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Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) (No. 2) Regulations 2021

Volume 817: debated on Tuesday 14 December 2021

Motion to Approve

Moved by

That the draft Regulations laid before the House on 9 November be approved.

Relevant document: 21st Report by the Secondary Legislation Scrutiny Committee (special attention drawn to the instrument).

My Lords, I will make a Statement on measures to make sure that our health and care system is as safe as possible in the battle against Covid-19 by making vaccination a condition of deployment for more health and social care settings.

Across the UK, the overwhelming majority of British people have played their part by getting vaccinated against Covid-19. Over 81% of people over the age of 12 have had two doses, a figure that rises to around 91% when you look at NHS staff. The impact of this outstanding vaccination effort is clear. The UK Health Security Agency estimates that at least 127,000 deaths and 24 million infections have been prevented as a result of the Covid-19 vaccination programme. In addition, around 260,000 hospitalisations have been prevented in those aged 45 years and over.

But we still need to do more. Uptake rates vary between different health and care organisations and across the country, and, despite the incredible effort to boost uptake across the country, over 94,000 NHS staff are still unvaccinated. It is important that our health and care staff get jabbed to protect the vulnerable who are in their care and to protect the NHS workforce in the wake of new variants, such as omicron. We made vaccination against Covid-19 a condition of deployment in care homes from 11 November this year. Contrary to initial fears, we are not aware of any care home closures where vaccination as a condition of deployment has been the primary cause.

Today, we are putting before your Lordships the regulations to extend this requirement to health and other social care settings, including NHS hospitals and GP and dental practices, regardless of whether a provider is publicly or privately funded. Anyone working in health or social care activities regulated by the Care Quality Commission will need to be vaccinated against Covid-19 if they are deployed to roles that have direct contact with patients or service users, apart from a few limited exemptions—for example, for medical reasons.

I hear the concerns that have been expressed or raised about the impact of these measures on the workforce, especially during these winter months. For this reason, we are allowing a 12-week grace period to give people the chance to make the positive choice to get protected. We are committing to enforcement of the requirements by 1 April next year, subject to the will of Parliament.

We are also increasing the number and diversity of opportunities to receive the Covid-19 vaccine, using the booster campaign to make the most of walk-ins, pop-ups and other ways to make sure that people are getting the vaccine as easily as possible. The NHS has already written to all providers providing early guidance, setting out what vaccination as a condition of deployment means for the system, as well as advising on next steps to boost uptake and help to ensure smooth implementation. After consulting on the policy in September, we have seen a net increase of over 55,000 NHS staff vaccinated with a first dose.

These steps complement key interventions that we have made to support services, including bolstering capacity across urgent and emergency care and the wider NHS, including with a £250 million investment in general practice, £55 million for the ambulance service and £75 million for NHS 111, and publishing an adult social care winter plan, including £388 million to support infection prevention control and £162.5 million for workforce recruitment and retention. In addition, we have invested £478 million for support services, rehabilitation and reablement care following discharge from hospital, and we are ensuring that health and social care services are joined up.

Although the Government believe that these measures are a proportionate way of protecting those at greatest risk, we recognise that some noble Lords have asked whether we should or would extend these measures even further. So let me state clearly that although we have seen plans for universal mandatory vaccinations in some countries in Europe, we do not support them here. The Government have no intention of extending condition of deployment to other workforces or introducing mandatory vaccination more widely.

At this point, I would like to address head on some of the concerns your Lordships may have regarding concerns raised by the Regulatory Policy Committee and the Secondary Legislation Scrutiny Committee about these regulations. I sympathise with noble Lords who are concerned with some of the procedural aspects of the passage of this legislation, but in unprecedented times such as these it is right that the Government do everything in their power to protect the vulnerable.

The Government have responded to the concerns raised by the Regulatory Policy Committee and the Secondary Legislation Scrutiny Committee as quickly as possible and have provided further information to your Lordships, including on the actions on workforce capacity—as I have set out—and the steps we are taking in collaboration with the NHS and adult social care sector to mitigate the risks to small business, which is of particular concern to the Regulatory Policy Committee. An updated Explanatory Memorandum has been provided to Parliament, and the department’s consideration of the RPC’s concerns has been published on the government website.

The updated Explanatory Memorandum provides further information on the scientific and clinical rationale for the policy, the exemptions that have been provided and those not provided, and the steps we have taken to further encourage uptake of vaccinations and to mitigate workforce issues. The Secretary of State also wrote to all Peers on 10 December to set this out.

In these difficult times, we have seen the very best of those who work in health and care. We have seen care, compassion and conscience. Noble Lords across the House continue to pay tribute to the heroic responses across the health and care sectors. Today’s Motion is about protecting not only health and care staff but the patients in their care. By protecting patients and staff, we protect the NHS from being overwhelmed. I commend this Statement to the House.

My Lords, I just want to make a quick adjustment: we are of course debating the Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) (No. 2) Regulations 2021.

Amendment to the Motion

Moved by

Leave out from “that” to the end and insert “this House declines to approve the draft Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) (No. 2) Regulations 2021 because Her Majesty’s Government have not published a full impact assessment”.

My Lords, I thank my noble friend the Minister for introducing this order with his customary clarity. I tabled my amendment because when I read the excellent report of your Lordships’ Secondary Legislation Committee, I saw red. This was yet another set of regulations from the Department of Health and Social Care that came without an impact assessment. My amendment asks the House to decline to approve the regulations as a full impact assessment has not been published. I was informed by the Printed Paper Office yesterday afternoon that the impact assessment was in fact laid on Friday, which I had discovered online over the weekend. So, to an extent my amendment has been overtaken by events and I do not expect to press it to a Division. The Department of Health and Social Care is, however, still seriously in breach of its obligations in relation to impact assessments with this late document, and I shall move my amendment so that the issues can be debated.

The department published a so-called impact statement alongside these regulations, but noble Lords should be in no doubt that there is a big difference between an impact assessment and an impact statement. The impact statement amounted to nine pages and was in a rather large font size. The impact assessment amounts to 69 pages in a normal font size. The arrival of this impact statement so late is all the more shocking because it has been rated red and not fit for purpose by the Regulatory Policy Committee, which carries out the independent reviews of impact statements required by the Small Business, Enterprise and Employment Act 2015. It is a very unusual for the RPC to rate statements not fit for purpose, so this is a serious issue.

While my instincts are against the compulsion these regulations introduce, I was prepared to be persuaded if a good case had been made. In the absence of the analysis and evaluation accompanying the regulations, the case was not made. The very late impact assessment, together with the RPC’s views, raise many questions that cannot simply be answered by a couple of sentences from my noble friend the Minister at the Dispatch Box or, indeed, by revised papers put on websites late in the day. It suits the Government to operate in this way. They have become accustomed to making sweeping changes to our lives without meaningful challenge from Parliament.

The 21st report of the Secondary Legislation Committee is excoriating in its criticism of the regulations and the quality of the supporting material accompanying them. The noble Baroness, Lady Thornton, had tabled a regret Motion that captured many of these criticisms, and I am sorry she has pulled it, doubtless for political reasons. I agreed with it and would have supported it had she chosen to divide the House. My amendment focuses on impact assessments because this strikes at the heart of effective policy-making and, importantly, effective parliamentary oversight. On effective policy-making, it is a clear requirement on the Government that the development of policy should be subject to rigorous analysis and evaluation of options, set out in a Green Book. There is little evidence that this has taken place.

Secondly, the Government’s better regulation framework builds on that foundation and requires impact assessments to be prepared at the consultation phase for policy development, as well as at the final policy implementation stage—the stage we are now at. Regulatory impact statements at the final stage have to be independently appraised by the Regulatory Policy Committee, but it is voluntary at the earlier consultation stage. It came as no surprise to find that when the DHSC issued its consultation on this policy in September, it did not include an impact assessment, let alone have it independently assessed.

All this raises serious questions about the quality of analysis underpinning the Government’s policy formulation, which has been a concern throughout the pandemic. Some on these Benches have regularly challenged the lack of impact assessments for the policies pursued under the Covid banner. Regulatory impact assessments are required in order to evaluate burdens on business, primarily, but the bigger issue is whether the Government have considered the broader costs and benefits of their Covid policies. We have been particularly concerned about the lack of analysis of the non-Covid health harms as well as the non-health harms—in particular, to education and to the economy. Certainly, there has been little government analysis of this in the public domain.

The Government’s line has always been that they are not required to produce regulatory impact assessments for policies expected to last less than one year—an excuse not available for these regulations. That is technically correct, but it entirely misses the point, which is that good policy formulation requires a comprehensive analysis of costs and benefits, however long the policy is expected to last, and that is what the Green Book requires.

Let me now turn to the dimension of effective parliamentary oversight. Parliament cannot be expected to scrutinise legislation, whether primary or secondary, without access to full impact assessments. That means impact assessments issued on a timely basis with the related documents, not rushed out days or hours before parliamentary debate. Parliament deserves not only the assessments required by the 2015 Act but the broad analysis that should underpin good policy-making; and in the case of Department of Health and Social Care orders, that must include impacts beyond the health and social care sector.

For example, this impact assessment’s central estimate of the likely loss of staff to the health and social care sectors is 126,000. That is twice the number expected to be vaccinated as a result of the policy. So, it does the calculation but makes no real attempt to explore whether it is feasible to recruit sufficient new staff and what would actually happen if suitable staff were not available. This is more than a mere calculation of costs, because it could impact on service availability, as has been the experience in the care home sector. The Minister referred to no care home closing, but care home capacity has been cut back in many areas where it has not been possible to recruit suitable staff. All these impacts can be significant.

My amendment is, at its core, a plea for the Department of Health and Social Care to stop taking Parliament for fools. The department must respect the role of Parliament by facilitating rather than evading effective parliamentary scrutiny. That means full impact assessments for all significant policy interventions, whether of long or short duration; and, of course, it means they must be timely. At the very least, I hope the Government and, in particular, the Department of Health and Social Care will reflect on their duty to ensure that Parliament can do its job of oversight of the Executive. I beg to move.

My Lords, I did not intend to contribute, but I just want to thank the noble Baroness, Lady Noakes, for that speech. I shall get Hansard tomorrow, make my little checklist and wait for what is coming from the other place—the borders Bill; the human rights Bill; the electoral reform Bill—and I will check off her claims about parliamentary scrutiny and believing in the House to see how sincere that speech really was.

My Lords, I would not doubt for half a second that my noble friend was entirely sincere. I also believe that she made some extremely powerful points which apply right across the legislative pattern, and which apply equally to both Houses. I hate to say this of a Conservative Government, but they behave as if they treat Parliament with contempt. Whether one is talking about Christmas tree Bills, Henry VIII clauses or the lack of impact assessments—a point made so very powerfully by my noble friend—the Government are found wanting. If we were marking in Greek letters the performance of the Government, I would, as an old schoolmaster, give them “gamma double-minus.”

It really is sad that we have a Government who are treating Parliament in this manner. I sincerely hope that, when he comes to reply, my noble friend the Minister will give a firm undertaking to draw the attention of his parliamentary masters in government to this debate and to the speech of the noble Baroness, Lady Noakes, in particular. They should read, mark, learn and inwardly digest it—to quote the collect for the second Sunday in Advent.

When it comes to the substance, I always deplore anything that smacks of retrospective legislation, because that again is treating Parliament with studied contempt. I know how difficult it has been during these last 18 months or more. We all know that—and we all know that mistakes have been made, sometimes with the very best of intentions. But it is deeply disturbing that there has not been a recognition that retrospective legislation is the very antithesis of democratic parliamentary government.

I have suggested many times, including very recently, that there should be a continuing committee of both Houses looking at Covid legislation and being able to pronounce on it quickly. I made this point only recently to my noble friend. He completely, I am afraid, misunderstood it and told me quite inaccurately that this was a matter for the Lord Speaker—but anybody who knows what the Lord Speaker is able to do and not able to do knows that that is fundamentally wrong.

I know that he is new to Parliament and is serving his apprenticeship with great distinction—we all appreciate that—but it is important that the powers that be realise that in an unprecedented situation unprecedented measures are sometimes needed. They have shown that by issuing diktats; they have not shown it by creating a vehicle for continuous parliamentary monitoring—and they should.

On the subject of compulsory vaccination, my noble friend Lord Bethell knows very well that I have been on about this almost from the very beginning, urging that care home workers should receive compulsory vaccination, and I believe that it is entirely logical to extend that to those who work, because people who come into close proximity to patients at their most fragile and their most vulnerable should not themselves be a potential risk to those patients. We know that in some care homes during the early months—I appreciate that it is much better now—you could find that 30%, 40% or even 50% of care home workers, looking after the most fragile and physically feeble of people, themselves not vaccinated.

How do you solve this? It is, of course, a combination of persuasion and cajoling, but at the end there has to be a point where you say that we cannot allow this to continue indefinitely. Therefore, I think on that point the Government are right and I am grateful for it.

However, we are a Parliament and therefore I come back, as I began, to the admirable speech from my noble friend Lady Noakes. She pointed out—as many others have over the past two or three years, particularly the noble and learned Lord, Lord Judge, who I think must go to bed with an image of Henry VIII by his bedside—how cavalier has been the treatment of both Houses of Parliament by the Government. We are approaching a new year. Let it be a resolution of the Prime Minister and all his Ministers that they are accountable to Parliament; they are not the masters of Parliament.

My Lords, I wish to make some comments about the actual substance of this statutory instrument, although I will start by saying that I have a lot of sympathy with what has already been said about the lack of proper parliamentary scrutiny and indeed the lack of an impact assessment, which is extremely regrettable.

As I have said in your Lordships’ House before, I am very sympathetic to the overall principle that both front-line health and care workers should be vaccinated. However, as I have always said, it must be handled in the right way, particularly given the absolutely acute pressures that both health and social care are under and will be over the winter months. It is absolutely critical that the right amount of help and support is made available to health and care workers who are genuinely vaccine hesitant—and that means things such as one-to-one conversations during work time in which they can express what their concerns are and, I hope, get additional information.

I know very well from personal experience that care homes that, for example, have brought GPs in to have one-to-one conversations, taken the concerns that care workers have expressed seriously and tried to explain why it would be a good idea to have the vaccine, have had an awful lot of success, and I am concerned that there is not enough focus at the moment on that help and support. It was very regrettable—this point was raised by the Secondary Legislation Scrutiny Committee —that the draft Explanatory Memorandum made no reference to any lessons learned from the rollout of the earlier care home regulations, as well as being silent on what contingency plans the department had to cope with the expected staff losses when the regulations take effect. I know that those staffing issues will be particularly acute in London, where I live.

I recently had a helpful meeting with Healthwatch, which shared with me some very good research. It commissioned an organisation called Traverse to undertake in-depth conversations with a range of people, mainly of African, Bangladeshi, Caribbean and Pakistani ethnicity, to understand the reasons for their vaccine hesitancy and what can be done about it. Although the research was carried out with the groups I have specified, I suspect that the conclusions drawn in the report have more widespread application.

I found it interesting that the attitudes expressed were incredibly personal to the individual. One of the lessons learned is that you cannot lump all this together and say, “This is the issue for this group”; you have to think very carefully about individual concerns. There was most clearly, as we know, a lack of trust, which featured strongly in terms of the vaccine, and there was very strong distrust of those who had any possibility of standing to gain commercially from the rollout, which I thought was an important point. Probably most notable of all, people said that they trusted most of all front-line healthcare workers to talk about Covid and the vaccine and had less trust in very senior people in the NHS or Public Health England, who were perceived to have less tangible experience. That interesting document ends with very seven practical tips: ways to try to encourage health and social care workers to become less vaccine hesitant.

I end by asking the Minister whether he is aware of this document—if he is not, I am very happy to send it to him—but, more generally, what steps the Government and NHS England have taken to promulgate this sort of important and practical good practice and advice?

My Lords, I echo the words of my noble friend the Minister in introducing the regulations before us in praising the heroic efforts of the whole health service: the volunteers, nurses, doctors and pharmacists—everyone involved. The vaccination programme is essential, but I hope that GPs and practitioners will have the vaccines in time to roll them out. My noble friend is aware of my work with the Dispensing Doctors’ Association.

I want to focus on two particular aspects: the implications for the workforce of the regulations before us and the helpful questions and comments posed by the 21st report of the Secondary Legislation Scrutiny Committee in that regard. What has the impact been on the care home workforce of the compulsory vaccinations that the regulations require? I presume that the reports were accurate that a number of those who did not wish to have vaccinations left care homes to go and work in the NHS, which is now the subject of these regulations. Is that the case, and how many were involved in that regard?

I share the concern that has been expressed by the Secondary Legislation Scrutiny Committee in its report that non-care-home staff who are not in face-to-face contact with patients are exempt from the compulsory vaccinations, despite the fact that SAGE—which of course advises the Government closely on these issues—suggests that co-workers may be an important factor in transmission. I yield to no one in my admiration for my noble friend Lord Cormack in the work that he has done to ensure that care home staff are vaccinated, but it is a case of whether we should look at the wider helpers of those working in care homes.

Lastly, I have a question that follows on from a question at Oral Questions today on the retention, as well as the recruitment, of the workforce. I do not know whether I am reading paragraph 1.37 on page 63 of the impact assessment correctly, but it says:

“Given uncertainty in how provides”—

I presume that is meant to read “providers”—

“will respond to workforce shortages we have made simplifying assumption that replacement staff are available immediately from wider labour market and used band 5 wages as a proxy for all staff affected by this”.

What is the current recruitment and retention in care homes in particular, as so many in your Lordships’ House have raised concerns in that regard?

My Lords, I think many of us are grateful for the comments from the noble Baroness, Lady Noakes, about process and impact assessments, and I echo those.

I shall make one or two comments about the substantive issues. Incidentally, we have been thanking the Government and medics for the rollout, but I want to pay tribute to the people who are going to be sitting up half the night: the managers of GP practices—they are the ones who get people there to get the vaccine. Very often they are forgotten, so I want to make that point.

I want to make some points about the very real problems that there are with this way forward. I am very sympathetic and, on balance, I think this is the way forward, but for many decades we have taken very seriously those who have very real concerns about receiving a vaccination. Those are not concerns that I share personally, but there are those, for example, who are concerned about the use of aborted foetal cells or testing on animals. We—both myself and more widely in the Church of England—have always maintained the position that freedom of belief or religion should not be compromised by the introduction of any form of coercion or forced decree. This is difficult, because it is not just about someone’s right but about the effect that they have on someone else. Recently, I heard from someone who was jabbing—giving vaccinations—that someone came in without a mask on. They challenged him and he said, “I don’t get on very well with masks”, to which one of the nurses said, “Well, I hope you get on well with a ventilator.” That is the implication; we know what the medical science is.

The problem is that there is the danger of a subtle form of racial discrimination via the backdoor. Ethnic minorities comprise a much higher percentage of healthcare staff compared with the overall population. We know that they are more likely to be religious than the white British majority, and vaccine hesitancy is much higher among these communities. There is a whole range of complex issues to do with social trust and people’s position in society that I do not want to steamroller over without raising and putting on the record as we move forward with this programme. A worrying confluence of factors could leave those historically discriminated against being forced to choose between violating deeply held principles and unemployment. No one, whether white or from an ethnic-minority background, should be forced into that corner.

This raises the really important issue of how we are addressing vaccination hesitancy. I have been talking to the noble Lord, Lord Sharpe, about how can we help with that more widely across the globe. This is a reminder to those of us who are in touch with—particularly if you are in my line of business—black churches and so on that we need to up our game in addressing the reasons for vaccination hesitancy. We need to do it urgently, because the more that we can win the argument, the more we will save ourselves a lot of unintended consequences of discrimination that may result from these regulations.

My Lords, I declare an interest as a member of the Secondary Legislation Scrutiny Committee. Your Lordships will no doubt be delighted to know that, in January, I shall be leaving it—not by choice but because I have been cycled off.

At the heart of this dispute with the Department of Health and Social Care is the requirement, not option, that any department submitting secondary legislation—principally to this House, since it is almost never discussed at the other end of the Corridor in the House of Commons —should include an impact assessment. This is not an optional extra. It is not a take it or leave it. It is a requirement at the heart of the process. The committee is meeting at the moment—it may have concluded—and it has a Conservative chairman, who is very good. There is no predetermined disposition among its members to seek a confrontation with any government department. However, in this case, the Secretary of State and his department have point-blank refused to carry out an impact assessment. It is a challenge to Parliament and to the parliamentary process. That is what is taking place.

I agree with almost everything that the right reverend Prelate said about enforcing vaccination and I realise that there are some very serious problems to be resolved there. But that is not what the argument is about. It is about whether Parliament—in this case, your Lordships’ House—has the right to require any government department to produce an impact assessment about its proposals for legislation. It is quite a simple matter. It is not onerous in most cases. It is necessary for the committee to consider the impact assessment—along with other aspects of the legislation, of course—before reporting to your Lordships’ House. I did not hear in the Minister’s opening remarks a coherent explanation—and I have never received or seen one—of why that is not possible in this case.

As I said, your Lordships require their colleagues on the committee to analyse secondary legislation. That is our role and, if we do not have an impact assessment, we cannot fulfil it. That is the issue. I agree with what the right reverend Prelate said, but this is not about enforcing vaccination. It is about trying to learn to understand the impact, through an impact assessment, of this proposed secondary legislation. If committees are not allowed to take a stand on this, there is little purpose to them, because this is one of the fundamental issues of secondary legislation. That is our job and our responsibility and it is what we have been trying to do.

My Lords, I had not intended to contribute to this debate, but I will say a few words. First, I am completely against any compulsory vaccination of any kind. It goes completely against all that we should believe in and I am totally opposed to it. Secondly, I recently put down two Written Questions to the Minister’s department: one about people who had been vaccinated and one about people who had tested positive with antibodies. I wanted to know the difference between the two; I wanted to know about protection from the disease and about transmission of the disease. The Answers that I got said, “We’re looking at it, but as far as we can tell at the moment, there is no difference”—it was 84% versus 85%. There is no difference between the protection that the vaccine offers and the protection given by antibodies in the normal course of events. Surely we are not going to vaccinate people who have the antibodies. It is absolutely pointless, particularly if they are thousands of schoolchildren. Can we not test people who have the antibodies and tell them that they do not need to be vaccinated? That seems to be common sense.

My Lords, it seems that we have come down to debating two specific issues. The first is, of course, the question of mandatory vaccination for healthcare staff and whether we should support it. The second is the way in which the Government have been treating Parliament over not just this issue but the hundreds of statutory instruments that have been brought in relation to Covid, many of them by the Minister’s department.

We are entitled to a full response as to why the impact assessment was published so late. As I said, I am afraid that this is not the first occasion. I have been following the work of Big Brother Watch over the Covid experience. It has set out clearly the hundreds of SIs that have been brought here retrospectively and the impact on parliamentary democracy. We all know that we are in the middle of a crisis and that, of course, the Government have to act quickly—we all understand that. Even so, the one thing that we are entitled to say is, if they are doing that, they should be able to produce the documentation to justify the action that they are taking.

The mandatory vaccination of healthcare staff was not a decision that was suddenly reached in the last few days; it has been trailed for weeks in the consultation. I declare my interest as a member of the GMC board. I am not speaking on its behalf, but the GMC and many other organisations responded to that consultation, so there is no excuse, in this instance, for there not to be a full impact assessment published alongside the SI so that my noble friend Lord Cunningham and his committee can consider it with ample time and we can then enjoy their recommendations to us.

A couple of weeks ago, two Select Committees of your Lordships’ House, the Secondary Legislation Scrutiny Committee and the Delegated Powers and Regulatory Reform Committee, produced two important reports. That of the latter, entitled Democracy Denied?, looked at what it saw as the urgent need to rebalance power between Parliament and the Executive. Each report contained a stark warning about a shift in power towards the Executive and both expressed considerable alarm, criticising the increasing tendency of Governments to adopt procedures that effectively bypass Parliament’s role in the legislative process by enabling Ministers to make the detailed laws that govern every aspect of how we operate. As the noble Lord, Lord Cormack, said, skeleton Bills or Christmas tree Bills giving Ministers huge powers have become not an infrequent passage but typical of each Bill brought before Parliament.

The problem that we have as a House is that, in effect, the veto power on secondary legislation is so huge that we hesitate to use it. The last time we did—if I remember rightly—the Front Bench opposite threatened to abolish the House of Lords. We talk about scrutiny of secondary legislation, but the reality is that we can have these debates and we can make our contributions but the Government will take absolutely no notice. That means that we must be very careful when it comes to SIs of this kind. I support this SI, but it is draconian—there can be no doubt about it. I think that it is justified but, my goodness me, to produce it without the proper supporting documentation is a contempt of Parliament.

My Lords, before I follow up my noble friend Lady Tyler’s comments, I want to say how much I agree with the noble Lord, Lord Cormack. The way in which this has been done—I agree also with the noble Lord, Lord Hunt—is absolutely shocking; it is a contempt of Parliament. I was horrified when I read the report of the Secondary Legislation Scrutiny Committee about how bad it was and how late the sort of impact assessment—I call it a sort of impact assessment —has been produced.

Of course, we do not need an impact assessment to know what the problem at the heart of this is, apart from the compulsion element, which I understand: it is the fact that so many people are hesitant and mistrusting about having a vaccination. We also know from the work of Healthwatch, mentioned by my noble friend, that the most effective way of addressing the problems that people have with the vaccination is to have a one-to-one discussion with them so that they can say what their problems are and have them addressed. It needs to be done with a person whom they trust—somebody who they believe has some knowledge and understanding of the issues.

The difficulty with doing this at the moment is that all those people are very busy. We have the winter problems coming up; we have the omicron variant of Covid-19 increasing day by day and our NHS is on the edge of falling over. So I have a little suggestion for the Minister. There are plenty of doctors and nurses relatively recently retired who for one reason or another are reluctant to come back into the front line at the moment. However, they retain the respect of the health community. I understand from the executive summary that the total cost of replacing members of staff who are likely to leave because, whatever happens, they do not want to have a vaccine is £270 million. Could not some of that money be used to get those doctors and nurses with the knowledge and the trust of their recent fellows to have those conversations, without interrupting the staffing of hospitals, where it is bad enough at the moment, as we have lots of vacancies? We know that we cannot take all those people out to have those conversations, because it takes time and it has to be done with sensitivity and consideration. Could not some of that money be used to bring back some of those very experienced people to have those conversations and, hopefully, to reduce the number of those who absolutely will not be vaccinated and, sadly, will leave the profession?

I shall ask the Minister one more question. A few weeks ago, I asked him whether patients had the right to request that they should be treated by vaccinated staff only. Whatever the Government do, it will not all be done until April, which is months away. So there will be lots of patients treated between now and then by people who are not vaccinated. I asked the Minister whether patients had a right to request to be treated by vaccinated people only. He very kindly wrote to me, but I am afraid he was not able to give me a definitive answer. Now all the work has been done on this statutory instrument, I wonder whether things have become any clearer on that issue.

My Lords, a great deal of concern about procedure has been expressed from all sides of your Lordships’ House. I have nothing to add on that, except to say that I share those concerns.

I have two specific questions for the Minister. The first builds on the comments of the right reverend Prelate the Bishop of St Albans, who talked about how we have to win the argument on vaccination and the concern about unintended consequences and potentially discriminatory outcomes. When I look at the impact assessment, it is focused entirely on the care and health sectors. For example, paragraph 126 refers to

“the possibility of negative behaviour change resulting from the policy. For example, a German experiment found that vaccination requirements increased anger among individuals with existing negative vaccination attitudes and led to a decrease in uptake”.

As far as I can see, there does not appear to be in this impact assessment any consideration of impacts outside the health and care sectors. If we are creating this process, it will have impacts right across society, not just in the health and care sectors. We are talking about systems thinking here: not just what making a decision in the health and care sectors means for the health and care sectors, but what it means across the whole of society. What are the negative impacts of people in general deciding not to get vaccinated because of this?

The second point I draw from a very useful briefing from the Homecare Association. I do not think anyone else has asked this question, and I feel I should ask it for the Homecare Association. It said that it is extremely concerned about the intention to legislate rather than persuade. It is asking about a contingency plan if, indeed, the results are towards the worst end of the impact assessment. What are the Government doing to plan for this situation, when we have already had 1.5 million hours of commissioned care not delivered between August and October because of lack of availability? If this gets much worse, what plans do the Government have to fill the gaps?

My Lords, I declare my interest as vice-chair of the All-Party Parliamentary Group on Coronavirus and a vice-chair of the All-Party Parliamentary Group on Adult Social Care. The Minister started and ended his contribution to the House by saying this was a statement. I suspect the Minister is in no doubt now that this is actually a statutory instrument. I thank the noble Baroness, Lady Thornton, and also the noble Baroness, Lady Noakes, for her Motion, given the clear failings of the presentation of this statutory instrument. The Minister needs to hear the concern from every part of your Lordships’ House this afternoon, and it very gracious of the noble Baroness, Lady Noakes, to say that she will not press her fatal Motion, for all the reasons cited by the noble Lord, Lord Hunt.

The 21st report of the Secondary Legislation Scrutiny Committee states at paragraph 10:

“An EM … should be a freestanding, comprehensive explanation, and it should not be necessary to conduct extensive research into other documents in order to achieve an understanding of what an instrument does: we regard this EM as an example of poor practice.”

From these Benches we thank the Secondary Legislation Scrutiny Committee, including the noble Lord, Lord Cunningham, whose presence will be missed when he leaves it, for going further and collating as much other information as it could for your Lordships’ House. The committee is excoriating about the failures of the legislation, the Explanatory Memorandum and the guidance, including unclear definitions in law.

For example, what does “vaccinated to a complete course” mean? At what point does the booster jab become compulsory? Will whoever is checking check that the severely clinically extremely vulnerable have had their four doses instead of three? That would require access to very personal staff health information. There is no definition and there are no practical suggestions. The use of the term “registered person” is set out in the Health and Social Care Act 2008, but there is no explanation of who, in reality, in a hospital, has responsibility for checking that staff have had their vaccines.

This SI speaks of people with face-to-face clinical and non-clinical ancillary contact with patients and those who are directly involved in patient care having to have the vaccination. The guidance, however, is still not published to define what is and is not in scope. Does it include clerks on the wards? What about catering staff bringing meals? Does “not being vaccinated” mean that you have to stay a certain number of feet away from patients?

The Secondary Legislation Committee report also points out that non-face-to-face staff are exempt—but they can still mix with front-line staff at other times. Does the Minister think that Covid can tell the difference and that the virus will not transmit from an exempted co-worker to a front-line member of staff in the cafeteria? We know that omicron is bypassing the vaccinated, even if it is bringing possibly less serious disease—although we are waiting to see the evidence.

The government consultation document published on 10 December on vaccination says that more than 1.2 million social care workers in England have now taken up the vaccination. As of 19 August, vaccination take-up was around 87% of staff in younger-adult care homes; 81% of domiciliary care staff; and 75% of staff in other settings. In London, obviously, this is lower, as we all know. This data, however, directly contradicts the Explanatory Memorandum, which says that only 65% of care homes are meeting the 80% staff rate; so they are not even co-ordinating on their own data. The Government’s own data has shown that there has been a 3% reduction in social care staff since March. Some—not all—will have left because of compulsory vaccines. They are not just leaving the care home; they are leaving the profession. They are going into retail or hospitality, and we know that people, having left, often do not return.

I entirely agree with my noble friends Lady Tyler and Lady Walmsley that targeted help and support has worked with a large number of social care staff, as the Government’s own figures in the 10 December document demonstrate. The evidence is that the most effective way of changing the minds of vaccine-hesitant people is to give them a chance to sit down with a local doctor and their own community leaders, ask questions in their own time and listen to people that they trust. The problem with compulsion, especially short-notice compulsion, is that it removes the opportunity to take that time to listen, think, discuss and be reassured. Worse, as we are moving into another wave of the pandemic, doctors will not have the time to do this, whether it is with other NHS workers or with more social care staff.

Even more than that, the Government undermine their own arguments for urgency. At paragraphs 25 and 26, the Secondary Legislation Committee report points out that, in discussing making the flu vaccine compulsory, the department said that

“the government has considered the concerns raised in relation to introducing flu vaccination requirements. The flu programme runs between October and March, with most flu vaccinations happening October through January. Due to the need to balance this with the time necessary for health and social care to implement the regulations, the government has decided not to introduce vaccination requirements for flu at this time. The government will keep this under review following this winter and ahead of winter 2022-23.”

It seems extraordinary that, while this precedent has been set to delay one type of compulsory vaccination due to the time of year and the extreme pressures on the healthcare and social systems, the Government are insisting on doing it for another. The left hand does not know what the right hand is doing.

Finally, the noble Baroness, Lady Noakes, raises concerns about the impact statement as opposed to the impact assessment. Your Lordships’ House has already—repeatedly—had this debate and, once again, Ministers are treating Parliament with contempt. The difference between an impact statement and an impact assessment is that the latter must have third-party validation and be published on the website, while a statement may be untransparent and unaccountable. The Minister is now hearing why noble Lords are concerned, and late-notice publication really is not helpful. I believe that the noble Lord, Lord Cormack, once again spoke for all of us who have spoken in this debate.

I hope that the Minister has some answers to all these contradictions. His concern for procedure is not matched by his department’s actions. Trust about the so-called “urgent business” is being squandered, given that our first debate on this matter was in July. The Government cannot argue that this is short notice. I hope that the Minister will give the House an undertaking that, in future, an impact assessment will be published in the proper way.

My Lords, I declare an interest as a non-executive director of an NHS hospital. I thank the Minister for explaining this statutory instrument, although I have to confess that I had a moment of panic during his opening statement. I thank him also for explaining his understanding of how the Government arrived at this point. I note that the department has at last produced at least something called an impact assessment, as well as other documentation. This was the subject of my Motion to Regret, now withdrawn. That does not mean that I no longer regret the lackadaisical manner in which this Government approach their accountability to Parliament and the legislative process.

As most noble Lords, including the noble Lord, Lord Cormack, have said to the Minister in clear language, we still wish to know how the legislation will operate. We hope that the Minister will be more forthcoming about, for example, the “significant workforce capacity risk” which the Secondary Legislation Scrutiny Committee mentioned in its very critical report. We note that the committee was damning in its criticism, and I thank my noble friend Lord Cunningham for speaking about the fact that these things are not an option but a requirement.

I say to the noble Baroness, Lady Noakes, that we agree with her criticism of the Government’s handling of these issues. We absolutely agree about the procedure, the drafting and the lack of justification that supports the legislation. I have been commenting on this from this Dispatch Box since March last year. However, the noble Baroness did not say that this was necessarily the wrong way to go. I withdrew my regret Motion because, today, given the new clear threat of omicron, we need to focus on the way forward. I do not believe that that is a political reason for withdrawing the Motion. Had the noble Baroness tested the opinion of the House on her fatal Motion, we on these Benches would have supported the Government, just as we are doing right now in the Commons. The Labour Party has acted, and will always act, in the best interests of our NHS, our public health and our nation.

Of course, we want everyone working in the NHS to take up the vaccine. It is safe and effective, and the Government should be focused on driving up vaccination rates through persuasion, education and support for the vaccine-hesitant, as many noble Lords, particularly those on the Liberal Democrat Benches, have said. We know that omicron is now a clear threat. It is important that the elderly and the vulnerable, and those being cared for in healthcare settings, are protected. Vaccination also protects staff from severe disease, so we will not oppose the Government on this.

Compulsory vaccination for NHS staff is a difficult question—of course it is—as the right reverend Prelate the Bishop of St Albans and my noble friend Lord Hunt explained to the House. We would all much prefer that all front-line NHS staff voluntarily agree to have the vaccine. The latest SAGE advice, however, suggests that omicron may increase the risk of hospital-acquired infections. Vaccination will not eliminate all transmission, but it will reduce the risks and protect both patients and staff in the NHS from severe disease. It may also reduce staff absences caused by Covid.

Of course, there is a precedent for certain NHS staff having to be vaccinated, for example against hepatitis, and given the evidence that being vaccinated reduces the risk of transmission, it is reasonable to ask whether those who are looking after our loved ones should themselves have taken every step possible to reduce the risk that they may pass the virus on to those whom they are caring for, many of whom may be elderly and vulnerable.

However, ahead of any rollout, the Government must ensure that this change does not make the staffing crisis in the NHS any worse and must work with the royal colleges, NHS Providers and the trade unions to agree a framework for how this change is rolled out. The trade unions and royal colleges have been critical of the proposals for compulsory vaccination, ahead of what will be, and is becoming, a very difficult and challenging winter for the NHS because of the implications this could have for staffing. So we welcome the fact that the Government have pushed the date back to April 2022, but we continue to be concerned about the implications that mandatory vaccination for NHS workers will have on staff shortages. We have asked the Government to set out a plan for this.

For the record, on the separate issue of mandatory vaccination for the public, the Prime Minister probably puzzled the whole nation—he certainly puzzled me—when he floated this idea. We are opposed to this—as is the Minister’s boss, I expect. We are opposed to the use of Covid status certification for access to essential services. Forcing the general population to have the vaccine would not only be wrong but impractical. The Government have not brought forward any measures to introduce this, and we would not support any future attempt to do so.

Finally, all of us want to enjoy Christmas safely this year. We all want to protect our NHS, which has been suffering from staff shortages and record waiting lists and has been performing miracles for the last 18 months. Our best defence against all variants of the virus, including omicron, is that we all get vaccinated.

My Lords, I thank all noble Lords for taking part in this debate. I apologise to noble Lords for getting the terminology wrong at the beginning. I will make sure that that is corrected in future.

I thank my noble friend Lady Noakes for raising this important issue, and for challenging us and rightly holding the Government to account on many procedural issues. I accept that your Lordships perform an essential role in scrutinising the measures that we have put forward today. That is one of the things that makes me very proud to be a Member of this House. I recognise the strength of feeling of your Lordships for and against what we are proposing and about the procedures thus far. I know that these feelings are sincere and heartfelt.

I now turn to some of the point raised by noble Lords. My noble friends Lady Noakes and Lord Cormack and the noble Baroness, Lady Brinton, raised questions about the red-rated impact assessment from the Regulatory Policy Committee. I hear the concerns of this House, and I acknowledge that, due to the necessity to move as quickly as possible and minimise the risk to those who are vulnerable, we were unable to publish the full impact assessment alongside the regulations being laid. We set out a statement of impacts, and the full impact assessment has now been published on GOV.UK, but I accept the argument made by noble Lords that this is rather late. We have also now published additional consideration of the points raised by the RPC in relation to private businesses.

My noble friend Lady Noakes also asked what the Government have done in response to the criticisms of regulations from the Secondary Legislation Scrutiny Committee. I reassure noble Lords that we have published the updated Explanatory Memorandum to provide additional information on the specific concerns raised. I also accept the criticisms that this could have been more timely. This includes more information on the scientific and clinical rationale for the policy, the exemptions that have been provided for, those not included, and the steps that we have taken to further encourage uptake of vaccinations and to mitigate work- force risks.

The SLSC also raised concerns about the impact assessment on process. We have worked hard and as quickly as possible to finalise the impact assessment that we feel best captures the likely impact of this novel policy in the uncertain circumstances that we are still living through and the need sometimes to react quickly. As my noble friend Lady Noakes rightly said, this impact assessment was laid before the House in advance of this debate.

My noble friend Lady Noakes also raised the question of whether a cost of £270 million is value for money, considering the impact assessment. While it is not possible to model the non-monetised benefits that this policy would have due to the limited data available, the health benefits through reduced infections and deaths among health and care users—as well as the wider community—from the workforce being vaccinated are likely to be large and should be considered when focusing on costs.

A key benefit is the impact of reassurance to patients and care users that they are being looked after by staff who are vaccinated. This avoids the very dangerous situation of people feeling wary of going to the NHS and other health and care providers, which can have dangerous long-term implications regarding health outcomes for our society. This is non-monetised, yet it remains a highly significant factor.

My noble friend Lady Noakes also asked about the workforce impact of this legislative instrument. As of 5 December, 521,000 staff in all care homes, or nearly 96%, have been vaccinated with the first dose, and 511,000 staff, or 94%, are reported to have received a second dose based on responses from 99% of providers. Although NHS workforce figures are dynamic as people join and leave, since the Government consulted on the policy in September, the latest published figures show an overall net increase of NHS staff vaccinated with a first dose of over 55,000.

My noble friend Lady McIntosh also raised valid questions about the impact on the social care workforce. We are not aware of any care homes where VCOD is the primary reason for closure, but we continue to work with our regional assurance team, which works closely with regions across the country to understand the local and regional pressures, and offer support and advice as appropriate.

In social care, we have already put in place a range of measures to help local authorities and providers to address workforce capacity pressures; indeed, I have announced some of those in this House. As in healthcare, there will be a 12-week grace period for workers in the wider social care sector before requirements come into force, which will give all unvaccinated staff time to get their jab. We are focusing every effort on promoting and encouraging vaccine take-up across social care, and £300 million was announced for the workforce on Friday 10 December to support the care sector over winter.

My noble friend Lord Cormack, the noble Lords, Lord Cunningham and Lord Hunt, and several other noble Lords have eloquently raised points about the use of retrospective legislation and emphasised the importance of parliamentary processes. I sympathise with noble Lords who are concerned about some of the procedural aspects of the passage of this legislation.

As my noble friend Lord Cormack rightly said, in unprecedented times such as these it is right that the Government do everything in their power to protect the vulnerable. Vaccination is our best defence against Covid. It reduces the likelihood of infection and therefore helps to break chains of transmission, as the noble Baroness, Lady Thornton, rightly acknowledged. It is safe and effective. The legislation will protect those receiving care in all health and social care settings as well as our valuable health and social care workforce themselves.

I agree with my noble friend on the point about reviewing the use of such legislation. I assure noble Lords that Regulation 5 sets out the requirement for the Secretary of State to carry out an annual review of these regulations, taking into account clinical advice and accessibility and availability of authorised vaccines, and to publish a report setting out the conclusions of this review.

On my noble friend Lord Cormack’s suggestion of an ongoing Joint Committee, I apologise if the response I suggested was inaccurate. I suggest that I discuss it with him so that I can learn from his experience of parliamentary procedures.

The noble Baroness, Lady Tyler, referenced the importance of encouraging the hesitant. I completely agree. We both come from the same part of London; indeed, she informed me that we went to the same school. We come from an incredibly diverse area, and we understand the different concerns and pressures in many of these communities; as noble Lords will recognise, I myself come from one of these communities. But as she will know, the NHS has focused in recent months on a targeted approach to improve uptake in hesitant groups by undertaking campaigns not only based on function, such as at midwifery staff, but directed at different communities, such as ethnic-minority groups and students, as well as using the booster campaign as an opportunity to re-engage staff. I repeat my gratitude to noble Lords across the House who have suggested to me ways that we can address many of these communities, including working with interfaith communities and networks which really understand these communities and have the trust of many individuals.

To maximise uptake over the winter months, the NHS’s plan includes a range of strategies. We have increased the number and diversity of opportunities to receive the vaccine. Many noble Lords will be aware of pop-up centres, pharmacies and mobile units available. It has come to this: we have to go out and take services as close to those communities and individuals as possible.

The right reverend Prelate the Bishop of St Albans echoed the vital importance of engaging with faith groups throughout; I recognise that. That is why, to maximise uptake over the winter months, the NHS is planning further increases in engagement, targeted at the communities where uptake is the lowest. We will look to have those one-on-one conversations, and to recognise and identify people who are trusted and who can help those conversations.

The noble Baroness, Lady Walmsley, spoke about the importance of encouraging uptake, noting the challenge with the winter months ahead. This is why we are ensuring one-to-one conversations for all unvaccinated NHS staff with their line manager, which take place with clear guidance. On her point on funding, the Government are making key interventions to support NHS services over the winter. This includes £478 million for support services, rehabilitation and reablement care following discharge from hospital, and ensuring that health and social care services are joined up. She also asked whether patients can ask whether staff treating them are vaccinated, prior to enforcement. I assure the House that there is no specific entitlement for patients in NHS facilities to ask whether the staff treating them are vaccinated but, once the regulations come into force, patients and service users will have confidence that all staff interacting with them as part of a CQC-regulated activity are either vaccinated or exempt.

The noble Lord, Lord Framlingham, noted recent data on the effectiveness of vaccinations against the new omicron variant and asked about the difference in protection between vaccination and infection antibodies. I emphasise to noble Lords that vaccination remains the best defence against Covid-19. There is also significant evidence that vaccines are effective at preventing infection and will therefore reduce transmission. We have not yet identified similar strength of evidence for natural immunity. The uncertainty around natural immunity and protection makes it difficult to consider this as an alternative to vaccination at the moment.

The noble Baroness, Lady Brinton, asked an important question about which health and care workers are in scope of policy. Those in scope include staff who have direct face-to-face contact with patients and service users in either secondary or primary care, community settings and wider care settings. This includes, for example, doctors, dentists, midwives, nurses, paramedics and social care workers. Also in scope are ancillary staff who may have social contact with patients but are not directly involved in patient care. This group includes receptionists, ward clerks, porters and cleaners. She also asked about the definition of a complete course of vaccination. The current definition is two doses, but we will keep this under active review and, in light of the omicron variant, will not hesitate to act if necessary to update that guidance at a suitable time to refer to three doses. All health and social care staff providers and staff are encouraged to follow national guidance.

The noble Baroness, Lady Thornton, asked what is meant by “registered provider”. A registered person is defined in Regulation 2 of the 2014 regulations as a person registered with the Care Quality Commission who is, in respect of a regulated activity,

“the service provider or registered manager in respect of that activity”.

She spoke of the threat that omicron poses, and I thank her for those comments. She also raised concerns about the workforce impacts. NHS workforce figures are constantly updated as people join and leave, but we can see that, since the Government consulted on the policy in September, the latest published figures show an overall net increase of staff vaccinated with a first dose of over 55,000. Our best mitigation, as identified in the advice of many noble Lords, is to encourage people to have that positive choice and take up the vaccine.

While vaccination has been and remains our best line of defence, I recognise that this is an emotive issue on many fronts. I also recognise concerns over civil liberties and parliamentary procedures. Whether in our care homes, our hospitals or any other health or care setting, it is an important duty of everyone working in health and social care to avoid preventable harm to the people they care for. People working in health and social care are often in close contact with some of the most vulnerable people in our society. That is the nature of the job and much of the reason behind our heartfelt gratitude and respect for the work they do. However, we know that those vulnerable people are more likely to suffer serious health consequences if they catch Covid-19.

The Government hear and recognise the concerns that have been raised about the impact of these measures on the workforce, especially during these winter months, but we continue to insist that mitigation against these risks is to keep driving uptake. We continue to encourage health and care workers to protect themselves and protect the people they care for before the deadline. The 12-week grace period allows time for both workforce planning and for more colleagues to come forward and get the jab. I recognise the concerns raised by noble Lords on a number of issues.

I am grateful for noble Lords’ contributions, for their passion and sincerity, and for the advice given to me to take back to my department. In the face of this virus that has harmed countless lives and livelihoods, we must do what we can to keep the British people safe. The measures before us will help us to do that and I hope in future that we will be able to improve on the procedures that we have adopted. I take on board the legitimate concerns about the procedures and I will take these back to the department.

I commend these regulations to the House.

My Lords, I thank all noble Lords who supported the points I made about needing better information for parliamentary scrutiny of government policy. This was very ably led by my noble friend Lord Cormack who put it very well when he talked about treating Parliament with contempt. That was echoed by a number of noble Lords. It was very good to hear from the noble Lord, Lord Cunningham, from his perspective on the Secondary Legislation Scrutiny Committee, which has served this House very well, particularly in relation to this order.

I am sorry that the noble Lord, Lord Rooker, questioned my sincerity in bringing these points to the House. I am a mere Back-Bencher; I was trying to make the kind of points that Back-Benchers should be making about effective parliamentary scrutiny. I cannot be held accountable for what the Government do in bringing legislation in the future, so I would encourage him not to try to use my speech as a checklist against future primary legislation brought to your Lordships’ House. This will not be my fault.

I am grateful for what my noble friend the Minister said. He accepted my criticisms with good grace and did not seek to defend the indefensible. As to the future, I would have hoped to have something a little more encouraging than that he hoped they would do better in the future and that he would take the matters back to his department. I hope he will take the matters raised back to his department but with a stern resolve to get them dealt with better next time. With that, I beg leave to withdraw my amendment.

Amendment withdrawn.

Motion agreed.