Winterbourne View Hospital and the Transforming Care Programme

Mark Harper Excerpts

Thursday 10th June 2021 Westminster Hall

[Mr Mark Harper (Forest of Dean) (Con)]

Thank you, Ms McVey. First, let me put on the record a declaration of interest: I chair the all-party parliamentary group on learning disability, so that is the context in which I am speaking. Mencap, which provides the secretariat for the APPG, has provided a very helpful briefing for the debate, which it has made available to all Members.

It is a great pleasure to follow the hon. Member for Worsley and Eccles South (Barbara Keeley). I do not propose to repeat everything she said, although I agree with the large bulk of it and the thrust of her remarks. I want to focus on the specific commitments that the Government have made. I am afraid—I say this with no great pleasure as a Government Back Bencher—that the Government have missed commitments on a number of occasions. I want to put on the record some very specific questions for the Minister about what the Government are doing to ensure they hit the revised targets that they have set out. I also want to remind people listening that the Government have now made a clear commitment to introduce proposals to reform social care this year. I know the Minister is well aware, as is the shadow Minister and everyone present, that social care does not just include care for older people; it includes care for people with disabilities.

I say that is because, when the public conversation happens, after about five seconds it immediately turns into a discussion only about older people—usually older people in a residential setting. We tend not to talk about older people who receive domiciliary care that enables them to stay in their homes, and the media do not focus on the fact that, actually—I think it is still the case—the majority of public spending on social care in England is not on older people; it is on people of working age. If we are to introduce social care reforms, they will not be worth having unless they properly encompass people of working age, including people with learning disabilities or autism. They will need to be very different reforms from those that deal with older people, because although many older people, though not all, have assets that enable them to make a contribution—obviously we will have a debate about the appropriate level of contribution—people of working age do not have such assets, particularly if they have been disabled from birth. If we were to have a means test of any description, we would simply build in a new barrier to people of working age with learning disabilities or autism getting into the workplace and working, which is what most of them want to do. Most of them are able to do so if we provide the tools.

I want to focus specifically on some questions for the Minister. I am mindful about what you said about ensuring we can get everyone in, Ms McVey, so I will try not to make my remarks too lengthy. The hon. Member for Worsley and Eccles South set out the various targets that have been missed. As I said, I take no great pleasure in that as a Government Back Bencher, so I will not repeat all the misses. I want to focus on the latest target in NHS England’s long-term plan, which is to deliver a 50% reduction in in-patient beds by March 2024.

First, I want to ask the Minister whether the Government have done any thinking about whether the 50% reduction is ambitious enough. It would be ideal if we did not have anybody in such settings and we were able to support almost everybody in the community. Perhaps the Minister could comment on whether the target remains ambitious enough. Given that the original target was to deliver a 35% to 50% reduction by March 2019, and that another five years has been added on and we are only in 2021, is March 2024 an ambitious enough target to hit the 50% reduction? Given that the previous targets have been missed, I accept that it might seem ridiculously ambitious to talk about introducing the latest target. However, given that we have let it slip by another five years, I want to test whether it is actually the right target.

The second thing is to focus on how we will reach the target. The hon. Member for Worsley and Eccles South rightly said that the only way we can really stop people being in those institutions is to provide proper support in the community. The Government have set out how they will do that with their transforming care plan and objectives about building the right support. I understand that the intention is that a cross-government action plan will be produced, so it will be helpful if the Minister will tell us how that is going and when it will be published. To what extent will the proposals to reform social care that are being worked on improve or transform care in the community for people with learning disabilities and autism? Will the decisions to be taken this year—alongside the comprehensive spending review, I presume—provide an opportunity for a step change in getting this ambitious target delivered on time?

The Minister will be familiar with the fact that the cross-party Joint Committee on Human Rights said in its report that it had no confidence that the Government would hit the target in the NHS long-term plan. It proposed a No. 10 unit with Cabinet-level leadership to ensure reform. I listened carefully to what the hon. Member for Worsley and Eccles South said about a commissioner, but I am slightly traditional and old-fashioned, and I think that accountability in government is held by Ministers. They are elected and accountable to both Houses of Parliament, and political responsibility for delivering on the proposals sits with the Secretary of State and the Minister. I am not keen on having a commissioner as another person who feels that it is their job to chivvy Ministers along, because that is our job, collectively, in Parliament.

I do want to know, however, what mechanisms are in place whereby the Secretary of State for Health and the Minister for Care can monitor what NHS England is doing. At present—this will not be the case under the proposed legislation—NHS England is an arm’s length body with a chief executive, so what are the Secretary of State and the Minister doing, on a regular basis, to hold NHS England to account to ensure that it delivers on this ambitious timetable, and perhaps achieves a more ambitious one?

My experience in government is that if something challenging has not happened in the past, there is only one way to get it done: Ministers making it clear, and saying, that they care about it; and, most importantly, showing that they care about it by focusing on it regularly, asking for information about delivery across the country—Mencap’s report shows that delivery is inconsistent throughout the country—and getting regular updates on progress, putting a bit of stick about when things are not on track. To do that, they need a plan with regular milestones so that progress towards a target can be measured. It would be helpful—there is no reason why it could not be done—if progress towards such milestones were not just shared with the House, but published, so that the families of people who have been badly treated, including those at Winterbourne View, can see that we are making progress.

Before I conclude, I wish to focus on the use of restraint, seclusion and segregation. I understand that a trigger for the Joint Committee on Human Rights inquiry and a CQC investigation was a BBC Radio 4 “File on 4” programme revealing the shocking use of restrictive practices in in-patient units. The CQC report, which was ordered by the Secretary of State, revealed widespread and frequent use of restrictive practices, including physical and chemical restraint, long-term seclusion and segregation. I understand that we are still waiting for the Government’s response to the report, so it would be helpful if the Minister would set out when it will be published so that we can find out what the Government will do as a result.

I hope that the Minister will set out a plan to make sure that we deliver against the new target so that we will not sit here in a few years saying, “The target that was set has been missed and rolled forward again,” with the families who have been subjected to unacceptable care feeling that no one is listening to them, and we are back on the hamster wheel with nothing having been done. If the Minister can focus on that, we will have taken a big step forward.

--- Later in debate ---

[The Minister for Care (Helen Whately)]

It is a pleasure to serve under your chairmanship, Ms McVey. I thank the hon. Member for Worsley and Eccles South (Barbara Keeley) for securing this important debate, for opening the debate and for her committed campaigning for people with learning disabilities and for autistic people. I also thank all Members who have spoken powerfully today, both in the Chamber and virtually, and shown the strength of feeling on the issue among parliamentarians. I particularly thank my hon. Friend the Member for Bexhill and Battle (Huw Merriman), as he has taken on the role of chair of the all-party parliamentary group on autism following, as he said, the very sad death of our right hon. Friend Dame Cheryl Gillan. She is missed so much by all of us, both as a colleague and for her work for autistic people, which has made such a huge difference over the years, although there is clearly much further to go.

The appalling abuse uncovered at Winterbourne View has no place in our society, and I share the shock and anger that hon. Members have expressed today. It was rightly described as heartbreaking and disgusting by my hon. Friend the Member for Broxtowe (Darren Henry), and it should never have happened, as my hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti) said. None of us accepts this kind of cruel and abusive treatment of people with learning disabilities and autistic people, and none of us wants people to be in-patients unnecessarily when they could be better off living in the community. I will use my time to talk about the work of Government, the NHS, the CQC, local authorities, and others we are working with to stop poor and—worse still—abusive care, and to improve care. As part of that, I will talk about what we are doing to reduce the number of people with learning disabilities and autistic people in in-patient units, which we know are rarely the best place for those people to be. As I do so, I will seek to respond to questions raised by right hon. and hon. Members.

First, I will talk about the approach we are taking to stopping abusive care. We are working with the NHS as care commissioners, local authorities, and of course the CQC, which plays a critical part. I fully support the much tougher approach that the CQC is rightly taking through its more robust inspection regime and updated methodology, which includes speaking more to patients and families and really digging into the culture of providers. It is in some of these closed cultures where there has been such concerning treatment of patients, and the CQC is taking a robust enforcement approach, including wasting no time in closing down services when it uncovers unsafe care. The sad truth is that this tougher approach by the CQC has exposed more cases of poor care, and I fully support the CQC in taking very robust action in those cases.

A significant number of people with learning disabilities and autistic people in in-patient units, about 59%, are autistic. As my hon. Friend the Member for Bexhill and Battle said, an in-patient unit is rarely a good environment for someone who is autistic, and can often be a really inappropriate one. I am clear that no one should be in an in-patient unit if it is not to their benefit—if they are not receiving some form of therapeutic treatment that helps them. Even then, their time in an in-patient unit should be as short as possible, and that unit should be as close to home as possible. Our target is to achieve a 50% net reduction in in-patients by 2025, from a base starting in 2015. Back in 2015, there were 2,895 people with learning disabilities and autistic people in in-patient units; that figure has come down to 2,035, which is a 30% reduction. England is divided into 44 transforming care partnership areas, 17 of which are on track to achieve the target, but that means that 27 are not on track. I take that failure very seriously.

My right hon. Friend the Member for Forest of Dean (Mr Harper) asked whether our target of a 50% reduction is ambitious enough, and whether we should be aiming for zero in-patients. That is a question that I have asked myself, and I have also asked it of the NHS and of clinicians. It has been made clear to me that there are times when people with learning disabilities and autism may need to be in an in-patient unit, when they have a mental health condition that could benefit from in-patient treatment. As such, I do not think it would be right to say that it is never appropriate, but it should be rarely considered appropriate, and alternatives should be tried wherever possible. I must also mention to my right hon. Friend that just under 30% of the numbers I am talking about are individuals who are under Ministry of Justice restrictions, so that is another challenge to discharging them. Those are net figures, however, and in the period that we are talking about, there have been more than 10,000 discharges, so it is not a static population. Of course, given that reduction of 30% and more than 10,000 discharges, there have also been a large number of admissions.

When I became the Minister for Care, with this in my portfolio, I straightaway asked the question, right back at the beginning of the pandemic, why are we behind the target? Why have we not made the progress that we should be making? Why is it taking so long? What needs to be done to fix that and to get back on track? We need to have a plan that we can all be confident in—all of us in the Chamber and the families of in-patients.

[Mr Harper]

Before the Minister moves on, may I test her? She said that she asked whether the 50% target was right. After all those conversations and yes, accepting that there might be some need for in-patient units, is the Government’s position that the 50% reduction is the right end state, or is there a different number? If it is 50%, will she publish the analysis that sets out why that is the right number?

[Helen Whately]

I can tell him that achieving the 50% will be hard. I am all for being ambitious, but in fact, from everything I have seen, achieving it will be hard, partly because some are more easily discharged—I pause as I say that, because it has been difficult to discharge many because we have complex situations here. We have seen some people continuing to be in-patients with long lengths of stay, and it has become almost harder and harder to find a way to find the right support for them in the community. Achieving the 50% will not be easy. I will get to the other part of my right hon. Friend’s question.

When I saw the position we were in and that we were not on target, I asked why and how come. Clearly, however, this is a complex system—it involves the NHS and local authorities doing things, and there are questions about housing supply, community schools and in-patient services. I therefore set up the building the right support delivery board, to which my hon. Friend the Member for Bexhill and Battle referred—I thank him for his supportive words. That board’s aim is to bring those involved together, because, much though we all like a clear line of accountability, to point a finger at somebody to say, “Solve this!”, the reality is that solving this involves bringing different organisations and different parts of our system together.

The delivery board has identified six priorities that we need to focus on to overcome the barriers to achieving lower numbers of in-patients: first, identifying the best practice models of care in the community. What does good look like? That may sound obvious, but getting the right answers is not the easiest thing to do. What is the right care for people in the community? First we have to find out what we want to see in all our constituencies that is available for that group of people.

Secondly, we have to focus on improving the transition into adulthood, in particular for autistic young people, because that is a particular problem resulting in in-patient admission. Thirdly, we have to reduce the number of people in in-patient care with judicial restrictions who, as I mentioned, are a significant proportion. Fourthly, we have to address some of the issues with funding flows and potential financial disincentives in the system, which hon. Members have mentioned, including the hon. Member for Worsley and Eccles South. Fifthly, we have to address the lack of available suitable supported housing. Housing is often cited as the most frequent barrier to discharge. Finally, we have to ensure that we have the right workforce.

Those are the priorities. Yes, we are working on a delivery plan, which will include milestones, such as my right hon. Friend the Member for Forest of Dean rightly called for—we all need to be able to see those. Specifically on the NHS role, since the pandemic, I have asked each of the 44 areas in the NHS to review where they are on delivering against our target and to come to me with what their trajectory is. Where will they get to over the coming months and years and, to the extent that they may be below the ambition, what actions will they take to close that gap?

I hope that that addresses my right hon. Friend’s question about my similar commitment to ensuring that we have clear milestones and targets, can see who is doing what, and have a grip on getting this delivered.

[Mr Harper]

Are the milestones in the plans going to be published?

[Helen Whately]

Yes, we plan to publish the delivery plan. We want to have time for the delivery board to feed into it, because we set that up earlier this year. It is complex and cross-government, so it takes a bit of time to bring that together, but broadly yes.

I want to touch on funding, because it was mentioned a number of times as one of the barriers. As part of the NHS England long-term plan, we are investing £40 million this year in improving community support and preventing avoidable admissions. There is an initial £31 million of funding for this issue as part of the NHS mental health covid recovery package. There is £11.35 million specifically to accelerate discharges from mental health hospitals, which includes funding to strengthen advocacy for people with a learning disability and autistic people, and £19.65 million to help prevent crises from occurring and to avoid admissions into in-patient care. There is also the £62 million community discharge grant, which is a fund over three years. The first tranche was issued last year, with a further £21 million to be distributed this year and next. That is particularly to cover some of the double running costs involved when a discharge happens. Someone may need care as an in-patient, but it also has to be set up in the community.

My right hon. Friend the Member for Forest of Dean also asked about the response to the CQC’s “Out of sight” review, which was requested by the Secretary of State for Health and Social Care and which reported back in October last year. It was a review of the use of restraint, seclusion and segregation. My right hon. Friend the Member for Forest of Dean asked when we would respond to it, and I can say that we will do so imminently. I hope he finds that reassuring, even if I cannot give a specific date.

I am mindful of the time, so I will wrap up. I thank all right hon. and hon. Members who have contributed to the debate. I know we are all deeply committed to ensuring that everybody with learning disabilities and autistic people get the care and support that they need. None of this is easy. Some of the individuals we are worried about have really complex needs, but I do not accept that as an excuse for poor or, worse still, abusive care. I will continue to work with the CQC, the NHS, local authorities and other Government Departments, and with the families and user representatives, who play a really important part and are part of the delivery board. I will work together with them to bring an end to this and make sure that autistic people and those with learning disabilities get the care and support that they need, and the support that their families need, to live their lives to the full.

Oral Answers to Questions

Mark Harper Excerpts

Tuesday 8th June 2021 Commons Chamber

[Mr Speaker]

Final question, Mark Harper.

[Mr Mark Harper (Forest of Dean) (Con)]

Mr Speaker, I am very grateful that you could fit me in at the end.

Yesterday during the statement the Secretary of State did not have the information to hand on the efficacy of the covid vaccines in reducing serious disease and hospitalisation. He made a commitment, rightly, to set them out today at Health questions at the Dispatch Box; and I am delighted, with this question, to give him the opportunity to do so.

[Matt Hancock]

First, I can say that a single dose of the Pfizer or AstraZeneca jab offers protection of 75% to 85% against hospitalisation, while data on two doses, which is currently available only for Pfizer, indicates 90% to 95% effectiveness against hospitalisation and 95% to 99% effectiveness at preventing death. However, my right hon. Friend also asked specifically about the delta variant, and I said that I did not have the figure in my head for the reduction in hospitalisations. I do not know whether I should be glad, but I can report to him that the reason is that there is not yet a conclusive figure. This morning I spoke to Dr Mary Ramsay, who runs this research at Public Health England, and she told me that the figure is currently being worked on. The analysis is being done scientifically and should be available in the coming couple of weeks. This is obviously an absolutely critical figure and I will report it to the House as soon as we have it.

Covid-19 Update

Mark Harper Excerpts

Monday 7th June 2021 Commons Chamber

[Matt Hancock]

We are doing work in this area and talking to all the relevant bodies. Aside from some who have not yet understood the full importance of high-quality usage of data in the health system, actually, the vast majority of people, including the BMA, the Royal College of GPs and others, can see the benefit of getting this right. So we are working with them. The goal, though, is really clear—to use data better in the NHS because data saves lives.

[Mr Mark Harper (Forest of Dean) (Con)]

The Secretary of State laid out a number of decisions that will be announced next Monday, and the most significant of those will be on social distancing. If that remains, whatever else changes, we will not have gone anywhere close to back to normal. However, can I press him a bit on vaccine efficacy? The SNP spokesman, the hon. Member for Central Ayrshire (Dr Whitford), said that the first dose was only 30% effective. I believe that that is correct for transmission, but as for what is actually important, which is reducing serious disease and hospitalisation, the first dose is significantly more effective than that. Will the Secretary of State set out to the House his and the Department’s current understanding about the efficacy of the vaccine on the first dose and the second dose against serious disease and hospitalisation?

[Matt Hancock]

My right hon. Friend is absolutely right about the figure for transmissibility reduction from the first dose. The figures for the reduction in serious disease and death are, as he says, higher than that, but since I do not have the precise figures in my head, what I propose to do is set them out tomorrow at the Dispatch Box at Health questions.

Obesity Strategy 2020

Mark Harper Excerpts

Thursday 27th May 2021 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)]

I beg to move,

That this House has considered implementing the 2020 Obesity Strategy.

I congratulate my hon. Friend the Member for South West Bedfordshire (Andrew Selous) on securing this important debate on something I know he is passionate about and about which I have met him on many occasions.

Currently 64% of all adults and 30% of children are classified as overweight or living with obesity. This masks the fact that in some areas the figure is as high as three in four adults. It is a complex issue that has a huge cost not to only the health and wellbeing of the individual but to the NHS and the wider economy. It makes individuals susceptible to a plethora of illnesses. Indeed, my hon. Friend the Minister for Care, who was at the Dispatch Box for the previous debate, commented to me that if we could get the general weight of the population down we would help people with more exercise and a better diet, as well as the health trajectory of those who live with dementia.

Covid has shone a light on why it is more important than ever that we need to get the nation healthy. Obesity is the only modifiable risk factor for covid-19 and a major modifiable risk factor for other diseases such as diabetes, cardiovascular, and some cancers—in point of fact, many. We are therefore at a teachable moment in which we can change attitudes, educate and influence drivers around less than healthy dietary and physical activity, and motivate behaviours so that they change. Helping people to achieve and maintain a healthy weight is one of the most important things we can do to improve our nation’s health, and we all have a role to play in meeting the challenge. It is complex. There is no silver bullet. There is no single source of responsibility. It will take action from all of us to work together to achieve our ambition—from the producer, to the processor, to the retailer, to the customer, with quite a dollop of influencing the environment through actions we in Government and in Parliament take and are taking.

Our strategy to meet the challenge, published last July, is far-reaching in its ambition. It reflects the significant work undertaken over the past four years to halve childhood obesity. Currently two out of every five children who enter primary school are overweight or obese. That number rises in the six years they are at primary school to three out of every five children.

[Mr Mark Harper (Forest of Dean) (Con)]

On the Government’s ambition, the Minister said very clearly, and it says in the strategy, that we want to halve childhood obesity by 2030. The strategy also says,

“reduce the number of adults living with obesity”,

although I looked and could not find a specific target. Is she able to set out what the Government think that trajectory should look like? What I am concerned about—she will see this when I make my remarks later—is that there are lots of practical measures in the strategy, but I am struggling to see how the Government will actually deliver the result, which is fewer people being overweight or obese. Having some milestones on that journey, rather than just waiting until 2030, would be helpful so we can judge whether it is working and make some course corrections.

[Jo Churchill]

I understand why my right hon. Friend is calling for milestones but, although the problem is a national one, there are different numbers for the proportion of the population that is overweight or living with obesity in each area. We can set milestones, but a national mile- stone may mask whether we are achieving what we need to achieve in the areas—often the more deprived areas in our communities—where we need to help, encourage, support and educate people to get them further on this journey. I will listen attentively to his contribution, as I always do, and then I may come back to him in my closing speech.

Three out of five children are overweight or obese by the time they leave primary school. We know that there is a direct correlation between the dietary habits picked up early in life and behaviour later on. We are working to create the right health environment to support people, and I will set out briefly some of the actions we are taking, starting with out-of-home calorie labelling. Restrictions laid in the House on 13 May will require large businesses in England with 250 or more employees, including restaurants, cafés and takeaways, to display calorie information for non-pre-packed food and soft drink items that they sell. Many have already gone some way in doing that. These regulations will support customers to make informed, healthier choices when eating out or purchasing a takeaway.

As I said, many businesses have articulated to me that they understand fully the importance of providing information and being proactive in leading the way. They recognise the demand from their customers for more information so that they can pursue a healthier lifestyle. Smaller businesses currently do not fall within the scope of the regulations.

We have also listened carefully throughout the consultation period to individuals and stakeholders who have the challenge of living with eating disorders. We feel we have been careful and sensitive and have put in reasonable adjustments to help that group. We have also exempted schools from the requirement to display calorie information, given the concern about children in school settings. We have included a provision in the regulations allowing business to provide a menu without calorie information on request.

[Jo Churchill]

If the hon. Lady allows, I will go through the rest of my contribution. I hope she will take away that this is about building blocks. As I said, it is a complex situation, and there is no silver bullet. We must look at the antecedents of both conditions, including the link to mental health for those who suffer from anorexia and certain other eating disorders, and at some of the broader challenges when we are looking at those who are overweight or living with obesity. They need to be taken in the round, but one cannot be cancelled out against the other.

[Mr Harper]

rose—

[Jo Churchill]

I am going to push on just a bit, and then I will of course come back to my right hon. Friend.

We are also taking action to stop the promotion of less healthy products by volume and prominent locations online and in store. We want to support shoppers to purchase healthier options and shift the balance of promotions that way by maximising the availability of healthier products. We still need to eat, and we are not banning anything, but we are trying to educate, encourage and make people aware, so that they have the option of a healthier choice by default.

Last December, we confirmed that we will legislate on the promotion of foods high in fat, salt and sugar in stores and online. This will apply to medium-sized and large businesses—those with more than 50 employees—in England, and it will come into force next year. I would like to congratulate and thank those large retailers that are already taking these steps, because the argument is often put forward that it is unaffordable for a business to do this, yet many of the large retailers are doing it.

[Jo Churchill]

My hon. Friend and I have spoken about Jordans. Indeed, my first job was selling Jordans Crunchy bars at county shows when I was—oh—several decades younger. I will of course be happy to talk to him after this, but I would also gently point out that I have British Sugar, which is also in this food group, in my constituency. I not only meet its representatives on a regular basis, but I also met as lately as yesterday representatives from the British Retail Consortium and the Food and Drink Federation.

[Mr Harper]

The intervention I was going to make when the Minister was dealing with the hon. Member for Bath (Wera Hobhouse) was on the impact assessment for the regulations she mentioned. I have looked very carefully at the evidence, and it seems to me that the best case for these regulations is that we will reduce the number of calories consumed by 80, which is an apple, and the worst case will reduce it by about eight, which is a 10th of an apple. It seems to me that the cost of these regulations simply is not justified by the outcomes.

Because the Minister did not take my intervention at that time, she went on to talk about the legislation for promotions online, and I have looked at this. The Government’s goal for this legislation is that it reduces the calorie consumption by 8 billion calories. That sounds like a lot, but if we look at the number of children in the period that is spread over, it is equivalent to each child eating one fewer Smartie a day. Given that the children who have the most serious obesity problem are consuming up to 500 calories a day, reducing their calorie consumption by three calories a day simply does not do it.

The Government’s ambition is correct, but I just have a real worry that these particular measures simply will not have the effect that the Government and all of us wish to happen.

[Jo Churchill]

I am very glad that my right hon. Friend is joining me in the ambition of wanting to get the weight of the nation down. I would gently push back, and say that I do not recognise those calorie figures. I am sure we can have a longer discussion over where that evidence base is drawn from, and about the fact that there is actually a much greater impact. As I have pointed out on two or three occasions, this is about the building blocks of all these different measures coming together, and they will be monitored and assessed as we go through.

Another element of the environment is advertising. Currently, we are failing to protect children from over-exposure to high-fat, salt and sugar products via advertisements on both television and online platforms. I would gently say that if adverts did not influence people, they would not be used. Therefore, to help tackle the current situation, let us just see more advertising of healthy food. It always strikes me as quite interesting when watching a diet programme on the television that each ad break is often interspersed with adverts for high-fat, salt and sugar products. This does not affect the advertising industry’s revenue, because there is still a need to advertise and people still need to eat, but the foods advertised often do not reflect the balance that we need to enjoy a healthy life.

--- Later in debate ---

[Greg Smith (Buckingham) (Con)]

Obesity is clearly a huge challenge facing our country, and one that absolutely should not be ignored, but I do fear that the state is significantly overreaching in some of the proposals that have come forward as part of the obesity strategy. The approach to foods high in fat, sugar and salt encompasses a perversely broad range of products, including butter, granola, porridge oats, muesli and protein bars, none of which have any particular appeal to or indeed are marketed to children, yet all of which are treated as junk food.

Breakfast cereals were previously heralded for high fibre but are now demonised. No distinction is made for naturally occurring sugars and fats from the dried fruits and nuts that are so often present in those products. If the state is really saying that breakfast cereals are bad, where does that naturally push people? A bacon sandwich? A full English? A pain au chocolat? All are things that I am particularly partial to but that I do not think the public health establishment will be keen to endorse. Perhaps people could have toast? But then we see that butter is on the HFSS naughty list.

Many breakfast cereal producers pay farmers, including in my constituency, a premium for buying their oats, thereby paying for the environmental and wildlife schemes that I am sure we all value. Let us be in no doubt that any policy that reduces cereal-makers’ ability to sell wholegrain cereals will adversely impact on great British farmers.

[Mr Harper]

I was intrigued to listen to my hon. Friend’s list of products. Is not the issue that there is a focus on individual products when, actually, the important thing in getting to a healthy weight is not individual products but a person’s diet as a whole and the balance between individual products across their diet? To demonise individual products is not the way to go.

[Greg Smith]

I absolutely endorse and agree with everything that my right hon. Friend says. It must be about the promotion of a balanced, healthy diet. Some of the things that we all know are not particularly good for us can be part of that balanced, healthy diet, so I absolutely agree.

The restrictions also undermine some alternatives to high-sugar sacks. For example, protein bars are used by many adults who lead highly active lifestyles. Surely the restriction contradicts the ultimate goal of the Government’s strategy: healthier living.

Let me move on briefly to the question of TV advertising. Broadcasters and creative industries throughout the United Kingdom are estimated to be in line to lose some £200 million because of the proposals. With children spending far more time watching online content than traditional TV channels, it is essential, not least for our public service broadcasters, that there is an absolutely clear level playing field between TV broadcast and online. Anything less would be to let down our broadcasters, particularly, as I say, our public service broadcasters.

I would also argue that the 9 pm watershed is equally destined to fail, as research shows that it will lower the calorie intake among children by just 1.7 calories a day, which is simply inconsequential. We need a more proportionate, less interventionist solution that ensures fairness for all. Obesity is a complex problem, but the solution cannot be nannying, ineffective policies.

I certainly did not get into politics to tell people what they should and should not eat, because when people are free to make an informed choice about the way they live, without coercion or state interference, they are much more likely to keep those changes long term, to the benefit of the health of the nation. I urge the Government to rethink the proposals and strip out the nonsensical inclusion of products such as cereals and protein bars. Let us look once more to freedom, choice and personal responsibility.

--- Later in debate ---

[Wera Hobhouse (Bath) (LD)]

I speak today as the chair of the all-party parliamentary group on eating disorders and I want to highlight the anxiety felt by many of those with an eating disorder about one specific aspect of the obesity strategy: calorie labelling on menus. Obesity causes serious health problems and there is no doubt that far too many people in this country do not have a healthy weight. I add my unequivocal support to the Government’s aim of addressing obesity, but obesity has to be considered as one side of our complex relationship with food. It is a form of disordered eating and therefore cannot be separated from other forms of disordered eating and cannot be dealt with in isolation. Calorie labelling on menus will not only be ineffective in tackling obesity, but will actively damage those with an eating disorder.

Studies show that there is only a small body of low-quality evidence supporting the suggestion that calorie counts on menus lead to a reduction in calories purchased. While there is limited evidence that calorie labelling will support the public in losing weight, there is convincing evidence that it would harm people with an eating disorder. About 1.25 million people in the UK have an eating disorder, and the 2019 health survey found that 16% of all adults aged 16 or over screened positive for a possible eating disorder. Over the pandemic, the charity Beat has reported a 173% increase in demand for eating disorder support, and research shows that individuals with anorexia and bulimia are more likely to order food with significantly fewer calories when presented with a menu including calorie counts. Those with binge eating disorder are more likely to order food with significantly more calories.

Many people with eating disorders also live with obesity. Up to 30% of people seeking weight management services would meet the diagnostic criteria for binge eating disorder. Clearly, a reductionist approach to nutrition means that the obesity strategy risks harming some of the very people it is designed to support.

[Mr Harper]

I am sympathetic to the point the hon. Lady is making, and she will know from my intervention that I think the evidence with respect to calories and out-of-home labelling is quite weak. Is labelling on products purchased in supermarkets also a problem for those with eating disorders? I ask that genuinely; I do not know the answer. Can she furnish that information?

[Wera Hobhouse]

I am particularly concerned about calorie labelling in restaurants. People who suffer from eating disorders are isolated and fearful of contact with others because they are thinking continuously about what they are going to eat or drink. Going out to a restaurant gets them through that step, and it is often a significant step towards recovery. As I say, my particular concern is labelling on restaurant menus.

In response to the survey on calorie labelling conducted by Beat, one respondent said:

“My eating disorder thrives off calorie counting and knowing all the calories in everything. I would feel compelled to look at calorie labels”

in restaurants and

“I would feel embarrassed asking for a different menu. Please don’t do it. Please.”

The Mental Health Minister has been extremely generous with her time, listening to the all-party parliamentary group’s concerns about the plan to mandate calorie labelling on menus. The APPG is grateful for her interest in improving early access to eating disorder treatment. However, I must repeat my plea to the Government to look again at this element of the obesity strategy.

Addressing obesity and tackling eating disorders should not be in competition. We must tackle them together. I look forward to working with the Minister to develop an obesity strategy that successfully addresses the obesity epidemic, but does not harm people with other forms of eating disorder.

[Mr Mark Harper (Forest of Dean) (Con)]

As I said in my interventions on the Minister, I very much support the Government’s objective. A situation in which 36% of adults in England are overweight and 28% are obese is not good, and there are many health consequences of it, but my view is that, fundamentally, we need, first, to enable people to understand whether they are overweight or obese. That might sound like a foolish thing to say, but there is some evidence that people do not recognise whether they or those around them are overweight or obese, and are not very good at working that out.

Secondly, we need to make people understand the health consequences of being overweight or obese. The Minister talked about incentives. The real incentive that people should have is that they want to be healthier. Unless individuals themselves want to be healthier and move towards a healthy weight, it seems to me that we will not get very far.

Frankly, getting to a healthy weight means having a healthy diet. It does not mean going on a diet and then going back to unhealthy eating; it means changing diet permanently. In many cases, it means making not dramatic changes but small changes that people stick to, such as reducing portion sizes. It is about reducing treats and things we like, not getting rid of them. When I eat, I like all the bad things, but I have become better as I have got older—I have needed to—and now I am a bit more controlled about how many times I have them. I watch the size of my portions, because as I have got older, I have had to watch what I eat.

It seems to me that it is about diet, not about individual foods. As my hon. Friend the Member for Buckingham (Greg Smith) said, demonising individual foods is not a very successful strategy. There are plenty of things that I like that would individually be very unhealthy, but I just do not eat them very often. That is where we need to get to: people need to understand what a healthy weight is, understand the health consequences and want to get there themselves.

I have a couple of questions for the Minister. She spoke about the evidence for out-of-home labelling. The impact assessment is a rather weighty document of 76 pages, but one of the things that I learned as a Minister is that it is worth plodding through such documents. There is lots of useful information in it, but I did not find any compelling evidence that introducing out-of-home calorie labelling would have any significant impact on the quantity of calories that people consume. Given the concerns that the hon. Member for Bath (Wera Hobhouse) and the charity Beat have rightly set out about those with eating disorders, the case for its successful impact is not very compelling. There is quite a lot of concern that it will not be helpful, so I think the Government ought to think again about their approach.

I also have a question about the soft drinks industry levy. The levy has been successful in reducing the amount of sugar consumed; in my constituency, Suntory Beverage & Food Great Britain and Ireland, which produces Lucozade, Ribena and Orangina, has led the industry in taking more than 50% of sugar out of its products. It has also invested £13 million in new machinery at its Forest of Dean plant to produce those products—I was very proud to launch the new production line. However, although we have reduced the amount of sugar consumed, I have seen no evidence that we have therefore reduced the quantity of calories consumed or made any impact as a result.

[Alun Cairns]

My right hon. Friend is making a very effective, cogent argument. Does he agree that because there is a will to come up with a solution that will have an impact, there is a danger that unless we take account of all the evidence, including his points about the impact of the sugar tax, we might well feel better for doing something, but not quite achieve what we set out to achieve?

[Mr Harper]

That is right. I am very keen that we look at the evidence. I can see that through reformulation we have led the industry—the company that makes Lucozade and Ribena has been successful in doing that—but the real question is whether that has reduced the number of calories consumed, both by adults and by children, and had any impact on the number of people who are overweight or obese. It has clearly been successful in reducing the quantity of sugar consumed, but as my hon. Friend the Member for Buckingham said, sugar in itself is not a bad thing; people need to consume a certain amount of sugar to have a healthy diet. My worry is that we have reduced the amount of sugar in these products, but that will not actually make any difference to whether people have a healthy diet.

All these measures need to be tested. The point that I was making to the Minister earlier is that I do not want us to introduce them, wait nine years until 2030, and then say, “Goodness, it hasn’t worked.” I absolutely accept the Minister’s point that national targets may not make sense, but we need to look, at a local level, at whether the measures are successful. If they are not working, we need to change them and look at what the evidence suggests would be more successful in getting people to a healthy weight so that we all lead a healthier lifestyle.

--- Later in debate ---

[Jim Shannon (Strangford) (DUP)]

I am grateful to be able to speak on this matter. It has been an ongoing issue for the United Kingdom and I appreciate that it is one of our greatest health challenges that affects people of all ages. I want to put on record my thanks to the Minister. I have been involved in many debates where she has responded on the issue of diabetes, which I think she referred to in her introduction. I believe that she is totally committed to bringing together a strategy that we can all endorse and will hopefully bring about a healthier and leaner United Kingdom. I also welcome the commitment to the alcohol strategy.

I am a type 2 diabetic and I have had diabetes for approximately 14 years. I am proud to say that since being diagnosed I have lost almost four stone on what I weighed back in 2008 and 2009. I am not proud of the circumstances that got to me to where I was. I did not even know what diabetes was, to be truthful. I was not even sure what the symptoms were until I met a diabetic maybe the year before. The choices that led me to be diagnosed with type 2 diabetes were ill-judged. I never really gave thought to the health issues that can come along with the foods I was eating. Sweet-and-sour pork and two bottles of Coca-Cola six nights week are not a good thing for anyone, and they certainly were not good for me, as I found out for the worse.

I am now confident and well pleased with how I deal with the issue. It takes self-control. The right hon. Member for Forest of Dean (Mr Harper) referred to self-control, which is very important. Not everybody can do it, but if they can, it is good that they can. Along with the tablets that I take for the diabetes, it seems to be bringing results. There is no place in society for judgment when it comes to the topic of obesity, as the hon. Member for South West Bedfordshire (Andrew Selous) said.

[Mr Harper]

I cannot remember whether I said—as I should have done, when I was talking about people being disciplined—that I accept that it is a simple thing in one sense to reduce one’s calorie intake and take more exercise, but it is not easy for people to do. I did not want to indicate, if I had left that impression, that I thought it was easy. Equally, while there is no alternative, ultimately, to people taking responsibility themselves, I accept that many people require help and support to do so. I am glad that the hon. Gentleman has given me the opportunity to put that on the record

[Jim Shannon]

I am grateful to the right hon. Gentleman for clarifying the matter. I knew that is what he meant, but I thank him.

The health survey for England refers to 1,000 people aged over 16, 277 of whom were obese and 31 were morbidly obese. In Northern Ireland, the figures are replicated; in fact, they are the same everywhere. Childhood obesity is a crucial issue on which much more needs to be done to make youths feel less self-conscious about the issue but at the same time able to do something about it. Obesity affects one in every five children in Northern Ireland. The figures there unfortunately show that there are outstanding problems to be addressed. Obesity exaggerates high blood pressure, diabetes and liver disease. Obesity is one of the three main causes of liver disease, in particular. Obesity also affects many other things, as the Minister said. It is very important to put that on record.

I have met constituents of mine over the years who had a medical condition that meant that they were not obese by choice but because of the circumstances of their own individual bodies. The people I am referring to had to go for bariatric surgery. I know some people who did that and I know it changed their lives. Perhaps the Minister could comment on how such procedures can be looked after within the NHS, because to do it privately costs over £10,000.

This is a serious health problem and it affects thousands of people. I want people to live their lives healthily and happily. I believe children should be taught that support is all around them and that their size is nothing to be ashamed of. There are ways to go about detecting obesity. However, I feel that one of the most important factors in tackling this issue is to reassure people that they will not be judged. Judgment often leads to resentment and failure, and there is no doubt that it is a sensitive issue for those who struggle with weight loss. I therefore urge the Minister to take that into consideration. I also urge others to be kind when it comes to such a topic. I believe that help and support is there for all those who are obese and seek help. I sincerely hope that in the coming years we can work together to bring forward a strategy that will encourage people and not do them down.

--- Later in debate ---

[Jo Churchill]

With the leave of the House, I would also like to thank everyone for the tone of the debate. It is important that we discuss these things and do so in the right way, which is essentially reflected in the comment of my hon. Friend the Member for Northampton South (Andrew Lewer) that he did not come into politics to tell people what to do. Neither did I; I came here to help them, and the crux of this strategy is to inform, to educate and, as my hon. Friend the Member for Stoke-on-Trent Central (Jo Gideon) said, to slowly knit together policies such as the Office for Health Promotion and the healthy start vouchers so that we can start changing lives, and so that children do not end up in front of my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson) as a 12-year-old weighing 9 stone, with the concomitant effect that one in 10 adults over 40 have diabetes and 4.7 million people in this country have diabetes. I have met the hon. Member for Strangford (Jim Shannon) discuss diabetes, the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) to discuss vascular disease—which is, again, completely compounded by carrying weight—and my hon. Friend the Member for Stoke-on-Trent Central to discuss the childhood challenges of poverty. We have often spoken about how particularly challenged Stoke-on-Trent is.

In no particular order, as I just happen to randomly have these figures to hand, I shall state that 8.6% of children in Northampton go into reception classed as obese, but that figure rises to 18.5% when they leave—about a 9.9% uplift. In the Forest of Dean the corresponding figures are 10.3%, with 19.3% of all children in year 6 coming out as obese. In Bedford the figures are 8.9% and 21% of all children, and more than six in 10 adults are overweight or obese.

Actually, I think the time has come to do something, and to help and to assist, because I do not think on our watch we can do nothing. This is about helping people have more quality, healthy life years, and surely that is why we are here. As my hon. Friend the Member for Sleaford and North Hykeham said, when we eat out we consume double the calories; surely it is better that we help inform, because if we were to prepare the food, we would have half the calories.

We are not banning advertising; indeed, we are offering probably the greatest marketing and advertising opportunity as we come out of the covid crisis. It cheered me this week that Kellogg’s has indicated that it will reformulate the amount of fat, salt and sugar in its products, taking out 10% of sugar and 20% of salt. The whole reason that the policy exists is to try to put children and, arguably, all of us on a better trajectory.

All the contributions were excellent, but I listened with some sorrow to my hon. Friend the Member for Buckingham (Greg Smith). I know his county and, indeed, I represent a rural county. I am not demonising breakfast cereals. Kellogg’s is going in the direction that its customers are demanding—I think, as the hon. Member for Nottingham North (Alex Norris) said, that customers are ahead of us in this House on this—and reformulating, which is what we want it to do. A noble Friend in the other place once mentioned porridge and was derided for doing so, but I want to help families and children so that, no matter what they can access and purchase, they are, by default, able to access a healthier choice, so that they are not forced into making the choice of saying, “That, at least, is something to give my children”.

We are not banning butter, so my hon. Friend the Member for Buckingham can rest assured that he will still be able to have his butter on a bit of toast, if that is what he likes. I will not repeat A.A. Milne’s:

“I do like a little bit of butter to my bread!”

However, we are also not putting more than 16 product lines into this, because we have listened to industry, the hon. Member for Bath (Wera Hobhouse) and various others who have noted the challenges. I talk regularly to the Minister for Patient Safety, Suicide Prevention and Mental Health, my hon. Friend the Member for Mid Bedfordshire (Ms Dorries), and we are incredibly cognisant of those who have eating disorders. The road that we travel has to be balanced so that people can make the right, informed choices.

[Mr Harper]

May I press the Minister—

[Jo Churchill]

No, I am terribly sorry, I have only two minutes left, but I am more than happy to talk to my right hon. Friend at considerably more length. He asked me for a bit of evidence on the sugary drinks tax. There is the fact that that, over three years, it has reduced the calories consumed on every occasion that somebody drank a soft drink by 35.2%. The figures on out-of-home calorie labelling show that £5.6 billion will be saved for the economy over 25 years, and that is before we even get to the associated benefits to people’s health.

I am sorry that I am probably not going to answer every point, but we want to achieve the full potential of all people. It is about a joint effort. My hon. Friend the Member for South West Bedfordshire (Andrew Selous) has been a doughty campaigner. I have met members of Bite Back 2030 with him, and those are young people asking us to do something. I am working with colleagues in the Department for Education and the Department for Environment, Food and Rural Affairs to make sure that we are doing that. Indeed, the Under-Secretary of State for Environment, Food and Rural Affairs, my hon. Friend the Member for Banbury (Victoria Prentis), who is on the Front Bench next to me, and I have the food strategy. Part 1 is already out and we are expecting part 2 in short order—that will very much go towards responding to what my hon. Friends the Members for Keighley (Robbie Moore) and for Stoke-on-Trent Central said. That Minister and I have worked together, with the Under-Secretary of State for Education, my hon. Friend the Member for Chelmsford (Vicky Ford), to look at how we can promote healthy eating for children and work across Government to drive these objectives.

I agree with my right hon. Friend the Member for Forest of Dean (Mr Harper), who said that this was about education, changing behaviour, changing the environment and not demonising individual foods. I want everyone to get to where he has, so I can see a future career as a healthy weight consultant, if nothing else. I congratulate Lucozade on what it has done. We will be continually monitoring the situation to make sure that we achieve our ambition on this. Partnership is key, and we are working with local authorities and working to build healthy weight management services. Promoting good health is central to this Government’s health agenda, and we will do that through the new Office for Health Promotion and proactively take the burden of preventable ill health and empower everyone to make the right choice. We would like to see immediate results, but the situation is complex, and we know it will take time. We all have a lot to gain by helping people achieve and maintain a healthy weight, and I look forward to the support of the whole House in doing that.

Question put and agreed to.

Resolved,

That this House has considered implementing the 2020 Obesity Strategy.

Covid-19: Government Handling and Preparedness

Mark Harper Excerpts

Thursday 27th May 2021 Commons Chamber

[Matt Hancock]

It has been an incredibly difficult time for those who have worked in and lived in care homes throughout this pandemic. That has been true across the world, and I pay tribute to the staff in social care who have done so much. It was, of course, a difficult challenge, especially at the start when many characteristics of this virus were unknown. As I have answered many times in this House, we have published full details of the approach that we are taking and that we have taken. We have worked with the care home sector as much as possible to keep people safe and followed the clinical advice on the appropriate way forward.

[Mr Mark Harper (Forest of Dean) (Con)]

May I take the Secretary of State back to what he said in his statement about the B1617.2 variant first discovered in India, which I think will be of the most concern to my constituents and the country in the days and weeks ahead? We are bound to see an increase in cases as we open up; that is inevitable. The important thing is breaking that link between cases, hospitalisations and deaths. My understanding of all the current evidence is that our vaccines are very effective in stopping serious disease, including from that B1617.2 variant. If that remains the case, does he agree that, on 15 June, there would be no reason not to go ahead with opening up fully on 21 June? That is the important question to which we need an answer.

[Matt Hancock]

That is literally the most important question to which we do not yet have a full answer. The data that we have suggest that, in the hotspot areas, around one in 10 of those in hospital are people who have had both jabs. That is a function both of the protection that we get from the vaccine against this variant and also of the age profile of those who are catching the disease. Those who have not been vaccinated include those who are old enough to have been offered the jab and those who have not yet been offered the jab. The fact that 90% of the people in hospital are those who have not yet been double vaccinated gives us a high degree of confidence that the vaccine is highly effective, but the fact that 10% of people in hospital have been double vaccinated shows that the vaccine is not 100% effective. We already knew that, but we are better able to calibrate as we see these data. We will learn more about this over the forthcoming week or two before we make and publish an assessment ahead of 14 June about what the data are saying about taking the step that is pencilled in for not before 21 June.

Covid-19

Mark Harper Excerpts

Tuesday 25th May 2021 Commons Chamber

[Nadhim Zahawi]

I am grateful for the hon. Lady’s question and I discussed this with the Mayor of London this morning. Of course Hounslow is on the list of affected areas and we are turbocharging the vaccination programme, as well as doing the surge testing and the sequencing and isolation. But as I have outlined in response to others, people need to exercise caution and common sense, and travel outside of the area only if it is essential. That is important. The right thing to do is for us to work together to make sure we deliver that message, as I did this morning with the Mayor of London.

[Mr Mark Harper (Forest of Dean) (Con)]

In The Telegraph story this morning about what the rules for self-isolation might be post 21 June, a Government source was quoted as saying, in response to the suggestion that they will not change:

“There is still a risk of getting the virus and spreading it on,”

That is of course true—there is a risk—but of course once people have been vaccinated the risk is much lower and, importantly, the vaccines are very effective at stopping serious disease, hospitalisation and death. So may I say to the Minister that post 21 June it is important not only that legal restrictions and social distancing go, but that all the remaining rules are adjusted to reflect the much lower risk that exists once we have vaccinated the population? Otherwise, we are going to have those rules in place forever.

[Nadhim Zahawi]

It is worth waiting for 14 June, when we will be saying more on this, but suffice it to say two things: first, even if someone has had two doses of either vaccine —I have had this experience in my own family—they can still contract covid and should therefore be isolating and quarantining; secondly, we are also looking at ways in which contacts of people who may have contracted covid can be regularly tested instead of isolating.

Covid-19 Update

Mark Harper Excerpts

Monday 17th May 2021 Commons Chamber

[Matt Hancock]

It is really clear that we are removing restrictions. I am delighted that we are able to remove restrictions, such as the absolute restrictions on close physical contact, and rely more on people’s personal responsibility. In order to do that, we are providing the best possible advice that we can, such as to hug, but cautiously. Everybody knows what that means: it means outside is better than inside, it means making sure it is in ventilated spaces and it means that those who have had the vaccine, and in particular two vaccines, are safer than those who have not.

It is incumbent on us all to communicate these messages from our scientists and to make sure that people understand them. I am pretty sure that the British public get that. Given how brilliantly people have responded to requests during the pandemic, I am highly confident that this approach will be successful and that people will be cautious, but enjoy the new freedoms that we are thankfully able to give.

[Mr Mark Harper (Forest of Dean) (Con)]

I listened very carefully to what the Secretary of State said in his statement about people being able to prove that they have had the vaccination through the NHS app. I also listened carefully to what he said about the importance of the Union. Can I just draw to his attention something that I hope he can look at urgently? I have thousands of constituents who live in England, but who are registered with GPs in Wales and who receive their vaccinations in Wales. At the moment, it is not proving possible for them to register with the NHS app that they have had their vaccination. Can I ask him to urgently fix that for my constituents and those across our United Kingdom?

[Matt Hancock]

This is another example of where we work better together as one United Kingdom; we are working to solve this problem precisely. Coming from the borders with Wales, I understand this very clearly. Work is under way to ensure that there is interoperability between the data systems in England, Wales, Scotland and Northern Ireland. This situation was not foreseen when health responsibilities were devolved. I have been working with my counterparts in the three devolved nations on fixing it, and we have agreed to fix it. Getting these data to talk to each other is technically complicated, but that work is under way.

Public Health

Mark Harper Excerpts

Monday 26th April 2021 Commons Chamber

[Nick Thomas-Symonds (Torfaen) (Lab)]

I beg to move,

That the Health Protection (Coronavirus, International Travel) (England) (Amendment) (No. 7) Regulations 2021 (S.I., 2021, No. 150), dated 12 February 2021, a copy of which was laid before this House on 12 February 2021, be revoked.

The House meets as the UK reaches a critical moment in our battle against the coronavirus. In the past year, the British people have shown remarkable fortitude in the face of this deadly threat and made extraordinary sacrifices to protect our NHS and save lives. The roll-out of the vaccine is now giving real hope to people that there is light at the end of this long tunnel. For that, we give thanks to the scientific excellence that enabled the vaccine to be developed so quickly, while we are indebted to the remarkable work of our NHS, military, local government, volunteers and all those frontline workers who have worked tirelessly on the roll-out. But amid this sense of optimism we know that very real dangers remain from this deadly and unpredictable virus, and one of the key threats is the importation of new strains that could threaten the efficacy of those vaccines. As restrictions loosen and people start to interact more, the opportunity for variants to spread becomes far greater. That is why protecting our borders against emerging strains of covid is such a vital challenge, and I am afraid it is a challenge that the Government are failing miserably.

That is why today we are taking this unusual step of debating Government measures that have been in place for months. I make it clear that it is not our intention to divide the House or to vote these measures down, because having them in place is better than nothing at all, but the verdict on the Government’s approach to quarantine is damning. They have failed to heed warnings that their inadequate system leaves the door open to new variants of covid, and the consequences are deeply worrying. Sadly, this is in keeping with the Government’s approach to protecting our borders against covid from the very start of the pandemic, with no formal quarantine until June of last year, no testing at the border until this year, and no hotel quarantining until 15 February—and then only a half-baked system. For months, Labour Members have been calling for a comprehensive hotel quarantine system to guard against variants reaching these shores and undermining the huge collective effort to defeat this virus.

As islands, we should have a natural advantage in guarding against bringing the virus into the country. Yet in the early days we allowed millions of travellers to enter the country—23 million between 1 January and 31 March last year—while cases of covid were rocketing across Europe. Millions of people coming into the UK with no tests and no formal quarantine requirements will remain a terrible case study for this Government’s approach of doing too little too late, lurching from one crisis to another, devoid of strategy. It is not as if Ministers were not told: constituents were travelling to our ports and airports, raising the lack of checks and tests from the start.

Of course I accept that dealing with a pandemic is hugely challenging, but the inability to protect our borders is a systemic failing. That failure to plan has made the current quarantine system ineffective and frankly dangerous. By extending the red list to only 40 countries, the Government are leaving the door wide open for new variants to enter the UK. On 1 February we gave MPs the opportunity to vote for a comprehensive hotel quarantine system and a sector support deal for the aviation sector, which Labour has been calling on the Government to introduce for months. The Government again refused to do what was necessary to protect our borders against covid.

There are a number of key reasons why a limited list is an ineffective strategy. Labour Members have set out those reasons, and sadly the warnings have come to pass. First, the hard truth is that we have no certainty about where the next dangerous covid strain will emerge. The thoughts of the whole House will, I am sure, be with the people of India, given the heart-breaking scenes we have seen. Countries not on the red list could have new variants in circulation that are spread by travellers to the UK before they are recognised and acted on. That is exactly what happened with the variant from India, which was classed as a variant under investigation in the UK only last week. Warning No.1 was ignored, and it came to pass.

[Mr Mark Harper (Forest of Dean) (Con)]

I am listening carefully to the right hon. Gentleman. How long does he propose that his regime would be in place? By worrying about potential variants coming from overseas, he seems effectively to be arguing for a system that will be in place forever, or at least until every other country is vaccinated. What is his position?

[Nick Thomas-Symonds]

No, I am not suggesting for a moment that such a system should be in place forever, and clearly there has to be scientific evidence about that. However, we certainly need to be at a more advanced stage of our own roll-out before we give such consideration, as the right hon. Gentleman suggests. The comprehensive hotel quarantine system should already have been in place.

The second weakness in the current position is that there are countries with significant outbreaks of the South African and Brazilian variants that are not even on the red list. We understand that the recent South African strain discovered in south London came to the UK via a traveller from an African country not on the red list. Warning No. 2 was ignored, and it came to pass. We know that people travelling to the UK on connecting journeys from red list countries have been mixing with people from non-red list countries on planes and in airports, creating dangerous opportunities for cross-infection. We have seen that in scenes from airports in recent months. Warning No. 3 was ignored, and it came to pass.

The Government try to say that their quarantine measures are tough, but the reality suggests otherwise. It is not just the Opposition giving these warnings. Minutes from the Scientific Advisory Group for Emergencies on 21 January show that Ministers were told

“that reactive, geographically targeted travel bans cannot be relied upon to stop importation of new variants…due to the time lag between the emergence and identification of variants of concern, and the potential for indirect travel via a third country.”

When the director general of Border Force gave evidence to the Home Affairs Committee, he set out a damning statistic that of the 15,000 people entering the country each day, only around 1% were entering hotel quarantine. That leaves 99% of visitors entering the country with virtually no controls. It is no use the Government saying that other quarantine measures in place are working, because their own figures show that just three in every 100 people quarantining have been successfully contacted. It is a record of negligence that leaves the doors open.

We know things are in a dire state when a video exists of the Home Secretary speaking against her own quarantine policy, and even the implementation of the half-baked measures we have now has been beset by mismanagement. It took 18 days after the announcement on 27 January for hotel quarantine to begin—more time lost. Even now, I hear reports from colleagues about mismanagement of the system—people unable to book in, poor service, lack of support for disabled people, and exceptions not working as they should for people in difficult circumstances. Then there is the Government’s glacial pace of adding countries to the red list.

--- Later in debate ---

[Mr Mark Harper (Forest of Dean) (Con)]

I do not intend to detain the House for too long, but I have some questions, and I will explain to the Minister why I am raising them now. I think that they are in order. If I understand this correctly, the Government have indicated that, as of 17 May, more international travel may well be possible, subject to a review, and they have indicated that they will give people a week’s notice of those changes. Mr Deputy Speaker, you will have spotted that the date for that announcement to take place is when we are expecting the House to be prorogued before the state opening of Parliament, so this is probably the last opportunity—depending on whether we have Transport questions on Thursday—for Members to ask Ministers questions about the international travel regime before it might change. I happen to think it is important that those questions are asked in the House, rather than simply being left to be asked at a press conference.

Before I set out those questions, however, let me just follow up my question to the right hon. Member for Torfaen (Nick Thomas-Symonds), who opened the debate for the Labour party. He answered one of my questions, when I could not quite work out why Labour had tabled a motion to revoke these regulations. He confirmed that Labour does not intend to press that to a vote, which makes sense, but he did not really deal with the other question I asked or with the companion question that my hon. Friend the Member for Winchester (Steve Brine) asked. I pressed the right hon. Gentleman on how long he felt a tougher regime should be in place, and in answer to me he indicated that it should be dependent on our vaccination roll-out, whereas in answer to my hon. Friend, he seemed to suggest that it would depend on what was going on around the world.

The reason that I am labouring this point—I am going to press the Minister on it as well—relates to what the regime is trying to deliver. If this is about worrying about what is going on in the rest of the world—given that it is entirely possible, even with a fair wind, that we will not have vaccinated the adult population around the world until the end of next year, 2022—this whole travel regime could be in place for the rest of this year and the whole of next year, which has very significant implications. If, however, the regime is to stay in place until we have vaccinated every adult in this country, that would have very different implications, as my hon. Friend the Member for Winchester pointed out, as we will have offered every adult a vaccination by July.

My question to the Minister is: will she set out for the House what the Government’s current thinking is? She has indicated that the regime should stay in place for little while, but I note that the explanatory memorandum to these regulations reminds us that the overall international travel regulations will cease to have effect on 8 June this year. That is not far into the future, so the Government will have to make a decision about whether to allow those regulations to lapse on 8 June, effectively resulting in no controls on international travel or, whether—as I suspect is more likely—to bring in further regulations, in which case they will need to be clear about how long they wish those regulations to remain in place.

The exchange between myself, my hon. Friend the Member for Winchester and the right hon. Member for Torfaen illustrated this question. Is this about how well we have rolled out vaccinations in the UK and therefore protected our population from covid? The Minister will know that we already have in place very good genomic sequencing, and as I understand it, all the manufacturers and developers are ready to tweak the vaccines they have already developed, if the genomic sequencing indicates any need to do so. At the moment, although these variants are called variants of concern, none of them evades the vaccine. My understanding is that the vaccines are effective against all of them, certainly in terms of preventing serious disease, hospitalisation and death. There is, I understand, a question mark about the extent to which the vaccines protect against the South African variant as far as mild disease is concerned, but if it enables mild disease to take hold then I am not sure that is something about which we need to be enormously concerned.

I press that point because if the Government are going to take the view that they are so worried about a potential variant that does not yet exist developing somewhere in the world and undermining the efficacy of our vaccine position, then it seems to me that that means we will have to keep the regulations in place at least until the whole of the world is vaccinated and the virus is driven down to a very low level globally. That may not be until the end of next year, on a best-case scenario. That has really quite dramatic consequences for the airline industry, the travel industry and the 3 million people who work in it, and the freedoms of our population, so if the Minister could say a little bit about that, that would be helpful.

[Steve Brine]

Perhaps it would be helpful if the Government were to say what level of reduced efficacy they would consider to be a cause for concern. Any flu vaccine that I ever purchased when I was doing the Minister’s job had about 60% efficacy. The three vaccines being used at the moment are way ahead of that, so even a reduction in efficacy of 10% would still significantly outpace the flu vaccine we currently roll out. Would it be helpful if the Government said at which level it would drop to where the indicators would flash red?

[Mr Harper]

That is a very good question. More widely, it would be helpful if the Government and their scientific advisers had a slightly better conversation with the public about variants and the impact they may have on vaccine efficacy, rather than this constant—I accept this is not always how they intend it, but it is the way it gets reported—conversation about scary variants or mutants.

Actually, at the moment—I am sure the Minister will correct me if I am wrong—all the variants we are aware of are dealt with by the existing vaccine portfolio to a greater or lesser degree. What we are concerned about is what may come along in the future, but we have a very good system in this country at least. My understanding is that none of the vaccine manufacturers yet feel they have to change the design of their vaccines to deal with any variant we are currently aware of anywhere in the world.

One further point I want to make is that how we name variants—the Kent variant, the South African variant, the Indian variant—is not actually terribly helpful. It gives the impression to the public that the variants only come from specific geographic parts of the world and if only we put in a sufficiently robust border arrangement, we could keep them out. The reality, of course, is that those variants could occur anywhere in the world, including here in the United Kingdom. I think I am right in saying that the best advice that exists is that even an incredibly tough border regime can, at best, only slow the transmission of viruses, rather than keep them out forever. At some point we will have to decide when we will allow travel to get back to normal, which is why I asked whether that would be about how the world is vaccinated or how the United Kingdom is vaccinated. I do not think that question has been sufficiently answered.

Specifically on the regulations, there is reference to the ports by which people are allowed to enter the United Kingdom. I want to ask one or two questions about ports of entry. The Minister answered some of this, in response to the concerns raised by the shadow Home Secretary, when talking about the efforts that Heathrow in particular has put in place to try to keep people separate. However, it is the case, having looked at pictures, and listened to the challenges faced by airport operators and the first-hand testimony of people travelling, that people from different countries, including red list countries and non-red list countries, are kept in airports for significant periods of time in a way that is not particularly well socially distanced. That is clearly a risk, if we then insist that they will have to spend time in quarantine, when they have just spent a considerable period of time next to people from completely different countries.

I mention that because I wonder what plans the Government have in place, as they think about increasing the volume of international travel, to automate the process. The Minister will be aware—I am, as a former Immigration Minister—that one of the ways in which we deal with the volumes going through airports is to have e-gates to automate the process of checking people’s travel documents. In order to deal with a significant increase in volume, the testing information on the passenger locator form will, I think, have to be put into some digital form, if airports are to have any hope of dealing with the volume of passengers. Given a significant increase in passenger volumes, even with an increase in the number of Border Force staff, in no way will airports be able to cope with checking all that information and dealing with the volume of flights without becoming absolutely overwhelmed. If the Government might change the position in just a couple of weeks’ time, will the Minister say how far forward those plans are?

My final point—you will be pleased to know, Mr Deputy Speaker—is about vaccine passports. I am not at all persuaded of domestic vaccine passports. They run a great risk of creating a two-tier society. Also, once we have vaccinated the adult population, in particular with the take-up rate among the groups so far of more than 95%, I am not at all sure what a domestic vaccine passport gets us once we have reached that level of vaccination coverage.

It seems to me that vaccine passports would be a big mistake. As the Paymaster General, who responded to the debate last Thursday, said to me, domestic vaccine passports and international ones are quite separate and should be treated separately, and it would be a mistake to run them together. I was heartened to hear that, and I hope that is the position the Government will stick to.

Internationally, however, some questions arise from the regime put in place here. I am much more relaxed about international vaccine passports than about domestic ones. We have already have precedents—people have to have yellow fever vaccinations to go to specific countries—and of course if a country requires people to be vaccinated to enter it, it is entirely up to it what rules are set for people who want to visit that country.

My first question for the Minister is because I understand that the World Health Organisation states in its most up-to-date policy paper of 5 February—the latest one on its website—that it does not recommend that countries have proof of covid vaccination to exist before they allow people to travel. The reason it sets that out is that it fears that that would in effect incentivise countries that had already had a good roll-out of vaccine to hog the global supplies for themselves, setting up some unfortunate sets of incentives. That is the organisation’s latest position. Will the Minister say whether the British Government will go along with that position?

I have two questions. First, if the UK Government ease up on the travel rules in May, is their position that they will require foreign nationals to be vaccinated before they come to the United Kingdom, or will the Government stick to the testing regime? Secondly, what steps have the Government put in place, working with the International Air Transport Association and other international bodies, for any kind of international vaccine passport? Perhaps the Minister will update the House on the Government’s plans.

I raise that because, if the Government announce a change to the international position in the next couple of weeks, knowing what plans are under way—and, I hope, this House being asked for its authorisation to implement such measures—would be very welcome. With those few questions, I conclude my remarks.

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[Jo Churchill]

There were a considerable number of questions from my right hon. Friend the Member for Forest of Dean (Mr Harper). I will try to cover those that I heard, but he will forgive me if I write to him on the matters for which I do not have the immediate answers. Let me say as a slight cover-all that many of the things to which he alluded will be brought forward by the global travel taskforce when it starts to lay out the approach to restarting international travel safely, aligned with the domestic road map. I appreciate that he said he felt that this was his last chance to raise this issue while the House was sitting, because, given the dates, it is highly likely that that will happen while we are prorogued or shortly after. However, this is live and dynamic at the moment, and I can give him few answers on the specific questions he raised on the global taskforce and what it will say in three weeks’ time about future travel arrangements. Although I apologise for that, there is really nothing I can say to pre-empt that set of instructions as to how and when we are going to lift restrictions, and the use of a traffic light system, where countries will be categorised as red, amber or green, and how we deal with people in that space.

[Mr Harper]

Let us assume, based on the timings that have been announced, that the results of the global travel taskforce are going to be announced when the House is not sitting. May I get an assurance from the Minister, then, that on the first day after the state opening of Parliament that it is permitted to have a statement there will be a statement at that Dispatch Box by a Minister, so that we are able to ask questions about the results of the global travel taskforce? Will she assure me that that will take place at the earliest possible opportunity?

[Jo Churchill]

I thank my right hon. Friend for that. I assure him that I will take that request back. As he knows, I cannot commit to that at the Dispatch Box.

My right hon. Friend asked which ports of entry people can fly into, why we have chosen those ports, whether we are extending them and what happens if someone from a red list country is booking in to arrive at a non-designated port. If someone has a pre-existing booking to a non-designated port, it is the individual’s responsibility to change it to a designated port. Carriers are not permitted to carry anyone who has been in a red list country in the previous 10 days to any port of entry other than those that are specified. Currently, those designated ports are clearly Heathrow, Gatwick, London City, Birmingham and Farnborough.

I ask the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) to write to me, but I gently say to her and to the hon. Member for York Central (Rachael Maskell)—I cannot discuss the specifics of the case of her constituent, for whom I have the greatest sympathy—that the challenge here is that their Front-Bench team are asking for stricter restrictions the whole time, across the piece. If all we then do is build more and more exemptions into the system, we will have a looser system than the one we are endeavouring to make sure is proportionate, delivers in a way that manages the arrivals from red zone countries, and has a degree of flexibility to ensure that as the system changes we can build countries back into travel and restrict others where there may be a flare-up.

It is right, as I have explained, that all these measures are kept under constant review. The combination of quarantine requirements for all international arrivals means that those arriving from countries presenting with the highest risk are asked to use the Government-approved hotel quarantine facilities. There is a robust testing regime prior to departure and then again on arrival. Enforcement is put in place if required. As we still have more to learn about the virus and, as my right hon. Friend said, more understanding to acquire, we must make sure that our approach is based on the best evidence, and that it is proportionate. That is the responsible approach to take to safeguard progress in defeating the virus and to make sure that we can all get back to some degree of normality.

[Mr Harper]

Before my hon. Friend sits down, may I press her on one further point? I accept that she cannot set out answers to my detailed questions until the global travel taskforce has presented its outcome and Ministers have made their decisions. The central question I did ask though requires a fairly wide policy decision. It may be that that will be decided by the global travel taskforce as well. Fundamentally, is our travel regime and how much protection we are going to have based on the extent to which we have vaccinated the British public, which is obviously proceeding at pace and suggests that we would be able to relax these measures sometime during the summer, or will it be based on the extent of the virus globally, which suggests, listening to some of the best voices on this, that we will be looking more towards the end of next year. That does not seem to me to depend on what the global travel taskforce is deciding. It possibly does, but perhaps she could furnish the House with an idea.

[Jo Churchill]

I do hate to disappoint my right hon. Friend, but I will have to do so once again. The answer to that question will appear with the global taskforce as we move into the coming months. In addition to that, there is a package that is linked to the work of the Chancellor of the Duchy of Lancaster on passport certification. We want to have a coherent integrated system that provides a proportionate response as we move forward.

Covid-19 Update

Mark Harper Excerpts

Monday 19th April 2021 Commons Chamber

[Matt Hancock]

We keep all these decisions for each country under constant review. The challenge of the genomic data is that some countries have excellent coverage of genomic sequencing and others do not. Actually, that is not particularly correlated with their income. For instance, South Africa, a middle-income country, has excellent genomic sequencing. We take the decisions very rapidly when we need to. We keep all this under constant review and I am glad that she welcomes the decision to put India on the red list today.

[Mr Mark Harper (Forest of Dean) (Con)]

May I add my congratulations to all those who have been involved in the fantastic vaccine roll-out that the Secretary of State set out in his statement? It is obviously breaking the link between cases, hospitalisations and deaths, as we are seeing dramatically from the figures. Many members of the public and businesses, having looked at the road map, which he also mentioned, will have seen that as of 21 June, the Government and the public are expecting the country to be broadly back to normal, but, of course, there is the small print about the reviews on social distancing. Will he confirm to the House and the public that as of 21 June, he expects us to be broadly back to normal, without social distancing? If that is not the case, will he set out what the evidence base will be for that decision?

[Matt Hancock]

Any decisions like that would be based on the evidence, and we have far more evidence now than we did when making these decisions previously. I fully expect that there will be some areas of life, without the need for laws in this place, where people will behave more cautiously than previously. The wearing of masks is one—before this pandemic, wearing a mask in public in this country was extremely unusual. I imagine that some people will wear masks, and choose to wear masks, for some time to come. Our goal is to manage this virus and the pandemic that it has caused more like flu—in fact, like flu. Flu comes through each year. We do take action to deal with flu—we take action on nosocomial infection in hospitals and through the flu vaccine programme—but we do not stop normal life as we know it. That is the overall attitude and approach. My right hon. Friend mentions that four reviews were set out as part of the road map and they will, of course, have to conclude. But that is my hope because, as he knows, I very firmly believe that this vaccine is breaking that link. We can see it in the data every single day and in the way that the country is responding. It is uplifting.

Coronavirus

Mark Harper Excerpts

Thursday 25th March 2021 Commons Chamber

[Matt Hancock]

Over the past year, we have all been engaged in a monumental national effort to fight coronavirus, which has required the House to take extraordinary measures in response to this extraordinary threat. Today, we debate our road map to recovery and what is legally needed to take the cautious but irreversible path out of this pandemic. We propose to remove some of the emergency powers that the House put in place a year ago and set the steps of the road map that my right hon. Friend the Prime Minister has set out into law, replacing the existing national lockdown. We are able to take this action and propose these measures thanks to the perseverance of the British people in following the rules and the success story that is our UK vaccination programme, which has now vaccinated more than 28.6 million people—55% of all adults in the United Kingdom.

Hospitalisations are now at their lowest point since September and are down 90% since the peak. To put this into context, there are today just over 5,000 people in hospital with covid. At the peak, just two months ago, there were just under 5,000 new admissions with covid each day. Deaths are now at their lowest point since October and they are down 94% since the peak. The research published today shows that our vaccination programme has already saved the lives of more than 6,000 people across the UK, up to the end of February.

The success of the vaccination programme means that we are now able to carefully replace the short-term protection of the restrictions that we have all endured, with the long-term protection provided by the vaccine. Our goal is to be cautious yet irreversible. I must tell the House, Madam Deputy Speaker, that while I am still, by nature, an optimist, there remain causes for caution. Cases are rising in some areas and they are rising among those under 18. There are early signs of cases flattening among the working-age population, too.

I am delighted that uptake of the vaccine is now 95% among over-60s and that protection against dying from the vaccine is around 85%. Both of those figures, 95% uptake and 85% protection, are higher than we could have hoped for, but while we are confident that we have broken the link between the number of cases and the hospitalisations and deaths that previously inevitably followed, no vaccine is perfect and take-up is not 100%, so that link, while broken, is not yet severed.

New variants also remain a risk because we do not yet know with confidence the impact of the vaccine against the new variants. We all want these next few months to be a one-way route to freedom, so as we restore the freedoms that we all cherish, we must do so in a way that does not put our NHS at risk.

[Mr Mark Harper (Forest of Dean) (Con)]

On that point about the take-up and the efficacy, one thing that the chief medical officer said was that the timings in the road map were driven by some of the modelling that the Government had seen. The assumptions behind that modelling I think came from February and are much more pessimistic than what we now know about take-up and efficacy. Can the Secretary of State ensure that that modelling is redone with the new assumptions to see whether that would justify a faster unlocking of the country, which is important to save jobs, save businesses and maximise the economic future of our young people?

[Matt Hancock]

While modelling is obviously something that is looked at, the observation of the actual data is I think the best guide. The good news is that the number of deaths has fallen very sharply and continues to fall sharply, and the number of hospitalisations has fallen sharply—not quite as sharply as deaths, but nevertheless sharply. Critically, the link has broken, so the weight that we place on the number of cases as an indicator is not nearly as great as it was before, because it used to be inevitable that that led to hospitalisations and deaths.

The reason for the timings in the road map is so that, after each step, we can see its impact before being able, carefully, to take the next step. That is the core reason for the timings in the road map—four weeks to see the impact of a step, and then one week to give warning of the next step. It is that, rather than the modelling, that I put the stress on for the timings in the road map.

[Mr Harper]

To come back very briefly on that final point, if deaths and hospitalisations are what is important, is the Secretary of State able to confirm the information that was published in The Times this morning on the modelling by SPI-M—the Scientific Pandemic Influenza Group on Modelling, the Government’s advisory committee —showing a dramatic reduction in hospitalisations and deaths taking place over the next week and throughout April? That really drives my assumption that we could go a bit faster. Is he able to confirm that for the House?

[Matt Hancock]

I have not seen that article in The Times—I have read parts of The Times, but not that bit—so I cannot confirm, but I can write to my right hon. Friend with details on this point. However, I would stress that the focus only on modelling is not really where the ultimate judgment on the timings of the road map is; it is about being able to observe progress and then take the next step with confidence. The central point here is that cases may well rise. In fact, I would say cases are likely to rise, not least with schools going back. The critical thing is that the automaticity—cases going up having an impact on hospitalisations—is no longer there. However, if cases got extremely high, even with a much weaker link from cases to hospitalisations, that is something we clearly have to guard against and it is set out in test 3 of the Prime Minister’s four tests.

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[Matt Hancock]

Yes, that is an important point. We have just started the process of working on that. If measures have worked well and we want to keep them because they are good, can we put them permanently on the statute book? That should, properly, take the process of normal primary legislation. My hon. Friend mentions a forthcoming health and care Bill. I look to the Leader of the House and I can see that he is smiling, although I cannot, of course, say whether that Bill will be brought forward until we have a proper sign-off—it is nice to see him looking so handsome there. [Laughter.]Our aim would be to get that on to the statute book, should we bring it forward, in the middle of next year, so there is a shorter-term question of the handling from here to there. We need to do that with the best administrative efficiency that we can, but I am talking here about the less controversial elements of the Act.

[Mr Harper]

I am grateful for the Secretary of State’s judgment and I will try not to test his patience again. He mentioned that there are some very valuable administrative measures. If they were the only things being rolled forward, I do not think people would mind, although my reading of the Act is that the registration provisions for medical staff are in section 89, in the permanent part of the Act rather than the temporary part. The controversial parts include the police powers to detain potentially infectious persons, which the hon. Member for Twickenham (Munira Wilson) referred to, and which have been used unlawfully on a number of occasions. It says in the one-year review of the Act that those are intended to be long-term powers and my right hon. Friend has just suggested that those provisions might be rolled forward a further six months. That is why so many of us are worried. These are extraordinary provisions, not for normal times, and they should be expired at the earliest possible opportunity.

[Matt Hancock]

I actually agree with my right hon. Friend that they should be expired at the earliest possible opportunity. The challenge, especially as we lift measures on all of us, is if there are, for instance, new variants that we need to pin down absolutely—in the same way that a new variant came about in Liverpool and we tackled it. We have not seen any new cases of it, not only because of fantastic local work, but because in lockdown that is easier. Having these very targeted interventions for now is important. Therefore, we have made the judgment that we should propose that they are necessary for now. I know that we disagree on that point, but I suggest that by voting against all these renewals, a whole load of valuable things that he and I would agree on would not be renewed, were that vote to go through.

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[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

I suppose I have an opportunity to reply to my right hon. Friend the Member for New Forest West (Sir Desmond Swayne), who has just spoken. I have a rather different take.

Many people seem to be seized of the idea that the vaccination programme has already freed us and that we are entitled to take back freedoms now. I want to challenge that. The threat of a third wave exists—in fact, there will be a third wave; it is just a question of how large it is going to be. The only thing that will constrain it is the proportion of the population who are resistant.

There is 85% take-up in half the population at the moment and the vaccines are on average 85% effective: that means that only 72% of half the population has immunity. The Secretary of State referred to Public Health England advice—based on very fresh data, I hasten to add—that bears out the most recent Imperial College modelling, which shows that even if all the restrictions are not lifted until July there is still a danger of a third wave. If the restrictions were lifted at the end of April, say, there would be a dramatic rise in the number of hospitalisations.

[Mr Harper]

I read with great care my hon. Friend’s article on ConservativeHome this morning. He refers to the modelling that Imperial and Warwick did. I went through that in some detail, but the problem is that the assumptions they made—I went through every single one—are all overly pessimistic compared with the actuality. That is why I asked the Secretary of State to redo that modelling, because if he did so, I think he would come to a much more optimistic conclusion than my hon. Friend has reached.

[Sir Bernard Jenkin]

I am perfectly prepared to accept that it is a worst-case scenario, but we are dealing with projections that are based on a great deal of speculation, and they do not take account of the possibility of new variants. I rather share the concern expressed by some Members in the debate that we need restrictions on people coming into this country, particularly from the continent, and that there should be more testing of people coming here. I am sure that the Government will want to implement those measures if they can. It is rather easier to call for them to implement them than to do so without causing a great deal of disruption.

I want to briefly touch on the continuation of our vaccination programme. One of the risks that we need to factor in is that the rate of vaccination will slow, and particularly the rate of first doses, because the vaccination programme now has to cope with the large quantity of second doses. The restrictions on vaccine supply mean that the number of first doses will perhaps reduce to as little as 50,000 a week in April. That does not rule out that we should adopt a generous attitude towards our European friends, however much they may be casting around for blame and trying to salvage their reputation from the failure of their own vaccination programmes. We can draw comfort from the fact that they are resorting to possible bans and blockades because they have no contractual obligations to enforce upon AstraZeneca—it is a misunderstanding of the difference between contracts that give rights over stock that exists and contracts that give rights over the flow of production, which is creating stock that does not yet exist.

The fact is that we are at the front of the queue, but I think that the United Kingdom should seek to be generous and to avoid this vaccine nationalism, even if it means giving up some of the flow of our vaccine, although it is understood that there are actually some large quantities of vaccine in the European Union that are not being used. The fact that they have trashed the reputation of the AstraZeneca vaccine is most unfortunate, and while understandable in psychological terms, it is unforgivable in public health terms.

Finally, on the issue of lifting covid restrictions in Parliament, I congratulate my hon. Friend the Member for Hazel Grove (Mr Wragg), the Chair of the Public Administration and Constitutional Affairs Committee, who cobbled together a majority in the Procedure Committee to get what he wanted in the Committee’s report. But I suggest that, in the end, it is a matter for the whole House what the House’s procedures are. There are things to learn, as the Prime Minister said yesterday, that will make the House more equal, fairer to people who are sick and fairer to people who have caring responsibilities and perhaps take the pressure off the shortage of time we have because we do not want too many late nights. Some of our debates have got too short, and speeches have got too short, and if those who had to be away could have proxy votes, we could have longer debates, better debates and better scrutiny of legislation, as well as a House that is more attractive for women to stay in and take part in.

--- Later in debate ---

[Mr Mark Harper (Forest of Dean) (Con)]

Let me deal with the two fundamental choices that we face today. The first is on the Government’s regulations implementing the road map that the Prime Minister set out. I am not going to vote against those. I am not going to support them, but I am not going to vote against them; it would be churlish. They are a road map to freedom, and my only quarrel is with the pace, not with the direction of travel.

I go back to what the Secretary of State said. He was very clear that the Government will not be looking at modelling; they are looking at real data. If we look at hospitalisation data, the dramatic reduction in the number of deaths and the fantastic pace of the vaccination roll-out—we have seen data today showing how fantastic the take-up of vaccination has been—it is clear that we are going to be able to save lives and protect the NHS not by staying at home but by the vaccination doing the heavy lifting.

I want to pick up a point that my hon. Friend the Member for Harwich and North Essex (Sir Bernard Jenkin) made about the quantity of the population that has been protected. It is absolutely true that we will not have vaccinated everyone by the end of April, but importantly, we will of course have vaccinated groups 1 to 9, which account for 99% of the deaths to date and over 80% of the hospitalisations. While we will not have stopped everyone getting covid, we will have dealt with the problem of significant numbers of people becoming seriously ill, going into hospital and potentially overwhelming the NHS, and large numbers of people dying. That is why I maintain—and, increasingly, the data will bear this out—that we could safely reopen society more quickly than the 21 June deadline. The reason why that is important is that there is another side to this situation: in that time, jobs will be lost, businesses will fail and some people will find the personal burden incredibly difficult to bear. We do not need to go through that for another two months if we are able to reopen safely earlier.

On the Coronavirus Act and the renewal of the temporary measures, I am very pleased that the Secretary of State confirmed at the Dispatch Box that what we have been hearing about the furlough scheme being brought to an end if we voted against the temporary provisions is nonsense. I said that at the weekend and I am glad that the Secretary State has now confirmed it at the Dispatch Box. I accept that there is a choice, but the problem is that some measures the Government want to take forward are very sensible, and I support them, while many others are egregious and absolutely not supported. Given that we have an up or down vote and no ability to amend, we have to balance these things. I will vote against the renewal of the temporary provisions, because the measures that the Government want to take forward are sufficiently bad and unwarranted that they do not deserve to continue. If the Government were to lose that vote—they are not going to lose it—they could, given their majority, easily implement the more sensible measures that are necessary in an alternative piece of legislation that would no doubt get through this House with cross-party and, I think, almost universal support.

Finally, I wish to reflect on what the Secretary of State said. I raised with him the point that was in the one-year review of the Act, which suggests that the schedule 21 powers—the ones that give the police the power to detain people—are necessary for the long term, and he did not rule out extending those measures for another six months. By the Government’s own admission in their explanatory notes, these measures are extraordinary and would not be acceptable in normal circumstances. Given that the Prime Minister wants us to have removed restrictions by June, it is not acceptable to extend those measures to October and I certainly do not think it necessary to extend them to March. That is why, regretfully, I will be voting against the renewal of the temporary provisions.