Public Health

Helen Whately Excerpts

Wednesday 30th December 2020 Commons Chamber

[The Minister for Care (Helen Whately)]

I beg to move,

That the Health Protection (Coronavirus, Restrictions) (Self-Isolation and Linked Households) (England) Regulations 2020 (S.I., 2020, No. 1518), dated 11 December 2020, a copy of which was laid before this House on 11 December, be approved.

[Madam Deputy Speaker]

With this we shall debate the following motions:

That the Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) Regulations 2020 (S.I., 2020, No. 1533), dated 14 December 2020, a copy of which was laid before this House on 14 December, be approved.

That the Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) (No. 2) Regulations 2020 (S.I., 2020, No. 1572), dated 17 December 2020, a copy of which was laid before this House on 17 December, be approved.

That the Health Protection (Coronavirus, Restrictions) (All Tiers and Obligations of Undertakings) (England) (Amendment) Regulations 2020 (S.I., 2020, No. 1611), dated 20 December 2020, a copy of which were laid before this House on 21 December, be approved.

That the Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) (No. 3) Regulations 2020 (S.I., 2020, No. 1646), dated 24 December 2020, a copy of which were laid before this House on 29 December, be approved.

[Helen Whately]

Before I say anything else, I want to say thank you to all our health and social care workers who have been working day and night through Christmas, Boxing day and the bank holiday. I know that every single one of them is feeling the strain and that they are not just tired but exhausted, having gone not just the extra mile but miles and miles of extra miles. I would also like to thank everyone across the country who has forgone the joy of sharing Christmas with family or friends. We have all missed those precious moments, and I know that this has been particularly painful for those facing what may be the last chance to spend Christmas with a loved one nearing the end of their life. That is why I say thank you to them from the bottom of my heart for what they have done, not so much for their own sake but to protect others.

I would like to take a moment to celebrate the good news of the authorisation of the Oxford-AstraZeneca vaccine for use. Although the development of vaccines is an international collaboration, we should recognise the contribution of the British life sciences sector, which offers the UK a way out of this disease and will make a huge impact on the global response.

[Mr William Wragg (Hazel Grove) (Con)]

Could my hon. Friend confirm the numbers of the AstraZeneca vaccine that are ready to be administered?

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[Helen Whately]

My hon. Friend may well have heard the statement by the Secretary of State for Health and Social Care, after which he answered a large number of questions about the vaccine. As he said, we will be rolling out the vaccine as rapidly as possible, we are poised and ready to start rolling out that particular vaccine as of next week, and it is all about getting the supply of the vaccine in to enable us to do that.

There is light at the end of the tunnel, but we are not there yet. We are here today to debate regulations that increased the restrictions on parts of the country before Christmas, but we also heard the Health Secretary’s statement earlier and know the seriousness of the situation we face despite those greater restrictions. We know that we have just had the highest number of new cases in one day—over 53,000—and in many parts of the country, our hospitals are stretched to the limit. We know we are facing a new variant of covid that is more infectious and spreading rapidly in many parts of the country, so I am in no doubt that we were right to introduce further restrictions when we did.

Before going into the details of the regulations, I will give a brief overview of the measures we are debating. On 2 December, a revised tiering system was introduced following approval of the all-tiers regulations in both Houses. Those have been amended four times. On 14 and 16 December, the all-tiers regulations were amended to move some local authority areas between tiers. Those changes came into force on 16 and 19 December respectively. On 20 December, the all-tiers regulations were amended to introduce a further level of restrictions—tier 4—and to move some local authority areas into that tier and to exclude tier 4 from the Christmas easements. Finally, on 24 December, the all-tiers regulations were amended to move some local authority areas into higher tiers, and some amendments were made to the measures in tier 4.

In addition to those four amendments to the all-tiers regulations, we are debating the Health Protection (Coronavirus, Restrictions) (Self-Isolation and Linked Households) (England) Regulations 2020, which reduce the self-isolation period for household and non-household contacts from 14 days to 10, based on evidence showing that the likelihood of being infectious as a contact after 10 days is low. That decision was made following advice from UK chief medical officers. To bring English policy in line with other nations in the UK, we now count the start date of this period from the day after exposure, onset of symptoms or a test. Those with covid-19 should continue to self-isolate for 10 days, as per Government guidelines. We have brought the wait time for those switching support or childcare bubbles down to 10 days, in line with those changes.

I know that some hon. Members have previously raised concerns about parliamentary scrutiny, and some may be disappointed that those amendments were made in advance of this debate. However, I am sure hon. Members will also appreciate that this virus does not wait for parliamentary procedure. The situation we faced in the run-up to Christmas, as we identified that the cause of the rapid rise in infections was the new variant, meant that we had to act, and act fast.

[Sir Charles Walker (Broxbourne) (Con)]

The great disappointment felt by many colleagues, who appreciate that the Government are under enormous pressure, is that the House rose on the Thursday, and the decision was made pretty much the next day. It is a great shame that the House was not recalled on the Friday, or possibly even the Saturday before Xmas, to scrutinise the new regulations. That is where the sense of disappointment lies. Most families are more than capable of making the right decisions for their relatives without being instructed to do that in law.

[Helen Whately]

I hear my hon. Friend’s point, and I share his view that throughout this pandemic the vast majority of people have behaved with great responsibility. I know that people in tiers other than tier 4 thought very hard about whether they should gather with relatives, even within the easing that was allowed during the Christmas period, and rightly so. We must all play our part in controlling the virus and stopping its spread.

[Sir Christopher Chope (Christchurch) (Con)]

Will the Minister give way?

[Helen Whately]

I will make some progress.

At the time of these provisions we were seeing an exponential rise in cases in London, Kent, and some other parts of the south-east, and it was clear that the tier 3 restrictions were not sufficient. We identified the existence of a new variant in those areas, and further analysis showed us that the new variant was driving the steep trajectory of infections. The new and emerging respiratory virus threats advisory group—NERVTAG—tells us that the new variant demonstrates a substantial increase in transmissibility, compared with other variants, and that the R value appears to be significantly higher, with initial estimates suggesting an increase of between 0.4 and 0.9.

There is no evidence to suggest that the new variant of the virus is more likely to cause more serious disease, but increased infections lead to increased hospital admissions and, sadly, increased loss of life. These winter months already pose great challenges for our NHS. That is why we had to take the action that we took before Christmas, and the further steps announced today to control the relentless spread of the virus. However, it is not all bad news.

[Sir Christopher Chope]

Will my hon. Friend give way on that point?

[Helen Whately]

I am making some progress and I am mindful that many Members want to speak this evening.

The roll-out of the Pfizer vaccine is happening at pace, with more than 600,000 people receiving it between 8 and 20 December. Vaccinations in care homes started on 16 December, and the NHS has already been getting the vaccine to those who are most vulnerable, and the care workers who look after them. Now, the Oxford-AstraZeneca vaccine has been approved, and it is much easier to get out to people and into arms. There is every reason for optimism, but we are not there yet. We must suppress the virus now and in the weeks ahead.

On the specific measures in these regulations, in response to the greatly increased risk, the addition of tier 4 stay-at-home measures will be familiar to people from the November national restrictions. Tier 4 involves minor changes to those national restrictions. As of November, people in tier 4 areas must stay at home and not travel out of tier 4. They may only leave for a limited number of reasons such as work, education, or caring purposes. We are advising that clinically extremely vulnerable people in tier 4 areas should do as they did in November and stay at home as much as possible, except to go outdoors for exercise or to attend health appointments. The regulations contain the same exemptions as other tiers for childcare and support bubbles. We advise that people elsewhere avoid travelling into a tier 4 area, unless they need to do so for work, education or health purposes.

[Sir Christopher Chope]

Can my hon. Friend help me? Statutory instrument 1572 required the people of Christchurch to move from tier 1 to tier 2, and it came into effect on 19 December. Today, the Secretary of State has announced that the people of Christchurch should be moving into tier 4, with effect from midnight tonight. What has happened between 19 December and today to force the people of Christchurch to lose all that liberty?

[Helen Whately]

One thing that I will do when I have finished speaking is see whether I can look up the specific data for the hon. Member’s constituency. In general, however, the announcements made today, just as with previous announcements, are based on the data that we are seeing, which includes rapidly rising rates of infection in certain areas, the level of new infections, the trajectory and hospital pressures.

The tier 4 regulations require all non-essential retail, indoor entertainment, hairdressers and other personal care services to close. International travel is also restricted to business trips only. However, we have listened to hon. Members and the public about what is most important to people in their daily lives so, unlike in the November restrictions, communal worship and a wider range of outdoor recreation are still permitted. We also recognise the restrictions’ impact on businesses and continue to provide them with ongoing support to help get through the crisis.

We know that these measures are hard. We know that they keep families and friends apart, yet we also know that they are necessary for us to get through this situation and to prevent the loss of lives as we do so. This virus thrives on the things that make life worth living, such as social contact, but that means we can all play our part in stopping the spread—as I said, if not for ourselves, then for others. The end is in sight, but for now it is our duty here in Parliament to put in place these restrictions—onerous though they are—to control this virus. I commend the regulations to the House.

[Madam Deputy Speaker (Dame Rosie Winterton)]

As I said, we will start with a five-minute time limit on Back-Bench Members. I remind hon. Members that, when a speaking limit is in effect for Back Benchers, a countdown clock will be visible on the screens of right hon. and hon. Members participating virtually and on the screens in the Chamber. For right hon. and hon. Members participating physically, the usual clock will operate.

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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.

[Mr Harper]

Will my hon. Friend give way?

[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.

[Steve Brine]

I want to get clarity on the point made by my right hon. Friend the Member for Forest of Dean (Mr Harper). If the reason for the restrictions on our constituents’ lives is to prevent people from getting infected, getting very sick and being hospitalised, and thereby to protect the NHS, once we have vaccinated the people who could get very sick and use the NHS, we will no longer have the problem of protecting the NHS, so we should be able to lift the restrictions. Even if the Minister cannot clarify that that is the Government’s position, does it not seem like the logical consequence, or am I just completely daft?

[Helen Whately]

I am being counselled not to respond to my hon. Friend’s description of himself. I do not think I should be drawn into speculation on the roll-out and what we face ahead of us. He will have heard the good news from the Secretary of State earlier that we have an additional vaccine that we can use and that the NHS is ready and poised to roll out at great pace. We are determined to do so. That is so important, as it means that we have hope as we go through this very difficult time.

It was very good to hear so many hon. Members recognise and thank not only NHS staff but those working in social care. Care home workers in particular were mentioned by my hon. Friend the Member for Thurrock, as were the social care workforce more widely. The hon. Member for Twickenham (Munira Wilson) mentioned the mental health of the NHS and social care workforce—something about which I care a great deal. I assure her and others who are concerned about this matter that we have put in place extra mental health support for frontline NHS and social care workers, including specialist helplines that are available 24/7 so that there is always someone they can call.

In conclusion, as we go about our lives under these restrictions, we must remember the pressure the pandemic puts on that workforce. I once again thank the public for all playing their part and for the sacrifices they are making for themselves, but especially for others. The end is in sight, but we have a way to go and we must take the steps necessary to suppress the virus here and now.

Question put and agreed to.

Resolved,

That the Health Protection (Coronavirus, Restrictions) (Self-Isolation and Linked Households) (England) Regulations 2020 (S.I., 2020, No. 1518), dated 11 December 2020, a copy of which was laid before this House on 11 December, be approved.

Public Health

Resolved,

That the Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) Regulations 2020 (S.I., 2020, No. 1533), dated 14 December 2020, a copy of which was laid before this House on 14 December, be approved.—(Rebecca Harris.)

Resolved,

That the Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) (No. 2) Regulations 2020 (S.I., 2020, No. 1572), dated 17 December 2020, a copy of which was laid before this House on 17 December, be approved.—(Rebecca Harris.)

Resolved,

That the Health Protection (Coronavirus, Restrictions) (All Tiers and Obligations of Undertakings) (England) (Amendment) Regulations 2020 (S.I., 2020, No. 1611), dated 20 December 2020, a copy of which were laid before this House on 21 December, be approved.—(Rebecca Harris.)

Resolved,

That the Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) (No. 3) Regulations 2020 (S.I., 2020, No. 1646), dated 24 December 2020, a copy of which were laid before this House on 29 December, be approved.—(Rebecca Harris.)

Covid-19: Effect on People with Learning Disabilities

Helen Whately Excerpts

Tuesday 15th December 2020 Westminster Hall

[The Minister for Care (Helen Whately)]

It is a pleasure to serve under your chairmanship, Ms Ghani. I thank the hon. Member for City of Chester (Christian Matheson) for securing a debate on this very important topic.

The pandemic has impacted everybody, but many of those with learning disabilities have been particularly hard hit. I know how difficult it has been for them, their carers and loved ones to continue to be supported to live fulfilling lives during the pandemic. Wherever possible, we have made exemptions and reasonable adjustments to the restrictions for disabled people, while balancing that with the need to keep people safe. Sadly, we know that some of those with a learning disability have suffered the worst effects of covid-19 and passed away. I send my deepest condolences to their families and friends.

The hon. Member for Bethnal Green and Bow (Rushanara Ali) asked me to talk about what we are doing about the high mortality from covid of those with learning disabilities. We commissioned Public Health England to analyse the information about deaths for people with learning disabilities in order to understand the impact of covid-19 and ensure that we could take every possible step to protect people. As hon. Members have said, its report estimated that, in the first wave, people with learning disabilities had a mortality rate from covid-19 that was between 4.1 and 6.3 times higher than the general population. We know that some of the difference is associated with having other health conditions such as Down’s syndrome and with place of residence.

The University of Bristol recently published a LeDeR—Learning Disabilities Mortality Review—report setting out findings from reviews of deaths from covid-19 of people with learning disabilities, which adds to our understanding. The findings of those reports are very concerning. I want to reassure hon. Members that we did not wait for the publication of those reports to take action. Rather, we have worked continuously to protect people throughout the pandemic, and I will briefly set out some of the actions we have taken.

From the adult social care action plan back in April to the adult social care winter plan published in November, we have worked to ensure that people who need care, including those with learning disabilities, are protected as much as possible from the worst outcomes of covid-19. That has included introducing the infection control fund, now totalling £1.1 billion, to ensure that care settings, including day services, are covid-secure. We are providing free PPE for adult social care providers until March 2021. That includes domiciliary care and personal assistance, as well as residential care homes. As testing capacity has increased, we have extended asymptomatic testing not only across care homes but to domiciliary care staff. Following the roll-out of the single round of national testing to the most high-risk extra care and supported living settings, we have launched regular retesting for those settings.

The hon. Member for City of Chester spoke about DNACPRs and the concern about their inappropriate recording in patient records. When I heard about that, I too was very concerned and shocked. The blanket application of DNACPRs to any group of people is completely unacceptable, and I want that message to be said as many times as it needs to be to ensure that that practice does not continue. When we heard that it was happening, a series of communications went out from the Department, the Secretary of State and NHS England to say that there needed to be an immediate stop to that practice. As has been said, the Care Quality Commission is looking into that. The 2021 general medical services quality and outcome framework was updated in September, and it requires GPs to review all DNACPR decisions for people with learning disabilities to make sure they are appropriate.

The hon. Gentleman also spoke about the need for training to ensure healthcare staff have the skill and understanding they need to care for people with learning disabilities. I completely agree with that, which is why I am working with Health Education England and Skills for Care to develop the Oliver McGowan mandatory training to ensure that all staff have the skills and understanding they need.

Several Members asked about remote consultations. The NHS medical director of primary care wrote to GPs in September, asking them to continue to ensure that patients who need to can access face-to-face care.

I am sure that, like me, hon. Members welcomed the incredible news that a vaccine against covid has been approved. They will know that the Joint Committee on Vaccination and Immunisation, the independent body responsible for identifying priority groups for vaccinations, has published its advice on prioritisation. In advance of that process, we shared with the JCVI the latest evidence on people with learning disabilities and covid—including the Public Health England work that I referred to—to inform their approach and ensure that those with learning disabilities would be considered alongside older people, for instance, for whom the risks are very well known. The JCVI’s advice, published in December, stated that people on the clinically extremely vulnerable list, including those with Down’s syndrome, should be in priority group four for vaccination, and that people with a severe or profound learning disability should be in priority group six.

[Rushanara Ali]

Could the Minister tell us now or in writing about how the actions she is taking to reduce the disproportionate impact of death rates for those with learning disabilities is being addressed with facts, so that we can see the progress that the actions of her Department have led to, given the number of deaths in the second wave? It is not clear whether those interventions are working, and it would be reassuring to see how those actions are helping.

[Helen Whately]

We will continue to scrutinise all possible evidence and data we can get to understand the impact of the steps we are taking. For instance, as I have set out, we have supported residential care settings and other carers to ensure that they have the PPE and infection control support they need. Sadly, we still see that care homes are experiencing outbreaks of covid. It is incredibly hard to stop the disease getting into these places when it is prevalent in the community. We know that the most important thing we can all do to keep those who are most vulnerable to covid safe is to take steps to reduce the spread of covid in the wider community. I assure the hon. Member that we are continually looking at the evidence and at what more is possible to do to keep people safe.

In fact—I was coming to this exact point—I have asked the Scientific Advisory Group for Emergencies care working group to consider the findings in the Public Health England and LeDeR reports to help us develop further targeted actions. The Department has commissioned research to better understand the impact of the pandemic on the wellbeing and lives of people with a learning disability. That is being led by the University of Warwick and Manchester Metropolitan University. The insights from this research will help us to further mitigate and reduce harm from covid-19, including tackling isolation and loneliness. We will keep the evidence under review.

I come now more broadly to restrictions, which I know have been particularly hard for people with learning disabilities. In particular, visiting loved ones for those who are in residential care settings has been incredibly difficult for families, friends and the individual themselves. On 1 December, we published updated guidance on visiting care homes. We advised care homes to use the rapid tests that we are providing, together with PPE and other infection control measures, to enable safer visiting. There is also guidance on visiting in-patient healthcare settings. That was updated in October, and NHS England and NHS Improvement wrote to mental health learning disability and autism in-patient providers to remind them that they must take all possible steps to enable safe regular visits.

The hon. Member for Warrington North (Charlotte Nichols) asked about the visiting out guidance for those of working age. An enormous amount of care was taken over that to try and establish the right balance to enable people to go and see their family if that is what they normally do while they live in a residential care setting, while recognising that they may well be in a setting where others in that care home, for instance, may be extremely clinically vulnerable to covid. As I have said, we know that once covid gets into a residential setting, it is really hard to stop it spreading. That is why the clinical advice is very strong on saying that those returning to a care setting after a visit out should quarantine for 14 days. I am really aware that that is a very difficult thing to ask people to do, but the reason it is in there is because that setting may well have people who are clinically extremely vulnerable, and there is such a risk. It is not just about the one individual visiting out; we must bear in mind the risk to the whole group of residents. That is why the guidance is as it is.

Before I conclude my remarks, I will talk about the restrictions on the day-to-day activities, which all of us have been complying with. We have made exceptions and reasonable adjustments wherever possible, for example by excluding support groups such as day services from the rule of six, setting out clear exemptions to mandatory face coverings, including where a person cannot wear one due to a disability, and working to ensure that that is communicated. There has been some debate about this and whether the ban should be much more strongly enforced, but I have personally worked really hard to communicate the importance of there being exemptions.

We have also, wherever possible, produced guidance in accessible formats, such as easy-read. We continue to work with stakeholder groups and organisations such as Mencap, which has rightly been mentioned during the debate, to ensure that we get input on the potential implications of restrictions on people with a learning disability, and how we can best mitigate those implications.

To conclude, I thank all hon. Members for their contributions on this important topic. We are all deeply committed to helping protect people with a learning disability from the worst effects of covid-19, and I hope that what I have set out today does assure Members that the Government are working tirelessly to make that happen.

Covid-19

Helen Whately Excerpts

Monday 14th December 2020 Commons Chamber

[The Minister for Care (Helen Whately)]

The speeches we have heard this evening remind us just what hard times we live in, when we have had to do things that would have been unimaginable just a year ago. There are the things we have done to save lives, but sadly, even so, many lives have been lost. As my right hon. Friend the Secretary of State set out in his statement to this House earlier today and the Minister for prevention, public health and primary care, the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), reminded us in her opening remarks, this is not over yet.

I know that people in the places moving into tier 3 on Wednesday morning will feel a real sense of disappointment, especially as we get closer to Christmas. We have heard today some powerful contributions from across this House about how our constituents have been affected. For instance, my hon. Friend the Member for Bolsover (Mark Fletcher) spoke about the impact of the restrictions on mental health, with the loss of routine, loss of social contact and loss of opportunities to pursue passions and activities that make life worth living—ice skating, as we have heard, but also dance classes. I should add to that the loss of livelihoods. Many colleagues have spoken about the impact on hospitality, and particularly pubs. Believe me, I really appreciate that, with a brewery as the largest employer in my constituency.

I also welcome the recognition and the tributes paid by hon. Members not only to the NHS and its workforce, but to care homes and care workers, who have indeed been there for the people they care for day in, day out throughout this pandemic. They are rightly prioritised for testing. I will pick up on a comment made by my hon. Friend the Member for Redcar (Jacob Young) and say that care agency staff absolutely should be tested regularly, using tests distributed to the care homes that they work at.

[Jacob Young]

The care agency that I referred to said that it has about 160 members of staff on its books, of whom 80 are in work regularly. Of those 80, 60 are included in testing in some care homes; it is that final 20 who are not getting regular tests. I was told that the same was true for other agency workers, too.

[Helen Whately]

It will probably be helpful if we pursue the specific case outside the Chamber. I just wanted to reiterate the importance of care agency staff being tested in care homes. Tests are being distributed to care homes for that purpose.

Whenever the Government have to take difficult decisions, such as the ones we have taken today, the impact of those decisions on people across the country is always at the front of our mind. With a 14% rise in average daily cases last week and a 13% rise in daily hospital admissions, we had no option but to act today, even ahead of the formal review point on Wednesday. As the Secretary of State reminded us earlier, Germany had to introduce tougher restrictions over the weekend, and Sweden is seeing real pressures on intensive care beds. As we set out in our winter plan, our strategy has always been to suppress the virus and prevent our NHS from becoming overwhelmed until the vaccine can make us safe.

I know that hon. Members will share my sense of optimism that, just as many other parts of the country have done so magnificently, the areas now facing rising rates can turn this around. They are getting the support they need to do that, right where it is needed most, including through the provision of community testing, with millions of newly invented tests targeted at the areas that need that support. I know that the Members representing those areas will want to play their part in this effort, so I can say that today we published a guide for Members so that colleagues can promote, support and champion local community testing and contact tracing in their areas.

I am grateful to my hon. Friend the Member for South Thanet (Craig Mackinlay), who spoke about how he had seen people become more careful in his area as they saw rates rise locally. He saw their behaviour change through the increased wearing of face masks, for instance, as people took the extra steps to keep themselves and others safe. That is a reminder that ultimately, all our efforts must be underpinned by a sense of personal responsibility. Our national effort begins with every one of us.

We all know what a difficult year it has been, yet that does not make those important public health messages any less true. As several hon. Members have reminded us this evening, we must continue to wash our hands, cover our face and make space. We must continue to self-isolate when we are asked to, for the 10 days now required. Perhaps even more challenging than that, though, we must be unafraid to ask ourselves difficult questions about who we are meeting, their vulnerability and whether that is a risk worth taking. Time and again, the common sense of the British people has prevailed, and it must continue to do so.

Finally, our vaccine deployment continues apace, because we know that vaccines represent our best route out of these difficult times. It is such a relief to be able to say about vaccination not if, but when. Tens of thousands of people have already been vaccinated, and GP roll-out started today in hundreds of parts of the country, so many more will be vaccinated this week, like the relatives my hon. Friends the Members for Stoke-on-Trent South (Jack Brereton) and for South Thanet mentioned.

[Emma Hardy]

The Minister will be aware that one of the issues raised during her call with the areas going into tier 3 was the need for boots on the ground—for people to help to administer the vaccine. The health force in Hull and areas like it is diminished because many are self-isolating, others are suffering from covid and it is an exhausted workforce. Will additional personnel resources be made available to help deliver the vaccine?

[Helen Whately]

I know that a huge amount of work is going on to ensure that we have the boots on the ground needed to vaccinate people. Indeed, that is one of the things that those who have volunteered—particularly those with healthcare experience who are returning to the NHS—are stepping forward to help with.

We will vaccinate in care homes by Christmas, and that process has already begun in Scotland. Most of us who are eligible can expect to receive our vaccine in the next few months, which is truly heartening, but we must all stay on our guard through Christmas and into the new year. This is not the time to ease up—quite the opposite, in fact, because this is the busiest time of year for our NHS and for the doctors, nurses and other health and social care workers who have already done so much for us in this pandemic. Along with many colleagues today, I thank our health and social care workers.

This is a moment to stand firm against this deadly virus and to redouble our efforts to keep one another safe. This is one of the toughest things we have ever had to do as a country and one of the toughest things that anyone has had to endure personally, but the end is in sight. We must steel ourselves and do the right thing, if not for our own sake then for others’, and we will get through this together.

Question put and agreed to.

Resolved,

That this House has considered covid-19.

Covid-19: Acquired Brain Injury

Helen Whately Excerpts

Tuesday 24th November 2020 Westminster Hall

[The Minister for Care (Helen Whately)]

It is a pleasure to serve under your chairmanship, Ms Eagle. I congratulate the hon. Member for Rhondda (Chris Bryant) and thank him for securing a debate on this important matter. I give him so much credit and pay tribute to his passion and his huge knowledge of this subject—I know that he has debated it at length with other Ministers—which he has brought to this debate and other debates on the matter. I also pay tribute to his commitment to this cause and the tireless work that he does. Of course, I know that he speaks on this subject from direct personal experience. I pay a huge tribute to him for all that he brings to these debates.

It is also good to have the hon. Member for Blaydon (Liz Twist) here. I thank her for the work she is doing with the APPG and the hon. Member for Rhondda to campaign for those with acquired brain injury.

I recognise the vital work of charitable organisations such as Headway, the United Kingdom Acquired Brain Injury Forum and the Disabilities Trust. Their work is invaluable not only in raising awareness but in providing hands-on help and support to patients, families and carers. I am aware that acquired brain injury affects not only an individual’s health but their family, work, relationships and education, in the case of children, so it has a huge impact on people’s lives.

I have met people with brain injuries. Shortly after I was elected, I visited Kent and Canterbury Hospital, which has a neurorehabilitation unit, and I spoke to staff and patients and saw the really impressive work that they were doing. I appreciate the points that the hon. Gentleman makes about the importance of effective neurorehabilitation.

As the hon. Gentleman set out, the pandemic has had a real impact on the care and treatment of people with acquired brain injuries. As he said, staff have been redeployed on to frontline covid work, and that has affected people’s care. For instance, some consultations have been moved online, and services are not what we would want them to be. Face-to-face neurology rehabilitation services are being restarted as quickly as possible. Guidance has gone out from NHS England and NHS Improvement and the Association of British Neurologists, and every effort is being made to catch up on delayed care. I will look into the point that the hon. Gentleman made about his concern that services are not yet up and running. I recognise that the pandemic has been a really difficult time for those affected by ABI across a range of areas, not simply access to healthcare services.

This debate and previous debates owe a debt to the all-party parliamentary group and the hon. Gentleman’s leadership. I want to flag the wide-ranging inquiry into the causes, impact and treatment of ABI, culminating in the report published in October 2018, which set out a host of things that we need to address across Government. As he knows, my Department worked with officials across Whitehall to give a response in February 2019. I welcome the fact that the APPG, along with UKABIF, continues to drive the “Time for Change” agenda, most recently in an online summit held on 16 November.

One of the key issues highlighted in the report, as the hon. Gentleman said, is the importance of better Government co-ordination. I absolutely take his point. He mentioned a conversation with the Chancellor of the Duchy of Lancaster. I speak directly for Health, but I am very aware that brain injury cuts across almost all aspects of an individual’s life, from education to work and welfare, and sadly sometimes the justice system, so we need to work on this across Government. I will work with my officials to drive stronger co-ordination for ABI across Government.

On the services available to patients with ABI, the hon. Gentleman will know that since 2012 we have had 22 regional trauma networks across England, and those major trauma centres can provide the specialist care needed by patients with major trauma, including brain injury. Alongside that, timely and appropriate neurorehabilitation is a critical part of care. As the hon. Gentleman set out, that is absolutely crucial for improving the outcomes for people with brain injury. For patients with the most complex need, NHS England commissions specialised rehabilitation services nationally. Trauma unit teams then work to assess and develop a rehabilitation prescription for brain injured patients. RPs are rightly regarded as very important for rehabilitation, as they reflect an assessment of the needs of the patient in the round. That approach is showing results. As the hon. Gentleman knows, the latest data shows that 94% of patients accessing specialist rehabilitation have evidence of functional improvement.

The hon. Gentleman spoke about local commissioning and the differences across the country. The majority of rehabilitation is commissioned locally. To support that, NHS England has produced guidance setting out what good rehabilitation looks like and what services people should expect. Community services clearly play a crucial role.

[Chris Bryant]

I am grateful for the nice comments that the Minister has made, but one of the problems with the guidance is that it does not feel very enforceable, and until the money goes with the guidance, as it were, I think it is unlikely that people will invest in this. It feels sometimes—not to use a cliché—a bit too Cinderella-like. I just wonder whether there is a means of twisting it into enforceability.

[Helen Whately]

I absolutely take the hon. Gentleman’s point, and I have heard the argument made about the service we are discussing and other services that are commissioned locally. There is the holy grail—people want a locally responsive health service to respond to what the community needs, but on the other hand they want consistency. Achieving both of those is hard and, arguably, not entirely possible, because the mere fact of having something locally responsive will involve some variation. However, I will also take away the hon. Gentleman’s point that there are ways to try to achieve a higher overall standard and more consistency without necessarily going all the way and saying that it must be done in exactly that way everywhere. Oversight is one way of doing that, so I shall see whether there is further we can go with regard to the point that he made.

I want to pick up on the list of questions—or the wish list, as we are approaching Christmas—

[Chris Bryant]

Demands.

[Helen Whately]

In that case, demands: I shall see which of them I can answer. One was about a national neurorehabilitation lead. During the period of covid-19 there is indeed a national lead. Suzanne Rastrick has been designated the national clinical director for rehabilitation, co-ordinating clinical advice and leadership in that area. That is for the period of covid. I appreciate that the hon. Gentleman’s demand is that it should go beyond the period of the covid pandemic.

As to whether all neurorehabilitation services will be restored after covid, I have no reason to believe that they will not, but I shall, again, take the matter away, and make sure that we see that happening. The hon. Gentleman asked whether neurorehabilitation is one of the 12 specialties that are protected during covid, and I can broadly answer yes. NHS England has made a specific provision for a subset of services, to ensure that they are protected, and complex rehabilitation services are included in that. I hope that answers the hon. Gentleman, at least on that issue. I shall look at his ask on a national neurorehabilitation strategy and consider whether it is something we can do. It is a clear request.

[Chris Bryant]

Will the Minister give way?

[Helen Whately]

I was just about to conclude, and I believe that the hon. Gentleman has a couple of minutes at the end.

[Ms Angela Eagle (in the Chair)]

No, he does not.

[Helen Whately]

In that case, I shall take his intervention.

[Chris Bryant]

I am grateful. I fully get that one of the dangers of having a postcode lottery is that trying to overturn it can mean ending up with no freedom locally, and all the rest of it; but I just say again that the Chancellor of the Duchy of Lancaster really needs to get everyone together. There are real benefits that we could deliver to people, as well as financial savings across the piece.

[Helen Whately]

The hon. Gentleman makes a good point, and I shall, as I say, take that matter away, as the Chancellor of the Duchy of Lancaster has done as well. In conclusion, I take the matter absolutely seriously. Clearly, covid has put huge pressure on the Department, Ministers and the whole health service, but the hon. Gentleman raises a really important point about how seriously we must take the care, treatment and rehabilitation of those with acquired brain injuries. I thank him again for all that he is doing to campaign on it, and for the impact that he has in doing so.

Question put and agreed to.

Oral Answers to Questions

Helen Whately Excerpts

Tuesday 17th November 2020 Commons Chamber

[Ellie Reeves (Lewisham West and Penge) (Lab)]

What steps his Department is taking to help ensure that family members can safely visit relatives in care homes during the covid-19 outbreak.

[The Minister for Care (Helen Whately)]

Visits from loved ones are what makes life worth living for many care home residents, yet, sadly, these have been too few over the last few months. Unlike the first lockdown, during this period of national restrictions, we want visits to be able to continue. That is why we published new guidance on 5 November advising care homes of the steps that they can take to allow safe visiting while there are high rates of covid in the community. Yesterday, we launched our visitor testing trial and plan to offer visitor testing to care homes across the country by Christmas.

[Ellie Reeves [V]]

There are almost 2,000 people living with dementia in Lewisham and for those in residential care, a lack of social interaction through visits can cause their condition to deteriorate. Testing for family and friends is the way forward, but the Government’s pilot for this was launched only this week and just 20 care homes are included. With the festive period rapidly approaching, why was this not done months ago, and is it not just another example of the Government delivering too little, too late?

[Helen Whately]

We have been testing and have prioritised testing in care homes going back as far as May, and we have been carrying out whole care home testing. We are now testing over 500,000 staff and residents in care homes every week. Now, as testing capacity increases, we are launching the visitor testing trial with 20 care homes across Hampshire, Devon and Cornwall. We will use the lessons from that trial to roll out testing more widely across the country as fast as we possibly can.

[Liz Kendall (Leicester West) (Lab)]

I am afraid the Government’s pilot scheme simply fails to understand the scale or urgency of the task. The average time someone spends in a care home before they pass away is two years, so after eight months of not being able to visit, families do not have a moment to lose. If the Government believe that weekly tests make it safe for care home staff to go to work, why not just do the same for families? Will the Minister now agree that a proportion of the 157,000 tests that are currently spare capacity every day will be ring-fenced for family visits so that we can safely bring all families back together in time for Christmas?

[Helen Whately]

I absolutely want to enable relatives to go and visit their loved ones in care homes, but we have to remember that we are against a backdrop where covid is incredibly cruel to those living in care homes. We have seen outbreaks that have gone from one resident across to almost all residents within a few days, with staff also affected, so we have to get the balance right. We have to make sure that we do this in a way that is safe to residents and staff. That is why we are carrying out the trial to learn the lessons, so that we do it right and so we can then safely roll out testing and more visiting across the whole country.

[Mrs Heather Wheeler (South Derbyshire) (Con)]

What assessment his Department has made of the effectiveness of the whole city covid-19 testing pilot in Liverpool.

--- Later in debate ---

[Sir David Amess (Southend West) (Con)]

What steps his Department is taking to protect care home residents during the covid-19 outbreak.

[The Minister for Care (Helen Whately)]

Sadly, covid is cruel to care home residents, and outbreaks are hard to prevent and control, especially when covid rates are high in the surrounding community. As we set out in our winter plan for adult social care, we have a regime of regular testing for staff and residents, we are supplying personal protective equipment to care homes, we have been offering training in infection prevention and control, backed up by Care Quality Commission inspections, and we are providing £1.1 billion to social care specifically to go towards the cost of infection prevention and control.

[Sir David Amess]

I know that my hon. Friend has already touched on this subject, but she will be aware that since April, many people have not been able to visit relatives and loved ones in care homes, so will she please tell the House again what is being done to improve testing and to roll out the flu vaccine to ensure that these visits can resume safely after the latest lockdown?

[Helen Whately]

My hon. Friend is a great advocate for the care sector—for those who receive care and for the workforce—in Southend West. Yesterday we launched a trial of visitor testing, and we plan to offer this to care homes across the country during December. On his question about flu vaccinations, this year we are carrying out the biggest ever flu vaccination programme. So far, the majority of care home residents have been vaccinated, but there is further to go for care staff, and I urge any careworker who has yet to have their flu jab to ensure that they get it over the next few weeks.

[Suzanne Webb (Stourbridge) (Con)]

What steps his Department is taking to support the adult social care sector during the covid-19 outbreak.

[The Minister for Care (Helen Whately)]

Our winter plan sets out what we are doing to support adult social care during the second wave of the pandemic, including supplying free PPE to meet social care’s covid needs across domiciliary care, day care services and personal assistance as well as in care homes, and includes a further £546 million of funding for the infection control fund, bringing the total we have provided to social care for infection control to £1.1 billion.

[Suzanne Webb]

The new megalabs will open in 2021, one of which will be just down the road in Leamington Spa. This is very welcome news for the care sector in Stourbridge, which needs fast access to testing to carry out its amazing work, and let us not forget that these megalabs will bring thousands of jobs to the midlands. The UK is already No. 1 in Europe for testing capacity. With these new labs on stream, that capacity will double. Will my hon. Friend commit to prioritising the social care sector in this new capacity?

[Helen Whately]

The answer to my hon. Friend’s question is yes. Adult social care has already been at the front of the queue for testing. Care homes in Stourbridge and across the country have had whole care home testing since May. We have now sent out more than 13 million test kits to care homes. Every week we are testing more than half a million staff and residents, with nearly 90% of results back within 72 hours. I will continue to make sure that social care is a priority, going beyond care homes to include domiciliary care and supported living as we increase testing capacity.

Dementia: Covid-19

Helen Whately Excerpts

Thursday 12th November 2020 Westminster Hall

[The Minister for Care (Helen Whately)]

I thank the hon. Members for Oldham East and Saddleworth (Debbie Abrahams) and for Strangford (Jim Shannon) for securing this important debate. I commend the many personal and powerful contributions from hon. Members, but I pay particular tribute to the work of the hon. Member for Oldham East and Saddleworth, who is the co-chair of the all-party group on dementia, and to the charities that she and I both work with, such as the Alzheimer’s Society.

It has not been easy to listen to hon. Members’ stories today. They are painful to hear, let alone for those who have lived them. Hon. Members have brought great knowledge to the debate, from the clinical challenges of diagnosing covid in those with dementia to the understanding of what makes a difference for those living with dementia, from physical contact to music. Hon. Members have brought to the debate a real understanding of the burden borne by informal carers across our constituencies. If anyone needed reminding about how lives are being blighted by the cruel combination of covid and dementia, they have been reminded. Even before the pandemic, people with dementia were some of the most vulnerable in our society; they were usually older and living with other health conditions alongside this terrible progressive disease, for which we still have no cure. Dementia was already the No. 1 cause of death in this country and, tragically, more than 12,000 people with dementia have lost their lives to covid—people who still had life left to live.

Many of my conversations over the past few months have been about how much worse the pandemic has made life for people with dementia, their families and their carers. For instance, restrictions that are hard for us can make life almost impossible for them. People with dementia can find it really hard to follow instructions or the rules and guidance on social distancing and hand washing. Being made to stay at home means that they may lose the independence that they used to have, and which they might never get back. For those living in care homes, there is confusion about why their families no longer come to see them. Although the care staff are often wonderful, how can they know someone’s needs as well as their partner, son or daughter, who perhaps used to visit several times a week or even every day?

Equally heartbreaking has been the experience of families who have been unable to see the person they love for many weeks, knowing that that person might be confused and lonely, and then, tragically, finding out that their health has declined. For carers, it has been extra tough without the usual support and respite care. I thank families and carers for their incredible resilience and for what they have done, day in and day out, for the people who so need their love and care. There are more than 5.4 million informal carers in England, from children to older people who themselves might be in need of support. That is why, as we bear down on coronavirus, the Government are doing all they can to support those who are living with the consequences of this cruel disease. I will briefly set out some of those things now. As I do so, I will pick up on the questions that hon. Members have asked during the debate.

First, I will outline the overall support that we are providing, as set out in the adult social care winter plan, which specifically drew on the expertise of those who are involved in dementia care. It sets out the Government’s commitments and our expectations of local authorities, the NHS and care providers. It includes our commitments to PPE for social care, to testing and to an investment of more than £546 million, bringing our funding for infection control in social care to £1.1 billion.

The hon. Member for Oldham East and Saddleworth asked me about parity of PPE and testing between social care and the NHS. We are now providing PPE for social care to meet all its covid PPE needs. Like the NHS, social care is getting the PPE that it needs for covid. In addition, we are providing regular testing—weekly for care home staff and every 28 days for residents—and social care has been at the front of the queue. We have also learned from and adjusted some of the restrictions from the first lockdown to take account of the difficulties for those with dementia and their carers. The hon. Member for Bradford South (Judith Cummins) asked, on behalf of her constituent Tracy, if an adult caring for another adult can form a support bubble with another household. As she probably knows, an adult can form a support bubble with another household as long as that household is a single person. The restrictions allow somebody entry into the house of a person who requires care to give care, and to give the carer respite. I will take away the question of a larger bubble—I have been asked about it by other colleagues, and she and I have spoken about it—and whether I can do anything further to help on that.

The hon. Member for Leicester West (Liz Kendall) spoke about day services. I know how important they are, particularly for people with dementia and those who care for them. That is why I worked with the Social Care Institute for Excellence to provide guidance to services on how they can operate in a covid-secure way. I have said that the infection control fund can be used to help with extra costs for day services, and I have urged them to reopen in a covid-secure way. I have also been working with the Local Government Association and the Association of Directors of Adult Social Services to find out about the provision of day services—how much provision is there, where are the gaps and what more can be done to increase it?

Many hon. Members spoke about visiting in care homes. I want people to be able safely to visit their loved ones in care homes, but this is hard. Covid has taken the lives of 15,400 people living in care homes, and we know that when covid gets into a care home, particularly one that is looking after people with dementia, it is hard to control. Anyone can bring it in, particularly since many people have covid without any symptoms, so they do not know they have it. That is why we have advised care homes to restrict visiting, particularly during this national lockdown when covid rates are high in much of the country; in some areas, as many as one in four people have covid.

I did not want care homes to be closed up again during this lockdown, as they were in the first time around. We are advising care homes to do things that many have already put in place, such as allowing visits through screens and windows, but I know that that is not the answer, particularly for those with advanced dementia. That is why we are launching our trial of visitor testing on 16 November in 30 care homes. We are trialling both PCR and lateral flow tests to find the best way of doing this, with the intention of rolling out testing for visitors across the country as fast we can in December. I want people to be able to touch, hold hands and hug again. I cannot say when that will be possible, but, believe me, I want to make it possible again.

I turn briefly to access to diagnosis. At the start of the pandemic, many memory assessment services were closed and dementia diagnosis rates fell below our national ambition for the first time in four years. While we have supported remote or virtual memory assessment services, I recognise their shortcomings. I want to see in-person services fully functional as soon as possible, because a diagnosis can make such a difference so that people can access the treatment and support they need. I know the hon. Member for Leicester West, who raised this point, will understand.

I want briefly to mention the important role of charities such as the Alzheimer’s Society and the Race Equality Foundation, which are doing particular work to support black, Asian and minority ethnic people with dementia. We have supported those charities with extra funding, but I know they have gone above and beyond in their work during this pandemic.

I conclude by saying that as we navigate these challenging times, we must never lose sight of what is important. Our efforts must not just be to save lives, but also to make life worth living for everyone—thinking hardest and trying hardest for those who live with the greatest of challenges. That means doing our utmost for those with dementia and their families.

Family Visits in Health and Social Care Settings: Covid-19

Helen Whately Excerpts

Wednesday 11th November 2020 Westminster Hall

[The Minister for Care (Helen Whately)]

It is a pleasure to serve under your chairmanship, Ms McVey. I congratulate and sincerely thank my hon. Friend the Member for Beaconsfield (Joy Morrissey) for securing this debate. My thanks also go to all those who have come here today and made such powerful speeches, talking about the really difficult situation of visiting restrictions in care homes. My hon. Friend spoke extremely powerfully on behalf of Jamie, acting as his advocate in this tragic situation. I thank her for discussing this with me in advance of the debate; I am looking into that case.

As many hon. Members have said this afternoon, and as Minister for Care I strongly agree, visiting is incredibly important for those living in care homes. It is hard to put into words how paramount, how crucial, contact with their loved ones is for residents in care homes, but let me offer three reasons. First, for the individual in residential care, it can be what makes life worth living. The chance to see a loved one—a husband, wife, son, daughter, grandchildren or oldest friend—these visits are things to look forward to.

Secondly, visits to see their loved ones are important for family members. I have recently heard about a couple, both in their 90s; the wife is living in a care home and her husband always used to go to see her, but he has not been able to do so for months. This is actually affecting him more than it is his wife, who sadly has much less awareness of the situation due to her advanced dementia. It is affecting him because he is not able to see her. So the visits are important for the family who want to visit as well.

The third reason is the role that families and visitors play in making sure their loved one living in the care home is safe and well—the role they play in their care, in fact. Hon. Members have spoken today about the problem of residents, especially those with dementia, who are deteriorating without the visits they are used to. The advocacy role is also important, as my hon. Friend mentioned.

To step back a moment, the Government’s overall aim is to keep people in care homes safe and well—as safe and well as possible in the extremely difficult circumstances of a pandemic of a virus that is so cruel in in how it affects the old and most vulnerable. As the hon. Member for North Ayrshire and Arran (Patricia Gibson) said, it is an incredibly hard balance to strike, and I appreciate the way she spoke about that. On the one hand we want to enable visits to care homes, to enable people to have the things that make life worth living, but on the other hand, we know that when covid has got into care homes, when there have been outbreaks, it has been extremely hard for care homes to control it. That we have seen so many deaths of people in care homes is tragic. The hon. Lady is absolutely right; it is a cause of sleepless nights for me and others who are trying to make the right decisions.

In my remarks, I intend to speak first about what has happened, then say where we are now, and finally look ahead. I will do my best to pick up some of the questions and comments from colleagues.

When the pandemic hit us, it is true to say that visits were stopped, other than in exceptional circumstances such as end of life. The problem was so bad and there seemed to be such a risk for care homes that visits were stopped. During that period, I spoke to care workers who really went the extra mile to support care home residents through that time—to try to make their lives still worth living and to have positive moments, and to use technology to keep people in touch.

I am not naïve—I know that having a screen is not the answer to the problem of visiting, but for some people in some circumstances it has enabled more contact between those living in residential care and their families. It certainly does not work for everybody. It is not the whole answer.

That is one reason why, as covid rates came down during the summer, new guidance was published on 22 July to encourage the opening up of care homes and to enable more visiting. It supported local discretion; the director of public health and the local authority would work with care homes to agree a reasonable level of safe visiting, using PPE and social distancing and so on. I was very keen to see care homes opening again. Many people did have the chance to see their family members in care homes during that period. Unfortunately, not every care home managed to open its doors at that point and, as the hon. Member for Halifax (Holly Lynch) mentioned, those in tier 2 or tier 3 high-risk areas still maintained strict restrictions on visiting.

As the hon. Member for York Central (Rachael Maskell) mentioned, there is a real problem of closed environments. One of the things that visitors do is raise a concern if there is a situation in a care home. She and I have spoken about an issue in her constituency a while ago, which was of great concern. That is why, when we went into the current lockdown, I was determined that we should not return to the situation of the first lockdown, where care homes were closed. I was determined that we should continue what visiting we could safely allow, and continue to have the Care Quality Commission crossing the threshold of care homes to identify and investigate where concerns had been raised. That is why the current visiting guidance is to encourage care homes to enable covid-secure visits, using screens, windows, visiting pods and so on.

Some care homes have been incredibly creative and innovative. My hon. Friend the Member for Warrington South (Andy Carter) had a great example of a care home in his constituency. The guidance draws on methods that we have seen care homes using over the last few months, with the aim of getting others to follow suit. It is supported by being able to draw on the infection control fund. We have put £1.1 billion into funding to support care homes with the extra costs of providing covid-secure care.

I absolutely hear the message. This is not where we want to be. I want people to be able to hold hands again, hug again and have the physical contact we all need, which is particularly important for those with dementia and those for whom this whole situation is confusing or frightening. We know it has been bad for their health and wellbeing. Right now, however, to allow such contact goes strongly against the clinical advice I have received.

I have been advised that every single additional person going into a care home takes with them the risk of taking covid into that setting. In some parts of the country, one in 40 people have covid. If there is a care home with 40 beds and each person has a visitor, one of those visitors may well be carrying covid into that care home, unbeknownst to them, because they may well have no symptoms. When it gets in, it can be extremely hard to control. That is why we have taken a cautious approach, but I absolutely want to open up care homes to allow for the kind of visiting that people want. I am looking ahead.

Hon. Members have asked about testing, which will be so helpful in reducing the risk that someone going into a care home is taking covid with them. We have a huge testing programme in place in care homes for staff and residents. Staff are tested weekly, and the vast majority of staff are now undergoing that. That is really valuable in catching covid outbreaks early. Residents are tested every 28 days, and the next step is testing for visitors. A trial will be launched this month in four local authorities in areas of lower prevalence, where the risk is lower. That will launch on 16 November in a range of 30 different care homes both to assess the practicalities of testing and to make sure that we are confident in its safety. That will trial both the polymerase chain reaction—PCR—test that has been used for some time and the newly introduced lateral flow test that can be turned around quickly.

Trialling both will enable us to see which is the best to enable visiting, and we then plan to roll that out more widely across the country in December to see how many visits testing will enable. I am optimistic that that, combined with the lower covid rates that our national self-discipline during the lockdown should achieve, will make it much more feasible to enable more testing. Looking ahead, the prospect of a vaccine that may be effective against covid, alongside testing and a supply of PPE, should put us in a much better position to achieve the level of visiting that we all want.

[Dan Carden]

Mass testing is taking place in Liverpool and many people are hopeful that that will allow for more visits to care homes in the weeks ahead. Will the Minister comment on what talks she has had with Liverpool about that?

[Helen Whately]

I am happy to do that, because I have been looking into that issue as well. The guidance I have been given is that Public Health England and those running the trial want it to take place first in the 30 care homes, which I mentioned. That will enable us to have confidence that those who have had a lateral flow test will be able to visit. There is sequencing to be done, but the issue is at the top of my mind. Lateral flows tests are already being used, and we should make the most of that to enable visiting. I hope to be able to put that more formally in writing in due course.

In the time available, I wish to pick up on a few of the other points that were made in the debate. The hon. Member for St Albans (Daisy Cooper) referred to the 30-minute time limit. I believe that that must be something that the care home in question has chosen to put in place. Our guidance advises that one should book a visit with a care home, but does not stipulate a 30-minute limit.

My hon. Friend the Member for Bexhill and Battle (Huw Merriman) set out an excellent list of things for me to take forward. Many of them are indeed in train, such as testing and work on the vaccine. The Joint Committee on Vaccination and Immunisation has proposed that care home staff and residents should be at the top of the list for that. He mentioned a reporting mechanism, which I am also taking forward.

The hon. Member for Liverpool, Walton (Dan Carden) referred to the lottery of visits. On the one hand, we responded to local authorities and care homes when they asked for more discretion and a local say in how we respond to the pandemic; on the other, we can find that in one area there is far more access than in another, so we need to combine allowing local discretion with being able to investigate whether somewhere is not being so supportive of visits. We need to ask what is going on and how can we bring this about.

My hon. Friend the Member for Beaconsfield focused on the situation of those of working age living in a residential care home. As she said, they have been talked about less during the pandemic than those of an older age, but the people of working age living in residential care are absolutely at the top my mind. As we have seen during the pandemic, those with learning disabilities might be at greater risk if they catch covid, and, like those of an older age with dementia, they need family visits and the support, love and advocacy of a family member.

As my hon. Friend also said, the pandemic has shone a light on some of the problems that existed in our social care system before the pandemic. Yes, the pandemic has been hard for social care, but there were problems before. Although the vast majority of care homes have provided wonderful supportive care—indeed, loving care—for those who live in their buildings, some have sadly let down those they care for. We must continue to identify, intervene and prevent cases where there is neglect or, worse, the abuse of those living in residential care.

We are in the thick of a pandemic that has made life so hard for those living and working in the social care sector. We have to step forward, get on the front foot and really achieve the social care reform that everyone has been crying out for, for so long. This is an, “If not now, when?” moment. We will seize this moment not only to support social care through the pandemic, but to bring about a system of social care where we can hold our heads up high and be happy for the care of our loved ones, our friends and family, or indeed for ourselves, should the time come when we need it.

Down Syndrome Awareness Month

Helen Whately Excerpts

Thursday 22nd October 2020 Commons Chamber

[The Minister for Care (Helen Whately)]

I would like to thank the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) for securing this debate on this important topic, and also for her work as chair of the all-party parliamentary disability group. Thanks to her, we are marking Down Syndrome Awareness Month here in the House with this debate today, and I am truly pleased that we have this opportunity to celebrate the brilliant contribution that people with Down’s syndrome make to our society, and also all the work of the many people and organisations who support those with Down’s syndrome to live their lives to the full.

Today, the hon. Member has outlined some fantastic stories about the achievements of people with Down’s syndrome, and also their hopes and dreams. I would like to share Michael’s story with the House. Michael has Down’s syndrome, a visual impairment and the muscle condition hypotonia. Despite his family being warned by doctors that he would probably need a wheelchair for the whole of his life, Michael has represented Wales and Great Britain in the Special Olympics and he has won more than 60 medals, which is an incredible achievement. He has not let the pandemic stop his plans. Earlier this month, he ran his first marathon in support of Mencap. He ran through rain, wind and mud to complete the virtual route around his local area in Wales. I want to take this opportunity to extend my congratulations to Michael on such an outstanding achievement.

While Michael’s achievements stand out as an inspiration to us all, I also want to celebrate the everyday achievements and contributions that people with Down’s syndrome make to their families and our communities, and the contribution they make to employment through participation and through love, friendship and laughter, enriching all our lives. That said, people with Down’s syndrome still face too many challenges and barriers. I want to see a society that works for everyone, where everyone can participate fully, feel included and be free to be themselves, so I want to talk briefly about some of the work we are doing to ensure that disabled people, including those with Down’s syndrome, are enabled to live full and rewarding lives.

First, in education, our ambition is for every child, no matter what challenges they face, to have access to a world-class education that sets them up for life, and that absolutely includes children and young people with Down’s syndrome. Supporting children, young people and adults with special educational needs is a particular need for us at this time, and our aim, even during the pandemic, is that education, health and care continue as far as possible, so that children and young people with SEND get the provision and support they need to fulfil their potential and achieve their ambitions.

The hon. Member spoke about work and employment in her excellent speech. We want everybody to have the opportunity to participate in meaningful and rewarding work and to gain the life skills and rewards that come from doing that. I am sure she knows from her work on the APPG that the Government have several programmes in place to support disabled people. An example is the Access to Work grant, which enables employers to buy personalised and tailored support to help disabled people to move into and retain employment. I should also say that, during the pandemic, Access to Work has particularly strengthened its support by making greater use of assistive technology and supporting the transport of assistive technology from workplaces to homes to enable more disabled people to work from home.

There is also the intensive personalised employment support programme, which helps disabled people with complex needs who want to work but require specialist support to do so, and the Disability Confident scheme, which supports employers to have the confidence to recruit and retain disabled people. However, I will take away the hon. Member’s question about what specific support is available through the kickstart scheme for people with disabilities, and also her point about particular schemes for those with disabilities to start their own businesses.

I also want to talk about health inequalities. We had a brief exchange about the improved life expectancy for people with disabilities, particularly those with Down’s syndrome, but despite the increase in life expectancy, there are still health inequalities facing those with Down’s syndrome and also those with learning disabilities. For instance, they are more likely to experience premature mortality. The recent Learning Disability Mortality Review report stated that the life expectancy gap for those with learning disabilities is 22 years for men and 27 years for women. That is absolutely not right.

[Bob Stewart]

When I was born in 1949, the life expectancy of someone with Down’s syndrome was 12 years. The life expectancy now, we hope, is somewhere in the 60s or 70s. I am sure the Minister will agree that we have to find a way to employ these people properly, and not just because, as some people would say, they are disabled; in my view, they are not.

[Helen Whately]

I completely agree with my hon. Friend. I do know that those with Down’s syndrome are in employment, but let us continue to support that as one of the rewarding things for everybody to experience in life. As he said, life expectancy has indeed improved enormously, but I am ambitious and determined that we go further and make sure that we reduce health inequalities for people with disabilities.

[Rachael Maskell]

I appreciate that this is a really sensitive topic, but we know that coming into the world is a real challenge for somebody with Down’s syndrome. Will the Minister go away and look again at the conversations that are had with parents who are diagnosed in pregnancy with somebody with Down’s syndrome and see how we can change that conversation, so that people can understand the positivity of bringing up a child and raising someone into adulthood with Down’s syndrome?

[Helen Whately]

The hon. Member makes a really important point. It is clearly a very difficult and sensitive topic, but it is absolutely the case that if, during pregnancy, any abnormality is detected or suspected there should at no stage be any bias towards abortion, which is what, as I understand it, she is referring to. I want to make that absolutely clear. It must be the case that all health and care staff involved in the care of a woman or a couple who might be considering the termination of a pregnancy must adopt a non-directive, non-judgmental and supportive approach. That absolutely should be the case throughout our health system. Should anyone experience anything different and find that that is not the case, they should raise it, because women and couples should be supported in a positive way so that they can make the right choice for them. I am choosing my words carefully given that this is a very sensitive topic.

While I have the opportunity, I want to talk briefly about the importance of the Oliver McGowan mandatory training in learning disability and autism, which the Government have committed to rolling out to make sure that all health and social care staff receive training in learning disabilities and autism. That is really important to make sure that people with those conditions get the right and appropriate care when they are in the health and care system, including, I should say, for end-of-life care, making sure that do not attempt CPR—cardiopulmonary resuscitation—orders are used appropriately.

In the light of the pandemic, one thing that has been raised with me, particularly for those who are caring for those with disabilities, is the importance of day services and respite services. I have been working really hard, including with the Social Care Institute for Excellence, on guidance to support the reopening of day services and to encourage local authorities to make sure that those are reopened.

To conclude before we are out of time, I am so glad that we have had this debate and been able to talk about the contribution that those with Down’s syndrome make to our society, and, to use a phrase from the excellent speech by the hon. Member for East Kilbride, Strathaven and Lesmahagow, to have made our contribution to changing the narrative. It is crucial that we should celebrate the achievements and contributions of those with Down’s syndrome to our society, so we have been and are taking action to support those with disabilities, including Down’s syndrome, but I believe that we can always do more and go further. So I say, let’s do that. Let’s do more and go further to support people with Down’s syndrome to achieve their dreams.

Question put and agreed to.

Joint Committee on Human Rights Reports: Detention of Young People with Learning Disabilities and/or or Autism, Human Rights and Implications of Government Covid-19 Response

Helen Whately Excerpts

Thursday 22nd October 2020 Written Statements

[The Minister for Care (Helen Whately)]

Today we have published the Government’s formal response to the recommendations made by the Joint Committee on Human Rights in its report “The detention of young people with learning disabilities and/or autism” published on 1 November 2019 and those made in its report “Human Rights and the Government’s response to covid-19: The detention of young people who are autistic and/or have learning disabilities” published on 12 June 2020. A copy of the response will be deposited in the Libraries of both Houses.

We welcome the Joint Committee on Human Rights’ (JCHR) reports and their recommendations. Protecting the rights of people with a learning disability and of autistic people is a matter of the utmost importance to the Government. Rights must be upheld regardless of wider circumstances, no matter how unprecedented. This is especially so for those who may be at a particularly vulnerable time in their lives, in crisis or receiving treatment in specialist mental health inpatient settings. The Government’s manifesto committed to improve how people with a learning disability/and or autistic people are treated in law and to make it easier for them to be discharged from hospital in recognition of some of the challenges faced by this group of people.

The JCHR made recommendations for Government and their system partners to improve the care and support of people with a learning disability and/or autism which was not found to always meet the high standard we would expect for each and every individual.

We have carefully considered these recommendations and are accepting in full or in principle the vast majority, including:

The JCHR have specifically recommended that a legal duty is introduced on local authorities and clinical commissioning groups to ensure the availability of sufficient community-based services. We have accepted this recommendation in principle and plan to consult on new duties to ensure an adequate supply of community services for people with learning disabilities and autistic people.

In response to the recommendation that families should not be prevented from speaking out about poor care, we will introduce guidance on the use of injunctions to stop the inappropriate use of injunctions and ensure that families are able to speak out, driving up the standard of care for people with a learning disability and/or autism.

This guidance will require health bodies to notify the Secretary of State for Health and Social Care of their intention to seek an injunction. This will enable us to monitor these instances and take further action such as following up with the body in question to seek additional information on the grounds seeking the injunction if required.

We propose to take forward a number of recommendations made by the JCHR through reform of the Mental Health Act and more detail will be provided in a Mental Health Act White Paper in due course. Reforming the Mental Health Act will help to ensure that when someone is admitted to hospital, the care they receive is therapeutic and beneficial and will have a positive impact for people with a learning disability and/or autistic people who are admitted for assessment or treatment. The White Paper will provide an opportunity to consult on changes as recommended by the JCHR including:

Placing care, education and treatment reviews (CETR) on a statutory footing. This would help to ensure that the CETR process is more robust and that there is greater involvement, where appropriate, of families. This should ensure that the process for resolving problems that keep people in hospital for longer than they should is improved along with improving current and future care planning, including plans for leaving hospital.

Reforming the detention criteria and the detention process should reduce inequalities by making sure inpatient care for people with a learning disability or autistic people is only used when it offers clear benefits. For those who need inpatient care, having a say in the care they receive and requiring care to be therapeutic should ensure that people with a learning disability or autism are treated with the same dignity and respect that we would all expect.

Enforcing and enhancing the rights of individuals and families to advocacy will be addressed, including through recommendations on improving access to independent mental health advocates, which would expect to have a positive impact in supporting individuals with learning disabilities and autistic people and their families.

The action we are taking in responding to these recommendations will help to ensure that people with a learning disability and autistic people are supported to live fulfilling lives in the community and that if they are admitted to hospital, the care they receive is both therapeutic and beneficial. The steps we are taking will also ensure that where appropriate family members will have a greater input into the care and support their loved ones receive. We must remain committed to delivering on our existing plans and on the new steps set out in this response.

[HCWS530]

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

Helen Whately Excerpts

Monday 19th October 2020 General Committees

[The Minister for Care (Helen Whately)]

I beg to move,

That the Committee has considered the Health Protection (Coronavirus, Restrictions) (Self-isolation) (England) Regulations 2020 (S.I. 2020, No. 1045).

[The Chair]

With this it will be convenient to discuss 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]

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.

[Catherine McKinnell (Newcastle upon Tyne North) (Lab)]

I am aware of situations where employees are very afraid of losing their job if they have to self-isolate. They are not necessarily able to access any sick pay or Government support. What messaging are the Government putting out to employers to make sure that they understand their obligations towards their employees? What can an employee do where they fear that they will lose their job if they do the right thing and self-isolate?

[Helen Whately]

The hon. Lady makes an important point about the role of employers as well as that of employees. Communications have been going out to make sure that people are aware of the importance of self-isolating. I may be able to offer something more specific about the communications to employers when I respond to the debate. There is financial support now in place because we found out from research that the financial impact of self-isolation was one reason that some people failed to do so.

[Matt Western (Warwick and Leamington) (Lab)]

I raised in Department for Work and Pensions Question Time just now my concern, which I am sure is shared by many Members, about schools that are forced to close at incredibly short notice. One large school in my constituency announced at 3 o’clock yesterday afternoon that it would be closed from 8.30 this morning. That means that many parents will have to stay at home and stay away from work. That impacts particularly heavily on mothers, sadly. They will not be entitled, currently, to the self-isolation payment. Is that something that the Minister is looking at or will support?

[Helen Whately]

I know that that point has been raised throughout the pandemic, and there will be reasons why parents, for example, will have extra childcare responsibilities. We had that challenge during the full lockdown, when schools were closed other than for the children of key workers, and we know that employers did everything they could to be understanding and support their employees. I will take away the hon. Gentleman’s question about whether anything further can be done.

To set out the rationale behind the regulations we are discussing, the headline point is their importance in our overall strategy to combat covid-19. Clearly, the number of people testing positive has risen sharply and, indeed, is still increasing. That is not only among younger people; worryingly, we are seeing increasing rates among the over-60s, particularly in parts of the country that have higher rates overall. Hand in hand with the increasing number of cases, we are seeing a higher percentage of people testing positive and increasing rates of hospital admission, again particularly in areas where the case rates are highest.

Against that backdrop of increasing rates, we heard that, unfortunately, compliance with the restrictions has not been what it should be. To answer the question from my right hon. Friend the Member for Forest of Dean, general population surveys conducted between March and August showed that self-reported self-isolation compliance was relatively low. For instance, only around 20% of the population reported that they fully complied with self-isolation if they had symptoms or were identified as a contact. That is evidence of the challenge with self-isolation compliance at that time.

[Catherine McKinnell]

The Minister will recognise that there is a difficult balance to strike between encouraging compliance and discouraging engagement with the system —not being tested and not reporting symptoms in order to avoid the consequences of not being able to self-isolate. Have the Government analysed the potentially worrying consequence that increasing the penalties may disincentivise doing the right thing from a health perspective?

[Helen Whately]

The hon. Lady makes a really important point. We would not want to disincentivise anyone from coming forward to get tested or sharing their contacts, because that is such an important part of controlling this virus. On the other hand, if the data shows that compliance is low, which it does, then what actions can we take? First, we ensure that people really know what action they should be taking—that they should get tested, share their contacts and ensure that their contacts know that they should be isolating. Secondly, we provide people with more support to enable them to isolate. Thirdly, we make self-isolation a legal requirement, which communicates both the seriousness of isolating and the fact that if someone does not self-isolate when they test positive or are a contact, they could be putting other people’s lives at risk. Ultimately, if something is serious, there is a penalty associated with it. Those three things need to go together, particularly the understanding of the importance of taking the responsible course of action and self-isolating if necessary.

By making self-isolation a legal duty enforced through penalties for non-compliance, our aim is to ensure that people who have tested positive for covid-19 and those who have been directly exposed to the virus recognise the importance of self-isolating in order to reduce transmission and actually do isolate. SAGE has advised that ensuring infected individuals and their close contacts isolate is one of our most powerful tools for controlling the spread of the virus, so now is the time to introduce this measure and to combat the rising incidence.

The regulations were introduced using emergency powers so that we could respond quickly to the increasing threat to public health posed by covid-19. The urgency in this case arises from the increasing rate of diagnosed positive cases at the time of making the measures. The self-isolation SI came into force on 28 September 2020. It will be reviewed before the end of the six-month period and will expire 12 months after coming fully into force. The Secretary of State for Health and Social Care keeps their necessity under consideration between the formal review points, too.

The regulations demonstrate our willingness to take action where we need to. That said, we are committed to ensure that the measures are only in place for as long as necessary. I therefore commend the regulations to the Committee.

--- Later in debate ---

[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]

Will my hon. Friend give way?

[Helen Whately]

I can, but I have only five minutes left.

[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.)