Health and Social Care Update - Statement

– in the House of Lords at 2:04 pm on 22nd March 2021.

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The following Statement was made in the House of Commons on Thursday 18 March.

“With permission, Madam Deputy Speaker, I would like to make a Statement on the support that we are giving to the NHS and social care to help recover from the pandemic.

Before turning to that, I want to update the House on vaccine supply and the rollout, and set out the facts, given some of the speculation that we have seen overnight.

Let me set out the position absolutely straightforwardly. Throughout the vaccination programme, the pace of rollout has always been determined by the availability of supply. As I have said in the House many times, supply is the rate-limiting factor. The process of manufacturing vaccines is complicated and subject to unpredictability. Because we get supplies out into the field so fast, and run a highly lean delivery system, changes in future supply schedules impact on the weekly availability of vaccine. This has been true throughout. We make public commitments to the goals we can reach according to our best estimates of future supply. That supply goes up and down. We are currently, right now, in the middle of some bumper weeks of supply.

We have now reached the milestone of 25 million vaccinations, within the first 100 days of rollout, and we have therefore been able to open up invitations to all people aged 50 and above. Yesterday, for example, we delivered over half a million vaccines, and we will do so again today. In April, supply is tighter than it is this month, and we have a huge number of second doses to deliver. During April, around 12 million people, including many colleagues in this House, will receive their second dose. These second doses cannot be delayed, as they have to be delivered within 12 weeks of the first dose. In the last week, we have had a batch of 1.7 million doses delayed because of the need to re-test its stability. Events like this are to be expected in a manufacturing endeavour of this complexity, and this shows the rigour of our safety checks.

We also have a delay in a scheduled arrival from the Serum Institute of India. I want to put on the record my gratitude to the Serum Institute of India for the incredible work that it is doing producing vaccine, not just for us in the UK but for the whole world. Its technology and its capability, which has been approved by the Medicines and Healthcare products Regulatory Agency, is remarkable. The Serum Institute of India is producing a billion doses of the Oxford AstraZeneca vaccine this year. It truly is a partnership that we can be proud of. I also want to put on the record my thanks to both AstraZeneca and Pfizer, who have been remarkable partners in this historic endeavour.

We have committed to targets, it is vital to say, to offer the vaccine to everyone aged 50 and over by 15 April and to all adults by the end of July. I can confirm that we are on track to meet both those targets. I also want to clear up some rumours that have been circulating and give people reassurance. There will be no weeks in April with no first doses. There will be no cancelled appointments as a result of supply issues. Second doses will go ahead as planned.

Most importantly, the vaccine data published yesterday show the life-saving impact of this vaccine. It is not just that the vaccines are safe; it is that they make you safe. You are much safer having had one. Shortly, the MHRA will be saying more on this matter, which of course it keeps under constant review.

I know the House will also want to hear some good news from Gibraltar. Throughout the crisis, we have provided Gibraltar with personal protective equipment, testing and a sovereign guarantee for its Covid spending. We have also provided Gibraltar with vaccines, as we have all other British Overseas Territories. I am delighted to be able to tell the House that yesterday Gibraltar became the first nation in the world to complete its entire adult vaccination programme. I want to pay tribute to all Gibraltarians for their fortitude during this crisis, and the kind words of Chief Minister Fabian Picardo, who said yesterday:

‘The United Kingdom has played a blinder on vaccinations and we have been among the beneficiaries in the British family of nations.’

I agree.

The vaccination programme has been a success thanks to a team spirit across the British family of nations. It has not always been easy; of course there are challenges thrown at us in what is the biggest civilian undertaking in history, which affects every single one of us. The whole House pays tribute to those who have helped make it happen, including Emily Lawson, Kate Bingham, Maddy McTernan, Ruth Todd, Nikki Kanani, Professor Jonathan Van-Tam, Professor Chris Whitty, Sir Patrick Vallance, Wei Shen Lim, Sarah Gilbert, Andy Pollard, Pascal Soriot, my officials in the department, colleagues across the House, and so many others who have made this a success.

With 25 million people vaccinated and a clear road map out of lockdown, we are taking careful steps out of this pandemic. Now, there are 7,218 people in hospital with Covid across the UK, down from a peak of almost 40,000 just seven weeks ago, the rate of hospitalisations has halved in just the past 16 days and, thankfully, the rate at which people are dying has fallen by a third in the last week.

As a result, I can tell the House that we are, from today, writing to all clinically extremely vulnerable people to let them know that shielding will come to an end on 31 March. I thank all those who have shown such fortitude, and all those who have done so much to look after the most vulnerable. The shielding programme truly has been Britain at its best—pulling together to help those most in need.

I know that colleagues in the NHS and social care are beginning, cautiously, to look to the recovery ahead. I know that everyone in this House is proud of the life-saving work we have seen in hospitals across the country. Yet we also know that our battles against covid-19 have meant that there are things that we have not been able to do, such as routine treatments and operations. The challenges of Covid are still with us. We must continue to treat patients with the disease and bolster our vital mission of infection control, while also laying the groundwork for a recovery that gets us back to where we need to be.

We have backed the NHS at every point in this pandemic so that it can treat patients, stay safe and save lives, and I am delighted to inform the House that we are backing it again today with a further £6.6 billion of funding for the first half of this coming financial year. This money is in addition to the £3 billion committed at the spending review last November to help the NHS meet the additional costs of Covid while, critically, starting the work on the elective recovery ahead.

Due to the pandemic, the waiting list for elective treatment in January was almost 4.6 million, and 304,000 people are waiting more than a year for an operation or diagnostic. Before the pandemic, we had reduced the number of 52-week waits—people waiting more than a year—from 20,000 in 2010 to 1,600. We were in fact on track to get that number to zero before the pandemic hit. This backlog of elective work is an inevitable consequence of the pandemic, and I know that NHS colleagues are as determined as I am to put it right.

We are also putting £594 million towards safe hospital discharge. Over the last year, the NHS’s existing discharge programme freed up over 6,000 beds and, with them, the valuable time of 11,000 NHS staff. We can be grateful that we are seeing so many people leave hospital and that our discharge programme has shown the way forward, ensuring that people can get the very best of care outside of our hospitals, helping them off the wards and into the right settings, with the right support at the right time.

Our £500 million mental health recovery package will help tackle the challenges that the pandemic has wrought in access to mental health services. I can also confirm that we will be extending enhanced discharge arrangements for mental health patients, getting patients safely from hospital into healthy community settings, providing better care and freeing up thousands of beds.

The challenge of mental ill health is so important. We all need to keep looking out for each other and doing all we can to strengthen our mental health. Tackling mental ill health is a core objective of our NHS long-term plan, and this Government are committed to seeing mental health treated on a par with physical health and to delivering on the long-needed reforms that we have set out.

I am equally committed to supporting the vital work of our colleagues in adult social care. Last Monday, we reopened care homes to visitors, with a careful policy of a single regular visitor, who will be tested and wear PPE. I know how important this is, and I know that colleagues will be cheered by the stories we hear each day of more and more residents safely reunited with people they love. It means everything to them.

I can today announce a further £341 million to support adult social care with the costs of infection prevention, control and testing that will make sure that visits are safe for everyone. That takes the total infection control fund and testing support to more than £1.6 billion, alongside the free PPE that care homes receive.

The pandemic has tested our NHS and our social care system like never before. That they have risen to meet the challenges of the past year is down to the incredible dedication and hard work of colleagues—they have our thanks. We will deliver on our commitments. We will build 40 new hospitals. We will hire 50,000 more nurses. We will vaccinate this country ahead of almost all others. We will back our NHS and social care as we build back better for everyone. I commend this Statement to the House.”

Photo of Baroness Thornton Baroness Thornton Shadow Spokesperson (Health)

My Lords, I thank the Minister for the Statement from last Thursday. We heartily welcome the rollout of the vaccine and place on record huge gratitude to the scientists from everywhere, the NHS staff—all of them—the local government officials, the pharmacists and the volunteers who have worked so hard and seamlessly to produce such a successful outcome so far. I also take this opportunity to support the AstraZeneca vaccine. I am sure we were all very pleased with the news from the USA, which supports all the scientists in the UK and Europe, that the AZ vaccine is both effective and safe.

However, it was not great news to learn that this amazing vaccine effort will have to slow down due to supply problems, and, I have to say, that did come as a surprise. We have one of the worst death rates in the world and our economy has taken a massive hit. Many key workers under the age of 50—such as teachers and police officers—who through the nature of their work have not been at home, are going out and are more exposed to risk. I imagine that many had hoped that vaccination for them was not very far away. An update on the vaccine supply, particularly on the issues around discussions with the European Union, which seem to have become more fractious, would be appreciated.

But, specifically, what has happened to the Moderna vaccine? I understand that it will start in April. Is there any prospect that, if Moderna supplies come on stream, new appointments can be offered in light of that? Can the Minister assure the House about the second vaccine which many of us await? Will there be sufficient supply and will providing the millions of second jabs delay further the first vaccines for the 30 and 40 year-olds? It seems that the vaccination programme will need to ramp up to about 3.5 million doses a week from May to ensure that everyone under 50 is vaccinated by mid-July. Is the Minister confident that these supply issues will be fixed by May?

Adam Finn of the Joint Committee on Vaccination and Immunisation said that infection rates may rise as a result of the delays. Does the Minister anticipate that any of the stages or dates in the road map for easing out of lockdown will be pushed back, given that we are rightly judging the road map by data, not dates?

There are two other issues that we particularly need to address today. May I ask about the impact of the EU-AZ concern on vaccine hesitancy in the UK? It has been reported that there was a jump in no-shows and people questioning or refusing to go ahead with the AZ vaccine in the last week or so here in the UK.

Many poorer areas today still have the highest infection rates relative to elsewhere in the country, and at the same time their vaccination rates are below average. The worry is that places such as Oldham, Leicester or Hartlepool might be facing a double whammy: they still have high infection rates, but they are not getting the vaccination rates up to the levels needed. Not only will the disease continue to circulate there, with the risk of people catching it becoming severely ill, this also raises the question: will these towns and cities be left behind as the rest of the country eases out of lockdown? Some areas such as Leicester have endured the longest coronavirus restrictions of any part of England, remaining in lockdown since last summer. Closer to home here in London, I understand that in Enfield there are 16,000 people who do not have GPs and are in wards with high levels of poverty, high Covid rates and low vaccine rates—some as low as 55%. What are the Government’s plans to support these areas and ensure that they are not left behind?

Secondly, vaccination centres are detecting a rising number of queue jumpers as Britain prepares to face a four-week jab drought. Officials say that people pose as care or health workers to cheat their way to an early jab and fear that fraudulent bookings will soar before next month’s slower rollout. When the cheats are caught, vaccination slots that could have gone to people entitled to a jab are wasted. In addition, according to anecdotal evidence and the Times article of yesterday, it seems that some centres more recently are not being diligent about requiring proof of the eligibility of the person claiming to be a care worker.

Anyone can fraudulently book a jab on the national booking website by ticking a box to say that they work in health or social care or provide “personal care” for people in their homes. The NHS insists that those who do this but do not bring proof of that to their appointment “will not be vaccinated”. But officials say that the loophole means that rising numbers are trying to exploit a system that is “open to abuse”. Some sites are catching 15 queue jumpers a day and fear that more are slipping through. The problem is that those appointments are lost and those vaccinations wasted. The centres therefore face a “difficult balance” between wanting to avoid wasted doses and appointment slots and rigorously checking ID cards. Bhaveen Patel, who runs a Covid-19 vaccination clinic in Brixton, says that he turns away 15 queue jumpers a day.

Finally, children make up about 21% of the population. That is a large segment of the population who will lack immunity. Obviously, research and trials are ongoing, but does the Minister have a timeline for when he hopes to vaccinate children? Does he anticipate, for example, being able to vaccinate children this autumn, as Anthony Fauci in the US has suggested could well happen over there?

Photo of Baroness Brinton Baroness Brinton Liberal Democrat Lords Spokesperson (Health)

My Lords, from these Benches I also thank the noble Lord for the Statement given in the Commons last Thursday and thank and congratulate everyone involved in the creation and delivery of all the vaccines so far, and for their continuing work to protect the world against mutant strains of the virus. It is good news at a time when much else is still worrying.

I also start with the availability of supply. Can the Minister explain to the House what guarantee there is for people on receiving their second doses? He has reassured the House before, but I am hearing from GPs worried that they have not had confirmation that they will receive enough doses or that they are getting any supplies at all at the moment, as well as from people who have had their first dose from their GP but who have been told they cannot book their second dose via the online national system because their first dose was delivered by their GP. There are a lot of confused people around.

Today’s news about the EU-UK war of words on the vaccine supply chain gets more bizarre by the hour. Are Ministers seriously considering holding back exports of the special lipids from the UK to the EU as a proposed retaliatory action if the EU holds back doses in the Netherlands? There should not be a war of words but the best possible collaboration to ensure that the “lumpy supply”, to quote the Prime Minister, is smoothed out.

On the issue of queue jumpers, both the NHS and the care sector have an effective ID system that has been in place for some time, although obviously it was probably easier to do when they were in the first group of people to be vaccinated. What are the Government doing to ensure that every vaccine centre understands what they need to see from people presenting for vaccines from the care sector?

On the hesitancy in uptake, I too have heard of the increase in no-shows. What are the Government doing to encourage especially those from the first six groups who have not yet come forward to do so? The publicity campaign that is beginning on reassurance about the AstraZeneca dose is good, as is the test news, but we need much more than that. We know that hesitancy tends to be reduced when people, especially doctors and nurses, talk directly to their patients.

As we have said from these Benches, it is good that the UK is playing its part in funding vaccines via COVAX. However, there is a lot of discussion at the moment that the UK should support TRIPS and encourage the sharing of intellectual property rights of vaccines. I have some concerns about this approach and agree with Professor Sarah Gilbert, who said:

“If another company tries to take the IP and go it alone, they are manufacturing a different product. The regulators would see it as a different product; it would have to go through all the efficacy trials again, and that would be very wasteful and very slow. I want to get rid of the idea that we should be sharing the IP and letting everybody make their own vaccines. It does not work like that. We have a way of sharing the materials and the expertise, and that is what we have been working very hard to do. That is the correct way to do it, because that is how we get the right vaccines to as many people as possible.”

The work of places such as the Serum Institute of India are examples of how this collaboration can work at its best. Can the Minister say what the Government will do to encourage and support more examples of such collaboration worldwide? Can he also say whether the UK Government plan to donate some of the spare doses that they have ordered to less developed countries and on what timescale this might be enacted?

The Statement refers to the end of shielding on 1 April. As a shielder, I have received another long letter from Matt Hancock and Robert Jenrick which says to shielders:

“Until the social distancing rules are eased more widely, it is important that you continue to keep the number of social interactions that you have low and try to reduce the amount of time you spend in settings where you are unable to maintain social distancing. Everyone is advised to continue to work from home where possible, but if you cannot work from home you should now attend your workplace. Your employer is required to take steps to reduce the risk of exposure to COVID-19 in the workplace and should be able to explain to you the measures they have put in place to keep you safe at work … From 1 April you will no longer be eligible for Statutory Sick Pay … or Employment and Support Allowance … on the basis of being advised to shield. Clinically extremely vulnerable pupils and students should return to their school or other educational settings.”

I said last year when I received an almost identical letter that this feels very strange. You are told that shielding ends but you should continue to do all the things you were doing before shielding—unless you were in receipt of SSP or ESA, because that is no longer available for those who have to go back to work in an unsafe workplace. In response to a question about shielding I asked at a briefing the Minister kindly held for parliamentarians with Chris Whitty, he said that shielders who are immunosuppressed should continue to shield unless the results of the OCTAVE clinical trial for immunosuppressed people was available. But it has not been announced yet. There is total silence from the Government, but there are many immunosuppressed people who will have received this letter and think that they are okay to start moving around more.

The end of the Statement talks about safe discharge, and the £594 million for safe discharge is welcome, but is that to go to the NHS or the better care fund, or will part of it go to local government? Is the £341 million mentioned later in the Statement to support adult social care with the costs of infection prevention part of that same £594 million or is it in addition and completely separate? How will that money get to social care providers?

Once again, why is only adult social care getting this funding? Once again, paid and unpaid carers for young disabled people, who are often extremely vulnerable to any infections, not just Covid, appear to be excluded from this grant. Can the Minister please explain?

Photo of Lord Bethell Lord Bethell The Parliamentary Under-Secretary for Health and Social Care

My Lords, I am enormously grateful for the questions from both noble Baronesses. I will try to address them and if I omit any, I will be happy to write to them with more details.

I will speak first about supply and its importance to the rollout of the vaccine. We have always said that a vaccine programme of this pace and scale may have lumpy interruptions in supply. Noble Lords will be aware that we have done incredibly well to get to the kind of rates that we saw over the weekend in the way that we have; more than 800,000 in a single day is an absolutely astonishing figure. However, delays are envisaged. This is in part due to a delay to a shipment from the Serum Institute of India, which is doing a herculean job of producing vaccines in such large quantities, and because of a batch that we already have in the UK that needs to be retested. We will receive slightly fewer vaccines in April that we did in March but that is still far more than we did in February, and the supply that we have will still enable us to hit the targets that we have set. I emphasise that point. That means that by 15 April we will be able to offer a first dose to everyone over 50 as well as those who are under 50 but clinically vulnerable. It also means that we will be able to give second doses to everyone who has had a first dose within the 12-week window, which means around 12 million second doses in April. It also means that we will be able to offer a first dose to every adult by the end of July. I hope that provides the reassurance that the noble Baronesses, Lady Thornton and Lady Brinton, are looking for.

On the Moderna vaccine, it is a fantastic achievement that the British Government have secured 17 million doses. These will come into play by mid-spring, and my understanding at this stage is that they will be in time to help supplement the rollout of the vaccine to some of the cohorts 1 to 9 at the end of April.

The noble Baroness, Lady Brinton, asked about our approach to EU relations. I reassure her that the British Government are utterly committed to a spirit of partnership and to respect for contract law in all our dealings. If the noble Baroness has good networks and friendships in Brussels and other EU capitals, it would be much appreciated if she could communicate those values to those in her network.

On those without GPs who would like to have the vaccine, I reassure the noble Baroness, Lady Thornton, that it is possible to get the vaccine without a GP, an NHS number or an NHS login. There are systems in place, and if anyone turns up at a vaccine centre without any of those materials, they will be guided and given the assistance they need to get the vaccine they need. I emphasise that the vaccine has proved to be a terrific opportunity for a lot of people to get to know their NHS number a bit better, to bring their GP records up to date and for many to register with an NHS login in order to get to know their patient records a bit better. It will be a massive inflection point in the digitalisation of the NHS, and that is an opportunity we are grabbing with both hands.

I will take some of the noble Baroness’s questions about queue jumping back to the department. I do not know the specifics of the stories that she described, but I reassure her that NHS records are matched against those for the vaccine, as are those for social care. We do not take a blind or naive approach to the rollout of the vaccine, but it is true that it is not the role of vaccine centre staff heavily to police those who come forward for the vaccine. I am not aware that this has been a material issue, but I should be glad to find out more for her.

Of course we are fully aware of the dangers that the European rhetoric on the AstraZeneca vaccine might lead to a rise in hesitancy here in the UK, but I reassure the noble Baroness, Lady Brinton, that the signs are not there yet. It would seem that the British public remain incredibly committed to the vaccine rollout, the numbers coming forward remain astonishingly high and the public attitude surveys that we are doing seem reassuringly concrete.

We are extremely keen to nut through the last remaining numbers in the cohorts 1 to 9. These few weeks will give us a really good opportunity to give time to GPs and other healthcare staff to spend time in dialogue with those who have legitimate questions. That principle of dialogue and answering questions has been the way we have approached the entire vaccine rollout, and we will continue to use that dialectic method in order to get people over the line. We are also very keen to get the vaccine rolled out among younger people, including, perhaps—if the clinical advice is affirmative—children. It is of course the case that children are eligible for and encouraged to take the flu vaccine, not because they are particularly in danger of hospitalisation or severe disease from flu but because they are transmitters of flu. Exactly the same principle applies to Covid. That is why we are extremely keen to get the message across to young people, and it is extremely reassuring that the rollout of the vaccine among older people may have a profound effect on loved ones in the same family unit. We are hopeful that that will be a big influence on younger people.

On our international approach, I reassure the noble Baroness, Lady Brinton, that Britain is as collaborative as a country possibly could be on the vaccine. I take my hat off to AstraZeneca, which has an extremely collaborative approach and, as she knows, a no-profit protocol for the vaccine. The MHRA has led the way in transparency and sharing of data. On therapeutics and clinical trials, we have shared an enormous amount of data around the world. We remain enormous financial sponsors of all the major vaccine programmes, including COVAX, Gavi, ACT and the others. This approach will continue, and we remain convinced that Britain should take a leading role in the global rollout of the vaccine. We will be using our chairmanship of the G7 to play that role.

Lastly, I hear and appreciate the comments of the noble Baroness, Lady Brinton, on the shielding letter. Those who are shielding are in a very awkward position, but I am afraid that it cannot be solved overnight. The OCTAVE programme is extremely ambitious: it is looking carefully at extremely complex and difficult questions about those who, for one reason or another, have suppressed immunity, and that includes a very broad range of conditions. Professor Paul Moss at Birmingham University Hospital, who is leading that programme, is doing a terrific job, and I pay tribute to him and all his team. We are looking at whether they have the right amount of resources. I had reassurances very recently that everything was in place, but we are looking extremely closely at this area, because the noble Baroness is right: those who have suppressed immunity are in a very special case and we need to be absolutely sure that they have the right vaccine delivered at the right time and the right information to make the decisions necessary to go back into life. Those decisions simply cannot be rushed. A passage of time is necessary to understand the effect of the vaccine on the human body, but we are doing everything we can to answer those important questions.

Photo of Baroness Garden of Frognal Baroness Garden of Frognal Deputy Chairman of Committees, Deputy Speaker (Lords)

My Lords, we now come to the 30 minutes allocated for Back-Bench questions: it is 30 minutes, not 20, which was printed in error on today’s list. Even with that extra time, I ask that questions and answers are brief so that I can call the maximum number of speakers. The noble Lord, Lord Lansley, has withdrawn, so I call the noble Baroness, Lady Hayman.

Photo of Baroness Hayman Baroness Hayman Crossbench 2:27 pm, 22nd March 2021

My Lords, a descent into a tit-for-tat vaccine war would obviously be disastrous, given the global nature of both vaccine supply chains and the pandemic itself. Given the worrying developments that we have seen in this area, what research has been done and consideration given to the possibility of mixing and matching second doses with a different vaccine—something which was talked about originally and might become necessary in the light of particular difficulties in supply chains?

Photo of Lord Bethell Lord Bethell The Parliamentary Under-Secretary for Health and Social Care

My Lords, I completely agree with the noble Baroness that a descent into some type of vaccine war would be extremely regrettable, and the British Government are doing everything they can to continue in a spirit of partnership with overseas Governments. We have not reached the possibility of taking on a mixing and matching approach. We believe that the supply chain we have in place is ample to achieve the targets we have already published. However, to answer her question directly, there is some evidence that mixing and matching may prove to be even better than having two of the same vaccine—that it may stimulate the immune system in ways that give you a more developed response to the virus. Therefore, we continue to look carefully at this possibility.

Photo of Lord Faulkner of Worcester Lord Faulkner of Worcester Deputy Chairman of Committees, Deputy Speaker (Lords)

My Lords, the Minister is right to draw attention to the success of the vaccination programme, but does he not agree that last Thursday’s Statement is rather light on advice on what people should do to protect themselves and others until the lockdown ends? In particular, there is no reference to the need to continue wearing face coverings. The Minister will recall that he kindly wrote to me about this on 28 January. His letter included the advice that, “The public should not challenge people for not wearing a face covering.” Will he now consider changing that advice as, surely, the wearing of masks is as important as social distancing and avoiding large gatherings?

Photo of Lord Bethell Lord Bethell The Parliamentary Under-Secretary for Health and Social Care

I am extremely impressed by the noble Lord’s perseverance on this issue. I know that he feels very strongly about the need for members of the public to be involved in policing the wearing of masks. However, that is simply not the way in which the British administration of guidelines is handled in this country; it is for those who are put in positions of badged authority to implement them. I simply cannot advocate that members of the public should intervene on one another to insist on, or apply any form of retribution regarding, the wearing of masks.

Photo of Baroness Jolly Baroness Jolly Liberal Democrat

My Lords, I welcome the Statement and the Government’s ambition. At the end of the Statement, there is a commitment to building 40 new hospitals, hiring 50,000 more nurses and backing the NHS and social care. Can the Minister outline what sort of backing the social care sector can expect, and by when?

Photo of Lord Bethell Lord Bethell The Parliamentary Under-Secretary for Health and Social Care

My Lords, I am grateful for the broad and large hook that the noble Baroness has provided me with. I reassure her that not only do we have a massive amount of support already in place for social care to help it through the current pandemic and the huge amount of pressure that has been put on its staff, residents and supply chain; we also have put in place an enormous amount of financial support for local authorities to ensure that they can provide the kind of improvements to social care that are needed. One area in which we have made enormous advances is care tech—that is, digital and technologically driven support. It has taken a huge step forward in the last year and impacted enormously on the lives of those in social care of all kinds.

Photo of Baroness Penn Baroness Penn Baroness in Waiting (HM Household) (Whip)

My Lords, we are having technical difficulties. I beg to move that the House do now adjourn until 3 pm.

Sitting suspended.

Photo of Lord Haskel Lord Haskel Deputy Chairman of Committees, Deputy Speaker (Lords) 3:01 pm, 22nd March 2021

My Lords, the House will now resume with questions on a Statement made in the House of Commons on 18 March: Department of Health and Social Care Update.

Photo of Lord Forsyth of Drumlean Lord Forsyth of Drumlean Chair, Economic Affairs Committee, Chair, Economic Affairs Committee

My Lords, what contingency plans do the Government have in place should the EUC/EU pursue its outrageous threats to prevent the export of vaccines under a legal contract with the NHS? In that event, can my noble friend say what estimate he has made of the delay, if any, to completing the undertaking he gave earlier that all adults in the UK will have had their first dose by the end of July?

Photo of Lord Bethell Lord Bethell The Parliamentary Under-Secretary for Health and Social Care

My Lords, from the beginning, we have put in place arrangements for the UK manufacture of vaccines, which, in the light of events, has proved to be a pragmatic and sensible move. We are hopeful that the EU will continue in the spirit of partnership and will respect contract law. I stand by the statement I made on our expectations on the supply of the vaccine to cohorts one to nine and all adults that I articulated earlier.

Photo of Baroness Greengross Baroness Greengross Crossbench

My Lords, what is the Government’s response to the 2020 report from Amnesty International which suggests that the Government, while knowing the vulnerability of many older people, failed completely to protect care home residents? People were discharged into care homes without testing, which, according to Amnesty, breached their human rights and contributed to the fact that the UK had the highest death toll in Europe at the time.

Photo of Lord Bethell Lord Bethell The Parliamentary Under-Secretary for Health and Social Care

My Lords, I simply do not recognise the characterisation that the noble Baroness has just presented. The view of our treatment of the elderly and vulnerable taken by Amnesty during the pandemic is completely inappropriate and inaccurate. Huge steps have been taken to protect those who are vulnerable and elderly. I cannot think of a country that could have done more under the circumstances. I therefore reject its analysis.

Photo of Baroness Warwick of Undercliffe Baroness Warwick of Undercliffe Labour

My Lords, this is a Statement on health and social care. I am astonished that the Minister has confined the Government’s policy on adult social care following the pandemic to a couple of sentences. He must know that most of the adult social care in this country is provided by family carers. They are regularly ignored in such Statements, but many of the 6 million carers looking after vulnerable adults, including those with learning difficulties, have been pushed to breaking point by the pandemic. Is there nothing to say to them about access to support services or respite care and nothing on carer’s allowance? Without support for these essential carers, policies such as enhanced hospital discharge, as mentioned in the Statement, will not be feasible. What is the Government’s strategy for dealing with this crisis in care?

Photo of Lord Bethell Lord Bethell The Parliamentary Under-Secretary for Health and Social Care

My Lords, I endorse completely the noble Baroness’s remarks that we depend on the generosity, public spirit and kindness of family carers who provide an enormous amount of support for their loved ones. Without them, the system could not possibly exist and the world would be a much graver place. I recognise that many carers have been pushed very hard by the pandemic. We have put a huge amount of resource into local authorities, which are responsible for providing support for those families, and that includes the kind of respite support that the noble Baroness has rightly pointed to. I am sure that more could be done and I would welcome any correspondence on this by way of follow-up that she would like to send my way.

Photo of Baroness Sheehan Baroness Sheehan Liberal Democrat Lords Spokesperson (International Development)

My Lords, the Serum Institute of India is producing a billion doses of the Oxford/AstraZeneca vaccine this year. However, we hear that the rate of production may be compromised because of delays in the supply chain of essential items from the US. What dialogue have our Government had with their US counterparts at all levels about how these delays might be overcome?

Photo of Lord Bethell Lord Bethell The Parliamentary Under-Secretary for Health and Social Care

My Lords, the noble Baroness is right to say that the Serum Institute of India is the world’s biggest vaccine manufacturer by far and we are enormously grateful for the strong relationship that this country has with the institute and the contribution that it is making to our vaccine rollout. The supply chains for the world’s vaccine production are unbelievably complicated, with ingredients and individual supply items coming from many different countries for each and every vaccine. It is not possible to provide a running commentary on the progress of each one; nor would it be wise to have a bilateral conversation with the country of origin of every vaccine ingredient. Our relations with India, America and the EU will, I am sure, return to the spirit of partnership and the respect of contract law that have characterised those relationships in the past.

Photo of Lord Cormack Lord Cormack Conservative

My Lords, I shall quote from the Statement:

“Last Monday, we reopened care homes to visitors, with a careful policy of a single regular visitor … we hear each day of more and more residents safely reunited with people they love.”

My wife and I have a dear friend whose mother is 99. She is indeed excited at the prospect of holding her mother’s hand for the first time in a year, but that excitement is overshadowed by the knowledge that several of the workers in the care home where her mother is being looked after have refused to take the vaccine. I urge my noble friend yet again to press forward on this.

Photo of Lord Bethell Lord Bethell The Parliamentary Under-Secretary for Health and Social Care

My Lords, I hear my noble friend’s message loud and clear and he has made the case both persuasively and thoughtfully. He is a little ahead of events. It is not possible for us to put in any form of certification or mandation until the vaccine has been offered to absolutely everyone in the country. However, he will know that the Cabinet Office has a review process in place that is looking at exactly the dilemma he has spoken to.

Photo of Lord Singh of Wimbledon Lord Singh of Wimbledon Crossbench

My Lords, I congratulate the Government on the success of their vaccination programme. We should also applaud the way that the NHS has responded to the pandemic in reorganising priorities and efficiently facilitating the vaccine rollout. Does the Minister agree that the controversially privatised NHS Supply Chain has done less well in the provision of PPE and that the Government’s track and trace programme has also been found wanting? According to the National Audit Office, some of its consultants have been paid thousands of pounds a day for sitting at home with very little work.

Photo of Lord Bethell Lord Bethell The Parliamentary Under-Secretary for Health and Social Care

My Lords, I am grateful to the noble Lord for his tribute to the NHS, both the front-line staff and those who have organised the vaccine rollout. He is right to say that this has been a huge national achievement. However, I do not accept the characterisation he has made of other aspects of our pandemic response, including the provision of PPE, which, by the way, involved a huge global competition for extremely rare materials and led to a massive increase in domestic production. I also do not agree with his characterisation of the test and trace programme, which has developed into becoming one of the largest testing programmes in the world. It is now extremely effective, with tracing completion rates above 90%.

Photo of Baroness Andrews Baroness Andrews Deputy Chairman of Committees, Deputy Speaker (Lords), Chair, Common Frameworks Scrutiny Committee, Chair, Common Frameworks Scrutiny Committee

My Lords, further to Minister’s exchange with the noble Lord, Lord Forsyth, can he update the House on plans to increase the manufacture of vaccine in the UK and when and where that might happen?

Photo of Lord Bethell Lord Bethell The Parliamentary Under-Secretary for Health and Social Care

My Lords, I am not sure that I have at my fingertips the precise rollout plan for domestic manufacturing. All I can do is reassure the noble Baroness that we are exploring all options equally hard and are working 110% on every opportunity we have for delivering vaccines into the UK. I reassure the noble Baroness and all noble Lords in the Chamber that we are doing all we can and that at this stage we are hopeful and confident that the supply chain will deliver the vaccines we need in order to vaccinate all adults by the end of July.

Photo of Lord Haselhurst Lord Haselhurst Conservative

My Lords, as it may not be possible to maintain the remarkable number of vaccinations currently being achieved over the next few weeks, and noting the pent-up desire of people for an overseas holiday, is the trickiest task now facing the Government not to persuade people to hold off a bit longer? There is still too great a risk of importing strains of Covid-19 and spoiling the progress that their sacrifice has achieved to date.

Photo of Lord Bethell Lord Bethell The Parliamentary Under-Secretary for Health and Social Care

My noble friend is entirely right: this is a considerable dilemma not just for the Government, but for everyone. We in the UK have an enormously valuable project in our vaccination programme. Who does not relish the potential freedom from this horrible disease that it gives us? Yet we need only look overseas to see infection rates rising and the variants of concern spreading. The bottom line is that we do not know the impact of the variants of concern on the vaccine. Anyone who says they do for sure is simply not representing the truth. We have to be patient and figure out and fully understand the threat from the variants of concern. When we have that information, we can make a pragmatic, sensible and informed decision on foreign travel, as the Prime Minister has promised.

Photo of Baroness Hollins Baroness Hollins Crossbench

My Lords, I am so pleased that all people with learning disabilities who are known to their GP are now in either group 4 or 6 for vaccination. Will the noble Lord commit to reporting on the take-up of Covid immunisation for people on the register, both nationally and locally? Will he also report on the implementation of visiting policies for people with learning disabilities in both supported living and residential settings, and whether those residents are able to choose their one visitor?

Photo of Lord Bethell Lord Bethell The Parliamentary Under-Secretary for Health and Social Care

Those were two extremely thoughtful and well-informed questions. I do not have the statistics at my fingertips, but I would be glad to go back to the department and write to the noble Baroness with the information she has asked for.

Photo of Lord Liddle Lord Liddle Labour

My Lords, I add my congratulations to the NHS on the tremendous success of this vaccination programme, but we should now be doing more to look forward to how we can address the social and public health inequalities that led to Britain having one of the largest death rates from Covid in the world. I speak in the context of being a Cumbria county councillor. The public health grant is what we use to tackle issues such as obesity, inactivity, smoking and alcohol, which greatly reduce people’s chances of surviving deadly disease. Next year’s public health grant is a mere £19 million—an increase of just 1.4%. Not only is this, frankly, a pathetic response to the social problems that led to all these Covid deaths, but it is unfairly distributed. Central London authorities such as Kensington and Chelsea, and Westminster, receive three to five times the amount per head that our authority in the north receives. How do the Government explain this and how does it square with their levelling-up agenda?

Photo of Lord Bethell Lord Bethell The Parliamentary Under-Secretary for Health and Social Care

My Lords, we are committed to both our levelling-up agenda and the kind of population health measures to which the noble Lord alludes. That is why we are bringing the NHS and social care Bill before the House later this year. I hope that the noble Lord engages with it to bring his insight to the debate.

Photo of Lord Dobbs Lord Dobbs Conservative

My Lords, I assume that my noble friend shares with me a profound sadness at what is going on in the EU. Will he, instead of following their appalling example or indulging in tit for tat, remind the world that Britain after Brexit does things differently? We prefer the rule of law to knee-jerk protectionism, we pursue free and fair trade, and we honour our commercial contracts. Does he agree that this makes Britain one of the most attractive places in the world for pharma, biosciences and anyone to do business with?

Photo of Lord Bethell Lord Bethell The Parliamentary Under-Secretary for Health and Social Care

My noble friend has just made a fantastic pitch for my job. He articulated the case for investing in Britain to pharmaceutical and medical devices companies around the world. Which company cannot be looking at Europe, right now, wondering whether Britain is not, by far, the best destination for their investment and research? I completely agree with my noble friend; my head is in my hands when I look at Europe and what is going on there, but my hope is that good sense will return. In the meantime, if anyone wants to invest any money in life sciences, please give me a ring.

Photo of Lord Loomba Lord Loomba Crossbench

My Lords, the vaccination milestone of 25 million in 100 days is commendable. However, we must be very careful that we do not undo or undermine our good work thus far. Will the Minister tell us why the Government do not consider it important—imperative, even—to ban all overseas holiday travel this summer, as many countries are now suffering from a third wave of Covid-19 due to new variants becoming apparent, and there is an increased risk of them being transferred to the UK via travellers?

Photo of Lord Bethell Lord Bethell The Parliamentary Under-Secretary for Health and Social Care

My Lords, the noble Lord puts the situation well. I do not agree with every aspect of his assessment, but his concerns are shared by the Government. We keep the whole situation under review, but the bottom line is that we do not know the impact of the variants of concern on the vaccine and vice versa. We keep the situation very closely monitored. The measures in place are entirely proportionate to the threat we face but, should that escalate, we will not hesitate to take the necessary decisions.

Photo of Baroness Ritchie of Downpatrick Baroness Ritchie of Downpatrick Non-affiliated

My Lords, in commending the rollout of the vaccination programme, could the Minister indicate whether the Government have made arrangements for its continuation in subsequent years? What discussions have there been and potential arrangements made with the devolved Administrations on this?

Photo of Lord Bethell Lord Bethell The Parliamentary Under-Secretary for Health and Social Care

My Lords, we very much hope that the vaccination programme being delivered today will lead to an inflection point in the whole country’s approach to vaccinations overall. That is not just for Covid, but for flu, HPV and other prophylactics. We are on the brink of a massive change in our mindset regarding preventive medicine. There is an opportunity here for us to completely change the way in which we do healthcare—from an emphasis on late-stage and acute medicine to preventive early-stage medicine. The stakes are enormous. We are determined to grab this opportunity with both hands and we will take our friends in the devolved authorities with us.

Photo of Lord Haskel Lord Haskel Deputy Chairman of Committees, Deputy Speaker (Lords)

The noble Baroness, Lady Blackstone, and the noble Lord, Lord Lucas, have both withdrawn, so I call the noble Lord, Lord St John of Bletso.

Photo of Lord St John of Bletso Lord St John of Bletso Crossbench

My Lords, I would like to probe the Minister outside the question of the vaccine supply and its admirable rollout. While welcoming the Government’s workplace testing scheme, in which lateral flow tests will be given to businesses until the end of June, what established workplace testing infrastructure is in place? What measures are being taken to ensure the high uptake of this strategy and that it is as safe and accurate as possible?

Photo of Lord Bethell Lord Bethell The Parliamentary Under-Secretary for Health and Social Care

The noble Lord is entirely right to emphasise this incredibly important aspect of our toolkit to manage infection rates down. The workplace is an area of infection threat and asymptomatic testing is a way to keep workplaces safe. We have put in place until the summer the free provision of lateral flow tests for those who wish to do workplace testing, and we are looking at ways in which we could potentially extend that, particularly in circumstances where the infection rate crept up again. We are working very closely with BEIS colleagues to look at the kind of regime that would be necessary. I pay tribute to DfT colleagues who have trail-blazed this area with the test to release programme, which uses private testing capacity for that important transport corridor, and to colleagues at UKAS who have put in place the accreditation necessary to create an independent, private ecology of the kind that the noble Lord refers to.

Photo of Lord Hunt of Kings Heath Lord Hunt of Kings Heath Labour

My Lords, I come back to the point raised by the noble Lord, Lord Cormack: the SPI-M-O consensus statement of 24 February showed that while 95% of care home residents had had the vaccine, only 70% of staff had. We really must do better on this; does the Minister agree?

Photo of Lord Bethell Lord Bethell The Parliamentary Under-Secretary for Health and Social Care

My Lords, I could not agree more heartedly; the vaccination of staff is a massive priority. Those figures give us cause for some reflection on how we can increase them. The adoption rate of vaccines by all healthcare workers has been much more impressive than on previous vaccine rollouts, so we are encouraged overall, but we are determined to hammer out all the last rock pools where people have not been persuaded. As I alluded to my noble friend Lord Cormack, we are looking at all methods to make sure that we get there in the end.

Photo of Baroness McIntosh of Pickering Baroness McIntosh of Pickering Conservative

I welcome the Statement, in particular the reference to the future discharge programme for hospitals. Does my noble friend agree that it is essential to rural-proof this policy? Will the Government look favourably on establishing health hubs in rural towns, to provide treatment and test availability and to allow the potential to avoid hospital visits?

Photo of Lord Bethell Lord Bethell The Parliamentary Under-Secretary for Health and Social Care

My noble friend hits the nail on the head; who could think that a return to the previous regime of turning up at a GP’s surgery or a hospital every time you feel ill could possibly be a wise way of going about your healthcare system? Professor Sir Mike Richards has done an extremely good report on community health hubs, which we are looking at very closely; it has some very wise words that we are minded to follow up.

Photo of Baroness Uddin Baroness Uddin Non-affiliated

My Lords, I congratulate the Government on the rollout of the vaccine programme. I have two questions. First, what steps are being taken to ensure that local authorities are making progress to resume assessments of the needs of adults with learning disabilities and autism, many of whom were forced to depend on their inadequate amount of disability benefit? Secondly, what steps have been taken to speak to family members who lost loved ones with the instruction for staff not to resuscitate? I raise this point as I have raised it before. Will the Minister assure this House that the practice is no longer applicable to residents in care homes and people with learning disabilities, unless in agreement with patients and their families?

Photo of Lord Bethell Lord Bethell The Parliamentary Under-Secretary for Health and Social Care

My Lords, the CQC has pronounced its report on do not resuscitate orders, which is absolutely crystal clear. I wholly endorse its findings and recommendations.

Photo of Lord Moynihan Lord Moynihan Conservative

My Lords, I warmly congratulate the Government on the management of the vaccine programme. As we emerge from the epidemic, will the Government commit to a major health policy initiative to ensure that all young people engage in a more active lifestyle, participate in sport and recreation, gain affordable access to gyms, swimming pools, leisure facilities and dual-use school facilities used by local communities, and to tackle what is the least fit generation of young people in over 100 years? Does my noble friend agree that affordability and access are the critical components in this context?

Photo of Lord Bethell Lord Bethell The Parliamentary Under-Secretary for Health and Social Care

My Lords, the policy on sports is best left to colleagues at the Department for Digital, Culture, Media and Sport, but on a personal level I emote complete sympathy with my noble friend’s sentiments. I may be naive in this matter but I cannot help hoping that this pandemic will have led to a feeling across the country that the health of the nation has to change—it has to change emphatically, not only through diet but the amount of activity taken. This nation has an opportunity to embrace a lifestyle with more outdoor activity and exercise and a greater commitment to healthy living. That is a reasonable ambition, not just for my noble friend but for the whole country, and I support it entirely.