Motion made, and Question put forthwith (
That, at this day’s sitting, Standing Order 41A (Deferred divisions) shall not apply to (a) the Motion in the name of Secretary Sajid Javid relating to the National Health Service and (b) the Motion in the name of Secretary Priti Patel relating to the Prevention and Suppression of Terrorism.—(Rebecca Harris.)
Question agreed to.
Main Question again proposed.
So there is a duty of care, and duty of care is a running theme. Currently, there is no law to say that vaccines are mandatory, so make no mistake: this is a departure from the legal precedent. However, it is not nearly as big or as wide a departure as the public or indeed this House may be led to believe, as, in essence, practically this precedent already exists in the NHS with the likes of TB.
Let us take the example of a medical student or a dental student. When a student joins a medical school, they have to have a TB check, an HIV check, a hepatitis C check and treatment to practise. While it is not a legal requirement, operationally it means that someone cannot do procedures, cannot do hospital placements and, in dentistry particularly, cannot progress. Why? A duty of care.
I do not recall a huge outburst about such concerns when the 2007 Department of Health clearance guidance entitled “Health clearance for tuberculosis, hepatitis B, hepatitis C and HIV”, which was revised in April 2014, was widespread. Why? Because when people enter these professions, the overriding principle hammered in time and again is that there is a duty of care to patients, and medical schools and providers have a duty of care for their students.
Of course my hon. Friend is an expert in these matters, but he has conceded that, in the cases he has referred to, that is not a legal requirement but a matter of health and safety. Why is it that in this case, he wishes to cross the Rubicon and mandate that someone may not be in a care home—apart from the conditions—unless they are vaccinated? Why does he want to put it in law in these circumstances?
My hon. Friend has pre-empted the rest of my speech, in which I will hopefully try to address some of that. It is about recognising the parity between professions. We heard Dr Allin-Khan talk about the professional recognition we need for social care. That is imperative. We have covered that in the Health and Social Care Committee, and our report is very clear that we need that parity of professional standards. We have heard time and again that people have gone above and beyond in their duty.
I am a realist on this, and I want the Government to draw people’s attention to the fact that there could be difficulties. It is going to cause a problem when there are 16 weeks’ consultation, and there could be an exacerbation of problems with the workforce. I also urge the Government to pick up on what other Members have said and encourage people to take up vaccination in the first place.
Fundamentally, however—perhaps this is what it comes down to for my hon. Friend Mr Baker—this comes down to a duty of care to the looked-after. I ask Members to imagine that it was their grandmother, grandfather, father or mother being cared for. I would expect Members to say that they wanted the best possible protections for that individual in the institution where they were resting.
Controversially, perhaps, I think that much of this statutory instrument is uncontroversial. The reason behind that is my own experience of being recruited to go through medical school. As part of the recruitment process, it was made very clear to me that I had to have hep B testing and I had to be vaccinated for hep B, and that going through and getting involved in becoming a medical student just would not happen if that was not the case. I think that is fair enough.
We expect our health staff to have vaccinations for a variety of conditions—not just hepatitis B but things such as chickenpox for people who have not been exposed, and rubella—because we know the impact that those things can have on the patients we look after or the people we care for. We know the huge impact covid has on the most vulnerable in our society. Its lethality—its severity—is linked to frailty, and one of the most frail groups are people living in care. It is important that people are vaccinated so that, when they have asymptomatic covid, they do not unintentionally pass it on. We know that vaccination rates are not high enough to give the protection necessary to protect people in care homes, and on that basis it is an entirely reasonable and sensible approach to bring forward measures saying that people have to be vaccinated to work in that setting. However, although that might be a reasonable approach I realise that it is different from my personal experience as I have just described, because that was a pre-recruitment process that I went through, whereas what we are talking about now is a process for people who are currently in post—people who might have been working for quite some time and have a lot of years behind them—and if they do not go through with vaccination, ultimately they will be without a job. That is a big deal. It is also important to recognise that those who may decide that they do not want to be vaccinated are not evil people who should be shunned; they are people who make decisions for whatever reason about vaccination, and that is important and should be respected.
Fundamentally, this SI is about risk, and I see two risks here. One is the risk of covid to people living in care settings, and that risk is very clear: there is loads of data on that—loads of data on the impact and on fatalities, and also on the protection provided by vaccination for people at risk of covid and protection in terms of reducing transmission. So, that side of the equation is very clear, but the side that is less clear is the risk in terms of staffing, and that is a critical issue. Some people will decide that not being vaccinated is more important to them than working in the care sector. I am completely unclear as to how many people will make that decision and I do not think anyone knows what that population is going to be—what the numbers are going to look like. That is a concern as we already have staffing issues in the care sector and it has been a long-term problem.
Nevertheless, perhaps the only way to test this out is to bring it forward and see what happens. The 16-week run-in makes a lot of sense, but it is critical that it is monitored to see what happens with regard to staffing and retention, and if that is a big issue—if retention pressures start coming through—we will have to change course. When my hon. Friend the Minister sums up I would welcome her saying what she will do over the summer as this is being brought in to work with and engage with people in the social care sector on its impact. If there is a substantial impact, I hope that she will undertake to come back to the House after the summer recess with plans to mitigate this or change course.
It is a pleasure to follow my hon. Friend Dr Spencer, and indeed the speaker before him, my hon. Friend Dr Evans. They are two learned medical practitioners who, with the underlying qualities that seem to attract to those positions, state their arguments in the finest tradition of the empirical method. As ever, I hope I can be forgiven for not being quite as rational as those two speakers.
I hope, too, that the House will indulge me because, frankly, I am in despair. We could perhaps have a painting next to me of Munch’s “The Scream” to get a sense of how I feel about the conduct of Government business in this House. The Government are treating this House with utter contempt: 90 minutes on a statutory instrument to fundamentally change the balance of human rights in this country is nothing short of a disgrace. It is a disgrace, too, that no impact assessment exists. I contend that it does not exist, and if that is proven to be the case I am afraid my hon. Friend the Minister will be in a tricky position if she contends it does when it does not.
The measures before us are in themselves entirely impractical. We have heard already about concerns about the workforce. I have the utmost respect for my hon. Friend the Member for Runnymede and Weybridge, as he knows, but if we were to follow his suggestion, I fear that it would be far too late to repair the damage done to the workforce of carers in this country.
It is an insult to care workers in this country that all they merit is 90 minutes on a motion that nobody here seemed to know anything about last week but which we are discussing this afternoon. Meanwhile, so many of our colleagues, presumably because of the proxy vote system and the fact that they find it generally inconvenient to be a Member of Parliament, will know nothing at all about the measures on which they are voting, and that too should concern us a great deal. I will vote against these measures, if that had not been made clear from my remarks so far.
I believe that 1898 was last time vaccination was mandated in this country, and following that mandate, the rates of vaccination fell. That should tell us all we need to know. We will give succour to lunatics and crackpots who advance ridiculous theories about vaccination if we mandate vaccination. The triumph of the vaccination programme has been the act of kindness that people have felt towards their fellow citizens in doing so, and we will lose that good will if we mandate it.
A lady called me a week or so ago, and she was in tears on the phone. She has a condition that involves blood clots, and she associated the news about one or two of the vaccines with her condition. She is a care worker, and she was distraught. She now equates her illness and the vaccination—and the fact that she cannot get a GP appointment to discuss it, but that is a different matter—with losing her job. Is that what we are prepared to do to our fellow citizens as a Conservative Government? Absolute lunacy! We would expect this in a communist country, which partly explains why so many of our eastern European fellow citizens have the scepticism they do, knowing the nature of the state and how it can be perceived as being malevolent.
This instrument is an abomination. It should be withdrawn, and the Government should stop treating this House with contempt.
I thank hon. Members for their contributions and the questions they have put to me during this debate. I welcome the consensus on the importance of protecting care home residents. This debate is about how best we do that and the level of evidence needed in order for us to take the steps to best protect those vulnerable residents. The problem we face is that the clock is ticking towards winter, and to a potential combination of covid and flu to which we know care home residents will be extremely vulnerable. The problem with inaction and waiting for more time is that inaction costs lives.
I have heard—I assure my hon. Friends on this—the strength of feeling about the impact assessment, and may I say that I apologise to my hon. Friends for the error, particularly in the explanatory notes to the regulations? I have done my utmost, as I did in my opening speech, to set out for hon. Members the situation with the impact assessment, and there is nothing further I can say on that now.
I do not know what other colleagues feel, but I find it offensive that, because we have expressed concerns about these regulations, it is somehow implied that we want to do away with or risk the lives of people in care homes. These regulations do not come into force for 16 weeks. There is ample time to take them away, review them, publish the impact assessment and get this House to make a decision, and protect people before the onset of winter. To suggest that Members want to do otherwise and that we are suggesting inaction that would put their lives at risk is offensive, and I urge the Minister to withdraw it.
No offence was meant on my part. The problem with what my right hon. Friend is suggesting is that, if there is a substantial delay—for instance, in the autumn—in bringing through this legislation, that leaves care workers who have not yet been vaccinated with very little time in which to get vaccinated, and that is why we are bringing this forward now.
I am sorry, but I am conscious of the time left.
Several hon. Members have argued that we should continue the current approach to increasing uptake and indeed do more. Of course, we will continue to support care workers to take up the vaccine, but, as flagged by my hon. Friend Steve Brine, the question is: how long do we give that? The vaccination of care home workers in England began in December last year, about eight months ago. We did take a similar approach to that in Scotland mentioned by Dr Whitford, where staff were vaccinated alongside residents in care homes. NHS teams went into care homes multiple times to offer the vaccination to staff. Indeed, we saw that that was effective and more staff took up the vaccination on subsequent visits. We also opened the national booking system to care home staff early on, before there was wider availability to everybody. We have worked with communities who have been particularly concerned and hesitant about vaccination. There have been materials in multiple languages. We have worked with faith groups. Local authorities have worked closely with care homes, alongside NHS vaccination teams, particularly care homes that have had lower vaccination rates. A huge amount has been done to raise the levels of uptake among care home staff.
We then have to ask ourselves the question: what more can we do? The No. 1 reason care home staff have given us for not yet being vaccinated is that they want some more time. Well, this gives them some more time through the summer in which to get vaccinated. Some care homes, as I have mentioned, are already doing this. One example is the Barchester care home group, which has over 16,000 staff. The vast majority, over 99%, have chosen to be vaccinated. Fewer than 0.5% have chosen not to be vaccinated. But the problem, if we leave it to care homes that are on the front foot to do this, is that others will be left behind and we will see inequality, where some residents are fortunate to be cared for in a care home where all the staff are vaccinated, and others will not be so safe. That leaves us with inequality for those care home residents, who will remain at greater risk. We know that the vaccination not only protects individuals, but reduces the risk of transmission.
Some hon. Members have raised the concern that care workers are being singled out in some way. That is not the case at all. This is about the setting of care homes, where we know there is the greatest risk and the greatest vulnerability to covid. This is about protecting individual residents in those care homes by requiring the vaccination of people who enter those care homes to work—so not only care home staff but NHS staff who enter care homes. This is about protecting residents in those care homes. Fortunately, at the moment, the rates are lower than they have been during peak times, but even in some of the recent outbreaks we have seen in care homes, the index case has been an unvaccinated staff member. That just emphasises the importance of us having high levels of vaccination among staff.
My hon. Friend Mark Jenkinson asked me about the data I referred to earlier, the SAGE data on minimum levels and the extent to which that is being achieved by care homes. I shared the most recent data that I have. What we do know is that there are still hundreds of care homes that have not yet met that safe threshold, which is a minimum threshold for avoiding outbreaks in care homes.
I say to my hon. Friends that the question before us is: what more can we do to protect those who are vulnerable in care homes? This is what we can do and I commend the regulations to the House.
The House divided: Ayes 319, Noes 246.
Question accordingly agreed to.
That the draft Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) Regulations 2021, which were laid before this House on
The list of Members currently certified as eligible for a proxy vote, and of the Members nominated as their proxy, is published at the end of today’s debates.
On a point of order, Mr Deputy Speaker. I was the Chairman of the Procedure Committee for seven years. It is absolutely incumbent on Government not to mislead the House and to behave honourably at all times. This explanatory memorandum is a parliamentary paper laid many days ago. This has been well rehearsed in this Chamber, but it needs to be rehearsed again. It clearly states:
“A full Impact Assessment has been prepared and will be submitted”— not is being prepared; “has been prepared”. Through your good offices, Mr Deputy Speaker, may I ask that Mr Speaker and the Clerk of the House conduct an investigation into this memorandum to ascertain whether the House has been misled by the Government and whether the Minister’s conduct at the Dispatch Box was good enough this afternoon?
I thank the hon. Gentleman for his point of order. As I said earlier, it is a totally unsatisfactory situation, irrespective of whether anybody has been misled by the statement in one of the official documents. Those on the Treasury Bench will have heard the point of order and will make absolutely certain that it gets through to the Department. I will, as the hon. Gentleman has asked, raise it with Mr Speaker at the prayer meeting tomorrow morning.
On a point of order, Mr Deputy Speaker. It always used to be the convention in this place that if a Minister was unable to answer all the questions raised in a debate, they would offer to write to hon. and right hon. Members whose questions had not been answered in the time available. Bearing in mind the cavalier way in which Ministers seem to be treating the conventions of the House, I wonder whether it is within your offices to be able to put pressure on the Government to restore that convention as a matter of courtesy.
I look particularly at my hon. Friend Sir Graham Brady, who had a pertinent question that could have been answered in two words. It was not answered and I am sure his constituents, on behalf of whom he speaks, will feel aggrieved about that. Why cannot this place restore some sense of reasonableness and good manners?
I thank the hon. Gentleman for his point of order. I have been a Member of Parliament for 29 years and many times, at the end of a debate, Ministers have said they cannot deal with each point that has been raised. We were under time pressure today, as has been pointed out by a number of Members, and therefore a number of questions have gone unanswered. Again, those on the Treasury Bench will have heard the point of order and will bring it to the attention of the Minister in order that she is able to answer the questions that went unanswered in her summing up.