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Covid-19 Update

Volume 699: debated on Monday 12 July 2021

Before I update the House on the pandemic, I would like to take a moment to congratulate the England football team on making history and on the way in which they have brought us all together with their skill and spirit over the past few weeks. Last night’s result may not have been the one that many of us were hoping for, but they played like heroes and the nation is proud of each and every one of them.

I also want to take this opportunity to condemn the shameful racism experienced by several members of the England team after the match. Racism has no place in football; it has no place in our society. I know that the whole House will agree that we must always show zero tolerance to this appalling behaviour.

With permission, Mr Speaker, I would like make a statement on our path out of the pandemic. All the way through our fight against the virus, we have looked forward to the day when we can roll back the legal restrictions and get closer to normal life. Now, thanks to the shared sacrifices of the British people and the protective wall of our vaccination programme, we have made huge advances. Today I would like to update the House on the next decision in front of us: whether to proceed to step 4 of our road map next Monday.

As I set out to the House last week, this will be a major milestone for the country, taking us another step closer to the life that we all used to live. It means carefully removing more of the restrictions that have governed our daily lives, such as how many people we can meet, how many people can attend weddings and how many visitors people in care homes can see, bringing them together with their loved ones. We have all been yearning to get there, and we all want this to be a one-way journey, so we have acted in a measured way, taking one step at a time, and looking at the very latest data and at our four tests before deciding whether to proceed.

The first test is the success of our vaccination programme. Ever since 8 December last year, when the world’s first clinically authorised vaccine was given right here in the UK, we have been putting jabs in the arms of people at a phenomenal pace, giving over 18 million doses in just seven months. We have given more doses per capita than any other large nation. As a result, around nine in 10 adults in the UK now have covid-19 antibodies, which are so important in helping us and our bodies to fight this virus. To bolster this protective wall even further, we made the tough but necessary decision to take a four-week pause to step 4, so that we could protect even more people before easing restrictions. Since making the decision, we have been able to give 7 million extra doses across the UK. We have pledged that, by 19 July, we will have offered every adult a first dose of vaccine and given two doses to two thirds of all adults. I am pleased to inform the House today that we are on track to beat both of these targets, so as we make this crucial decision, we are in a stronger position than ever before.

We have looked not just at how many jabs we have put in arms, but at what impact they are having on hospitalisations and the loss of loved ones. This is our second test. There is increasing evidence that the vaccine has severely weakened this link—a link that was once a grim inevitability. Data from Public Health England estimates that two doses of a covid-19 vaccine offer around 96% protection against hospitalisation, meaning fewer covid patients in hospital beds and fewer people mourning the loss of a loved one. The data also estimates that the vaccination programme in England has prevented between 7.5 million and 8.9 million infections. It has prevented some 46,000 hospitalisations and prevented about 30,000 people from losing their lives, all because of the protection that the vaccines can bring.

Our third test is around whether infection rates would put unsustainable pressure on the NHS. I want to be open about what the data is telling us and why we have reached the decision that we have. Cases are rising, propelled by the new, more transmissible delta variant. The average number of daily cases is over 26,000, and this has doubled over the past 11 days. Sadly, the case numbers will get a lot worse before they get better. We could reach 100,000 cases a day later in the summer.

Hospitalisations are also rising, with sustained growth over the past month. Once again, they will rise too, but we should be encouraged that hospitalisations are far lower than they were at this point during the previous wave, just as we should be encouraged that people over the age of 65, who are more likely to have had both doses of a vaccine, made up 31% of covid admissions last week, compared with 61% in January. This is further evidence that our vaccination programme is doing its job and protecting the NHS. As more people get the jab, our protective wall is getting stronger still.

We will stay vigilant and keep a very close eye on the data, as well as on the impact of long covid, on which we are investing £50 million into new research. But on the basis of the evidence in front of us, we do not believe that infection rates will put unsustainable pressure on the NHS. It is so important that everyone still does their bit in helping the NHS to stand strong. The best thing that each and every one of us can do, if we have not done so already, is get the jab and, crucially, get both doses.

Our final test is that the risks are not fundamentally changed by new variants of concern. We have seen from the growth of the delta variant, which now makes up 99% of new cases in this country, just how quickly a new variant can take hold. However, although the delta variant is more transmissible than the alpha variant, the evidence shows that two doses of the vaccine appears to be just as effective against hospitalisation. But we know that the greatest risk to the progress we have made is the possibility of another new variant, especially one that can escape immunity and puncture the protective wall of out vaccination programme, so even as we look to ease restrictions, we will maintain our tough measures at the borders and we will expand our capacity for genomic sequencing, which is already one of the largest in the world, so that we can come down hard the moment we detect a new variant.

We have looked closely at the data against these four tests and we firmly believe that this is the right time to get our nation closer to normal life, so we will move to the next stage of our road map on 19 July. To those who say, “Why take this step now?”, I say, “If not now, when?” There will never be a perfect time to take this step because we simply cannot eradicate this virus. Whether we like it or not, coronavirus is not going away. Moving forward next week, supported by the arrival of summer and the school holidays, gives us the best possible chance of a return to normal life. If we wait longer, we risk pushing the virus towards winter, when the virus will have an advantage, or, worse still, we will not be opening up at all. We delayed step 4 by four weeks so that we could build the vaccine wall even higher. We believe that this wall means that we can withstand a summer wave. While the wall would be higher still if we waited until winter, we know the wave would be much more dangerous. So while we know that there are risks with any decision, this is the most responsible decision that we can take.

This step forward is about balancing the harms that are caused by covid with the undeniable harms that restrictions bring. These restrictions were vital to protect the NHS, but we must be upfront about the impact of keeping them just as we are about removing them: the rise in domestic violence, the impact on mental health and the undiagnosed cancer, to name just a few. So we will ease the restrictions next week while at the same time maintaining the defences we have built against this virus, like our vaccination programme, where we still need more young people to come forward; our work to support the most vulnerable; and the contingency plans that we have put in place to stay one step ahead of this virus.

But this is not the end of the road: it is the start of a new phase of continued caution while we live with this virus and we manage the risks. We are today publishing a plan showing the safe and gradual approach that we will be taking throughout the summer. It includes details of how we will be encouraging businesses and large events to use certification in high-risk settings to limit the risk of spreading infection, how we will use guidance for those who are clinically extremely vulnerable, and details of a review that we will be conducting in September to assess our preparedness for autumn and winter.

As we make these changes, it is so important that people act with caution and with personal responsibility. For example, everyone should return to work gradually if they are currently working from home, they should try to meet people outside where that is possible, and it is expected and recommended that people should wear face coverings, unless they are exempt, in crowded indoor settings like public transport.

I also want to take this opportunity to update the House on our policies for self- isolation. Last week I announced to the House that from 16 August double-jabbed adults and under-18s will no longer need to self-isolate if they are a close contact of someone with covid-19. Until then, with case rates expected to rise, it is vital that we ensure that our systems for self-isolation are proportionate and reflect the protection given by our vaccine programme. As part of this approach, we will be working with clinicians and the NHS to explore what more can be done for colleagues in patient-facing roles—this would be used only in exceptional circumstances where the self-isolation of fully vaccinated close contacts could directly impact the safety of patients—so that we can keep our vital services going as we safely and gradually get closer to normal life.

Mr Speaker, 19 July will mark another step forward in our road to recovery. Getting here has been hard fought, and it has been long awaited, but this battle is not over yet. Let us move forward in a confident but measured way so that we can get closer to normal life and protect the progress that we have already made.

I thank the Secretary of State for advance sight of his statement. I join him and others across the House in paying tribute to the England side. They did indeed unite the country, and we are proud of each and every one of them. Of course, those players did take the knee to show they were taking a stand against racism. Labour again offers them our solidarity and joins with others in condemning utterly the racist, vile abuse that we have seen in the last 24 hours.

We want to see the economy reopen in a balanced, safe and sustainable way. That means maintaining certain mitigations to contain the speed at which infections are rising, to help reduce transmission and to help to limit the numbers exposed to the virus before they are fully vaccinated. Instead, the Secretary of State has taken a high-risk, fatalistic approach, trying to game what might happen in the winter and deciding that infections are going up anyway. Instead of caution, he is pushing his foot down on the accelerator while throwing the seatbelts off. He admits that that could mean 100,000 infections a day, which means potentially thousands suffering debilitating long covid and that, as more cases arise, more may escape, with the threat of a new, more transmissible variant emerging.

Two weeks ago, the Secretary of State justified unlocking by suggesting that it would make us healthier. Today, hospital admissions are running at more than 400 a day and there are now 393 people in intensive care units, up by more than 100 since the start of July. Of course, significant increases in admissions have a knock-on effect on the NHS’s ability to provide wider care. He says that infection rates will not put unsustainable pressure on the NHS, but last week cancer patients at Leeds were having their surgery cancelled and ambulance trusts across the country were reporting some of their busiest days ever. The 111 service is under intense pressure.

At the weekend, the Secretary of State warned that the elective waiting list could rise as high as 13 million. Perhaps he could therefore define what he means by “unsustainable pressure”. What does he predict that hospital admissions will peak at? He has told us he expects 100,000 infections, so how many hospital admissions does he expect? Does his confidence mean that there will be no extra resources for the NHS this summer to get through this summer wave? He again highlights vaccination, but why are vaccination rates slowing down? What will he do to drive up rates among younger people, which are still at only about 56% of 18 to 24-year-olds? When will we begin vaccination of adolescents? Other countries are doing it—why are we not?

To rely only on vaccination as infections climb is the approach of the one-club golfer. The Secretary of State needs to put other measures in place as well. First, Labour would continue with mandatory mask wearing. I notice that his tone has shifted in the last week or so and now his view is that it would be irresponsible not to wear a mask in a crowded room. Surely it is equally irresponsible for the Government to abandon mandatory mask wearing.

Secondly, on working from home, yesterday Susan Hopkins from PHE suggested that for the next four to six weeks at least people should try their best to work from home, so will the Secretary of State guarantee that anyone who wants to continue working from home will have the right to do so?

Thirdly, we know how important fresh air is. Germany has funded air filtration systems in public buildings. Last week, the Secretary of State referred to the infection control funding given to social care, but that was not for ventilation. There are British firms that manufacture air filtration and ventilation units, so let us support those firms and British jobs, and offer grants to premises to install air filtration units. Will he also use the summer to install air filtration systems in every school?

Fourthly, as more virus circulates, more people will be exposed, more people will become ill and more will have to isolate, but some people still cannot isolate because of their finances, and those with caring responsibilities for someone who has had to isolate can also be financially penalised. Furlough is beginning to be withdrawn, so financial support for isolation will become even more urgent. Will the Secretary of State ensure that those who need to isolate can access adequate sick pay and support?

Fifthly, to get through this third wave and flatten the curve, we will need ongoing testing, and contact tracing will need extra capacity. Will the Secretary of State give local authorities the resources to lead the enhanced retrospective and forward contact tracing they need to do, and will he now abandon the proposed charges for lateral flow tests, which he is set to introduce?

Finally, when the Secretary of State was appointed, he said that any easing on 19 July would be, in his word, “irreversible”. Other countries have thought the same with their road maps, yet Israel has reintroduced masks, and the Netherlands reopened nightclubs and had to close them again after two weeks. Is it still his view that the 19th is terminus day and that everything he has announced today is irreversible, or does he agree that it would be more sensible to have regular review dates in place through the summer as we deal with this third wave and rising infections?

The right hon. Gentleman started by saying that he supports a balanced approach in a sustainable way, and that is exactly what I have set out today from this Dispatch Box. That is the Government’s approach, so I agree with him. We as the Government have set out the detail, but I am still not sure what his plan actually is. However, given that he set out those objectives, I hope he can support this plan. He talks about the risks that are involved, and I have been very up front about that. The Government have been up front: there is no risk-free way forward. Opening up is not without risk, but ongoing restrictions are not without cost, and I hope he appreciates that.

The right hon. Gentleman raised a number of questions, and one of his first was about hospitalisations. As I have said, case numbers are going up and we expect them to continue going up, but the most important difference today versus the last wave is vaccination—the wall of defence that our country has built—which has meant that hospitalisations, although they are rising as case numbers rise, are rising at a rate that is a lot slower than before. I have set out specifically regarding test 3 in a road map that we believe the pressure, with all the data we are seeing at this point, is not unsustainable for the NHS.

The right hon. Gentleman talked about vaccinations, and I am pleased he is highlighting that, especially for more young people to come forward. As I mentioned in my statement, we are ahead of the plans we set out when step 4 was temporarily pushed out by four weeks. He also asked about the vaccination of children. He knows that we have a group of expert science advisers—the Joint Committee on Vaccination and Immunisation—and this is something it is actively looking at. At some point, we will reach a final decision, but I hope he will agree with me that we should take the scientific advice on that and consider it very carefully before making such a move.

On air ventilation units, some of the £90-plus billion extra the Government have provided to the health and care system during the course of this pandemic has of course gone on air ventilation units, and we should continue to support that. A lot of extra funding has also gone to people to support them financially if they are asked to isolate, and it is important that that is both kept under review and continues to be taken seriously.

The right hon. Gentleman mentioned lateral flow tests and something about charging for them. That might be his policy, but it is not this Government’s policy. I do not know where he has got that one from, but we have no plans to charge for lateral flow tests.

Lastly, 19 July is a step forward on our road map. As we have clearly set out, the pandemic is not over, but it is a very significant step forward. The right hon. Gentleman talked about reviews. I have just said that we will have a review in September to make sure that we are properly set up for autumn and winter.

The virus today is a totally different creature from a year ago, with only one in 40 new cases being hospitalised, an average age for new cases of 25, and all over-40s being offered two jabs, accounting for 99% of the age group that have had covid fatalities to date, so the Government’s approach is entirely reasonable. However, does the Health Secretary agree that there remain, to paraphrase the late Donald Rumsfeld, a number of unknown unknowns and known unknowns, not least the impact of long covid, the potential for vaccine escape and the potential for new variants? Will he reassure the House that if the data deteriorates beyond what is currently envisaged, he will not hesitate to take decisive action, not just to save lives but to head off the need for a further lockdown which would be enormously damaging for our jobs and businesses?

I am very happy to give my right hon. Friend that assurance. He made some excellent points. I thank him for his support for the Government’s action, but he is right to point out that there is still uncertainty for us and countries across the world in dealing with this pandemic. I am very pleased to assure him that if that risk matrix changes, for example with variants of concern, we will not hesitate to take the appropriate action.

I would first like to associate myself and my colleagues with the Health Secretary’s condemnation of the racism sadly faced by members of the England football team after their impressive performance throughout the Euros.

Turning to covid, the Secretary of State himself has suggested that covid cases could soar to 100,000 a day once all restrictions are removed next Monday. While research shows that hospitalisation rates have, thankfully, dropped to 3% of cases because of vaccination, that would still mean up to 3,000 admissions, the same as during the first wave. Can he explain how he will avoid such a surge putting pressure on health services, which would further delay clearance of the backlog of patients waiting with other conditions?

With the likelihood of such high transmission rates, how does the Secretary of State hope to prevent the generation in the UK of yet more new variants, perhaps with significant vaccine resistance? Evidence is growing of the debilitating impact of post-covid morbidity, and the Office for National Statistics estimates that it could affect 10% of those who have had the virus, so how does he plan to avoid an unacceptably high risk of long covid in young adults and children, who are not fully vaccinated?

Finally, why is the Secretary of State ending the mandatory wearing of masks in indoor spaces and on public transport, given that they reduce viral spread and cause no economic detriment? Does he not recognise that, as vulnerable people cannot count on others wearing masks, for them 19 July will not be freedom day but the exact opposite?

I thank the hon. Lady for what she said about the English football team, but I noticed that she did not say who she supported. I hope it was England.

The hon. Lady is right to raise hospitalisations, as other colleagues have. Of course, as cases rise, which sadly they will for the reasons I have set out, hospitalisations will rise too. However, again for reasons I have set out—No. 1 being the vaccine—the rate of hospitalisation will be far, far lower than anything we have seen before. She will also know, given her experience, that the treatments available are a lot better and more effective than what we had at the start of the pandemic and during the last wave. That is also helping should people, sadly, find themselves in hospital. That is part of the three tests, test number three, that we have looked at very carefully. We have looked at the data and we of course work very closely with our colleagues in the NHS on an almost minute-by-minute basis to ensure that the increased pressure—I accept there will be increased pressure; I have been very open about that—can be met in a sustained way.

The hon. Lady mentioned the backlog. It is important to understand that the backlog built up over the pandemic because people stayed away from the NHS for perfectly understandable reasons, but we need to start to get back to normal as quickly as we reasonably can so that we can start to see more and more people in the longer term and improve the backlog more quickly.

As for masks, I believe I have answered that question. The most important thing is that our guidelines will be very clear. They will be published later today, too.

Enterprises are having to shut because key members of staff, despite having been vaccinated twice, are having to isolate as contacts. As infections increase, so will contacts who have to isolate and there is every possibility that the economy will grind to a halt. Will the Secretary of State review the need to self-isolate for those who are twice vaccinated and showing a negative test?

It is precisely for the reasons my right hon. Friend sets out, and for other reasons, that we have already reviewed the rules on self-isolation. That is why we have announced that there will be a change from 16 August. We will keep them under review.

For the 3.8 million clinically extremely vulnerable people, the prospect of a so-called freedom day next week is actually anything but. They and many clinically vulnerable people, such as pregnant women, are living in fear of what living with covid means for them. Last Monday, the Secretary of State promised me that guidance was forthcoming. Last Wednesday, Members in the other place and charities met his ministerial colleague Lord Bethell and officials, who admitted that this was not good enough and that something more had to be done. Can the Secretary of State tell us today what support and guidance will be forthcoming and when, or is he pursuing a survival-of-the-fittest policy, whereby the most vulnerable will be thrown to the wolves?

This is one of the most important issues. As the hon. Lady says, many people are immuno-suppressed or severely clinically vulnerable. It is important that at every stage of dealing with this pandemic we are thinking of them and having them at the front of our mind. That is what I believe we have done. Of course, when people in that category are able to take the vaccine they should, but not all are able to do so. She asks about advice, and I can tell her that we are publishing it today.

First, it is worth saying that I strongly welcome the statement from the Secretary of State. When he is back at the Dispatch Box in the autumn, as I fear he may be, announcing further restrictions, guidance or even another lockdown, one of the things that will have driven that will be hospitalisation data. The big flaw in that data at the moment is that it includes anyone who tests positive for covid who goes into hospital, not whether they have gone into hospital because they are ill with covid. That will drive poor decision making, and it is vital that it is fixed urgently. We cannot have hundreds of thousands of livelihoods and wellbeing sacrificed on the altar of dodgy data.

That is an important point from my right hon. Friend. He will know—I judge that is why he asked the question—that at the moment the figures available are “with covid”, which does not make a distinction about what is causing that individual to be in hospital, so the data are not precise and detailed enough. I think that is what he is getting at. It is a very good point and I have asked for advice on it. I hope we can start to get clearer data precisely for the reason he raises.

Primary care is not only the frontline of the fight against covid; it is also the front door of the NHS and many staff are on their knees at the moment. May I ask the Secretary of State to help more medical students to choose general practice and to stay in it, as that is absolutely fundamental to helping more people get in to see a GP easily?

I agree. My parents wanted me to be a doctor—a GP—so they were a bit disappointed, although my mum did say that my current role might make up for it. My hon. Friend is absolutely right. He knows our commitment to 50 million more appointments and to having more GPs. That remains a huge priority, which I think this pandemic has made even more important than before.

I join the Secretary of State and other colleagues in deploring the appalling racism shown against a football team who have shown the absolute best of our country.

The Secretary of State says that caution is absolutely vital, given the soaring infection rates. I agree, but if caution is absolutely vital, why is he weakening the measures to deliver it? The message around face masks on public transport, for example, has been downgraded from being a clear legal requirement to being an optional personal choice. As more than 100 scientists and medics said last week in a letter to The Lancet, this is reckless and risks driving up infections. He asks, “If we do not open up now, then when?”. The answer has to be: when a far higher percentage of the total population is vaccinated; when basic public health protection such as test, trace and isolate is properly functioning; when people can afford to self-isolate; and when measures such as air filtration systems are in our classrooms. Frankly, the Government seem to be pursuing a Darwinian strategy, relying on immunity by natural infection. Does he realise how dangerous that is?

I am afraid that the hon. Lady is just not being realistic. I have set out very clearly in my statement the issues around timing. No one is pretending that there is a perfect time to start lifting some of these restrictions. It therefore requires a balanced and measured approach, and that is exactly what we are doing.

Steroid inhalers, of the type used by millions of asthma sufferers worldwide, are known to be safe and cheap, and trials show that they are also very effective in reducing the severity of covid symptoms and the length of time they are suffered. Will my right hon. Friend take rapid steps to revise the guidance to ensure that this becomes an immediate part of GPs’ armoury in dealing with people who present with covid symptoms?

When my hon. Friend wants something done rapidly, I listen very carefully to him. I am pleased to tell him that the clinical guidelines have been published today that allow the central alerting system to recommend to clinicians that they prescribe inhaled steroids on a case-by-case basis for exactly the purpose that he set out. I hope that is quick enough for him.

I hope that I will get an equally happy response to my question. The Secretary of State has said that he is anticipating as many as 100,000 covid infections daily. If that were actually to happen, according to his figures how many people would he expect to be hospitalised, and how many would he expect to develop long covid as a result?

I can tell the hon. Lady that there are currently about 30,000 infections a day. In the last 24 hours in England, we have seen about 400 people being hospitalised. The last time that infections were around the same level—at 30,000 cases a day—I believe that more than 2,000 people a day were being hospitalised. That is what I mean when I say that the link has been severely weakened, and for that we have the vaccines to thank.

I look forward to having a look at and scrutinising the new road map when it is published this afternoon. Further to the point raised by my right hon. Friend the Member for Forest of Dean (Mr Harper), I am just trying to get clear the data on hospitalisations. I was told today of a lady admitted this weekend to a hospital in my region to give birth. She was, of course, tested on admission and was positive, so she is a covid-positive person in hospital. Given the advice that the Secretary of State has just confirmed to the House that he has sought, when does he think he will be able to advise us of the figures for those admitted with covid versus those admitted for covid?

I know that my hon. Friend speaks with experience, and I am glad he has raised this point again. I have asked for that advice, because it is important that we try to analyse better the primary diagnosis of anyone coming into hospital. I can understand why that was not easily possible in the early days of the pandemic, but I think we have now reached the stage at which we can provide better data, and I hope I can get that done as quickly as possible.

The recent report from the Health and Social Care Committee on NHS staff burnout showed that low pay was a particular issue for care workers, and that most NHS staff were working unpaid hours on top of their contracts. Those are hours that could otherwise be spent with family members like the brilliant student I met this morning, Brendan from Cardinal Newman School, whose dad works for the NHS. How does the Secretary of State plan to clear the backlog and fill the 40,000 nursing and 112,000 care worker vacancies if this Government continue to say no to the pay rise that NHS heroes like Brendan’s dad deserve?

I agree with the hon. Lady that the workers in the NHS, no matter what their role, have been the heroes of this crisis, as have care workers. I think we agree on that, and that making sure it is recognised also requires us to ensure that they are paid properly. The hon. Lady is also right to link this issue to, for example, the backlog and the huge amount of work that lies ahead. I hope she will bear with me, and in due course we will set out our response to the pay review recommendations.

I welcome my right hon. Friend’s statement. He will know that on 29 April, a pilot scheme to test and release was introduced to avoid the disruption caused by the need for contacts of people with covid to isolate for 10 days. He will also know that our right hon. Friend the Chancellor of the Duchy of Lancaster was a beneficiary of that scheme. Will he say what the results of the pilot have been, and when it might be available to the rest of us, which I hope will be before the third week in August?

I thank my right hon. Friend for his support for my statement. That scheme is very important. I have not yet seen the final results, but results are starting to come into the Department. As my right hon. Friend will know, while the pilot has been going on the Government have also made an announcement about more flexibilities for double-vaccinated people from 16 August onwards, but I will endeavour to say more about this and publish more data as soon as I can.

I have heard what the Secretary of State has said about masks today, but as was pointed out by my hon. Friend the Member for Central Ayrshire (Dr Whitford)—the SNP spokesperson—there will be no “freedom day” for vulnerable people if the legal requirement to wear a mask is scrapped. Many of my constituents wrote to me over the weekend expressing concern about this issue. Along with leading scientists, trade unionists and large sections of the public, they are keen for the legal requirement to wear masks in indoor spaces and on public transport to be kept at least for now. Why can the Secretary of State not make that commitment?

I think I have set out the general approach at the Dispatch Box a number of times. As we begin to move towards a more normal position, we want to start removing the regulations and replacing them with guidelines, and then to ask people to follow those guidelines. For example, we have made it very clear that in crowded and enclosed spaces we would expect everyone to wear a mask, and we would recommend that. Given all the data that we have set out, including the vaccination rate, we think that now is the time to take that kind of more measured approach, and we will keep it under review.

I welcome what the Secretary of State has said. On Friday I visited Blue Bay Travel, an international travel company based in my constituency which strongly supports the easing of public health restrictions from 19 July for those who are fully vaccinated. Will my right hon. Friend continue to do all he can to ensure that we help jobs and industries of that kind, which have been hit hardest by the covid measures, to recover fully as soon as possible?

Yes, I can give that commitment to my hon. Friend. He is right to raise this issue. The travel sector has been one of the hardest hit, and I hope that as we take this measured approach and start opening up more, the sector will, in terms of both jobs and opportunities, start to benefit in his constituency and elsewhere. I hope that the company he referred to in his constituency welcomes the changes we have set out so far.

The Secretary of State mentioned the serious problems being caused in the NHS by the Government’s pinging system, but schools and businesses are also suffering. Now, in the transport and travel sector, scores of trains were being cancelled over the weekend because drivers and other train staff had been pinged. If he will not bring forward his 16 August date, why on earth will he not continue to mandate masks on public transport, both to protect staff and passengers and to give them the confidence to travel at least up until that 16 August date?

The right hon. Gentleman may know that when we set the 16 August date, and I think I made this clear in the statement last week, it was based on clinical advice—the public health advice that we received and in particular that it was better to make sure that more people are vaccinated than will be on 19 July, and I think that is valuable advice. When it comes to masks, I think I have made the Government’s position clear.

Lifting legal restrictions is a massive relief for all those who rely on pubs, restaurants and nightclubs for their livelihoods, the overwhelming majority of which are taking their responsibilities seriously at enormous cost to themselves. Does my right hon. Friend agree that as we open up our society and economy, not only must all hospitality businesses take sensible steps to protect us from disease, but all customers must also play their part and respect venues and their staff, who are working so hard to do the right thing?

Yes, I agree wholeheartedly with my hon. Friend. It is a responsibility as we open up not just for the owners of the businesses, the nightclubs and the pubs to take that sensible, measured attitude, but for customers to give a thought to those who are serving them at the table or behind the bar and to be respectful of their needs.

Last week, the Chancellor of the Duchy of Lancaster’s review was reported to this House as having concluded that covid vaccine certification was not necessary and would not go ahead. Since then, however, there seems to have been a review of the review, because the Secretary of State said today that

“the Government will be encouraging businesses and large events to use certification in high-risk settings”.

Can the Secretary of State tell the House now what constitutes a high-risk setting in this context, and who will be the judge of what is a high-risk setting? What constitutes “large events”, and who will judge what they are? What is meant by “encouraging businesses” and what will be the consequences for any businesses that resist the encouragement from Government in this way? Finally, how will the data that is captured in this way, which belongs to us all, be held and protected?

The remarks that the right hon. Gentleman refers to by the Chancellor of the Duchy of Lancaster are absolutely correct. As we move away from regulations, there will no longer be a legal requirement for any establishment to have covid vaccine certification, but the guidelines, which we will publish today, will be very clear that we expect corporate bodies and responsible businesses to have a system. We will continue to provide the infrastructure, where we will work with them and with the respective Government Departments. The Department for Digital, Culture, Media and Sport and the Department for Business, Energy and Industrial Strategy are already talking to industry leaders and working with them, and the industry welcomes the work on a basis of guidelines, rather than regulation.

A rate of 87% for first vaccinations is truly impressive, and it is in excess of all the estimates that I read about when the vaccination programme was first launched, but there is evidence of a worrying fall-off in people coming forward for their second vaccinations in London and the south-east. Can my right hon. Friend say what steps he is taking to ensure that people, especially young people, are committing to completing the vaccination course?

My hon. Friend is right to raise this. As she says, the rate of vaccination that we have achieved in this country is the envy of the world. We want to make sure that is maintained. We definitely want to make sure that more young people are coming forward. The walk-in clinics that have popped up around the country, and the mass vaccination events that have been taking place in parts of the country, are part of that. We are also looking actively at other ways to promote the importance of vaccination.

A schoolteacher recently told me that some families cannot afford to self-isolate. If we are learning to live with the virus, why has the Secretary of State for Health and Social Care refused to introduce proper financial support to self-isolate, to ensure that those who test positive can safely self-isolate at home?

The hon. Lady will know that we have in place financial support for those who need it and who are asked to self-isolate. It is something that is important. It continues to be important, and it is something that we will keep under review.

Thanks to jabs and far better treatment, the case fatality rate is now 0.085% and falling. Had it been so a year ago, is there the remotest possibility that jurisdictions would have embarked on restrictions of the same breadth and scope? Does it not follow that now is the right time to move to step 4 and release burdens on people, so that we can get society going? Will the Secretary of State please caution the Opposition on their undue reliance on masks? They are not the solution; vaccinations are.

My right hon. Friend is absolutely right to raise the importance of vaccination. That has been the key to getting us to where we are on our road map, which is why we cannot emphasise enough the importance of continuing with the programme. That is why we have set out that we plan to have a booster programme in September.

I have constituents who are absolutely ready for restrictions to be lifted, and I have others who are very concerned about the effect of the Johnson variant, which is prevalent in my area, so I can understand entirely the Secretary of State’s desire for balance. That balance is not provided by the Prime Minister saying one thing—usually incoherent bluster about freedom day or terminus day—and other Ministers, such as the Secretary of State, saying other things about the need to continue wearing masks. Does he understand that the continued mixed messaging from the Government is not helping us to get through this crisis?

Tomorrow, my right hon. Friend will be asking the House to approve regulations that will put thousands of care workers in England out of a job. Two weeks ago, we were promised that a regulatory impact assessment was available. As of midday today, it is still not available. When will it be available, and why has it not been made available so far?

I believe my hon. Friend is referring to the measures that the Government have already announced around vaccinations and people who work in care homes. Ideally, I would like to make sure that the impact assessment is available. I do not know the full detail as to why it has not been completed, but at the same time, I think it is important to get on with this part of building our vaccine wall. We will have more to say about it tomorrow.

The Secretary of State will be aware that Singapore has announced its plan to navigate from pandemic to endemic and to co-exist with the virus—they could almost have been reading my speeches and articles. Will the Secretary of State get the economy and society moving again and, in particular, take a fresh look at vaccine passports or certificates, including the vaccine card that we all carry? Let us allow our people to get back to normality.

I take it from that that the right hon. Gentleman supports the measures that I have set out today in this statement, and I thank him very much for his support.

I very much welcome this statement today on the back of the successful vaccine roll-out programme. However, given the rising numbers of people having to isolate and the impact this is having on businesses and our economy, can I reiterate the call to my right hon. Friend to consider bringing forward changes to the requirement to isolate after contact with a confirmed case for those who are fully vaccinated? There has to be a better way forward that does not have the economic impact that the current isolation policy is having.

I understand the importance of the point my hon. Friend has made. As I said in response to another question, the date of 16 August is based on the best advice that we can get at this point in time. He may be interested to know that, as well as the test and trace system, there is the NHS covid app. A number of people have referred to the so-called pinging. I want to take a careful look at this to ensure that it can also provide a more proportionate and balanced system, given the rate of vaccination.

There is understandable concern among those who are immunosuppressed, particularly those with blood cancers, about the effectiveness of vaccines and I know that the Secretary of State mentioned this earlier. Can he be really clear: are the vaccines working? Will those people get booster doses early? When will detailed and specific advice on the whole range of conditions be available? I declare an interest, as somebody in my own family and many of my constituents are affected. When will they get clear advice so that their concerns can be put to one side?

The hon. Gentleman is right to raise this issue. The vaccines are working and I have set out clearly why. The Government have published much evidence on that. The booster programme begins in September and the immunosuppressed and clinically vulnerable will get priority in that; they will be in the initial cohort. The advice that I referred to earlier will be published today.

In what circumstances or conditions does my right hon. Friend consider that it will be responsible to work in crowded spaces, such as in retail or hospitality—or, indeed, in this place—without wearing a mask?

My hon. Friend is right to raise this and our guidelines on mask wearing will be very clear. If people are in retail spaces and they are crowded—as we know, most of them are enclosed—they should consider wearing a mask. They should be thinking not just about themselves but about the people around them and the people serving them.

The Secretary of State will have seen the huge and rising number of covid infections in the north-east, and the decision to remove controls will clearly accelerate that and increase concerns about the short-term and long-term impacts of covid and the risk of vaccine-resistant variants. Regardless of the proposed covid passports, businesses in the north-east—especially in sectors such as hospitality, where large numbers of young unvaccinated people work—are already struggling to function with reduced staff and customers cancelling at the last minute to self-isolate. With the Government withdrawing economic support at the same time, does the right hon. Gentleman appreciate the concern that, for many hospitality businesses, the Government’s summer of high covid may be too much to survive?

The hon. Lady will know that there is still significant economic support in place, and of course it is the job of the Treasury to keep that under review. When it comes to self-isolation and the impact that it has on businesses, it is important, now that we have such a high level of vaccination, including in the north-east, that we can take a more proportionate and balanced approach, and that is exactly what we are doing.

It is great news that we are moving back to personal responsibility next week, and I thank the Secretary of State for that. However, the rates are increasing in Redcar and Cleveland. Although hospitalisations are not climbing in the same way, my concern is that more and more people are having to self-isolate due to the dreaded ping from the NHS app. We all remember the difficulties of last year when people struggled to get a test, but since then the Government have massively increased the testing capability and getting a test is no longer an issue. What more can be done to utilise this immense testing capability to prevent people from having to self-isolate unnecessarily?

My hon. Friend is right to raise this. The so-called ping does serve a purpose and it has served a huge purpose as we have been dealing with this pandemic, particularly during the last wave. If someone is pinged, it might be very useful information to them if they were planning in the days ahead to visit a vulnerable person, perhaps a grandparent or someone, so I think it is valuable information to give people. But as I said earlier, I think we can look at the approach and make it more measured, given the high rate of vaccination, and then also, as he suggested, make more use of tests, which is exactly what we are doing.

What assessment have the Secretary of State and his Department made of the number of children with long covid, and when will children get vaccinated?

On children and covid—the hon. Gentleman asked about long covid—a huge amount of research is being done both in the NHS and in my Department. I mentioned, for example, the extra £50 million of funding that we are providing to do even more research and to step this up. As he knows, long covid is a problem the world over, and I hope that the UK can become a world leader in trying to help with this problem and share the research that it does with other countries. On the vaccination of children, as I said in response to a similar question, the JCVI is actively looking at this issue. Once we have its final advice, we will set out our plans.

I welcome my right hon. Friend’s confirmation of the return of our freedoms. Knowing what we do now about the impact of some of our interventions, we must never return to those dark days. While we have taken a huge backward step in this regard, does he agree that we should use this great unlock to usher in a new era of personal responsibility? Perhaps we could start with a review of clause 125 of the Health and Care Bill, which would appear, on the face of it, to prevent UK food manufacturers from advertising their products anywhere online, not just in the UK, while conferring advantage on huge, globally recognised brands.

Obesity is a real problem in this country and others and its causes are very complex, but we do want to make sure that we have the best approach possible. My hon. Friend will know that we are planning to debate this Bill on Wednesday and I look forward to seeing him in the debate.

I want to press the Secretary of State a little further on wearing masks. He said that he has been perfectly clear, but the opposite is the case. His Government were dithering on mask wearing in this very week last year, and the dithering and mixed messages continue. He tells us that masks will no longer be compulsory but that wearing them will be expected, as the Chancellor boasts that he will stop wearing a mask on 19 July. The Government chief medical officer and the chief scientific adviser say that they will continue to wear masks. Why has this important public health tool been so undermined by the dithering and mixed messages of his Government?

It is 16 months since I contracted a fairly mild bout of coronavirus, which, unfortunately, developed into terrible long covid, and the symptoms still persist all these months later. The vaccination programme has been a game changer and I want a return to normality, like everyone else, but does the Secretary of State understand that the consequence of his decision may well be more people with long covid? The money for research is welcome, but what more is he planning to do to support those with long covid with health, rehabilitation and social security measures and to support employers with the reality that sections of their workforce might be unfit for work for periods, too?

First, as I have said a number of times in this debate, opening up is not without risk, but I hope that the hon. Gentleman understands that keeping restrictions in place is also not without cost, so the Government have to take a balanced approach. He is right to raise the issue of long covid. As I mentioned, this is something that the Government take very seriously. I have announced another £50 million of funding for research into it. This is a problem not just in the UK; it is an issue the world over. We still do not know enough about long covid. We are learning more all the time, but it will be an absolute priority of this Government to work with people with long covid and do everything that we possibly can.

More double-vaccinated people than ever are being asked to self-isolate because they have come into contact with someone who has tested positive for covid. That is incredibly difficult for individuals and families and of course it disrupts jobs and businesses; I have heard cases of people being asked to self-isolate more than once in the same month. May I add my voice to others across the House and ask my right hon. Friend to consider bringing forward before 16 August some form of test and release measure for people who are double-vaccinated?

Again, this is an important issue. My hon. Friend may have heard the response that I gave earlier about the test and release scheme. I am eagerly waiting to look at the results of that and see whether we can provide further flexibilities. I hope she will also welcome some of the flexibilities that we have already announced, including the changes that will take effect on 16 August.

I take this opportunity to condemn the vile online racism against some members of the England football team yesterday after they had given their all for their country.

The World Health Organisation has expressed its concerns about rising infections in England and the risk to the 17 million people who still remain unprotected by vaccination. But even those who have been vaccinated are at risk of long-term illness and disability if they become infected; Office for National Statistics data indicates that one in seven infected people of working age will experience ill health after 12 weeks.

May I follow my hon. Friend the Member for Denton and Reddish (Andrew Gwynne) in chasing the Health Secretary about his estimates of the incidence of long covid as a result of the third wave? What discussions has he had with the Work and Pensions Secretary about what that means when it comes to support through the social security system if people are unable to work?

The hon. Lady raises the importance of vaccination, and she is right to do so. As I mentioned earlier, according to the ONS, nine out of 10 adults in this country have antibodies, which are part of the wall of protection.

The hon. Lady is right to mention that cases will rise in this wave. We have been very open about that. I hope that she heard earlier in my statement that there is no perfect time to start opening up. The risk is that, if we do not do it now and wait until after the summer, the schools will be back, and if we wait longer it will be winter—there is a real, serious risk, which we have been advised about, that the wave could be even bigger than what is anticipated at this point. Many more people would then end up getting infected and, by extension, getting long covid.

I hope that the hon. Lady can consider all that together in a balanced way. If she would like to meet any Ministers or officials in my Department to understand the situation better, I will be happy to arrange that.

From previous answers given, I am delighted that my right hon. Friend is now looking at the underlying settings of the Track and Trace app—I ask him to do that as a matter of urgency. Those settings take no account of vaccination status or any other behaviours; it is just a blunt, bluetooth signal. It might have had value when there were few other tools in the box, but it must now be highly questionable to condemn potentially millions of people to unnecessary self-isolation and the economic impact thereof.

My hon. Friend makes an important point. I hope that he noted my comment that, precisely for the reasons he set out, given the high rate of vaccination, we are taking a fresh look at the app. I have asked for advice—and have just started to receive some of it—about how we can take a more proportionate and balanced approach.

It is clearly right to take further steps towards unlocking, but it is not the all-or-nothing choice that the Secretary of State has suggested and vaccines are not the only tool available. The wearing of masks in enclosed spaces reduces infection and therefore hospitalisations and deaths. It is supported by health experts and backed by the public. The reasons why the wearing of masks was made mandatory remain the same as when the Government recommended it all those months ago. With hospitalisations up 34% on a week ago, will the Secretary of State not put public health before the pressure from his more vocal Back Benchers and retain mandatory mask wearing for public transport and other enclosed spaces?

I agree with the hon. Gentleman that it is not all or nothing, which is why the Government have been very clear that as we start opening up other measures will rightfully stay in place—I mentioned earlier the border controls, the test and trace system and the plan for booster vaccines. I hope that he would welcome that.

I have had the privilege of seeing some of the terrific work being done in Aberconwy by Betsi Cadwaladr University Health Board on the delivery of the UK vaccine throughout north Wales. Does my right hon. Friend think that the pandemic has shown us, or perhaps reheated or reinforced, the importance of working together on health matters? Does he agree that the UK Government and the devolved Administrations should now explore opportunities to work together on better health outcomes for all UK residents in all parts of the UK?

Yes, I agree wholeheartedly with my hon. Friend. During this pandemic we have seen that, by working together on all types of public health issues, but especially the vaccine and its delivery, we are stronger together. We should draw some long-term lessons from that about how we can use it not only to protect against future pandemics—sadly, there will be some—but in respect of other public health issues that we face collectively to find a way to do a better job together.

I have written to the Secretary of State to urge him to do everything that he can to protect immunocompromised people as restrictions are eased. We urgently need the results of the OCTAVE study into the efficacy of covid-19 vaccines on this population; when will we get them? In the meantime, will the Government provide antibody tests for immunocompromised people, allowing them to make informed decisions? Better communication and proper support will go a long way towards alleviating the escalating levels of concern.

On the study to which the hon. Lady referred, I will look into that and write to her, if she will allow me. Immunocompromised people and what we can do to help them has come up a number of times during this statement. I direct the hon. Lady to the comments I have already made and highlight the fact that we will publish some guidance today.

I welcome my right hon. Friend’s statement. Last week, I heard from a self-employed small business owner in my constituency of Keighley and Ilkley who has been told to self-isolate three times in the past two months, despite not testing positive on any of those occasions. Such an experience is both impractical for the individual and harmful to our local economy, so will my right hon. Friend assure me that he is exploring all possible options to remedy the situation, whether through adjustments to the NHS app or changes to the self-isolation rules?

On the app and the so-called pinging—my hon. Friend referred to an individual in his constituency who has perhaps been pinged too many times—it is right, as I have said, that we take a fresh look at any changes that we can make in the light of the success of the mass vaccination campaign. If my hon. Friend will bear with me, I think he will be pleased with our course of action.

In response to my hon. Friend the Member for City of Chester (Christian Matheson), the Secretary of State said that the Government speak with one voice. Well, clearly on masks they change in response to whatever the latest YouGov poll says. He has been very clear today that people should wear a mask in confined spaces, so I ask him a direct question: what is his advice to retailers? Should they insist on their customers wearing masks when they enter their shops?

On a point of order, Madam Deputy Speaker. It arises directly out of the response that the Secretary of State gave to me. Tomorrow this House is being asked to approve the Draft Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) Regulations 2021. When that instrument was laid on 22 June, the explanatory memorandum said:

“A full impact assessment of the costs and benefits of this instrument is”—

I emphasise “is”—

“available from the Department of Health and Social Care…and is published alongside this instrument”.

As of 12 o’clock today, I have been trying, through the good offices of our excellent colleagues in the Library, to get an answer from the Department as to when we are going to get that impact assessment. The officials at the DHSC are quoted by the Library as having said, “The impact assessment has not been laid yet”—we knew that—and, “We will be laying it at the earliest opportunity.” This is very serious, because on 6 July the Secondary Legislation Scrutiny Committee referred to the impossibility of being able to scrutinise the legislation properly without the impact assessment. Despite the Secondary Legislation Scrutiny Committee recommending that the debate be deferred, nothing has happened and all that the Secretary of State said in response to me was, “Well, we don’t know where it is but don’t worry about it—we’ll carry on tomorrow anyway.” That is just not good enough. I would be grateful for your guidance, Madam Deputy Speaker, as to what we can do to ensure that we have an informed debate with the impact assessment before us.

Further to that point of order, Madam Deputy Speaker. In intending to be helpful to those on the Treasury Bench, I have noticed, looking at the said regulations, that they do not actually come into force until 16 weeks after they are approved by the House. It seems to me that in four months there is plenty of time for the Government to produce the relevant information for the House and for the House to take a decision, with no detriment at all to the health and safety of anyone in our care homes.

I thank both hon. and right hon. Gentlemen for their points of order. I am sure the House is well aware that it is not a matter for the Chair. I will not spring it on the Secretary of State for him to give an answer on this operational matter, but Mr Speaker usually observes that it is helpful to the House for Members to have as much information as possible before them when a matter of importance is to be considered.

Further to that point of order, Madam Deputy Speaker. The explanatory memorandum falsely asserted that the full impact assessment is available. Why was the House misled in that way?

Once again, the hon. Gentleman knows that I cannot answer that question, because what is said by Ministers and their Departments is not a matter for the Chair. However, if it were to be the case that a spokesman for a Minister had suggested that something had happened that had not happened, and on which Members were trying to rely and could not rely, Mr Speaker would take a very dim view of that. It is better if Ministers make sure that their Departments give as much information as possible to Members ahead of discussions.

It is indeed further to that point of order, Madam Deputy Speaker. I rise to reinforce the point raised by the hon. Member for Christchurch (Sir Christopher Chope) and the right hon. Member for Forest of Dean (Mr Harper). What the House is being asked to decide tomorrow is whether to proceed with compulsory vaccination for a certain section of the healthcare workforce. We have not had compulsory vaccination in this country since the 19th century, when it was tried and abandoned. This is an incredibly serious intervention. Is there a procedure by which the House can delay coming to a decision tomorrow until the assessment is published?

I do not believe there is such a procedure, as the matters on the Order Paper are a matter for the Government. I note that the Lord President of the Council has just come into the Chamber, so he will undoubtedly hear the end of this matter, although he did not hear the beginning of it and so I would not dream of asking him to comment. If the hon. Gentleman is suggesting that a delay should be put in place, I am sure he will be able to make reference to that when he has the opportunity to do so tomorrow.

On a point of order, Madam Deputy Speaker. Will it be possible—will it be in order—to question the Leader of the House about this matter, as he is about to make a statement about tomorrow’s business?

No. The right hon. Gentleman is fond of short questions and short answers, and that is my short answer. The statement that will be made after a brief suspension of the House, which I am about to announce, by the Lord President of the Council, will be, I understand, on a very narrow and specific matter, and I will allow questions only on that very narrow and specific matter. Having said all that, I am quite sure that the Secretary of State and those on the Treasury Bench have taken note of what has been said over these past minutes. [Interruption.] I am pleased to see that the Secretary of State has indeed taken note, so hon. Members have achieved what they set out to achieve. I shall now suspend the House in order that arrangements can be made for the next item of business.

Sitting suspended.