Commons approves the draft Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) Regulations
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The Minister for Care (Helen Whately): I beg to move, That the
draft Health and Social Care Act 2008 (Regulated Activities)
(Amendment) (Coronavirus) Regulations 2021, which were laid before
this House on 22 June, be approved. As we head towards a winter
where care homes may have to battle with covid and flu, the
question we should ask ourselves is this: what more can we do? Over
the last year and a half, covid-19 has sadly taken many thousands
of lives, particularly the...Request free trial
The Minister for Care (Helen Whately): I beg to move, That the draft Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) Regulations 2021, which were laid before this House on 22 June, be approved. As we head towards a winter where care homes may have to battle with covid and flu, the question we should ask ourselves is this: what more can we do? Over the last year and a half, covid-19 has sadly taken many thousands of lives, particularly the lives of older people and those with underlying health conditions, and particularly the lives of those who need the kind of care received in a care home. There have been more than 40,000 deaths among care home residents. They were mothers and fathers, grans and grandads, brothers and sisters, sons and daughters. Sadly, we have lost some of our dedicated care workers, too: despite all the efforts that have been made by care homes and their staff, local authorities and by us in Government to keep covid out, despite personal protective equipment, despite testing, despite isolation. Throughout the second wave, care homes used 26 million tests and—
Sir
Christopher Chope
(Christchurch) (Con)
Mr Deputy Speaker (Mr Nigel Evans)
Helen
Whately
Mr
William
Wragg (Hazel Grove) (Con)
Helen
Whately I know that some hon. Members may wish to delay this debate, because they wish to review—
Mr Wragg “A full Impact Assessment has been prepared”. If it has been prepared, it cannot currently be in preparation. So where is it?
Mr Deputy Speaker (Mr Nigel Evans)
Helen
Whately
Mr
Mark
Harper (Forest of Dean) (Con)
Helen
Whately
Helen
Whately
Mr Harper
Helen
Whately As I was saying, throughout the second wave care homes used 26 million tests and 1.2 billion items of personal protective equipment, yet still we saw outbreaks in many care homes during the winter and 14,000 deaths from covid among care home residents. But there is one thing now making a huge and crucial difference, a major advance that is unequivocally saving the lives of care home residents and staff from this cruel and pernicious virus, and that is vaccination. I have spoken to residents who were in tears of joy and relief as they were vaccinated, as they at last had their own defence against this virus. So far, the vaccine roll-out to residents and staff in care homes has been a big success story. The Joint Committee on Vaccination and Immunisation made residents and staff in older age care homes the highest priority as soon as vaccines were available, and the NHS hit its target of offering the first dose to all care homes by the end of January, which was a fantastic effort.
Sir
Christopher Chope
Helen
Whately Our vaccination teams have gone to great lengths to support and encourage those who have been worried about the vaccination, along with care home managers and care colleagues. I am sure that Members will join me in thanking everyone in the NHS, local authorities and care homes who have worked so hard together to achieve such levels of vaccination.
Helen
Whately
Mr Harper
Helen
Whately
Sir
Desmond
Swayne (New Forest West) (Con)
Helen
Whately
Rachael
Maskell (York Central) (Lab/Co-op)
Helen
Whately
Mr Wragg
Sir
Christopher Chope
Helen
Whately
Sir
Christopher Chope
Helen
Whately
Mr Wragg “A full impact assessment of the costs and benefits of this instrument is available from the Department of Health”. It gives the Department’s address and indeed the website on which the assessment is supposedly published. So is the explanatory note in the instrument correct or not?
Mr Deputy Speaker (Mr Nigel Evans)
Helen
Whately
Sir
Christopher Chope
Mr Deputy Speaker
Helen
Whately The Scientific Advisory Group for Emergencies recommends that 80% of staff and 90% of residents should be vaccinated in any care home, at a minimum, to provide protection against outbreaks of covid. While the majority of care home workers have now been vaccinated, our most recent data has told us that only 65% of older-age care homes in England were meeting that safe minimum level, and the figure fell to 44% in London. That is why the instrument is being put forward today. It means that, by November, subject to parliamentary approval and a subsequent 16-week grace period, anyone entering a Care Quality Commission-registered care home in England must be vaccinated unless an exemption applies. That will apply to all workers employed by the care home, those employed by an agency and volunteers in the care home. Those entering care homes to undertake other work, for example, healthcare workers, tradespeople, hairdressers and CQC inspectors, will all have to follow the regulations. The introduction of this policy has not been taken lightly. We have consulted extensively, including with a wide range of valued stakeholders, and used their feedback to inform this legislation. We recognise that some people feel that workers should have freedom of choice about vaccination, while others do it as a duty of care to protect the people most at risk. I know from speaking directly to people who receive care and to those who have relatives living in care homes that, although they might not be sure about requiring all care workers to be vaccinated, they are sure that they, individually, want to be cared for by someone who has been fully vaccinated. Many people have little choice about who cares for them.
Mr Wragg “a majority (57%) of respondents did not support the proposal”. How, therefore, does the feedback show that there is support for it?
Helen
Whately One thing that we are already seeing is that some care homes are bringing in the policy themselves.
Mark
Jenkinson (Workington) (Con)
Helen
Whately
Jim
Shannon (Strangford) (DUP)
Helen
Whately Never again do we want to be back in the situation of having covid outbreaks across hundreds of care homes, with those who live and work in them losing their lives to this virus. Vaccination is a safe and effective way of preventing the spread of covid. The majority of care home workers have already taken up the vaccine, and it is essential that all care home workers who can have the vaccine do so in order to protect those in their care. The original scope proposed in the consultation was to apply the policy only to care homes that look after older people, but following the consultation it became clear that there was a compelling case to extend the obligation to all care homes that provide care to the most vulnerable, for example young adults with learning disabilities. There was also significant support for broadening the scope of the policy to include all those who come into contact with residents, and there was support for including all those who enter care home residences in any capacity.
Sir
Graham
Brady (Altrincham and Sale West) (Con)
Helen
Whately We listened to the responses and made the decision to apply the policy to all people working inside care homes, unless they have a medical exemption or are not eligible for vaccination—under-18s, for instance. There are further exemptions, including people providing emergency assistance or undertaking urgent maintenance work, and family or friends visiting. Guidance will be published that gives more detail about the exemptions, which will reflect the green book on immunisation and clinical advice from the JCVI.
Sir
Graham
Brady
Helen
Whately When somebody, including a tradesperson, comes into a care home, they might spend significant time in the care home, move around and move from room to room, so they might be a significant infection risk to the care home. They might also move between one care home and another, particularly if they are a specialist who serves multiple care homes. We know there is a risk when individuals are moving between care homes, so there is a clinical case for the regulations. We also heard from providers responding to the consultation that they want a consistent approach for people who enter a care home to work, and these regulations will make it more straightforward for them to implement that.
Dr
Luke
Evans (Bosworth) (Con)
Helen
Whately
Helen
Whately I put on record my sincere thanks to care workers across the country, not just for their work throughout the pandemic but for all they bring to our health and care services. People working in care homes have played an incredibly important role in caring for those most at risk from this terrible virus. The vaccine is working, with more than 14,000 lives saved so far. It is only right that we take every possible step to protect those most at risk. As I said at the outset, we must all ask ourselves what more we can do to protect care home residents, and these regulations are what we can do.
Mark
Jenkinson
Madam Deputy Speaker (Dame Rosie Winterton) 18:18:00
Dr
Rosena
Allin-Khan (Tooting) (Lab) These are not the words of a politician or even a doctor; they are the words of a daughter who had to say goodbye to her father during the pandemic. I am eternally grateful for the care my father received, which went above and beyond what I could have expected. Carers showed my family and me what humanity truly is: changing their shifts to be with him, being on the end of the phone whenever we needed them, and facilitating whatever they could for us to be with him in his last moments. I can never repay my father’s carers for the humanity that they showed him as his condition worsened while my family could not be by his bedside. Carers were scared, and many still are. The idea of passing a deadly virus on to the people in their care tormented them, and that is why we are here today. The idea that care workers do not think about the day-to-day safety of the people they care about is an insult. From my own experience, I know that their residents are of the utmost importance to them. So often poorly paid, they put in the gruelling work because they truly care. To argue that they do not neglects their fears. We want everyone working in a care home to take up the vaccine, which is safe and effective, but we are not inclined to support these proposals or the case for compulsory vaccination. There are serious warnings from the care sector that the Government’s plan could lead to staff shortages in already understaffed care homes. This would have disastrous consequences for the quality of care. It is vital that we examine the current reality of life on the frontline in care settings. During the pandemic, Unison surveyed its members, who shared that they were feeling more anxious and depressed than before owing to the fear of passing the virus on to their relatives and those under their care. Many felt that their management were not equipped to support their needs. Resoundingly, care workers just wanted people to listen to their experiences and the challenges they were experiencing without, and I quote, “fear of being singled out as a troublemaker”.
Rachael
Maskell
Dr Allin-Khan We have to listen to our care workers today. For the young, pregnant carers worried about their next pay cheque, will these proposals make them more secure? For all those carers from communities who have lost trust in authority, will the threat of losing their jobs instil more trust? For all those carers who have loved and cared for their residents but have concerns about the vaccine and have not had anyone answer their questions, are they being told that their dedication is suddenly irrelevant? To understand why there may be hesitancy among care home workers to take up the vaccine, it is important to understand the health inequalities that much of the workforce face. Ethnic minorities are over-represented in the adult social care workforce, with 21% of all care staff coming from a minority ethnic background. Negative experiences of a culturally insensitive health service, the higher rates of death from covid for people from black and south Asian communities, and a lack of representation of minority groups in vaccine trials and wider health research all serve to build distrust in the health system. These are some of the communities that have been hit the hardest during the pandemic. The disproportionate use of coercive and restrictive practices on minority communities also, importantly, erodes trust in the system. Black people are four times more likely to be detained under the Mental Health Act 1983 than white people, despite making up a much smaller percentage of the overall population. With trust so low, that creates hesitancy, but this can be overcome through effective communication and an understanding of the issues that have created it. Further coercion and punishment through the threat of being dismissed from employment only reinforces the reasons for hesitancy in the first place.
Steve Brine
(Winchester) (Con)
Dr Allin-Khan
Dr Allin-Khan These measures will disproportionately punish groups whose needs are already rarely reflected in mainstream health services or the labour market. Respectfully listening to concerns and offering practical support would not only tackle vaccine hesitancy; it would also help to rebuild trust in health services, which in turn could eventually lead to reduced health inequalities for all minority groups. Let us be clear: vaccine hesitancy is entirely different from being an anti-vaxxer. Vaccine hesitancy is a challenge for the Government to tackle. It is harder work. There is no quick fix. The Government are trying to make an incredibly complex issue into a black and white one, and that does nothing to pay respect to the sacrifices that care workers have made since the start of the pandemic. More must be done to encourage uptake of the vaccine.
Dr
Luke
Evans
Dr Allin-Khan The UK Government should learn from the fantastic work of the Labour-led Welsh Government, who are running the fastest vaccine programme in the world and have vaccinated a far greater proportion of their staff than England; yesterday’s figures showed that almost 95% of care home residents and 88% of care home staff are double vaccinated. Wales has rejected compulsory vaccinations and instead chosen to work closely with the care sector to drive take-up, as well as valuing the workforce with a proper pay rise. That is the sort of leadership that is needed here. A failure of leadership here will place the care sector in an even more precarious situation, with even fewer staff than at present. There are serious warnings from the care sector that the Government’s plan could lead to staff shortages in already understaffed care homes. That would have disastrous consequences on the quality of care. More than 100,000 posts in the care sector are currently unfilled, with recruitment and retention already extremely difficult due to low wage levels for difficult and demanding jobs. Not only could this plan have a disastrous impact on those relying on care, but the stress and trauma placed on their relatives will affect so many across the country. We already have a social care crisis. Let us not deepen it. These proposals are at odds with the Government’s decision to throw caution to the wind by making social distancing and mask wearing optional and up to individuals to decide on. It makes no sense. Surely forcing workers to receive a vaccine is at odds with the individualism that the Government seek to promote at every opportunity. It seems odd that care workers are being singled out. Why is there a different rule for them? Are the Government hoping that the public will simply forget about their failure to protect care homes over the past year? Is that what is going on here? Forcing carers to choose between losing their job and taking a vaccine that they are afraid of is inhumane. These are people who often work for less than the minimum wage. They are incredibly vulnerable people and their voices must be heard. Many of these people have lost multiple family members during the pandemic. They are being asked to put their faith in a vaccine that they are afraid of. The Government need to be doing more to tackle misinformation, promote the positive benefits of taking up the vaccine and support care home staff to do so. They have not been doing enough to support care workers who have done so much during the crisis. They should be focused on driving up standards and staff retention by treating care workers as the professionals they are, with improved pay, terms and conditions and training. We have a moral imperative not to force people to take a vaccine that they are afraid of, so I urge the Government to listen to our care workforce. Surely they deserve at least that after the last year.
Madam Deputy Speaker (Dame Rosie Winterton) 18:29:00
Sir
Christopher Chope
(Christchurch) (Con) Both the Welsh and Scottish Governments, as I understand it, are against this type of regulation. The Minister told us that other Administrations were watching, but this Administration should be watching what the other Administrations are doing and following their lead. I must say that this was probably the most depressing performance from a Minister that I have listened to in this House. She showed a cavalier disregard for the conventions and courtesies of this House, and, as she has admitted to, she completely breached the rules under the Government’s better regulation framework, which is designed to inform decision making for regulations that affect businesses and individuals in this country. When criticised, the Minister’s response is best described as dumb insolence, and that is just not good enough. One question that I would have liked to ask in an intervention was: what is the Government’s rationale for not requiring care home residents to be vaccinated? These regulations were laid on 22 June. There was an accompanying explanatory memorandum that expressly referenced a full impact assessment. It said: “A full impact assessment of the costs and benefits of this instrument is available from the Department of Health and Social Care…and is published alongside this instrument and its Explanatory Memorandum”. The Minister has not explained what has happened to it, whether it ever existed, and whether it contained information that she found embarrassing and has therefore been suppressed. An impact assessment is not an optional extra. As the Secondary Legislation Scrutiny Committee made clear in its report of 6 July: “An impact assessment is a fundamental tool for those who wish to scrutinise legislation before nodding it through”. Indeed, an impact assessment should be cleared by the Minister before the proposals are brought forward. The Government’s better regulation framework principles, set out in March 2020, says: “Where government intervention requires a legislative or policy change to be made, departments are expected to analyse and assess the impact of the change on the different groups affected – which should generally take the form of an impact assessment.” That has not happened. Why has it not happened? I put down some parliamentary questions about this, because I feared that we would not get the impact assessment, and those questions have received holding answers rather than substantive answers. One asked what estimate he has made “of the number of employees in…England who will face dismissal from their employment as a result of the enactment of regulations…and whether those staff will be eligible for compensation”. There was not an answer to that, and there has not been one so far today. I then asked what estimate has been made “of the number of staff employed in care homes in England who have not been vaccinated against covid-19 for (a) clinical reasons and (b) reasons of personal choice including religion, belief and conscience”. Again, no answers—not even to parliamentary questions. How can we hold the Government to account if they will not even answer our questions? My constituents are absolutely livid about what is being proposed. I will not quote extensively from a letter that I received from Mr Davis from Ferndown, but he says that it is completely wrong and unethical and that it makes no sense. An NHS consultant in Christchurch says that, “Mandatory vaccination would be crossing the Rubicon on medical choice, medical confidentiality and bodily autonomy.” These are vital elements of the right to privacy. A Christchurch care home manager to whom I have spoken has said that the whole proposal “undermines” the need for parity of esteem between care workers and NHS workers. You may have seen, Madam Deputy Speaker, the article in the British Medical Journal on 8 July, which says that, while it may reduce the risk of transmission, vaccination “is not a panacea for safety”. Why are we not saying that people who have had previous infection and got immunity from that are exempt from these regulations? I think that this is an unnecessary, disproportionate and misguided proposal. I hope that, given what has happened in Scotland and Wales, we reject these regulations and put the Minister out of her misery. 18:34:00
Dr
Philippa Whitford (Central
Ayrshire) (SNP) [V] As chair of the all-party parliamentary group on vaccinations for all, I totally support vaccination and I draw attention to our recent report, published in May, on how to improve the uptake of all vaccines. Virtually all our expert contributors highlighted the dangers of making vaccination legally mandatory because while it may force uptake among some, it tends to increase distrust and suspicion of vaccines and drive those who are hesitant to become vaccine refusers. In Scotland, virtually 100% of care home staff are fully vaccinated with both doses, without mandating it. That has been achieved through three key policy approaches. First, as part of developing caring as a profession, care home staff in Scotland are now registered, which means we have information on who we are trying to reach. Secondly, when the Scottish Government became aware that care home staff were being deliberately targeted with disinformation on covid vaccines, they arranged expert webinars for staff with our chief medical officers and NHS director. Thirdly, as soon as the Pfizer vaccine became available in December, care home staff were vaccinated at the same visit as residents. That not only improved convenience, but created a strong sense of solidarity between colleagues and with the vulnerable people they care for. The Scottish Government faced considerable criticism at the start of the year for spending so much time and effort on care homes rather than pushing ahead with mass vaccination centres, but it has paid off. We hear that in England, 86% of care home staff have received a first dose and 75% are fully vaccinated, although I understand that that hides a wide variation in uptake. While repeat visits have now been provided to care homes in England, that was not national policy at the start of the programme when many providers reported difficulty in accessing vaccine appointments for their staff. The UK Government have never taken forward the principle of care staff registration and professionalisation in the care sector. As has been highlighted, staff in England are not even paid the real living wage. Care home staff have faced a very difficult time in the last 18 months and we all owe them a great debt of thanks. I still believe that locally targeted support, information and persuasion would be more successful in convincing care home staff than heavy-handed legislation, which threatens their jobs. We all agree about the need to get the highest rate of vaccination possible to protect care home residents. The difference is in how to get there. Our APPG report makes it clear that the most important approach when dealing with communities with hesitancy is not to make assumptions about the cause but to listen to them and then act on what they are seeking. Apart from my concerns about the principle of mandating vaccination, I call on the Minister to clarify that the legislation applies to England only. The Scottish Government do not accept the principle of making vaccines mandatory, nor do they see the need for such an approach after the fantastic uptake by our care home staff. 18:38:00
Mr
Mark
Harper (Forest of Dean) (Con) I should say first, before I touch on the specific proposals in front of us, that I agree with the Minister when she says it is very important that we protect those who live in a care home setting. We have all seen the damage over the past year from covid, and it is fantastic that we can now vaccinate those residents, because we know that covid is a disease that is focused on wreaking the most havoc on those who are older and those with health conditions. It is fantastic, as the Minister said, that 96% of residents of care homes have had a first dose and 93% a second dose. That means they have very substantial protection against serious disease, hospitalisation and, tragically, death, and that is fantastic. Everyone in the House—I think I can speak for everyone—wants to make sure we protect people in care homes. This debate is about how we best do so. Let me just take the arguments that the Minister set out. First, I agree with what the hon. Member for Central Ayrshire said in terms of persuasion. I have certainly talked to my local health professionals, and they very much advocate listening to staff who are hesitant, understanding the reasons and then trying to address those reasons. I know that the Minister has said that a significant number of healthcare staff have been vaccinated, but it is not consistent across the country. In some places it will be 100%; in other places, it will be much lower. It seems to me that we therefore need to focus on those areas where take-up is much lower and understand what the barriers are, rather than insisting that people have got to do something that they clearly have some concerns about. That may be because they are from a particular ethnic minority, and we know there is differential vaccine take-up there, or it may be that they are a younger female of childbearing age, and they are concerned—I think erroneously—about things they read about fertility. We need to deal with those concerns. We cannot threaten somebody who is young and worried about fertility and insist that they take a vaccine they are worried about without dealing with those concerns. I think we all agree about that; this debate is about how best to do it.
Mr
Steve
Baker (Wycombe) (Con)
Mr Harper The proposals will have a very significant impact on hundreds of thousands of people and many thousands of businesses—it is a significant step; it is the first time that we will have mandated in law effectively compulsory vaccinations—and it is frankly offensive that it is being debated in a 90-minute statutory instrument debate in the House. From the name of the regulations it does not leap out as to what they are, and I think many colleagues were unaware of the fact that we were being asked to vote on this measure today until it was drawn to their attention. That is the first point. The second point is that if the information is available, even if it is imperfect—I accept that it will be imperfect and there will be things that we cannot be certain about—it is the Minister’s duty, if she has that information, which one of these documents says she does and one of them says she does not, to put what she has in front of the House. She should sign it off—she is responsible for that—and allow us to see it before we are asked to vote on the regulations. I am afraid it is an abuse of the House to ask us to vote without that information. If this was genuinely an emergency, that might be acceptable, but, as I have already said, these regulations, if passed, do not come into force for 16 weeks. That is November. There is ample time to complete the impact assessment and bring the regulations back before the House. Even if that was in September, we could then have a tighter deadline and still deliver the legislation before it is currently scheduled to become law. I think that would be preferable. It is worth saying that I could have been persuaded, although I have reservations, to support mandatory vaccination for care home staff, if a good case had been made about the risk reduction to residents. I did not actually hear the case being made about the risk reduction to residents. It is not set out in any of the documents in front of us, and the Minister did not set it out in her remarks, but I remain open to that, which is why I would urge her to bring back further proposals later. However, that is not at all what is in front of us. These proposals are incredibly broad: they apply to everybody who enters the premises of a care home. Even if they never see a resident or are there only for moments, the care home will be prohibited by law from allowing them to enter, and will have to ask them intrusive questions about their health status, perhaps including what health conditions they have that mean they do not have to get a vaccination. That care home will then have to ask the employer, and those businesses that want to transact with care homes will then have to ask those intrusive questions of their employees. The scope of these proposals is massive, and is particularly troubling given what the Government said yesterday in the House about domestic vaccine passports. Many of us are concerned that insisting that employers ask their staff intrusive questions about their health conditions, when there is no good reason to do so, is the thin end of a wedge.
Craig
Mackinlay (South Thanet) (Con)
Mr Harper I will bring my remarks to a conclusion, because Mr Deputy Speaker wants to make sure that we get everybody in. My final point is that, coming back to the consultation that took place, it is very clear that most of the people responding did not support these proposals. They were very concerned about them; certainly, the care homes and those involved in the sector who I have heard from are very concerned about them. The proposals do not command wide support, so I say to the Minister that I would listen to the concerns that are being expressed, take these proposals away, and come back with some well-thought-through proposals to secure the support of the House. If she presses them to a vote today, I regret to say that I will be forced to vote against them.
Mr Deputy Speaker (Mr Nigel Evans) 18:47:00
Munira
Wilson (Twickenham) (LD) As we have heard, the care sector is facing chronic staff shortages, and making vaccines mandatory has a real potential to exacerbate those acute shortages. The Government must do much more to convince and persuade care workers to get vaccinated. As many experts have said and as we have heard already, coercion is usually ineffective or, worse, counterproductive, and risks eroding trust in the sector. Indeed, the care sector has a long history of being overlooked and underfunded. Some 1.6 million social care workers earn less than the living wage; a quarter of the workforce are on zero-hours contracts; and there is a lack of any progression or career prospects. There is a real concern that those who are vaccine-hesitant may simply leave the profession rather than get vaccinated, particularly as we know that there are serious shortages in other sectors—such as hospitality—that are offering more competitive pay. With 1.5 million older people currently not getting the care they need, already overstretched staff will become even thinner on the ground. Care providers, many of whom are already in a fragile state as a result of the pandemic, could find themselves having to deal with the costs of tribunals and legal challenges as a result of individuals losing their jobs. What support and resource is being provided to the sector to implement this policy? Coercion is not an effective way to overcome hesitancy. Compulsory vaccination is a blunt tool for a complex issue, and research has highlighted that pressuring care workers can have damaging effects leading to the erosion of trust, worsening concerns about the vaccine and hardened stances on refusing vaccination. Indeed, digging into the detail shows that the rate of uptake may not be as bad in some places as it initially seems. The data is somewhat encouraging in that there is a significant disparity in the percentage of staff who have taken their first jab and not their second. For instance, Wandsworth has the lowest uptake rate, with 70% of staff having had their first jab but only 53% having had their second. This could indicate that Government and NHS initiatives are bearing fruit, and that mandating vaccination could therefore be premature. Alternatively, it might suggest there is a problem with trying to get care workers back to have their second jabs. This all suggests a much more complex picture, for which this blunt tool is not the answer. As others have said, we risk going down a slippery slope to chip away at people’s rights and freedoms to make their own health choices. This decision sets a precedent and must not be taken lightly. That leads me to my final point. In part, we have arrived at this situation precisely because the care sector has been overlooked for so long. It has long been a Cinderella service and a poor relation to the NHS, and yet again, we see that this legislation applies only to care home workers and not NHS staff, so it feels discriminatory to many in the care sector. I come back to where I started. I want to protect the most vulnerable, but I fear that these measures will do more harm than good and that we risk a mass exodus of staff from an already overburdened, overstretched and underfunded sector. In March last year, when my Liberal Democrat colleagues in the other place and I were asking searching questions of Ministers about testing and PPE to protect care homes, there were no answers. The truth is that the tragedy we have seen unfold in our care homes throughout the pandemic resulted in thousands of excess deaths because the protective ring that Ministers talked about went in far too late. This legislation we are being asked to support is a reaction to Government inaction and failure to protect care homes, and they continue to drag their feet on reforming the sector properly. Coercion and an assault on fundamental rights and liberties should not be the response to this. We must encourage, empower and support people to make the right decision to get vaccinated, and we must pay and value our heroic care staff properly, rather than pointing the finger of blame at them. 18:52:00
Sir
Graham
Brady (Altrincham and Sale West) (Con) This is a very serious innovation. Imposing a legal requirement for people to undertake a medical intervention, maybe against their will, is a remarkable change in our law. As the hon. Member for Twickenham said, it sets a serious precedent, and it is a precedent that the Minister herself slightly alarmingly raised when she said that covid and flu would be a problem as the winter approached. As yet, we are not talking about compulsory vaccination for flu, but once we begin down that road, where does it end? The scope of this measure is unnecessary. As I said in my intervention, insisting that people are vaccinated even if they will have no contact whatsoever with residents of care homes is entirely unreasonable. The application of the measure to a plumber who comes to fix a boiler, or to a trustee of a charity who may go to sit in an office but have no contact in any of the areas where residents would be, would be unreasonable. The measure is also inconsistent. Why does it apply only to care workers and not more widely in the healthcare sector?
Mark
Jenkinson
Sir
Graham
Brady I want to focus in the brief time available on a specific point: the importance of respecting religious freedom. Lime Tree House in Sale in my constituency is one of only two Christian Science care homes in the country. The rights of Christian Scientists were protected by the Labour Government when the Care Standards Bill was introduced in 2000. The then Minister, Lord Hunt of Kings Heath, gave an explicit assurance in the House of Lords: “Perhaps I may say right at the start that the Government have no intention of preventing or discouraging people from being cared for in accordance with the principles and practices of the Church of Christ, Scientist. The Care Standards Bill will not mean that Christian Science houses or their visiting nurse services will have to give medical treatment to their patients, or do anything else which would go against their religious principles...The Department of Health will consult and work with the Church of Christ, Scientist, to ensure that regulation by the commission is compatible with the church’s principles and practices.”—[Official Report, House of Lords, 28 March 2000; Vol. 611, c. 741.] Christian Scientists responded to the consultation in May. Since then, they have written to the Minister and indeed the new Secretary of State—obviously, that was very recently—but have not received a response. Clearly, there is no provision in the legislation to protect this important principle. May I ask the Minister when she responds to give an absolute assurance that the principle of religious freedom will be respected by the Government, as it was by previous Governments? Will she undertake either to introduce an amended statutory instrument in the House or, if not, will she commit to including matters of conscience in the exemptions provided for in the measure? I am talking about two small care homes, a handful of residents and a situation in which both residents and carers might prefer not to have a medical intervention inflicted on them against their will, but a very big principle is at stake.
Mr Deputy Speaker (Mr Nigel Evans) 18:57:00
Dr
Luke
Evans (Bosworth) (Con) Like many hon. Members, I baulk at the prospect of mandatory mask certification or vaccination. I have made that clear privately and to my constituents who ask about it, as I did not think that it was ethically, practically or even medically reasonable. We should always be proportionate in our response. However, I have also made it clear that there are specific carve-outs aimed at those most at risk. Indeed, when it comes to healthcare and public health, this is a prime example, given the essence of who we are dealing with: the elderly and the vulnerable. This argument boils down to rights versus responsibilities. There is a duty of care by the Government and internal providers both to patients and to members of staff. The House has to navigate the difficult path between limiting the risk to patients and residents from the spread of the virus while respecting the staff’s rights and responsibilities. In the next minute or two, including the break at 7 o’clock, I will go over a couple of principles that are in practice, and some real-world challenges that we face. According to the Care Quality Commission, when it comes to talking about vaccinations, there are three pieces of legislation that are important: the Health and Safety at Work etc. Act 1974; the Control of Substances Hazardous to Health (Amendment) Regulations 1992; and the Health and Social Care Act 2008. We are obviously dealing with the latter, but the former two measures set a precedent of safe working environments, dealing with substances dangerous to health, putting responsibility squarely on organisers and providers to mitigate that for staff and users as best as possible. I do not expect that it will be too long before we see a legal challenge, where a resident dies from covid and the finger is pointed squarely at the care home staff, or at the care home for not having vaccinated staff, given that we know the vulnerability of the elderly. There is a duty— 19:00:00 Debate interrupted. Deferred Divisions Motion made, and Question put forthwith (Standing Order No. 41A(3)), That, at this day’s sitting, Standing Order 41A (Deferred divisions) shall not apply to (a) the Motion in the name of Secretary Sajid Javid relating to the National Health Service and (b) the Motion in the name of Secretary Priti Patel relating to the Prevention and Suppression of Terrorism.—(Rebecca Harris.) Question agreed to. Debate resumed. Main Question again proposed.
Dr Evans Let us take the example of a medical student or a dental student. When a student joins a medical school, they have to have a TB check, an HIV check, a hepatitis C check and treatment to practise. While it is not a legal requirement, operationally it means that someone cannot do procedures, cannot do hospital placements and, in dentistry particularly, cannot progress. Why? A duty of care. I do not recall a huge outburst about such concerns when the 2007 Department of Health clearance guidance entitled “Health clearance for tuberculosis, hepatitis B, hepatitis C and HIV”, which was revised in April 2014, was widespread. Why? Because when people enter these professions, the overriding principle hammered in time and again is that there is a duty of care to patients, and medical schools and providers have a duty of care for their students.
Mr
Steve
Baker
Dr Evans I am a realist on this, and I want the Government to draw people’s attention to the fact that there could be difficulties. It is going to cause a problem when there are 16 weeks’ consultation, and there could be an exacerbation of problems with the workforce. I also urge the Government to pick up on what other Members have said and encourage people to take up vaccination in the first place. Fundamentally, however—perhaps this is what it comes down to for my hon. Friend the Member for Wycombe (Mr Baker)—this comes down to a duty of care to the looked-after. I ask Members to imagine that it was their grandmother, grandfather, father or mother being cared for. I would expect Members to say that they wanted the best possible protections for that individual in the institution where they were resting.
Mr Deputy Speaker (Mr Nigel Evans) 19:03:00
Dr
Ben
Spencer (Runnymede and Weybridge) (Con) We expect our health staff to have vaccinations for a variety of conditions—not just hepatitis B but things such as chickenpox for people who have not been exposed, and rubella—because we know the impact that those things can have on the patients we look after or the people we care for. We know the huge impact covid has on the most vulnerable in our society. Its lethality—its severity—is linked to frailty, and one of the most frail groups are people living in care. It is important that people are vaccinated so that, when they have asymptomatic covid, they do not unintentionally pass it on. We know that vaccination rates are not high enough to give the protection necessary to protect people in care homes, and on that basis it is an entirely reasonable and sensible approach to bring forward measures saying that people have to be vaccinated to work in that setting. However, although that might be a reasonable approach I realise that it is different from my personal experience as I have just described, because that was a pre-recruitment process that I went through, whereas what we are talking about now is a process for people who are currently in post—people who might have been working for quite some time and have a lot of years behind them—and if they do not go through with vaccination, ultimately they will be without a job. That is a big deal. It is also important to recognise that those who may decide that they do not want to be vaccinated are not evil people who should be shunned; they are people who make decisions for whatever reason about vaccination, and that is important and should be respected. Fundamentally, this SI is about risk, and I see two risks here. One is the risk of covid to people living in care settings, and that risk is very clear: there is loads of data on that—loads of data on the impact and on fatalities, and also on the protection provided by vaccination for people at risk of covid and protection in terms of reducing transmission. So, that side of the equation is very clear, but the side that is less clear is the risk in terms of staffing, and that is a critical issue. Some people will decide that not being vaccinated is more important to them than working in the care sector. I am completely unclear as to how many people will make that decision and I do not think anyone knows what that population is going to be—what the numbers are going to look like. That is a concern as we already have staffing issues in the care sector and it has been a long-term problem. Nevertheless, perhaps the only way to test this out is to bring it forward and see what happens. The 16-week run-in makes a lot of sense, but it is critical that it is monitored to see what happens with regard to staffing and retention, and if that is a big issue—if retention pressures start coming through—we will have to change course. When my hon. Friend the Minister sums up I would welcome her saying what she will do over the summer as this is being brought in to work with and engage with people in the social care sector on its impact. If there is a substantial impact, I hope that she will undertake to come back to the House after the summer recess with plans to mitigate this or change course. 19:07:00
Mr
William
Wragg (Hazel Grove) (Con) I hope, too, that the House will indulge me because, frankly, I am in despair. We could perhaps have a painting next to me of Munch’s “The Scream” to get a sense of how I feel about the conduct of Government business in this House. The Government are treating this House with utter contempt: 90 minutes on a statutory instrument to fundamentally change the balance of human rights in this country is nothing short of a disgrace. It is a disgrace, too, that no impact assessment exists. I contend that it does not exist, and if that is proven to be the case I am afraid my hon. Friend the Minister will be in a tricky position if she contends it does when it does not. The measures before us are in themselves entirely impractical. We have heard already about concerns about the workforce. I have the utmost respect for my hon. Friend the Member for Runnymede and Weybridge, as he knows, but if we were to follow his suggestion, I fear that it would be far too late to repair the damage done to the workforce of carers in this country. It is an insult to care workers in this country that all they merit is 90 minutes on a motion that nobody here seemed to know anything about last week but which we are discussing this afternoon. Meanwhile, so many of our colleagues, presumably because of the proxy vote system and the fact that they find it generally inconvenient to be a Member of Parliament, will know nothing at all about the measures on which they are voting, and that too should concern us a great deal. I will vote against these measures, if that had not been made clear from my remarks so far. I believe that 1898 was last time vaccination was mandated in this country, and following that mandate, the rates of vaccination fell. That should tell us all we need to know. We will give succour to lunatics and crackpots who advance ridiculous theories about vaccination if we mandate vaccination. The triumph of the vaccination programme has been the act of kindness that people have felt towards their fellow citizens in doing so, and we will lose that good will if we mandate it. A lady called me a week or so ago, and she was in tears on the phone. She has a condition that involves blood clots, and she associated the news about one or two of the vaccines with her condition. She is a care worker, and she was distraught. She now equates her illness and the vaccination—and the fact that she cannot get a GP appointment to discuss it, but that is a different matter—with losing her job. Is that what we are prepared to do to our fellow citizens as a Conservative Government? Absolute lunacy! We would expect this in a communist country, which partly explains why so many of our eastern European fellow citizens have the scepticism they do, knowing the nature of the state and how it can be perceived as being malevolent. This instrument is an abomination. It should be withdrawn, and the Government should stop treating this House with contempt. 19:11:00
Helen
Whately I have heard—I assure my hon. Friends on this—the strength of feeling about the impact assessment, and may I say that I apologise to my hon. Friends for the error, particularly in the explanatory notes to the regulations? I have done my utmost, as I did in my opening speech, to set out for hon. Members the situation with the impact assessment, and there is nothing further I can say on that now.
Mr Harper
Helen
Whately
Rachael
Maskell
Helen
Whately Several hon. Members have argued that we should continue the current approach to increasing uptake and indeed do more. Of course, we will continue to support care workers to take up the vaccine, but, as flagged by my hon. Friend the Member for Winchester (Steve Brine), the question is: how long do we give that? The vaccination of care home workers in England began in December last year, about eight months ago. We did take a similar approach to that in Scotland mentioned by the hon. Member for Central Ayrshire (Dr Whitford), where staff were vaccinated alongside residents in care homes. NHS teams went into care homes multiple times to offer the vaccination to staff. Indeed, we saw that that was effective and more staff took up the vaccination on subsequent visits. We also opened the national booking system to care home staff early on, before there was wider availability to everybody. We have worked with communities who have been particularly concerned and hesitant about vaccination. There have been materials in multiple languages. We have worked with faith groups. Local authorities have worked closely with care homes, alongside NHS vaccination teams, particularly care homes that have had lower vaccination rates. A huge amount has been done to raise the levels of uptake among care home staff. We then have to ask ourselves the question: what more can we do? The No. 1 reason care home staff have given us for not yet being vaccinated is that they want some more time. Well, this gives them some more time through the summer in which to get vaccinated. Some care homes, as I have mentioned, are already doing this. One example is the Barchester care home group, which has over 16,000 staff. The vast majority, over 99%, have chosen to be vaccinated. Fewer than 0.5% have chosen not to be vaccinated. But the problem, if we leave it to care homes that are on the front foot to do this, is that others will be left behind and we will see inequality, where some residents are fortunate to be cared for in a care home where all the staff are vaccinated, and others will not be so safe. That leaves us with inequality for those care home residents, who will remain at greater risk. We know that the vaccination not only protects individuals, but reduces the risk of transmission. Some hon. Members have raised the concern that care workers are being singled out in some way. That is not the case at all. This is about the setting of care homes, where we know there is the greatest risk and the greatest vulnerability to covid. This is about protecting individual residents in those care homes by requiring the vaccination of people who enter those care homes to work—so not only care home staff but NHS staff who enter care homes. This is about protecting residents in those care homes. Fortunately, at the moment, the rates are lower than they have been during peak times, but even in some of the recent outbreaks we have seen in care homes, the index case has been an unvaccinated staff member. That just emphasises the importance of us having high levels of vaccination among staff. My hon. Friend the Member for Workington (Mark Jenkinson) asked me about the data I referred to earlier, the SAGE data on minimum levels and the extent to which that is being achieved by care homes. I shared the most recent data that I have. What we do know is that there are still hundreds of care homes that have not yet met that safe threshold, which is a minimum threshold for avoiding outbreaks in care homes. I say to my hon. Friends that the question before us is: what more can we do to protect those who are vulnerable in care homes? This is what we can do and I commend the regulations to the House.
Sir
Charles
Walker (Broxbourne) (Con)
Mr Deputy Speaker (Mr Nigel Evans) Question put.
Division 53 Resolved, That the draft Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) Regulations 2021, which were laid before this House on 22 June, be approved. Statement by the Regulatory Policy Committee This is the Regulatory Policy Committee statement on The Draft Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) Regulations 2021 The Draft Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) Regulations 2021 were debated in the House of Commons today, 13th July 2021. The Department of Health and Social Care (DHSC) has not yet submitted an appropriate impact assessment (IA) to the RPC for us to assess and provide an opinion on. As a qualifying regulatory provision, an IA should have been produced by the Department, submitted to the RPC for independent scrutiny, seen by ministers and presented to Parliament. We remain open to the DHSC submitting an appropriate IA for RPC scrutiny to allow us to provide an opinion on whether it is fit for purpose or not fit for purpose. |