PARLIAMENTARY DEBATE
National Health Service - 13 July 2021 (Commons/Commons Chamber)

I beg to move,

That the draft Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) Regulations 2021, which were laid before this House on 22 June, be approved.

As we head towards a winter where care homes may have to battle with covid and flu, the question we should ask ourselves is this: what more can we do? Over the last year and a half, covid-19 has sadly taken many thousands of lives, particularly the lives of older people and those with underlying health conditions, and particularly the lives of those who need the kind of care received in a care home. There have been more than 40,000 deaths among care home residents. They were mothers and fathers, grans and grandads, brothers and sisters, sons and daughters. Sadly, we have lost some of our dedicated care workers, too: despite all the efforts that have been made by care homes and their staff, local authorities and by us in Government to keep covid out, despite personal protective equipment, despite testing, despite isolation. Throughout the second wave, care homes used 26 million tests and—

On a point of order, Mr Deputy Speaker. I raised a point of order earlier this afternoon about the lack of an impact assessment before the House, despite it having been referred to on 22 June as having been made available. I was informed during the course of that point of order that pressure was going to be put on the Government to explain why there was no impact assessment. It is therefore a source of great disappointment that the Minister has not started off her speech with such an apology and explanation.

Thank you for that point of order, Sir Christopher. The Minister is on her feet and she looks as if she may respond to that point of order herself, as it is not a point for the Chair.

Thank you very much, Mr Deputy Speaker. I was indeed intending to come to that point. I was commencing my speech by giving some further context, but I can respond to the specific point made by my hon. Friend. The impact assessment is being worked on. I will be clear with hon. Members. One of the challenges is that there is significant uncertainty about the level of behavioural change we may see in the weeks ahead from this and other measures, for instance the requirement for vaccination to travel to some countries, which we anticipate will lead to further vaccination uptake.

Will the Minister give way?

If my hon. Friend will let me, I will cover his exact point.

I know that some hon. Members may wish to delay this debate, because they wish to review—

On a point of order, Mr Deputy Speaker. It states in the explanatory notes:

“A full Impact Assessment has been prepared”.

If it has been prepared, it cannot currently be in preparation. So where is it?

That is not a point of order for me, but it could have been an intervention upon the Minister, so let us allow the Minister to give the full response to the points that have been made and perhaps she can include that one from William Wragg.

As I said, the impact assessment is being worked on. That is the current situation. I was explaining one of the challenges in coming to an impact assessment that we can share with colleagues to inform them accurately. I really hear that hon. Members want to have the full set of information for this debate. We face a dilemma: the clock is ticking and each day we are moving closer to winter. I am going to come on to it in the detail of my speech, but one important feature of this proposed legislation is that it gives staff a grace period in which to get vaccinated. The longer we take on this, the more risk there is to having that grace period.

Will the Minister give way on that point?

In one moment. One thing I can share is evidence that we have on how this kind of policy is working in practice from a large care home provider that is already implementing a requirement for its staff to be vaccinated. It has seen the vast majority of staff get vaccinated, with less than 1% of its workforce choosing not to be vaccinated. We have committed—and the Minister for Covid Vaccine Deployment, my hon. Friend the Member for Stratford-on-Avon (Nadhim Zahawi) committed to this earlier to the Lords Secondary Legislation Scrutiny Committee—to publishing an impact statement setting out the evidence we have in advance of the Lords debate.

If my hon. Friends would allow to make a little more progress, I will absolutely take more interventions. However, I am conscious of wanting to set out the context and thinking behind this piece of legislation.

I may well answer many of my hon. Friends’ questions as I proceed, so I ask my right hon. Friend to let me make a little progress and I assure him I will take interventions.

As I was saying, throughout the second wave care homes used 26 million tests and 1.2 billion items of personal protective equipment, yet still we saw outbreaks in many care homes during the winter and 14,000 deaths from covid among care home residents. But there is one thing now making a huge and crucial difference, a major advance that is unequivocally saving the lives of care home residents and staff from this cruel and pernicious virus, and that is vaccination. I have spoken to residents who were in tears of joy and relief as they were vaccinated, as they at last had their own defence against this virus. So far, the vaccine roll-out to residents and staff in care homes has been a big success story. The Joint Committee on Vaccination and Immunisation made residents and staff in older age care homes the highest priority as soon as vaccines were available, and the NHS hit its target of offering the first dose to all care homes by the end of January, which was a fantastic effort.

Will the Minister give way?

In one moment. Vaccination teams have made multiple visits to care homes since then and as a result 96% of those living in older age care homes have had their first dose and 93% have had their second dose. Some 92% of residents living in working age care homes have had their first dose and 87% have had their second dose. Take-up among staff has also been strong, with 86% of staff in older age care homes having had their first dose and 75% having had their second dose, and 83% of staff in working age care homes having had their first dose and 72% having had their second dose. Our vaccination teams have gone to great lengths to support and encourage those who have been worried about the vaccination, along with care home managers and care colleagues. I am sure that Members will join me in thanking everyone in the NHS, local authorities and care homes who have worked so hard together to achieve such levels of vaccination.

I will take an intervention from my right hon. Friend the Member for Forest of Dean (Mr Harper).

I come back to the point about the impact assessment. The document prepared for the House says that a full impact assessment has been prepared. Ministers need to give accurate information to the House, so if that is not correct and is misleading, it should be corrected immediately. It is not good enough to say that something will come along afterwards; we are being asked to vote on these regulations today. There is no urgency—the regulations do not come into force for 16 weeks, until November—so it is perfectly reasonable for them to be taken away and for the impact assessment that has been prepared to be published. If there is uncertainty, share the uncertainty with the House. It is not good enough to expect us to vote on something that is difficult, controversial and complicated and not share with the House the information that the Minister has at her disposal. It is an abuse. It is not good enough.

During the course of this speech, I will share as much information as I can with my right hon. Friend on the rationale behind this, but let me address his point about the timing. He says that it could be done later, but the problem is that, if we do it later, will we suggesting that it is too late for care home staff who have not yet been vaccinated? The point is to give care home staff the time between this being legislated upon and its being implemented in time for the winter, when we know that there is a greater risk of a combination of covid and flu, to get vaccinated, in the knowledge that we are generally seeing an eight-week period between doses.

The Minister will appreciate that the provisions before us extend well beyond the care home staff. With respect to the 1% of those staff of whom she spoke, in the absence of the impact assessment, if their failure to be vaccinated results in dismissal, who will be responsible for the compensation?

My right hon. Friend asks an important question about how things would work in practice, although I think he is presuming that there is a question of compensation. I expect to see care homes being able to follow a process, and so long as they follow a fair process, there should be no need for the compensation that my right hon. Friend suggests. We will set out guidance, but the point is that there is a fair process in which, for instance, a care home can discuss vaccination with its staff member and, indeed, look at whether there might be an alternative role for an individual if they really do not want to be vaccinated, although I am realistic that there are not that many roles for staff in care homes that do not involve being in the care home. After that, if the situation is still that the staff member does not wish to be vaccinated, the care home must follow a notice period and make sure that it follows a fair process.

I want to help the Minister. We are having to make a decision this evening on the balance of risk, but we have not been given the data because the impact assessment has not come forward. The Minister is, in effect, asking us to make a decision on information that we have not yet been able to see. Would it not therefore be more sensible to withdraw this statutory instrument and ensure that we have the right data in front of us, so that we can then make an informed choice?

We live in an uncertain world, but we know that covid is a killer for people living in care homes and we know that the winter ahead of us is going to be challenging both because of the ongoing circulation of covid and because of flu. The question we should put to ourselves today is: what are the steps that we can take to make people safer in the months ahead? This time last year—last summer—infection rates were low, but we did not sit back and say, “In that case, it’s going to be okay for the winter.” We in Government, working with local authorities and care homes, made preparations for the winter ahead. Thank goodness we did make those preparations. Although sadly there were many deaths, had we not put in place the personal protective equipment distribution system, had we not had the level of regular testing that went on in care homes throughout the winter, and had we not had the support with infection prevention and control, I fear that last winter would have been much worse. We know that the winter ahead is going to be another challenging one and we must prepare for it.

Will the Minister give way?

Will the Minister give way?

I will make some progress. As the Prime Minister and our chief medical officer have said, even when we are no longer in a pandemic, the virus will remain in some shape or form and we will have to learn to live with it. It will continue to circulate and potentially evolve into new variants, and there is a serious risk of a resurgence of flu and other seasonal infections. A combination of covid and flu may be unpleasant for many of us, but it will be life threatening for those who are most vulnerable.

Will the Minister give way on that point?

We must ask ourselves: what more can we do to protect those who will be most vulnerable?

On a point of order, Mr Deputy Speaker. To assist the debate, there is a discrepancy between the explanatory memorandum and the explanatory note on the back of the statutory instrument. The note states:

“A full impact assessment of the costs and benefits of this instrument is available from the Department of Health”.

It gives the Department’s address and indeed the website on which the assessment is supposedly published. So is the explanatory note in the instrument correct or not?

Again, this is not a matter for the Chair, but it is certainly a point for the Minister to address. I think it would be helpful if the Minister could directly address that particular issue, which many Members are now raising.

Thank you, Mr Deputy Speaker. There is not a great deal more that I can say on that point. As I have said, the impact assessment is being worked on and we will share it with colleagues as soon as we can. That is all I can say on that particular point.

Further to that point of order, Mr Deputy Speaker. Yesterday, I asked the House of Commons Library to inquire of the Department where this impact assessment was, and the Department informed the Library that it was about to present the impact assessment. It did not say that the assessment was still under preparation. The implication was that it was ready to be given to the House and it was just a matter of time—they said they would do it as soon as possible.

Again, I can only say what I have heard during the debate and apparently the impact assessment is simply not available. This is clearly not the best situation. We can see exactly what it is, but it is what it is.

Thank you, Mr Deputy Speaker.

The Scientific Advisory Group for Emergencies recommends that 80% of staff and 90% of residents should be vaccinated in any care home, at a minimum, to provide protection against outbreaks of covid. While the majority of care home workers have now been vaccinated, our most recent data has told us that only 65% of older-age care homes in England were meeting that safe minimum level, and the figure fell to 44% in London. That is why the instrument is being put forward today. It means that, by November, subject to parliamentary approval and a subsequent 16-week grace period, anyone entering a Care Quality Commission-registered care home in England must be vaccinated unless an exemption applies. That will apply to all workers employed by the care home, those employed by an agency and volunteers in the care home. Those entering care homes to undertake other work, for example, healthcare workers, tradespeople, hairdressers and CQC inspectors, will all have to follow the regulations.

The introduction of this policy has not been taken lightly. We have consulted extensively, including with a wide range of valued stakeholders, and used their feedback to inform this legislation. We recognise that some people feel that workers should have freedom of choice about vaccination, while others do it as a duty of care to protect the people most at risk. I know from speaking directly to people who receive care and to those who have relatives living in care homes that, although they might not be sure about requiring all care workers to be vaccinated, they are sure that they, individually, want to be cared for by someone who has been fully vaccinated. Many people have little choice about who cares for them.

The Minister mentions feedback, but the draft explanatory memorandum states that

“a majority (57%) of respondents did not support the proposal”.

How, therefore, does the feedback show that there is support for it?

We have reviewed the huge number of responses to the consultation. Not everybody who responded supported the proposal—as my hon. Friend says, 57% did not—but it was interesting that the picture in care homes was fairly even between those who supported it and those who were concerned.

One thing that we are already seeing is that some care homes are bringing in the policy themselves.

Will the Minister give way?

I may pre-empt my hon. Friend’s point. I know that hon. Friends have asked why the Government need to bring in the policy if some care homes are doing it themselves. The problem is that we could risk a situation in which someone fortunate enough to be living in a care home that has required vaccination for its workers is highly protected against the virus, but someone less fortunate, in a care home in which far fewer staff are vaccinated, is unfortunately at much greater risk. That is not an inequality that any of us should be comfortable with.

If we take a vote tonight, it will set a trend, set down a marker and point the direction not just for this place, but for the whole United Kingdom; I mention Northern Ireland in particular. Before we make the decision, may I ask whether the Minister has had any opportunity to talk to the regional, devolved Minister, Robin Swann, to gauge his opinion on how the legislation will affect us?

The hon. Member is right: I know that other parts of the United Kingdom are watching what we are doing here in England. There are regular conversations between the Department of Health and Social Care in England and the other Administrations. Also relevant is the international situation: other countries have either done what we are doing or are looking very hard at it. In fact, France has just announced that it will require vaccination for health and social care workers on a faster timeline than the one we propose.

Never again do we want to be back in the situation of having covid outbreaks across hundreds of care homes, with those who live and work in them losing their lives to this virus. Vaccination is a safe and effective way of preventing the spread of covid. The majority of care home workers have already taken up the vaccine, and it is essential that all care home workers who can have the vaccine do so in order to protect those in their care.

The original scope proposed in the consultation was to apply the policy only to care homes that look after older people, but following the consultation it became clear that there was a compelling case to extend the obligation to all care homes that provide care to the most vulnerable, for example young adults with learning disabilities. There was also significant support for broadening the scope of the policy to include all those who come into contact with residents, and there was support for including all those who enter care home residences in any capacity.

Will the Minister give way on that point?

I will proceed, and I may answer my hon. Friend’s question as I go.

We listened to the responses and made the decision to apply the policy to all people working inside care homes, unless they have a medical exemption or are not eligible for vaccination—under-18s, for instance. There are further exemptions, including people providing emergency assistance or undertaking urgent maintenance work, and family or friends visiting. Guidance will be published that gives more detail about the exemptions, which will reflect the green book on immunisation and clinical advice from the JCVI.

Can the Minister explain why the draft regulations do not distinguish between those workers who actually come into contact with residents and those who do not?

My hon. Friend asks a reasonable question. We consulted on exactly that point. There are two reasons relevant to the breadth of the policy, which covers not only care workers, but others coming into the care home, such as hairdressers, health professionals and tradespeople.

When somebody, including a tradesperson, comes into a care home, they might spend significant time in the care home, move around and move from room to room, so they might be a significant infection risk to the care home. They might also move between one care home and another, particularly if they are a specialist who serves multiple care homes. We know there is a risk when individuals are moving between care homes, so there is a clinical case for the regulations.

We also heard from providers responding to the consultation that they want a consistent approach for people who enter a care home to work, and these regulations will make it more straightforward for them to implement that.

I am grateful to the Minister for giving way. On making sure there is equity, where does she believe the duty of care falls, given these regulations?

My hon. Friend makes a really important point. Throughout the pandemic, the Government and I have felt our responsibility to protect those living in care homes from covid as best we can. We can try to do that by extending to them the protection of being cared for by people who are doubly vaccinated, knowing as we do now, from the increasing evidence, that being vaccinated not only protects the individual but reduces the risk of transmission.

I will sum up, as I know other colleagues wish to makes speeches.

I put on record my sincere thanks to care workers across the country, not just for their work throughout the pandemic but for all they bring to our health and care services. People working in care homes have played an incredibly important role in caring for those most at risk from this terrible virus. The vaccine is working, with more than 14,000 lives saved so far. It is only right that we take every possible step to protect those most at risk.

As I said at the outset, we must all ask ourselves what more we can do to protect care home residents, and these regulations are what we can do.

On a point of order, Madam Deputy Speaker. I seek your advice on whether the vaccination figures cited by the Minister, which are more than a month out of date, might have inadvertently misled the House. Her earlier figures on the vaccination status of care home staff and residents suggest it simply is not possible for the figures both to have reached the SAGE threshold and to be as low as the House was informed.

I thank the hon. Gentleman for that point of order. Obviously, I cannot comment on figures the Minister may or may not have used. I am sure she will have heard what he said and, if there is anything that needs correcting, will do so in her summing up.

I am really grateful for the speech that my hon. Friend is making and obviously pass on my condolences to her. Does she agree that after all that our care workers have been through, what they need at this time is not only supported conversation about how they can progress with their own vaccination, or not, but to have the right people in place giving them that supported conversation?

I hear what the hon. Lady is saying. My first instinct on persuasion, months and months ago, was exactly the same, but more than seven months on, it has not happened. I am tempted to ask, “If not now, when?”, to coin a phrase. What is her response to that?

Will the hon. Lady give way?

This debate finishes at 7.19 pm and I need to bring the Minister in at the end. That means that if colleagues speak for between four and five minutes, everybody will get in. If colleagues do not speak for between four and five minutes, everybody will not get in.

It is a pleasure to follow the hon. Member for Tooting (Dr Allin-Khan). I am delighted that the Official Opposition share my view and that of many of my colleagues that these are bad regulations and that they should be opposed this evening.

Both the Welsh and Scottish Governments, as I understand it, are against this type of regulation. The Minister told us that other Administrations were watching, but this Administration should be watching what the other Administrations are doing and following their lead. I must say that this was probably the most depressing performance from a Minister that I have listened to in this House. She showed a cavalier disregard for the conventions and courtesies of this House, and, as she has admitted to, she completely breached the rules under the Government’s better regulation framework, which is designed to inform decision making for regulations that affect businesses and individuals in this country. When criticised, the Minister’s response is best described as dumb insolence, and that is just not good enough. One question that I would have liked to ask in an intervention was: what is the Government’s rationale for not requiring care home residents to be vaccinated?

These regulations were laid on 22 June. There was an accompanying explanatory memorandum that expressly referenced a full impact assessment. It said:

“A full impact assessment of the costs and benefits of this instrument is available from the Department of Health and Social Care…and is published alongside this instrument and its Explanatory Memorandum”.

The Minister has not explained what has happened to it, whether it ever existed, and whether it contained information that she found embarrassing and has therefore been suppressed.

An impact assessment is not an optional extra. As the Secondary Legislation Scrutiny Committee made clear in its report of 6 July: “An impact assessment is a fundamental tool for those who wish to scrutinise legislation before nodding it through”. Indeed, an impact assessment should be cleared by the Minister before the proposals are brought forward. The Government’s better regulation framework principles, set out in March 2020, says:

“Where government intervention requires a legislative or policy change to be made, departments are expected to analyse and assess the impact of the change on the different groups affected – which should generally take the form of an impact assessment.”

That has not happened. Why has it not happened? I put down some parliamentary questions about this, because I feared that we would not get the impact assessment, and those questions have received holding answers rather than substantive answers. One asked what estimate he has made

“of the number of employees in…England who will face dismissal from their employment as a result of the enactment of regulations …and whether those staff will be eligible for compensation”.

There was not an answer to that, and there has not been one so far today. I then asked what estimate has been made

“of the number of staff employed in care homes in England who have not been vaccinated against covid-19 for (a) clinical reasons and (b) reasons of personal choice including religion, belief and conscience”.

Again, no answers—not even to parliamentary questions. How can we hold the Government to account if they will not even answer our questions?

My constituents are absolutely livid about what is being proposed. I will not quote extensively from a letter that I received from Mr Davis from Ferndown, but he says that it is completely wrong and unethical and that it makes no sense. An NHS consultant in Christchurch says that, “Mandatory vaccination would be crossing the Rubicon on medical choice, medical confidentiality and bodily autonomy.” These are vital elements of the right to privacy. A Christchurch care home manager to whom I have spoken has said that the whole proposal “undermines” the need for parity of esteem between care workers and NHS workers.

You may have seen, Madam Deputy Speaker, the article in the British Medical Journal on 8 July, which says that, while it may reduce the risk of transmission, vaccination

“is not a panacea for safety”.

Why are we not saying that people who have had previous infection and got immunity from that are exempt from these regulations? I think that this is an unnecessary, disproportionate and misguided proposal. I hope that, given what has happened in Scotland and Wales, we reject these regulations and put the Minister out of her misery.

I do not usually speak in the debates about statutory instruments on covid regulations as they apply only in England, but I feel I have to make a couple of points on the plan to make covid vaccination mandatory for all care home staff—the first mandatory vaccination legislation in the UK for well over a century.

As chair of the all-party parliamentary group on vaccinations for all, I totally support vaccination and I draw attention to our recent report, published in May, on how to improve the uptake of all vaccines. Virtually all our expert contributors highlighted the dangers of making vaccination legally mandatory because while it may force uptake among some, it tends to increase distrust and suspicion of vaccines and drive those who are hesitant to become vaccine refusers.

In Scotland, virtually 100% of care home staff are fully vaccinated with both doses, without mandating it. That has been achieved through three key policy approaches. First, as part of developing caring as a profession, care home staff in Scotland are now registered, which means we have information on who we are trying to reach. Secondly, when the Scottish Government became aware that care home staff were being deliberately targeted with disinformation on covid vaccines, they arranged expert webinars for staff with our chief medical officers and NHS director. Thirdly, as soon as the Pfizer vaccine became available in December, care home staff were vaccinated at the same visit as residents. That not only improved convenience, but created a strong sense of solidarity between colleagues and with the vulnerable people they care for.

The Scottish Government faced considerable criticism at the start of the year for spending so much time and effort on care homes rather than pushing ahead with mass vaccination centres, but it has paid off. We hear that in England, 86% of care home staff have received a first dose and 75% are fully vaccinated, although I understand that that hides a wide variation in uptake. While repeat visits have now been provided to care homes in England, that was not national policy at the start of the programme when many providers reported difficulty in accessing vaccine appointments for their staff.

The UK Government have never taken forward the principle of care staff registration and professionalisation in the care sector. As has been highlighted, staff in England are not even paid the real living wage. Care home staff have faced a very difficult time in the last 18 months and we all owe them a great debt of thanks. I still believe that locally targeted support, information and persuasion would be more successful in convincing care home staff than heavy-handed legislation, which threatens their jobs.

We all agree about the need to get the highest rate of vaccination possible to protect care home residents. The difference is in how to get there. Our APPG report makes it clear that the most important approach when dealing with communities with hesitancy is not to make assumptions about the cause but to listen to them and then act on what they are seeking.

Apart from my concerns about the principle of mandating vaccination, I call on the Minister to clarify that the legislation applies to England only. The Scottish Government do not accept the principle of making vaccines mandatory, nor do they see the need for such an approach after the fantastic uptake by our care home staff.

I do not often say this, but it is a great pleasure to follow the hon. Member for Central Ayrshire (Dr Whitford), who speaks for her party and, in this case, the all-party parliamentary group on vaccinations for all. I agree with almost every word—not necessarily about the Scottish Government—she said about the right way of persuading care home workers to get vaccinated.

I should say first, before I touch on the specific proposals in front of us, that I agree with the Minister when she says it is very important that we protect those who live in a care home setting. We have all seen the damage over the past year from covid, and it is fantastic that we can now vaccinate those residents, because we know that covid is a disease that is focused on wreaking the most havoc on those who are older and those with health conditions. It is fantastic, as the Minister said, that 96% of residents of care homes have had a first dose and 93% a second dose. That means they have very substantial protection against serious disease, hospitalisation and, tragically, death, and that is fantastic. Everyone in the House—I think I can speak for everyone—wants to make sure we protect people in care homes. This debate is about how we best do so.

Let me just take the arguments that the Minister set out. First, I agree with what the hon. Member for Central Ayrshire said in terms of persuasion. I have certainly talked to my local health professionals, and they very much advocate listening to staff who are hesitant, understanding the reasons and then trying to address those reasons. I know that the Minister has said that a significant number of healthcare staff have been vaccinated, but it is not consistent across the country. In some places it will be 100%; in other places, it will be much lower.

It seems to me that we therefore need to focus on those areas where take-up is much lower and understand what the barriers are, rather than insisting that people have got to do something that they clearly have some concerns about. That may be because they are from a particular ethnic minority, and we know there is differential vaccine take-up there, or it may be that they are a younger female of childbearing age, and they are concerned—I think erroneously—about things they read about fertility. We need to deal with those concerns. We cannot threaten somebody who is young and worried about fertility and insist that they take a vaccine they are worried about without dealing with those concerns. I think we all agree about that; this debate is about how best to do it.

Does my right hon. Friend agree that in some cases, seeming to threaten people will only worsen the problems of trust in authority from which people might already be suffering, causing them to be hesitant in the first place?

I agree with my hon. Friend, and that is why I think these proposals are mistaken. Let me just step briefly through the proposals in front of us. First of all, I completely agree with what my hon. Friend the Member for Christchurch (Sir Christopher Chope) said about the impact assessment. I have been a Minister; I have been through impact assessments, prepared them, signed them off and presented them to the House, and I am afraid it is not good enough.

The proposals will have a very significant impact on hundreds of thousands of people and many thousands of businesses—it is a significant step; it is the first time that we will have mandated in law effectively compulsory vaccinations—and it is frankly offensive that it is being debated in a 90-minute statutory instrument debate in the House. From the name of the regulations it does not leap out as to what they are, and I think many colleagues were unaware of the fact that we were being asked to vote on this measure today until it was drawn to their attention. That is the first point.

The second point is that if the information is available, even if it is imperfect—I accept that it will be imperfect and there will be things that we cannot be certain about—it is the Minister’s duty, if she has that information, which one of these documents says she does and one of them says she does not, to put what she has in front of the House. She should sign it off—she is responsible for that—and allow us to see it before we are asked to vote on the regulations.

I am afraid it is an abuse of the House to ask us to vote without that information. If this was genuinely an emergency, that might be acceptable, but, as I have already said, these regulations, if passed, do not come into force for 16 weeks. That is November. There is ample time to complete the impact assessment and bring the regulations back before the House. Even if that was in September, we could then have a tighter deadline and still deliver the legislation before it is currently scheduled to become law. I think that would be preferable.

It is worth saying that I could have been persuaded, although I have reservations, to support mandatory vaccination for care home staff, if a good case had been made about the risk reduction to residents. I did not actually hear the case being made about the risk reduction to residents. It is not set out in any of the documents in front of us, and the Minister did not set it out in her remarks, but I remain open to that, which is why I would urge her to bring back further proposals later.

However, that is not at all what is in front of us. These proposals are incredibly broad: they apply to everybody who enters the premises of a care home. Even if they never see a resident or are there only for moments, the care home will be prohibited by law from allowing them to enter, and will have to ask them intrusive questions about their health status, perhaps including what health conditions they have that mean they do not have to get a vaccination. That care home will then have to ask the employer, and those businesses that want to transact with care homes will then have to ask those intrusive questions of their employees. The scope of these proposals is massive, and is particularly troubling given what the Government said yesterday in the House about domestic vaccine passports. Many of us are concerned that insisting that employers ask their staff intrusive questions about their health conditions, when there is no good reason to do so, is the thin end of a wedge.

My right hon. Friend is making a fantastic argument, as he always does in this place. I have interweaved these new regulations into where they would fit in the Health and Social Care Act 2008 and the 2014 regulated activities regulations, and have found that we are asking care homes to be the policemen of delivery people, plumbers and window cleaners with a possible £4,000 fixed penalty fine. I do not know whether my right hon. Friend was aware of the extent of the fine that backs up these regulations.

I am grateful to my hon. Friend for bringing that information to the attention of the House.

I will bring my remarks to a conclusion, because Mr Deputy Speaker wants to make sure that we get everybody in. My final point is that, coming back to the consultation that took place, it is very clear that most of the people responding did not support these proposals. They were very concerned about them; certainly, the care homes and those involved in the sector who I have heard from are very concerned about them. The proposals do not command wide support, so I say to the Minister that I would listen to the concerns that are being expressed, take these proposals away, and come back with some well-thought-through proposals to secure the support of the House. If she presses them to a vote today, I regret to say that I will be forced to vote against them.

I can guarantee that everybody will get in: there is a five-minute limit.

It is a pleasure to follow the right hon. Member for Forest of Dean (Mr Harper), and I pretty much agree with everything he had to say. I wish to preface my remarks on these regulations by making it abundantly clear that I and my Liberal Democrat colleagues unequivocally and strongly support vaccination, and would urge everybody who is eligible to be vaccinated. We know that vaccines are safe, effective, and save lives, and for those on the frontline—whether working in social care or in the NHS—vaccination is critical. If I had a loved one in a care home, of course I would want maximum protection for them, and therefore would want all staff to be vaccinated. The question we as legislators have to grapple with is whether coercion is the answer, and what might be the unintended consequences of mandating vaccination for some of the lowest paid and most undervalued workers in our society, and for a sector that is on its knees.

As we have heard, the care sector is facing chronic staff shortages, and making vaccines mandatory has a real potential to exacerbate those acute shortages. The Government must do much more to convince and persuade care workers to get vaccinated. As many experts have said and as we have heard already, coercion is usually ineffective or, worse, counterproductive, and risks eroding trust in the sector. Indeed, the care sector has a long history of being overlooked and underfunded. Some 1.6 million social care workers earn less than the living wage; a quarter of the workforce are on zero-hours contracts; and there is a lack of any progression or career prospects. There is a real concern that those who are vaccine-hesitant may simply leave the profession rather than get vaccinated, particularly as we know that there are serious shortages in other sectors—such as hospitality—that are offering more competitive pay.

With 1.5 million older people currently not getting the care they need, already overstretched staff will become even thinner on the ground. Care providers, many of whom are already in a fragile state as a result of the pandemic, could find themselves having to deal with the costs of tribunals and legal challenges as a result of individuals losing their jobs. What support and resource is being provided to the sector to implement this policy?

Coercion is not an effective way to overcome hesitancy. Compulsory vaccination is a blunt tool for a complex issue, and research has highlighted that pressuring care workers can have damaging effects leading to the erosion of trust, worsening concerns about the vaccine and hardened stances on refusing vaccination. Indeed, digging into the detail shows that the rate of uptake may not be as bad in some places as it initially seems. The data is somewhat encouraging in that there is a significant disparity in the percentage of staff who have taken their first jab and not their second. For instance, Wandsworth has the lowest uptake rate, with 70% of staff having had their first jab but only 53% having had their second. This could indicate that Government and NHS initiatives are bearing fruit, and that mandating vaccination could therefore be premature. Alternatively, it might suggest there is a problem with trying to get care workers back to have their second jabs. This all suggests a much more complex picture, for which this blunt tool is not the answer. As others have said, we risk going down a slippery slope to chip away at people’s rights and freedoms to make their own health choices. This decision sets a precedent and must not be taken lightly.

That leads me to my final point. In part, we have arrived at this situation precisely because the care sector has been overlooked for so long. It has long been a Cinderella service and a poor relation to the NHS, and yet again, we see that this legislation applies only to care home workers and not NHS staff, so it feels discriminatory to many in the care sector. I come back to where I started. I want to protect the most vulnerable, but I fear that these measures will do more harm than good and that we risk a mass exodus of staff from an already overburdened, overstretched and underfunded sector.

In March last year, when my Liberal Democrat colleagues in the other place and I were asking searching questions of Ministers about testing and PPE to protect care homes, there were no answers. The truth is that the tragedy we have seen unfold in our care homes throughout the pandemic resulted in thousands of excess deaths because the protective ring that Ministers talked about went in far too late. This legislation we are being asked to support is a reaction to Government inaction and failure to protect care homes, and they continue to drag their feet on reforming the sector properly. Coercion and an assault on fundamental rights and liberties should not be the response to this. We must encourage, empower and support people to make the right decision to get vaccinated, and we must pay and value our heroic care staff properly, rather than pointing the finger of blame at them.

I agree with much of what the hon. Member for Twickenham (Munira Wilson) has said. I shall begin, as others have done, with the impact assessment—or the lack of one. I hope that the Minister will, on reflection, accept that it is simply wrong to bring these measures forward without giving the House the impact assessment in advance. She still has the opportunity to do something about this by withdrawing these measures and coming back at a later date, and I hope she will consider that.

This is a very serious innovation. Imposing a legal requirement for people to undertake a medical intervention, maybe against their will, is a remarkable change in our law. As the hon. Member for Twickenham said, it sets a serious precedent, and it is a precedent that the Minister herself slightly alarmingly raised when she said that covid and flu would be a problem as the winter approached. As yet, we are not talking about compulsory vaccination for flu, but once we begin down that road, where does it end?

The scope of this measure is unnecessary. As I said in my intervention, insisting that people are vaccinated even if they will have no contact whatsoever with residents of care homes is entirely unreasonable. The application of the measure to a plumber who comes to fix a boiler, or to a trustee of a charity who may go to sit in an office but have no contact in any of the areas where residents would be, would be unreasonable. The measure is also inconsistent. Why does it apply only to care workers and not more widely in the healthcare sector?

We heard from the Minister about the 99% vaccination uptake where an employer had mandated it themselves. Would it not be the case, as in the case that my hon. Friend set out with visitors, that if this was in departmental guidance, it would be incumbent on the care home to take cognisance of it in the risk assessment?

I agree with my hon. Friend. There are perfectly rational arrangements that could allow particular residents to insist on only a vaccinated carer being in attendance.

I want to focus in the brief time available on a specific point: the importance of respecting religious freedom. Lime Tree House in Sale in my constituency is one of only two Christian Science care homes in the country. The rights of Christian Scientists were protected by the Labour Government when the Care Standards Bill was introduced in 2000. The then Minister, Lord Hunt of Kings Heath, gave an explicit assurance in the House of Lords:

“Perhaps I may say right at the start that the Government have no intention of preventing or discouraging people from being cared for in accordance with the principles and practices of the Church of Christ, Scientist. The Care Standards Bill will not mean that Christian Science houses or their visiting nurse services will have to give medical treatment to their patients, or do anything else which would go against their religious principles...The Department of Health will consult and work with the Church of Christ, Scientist, to ensure that regulation by the commission is compatible with the church’s principles and practices.”—[Official Report, House of Lords, 28 March 2000; Vol. 611, c. 741.]

Christian Scientists responded to the consultation in May. Since then, they have written to the Minister and indeed the new Secretary of State—obviously, that was very recently—but have not received a response. Clearly, there is no provision in the legislation to protect this important principle.

May I ask the Minister when she responds to give an absolute assurance that the principle of religious freedom will be respected by the Government, as it was by previous Governments? Will she undertake either to introduce an amended statutory instrument in the House or, if not, will she commit to including matters of conscience in the exemptions provided for in the measure? I am talking about two small care homes, a handful of residents and a situation in which both residents and carers might prefer not to have a medical intervention inflicted on them against their will, but a very big principle is at stake.

I remind Dr Evans that I will interrupt him briefly at 7 o’clock to put the motion on deferred Divisions to the House so that we can have live votes on this and on the terrorism motion.

Thank you, Mr Deputy Speaker. I look forward to that, as it will give me time to catch my breath.

Like many hon. Members, I baulk at the prospect of mandatory mask certification or vaccination. I have made that clear privately and to my constituents who ask about it, as I did not think that it was ethically, practically or even medically reasonable. We should always be proportionate in our response. However, I have also made it clear that there are specific carve-outs aimed at those most at risk. Indeed, when it comes to healthcare and public health, this is a prime example, given the essence of who we are dealing with: the elderly and the vulnerable.

This argument boils down to rights versus responsibilities. There is a duty of care by the Government and internal providers both to patients and to members of staff. The House has to navigate the difficult path between limiting the risk to patients and residents from the spread of the virus while respecting the staff’s rights and responsibilities. In the next minute or two, including the break at 7 o’clock, I will go over a couple of principles that are in practice, and some real-world challenges that we face.

According to the Care Quality Commission, when it comes to talking about vaccinations, there are three pieces of legislation that are important: the Health and Safety at Work etc. Act 1974; the Control of Substances Hazardous to Health (Amendment) Regulations 1992; and the Health and Social Care Act 2008.

We are obviously dealing with the latter, but the former two measures set a precedent of safe working environments, dealing with substances dangerous to health, putting responsibility squarely on organisers and providers to mitigate that for staff and users as best as possible.

I do not expect that it will be too long before we see a legal challenge, where a resident dies from covid and the finger is pointed squarely at the care home staff, or at the care home for not having vaccinated staff, given that we know the vulnerability of the elderly. There is a duty—

So there is a duty of care, and duty of care is a running theme. Currently, there is no law to say that vaccines are mandatory, so make no mistake: this is a departure from the legal precedent. However, it is not nearly as big or as wide a departure as the public or indeed this House may be led to believe, as, in essence, practically this precedent already exists in the NHS with the likes of TB.

Let us take the example of a medical student or a dental student. When a student joins a medical school, they have to have a TB check, an HIV check, a hepatitis C check and treatment to practise. While it is not a legal requirement, operationally it means that someone cannot do procedures, cannot do hospital placements and, in dentistry particularly, cannot progress. Why? A duty of care.

I do not recall a huge outburst about such concerns when the 2007 Department of Health clearance guidance entitled “Health clearance for tuberculosis, hepatitis B, hepatitis C and HIV”, which was revised in April 2014, was widespread. Why? Because when people enter these professions, the overriding principle hammered in time and again is that there is a duty of care to patients, and medical schools and providers have a duty of care for their students.

Of course my hon. Friend is an expert in these matters, but he has conceded that, in the cases he has referred to, that is not a legal requirement but a matter of health and safety. Why is it that in this case, he wishes to cross the Rubicon and mandate that someone may not be in a care home—apart from the conditions—unless they are vaccinated? Why does he want to put it in law in these circumstances?

My hon. Friend has pre-empted the rest of my speech, in which I will hopefully try to address some of that. It is about recognising the parity between professions. We heard the hon. Member for Tooting (Dr Allin-Khan) talk about the professional recognition we need for social care. That is imperative. We have covered that in the Health and Social Care Committee, and our report is very clear that we need that parity of professional standards. We have heard time and again that people have gone above and beyond in their duty.

I am a realist on this, and I want the Government to draw people’s attention to the fact that there could be difficulties. It is going to cause a problem when there are 16 weeks’ consultation, and there could be an exacerbation of problems with the workforce. I also urge the Government to pick up on what other Members have said and encourage people to take up vaccination in the first place.

Fundamentally, however—perhaps this is what it comes down to for my hon. Friend the Member for Wycombe (Mr Baker)—this comes down to a duty of care to the looked-after. I ask Members to imagine that it was their grandmother, grandfather, father or mother being cared for. I would expect Members to say that they wanted the best possible protections for that individual in the institution where they were resting.

Order. Sorry, we have to leave it there. Four minutes each. I call Dr Ben Spencer.

Controversially, perhaps, I think that much of this statutory instrument is uncontroversial. The reason behind that is my own experience of being recruited to go through medical school. As part of the recruitment process, it was made very clear to me that I had to have hep B testing and I had to be vaccinated for hep B, and that going through and getting involved in becoming a medical student just would not happen if that was not the case. I think that is fair enough.

We expect our health staff to have vaccinations for a variety of conditions—not just hepatitis B but things such as chickenpox for people who have not been exposed, and rubella—because we know the impact that those things can have on the patients we look after or the people we care for. We know the huge impact covid has on the most vulnerable in our society. Its lethality—its severity—is linked to frailty, and one of the most frail groups are people living in care. It is important that people are vaccinated so that, when they have asymptomatic covid, they do not unintentionally pass it on. We know that vaccination rates are not high enough to give the protection necessary to protect people in care homes, and on that basis it is an entirely reasonable and sensible approach to bring forward measures saying that people have to be vaccinated to work in that setting. However, although that might be a reasonable approach I realise that it is different from my personal experience as I have just described, because that was a pre-recruitment process that I went through, whereas what we are talking about now is a process for people who are currently in post—people who might have been working for quite some time and have a lot of years behind them—and if they do not go through with vaccination, ultimately they will be without a job. That is a big deal. It is also important to recognise that those who may decide that they do not want to be vaccinated are not evil people who should be shunned; they are people who make decisions for whatever reason about vaccination, and that is important and should be respected.

Fundamentally, this SI is about risk, and I see two risks here. One is the risk of covid to people living in care settings, and that risk is very clear: there is loads of data on that—loads of data on the impact and on fatalities, and also on the protection provided by vaccination for people at risk of covid and protection in terms of reducing transmission. So, that side of the equation is very clear, but the side that is less clear is the risk in terms of staffing, and that is a critical issue. Some people will decide that not being vaccinated is more important to them than working in the care sector. I am completely unclear as to how many people will make that decision and I do not think anyone knows what that population is going to be—what the numbers are going to look like. That is a concern as we already have staffing issues in the care sector and it has been a long-term problem.

Nevertheless, perhaps the only way to test this out is to bring it forward and see what happens. The 16-week run-in makes a lot of sense, but it is critical that it is monitored to see what happens with regard to staffing and retention, and if that is a big issue—if retention pressures start coming through—we will have to change course. When my hon. Friend the Minister sums up I would welcome her saying what she will do over the summer as this is being brought in to work with and engage with people in the social care sector on its impact. If there is a substantial impact, I hope that she will undertake to come back to the House after the summer recess with plans to mitigate this or change course.

It is a pleasure to follow my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer), and indeed the speaker before him, my hon. Friend the Member for Bosworth (Dr Evans). They are two learned medical practitioners who, with the underlying qualities that seem to attract to those positions, state their arguments in the finest tradition of the empirical method. As ever, I hope I can be forgiven for not being quite as rational as those two speakers.

I hope, too, that the House will indulge me because, frankly, I am in despair. We could perhaps have a painting next to me of Munch’s “The Scream” to get a sense of how I feel about the conduct of Government business in this House. The Government are treating this House with utter contempt: 90 minutes on a statutory instrument to fundamentally change the balance of human rights in this country is nothing short of a disgrace. It is a disgrace, too, that no impact assessment exists. I contend that it does not exist, and if that is proven to be the case I am afraid my hon. Friend the Minister will be in a tricky position if she contends it does when it does not.

The measures before us are in themselves entirely impractical. We have heard already about concerns about the workforce. I have the utmost respect for my hon. Friend the Member for Runnymede and Weybridge, as he knows, but if we were to follow his suggestion, I fear that it would be far too late to repair the damage done to the workforce of carers in this country.

It is an insult to care workers in this country that all they merit is 90 minutes on a motion that nobody here seemed to know anything about last week but which we are discussing this afternoon. Meanwhile, so many of our colleagues, presumably because of the proxy vote system and the fact that they find it generally inconvenient to be a Member of Parliament, will know nothing at all about the measures on which they are voting, and that too should concern us a great deal. I will vote against these measures, if that had not been made clear from my remarks so far.

I believe that 1898 was last time vaccination was mandated in this country, and following that mandate, the rates of vaccination fell. That should tell us all we need to know. We will give succour to lunatics and crackpots who advance ridiculous theories about vaccination if we mandate vaccination. The triumph of the vaccination programme has been the act of kindness that people have felt towards their fellow citizens in doing so, and we will lose that good will if we mandate it.

A lady called me a week or so ago, and she was in tears on the phone. She has a condition that involves blood clots, and she associated the news about one or two of the vaccines with her condition. She is a care worker, and she was distraught. She now equates her illness and the vaccination—and the fact that she cannot get a GP appointment to discuss it, but that is a different matter—with losing her job. Is that what we are prepared to do to our fellow citizens as a Conservative Government? Absolute lunacy! We would expect this in a communist country, which partly explains why so many of our eastern European fellow citizens have the scepticism they do, knowing the nature of the state and how it can be perceived as being malevolent.

This instrument is an abomination. It should be withdrawn, and the Government should stop treating this House with contempt.

I thank hon. Members for their contributions and the questions they have put to me during this debate. I welcome the consensus on the importance of protecting care home residents. This debate is about how best we do that and the level of evidence needed in order for us to take the steps to best protect those vulnerable residents. The problem we face is that the clock is ticking towards winter, and to a potential combination of covid and flu to which we know care home residents will be extremely vulnerable. The problem with inaction and waiting for more time is that inaction costs lives.

I have heard—I assure my hon. Friends on this—the strength of feeling about the impact assessment, and may I say that I apologise to my hon. Friends for the error, particularly in the explanatory notes to the regulations? I have done my utmost, as I did in my opening speech, to set out for hon. Members the situation with the impact assessment, and there is nothing further I can say on that now.

I do not know what other colleagues feel, but I find it offensive that, because we have expressed concerns about these regulations, it is somehow implied that we want to do away with or risk the lives of people in care homes. These regulations do not come into force for 16 weeks. There is ample time to take them away, review them, publish the impact assessment and get this House to make a decision, and protect people before the onset of winter. To suggest that Members want to do otherwise and that we are suggesting inaction that would put their lives at risk is offensive, and I urge the Minister to withdraw it.

No offence was meant on my part. The problem with what my right hon. Friend is suggesting is that, if there is a substantial delay—for instance, in the autumn—in bringing through this legislation, that leaves care workers who have not yet been vaccinated with very little time in which to get vaccinated, and that is why we are bringing this forward now.

Will the Minister give way?

I am sorry, but I am conscious of the time left.

Several hon. Members have argued that we should continue the current approach to increasing uptake and indeed do more. Of course, we will continue to support care workers to take up the vaccine, but, as flagged by my hon. Friend the Member for Winchester (Steve Brine), the question is: how long do we give that? The vaccination of care home workers in England began in December last year, about eight months ago. We did take a similar approach to that in Scotland mentioned by the hon. Member for Central Ayrshire (Dr Whitford), where staff were vaccinated alongside residents in care homes. NHS teams went into care homes multiple times to offer the vaccination to staff. Indeed, we saw that that was effective and more staff took up the vaccination on subsequent visits. We also opened the national booking system to care home staff early on, before there was wider availability to everybody. We have worked with communities who have been particularly concerned and hesitant about vaccination. There have been materials in multiple languages. We have worked with faith groups. Local authorities have worked closely with care homes, alongside NHS vaccination teams, particularly care homes that have had lower vaccination rates. A huge amount has been done to raise the levels of uptake among care home staff.

We then have to ask ourselves the question: what more can we do? The No. 1 reason care home staff have given us for not yet being vaccinated is that they want some more time. Well, this gives them some more time through the summer in which to get vaccinated. Some care homes, as I have mentioned, are already doing this. One example is the Barchester care home group, which has over 16,000 staff. The vast majority, over 99%, have chosen to be vaccinated. Fewer than 0.5% have chosen not to be vaccinated. But the problem, if we leave it to care homes that are on the front foot to do this, is that others will be left behind and we will see inequality, where some residents are fortunate to be cared for in a care home where all the staff are vaccinated, and others will not be so safe. That leaves us with inequality for those care home residents, who will remain at greater risk. We know that the vaccination not only protects individuals, but reduces the risk of transmission.

Some hon. Members have raised the concern that care workers are being singled out in some way. That is not the case at all. This is about the setting of care homes, where we know there is the greatest risk and the greatest vulnerability to covid. This is about protecting individual residents in those care homes by requiring the vaccination of people who enter those care homes to work—so not only care home staff but NHS staff who enter care homes. This is about protecting residents in those care homes. Fortunately, at the moment, the rates are lower than they have been during peak times, but even in some of the recent outbreaks we have seen in care homes, the index case has been an unvaccinated staff member. That just emphasises the importance of us having high levels of vaccination among staff.

My hon. Friend the Member for Workington (Mark Jenkinson) asked me about the data I referred to earlier, the SAGE data on minimum levels and the extent to which that is being achieved by care homes. I shared the most recent data that I have. What we do know is that there are still hundreds of care homes that have not yet met that safe threshold, which is a minimum threshold for avoiding outbreaks in care homes.

I say to my hon. Friends that the question before us is: what more can we do to protect those who are vulnerable in care homes? This is what we can do and I commend the regulations to the House.

On a point of order, Mr Deputy Speaker.

I am afraid that the point of order will have to come after the Division. I am sorry.

Question put.

On a point of order, Mr Deputy Speaker. I was the Chairman of the Procedure Committee for seven years. It is absolutely incumbent on Government not to mislead the House and to behave honourably at all times. This explanatory memorandum is a parliamentary paper laid many days ago. This has been well rehearsed in this Chamber, but it needs to be rehearsed again. It clearly states:

“A full Impact Assessment has been prepared and will be submitted”—

not is being prepared; “has been prepared”. Through your good offices, Mr Deputy Speaker, may I ask that Mr Speaker and the Clerk of the House conduct an investigation into this memorandum to ascertain whether the House has been misled by the Government and whether the Minister’s conduct at the Dispatch Box was good enough this afternoon?

I thank the hon. Gentleman for his point of order. As I said earlier, it is a totally unsatisfactory situation, irrespective of whether anybody has been misled by the statement in one of the official documents. Those on the Treasury Bench will have heard the point of order and will make absolutely certain that it gets through to the Department. I will, as the hon. Gentleman has asked, raise it with Mr Speaker at the prayer meeting tomorrow morning.

On a point of order, Mr Deputy Speaker. It always used to be the convention in this place that if a Minister was unable to answer all the questions raised in a debate, they would offer to write to hon. and right hon. Members whose questions had not been answered in the time available. Bearing in mind the cavalier way in which Ministers seem to be treating the conventions of the House, I wonder whether it is within your offices to be able to put pressure on the Government to restore that convention as a matter of courtesy.

I look particularly at my hon. Friend the Member for Altrincham and Sale West (Sir Graham Brady), who had a pertinent question that could have been answered in two words. It was not answered and I am sure his constituents, on behalf of whom he speaks, will feel aggrieved about that. Why cannot this place restore some sense of reasonableness and good manners?

I thank the hon. Gentleman for his point of order. I have been a Member of Parliament for 29 years and many times, at the end of a debate, Ministers have said they cannot deal with each point that has been raised. We were under time pressure today, as has been pointed out by a number of Members, and therefore a number of questions have gone unanswered. Again, those on the Treasury Bench will have heard the point of order and will bring it to the attention of the Minister in order that she is able to answer the questions that went unanswered in her summing up.