National Health Service
Debate between Mark Harper and Helen Whately(3 years, 4 months ago)
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Helen Whately
As I said, the impact assessment is being worked on. That is the current situation. I was explaining one of the challenges in coming to an impact assessment that we can share with colleagues to inform them accurately. I really hear that hon. Members want to have the full set of information for this debate. We face a dilemma: the clock is ticking and each day we are moving closer to winter. I am going to come on to it in the detail of my speech, but one important feature of this proposed legislation is that it gives staff a grace period in which to get vaccinated. The longer we take on this, the more risk there is to having that grace period.
Mr Mark Harper (Forest of Dean) (Con)
Will the Minister give way on that point?
Helen Whately
In one moment. One thing I can share is evidence that we have on how this kind of policy is working in practice from a large care home provider that is already implementing a requirement for its staff to be vaccinated. It has seen the vast majority of staff get vaccinated, with less than 1% of its workforce choosing not to be vaccinated. We have committed—and the Minister for Covid Vaccine Deployment, my hon. Friend the Member for Stratford-on-Avon (Nadhim Zahawi) committed to this earlier to the Lords Secondary Legislation Scrutiny Committee—to publishing an impact statement setting out the evidence we have in advance of the Lords debate.
Helen Whately
If my hon. Friends would allow to make a little more progress, I will absolutely take more interventions. However, I am conscious of wanting to set out the context and thinking behind this piece of legislation.
Helen Whately
I may well answer many of my hon. Friends’ questions as I proceed, so I ask my right hon. Friend to let me make a little progress and I assure him I will take interventions.
As I was saying, throughout the second wave care homes used 26 million tests and 1.2 billion items of personal protective equipment, yet still we saw outbreaks in many care homes during the winter and 14,000 deaths from covid among care home residents. But there is one thing now making a huge and crucial difference, a major advance that is unequivocally saving the lives of care home residents and staff from this cruel and pernicious virus, and that is vaccination. I have spoken to residents who were in tears of joy and relief as they were vaccinated, as they at last had their own defence against this virus. So far, the vaccine roll-out to residents and staff in care homes has been a big success story. The Joint Committee on Vaccination and Immunisation made residents and staff in older age care homes the highest priority as soon as vaccines were available, and the NHS hit its target of offering the first dose to all care homes by the end of January, which was a fantastic effort.
Helen Whately
I will take an intervention from my right hon. Friend the Member for Forest of Dean (Mr Harper).
Mr Harper
I come back to the point about the impact assessment. The document prepared for the House says that a full impact assessment has been prepared. Ministers need to give accurate information to the House, so if that is not correct and is misleading, it should be corrected immediately. It is not good enough to say that something will come along afterwards; we are being asked to vote on these regulations today. There is no urgency—the regulations do not come into force for 16 weeks, until November—so it is perfectly reasonable for them to be taken away and for the impact assessment that has been prepared to be published. If there is uncertainty, share the uncertainty with the House. It is not good enough to expect us to vote on something that is difficult, controversial and complicated and not share with the House the information that the Minister has at her disposal. It is an abuse. It is not good enough.
Helen Whately
During the course of this speech, I will share as much information as I can with my right hon. Friend on the rationale behind this, but let me address his point about the timing. He says that it could be done later, but the problem is that, if we do it later, will we suggesting that it is too late for care home staff who have not yet been vaccinated? The point is to give care home staff the time between this being legislated upon and its being implemented in time for the winter, when we know that there is a greater risk of a combination of covid and flu, to get vaccinated, in the knowledge that we are generally seeing an eight-week period between doses.
Helen Whately
I thank hon. Members for their contributions and the questions they have put to me during this debate. I welcome the consensus on the importance of protecting care home residents. This debate is about how best we do that and the level of evidence needed in order for us to take the steps to best protect those vulnerable residents. The problem we face is that the clock is ticking towards winter, and to a potential combination of covid and flu to which we know care home residents will be extremely vulnerable. The problem with inaction and waiting for more time is that inaction costs lives.
I have heard—I assure my hon. Friends on this—the strength of feeling about the impact assessment, and may I say that I apologise to my hon. Friends for the error, particularly in the explanatory notes to the regulations? I have done my utmost, as I did in my opening speech, to set out for hon. Members the situation with the impact assessment, and there is nothing further I can say on that now.
Mr Harper
I do not know what other colleagues feel, but I find it offensive that, because we have expressed concerns about these regulations, it is somehow implied that we want to do away with or risk the lives of people in care homes. These regulations do not come into force for 16 weeks. There is ample time to take them away, review them, publish the impact assessment and get this House to make a decision, and protect people before the onset of winter. To suggest that Members want to do otherwise and that we are suggesting inaction that would put their lives at risk is offensive, and I urge the Minister to withdraw it.
Helen Whately
No offence was meant on my part. The problem with what my right hon. Friend is suggesting is that, if there is a substantial delay—for instance, in the autumn—in bringing through this legislation, that leaves care workers who have not yet been vaccinated with very little time in which to get vaccinated, and that is why we are bringing this forward now.
Winterbourne View Hospital and the Transforming Care Programme
Debate between Mark Harper and Helen Whately(3 years, 5 months ago)
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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.
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.
Public Health
Debate between Mark Harper and Helen Whately(3 years, 10 months ago)
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Helen Whately
I thank hon. Members from across the House and those who have contributed virtually for the many truly thoughtful contributions in what has been a really wide-ranging debate this evening. In a moment, I will respond, as far as I can in the time that I have, to many of the points and questions that have been raised.
As I stated at the outset, although we have the truly welcome news of the MHRA approval of the Oxford/AstraZeneca vaccine for use, right now we face a very serious situation. We face rapid rates of covid transmission and new cases of the new variant of the virus. We began to see that before Christmas, when we brought in the measures and the introduction of tier 4, which we are debating today. No Government would want to do what we are having to do, which is to put such restrictions on people’s lives, but, as many hon. Members have recognised in their speeches, we see the pressures on the NHS and know that rises in infections and rises in hospital admissions very sadly lead to loss of life. We also know the implications of those pressures on the NHS not only for those with covid, but for those needing treatment for other illnesses. The alternative to taking measures to suppress the virus is unthinkable. These decisions are not easy to make, but the data is clear, including on the additional infectiousness of the new variant.
Some hon. Friends asked why their constituencies had been moved up tiers either in the past couple of weeks or today and sometimes moving at some pace from a low tier to as far up as tier 4. The reason is that a combination of the epidemiological evidence and hospital pressures, looking at the five criteria that we have set out, makes it clear that that is what needs to happen. I remind my hon. Friends of the five criteria. We look at the case rates for all ages, the case rates for over-60s—which particularly translate into hospital admissions—the change in the case rate, the positivity rate and pressures on hospitals such as occupancy rates and the trajectory of those. Looking at that dataset, it is clear when action is needed.
Mr Harper
Can I look into that point a bit? I thank the Opposition spokesman for giving us so much time to deal with the things we did not have time to deal with in our limited remarks. On the point about looking at the data—I listened carefully to a number of colleagues, and I had this in my constituency—I genuinely do not understand how my constituency was put into tier 3 starting at midnight on Boxing day, and after only three days had elapsed a decision was taken to move it to tier 4. What data had changed? Nothing significant happened between those two dates. Other colleagues went through three tiers in a matter of days. The problem is that that does not engender confidence among our constituents that the decisions are being taken for understandable reasons. Will the Minister say a little bit more about the decision-making process so that we can take that back to our constituents to try to give them a little more confidence?
Helen Whately
Something that I can say to give my right hon. Friend some extra insight is that, for instance in introducing the latest measures, one of the things that we saw was a rapidly changing situation. During the national lockdown and the weeks following that, there was some puzzling about what was going on. We were seeing a large increase in the case rate in the south-east, especially in Kent and part of my constituency. What we came to investigate and understand was the new variant playing its part in that. It is the data that tells us that we need to make an urgent change, for instance in the tier that an area is in.
I have one very specific example that I want to give, not in relation to my right hon. Friend’s constituency but in response to the question that my hon. Friend the Member for Christchurch (Sir Christopher Chope) asked about why his constituency had changed tier and what had happened in the period that we are talking about. I can tell my hon. Friend the Member for Christchurch—he is not in his place, but I hope that he is listening remotely—that we saw a 68% increase in the case rate in his area of the country between 17 and 23 December, as well as a rapidly rising rate in the over-60s and a rising positivity rate. That is the kind of story that tells us that we need to take rapid action.
My right hon. Friend the Member for New Forest West (Sir Desmond Swayne) also questioned the timing of the introduction of the new measures, and I can tell him that we saw the number of cases increasing fast—both cases and hospital admissions. There was quite simply no time to waste. The analysis was clear that that was driven by the new variant.
Some hon. Members have questioned the effectiveness of the measures. My hon. Friend the Member for Thurrock (Jackie Doyle-Price) spoke about her area now having the highest case rate in the country—something I can relate to because part of my constituency previously had the highest case rate in the country—and it is not a reason why you want your area to be famous.
In the parts of Kent that were hit hardest with the new variant a few weeks ago, we are now seeing some stabilisation in rates. I should warn that that is at a relatively high level. It is also very soon after the introduction of tier 4—just 10 days ago—for us to see its full effect. We and everyone living in those areas can play their part in making sure that the restrictions work. My hon. Friend the Member for Aylesbury (Rob Butler) said to us on the screen that he had one simple message, which was to follow the rules. The virus thrives on social contact and the restrictions reduce that, and the Government will of course continue to keep these measures and their effectiveness under review.
Many hon. Members spoke up for businesses in their constituencies, and I absolutely recognise the huge challenges that the pandemic has placed on many businesses in some sectors such as hospitality and tourism and travel in particular. We have, of course, sought to protect livelihoods as well as lives. We have spent over £280 billion this year to support businesses and individuals. That includes extra support for higher tiers, recognising the extra costs incurred in those areas. I have no doubt that my honourable colleagues in the Treasury will be taking note of many of the arguments made by colleagues today.
Helen Whately
May I make a little progress? I did take an intervention from my right hon. Friend a moment ago, and I am trying to respond to the many points made in the debate.
My right hon. Friend the Member for South West Wiltshire (Dr Murrison) rightly referred to the unpredictability of this virus, and to how it does not follow due process, as we have seen with the new variant. Unlike many mutations, which are normal things that occur with a virus, this variant has changed the behaviour of the virus. As my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer) said, thanks to the UK’s world-leading virus surveillance capability, we were able to detect and analyse the spread of this new strain. We know that it is most evident in the areas with exponential rises in cases at the moment, and those are the areas that have been placed in tier 4, either before Christmas or with the announcements today.
Many hon. Members spoke about the vaccination programme, and they welcomed the good news about the Oxford/AstraZeneca vaccine. Some hon. Friends even sought to change the way we describe the vaccine, by claiming it for their own constituencies. The hon. Member for Strangford (Jim Shannon) said that the vaccine has put a spring or a skip in his step, which I know that Members around the House will welcome.
The NHS has done a brilliant job of already vaccinating more than 600,000 people with the Pfizer-BioNTech vaccine, and with the opportunity to now bring into play the Oxford/AstraZeneca vaccine, we are driven and committed to its rapid roll-out. We have secured 100 million doses, and the NHS stands ready to deploy them from next week. We have an infrastructure of hospital hubs, GPs, vaccination centres and pharmacies ready to play their part and, as my right hon. Friend the Member for South West Wiltshire said, they will be drawing on a workforce that includes volunteers from among our fabulous NHS returners, who stepped forward to offer their help to the NHS during the pandemic.
Mr Harper
The Minister is being generous in giving way. I wish to ask about one issue that cropped up today at the Prime Minister’s press conference, and something that Professor Van-Tam said about what we do and do not know about the vaccine’s ability to reduce the transmission of the virus. My understanding is that once we have vaccinated those who are at most risk, and reduced the risk of people dying or being hospitalised, we will then be in a much better place. He seemed to imply that if the vaccine does not reduce the transmission of the virus, that will somehow prolong the restrictions we have to keep in place, but I do not follow why that would be. Can the Minister clarify the Government’s position on that? I think that once we have vaccinated the at-risk groups, we can remove the restrictions. Am I wrong?
Helen Whately
I do not think that now is the moment for me to hold a remote debate on that with the deputy chief medical officer, and my right hon. Friend also asks me to see into the future regarding the roll-out of the vaccine. I can say, however, that we are following the prioritisation as set out by Joint Committee on Vaccination and Immunisation. That is first and foremost to vaccinate those who are at greatest risk of losing their lives to covid, and that is why we are starting with residents in care homes, which have been so hard hit by the pandemic, as well as care home workers. The next priority category is those who are over 80 and broader health and social care workers, and it then moves down the ages. Our approach follows the JCVI prioritisation to put the vaccine to that crucial and important effect of saving people’s lives from this cruel disease.
The hon. Member for Nottingham North (Alex Norris) asked about the publication of JCVI advice on the use of the vaccine. I can tell him that it has already been published and is available on gov.uk.
HEALTH PROTECTION (CORONAVIRUS, RESTRICTIONS) (SELF-ISOLATION) (ENGLAND) REGULATIONS 2020
HEALTH PROTECTION (CORONAVIRUS, RESTRICTIONS) (NORTH OF ENGLAND, NORTH EAST AND NORTH WEST OF ENGLAND AND OBLIGATIONS OF UNDERTAKINGS (ENGLAND) ETC.) (AMENDMENT) REGULATIONS 2020
Debate between Mark Harper and Helen Whately(4 years, 1 month ago)
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Helen Whately
I will briefly explain each statutory instrument in turn.
The regulations on self-isolation, SI 2020, No. 1045, came into force on 28 September 2020. They make it a legal requirement to self-isolate if an individual tests positive for coronavirus, or is contacted by NHS Test and Trace and told to self-isolate. Financial penalties have been introduced for non-compliance with the regulations.
The regulations on the protected areas in the north of England, the north-east and north-west of England, as well as obligations of undertakings, SI 2020, No. 1057, came into force on 22 September 2020. They originally delivered a number of amendments to regulations that have since been replaced by the local covid-19 alert level regulations. Now, only amendments to the Health Protection (Coronavirus, Restrictions) (Obligations of Undertakings) (England) Regulations 2020 still continue to apply. Those amendments include inserting a definition of “indoors” to the obligations of undertakings regulations. They also amend the obligations of undertakings regulations to add a requirement on certain businesses to take all reasonable measures not to take bookings that would not be in line with certain gathering limits. The new requirements were originally related to relevant premises in areas covered by the north-east and north-west of England regulations. Those regulations have been revoked and the amendments made by SI 2020, No. 1057 now apply in relation to relevant premises in areas covered by Health Protection (Coronavirus, Local COVID-19 Alert Level) (Very High) (England) Regulations 2020.
It has been necessary to maintain the regulations to ensure that the requirements on businesses, as provided under the obligations of undertakings regulations, continue to support the covid-19 response. In particular, they align with and support the new local covid-19 alert level regulations.
Both sets of regulations have been introduced to mitigate the unprecedented impact of the covid-19 pandemic, and I urge the Committee to approve them so that we may continue to use those powers to save lives.
As the amended statutory instrument adds only a definition of “indoors” and a requirement on certain businesses to take all reasonable measures not to take bookings, I will now focus primarily on the regulations on self-isolation. The legal duty to self-isolate is one element of a three-part strategy to increase compliance with self-isolation after a person has been infected by, or exposed to, coronavirus. First, we aim to increase to public understanding of the importance of self-isolation to stopping the spread of the virus, and of the circumstances in which individuals must self-isolate. We have put in place a comprehensive media campaign to increase public awareness of NHS Test and Trace, explaining what it is, why it is important and what the public need to do.
Secondly, we are supporting people to comply by providing assistance to those who may have practical difficulties in self-isolating. NHS Test and Trace officials check in with individuals who have tested positive and who are contacts of cases through follow-up phone calls and text messages to reinforce the importance of self-isolation. They also provide advice and ensure that people have access to support that they need. Where a support need is identified, local authorities play a role in encouraging, educating and supporting compliance. In addition, a test and trace support payment has been introduced to help ensure that people on low incomes self-isolate when they test positive or identify as a contact, and to encourage more people to get tested.
Thirdly, we want to reinforce the seriousness of non-compliance. The regulations therefore introduce new legal duties, along with fixed penalty notices, for those who do not follow the rules. Where there is clear evidence that someone is not following the rules, the police will determine what follow-up action to take and, when necessary, issue fixed penalty notices. Fines start at £1,000 and may increase up to £10,000 for repeat offences. For more serious breaches, fines start at £4,000, increasing up to £10,000. Serious breaches may include where an individual comes into close contact with others and is reckless as to the consequences for the health of other people.
Mr Mark Harper (Forest of Dean) (Con)
I have listened carefully to what my hon. Friend has said about compliance. Does she have any evidence about how well people are actually complying with the self-isolation requirements? At a SAGE meeting in August, the SPI-B —scientific pandemic influenza group on behaviours—sub-committee was given an action to understand and improve adherence to self-isolation. It would be interesting to judge the regulations before us by understanding the extent to which people are or are not complying with the existing rules.
Helen Whately
I thank my right hon. Friend for his question, and I will indeed cite the evidence that we have on the level of compliance with self-isolation later.
The regulations also recognise the importance of employers respecting self-isolation requirements. No employer should prevent an employee from self-isolating or encourage or put pressure on them not to do so. Where an employer is found to be in breach of that obligation, they face a fine. That is in line with fines for other employer covid-19 breaches. Employees who need to self-isolate must also inform their employers of their legal requirement to do so, and a fixed fine of £50 is set for employees who do not inform their employer. There is a clear reciprocal duty between employees and employers about self-isolation, which supports both the opportunity and motivation to comply.
We recognise that there may be exceptional circumstances in which an individual may need to break their self-isolation; for instance, if they are unsafe or if emergency assistance is needed. In those cases, the legal duty would not apply and individuals would not face a penalty. The regulations specify the circumstances in which breaking self-isolation would be permitted.
Helen Whately
I thank colleagues for their contributions to the debate, and I will do my best to respond to as many as I can. I might not manage to get to them all, because I do not have much time.
I want to pick up on the comments made by the hon. Member for Ellesmere Port and Neston. I thank him for his overall tone, the approach that he takes to these debates, and the rigour with which he has gone through the regulations and asked totally reasonable questions. I will do my absolute best to respond to them. Like others, he had called for earlier scrutiny of regulations such as the ones we are debating, and I thank him for acknowledging that progress was made last week when we debated changes to regulations. Scrutiny is a valuable part of our democratic process.
The hon. Member for Newcastle upon Tyne North asked whether we could follow the normal processes for introducing and debating legislation, but she will know that we have the extraordinary challenge of the pandemic, which moves at a fast pace. With doubling times and exponential increases in case rates, there is a real trade-off between taking steps that will save lives and spending time debating them. We are constantly trying to get the balance right, so that we can move quickly and allow scrutiny, which, as I say, plays a valuable part in our legislative process.
The hon. Members for Ellesmere Port and Neston, and for Newcastle upon Tyne North, talked about some of the confusion about regulations, which I totally appreciate. We have been through a national lockdown in which the same rules applied to everybody. That was very simple, but it also had an enormous impact on the lives and livelihoods of the whole population. In response to that, the Government committed to trying to be more focused in our interventions, and to ensuring that interventions reflected what was going on locally where Test and Trace has given us information about how the virus is being transmitted. That led to local restrictions, and we worked closely with local authorities on what they felt would make the most difference in their area. That has led to different areas having different regulations. That can lead to confusion, in local authority border areas, about why the restrictions are different for people who live down the road.
We therefore introduced the tiering system—the local alert levels—to achieve more consistency while still allowing for local variation. That recognises that different areas have different infection rates, but it has led to people having to keep up with changes to rules. We are trying to strike the right balance between providing a local response to the virus and making the system as simple as possible. That is absolutely what the Government are trying to do, but it is clearly a difficult situation that we all find ourselves grappling with.
The hon. Member for Ellesmere Port and Neston expressed some confusion about the duration of self-isolation, and he asked about notifications. In general, self-isolation is for 14 days from the onset of symptoms. Clearly, that differs in some circumstances, depending, for instance, on whether we are talking about a member of a household or multiple members of a household, but I will look into the possibility that different things are being communication by Test and Trace, as it needs to be clear to everybody.
If I understood the question correctly, where a notification issued by a contact tracer is withdrawn because new evidence reveals that the person told to self-isolate was not actually a contact, these regulations would mean that the duty to self-isolate no longer applied. The hon. Member asked about close proximity. In general, that is being within 2 metres of somebody for more than 15 minutes, but further details can be found on gov.uk.
The hon. Member for Newcastle upon Tyne North asked about communications to employers. The Department for Business, Energy and Industrial Strategy has contacted major business representatives, such as the Confederation of British Industry and the Federation of Small Businesses, and there is also the ACAS helpline, so there are sources of information for business. I agree with what was said on the efforts that the hospitality sector has made to keep up to date with regulations, and its huge efforts to make premises covid-secure. We should absolutely appreciate what it is doing to keep us all safe.
On the important points made about the responsibilities of employers, it is unacceptable for any employer to discriminate against an employee because they are rightly self-isolating, either because they have tested positive or because they are a contact. The hon. Lady is absolutely right that that should be and is a clear message. It would be completely wrong for an employer to penalise somebody for doing the right thing. We all need to be responsible employers and citizens, supporting each other to do the right thing.
On the questions about annual leave, this is a choice for employees. If an employee faced being on statutory sick pay to self-isolate, but wanted to have full pay, they could choose to take annual leave instead, but that cannot be imposed on them by an employer. I am particularly alive to the financial challenges that this issue—and the pandemic in general—is imposing on people and, as hon. Members will know, the Treasury has made many announcements of support for people, but we are in difficult times.
Of relevance to this debate is the important introduction of that £500 support payment for those on lower incomes who are self-isolating; we know that is important in enabling self-isolation. This brings me directly to the question about research. The one reason why that payment was introduced was because research told us that one of the explanations people gave for not self-isolating was that they could not afford to.
The hon. Member for Ellesmere Port and Neston asked me about the source of the research; the figure I gave earlier of only around 20% of the population reporting compliance was based on the summary of results from around 21 nationally representative surveys. There is ongoing research on compliance, as that will be important in informing the ongoing response.
The hon. Member also spoke about the app; my right hon. Friend the Member for Forest of Dean (Mr Harper) made some of the arguments about its importance, why it is anonymous, and why, as a result, notifications received through the app are treated differently from notifications through the manual contact-tracing system. The hon. Member for Ellesmere Port and Neston also asked about the uptake of self-isolation payments; I can tell him that as of 13 October, 60 payments had been processed.
My right hon. Friend the Member for Forest of Dean talked about Test and Trace and its performance; it is absolutely an important part of our system. If I recall correctly, around 600,000 people have been contacted and asked to isolate as a result of the Test and Trace system, so it is having a material impact. Of course, we would like it to contact absolutely everybody.
Mr Harper
I will be brief—and it is mostly my questions that the Minister has not got to yet, so I am only affecting myself. She says Test and Trace is having a material effect, but that is not the view of SAGE, which was clear in its minutes of 21 September that it is not having a material effect. It said that if something does not happen, things are likely to get worse. That is SAGE’s view, not mine.
Helen Whately
We have been doing Test and Trace for some months now, and over a period of time, large numbers of people have been contacted through the system about the need to self-isolate.
I turn to the point made by my right hon. Friend and the hon. Member for Newcastle upon Tyne North about the role of local public health teams. Local public health teams are an incredibly important part of our response to the pandemic, both through their support of Test and Trace and—I see this in my work as care Minister—all the work they are doing with the social care sector in care homes. My right hon. Friend the Member for Forest of Dean is right that local authorities’ ability to knock on people’s doors, if we cannot get through to them by phone, is an important part of the response. I note his call for more resources to support that for areas, such as his, in tier 1.
My right hon. Friend asked me whether the MOU had been published. It has not been yet, but it will be. He also asked whether self-isolation can be challenged. An appeals process is being worked on to enable that. He also asked a number of questions about policing and reasonable force, on which I will have to get back to him, because I would not want to give anything other than the correct information. He also asked about the location in which students should self-isolate. In the regulations, as I am sure he is aware, there is a set of exemptions or reasonable excuses for why someone might not be able to self-isolate fully. Those excuses include, as I think was mentioned, taking an animal to the vet, seeking medical assistance, and avoiding risk of harm.
The purpose of the regulations is to make fully clear the importance of self-isolation, to educate people on their obligations, and to support people who are self-isolating; they then provide for enforcement, including fines, for those who knowingly and deliberately choose not to follow the rules. In addition, statutory instrument No. 1057 ensures that the requirements on businesses in the Health Protection (Coronavirus, Restrictions) (North of England, North East and North West of England and Obligations of Undertakings (England) etc.) (Amendment) Regulations 2020 continue to support our covid response, and are in alignment with the new local alert level regulations. We will review the regulations regularly, and continue to assess them in the light of the latest science and other data.
Question put and agreed to.
Resolved,
That the Committee has considered the Health Protection (Coronavirus, Restrictions) (Self-isolation) (England) Regulations 2020 (S.I. 2020, No. 1045).
HEALTH PROTECTION (CORONAVIRUS, RESTRICTIONS) (NORTH OF ENGLAND, NORTH EAST AND NORTH WEST OF ENGLAND AND OBLIGATIONS OF UNDERTAKINGS (ENGLAND) ETC.) (AMENDMENT) REGULATIONS 2020
Resolved,
That the Committee has considered the Health Protection (Coronavirus, Restrictions) (North of England, North East and North West of England and Obligations of Undertakings (England) Etc.) (Amendment) Regulations 2020 (S.I. 2020, No. 1057).—(Helen Whately.)
Public Health
Debate between Mark Harper and Helen Whately(4 years, 1 month ago)
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Helen Whately
My hon. Friend makes a really important point. In making these decisions, we look at multiple factors. We look at the incidence rate per 100,000, for instance. We look at the positivity rate—the percentage of tests that are positive—and we keep a close eye on hospital admissions. All those factors are important. The good thing about the data from our testing systems is that they give more leading indicators of things that may follow on. All of those are an important part of the information that goes into the decisions that are made.
Incidence rates across Merseyside, Halton and Warrington over the seven-day period 17 to 23 September 2020 range from 163.3 per 100,000 people in St Helens to 257.7 per 100,000 people in Liverpool. Test positivity was high too, ranging from 10.5% in the Wirral to 15.7% in Liverpool in the same period. With those levels of infection, including growing infection rates in people aged 60 and over, for whom we know the risks of complications are greater, action was clearly necessary. By contrast, in Bolton, which until the regulations were introduced was under greater restrictions and interventions than nearby areas, infection rates have stabilised, although they are still high, at 241.8 per 100,000 people, with a test positivity rate of 12.3%.
Many areas across the north of England have been subject to extra restrictions, in some cases, for weeks. I know that that is really hard for people, day in, day out, and for many businesses. The regulations do not introduce any new measures, but they amend existing legislation.
Mr Mark Harper (Forest of Dean) (Con)
Briefly, the Minister touched on the point that the regulations amend previous regulations that have been in force for some time. Something which, I suspect, Opposition Members will raise is the incidence rate, based on testing. As my hon. Friend the Member for Redcar (Jacob Young) said, there are other measures on hospitalisations and other things. Can the Minister set out some of the evidence that demonstrates that the measures that have been introduced in the Liverpool area are likely to have some prospect of working, because that will be important in reassuring our constituents that the Government have got a grip on the situation?
Helen Whately
I thank my right hon. Friend for his intervention. I will come on to the impact and detail of the rationale for the interventions.
Helen Whately
Again, my hon. Friend is asking me to stray beyond the scope of the SI, but what I will say is that, in the decisions that are made about interventions and policies more generally, clearly we are always looking at what is going on and what the transmission rate is. Something we saw during the period when there was eat out to help out was that that was a period when, in general, we had lower rates of infection. It gave great support to the hospitality sector, which had been clearly having a really difficult time. We are now very much seeing a second wave, particularly in much of the north of England, and therefore it is absolutely appropriate that there are, in general, greater restrictions. We absolutely must suppresses this virus and one place where we know that infection goes on is through hospitality, where there is social contact.
I will return to the job in hand, Madam Deputy Speaker. Guidance has been updated for people living in protected areas to make it clear what they can and cannot do under the restrictions. Again, I know local authorities are working hard on communications as these measures only work if people know about them, understand them and comply. These regulations, as with the other local regulations we have debated already, demonstrate that we will take action where we need to. In mirroring the restrictions that have been used in other parts of the country, we are drawing on and learning from experience. We will, of course, use continued experience of these measures to inform and help us develop our responses to ongoing local outbreaks.
I reiterate to the House that, for significant national measures with effect in the whole of England or UK-wide, we will consult Parliament and, wherever possible, we will hold votes before such regulations come into force, though of course responding to the virus means that the Government must act with speed when required, and we cannot hold up urgent regulations that are needed to control the virus and save lives. I am sure that no Member of this House would want to limit the Government’s ability to take emergency action in the national interest, as we did in March, but we will continue to involve the House in scrutinising our decisions in the way my right hon. Friend the Prime Minister set out last week. This will be through regular statements and debates, and providing opportunities for Members to question the Government’s scientific advisers more regularly. I am grateful to all Members for their continued engagement in this challenging process.
Helen Whately
I am just wrapping up, and I have taken many interventions. I am very sorry, but I am not going to take a further intervention at this point, as there are people waiting to speak.
I particularly thank people in the protected area in the north of England, who are restricting social contact and forgoing many of the things that make life worth living. In so doing, they are playing their part in supressing the virus and protecting those whose lives are at risk.
Public Health
Debate between Mark Harper and Helen Whately(4 years, 1 month ago)
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The Minister for Care (Helen Whately)
I beg to move,
That the Health Protection (Coronavirus, Restrictions) (No. 2) (England) (Amendment) (No. 4) Regulations 2020 (S.I., 2020, No. 986), dated 13 September 2020, a copy of which was laid before this House on 14 September, be approved.
I will start with a short summary of the social distancing regulations, as context to this debate. The Health Protection (Coronavirus, Restrictions) (England) Regulations 2020—the major lockdown regulations—were introduced on March 26. Those regulations outlined restrictions on gathering and required a number of businesses to close. The regulations were amended four times as we opened up the economy and allowed for technical clarifications. They were then revoked and replaced by the Health Protection (Coronavirus, Restrictions) (No. 2) (England) Regulations 2020. Those regulations had been amended three times prior to 13 September to allow more businesses to reopen, as the transmission of the virus was falling or stabilising. Unfortunately, as winter approaches, the picture has changed and we now need to introduce tighter restrictions to control the virus, protect the NHS and save lives.
Mr Mark Harper (Forest of Dean) (Con)
The regulations were obviously made and brought into force ahead of the commitment that the Secretary of State made to the House last week. Given that the regulations that we are debating today cover the whole of England and are obviously of very great significance, will the Minister confirm that regulations of this nature would in future be covered by the Secretary of State’s commitment and would be brought for debate and decision in this House before they came into force? Would that also apply to, for example, the self-isolation regulations, which have not yet been debated by this House and which are also significant? I want to ensure that we are following through on the commitments that the Government made last week, and that this House will get to debate measures that cover the whole country and are of great significance.
Helen Whately
I thank my right hon. Friend for his point. Indeed, the Secretary of State has made a commitment that for future changes to restrictions that would have national effect, we will do our very best to bring them to the House to a vote, although obviously we have to bear in mind that there are circumstances in which we need to act very quickly, because, as we have seen, things can move very quickly with the infection rate and the consequences of the pandemic.
The regulations that we are debating today amend the Health Protection (Coronavirus, Restrictions) (No. 2) (England) Regulations 2020 so that people may not participate in social gatherings in groups of more than six unless they are members of the same household or support bubble, or exemptions apply. The regulations were made under the emergency procedure in order to respond quickly to the serious and imminent threat to public health posed by coronavirus.
Helen Whately
If my hon. Friend allows me to make a little progress, I will pick up on that point during the course of what I will say.
I appreciate that these national regulations have caused real disruption to people’s lives, placing restrictions on who people can see and what they can do. However, the evidence indicated that the covid-19 infection rate was rising across the country. It was therefore vital that the Government took decisive action to limit and slow the spread, to protect public health and to reduce the likelihood of a further national lockdown of the type that was necessary earlier this year.
Madam Deputy Speaker, I am aware that you, Mr Speaker and a number of Members have raised concerns about parliamentary scrutiny. As the Secretary of State for Health and Social Care outlined to the House last week, for significant national measures with an effect on the whole of England or UK-wide, the Government will consult the House of Commons wherever possible and hold votes before such regulations come into force.
Mr Harper
I am grateful to my hon. Friend for indulging me a second time. The point of our arguing for that was insisting that Ministers had to set out their arguments and the evidence. I understand that one of the key ways of transmitting the virus is social contact, and that as the regulations have been in force for three weeks, they would lapse if this House did not debate and vote on them in the next four days, but what evidence is there that the measures are actually having an effect on reducing the rise in cases of the virus? Having looked at the data, I do not see any evidence that they are having any practical effect. We want to see action—yes—but we want the right action to be taken which will have the effect that we all wish to see.
Helen Whately
I will answer the question that my right hon. Friend asked in a moment, if he lets me continue.
As the Health Secretary set out in his statement to the House on 1 October, this virus spreads through social contact, so we are having to take difficult decisions to suppress the virus while allowing people to socialise safely. The regulations we are debating today brought previous guidance into law while tightening and simplifying it. The rule of six means that people can now gather only in groups of six both indoors and outdoors. There are exceptions to that rule for households or support bubbles that are larger than six, as well as for areas including work, schools, weddings and organised sports activities.
The regulations also gave the police the powers to enforce those legal limits, including issuing fines of £100, doubling for further breaches up to a maximum of £3,200. The vast majority of the general public will do the right things and follow the rules, but to protect public health, it is important that the police have appropriate powers to deal with those who flout the rules. As the Prime Minister announced, these measures were not a second national lockdown but are aimed at preventing the need for one.
Helen Whately
At that specific moment, I was doing my very best to answer the point made by my hon. Friend the Member for Winchester. I think I should make some progress, but I am happy, of course, to come back to this point if colleagues feel that they have not had all the answers that they need.
As I was asked about this a moment ago, I wish to move on to the impact of these measures. I note that they have been in place for only just over three weeks. We know that, because of the incubation period of the virus, it takes at least a couple of weeks for us to see the measures take effect. When social distancing measures were first introduced, we saw high understanding, high awareness and lots of concern about covid and high adherence to the rules. What we have seen over time, with an easing of restrictions and perhaps lower levels of public concern, is that people’s social contacts have increased. Since the introduction of this rule, levels of socialising have begun to decrease again, including specifically socialising in larger gatherings—we know that, sometimes, larger gatherings have been a factor in some outbreaks. Clearly, we are keeping a close eye on infection rates and absolute case numbers across the country.
I will now briefly talk through some further changes that have come into effect since the regulations were made.
Mr Harper
I am grateful to the Minister for what she has said. What she seemed to be saying was that it is too soon to tell. It is very clear from the test and trace data that the primary location for infection is in people’s households and among visitors to households. Clearly, the rule of six may have an impact on visitors to households. May I ask her to make sure that the Government publish the data as they track it out each week?
The Minister also talked about compliance. The Government keep referring to how well people are complying with regulations—or not. They do not publish any data on that. Will the Government publish the compliance data to which they have access, so that we can all see the extent to which people are complying with the rules? There is no point making rules if no one is following them. That is an important matter for this House to be aware of when it is assenting to them.
Helen Whately
My right hon. Friend makes two important points. He will be aware that the Government are publishing a large amount of data and seeking to be as transparent as possible with colleagues and, clearly, with the public, and we will continue to publish what we can. I will take away his specific requests for even further publication.
Helen Whately
I will make progress, as colleagues made a large number of points during their speeches that I am keen to respond to. I will take further interventions if there is time.
Mr Harper
I just wanted to challenge the Minister on this let it rip point, as the Secretary of State has done that as well. I ask the Minister to take it from me that we all want the Government to be successful, but if every time somebody asks a question or posits a different strategy, we are accused of wanting to “let it rip” and kill tens of thousands of people, this debate will not remain good tempered. Please accept that we are all trying to get this right. We are all willing to be generous, because, as the hon. Member for Westmorland and Lonsdale (Tim Farron) said, this is difficult, but I ask the Minister please not to say that Members of this House who suggest a different strategy in order to be successful want to let the disease rip and kills tens of thousands of people. We do not, and we will not be pleased if that is what we are accused of doing.
Helen Whately
I absolutely hear my right hon. Friend’s point. I reiterate the response that I just gave, which is that I very much appreciate the support of colleagues in general for taking action to suppress the virus, and I think it is extremely valuable for us to be debating some of the measures, as we are this evening.