Considered in Grand Committee
My Lords, over the past few months, the Government have made a concerted effort to bring forth a sense of normality across the country with the easing of restrictions, while maintaining caution with regard to this deadly virus, which clearly has a long way to run. These regulations are a key part of this dual-track effort, significantly reducing the burden of self-isolation while protecting society from the threat of contagion. The main focus of the regs is the isolation protocols, so I begin by reflecting on the crucial role that contact tracing and self-isolation play in fighting the virus.
Since it was established in May 2020, NHS Test and Trace has contacted more than 15 million people who have tested positive for Covid-19 or who have been in contact with a positive case. Tracing—the bedrock of any public health intervention—has improved substantially over the last several months. In October 2020, 60% of close contacts were being reached. In comparison, over the period from 26 August to 1 September, 87.3% of positive cases transferred to NHS Test and Trace were reached, as have 89.5% of their contacts where usable contact details were provided. That is a remarkable achievement.
The public realise the importance of isolation. July’s ONS statistics that show 79% of positive cases reported complying with the self-isolation guidance, alongside 89% of close contacts. That is a terrific response from the public and it has proven a vital weapon in our arsenal against the virus.
What is the impact of this massive financial and societal investment? A recent study from PHE, published today and called the Canna model after the idyllic Scottish western isle, which some noble Lords may have visited, shows that from August last year to this April, test, trace and self-isolation activity reduced the transmission of the virus by between 10% and 28%. The PHE research demonstrates that self-isolation helped to bring R below one at crucial times, reducing the duration and impact of lockdown. Over the full period of the study, the Canna model estimates that isolation due to test, trace and isolate policies prevented between 1.2 million and 2 million secondary cases. The NHS Test and Trace service has also enabled us to identify peaks and troughs in case rates, supporting decisions on when restrictions should be tightened or could be eased.
We recognise that none of this has been easy. The requirement to isolate creates enormous challenges for individuals and their families across the country. A study in March 2021 by the BMJ concluded that offering financial and practical support to individuals who needed to self-isolate would likely improve compliance. We support that view. Since September last year, we have provided councils with £280 million to issue support payments to those who may face financial hardships because of self-isolation. We have also made up to £100 million available between March and September this year for councils to offer practical and emotional support to some of the most vulnerable in our communities, covering over 200,000 people. It is right, though, that we sought to reduce the burden of self-isolation at the earliest opportunity.
The amendments to the self-isolation regulations we are debating balance these factors and provide a significant easing of burden from self-isolation requirements while maintaining vital measures to reduce the spread of the virus. These amendments came into effect on 16 August and allow those who are fully vaccinated to be exempt from self-isolation if they are the close contact of a positive case. Based on the data, we know that the vaccines reduce overall symptoms by between 80% and 90%, hospitalisations by between 90% and 95%, and deaths by around 95%. Therefore, we have adapted our approach to self-isolation to reflect this and ensure we balance the need to slow down the transmission of the disease with the need to get back to normal.
As well as fully vaccinated adults, several other groups have also been exempted from the requirement to self-isolate. The amendment provides an exemption to self-isolation for the close contacts who have taken or are taking part in an MHRA-approved trial for a Covid vaccine. This will ensure that they are not disadvantaged as a result of their personal sacrifice. We recognise also that some groups cannot be fully vaccinated on medical grounds. The amendment therefore includes an exemption for those close contacts who can evidence that they are unable to be vaccinated for medical reasons.
Finally, we have carefully considered the impact on those under the age of 18. There are unqualified harms to children’s educational, emotional and social outcomes as a consequence of self-isolation, as well as of the infection itself. The risk of hospitalisation and intensive care admission in children due to Covid is very low—approximately eight per 100,000 population aged under 18 are admitted to hospital. The incidence of mortality in children as a result of Covid is also extremely low. By balancing these factors, the SI provides an exemption for those close contacts under the age of 18 from self-isolation.
Those who are exempt will be advised to take a PCR test as soon as possible to check whether they have the virus. Though not required to self-isolate, they will be advised to consider other precautions, such as wearing a face covering in enclosed spaces, as well as limiting contact with others, particularly those who are clinically extremely vulnerable. However, it remains the case that if any of these groups develop symptoms they should self-isolate immediately and take a PCR test. Anyone, whether fully vaccinated or not, who goes on to test positive will remain under a legal duty to self-isolate.
Although I sympathise with the burden and the challenges that self-isolation creates, it will continue to play an indispensable role in containing the virus. The Secretary of State said more on this in his Statement earlier on the winter strategy for tackling the virus. While restrictions are easing, we must all continue to adhere to the self-isolation regulations and the guidance if we are to continue protecting our friends, families and communities. I commend these regulations to the Committee.
My Lords, I very much agree with what the Minister said about the importance of self-isolation. I note that emphasis is given in the winter plan to the importance of isolation in relation to breaking transmissions. The issue I have is that there is a proportion of the population who find self-isolation very difficult, and there are legitimate reasons for that. I have been studying TUC research, which shows that 24% of low-paid workers say they cannot afford to take time off for sickness, as opposed to 6% of high-paid workers. It reckons that only 35% of low-paid workers get full sick pay, as opposed to 80% of high-paid workers, defined as those earning more than £50,000 per annum. Statutory sick pay is only £96.35, less than any other OECD country. It is reckoned that 72% of low-paid workers cannot work from home, compared with 20% of high-paid workers.
The Minister may respond by saying, “Ah, but we have a self-isolation payment scheme”, and we do, but my understanding is that 34% of applications to councils are being rejected because councils are worried about running out of funds. In areas with a high proportion of low-paid workers who cannot work from home, the approval rate is even lower. Do the Government recognise that we have a serious problem here? If we have to tighten self-isolation rules again—indeed, even under the current, voluntary system—will this be addressed?
I relate this to work by SAGE in interpreting differential health outcomes among minority-ethnic groups in the first and second waves. As it pointed out,
“all minority ethnic groups … have been at higher risk of mortality”
during the pandemic, but there is
“a particular intensity in this pattern of differential mortality among Bangladeshi and Pakistani groups”.
“suffer severe, debilitating underlying conditions at a younger age and more often than other minority ethnic groups due to health inequalities. They are more likely to have two or more health conditions that interact to produce greater risk of death from Covid”.
A number of factors provide some explanation, including:
“Practical difficulties of access … to … NHS Track and Trace services due to … site locations, difficulties taking time off … for testing”,
and real fear of
“loss of livelihood if required to self-isolate”,
as I have mentioned.
As SAGE said at the time:
“Furlough, self-employment and business support schemes have helped thriving businesses and better-off self-employed people the most, rather than those in the most hard pressed situations”.
“Unaffordability of taking unpaid time off, or concerns about the effect of absences on job security”
will need to be tackled. How is this to be tackled?
I will comment on the removal of the requirement on children to self-isolate when they have had close contact with a person who has tested positive. The Government argue:
“At present those under 18 are unable to be vaccinated”—
that has obviously changed since the regulations were published—
“but have experienced a significant impact on their social and educational development as well as their physical and mental health through having to self-isolate. Removing the requirement to self-isolate will significantly improve a range of outcomes for this cohort.”
I do not disagree with that at all, but have our schools, in particular, been made as safe as possible? Recently, Independent SAGE pointed out that many of the recommendations it made about schools more than a year ago are still “highly relevant” today,
“including advice on bubbles, distancing, ventilation, testing and support for staff and students, particularly students from deprived communities.”
As it says, not enough progress has been made.
I am glad to see that on page 18 of the winter plan there is a section on ventilation where the Government lay out five ways in which they are going to
“support improved ventilation in key settings”.
They refer to the public sector estate and evidence an initiative in 30 Bradford schools. Will they go further? At the moment, my understanding is that many schools are very concerned about the lack of ventilation equipment. They will not always be able to afford the cost of sorting this out, which sometimes can be very high. It goes with the territory: having removed the requirement on children to self-isolate, which I fully understand, surely we need to do more in relation to school ventilation. I know we will come to debate the winter plan later in the week, but one of my questions is whether there will be some resource available to help schools improve ventilation.
I thank the Minister for introducing the regulations as he did, but it does not alter the fact that the current rules around self-isolation and PCR and lateral flow testing are confusing. People who are not stupid and who genuinely want to know what to do and what they should be doing for the best find them difficult. I heard about someone who had contact with a positive case last week trying to work out from GOV.UK if it was okay that they had had a negative PCR test and had no symptoms—what were they then supposed to do? It is imperative that we continue to have very clear and sustained messaging around testing and isolating.
Ministers have made great play of the fact that the front line of defence is double vaccination. Okay, but that is only as strong as it is if you continue to have the second-line defences of testing and isolating in behind it; if you do not, that places a much greater strain on the vaccination process. We know that from other countries. I know that the Minister said that there were other mitigations, and he talked about investment in therapeutic treatments, but they are not yet with us. Therefore, we need to concentrate yet again, albeit with fewer restrictions than there were before, on who is being tested and who is having to isolate.
I go back to one point on which I have asked the Minister questions for more than 12 months. What about people who are not registered with GPs? There are still such people in the country, perhaps people whose first language is not English and who—surprisingly, perhaps—do not know about what to do about going to get vaccinated. I have come across a couple of examples recently. I do not think that there are vast numbers of such people, but there is a significant cohort in some communities who are hesitant not because they have any great ideological disposition against vaccination—they just simply do not know what to do, or they may have language problems, which means that they are concerned about going to vaccination centres.
I want to talk again about schools, because we have the data that has come through from Scotland. I point out to noble Lords that mask-wearing in schools in Scotland is still in place. From talking to epidemiologists, as we did earlier this year, about the whole process of the country coming out of tight restrictions, one thing that they said to my noble friend Lady Brinton and our team is that with enclosed spaces it is not just ventilation that you have to look at—you have to look at air purification as well. The big health risk is when you have stagnant air into which people who are positive are exhaling droplets of the virus. What has been done to enable schools to look at things like carbon dioxide monitors, as a proxy for measuring stagnant air? Again, I do not think that many schools have had the resources to enable them to deal with that.
I want to make one point that my noble friend Lady Brinton would have made had she been here. We are still talking about 1,000 deaths a week and 50,000 deaths per annum. By the Prime Minister’s reckoning, that is an acceptable but very high number of deaths. The reason why these regulations are not helping is that they seem to be part of a high-level message that says, “It’s over.” A lot of people think it is over, but it is not; it will not be for a considerable time and it will continue to be very dangerous if we chip away at the side mitigations that go beyond the vaccine.
Finally, we have always said that local authorities have a key role to play in identifying those people who are in the communities that are most vulnerable, and they are the communities that need the most help to self-isolate. When will the Government produce a comprehensive report on the funding of local authorities for local self-isolation schemes and their effectiveness?
My Lords, my noble friend Lord Hunt made the most pertinent point, which is that, as we have acknowledged, Covid has pointed to the gross inequalities in our society. That can be seen absolutely when we look at the self-isolation regulatory regime and the impossibility of those on low incomes self-isolating because they then have to choose between feeding or not feeding their children; they cannot afford to self-isolate. We still have not solved that problem sufficiently well.
As we move into the winter, as the noble Baroness, Lady Barker, said, this pandemic is not over. If you have 150 to 200 people a day dying, it is not over. If you have half the ICU beds in our hospitals still occupied by people with Covid, it is still not over and we will never catch up with all the NHS waiting lists that have fallen so abysmally behind in the past 18 months. So it is not over.
Self-isolation is part of the toolbox, to use the Prime Minister’s and Secretary of State’s word, that will help to control the spread of this virus. What the old regulations did—do—is amend the self-isolation regulations. With effect from 19 July, they allow a person to leave self-isolation and put an antibody test in the post, and from 16 August certain people were no longer required to self-isolate if they had come into contact with a person who had tested positive for Covid. The Minister listed who those different groups are, including children under 18. I completely agree with my noble friend about the need to include children under 18, but we have to address the issue of what that means for schools.
The Minister said before the summer, when we were hearing Statements about the easing of these regulations, that people were going to have to behave “in a responsible fashion”. I had a particular issue with that last week, when a friend I was supposed to be meeting called me to say that her husband had caught Covid. Both were double vaccinated, he was not very ill—I am pleased to say. They had been at a wedding, and there was a family there who were anti-vaxxers; they did not know and he caught it. She tested negative for the next four or five days.
I was personally quite torn about what to do: should we meet or not? The idea shocked me that somebody who is living with somebody who has Covid did not have to self-isolate. I worked my way through it; I read the regulations, which I must say are complex and not completely clear. She did not say, “I am allowed to go out”; she was being very responsible, but I thought that millions of people must be facing those issues all the time. Just saying that people have to behave “in a responsible fashion” may not be quite the point.
Before I talk about schools, I would like to ask whether there has been monitoring by the JCVI and others on the effect of the decision that was taken in July and became effective in August. Are we fully confident that the spread of the delta variant is sufficiently understood to justify lifting that restriction? If anybody gets Covid these days, it will be the delta variant. Are we sufficiently confident in the science to lift that restriction?
This statutory instrument relaxes the bubble rules that would require entire groups of students to self-isolate following positive cases and leaves the decisions to schools themselves. The Minister will be aware that a handful of schools in England have had to close classrooms just days into the new year, following Covid outbreaks among students and staff. This puts schools in a difficult position. First, school leaders need quick, clear and unequivocal guidance about how to respond if they see a rise in case numbers and not to be left on their own to make those decisions. The lack of investment to enable our schools to have clean air in their classrooms is unfortunate.
All our local secondary schools opened last week and one had anti-vax parents demonstrating outside it. I do not know whether this is happening elsewhere. They were demonstrating about 12 to 15 year-olds being vaccinated, and that is very worrying. I will leave that with the Minister. It is shocking, but what on earth can we do about it?
My Lords, I am enormously grateful for this rich debate. The reflections of noble Lords are shared by the Government in many ways. I will start with the poignant remarks made by the noble Lord, Lord Hunt, on support. We agree that financial support is an important part of the isolation process. It would be inhumane to suggest that someone can somehow live off the generosity of others to support themselves over this difficult period. We have actively promoted the financial support available to people who need to self-isolate, are working with local organisations to extend our reach and continue to improve those arrangements.
Please do not forget that we have already invested £280 million in the test and trace support payment scheme, which has been specifically designed to encourage more people to get tested and to ensure they self-isolate if they are positive. From March this year, we increased the funding available to local authorities to make discretionary payments under the scheme to £20 million a month. This enables a wider range of people to be supported and addresses some of the points made, not unreasonably, by the noble Lord, Lord Hunt, about the availability of funding and how it might touch local authorities’ provision of those payments.
In May, the Government launched nine trail-blazing pilots in England to try different, creative ways to ensure that people stick to self-isolation rules in areas with a higher prevalence. Some individuals have had concerns about their practical ability to self-isolate, either because they did not think they would get support with food delivery or dog walking, or perhaps because of the impact on their mental well-being. Interventions, such as one-to-one buddy support and the provision of practical assistance, aim to support self-isolation.
The programme has provided funding for areas such as Greater Manchester to pilot ways to reach, support and engage with households within 24 hours of a positive test to develop a personalised plan for their self-isolation. In Peterborough, those living in houses of multiple occupancy or in larger multigenerational environments, who are unable to effectively self-isolate and are more likely to increase transmission through household contact, if they have nowhere to go, have had specific projects of support. Our Local-O initiative means that we are improving local tracing techniques to reach those who need to self-isolate quicker. The support payment itself is around £500 a month.
These are the kinds of measures that we have put in place to improve the reach and effect of our support. Of the £280 million we have spent so far, £114 million has covered the cost of the main test and trace support programme, £116 million has been in discretionary payments and £50 million has been in administrative costs. This, in addition to the medicine delivery service launched on 16 March 2021, which has delivered £17.8 million-worth of medicines, has made a huge impact and supported those in isolation, but we continue to review this area.
Many noble Lords made extremely pertinent points on schools. I completely agree that schools and potential infection from them are critical. That is why we brought in twice-weekly asymptomatic testing in secondary schools and colleges, which will continue during September. That programme includes two tests specifically at an asymptomatic testing site three to four days apart for students at schools and colleges on their return. Most of them have just happened and there is a review point at the end of September when we will assess the levels of infection in schools. We are encouraging schools to continue with twice-weekly asymptomatic testing. We very much hope that staff and pupils in secondary schools and further education providers, and staff in primary schools and early years settings, will continue to do testing and we will assess compliance at the end of September.
I hear loud and clear the concerns about ventilation. We have in fact brought in plans in the winter plan on this matter. Changing the ventilation arrangements of our estate of 25,000 schools is itself a mega generational project of hundreds of billions of pounds, so this is not one that we can turn around overnight. The vaccine will certainly have a lot more impact in its immediate efficacy, but we are investing £25 million in around 300,000 CO2 monitors for schools. That in itself is a terrific initiative and I hope will not only make an impact on the schools involved but give us the learnings to understand how ventilation can be used to stop the spread of the virus.
We will also have trials of high-efficiency particulate-absorbing filter and ultra-violet C air cleaners in 30 Bradford schools, as well as working with stakeholders such as the Rail Delivery Group and the Rail Safety and Standards Board to trial the use of upgraded air filtration devices on passenger rolling stock. I will not pretend to understand the full technicalities of those arrangements, but I am extremely impressed by how quickly officials have moved to address these concerns.
As I said, we are committed to testing in schools and will review it in September. Social distancing remains in place wherever it can, but I am relieved to say that the bubbling arrangements, which were so disruptive in the first half of this year, are now largely in the past.
I know that the noble Baroness, Lady Barker, is extremely concerned about those not registered with GPs. I assure her that I have a regular meeting with the vaccination team to address this specific point. The outreach we do is to marginal groups of all kinds, ranging from Traveller groups who might not be registered with GPs and have a suspicion of the vaccination programme, through to those who may have religious, language or other distinctive qualities that mean they would not normally be captured in a vaccination programme. We have done an enormous amount to reach out to these groups. Vaccination can now happen without being registered. We have turn-up sites and a vaccination can happen at any of our main vaccination centres without full registration. If the noble Baroness would like to know more details of this part of our vaccination programme, I would be very glad to arrange a briefing. I know that it is very much on her mind.
I do not accept the premise that the Government are running an “it’s all over” programme in their communications. The winter programme that we have announced today is extremely proportionate. It relies on the responsibility of individuals. We cannot legislate for every sneeze and splutter in the country for years to come. We have to rely on people. I think the story that the noble Baroness, Lady Thornton, told of her friend and the wedding and the very detailed judgments that we all as individuals have to make is exactly what we all have to live with. The Government do not seek to intervene in those judgments—they are for the noble Baroness and her friend to work out for themselves. That is a proportionate climate for us to proceed in. Of course, should the worst happen, and should we need to, we have a back-up plan—described in the winter plan that we have announced today—where we bring back the awful measures that tied this country down so heavily earlier this year. We are seeking to avoid that.
Lastly, on the local authority funding settlement, there is more work to be done with local authorities—the noble Baroness, Lady Barker, is right. The funding settlement is not finalised yet. Local authorities will continue to play a critical role in public health protection, emergency response and infectious disease control. They will have support through the contain framework, which continues, and through the enhanced support that we offer through test and trace. I think noble Lords are aware of the surge testing, vaccination logistics support and national funding that we have in place in areas where there are major outbreaks. There is also the education contingency framework, which provides schools with additional support. We are totally engaged with local authorities in discussing the practical and financial support that we can offer them.
I think the place we are in has a huge sense of relief, because the vaccination programme is largely working, but also enormous uncertainty. If the CMO were here today and we were to press him to tell us how exactly things are going to play out, he would say that he could not be sure and that he has never faced a moment of such uncertainty in his life. I am sure he speaks with his normal integrity and discretion on that. As a result, we have put in place a proportionate plan for the near future but are ready to bring in other measures if necessary. I think that is the right approach. I beg to move.