Covid-19 Update - Statement

– in the House of Lords at 2:11 pm on 10th November 2021.

Alert me about debates like this

The following Statement was made in the House of Commons on Tuesday 9 November.

“With your permission, Mr Deputy Speaker, I would like to make a Statement on the further steps we are taking to keep this country safe from Covid-19.

We head into the winter months in a much stronger position than last year. Of all the reasons for this progress, the greatest is unquestionably our vaccination programme. Across the UK, the overwhelming majority of us have made the positive choice to accept the offer of vaccines against Covid-19. Almost eight in every 10 people over the age of 12 have chosen to be double-jabbed and more than 10 million people have now received their boosters or third jabs. I am grateful to colleagues from all parties for their steadfast support for our national vaccination programme.

Despite the fantastic rates of uptake, we must all keep doing our bit to encourage eligible people to top up their defences and protect themselves this winter. I understand that vaccination can, of course, be an emotive issue. Most of us have taken this step to protect ourselves, our families and our country. Sadly, we have all seen how Covid can devastate lives, but we have also seen how jabs can save lives and keep people out of hospital.

Our collective efforts have built a vast wall of defence for the British people, helping us to move towards the more normal way of life that we have all been longing for. The efforts of the British public have been phenomenal and those working in health and social care have been the very best of us. Not only have they saved lives and kept people safe through their incredible work, but they have done the same by choosing to get vaccinated. I thank NHS trusts and primary care networks for all the support and encouragement they have given to their staff to take up the vaccine. The latest figures show that 90% of NHS staff have received at least two doses of the Covid-19 vaccine, although in some trusts the figure is closer to 80%.

Although our health and social care colleagues are a cross-section of the nation at large, there is no denying that they carry a unique responsibility. They have that responsibility because they are in close contact with some of the most vulnerable people in our society—people we know are more likely to suffer serious health consequences if they get Covid-19. Whether it is in our care homes, our hospitals or any other health or care setting, the first duty of everyone working in health and social care is to avoid preventable harm to the people they care for. Not only that, but they have a responsibility to do all they can to keep each other safe.

Those twin responsibilities—to patients and to each other—underline, once again, why a job in health or care is a job like no other, so it cannot be business as usual when it comes to vaccination. That is why, from the very beginning of our national vaccination programme, we put health and care colleagues at the front of the line for Covid jabs and it is why we have run two consultations to explore some of the other things that we might need to do.

The first consultation looked at whether we should require people who work in care homes to be vaccinated —what is called the condition for deployment. After careful consideration, we made vaccination against Covid-19 a condition for deployment in care homes from 11 November. Since we announced that in Parliament, the number of people working in care homes who have not had at least one dose has fallen from 88,000 to just 32,000 at the start of last month.

Our second consultation looked at whether we should extend the vaccination requirement to health and other social care settings, including NHS hospitals and independent healthcare providers. Our six-week consultation received more than 34,000 responses and, of course, covered a broad range of views. Support for making vaccination a condition for deployment was tempered with concern that, if we went ahead with that condition, some people might choose to leave their posts. I have carefully considered the responses and evidence and have concluded that the scales clearly tip to one side. The weight of the data shows that our vaccinations have kept people safe and saved lives and that that is especially true for vulnerable people in health and care settings.

I am mindful of not only our need to protect human life but our imperative to protect the NHS and those services on which we all rely. Having considered the consultation responses and the advice of my officials and of NHS leaders, including the chief executive of the NHS, I have concluded that all those who work in the NHS and social care will have to be vaccinated. We must avoid preventable harm and protect patients in the NHS, colleagues in the NHS and, of course, the NHS itself. Only those colleagues who can show that they are fully vaccinated against Covid-19 will be employed or engaged in the relevant settings. There will be two key exemptions: one for those who do not have face-to-face contact with patients and a second for those who are medically exempt. The requirements will apply across the health and wider social care settings that are regulated by the Care Quality Commission.

We are not the only country to take such steps: there are similar policies for specific workers in other countries, including the United States, France and Italy. We also consulted on flu vaccines but, having considered views that we should focus on Covid-19, we will not introduce any requirement to have flu jabs at this stage, although we will keep the matter under review.

Of course, these decisions are not mine alone: as with other nationally significant Covid legislation, Parliament will have its say and we intend to publish an impact assessment before any vote. We plan to implement the policy through the powers in the Health and Social Care Act 2008, which requires registered persons to ensure the provision of safe care and treatment. I will shortly introduce to the House a draft statutory instrument to amend the regulations, just as we did in respect of care homes.

This decision does not mean that I do not recognise concerns about workforce pressures this winter and, indeed, beyond as a result of some people perhaps choosing to leave their job because of the decision we have taken. Of course I recognise that. It is with that in mind that we have chosen not to bring the condition into force until 12 weeks after parliamentary approval, thereby allowing time for remaining colleagues to make the positive choice to protect themselves and those around them, and time for workforce planning. Subject to parliamentary approval, we intend to start the enforcement of the condition on 1 April.

We will continue to work closely across the NHS to manage workforce pressures. More than that, we will continue to support and encourage those who are yet to get the vaccines to do so. At every point in our programme we have made jabs easily accessible and worked with all communities to build trust and boost uptake. That vital work will continue, including through engagement with the communities where uptake is the lowest; through one-to-one conversations with all unvaccinated staff in the NHS; and through the use of our national vaccination programme capacity, with walk-in centres and pop-up centres, to make it as easy as possible to get the jab.

Let me be clear: no one working in the NHS or in care who is currently unvaccinated should be scapegoated, singled out or shamed. That would be totally unacceptable. This is about supporting them to make a positive choice to protect vulnerable people, protect their colleagues and, of course, protect themselves. The chief executive of the NHS will write to all NHS trusts today to underline just how vital the vaccination efforts are.

I am sure the whole House will want to join me in paying tribute to the heroic responses across health and care. Those who work in health and care have been the very best of us in the most difficult of days. Care, compassion and conscience continue to be their watchwords and I know they will want to do the right thing. Today’s decision is about doing right by them and by everyone who uses the NHS, so that we protect patients in the NHS, protect colleagues in the NHS and protect the NHS itself. I commend this Statement to the House.”

Photo of Baroness Thornton Baroness Thornton Shadow Spokesperson (Equalities and Women's Issues), Shadow Spokesperson (Health) 2:20 pm, 10th November 2021

My Lords, I thank the Minister for the Statement, which largely concerns the matter which we discussed on Monday—making vaccination mandatory for patient-facing NHS staff. I need here to declare an interest as a non-executive director of a local trust.

We know that vaccination saves lives and that it is the best protection against this deadly disease. It helps to cut transmission. We, of course, want to see NHS staff vaccinated. But have the Government considered and taken account of the fact that the NHS is already under the most intense pressure this winter? Waiting lists are close to 6 million, there are already more than 90,000 vacancies across the NHS, and in his Budget the Chancellor failed to allocate funding for training budgets to train the medics we need for the future.

There will be anxiety at local trust level. However laudable the principle, it could exacerbate some of these chronic understaffing problems. We simply cannot afford to lose thousands of NHS staff overnight. Indeed, I spent this morning, as a non-executive of my local trust, discussing risk and its mitigation. Without doubt, the highest risk facing the whole of the NHS is staff shortage.

It was clear that the mandatory vaccine for care home workers covered all staff. These are predominantly in the private sector. Does this new mandate for vaccination apply also to all patient-facing staff, whether they work in the NHS or for private providers?

It is important that the Government have listened to representations from organisations such as NHS Providers, the NHS Confederation and others about delaying the implementation of this until after the winter. We welcome that. I urge the Secretary of State and the Minister to resist the blandishments of the former Secretary of State to bring forward any deadlines. However, have the Government consulted the British Medical Association, relevant trade unions and the royal colleges, which have raised concerns about the practicalities of implementing this policy? It seems to me that there needs to be a push right across the piece.

Will the Minister outline to the House what success looks like for this policy? Some of the 10% of NHS staff who are not vaccinated include those with medical exemptions, those who are on long-term sick and those who could not get the vaccine first time round because they were ill with Covid. Can the Minister tell the House the actual number of NHS staff who should be vaccinated but have not had the vaccine? In other words, when does he consider there to be success? Does full vaccination across the NHS look like 94%, 95% or 96%? What are we aiming for here? What is the target?

The aim of this policy is presumably to limit those with Covid coming into contact with patients, but one can still catch and transmit Covid post vaccine, so will the testing regime that is already in place for NHS staff—I think it is about twice a week at the moment— increase in frequency? Furthermore, will the thousands of visitors who go on to the NHS estate every week be asked whether they have had a vaccine or have proof of a negative test?

What analysis have the Government done of those who are vaccine hesitant in the NHS workforce? What targeted support has been put in place to persuade take-up among those groups? We know that in trusts where take-up is around 80%, specific support has been put in place—I know it has been in my own trust. But we know from society more generally that there has been hesitancy, for example, among women who are pregnant and those who want to have a baby. That means, sadly, that a significant proportion of those in hospital with Covid are unvaccinated pregnant women and, indeed, some of them have died. So, for example, will there be a dedicated phone line to give clear advice to women and their partners who might have concerns?

Today on the BBC “Today” programme, the Secretary of State spoke about the impact assessment for the mandatory vaccination of care home staff. We have been asking the Minister for this information to be brought to the House. We have done that many times. When will the impact information be available to Parliament?

Finally, on vaccination more generally, Leicester has a vaccination rate of 61%, Bradford—where I come from —63%, Bolton 69%, and Bury 71%. Generally, on children’s vaccinations, we seem to be stuck at 28%. On boosters, there are still around 6 million people eligible for a booster who have not yet had one. The Government’s own analysis shows that people over 70 who are dying from Covid or hospitalised should have had a booster, but many have had only two jabs.

With Christmas coming, which will mean more mixing indoors at a time when infection rates are high—with one in 50 having Covid—we are facing six crucial weeks. What more support will the Government offer now to local communities, such as those I have named, to drive up vaccination rates? Nobody wants to see either local or national lockdowns again.

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

My Lords, I declare my interest as a vice-president of the Local Government Association. I also thank the Minister for repeating this Statement. Covid-19 Statements are now taking on the role of London buses—large gaps for a while and then suddenly two in one week on vaccines. It feels as though arguments were going on behind the scenes for such a quick second vaccine Statement to be repeated in less than two or three working days.

Like the noble Baroness, Lady Thornton, my honourable friend Daisy Cooper MP asked yesterday about the publication of the long-awaited impact statement —Making Vaccination a Condition of Deployment in Health and the Wider Social Care Sector—that this Statement refers to. It would have been helpful for MPs to have had sight of it at the same time as the Statement. As the noble Baroness, Lady Thornton, said, frankly we needed to see it a long time ago, given that the social care deadline starts tomorrow. It was finally published overnight, and I have some questions on it for the Minister.

The Statement announces that all NHS and social care staff will have to have to be fully vaccinated by 1 April 2022. The deadline for care home staff remains tomorrow. The predicted numbers on page 4 of the impact statement are pretty staggering—up to 126,000 staff, of whom 73,000 are expected to be NHS staff. Page 6 of the impact statement also says that the modelling cost of replacing unvaccinated workers is between £162 million and £379 million. That is also staggering, given the financial pressures and backlog of cases across a health and social care sector that at the moment is still struggling with the pandemic.

From these Benches we really want to see staff vaccinated but would prefer that it is voluntary and remain concerned about the consequences of tomorrow’s care homes deadline. Page 6 of the impact statement published overnight talks about the disruption to health and care services. But for social care that disruption has already started. Many care home staff have already left or this week are being fired, with a good number moving to the NHS and to retail and hospitality roles.

Large homes are reporting closing down wings of beds due to lack of staff and some smaller homes are handing back state-funded patients to local authorities. Both the Statement and the impact statement are silent on how patients will be looked after before we even get to the consequences of social care homes without beds.

So can I ask the Minister what emergency plans there are to help areas? By the way, answers that say “It’s down to local authorities” are not helpful. This is a crisis created, at least in part, by mandatory vaccines, and there are no staff or beds that can just magically appear. Or is what Sajid Javid said at the Conservative Party conference the reality: namely, that families will be expected to step up to the plate to look after their loved ones in the absence of care home beds? If so, it would be good to see Ministers’ planning for that and the consequent problems for the workforce.

The Statement says that other parts of the social care system—for example, domiciliary care—that were excluded from the original care decision will now be included, but neither the Statement nor the impact statement is clear about the deadline for those in the social care system now being drawn into mandatory vaccination. Can the Minister say what the deadline is for these new groupings? It surely cannot be that the deadline for domiciliary workers is this week. Is this just for full-time staff employed by the care sector, or will others offering regular services such as activities in care homes or subcontractors working in hospitals now be included? There are staff working as sub- contractors for the NHS who have front-line access to patients; for example, delivering meals. Are they included or excluded?

The table on page 4 of the impact statement lists the total number of staff in each sector exempt from vaccination. I cannot find anywhere the criteria for exemption. Can the Minister please tell the House what those criteria are?

I have now asked the Minister at least twice in the past fortnight about the online vaccination form which sits behind the GP records and the app. How many of those who were vaccinated overseas and those who took part in clinical trials are now on the records system? Has it increased from the 53 people that he talked about last week, and are the arrangements for logging third doses for the severely clinically extremely vulnerable, as distinct from the booster doses for everyone over 50 and health staff, now sorted out? I am still getting reports that they are not.

Finally, there has been considerable concern that the Prime Minister was not wearing a face mask at Hexham hospital yesterday, against all NHS advice. This morning, Dr David Nabarro, the World Health Organization’s special envoy for Covid-19, said on Sky News:

“I’m not sitting on the fence on this one … Where you’ve got large amounts of virus being transmitted, everybody should do everything to avoid … getting the virus or inadvertently passing it on. We know that wearing a face mask reduces the risk. We know that maintaining physical distance reduces the risk. We know that hygiene by regular hand washing and coughing into your elbow reduces the risk. We should do it all, and we should not rely on any one intervention like vaccination on its own. So … please, would every leader be wearing face masks, particularly when in indoor settings? … This virus is unforgiving, and we need to do everything possible to prevent it getting in between us and infecting us.”

Can the Minister explain why the Prime Minister was not wearing a face mask, in breach of Hexham hospital’s rules, and will he pass on those words from Dr Nabarro to No. 10 Downing Street?

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

I thank both noble Baronesses for their questions and the important points they made. It is important that we are clear about many of the issues that they have brought up.

Let us be clear that the best mitigation against this is to encourage those who are vaccine hesitant to take up the offer of vaccination. In both health and social care, we have worked extensively with key stakeholders and arm’s-length bodies to encourage vaccine take-up. This has involved a number of different measures: bespoke communications materials, paid advertising, stakeholder toolkits, positive messaging using influencers and leaders, content in different languages, briefings with different faith groups, webinars with clinical experts, vaccine champions and practical support including vaccination at places of work, flexible access to vaccine hubs, digital booking support and monitoring and support from NHS England. We will continue to encourage uptake in the run-up to the requirements coming into force.

The NHS has also focused in recent months on a targeted approach to improve uptake in hesitant groups by undertaking specific, targeted campaigns directed towards, for example, midwifery staff, ethnic minority groups in certain areas that have been hesitant and students, as well as using the booster campaign as an opportunity to re-engage staff. I thank noble Lords across the House for the advice that they have given me on how we can address hesitancy in some communities and for their very useful suggestions. I have discussed this with a number of other people, and we are looking at potential pilot projects, one working, for example, with faith communities in inner-city areas and mapping the data from Public Health England and the relevant offices.

It is interesting to see how many absences are due now to the unvaccinated. The seven-day average to 6 October 2021 shows an average of 74,863—nearly 75,000—absences in NHS trusts per day, of which more than 15,500 were for Covid-19-related reasons, including the need to isolate. This benefit would be reduced if we relied only on testing, although that remains part of our armoury.

I was asked a number of questions about scope and who this extends to. It applies to all providers, both public and private, of a CQC-regulated activity. This obviously covers a wide range of services, including hospitals, GP and dental practices, and social care providers. Further support on implementation for the sector will be provided through continuous guidance. The policy does not apply to those services and activities which are not regulated by the CQC. Children’s and social care services which are CQC regulated will be in scope of the requirement, but it will not apply to services that are provided as part of shared-living arrangements. Many of these reasons are of course as a result of the extensive consultation that has been undertaken.

I was asked for the number of uptakes. The vaccination uptake figures for NHS staff show that nearly 93% have had at least one dose. Uptakes still vary, from 84% to 97% for the first dose, among NHS trusts. Among primary care workers, this ranges from 94% in the south-west to 76% in the east of England—so we would welcome the advice of any noble Lords who have experience of the east of England. In adult social care, nearly 84% of domiciliary care staff have received one dose of the vaccine, and nearly 75% have had a full course of a Covid-19 vaccine, as of 14 October, which we believe represents the best proxy for the workforce in scope of the policy in other settings, too. So, despite our best efforts, there is still much more that we can do. I personally feel very uncomfortable about compulsion, but I also understand the arguments on both sides when I meet many patient groups and others who tell me that, if they were in hospital or a care home or had relatives there, they would feel much better if the staff were vaccinated and were protected.

What more can we do? The Covid-19 vaccines have been approved by the MHRA as safe and effective, and we continue to send that message out. Analysis suggests that the Covid-19 vaccination programme prevented more than 100,000 deaths in England as of 20 August. We continue to have targeted engagement. The NHS plan also includes one-to-one conversations for all unvaccinated NHS staff with their line manager, with clear guidance on how to do this. We have found that such one-to-one conversations are working in some cases. We want to make sure that we listen as well, hearing concerns that are seen to be legitimate as well as concerns that are not medical reasons but other reasons that staff may have for being so hesitant. It is really important that we understand, and that was all part of the extensive consultation.

We are trying to increase the number and diversity of opportunities. We are using the booster campaign, walk-ins and pop-ups for not only the public but staff as well.

A question was asked about pregnant women. Short-term exemptions from requirements are available to those with short-term medical conditions, but also including pregnancy. For pregnant women, the exemption expires 16 weeks after childbirth. This will allow them to become fully vaccinated after the birth. We will set out these arrangements, as has been called for by noble Lords, in the guidance on exemptions.

As noble Lords acknowledged, we set out yesterday an assessment of the impacts alongside the laying of the regulations. We also published a full impact assessment yesterday for the original care home regulations, and I thank the noble Baroness for acknowledging that. As committed to by my right honourable friend the Secretary of State in the other House yesterday, we will publish a full impact assessment for the regulations as soon as possible, and before Members vote on the proposed legislation. I recognise that Peers will be keen to understand the impacts of the policy as soon as possible and as part of consideration of the regulations. However, I hope that noble Lords will appreciate the necessity of trying to move as quickly as possible to ensure that patients are protected and that workers are given as much notice as possible. We will set out the statement of impact, which noble Lords will be able to consider, and it will be published before Members cast a vote.

We have done a number of things on vaccine hesitancy, and I have laid them out already. We want to encourage as many people as possible to take up the vaccine ahead of the regulations, which is one reason why we have the grace period until 1 April next year. The individual worker maintains a choice as to whether they decide to have the vaccine. Even if they choose not to have the vaccine, the registered person may redeploy them to a non-patient-facing role. When that is not possible, the worker cannot be employed or otherwise engaged by the registered person. This is incredibly important when it comes to patient-facing staff, especially for the families of those patients who are deeply concerned that their loved ones may be infected by unvaccinated staff.

I was asked how the measure will be enforced. On the approach to vaccination requirements, it is the CQC’s role to monitor and take enforcement action. At the time of registration and when inspected, health and care providers would need to demonstrate that they have effective systems in place. There are a number of measures in place to support care home workers. The majority of care home staff are now fully vaccinated, but there are a number of different programmes. Given the time, I shall not go into them but, if noble Baronesses would like more details on those encouragement programmes, I should be happy to write.

Photo of Lord Campbell-Savours Lord Campbell-Savours Labour 2:41 pm, 10th November 2021

My Lords, if, after Friday, without the knowledge of management as to vaccination, an unvaccinated person working in a care home knowingly or unknowingly transmits the virus to a care home resident, does not the act of transmission constitute a criminal act under a legal definition of assault? Would not an action, whether civil or criminal, be against the care home worker personally and not the care home itself, which would be an innocent party? This is an important issue and, if the Minister feels unable to answer me today, perhaps he could write to me.

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

I thank the noble Lord for giving me notice of his question just before we came in. I tried to get an answer as quickly as possible, and I apologise that that answer has not arrived. I want to make sure it is absolutely right and that I am certain that I do not mislead the House unintentionally.

Photo of Baroness Walmsley Baroness Walmsley Co-Deputy Leader of the Liberal Democrat Peers

My Lords, as we move towards 1 April, I want to raise the issue not just of the concerns of staff, which the Minister has rightly mentioned, but the concerns of patients. Could patients in a ward, an NHS clinic, primary care or any other health setting be informed as to which members of staff have not been vaccinated? Would they then have the right to politely request that they are treated only by vaccinated staff?

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

The noble Baroness makes a very interesting point and an interesting suggestion. I am not quite sure of the details absolutely on those issues—as I said, further guidance will be published. But I promise to write to her, as she so gallantly intimates or hints.

Photo of Lord Framlingham Lord Framlingham Conservative

Does the Minister appreciate that quite a lot of people find the idea of compulsory vaccination absolutely intolerable, for all sorts of reasons, however beneficial it may be? This is a serious move for the whole country. Yesterday, in the House of Commons, I believe that the last Secretary of State said that he would not mind the same conditions being applied to flu. Just where does this end?

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

I thank my noble friend for the question. As noble Lords will know, I see myself as a bit of a civil libertarian. Personally, I have asked a number of questions internally about the whole issue of compulsion. It is a very difficult issue, but I understand the arguments on the other side—that we want patients to feel safe and feel that they are looked after by staff who have been vaccinated. Stakeholder analysis and round-tables came out in favour of compulsion on the Covid vaccine and boosters. When it came to flu, interestingly enough, there was a significant disagreement on the practical timing of the flu vaccine supply and the vast majority of doses being available. We have promised to keep it under review, but that is not mandated at this stage.

Photo of Baroness Watkins of Tavistock Baroness Watkins of Tavistock Deputy Chairman of Committees

My Lords, I declare my interest as a mental health nurse, as outlined in the register. I am concerned about the unintended consequences of making vaccines mandatory for healthcare staff, despite the fact that I fully support the vaccine and have had three doses myself. It is a relatively small number of healthcare staff who are not vaccinated—I accept that it varies across the country—but is it right to give no authority at all to boards in trusts to decide the best way forward for the minority of staff who do not wish to be vaccinated? I am concerned that there will be unintended consequences associated with a lack of care staff, particularly nurses, in mental healthcare environments, which may result in poorer care for patients than if we carefully supported that small number of staff in working perhaps with patients who do not want to be vaccinated themselves.

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

I start by thanking the noble Baroness, not only for her question but for the conversations that we have had to help my understanding of the subject and the consequences of some of these actions. I welcome the expertise from across the House when it comes to a number of health-related issues.

The consultation quite clearly said that many felt that vaccines remain our best defence against Covid-19 and that the vaccination programme has prevented thousands of hospitalisations and deaths in the UK. The more staff who are vaccinated against Covid-19, the more likely it will be that vulnerable people in their care, and other colleagues, are protected. Several studies have provided evidence that vaccines are effective at preventing infection and transmission—and beyond preventing infection have an additional benefit of reduced transmission by those individuals who become infected despite vaccination because of a reduced duration or level of viral shedding.

On the specific question, I am sure that the noble Baroness recognises—as I know from when we discussed these issues—how complex this issue is. There are ethical and health issues, and the concerns of patients and their families, who feel much more comfortable about being treated by staff who are vaccinated.

Photo of Baroness McIntosh of Hudnall Baroness McIntosh of Hudnall Deputy Chairman of Committees, Deputy Speaker (Lords)

My Lords, I think that there are probably very few people, apart from hardened anti-vaxxers, who do not accept that vaccination is good and that it has done a huge amount to reduce the impact of the pandemic, which has had such devastating effects. However, following on from the question from the noble Baroness, Lady Watkins, it would appear likely that there will be not unintended but predictable and intended consequences as a result of this policy, which is that some NHS staff, and, more immediately, some social care staff, will simply give up doing what they do. In those circumstances, what advice is the Minister or his Government offering, particularly to private sector care homes, as to what they should do if faced with staff losses other than simply to reduce their capacity to take in new patients?

I noticed that the Minister did not pick up the question from the noble Baroness, Lady Brinton, about the example that people in public life—I name nobody in particular—can set by wearing their masks, appropriately, on all occasions when it is sensible to do so. What encouragement can he offer to the rest of us about further examples being set on that front?

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

There clearly are concerns. These were expressed in the stakeholder engagement that occurred with both the social care sector and other sectors that will need to bring this in from March next year—we are bringing it in now but with a grace period until next March. A lot of this engagement and consultation discussed how we can support staff who are unwilling to be vaccinated as well as understanding their concerns and whether employers see these as legitimate.

Thinking back to the beginning of the crisis, one of the reasons this was called for in care homes as quickly as possible was the data from the early part of the pandemic, when there were a disproportionate number of deaths in care homes. A number of people, including patient groups and families of patients, were quite adamant that if their relatives were in a care home, they wanted to make sure that they were being looked after by staff who had been vaccinated.

There is another vaccine that is a condition of deployment, that for hepatitis B. I have asked medical staff whether they are concerned about this and a number have said no, because they are already compelled to have the vaccine for hepatitis B. That is a condition of deployment and staff see this vaccine as just as essential. That assuaged some of the concerns I had over compulsion. These are difficult, unprecedented times. We would not ordinarily want to go with compulsion, but the health of the nation is at risk and many people want to feel much more reassured that they, or their family members who are receiving care, are looked after by people who have been vaccinated.

Photo of Lord Scriven Lord Scriven Liberal Democrat

Evidence-based policy is really important on this. Statistics from the Nuffield Trust show that, with the mitigations that healthcare and hospitals are putting in place, hospital-acquired Covid rates have been coming down since the middle of the year, while rates in the community have been rising. The reason for that is that the mitigation includes face-covering measures which, as the NHS Chief Nursing Officer, Ruth May, said in July,

“will remain in place across healthcare settings so that the most vulnerable people can continue to safely attend hospital”.

If that is the case, why was the Prime Minister not wearing a face covering when in a hospital this week?

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

I thank the noble Lord for that question and other noble Lords for their questions. I am not the Prime Minister’s keeper; it is as simple as that. We all decide for ourselves. I wear a mask whenever I can and when I talk to different people, I make sure that we are seen to be wearing masks. I thank noble Lords across the House who are leading by example by wearing a mask.

Photo of Baroness Pitkeathley Baroness Pitkeathley Deputy Chairman of Committees, Deputy Speaker (Lords)

Patients in care homes and hospitals suffered very badly from not receiving visitors during the three lockdowns. Family ties were strained and a lot of extra distress was caused. From next April, if all, or the majority of, health service staff are vaccinated, what plans do the Government have for ensuring that visitors do not bring Covid into hospitals and care homes?

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

In many cases, that decision will be left to the individual trust or care home. We know that a number of care homes and different trusts are already concerned about unvaccinated visitors. Many will know already that during the previous lockdowns it was very difficult to visit your loved ones in hospital. I was not able to see my father between January last year and when he died last September. It was incredibly challenging, but we understood the reasons given by the care homes.

Photo of Lord Watts Lord Watts Labour

The wearing of masks is a public health issue. It should not be left to individuals to make a decision on whether or not to wear a mask when they are coming into contact with vulnerable people. Can the Minister explain why the Prime Minister takes the view that he does not need to wear a mask?

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

I thank the noble Lord for pressing on that point, as a number of others have. I am assured that the Prime Minister and his team followed all the rules that they were required to follow in that hospital, whether about face masks or otherwise. This is what I have been informed and it is all I can report.

Photo of Baroness McIntosh of Hudnall Baroness McIntosh of Hudnall Deputy Chairman of Committees, Deputy Speaker (Lords)

Since we have a little time left, could I ask the Minister to go back to the question of the support that care homes, hospitals and other healthcare settings may need in the not unlikely event that they will lose staff as a result of this policy? I completely understand that vaccination is highly desirable and that the intention is to encourage people to be vaccinated. However, it is pretty clear that some will not be and that will have an impact. What support will be on offer in healthcare settings to people who are having to cope with the impact of losing staff as a result of this policy?

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

In consultation with the social care sector and the wider NHS, including trusts, discussions have looked at the impact and what would happen, but also how to make the message more positive, how to encourage staff to take up vaccines and how to listen to their concerns. In some cases, employers have said that they do not feel that staff have given a legitimate reason for not taking up the vaccine, but they are also under pressure from patients’ families to make sure that they employ care staff who have been vaccinated. They are trying all the different areas of persuasion, including targeted campaigns and one-to-one conversations in some cases, to encourage them as much as possible. At the end of the day, even before the introduction of vaccinations as a condition of deployment, many care homes were already trying to push their staff to take vaccinations because they are concerned about their patients.

Photo of Lord Scriven Lord Scriven Liberal Democrat

As we have time, the Minister has just said from the Dispatch Box that the Prime Minister was following the rules of the trust he visited. That trust says on its website that you must

“wear a face covering when you enter the hospital until you leave”, and adds:

“You must ensure that you wear your covering or mask throughout your visit and you must not remove your face covering/mask or kiss your loved one.”

By not wearing a mask, in either a clinical or non-clinical area, how was the Prime Minister carrying out the policy of that trust to try to save vulnerable people from being contaminated with Covid-19?

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

Whenever I have visited hospitals during the lockdowns or restrictions, we have sought advice from the staff around us. We have asked what measures are appropriate and whether we should keep face coverings on at all times. There have been times when they have said that, in particular areas, you can take your mask off. I was not at the visit yesterday, as I am sure the noble Lord will acknowledge—in fact, I was here answering questions—so I cannot go into detail. However, having visited hospitals myself, I am aware that you go in wearing a mask by default, but there are times when staff say, “In this area, you can take it off”.

Photo of Lord Campbell-Savours Lord Campbell-Savours Labour

Is not the answer to the question asked by my noble friend that the Prime Minister was acting irresponsibly and was wrong?

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

I am afraid that I was not there, so I do not know what advice he had been given at that moment by that particular trust. Noble Lords can do trial by TV as much as they like, but while you go in with a mask on by default, when you are there with workers from the NHS who are often giving advice, they may say at times, “In this part, it’s fine. You do not need to do that.” That may well have been the case, but I am afraid that I do not know the details.

Sitting suspended.