Health Protection (Coronavirus, Restrictions) (Self-Isolation and Linked Households) (England) Regulations 2020

Motion to Approve

Moved by

That the Regulations laid before the House on 11 December 2020 be approved.

My Lords, today we have more than a million people in Britain infected with Covid. A third are asymptomatic, and most are highly infectious. That is just too many. That is why on Monday the Prime Minister announced a new national lockdown. The measures are tough but necessarily so. They reflect not only the current case rate but the extent of the pressures faced by our health and care system.

We have over 30,000 people with Covid in hospital beds, with over 2,500 people on mechanical ventilation, and based on the infection rates of the last month and the inevitable clinical chain reaction those numbers are set to rise. Yesterday, sadly, the UK reported a further 1,041 people who had died after testing positive in the 28 days previous and, with yesterday recording our highest daily increase since mass testing began, unfortunately it is inevitable that more deaths are on their way. That is why the Government took swift and decisive action this week, introducing a national lockdown and closing schools. We take this action with deep regret—for society and for the economy—but it is necessary to respond to the grave situation that we face.

The SIs we are debating today cover the tiering system introduced following the November national lockdown. Those regulations have been amended five times to extend the geographical reach and to fine-tune the terms, and we are also debating this week’s national lockdown. Overall, these SIs tell the story of our containment of the original strain of the virus, with a tiering system that eventually proved to work. They also cover the subsequent identification of and reaction to a more transmissible strain of the virus that was far more aggressive than anything that had been seen anywhere in the world before.

The New and Emerging Respiratory Virus Threats Advisory Group spelled it out clearly: the new variant demonstrates a 70% increase in transmissibility. This means that successful measures that were previously in place such as tier 3 are no longer enough to reduce the transmission of cases. The new variant makes up around 60% of cases in some parts of England, and that is rising. Since the beginning of December, cases reported per day in the UK have steadily increased, with on average 15,000 reported in the week of the 6 December, 34,000 in the week of 20 December, and a shocking 57,000 in the week to 3 January. This will inevitably lead to more hospital admissions and increased pressure on secondary care over the coming weeks. This is why a national intervention, introduced swiftly, is so necessary, and why the tier 4 measures have been strengthened by the closure of schools.

We are also taking on additional measures to support industry given the further national restrictions. We have announced additional support to the most affected businesses worth £4.6 billion across the UK. This support will help businesses get through this difficult period until spring. We will take further decisions about our economic response to coronavirus and how best to support the economy, businesses and jobs at the Budget on 3 March.

My Lords, I am very grateful to the Minister and declare my interests as a member of the GMC. As we enter lockdown, the NHS finds itself in a critical position, with the four Chief Medical Officers warning that it is at risk of being overwhelmed in parts of the country. This week, NHS Providers has given a sobering analysis of some of the pressures. Indeed, since Christmas Day, the NHS has had 5,000 more Covid in-patients, equivalent to filling 10 hospitals. It also has fewer beds in use than this time last year because of the need for tight infection control to protect patients and staff.

Areas with a high Covid load are suffering from a double whammy of high numbers of Covid patients and high levels of staff absence. Trusts are utilising every last ounce of capacity available and are seeking to maximise the number of patients being safely discharged into community beds and being looked after at home. However, there is understandable concern about the impact of this on already tired and exhausted staff who are now being asked to delay leave, work extra shifts and transfer to new roles, for instance to help in critical care.

I would like to hear from the Minister what plans are under way to try to relieve at least some of the immediate pressure. I have asked him before about the nearly 30,000 additional doctors who were brought on to the GMC’s supplementary list; I know there is an issue around the bureaucracy involved, but is there also an issue of philosophy? Is the NHS, per se, reluctant to use this incredible facility that could be made available? Can he assure me that, as we come out of this critical situation, thought is being given to what support needs to be given to the thousands of staff who will inevitably be scarred and deeply affected by what they have gone through?

We have a national emergency. The number of people catching the virus is rocketing; the NHS is struggling to provide urgent care to all those who require it; and there is the tragedy of early death for so many families. Everyone must do all they can to keep people safe. As difficult as these regulations will be for so many, these Benches support them. We do so with suggestions the Government should listen to and will hopefully take forward. I offer improvements for self-isolation; others will make other suggestions.

We are now vaccinating, but virologists say it is highly likely that we will have to live with the virus for years to come. Fully funded localised test, trace and isolate systems will therefore be important. Changing the number of days for which a person has to self-isolate is totally useless if less than 20% do so. We must deal with the cause of this, which for many is the lack of financial security and support. The present financial support is not enough; SSP works out at £2.59 per hour, and even if a person claims the £500 grant, that still works out as below the rate of the national living wage. What percentage of eligible people apply for and receive the £500 one-off grant for self-isolation?

To improve the numbers of people who self-isolate, the Liberal Democrats request that the Government pay lower-paid people their normal income for the period of isolation, along with a bonus for completing the required days to thank them for doing the right thing. This must be supported by fully funded Covid community teams that are in regular contact with people isolating to offer full practical and well-being support. These two things would give people the security and support to self-isolate. It is a blind spot of the Government and needs to be addressed. They should start to plan and prepare for when we come out of lockdown and not be caught off guard again. With the right government actions and support, it becomes easier for my actions to save your life and for your actions to save mine. That is why self-isolation payments and support must be addressed urgently.

My Lords, I wish to make two points.

Many, including in this House, question the need for and see no benefits in policies related to lockdown. Some believe that the rising rates of infection mean that restrictions to reduce people’s contacts and movement are ineffective in controlling the transmission of the virus. Many factors affect the transmission of the virus, contact between people being the key factor. In the case of the variant that more readily attaches to the ACE2 cells of the host, reducing contact between people is even more important. What matrix do the Government use to assess the effectiveness or otherwise of measures such as lockdown, apart from the decrease in the number of new infections, to inform the public better?

Secondly, on the vaccination strategy, the Government’s ambition is to vaccinate the JCVI’s top four priority groups by mid-February. I commend that, even if the target is not met. The concern voiced in popular and science media is about the proposal to extend the second dose of the vaccine by up to three months, especially for the Pfizer/BioNTech vaccine. Does the Minister agree that the JCVI should publish the scientific data on which this decision is based, for both approved vaccines, to reassure scientists and the public that the dosage regime does not compromise the effectiveness of the vaccines, which I believe to be the case? If he does not have time to answer me today, could he write to me and put a copy in the Library?

My Lords, my awareness of the situation we are in was heightened last night by an email from the care home in which my mother lives informing me that eight residents and six members of staff have tested positive, in a place where they have been remarkably successful at controlling the virus hitherto. It is this new variant; nobody suggests that there are easy answers and we can all feel the Prime Minister’s inner and outer struggles every time he stands to speak.

In these circumstances, these regulations, unwelcome as they may be in some respects, must be agreed and given force. In the equivalent debate in the other place, some were asking for various clear undertakings as to what might happen in particular circumstances in future. All that we have seen hitherto tells us that, while we can and should plan for a range of scenarios, such attempts at certainty are just not realistic. Even with vaccines and the prospect of their effective rollout, we, as a technologically advanced society, are having to live with the reality of our own vulnerability: imperfect knowledge and an inability fully to control our circumstances—things with which people in other places and cultures are more familiar.

In that respect, our societal pride and self-confidence have perhaps been somewhat challenged. It is little wonder that we see a rise in mental health issues, anxiety, doubts about people’s futures and bereavement, in loss of both life and life opportunities. These are not matters that can easily be addressed by, for example, a financial package from the Chancellor. How and by whom does the Minister think these issues in our society might best be addressed?

My Lords, we are repeatedly told that we are in a race against time. It is in fact a race against the virus; presently, the virus, tragically, is winning. This must change. These restrictions may be regrettable but they are necessary and must be persisted with. Will the Government make it clear that a relaxation of restrictions can happen only when the alert level is brought down to three, and not fully relaxed until it is down to two? Even if the most at-risk population is immunised, this will not be 100% effective, and we should maintain social distancing while we drive cases down to the point where test, track and trace can suppress outbreaks.

I want to ask about two issues. First, on the NHS Covid-19 app, we have 20 million-plus downloads and 750,000 QR codes, but how many positive tests are being registered on the app? It should be some 25,000 a day, and we should expect more than 100,000 alerts to be sent out each day. Without them, contact tracing and isolation will miss most of the contacts in public places. Can our app, like those of some other countries, have the option to provide a mobile phone contact number to allow track and trace to follow up those testing positive?

Secondly, we must now maximise the capacity for vaccination, using the military medical support units and community pharmacy. We should not have arrived at the point yesterday where the pharmacy sector was saying that it did not know whether it would be used. Thousands of trained vaccinators are an essential resource. Can my noble friend confirm that they will be integral to our vaccination programme?

My Lords, I will make only two points.

First, if our fellow citizens are being asked to undergo testing and tolerate restrictions, self-isolation, lockdown and so on—I support these measures—how on earth do the Government explain why so many visitors to this country have been able to fly into our airports without testing, self-isolation and lockdown? How do they explain that to people?

Secondly, what consideration is being given to the effect of the restrictive regulations on the terminally ill? Each year, some 225,000 people undergo palliative care in the United Kingdom. Some have only weeks or months to live. To them, every day is like gold dust, yet currently those undergoing such treatment outside hospices are behind some 7 million other people in the queue for vaccinations. Do not the restrictions being placed on that group cry out for a commensurate prioritisation in vaccination?

My Lords, as we debate these regulations—after the event, as ever—we are in the throes of a national emergency the like of which I have not witnessed in my lifetime. We must learn lessons from the handling of the pandemic so far. The overriding need is to act fast, early and with consistency of message. We need to treat the population like grown-ups who prefer to hear it straight, even if the news is bad.

With the new, more aggressive strain of the virus, we are in a race against time, as my honourable friend Munira Wilson said yesterday, and we need a military-style response. Above all, we must introduce a 24/7 vaccination programme, bringing the vaccine to every high street in the country, including on Sundays. We must make maximum use of volunteers for all the nonclinical tasks involved and remove unnecessary barriers to recruitment. Critically, we must make full use of the roughly 11,400 local pharmacies that already administer millions of flu jabs every year. They have the capacity to vaccinate about 1.3 million people each week, which will save the lives, particularly, I suggest, of people who are not registered with a GP. What assurances can the Minister give that this will now happen?

The next few weeks will put huge strain on the mental health of millions, particularly the vulnerable, the marginalised and young people. What assurances can the Minister give that mental health services will be fully resourced and will stay open to respond to the ever-growing mental health need?

Finally, with the number of Covid patients in UK hospitals topping 30,000, and having witnessed the harrowing scenes in last night’s news coverage of the intensive care unit at University College London Hospital, will the Minister say what specific steps the Government are taking to support the mental health needs of front-line health and social care workers who are suffering from exhaustion, burnout and flagging morale? You can only stretch a piece of elastic so far, and many are close to breaking point.