Smoking Cessation: Prescription of E-cigarettes
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Lord Hunt of Kings Heath (Lab)
My Lords, the Minister has mentioned the MHRA a considerable number of times, which is a great tribute to the work that it is doing. Can he tell us why it is facing budget cuts at a time when we need our independent regulator in this country to be doing all it can to regulate and encourage new innovative products, including pharmaceutical products, to the market?
Lord Kamall (Con)
As the noble Lord will know, some of the issues are related to leaving the EU, but it is interesting to learn from conversations with the MHRA that it is hugely excited about its ability to be more global in its outlook and to be a centre of expertise that many people across the world will want to learn from. With respect to international engagement, as well as making sure that it updates its guidelines to take account of medical technology there will be ongoing reorganisation and changes, and it hopes to be fit for purpose for many years to come.
Public Health Grant to Local Authorities
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Lord Kamall (Con)
The noble Baroness raises a very important point about needing to tackle disparities across our nations. The ring-fenced grant that we provide to local authorities to spend on public health services comes with a condition that they consider the need to reduce health inequalities in their areas. Also, the grant’s distribution is heavily weighted towards areas facing the greatest population health challenges. Per capita grant funding for the most deprived decile of local authorities is nearly 2.5 times greater than that for the least deprived. In addition, noble Lords will be aware of the new Office for Health Improvement and Disparities. The pin-light focus of that office is on health disparities and how we tackle them.
Lord Hunt of Kings Heath (Lab)
My Lords, I must say that that is a rather surprising answer. The Minister will know that the Prime Minister has promised to help level up the health expectancy of the poorest areas, but I take the Minister to his answer. The Health Foundation stated in the summer that there is no sign of concerted action to do this and:
“Current plans appear to be partial and fragmented, and many deprived areas where people are likely to have poorest health have not been identified as priorities for investment.”
Will the Minister reconsider his answer to my noble friend?
Lord Kamall (Con)
The noble Lord raises a very important point about how we tackle these disparities. This is one of the reasons. Given that a lot of powers to intervene at local level are in the form of local authority grants and local public health officials, it may well sometimes come across as fragmented. This is why the Office for Health Improvement and Disparities is very important to take an national overview of areas of disparity and target them.
Health Care and Adult Social Care
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Lord Kamall (Con)
I do not see myself as someone who is able to offer jobs advice or careers advice. But the points made by the noble Lord help to explain in many ways some of the pressures that care home providers are facing when recruiting in a competitive market. The Government have looked at funding and how we can work with care providers, particularly as many are in the private sector, as I said earlier. They are not directly controlled by the Government and we can therefore work with local authorities and care providers on how to make sure that they pay a competitive salary to attract care workers to work in the social care system, as opposed to some of the more competitive sectors that the noble Lord mentioned.
Lord Hunt of Kings Heath (Lab)
My Lords, one of the areas where there is most pressure has been that of unpaid carers. Not only are they having to take on a much greater load but for a long period they could not even visit their loved ones in care homes. In all the programmes that the Government are taking on, can the Minister say explicitly what is going to be done to support carers in their invaluable role?
Lord Kamall (Con)
I think that all noble Lords will agree with the point made by the noble Lord about the importance of unpaid carers and also paid carers. In relation to unpaid carers, we hope that as the social care reforms, in particular, come through, patients will be able to take advantage of social care. That will remove some of the burden from unpaid carers and free up their time. We are, however, looking closely at the implications and consequences of some of the proposed reforms.
Coronavirus Act 2020
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Lord Hunt of Kings Heath (Lab)
My Lords, I thank the Minister for his comprehensive introduction to the debate and the statutory instrument. Of course, Covid has brought unequalled challenge to us—a challenge that we have not seen for decades. It has disrupted our lives and many people have died as a result. Of course, the powers that the Government have taken to themselves have been quite exceptional. I do not agree with everything that Big Brother Watch says, but I think it is right to point to the draconian nature of some of those powers. I was very glad the Minister said what he said in relation to Schedules 21 and 22. My understanding is that every single charge made under those schedules was found to be unlawful. As he read out the powers, I shall not repeat them—but they are draconian. They may have been justified, but they were misused. The Minister said that they will be withdrawn. Can he clarify whether they will be withdrawn through a statutory instrument?
The second area I wanted to raise is parliamentary scrutiny. The noble Lord, Lord Cormack, raised during the Urgent Question repeat in the Chamber the point that the Government now seem to announce everything in the media before coming to Parliament. The way in which Parliament has been dealt with over Covid has been very unsatisfactory. We have had more than 500 pieces of secondary legislation; most were rushed out and considered by Parliament retrospectively. The Justice Select Committee reported on this and stated:
“Parliament plays an important role in making sure that the law and any new criminal offences are so far as is possible intelligible, clear and predictable. It is not satisfactory … that Parliament was not … able to fulfil its function when Members were required to consider statutory instruments already superseded”—
this has happened on a number of occasions.
Although it falls to the Commons to vote on the renewal of powers, while we have simply a Take Note approach, the powers are substantial and I must say that I do not think that they should be debated in Grand Committee; they are important enough to be debated in the Chamber and I find it very disappointing that we are here, having to do it in this way.
It is notable that, since we came back in September, there have been hardly any debates on Covid. Again, I find this very worrying, and I would like the Minister to tell me why there have been no Statements. I think the Statement last week was the first one we have had on Covid since we came back. This really is not satisfactory and hardly counts as parliamentary scrutiny.
I also ask the Minister what has happened to SAGE. There has apparently been a downscaling of SAGE’s role. It seems that it now meets only once a month. Can the Minister confirm that and tell me why it is? A government source has been quoted as saying that there is now a lessened demand for scientific advice. Well, I do question whether that is accurate. We are still in a difficult situation: Covid infections are rising and there is a real risk that the booster jab and school vaccinations are behind where they ought to be—hence the Minister’s comments at the end of his introductory speech. My concern is that the Government’s mistakes and, frankly, dubious exceptionalism at the beginning of Covid look like being repeated time and again.
There was another very good joint Select Committee report, from the Health and Social Care and Science and Technology Committees, which was published on 12 October and looked at what has happened over the past 18 months. The report pointed out that the UK was not alone in having suffered badly because of Covid, but we did significantly worse in terms of deaths than many countries, particularly when compared to those in east Asia, even though they were much closer geographically to where the virus first appeared. The report said the UK’s pandemic planning was too narrow and effectively based on a flu model, which failed to learn the lessons from SARS, MERS and Ebola.
Particularly telling was the report’s comment that the Government’s desire to avoid a lockdown because of the harm to the economy that it would entail had a big impact. In the absence of other strategies such as rigorous case isolation, a meaningful test and trace operation and robust border controls, a full lockdown was inevitable and should have come sooner. We saw history repeat itself last autumn, when the Government’s decision not to have a circuit breaker did not follow the scientific advice and Ministers were clearly optimistic in their assumption that the worst was behind us during those summer months.
The question before us today is whether history is repeating itself. We know that our weekly death rate stands at three times the level of other major European nations. We know hospitalisations are rising, and they are certainly at a higher level than in many countries on the continent. The decision to end compulsory mask wearing and to pause plans for vaccine passports in England has made the Government an outlier in their management of the pandemic. By contrast, western European countries such as France, Italy, and in particular Spain, have brought down infection rates to their lowest level since the summer of 2020.
The Government have not been short of advice. When the latest October minutes from SAGE came out, they pointed to current population behaviours being estimated as being closer to pre-pandemic norms than at any point since March 2020—which I think means that people are not wearing masks very much and are not distancing themselves socially. SAGE pointed to early interventions that may reduce the need for more stringent, disruptive and longer-lasting measures to avoid an unacceptable level of hospitalisations.
We have also heard the NHS Confederation calling for not just plan B to be implemented but plan B-plus: calling on the public to mobilise around the NHS and do whatever they can to support front-line services this winter. On the other hand, it has been reported that modelling by the London School of Hygiene & Tropical Medicine has suggested that cases will peak soon and fall away steeply in the winter months. So I ask the Minister to set out current ministerial thinking. I see the temptation to wait and see, in the light of the London School’s modelling. On the other hand, every time the Government have waited and seen, they have turned out to be wrong, so I think at the very least we ought to know today the hard thinking behind the Government’s position in relation to plan B.
Lord Naseby (Con)
My Lords, I declare an interest in that I am married to a doctor, a former GP who ran a big practice in Biggleswade.
Lord Kamall (Con)
My Lords—apologies while I remove my mask—I thank all noble Lords for their valuable contributions to this important debate, and for the range of views expressed in the best tradition of our debates. The Government see extending the No. 3 and self-isolation regulations until 24 March next year as vital to allow local authorities to respond to serious and imminent threats from Covid-19, but also to ensure that the self-isolation system continues to protect the public during the challenging winter ahead. I have listened to and have taken on board—and will take on board—many of the concerns raised here today.
The Government believe that the Coronavirus Act continues to be a critical part of our country’s response to this awful virus, which has touched every corner of our society. In terms of parliamentary scrutiny, I understand the points that have been made by many civil libertarians here today. The Government believe that the Coronavirus Act has enabled them to provide help and support to people, businesses and our public services, and to boost the healthcare workforce at a critical time of need. I assure noble Lords that we will continue to review every aspect of coronavirus legislation, but we are now able to expire seven provisions and part of a further power in the Coronavirus Act. I hope this demonstrates the Government’s commitment to, and progress towards, winding down the emergency powers.
The Government see themselves as taking only those powers that are critical to our response and recovery—for example, powers that help make sure that the NHS is properly resourced and that statutory sick pay is available to those who are self-isolating. It is always a very difficult balance; we heard from the noble Baroness, Lady Merron, that she would have preferred us to keep some of the other emergency provisions. The Government’s autumn and winter plan sets out how we hope to sustain and bolster the progress that we have made thus far.
I turn to some of the specific points made by noble Lords; I hope I will have the time to respond to as many as possible. If I do not respond to every point, I will make sure that I write to noble Lords in answer to their specific questions. The noble Lord, Lord Hunt, asked when an SI would be laid. He also talked about unlawful convictions and incorrect charges, as many other noble Lords spoke eloquently about. I thank them for their contributions about the incorrect charging decisions under Schedule 21 to the Act. Of course it is regrettable that 295 incorrect charging decisions have been made under the Coronavirus Act. The primary issue that the Crown Prosecution Service has identified is that individuals were erroneously charged under Schedule 21 rather than under other legislation such as various health protection regulations. Since April 2020, the CPS has agreed to review all prosecutions made under the Coronavirus Act and it continues to do so. I hope, in some ways, that that reassures the noble Lord.
The noble Lords, Lord Hunt and Lord Scriven, my noble friend Lady Foster, and the noble Baronesses, Lady Fox and Lady Brinton, asked about parliamentary scrutiny. I know that this is an issue of concern to many noble Lords. The Government are confident that they have upheld their promise to allow for proper scrutiny and accountability of the powers in the Act. Many criticisms were levelled, which I understand, and I hope that noble Lords will continue to hold us to account on accountability. Maybe I can have some conversations offline with some noble Lords to make sure we do this as much as possible.
My noble friend Lord Balfe talked about living in the same street as former MEPs and doctors. He then went on to say that the doctors were his friends, but he did not say anything about whether the former MEPs were also his friends. I hope so, but I assure him that he still remains my noble friend.
On occasion, it has been necessary to introduce urgent measures to protect the NHS and save lives. The Government have committed to debates in advance of regulations coming into force wherever possible for measures of national significance. This included Parliament being recalled to debate the national lockdown in January, and debates and votes on regulations covering the tiers system; the steps regulations in March, which set the path for implementing the Government’s road map out of lockdown; and, in June, pausing the move to the next step of the road map.
The noble Baroness, Lady Fox, talked about impact assessments. On the evidence for decision-making, a full regulatory impact assessment was not prepared for many coronavirus regulations, as they fell under the civil contingencies exclusions of the better regulation framework. The Better Regulation Executive will not seek to enforce the current administrative requirement for validating impacts for temporary coronavirus legislation in advance of the wider reform of the better regulation framework.
The noble Baroness, Lady Brinton, and the noble Lords, Lord Hunt and Lord Scriven, accused us of ignoring the scientific advice by not implementing plan B now and asked who is advising us and what the trigger points are. Our approach has always been informed by scientific and medical evidence, and by the latest data. We take evidence from the Chief Scientific Adviser, the Chief Medical Officer, SAGE, of course, as part of that, the UK Health Security Agency, the NHS and others. They remain valuable when we balance the evidence of scientific opinion. Scientific experts have contributed directly to ministerial discussions.
As we have heard in this debate, many noble Lords have contested the science or referenced certain reports. It shows that, even around this area, science is contestable. That has been revealed in the way the Government assess all these trade-offs. What is also interesting is that many people in other parts of the health sector are concerned about some of the provisions, such as the impact on mental health and other unintended consequences. All these have to be balanced. The Government have benefited from the expertise of their science and medical advisers through the pandemic and remain deeply grateful for the role they have played in saving lives and protecting the NHS.
In our debate on Thursday last, I mentioned the work of Professor Mark Pennington, professor of political economy at King’s College London, who talked about the response to the pandemic via decision-making. He talked about the situation being almost a Hayekian, complex system, with many individuals having incomplete knowledge or, as Hayek said, the conceit of knowledge. That expresses and shows the difference of opinion. This is a case where we have to weigh up many different views, particularly among the scientific community, and, in addition, some of the papers referenced today by many noble Lords.
Noble Lords have asked what the set threshold is. The Government and our scientific advisers monitor a wide range of Covid-19 health data, including on cases, immunity, the ratio of cases to hospitalisations, the proportion of admissions due to infection, the rate of growth in cases and hospital admissions in the over-65s, vaccine efficacy and the global distribution and characteristics of variants of concern. In assessing the risks to the NHS, the key metrics include: hospital occupancy for Covid-19 and non-Covid-19 patients; intensive care unit capacity; admissions of vaccinated individuals; and the rate of growth of admissions. The Government also track the economic and societal impacts of the virus to ensure that any response takes those wider effects—that is, socioeconomic effects as well as those in the medical and scientific professions—into account and assesses that range of views. It is not necessarily a binary decision but a range of views that must be considered and weighed up. Noble Lords have expressed eloquently in this debate the range of scientific views and papers on Covid.
A number of noble Lords, including the noble Lord, Lord Hunt, and the noble Baroness, Lady Brinton —forgive me if I do not remember the others—asked how regularly SAGE meets. Throughout the pandemic, SAGE has been a vital source of co-ordinated scientific advice and technical support to help guide the Government’s response. However, as I have said previously, we also consider other bits of scientific advice. Committee members utilise the latest scientific research, insight and analysis from across government, academia and industry. As new evidence or data emerges, SAGE updates its advice accordingly. As Covid-19 was completely unknown to us less than two years ago, this means that some of the guidance provided in the earlier stages of the pandemic has now been superseded or amended to reflect our ever-evolving understanding of the virus.
The noble Lord, Lord Scriven, asked about face coverings—
Lord Hunt of Kings Heath (Lab)
I am grateful to the Minister for explaining the Government’s approach to SAGE, but I have to say that it is rather confusing since SAGE clearly encompasses a wide range of scientific views. The Minister seems to be saying that it has been given a subordinated role, meeting only monthly, and, in essence, the Government are looking for other bits of scientific advice. I would like clarification on this because, for me at least, this is clearly a significant change in policy and practice.
Lord Kamall (Con)
I thank the noble Lord for that question. As I laid out earlier and have said formerly, the Government listen to a range of scientific advice, including from SAGE but also from the Chief Scientific Adviser, the Chief Medical Officer, the NHS and a range of other views.
Lord Hunt of Kings Heath (Lab)
I am sorry to pursue this but it seems to me that the Minister has made a very significant statement because all those people are on SAGE, as far as I am aware from looking at the minutes. I do not think that the Government can get away with simply saying, “We listen to a whole range of advice, including from SAGE”. Surely SAGE is the primary place from which the Government get advice.
Lord Kamall (Con)
I can only repeat what I have said previously but I will look at this in more detail and respond to the noble Lord if he is not satisfied with my response. I will try to make sure that I send a satisfactory response.
A number of noble Lords talked about the evidence around face coverings. Some noble Lords said that they definitely work. Others said, “No, there is no evidence that they work”. Others said, “Actually, they are useful as part of an overall package of other measures”. If the data suggests that the NHS is likely to come under unsustainable pressure, the Government will implement their prepared plan B. That is why we have explained it in advance: so that we cannot be accused of doing things at the last minute. Plan B would include legally mandating face coverings in certain settings, but we are not yet at that stage. The continued efforts of the public in practising safe behaviours and getting fully vaccinated will be critical to ensuring that the NHS does not come under unsustainable pressure.
NHS England Funding: Announcement to Media
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Lord Kamall (Con)
I thank my noble friend for that question. Last week we had a discussion on healthy ageing and making sure that the population of the UK is able to live healthy lives for longer. That is very much part of the overall thinking on health reform and we hope to have more details in due course.
Lord Hunt of Kings Heath (Lab)
My Lords, the Minister says that Ministers are dealing with workforce shortages. But surely he knows that, throughout the health service, there is a critical crisis. No one is in charge; it does not seem to be the responsibility of Ministers, Health Education England or NHS England. Who will sort this out and who will be held to account?
Lord Kamall (Con)
The noble Lord makes a valid point on workforce shortages. The Chancellor will confirm wider health budgets at the spending review, which is in only a few more days. We have already increased training places this year and will feed through into the available workforce. Ensuring that we have the workforce necessary to support this expansion will be driven by a combination of things, such as enforced workforce productivity, including from the spending review digital diagnostic investments, which are expected to deliver a 10% to 15% workforce productivity uplift. We are also looking at existing Health Education England funding, which will provide a pipeline for growth in training numbers.
Men’s Health Strategy
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Lord Kamall (Con)
I thank my noble friend for his warm welcome and hope that this continues for some time. To answer his question, the Government regularly consider the social determinants of health, especially how they contribute to our life and healthy life expectancy. We have seen growth in life expectancy slow in line with many countries, which is a challenge that has been exacerbated by the Covid-19 pandemic. We have not yet made a specific assessment of how social determinants drive male life expectancy. On the point about men’s loneliness, since the beginning of the pandemic we have invested £34 million in organisations supporting people who experience loneliness, including men.
Lord Hunt of Kings Heath (Lab)
My Lords, I am not sure from the first Answer whether the Minister was actually saying that there would be a strategy with resources and led by someone senior in the NHS. He will probably know that the All-Party Group on Issues Affecting Men and Boys has looked into some of the poor health outcomes for men. There is an acceptance in the NHS that this is almost a biological norm. This is a real problem that needs to be reversed and I hope that the Minister will agree that we need a firm strategy.
Lord Kamall (Con)
I thank the noble Lord for the advice that he has given me to date on many issues relating to this portfolio. In terms of a specific men’s health strategy, it was quite clear that we needed a women’s health strategy because for many years women’s health had not been given the consideration that it needed, including on a whole range of issues such as clinical trials and data, for example. On male life expectancy, the issues that men face are quite disparate, so we target particular issues such as systemic heart disease, cancers, particularly prostate cancer, the fact that more men than women die from suicide, alcohol-related deaths, drug-poisoning, smoking and obesity. We look at those and target them specifically, rather than putting them into an overall men’s strategy.
NHS: Hospital Visiting
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Lord Hunt of Kings Heath (Lab)
My Lords, of course I understand the reason for very great care in relation to infection control in our hospitals, but it is notable that a press release by NHS England in July, at the time of the announcement of a reduction in restrictions by the Government, said that hospital visiting guidance is set to remain in place for all staff and visitors. The concern is that the health service will never change this guidance. Surely there should be some review of the general guidance, given what is happening in society as a whole and the autumn and winter plan that the Government announced yesterday.
Lord Bethell (Con)
My Lords, we brought in harsh guidance at the early stage of the pandemic. That was lifted quickly, for exactly the reasons the noble Lord gave, and we keep the current restrictions under review all the time. But it is up to local trusts to put the right infection control measures in place. Although we have some guidance in place, it encourages visiting, for the reasons the noble Lord points out, and we leave it to trusts to make the ultimate decisions.
Health Protection (Coronavirus, Restrictions) (Steps etc.) (England) (Revocation and Amendment) Regulations 2021
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Lord Hunt of Kings Heath (Lab)
My Lords, I am very glad to follow the noble Lord and to speak to these regulations. They were laid two months ago and, once again, we are debating regulations that in a sense have been superseded by the various announcements made over the last 24 hours. I realise that this week we will probably debate at least two of the Statements, as well as looking forward to a lot of activity when we return.
I will focus on the instruments. At the time they were brought into force, the Government stated:
“The vaccine deployment programme continues successfully … Evidence shows vaccines are sufficiently effective in reducing hospitalisations and deaths in those vaccinated”
and that confidence in vaccine effectiveness against the delta variant has increased significantly. I hope the Minister can update us on that.
Can he confirm the number of adults who have not yet been vaccinated? I think there are figures in the winter plan that I have just seen. Does he agree that, while one should applaud all the efforts of those who have made the vaccination programme possible, it is still striking that so many adults have irresponsibly decided not to vaccinate? I know we will debate the issue of children aged 12 to 15 later this week, but I for one feel very uncomfortable that, even with just one jab, there will be a small risk to those taking it— particularly some boys—partly because of the selfishness of adults in not taking the vaccine. I personally think there are some ethical issues and am not surprised that the JCVI found this a very difficult decision. What else does the Minister think can be done to encourage adults to take up the vaccine?
Could the Minister also say a little about the unknown risks of vaccine effectiveness in high-prevalence environments where transmission pressures are high? I will also ask about the relationship between the booster jabs, which I think the Chief Medical Officer recently announced are to happen, and the flu vaccine programme. I understand that there is concern that immunity to the virus is low, leading to fear that flu, together with other winter viruses, could put the NHS under extreme pressure. Could he also comment on the likely effectiveness of the flu vaccine, which I gather is pretty low?
May I also ask about face coverings? These regulations remove the requirement for people to wear face coverings when using public transport services and in relevant indoor settings. The rationale for that was that the success of the vaccination programme meant we could move away from strict legal restrictions towards personal responsibility and informed judgment. Last week we debated this to an extent and the Minister pointed to data that his department had showing that this had not had much impact on people’s behaviour. From talking to noble Lords, I note that there is some surprise about this, because to the visible eye mask-wearing has dropped off considerably, particularly among men. I wonder about the extent to which this is being monitored and whether we need to step up some programmes about why it is still to be encouraged.
Finally, I will ask about local authority powers. These regulations enable local authorities to take action where an outbreak or risk of outbreak is linked to premises or an event, with local authorities retaining powers to respond to local serious and imminent public health threats. That is a very sensible provision. The Government then describe those regulations as continuing
“to act as an important public health tool for local authorities”.
Could he update me on the use of these regulations since they were passed?
Baroness Barker (LD)
My Lords, I am speaking in this debate because my noble friend Lady Brinton cannot be in her place to take part. We have the technology to enable remote participation in debates in the Moses Room, but the House authorities have not yet permitted that for contributions in Grand Committee, so virtual participation in these proceedings is unfortunately not possible, even though we have seen in this last week that the very few participants who need to take part remotely can be managed very effectively without recourse to extensive speakers’ lists.
It is also a loss to the Committee, because my noble friend Lady Brinton cannot take part for one very important reason, about which she has been quite public: she is clinically vulnerable, and one thing she cannot do is travel on public transport, which she cannot do because people are not wearing masks. Of all people, she should have been able to be here to make that point.
Yet again, these SIs were tabled very late. They came in just before the recess in late July, so yet again we are back to debating things that are long in the past. We have repeatedly asked the Government to respect the House and timetable SIs when they are not genuinely urgent. However, these are, as the noble Lord, Lord Hunt of Kings Heath, said, quite pertinent in view of the Statements being made this week.
This statutory instrument mostly deals with the revocation of statutory instruments on 21 July, which confirmed a number of the changes in the Prime Minister’s so-called freedom day. However, there is one extension, in Regulation 4, to the expiry date of the Health Protection (Coronavirus, Restrictions) (England) (No. 3) Regulations, which are now to end on 27 September. The Explanatory Memorandum says that this
“will ensure that local authorities retain powers to respond to local serious and imminent public health threats as a result of the spread of coronavirus. The No. 3 Regulations will continue to act as an important public health tool for local authorities in their local coronavirus outbreak management, compliance and enforcement activities. This is particularly important in light of the revocation of the other restrictions mentioned above”.
As we have said all the way through this pandemic, it is important that local authorities have the power to manage local outbreaks. Simply extending that power in law, but not making sure that they have the resources, will not work. As epidemiologists have said to us in terms, there will inevitably be points when it is important to close all the pubs in a certain area, simply because an outbreak has to be contained. While we welcome that, it behoves the Minister to say something about local authorities such as Croydon, which is insolvent, and how it will have the resources to manage this significant and enduring public health problem.
We regret the removal of face coverings on public transport and other crowded venues. I can say, as somebody who travels on the London Underground every working day, that fewer and fewer people are wearing masks and, as more and more people are on the Tube, I am certain we will see a spike in infections as a result. I also point out to noble Lords that the bad messaging on this does not help. There is genuine confusion. One of my colleagues was on a train to Scotland in the summer and, when it got to the border, there was an announcement that the law now required everybody on that train to wear a mask, and they did, as they should have done all the way.
It is now clear that the Government, and in particular the Prime Minister, have been so desperate to place emphasis on the vaccination programme as our primary defence that they have forgotten to look at the role of other mitigations against the disease. Although we support the passing of these regulations, we need to make the messaging clearer as a matter of urgency, so we can avoid the confusion that is now prevalent among people in England.
Flu Vaccination and Blood Test Cancellations
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Lord Bethell (Con)
I would be absolutely delighted to put the letter into the Library as requested by the noble Baroness, but please do not think for a moment that I am in any way seeking to pass responsibility. I am pointing out the very clear fact that GPs are responsible for implementing the flu vaccination programme. It is something that they do brilliantly. No other country has a flu vaccination programme with the impact that ours has. GPs are taking on more responsibilities this year with secondary school children being vaccinated. The rate I am expecting for this year will be higher than we have ever seen before.
Lord Hunt of Kings Heath (Lab)
My Lords, any delay in blood tests or flu vaccination must have some impact on patient safety. What monitoring are the Government doing to try to measure the impact? Will the Minister ask the Healthcare Safety Investigation Branch to conduct a review?
Lord Bethell (Con)
My Lords, my understanding is that patient safety has not been at stake, but the noble Lord makes an extremely good point. I am not sure it is my role to instruct HSIB on this, but I will look into whether investigation is necessary. I reassure him that these shortages have not had a profound impact. We have marshalled the use of the tubes extremely carefully and have pushed back some routine blood-taking. That will have a small impact but we have put in place provision for a catch-up.
Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) (Amendment) Regulations 2021
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, over the past few months, the Government have made a concerted effort to bring forth a sense of normality across the country with the easing of restrictions, while maintaining caution with regard to this deadly virus, which clearly has a long way to run. These regulations are a key part of this dual-track effort, significantly reducing the burden of self-isolation while protecting society from the threat of contagion. The main focus of the regs is the isolation protocols, so I begin by reflecting on the crucial role that contact tracing and self-isolation play in fighting the virus.
Since it was established in May 2020, NHS Test and Trace has contacted more than 15 million people who have tested positive for Covid-19 or who have been in contact with a positive case. Tracing—the bedrock of any public health intervention—has improved substantially over the last several months. In October 2020, 60% of close contacts were being reached. In comparison, over the period from 26 August to 1 September, 87.3% of positive cases transferred to NHS Test and Trace were reached, as have 89.5% of their contacts where usable contact details were provided. That is a remarkable achievement.
The public realise the importance of isolation. July’s ONS statistics that show 79% of positive cases reported complying with the self-isolation guidance, alongside 89% of close contacts. That is a terrific response from the public and it has proven a vital weapon in our arsenal against the virus.
What is the impact of this massive financial and societal investment? A recent study from PHE, published today and called the Canna model after the idyllic Scottish western isle, which some noble Lords may have visited, shows that from August last year to this April, test, trace and self-isolation activity reduced the transmission of the virus by between 10% and 28%. The PHE research demonstrates that self-isolation helped to bring R below one at crucial times, reducing the duration and impact of lockdown. Over the full period of the study, the Canna model estimates that isolation due to test, trace and isolate policies prevented between 1.2 million and 2 million secondary cases. The NHS Test and Trace service has also enabled us to identify peaks and troughs in case rates, supporting decisions on when restrictions should be tightened or could be eased.
We recognise that none of this has been easy. The requirement to isolate creates enormous challenges for individuals and their families across the country. A study in March 2021 by the BMJ concluded that offering financial and practical support to individuals who needed to self-isolate would likely improve compliance. We support that view. Since September last year, we have provided councils with £280 million to issue support payments to those who may face financial hardships because of self-isolation. We have also made up to £100 million available between March and September this year for councils to offer practical and emotional support to some of the most vulnerable in our communities, covering over 200,000 people. It is right, though, that we sought to reduce the burden of self-isolation at the earliest opportunity.
The amendments to the self-isolation regulations we are debating balance these factors and provide a significant easing of burden from self-isolation requirements while maintaining vital measures to reduce the spread of the virus. These amendments came into effect on 16 August and allow those who are fully vaccinated to be exempt from self-isolation if they are the close contact of a positive case. Based on the data, we know that the vaccines reduce overall symptoms by between 80% and 90%, hospitalisations by between 90% and 95%, and deaths by around 95%. Therefore, we have adapted our approach to self-isolation to reflect this and ensure we balance the need to slow down the transmission of the disease with the need to get back to normal.
As well as fully vaccinated adults, several other groups have also been exempted from the requirement to self-isolate. The amendment provides an exemption to self-isolation for the close contacts who have taken or are taking part in an MHRA-approved trial for a Covid vaccine. This will ensure that they are not disadvantaged as a result of their personal sacrifice. We recognise also that some groups cannot be fully vaccinated on medical grounds. The amendment therefore includes an exemption for those close contacts who can evidence that they are unable to be vaccinated for medical reasons.
Finally, we have carefully considered the impact on those under the age of 18. There are unqualified harms to children’s educational, emotional and social outcomes as a consequence of self-isolation, as well as of the infection itself. The risk of hospitalisation and intensive care admission in children due to Covid is very low—approximately eight per 100,000 population aged under 18 are admitted to hospital. The incidence of mortality in children as a result of Covid is also extremely low. By balancing these factors, the SI provides an exemption for those close contacts under the age of 18 from self-isolation.
Those who are exempt will be advised to take a PCR test as soon as possible to check whether they have the virus. Though not required to self-isolate, they will be advised to consider other precautions, such as wearing a face covering in enclosed spaces, as well as limiting contact with others, particularly those who are clinically extremely vulnerable. However, it remains the case that if any of these groups develop symptoms they should self-isolate immediately and take a PCR test. Anyone, whether fully vaccinated or not, who goes on to test positive will remain under a legal duty to self-isolate.
Although I sympathise with the burden and the challenges that self-isolation creates, it will continue to play an indispensable role in containing the virus. The Secretary of State said more on this in his Statement earlier on the winter strategy for tackling the virus. While restrictions are easing, we must all continue to adhere to the self-isolation regulations and the guidance if we are to continue protecting our friends, families and communities. I commend these regulations to the Committee.
Lord Hunt of Kings Heath (Lab)
My Lords, I very much agree with what the Minister said about the importance of self-isolation. I note that emphasis is given in the winter plan to the importance of isolation in relation to breaking transmissions. The issue I have is that there is a proportion of the population who find self-isolation very difficult, and there are legitimate reasons for that. I have been studying TUC research, which shows that 24% of low-paid workers say they cannot afford to take time off for sickness, as opposed to 6% of high-paid workers. It reckons that only 35% of low-paid workers get full sick pay, as opposed to 80% of high-paid workers, defined as those earning more than £50,000 per annum. Statutory sick pay is only £96.35, less than any other OECD country. It is reckoned that 72% of low-paid workers cannot work from home, compared with 20% of high-paid workers.