My Lords, I think the first thing I need to say is that Covid is not over. People are still catching Covid; some are still being very ill; some end up with long Covid. Our NHS is still battling with Covid itself and the terrible effect it has had on the whole of the NHS’s ability to do its job and catch up with the backlog which Covid produced, on top of the waiting lists which already existed and were growing in 2019 before the pandemic. This is the background of our discussion today
Given the number of speakers across the House for this debate, I am very pleased that so many agree it is about time we reflected on the emerging short and long-term challenges of long Covid. I thank the Library, the British Medical Association, Nuffield Health and many others who provided us with such large quantities of briefing.
I thank all the speakers who will follow me, and I anticipate a well-informed debate which will no doubt be challenging for the Minister, not least because, although this is designated a health debate, I think if 2.1 million—and I have seen lower and higher figures—of our fellow citizens are reporting experiences of some or many of the range of symptoms of long Covid, then this has wider societal implications. It affects the workplace, incomes, families and our mental health and social care services. It raises questions about defining a disabling condition, which will affect treatment, support, insurance, pensions, income support, careers, jobs and the reasonable adjustments which need to be made, and how we will support children who may get long Covid.
Part of the challenge is that it seems there is yet no internationally agreed clinical definition of long Covid, and the evidence base on what constitutes long Covid, in terms of range and length of symptoms, is still emerging. In October 2021, the World Health Organization defined “post-Covid-19 condition” as occurring
“in individuals with a history of probable or confirmed SARS CoV-2 infection, usually 3 months from the onset of COVID-19 with symptoms and that last for at least 2 months and cannot be explained by an alternative diagnosis.”
More recently, the NICE guidance on managing the long-term effects of Covid-19 covers care for
“people who have signs and symptoms that develop during or after an infection consistent with COVID-19, continue for more than four weeks and are not explained by an alternative diagnosis.”
As noble Lords will be aware, common symptoms include fatigue, shortness of breath, chest pain, problems with memory, heart palpitations, dizziness, joint pain and many others.
To advance our understanding of long Covid, it is crucial that prevalence data is collected, and this is my first substantive point for the Minister. Government commitments have been made; for example, in June 2021, NHS England committed to setting up a long Covid registry to collect long Covid activity data. However, to date, data is not collected accurately and consistently across the UK, meaning the UK Government are still relying on ONS self-reported data. When will this important data collection happen in a consistent fashion?
My Lords, I start by thanking the noble Baroness, Lady Thornton, for bringing about this important debate. She has held the Government’s feet to the fire—in fact, she held my feet to the fire—on this issue, and I absolutely commend her persistence.
Rehabilitation in general and post-viral syndromes in particular have a long history of being horribly overlooked in this country. I am afraid that this regrettable neglect has contributed darkly to the long-term poor health of many in this nation. However, before I speak about the consequences of this on long Covid, I will take a moment to recognise that Britain has done more than almost any other country to address long Covid. Professor Chris Whitty and the CMO’s office prioritised NIHR research, with £50 million going into 19 projects, giving a clear signal for other research. The NHS, and in particular the noble Lord, Lord Stevens of Birmingham, launched a welcome five-point plan, as the noble Baroness mentioned, and Amanda Pritchard has rolled out excellent long-term long Covid clinics. Treatments such as monoclonal antibodies and pulmonary rehabilitation are emerging as a result. I pay tribute to Dr Harry Brünjes, who pioneered the Breathe programme at the English National Opera, which is a fantastic example of social prescribing that has produced some very promising clinical trial results. I thank the noble Lord, Lord Darzi, who kicked off the important REACT programme at Imperial College which has generated hefty longitudinal population studies. Lastly, I pay tribute to the patient groups, who are both vocal and thoughtful in their responses, for their testimony.
Despite these considerable collective efforts, I am sad to say that the long Covid story has become a parable for how the UK health system fails to protect people’s freedom from disease and illness. It fails to properly rehabilitate our sick, and we are paying a horrible economic price as a result. The scale of long Covid is enormous, as the noble Baroness rightly pointed out, but the clinical response I referred to is sadly inadequate. The ONS says that there are 1.5 million sufferers, yet the long Covid clinics can see only 60,000 patients per year. Patient groups are frustrated that, when they do get seen, clinicians do not have the latest pathways that might lead to positive outcomes. The NIHR agrees with patients that there are a lot of unanswered questions.
Will the noble Lord give way, please? Does he agree there is a growing concern about the serious side-effects that the booster vaccinations can have? Does he agree with me that the Government should look at this very carefully?
My Lords, the vaccine programme has been an astonishing success, and the uptake of those vaccines has shown the enormous public confidence in them. I will speak on another date about the profound impact this has had on the health of the nation.
My point here is that, at this moment when we are feeling the effects of Covid heavily on our workforce and economy, the finances at the UKHSA and OHID are under huge pressure. The public health infrastructure built over the pandemic has largely been dismantled. At the same time, we have an NHS straining to look after the sick and a workforce many of whom are too sick to work.
It is time that we work towards a new political settlement that prioritises the health of the nation and not just the treatment of the sick; and that we make the operational decision in health and care to move towards prevention.
My Lords, I thank the noble Baroness, Lady Thornton, for bringing this important subject to the House. I have a very close relative who has had ME for a number of years, and I have seen at first hand how debilitating and life changing it can be. I have become the vice-chair of the APPG for ME and I have talked to hundreds of ME patients who have had their condition ignored or ridiculed. They have been subject to inappropriate and sometimes dangerous medical intervention, and they are struggling with an employment and benefits system that simply does not acknowledge the realities of their condition. Those 250,000 ME patients are now, in effect, being joined by over 2 million long Covid sufferers.
It is worth starting by pointing out that debilitating post-infection syndromes such as long Covid are not new clinical entities. In American medical literature, ME-like symptoms are described as far back as 1934. When ME was first noticed in this country it was described as “yuppie flu”, but in fact these syndromes affect millions of people suffering from a range of viruses, including those living in poor, third-world countries.
The Institute for Fiscal Studies estimates that one in 10 people with long Covid have given up work, with “persistent labour market effects”. This month’s Lancet said that
“post-acute infection syndromes could pose a substantial public health burden in the near future if appropriate measures are not … taken”.
Despite the huge economic cost they inflict, as the noble Lord, Lord Bethell, said, post-viral illnesses have been neglected, dismissed and under-researched for far too long. We still have no diagnostic blood tests for either long Covid or ME.
As well as the breathlessness, chest pains and loss of taste or smell which characterise long Covid, patients exhibit a cluster of symptoms such as the debilitating fatigue, post-exertional malaise, cognitive dysfunction, PoTS and sleep disturbances that are also diagnostic of ME and other post-infection syndromes. While all the funding for research into long Covid must be welcomed, it is disappointing that some researchers are still ignoring or are not aware of what has already been learned about what may be causing ME and how this could help us to understand the causes of long Covid.
My Lords, I thank my noble friend Lady Thornton for initiating this debate. I am concerned about the low level of awareness of something that affects up to 2 million people. One person said to me on Monday, “Does that mean they’re still contagious?” I am also concerned about the economic implications, particularly for the health service, whose staff were on the front line throughout the worst period. My third concern, which my noble friend Lady Thornton already raised, is about continuing government funding for research into long Covid.
On public awareness, are the Government satisfied that they are doing enough to raise the profile of the devastating effect of long Covid? Now that the newspapers and media appear to have moved on from covering Covid, the sufferers must feel like the disappeared.
I chair the mesothelioma oversight committee, which ensures that payments are made speedily and efficiently to some of the 3,000 people a year who are dying from mesothelioma. It has a low profile, but at least those diagnosed have the satisfaction of knowing that they and their families will have financial support—thanks to the noble Lord, Lord Freud, when he was the Minister.
Of course, I do not claim that long Covid is a terminal illness for most sufferers. I am grateful to and thank the noble Baroness, Lady Scott of Needham Market, for using the parallel cases of ME sufferers. Awareness, financial support and funded research are vital in all these health areas. What plans do the Government have to raise awareness and enable families to feel supported?
Secondly, on the economic and employment implications, I am aware that the National Institute for Health and Care Research is doing some research into economic evaluation, but does the noble Lord have more information about the impact on health workers? How many are affected, and in what areas? Given the number of vacancies in the health service, surely a focus on the recovery of these workers as speedily as possible would pay dividends.
My Lords, I join other noble Lords in thanking the noble Baroness, Lady Thornton, for having secured this important debate and for the very thoughtful way in which she introduced it. I declare my own interests as chair of King’s Health Partners, chairman of UK Biobank and an active researcher in the field of thrombosis, a particular pathophysiology that has both impacted acutely on Covid and may have some role in long Covid symptoms.
We have heard that some 2.1 million people—some 3.3% of our population—have self-reported, as part of the ONS data collection programme, symptoms attributable to long Covid. It is striking that some 500,000 of those individuals reported having had Covid some two years previously. This represents a substantial, ongoing, chronic burden of disease. We should all be conscious of its potential impact on the way in which we are able to deliver healthcare through the National Health Service.
As we have heard, little is known about the etiology of long Covid. There is a suggestion that part of it may be attributable in some individuals to a failure to properly clear the virus from their bodies. It is also possible that there are genetic determinants that drive individual immune response and that this dysfunction is part of the explanation for long Covid symptoms. There is a now well-established phenomenon of dysfunction in the microvascular and endothelial cells that line blood vessels, which may be responsible for some of the long Covid symptoms. Indeed, a profound hypercoagulable state—a tendency to a risk of thrombosis and blood clots—manifests itself in an important number of long Covid patients.
We have heard of the importance of research in trying to understand more about the etiology of long Covid and to better understand its history. This is critically important if we are to be able not only to research and develop new therapies but to address the question of long Covid through the mechanisms underlying its development and sustained impact. This research is also critically important in understanding how we should properly develop services to manage patients. At the moment, His Majesty’s Government have committed some £194 million to the provision of clinics and services to manage Covid patients—some £90 million of which is to be spent in the financial year 2022-23. However, when one looks at the burden, this resource is only able to provide services for some 5,000 patients a month. The substantial demographic of long Covid is running into many hundreds of thousands, if not millions, of people. We clearly need to understand from prospective research not only what volume of services is needed but how those services should be constructed, based on our knowledge of the natural history of the disease, in order to adequately and properly manage the requirements of those patients beyond symptom control.
1:08 pm
The Lord Bishop of Exeter
My Lords, I too thank the noble Baroness, Lady Thornton, for securing this important and timely debate.
I will focus my remarks on the rural dimension of long Covid, which is having an impact on many people in Devon where I am privileged to serve. I am concerned about rural sustainability and the need to ensure that the Government’s levelling-up agenda is not focused exclusively on urban deprivation. Rural poverty may not show up on government statistics because it is dispersed in pockets, but it is just as real. Research suggests that structural inequalities, including poverty, are important in the development and course of Covid-19 and may form an important context for long Covid.
As far as Devon is concerned, the picture postcard view of my county beloved by holidaymakers is only half the story. The best information we have is that there are currently around 16,000 people living with long Covid in Devon and, as I am sure the noble Baroness, Lady Watkins of Tavistock, will corroborate, it is impacting on the economic life of our county.
As in other parts of the United Kingdom, we know that the groups most likely to be affected by long Covid are people between the ages of 35 and 69; women; people living in more deprived areas; those in care; those with a high body mass index; those working in close-contact professions; and those living with long-term health conditions. Of the 16,000 people in Devon living with long Covid, only around 70% have been referred to long Covid treatment services. Research has revealed that children, older people, men and those living in deprived areas are less likely to seek help and be referred.
The pandemic has impacted people’s health and self-confidence, well-being and the demand for services. It has had an adverse effect on mental health, with higher levels of mental health anxiety and loneliness. For those suffering from long Covid, unsurprisingly, research has revealed that they have lower levels of life satisfaction and happiness, and some have lost hope of change or improvement. Overall, the pandemic has had a greater impact on those groups already suffering from greater disadvantage and higher health inequities than average across the county. In Devon, service providers have reported increased demand for mental health, domestic violence, and drug and alcohol support services. There have also been increased concerns over the safety of children, young people, and vulnerable adults.
Sadly, young people in Devon reflect the national picture, with a significant rise in child obesity during or after the lockdowns, especially among boys and those living in the most deprived communities. The noble Lord, Lord Dubs, highlighted that in his Question this morning.
1:14 pm
20 of 50 shown
There are currently a lot of unknowns when it comes to treating long Covid. Despite recent investment, more research is needed to increase the understanding of the condition, including psychological aspects, and to develop more effective treatments. In October 2020, NHS England and NHS Improvement set out a five-point plan for long Covid support, which included a commitment of £50 million to fund research. The Government said that £20 million of the £50 million previously committed to research would go into 15 UK-based research studies, through the NIHR, the National Institute for Health Research, to better understand the condition, improve diagnosis and find new treatments. As part of this investment, various studies are investigating whether there might be potential pharmaceutical treatments that would be effective in treating long Covid.
Long Covid is a focus for researchers globally, with the European Commission announcing it would accelerate its research into long Covid and develop treatments, while the United States is also running clinical trials. I would like to ask the Minister whether we are participating in these research programmes, and, if so, what are the outcomes?
Similarly, major pharmaceutical companies have demonstrated an interest in developing targeted new treatments or repurposing existing ones. Although researchers have been surveying the broad spectrum of symptoms associated with long Covid, it has to be said they have not found one biological explanation. It is likely there are various mechanisms involved. Similarities between long Covid and other post-infection syndromes need to be considered, and I am confident this will be raised during the debate today.
Despite the investment into research for treatments for long Covid, much of the research is in its early stages, resulting in a lack of evidence on effective treatments. In terms of resources, of the million or more who are reporting with long Covid, only 60,000 patients can access treatment. This means that hundreds of thousands of people with long Covid are feeling isolated and frustrated in their search for treatment, and as a result sometimes live in poverty and despair. I would like to commend the patient groups that have been doing a great job in mutual support and campaigning.
Let us look at the research, of which there must be much more. It is true the Government agreed to invest £50 million in research, although I think there are some blockages, which I would like to raise with the Minister, such as approvals to facilitate research pathways, and through developing pathways support more rapid implementation of promising findings in relation to the diagnosis, assessment, and treatment of long Covid. It would seem, despite the increased funding in research, the UK Government need to increase the infrastructure to meet the scale of the problem. While the MHRA, through the Innovative Licensing and Access Pathway, aims to accelerate the time it takes to get treatments to market, there may need to be some changes to clinical trials research legislation to enable this to be carried out. Is that the case, and are the Government considering it, and what should happen next, because it is vital that if the research is there and the pharmaceutical industry wants to bring forward treatments, we should make sure the pathway is completely clear of any obstacles.
There are huge challenges concerning work and long Covid. The first is the need to support the post-pandemic return to work, which we have discussed before in this House. Since the pandemic, there has been a marked increase in the number of workers aged 50 to 64 who have left employment. Recent labour market statistics from the ONS found that the number of people in this age group classified as “economically inactive” stood at 374,000-plus from June to August this year, compared with 37,000 in the first three months of 2020, as Covid-19 took hold. A recent analysis by the ONS found that 51% of people in this age category who had left work since the pandemic and had not gone back had reported a physical or mental health condition or illness, including long Covid. Apart from anything else, this points to the fact that people need extra support from employers to prevent them being squeezed out of the workplace. It seems to me that guidelines for employers are required—are they available? Are they being planned?
There are health and social care workers who have been particularly exposed during the pandemic. Of course, long Covid makes it even more difficult for the NHS to function as it should, to say nothing of the lives being wrecked and the families suffering terribly. The Industrial Injuries Advisory Council has made its recommendations to the Secretary of State regarding the circumstances in which long Covid should be prescribed as an occupational disease. Why have the Government not acted on this? Covid special leave provisions ended across the UK by 1 September 2022. The British Medical Association has repeatedly called for enhanced Covid-19 sickness pay provisions to continue until a long-term strategy for dealing with Covid-19 is in place. I need to know why the Government have not put a sufficient compensation scheme in place for healthcare workers who are developing long Covid.
Further to this, the Secretary of State for Work and Pensions published the Industrial Injuries Advisory Council report on Covid-19 and its occupational impacts. This report was provided to the Secretary of State and was laid before Parliament yesterday; I thank the Minister for making it available to this House. The council argues that there is sufficient evidence to recommend prescription for health and social care workers whose work brings them into frequent proximity to patients and clients where there is a significantly increased risk of infection, subsequent illness and death. Now that the Government have that report, and it has been made public, will they act upon it?
We need to address the issue of preventing long Covid in children. Will the Government develop a campaign with more consistent messaging about long Covid and clear information and guidance for parents regarding the benefits of vaccination for children and how it can protect children from long Covid?
Clearly, there needs to be more support for health professionals to identify and treat long Covid. All health professionals should be supported and equipped with up-to-date information to ensure that they understand the variable symptoms of long Covid and are aware of the available support and how to refer people to it. In terms of the funding and resources to establish multidisciplinary services, pathways for long Covid should focus on addressing patients’ multisystem symptoms and rehabilitation needs and provide individualised care plans accordingly. There also needs to be a more consistent provision of long Covid clinics, including for children, so that there is less variation in waiting times for treatment. Increased funding and independent workforce planning are key to the success of these services. How many more multidisciplinary centres are planned, and by when?
Turning to improved financial and wider support for people unable to work due to long Covid, the Government need urgently to provide employers with better guidance on how to support employees with long Covid. Perhaps the Government should set up a task force to review the UK’s statutory sick pay allowance system and whether it should be increased so that it is in line with other OECD countries. Does the Minister accept that the decision to end special Covid leave for NHS staff has put patients and healthcare workers at risk? Why do the Government not reinstate this scheme until a longer-term compensation scheme to support staff is in place?
At the end of this debate, I would welcome an acknowledgement by the Minister that the Government recognise that long Covid is having a major impact on productivity, employment and wider society, as well as our health services. I would like the Minister to tell me that they have a plan for this to be tackled in a comprehensive fashion across government. I beg to move.
We are familiar in this country with the rationing of scarce health resources and the uneven distribution of the latest research—uncomfortable though that is—but I will focus a few words on the profound economic effects of this troubling British healthcare strategy. ONS data reports that 500,000 people have left the workforce over the last 18 months, and 75,000 of those are economically inactive due to long Covid. The Institute for Fiscal Studies has a slightly different figure of 110,000, and it says that the cost is almost £1.5 billion in lost earnings a year. Another IFS study suggests that there is an average of 2.5 hours of sick leave per worker being taken due to those who have long Covid. Either way, the OBR has recognised that Covid in the round could cost around £2.7 billion in welfare benefits such as incapacity and housing. That is an absolutely staggering sum.
My point is that we cannot shrug our shoulders about the impact of conditions like long Covid on the economy. We have to take on the challenge of making this country healthier and pivot towards prevention. Andrew Haldane, chief executive of the Royal Society of Arts, put it well in his recent speech:
“We’re in a situation for the first time, probably since the Industrial Revolution, where health and wellbeing are in retreat … Having been an accelerator of wellbeing for the last 200 years, health is now serving as a brake in the rise of growth and wellbeing of our citizens.”
Yesterday, Andrew Bailey, the Governor of the Bank of England, told the House of Commons Treasury Committee that part of the reason the country was being held back was the sharp decline in the size of the workforce since Covid.
Despite this, the Treasury plan for living with Covid makes no mention of investment in rehabilitation or major initiatives for getting the workforce back to work. Finances in the UK Health Security Agency and the Office for Health Improvement and Disparities, the main legacy public health organisations—
Almost 40 clinical trials into possible treatments for long Covid have been registered, some involving interventions that have already been assessed in ME. Some of these treatment trials have small sample sizes or no control groups. The lessons do not appear to have been learned from the use of poor-quality methodology in many clinical trials involving ME. Some health professionals who are managing people with long Covid are unaware of or ignoring what we have learned about the management of ME and other post-infection syndromes, on activity and energy management particularly. The ME charity sector produces excellent information on symptom and energy management, as does the new NICE guideline, but people with long Covid are often simply unaware of this information, as are many health workers.
Another important lesson that needs to be learned from ME is that misdiagnosis can occur when people with chronic fatigue are not properly assessed and are labelled as having a post-viral syndrome. There are some very disturbing cases being reported of people having long Covid when, in fact, they have another medical condition. A Suffolk councillor recently featured in the news when, it turned out, her long-standing diagnosis of long Covid actually proved to be lung cancer.
Research into the cause and diagnosis of, and effective treatments for, long Covid could help those with ME. The ME Association has requested that clinical trials for long Covid treatments include a group with ME. What has been learned about the management of ME can help many people with long Covid.
Harlan Krumholz, a cardiologist at Yale, said:
“No one wanted the pandemic, but sometimes a jolt to the system can create innovation in ways that wouldn’t have occurred otherwise”.
That should be our guiding principle.
The BMA said that doctors who had contracted long Covid had been let down by the Government’s failure to provide adequate support, with staff faced with a premature return to work—assuming they are physically able to—or with being unable to pay their mortgages. We know that 2,100 health and care workers lost their lives due to Covid-19, and at least 199,000 NHS workers are living with long Covid. They are seven times more likely to have had severe Covid than other workers, and much of this took place with no or inadequate PPE.
Temporary staff or locums have already lost their jobs because they did not have job security. Does the Minister know how many formal absence procedures have been initiated in the health service, and how many people have been dismissed due to long Covid? We still do not appear to know the extent of the loss to the labour market. The noble Lord, Lord Bethell, also broached this. The Resolution Foundation stated that it could be 600,000. The Institute for Fiscal Studies estimated that it was one in 10. It is clear that the majority are not getting enough help. NHS England data suggested that, up to August 2022, only 60,000 people suffering from long Covid had been assessed by an NHS specialist. If the 600,000 figure is correct, the gap is concerning.
This brings us back to the questions of awareness and profile. The patient does not know that they can get help, and the GP does not recognise the symptoms. Either way, there is a huge job to do. What role do the Government have in improving the position?
The Chief Executive of NHS England, Amanda Pritchard, said recently:
“The NHS faces the toughest winter of my career and potentially the toughest winter in its history.”
This does not sound like someone expecting adequate support from the Government.
In the paper, Our Plan for Patients, published by the DHSC in September, the then Secretary of State, Thérèse Coffey, said that
“this Government will be on your side when you need care the most.”
This sounds fine, but there is no reference to long Covid in that paper.
Finally, what assurances can the Minister give about the Government’s continuing funding for research? I am aware that the NIHR is conducting 19 studies. Ten years ago, I was an independent member of one of its sub-committees, but I no longer have that link. Many of these pieces of research are still in progress, but some themes are emerging. Mesothelioma was underresearched for decades. Will the Minister guarantee that this will not happen with long Covid?
Is the Minister content that the approach to research is sufficient? As we have heard, some £50 million has been committed by the Chief Medical Officer to a variety of research programmes. Is he able to address the question, raised by the noble Baroness, Lady Thornton, of why a national cohort has not been established to allow us to marshal the current clinical burden of long Covid in our country and then to apply an appropriate methodology and protocols to the evaluation of these individuals? Research undertaken in this systematic fashion is not only highly efficient but provides the best opportunity for us rapidly to understand and start addressing the questions that need to be addressed if we are to be able to develop these new therapies and organise and deliver services in the most appropriate way for these patients.
Beyond the financial commitment to the development of a long Covid research cohort, there is also the need to ensure that the data collected through routine exposure of these patients to NHS services can be marshalled to inform the research effort. Those data should be able to link with other datasets whose huge value in addressing acute Covid and in the post-infection period has been established. I reiterate my interest as chairman of UK Biobank, which has been used in this regard. It is a unique resource, available to the country, where half a million of our fellow citizens have provided their biological material. The genome in those individuals has now been mapped and the opportunity exists to interrogate the dataset, using that biological material, to assess novel biomarkers and the prevalence of disease. The deep phenotyping and repeat imaging give the capacity to understand structural end organ dysfunction in Covid. All this requires an approach from His Majesty’s Government with regard to data sharing, within and across datasets, between researchers in different institutions and, as we have heard, with those outside the public sector wishing to support this research. Is the Minister able to provide some reassurance on this?
The picture is not all negative. I am immensely proud of my county and the resilience of many rural communities, much of it, I am proud to say, fostered and supported by local churches.
However, one particular concern in Devon is the impact of long Covid on the workforce. National research shows that before contracting Covid-19 and then developing long Covid, two-thirds of respondents had been working in front-line jobs such as hospitality, schools, care homes, childcare, emergency services, retail, transport and delivery. Most respondents believed that they had almost certainly, 41%, or very likely, 18%, caught Covid-19 at work, pointing to the lack of PPE and the direct contact with Covid-positive patients. As one researcher commented:
“Key Workers are overwhelmingly paying the price of workplace Covid-19 exposure with loss of health, loss of employment and loss of income.”
As we move into winter, this is really serious.
This national picture is exacerbated in rural counties such as Devon. One of the problems facing the countryside post Brexit has been the shortage of workers, both in the care sector and agriculture. Not only is there a smaller population in rural areas from which workers are drawn but, on average, they have to spend more time travelling to and from their jobs or, in some cases, between jobs. Because long Covid disproportionately impacts lower-paid women in front-line roles, this has made it more difficult to recruit suitable staff in the countryside. This shortage is now being seen in many rural businesses in Devon, especially in the hospitality sector, which are closing for the winter period due to lack of staff and higher energy bills.
In conclusion, therefore, I ask the Minister: what research is being undertaken to assist the medium and long-term effects of long Covid, specifically in rural communities?