Health and Care Bill

Debate between Steve Brine and Jonathan Ashworth

2nd reading
Wednesday 14th July 2021 Commons Chamber

[Jonathan Ashworth]

I have. The hon. Gentleman is a dogged advocate for that proposal for social care, and he is quite right: he always raises it with me. I am unpersuaded but I am more than happy to sit down with the Secretary of State and with my hon. Friend the Member for Leicester West to discuss a solution to social care. We keep being told that there are going to be cross-party talks, but I think I missed the Zoom link, because they have not happened so far.

As I was saying, these committees do permit a seat, if the committees want it, for the independent sector. In Bath, in Somerset, we have seen Virgin Care get a seat on the shadow ICS. The Opposition think that is unacceptable and we shall table amendments to prohibit it.

I welcome the removal of the section 75 competition and procurement rules, finally scraping the remnants of the Lansley competition rules off the boots of the NHS. We did warn him and others that this compulsory competitive tendering would lead to billions going to the private sector, would be wasteful and bureaucratic, and would be distracting—and it even led to the NHS getting sued by Virgin Care when it did not win a contract. But this is not the end of contracting with the private sector. Without clauses to make the NHS the default provider, it would be possible for ICBs to award and extend contracts for healthcare services of unlimited value without advertising, including to private companies. Given the past year, when huge multibillion-pound contracts have been handed out for duff personal protective equipment and testing, we naturally have concerns about that and will seek safeguards in Committee. We are worried about further cronyism.

We are particularly concerned about the Bill because of the power grab clauses for the Secretary of State. He is creating 138 new powers, including seven allowing him in effect to rewrite the law through secondary legislation, to transfer functions between arm’s length bodies without any proper scrutiny. He has not explained why he needs these powers or given any guidance on how he expects to use them. These powers also include a requirement that Ministers be informed of every single service change, every single reconfiguration, and the Secretary of State will then decide whether or not to call them in for ministerial decision. Are you sure you want that power, Secretary of State?

The Government have gone from wanting to liberate the NHS under Lansley to now listening out for the clang of every dropped bedpan echoing through Whitehall. This is not a plan for service modernisation; it is a “Back to the Future” plan and it will mean more inertia. Instead of powers to interfere at every level, resetting the mandate for the NHS within years, we instead would want the duties on the Health Secretary, and therefore on the 42 ICSs to which he delegates those responsibilities, to continue the promotion in England of a comprehensive health service, as per the National Health Service Act 2006, to be fully reinstated and made explicit.

[Steve Brine (Winchester) (Con)]

As ever, I have listened carefully to the right hon. Gentleman. If this is the “Back to the Future” Bill, presumably it puts right what once went wrong. Does he support the clauses on foods that are high in fat, salt and sugar, and the watershed proposals for advertising?

[Jonathan Ashworth]

Yes, although I am disappointed that they are in this particular Bill. I think they should be part of a stand-alone Bill. In my concluding remarks, I will make a point or two about other public health interventions, which I imagine and hope that the hon. Member, as a great champion of public health, would support.

It is crucial that the Secretary of State’s duty to provide comprehensive healthcare is reinstated, rather than the duty to meddle in the NHS at any time he wants, because there is a lack of clarity about how the funding flows work in this system. The talk is of moving to capitated budgets for an area to provide holistic care to meet the complicated care needs of individual. But when waiting lists are increasing at the current rate, and when cancer waits and mental health referrals are going up, how is an area going to fund the episodic care for each unit of extra care that is needed—often care that is expensive and more complicated because it needs to be done in the acute sector?

We have worries. Clauses 21 to 24 on the financial duties on ICS boards, NHS trusts and NHS foundation trusts are alarming, because they put in place a duty to ensure financial balance across the ICS area, but there is no clarification of how that balance should be achieved and enforced. Local health budgets have been stretched to breaking point after years of underfunding, so what does this duty mean for existing deficits? At the moment, trusts have a combined deficit of £910 million. King’s has a deficit of £111 million. Worcestershire has a deficit of £81 million. University Hospitals of Leicester NHS Trust has a deficit of £80 million. Will the ICBs need to fill this £900 million black hole before they are even up and running How exactly will trust and ICS board deficits be dealt with at the end of each financial year?

This could well be a return to the days that we saw in the ’80s, which some Members in the House may recall, when health authorities would close beds and put off paying bills from January onwards in order to hit financial balance. If health authorities have to hit this financial balance year by year, will it result in a postcode lottery of more rationing and an even longer list of treatments being removed from the NHS through the decisions of ICBs because they have to hit balance, effectively forcing patients either to go private or go without? I hope that the Minister, in summing up, can clarify what the situation will be.

If a set of providers, trusts and an ICB feel that the financial settlement they have been given by NHS England will not allow them to deliver the levels of care to bring down the waiting lists, which the Secretary of State said is one of his top priorities, or to improve mental health outcomes, which he has also said is one of his top priorities, what is their appeal process? How will the arbitration process work on an area’s financial settlement under the current plans to bring together NHS England and NHS Improvement, not split them out?

The Bill is spun as an attempt to integrate health and social care, but there is nothing in it actually to integrate health and social care, because there is nothing in it to fix social care. If it is about integrating health and social care, where is the long-promised Bill to reform social care? The Bill will repeal provisions in the Care Act 2014 that require patients to be assessed for their social care needs before they are discharged from hospital. Without long-term funding in place, that could mean a patient being sent home, left out without support and waiting for an assessment. Will the Secretary of State, or the Minister who responds to the debate, guarantee that that will not be the case? Will they put in place the necessary funding alongside the Bill?

A number of royal colleges and health bodies have said today that the biggest challenge facing the NHS is workforce. The Bill proposes a duty on the Secretary of State to report on workforce once every five years. That is simply not good enough. We need a solution to workforce now; we need a solution to recruitment now; staff need a fair pay rise now; we need more investment in training and professional development budgets now; and we need safe staffing legislation now. We will therefore look to amend the Bill, hopefully on a cross-party basis and perhaps working with others who put forward proposals to improve the workforce sections of the Bill.

As my hon. Friend the Member for York Central (Rachael Maskell) asked the Secretary of State, what does the Bill mean for “Agenda for Change”? The Bill suggests that an integrated care system will be able to change “Agenda for Change” terms; we disagree with that.

Finally, on public health, the Bill introduces restrictions on the advertising of less healthy food and drink. We welcome this step—it, too, was in our 2017 manifesto, which the Secretary of State has been reading—but we would go further. Why can we not have more restrictions on the advertising of unhealthy food around schools? Our public health crisis is about not just obesity but smoking and alcohol, so why are there no provisions in the Bill on smoking services and to ensure alcohol calorie labelling? We will table amendments on those issues in Committee.

This is the wrong Bill at the wrong time. Will the person with learning difficulties or the older person who needs social care experience improved care? No. Will social care be brought back in from the wilderness? No. Will the cancer backlog be tackled more effectively? No. Will health inequalities be narrowed? No. Will parity of esteem for mental health be delivered? No.

Instead of this being a simple Bill to end competition and foster local collaboration, NHS staff will be left trying to second-guess where the Secretary of State will interfere next in the safe running of their local NHS with his in-year changing mandate. The rules on funding could result in more rationing and cuts, so we cannot possibly support the Bill. We have championed integrated care for many years, but the Bill does not deliver it and we urge the House to accept our reasoned amendment.

Coronavirus

Debate between Steve Brine and Jonathan Ashworth

Wednesday 16th June 2021 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

I begin by paying tribute to our much-missed friend and colleague Jo Cox. Jo was an internationalist, and I know that, if she were with us today, she would be rallying support not just across this country but through her international contacts for a campaign to vaccinate the world. She would remind us that we will defeat this virus only through our common endeavour. I think that all of us miss Jo and want to send our best wishes to her family today.

We will support the extension of restrictions in the Lobbies tonight, but we of course do so with a heavy heart. We are guided by data not dates, and we have to recognise the facts before us. The delta variant is 60% more transmissible than the alpha, and even with the current restrictions in place the daily total of positive cases has been rising, with a seven-day rolling average of more than 7,000 per day compared with around 2,000 per day in early May. That is beginning to translate into hospitalisations. With cases doubling every nine days, at the moment it looks like hospitalisations are also doubling. On 4 June, 96 people with covid were admitted; nine days later, 187 people were admitted—almost double. If that continues to double, within four sets of doublings we will be close to the April 2020 peak.

Given that we know that there is always a lag in the figures, we are no doubt likely to see around 250 admissions a day in 10 days’ time. We are seeing a third wave in the NHS. We need to do all that we can to stop hospitalisations rising, because this is a time of huge pressure on the national health service. We have lost a number of beds over the past 10 years, and because of the need for infection control measures we have fewer general and acute beds open today in the NHS as well. We are facing a monumental backlog in care, with 5 million people on the waiting list, more than 385,000 waiting over 12 months for treatment, and nearly 3,000 now waiting over two years for treatment.

Throughout the crisis, we have said that the NHS was not overwhelmed, but it was not overwhelmed only because of some of the terrible choices that had to be made. To be frank, I do not want to see the NHS forced to make choices between providing covid care and cancer care. That is why we should listen to those NHS leaders who have warned us about the increasing pressures on the NHS. Chris Hopson of NHS Providers said:

“The NHS is running hot at the moment dealing with backlog recovery and emergency care pressures.”

The NHS Confederation said:

“Health leaders are very aware of the damaging effects that prolonged social restrictions could have on the nation’s physical health and mental wellbeing…Yet, according to our survey the majority of NHS leaders are concerned about the risks that lifting prematurely could have on the NHS’s ability to cope”.

[Steve Brine]

I know that the official Opposition’s position will be to support the regulations today, but I am keen to explore this with the right hon. Gentleman. Would he be happy to see the terminus on 19 July, or would he like to see it maybe at the end of September, when the entire adult population will be double-jabbed, or at the end of next year, when the G7 thinks that the rest of the world will be vaccinated? What would his instinct be?

[Jonathan Ashworth]

Of course I want to see terminus day on the 19th, although I am not sure if we are going to see terminus day on the 19th. The hon. Gentleman, who is always well-informed, will no doubt have read the explanatory notes, which indicate that this four-week period is to assess the data, and the four tests will be applied at the end of that four-week period. That is not quite the terminus day that the Prime Minister and the Secretary of State have indicated.

--- Later in debate ---

[Steve Brine]

rose—

[Jonathan Ashworth]

I will give way first to the former Public Health Minister, and then to the former Chief Whip.

[Steve Brine]

The right hon. Gentleman is right: we had a battle royal with influenza in the first year that I was in the job, but the difference was that we did not have any non-pharmaceutical interventions. Our interventions were about the take-up of the vaccine—yes, for children as well as for adults, especially the vulnerable. One of our chief advisers, the deputy chief medical officer then, one Professor Chris Whitty, never suggested masks, let alone closing schools—just a really good roll-out of the flu vaccine. We lost 22,000 people that year. Never were those numbers rolled on BBC News; never did we know the R number, but there was a point where we accepted an element of risk in society. I guess that was the point of my earlier intervention on the hon. Gentleman: what element of risk is he prepared to accept? Because that is what it comes down to—our own mortality is part of the human condition.

[Jonathan Ashworth]

We do accept it but we do not glibly accept it, because year by year we are looking for improvements in vaccinations, therapeutics and medicines to push infection rates down as low as possible. Even though we are grown-up enough to be aware that sadly some people will die from flu and pneumonia, we do all we can to avoid it. That is what we will have to do with this, but I do not want to see it done by some of the wider restrictions and lockdowns that we have heard about. That is why I would be interested to know whether the Department has developed plans for restrictions this winter and whether the Secretary of State has been discussing that with Whitehall colleagues.

Public Health

Debate between Steve Brine and Jonathan Ashworth

Wednesday 6th January 2021 Commons Chamber

[Jonathan Ashworth]

I think that that is a very good recommendation. May I extend an invitation to the hon. Gentleman to return to Leicester to watch our great football team, when we are allowed and are out of lockdown? Perhaps I will take him around and show him some of the great inter-faith work that we do in Leicester as well.

The lockdown will have a huge impact on the wellbeing of our children, so a plan to get our children back safely to school is a priority. There are thousands of children out of school in overcrowded, cramped accommodation, unable to access learning properly from home. There are other children at risk of abuse and violence. Members may know that I have spoken of my own experiences growing up in a home with a parent who had a problem with alcohol. Many children face the prospect of being locked in their home with a parent who abuses drink or drugs, so I urge Ministers to work with and fund children’s advocacy and support groups such as the National Association for Children of Alcoholics, with which I have worked closely, that will do so much throughout this lockdown.

Today, I agree with the Secretary of State. We do, unfortunately, have to restrict freedoms further to safeguard freedoms for the future and save lives. As he said, the tragic reality is that the virus is out of control. To be blunt, there is no freedom for our constituents if they are in the graveyard. There is little freedom either for those who suffer the enduring, debilitating effects of long covid. Yesterday, almost 55,000 cases were reported in England—one in 50, as the Secretary of State said, have the virus. The numbers in hospital are higher than in April, with over 1,800 in intensive care. Yesterday, there were over 3,300 hospitalisations—a record—and admissions are going up in every region.

This is a national emergency, and a national lockdown is necessary. Indeed, we should have locked down sooner. We are voting this lockdown through on Twelfth night, yet in the run-up to Christmas the alarm bells should have been ringing. The Secretary of State came to the House on 14 December to report a new strain, now known as the B117 strain. He told the House:

“Initial analysis suggests that this variant is growing faster than the existing variants.”—[Official Report, 14 December 2020; Vol. 686, c. 23.]

The Prime Minister learned of the rapid spread of the new variant on 18 December. The New and Emerging Respiratory Virus Threats Advisory Group met that day and concluded that the new strain added at least 0.4 to the R. On 21 December, the chief scientific adviser, Patrick Vallance, said that the new strain was “everywhere” and cases would rise after the “inevitable mixing” at Christmas. He said:

“The lesson…you have to learn about this virus…is that it’s important to get ahead of it in terms of actions”.

The Scientific Advisory Group for Emergencies met on 22 December, the following day, and concluded:

“It is highly unlikely that measures with stringency and adherence in line with the measures in England in November…would be sufficient to maintain R below 1 in the presence of the new variant.”

Here we are, two weeks later, with half a million infections and 33,000 hospitalisations since 22 December. This is a national tragedy. Why does the Prime Minister, with all the scientific expertise at his disposal, all the power to make a difference, always seem to be the last to grasp what needs to happen? He has not been short of data—he has been short of judgment, and yet again we are all paying the price.

As the Secretary of State has said, there is light at the end of the tunnel. Vaccination is how ultimately we are released from these restrictions. I pay tribute to everyone involved in helping to distribute and administer 1.3 million vaccine doses so far. This a great achievement, but we need to go further and faster.  The Prime Minister has promised that almost 14 million people will be offered the vaccine by mid-Feb. That depends on about 2 million doses a week, on average. Both the Secretary of State and the Prime Minister have assured us in recent days that that is doable, based on orders, but, in the past, Ministers told us that they had agreements for 30 million AstraZeneca doses by September 2020 and 10 million Pfizer doses by the end of 2020, so I think that people just want to understand the figures and want clarity. How many of the ordered doses have been manufactured, how many of the ordered doses have been delivered to the NHS, and how many batches are awaiting clearance through the Medicines and Healthcare Products Regulatory Agency clearing processes? Two million a week would be fantastic, but it should not be the limit of our ambitions. We should be aiming to scale up to 3 million, to 5 million, to 6 million jabs a week over the coming months. If we can vaccinate 29.6 million people, deaths and hospitalisations will be reduced by 99%. That is what we should be aiming at now.

[Steve Brine]

Obviously the Opposition will support this tonight, but, further to the exchanges that a number of Government Members had with the Secretary of State, will the hon. Gentleman tell the House at what point he and the Leader of the Opposition will be calling for our constituents to be released from the restrictions? Please do not say, “When it becomes obvious it is going to happen.”

[Jonathan Ashworth]

The hon. Gentleman asks a perfectly reasonable question. Of course, as we vaccinate more, mortality rates will improve more and we will be able to save people’s lives, but there will be others who remain unvaccinated and exposed to the virus, and will possibly develop debilitating symptoms of long covid as a result of that exposure. I do believe that we can begin to ease restrictions once we increase the proportions of those who are vaccinated, but we will not be able to go back to normal yet, because the virus will still be circulating. Even though they may not end up in hospital and on ventilation, many who have contracted this virus have remained incredibly ill as a result.

Public Health: Coronavirus Regulations

Debate between Steve Brine and Jonathan Ashworth

Tuesday 13th October 2020 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

Madam Deputy Speaker, I have heard your message loud and clear; I will endeavour to be brief and not to detain the House for too long, given the points you have rightly made.

The House will understand that we are grappling with a virus that spreads with speed and severity. Throughout this crisis, we have urged the Government to adopt an approach with the strategic aim of suppressing the virus and bringing the R below 1 in order to save lives, minimise harm and keep our children in school. That has to be our priority, and no one should be surprised that, as we are in autumn and going into winter, that presents us with immense challenges.

Before the summer, the Academy of Medical Sciences, in a report commissioned by the Government, modelled that we could see 119,000 deaths between September 2020 and June 2021. The academy also warned, as did we, that without an effective test, trace and isolate regime the virus would get out of control. Sadly, we were proved correct. The Secretary of State has run through the numbers on the prevalence of the virus, but I will just underline the point that hospital admissions are rising.

Yesterday, there were 3,665 patients in hospital in England, 568 more than on 23 March when we went into lockdown. Since September, 856 patients have been admitted to critical care across England, Wales and Northern Ireland—more with every week that goes by. The largest number of critical admissions are in the north-west, north-east, Yorkshire and the midlands. More than 100 patients are on ventilation for covid across the north-east and Yorkshire. More than 130 patients are on ventilation across the north-west.

A disproportionate number of those in critical care today are from poorer backgrounds and from black, Asian and minority ethnic communities. That is a reminder that covid thrives on and exaggerates inequalities, and that any long-term covid strategy cannot just rely on a vaccine but demands an all-out assault on health inequalities as well.

Just as hospital beds fill, there are more concerns about the availability of beds for the rest of winter. Last week, there were warnings that some hospitals across the north of England are set to run out of beds for covid patients within days, and NHS Providers reminded us that the sustained physical, psychological and emotional pressure on health staff is threatening to push them beyond their limits. The British Medical Association is saying that without stringent measures rapidly introduced, the NHS and its workforce will very quickly be overwhelmed. This House cannot overstate how serious the situation is.

Yes, as the Secretary of State said, our clinicians have made extraordinary strides in treatment. We know that steroid and antiviral drugs will help improve mortality, but we also know that when infections rise, as night follows day, hospitalisations rise, and, sadly and tragically, that means that more will die as well. For those who avoid hospitalisation, many can be afflicted with serious, long-term, debilitating health problems—so-called long covid. None of us knows whether those conditions—that syndrome—will last for the rest of their lives or whether they will recover in the next 12 months.

Just as we have to protect our NHS, we cannot allow the mass, industrial halt to elective surgery and delays in treatment never seen before in the history of the NHS. We have to mobilise our national health service to perform the care for non-covid patients as well. The decision in March, although entirely understandable—I do not criticise the Government for taking it—has bequeathed us waiting lists of 4 million. Today there are 111,000 people waiting beyond 12 months for treatment. In January of this year, there were just 1,600. Three million people have missed out on vital cancer screening. One in three cancer patients has said that their treatment has been impacted by the effects of covid. I make these points not to criticise the Secretary of State but to reinforce the point that we have to protect our national health service as we go into the winter months.

I know that no Member across this House is complacent about these matters. Every hon. and right hon. Member is united and determined to see infection rates reduce and care improved. I know that everyone across this House wants to see the immense backlog in non-covid care tackled. I know that none of us wants to see this virus let rip and leave the weakest and the frail to fend for themselves. So I do not come to this House to caricature the position of any hon. Member. Our differences are about how we apply the tools we have at our disposal, and how we confront this, the biggest public health crisis for 100 years.

We know, as the Secretary of State said, that the virus thrives on close human contact, especially where air is stagnant and in conditions that are poorly ventilated. We know that the virus is airborne. We know that fundamentally our best defences are hand hygiene, distancing, mask wearing, and avoiding crowds. But we also know that a full national lockdown stretching for weeks and weeks, like we had through April, with a rule, effectively, of one-household contact—a rule of one, indeed, for some people—would be disastrous for society. Again, I do not believe that anyone in the House is proposing that.

The question is what measures can be taken now to bring R below 1 without resorting to that full lockdown. We know that when 8 million children returned to school, that would have put upward pressure on infection rates. I am critical of the Government for not providing the extra testing capacity that would have been needed, as should have been obvious. Yet we must do everything we can to keep our children in school. The implications of children not being in school are devastating for their life chances and development. We know that crowded public transport puts upward pressure on infection rates, but I do not believe that any Member of this House would consider it sensible to close public transport networks—to close the underground or to close the Metrolink across Manchester. We know we have to encourage people to work from home, and many are doing that, but we also know that there are many who cannot work from home, and they should be protected with access to mass testing—particularly NHS staff. I hope that the Government get on with routine testing of frontline NHS staff. We have repeatedly called for the Government to do that.

That then therefore leaves us with few levers to pull. That brings me to hospitality, because—I am sorry to have to say it—pubs and bars do bring people together. Every Member across this House knows that after a few drinks people lose their inhibitions. It should come as no surprise to us that social distancing breaks down, and if bars and pubs are poorly ventilated—as, sadly, some are—then airborne transmission is more of a risk. I know that Members will point out to me, as they have in the past few days, that the data show that household interaction is the biggest driver of transmission. That is correct—but how does the virus get into the household in the first place? It does not come down the chimney, like Father Christmas: someone brings it into the house.

If we cannot close, schools, workplaces or shops and cannot shut public transport, the only lever that we have is hospitality, so, yes, we support the restrictions announced yesterday by the Secretary of State and the Prime Minister. We know from experience in Bolton and Leicester that the pub closures had an impact—the virus is still prevalent in my city and in Bolton—but without the closures the virus would have been driven up further.

We therefore support the announced measures, difficult as they are. Indeed, we support the measures aimed at constraining the time people can spend in the pub. I understand the Secretary of State’s procedural points about the instruments before us and the 10 pm curfew, and he knows that I know that many Members are deeply sceptical about that curfew. We will not stand in the way of the passing of the statutory instrument, but if the House’s procedures had allowed it, we would have proposed an amendment to implement the Welsh scenario, where there is drinking-up time, off sales are banned after 10 o’clock and there is no hard stop at 10 pm.

We have all seen the pictures that the hon. Member for Bexhill and Battle (Huw Merriman) mentioned, although I must say to many of my hon. Friends who made the point about city centres being full of revellers after leaving the pub that it is not as though we have seen such pictures only once the 10 pm curfew was introduced—we have seen them before in our city centres, sadly. I have been on public transport after 11 pm! This is a longstanding issue. The 10 pm curfew does not help it, but let us not pretend it has caused all these issues.

[Steve Brine]

If the hon. Gentleman could amend the instrument, would he amend it so that off licences cannot sell after 10 pm?

[Jonathan Ashworth]

I think I made that point, but, yes, I most certainly would. If I had proposed that amendment, I hope the hon. Gentleman would have joined us in the Division Lobby, although I know that since leaving the Government he has been very lax about going through the Lobby with the Opposition—[Interruption.] I drank my water too quickly as the hon Gentleman’s intervention was shorter than I anticipated—[Interruption.] I beg your pardon; I assure Members it is not the virus.

Many Members affected by this in recent days will know that the decisions made to put an area into restriction will be effective only if they are made in conjunction with local people. I know that extremely well as a Leicester Member, where we have had restrictions for 105 or 106 days. People in towns such as Bury or Bolton or across Greater Manchester or in boroughs such as Wolverhampton, West Bromwich or parts of Birmingham need clarity about their future and local leaders need reassurance that there is a plan. Local leaders need reassurance that if they are put into a tier there is a plan to get them out of it and moved into the lower tiers. It is not clear at the moment why particular areas are in the medium tier and not in, for example, tier 2. I do not want to pick on my near parliamentary neighbour, the hon. Member for Charnwood (Edward Argar), but I hope he can explain when he responds to the debate why the city of Leicester is in tier 2 with restrictions yet his constituency, where the infection rate is 150 per 100,000, is not. Why is North East Derbyshire, where the rate is 164 per 100,000, not in that tier? Why is Barrow, where the rate is 277 per 100,000, not in that tier? There are many other examples across the House. People living in areas where restrictions are in place would like to be reassured that there is some consistency in these matters and that decisions are made transparently. I do not want to pick on the hon. Gentleman’s area, but he will see the point I am trying to make.

Of course, the areas where hospitality has closed need support to save jobs and protect livelihoods. At the moment, there is a financial package on offer for tier 3 —the Opposition do not think it goes far enough; we do not think it is adequate—but there is no financial support for tier 2, even though there will be a significant impact on the local economy, as we have seen in Leicester. On tiers 2 and 3, could the Minister, in responding to the debate, say a little bit about care homes? What does he say to the thousands of families who, under tier 2 and now tier 3, will not be able to visit their loved ones in care homes? The impact on a loved one in a care home of not being able to see their family is immense, especially in the winter months as we run up to Christmas. What steps will the Government take to support those areas in tiers 2 and 3 so that families can safely resume visiting their loved ones? Will he commit to a 24-hour turnaround in test results in care homes so that care homes and residents are protected?

This brings me to testing and tracing. One of the great strides we made in Leicester was door-to-door testing. Can the Minister guarantee that any areas in tier 2 and tier 3 will get capacity for door-to-door testing? Back in August, the Government promised that local areas would have more control over test and trace, with dedicated teams backed up by local authorities, but under this tiered system it was reported yesterday that only areas in tier 3 would have greater local control over contact tracing and testing. Why was this not put in place months ago, and why has it not been put in place everywhere across the country, not just for tier 3? This is the point that the right hon. Member for Forest of Dean (Mr Harper) made, and he made it extremely well.

I am sorry, but the testing and tracing regime has become a broken system that continues to misfire. We even have SAGE now warning that it is having a marginal impact on transmission, as the right hon. Gentleman said. To be frank, and I know Conservative Member will groan at this, if Serco has not come up with a solution by now, it never will. Scrap the contract, put public health and local NHS partnerships in control of testing, and invest in the widespread backward contact tracing we need. It is still only in its infancy, but it is absolutely vital to getting in control of the virus, and we need to expand it at a local level.