PARLIAMENTARY DEBATE
Covid-19 Update - 9 November 2021 (Commons/Commons Chamber)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I thank the Secretary of State for, as always, timely advance sight of the statement.

Vaccination saves lives—it is the best protection against this deadly disease and helps to cut transmission—and we of course want to see NHS staff vaccinated. As has been pointed out many times before, there are already categories of staff for whom a hepatitis vaccination is expected. We will look carefully at the regulations and the equality impact assessment, but I urge the Secretary of State to proceed with caution, because the NHS is already under the most intense pressure this winter; waiting lists are close to 6 million; there are more than 90,000 vacancies across the NHS; and the Chancellor failed to allocate in his Budget funding for training budgets to train the medics we need for the future. There will be anxiety at trust level that a policy, however laudable in principle, could exacerbate some of these chronic understaffing problems. We simply cannot afford to lose thousands of NHS staff overnight.

We do welcome the fact that the Secretary of State has listened to representations from organisations such as NHS Providers and others about delaying the implementation of this until after the winter; we welcome that. None the less, there are still organisations, such as the British Medical Association, that have raised concerns about the practicalities of implementing this policy. Helen Stokes-Lampard of the Academy of Medical Royal Colleges has said that mandatory vaccination is neither “necessary” nor “proportionate”. Will he agree to meet the royal colleges, the BMA, and the relevant trade unions to agree a framework for how this policy will be implemented? Will he outline to the House what success looks like for this policy? Some of the 10% of NHS staff who are not vaccinated include those with medical exemptions, those who are on long-term sick, and those who could not get the vaccine first time round because they were ill with covid. Will he tell the House: what is the actual number of NHS staff who should be vaccinated, but who have not had the vaccine? What is the actual number? In other words, what then does he consider a success? What does full vaccination across the NHS look like for him? Is it 94%, 95%, or 96%? What are we aiming for here? What is his target?

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

What analysis has the Secretary of State done of those who are vaccine hesitant in the NHS workforce? What targeted support has he put in place to persuade take-up among those groups? He refers to trusts where take-up is around 80%, so what specific support has he put in place to help those trusts drive up vaccination rates? We know from society more generally that there has been hesitancy, for example, among women who are pregnant and who want to have a baby. That has meant that a significant proportion of those in hospital with covid are unvaccinated pregnant women. A large proportion of the NHS staff workforce are women of a similar age, so is this one of the issues as to why there is hesitancy in certain pockets across the NHS? Will he therefore look at a large-scale campaign to reassure pregnant women of the safety of the vaccine and look at launching an information hub, perhaps a dedicated phoneline, to offer clear advice to women and their partners who might have concerns?

Finally, on vaccination more generally, I do not want to see—I do not think that anyone across this House wants to see—anymore lockdowns imposed on cities such as my own in Leicester, or across Greater Manchester, or Bradford, but in many of these areas, vaccination rates are not good enough. Leicester has a vaccination rate of just around 61%, Bradford 63%, Bolton 69%, and Bury 71%. Generally, on children’s vaccinations, we are only at 28%. On the boosters, there are still around 6 million people eligible for a booster who have not yet had one. The Government’s own analysis shows that people over 70 who are dying from covid or hospitalised should have had a booster, but have had only two jabs.

With Christmas coming, which will mean more mixing indoors at a time when infection rates are still high—one in 50—we are facing six crucial weeks. What more support will the Secretary of State offer now to local communities, such as Leicester, Bolton, Bury and Bradford, to drive up vaccination rates, because nobody wants to see those local lockdowns again.

I thank the right hon. Gentleman for his approach to this matter and to issues around vaccination in general. There is no doubt that the general consensus in this House, across parties, has played a vital role in building confidence in vaccines among our citizens, and, once again, I thank him and his party for their approach to vaccination.

The right hon. Gentleman has raised a number of questions. He suggested caution in this approach and he was right to do so. I hope that, from what I have already shared with the House today and what I will continue to share, he will feel that we are taking that cautious approach. For example, if Parliament supports this move, there will be a grace period so that those in the NHS and social care who have not yet chosen to take any vaccine will have plenty of time to do so.

The right hon. Gentleman asked about meeting healthcare leaders. He will not be surprised to hear that, probably like him, I meet healthcare leaders all the time and will continue to do so. I am more than ready to listen to them. Following the consultation that we have had on this so far, we would like to know what further suggestions they have, especially around implementation and take-up.

The right hon. Gentleman specifically asked me about the NHS take-up. The take-up throughout the NHS in England is 93% for the first dose and 90% for two doses, which leaves, I think, 103,000 people in the NHS who are unvaccinated—in other words, they do not have even one jab. As he will understand, it is hard to know what portion of that number will take up the offer of vaccination. If we look at what has happened in care homes since that policy was announced, we can see that there was a significant fall in the equivalent number, and I think that we can certainly expect that here, but, as he has suggested and as came through very clearly to the consultation, it is about making sure that people are encouraged to take a positive choice. From what I said earlier, I cannot be clearer that no one should scapegoat or single out anyone in the NHS or in social care who has, at this point, for whatever reason, chosen not to get vaccinated. This is all about working with them positively, making sure that they have the information that they need. In answer to his question of what more will be done to help people make that positive choice, I say that, as well as information, one-to-one meetings will be offered to everyone who is unvaccinated, if that is what they want. They will have the opportunity to meet clinicians and others to allay any concerns they may have. That includes, of course, those who are pregnant or thinking of one day becoming pregnant. The right hon. Gentleman was right to raise that, too.

Lastly, on the vaccination programme overall, I think the right hon. Gentleman will agree that, as a country, we have done remarkably well. Almost eight out of 10 people over the age of 12 are double vaccinated. That is one of the best vaccination rates in the world, but, as he and others have said, we still need to be working hard to do better. There are still too many people who have not taken up an original offer of a vaccine. We also need to make sure that, for those who are eligible for a booster shot, it is made as easy as possible for them. Some of the recent changes to the booster booking system have led to a phenomenal increase in booster shots—more than 10 million throughout the UK—and the number is growing all the time.

This is a difficult decision, but it is the right decision, and I congratulate the Health and Social Care Secretary on biting the bullet on this. I congratulate his predecessor, my right hon. Friend the Member for West Suffolk (Matt Hancock), on laying the foundations of the vaccination programme that has made it possible.

When we have a disease that can be transmitted asymptomatically, all of us have a responsibility to protect the most vulnerable people, and no one more so than doctors and nurses. I do not know of a single doctor or nurse who do not want to be double or triple jabbed in order to make sure that they are protecting their own patients. Reducing the number of nosocomial infections is one of the big learning points from this pandemic going forward, so this is the right thing to do.,

Exactly the same arguments for the covid vaccine apply also to the flu vaccine. I note that, today, the Health Secretary has not made an announcement about the flu vaccine. Can I encourage him to do so? I wanted to vaccinate NHS staff for flu much more comprehensively than was happening. I think my successor wanted to do it as well. This needs to happen for exactly the same reasons. There is asymptomatic transmission of flu just as there is asymptomatic transmission of covid. I encourage my right hon. Friend to look at that and I would be interested to hear what his plans are on that front.

I thank my right hon. Friend for his support for today’s announcement. I know that he speaks with huge experience, that he has rightly focused for years on the importance of patient safety, and that he will also welcome this as a patient-safety measure. On his particular question around flu, we did consider that carefully. As he knows, we did consult on it. We looked at the response to the consultation and, after consideration, we were not convinced that we should go ahead with flu at this stage, but the option remains open.

I am guardedly sympathetic to the direction of travel in which the Secretary of State is going, but this obviously could lead to specific skills shortages in different parts of the health service. Can he give us a guarantee that this will be monitored at a granular level, so that each hon. Member can be certain that we do not find out that our own hospitals have developed those skills shortages in vital services?

The hon. Gentleman is right to raise that point. It was a concern in making the decision, and I have set out how I have taken that into account. However, I assure him that the issue will be monitored on a day-by-day basis by our colleagues in NHS England and of course the Department itself, and that whatever workforce planning is necessary will be done.

I warmly welcome the Secretary of State’s decision and the cross-party consensus behind it. Medicine is based on science and the vaccine is the best of science, and we should use all the science and tools at our disposal to keep people safe. That is the justification for this policy. I support the extension of the decision in due course to flu. I am glad that the Secretary of State is keeping that option open, and urge him to continue to push on that as soon as is practicable.

May I invite my right hon. Friend to join me in saying that, given that there is cross-party consensus and that the announcement has now been made, this is clearly going to happen; and that all those working in the NHS, including those who have so far been hesitant, should therefore come forward as soon as possible to get the vaccines? They are going to have to get them, so better to get them sooner rather than later.

I agree wholeheartedly. May I take this opportunity to thank my right hon. Friend again for the work that he has done in Government, and particularly in this Department in laying the foundations of our successful vaccination programme? Without those foundations, we would not have been able to take this positive step today. He is right to point to the fact that vaccines work, and that they are safe and effective. Public Health England estimates that at least 230,000 hospitalisations and more than 100,000 deaths have been prevented by the vaccines. He is also right to say that now that the Government have made our decision, subject to the will of Parliament, this will happen; and that there is already an opportunity from this moment for people to make the positive choice. In doing so, we will help those people in every way that we can.

I welcome the Secretary of State’s announcement, but if this is about minimising transmission, surely it follows that we should be reviewing the guidance on facial protection and FFP3 masks. Will he be following the recommendations of the royal colleges and trade unions that frontline staff in care homes and the NHS should be issued with FFP3 masks?

The hon. Gentleman will know that masks play an important role in vulnerable settings in healthcare and social care already. He points to a suggestion by some that the requirements regarding the type of masks should be changed. I reassure him that we keep this issue under review at all times, and if such a change were necessary, we would support it.

It is obvious that the booster jab is essential to protect the very vulnerable. I have an elderly family member who is 90 years old and completely bedbound. He lives at home, and cannot get out of the flat and down the steps, and he has been waiting for weeks for his booster jab. He said to me on Sunday, “Where is my booster jab?”. I suspect that across the country it is quite inconvenient to get out to very elderly people who are living at home—not in care homes, but in their own home. These people are being looked after all day by care workers, coming in and out. Will the Secretary of State now give an instruction to health authorities, GPs and district nurses to get out and get the booster jabs into these very old and vulnerable people?

What my right hon. Friend has just said deeply concerns me. Anyone who is 90 years old and homebound should have been contacted—certainly at that age. I am assuming that it has been at least six months since the individual’s second jab. On that basis, he should have been contacted and visited by his GP. First, I would like more details about that particular case, if my right hon. Friend will supply them. I would want then to ensure that there are no other instances like that, because someone at that age who is homebound should certainly already have received their booster jab.

I thank the Secretary of State for setting out his thinking today. The Government said in the Budget that they planned to invest responsibly. Does he believe that it was responsible to cancel a multimillion-pound contract to supply a covid vaccine that phase 3 trials show may be more effective than the Oxford vaccine, threatening hundreds of jobs in Livingston for no apparent good reason? Will he consider rethinking that unfortunate decision?

I know the case to which the hon. Lady is referring. We are clear in our decision, which was made for all the right reasons. I hope that she will understand that I am not at liberty at this point to share those reasons, due to commercial and legal sensitivities, but I assure her that there is absolutely no point in revisiting that decision.

I welcome what the Secretary of State has said about his proposed method of dealing with this issue in Parliament, and his confirmation that he is going to publish an impact assessment ahead of the decision. That, of course, was not what happened when we voted on the care home vaccination issue, for which, to be fair to him, he was not responsible; the way in which that decision was conducted was an abuse of this House, which was asked to vote on it.

The Secretary of State has just confirmed that of the 40,000 care home staff who the Government estimated were going to leave the care home sector because they had not been vaccinated, 32,000 of them—two days away from the deadline—remain unvaccinated. That is a significant number. When he publishes all the information before we make a decision, will he ensure that as well as the impact assessment he includes a plan to deal with what sounds like it will be something like tens of thousands of NHS staff, who, if the care home workforce are any precedent, are going to end up leaving the national health service? It may be the right decision, but we must have a plan to deal with it. Not having had a plan for the care home sector is causing enormous pressure not just on the care home sector, but on the NHS. I want to ensure that when Members are asked to make a decision, we have all the information at our disposal so that we can make the best possible decision in all the circumstances.

My right hon. Friend is absolutely right that parliamentary procedure is vital. As well as publishing the impact assessment before a vote, I can share with the House that we will be publishing an impact statement today. That will be followed by the impact assessment, later. He mentioned the figure of 32,000. That is the latest published number, from the end of last month. Although it has only been a few days since then, the situation is currently quite fast moving because the number might include a number of people—perhaps in their thousands—who are medically exempt but about whom the Care Quality Commission has not yet been informed. He has pointed to the need for the Government to share our thinking or that of the NHS on workforce planning with respect to this new measure. We will set out more details.

A number of care home owners have said that the damage has already started to be done, and that some of their carers are leaving either their jobs or the sector entirely. I welcome the Secretary of State’s statement that an impact assessment will be forthcoming, and look forward to seeing the impact statement later today. In response to the hon. Member for Rochdale (Tony Lloyd), the Secretary of State also mentioned that the Department is monitoring the issue on a “day-by-day basis”. I worry that an impact statement might be too late if we have to wait two or three months for a vote. Will he commit to publishing the data that he is looking at day by day, so that Members of the House can see in real time whether the policy is going to have an impact on the workforce situation in the NHS and care homes?

We will be publishing the impact statement today.

Although I want everybody to be vaccinated, I do not support mandatory medical interventions, and I worry about the impact on the already high vacancy rate in the workforce. My right hon. Friend the Secretary of State must have done some risk assessments, so can he tell me this? As previously asked, how many of the 10% who are un-jabbed does he assess will be subject to medical exemptions? What calculations has he made of the likely job losses overall? When will he publish a list of exactly what personnel are involved? Will it involve cleaners, for example, who do not have medical engagement with patients but are certainly in proximity to them? When will he publish the evidence and the data on the number of patients who have been infected with covid by unvaccinated staff while in hospital?

I hope my hon. Friend appreciates that there were a lot of questions. The impact statement will be published today, and the impact assessment will be published before he and other Members are asked to vote. Those documents will help to answer their questions. I also draw his attention to the experience thus far of the condition of deployment measure that we took in a similar way with care homes, and how dramatically the numbers were cut from the point of announcement.

I gently say to the hon. Lady that she really should not try to play politics with the story that she is perpetuating about the Prime Minister on a hospital visit yesterday. As the hospital trust said, and as I am sure she knows, the Prime Minister and his team followed all the rules that they were required to follow, whether they were about face masks or otherwise, in that hospital. Something tells me that she knows that, but sadly she has decided that she wants to play politics with such an important issue.

As for information on vaccination rates in Bristol, the hon. Lady knows that every region of England has a director of public health. She probably knows who hers is, and they will be able to supply a lot of information. If she is having any difficulty getting that information, I will certainly help her in any way that I can.

I declare my interest as a vaccinator. I support the Government’s position, but will my right hon. Friend the Secretary of State tell us what assessment he has made of the risk of transmission of coronavirus from an apparently healthy person to a vulnerable person? As with hepatitis B, the only justification for the measure must be that there is a significant risk of transmission.

Furthermore, will he reassess his position on flu following the comments of his two predecessors, which I support? Will he ensure that we do nothing to trespass on the rights of individuals unless it is absolutely essential to keep vulnerable people safe? Finally, will he say why he has gone for 1 April? If this has to be done, it is better to do it quickly. By the spring, we will clearly be past the winter pressures that we are all concerned about.

I thank my right hon. Friend for his support. On the assessments that we have done, I have shared some information with the House, and there will be an impact statement followed by an impact assessment that will give him more information. It may be helpful for him to know that studies already in the public domain show that against the delta variant, the AstraZeneca vaccine is 65% effective and the Pfizer vaccine is 85% effective in preventing infection. The fewer people who are infected in these settings, the less spread there will be.

I think I have set out the Government’s thinking on flu, but it remains under review. There are many reasons why we have focused on the 1 April date, but the main one is to give those in the NHS who have not yet had a single jab—there are 100,000 of them—to make the positive decision to get vaccinated.

In York, vaccination rates are high at 87%, but transmission rates of covid are also extremely high, and transmission is happening in the community. As a result, directors of public health such as my own are absolutely despairing that the Secretary of State and others in the Department are not listening to public health experts who are asking for the tools to be restored to manage the virus. That is about moving contact tracing immediately into local authorities, where they got on top of the virus and locked it down. It is also about ensuring that greater public health measures are taken—hands, face, space needs restoring in all settings.

The hon. Lady is right to point to the high vaccination rates in York, and everyone involved is to be commended. When it comes to other measures that may or may not be taken, I think the plan A approach that the Government set out is the right one. There may be reasons to take a slightly different approach in certain regional areas, and that is also possible with the right evidence. This is something that we always keep under review.

I thank the Secretary of State for his clear commitment and for the regular updates that we get in the House. Can he provide an assessment of the availability of the new covid drug molnupiravir? If people get that pill within five days of symptoms, hospitalisation and death rates are cut by 50%. Will the drug be available across the whole United Kingdom, and will the vulnerable classification include the diabetic and the immunosuppressed?

I can tell the hon. Gentleman that the antiviral drug that he refers to has been approved by the Medicines and Healthcare Products Regulatory Agency. We do have that drug, and since the point of approval last week we have already started deploying it in certain settings across the United Kingdom. We have put an order in for another antiviral, which has had very successful trial outcomes, but it has not received any final approval. If the MHRA independently decides to approve it—of course, that is a decision for the MHRA—the country will be in the fortunate position of having procured that drug, too.

One of the major objectives behind the successful vaccination programme is obviously to reduce infections, reduce hospitalisations and allow health professionals to focus on other, even more dangerous conditions, including cancer. The Secretary of State will be aware that in 2020, there were 35,000 missed cancer diagnoses. The London School of Economics study shows some 60,000 potential years of life being lost to cancer as a consequence of covid, and it is estimated that the NHS’s diagnostic and treatment services will have to work at 120% capacity for two solid years just to get back to March 2020 levels.

I suspect that the Secretary of State was as disappointed as I was that there was nothing in the Budget to help us to catch up with cancer. Will he follow the Government’s good example on the vaccine roll-out and adopt the same relentless focus on catching up with cancer, with targeted resources and leadership? Will he agree to meet clinicians and those involved in the cross-party Catch Up With Cancer campaign so we can work together to save those tens of thousands of lives, which will otherwise be unnecessarily lost?

The hon. Gentleman is absolutely right to raise the importance of cancer. For all the reasons he set out and more, it has remained an absolute priority of the Government and the NHS throughout the pandemic, despite the huge pressure that the NHS was under. Sadly, he is also right—I have spoken about this, just as he has—that many thousands of people went undiagnosed because they were asked to stay away from the NHS to protect it. We all understand why that happened, but sadly it had an unintended consequence. He is not right, though, to suggest that there was nothing in the Budget or the accompanying spending round to help with that problem. I draw his attention, for example, to the billions of investment in the new community diagnostic centres. There will be more than 100 across England, which will mean it will be much easier and quicker for GPs or others to refer people with suspected cancer for diagnosis. There are other examples, but I hope he is reassured that this remains an absolute priority.

I thank the Secretary of State for Health and Social Care for his statement today and for responding to questions for 40 minutes.