Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) Regulations 2021

Lord Bethell Excerpts

Tuesday 20th July 2021 Lords Chamber

Moved by

[Lord Bethell]

That the draft Regulations laid before the House on 22 June be approved.

Relevant documents: 8th and 10th Reports from the Secondary Legislation Scrutiny Committee (special attention drawn to the instrument)

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con) [V]]

My Lords, more than ever, the social care workforce demonstrates unwavering compassion and dedication for our elderly and most vulnerable. We are proud of and immensely grateful to them. I pay huge tribute to their tireless work during this pandemic to protect people who are most vulnerable to Covid-19, including their incredible efforts to support the vaccination rollout across the sector, to bring in infection controls and to provide pastoral care during this most heartbreakingly lonely episode.

To date, 1.2 million social care workers in England have been vaccinated. This is an incredible achievement and an important step for staff to protect themselves, their loved ones and the people they care for from becoming seriously ill or potentially dying from Covid-19. However, there is a tipping point here. It is a tipping point of safety when it comes to care homes, where many of our most vulnerable priority-list loved ones live. We are not quite there yet.

SAGE recommends that 80% of staff and 90% of residents should have received their first dose of the vaccine to provide a minimum level of protection against coronavirus outbreaks. We have all been witness to the incredible pace at which vaccination programmes have been rolled out. I am delighted to report to the House that 96% of those living in older-age care homes have received their first dose and 93% their second dose. Meanwhile, 93% of those living in younger-age care homes have received their first dose and 88% their second dose.

In many places, take-up among care home staff is also impressive. Some 87% of those working in older-age care homes have had their first dose and 76% their second dose. This compares with 83% and 73% respectively for staff working in younger-age care homes. However, there is also significant variation at a regional and a local level. Only 65% of older care homes in England are meeting SAGE’s stipulated safety tipping point in the latest published data. This drops to an even more worrying 44% in the London area.

As a result, despite very high levels of vaccination, testing, PPE and other infection control measures, we are still seeing outbreaks in care homes, where residents are incredibly vulnerable to the serious effects of this terrible disease. Since January this year, care homes have tested staff more than 21 million times and made proper use of 1.2 billion items of PPE. Yet nearly 14,000 care home residents have died because of the virus this year alone.

This winter will be challenging and, in the face of rising case rates across the country, we need to make sure that we have done everything we can to prepare and to minimise the risks for residents in care homes and the incredible staff who care for them.

This is the context. It makes this legislation critical. By November this year—and subject to the usual parliamentary approval and, we hope, a helpful and practical 16-week grace period—anyone entering a CQC-registered care home in England must be vaccinated, unless a valid exemption applies. This will apply to all care home workers, agency staff and volunteers. Visiting healthcare workers, tradespeople, hairdressers and CQC inspectors will also be obliged to follow the new requirement.

We have considered this policy incredibly carefully, consulting thoroughly and extensively to get this right both for residents who are so vulnerable to Covid and the staff who go above and beyond in caring for them every day. The policy will therefore apply to all people over 18 who work inside a care home unless they have a medical reason not to be vaccinated.

Further limited exceptions have been made to ensure that this works on the ground. Emergency services, people providing emergency assistance and those undertaking urgent maintenance work can all enter a care home without needing to show that they are vaccinated. Visiting family and friends are also exempt, given the significant well-being benefits such contact provides. While we would always encourage all these people to take up an offer of a vaccine, we have acted on the advice from SAGE that a balance must be struck.

Before I turn to our assessment of the impact this may have on the workforce, I acknowledge the vital role the Secondary Legislation Scrutiny Committee has played in its calls for further details outlining the Government’s current analysis of the expected impact of the draft regulations. Following its eighth report, we made an impact statement available to this effect, and we note the further points raised in its 10th report yesterday. I can also confirm to the House that we will be publishing a full impact assessment as soon as possible.

After everything care home staff have done in the pandemic, we owe them the greatest consideration and respect. We understand that providers and their staff need time to prepare for these changes, which is why the 16-week grace period immediately following the enactment of regulations will allow staff who have not been vaccinated to make arrangements to have both doses. Unfortunately, we recognise that there will be some staff who will choose to leave rather than be vaccinated. Our central analysis estimates that around 7% of current staff may not meet the requirement by the end of the 16-week grace period. This equates to 40,000, out of a workforce of 570,000, who may need recruiting to replace staff who do not meet the requirement.

However, this estimate is very uncertain. We just do not know yet exactly how staff will respond to the requirement, not least because staff turnover in this sector is around a third each year. I am grateful to Professor Martin Green of Care England for talking me through these concerns. Of course, we do not want to lose valuable care home staff who have made an enormous sacrifice over the last year and a half, and we will continue our efforts to drive uptake across the sector. We owe it to ourselves and to their commitment to try our hardest. However, our overriding priority has to be the safety and well-being of the people they care for.

Before closing, I pay a final tribute to all care home staff, past, present and future, who have played a vital role in our nation’s recovery from the pandemic. We did not take lightly the decision to introduce this legislation. However, the risks that this winter will undoubtedly pose to the most vulnerable in our society make clear the choice that we must make: to do everything in our power to protect them. With that sentiment in mind, I commend these regulations to the House. I beg to move.

Amendment to the Motion

Moved by

--- Later in debate ---

[Lord Bethell (Con) [V]]

My Lords, I thank noble Lords for their considered questions and huge interest in the instrument laid before us today. Tragically, there have been more than 30,000 deaths recorded among care home residents during this pandemic. We have a duty to do all we can to prevent further suffering. Testing,PPE and infection prevention can go only so far in the mitigation of risk. Ensuring very high levels of vaccination for people living and working in care homes is an essential public health intervention for a serious vaccine-preventable disease.

To answer my noble friend Lord Lansley, the residential care workers covered by these regulations are handling the most vulnerable and elderly in priority list 1, which is why we started with them. Forthcoming consultations will address those who work with priority lists 2 to 4 and, in response to the noble Baroness, Lady Brinton, we may ultimately consult on extending further into the rest of the health and social care workforce. My noble friend Lord Lansley asked about resources. Our focus has been on ensuring that the social care sector has the resources it needs to respond to the pandemic. On 27 June, we announced a further £251 million of adult social care Covid-19 support, through an extension of the infection control and testing fund.

I say to my noble friend Lady Foster, who spoke with such passion on individual choice, that it is worth bearing in mind that many people are not afforded much, if any, choice in who cares for them. We have heard from people with lived experience of care. They want to know that the person who cares for them is vaccinated. I am not instinctively a supporter of mandatory measures. I note my noble friend’s philosophical points on this with great interest. I am even less keen to impose obligations on those people just at the time when the rest of society is opening up around them. But the noble Baroness, Lady Tyler, put it very well. She made a strong case, with moving personal testimony, that it is right that we protect the most vulnerable, even if it would take us further than we would normally go. We simply cannot be in a position where those most in need of care and the highest level of protection from the threat of Covid face a lottery of risk depending on the level of vaccine uptake by those working in their care. My noble friend Lord Cormack has spoken on this on several occasions extremely movingly.

It is not our intention to compel anyone to take the vaccine against their will. We can, and should, make it an essential criterion for working in care homes—to make it an explicit duty of care, providing peace of mind to colleagues, residents and all who visit. Barchester, a large care home provider with over 16,000 staff, already requires staff to be vaccinated. The evidence there gives us real cause to be hopeful, showing that, having taken the time and effort to engage with employees, understand their concerns and encourage them to take up the vaccine, only 0.5% of staff left the workforce. I reassure the noble Baroness, Lady Wheeler, that there have been huge efforts to drive vaccination take-up among care home staff in recent months already. In response to the noble Baroness, Lady Brinton, and others who have spoken on this point, I would welcome the opportunity to update noble Lords on these efforts, in detail, at a suitable briefing.

We have heard the arguments made by the noble Baroness, Lady Tyler, that social care teams need support. That is exactly why vaccination teams have visited care homes to offer vaccinations to both residents and staff, with actions at the national, regional and local level to improve access and address concerns. To answer the concerns of the noble Baroness, Lady Wheeler, on guidance, I reassure the House that we recognise the need to introduce these changes with the utmost care and sensitivity. To the noble Baroness, Lady Brinton, we are working with representatives from the sector to produce detailed operational guidance to support implementation. The noble Baroness, Lady Tyler, is right that the implementation is complex, so we will also be working with Skills for Care, the charity focused on workforce development, to ensure that guidance and best practice are available to support providers and local authorities. I say to the noble Lord, Lord Campbell-Savours, that the wearing of masks in a care home setting is properly governed by regulations. I reassure him that the guidelines are rigorously enforced.

I will address the heartfelt, tough and, if I may say, challenging remarks of noble Lords on the impact statement. I reassure noble Lords that this Minister, this department and this Government fully respect Parliament, and the scrutiny and challenge brought by Parliament and this House. We have published an impact statement. I say to the noble Lord, Lord Hunt, that there is no question of us trying to hide that. But it is very complex. I hope the House will appreciate that there is an enormous amount about this pandemic that is unprecedented. The noble Lord, Lord Hunt, put it well. We cannot be sure how staff will react to this unprecedented measure. That is what drives the financial model, but how do we know how many will leave the sector or take a lateral move to a non-sensitive role?

Much about the vaccine has confounded expectation. Who would have thought a year ago that the take up of the vaccine among the elderly would be in the mid-90% range, or that the take-up among the young would be incredibly encouraging? As I said, one major care home provider has already brought in such a measure and saw a drop-off of less than 1%. That is why the drafting of the impact assessment has been such a struggle. There is no question of hiding or of misleading the House. We are working with partners to generate the most credible calculations possible. We will publish the impact assessment as soon as possible and we are using this time to hammer out the best estimate we can.

To the concerns of the noble Baroness, Lady Wheeler, I say that it is right that we start with care homes, where residents and staff are the top priority, and we intend to consult further on the rest of health and social care. It is also right to acknowledge the important role of the Joint Committee on Statutory Instruments in considering the regulations. I acknowledge fulsomely the vital role of the Secondary Legislation Scrutiny Committee in scrutinising the legislation and holding the Government to account. We are particularly grateful to the committee for giving us the opportunity to explain the policy in further detail in an evidence session last week.