong question or doing the wrong thing in terms of who they can and cannot let into their pubs and so on. We all have a responsibility to try to explain the rules as best we can, but at the moment we are not assisted by the often confusing manner in which they are set out.

I make one final point on SI No. 1057. Paragraph 6.6 of the explanatory memorandum says of regulation 2:

“There is no practical effect from these changes”.

Clearly this was written before it was superseded, but our debating a regulation that apparently has no actual effect makes me wonder whether this is the best use of our time, and whether there needs to be more attempts to try to regularise regulations before they come before us.

I do not make these points to try to catch the Government out, because as I said, we are in broad agreement with the measures being taken. However, I make the point again that, because there is such a bewildering array of regulations, we are not clear what is and is not legal, so how can we expect our constituents to be? This is particularly important given the severe financial penalties and the health issues that the regulations are trying to prevent?

[Catherine McKinnell]

Something occurred to me as my hon. Friend was speaking: it is the way that we are legislating and regulating these activities that results in such confusion. If we follow the normal procedure of announcing an intention and Parliament debating it, we will get that automatic feedback on how the regulations will work in practice, problems will be ironed out and it will be legislated for, and the country will have been briefed directly through Parliament, rather than through the papers. I think that would run much better. If the Government go back to the normal way of doing parliamentary democracy, it might help our response to the pandemic.

--- Later in debate ---

[Justin Madders]

My hon. Friend is absolutely right. On many occasions, regulations have been laid—I think of the face-covering ones, for example—and points we have made about inconsistencies in the regulations have then appeared in subsequent regulations, showing the importance of parliamentary scrutiny. Of course I accept that, in a pandemic, things cannot always be done as quickly as possible, but certainly for self-isolation, which been a requirement from the very early days of the pandemic, there is absolutely no need for those regulations to have been introduced at such short notice.

[Matt Western]

To pick up on the point made by my hon. Friend the Member for Newcastle upon Tyne North, this issue is about confusion versus simplicity. Does my hon. Friend favour, as I do, the simplicity and clarity that the Welsh Government are giving, in contrast to the UK Government?

[Justin Madders]

My hon. Friend tempts me to go outside the scope of the regulations. His point about simplicity and clarity of message is vital. In the early days, when there was a clear, national lockdown, it was much easier to convey messages, but issues have become more complicated, and there are a whole range of areas where confusion and uncertainty arises, certainly about the self-isolation regulations. I will be taking the Committee through a number of examples of that.

The self-isolation regulations were laid before Parliament at 5 pm on a Sunday evening and came into force the following day. As we have already said, they contained significant requirements and penalties for individuals and employers alike. I do not think seven hours’ notice on a Sunday evening is the reasonable period of warning that we would want to see as the norm if we want people to understand and comply with the laws. It is not as if self-isolation is a recent development. The requirements have been in place for many months now, and with a little more thought and planning, we could have debated those regulations before they came into force. Nothing I have heard from the Minister today persuades me that there was an urgent need for the regulations to be enacted before debate in Committee.

As we heard from the Minister, the regulations strengthen the duties on those who are required to self-isolate, and increase the penalties for non-compliance. Regulation 2 states that adults who have been notified other than through the NHS app that they have tested positive for coronavirus, or have been in close contact with someone who has tested positive, must self-isolate in their home or another suitable place. Those who test positive are required to self-isolate for 10 days and those who live in the same household, or who have been in contact with someone who has tested positive, must self-isolate for 14 days. The regulation also makes it clear that they are responsible for ensuring that any child under the age of 18 in their household self-isolates.

Regulation 2 sets out the details of the people who are authorised to issue notifications regarding the duty to self-isolate, and states that notifications that are withdrawn are treated as never having been issued. It is not clear from the regulations what the process is following withdrawal, or in what circumstances such a withdrawal might take place. Could the Minister set out in more detail how a withdrawal or a proper notification might come about, and what the practical and legal consequences of such notification might be?

Regulation 3 sets out periods for self-isolation, which differ depending on whether a person has tested positive for coronavirus, lives in the same household as a person who has tested positive, or is a close contact of a person outside their household who has tested positive. As we have already said, clear communication is a key weapon in this fight. I will not recount the many confused and mixed messages we have had, but I will raise with the Minister a real and current concern I have with contradictory messages around self-isolation periods.

Regulation 3(3) states that the period of self-isolation begins on the day symptoms show and lasts for 10 days, but a number of my constituents, having had symptoms, have subsequently obtained a test, and have then been told by the Test and Trace system that their period of self-isolation of 10 days begins from the date on which they were contacted by Test and Trace. The official advice is clear, but this notification is causing confusion. Can the Minister take that away and investigate whether anything needs to change in the system and the messages it is putting out?

Can the Minister clarify the circumstances in which regulation 3(3)(a)(i) applies? Regulation 3(4) states:

“(4) The period ends with the final day of a period where regulation 2(1)(a)(ii) or (b)(ii) applies, of 14 days beginning—

(a) where P is living in the same household as the person (“C”) who tested positive for coronavirus—

(i) in a case where C, or R where C is a child, report to a person specified in regulation 2(4) of the date on which symptoms first developed, with whichever is the later of—

(aa) the date five days before the test pursuant to which notification referred to in regulation 2(1) was given”.

I quote that provision word for word because it highlights an issue to do with communicating what we are trying to do. I thought I was clear on when periods of self-isolation started, but the insertion of

“five days before the test”

in sub-paragraph (a)(i) makes me want to lie down with a hot towel over my forehead. I am trying to work out exactly what that means. People want to do the right thing, but this kind of language does not make it easy for them. When penalties are applied for not doing it, it is doubly important. We need to make it very clear exactly what the situation is in that part of the regulations.

Regulation 5 deals with the definition of “close contact”, which includes not only face-to-face contact within 1 metre, but

“spending more than 15 minutes within 2 metres of an individual”.

It is not expressly clear whether that applies regardless of whether face coverings are worn, but I would assume it does. I would be grateful if the Minister could confirm that when responding. It also includes

“travelling in a car or other small vehicle with an individual”,

which I presume is meant to exclude most forms of public transport such as buses, but may we have confirmation from the Minister of whether “small vehicle” is meant to cover all personal forms of travel or personal vehicles?

The bit in this regulation that I have more difficulty understanding is the exact remit of the phrase “close proximity” in regulation 5(c) regarding travel on an aeroplane. Is the Minister able to put “close proximity” into a measurable distance for the purposes of communicating this to our constituents?

Regulations 7 to 9 require a worker or agency worker to notify their employer of the requirement to self-isolate as soon as is reasonably possible. In addition, it prohibits employers or agencies from allowing them to work in any place except the place where they are self-isolating, and introduces fines for employers who knowingly breach the regulations. As my hon. Friend the Member for Newcastle upon Tyne North said, there are understandable concerns from individuals who are required to comply with the self-isolation regulations, because what is missing is any kind of extra protection for the employee or worker who might be on the receiving end of detrimental treatment from their employer for self-isolating.

Throughout our legislative landscape, there are protections for individuals in the workplace. There are protections for those raising concerns about breaches of the working time regulations or about health and safety in the workplace, and protections in whistleblowing legislation for those suffering detrimental treatment. However, we do not have any equivalent protection for the employee or worker who is required to self-isolate for any of the reasons set out in these regulations. I do not know whether that is a deliberate or an accidental omission, but it is concerning to me all the same, and it places the individual who is required to self-isolate in a very vulnerable position.

We need to make it as easy as possible for people to self-isolate, and not leave them exposed to detrimental treatment, such as refusal to pay sick pay, if they are entitled to it, or possibly even dismissal. There is nothing in these regulations to stop workers receiving punishment for self-isolating from a particularly unhelpful employer. I have heard concerns from constituents that their period of self-isolation would trigger a sickness absence review, or be used as part of an absence review process that is already under way.

It is quite possible that people will have to self-isolate on multiple occasions, because, say, other members of their household get symptoms or test positive, so I am sure we can all understand the genuine anxieties people have about telling their employer that they have to self-isolate for a second or third time. Why is there nothing in these regulations to give people workplace protections for doing the right thing?

The Government website advice page entitled, “Self-isolating after returning to the UK: your employment rights”—I accept that that is a slightly different situation from the period of self-isolation envisaged within these regulations, but it was the only advice page on the site that I could find on the issue of employment rights and self-isolation—talks about people working from home if they can. That is absolutely the right and obvious thing to do, but I am sure the Minister will appreciate that that option is not available to everyone.

The website goes on to suggest that as an alternative, annual leave could be taken. That raises the very interesting question of whether that advice would apply in this situation. I very much question whether we could call a period during which someone is legally required to remain at home annual leave. I would be grateful if the Minister could state for the record what advice has been given to employers on how they should classify a forced period of self-isolation.

I would like to make it clear that I am not at all comfortable with the idea of employers being able arbitrarily to designate a period of self-isolation as annual leave. There is a tension here with what the working time regulations allow; they state that in the absence of any other agreement, an employer can designate particular periods as annual leave. My question to the Minister is whether there is anything to stop an employer declaring to an employee that, as they will not be available because of self-isolation, they will be classed as being on annual leave.

That also raises the question of whether employers could put pressure on employees to take this period as annual leave, perhaps suggesting to them that if they do not, it will be classed as an unauthorised absence and will go on their employment record. It would be helpful if the Government stated clearly through guidance or regulations that a period of self-isolation should be classed as other leave, and cannot be classed as unauthorised leave, sickness absence, or annual leave that can be counted as part of any annual entitlement, and that it cannot be used in a disciplinary or capability process. If we are to improve compliance, it is important that we have that clearly set out.

[Catherine McKinnell]

There is another aspect. The economy faces a challenging period ahead, and businesses need to make savings. There will be employers who will not necessarily cite self-isolation as the reason why they are dismissing or penalising an employee. Although we cannot legislate for everything that an employer might decide to do, the Government could do a lot more to send the clear message that such behaviour is not acceptable and will be frowned on. It is socially unacceptable for any employer or business to treat any employee detrimentally for doing the right thing in relation to coronavirus. The Government could do much more to set a very clear tone on that front.

[Justin Madders]

My hon. Friend is absolutely right. When I practised employment law, I saw an amazing number of coincidences: when employees raised complaints about or concerns with their employers, other issues would suddenly be raised from out of nowhere, in a pushback against the employee; we are used to that. There is a role for the Government here. There is something we can do to give employees more confidence that they will not face adverse consequences for doing the right thing; that is what we are trying to achieve.

The intention of the regulations, as we know, is to increase compliance. The Minister referred to a study that the Department has undertaken. I presume it is the same one that I have read about in the media, which I believe has been analysed by members of the Scientific Advisory Group for Emergencies. Why did it take so long for that to come out, given that the study began in February? I will go into more detail on the findings of the study. It is reported that people were asked why they did not self-isolate for 14 days. Some of the reasons given included caring for a vulnerable person at 9.9%; going to work at 8.9%; and thinking that they had already had coronavirus and were immune at 10.4%. I hope that with greater public information and engagement, we will see a reduction in those giving the latter reason. The second reason will hopefully be dealt with by the self-isolation payment, but there is nothing I can see in the exceptions in regulation 2(3)(b) that covers the first of those situations.

I note that under the regulations someone can take their parrot to the vet when they are self-isolating, but they cannot provide care for their elderly grandparent. I am not for one minute suggesting that those who are self-isolating should do that. We do not want to risk those who are already vulnerable coming into contact with someone who has to self-isolate, but it is estimated that around one in eight adults, or 6.5 million people, is a carer. Some of those people will be asked to self-isolate, and will be unable to provide care as they would normally. Hopefully they will be able to find others in the family, or friends, to step in, but of course many family members are in the same household, and they might be required to self-isolate as well. There will be some tension when people who are asked to self-isolate have caring responsibilities that cannot be fulfilled. Is a Government strategy being adopted to try to take the pressure away from people in such situations, so that we can make sure that someone can step in and provide the necessary care when a carer is asked to self-isolate?

Perhaps the most concerning finding of the survey was that only 18% of people with symptoms self-isolated. That went down to just 11% among those who were told to self-isolate by Test and Trace. I know those figures have not been peer-reviewed, but this is the best information that we have. Can the Minister confirm whether that is the basis on which the regulations were formed?

As we know, there are questions about entitlement to self-isolation payments being tied to the receipt of universal credit, working tax credit, income-based employment and support allowance, income-based jobseeker’s allowance, income support, housing benefit and/or pension credit. Although around 4 million people are potentially covered by that, it is not everyone, and there may be those who are not in receipt of any of those benefits who do not receive any contractual sick pay, and so would be left trying to claim statutory sick pay or employment and support allowance. That is frankly not good enough.

We know SSP is far below the rates set for the self-isolation payment, and the Secretary of State himself famously said that he could not live on that amount. I ask the Minister whether there will be any consideration of whether to relax the restrictions on eligibility for this payment. We are asking those who are not eligible at the moment to take a reduction of 70% or 80% to their pay every fortnight. We are already seeing constituents who are not eligible for any support in significant financial hardship.

As my hon. Friend the Member for Warwick and Leamington mentioned, there is an issue about school children as well. This issue most notably occurs when parents are having to self-isolate to look after children who have developed symptoms or have been sent home on the instructions of the school. I ask the Minister whether there are any plans to look at the dilemma of parents of children who have been sent home from school and are not eligible for any payment.

Regulation 10 deals with enforcement and gives powers to an authorised person, such as a police officer, or a person designated by the Secretary of State to act in support of enforcement. It would enable such a person to direct people to return to the place where they should be self-isolating, and in cases where an authorised person believes that a child is repeatedly failing to comply, they may also direct the person responsible for that child to ensure compliance as far as is possible. It also sets out that reasonable force may be used to enforce the regulation’s requirements if that is necessary, and an authorised person is allowed to exercise power under this regulation only if they have reasonable grounds for believing that it is necessary and proportionate to do so.

Regulation 11 deals with offences under these regulations that are punishable on conviction by fines. Fixed penalty notices are available as an alternative. I will not go through the full list of offences that are created or the level of fines, as other hon. Members wish to speak. Suffice it to say that there is a considerable number in there.

The explanatory memorandum states that these regulations have

“a key role to play in slowing or preventing a rise in the rate of reproduction (R) of Covid-19 and reducing the total number of infected people”.

That is the overarching intention behind most of the regulations that we have been debating in recent weeks. The Secondary Legislation Scrutiny Committee has expressed its surprise that the explanatory memorandum failed to mention that it had been reported that these stronger measures are required as a result of the study that we have discussed, which mentioned low levels of compliance.

The Committee also noted its surprise that the explanatory memorandum did not mention the figure on compliance, or give the Government’s estimate of the numbers breaching quarantine, in support of policy changes. As the independent Scientific Pandemic Insights Group on Behaviours reported on 16 September, the rate of self-isolation is very low—less than 20%, based on self-reporting. It is particularly low among the youngest and poorest. It was an oversight for the Government not to mention that in the explanatory memorandum, and not to explain that that was part of the motivation for this regulation, if indeed that is the case,.

The Secondary Legislation Scrutiny Committee raised a concern about the potential for discrimination. As we have heard, regulation 2 requires someone to self-isolate where their sample tests positive for coronavirus, or where they have been in close contact with such a person. The exception is when they are notified by the NHS covid-19 smartphone app. That app cost £4 million, was rolled out many months late, and does not operate on phones that are more than five years old—and does not actually require people legally to self-isolate; I am sure that will come as a surprise to the millions of people who have downloaded it. That is about as far away from world-beating as possible.

The Department has confirmed the app has explicitly been designed to protect the anonymity of users, and the legal duty and fines do not apply to people notified through it. Instead, it will just advise the individual to self-isolate. The Department says:

“there is no discriminatory effect: the legal duty to self-isolate applies equally to anyone identified as a contact through standard contact tracing processes, whether or not they also happen to be an app user.”

This does raise questions about inequalities among certain groups, such as the elderly or those on low incomes who may not have the necessary technology to use the app. Although 14 million people have downloaded it, far more have not.

We know that the app is only accessible to those people whose phones have modern software, thereby excluding people who have older phones or no phone at all. Those people are typically poorer and older members of society. These groups are therefore more likely to be required to self-isolate through track and trace than through the app and are subsequently more likely to be in receipt of fines than those with the latest smartphones. The Committee pointed out that this raises concerns regarding the potential for avoidance.

The Government cannot track those who have been informed by the NHS app, creating a potential loophole for those informed by the app to avoid being fined for failing to self-isolate. If the Government do not know people are being contacted through the app, how can they be contacted? Again, there is a flaw in these regulations that there has been no impact assessment or consultation prior to their publication.

Returning to enforcement, the fines are substantial—an enormous sum of money to most people—but they are, of course, dependent on contact tracing working effectively. The most recent statistics show that only two thirds of people who tested positive were even transferred to the contact tracing system, and of those only 68.6% of close contacts were reached. That is a very low figure, almost as poor as when we first started, and it is lower for cases handled either online or by call centres. The overall proportion of people reached has decreased for each of the last three weeks and is similar now to when we first started. If we cannot actually get hold of people, how can we ask them to self-isolate? SAGE has warned that unless the system grows at the same rate as the epidemic and support is given to people to enable them to adhere to self-isolation, the impact of testing, tracing and isolating is likely to decline in future rather than improve, which is very worrying.

It is expected that around 4 million people will qualify for the payment, but as I say, significant numbers will not qualify. On 28 September, I tabled a written question some time ago asking how many applications and approvals have been granted for the self-isolation payment in the first week of its operation. That was a named day question due for response 11 days ago, but I have not had a response yet. Is the Minister able to update us on the uptake of self-isolation payments?

It is not just about the compliance, of course, it is about enforcement. We know that the police have expressed concerns about their ability to enforce all the regulations that have been introduced. I understand that over the weekend a memorandum of understanding was signed with police forces to enable them to access Test and Trace data. I would be grateful if the Minister clarified two points in that respect. Is it the case that until this date the police forces were not able to access the data? Will she comment on the point made by many in the medical profession, that the involvement of police may dissuade people from getting a test in the first place? The Minister said in her opening remarks that it is important not to discourage people from taking part in the system. Could measures be put in place to mitigate those concerns? Police forces have made it clear in relation to the recent introduction of fines for other offences that officers do not have the resources or capacity to enforce these fines. If the Minister is able to give us a realistic assessment of the resourcing for enforcement of these regulations, I would be most grateful.

I return briefly to authorised persons under regulation 12(12)(c), which gives the Secretary of State broad powers to designate officers for the purposes of these regulations. As I have already mentioned, these officers have the ability to use reasonable force to ensure compliance with the regulations. It is, I think, quite a worrying development that we have unspecified officers able to use reasonable force. Could the Minister set out who, if anyone, has been given that designation by the Secretary of State to carry out these functions, and, if so, what skills, experience, and training do they have in the use of reasonable force?

I would also like some clarity regarding the liability of parents where children fail to comply with the self-isolation regulations. It is set out that the authorised person may direct the person responsible for the child to ensure compliance as far as that is possible, but there is some indication that parents will be found liable, in terms of fixed penalty notices, for the actions of their children. How realistic is it to expect a parent to make a burly 16-year-old stay in the house for two weeks?

With regard to the fines issued so far, new data last week showed that this is a bit of a postcode lottery, with police forces issuing wildly different levels of fines. Some have issued more than 1,000, and others fewer than 100—this is across the spectrum of regulations to deal with coronavirus. Will the Minister comment on what appears to be a postcode lottery when it comes to enforcement of regulations and say whether any steps will be taken to ensure that there is no disparity in their application? I have asked on a number of previous occasions what additional resources will be given to the police to ensure compliance with regulations. Is the disparity partly to do with resources or other priorities, and what can the Government do to address that concern?

[Matt Western]

My hon. Friend is making some incredibly important points, but does he share my concern about hearing just a week or two ago that in Dagenham or Redbridge—I am not sure which area it was, but it was somewhere like that—the local authority was trying to enforce regulations, but was overturned by the Government?

[Justin Madders]

Yes, I did read that with concern. I am not sure whether it has been addressed with the new tier 3, 2 and 1 regulations that were introduced last week. Clearly, we cannot have a situation in which, on the one hand, the Government’s message is that the rules have to be applied equally, but on the other hand, authorities that want to take swift enforcement action are prevented from doing so. We have to apply the law consistently and firmly in a situation such as this.

I am nearing the end of my comments and I am aware that other hon. Members wish to speak, but I want to ask about other measures that the Department might introduce to ensure compliance with the rules, particularly given the suggestion that Test and Trace call handlers may now be contacting more regularly people who are self-isolating. Given the shoddy record so far from the likes of Sitel and Serco, I wonder whether it is the right move to divert staff to that, taking them away from their core responsibility of contact tracing. What steps is the Department taking to ensure that Test and Trace call handlers doing these additional contacts with people who are self-isolating will be able to carry on and have the same capacity to address those needing to be contacted in the system in the first place? Will those additional responsibilities now being put on these private providers result in additional payments being made to them outside their original contract? I do not know whether the Minister will be able to give us an answer on that today, but it is very important that we have some transparency in this area.

We will not be opposing the regulations today. We have long argued for greater support for those who need to self-isolate, but questions remain, particularly about eligibility and enforceability, not to mention many other areas that we have covered during the debate today. I appreciate that I have asked lots of questions. If the Minister cannot deal with them all in her response today, I will be more than happy if she is able to put her answers in writing in due course.

--- Later in debate ---

[Mr Harper]

I am not familiar with that local authority, but from my experience in my own area, I think the local authority in Gloucestershire would do a very good job, and I think that we would get better results.

The hon. Member for Ellesmere Port and Neston referred to data sharing with the police. Some of the headlines at the weekend were perhaps unhelpful, because they had the wrong impact. I do not know whether this was the Government’s thinking, but although one can argue that cranking up the toughness of the regime may have an impact on some people, to suggest that people may get into trouble with police may drive them away from testing and sharing their contact information. When one actually reads the information on the NHS website about how the data will be shared, it seems incredibly reasonable. In the first instance, it is shared with the local authority, and only if the local authority cannot make progress is it shared with the police. If the police are investigating a specific case, they can request it, so the impression of blanket sharing of information with the police was not helpful. I do not know whether that was the Government’s intention, but it was not entirely helpful.

My only question for the Minister is: has the memorandum of understanding between the Department and the National Police Chiefs Council been published? I have investigated but been unable to find it anywhere. It would be better if there was more transparency and we were clear about what information may be shared. We saw one of the potential risks at the weekend when the busy NHS covid-19 app Twitter account had to leap into action to reassure everybody that information from their mobile phones could not make its way to the police. The concern was that that would reduce the uptake and use of the app.

I perhaps hold a different view from the hon. Gentleman, because I was pleased that the Government changed tack and moved away from the central database option for the app and went with Google and Apple API, whereby the information is stored on a phone. A central database might have seemed attractive, but it would have reduced uptake and many people would not have wanted the app. Having more people use the app and being aware if they need to isolate, which is in their interest and that of the community, is better than having a central database and no one using the app because they do not want personal information being stored by the Government.

[Justin Madders]

We agree with that move, but we were trying to address the concerns expressed by the Secondary Legislation Scrutiny Committee about inadvertent discrimination as a result of use of the app.

[Mr Harper]

Point taken.

It is welcome that the regulations create an offence of falsely giving contact information, meaning that someone needlessly has to isolate at some considerable cost to themselves. Self-isolation is the equivalent of house arrest, which under the criminal justice system requires a high bar of evidence.

Under the regulations, if Test and Trace tells someone to self-isolate they must do so, but what procedures are available to challenge that? Some people will not have travelled on public transport or have met the criterion of having been closer to someone than 2 metres for 15 minutes. If they receive a message that they must self-isolate but know they have not been in contact with anyone, is there a mechanism whereby they can challenge that? I suspect the answer is that there is not because of the need of the person who has tested positive to be anonymous, but if that has been considered by Ministers I would like them to say so and accept that it is unfortunate but that there is nothing that can be done about it.

I am concerned about it because for those in this room self-isolation is not a massive burden: we are still paid and can do quite a lot of our job at home. But for some people self-isolation is a real problem, and if it is not necessary in order to keep the community safe I do not want people to have to do it and I do not want anything to damage their confidence in the regulations.

Regulation 2(3)(a)(i) states that somebody must self-isolate in their home or in the home of a friend or family member. When we were debating where university students had to self-isolate, I asked whether, if a university student or anyone else who potentially has more than one home tests positive, they have to self-isolate in their university accommodation. Clearly, they must not do what a Member of this House did and get on public transport to go to another place and put other people at risk. However, if they were able to travel from one location to another in a private car, for example, where they were not going to come into contact with anyone else, and the person they were staying with was perfectly happy for them to do so, is there anything in these regulations that prohibits them from doing that?

The reason I ask is that the Department for Education is putting quite a lot of effort into thinking about what changes might have to take place in the period running up to Christmas to enable students to go home. When I read these regulations, I could not quite see on the face of it any reason why even a student who had tested positive, if they could travel safely, with the agreement of their family and where there was nobody at particular risk, could not just go home anyway and have their period of self-isolation at home, while obviously taking appropriate precautions. I would be grateful if the Minister could clarify that.

The final point I will raise—I think I am perhaps a bit firmer on this than the Labour party—is that I have a particular reason to be unhappy with the enforcement powers in the regulations, particularly giving the power to use “reasonable force” to officers of the state. Let me tell the Committee briefly why I am very concerned about this, to the extent that I have already made it clear on the Floor of the House that I am not satisfied by the Minister’s answers I will seek to vote against these regulations even though I am completely in favour of people’s having to self-isolate.

I became a Minister in the Home Office shortly after some individuals who are being deported had sadly lost their lives as a result of poor restraint procedures on aircraft. We carried out a significant independent inquiry into that and into how to use force, if required, on somebody in a way that kept them safe. I have no problem with powers being given to police constables; they already have the power to use reasonable force and their use of reasonable force is governed not only by a number of pieces of primary legislation, but by common law. A new police officer has a five-day training course specifically on using reasonable force and has to attend a two-day refresher course every year. There is a national decision-making framework that officers are familiar with, which they use to make those decisions, and in all their safety training that they are assessed to ensure they understand how to use reasonable force and what their legal requirements are. They also have to state the length of time since their personal training and refresher course when they use force, and any use of force by a police officer is reviewed by an independent panel.

That part of it I am fine with, but I have a real problem with the other three groups of people being given that power. People may not be aware that police community support officers do not have the power to use reasonable force except to detain someone until a police officer arrives. They do not have the power to use force any more than a member of the public does, and they do not go through all those training procedures that I have just talked about. I have no idea what sorts of people the,

“person designated by the Secretary of State”,

will be, but I want to know who we are thinking of and what training they have undertaken to ensure that this is safe.

The final group is officers designated by the local authority. I do not want local authority employees having the power to use reasonable force. I do not think the Ministry of Housing, Communities and Local Government does either, because if we look at the regulations that the House approved last week on tiers, there are powers to use reasonable force in those, and although they still include the powers to use reasonable force for police community support officers, the powers available to local government employees have been constrained to a specific part of the regulations. They have been narrowed—I am still not happy with them, but they have been narrowed.

The reason why that is important is that we are talking here about using force on people with coronavirus. In itself, that is a risk. Giving the power to use reasonable force to agents of the state is a big deal. We do not generally give state employees the power to use reasonable force to detain and move people. That is a limited power. Because of all the regulatory requirements, where we give that power to police officers, there is a huge number of controls around it, quite properly. Unless the Minister can give me a very good reason why the powers are here, and say what the thinking is behind them and what steps the Government have taken to make sure they will be exercised in a safe manner, I cannot support these regulations.

Not everyone will feel the same way as me, but I have been a Minister with this responsibility, and have seen what happens when powers like these are used inappropriately: they lead to deaths. I do not think they should be here. Frankly, we should take these regulations away and strip those powers out. They should be given only to police officers—people trained to use them, and who know how to use them when all the appropriate safeguards in place. This is incredibly serious. I conclude there, to give the Minister time to answer our questions in the remaining 20 minutes.

Botulinum Toxin and Cosmetic Fillers (Children) Bill

Justin Madders Excerpts

2nd reading & 2nd reading: House of Commons
Friday 16th October 2020 Commons Chamber

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

I welcome this debate, and I do not intend to take up too much time, as my party supports the Bill, as I think do all Members who have spoken today.

As we know, cosmetic procedures such as botulinum toxin—or Botox, as it is more commonly known—are used to reduce the appearance of wrinkles, and dermal fillers are used to fill out wrinkles and creases in the skin and to fill the cheeks and lips. Those procedures are becoming more and more commonplace. While the effects of the procedures are not permanent—usually lasting three to four months or six to 18, depending on which procedure has been undertaken—it is recommended, as with all cosmetic procedures, that they should be carried out by an experienced and suitably qualified practitioner.

As we have heard, there are a number of associated risks. Although side-effects are rare, in the worst-case scenarios they can include infection, scarring and tissue death, as well as psychological problems. We have heard a number of stories about serious issues and problems arising from these procedures. It is, then, a concern that currently there are no statutory provisions to restrict access to these procedures for children and young people. As has been said, they should be on a par with other appearance-related procedures, such as tattoos and sunbed use, for which there is already a statutory minimum age of 18. The measures in the Bill are necessary to protect young people from the serious consequences of uninformed and unregulated procedures. The hon. Member for Wantage (David Johnston) summed up the mood of a number of Members when he said he could not believe that this was not already covered in law.

In 2013, the Keogh review of regulation of cosmetic interventions called for greater protection for vulnerable people, noting that young girls in particular were becoming more concerned about their appearance, as we have heard from several speakers. A Mental Health Foundation study found that 40% of teenagers said that images on social media cause them to worry about their body image. Be Real’s “Somebody Like Me” campaign found that 36% of 11 to 16-year-olds throughout the UK would do “whatever it takes” to look good, including considering surgery. Whatever it takes—what a chilling phrase in this context. Worryingly, Save Face, a national register of accredited practitioners who provide non-surgical cosmetic treatments, has reported increasing numbers of complaints from under-18s who have suffered at the hands of unregulated practitioners.

For too long we have not had the robust, consistent and enforceable standards that we need for these treatments and there has been no accountability for malpractice. The absence of standards leaves practitioners with no support and customers with no guarantee of safety. The Bill is a big step in terms of addressing those issues. I congratulate the hon. Member for Sevenoaks (Laura Trott) on bringing the Bill to the House and on her hard work. As we have heard, it is quite a lot of work to get a private Member’s Bill not only debated but passed into law. Her introductory speech was compelling and she made a powerful case about the need for additional safeguards. She was right to say that some of the examples of malpractice that have impacted on women’s health go far beyond today’s discussion, but there are a number of other examples of where things have gone on for too long without intervention.

I wish to recognise the contributions from the other hon. Members who have spoken today. There is clearly a great deal of knowledge and expertise in this debate. The hon. Member for Bosworth (Dr Evans) in particular gave us a comprehensive overview of the medical aspects of this issue. He was absolutely right about accountability being at the heart of the Bill. Most Members spoke about the pervasive influence of social media in particular and its impact on young people in terms of the pressure that it puts on them. Clearly, that is beyond the scope of today’s discussion, but there is certainly a mood in the House in favour of doing more in that policy area.

While I am talking about Members’ contributions, I wish to pay tribute to the work of the all-party group on beauty, aesthetics and wellbeing, and particularly its co-chairs, my hon. Friends the Members for Swansea East (Carolyn Harris) and for Bradford South (Judith Cummins). The group has been highlighting the lack of age restrictions for these procedures and has also raised concerns about advertising and social media promotion that leaves young people vulnerable and at risk. The group’s inquiry on non-surgical cosmetic procedures is the first to assess the regulation of such procedures and its adequacy. The inquiry has brought together people from across the sector to talk about the lack of robust, consistent and enforceable standards and the all-party group is looking to reach consensus on those issues. The inquiry is still ongoing, but I am sure that when it reports it will be a helpful tool for the Government in respect of future legislation, should any be necessary.

Coming back to the Bill itself, as we know, it is intended to safeguard children from the potential risks associated with these procedures. The Bill prohibits specific cosmetic procedures, commonly known as botox and dermal fillers, being performed on young people under the age of 18 in England for purely aesthetic purposes, although, as I understand it, the procedures will still be available to under-18s through registered health professionals where there is an assessed medical need. The Bill provides that the administration of botulinum toxin and cosmetic fillers by injection on a person of the age of 18 will be an offence and that the person who commits that offence is liable on summary conviction to an unlimited fine. The Bill also imposes a duty on businesses to ensure that they do not arrange or perform procedures on under-18s and that will be enforced by a local authority regulatory regime.

The offence is a strict liability offence, which means that if it is committed by a business, or arrangements are made for the administration of one of the substances covered by the Bill for a cosmetic purpose, it will unfortunately be found guilty automatically. However, a defence of reasonable precautions and due diligence will be available to businesses if they can demonstrate that they took all reasonable precautions and exercised due diligence to require proof of a person’s age before any procedures took place. The Bill, if it becomes law, will also provide that any body corporate that commits an offence, or if one is attributable to the neglect of an officer of the body corporate, then that officer, as well as the body corporate, will be guilty of the offence.

Finally, although the Bill does not create any new enforcement or investigatory powers, it does set out that local authorities can enforce the provisions in the Bill using their powers available under schedule 5 of the Consumer Rights Act 2015. Clearly, these are significant new responsibilities for local authorities. Of course we have expressed concern over the way that councils have had their funding stripped over the past decade, so it does raise questions about how comprehensive the enforcement regime will be. That probably is an issue that this House will return to on many other occasions, but it is not a reason for us to reject the Bill today. I conclude by welcoming what the Bill seeks to achieve, and I wish it a speedy passage through the rest of its parliamentary process.

Public Health: Coronavirus Regulations

Justin Madders Excerpts

Tuesday 13th October 2020 Commons Chamber

[Dr Luke Evans (Bosworth) (Con)]

On buying-in the local community, would the Secretary of State consider having a Government postcode checker so that people know exactly where they should be, in having the three tiers?

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

That was my idea.

[Matt Hancock]

My friend, the hon. Member for Ellesmere Port and Neston (Justin Madders), says from a sedentary position that that was his idea, but success has many fathers and I can tell my hon. Friend the Member for Bosworth (Dr Evans) that such a postcode checker was launched this morning. I will send him the link. It is still in beta, so it will be constantly improved, not least to ensure that, if a postcode covers an area that is in two different levels, that is clear. That is being sorted at the moment. A postcode checker is a great idea. It tells you the level of local risk. Furthermore, the NHS covid app, which has now been downloaded by over 17 million people, has a link to the local alert level as well.

To turn back to the measures before us, we will keep the measures under constant review. The overarching regulations sunset after six months, but regulation 8(1) of statutory instrument 1105 makes clear that the allocation of a particular area to local alert level 3 will automatically expire after 28 days. We will work with local areas on the level they need to be at and that work continues at pace. Decisions to move local areas between the levels will be considered by the JBC, working across Government and with local government on the normal weekly cycle. While, of course, there will be times when we need to act quickly to contain the virus, we want to give the House the opportunity to consider the measures on the medium and high local alert levels, and the baseline measures for the very high alert level. I urge the House to support the measures set out today.

Draft European Qualifications (Health and Social Care Professions) (EFTA States) (Amendment Etc.) (EU Exit) Regulations 2020

Justin Madders Excerpts

Wednesday 7th October 2020 General Committees

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

It is a pleasure to serve under your chairmanship today, Ms Fovargue.

I thank the Minister for his introduction to the regulations. Dry and technical though they are, they are none the less extremely important, as he outlined. As we have heard, the regulations seek to implement parts of the Swiss citizens’ rights agreement and the EEA EFTA separation agreement concerning RPQ—the recognition of professional qualifications of health and care professionals and those that are not covered by the existing “no deal” RPQ legislation, which was adopted in March 2019. As we also heard, these regulations will also make minor corrections to the 2019 EU exit regulations.

Current EU law sets out a reciprocal framework of rules for the recognition of doctors’ professional qualifications. This enables EEA and Swiss nationals to have their qualifications recognised and gain access to the regulated profession in which they are qualified, in order to work on a permanent or temporary basis. After the end of the Brexit transition period, those arrangements will no longer apply to the UK because current legislation to implement them will not operate effectively.

New provisions detailing the route that EEA qualified health and social care professionals will take to join the register were added in March 2019. The regulations ensure that the same provisions are available for Swiss and EFTA qualified health and social care professionals.

With just under three months until the end of the transition period it is not only right but prudent to put arrangements in place to clarify how Swiss and EFTA health and social care professionals will join the relevant UK medical registers. That is vital to mitigate any possible disruption to the NHS medical workforce, and it is a matter of regret that we are dealing with this rather late in the day. I am sure that the individuals concerned would have liked greater certainty earlier, but we are where we are.

I have several questions about the possible impact of the regulations on the delivery of health care. As we know, the nationals of the EU and other countries make up 9.1% of doctors in England’s hospitals and community health services. They account for 6% of all nurses and 5.8% of scientific, therapeutic and technical staff. Given the record number of NHS vacancies, there is clear potential for workforce disruption if EEA and Swiss nationals cannot register in the UK. We must do all that we can to minimise that risk in a no-deal scenario. That is a particularly important consideration given that, prior to the covid-19 outbreak, there were 106,000 vacancies across the NHS, including 44,000 nursing vacancies and around 120,000 vacancies in social care.

There is no doubt that the current workforce challenge has been exacerbated by the referendum result, or since then at the very least. The percentage of doctors and nurses with EU nationality grew between 2009 and 2016, but since then the percentage of EU national nurses has fallen and the Nursing and Midwifery Council has reported that the number of people from the EEA on its permanent register has decreased steadily from 38,024 in 2016-17 to just 31,385 in 2019-20, with 1,650 people, or equivalent to 5%, leaving the register in the last year. At the same time, the number of EU nurses and midwives coming to work in the UK has also fallen from 6,382 in 2016-17 to just 913 who joined the register in 2019-20.

Given the contribution of EEA and Swiss-qualified professionals to the NHS, it is vital that we stem the tide of vacancies. For that reason, when we debated the previous regulations more than 18 months ago, I asked the then Minister what assurances he could give that the NHS would be able to stem the huge losses of those important health and social care staff. Given the numbers I have cited today, I ask that question of the current Minister.

The Government have previously acknowledged that changes to the procedures for recognising qualifications could make access to health and care professions more difficult. That too could affect the availability of professionals. Given that no impact assessment was published alongside today’s measure, can the Minister confirm whether any study has been made of the costs or barriers that may prevent applicants from the EEA and Switzerland from entering the country, and the possible impact on the health service?

Can the Minister clarify who would be captured by enforceable EU rights, as drafted? I know that EU regulators have raised concerns about that. The regulations allow a four-year period for Swiss and certain UK nationals who have professional qualifications, or are in the process of obtaining a qualification before the completion of the transition period, to apply for recognition under pre-exit rules, and that includes those with third-country qualifications that have been recognised or are in the process of being recognised in Switzerland at the end of the transition period. Regulators are concerned that it is not clear whether that requirement is just intended to capture third-country nationals with enforceable EU rights or EEA nationals with enforceable EU rights. I understand that the current drafting refers to third-country nationals, which appears to suggest that it applies to the former example rather than to the latter. Some regulators are calling for clarity and guidance so that they can operate within the new rules from 1 January 2021. Can the Minister confirm that such guidance will be available ahead of that date?

Although it is clear that the regulations are temporary, there is no clarity about plans to introduce sustainable, long-term arrangements for registering and licensing EEA and Swiss nationals. Will the Minister give us some further information on what plans he has beyond the current timeframe, and the four-year period provided for by the statutory instrument? I recognise that the measure is an improvement on where we were before, but clearly work will still need to be done at the end of that four-year period, so can he confirm that he will work with health and care regulators to design a bespoke system for the recognition of professional qualifications? How will he ensure that such a system puts patient safety at the forefront, applies consistent standards and is fair and transparent for all overseas-trained professionals to join the relevant professional register, regardless of where in the world they qualified?

Finally, the impact on UK professionals wishing to work in the EEA must not be forgotten. Of course, under the current rules, up until the end of 2020 the current UK qualifications will be recognised in other EEA member states under the current legal framework. But while the amendments to the Medical Act 1983 that were adopted in March 2019, and which are being tweaked by today’s regulations, allow for the majority of EEA-qualified professionals to have their qualification recognised by UK regulators after the end of the transition period, those provisions are not automatically mutually reciprocated by the EU. So, after 31 December 2020, UK nationals and EEA nationals holding a UK medical qualification will be treated as third-country nationals if they seek to have their qualification recognised in an EEA state. Has the Minister had any discussions with his EU counterparts about the impact on UK professionals wishing to practise in the EU after the end of the transition period? I think he said there were some talks about mutual recognition, but can he confirm whether EU countries are intending to continue to recognise UK qualifications once that becomes a matter for the regulators in the EEA area? Does he have an estimate of how many UK professionals will be affected by that issue?

We do not oppose the regulations or what they seek to achieve. We recognise, as the Minister—and I believe every hon. Member—does, the valuable contribution to the NHS of staff from the EEA and Swiss areas.

[Edward Argar]

It is, as always, a pleasure to serve opposite the shadow Minister, who always approaches these debates in a spirit of common sense and constructive challenge; so I am grateful to him, although I am not quite sure what I should read into his reference to me as the “current” Minister, and whether he knows something that I do not. Maybe it is a reflection on the number of my predecessors that he has seen standing in this place opposite him during his tenure.

[Justin Madders]

I meant that the Minister is a very talented individual, and no doubt will be elevated to higher service in the not too distant future.

[Edward Argar]

The hon. Gentleman is very kind, but I am not sure whether his comments will help or hinder that cause—as the Whip takes note.

The hon. Gentleman is right that the statutory instrument is dry and technical but important. It represents our taking—in co-operation with the Opposition, for whose support we are grateful—a prudent series of steps to help address concerns about what will happen for those professionals from this country who work in Switzerland and EFTA and, likewise, the reciprocal rights.

The hon. Gentleman asked several questions; I will try to respond to them all. He mentioned the timing. Everyone would wish that we were able to bring measures such as this forward as soon as possible, to give those affected as much time as possible to prepare, but in the nature of things, with all the multiple strands being negotiated, these matters came to be negotiated after the 2019 SI and we have brought them forward as soon as we could following the conclusion of those treaties.

The hon. Gentleman reflected a great deal on workforce numbers, and the impact on the workforce more broadly of the decision in the referendum to leave the EU and what steps we were taking to ensure that the NHS and social care continued to have the numbers they needed to provide the extraordinary service that all those professionals perform for people. He was right to highlight a small drop in the number of registered nurses from EU and EFTA countries—although I would point out that the number of doctors from those countries has remained broadly constant since 2016. Actually, that small reduction has been more than offset by the significant increase in the number of nurses coming from outside EU and EFTA states—an increase of around 29,500. In reply to his perfectly reasonable question on what guarantees, what reassurances, I can offer about the continued supply of nurses, doctors and social care workers to our caring services, I remind him that the Government are well on target to meet their pledge of 50,000 more nurses in the NHS in the course of this Parliament. I think—I may be slightly out—we are well over 13,000 up. While I note his point, if we look at the overall nursing, social care and medical workforce in the round, any slight reduction from EU sources has been more than offset by increases from elsewhere.

The hon. Gentleman asked whether there were any other costs or barriers or assessments thereof for Swiss or EFTA nationals. None has been drawn to our attention. The regulations address one of the key things that was a risk and a barrier, but if he is aware of any specific issues, I am happy for him to raise them with me.

The hon. Gentleman’s final point was on EU enforceable rights. I will endeavour to give him clarity. This answer is slightly technical, so if he feels his question is not answered fully, I am happy for him to write to me following the Committee and I will try to provide more detail. The regulations apply to both Swiss nationals with qualifying professional qualifications and to a national of a third country who has an enforceable EU right through their relationship with a Swiss national. That means, in effect, that spouses and dependants of Swiss nationals must have their health and care qualifications assessed in the same way in which a Swiss national would. There is a single exception relating to EU nationals who are spouses or dependants of particular groups. I will write to him with some of the technical points around that if he wishes, because I think he seeks a greater degree of clarity.

The hon. Gentleman also raised more broadly the long-term arrangements for the EU workforce in our health and social care sector. I would have been surprised had he not done so. My answer, which will not surprise him—I suspect it is the same one he has received from many of my predecessors—is that these are matters outwith the treaty and outwith Switzerland and EFTA. They are matters for the ongoing negotiations with the EU that we are engaging in continuously and constructively. I do not want to prejudge the outcome of those negotiations, but I hope that both sides can find a way forward to an agreement in the coming weeks.

Question put and agreed to.