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Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) (No. 2) Regulations 2020

Volume 808: debated on Wednesday 30 December 2020

Motion to Approve

Moved by

That the Regulations laid before the House on 17 December be approved.

Instrument not yet reported by the Joint Committee on Statutory Instruments.

My Lords, despite all the pressure we are under, I would like to take a moment to celebrate some good news. The Government have today accepted the recommendation from the Medicines and Healthcare products Regulatory Agency to authorise Oxford University/AstraZeneca’s Covid-19 vaccine for use. This follows rigorous clinical trials and a thorough analysis of the data by experts at the MHRA, which has concluded that the vaccine has met its strict standards of safety, quality and effectiveness. We have hundreds of thousands of doses ready to go and 100 million on order—enough for everyone.

On 4 January, the NHS will start administering doses to a revised list that reflects many of the interventions by noble Lords in this Chamber in recent debates. While the vaccine project is an international collaboration, we should take a moment to recognise the contribution of the British life sciences sector and reflect that this easy-to-administer, affordable and mass-produced vaccine offers Britain a way out of this disease, and will make a huge impact on the global response.

But, in the meantime, news from the front line remains grim. While the November national restrictions drove cases down in most areas, it is now clear that cases are rising again at a worrying rate. Across the whole country, cases have risen 57% in the last week, driven by the highly transmissible new variant. The number of people testing positive for Covid-19 has increased rapidly and a growing proportion have the new variant. Data from 29 December showed that there were an enormous 53,135 new Covid cases across the UK—half with the new variant—an increase of 272,551 over seven days. NERVTAG has concluded that the new variant demonstrates a substantial increase in transmissibility, of around 70%, and the R value appears significantly higher, with initial estimates at 0.39 and 0.93 higher—a massive margin in epidemiological terms.

In September, we introduced the tiering framework, which we built upon and refined in December. This is designed to provide a flexible and responsive system, which allows areas to move up and down the tiers as case rates change. It proved effective, with many areas containing transmission. Despite our efforts, the new variant has changed things. It forced us to establish the new tier 4 and to move regions, such as London and the majority of the south-east, into this higher tier.

The good news is that there is no evidence, at this stage, to suggest that the new variant of the virus is likely to cause more serious disease, that our current testing regimes will not detect it or that a vaccine will not respond effectively to it. For this, we give thanks. But the bad news is that there is no data showing that it causes less disease. The new variant accounts for 60% of cases in London and is growing around the country. As always, we see that increased infections lead to increased hospital admissions and loss of life. I need hardly remind noble Lords that this is a time when the NHS faces enormous challenges from winter pressures, its commitment to elective procedures and now the new variant. That is why we introduced the tier 4 stay-at-home measures we are debating today.

As in the November lockdown, people in tier 4 areas must stay at home and not travel out of tier 4. They may leave only for a limited number of reasons, such as work, education or caring purposes. People elsewhere are advised to avoid travelling into tier 4 areas. In tier 4, support and childcare bubbles are the same as in all other tiers. However, all non-essential retail and indoor entertainment will close. International travel is restricted to business trips. The clinically extremely vulnerable in tier 4 areas should do as they did in November and stay at home as much as possible, except to go outdoors for exercise or to attend health appointments.

However, we have listened to noble Lords in this Chamber and the public about what is important for the way people go about their daily lives. Unlike under the November restrictions, communal worship and a wide range of outdoor recreation are permitted. The restrictions imposed in tier 4 areas are hard, but necessarily so. They are designed to reduce transmission of this new variant, so that the NHS is not overwhelmed and we can return to normal as quickly as possible. These stricter rules are in line with other major European countries.

In addition to Greater London, other areas have now moved into tier 4, including Cambridgeshire, the rest of Essex, Norfolk, Suffolk, West Sussex, Hampshire, Southampton, Oxfordshire and Waverley. These changes took place on Boxing Day. We have balanced the economic impact of greater restrictions on business with measures to protect public health. These restrictions impact business in the short term, which is hugely regretful, but we should be clear that they will be economically beneficial in the long term, because we will get back to normal quicker. We are also mitigating the short-term impact through financial support schemes.

On 19 December, we had to take the horribly difficult decision to reduce the Christmas bubble exemption. I know that this meant that the majority of us could not celebrate in the way we would choose. However, given the increase in transmission rates, it would have been irresponsible and reckless to provide too great a window for increased social mixing and the inevitable increase in transmission that that brings.

Therefore, the Government had to ask people across the country to make further restrictions to their Christmas plans. Although this period has been difficult, we now have clear hope. With the rollout of the vaccine under way, we can start to plot our path out of the pandemic with greater certainty, but it is precisely because of this hope that we cannot give up now. That is why my right honourable friend the Secretary of State for Health and Social Care will make a Statement in the House of Commons later this afternoon, addressing future tiering arrangements in response to the new variant. My right honourable friend the Secretary of State for Education will make a Statement in the other place on the return of schools and universities. The sacrifices we make now are crucial to getting back to normal and ensuring that, next year, Christmas will be much more normal for every family in the country.

I commend the hard work of the NHS teams on the front line, including our Chief Medical Officer, scientists developing vaccines and other therapeutics, and those in the life sciences industry seeking to mitigate the impact of this epidemic. I also express the sympathy of us all to those feeling under pressure of any kind—financial hardship, domestic strife, health concerns, educational worries, mental health pressure or just the worry for loved ones and an uncertain future. To all those, I say that there is light at the end of the tunnel. With new scientific advances being made every day, we are taking concrete steps but, in the meantime, we must dig deep. The end is in sight and, until science can make us safe, it is our duty to put in place these new rules, which will help us to keep this virus under control. I commend these regulations to the House.

My Lords, we are at the point of a national emergency. If things continue as now, the NHS will fall over in the next few weeks. The virus is moving at frightening speed, yet the Government have not kept up. The time for the Government to follow public health and not public opinion is now. Hope is on the horizon with the vaccines, but short-term action is more important to keep people alive than extenuating future positives.

These regulations were too little, too late. Today the Government have to go further. The balance between the economy and saving lives is difficult, but you cannot contribute to the economy if you are dead. Government policy based on balancing the splits in the Tory party over lockdowns has to stop. The number of new cases, people dying and the stress on the NHS show that further action is required now, to slow the spread of the virus, keep people alive and protect the NHS. The Government have to follow the SAGE advice and implement a lockdown until R is well below one.

Evidence shows that secondary school pupils do spread the new variant, and therefore action is required on secondary school openings. Not to do so will endanger public health. To mitigate the educational issues facing young people, a Covid-19 premium must be implemented and given to schools so that young people get the support they need to catch up. This should be in place for the whole of this Parliament and not just a payment to schools for the next few months.

The NHS is getting to the point of not being able to cope. When will the promised insurance policy Nightingale hospitals be open to take, in London, say, 100 Covid-19 patients, rather than transferring people over 300 or 400 miles? People seek decisive and evidence-based leadership from government—not to do so is the biggest gift for the virus. These regulations have not stopped the speedy spread of the virus and deaths. Further action is required now.

Dame Deirdre Hine’s report on the 2009 influenza pandemic recommended raising public awareness and understanding about the key characteristics of a pandemic and core response measures. Yet we learned little. A failure of public communication through excessively optimistic mixed messages has led to deepening distrust. Some reporters, such as Fergus Walsh, have explained the scientific and clinical reality well, but we need clear, consistent messaging across the UK, sharing uncertainty and true risk. For example, the B.1.1.7 variant infectivity in effect adds more than 0.4 to the R number. The current reality is proving even worse than the modelling predictions for the coming months for bed shortages, overloaded services, staff infections and exhaustion. Second-time infections are now presenting, as antibodies seem to be short-lived.

Yes, the vaccine is brilliant news; it should prevent fatal infection. But infection control measures will remain essential in the long term. We do not know how long the immunity will last, whether those immunised will still get infected and be viral carriers and spreaders, nor how rapidly further mutations will develop, leading to the need for new modifications and new vaccines. Will the Government collate immunisation data from the NHS number with diagnostic data in the long term to understand the epidemiology as it evolves? Mixed messages and false hope fuel mistrust. Control will only be achieved by collaboration with the public when they understand that vaccination is not a quick fix.

My Lords, it is ironic, is it not, that on the very day that we are considering the European Union (Future Relationship) Bill, which should, in theory, make government far more accountable to Parliament, we are also considering yet more restrictions, retrospectively, which suggest that, in practice, we are moving in the opposite direction. If I were speaking in the Bill debate later today, I would applaud the achievement of the Prime Minister and the noble Lord, Lord Frost. It is immense, not least because it was secured in the face of sustained “scrutiny” by your Lordships’ House and the other place at every single step of the way.

I do not mean to detract at all from the fantastic progress made in finding a vaccine. I welcome today’s announcement that the AstraZeneca vaccine has been approved. It is, of course, wonderful news, but equally welcome would be a new approach by the Government of engaging with parliamentarians, such as Mark Harper in the other place, on cost impact assessments, for example —an issue so ably addressed by my noble friend Lady Neville-Rolfe in the debate on her regret Motion earlier this month.

Difficult decisions have had to be made; doubtless, more lie ahead of us. That is why I would urge the Government to make this new year’s resolution: to trust Parliament more and to treat it with the respect it deserves. That is the best way, indeed the only way, we are going to emerge from such a testing time as a renewed and reinvigorated parliamentary democracy, able to embrace the exciting opportunities afforded to us by our future relationship with the EU.

My Lords, I remind the House of my membership of the GMC board. We meet while the NHS is under huge pressure, with a record 53,000 Covid cases reported yesterday. Yet the Government’s record has been one of delay, indecision and vacillation.

The errors in the spring were compounded by the Government’s decision to ignore the advice of SAGE given in September for a two-week circuit breaker. Then on 2 December, a consensus statement signed off by SAGE warned that additional mixing to be allowed at Christmas could have a large impact on prevalence. Again, this was ignored by the Government. On 9 December, the Health Service Journal was reporting a rise in admissions. Yet still Christmas plans remained unchanged. On 14 December, the Secretary of State updated the Commons on the new variant associated with the faster spread in the south-east of England. The next day, the Health Service Journal and the British Medical Journal called for the Government to respond to this worsening situation by cancelling their plans to allow household mixing over Christmas and tightening the tiered restrictions immediately. This was ignored. On 16 December, Boris Johnson dismissed concerns raised by Sir Keir Starmer. Three days later, we saw the U-turn which sent thousands of people on to overcrowded trains, exporting the new variant far and wide.

Have the Government finally learned their lesson? I hope that this afternoon they will show they are prepared to act decisively. I also hope that, with the fantastic news today of the approval of the Oxford AstraZeneca vaccine, the Government are able to raise the weekly vaccination rate up to 2 million a week, as Professor Neil Ferguson has recommended. I also hope to hear from the Minister what plans they have to reduce the immediate pressures on the NHS. Are the additional nearly 30,000 doctors who were brought on to the GMC’s supplementary list really being used sufficiently to help the NHS?

My Lords, the last time that we discussed restrictions, I asked the Minister whether volunteers would be used for non-medical tasks to improve the speed of testing and tracing. The Minister dismissed the idea. Now they are asking for volunteers to marshal patients in vaccination centres. Will he now recognise the important role of these public- spirited people and tell us what resources will be given to St John Ambulance to organise them?

The Government spoiled Christmas for head teachers by insisting, on the last day of term, that schools should open on time next week and that all children and staff should be given the rapid test. Yet virtually no time, money or person power has been provided to enable them to do this. While I believe that keeping schools open safely should be a priority, what are the Government doing to support heads and teachers? Will there be enough testing kits provided for schools to use? Will staff be given priority for vaccination to give them the confidence to return to work? Will volunteers be recruited to help with the testing to allow teachers to teach?

Children’s education is vitally important, but many of them have lost weeks of classroom time intermittently, not because of lockdowns but because of serial Covid outbreaks in the school and the need to go home for two weeks—over and over again. If the imminent announcement by the Secretary of State for Health and Social Care does not introduce strict measures to stop the virus in its tracks and if the Government do not implement an efficient vaccination rollout, this stop-start education will continue. The effect on our children’s education is not just whether or not we open schools but whether or not we win the battle against the virus. Does he agree?

My Lords, we keep on hearing about the end of this tunnel, at which there is some light. It is an extraordinary long tunnel, and the pinprick of light seems to be very small. In the past I have asked the Minister whether he still stands by Professor Ferguson’s prediction of 4,000 deaths a day, which has never been withdrawn and never got near, and whether he is willing to widen the pool of experts that the Government rely on. Many experts are casting doubt on the figures and their interpretation, not on a one-off basis, but very regularly. I would like to see those people inside the government tent that is producing the projections we are asked to live with.

In particular, will the department publish an updated table showing deaths by age and previous condition? Are we still dealing with people aged on average 84.4 years-old with underlying conditions, or is the disease spreading to a lower cohort? We need to know more what its impact is and a bit less about the numbers, as has been agreed. The numbers have gone up because the number of tests has gone up, among other things.

The second thing is: can we have some idea of hard plans for vaccinations, not just that they are there or that they will be used? What are the plans, and when is it expected that all the over-80s, the health staff, and the over-75s will be vaccinated? Can we have a plan for each area and something that we can hold the Government to account against?

My Lords, I congratulate the Government. The Minister just announced the MHRA’s clearance of the Oxford University AstraZeneca vaccine. I congratulate Kate Bingham and the Vaccine Taskforce on this phenomenal example of collaboration between business, universities and the Government, and of international collaboration between Sweden and Britain. India has a contract for 1 billion doses to the Serum Institute of India—the largest vaccine manufacturer in the world. Could the Minister assure us that there will be all hands on deck for vaccinators, including retired doctors and nurses, wherever we can get volunteers, and that we will use all possible premises, including workplaces, as long as they are in a safe supervisory environment?

There was an excellent article in the FT the day before yesterday on rapid Covid tests, titled:

“Rapid Covid tests are being used more widely: can they be trusted?”

Yet here we have the example of Britain and France using rapid Covid tests to unblock the 48-hour blockage of movement. Enabling the use of these tests has saved so much. Can the Minister confirm that permission was granted on Tuesday for the public to use these tests on their own? Will the lateral flow tests now be available to the public? Professor Sir John Bell, Regius Professor at Oxford University, said:

“Testing asymptomatic people is an enormous priority … If there’s no testing, they don’t get caught. Every successful positive you get is a win.”

Surely that gives validation to this, yet we have others who say that we will miss half the cases. Professor Tim Peto of the University of Oxford said:

“They’re not perfect, but that doesn’t stop them being a game changer for helping detect cases of infectious disease”.

Would the Minister agree? There is also the very clear example of Slovakia. That test was employed throughout the country and lead to a 60% to 70% reduction in the rate of infection across Slovakia.

There is no perfect test. “Everything is a compromise”, according to Jo Martin at Queen Mary University. The best will otherwise be the enemy of the good.

My Lords, I speak from the sunny snow-covered east Lancashire uplands, where I am a councillor. The general feeling among people as a whole here is one of dismay and gloom. Since last March we have been in a continuous period of lockdowns, the northern intervention area, more lockdowns and tier 3. We are now threatened with tier 4. Apart from a few weeks in the summer it has been a year of total gloom and, frankly, it has not been working. Despite heroic local efforts it has not worked since August. We need proper tracing, the community testing on a large scale that was promised and proper support for people in isolation. Even when we get the vaccine, we will need alternative approaches, based on putting it in the hands of local people, giving them faith and confidence, and working for hearts and minds, not just telling them what they have to do.

It is quite clear, from looking at detailed statistics for the whole of Lancashire and all the councils every day since March, that the real stimulus and catalyst for the big increase since the middle of September has been the return of schools. Unless we tackle the problems in schools we will not tackle this virus, however much vaccination there may be. I suggest that all staff in schools should be the top priority for the vaccine, that schools should not return until the end of January, that we should scrap the examinations this summer already, that kids who need laptops at home should actually get them, and, more controversially, that we should scrap the present school year, reset it and start it again next September.

My Lords, I am delighted, as are others I am sure, by the news of the Oxford vaccine. I hope that it will lead to a return to normality.

In my two minutes, I will focus on one issue alone: do these restrictions and lockdowns work? As the noble Lord, Lord Hunt of Kings Heath, referred to, SAGE—which is apparently running the country now, too—said back in September that it was certain that two-week or three-week circuit breakers would crack the growth in cases. Wales did this and cases rose rapidly shortly afterwards. We had a month’s lockdown in November that ended not a month ago. Cases went up, or are now going up anyway. Huge damage is being done to the country, livelihoods, the economy, suicide rates, and to young people and their future.

So do these restrictions work? I am very grateful to my noble friend the Minister, as I got a response from him yesterday. I asked whether they worked, and he said:

“Evidence suggests that more stringent interventions tend to reduce the reproduction number … The lockdown imposed in late March and the changes in behaviour … resulted in a rapid reduction in the reproduction number … We continue to review the efficacy of measures.”

In other words, we do not actually know whether they work. Leicester has essentially been under lockdown since July. It will now almost certainly be properly locked down into tier 4 later today. Lockdowns just do not appear to work. We do not know about this new variant; my noble friend the Minister said that just a short while ago. We do not know whether these restrictions work. We are trashing our future based on risk-averse scientific advice, based on failed modelling, from scientists who do not know either.

I regret to say that the Government are losing the confidence of the public because they keep changing their mind. I also regret to say that people are now ignoring government advice and diktats because they no longer believe what they are being told by the Government.

My Lords, nobody could disagree that it has been a hard year for anyone governing a country, with the pandemic and the heavy load of Brexit, but the Government handled things badly from the very start. They were prone to dither, to delay and not to make up their mind when they were advised to, but later when it was too late. Part of the problem has been that they treated this not as a public health crisis, but as an economic crisis. Clearly, there is an impact on the economy, but that is not the primary reason to try to push back on the pandemic. Time and again, instead of locking our borders and advising people to stay at home, the Government did the opposite: they have advised us to go to work, and to eat out to help out. Of course, with their support of Dominic Cummings, they reduced public confidence in the Government as a whole. They really have themselves to blame.

We have heard from other noble Lords that there were 53,000 new cases yesterday. This is more than France, Germany, Ireland, Italy, the Netherlands, Poland and Portugal combined—all those countries together have fewer cases than we have.

Covid has done some good: it has reminded us of the value of community, collaboration and working together to find solutions. Quite honestly, the Government really ought to be doing this as well, but dithering and delaying means that they have not, so I will give them an idea. They must start helping the most vulnerable people—those who are clinically vulnerable but who are told by their bosses that they have to go to work. The hostile environment against migrants must be ended; it is now a threat to public health. We should end NHS charges for migrants, close detention centres and abolish “no recourse to public funds”. Finally, the Government really have to get a grip on schools. It is obvious that closing them will be the short-term option. I very much hope that the Government start to listen to the experts and do things in time.

My Lords, I am by nature a libertarian, believing that individuals should, by and large, be responsible for their own behaviour. However, I fully support these regulations, and think that they do not go far enough given the current R rate and the Covid-19 challenges.

Nursing staff, of whom I am one, as your Lordships know, play an indispensable role in delivering health and social care services, and have gone far and beyond during this crisis. The challenges presented by Covid-19 have been exacerbated by existing and severe staffing shortages in our healthcare sector. We are now seeing the highest numbers of recorded cases of Covid-19 in the UK, with some trusts and areas reporting that they are at breaking point. With the added pressure of winter and unprecedented demand on the service, there are not enough healthcare staff to care for people across the system. These pressures not only exacerbate workforce issues but put patient safety at risk.

Having spoken to Dame Donna Kinnair, the chief executive of the Royal College of Nursing, and having considered other briefings, including from the NHS Confederation, I believe that we need to introduce tomorrow night, as an emergency, some kind of curfew, so that people do not go out in pairs, meet others in pairs, or get alcohol from those off-licences that can open, in order to protect the few beds that we have available in the health service at the moment and ensure that we do not make things worse in the next 24 hours.

My Lords, on Christmas Day, there were 578 Covid-related hospital admissions in London; 16 weeks earlier there had been just two. That number became 38, four weeks later, and, after another eight weeks, 124. It is now 578. That is an exponential growth, with the total number of in-patients in London now at just above the previous peak on 8 April. If anything, these figures understate things. The threshold of illness to be admitted to hospital is now higher, and more people are dying in the community without ever entering hospital. And the virus is now more transmittable than it was. So of course these measures are needed. The question is whether they are—or rather, were—sufficient.

Throughout the whole of this year, the Government have dithered, responded too late and then acted inadequately. There were five wasted weeks at the beginning, no monitoring of those entering the country and the chaos of test and trace, and dither and confusion continue. Will the schools reopen next week, the week after or later still? This is overpromising and under- delivering, yet again. Some 1,500 soldiers to help test the nation’s schoolchildren means one soldier to every 20 schools—it is a joke.

Ministers are chasing headlines and not listening to those who have to deliver on the ground. Contracts are given to cronies who fail to deliver but still walk off with eyewatering profits; contrast that VIP channel to riches with the businesses going under for ever because of the chaotic cycle of lockdowns and them never being provided with adequate bridging funds to survive.

With the failure to compensate properly those who are expected to quarantine or self-isolate, it is no surprise that some do not follow the rules. This is a litany of failure, with the worst death rates in Europe and probably the most damaged economy. My question is simple: how can the noble Lord defend it?

My Lords, I join my noble friend in thanking all the NHS staff who worked over Christmas and who will work over the new year. I applaud the approval of the Oxford AstraZeneca vaccine.

Will my noble friend ensure that the double dose of whichever vaccine is used is rolled out as it was originally believed that it should be, so that both doses will be given to the most vulnerable as a priority, and to NHS staff, many of whom have not yet been vaccinated, to protect NHS beds and staff as best we can? Will he tackle, as a matter of urgency, the apparent hurdle to enabling GPs and other recently retired staff—here I declare an interest, as my brother falls into this category—who are willing to serve but appear to have a problem with indemnity and face other barriers? That seems inconceivable, given that they are prepared to swing into action to roll out vaccinations and presumably help with triage at hospital admissions.

As the noble Lord, Lord Scriven, mentioned, will my noble friend look carefully at the role that secondary schools in England appear to be playing in the recent rampant spread of this latest mutant infection? Will he consider taking actions such as Wales and Scotland have to delay the return of schools by more than the two weeks envisaged?

Finally, my noble friend said—I think I am quoting him correctly—that, economically, the restrictions set out today will be beneficial in the longer term as they will enable us to get back to normal sooner, yet there is very real concern in the hospitality industry that many establishments will simply not be in a position to reopen. Will additional support be considered at this time, as a matter of urgency?

My Lords, I too welcome the approval of the Oxford AstraZeneca vaccine, and commend the work of scientists and those on the social care and NHS front lines.

I ask my noble friend the Minister—whose dedication and courtesy I always appreciate—whether he can confirm, as was suggested by my noble friend Lady McIntosh of Pickering, the stories of medical and nursing staff who have volunteered to return from retirement but who are unable to get to work due to various bureaucratic delays. Without extra staff, clearly the automatic response of calling for ever-tighter restrictions will not cease. We have Nightingale hospitals that cannot be used and we need vaccines to be administered.

Yet again, we are debating retrospective legislation which has imposed further draconian restrictions on people’s lives without trusting them to be responsible. Yes, some are being irresponsible, but that is a small minority. Yet against the backdrop of Covid cases rising and winter pressures on the NHS, plus our ageing population, clearly there are reasons for concern. But as many noble Lords have stressed, recent history and examples from around the western world suggest that lockdowns and tiered restrictions have not defeated this virus. In Wales, the two-week circuit breaker has not defeated the virus, as my noble friend Lord Robathan said.

I echo the calls of my noble friend Lord Shinkwin for the Government to ensure more engagement with Parliament, and those of my noble friend Lord Balfe for better data, and context for that data, to allow relevant comparisons, and for a proper cost-benefit analysis, including impacts on other forecast deaths resulting directly from the tier restrictions, such as from cancers left undetected or inadequately treated, strokes, heart problems or suicide.

I am delighted that places of worship have remained open, and I have tremendous fears about the impact of school closures on younger people if that is decided again.

My Lords, I shall speak about the wearing of face coverings on public transport. What do the Government intend to do about the attacks on public-spirited individuals who attempt to encourage non-wearers of masks to comply with the law? What advice can they offer to members of the public who believe that the law should be obeyed but are deterred by the threat of physical violence on confronting the lawbreakers?

Yesterday the Evening Standard reported the case of a train passenger who was attacked with a knuckleduster and put in hospital after he asked two men to wear face masks. He was kicked as he got off the train at Barnes station and then beaten up on the platform. He suffered a punctured lung and multiple broken ribs. In an earlier incident in October, an NHS worker confronted a group of two men and a woman on a District line train and asked them why they were not wearing masks. He too was attacked, punched several times on the side of the head and then thrown off the train on to the platform at High Street Kensington. I suspect that a number of your Lordships may have remonstrated with non-wearers of masks on trains, tubes or buses and been rewarded with mouthfuls of vile abuse for doing so; I recall my noble friend Lady Thornton recounting such an incident in your Lordships’ House, and I certainly have.

If we ask public transport workers to support us, they tell us they have no powers to enforce mask wearing. That even goes for Transport for London bus drivers, who will not refuse boarding to non-mask- wearing passengers. My appeal to the Minister is to take whatever powers are needed to get the law enforced, issue new instructions to public transport operators and help all of us who support the policy to stay safe —both from the threat of the virus and from the threat of the thugs.

My Lords, I offer my unreserved congratulations to the Government, their scientists and the National Health Service on the signal success of getting to the point where the Oxford vaccine is available to us. We are entering the last phase of this struggle. I in no way share the gripes of those of my colleagues who have expressed them. The best that can be said for them is that if they had been in charge, they might possibly have made different mistakes. I think the Government’s record has been one that we will look back on, if not with pleasure then at least with confidence that they have done as well as anyone might expect under the circumstances.

When it comes to the vaccine rollout, I join the noble Lord, Lord Bilimoria, and my noble friends Lady McIntosh of Pickering and Lady Altmann in being concerned that there are some signs that the rollout is being held up by an insistence on good practice, which is appropriate in normal times but not now. We really must not let the best be the enemy of the good. Every day’s delay is another day’s deaths.

I cannot see what the difficulties are in, say, chucking the vaccine out to pharmacies. There are 65,000 pharmacies in this country and they are all used to administering flu vaccines; if they were administering 15 Covid vaccines a day, we would be doing 1 million a day in total. It is well within our capacity to get this out while accepting a few imperfections in the cause of a much-reduced tally of deaths.

My Lords, we have exponential infections and the highest number of deaths in Europe. Are the Government seriously not questioning where they have gone wrong? What must now be done to further mitigate this country’s distress? I share the many concerns raised by other noble Lords; my local hospital, the Royal London, has ambulances lined up like the lorries at Dover with patients waiting, often for urgent and emergency care.

Can the Minister say why the Excel Nightingale remains closed to patient care? If it is due to the shortage of 84,000 clinical staff, what consideration is being given to recalling early retirees and utilising the military medical corps for the Nightingales to relieve some of these extraordinary pressures?

We know that tiers are not impactful in controlling deaths and infections. Surely, given the national emergency, we must consider an immediate national lockdown. I agree wholeheartedly with the noble Baronesses, Lady Jones and Lady Watkins of Tavistock, the noble Lord, Lord Harris of Haringey, and many others. That must include schools. Our schools must also be shut down and all the necessary support put in place for schools, families and businesses. Schools have rapidly spread the infection, particularly in areas such as Tower Hamlets, Newham and Hackney.

The prevention strategy must continue, as others have argued. Face coverings must be made available free of charge in many institutions, including in shops and even on public transport. Maybe people would then begin to take their use seriously.

Testing and tracking alongside effective communication with all communities must go hand in hand with the vaccine becoming widely available for those who can and wish to take it up. I congratulate the Oxford team on this wonderful news, and long may it continue.

My Lords, there is a pressing need for credible testing and data if the tiers being proposed today are going to work. As long ago as March, the director-general of the World Health Organization said:

“We must test every suspected case … Test, test, test”

and paragraph 7.3 of the Explanatory Memorandum includes case detection rates as part of the criteria on which the tiers are allocated.

The Government have a long history of failure on this. The system collapsed in September, there was a huge IT failure in October and, as my noble friend Lord Harris of Haringey said, the last nine months have been a long history of chaos, despite costing £22 billion. Meanwhile it seems that most of the contracts that were awarded went to friends and relations of MPs rather than to local delivery, which was the obvious answer.

There was a bad but wonderful example of a massive failure of testing that we saw a week or two ago in Kent. It was quite reasonable for the French Government to require the testing of incoming drivers, and about 5,000 drivers needed urgent testing. As well as the lack of toilets on the M20, there was chaos with that testing. In the end, the French fire brigade sent across 20 firemen with testing kits to help to clear the backlog, as did the Polish army. It took nine days over Christmas to clear a backlog of just 5,000 testing needs. I am afraid that demonstrates the total incompetence of the Government on testing. No amount of lockdown will work without a credible and efficient testing programme.

My Lords, I support the regulations. I have been a strong proponent and defender of the principle of tiers in defending us from Covid; in my view, it is the correct strategic approach. I thank my noble friend Lord Shinkwin for his kind words about my work on cost-benefit in this very interesting debate.

I congratulate the Government and my noble friend the Minister on the vaccine programme, and I thank Kate Bingham for her entrepreneurial flair in buying into several vaccine options. A key principle of investment, which she obviously understands, is to spread the risk. That has enabled us on this occasion to be genuinely world-leading. However, with the economy reeling, we must have a rapid rollout of approved vaccines. To judge by what has happened so far, that will prove challenging, and I welcome suggestions that the military will be involved at an early stage.

Like everyone, I am concerned about the situation in our hospitals—from Salisbury, my hometown, where cases are up sharply, to the outer reaches of the UK. I have been reflecting on what we can do to improve things and look forward to the Minister’s comments. I have four thoughts and questions.

First, on information, we have been plagued throughout this epidemic by a lack of timely information and transparency. The latest example is not knowing hospital by hospital how many admissions there have been by type, age, medical condition, postcode, Covid variant, and so on. Please can this deficiency be removed? Secondly, on local incentivisation, if any of us are informed that we are at risk or live in an area where our local hospital is in danger of being overwhelmed, we will change our behaviour. Thirdly, on oxygen, I know from my son’s experience in LA, from Boris Johnson’s in St Thomas’s and from the sad news this week from Woolwich that reliable supplies of oxygen and staff to administer it are literally the difference between life and death. Why have we not made better preparation for oxygen supply? Fourthly and finally, on staff, I was told by a friend at the WHO that the biggest problem in fighting this epidemic in the UK is the availability of trained staff to help with Covid. What have we been doing to tackle this, if necessary by bringing in retired staff?

My Lords, much of the criticism expressed by your Lordships today has of course been cogent, but I do not share the sense of certainty over the desirability of alternative options, nor the sense of recrimination, in most instances, in relation to the Government’s actions so far. Government Ministers and, looking outwards, all of us carry an extraordinary weight in imposing such levels of restrictions, which I have supported and will support in future. But they are creating huge pressures on communities, families and individuals, which will in many cases be felt for the entire lifetimes to come of those who endure them.

I want to use the little time I have to ask the Minister about people attempting to beat the deadline. We saw that happening in the week before Christmas, with that distressing sight of huge queues and overcrowded trains as people left the capital. Have the Government made any assessment of the level of increased spreading of the virus which such behaviour created, in that instance and others, and of what they can do to prevent the problem that people will act to beat these deadlines with a greater degree of harmful behaviour, ahead of any deadline imposed in future?

My Lords, in the two minutes available I want to make three quick points but also to say how much I appreciated the balanced intervention there from the noble Lord, Lord Walney. I hope that we will have a chance early in the new year to debate the overall strategy, with more time for contributions.

First, I am totally opposed to the further mass closure of schools in any part of the United Kingdom. I do not think that the younger generation should be made to pay for the challenges which there clearly are in public health for the rest of the population. It is not beyond our wit and imagination to provide appropriate ways in which schools can stay open and children be taught using additional staff, volunteers and IT equipment, and additional space. That should remain a top priority for the Government. I would like the Minister to confirm that the Government still consider schools and other educational establishments critical infrastructure.

Secondly, while vaccinating health service staff and vulnerable, elderly people is very important—it is, no doubt, popular and in many ways correct—it is vital that we vaccinate other sections of the population. There are those who have to work, for example, such as bus drivers and those collecting our domestic waste, or those in our schools and educational establishments. There are also those working in factories and other manufacturing establishments where they cannot work from home; they may be working closely together. The vaccination programme needs to be more diverse and the strategy needs to take additional factors into account.

Thirdly and finally, it is absolutely vital that at the start of the new year, at the end of this week, we take a wholly new approach to co-ordination between the four nations of the United Kingdom. It has been a shambles. It has almost certainly cost lives because the public messaging, collation of evidence, reviewing of rules and the rules available for international travel have been so diverse and shambolic across the four nations of the UK. There is a need for leadership on this and for a new energy, so as to have a more concerted approach. I hope we will see that from all four Governments at the start of the new year.

My Lords, this pandemic is still, unfortunately, incredibly potent. It requires us all to do our bit and continue to make those sacrifices. There are incredibly difficult decisions to be made and although today’s news of the approval of the AstraZeneca Oxford vaccine is incredibly good, none of us can afford to drop our guard against this wretched and dangerous virus, so I fully support the measures we are discussing.

I know that there will be a Statement later in the other place, announcing more measures. No Government would be introducing such measures without serious consideration. I hope my noble friend the Minister will be able to reconfirm that expectant mothers can still have a birth partner present for the birth of their babies, whatever tier they happen to be in. I also hope that the Statement to be made on the restarting of schools will give much-needed clarity, as there is so much anxiety for teachers, parents and pupils alike presently.

There are plenty of people claiming that we should have done this or not done that but it seems that no single approach has been successful: you only have to look at other European countries. Circuit breakers are advocated in some parts of this Chamber but do not seem to have worked in Wales, for example. Some noble Lords have correctly observed that not everyone believes in these measures. I simply observe that well over 40 noble Lords have signed up to speak in person in the Chamber today, despite polite exhortations to participate remotely. I make no further comment, but we must not snatch defeat from the jaws of victory. I agree entirely with the noble Lord, Lord McConnell, about the need for unity across the four nations of the United Kingdom but we need to exercise more patience and forbearance if the sacrifice of so many is not to be wasted.

I am hearing July for the time by which everyone will have had the chance to be vaccinated. If you take a district such as Bassetlaw, with 120,000 adults, why can it not be done within a four-week period? Logistically, it is possible but the barriers are those I saw previously when working closely on public health with the primary care trusts and the GPs. The financial model for GPs does not lend itself to volunteers; neither does the primary care model. They would see 50 volunteers as incredible. I could get 500 volunteers within a week—competent volunteers, trained up with ease. They will be thinking of the venues that they use, rather than venues that are difficult to get hold of because that is not what they do. Most critically, employing new people on short-term contracts has been, and is, a big barrier to scaling up.

Indemnity has been raised before. The Government need to get in and facilitate that. It is precisely what we did in Bassetlaw when we managed, within four weeks, to get the vast majority of heroin addicts into medical treatment. Within four weeks, we had that majority. Why? Because we thought outside the normal bounds and got that financial indemnity, using money to ensure that there was no risk to those doing the treatment. I know of nurses, ex-nurses and other health professionals who would love to be involved now but are not getting the opportunity. That must happen.

Finally, on the anti-vaxxers, this place and the Commons should be vaccinated. The anti-vaxxers are far stronger than we imagine, beneath the surface and online. It is crucial that religious leaders should be vaccinated—and seen to be vaccinated—in the next few weeks.

My Lords, I would like to start from these Benches by thanking all those working in health and social care over the last few weeks, and especially those who have had no break over the Christmas holiday. Everyone has talked about Christmas being different this year, but for those staff on Covid wards, those on equally pressurised non-Covid wards, staff in primary care, in laboratories processing tests, those tracing contacts of patients, those working on 111 or running our paramedic services, this has been a really tough end to an already tough year. In tier 4 areas, where cases continue to rise alarmingly, everyone in the extended health system has risen again to do everything they can to keep people safe despite being exhausted. We salute you and we thank you.

These three statutory instruments are, as has become common, already out of date before Parliament has a chance to debate them. Some of that is understandable: this pandemic continues do its best to battle us at every turn and, make no bones about it, we are at war with Covid-19. The role of the scientists and medics is to warn us of the next skirmishes and battles, and the role of government is to provide the resources to defeat the next attempted incursions. Over the last few weeks members of SAGE, Independent SAGE and many front-line doctors and nurses have told us repeatedly that we must act now to prevent further surges.

From these Benches we have been critical of the patchy nature of the tier system, and specifically of the fact that this Government have repeatedly introduced new arrangements, whether local or national, much later than scientists and medical experts have recommended. Over the last three weeks they have said that the Government should take strong action now across England.

However, on Radio 4 this morning the Secretary of State for Health and Social Care once again said that he will go against this, refusing to take that strong action to get on top of the virus, despite many reports across the country that health services are already under extreme pressure, with patients being treated in ambulances and corridors, and some hospitals again facing low oxygen pressure, others with high levels of staff sickness or staff in isolation, and others converting more and more wards for Covid patients. This all seems horribly familiar.

To those who have been saying either that we should not have restrictions or that they are not convinced by them, and that the needs of the economy should take precedence, just before Christmas Dr Tedros Ghebreyesus from the World Health Organization reminded nation states that

“there is no excuse for inaction. My message is very clear; act fast, act now, act decisively. A laissez-faire attitude to the virus, not using the full range of tools available, leads to death, suffering and hurts livelihoods and economies. It’s not a choice between lives or livelihoods. The quickest way to open up economies is to defeat the virus.”

Worrying news was reported overnight in the Health Service Journal that patients with the new high-transmission Covid variant from London and Kent are likely to be moved into hospitals in regions with much lower levels of the Covid variant. What happens when the receiving hospitals in Devon, Newcastle, Sheffield and elsewhere are filling up with patients from the greater south-east, but their own local cases increase and there are no beds for them? Is there enough PPE available for hospitals for a winter wave larger than the spring wave we have already seen?

Before Christmas it was reported that NHS England had not yet signed any new deals with private hospitals because of arguments over costs. Now that some non- Covid services—including elective and cancer services —are beginning to be paused in these overburdened hospitals, are we using private hospitals to full capacity to ensure that those patients are not left behind?

We are hearing that pressure is now being put on care homes in tier 4 areas to take both Covid and non-Covid patients from hospitals. Can the Minister assure those who live or work in care homes that there will not be a repeat of untested patients being moved into care homes, and that care homes will have access to full testing, early vaccines and appropriate levels of PPE?

I would like to build on the question asked by my noble friend Lord Scriven. In the spring Ministers said that the Nightingale hospitals were the NHS safety net. The military delivered them in record time ready for use—for which both it and Ministers deserve credit. Yet, with the exception of the Exeter Nightingale, they lie unused. Can the Minister say when and how will they operate? We keep being told that staffing is the problem, but surely when they were planned there was also an emergency plan to staff them? If there was not, what have Ministers been doing over the last nine months since they were built? As Andy Cowper of the Health Service Journal has asked, were they just theatre?

Finally, the Minister began with news about the MHRA approval of the Oxford University/AstraZeneca vaccine—which is indeed great news, and they are to be congratulated on their joint work which started in January. The logistics for delivering 2 million doses a week if 50 million people are to be vaccinated by the summer are extraordinary. I hope that this House will have a chance to debate the detail of that, with a repeat of the Statement Matt Hancock is making this afternoon in the Commons. Can we debate it preferably next Tuesday?

My Lords, I join with other Noble Lords in giving wholehearted welcome to the approval of the AstraZeneca vaccine which, for once, will be a game-changer in defeating this horrible virus. I thank and pay tribute to our scientists and the volunteers who came forward to be tested. It means, crucially, speeding up on vaccination. This is now a race against time. I ask the Minister how many of those over 80, and how many care home residents, have been vaccinated? As for the substantive issue before us today, as ever the Government are behind the curve in their control of the virus and our debates on them, as we will see later when the Statement that is likely to extend tier 4 is made in the Commons.

The major changes to Christmas provision were late but welcome. But they were devastating for many. The Prime Minister announced the changes on Saturday 19 December at 5 pm. Why was guidance not published at the same time to give people much-needed clarity? People who were due to attend funerals or get married the next day were unsurprisingly desperate to know and very anxious. Why were the Government not better prepared, given the rapidly rising infection rates and the identification of the new strain? It was known in September that we had a new strain; this was not news. The Government knew that the three-tier system was not enough and should have had contingency arrangements and communications ready to go.

We all saw the scenes of chaos following the announcement, with packed trains leaving London. Does the Minister accept that the appalling communication strategy contributed to this, and will have contributed to the spread of the virus? That is to say nothing of the issue of face masks raised by my noble friend Lord Faulkner. What assessment has the Government made of compliance over the Christmas period? What additional support is available in tier 4 areas? Is there access to testing and income support? There is a need to incentivise people on low incomes whose jobs are in jeopardy to stay at home. The events of 19 December were totally typical of the procrastination, the constant overpromising and underdelivering, the opaqueness of information, the refusal to release SAGE advice in a timely fashion, a Prime Minister who seems incapable of taking timely decisions and a pandemic out of control.

Yesterday, we learned that all the hospitals in Essex were 48 hours away from having to refuse any more patients, Covid or otherwise—so, if you broke your leg, you would be refused entry. This is because over 700 staff in south-west Essex alone were off isolating with symptoms, with no strategy to get temps in from tier 2 areas, no vaccines for the staff and no lateral flow tests, as promised in October. Today, the leaders of the councils in Essex have declared a major incident—so how quickly, and how, will the Government give Essex hospitals the urgent support they need?

We on these Benches support the regulations, but we must ask ourselves, as we have so many times before: can the Minister tell us if this is enough action necessary to contain this virus? As the noble Baroness, Lady Watkins, and others asked, what is going to happen in the next 24 hours? How will the Government seek to control people going out to celebrate the new year?

This virus is out of control. Yesterday, over 50,000 cases were reported, and there are now more patients in hospital in London than at any other time in the pandemic—and, last week, 3,000 people died. So far, tier 4 areas show no sign of slowing down, and the NERVTAG minutes of 18 December suggest that this strain could add 0.4% to the R number. This new variant means that it will be harder to bring infections under control, so harder measures are needed. Will the Government publish, in real time, the advice they are now receiving from SAGE? As other noble Lords have asked, do they really intend to move people from London hospitals, with the new variant virus, to other parts of the country? I would like a yes-or-no answer to that question.

This takes us to the Nightingales. Is it true that the ExCeL Nightingale in London has been mothballed and its equipment removed? Again, a yes-or-no answer would be appreciated. There have been white elephants, stunts and overpromising, and getting the army and others to work their socks off, thinking they were helping their country—absolutely typical of the handling of this pandemic, where national interests and people’s lives seem to have been secondary to political expediency, the threat of Tory backwoodsmen and a photocall for the Prime Minister and the Secretary of State. This is very serious indeed; for the sake of our country, we need to get this under control.

I finish by talking about our children and young people. The way this Government have treated our teachers and headteachers with such contempt is shocking. There are five questions that the Minister needs to answer. What does the science tell us about Covid in schools? What is the plan for next week that we do not know? Will all students have IT for home learning? What is the plan on support for mass testing? When will school staff be vaccinated? How much worse does this have to get before further action is taken?

My Lords, I am enormously grateful to noble Lords for an informed, thoughtful and passionate debate. These regulations are incredibly important, but they are clearly not enough to battle the growth of Covid in recent weeks, and the noble Lord, Lord Harris, was entirely right to spotlight the situation in London, which is particularly acute. In Havering, there is a prevalence of 1,500 per 100,000. I remember being surprised when somewhere hit 200, and we used to be happy with 400—1,500 is an astonishing number. I fear that that is what we are looking at, at the moment, and that is the seriousness of the situation we have to face up to.

Some noble Lords have suggested that we are not doing enough, and I will answer a few questions in that area. As noble Lords who have frequently attended these debates will know, we could not have been more committed to our testing regime. In the last reported week, from 10 to 16 December, 92.6% of contacts were reached, 93.9% of pillar 1 tests were within 24 hours and 91.1% of care home tests were within three days. Some 2,293,012 tests were done in that week. That is a colossal number, which reflects an enormous commitment.

The noble Lord, Lord Berkeley, is quite wrong when he describes the project in the Channel Tunnel as chaotic. It was a remarkable achievement, and I do not think that any other country could have pulled it off: 30,000 tests were brought together incredibly quickly on the roadside, with a multinational team of hauliers, under the most difficult circumstances. This helped to get trade moving, and I personally pay tribute to colleagues from the DfT, the military, local police, the test and trace programme and all those who made that possible. I also pay tribute to those who are pulling together tracing partnerships and the community testing regimes over the Christmas period; they have made enormous progress.

A number of noble Lords have quite rightly asked about volunteers and whether we could or should be using them more. I reassure noble Lords in the Chamber that we are absolutely working our hardest to make use of volunteers where we can. A number of noble Lords have asked about administrative problems, and I reassure noble Lords that NHS Resolution has put in place clinical negligence schemes for coronavirus under the terms of the Coronavirus Act, which we debated here at the beginning of the year, and Covid-19 has been added to the Vaccine Damage Payments Act.

NHS volunteer responders have delivered 1 million tasks to 123,455 unique clients; that is the work of 360,000 NHS responders. The St John Ambulance, which has had an absolutely massive impact, has delivered 200,000 hours of support and has very helpfully been involved in training 30,000 people for the administration of the vaccine. It is very much our intention to make use of that valuable resource. Of the 45,000 on the Bringing Back Staff team at the NHS, 2,700 have already been used, and many more will be deployed right now.

In relation to the vaccination, I reassure noble Lords that the authorisation today is a complete game-changer in relation to the scale and speed of the deployment. Not only is the vaccine massively easier to take to care homes, in particular, and GP surgeries, but the change in the dosage pattern means that we can not only deliver every single dose as it arrives in the warehouse but we do not necessarily have to book someone in for an immediate second dose. That gives our deployment programme an enormous amount of flexibility, and will lead to a great increase in our turnover: we will literally be delivering them as quickly as they can be manufactured.

Others are concerned that we are doing too much, and I will address that very quickly. In relation to projections, I have stood at this Dispatch Box and had the projections of the Government, SAGE and PHE derided by noble Lords as fearmongering. Who could possibly have believed that we would have 53,000 new infections? It is a little bit rich of noble Lords to question the work of scientists and our modelling teams in relation to their projections on today of all days. We accept advice from a very wide range of scientists; no voice is excluded. It is the role of government to synthesise advice into policy, and we do not need to smear or deride the scientists who supply that advice.

I have been through the statistics on public support on numerous occasions; I do not think I need to go through that again. There is massive public support for the measures that we have implemented. As for ignoring the Government, adherence rates are remarkably high, and I pay tribute to the public, which, although there are exceptions, by and large are incredibly committed to the regulations that are in place.

Lastly, as I have said before, it is not the Government’s policy to use two-week lockdowns as an emergency brake. These were used in Wales but not nationally, and that will not be our policy.

I agree with the sentiments of the noble Baroness, Lady Watkins—at heart, I also celebrate British liberties, but it is the virus that is not respecting liberty, not government, and we have no option but to bring in these kinds of measures to battle the virus, save lives and protect future generations.

A number of noble Lords mentioned schools, which are, without doubt, the most difficult subject at the moment. Of course it is right that we should do absolutely everything we can to keep schools open. Noble Lords who made that point enjoy my complete and utter support, but the epidemiology is very challenging. Schools have undoubtedly been the source of an enormous amount of transmission. Some of that is asymptomatic, but it is deadly nevertheless. The opening of schools has contributed to the high rate of transmission, particularly in London. It will be up to the Secretary of State for Education in the other place to make the announcement on schools, but the Government are entirely committed to trying to keep schools open for exactly the reasons cited in this Chamber, not least because it is those who come from the poorest backgrounds who undoubtedly suffer most from their closure. However, in order to make an effective regime to battle this virus we may need to make some tough decisions.

The noble Baroness, Lady Thornton, asked whether this is going to be enough. That is not for me to answer; my right honourable friend the Secretary of State for Health will be making a Statement in the other place shortly and he will address the question of any future restrictions or regulations. However, the noble Baroness is entirely right; the challenge we face this week is completely different to the one we had when we went into recess before Christmas. This new variant is of a different order; we may as well be battling a different disease. We will have to step up to that challenge in order to see ourselves through to the spring, when the vaccine will have been delivered to sufficient numbers to make a real difference. I regret that that may strike a chilling note at the end of this debate, but we have to face up to it.

Motion agreed.