PARLIAMENTARY DEBATE
Covid-19 Update - 26 November 2020 (Commons/Commons Chamber)

With permission, I will make a statement on coronavirus. We are approaching the end of a year in which we have asked so much of the British people. In response to this unprecedented threat to lives and to livelihoods, the British people have well and truly risen to the challenge by coming together to slow the spread and support each other. I know how difficult this has been, especially for those areas that have been in restrictions for so long. The national measures have successfully turned the curve and begun to ease pressure on the NHS. Cases are down by 19% from a week ago, and daily hospital admissions have fallen 7% in the last week.

January and February are always difficult months for the NHS, so it is vital that we safeguard the gains we have made. We must protect our NHS this winter. We have invested in expanded capacity, not just in the Nightingales, but in hospitals across the land, and we have welcomed thousands of new staff. This morning’s figures show that the number of nurses in the NHS is up 14,800 compared with just a year ago, so we are well on our way to delivering on our manifesto commitment of 50,000 more nurses. Together, while we invest in our NHS, we must also protect our NHS, so that it will always be there for all of us during this pandemic and beyond.

I am so grateful for the resolve that people have shown throughout the crisis. Thanks to this shared sacrifice, we have been able to announce that we will not be renewing our national restrictions in England, and we have been able to announce UK-wide arrangements for Christmas, allowing friends and loved ones to reunite and form a five-day Christmas bubble. I know that this news provides hope for so many, but we must remain vigilant. There are still today 16,570 people in hospital with coronavirus across the UK, and 696 deaths were reported yesterday. That means 696 more families mourning the loss of a loved one, and the House mourns with them.

Tempting as it may be, we cannot simply flick a switch and try to return life straight back to normal, because if we did that, we would undo the hard work of so many and see the NHS overwhelmed, with all that that would entail. We must keep suppressing the virus, while supporting education, the economy and the NHS until a vaccine can make us safe. That is our plan. We will do that by returning to a tiered approach, applying the toughest measures to the parts of the country where cases and pressure on the NHS are highest and allowing greater freedom in areas where prevalence is lower.

While the strategy remains the same, the current epidemiological evidence and clinical advice shows that we must make the tiers tougher than they were before to protect the NHS through the winter and avert another national lockdown. We have looked at each of the tiers afresh and strengthened them, as the Prime Minister set out on Monday. In tier 1, if you can work from home, you should do so. In tier 2, alcohol may only be served in hospitality settings as part of a substantial meal. In tier 3, indoor entertainment, hotels and other accommodation will have to close, along with all forms of hospitality except for delivery and takeaway.

I know that people want certainty about the rules they need to follow in their area. These decisions are not easy, but they are necessary. We have listened to local experts and been guided by the best public health advice, including advice from the Joint Biosecurity Centre. We set out the criteria in the covid-19 winter plan, and we publish the data on which the decisions are made. As the winter plan sets out, the five indicators are the case rate in all age groups; in particular, cases among the over-60s; the rate at which cases are rising or falling; the positivity rate; and the pressures on the local NHS.

When setting the boundaries for these tiers, we have looked at not just geographical areas but the human geographies that influence how the virus spreads, such as travel patterns and the epidemiological situation in neighbouring areas. Although all three tiers are less stringent than the national lockdown we are all living in now, to keep people safe and to keep the gains that are being made, more areas than before will be in the top two tiers. That is necessary to protect our NHS and keep the virus under control.

Turning to the tiers specifically, the lowest case rates are in Cornwall, the Isle of Wight and the Isles of Scilly, which will go into tier 1. All three areas have had very low case rates throughout, and I want to thank residents for being so vigilant during the pandemic. I know that many other areas would want to be in tier 1, and I understand that.

My constituency of West Suffolk has the lowest case rate for over-60s in the whole country, and I wish to thank Matthew Hicks and John Griffiths, the leaders of Suffolk County Council and West Suffolk Council, and their teams for this achievement. However, despite that, and despite the fact that Suffolk overall has the lowest case rate outside Cornwall and the Isle of Wight, our judgment, looking at all the indicators, and based on the public health advice, is that Suffolk needs to be in tier 2 to get the virus further under control. I hope that Suffolk and so many other parts of the country can get to tier 1 soon, and the more people stick to the rules, the more quickly that will happen.

We must make the right judgments, guided by the science. The majority of England will be in tier 2, but I am afraid that a significant number of areas need to be in tier 3 to bring case rates down. I know how tough this is, both for areas that have been under restrictions for a long time, such as Leicester and Greater Manchester, and for areas where cases have risen sharply recently, such as Bristol, the west midlands and Kent. The full allocations were published this morning and laid as a written ministerial statement just before this statement began. I understand the impact that these measures will have, but they are necessary given the scale of the threat we face.

We will review the measures in a fortnight and keep them regularly under review after that. I want to thank everybody in the tier 3 areas for the sacrifices they are making to protect not just themselves and their families, but their whole community. Regardless of their tier, I ask everyone to think of their own responsibilities to keep the virus under control. We should see these restrictions not as a boundary to push but as a limit on what the public health advice says we can safely do in any area. Frankly, the less any one person passes on this disease, the faster we can get the disease under control together—and that is on all of us.

We must all play our part while we work so hard to deliver the new technologies that will help us get out of this—in particular, vaccines and testing. The past fortnight has been illuminated by news of encouraging clinical trials for vaccines, first from Pfizer-BioNTech, then from Moderna and then, earlier this week, from the Oxford-AstraZeneca team. If these vaccines are approved, the NHS stands ready to roll them out as soon as safely possible.

Alongside vaccines, we have made huge strides in the deployment of testing. Our roll-out of community testing has been successful, because it means we can identify more people who have the virus but do not have symptoms and help them isolate, breaking the connections that the virus needs in order to spread. As part of our covid-19 winter plan, we will use these tests on a regular basis, for instance to allow visitors safely to see loved ones in care homes, to protect our frontline NHS and social care colleagues, and to allow vital industries and public services to keep running safely.

We have seen in Liverpool, where more than 300,000 people have now been tested, how successful this community testing can be. I pay tribute to the people of Liverpool, both for following the restrictions and for embracing community testing. It has been a big team effort across the whole city, and the result is that in the Liverpool city region the number of cases has fallen by more than two thirds. In the borough of Liverpool itself, where the mass testing took place, cases have fallen by three quarters. It has not been easy and, sadly, many people in Liverpool have lost their lives to covid, but thanks to people sticking to the rules and to the huge effort of community testing, Liverpool’s cases are now low enough for the whole Liverpool city region to go into tier 2. This shows what we can do when we work together. We can beat the virus. I want to pay tribute to the people of Liverpool, NHS Test and Trace, the university, the hospital trust, Mayor Joe Anderson and so many others who have demonstrated such impressive leadership and responsibility, and a true sense of public service.

We are expanding this community testing programme even further to launch a major community testing programme, homing in on the areas with the greatest rates of infection. This programme is open to all local authorities in tier 3 areas in the first instance and offers help to get out of the toughest restrictions as fast as possible. We will work with local authorities on a plan to get tests where they are needed most, and on how we can get as many people as possible to come forward and get certainty about their condition. The more people who are tested, the more quickly a local area can move down through the tiers and get life closer to normal.

Viruses can take a short time to spread but a long time to vanquish. Sadly, there is no quick fix. They call upon our determination to make sacrifices that will bring them to heel and upon our ingenuity to make scientific advances that will get us through. Hope is on the horizon, but we still have further to go, so we must all dig deep. The end is in sight. We must not give up now. We must follow these new rules and make sure that our actions today will save lives in future and help get our country through this. I commend the statement to the House.

I thank the Secretary of State for advance sight of his statement. I suppose that we should all thank him for advance sight of the website, but sadly, it crashed before we could check what tiers we were in.

The news of a vaccine is indeed light at the end of the tunnel, but we are still in the tunnel and we have a significant way to go to drive infection rates down and keep our constituents safe. We understand why tough restrictions are still needed, but let us be clear: today, millions of people trying to survive in the second lockdown will soon be forced to endure further local lockdown restrictions. Does the Secretary of State accept that these interventions succeed when made in tandem with local communities?

I remember that when areas such as Bury and Trafford went into lockdowns in the summer, the Secretary of State promised that MPs would be involved in the decision. Has that commitment been abandoned? Then, Ministers agreed to involve regional leaders, but took exception to being challenged by Andy Burnham. What role do regional leaders now have in these decisions, or is the position really that the Prime Minister imposes from Downing Street restrictions on communities across the midlands and the north—restrictions that will have a huge impact on the livelihoods of families and small businesses?

Christmas, the Secretary of State will know, is vital to pubs, restaurants and entertainment venues across those areas. They will need substantial financial support to get through this period. Will those areas that went into tier 3 lockdowns before the national lockdown, such as Greater Manchester and South Yorkshire, get backdated economic support for their local small businesses?

Parts of the country, such as my own city of Leicester and Bury, Leigh and Heywood, have been under a form of lockdown for months, with families forced apart and grandparents not seeing their grandchildren. Those families today will want to know what the exit strategy is and what voice they will have in that strategy. The Secretary of State has outlined five criteria by which local lockdowns will be judged. Will he publish clear, transparent rules for areas entering and leaving tiers—a score card for every area, assessing its covid progress against its criteria, so everyone can judge this publicly?

The Secretary of State talks of mass lateral flow testing, and we welcome the advances, but over two weeks ago he announced he was sending, I think, 930,000 of those tests to local authorities, yet only around 8,500 are being used a day. Can he explain why that is? He will also be aware—I am sure he will have studied this—that Slovakia recently tested more than 3 million people over a weekend using those tests. The Slovaks incentivised people to get tested by offering greater freedoms. Is that part of the Government’s thinking on how those tests could be used?

Evidence from Liverpool suggests that there is a lower take-up of tests in poorer, harder-to-reach communities. Is not the problem that if people and their contacts feel they will be financially penalised for a positive test, they will avoid a test, they will switch off the app and they will not answer their phone to unrecognised call centre numbers? The reason people soldier on when ill is not a stiff upper lip: it is that they cannot afford to feed their families otherwise. Surely, after months and months, it is now obvious that low-paid people such as care workers on zero-hours contracts need better support to isolate. Why did the Chancellor not increase statutory sick pay in the spending review yesterday?

The test and trace budget has now increased to £22 billion, more than the annual budget for the police and the fire service combined, yet the Office for Budget Responsibility yesterday confirmed that its forecasts are based on the fact that

“a less effective TTI”—

test, trace and isolate—

“system necessitates keeping a more stringent set of public health restrictions in place over the winter.”

At what point will the Secretary of State accept that the current Serco model has failed? I am not against using the private sector, but I am against throwing shedloads of taxpayers’ money at failing private sector contracts. Local authorities, especially those now in tier 3, should be leading this retrospective contact-tracing work, and they should be given the data from day one, so they can get on with it. By the way, why was there no uplift yesterday in the public health grant? Surely, this is a time when we should be investing in public health, not freezing the grant.

On the easements for Christmas, there will indeed be relief in families across the country, but the Secretary of State will understand that there will also be nervousness across the NHS. We need a clear public health message: asking people to be “jolly careful” is not good enough. He will know that January is an immensely busy and pressured time for our NHS. It is not just the patients filling up covid beds; it is the emergency pathways that are already running at hot and it is the immense elective backlog. We know there are fewer beds because of social distancing. We know staff are exhausted. One in seven hospitals have restricted elective surgery or planned operations so far this winter. What plans are in place to protect the NHS through January, especially if there is a long cold snap? How many elective operations does he anticipate will be cancelled in January? Nobody in this House wants to see a third lockdown, so can he guarantee that the measures he has announced today will be enough to bring the R down and sustain it below 1 for the coming months until a vaccine allows life to return to normal?

The goal of the Government is to bring R to below 1 to suppress the virus until a vaccine can keep us safe. That is the strategy.

I shall take the precise points that the hon. Gentleman raised. He asked for an exit strategy. The statement I outlined is the exit strategy: it is to keep the virus suppressed with the minimum damage possible to the economy and, indeed, to education, while we work as fast and as hard as we can towards a vaccine and with the widespread use of community testing across the piece to help to keep the virus under control.

I would have expected the hon. Gentleman to welcome the massive progress in Liverpool which has shown that a combination of sticking by the rules and community testing on a very large scale can help to bring this virus right under control. Instead, he criticised it for not getting into harder-to-reach communities. That is exactly where we need to get into, and that is why we do it in combination and hand in hand with the local authority.

I praise Joe Anderson, and I also praise other local leaders, such as Ben Houchen in Tees Valley, who is working with us on this; Andy Street and leaders across the west midlands; and the hon. Member for Barnsley Central (Dan Jarvis) in South Yorkshire, who we are working with to get a community testing system up and running in places such as Doncaster. I want to see the community testing that has been successful in Liverpool rolled out across the tier 3 areas as much as is possible, and I invite all councils to engage.

We invited councils to engage ahead of the decisions today, and we also invited all colleagues in the House to have an input, but it is important that we have clear public health messaging, because unfortunately we did see the number of cases going up and continuing to go up in those areas where local leaders were not working alongside us. It was a sharp contrast with what happened, for instance, in Liverpool, but also in other areas where the local leadership was so constructive and positive.

The hon. Gentleman asked for a scorecard for the exit strategy. We publish the data, and if we can make it into an even more accessible format, I think that is a good idea. He asked about supporting the NHS—absolutely. I am delighted that, yesterday, my right hon Friend the Chancellor of the Exchequer, with the support of the Prime Minister, put another £3 billion into the NHS, on top of the £6.6 billion that is already being invested. That money starts flowing in this financial year, for this winter, and then runs into next year.

The hon. Gentleman mentioned the need to support people who have tested positive. We have put in place a £500 support payment. On NHS Test and Trace, I thought from the figures this morning that he would welcome the fact that the majority of in-person tests are now turned around within 24 hours. That is significant progress on the speed of turnaround in testing, for which I am very grateful to my team. There will be further support for local councils that find themselves in tiers 3 and 2 to support the action that is needed. But all in all, let us come together and work together to get this virus under control and keep it under control, so that we can get life back to normal as soon as possible.

May I welcome the Prime Minister back from his splendid isolation to the place that he has no doubt been itching to get back to more than any other—this House of Commons—and say how wonderful it is to see him here?

It is great to see you.

From a sedentary position, I think the Prime Minister said that he was delighted to see me here. [Interruption.] Indeed, he is delighted to see me here—on the Back Benches. [Laughter.]

Turning to more serious matters, these are very difficult decisions, and part of the leadership we have to show in a pandemic is telling people unwelcome news. I want to salute the Health Secretary’s cautious approach to Christmas, because, much as we all want Christmas to be as normal as possible, nothing would be more crazy than to take our feet off the accelerator at this moment and then see a spike in deaths in February, so I think this is the right approach.

There is one bit of further good news—on top of the news about vaccines and on top of the news about mass testing—that I know the Health Secretary would like to be able to give and that would be enormously welcome: that every single person living in a care home could be sure that they could be visited by a close relative before Christmas. I know he wants to do that, but there are huge logistical challenges in getting that mass testing technology to work in time. May I urge him to do everything he can, because that would make such a big difference to the nearly 400,000 people in care homes?

I hesitate to interrupt the love-in between the Prime Minister and my predecessor, but I am grateful for his support—for their support. This is a set of difficult measures, but I think the public understand why we have to take them and why they are necessary.

On the point about getting visiting going in care homes, my right hon. Friend is absolutely right. Sometimes we talk about these tests and this new technology in an abstract way or from a scientific point of view, but it really matters and it really improves people’s lives. Where we can use testing to make visiting safe in care homes, that is an example of the way in which these new technologies can help to get life a little bit back towards normal. Of course, it must be done in a safe way and carefully, but we are now developing the protocols for exactly how that can happen and working hard with the goal that everyone should have the opportunity to visit a loved one in a care home before Christmas.

Many scientists have expressed concern that the easing of restrictions at Christmas could lead to another surge of covid cases in January. With cases still over 80% of the level at the start of lockdown, is the Secretary of State not worried that allowing outdoor events of 2,000 participants and indoor events of 1,000 in level 2 high-risk areas could drive up infection rates ahead of Christmas? Although lateral flow testing is very welcome, given how it increases capacity, the Secretary of State previously stated that the mass testing in Liverpool was a pilot and would be evaluated before being rolled out elsewhere. As the city has also been under tight restrictions and then lockdown, how will the impact of mass testing alone be evaluated? How does he plan to counter the lower uptake among deprived communities—the very ones at highest risk, as seen in Liverpool—and, with no clinical evaluation yet published, how can he justify putting out contract tenders for an eye-watering £43 billion and rolling out this approach to 67 other areas? Should this strategy not be compared with investing money and energy in getting the traditional test, trace and isolate system working properly? Currently, over 40% of contacts in England are still not even informed that they should be isolating.

Finally, the Secretary of State knows that it is not testing, but isolation, that stops the spread of the virus. If people who are infected or could be carriers are not isolating, no amount of testing will stop viral spread. A study by King’s College London that suggested that fewer than a quarter were isolating when advised to do so was incredibly worrying, so what assessment are the Government doing to clarify current isolation rates and understand the reasons why people may not follow the advice they are given?

Of course, we are constantly evaluating the impact of people isolating, and how many people isolate when asked to. I would encourage the hon. Lady to look at a broader range of studies than just that one from King’s College, especially those dealing with the self-isolation of those who test positive, for whom the rate tends to be higher.

The hon. Lady asked about the use of lateral flow tests to have a negative impact on the number of cases in an area. Of course, we have been evaluating this through out the study in Liverpool, which is why we can have confidence in rolling it out more broadly across tier 3 areas. I included in my statement a high-level assessment. The number of cases in the Liverpool city region is down by two thirds, but in the city itself, where the testing took place—the testing was of people who live in the city, and of people who work in the city and live largely in the wider city region—the number of cases is down by over three quarters. That is one piece of evidence. It is clear that it is the combination of people following the rules and community testing, with appropriate incentives to get people to take up that mass community testing, that can help to make this work. We want to work with local directors of public health to understand how this can work effectively in their areas, precisely to reach those hard-to-reach people whom the hon. Lady mentioned.

Finally, I echo the hon. Lady’s request that we be cautious this Christmas. However, I am delighted that we have agreed an approach across the whole UK, including the SNP Administration in Edinburgh, the Welsh Labour Administration and the cross-party Administration in Northern Ireland, because there are so many ties that bind us together and mean that we are stronger as one United Kingdom, working together to tackle this virus.

It is incredibly disappointing news that Buckinghamshire, having entered the national lockdown in tier 1, will emerge from that lockdown into the more punitive restrictions of tier 2 —a decision that will be hard to understand in the rural communities of north Buckinghamshire which have relatively low infection rates, and one that is hard to understand given that there has been zero consultation between central Government, Buckinghamshire Council and our local NHS. I appreciate that my right hon. Friend has impossible choices to make in order to control this virus, but will he commit to ensuring that Buckinghamshire Council and our local NHS are fully consulted as these tiers are reviewed going forward?

Yes, of course. Along with my hon. Friend, the director of public health in Buckinghamshire was invited to engage with the team as we were looking at the indicators and making this decision. These are difficult decisions; he is right about that. The case rate in Buckinghamshire is 138 per 100,000, and positivity is above 5%. We will review these allocations in a fortnight and then regularly thereafter. I look forward to working with my hon. Friend and supporting the people of Buckinghamshire to do what is right, to get the case rate down and to get Buckinghamshire—if at all possible, and if it is safe—into tier 1, with the lighter restrictions. But it is critical, to keep people safe, that we take the action we need to today.

A recent University College London study found that less than half the public understood what the rules were in the previous tier system. Today we have a new tier system. We have a five-day relaxation at Christmas. We have a Government website that has crashed this morning. The written ministerial statement published this morning has a number of question marks against different areas. There are inconsistencies between what the Prime Minister has said, what the OBR has said and what the Secretary of State has told MPs about the length of restrictions. I have a simple request: will the Secretary of State ensure that there is a clear, consistent and honest communications campaign to ensure public trust and compliance and so that we do not overly raise expectations?

Yes, there will be a widespread public information campaign about these new tiers. It is on all of us to follow the rules in our local area. Notwithstanding the rules, we all need to behave in a responsible way, because we all have a role in controlling the spread of the virus.

As the Government continue to impose further unprecedented restrictions on people’s freedoms, it is important to give people hope and justification. As York’s covid rate continues to fall and is the lowest in Yorkshire, can the Secretary of State outline how we can get to tier 1 as fast as possible? Will he publish the assessment and the data based on which York was placed in tier 2, so that we can best judge how to get to tier 1? He talks about regular reviews, but a weekly review would be much more desirable.

Yes; I can answer positively on all counts. We have a regular weekly session to go through all these. I am committing to regular reviews rather than weekly ones simply because we sometimes have to do it more than weekly, especially if cases are shooting up in an area. On my hon. Friend’s point about publication, we have published today not only the data—and we will publish more data on each area—but an explanation of the reason for the decision taken in each area. I know that he and colleagues across York have worked hard, because there was quite a serious spike in York, and it is coming down at the moment. Overall, we still require the whole of North Yorkshire to go into tier 2 because the case rates are still elevated right across it, and we all need to work together to get them down.

I share the concern of my neighbouring colleague, the hon. Member for Twickenham (Munira Wilson), about clarity over tiers and messages. One message and rule that is clear but unwelcome is the 11 pm curfew for pubs and restaurants. Curfews fail to address the issue of crowds in the streets and on public transport, which risk spreading infection. Will the Secretary of State commit to meet London government, including the Mayor of London, as soon as possible to discuss this and agree the criteria that London needs to meet to de-escalate as soon as possible?

Of course we have been engaging with the team who work across London. There is a lot of work to do in London. There are parts of London where cases continue to rise, and we need to get that under control, but there are also parts where they are falling and things are very much going in the right direction. Likewise, there is pressure in some parts of the NHS, but there is a lot of mutual aid within the NHS across London. There is a lot of work to do in London to keep it in tier 2, and I look forward to working with the hon. Lady and other London colleagues on that.

People living in Runnymede and Weybridge often ask me on what basis we are subject to local tiers and to restrictions, and it is clear that, alongside the data, other factors are taken into account in the two decisions. I thank my right hon. Friend for his response to the question from my hon. Friend the Member for York Outer (Julian Sturdy) that the reasons and the data will be published. Will local hospital bed utilisation be part of the reasons published?

Yes. There are five indicators that we take into account in deciding on which tier. One is pressure and anticipated pressure on the local NHS, and bed occupancy rates are of course a critical part of that assessment. I know that people are looking for a clear numerical boundary between the different tiers, but because we are looking at five different indicators rather than a single one, there is no automatic figure at which a different tier is triggered. We have to look at all the circumstances, including, for instance, outbreaks. Some cities, on their pure numbers, would be in tier 3, but because an outbreak is specific—for instance, in a school or care home—it is appropriate that they are in tier 2. We have to look at these very localised issues as well, and that is why the engagement with local directors of public health is so important.

There will be bitter disappointment in Dorset, in both the urban and rural areas, that we are in tier 2 even though our infection rates are now falling quite rapidly. My main interest today is finding out how we get out of tier 2 and into tier 1. If we are going to have regular—that is, weekly—reviews, that is great and fine, but if we are not, and we are stuck in that tier for two or three weeks, would the Secretary consider some kind of appeals process, and might his admirable Minister for Health be the appeals process?

We work as a very cohesive team of Ministers in the Department, and we all work on covid-related issues. I take it from my hon. Friend’s gentle chiding that he would rather my No. 2 took these decisions, but I am afraid he is stuck with me for the time being.

On the serious point that my hon. Friend raises, we will review the tiers in a fortnight and then regularly, which he can reasonably take to be weekly. We have a weekly cycle of meetings, with the chief medical officer chairing a meeting, typically on a Tuesday. I then chair a meeting on a Wednesday for an announcement on Thursday of any change to the tiers.

The Secretary of State knows that I chair the all-party parliamentary group on air pollution, so he will not be surprised if I point out that tier 3 areas tend to be the areas with the highest pollution. Every microgram of PM2.5 per cubic metre increases covid deaths by between 14% and 18%, and that is on top of the 40,000 deaths annually from air pollution. Does he agree that we need cross-Government activity and an all-Government report annually—from the Department for Environment, Food and Rural Affairs, the Ministry of Housing, Communities and Local Government and the Department for Transport—on what they are doing individually and collectively to combat air pollution and, in so doing, to reduce the covid death rate and the overall death rate? I can see the Prime Minister nodding sagely. Would the Secretary of State agree to an annual report?

It is very impressive that the hon. Gentleman can see the Prime Minister, since he has just left the Chamber, but I am sure the Prime Minister is nodding sagely, wherever he is. The hon. Gentleman makes a very serious and important point, on which we agree. Air pollution is a very serious issue. In lockdowns, air pollution has been reduced; that is one upside to what are otherwise very damaging things to have to do, although they are necessary to keep the virus under control. I hope we can continue to work together on tackling air pollution long after this pandemic is over.

With Gloucestershire in tier 2, next to South Gloucestershire, in tier 3, and the Welsh border, will the Secretary of State confirm that there will be no travel restrictions between different tiers or across the Welsh border? Since the Government can change tiers without debate, which has a huge impact, especially on the hospitality sector in terms of moving from tier 2 to tier 3, will he also confirm when the tier decisions will be published?

I am afraid that I cannot confirm that with respect to the Welsh border, because the legal restrictions on travel were a decision by the Welsh Administration, rather than by the UK Government for England. We have taken the view that travel restrictions should be in guidance, because there are all sorts of complicated circumstances in which people might need to travel. We have done that when we have been in national lockdown across England, as well as locally. I am sorry that I cannot be clearer than that. On the point about renewal and when we review these matters, we are proposing to review first on 16 December and then regularly thereafter to ensure that we keep the tiered restrictions as up to date as possible.

The Health Secretary will know the pressure that Pinderfields Hospital, especially, has been under. The staff there have been doing an incredible job. It is welcome that the number of covid patients in hospital is starting to fall and that the number of infections locally has fallen by around 30% in the last week, but he will also know that our NHS, social care and public health staff have had a really difficult year and that the winter is going to carry on being tough, with many operations to catch up on. Will he now look swiftly at the case for added support and pay for NHS, public health and social care staff this winter, in recognition of the incredible job they have been doing to care for all of us?

I am delighted that we have a significant increase in the number of NHS staff. The figures published this morning show that there are 14,800 more nurses than there were this time last year in the NHS. I am really pleased about that. The right hon. Lady will no doubt have seen yesterday that the pause on pay increases across the public sector announced by my right hon. Friend the Chancellor does not apply to nurses and doctors. That is, in part, in recognition of the incredible work that they have done during this pandemic.

As the economic damage the pandemic is doing becomes increasingly apparent, it is clearly right that businesses of all types are reopened as soon as it is safe to do so. This will take longer than it needs to if the restrictions on those businesses are calculated on the basis of virus information for places a long way away or as a geographical average for a wide area encompassing urban and rural parts. That is exactly what is going to happen to the businesses in my constituency, which will not be able to open next week if they are hospitality businesses, not because of the rates where they are, but because of the rates somewhere else. Surely it is more sensible to calculate restrictions on the smallest geographical area where data is reliable, which is largely boroughs and districts. Will my right hon. Friend commit in his review in two weeks’ time to look not just at whether individual areas are in the right tier but at whether the areas are properly constructed?

Yes, absolutely. My right hon. and learned Friend is absolutely right about the importance of this. We have to balance the need for an area to reflect the human geography in which people live and effectively communicate the tiering decisions across that geography, with precisely the concerns that he mentions. For instance, Slough is in tier 3, despite the fact that Berkshire, of which it is a part, is in tier 2, so we are prepared to take those decisions at a lower-tier local authority area level. That is the exception rather than the norm, but we look at this every single week.

Covid-19 is a world pandemic and it needs to be tackled on a global basis. International travel will expose the UK to future outbreaks, particularly if the virus mutates, so on both humanitarian and public health grounds, does the Secretary of State not agree that it is indefensible to cut the international aid budget, just as a global vaccine roll-out begins?

Of course, we have been hugely supportive. In fact, the UK is the biggest supporter internationally of providing vaccines in countries that would not be able to afford them themselves. I am sure that that will continue, because we will continue to have one of the largest international aid budgets in the world.

I know that my right hon. Friend will thank everyone in both East and West Suffolk for bringing down the level of infections, and that it is with a heavy heart that he has concluded that the county cannot exit to tier 1. Will he ensure that there are clear indicators as to what else needs to be done so that Suffolk may move to tier 1 as quickly as possible, and will he liaise with the Chancellor of the Exchequer to put in place additional support for the hard-hit hospitality sector?

I have constant discussions with the Chancellor of the Exchequer about the support needed. My hon. Friend is right to raise that, especially in Suffolk. It is with a heavy heart that we took the decision on Suffolk. Its case rate is higher than those in the Isle of Wight and Cornwall, which are the two areas in tier 1, but that gives an indication of where we need to get to. I am sure that if we all work together, we will be able to get there.

We are stuck in an endless cycle of lockdowns that are simply not working. The Government have again wasted the opportunity over the past few weeks to get a handle on testing, tracing and isolating. Once again, hospitality in South Shields will be absolutely battered, and my constituents’ liberty impacted on. Will the Secretary of State tell us exactly what will be different this time that will make our sacrifices yield a reduction in the infection rates?

First, I urge the hon. Lady to look at the figures published this morning, which show that the majority of tests when done in person are now turned around within 24 hours across the country, and capacity has increased radically. What I would ask of her for the future, to help the north-east get out of tier 3, is to work with her local councils, with the directors of public health, to embrace the community testing that has been effective in Liverpool. If they are up for doing that—it has to be in consultation and conjunction with the local councils, because they know the area—I very much hope that they will come forward to pick up the baton and make that happen.

This is not an easy question, but how will the Health Secretary take into account the wider mental and physical health implications for people who are prevented from living their lives as they would wish to live them?

We look as much as we can at taking the impacts into account. For instance, the mental health of people under lockdown is of course more challenged than in normal circumstances. We balance that against the impact of covid both directly and, in filling up the hospitals, on the healthcare that we all get for all the other conditions that exist. It is a difficult balance to strike. On the particular impact on mental health, the Royal College of Psychiatrists has done very interesting work to understand the nuanced balance between the impact of covid on people’s mental health and the impact of lockdown. Both are significant and I commend its work to him.

It is devastating that after all its efforts, the north-east will be in tier 3. Across the whole country, obesity remains a serious factor in covid-19. Yesterday, the all-party parliamentary group on obesity launched its report to build on the Government’s obesity strategy. Will the Minister meet officers of the group to discuss the report’s recommendations and work with us to ensure a focus on the prevention and treatment of obesity in the fight against covid-19?

Yes. the hon. Member and I share an enthusiasm for this agenda with the Prime Minister, who is a personal convert to the need to tackle obesity. In fact, this crisis shows how important it is, because people who are obese are more likely to have a more serious impact from covid, if they catch it.

We have consistently been told that we must accept restrictions to protect the NHS, and Buckinghamshire Healthcare NHS Trust has done an amazing job in dealing with the pandemic from the very beginning. Can my right hon. Friend therefore explain the weighting that he puts on the pressures on the local NHS as one of the five indicators in the decision-making process over tiers? It will be very difficult for people in Aylesbury to accept stringent controls on our lives and livelihoods if, in fact, there is plenty of capacity in hospitals for both covid and non-covid cases.

We look at all five indicators essentially equally. The point about pressure on the NHS is a more sensitive indicator on the decision to go into tier 3. If an area is in the situation of Buckinghamshire, for instance, where the case rate is elevated, but not as high as in many other parts of the country, the key thing to do is to keep that case rate where it is or lower. We could not make the decision to put Buckinghamshire into tier 1 because, if it went up from where it is, it would not be long until Buckinghamshire was in trouble. Therefore, the decision was to put it into tier 2.

I very much hope that the cases can continue to go down until they are very low—like they are in Cornwall and on the Isle of Wight, for instance. We will then be able to review and consider tier 1. I hope that that is a reasonable explanation. We need to continue to debate this matter as we try to ensure that we get the judgments around these geographies exactly right.

The good people of Luton will want to get out of tier 2 as soon as possible, but the current resources provided to Luton Borough Council for the lateral flow rapid testing pilot are insufficient to enable it to provide the level of mass testing that is being described nationally. The contained funding—£8 per person—just will not cover tests for 10% of Luton’s population, as the funding also needs to be used for the wider covid response, including wellbeing support for vulnerable residents. Can the Secretary of State confirm that there are national plans to provide additional support and resources to expand testing if the intention to test close contacts daily is pursued?

Yes, there will be further funding for those areas that go into tier 2 and yet more funding for the areas that go into tier 3. That funding will go to the councils for the extra support that is needed.

I thank the Prime Minister for the flexibility that the Government are providing so that we can all have a family Christmas, but what consideration has been given to Hanukkah, which starts two weeks today, regarding family gatherings and public menorah lightings? Does my right hon. Friend think it is fair if no flexibility is shown to the Jewish community?

We carefully considered this issue, consulted on it and discussed it widely. Christmas is a national holiday, as well as being very much a Christian celebration. That is reflected, for instance, in the fact that we have two days of bank holidays. We consulted members of different faiths around precisely the question that my hon. Friend rightly raises, and there was a strong degree of support for having something special in place for Christmas for everybody, even though we have not been able to put that in place for Hanukkah or for other celebrations of other faiths.

May I start by assuring the Secretary of State that directors of public health and local authorities in the LA7 area and the wider north-east are certainly very focused on getting that figure down and have had some success? I would like to make that absolutely clear. The second point I would like to make is that my constituents and others across the north-east will be hugely disappointed to find they are in tier 3, particularly those businesses in hospitality and leisure which are going to be so desperately hit by this. The real point I want to make, however, is about public health. Nothing has shown more than this pandemic that public health should be at the heart of what we do. We know it affects outcomes in covid-19, and we know it affects health inequalities and the rate of transmission. Will the Secretary of State ensure that he impresses that on the Chancellor, and ask him for more funding for public health services, both now and in the future?

Yes, I agree with every word of what the hon. Lady said.

My constituency of Beckenham is very relieved to be in tier 2. Very kind of you, Secretary of State. I have had a couple of constituents ask me whether they have to have a vaccination. I have said that no, they do not, as far as I know. Can my right hon. Friend tell the House what percentage of the population is required to be vaccinated in order for the measures to be effective, so we can get back to normal?

I would urge everybody to get a vaccination, if we manage to get a vaccine that is approved by the authorities, because the regulator will only approve a vaccine if it is safe and effective. Having said that, we are not planning to make it mandatory, because we hope that the vast majority of people will take it up, not least because it will help to protect them and their community, and get the whole country and indeed the world out of the mess we are in.

The winter plan confirms that the Government will be taking action to restrict the movement of care staff between care homes. On the face of it, that is a perfectly sensible infection control measure. However, many care staff are forced to work between multiple homes because of low hourly wages. Can the Secretary of State therefore give a commitment that care workers will suffer no loss of income as a result of the policy? Can he set out what he will do to ensure that no care staff lose any of their jobs because they are being forced to choose between the different homes they work in?

I hope that, partly through this measure and the increase in the national living wage that the Chancellor confirmed yesterday, we can improve the pay and conditions of staff across social care. The proportion of people in social care who work in a number of settings and work in agency and less secure work is, in my view, something we should tackle together. I hope we can use what has obviously been put in place, as the hon. Lady rightly says, for public health infection control reasons also to improve employment standards across social care. That is, of course, directly contracted by local authorities, rather than by central Government. Nevertheless, this is an area that I think we all know we need to work to improve as a nation.

I am sure my right hon. Friend appreciates that many elderly people die with serious illnesses, such as prostate cancer, but not from those illnesses. How certain is he that statistics showing the number of people dying with covid-19 are not being presented or misinterpreted as people dying from covid-19?

The statistics on the number of people dying with covid-19 are the best estimate that the statistics authorities, both in Public Health England and the Office for National Statistics, come up with. It is one of the widest definitions, which countries use internationally. Therefore, as my right hon. Friend implies in his question, it does include people who may have died of something else, but with covid. Nevertheless, each of these deaths we should work to avoid. The best measure, according to the chief medical officer, is the total number of excess deaths compared with this time of year last year. That is elevated now and we need to get it down.

May I first thank the Secretary of State for listening to local leaders, who have been pushing for a one-Oxfordshire approach to coronavirus as we go into tier 2? I am sure many residents understand the need to be careful for Christmas. Although Oxfordshire’s data is better than that of surrounding counties, we cannot risk any further damaging lockdowns. The reason we have done so well is superb team working and a county-wide systems approach, involving all councils, the NHS and businesses. In particular, we were quick off the mark to implement a local test, trace and isolate system, which is paying dividends. Does the Secretary of State agree that the key to beating this virus is to treat local areas as partners, and when they say they should be moving up and down tiers, will he give their voice considerable weight?

Yes, I do give considerable weight to the voice of local leaders when they make a case for a particular tier for their area, and in the hon. Member’s case I would like to pay tribute to Ian Hudspeth, who has worked incredibly hard during this crisis for the benefit of people right across Oxfordshire. I talk to him regularly about the situation in Oxfordshire, which has made great strides in tackling this virus, including tackling the student outbreak at the universities in Oxford. I hope those local leaders can work to get Oxfordshire appropriately down into tier 1 as soon as possible, but there is some work still to do.

Today’s decision will be disappointing to businesses and residents across Burnley, who have had extra restrictions on their lives and their businesses for longer than most. Can my right hon. Friend set out exactly what support go to Burnley and the wider Lancashire area, and when it will be delivered, so we are able to end these restrictions as soon as we possibly can?

Yes, Burnley has been in restrictions for a long time now. It has brought its case rate down by about half since the peak in late September. My hon. Friend has played a dutiful and impressive role in his public leadership within Burnley. I hope that we can work with Burnley Borough Council and Lancashire County Council to get the case rate down and get Lancashire down into tier 2, in the same way as Liverpool has managed to come down into tier 2: a combination of people following the rules and community testing. That is available to people in Lancashire, and I very much hope to be able to work with the team in Burnley and across Lancashire to make this happen.

The final thing I would say is that these are tough measures; I get that. I understand the impact on hospitality, but they are done for the right reasons, which is to keep people safe and stop the local NHS being overwhelmed.

Warrington will be breathing a sigh of relief that we are emerging from national lockdown into tier 2, but while I welcome the return of fans to stadiums, I cannot support the extension of the substantial meal requirement to tier 2, which will leave many pubs across my constituency closed. The pub sector faces an existential threat and it flies in the face of logic and fairness that thousands can congregate at the rugby but wet pubs that are at the heart of our community must stay closed. Will the Secretary of State commit to publishing the specific evidence that underpinned the substantial meal requirement extension and, if he cannot, to removing this requirement?

Unfortunately, we will not be removing that requirement from tier 2. It is incredibly important that we keep the cases under control. The local team in Warrington has worked very hard along with the Liverpool city region to get the case rate down. They went into national lockdown in tier 3 and have come out in tier 2, and the people of Warrington should be commended for that, but the measures of tier 2 are necessary to keep the virus under control because, unfortunately, the virus thrives when people get together. The hon. Member mentioned the point about events on a larger scale. They will only be held where there is very stringent social distancing, so there will not be congregations, as she said, of thousands of people—I would like to reassure her of that—because these events will only take place when the capacity in normal times of any venue is much, much bigger than the number of people who are there.

First, I want to thank residents in my constituency for their hard work and sacrifice; their borough has been hard hit by the virus. With my constituency being in one of the worst affected areas, will my right hon. Friend consider rolling out the vaccine as a priority when it is ready to the country’s worst affected areas, which have been not only blighted by this virus, but hard hit economically? These are the areas that will be in much need of assistance to get back on their feet following prolonged lockdown of the local economy. The vaccine would provide much needed respite in these worst affected areas.

We have taken the decision to roll out the vaccine UK-wide at the same pace. I want to get it as soon as possible to the west midlands and to everywhere else, but it is fair to the areas that have had a low, or relatively low, incidence of the disease to make sure that they also have access to the vaccine. Also, the incidence in different parts of the country changes, and the vaccine roll-out programme is very complicated. It does not speed up the delivery of the vaccine in one area to have slowed it down in another. That is why we have taken a UK-wide approach.

In keeping with my right hon. Friend’s spirit of working together, I stand not only to represent Wealden, but to speak on behalf of my hon. Friends the Members for Bexhill and Battle (Huw Merriman), for Eastbourne (Caroline Ansell) and for Hastings and Rye (Sally-Ann Hart). We wish to collectively thank the CEOs of the clinical commissioning group and East Sussex Healthcare NHS Trust, our county leader, Keith Glazier, and our local department for public health for working with us day in, day out to understand the data and the reason for the infection rates.

We are deeply disappointed that—considering all the five indicators, where we mark extremely low—we are in tier 2, and we are disappointed that central Government have not consulted local leaders, because they would then have been able to investigate the data and, hopefully, show us how we could move into tier 1 from tier 2. Will my right hon. Friend provide some assurances that these conversations will take place with local leaders and confirm that transparent objective criteria will be published for each tier, and explain how we can slide between each tier?

Yes, absolutely—I can give both those assurances. Across Sussex, case rates are at 120. They do need to come down. Like my hon. Friend, I would like to see Sussex go into tier 1 as soon as possible, and we will keep talking to the local area. As I said earlier, all directors of public health have been invited to discussions and consultations with the public health team. That feedback fed into these decisions, but we have to make sure that those conversations continue. The key message to everybody across Sussex and in the Weald, in particular, is that if we all stick together and follow the rules, we know that we can get this virus under control, and that will then lead directly to the lifting of restrictions, which we will regularly review.

The Secretary of State will be aware of reports on the Oxford vaccine that the sub-group that suggested 90% effectiveness was due to a manufacturing error, rather than being a planned protocol. It included fewer than 3,000 people and did not have any participants over 55. Does he agree, therefore, that further research is required to verify the efficacy of the lower dose in all age groups before it can be adopted as a standard regimen?

Questions over the interpretation of the data in the clinical trials are rightly for the Medicines and Healthcare products Regulatory Agency, which will assess these clinical trials and will only approve a vaccine for use if it is effective and safe.

The first review of Kirklees being in tier 3 will be on 16 December. Will the Secretary of State please confirm that his Department will consult local MPs, council leaders and the local director of public health? Will he publish the full numerical criteria so that we know what we need to achieve to get out of tier 3? Will the Government support Kirklees in delivering mass testing? Finally, will the Secretary of State have a conversation with the Chancellor about delivering extra financial support for our hospitality businesses?

I will absolutely take up all those suggestions. We are in discussions with Kirklees about what more we can do, including in the area of large-scale community testing and the other considerations necessary to make that happen.

The Secretary of State is to be commended for the initiative that he and the Minister for Care have spearheaded to allow close-contact visits between relatives and residents in care home settings. Will the proposed access vary depending on what tier a home is located in? I acknowledge that care is a devolved issue, but with little progress being made in this regard in Northern Ireland, will the Secretary of State undertake to share the experiences of his pilot with the Health Minister in Northern Ireland so that my constituents can also look forward to visiting loved ones as soon as possible?

Subject to the results of the pilots, which are ongoing, we hope to enable testing in England to allow for visiting in care homes before Christmas. I will certainly have another conversation with my opposite number Robin Swann, who is the Health Minister for Northern Ireland. Robin Swann is an excellent Health Minister, we work very closely together, and I am absolutely sure that together we will be able to make progress on testing and other matters. He and I are constantly in touch about how we can best serve the communities of Northern Ireland, from the position of the UK Government’s role in procuring tests around the world and, of course, his vital role in keeping people safe right across the Province.

I thank the Secretary of State; we have completed our exchanges on the statement.

In order to allow the safe exit of hon. Members participating in this item of business and the safe arrival of those participating in the next item of business, I will now the House.