The following Statement was made in the House of Commons on Monday 28 November.
“As the House will know, sadly, on the morning of 19 November an individual who had arrived in the United Kingdom on 12 November, and who had been staying at the Manston processing site, died in hospital. Initial test results for an infectious disease were negative, but a follow-up PCR test was positive. We must now await the post-mortem results to determine the cause of death, and our thoughts are with the individual’s family.
There has been speculation about the wider health implications across the asylum accommodation system, so I wanted to come to the House to set out the facts, to outline the steps that have already been taken to protect migrants and the general public, and to reassure the public about the additional precautionary measures that we are now taking.
The control and testing of infectious diseases is led by the UK Health Security Agency and the Department of Health and Social Care. The Home Office continues to work closely with both, taking their advice on all these matters and following it. As part of our ongoing dialogue, the Home Secretary and I were updated over the weekend on the situation by Dame Jenny Harries of UKHSA, who confirmed to us that 50 cases of diphtheria had been reported in asylum accommodation. It is important to emphasise that UKHSA has made it clear that the risk to the wider UK population from onward transmission of diphtheria is very low, thanks in no small part to our excellent childhood immunisation programme, and also because the infection is typically passed on through close prolonged contact with a case. UKHSA confirmed that it considers it likely that these cases developed before the individuals entered the UK.
The Home Office has worked closely with the NHS and UKHSA to identify and isolate anyone with a diphtheria infection. That includes providing diphtheria vaccinations and moving confirmed cases into isolation. While these robust processes and plans for a situation of this type are already in train, it is absolutely right for us now to be vigilant: that is what the public would expect, and that is what we are doing. There are, for instance, robust screening processes on the arrival of individuals at Western Jet Foil in Dover to identify proactively those with symptoms of diphtheria; round-the-clock health facilities at Manston, including emergency department consultants and paramedics; guidance in multiple languages on spotting the symptoms of diphtheria; and an enhanced diphtheria vaccination programme, offered to all those arriving at Manston. I can confirm that of those who arrived at the facility this weekend, 100% took up that vaccine offer. There is testing for those presenting with symptoms and for close contacts, and those testing positive are being isolated in a designated place.
Today we are going above and beyond the UKHSA baseline by instituting new guidance on the transportation and accommodation of individuals displaying diphtheria symptoms. From today, no one presenting with symptoms will progress into the asylum accommodation system. They will either remain at Manston, isolating for a short period, or they will travel to a designated isolation centre in secure transport, where they will be treated until deemed medically fit. This is a well-practised protocol from Covid times.
We will also continue to ensure that all asylum accommodation providers are given access to the very latest public health advice from UKHSA, and we will ensure that they are aware of their responsibilities for testing and isolating cases of infectious disease. We will continue working with UKHSA to ensure that arrangements are of the highest standard and that UKHSA has everything it needs from the Home Office. We are engaging with French counterparts to assess the state of infectious disease in the camps in northern France.
I fully understand and appreciate the concerns that have been raised, and I assure the House that the Home Office is acutely aware of our responsibility both to those in care and to the British public. For me, the Home Secretary and the Government as a whole, public health is paramount. We will take all steps necessary to ensure that the public are protected. I commend this Statement to the House.”
My Lords, we know that the Government’s asylum system is in chaos. Just 2% of last year’s small boat cases have been decided, creating a backlog of nearly 100,000 people waiting more than six months for a decision. Such is the chaos that we have seen, and are seeing, that we have the completely inappropriate last-minute use of hotels, with no proper information for local councils or public health officials. Then, of course, there is the disgrace that has been and is Manston.
We are all aware of revelation after revelation of overcrowding at Manston, of people being kept long after legal limits were passed and of poor health and hygiene. What is the latest revelation that we have from Manston? It is of 50 diphtheria cases—compared with just three last year. Was the Home Office warned four months ago, as reported in today’s media, that measures to prevent the spread of infectious diseases such as diphtheria at Manston were poor and that staff were ill prepared to deal with them? When were Ministers first told that there were diphtheria cases at Manston?
By mid-October, the Home Office had admitted that there were cases at Manston, but its officials told the Home Affairs Committee on 26 October that they had sufficient health measures in place to address diphtheria. Why, when they clearly did not? The Government kept thousands of people in overcrowded conditions at Manston, described by one as thousands of people “huddled around fan heaters” to stay warm. I am no expert but those seem like perfect conditions for infections to spread, so why on earth was it only on 11 November, weeks later, that diphtheria screening and vaccinations were recommended for everyone passing through Manston? How was it possible that, despite this, the Home Office continued to move people from Manston into hotels across the country, even as potential carriers of diphtheria? Why was this done in some cases with local public health councils or local authorities not being told or given proper information?
The Health Secretary tells us that 500 people have now been screened and vaccinated, but what about the thousands of others who have passed through Manston? Wherever they are in this country, have they been screened and vaccinated for diphtheria, or have they just been left? Have all those with possible symptoms been given antibiotics? Given that this was the recommendation of public health officials some three weeks ago, if it has not been done, why not? What liaison is taking place between the health department and the Home Office? What is the plan?
Across the country, residents and migrants from Manston have been dispersed. We were told by the Immigration Minister yesterday that asylum seekers with symptoms of diphtheria are to be isolated for a short period at Manston or in designated isolation hotels. Can the Minister say any more about the numbers of cases across the country and where they are? What is the current situation?
Of course, the Government, the Minister and the Home Office will now do all they can to protect public health, prevent infection and give healthcare to those who need it—but it should never have come to this, should it? It is time for the Government to listen, advise, act on advice and get a grip. Manston and now this associated health issue of diphtheria have been a public policy disgrace, alongside asylum backlogs and chaos in the channel. Frankly, it is shocking, and the Government need to get a grip.
My Lords, it is a pleasure to follow the noble Lord, Lord Coaker. I am afraid I will repeat not only some of his questions but the many that I have asked the Minister on this issue over the last month.
On 31 October, the Home Secretary said:
“Manston … has very good medical facilities and all protocols have been followed.”—[Official Report, Commons, 31/10/22; col. 649.]
On 27 October, Robert Jenrick, the Immigration Minister, said:
“The basic needs of arrivals are provided … including … medical care.”—[Official Report, Commons, 27/10/22; col. 401.]
When we had the Statement last Thursday, it felt like the Home Office had emptied Manston and dumped unfunded people, unscreened and unvaccinated, without access to their local NHS in their new venues.
It is good that things are starting to change, and that is why I thank the Minister. If he had anything to do with the message that came out on Friday afternoon that the spot accommodation arrangements that prevented people moving from Manston to hotels from accessing GPs have now been changed. It is a shame that it has taken repeated questions to make that happen.
On Saturday morning we heard that the man who died after staying at Manston had died from diphtheria, which was clarified by a PCR test, despite some earlier negative tests. One of the problems with diphtheria is that the symptoms are not always obvious. On 1 November, I asked the Minister whether people were being routinely screened and tested, but it appears that they are still not, let alone being vaccinated.
The spread of infectious diseases was highlighted by Charlie Taylor, Chief Inspector of Prisons, in his unannounced inspection of Manston and Jet Foil at the end of July. The report was published on 1 November, but I am sure that it is still the convention for Ministers to see a draft beforehand. It says:
“Facilities for the management of detainees with COVID or other infectious diseases were poor. Detainees were placed in a claustrophobic portacabin with no clear responsibility assigned for managing their care. Paramedic staff were unsure of any guidance, policy or procedure for the management of infectious diseases.”
What happened after the draft of this advice was seen by Ministers, prior to assurances given by Ministers, from the end of October onwards, that good healthcare and protocols were being followed?
Diphtheria is a notifiable disease because, in unvaccinated people and untreated cases, it has a fatality rate of 5% to 10%. It spreads in overcrowded communities whose health may be compromised for other reasons, which is absolutely typical for asylum seekers. What data is there for how many of the people held at Manston since the middle of October have now been screened, tested and offered vaccinations? The UNHCR, UNICEF and the American CDC all vaccinate refugees and migrant communities, and it is now compulsory if you come into America through the border with Mexico.
On Sunday, the Home Office said that infectious migrants will now be told to isolate in hotel rooms but, prior to this, the only advice about those in hotels was given to hotel staff, not local doctors and certainly not directors of public health. It is good that this is beginning to change.
Yesterday morning, the government webpage entitled “Protecting yourself against diphtheria” was updated—and that too is good. It is important to say that the wider public are not at risk; only people coming into contact with someone with diphtheria are at risk. The guidance now says:
“Everyone arriving to claim asylum in the UK is currently being offered a dose of a diphtheria containing vaccine and a course of antibiotics … to reduce the risk of diphtheria and some other infections.”
This should have been normal practice the moment the first case emerged, so why is it only starting to happen now?
The Statement says that an “enhanced diphtheria vaccination programme” will be “offered to all”. So I ask the Minister what the definition is of “those arriving”: does it cover everyone who has been at or through Manston since the numbers bloomed after Suella Braverman was appointed as Home Secretary, rising from 1,500 to 4,000 in the space of three weeks? Or is it only those currently at Manston? Or will it now be every asylum seeker in the country, as is the case with CDC in America?
I also ask whether those who come through Manston have also been screened for infectious diseases, including diphtheria and scabies? Who will be managing this; will the Home Office be funding screening and vaccinations? I hope so, because local health services should not have to pick up the tab.
The Statement says that “robust screening processes” on arrival will “identify proactively” those with symptoms. However, we know that diphtheria is asymptomatic. Two are currently hospitalised, one person is dead and there are at least 50 confirmed cases. We have had only about 50 cases in the last 10 years in the UK, but the directors of public health in local areas are still struggling to get access to information and resources, from either the Home Office or the UKHSA. When will that happen? If the Minister cannot answer all these questions, please can he write to me with some answers?
I thank both the noble Lord and the noble Baroness for their speeches. The Home Secretary and the Minister for Immigration were updated over the weekend by Dame Jenny Harries of the UK Health Security Agency, who confirmed that 50 cases of diphtheria had been reported in asylum accommodation. This had the unfortunate effect of being a consequence of the speed with which Manston had been emptied in response to the earlier concerns about the conditions at Manston. While robust processes and plans have now been put in place, it is right that we remain vigilant. As the noble Baroness observed,
“robust screening processes on … arrival … at Western Jet Foil … to identify proactively those with symptoms of diphtheria”
are in place, and the
“‘round-the-clock’ health facilities at Manston”,
which I previously referred to in this House,
“including emergency department consultants and paramedics”,
remain available to those at Manston and will readily identify conditions that those people may have.
Guidance is also available
“in multiple languages on spotting the symptoms of diphtheria”,
and I am grateful to the noble Baroness for noting that changes have made on the website in an effort to enhance the spread of that message. In addition,
“an enhanced diphtheria vaccination programme, offered to all those arriving at Manston”
is now in place, and
“of those who arrived at the facility this weekend, 100% took up that … offer”.
“testing for those presenting with symptoms and for close contacts”
of confirmed cases was also available,
“and those testing positive are being isolated in a designated place.”—[Official Report, Commons, 28/11/22; col. 676.]
As the noble Baroness has observed, certain “isolation hotels” have been set up to provide facilities to make that isolation possible and easier for those who need it. Equally, special transport is provided to ensure that they can travel to their place of isolation until the symptoms of the condition have resolved.
On the question asked by both the noble Lord and the noble Baroness in relation to liaison with local health departments, the Home Office’s contracted accommodation providers are contracted to provide a liaison with health services, to provide those residents with health services, and to signpost them to local GPs and other health providers. Local authorities, too, are provided with £3,500 per person to provide their services to those in Home Office accommodation. That, of course, includes public health obligations on local authorities. As the Minister in the other place made clear, the department is going above and beyond the UKHSA baseline by instituting new guidance on the transportation of individuals displaying diphtheria symptoms.
It is clear that this is a very unfortunate consequence of the speed with which Manston was emptied in the run-up to the previous weekend, and steps are now being taken to ensure that all those in accommodation are offered a vaccination for diphtheria. Clearly, there is widespread awareness of the issue now.
On the final point raised by the noble Baroness, Lady Brinton, in relation to the medical facilities at Manston, the comments in July bear no relation to the present position. As I said, I have visited those medical facilities and found them to be very impressive. They are not accommodated in the temporary accommodation to which the noble Baroness referred. Those working in that sphere do a fantastic job, and I thank them for it.
My Lords, I am grateful to the Minister for his answer. I appreciate that he has been a Member of your Lordships’ House and therefore, I assume, in his ministerial post for only just over a month, so this is not intended as a personal criticism in any sense. However, I do not understand the logic of saying that this is a consequence of the speed with which Manston was emptied. How did the disease get into Manston in the first place? The Minister may say that people brought the disease from other countries and that it has been spreading within Manston, but we have been living for two years inside a global health emergency. Why has it taken this death and this scandal to now introduce health screening for people arriving at our shores?
The answer is clear from Dame Jenny Harries that those with diphtheria contracted it prior to entering the UK. It seems that the conditions through which they travelled in other countries were such that clearly they were able to contract the condition—and that is most unfortunate.
As to the reason why it has taken us so long to take steps in relation to it, I remind the noble Baroness that comprehensive health screening has been available at Western Jet Foil and Manston. As recently as late October, only five cases of diphtheria were found to be present in the population at Manston, and those were not sent onwards to accommodation without being treated. As the noble Baroness, Lady Brinton, pointed out, diphtheria is one of those conditions which can present without symptoms, so it is difficult to screen for. Further steps are being taken to preclude that occurring, as I have outlined.
My Lords, the Minister said that the speed at which Manston was emptied was unfortunate—but of course that was not the problem, was it? The problem was the speed at which Manston was crowded, and for how long those people were held like that. Has the Minister in his department seen any embarrassment or even shame at these events?
I agree with the noble Baroness that the reason these problems arose was the speed with which people were crossing the Channel illegally: that gave rise to the condition. The noble Baroness may shake her head, but the reality is that, if these people were not crossing the Channel illegally, the situation would not have occurred.
My Lords, I share the surprise of the noble Baronesses, Lady Chakrabarti and Lady Jones of Moulsecoomb, that the Government are trying somehow to claim credit for rapidly emptying Manston. The fact is that it has been a story of incompetence and chaos, followed by panic. However, I particularly want to ask about staff in the hotels that the asylum seekers are living in. I have seen assurances from the Government in the press that it is not a problem for the wider community because most British residents are vaccinated. But I have also seen a concern expressed about eastern European staff in some of those hotels who apparently—I am relying on press reports—were not routinely vaccinated in their home countries against diphtheria. Is this something that the Government are paying attention to, because although we talk about “isolation hotels”, there will be some staff contact and, if it is an airborne disease, those staff could be at risk?
I entirely get the sense of the noble Baroness’s question. The accommodation, as I say, is run by three contractors on behalf of the Home Office and I would sincerely hope that they are aware of their obligations to their staff to ensure that this is the case. I do not know the precise figures, and I can write to the noble Baroness about that.
My Lords, Napier barracks in Kent is still being used to house asylum seekers, despite an inspector’s report that said it was not fit for that purpose. Last year, an epidemic of Covid took hold there because of the unsatisfactory accommodation, with up to 24 people in dormitories. Can the Minister assure us that nobody went directly from Manston to Napier; that everybody at Napier is being screened for a disease which he says does not always exhibit symptoms; and that the conditions there are now suitable for people to be held?
Taking that question in reverse order, yes, the conditions are now suitable for those held there. I do not have the answer as to whether people were transferred directly from Manston to Napier barracks: I can make inquiries about that and write to the noble Baroness. As for her final point, on the provision of healthcare at Napier barracks, similarly, those operating that accommodation facility will provide healthcare and signpost healthcare facilities to those who are resident there.
I do not think the Minister answered the last question, because the whole point is that a humanitarian visa would be a new safe and legal route and it is one for which many of us have argued for quite some time. It would discourage people from travelling by boat. They could apply for a visa before they came and, as the noble Lord, Lord Paddick, said, they could also be vaccinated before travelling.
I understood the noble Lord, Lord Paddick, to ask me whether those who had arrived at Manston should be given a humanitarian visa and be inoculated. That is not the case. On the method that the right reverend Prelate asked about, there are safe and legal routes from the countries that were discussed in the earlier topical Oral Question. Those are the routes that are to be utilised.
If the House will indulge me, I shall clarify my question. The Home Secretary was asked at the Home Affairs Select Committee last week what would happen to a genuine refugee, say from sub-Saharan Africa, where there are no safe and legal routes. Why could someone in that situation not make an initial application in country for a humanitarian visa and be vaccinated in country before they arrive in the UK? The clue in the question I asked previously was “before they arrive in the UK”.
My Lords, the Minister said in reply to my noble friend Lady Ludford that he hoped that the private sector companies which fulfil the contracts would have a care for their staff. Is that not something that the Government should urgently check into? Do the Government themselves not have an obligation in the quite unusual circumstances we are talking about? Secondly, what arrangements are there for the families of patients—I call them patients quite deliberately, because that is how we should treat them—who are put into isolation? Are the families kept together? The Minister will understand that there is a whole ream of questions like this which the House would like to know the answers to.
As the noble Baroness is aware, the vast majority of those crossing the channel are single young men, so the issue has arisen in relation to single men. I do not know the answer about accommodation for any potential family members, but I will certainly ask the department and inform the noble Baroness of the outcome.