Skip to main content

Public Health

Volume 686: debated on Wednesday 30 December 2020

The Business of the House motion just agreed to by the House provides for the motions on the five statutory instruments on today’s Order Paper, each relating to public health, to be debated together for up to three hours. Those are SI Nos. 1518, 1533, 1572, 1611 and 1646. At the end of the debate, I will put the Question on each motion separately. A large number of Members want to contribute to the debate, so we will start with a five-minute time limit.

I beg to move,

That the Health Protection (Coronavirus, Restrictions) (Self-Isolation and Linked Households) (England) Regulations 2020 (S.I., 2020, No. 1518), dated 11 December 2020, a copy of which was laid before this House on 11 December, be approved.

With this we shall debate the following motions:

That the Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) Regulations 2020 (S.I., 2020, No. 1533), dated 14 December 2020, a copy of which was laid before this House on 14 December, be approved.

That the Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) (No. 2) Regulations 2020 (S.I., 2020, No. 1572), dated 17 December 2020, a copy of which was laid before this House on 17 December, be approved.

That the Health Protection (Coronavirus, Restrictions) (All Tiers and Obligations of Undertakings) (England) (Amendment) Regulations 2020 (S.I., 2020, No. 1611), dated 20 December 2020, a copy of which were laid before this House on 21 December, be approved.

That the Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) (No. 3) Regulations 2020 (S.I., 2020, No. 1646), dated 24 December 2020, a copy of which were laid before this House on 29 December, be approved.

Before I say anything else, I want to say thank you to all our health and social care workers who have been working day and night through Christmas, Boxing day and the bank holiday. I know that every single one of them is feeling the strain and that they are not just tired but exhausted, having gone not just the extra mile but miles and miles of extra miles. I would also like to thank everyone across the country who has forgone the joy of sharing Christmas with family or friends. We have all missed those precious moments, and I know that this has been particularly painful for those facing what may be the last chance to spend Christmas with a loved one nearing the end of their life. That is why I say thank you to them from the bottom of my heart for what they have done, not so much for their own sake but to protect others.

I would like to take a moment to celebrate the good news of the authorisation of the Oxford-AstraZeneca vaccine for use. Although the development of vaccines is an international collaboration, we should recognise the contribution of the British life sciences sector, which offers the UK a way out of this disease and will make a huge impact on the global response.

My hon. Friend may well have heard the statement by the Secretary of State for Health and Social Care, after which he answered a large number of questions about the vaccine. As he said, we will be rolling out the vaccine as rapidly as possible, we are poised and ready to start rolling out that particular vaccine as of next week, and it is all about getting the supply of the vaccine in to enable us to do that.

There is light at the end of the tunnel, but we are not there yet. We are here today to debate regulations that increased the restrictions on parts of the country before Christmas, but we also heard the Health Secretary’s statement earlier and know the seriousness of the situation we face despite those greater restrictions. We know that we have just had the highest number of new cases in one day—over 53,000—and in many parts of the country, our hospitals are stretched to the limit. We know we are facing a new variant of covid that is more infectious and spreading rapidly in many parts of the country, so I am in no doubt that we were right to introduce further restrictions when we did.

Before going into the details of the regulations, I will give a brief overview of the measures we are debating. On 2 December, a revised tiering system was introduced following approval of the all-tiers regulations in both Houses. Those have been amended four times. On 14 and 16 December, the all-tiers regulations were amended to move some local authority areas between tiers. Those changes came into force on 16 and 19 December respectively. On 20 December, the all-tiers regulations were amended to introduce a further level of restrictions—tier 4—and to move some local authority areas into that tier and to exclude tier 4 from the Christmas easements. Finally, on 24 December, the all-tiers regulations were amended to move some local authority areas into higher tiers, and some amendments were made to the measures in tier 4.

In addition to those four amendments to the all-tiers regulations, we are debating the Health Protection (Coronavirus, Restrictions) (Self-Isolation and Linked Households) (England) Regulations 2020, which reduce the self-isolation period for household and non-household contacts from 14 days to 10, based on evidence showing that the likelihood of being infectious as a contact after 10 days is low. That decision was made following advice from UK chief medical officers. To bring English policy in line with other nations in the UK, we now count the start date of this period from the day after exposure, onset of symptoms or a test. Those with covid-19 should continue to self-isolate for 10 days, as per Government guidelines. We have brought the wait time for those switching support or childcare bubbles down to 10 days, in line with those changes.

I know that some hon. Members have previously raised concerns about parliamentary scrutiny, and some may be disappointed that those amendments were made in advance of this debate. However, I am sure hon. Members will also appreciate that this virus does not wait for parliamentary procedure. The situation we faced in the run-up to Christmas, as we identified that the cause of the rapid rise in infections was the new variant, meant that we had to act, and act fast.

The great disappointment felt by many colleagues, who appreciate that the Government are under enormous pressure, is that the House rose on the Thursday, and the decision was made pretty much the next day. It is a great shame that the House was not recalled on the Friday, or possibly even the Saturday before Xmas, to scrutinise the new regulations. That is where the sense of disappointment lies. Most families are more than capable of making the right decisions for their relatives without being instructed to do that in law.

I hear my hon. Friend’s point, and I share his view that throughout this pandemic the vast majority of people have behaved with great responsibility. I know that people in tiers other than tier 4 thought very hard about whether they should gather with relatives, even within the easing that was allowed during the Christmas period, and rightly so. We must all play our part in controlling the virus and stopping its spread.

I will make some progress.

At the time of these provisions we were seeing an exponential rise in cases in London, Kent, and some other parts of the south-east, and it was clear that the tier 3 restrictions were not sufficient. We identified the existence of a new variant in those areas, and further analysis showed us that the new variant was driving the steep trajectory of infections. The new and emerging respiratory virus threats advisory group—NERVTAG—tells us that the new variant demonstrates a substantial increase in transmissibility, compared with other variants, and that the R value appears to be significantly higher, with initial estimates suggesting an increase of between 0.4 and 0.9.

There is no evidence to suggest that the new variant of the virus is more likely to cause more serious disease, but increased infections lead to increased hospital admissions and, sadly, increased loss of life. These winter months already pose great challenges for our NHS. That is why we had to take the action that we took before Christmas, and the further steps announced today to control the relentless spread of the virus. However, it is not all bad news.

I am making some progress and I am mindful that many Members want to speak this evening.

The roll-out of the Pfizer vaccine is happening at pace, with more than 600,000 people receiving it between 8 and 20 December. Vaccinations in care homes started on 16 December, and the NHS has already been getting the vaccine to those who are most vulnerable, and the care workers who look after them. Now, the Oxford-AstraZeneca vaccine has been approved, and it is much easier to get out to people and into arms. There is every reason for optimism, but we are not there yet. We must suppress the virus now and in the weeks ahead.

On the specific measures in these regulations, in response to the greatly increased risk, the addition of tier 4 stay-at-home measures will be familiar to people from the November national restrictions. Tier 4 involves minor changes to those national restrictions. As of November, people in tier 4 areas must stay at home and not travel out of tier 4. They may only leave for a limited number of reasons such as work, education, or caring purposes. We are advising that clinically extremely vulnerable people in tier 4 areas should do as they did in November and stay at home as much as possible, except to go outdoors for exercise or to attend health appointments. The regulations contain the same exemptions as other tiers for childcare and support bubbles. We advise that people elsewhere avoid travelling into a tier 4 area, unless they need to do so for work, education or health purposes.

Can my hon. Friend help me? Statutory instrument 1572 required the people of Christchurch to move from tier 1 to tier 2, and it came into effect on 19 December. Today, the Secretary of State has announced that the people of Christchurch should be moving into tier 4, with effect from midnight tonight. What has happened between 19 December and today to force the people of Christchurch to lose all that liberty?

One thing that I will do when I have finished speaking is see whether I can look up the specific data for the hon. Member’s constituency. In general, however, the announcements made today, just as with previous announcements, are based on the data that we are seeing, which includes rapidly rising rates of infection in certain areas, the level of new infections, the trajectory and hospital pressures.

The tier 4 regulations require all non-essential retail, indoor entertainment, hairdressers and other personal care services to close. International travel is also restricted to business trips only. However, we have listened to hon. Members and the public about what is most important to people in their daily lives so, unlike in the November restrictions, communal worship and a wider range of outdoor recreation are still permitted. We also recognise the restrictions’ impact on businesses and continue to provide them with ongoing support to help get through the crisis.

We know that these measures are hard. We know that they keep families and friends apart, yet we also know that they are necessary for us to get through this situation and to prevent the loss of lives as we do so. This virus thrives on the things that make life worth living, such as social contact, but that means we can all play our part in stopping the spread—as I said, if not for ourselves, then for others. The end is in sight, but for now it is our duty here in Parliament to put in place these restrictions—onerous though they are—to control this virus. I commend the regulations to the House.

As I said, we will start with a five-minute time limit on Back-Bench Members. I remind hon. Members that, when a speaking limit is in effect for Back Benchers, a countdown clock will be visible on the screens of right hon. and hon. Members participating virtually and on the screens in the Chamber. For right hon. and hon. Members participating physically, the usual clock will operate.

I hope you had a good Christmas, Madam Deputy Speaker, and I wish you and all colleagues a happy new year. I take this moment to express our gratitude for the work of you and the staff to ensure that we could sit today. I also associate myself with the Minister’s comments regarding this country’s outstanding health and social care workforce, who have made Herculean efforts over Christmas and new year. They are greatly appreciated.

There is something very 2020 about discussing covid regulations three hours after a subsequent set of regulations were introduced, but it is nevertheless important that we do so. I will cover each of them, perhaps making some cross-cutting points as I do so.

With regard to SI No. 1611, we discuss these regulations today because we are obliged to do so following their introduction on 20 December. However, we are compelled to do so because the failures of the restrictions announced on 2 December. At some point in the next few parliamentary days, we will debate the restrictions announced from the Dispatch Box earlier, and we are compelled to do that because of the failure of restrictions that we talk about today. This episode is a perfect encapsulation of the failings of the Government’s handling of the pandemic: slow and always falling short.

The Government have now had three goes at a tier system. The first two have failed, and today’s announcement marks the final attempt to salvage a third go. We must hear from the Minister today a clear commitment that, based on the best scientific guidance available, the Government firmly believe that these restrictions will halt the rise in the infection rate and, indeed, start to reduce it. We must have that commitment today, because otherwise we will be back here time and again. When the Minister hopefully makes that commitment, there ought also to be a commitment to publish the guidance that the judgments are based on, so that we might begin to repair damaged trust.

The stakes are high. We cannot afford failure. Our national health service is experiencing dire pressures. A major incident was declared in Essex this afternoon. Elsewhere, exasperated doctors are taking to social media to report that oxygen is running out. An internal incident has been declared at the Queen Elizabeth Hospital in Woolwich. London hospitals are asking their counterparts in Yorkshire for support. Rates of sickness in our care facilities are increasing. Right hon. and hon. Members had a call this afternoon with Stephen Powis from NHS England, and it was clear not only that the pressures are significant, but that we can expect multiple weeks of growing demand. If the Government dither and delay again today, the price will be significant indeed.

We are considering a bundle of five different regulations. I do not intend to labour too much on SI No. 1533 or SI No. 1572, as they exclusively deal with moving specific geographies into specific tiers and are now significantly out of date, as was elegantly demonstrated by the hon. Member for Christchurch (Sir Christopher Chope).

SI No. 1611 creates tier 4, something that nearly 80% of us will now need to get used to. I shall cover that shortly, but it also deals with Christmas. Although that is of course now in the past, it is worth reflecting on briefly. The change was announced on 19 December, turning the nation’s plans upside down at a stroke. Of course, some allowance must be made for the changing nature of the virus; I accept that. We are in very fast moving times. However, it was clear many days before the announcements were made that the initial Christmas plans would not be sustainable. That was regrettable, but it was clear. On 16 December, the Leader of the Opposition asked the Prime Minister from this Dispatch Box to look at it again, and the Prime Minister replied characteristically with bluster and bluff. Later that day, he said that it would be an “inhuman” thing to do, but of course he had to. He delayed, he dithered and, eventually, he had to do it anyway. Again, these things matter because they chip away at public confidence bit by bit to create a sense that the Government do not really have a handle on the crisis.

We will all have been cheered—the Minister majored on this in her speech—to wake up this morning to the news of the approval by the Medicines and Healthcare Products Regulatory Agency of the Oxford-AstraZeneca vaccine. This is an extraordinary scientific success and a vindication of the Government’s backing of multiple vaccine candidates. We should be exceptionally proud of Britain’s role in this vaccine and others. It is a great success story for our country and our place in the world after such a significant day today.

The Health Secretary said today that the vaccine is the way out of the pandemic, so for us today the vaccine must be the way to end the regulations. That is nearly right, because actually it is a vaccination programme that is the way out of this. Of course, a vaccine is the most vital component of such a programme, but now that we have that it ceases to be so much a question of science and becomes a much more rudimentary and basic exercise in logistics.

The Government have faced two such major logistics challenges in this pandemic. The first was the effective and urgent procurement and distribution of personal protective equipment and the second was the roll-out of the test, trace and isolate system. Both have been significant failures. The PPE roll-out was a farce for at least the first two months, and the test and trace system has not delivered, even on the Government’s own metrics, since its introduction. At the root of both these failures has been the same slowness that has characterised the Government’s response to the pandemic. They have been slow to respond and slow to grasp the scale of the challenge—this cannot happen again with the vaccine.

I have an awful lot more confidence in a programme that will be delivered by the NHS than in one delivered by one of the companies that the Government seem to default to even though they do not tend to deliver for them. There are still some questions, however. NHS staff are in category 2 of the initial prioritisation, but we are still hearing that there has not yet been a full roll-out. Can the Minister let us know when she anticipates that all of our NHS heroes will have had their jab? Of course, that is the least they deserve, but we have heard today from the British Medical Association that NHS staff absence is at 10%, so it is a pragmatic necessity that, as we deal with increasing demand, we have a resilient workforce to do that.

We saw a significant change of direction in the administration of the vaccine this morning. Previously, we were administering it in pairs about a month apart, and that was seen as the best way of delivering it effectively. Now, the Government have made the judgment that they will go to a first shot, with a second shot to come three months or so later. I assume that this reflects the best advice of the Joint Committee on Vaccination and Immunisation, and if so we will support it, but will the Minister publish that advice and, crucially, the roll-out plan?

We know now that we have enough vaccines for everyone who wishes to take the offer up. We know that we have a national health service and different ways of dispensing it through our GPs and our hospitals. We know all the components, but we now need to know the timetable. That is important so that it can be scrutinised and perhaps improved, but also so that we can build public confidence in this crucial plan. People are rightly looking at this with great hope, and it is right that they know that there is a proper process behind it. In the meantime, however, the way out of the tiers as constituted in SI Nos. 1611 and 1646 remains to reduce the five metrics on which the Government say the tiering decisions are based.

As a constituency MP, I have to say that this is a Kafkaesque process. Like you, I suspect, Madam Deputy Speaker, I have met Ministers, Government scientists and NHS leaders, both national and regional, and I still do not believe that there is a particular criterion for going up and down tiers. It is more that you kind of know it when you see it. To an extent, that is understandable. This is a complicated mix of infection rates, healthcare capacity and their associated trajectories and direction of travel, and then you kind of cook them all up altogether, so it is never going to be one number at one time at one moment. However, it is a significant issue for us as local leaders that we cannot build confidence in regulations by answering the basic question from constituents. I have had this multiple times, as will other hon. and right hon. colleagues. Constituents are saying, “I accept that we are in the tier that we are in, and it is important that we are. I wish that we were in a lower one, so that I could do more of the things that I enjoy doing. What do we need to do in order to achieve that?” Frankly, as a local leader, I cannot answer that question and I doubt that anybody, including the Minister, could answer that question either.

What we did not hear from the Health Secretary from the Dispatch Box earlier, and what we did not hear from the Care Minister in her contribution just now, is that the reality is that you are in your tiers now, especially in tier 4, until the vaccine is rolled out. However, we have heard from the Prime Minister on that, hints on that from Robert Peston and hints on that in a reply after the Downing Street briefing. If that is the case, it is time for the Government to be honest about it. The one thing that we know after the year that we have had is that the British people can take it. They can take that level of honesty. What they hate is when plans are changed at the last minute. What they hate is being told that, if they push down the infection rate in their community, they will be able to get back to doing the things that they love doing, and then finding out that it is no longer that but the percentage of positive tests. We have been through that in Nottingham; it is horrible and it is chipping away at confidence. It is time for a bit more honesty.

We support the introduction of these tiers. We withheld our support from the three-tier system. We did not believe that it would work and it did not. This goes further, so we are willing to support it, but two things need to be resolved with regulations that flow from today’s announcements, but also relate to the regulations we are discussing today. First, on the support for business, the £1,000 for wet pubs was an insult—£30 a day for the busiest time of year. Tiers 3 and 4 mean a shuttered hospitality sector. Viable businesses, jobs and livelihoods that are closed for very good reason must be better supported.

Similarly, tier 4 restrictions were introduced 10 days ago. We have worked throughout this pandemic on the principle that as restrictions increase, so does support for businesses, jobs and communities, but we have heard nothing since then. Where is the Chancellor? His slow and shorthanded response in his winter economic plan meant that, in the end, he had to have four different versions of it. Frankly, we might need another one because, otherwise, these restrictions will mean significant damage to our economy and to lives. This means action, finally, for those who have fallen between the various schemes on offer. We could dispute all day how many have been excluded, but we cannot deny their existence. I would give the Government significant latitude in understanding that, as you make up a furlough scheme and a self-employed scheme out of nowhere for the first time, there will be gaps between those schemes. It is entirely obvious that that will happen. However, what we must do is do something about it and close those gaps. It has been months and months, and now the Government really have to do it.

Secondly, a fundamental gap remains the test, trace and isolate system, which is fundamental to breaking the chains of transmission. The Prime Minister promised 100% of results within 24 hours nearly six months ago. At the moment, that figure is 19%. If we allow for next day, rather than 24 hours—because it is still the Christmas season—that figure rises to 37%, which is pathetic. On tracing, things have got better, with the greater improvement of local authority teams. However, the one way the Government have made significant inroads in their testing statistics is by defaulting to the canniest tactic in the book; they have changed the way this is counted. Generally, that is not a good sign about how things are going. Again, progress here has been pathetic.

Crucially, we come to isolation payments. All colleagues will have heard stories of constituents making that impossible choice between feeding their families and doing the right thing for the national effort. The £500 payment was too slow to come forward and does not adequately replace lost income. The scheme is still so full of holes and very much depends on how the system picks you up. Self-isolation should be automatic and we have failed communities by not creating conditions for it to be so. Ministers will want to blame the new strain for covid’s continued spread, but the reality is that they did not have control of the virus prior to this and they still do not have an adequate test and trace system to subdue and control it anyway. In the course of such a defective system, we have managed to spend £22 billion—dearie, dearie me.

Finally, on regulation No. 1518, we are happy to support the reduction of the self-isolation period from 14 to 10 days, assuming, again, that it is based on the best scientific evidence. Will the Minister commit to publishing this?

To conclude, we are at a crucial point in this pandemic. Today, with profound sadness, we hear of the passing of a further 981 of our fellow countrymen and women. The total directly who have lost their lives from covid alone is over 70,000 but, in reality, it will be many, many more. Those are big numbers but behind every one of them is a life, a person missed, a grieving family. Today, we have heard that the way out of this is in sight. However, we have also heard that things are poised to get much, much worse before they get better. In recognising this, the Government’s response is another system of tiers. These have failed every time so far. They must not fail now and we must hear from them why they believe they will work. We must also hear more clearly what they are going to do to deliver on other crucial aspects—on the vaccine and on test and trace. Failure to do otherwise will cause extraordinary harm.

This House legislated explicitly for specific arrangements to govern the celebration of Christmas, and no sooner than the House had risen itself for Christmas, the Government, by ministerial fiat, changed those arrangements. We are asked this evening to give retrospective legislative approval to the changes that they made. We are in the absurd position of being asked to vote for the ghost of Christmas past.

Sometimes in a democracy, process has an importance. I am constantly—daily—confronted by individuals and businesses facing ruin, notwithstanding the huge investment that they made in covid-secure premises and procedures. What we have never had, and what we have always been asking for, is the cost-benefit analysis that the Government made on each of the restrictive measures that make up the menu of their tier system. I do not for one moment question the motives of Ministers. I do, however, question their ability, in exactly the way that I question my own ability.

When the House rose, the lobby of Government scientific advisers—a lobby, we should remember, that had already publicly expressed their frustration that their earlier strictures on how Christmas should be celebrated had not been fully taken on board by the Government—announced that they had discovered a new strain of the disease so much more transmissible than the earlier one. They bounced the Government. I have to accept, of course, the possibility that they may be absolutely right, but I know this: were I presented by such a lobby of eminent scientists—eminent people leading in their field—and told that they had discovered this new emergency, and that so many more people were going to die, and unless I did what they said, I would be responsible for their deaths, I would find great difficulty in having the wherewithal to identify and ask the right questions to be sure that they were on the money, or 100 miles from it.

What I would certainly want, and what I believe the Government need, is an alternative source of expertise—a competitive source of expertise—particularly statisticians leading in their fields, who would be able to furnish me, to arm me, to arm Ministers, with the right questions to ask about the validity of the modelling and the data. It can only improve the decision-making process. But what is really galling in all this is then to hear on the airwaves Professor Ferguson being interviewed, giving his wisdom to the nation once again, to all intents and purposes as if he were still a key Government adviser. I do hope that the Minister winding up the debate will be able to assure us that that is most certainly not the case. I was always rather jealous of Poole, Christchurch and Bournemouth, because our infection rate in the New Forest was substantially lower than theirs, but they turned out to be in tier 2 and we were in tier 3. Now we are all together in tier 4.

My right hon. Friend is absolutely right to say that we are now in tier 4, but in statutory instrument No. 1646, which was laid before this House on 29 December, we were in tier 2. Today—one day later—we are in tier 4. Is that not a mockery?

The reality is this. These are the questions that my constituents put to me, and I am reduced to saying, “It’s one of life’s great mysteries.” The decision-making process is entirely opaque. That is why I voted against it when I had the chance.

May I join colleagues in thanking House staff, Mr Speaker and the Deputy Speakers for enabling us to be recalled today?

This is a dangerous moment for our country, with hospitalisations now higher than they were during the first peak. With a new variant of the virus circulating in many areas of the country, we need action to protect lives. The route out of this pandemic is vaccination, so it is welcome news that we have the Oxford-AstraZeneca vaccine and that the vaccine roll-out is accelerating. However, there remains significant confusion about who is currently eligible for the vaccine. We have been told that NHS and care staff will be a priority, but I have also heard that some trusts are putting a 5% cap on the number of vaccines for staff. We have already lost more than 600 healthcare workers to the virus, and leaving them unvaccinated for longer puts them at risk.

Does the Minister agree that we need a target date for vaccinating all frontline NHS and care staff, rather than just leaving it that they can get any vaccines spare at the end of the day, as the Secretary of State said earlier? The Minister thanked our staff, but can we now ensure that we protect them by vaccinating them?

We know that restrictions will work only if people comply with them, and although compliance has been generally high with people choosing to do the right thing, it appears to be slipping. That is deeply concerning in the context of the higher transmission rates that we are now seeing with the new variant. Unless compliance remains high, we will need ever-tighter restrictions to keep the virus under control. Will the Minister set out what the Government are doing to boost compliance, particularly with regulations such as those on face coverings? Will he confirm what support the Government are giving to local authorities and businesses to allow them to enforce the regulations? At the moment, many businesses feel unable to take the steps they need to take to keep their customers and staff safe. That is vital because of the pressure that our NHS is now under.

With more than 21,000 people in hospital and major incidents declared across the south-east, it is clear that our hospitals cannot cope if cases continue to rise. On top of that, many NHS staff are worn out and burned out after a year in which they have been under constant pressure. We are facing a situation in which the NHS may be overwhelmed, and there appears to be no safety net. Will the Minister confirm what the Government are doing to get more staff into or back into the NHS, and what contingency plans they have to ensure that routine services can continue if coronavirus cases continue to rise?

Finally, I want to ask the Minister what will happen if moving many areas into tier 4 restrictions, which we have been told is necessary to control the new strain of the virus, proves insufficient. What are the escalation plans and trigger points after tier 4? Setting out any plans for escalation in advance would enable people and businesses to plan for the worst while hoping for the best. I hope the Government will now set out a plan that makes clear what they will do if case numbers continue to rise. As my hon. Friend the Member for Nottingham North (Alex Norris) said, the British people can take honesty.

May I put on the record some remarks about our former colleague the Member for Northampton South, Brian Binley? He was first elected in 2005, in the same election as me, and was a valued colleague and a very kind man; many new Members have said that he was very kind to them, and I know that he will be much missed by his family and friends. I thought it appropriate to say those remarks in this Chamber, where he loved serving his constituents.

I also mention Parliament because I am very disappointed that the House will not sit next week. I listened carefully to Mr Speaker’s remarks at the start of today’s business and I recognise the pressures on the staff of the House; I add my thanks to all those who have worked and are working incredibly hard, not just today but on preceding and subsequent days, to ensure that the House can sit. However, at a time when the country faces incredible challenges and many workers in the public service are working incredibly hard, the House’s role in scrutinising the important decisions of Government is essential.

I made representations earlier today and was pleased to listen to the Leader of the House’s response to the shadow Leader of the House, the right hon. Member for Walsall South (Valerie Vaz), in which he made it clear that if the House votes this evening to adjourn until 11 January and if events over the next week or so demand it, the Government would seek to recall the House so that it could hold them to account. I assure the Government that if events necessitate a recall but it does not happen, hon. Members—certainly on the Conservative Benches, but I suspect on both sides of the House—will make appropriate representations very loudly indeed.

I have a couple of questions about the new variant of coronavirus. I have read some of the science behind it, and I recognise that there is a significant body of evidence about the increased transmissibility, but I am not clear what other steps individuals should take to deal with the fact that it is more transmissible. I have not heard any guidance about whether we need to maintain larger distances, wear masks in more scenarios or take other steps ourselves. The Government’s only response seems to have been to shut more sectors of the economy. I think that the Prime Minister admitted at the press conference today that it is an open question whether the tier 4 measures are likely to be effective.

As usual, my right hon. Friend is making a very thoughtful speech. As the Health Secretary said this evening, the vast majority of the big rise in infections yesterday were of the new variant, which logically suggests that the old variant is almost disappearing from the community. We could do with understanding that distinction each day when new data on infections is published.

My hon. Friend makes a good point, because that will help us to understand the extent to which the new variant is spreading across the country; I know that the Government are concerned about that. I suspect, although I do not know—perhaps the Minister could confirm this at the end of the debate—that that was behind the move of significant portions of the country into tier 4.

Given that most of the country is in tier 4 and most of England is now effectively in lockdown, it seems to me that the only measure in terms of closure that remains to the Government is to close schools and colleges—we saw a hint of that this afternoon in what the Secretary of State for Education said. There are not many other measures left to the Government, so if that does not work, they will need to think again.

Finally, let me elaborate on what I said to the Secretary of State earlier about the vaccine roll-out. As the Government have made clear and as I think the Secretary of State said in an interview with Andrew Marr, the areas that have been moved into tier 4, which includes 78% of the country and I suspect by next week will probably include the rest, will basically stay there until we have rolled out the vaccine; the Opposition spokesman, the hon. Member for Nottingham North (Alex Norris), referred to that as well. It therefore has to be job No. 1, not just for the Department of Health and Social Care but for the whole Government, to get the vaccine rolled out as fast as possible.

In my question to the Secretary of State, I said that that meant that the Government need to get to 2 million doses a week. If they do that, we can vaccinate everybody over 65 by the third week of February, which will take nearly 90% of the risks of death and hospitalisation out of the equation. At that point, we should be able to remove restrictions, at least in law, and allow the country to open up again. The Secretary of State appeared to agree—he said that he agreed.

The Government need to put their shoulder to that objective. This has got to be the central task, and the reason for that is the significant cost to businesses. I know that there will be many businesses in my constituency—non-essential retail, personal care services—that will be devastated by the fact that, as of midnight tonight, they are going to have to close. I have had drawn to my attention the devastation in hospitality businesses in tier 2 areas that were preparing for a really busy evening tomorrow, but that, with just 24 hours’ notice, are now going to have to close. They are going to have a huge amount of stock and product that they have bought, which in effect will have to be thrown away. They are not going to get compensated for that, and that economic loss is going to be devastating for many businesses.

Those are the things that I think the Government need to weigh in the balance, and I look forward to listening to the Minister when she winds up the debate in a couple of hours’ time.

I want to start by giving my thanks to key workers and the NHS for everything they have been doing across Christmas. I know many of them are feeling utterly and completely exhausted, and that many are feeling frightened when they think about how they are going to cope and what is going to happen in the weeks and months ahead. I just want to put on record my gratitude to them for everything they have done.

I fear that I will be repeating myself, because this is the third debate I have spoken in on this subject and I am nothing if not persistent. I may be overly optimistic that, at some point, the Government will listen and give me the things I am asking for. My questions include: where are the Nightingale hospitals? I have raised this question many times and I tried to raise it earlier in a call with the Minister, but I still have not been given a clear answer. Are they going to be opened and are they going to be used again? Where is the surge capacity that the Government promised us? I am in danger of thinking that the opening of these hospitals was in fact just a publicity stunt, but surely I must be wrong.

I recognise the need for the additional covid restrictions to help save lives, especially with the new variant being transmitted at a much higher rate. However, I fear that the Government will lose support for these restrictions and their tiering system if people continue to see their livelihoods go and their life’s work destroyed. Whenever they announce tiers and restrictions, surely at the same time the Government should be putting out an economic statement telling people how jobs must be saved.

I make no apology for again raising the plight of the coach industry. This is the fifth time I have raised this problem, and I had hoped after I had a personal meeting with a Treasury Minister, along with representatives from the industry, that the Government had finally listened. However, I was deeply disappointed with the response to some of our asks, especially since—believe it or not, Madam Deputy Speaker—I had managed to make requests that were cost-neutral to the Government. They just required will and a little bit of effort. In a letter back from the Minister, they stated that

“it will not be possible to preserve every job or business indefinitely, nor stand in the way of the economy adapting and people finding new jobs or starting new businesses.”

This completely failed to recognise that the coach industry is a viable industry. The only reason this industry is suffering is the covid restrictions—there are no other reasons—and it will be successful again.

When I raised concerns about the coronavirus business interruption loans and that only 20% of the industry was successful in applying for them, the response again from the Government was:

“We believe these measures to be sufficient.”

That is in complete contrast to the reality these businesses face. They also said in the letter that

“it would not be appropriate to contact lenders on a sector by sector basis.”

I really urge the Government to think again about that, because that is exactly what this industry needs. Finally, to make it worse, in the letter this Government wash their hands of any further support for the industry, stating that

“options to refinance existing facilities…is at the discretion of the lender”.

Basically, they are saying, “It’s nothing to do with us.” It is no wonder that people are rebelling against the restrictions the Government are imposing when they are not being given the support they need. The Government could decide to support this industry, and they are actively making a choice not to.

In the remaining time I have, I would like to mention, also again, the young people excluded from support, who are facing a desperate Christmas. I want to quote from a letter from Charles Cracknell regarding the young entrepreneurs in Kingston upon Hull West and Hessle, because this makes the point for me. He said:

“I am particularly concerned for those that came off benefits to establish a business or who were working and/or studying to run a business and now find themselves on benefits which means it’s more difficult for them to invest in their businesses or had just started out and who had struggled even before the current situation but were showing great determination to make a contribution to the local economy. Less than a third of the young entrepreneurs that we have supported…are in a position to trade at the moment and even with gradual reduction in lockdown arrangements find themselves in difficulties and it would be inappropriate for them to take out a loan and to be honest why should they at this early stage of development as a business.”

These young people have received nothing from Government and face seeing the businesses they have worked so hard to develop being destroyed, with a return to the life on benefits that they have only just escaped. Because of the restrictions, their businesses cannot open, so more must be done to help them.

In my last 20 seconds, I want to mention the hospitality industry again. Why are there rules to shut down yoga studios? Why the lack of additional support for Hull? If the Government want support for tiers to continue and if they want my support for these restrictions, they must begin to give Hull West and Hessle the financial support that we need.

May I, too, add my thanks to all our frontline NHS and care staff, and to all those who have been involved in bringing the Oxford/AstraZeneca vaccine to approval today? The news is very welcome.

With all this talk of the cavalry arriving, the reality at our hospitals on the ground is stark. We see ambulances queuing and major incidents being declared in London and Essex, with reports that ICU patients are being transferred the length and breadth of the country. It did not have to be this way. The timing of this debate and the content of the statutory instruments that we have been asked to consider epitomise the Government’s handling of the pandemic to date: too little, too late, in the face of clear advice from scientists and health service leaders. The fact that, as a London MP, I was asked to consider the move to put my area into tier 3 on 16 December after just two weeks in tier 2, following a national lockdown, then the move into tier 4 on 20 December, together with the belated changes to Christmas restrictions, shows just how ineffective, ill-timed and ill-thought-through some of the interventions have been, with limited transparency on some of the criteria.

That dither and delay, with constant chopping and changing on the rules is proving a catastrophe for our health service, costing thousands of lives. Of course, the new variant of the virus has made matters much worse, and quickly, but all the signs were that something was afoot in Kent in the November national lockdown. Given the growing gravity of this national health emergency, new restrictions and the confirmation of the new variant, I simply do not understand why Parliament was not recalled before Christmas, as other hon. and right hon. Members have said. To bundle all these retrospective decisions up with consideration of a monumental change to this country’s relationship with the European Union on just one day of parliamentary time demonstrates the Government’s complete and utter contempt for Parliament.

Over the past nine months, my Liberal Democrat colleagues and I have raised in the House what experts have repeatedly called for to tackle the pandemic more effectively, including evidence-based interventions; a robust system not just to test but to trace and isolate every case; proper support for our health and care staff, including personal protective equipment, mental health support and now vaccination; and prioritisation of social care alongside the NHS. The Government have either not listened or have been too slow to act. They have let down the House and our country, and they have let down the very people on the frontline who are tackling the crisis head-on: NHS and care workers. We have seen a growing mental health crisis among staff, which is set to become worse with the prospect of another peak that is worse than the first. The Secretary of State promised to look at my proposals for additional mental health provision for staff in May, yet this week a psychiatrist said to me:

“Staff are anxious and we…have been treating colleagues who are at breaking point and attempted suicide. Some have been admitted to mental health units.

That happened before but it is worse now.

Add to that the message that staff are expendable and getting the vaccine to them is not happening and I think my mental health team will be seeing more staff.”

While Ministers are patting themselves on the back today, they should hang their heads in shame. We are beginning 2021 as the sick man of Europe, with our health care workforce on their knees. If the very welcome cavalry are to succeed, Ministers must urgently publish a detailed, cross-departmental roll-out plan for the vaccine. Modelling has shown that a vaccination rate of 2 million per week will need to be delivered, alongside ongoing restrictions, to significantly reduce deaths by next summer. With GP surgeries and hospitals already overstretched, the logistical challenge is immense.

There was an alternative to 2020. We did not have to be in the position where people were alone at Christmas and families sat down with an empty space at the table. As we start the new year, I beg the Government to show some humility. They should listen to the experts and ensure a swift and efficient roll-out of the vaccine, or they will not be forgiven. So we will support these regulations, given the parlous situation we face, but we need more transparency and publication of all the evidence and criteria. We need an improvement in contact tracing, giving local authorities control of that, and more financial and practical support for self-isolation, as well as financial support for the hardest-hit sectors.

I hope that everyone in this House would agree that we all long for the day when we can throw the last mask in the bin and enjoy the freedoms we expect in life. I am sure that my constituents in East Devon will share my disappointment that we are now heading into tier 3, but throwing caution to the wind now could bring more than a hangover in the new year, as case numbers continue to rise across Devon and our NHS remains under strain. However, it is clear that we need a pathway and a timeframe to come out of these restrictions sooner rather than later. The hospitality industry now faces widespread closure as more of the country heads into tougher restrictions; it is time to look again at the financial support for our pubs, hotels and restaurants and their suppliers. They all did their duty to keep customers safe, so let us not put hard-working staff in danger of losing their jobs.

As 2020, thankfully, draws to a close we do have real hope for the future; the roll-out of the Pfizer BioNTech vaccine was a major step forward in our fight against covid. I would like to thank Dr Barry Coakley, Dr Simon Kerr and everyone at the vaccination centre in Exmouth for their hard work to give 2,000 people the first dose of the vaccine in the run-up to Christmas. It is a truly remarkable achievement, and Exmouth is not the only place where people in East Devon can get vaccinated.

We all woke up to the very welcome news about the independent approval of the Oxford AstraZeneca vaccine. The Government have ordered 100 million doses. That is enough to vaccinate 50 million people. The roll-out begins next week, and I would like to thank the Secretary of State and his team for all their hard work to make this possible.

Mr Deputy Speaker, we cannot let our guard down, but we can now look ahead to 2021 with renewed hope and optimism.

I also pay tribute to those working on the frontline, particularly at the moment at the Homerton hospital in the heart of my constituency, which is experiencing a very high pressure of new covid cases coming in, and the Royal London, where I lived for nine weeks with one of my children when they were very sick, which is also experiencing huge pressure and serves my constituency well as well. I also want to pay tribute to Hackney council staff, in particular those who empty our bins and keep our streets clean and our parks nice. Our public realm has risen to the occasion, which is an odd thing to say in covid, but we always had clean streets and good parks. They have done a sterling job and kept us going through the dark days of lockdown.

Hackney and the City—we were linked with the City for health purposes—were already in tier 4 and have been since before Christmas. Our cases are now more than 850 per 100,000, which is an exponential increase when we look back to 25 November when we were at 124 per 100,000. Just before we went into tier 4 we were at just over 500 cases per 100,000. It is a very serious matter and had this been a month ago, when we were at 124, I would perhaps have been arguing a slightly different case. So on public health grounds I back tier 4 and I suspect—I hope that the Minister will be honest—that there will be a tier 5 or some further lockdown if this new strain keeps replicating at the rate it is doing, and of course if any other new strains arrive. We all pray that no strain becomes apparent that will affect our children worse than they are already affected.

I do have concerns—very big concerns—about how the Government have handled this. We have had mixed messages. The schools announcements today and just before the recess were all over the place. Half-announcements are made, but no detailed information is available. If we press a question, we get nothing back. It is great when the House is sitting, so theoretically we can hold Ministers to account, but too often we get no answers. At times we have online briefings, but—I say this with respect for the Minister, who is a good Minister and tries hard—they are short; they are not enough. We cannot get hundreds of colleagues on and get their questions answered. As MPs in our area, we need information to be able to answer the questions that are already flying in from headteachers not knowing what is going on with schools next week, with our rates so high but our schools still open. Of course I and local headteachers want our schools open, but why are they open when schools in neighbouring boroughs with similar rates are closed? It is very confusing.

We also need clarity about where the transmission is coming from. What I understand from public health briefings—I am sure the Minister will elaborate—is that it is largely community-driven. The community driver goes into schools, from where it then spreads. We need to be really clear about that, because, judging by a number of emails I have had in the past couple of days, teachers and headteachers are frightened about what next week will bring. They need clarity and certainty. They are vital frontline key workers, doing their best to educate our children in difficult circumstances.

I completely agree with the hon. Member for East Devon (Simon Jupp) about the business issues. My local hospitality industry has been decimated. The 10 pm curfew seems to have been plucked from the air, because it became 11 pm only about six weeks later. Again, we need clarity. If it is not clear, or the decision is a subjective one, fine, but level with the British public and the industries affected—the events industry, the creative industries. Tell them, engage them, get them into Government earlier. When I talk to permanent secretaries, as I often do on the Public Accounts Committee, and ask them who they are engaging with, I get vague answers, but actually sometimes they do not have the right people in the room. However brilliant and clever our civil servants are, they need to be talking to people on the frontline, because in the end who is delivering the tests in schools? It is the headteachers and staff. Who is at the frontline in hospitals? It is not civil servants; it is our health workers, and we need to listen to them.

I am concerned about the frontline impact in the NHS. Earlier, I raised with the Secretary of State the number of nurses who are potentially able to work and want to—about 71,000 of them, yet only 1,000 got through the system. Frontline nurses from various parts of the country, not just Hackney, have told me that they are struggling to get to the right place to contribute.

In short, we need proper economic support for the businesses that are closed. We need proper testing in place, and that must be worked on with the organisations that will have to deliver testing. We need clarity on testing and in the messaging. Above all, we need honesty—honesty about the route out. We need to treat the British public with the respect they deserve by providing information and explanation when it is not clear. That is enough. People understand that difficult decisions have to be made, sometimes at the last minute, but people need to know if something is coming down the line. People in government always think they need to have a definite decision or a definite point of view to put out there, but actually, in this situation, people can sense what is coming and the Government need to be much more honest about that. I hope the Minister will respond when she winds up the debate.

None of us went into politics to do this kind of thing —to put restrictions on people’s liberties and their livelihoods. With the exception of statutory instrument No. 1518, which at least reduces the period of self-isolation from 14 to 10 days, I loathe all these regulations, but I judge that this time, based on the evidence available to us right now, they are necessary. However, today’s good news means that we may see the end of these horrible measures sooner rather than later. In particular the news that one jab will bring 70% efficacy is good news indeed, because it means that we may see the back of this sooner than many of us thought possible. That is the good news.

We also need a degree of humility. No set of regulations can govern every vignette of human activity. I feel for those who had to draft the instruments and plough through them, trying to work out what may cause people to be at risk. Producing something that makes at least some sort of sense and that we can sell to our constituents is extremely difficult. We also need to understand that the virus is not orderly; it does not respect the parliamentary timetable, so anticipating what may be required in two, three or four days’ or indeed weeks’ time is almost impossible. Pointing out that statutory instrument No. 1646 has already been overtaken by events is therefore churlish. I am sorry that the Opposition do not cut us a little bit of slack when we are faced with a virus that does not respect any sort of timetable and that will change and change again.

It is difficult to explain to our constituents why, for example, they can go to a garden centre but cannot play golf. It is the duty of all colleagues to explain to the public, who are the unsung heroes in all of this and who, by and large, have kept the faith, why we have to have these restrictions and that all of us are trying to ensure that their liberties and livelihoods are returned to them at the earliest possible opportunity.

I have been troubled by one or two points about tiering. The tiers are based on five points, one of which is the ability of hospitals to cope. In the south-west this has been disappointing, because it has revealed that our capacity is not as robust as in other parts of the country. Partly that is because of staffing. I was disappointed over the summer that many of those who volunteered, either as recent retirees or as people who are not currently in patient-facing roles, were not trained. That has been, to some extent, a missed opportunity. I hope that as we go into the second wave, those skills that are not now in place will not be needed, otherwise there is scope for some embarrassment. I know, because I spoke to the Secretary of State, that he understands and empathises with some of these difficulties. I hope that Ministers will redouble their efforts to make sure that those volunteers are utilised.

I very much welcome the remarks of the Education Secretary earlier on. The contingency framework, which those who are less charitable might say creates tier 5 or tier 4-plus, is correct. If possible, I would like some resolution of the confusion over the scale of the schools that are involved. It seems to be rather more than we initially expected. I urge Ministers to do everything they can to keep schools open. It is vital, for every conceivable reason, that we keep schools open. I again emphasise the work of Ackland and others in Edinburgh, using the Imperial College model, which was published in the October edition of the BMJ. It suggests that closing schools may have a counterproductive effect in terms of lives saved from covid.

I entirely endorse the remarks of the hon. Member for Leicester South (Jonathan Ashworth), who said that we should “go hell for leather” in vaccinating people. That is clearly the way out of this, as my right hon. Friend the Member for Forest of Dean (Mr Harper) made clear.

Finally, Mr Deputy Speaker, may I wish you, the officers and staff of the House who have worked so hard and colleagues a much happier new year?

I accept that we need measures to suppress the virus while we await the vaccine roll-out, even if those measures are draconian. I therefore find it difficult to object to the Government restrictions, but I am not convinced that areas switching tiers or being placed in higher tiers will work. The tier system seems flawed, with arbitrary entry points, as in the initial London decision, and no obvious exit route. We have also seen the nonsense of a tier 1 area, Herefordshire, sharing a border with Wales.

If we need a lockdown and further restrictions, surely it should be the same for everyone. This thing does not recognise boundaries on a map, and businesses in all areas have the same needs. If they cannot open and operate, they should receive adequate support and compensation. They need protection from the financial consequences of Government action as well as those of the virus. The hospitality sector, vital small enterprises that cannot pay their rent, the self-employed being punished through no fault of their own—they all need support.

In Birmingham, many of those businesses will be wiped out and thousands more people thrown out of work if the Government do not act. Sure, it costs money, but I say that punishing innocent people will prove more costly in the long run. They are the people and businesses that will help our economy to pick up when we have got on top of this thing and are able to move on.

Why not be honest with everyone—health workers and teachers who have given so much, parents and the elderly? Why not admit another lockdown is necessary? The vast majority will co-operate if they believe it is fair. I think the Minister is well intentioned, but creating umpteen different systems and restrictions has proved a recipe for chaos rather than controlling the virus. And, of course, just as the Barnard Castle episode damaged initial trust, the spectacle of this Government standing by while the Boxing day hunts were free to spread the virus far and wide just serves to reinforce the idea that the rules are not applied fairly to all.

It is not too late to row back from what has become a suicidal game of snakes and ladders, pitting area against area and punishing people for no good reason. I fear that these inadequate solutions will only sow further divisions. Let us learn from mistakes and not go into the new year repeating the same old errors.

One concern that I share with the hon. Member for Birmingham, Selly Oak (Steve McCabe) is about the certainty and clarity of the tiering system and what can be seen as a slightly erratic aspect of that. I appreciate that from the Government’s perspective it is very difficult to judge the impact that tiering will have. As the spread of the virus evolves, it is difficult to have a cast-iron guaranteed view of it, so of course there will be uncertainty in this area, and I think we all appreciate that.

One area where we ought to have a bit more clarity, however—a point well made by many colleagues—is the overall impact assessments that we ought to have for the lockdown. What impact does the lockdown have on employment and business? What impact does it have on health, whether we are thinking about cancer and heart disease, or cataract surgeries and hip replacements? We must also think about the impact on education, which is particularly pertinent today, given the statement by my right hon. Friend the Secretary of State for Education.

We ought to know more clearly about those issues, because we have the experience of the impact on people’s health and education, if they are excluded from education or they do not get their healthcare. We ought to have a greater sense of that, and the Government should have the ability to share that data so that we are better informed when we come to a vote. I also appreciate that when we are looking at tier 4—it was a little bit of a surprise, but not a complete surprise, when it was announced at the beginning of Christmas—we can see why the Government would feel that it had to come in, because of this mutant strain, or variation on a theme, of severe acute respiratory syndrome coronavirus 2.

We appreciate why tier 4 came in, but it was very disappointing, as someone who represents Bolton and can see the impact of having slightly harsher conditions than much of the rest of the country, to see the south-east of England being plunged into tier 4. It was disappointing today to see Bolton as well as Wigan borough—I represent both boroughs—being put into tier 4. It is disappointing that there has not been the opportunity to have a vote on that today, but there may be an opportunity for a vote on what has already been implemented and imposed this year. It would therefore be useful if we could vote in advance and have that data and information so that we can make an informed decision when we vote and get a sense of the impact. Yes, the data on the spread of the virus will not be perfect, but we should be better informed about the impact of the lockdown on our society.

How tiering is imposed is also concerning. For example, Wigan and Bolton boroughs—I represent both—have a lower transmission rate than all the boroughs in the Liverpool city region, yet Liverpool city region is in tier 3 while my constituents are in tier 4. Earlier in the pandemic, the Secretary of State for Health was very clear that individual areas—this is represented now by Slough, I think—can be taken out of a wider lockdown, such as that imposed on Greater Manchester. We would appreciate being withdrawn from tier 4 and perhaps going to tier 3 or lower as soon as possible.

My hon. Friend the Minister for Care might not have the information to hand, but I would like her to look into that and report back, perhaps working with colleagues in the Department for Education, as soon as possible. We know that there will be far more testing in tier 4. We know that the Government’s plan is to have far more testing in schools, and we know that with each positive test, a class or perhaps even a year will be sent home. That has a major impact on children’s education. For months children were excluded from schools and, in the term we have just had, many will have been excluded not once or twice but three times. That means for six weeks. We know that this is set to get worse in the coming year, because there will be far more testing and therefore far more positive tests, which will mean the exclusion of those children. Can we at least have an assessment of the impact of this tier 4 lockdown on those children?

I would like to echo what many have said by wishing the House staff a very happy new year and thanking them for what they have done. I also thank those on the frontline in the health service, who have worked so hard for so many months. They may have had a little respite in the summer, but since then they have not stopped, and I know that many are feeling very tired indeed.

I should like to start my few remarks on a positive note by talking about the AstraZeneca vaccine. Everybody in the country must have welcomed waking up this morning to find that it had been licensed. We need to roll it out as fast as we can. I agree with many other Members, particularly my right hon. Friend the Member for Forest of Dean (Mr Harper), who has said that we need to vaccinate 2 million a week. We need to do that to get ourselves out of this desperate situation of lockdown that does not work and all sorts of problems with businesses, schools and the overwhelming of the NHS, which is what Ministers are extremely worried about. We have to do this as fast as we can. I would like the Minister for Care to look into how well Derbyshire will do that, because I am not convinced that it is ready to go full pelt and vaccinate all the vulnerable and elderly. It is right to aim to get those above 65 vaccinated within seven weeks. That is really important.

I am going to change tack slightly and say, “Bah, humbug!” I felt very disappointed earlier this year when we went into lockdown. In Derbyshire, we had voluntarily gone into tier 2. We then went into the second lockdown, came out several weeks later and were immediately put into tier 3. We are now going into tier 4, from a minute past midnight tonight. When we were put into tier 3, the same as many other constituencies, why were we not called back, since the decision was made the day after we left for our Christmas recess? We could have operated remotely, as many of us are doing today. Looking at the Chamber now, there are very few Members in there, so most of us are working remotely. We could have done that on the day after we had gone into recess. It would have been simple to do, because the staff were still around. We could have made the decision and voted on it then. We are now being asked today to vote on a decision that was made several weeks ago, but we will not be voting on the decision that has been made today. That does not seem logical. Some areas moved into much higher tiers just a few days after the previous decision, but none of us will be voting on the decision today whereby people have gone up to a higher tier and we do not have a clue when we will be coming out of it.

Since coronavirus first started and we started having all the lockdowns and the different tiers, I have been very concerned about businesses. Hospitality businesses spent tens of thousands of pounds, in some cases, on making themselves covid-secure, but they have never been allowed to open. There are small craft breweries in my constituency that are having real trouble because they cannot sell to the pubs as they are not open, so they are selling to the public. There are artists, actors, musicians, singers and dancers who have no job at the moment, and many other self-employed people who are really struggling. We have to look at how we can support those people. We have to look at how quickly we can get this vaccine out so that we know that we are going to be covid-secure and covid-safe and people can get on with their lives.

As announced today, Leicester will move into tier 4. This is a city that has been in lockdown for longer than most. In Leicester we have not been allowed to meet inside any household since the start of the first UK lockdown—that is 10 months.

The Home Secretary was dangerously wrong to claim that the Government have been ahead of the curve throughout the pandemic. There can be zero doubt that on every major strategy the Government have got this wrong. The Government have lost control of the virus. Today there have been 50,023 new covid cases and 981 deaths. On 1 August, deaths from coronavirus had fallen to almost zero. We were at a crossroads. The Government should have opted for a zero covid strategy. Germany invested €500 million in improving schools’ ventilation. China brought plexi-screens into classes. Italy carried out randomised testing of pupils. In England, with no disrespect to our teachers, headteachers and excellent teaching unions, we put some sticky yellow tape on the floor, claiming that that meant distancing in the classroom would be sufficient to scare off the virus. The Prime Minister visited a school in the county of Leicestershire and proclaimed that students’ classrooms were safe. Within days of his visit, a positive infection had been confirmed.

The Government had a choice. Their own SAGE experts told them that opening schools would push the R rate above 1. Indeed, this week SAGE explicitly told the Government to close schools. In the first wave alone, 148 education staff died of coronavirus, according to the Office for National Statistics. In the second wave, deaths of teachers have continued to mount. History will judge us harshly for ignoring teaching professionals and scientists when they warned us to close schools.

The Government acted in the way they did because they perceived themselves to be putting wealth before health. It did not matter to them that African, Asian and minority ethnic people or the poor were more than twice as likely to die from coronavirus. As long as the City of London kept trading, they thought it was a price worth paying. What the Government have failed to grasp is that health is wealth. It was a false choice. By pursuing a zero covid approach, they could have crushed the R rate right down and bought time to implement a proper randomised testing system. They could have invested in online learning and proper equipment, including the internet, so that students could study from home.

Most of all, the Government should have trusted NHS professionals to run the test and trace system. By handing £12 billion of coronavirus contracts to people linked to the Tory party, they put donors first. Public Health England and local NHS bodies are ideally placed to conduct test and trace, and the Government failed to include them.

There is still time to save many thousands of lives, go further than the tiered approach, which at best gives rise to divide and rule, and implement a zero covid approach and a national lockdown. Yes, close schools and keep them closed. Listen to the science and give people the full financial support to stay safe, including the 3 million excluded. We are only as safe as the most vulnerable among us. Give status now to all undocumented workers.

The recently announced vaccine approval is inspiring news for all. Where politicians have failed, scientists have stepped up. The Government must now ensure that those most at risk get the vaccine first, which obviously means care home residents and NHS staff, but it should also include the minimum-wage workers who are getting us through this pandemic. A Deliveroo rider has more right to the vaccine than Etonian billionaires.

We must also make sure that African, Asian and minority ethnic communities and the poor are given fair access to the vaccine. We know that the elderly are most at risk from the virus, yet more than 70,000 Indian and Pakistani grandparents live with school-age children. The Government would be willing to place these communities at risk by reopening schools. I implore the Government to change direction before many thousands more lives are lost.

One last thing, Mr Deputy Speaker—

I would like to start by paying tribute to the NHS staff and care workers who have gone above and beyond the call of duty to care for people suffering from this dreadful virus, and to all those who have been involved in setting up testing centres and the new vaccination centres. They, once again, have had to work incredible hours over the festive period to make our lives more tolerable and to enable people to be tested and vaccinated.

The situation in London tonight is at a critical stage. The report suggests that London hospital capacity is at 99.7%, which does not leave any room for people suffering from covid to be transported to hospital. Equally, the new variant appears to be causing this huge rise in the transmission rate, and the last data showed that every London borough is experiencing an increase in the transmission rate across the board.

In the last public data, my borough was sitting at 632 cases per 100,000 population, yet tonight the report says it is 792—a dramatic increase once again. All the boroughs across London are experiencing these problems, and testing is definitely the answer, but there is a confusing message.

I ask my hon. Friend the Minister for Care to ensure that people understand the process by which they should go for a test. By definition, if we have walk-in centres, some people are walking in thinking that that is all they have to do to get a test. They are not phoning ahead to book a test, or even going on the website to make sure of the correct advice before they turn up. Even more confusingly, in some cases people are literally walking in and getting a test, whereas others are being turned away.

I am also concerned about the position of the vaccine centres. The reality is that, if we now advise people that one jab will be sufficient and that they should wait 12 weeks for the next jab, this will potentially lead to a source of confusion. One of the problems we are going to experience is that people can still carry covid-19 and infect others, even after they have had a vaccine. We need to be clear on that position so that people do not go out and inadvertently cause further infections and transmissions.

The position of learning-disabled people on the vaccination priority list is also an issue. They appear to be just included based on the age range, but in many cases learning-disabled people need the assistance of a carer to attend a vaccine centre. They are not necessarily able to do that by themselves.

We must also take into account the economic impact of this dreadful virus. We have heard about the hospitality industry, but there are many people who have received no help whatsoever from the Government. They may have changed jobs at just the wrong time, or they may be self-employed and unable to produce accounts—we could go through the list. Those people desperately need assistance. In my own borough, unemployment has doubled since the pandemic began. We had virtually full employment, so we were in a position to cope with that, but that has not been the case in many other parts of the country.

On vaccination rates, the reality is that if we vaccinate 1 million people a week, it will take 14 months to vaccinate the whole population. If we can do 2 million a week, we will reduce it to seven months, but that is still far too long. There are also people out there who will resist having the vaccine. We have to promote the vaccine and encourage people to have it as quickly as possible, so that we can get back to as near normal as possible by Easter and beyond. Then we can make sure that the economy bounces back and people are safe.

Finally, I ask my hon. Friend the Minister for Care to respond to this point. The whole of London is in tier 4 right now, but the position in Harrow is confusing because it appears that all the primary schools in the surrounding boroughs will be closed from next Monday, whereas those in Harrow will be open. That seems to be confusing everyone, given that we are in the same position as every other London borough.

First, I put on the record my thanks to all the doctors, nurses and care workers who have done their utmost for each and every one of us and our constituents across the whole of the UK of Great Britain and Northern Ireland. These are difficult times and it is difficult to know whether we are getting it right, but as has been said to me, we have to do the best we can and, in my case and everybody’s case, we have to leave it to our Lord Saviour to take us through.

The public health motions before the House most certainly attempt to do what is seen as the best. However, it is only time that will be able to judge whether they are right. That is not anybody’s fault, by the way, because we and the Government are doing the best we can.

In his covid-19 update statement, the Secretary of State for Health and Social Care underlined that he has regular discussions with the devolved Health Ministers, and I know that he has regular meetings with the Northern Ireland Minister of Health. In the past week, the vaccine has been rolled out to all the nurses and care workers in all the trusts in Northern Ireland. Northern Ireland is, of course, under different restrictions. We have a strict curfew from 8 pm until 6 am every day. That really makes me wonder sometimes. We are allowing fewer businesses to open and the Health Department makes the call on what is and what is not essential. I tried to explain to the cooker and washing machine shop next to my advice centre in Newtownards that mechanics are essential but they are not. I sometimes find that hard to understand and explain. We ask those who can work from home to do so. That is right and proper, but can additional help be provided to coffee shops, which open for takeaway but have no footfall for their business? Although they are able to open, it is not cost-effective for them to do so. What help is coming the way of egg distributors whose sales have dropped by over one third due to hospitality closures and who have donated eggs to homeless centres, shelters and food banks?

We need to implement rules to keep people safe, but that cannot be done without help for businesses going hand in hand with them. I know that this is not the Minister’s responsibility, but my point is that the Chancellor and Health Ministers can work together to provide help.

Lives are paramount and so is future health and the health of the economy to pay for cancer drugs, innovative treatments and research on diseases that kill tens of thousands of people each year. That can only come with money in the Treasury, which can only be there if we invest in viable businesses to keep them afloat in these difficult days. We need to understand that paying rates and council tax is not enough when businesses have to deal with hiring equipment and with mortgaged or rented premises. Although the extension of furlough has undoubtedly saved jobs, and I thank the Chancellor for all he has done, it is not enough to save businesses in the long term. Although I welcome the moves to keep as many people as possible in work until the vaccine roll-out is well established, this may not be enough—indeed, for some it may be too late.

I know that these motions are about health, but, having dealt with businesses, I know that they hear the headline of what is to close and what can remain open, and then wait weeks to hear about the assistance they are to receive. The assistance needs to be there almost immediately, and we must do more to make dual announcements, instead of propagating fear, which inevitably turns to anger. I have seen local businesses breathe a sigh of relief to have made it through the lockdown, only to find out that there is another lockdown and more regulations. They then have to deal with that and muddle their way through, hoping that they can get enough of a breather to get to the other side. It is little wonder that fear and mistrust are giving way to lies spread on social media, which are taking hold, with people believing that it is safe to live life as they ever did before. No, they cannot! We all have a responsibility for each other. We must ensure that regulations, such as those we seek to approve today, come with information and guidance that take the fear out of the equation and deliver the facts. We must let people understand the medical rationale behind a decision, while understanding that they are not being left alone and that help is available.

Today, the Oxford vaccine has given us great hope. As I said earlier, it has almost put a skip in my step to realise that potentially we have turned the corner. It has been hailed as the easiest vaccine to distribute because it does not need to be stored at very cold temperatures. Some stories in the press have been about vaccine being lost because of the temperature controls not being right, but this time we will be able to produce and distribute the vaccine ourselves. We hope that it will speed up the ability of businesses to open, still in a safe way, but permanently.

The danger we have is that businesses are worried for the future, staff are waiting on the redundancy letter, families are stressed, the elderly and vulnerable are feeling alone, and schoolchildren are feeling isolated and uncertain as to what their future lives look like. I am aware, as are others in the Chamber, that mental health problems are rising among our children. The message that comes from this place must show a plan of action and highlight that our Government are standing shoulder to shoulder with every age group that needs help. I plead with the Government to ensure that the same messaging is clear in every region of the UK: we are stronger together, we are coming through this and we must help each other. We can help each other and we can be better together for the future.

This time last year, I was really looking forward to 2020, as the year when we finally get Brexit done. Everything was looking so positive, but what an appalling year it has been. It is nice to end it on a bit of a high, not least having passed the Bill today, but with the welcome news about the AstraZeneca vaccine, which will transform the way in which we will handle this disease. I pay tribute to everyone who has been involved in all the missions to find an appropriate vaccine—it has been a trial. I was not confident that we would ever achieve it and it is a blessing that we finally have done so. It will transform our ability to manage this disease, but we still have a long way to go, because the logistical task of vaccinating a critical mass of the population in order to stop the spread of the disease and save lives will take a number of weeks.

We are therefore still facing restrictions on our behaviour for some time yet, particularly as the Government are using the tools in these motions to tackle the transmission. I still have serious concerns about whether these measures are effective, and I say that as the representative for Thurrock. We are at the top of a league that no one wants to top, as we currently have the highest incidence of covid cases at 1,411 per 100,000 people—the figure for the over-60s is 1,012. We are at that stage despite going into the November lockdown in tier 1. We came from such a good place; we had had no deaths since July and the disease was being managed, yet lockdown has seen it mushroom.

So what has happened? The truth is that closing down businesses clearly was not effective in stopping the transmission of the virus, because it grew in our schools. We had asymptomatic transmission, with schoolchildren taking it home and then from the homes it was going into the workplaces. In Thurrock, we have particular workplaces where the disease has just spread. For example, our local Royal Mail depot has had to close because of the extent of the infection, and in Grays, where I live, we have not had any postal delivery for three weeks. You can imagine, Mr Deputy Speaker, how upset our constituents get at Christmas when they do not receive their post. I have not been a very popular Member of Parliament when I have asked people to be patient at this time of year. That illustrates that there is a question about whether we have really been using the right tools to tackle virus transmission. Putting Thurrock—home to Lakeside shopping centre, a major employer—in tier 4 in the last week before Christmas has frankly done nothing to stop the spread, but it has caused significant economic harm to all who work in retail in my constituency. I urge the Government to focus please on whether the measures that we are using to tackle this virus are effective and delivering the outcomes that we want.

In previous debates on these matters, I have paid tribute to particular staff involved in delivering our healthcare, most notably pharmacists, paramedics and ambulance workers. Today, I want to thank all those in our care homes who have given real care, particularly over Christmas, to vulnerable people who are in the twilight of their lives and who are experiencing severe distress at the inability to spend time with their families. For an elderly person in the twilight of their life to see their loved ones through plastic screens and wearing masks—frankly, it ain’t much fun. It is made bearable only by the real dedication of those who look after our elderly people, and I really pay tribute to those staff today.

Finally, I come back to businesses. Once the March lockdown was lifted, 25% of our independent retailers did not reopen. We know that the retail sector depends heavily on Christmas to sustain businesses for the rest of the year. I have severe fears about what will happen to the retail sector after we emerge from this period, because businesses will have lost that Christmas. They will emerge debt-ridden, with no cash flow. What this Government have done has hastened the decline of the high street, and the economic costs will be severe.

Today is a bittersweet end to the year. The news is sweet nationally, as we hear of another new vaccine coming online in the fight against the coronavirus, and because we have got the Brexit deal done. That is hugely important to my constituents, the majority of whom voted for Brexit, but it also gives us the chance to pull remain and leave together to look forward, I hope, to an outward future for 2021. However, the news is bitter locally, because my constituency and the entire region in which I live are moving into tier 4. With that comes all the heartache, anxiety, stress, morbidity and mortality that go with increasing rates of covid.

I accept that decision, and I think it is the right thing. I have had contact with the hospitals that serve my area and the clinical commissioning group in Leicestershire. Some 30% of my patients go across towards the George Eliot, and both the health organisations there have talked about the pressure on the NHS—not only the numbers of covid patients coming in, but the pressure on non-covid services and the impact of covid on staffing, with the real threat posed by absences. Those things combined make for a really difficult issue.

On top of that, our rates are steadily increasing, although in my patch, in particular, we are lower than the national average. That all comes on top of the new strains that we have heard about in the last few weeks. I believe the Government were right to take the decisions that they took, and to change when the information changes. That is why I am pleased to welcome the Government’s dropping of the 14 days of isolation to 10 days. As the science changes and as we know more, we should change our approach and do something different.

That leads me on to my asks for the Government, and they are threefold. First, I have previously welcomed the Government’s approach of structuring their focus and putting the NHS first, followed by education, businesses, health and leisure activities, and then the hospitality industry. However, as we have ratcheted back up with the new tiers, we clearly still have the fundamental problems of providing support for things such as the travel industry, the pubs, the restaurants, the events industry and the wedding industry. Those problems are not going away. Fortunately, with the advent of a vaccine, the period is time-limited, so I urge the Government to consider putting in further support for those businesses to try to get them through.

My second ask is about the vaccine roll-out. As I said, I really welcome the fact that the Oxford vaccine has now come on line and will be going live from 4 January, with more than 500,000 vaccinations going out in the first week. It is also really good news that Ministers are reassuring us that the infrastructure is there and that as the supply becomes greater so too will the delivery, getting the fight against this virus under way. However, I am concerned about, and would like the Government to address, what happens when 10% or 20% of the population are vaccinated. For me, there is a real issue. As the public start to see people getting vaccinated, the way they behave may well change and in turn create a vicious spiral, where we elongate the period under covid and the need for further tiered restrictions because people feel that it is safe to go out. A strong message must come from the Government to make sure that people adhere to the restrictions and to give us an idea of what the saturation point for covid will look like. As the science changes, so should the advice.

Finally, in my last minute, I would like to raise something that I raised in the summer. Given that the end of the covid debacle is hopefully in sight, be it in the spring or the summer, I would like to push again for a Department of virus legacy—a time-limited Department to look at all the changes that have taken place during the covid pandemic. After all, covid has hit every aspect of our working lives and, indeed, our social lives—sometimes for good, and sometimes for bad. It is really important for the future to understand the lessons learned and to capitalise on the changes in my sphere of medicine, for example, where we now have telemedicine, better communications, a huge diagnostic network and a much improved vaccine programme, which will cover the entire nation. All those things should be looked at and capitalised on to make sure we have something that will stand the test of time if we ever face another virus.

Naturally, my constituents and I are disappointed that we were placed in tier 4 and at the short notice of the changes. Of course it is right that in the face of changing facts the Government respond quickly and decisively, and while I regret that we have not been able to debate the tier 4 restrictions sooner, I am glad that Parliament is here now and that we are debating the changes today.

There have been two huge developments in the last fortnight in terms of the pandemic and our response to it. One is the emergence of a new strain of covid that is more infective and that is thwarting some of our measures to contain it, and the other is the development of safe and effective vaccines that can be deployed at pace. I am sure that everyone in the House will celebrate the success of the British science and research that led to the development of the Oxford/AstraZeneca vaccine and of the genomics surveillance that made possible the early discovery of the new variant of covid. It is the Government’s long-term planning that led to our procuring the vaccine in advance, so that we are now best placed to deliver it at pace to our population, and it is science that led to the reduction of the self-isolation time, reducing the impact of infection control measures and making it easier for people to follow them.

However, amidst this positive news, the evidence that the new variant is much more infectious is concerning indeed. It raises serious concerns about the effectiveness of our previous tiers and the individual restrictions in reducing rates of infection and ensuring that they do not spiral out of control and overwhelm NHS capacity—and this is all about NHS capacity. We therefore need to take stock in the context of a rapidly changing situation, with rates increasing in front of us, and urgently research this new variant and the impact of the measures needed to control the rate of infection.

While I am disappointed that my constituency has gone into tier 4, we can all see the pressure that the NHS faces at the moment, we can see the impact of the new variant and we can see our rapidly expanding vaccination programme, which, after today, will really take off. As a doctor, I was always taught to look at every intervention in terms of the risks and the benefits, the costs and the harms. I have been calling for a cost-benefit analysis of the suite of individual restrictions that we and all our constituents have to face. Clearly, the facts that I have just laid out radically shift the cost-benefit ratio faced by our constituents and our country, which we have discussed in this place at length. A change in the facts can, and in his case I believe must, force a change in response.

I support the restrictions that are coming into force, but they will not be without their own harms, which need to be mitigated until the restrictions can be lifted. I wish to talk in particular about uncertainty. I have had many meetings with constituents who work in a range of sectors that are directly impacted by the restrictions. I have spoken to Runnymede and Weybridge’s businesses, publicans and gym owners and to people who work in events, corporate events and weddings—the list goes on—and the message from each is clear: the uncertainty around the restrictions and all the opening and closing is one of the most difficult challenges that they face. My local school leaders tell me that they can prepare and handle anything for the good of their pupils and students; they just need time to put in the contingency planning so that they know where they stand.

Uncertainty is not just harmful for business but detrimental to us all. We need to know, and see, how and how soon we can get out of this situation and when we will be able to see our friends and family again and to reopen those businesses that have shut down. A vaccine is here and about to be scaled up, so as we start to plan for a future when the pandemic is behind us, will my hon. Friend the Minister chart and publish the plan out, detailing in granular detail how many need to be vaccinated and what impact that will have on lifting the restrictions, and show my constituents in Runnymede and Weybridge the road map through the pandemic to the other side and the end of the restrictions that we have brought in to mitigate it?

I am very supportive of this legislation and the principle of tiers, but the counterpart to legislation is, of course, implementation, which could perhaps be improved by the taking of a more localised approach and by giving local responsibility to our excellent local resilience forum. Will our excellent Minister consider making the North Yorkshire local resilience forum a pilot scheme for a more localised implementation process?

I have listened carefully to many of the speeches in this debate, and I quite understand the concerns about a Government who restrict freedoms. In particular, our Government—a Conservative Government—should be the guardian of our freedoms. We are the party of business and should at all costs keep the economy open, so I can understand the concerns. Having said that, we are also the party that is responsible for running the NHS, and it would not be me or other Back Benchers who have spoken in this debate who would have to answer to the press, to other parliamentarians and to the public if the NHS was overrun by covid, so I quite understand that we need these restrictions.

Today, North Yorkshire has gone into tier 3, which I support—other areas have gone into tier 3 at a similar level of infections—but North Yorkshire is a huge place: our districts are the size of counties in other parts of the country. As you probably know, Mr Deputy Speaker, it takes two and a half hours to drive from one side of the constituency in the west to the east side—and that is not in my car; that is in a good car on a good day. Putting a huge county such as North Yorkshire into one tier masks huge differences in the infection rate among districts. Some districts have an infection rate that is two or three times that in other districts, so it is possible that some of our districts should be in a higher tier and some in a lower tier. We should consider that.

My other concern about tier 3, as I understand it, is that lots of areas have gone into tier 3 and not seen infection rates fall. That may well be because of what we have seen in North Yorkshire: we saw lots of people from other parts of the country that were in higher tiers travel down into York and North Yorkshire because of our greater freedoms. There are a number of things that our local resilience forum might try in York and North Yorkshire—for example, using districts for tiers because of the huge geographical differences and the differences in infection rates, and taking a different approach to solving problems. Our resilience forum identified that the problem in one part of the county was not with hospitality but with household mixing. It introduced an excellent process to speak to households and inform them, which has seen rates falling in one district of the county very successfully.

We might try a shorter, sharper shock, which I would support from a business point of view; I declare my interest in that regard. We may feel that schools should close for a longer period, to try to bring infection rates down more quickly to a level that will enable us to go into a lower tier. I speak as the parent of a child who is doing their A-level exams this year, so I do not say that lightly. We would definitely want to move travel restrictions from guidance to being an offence. That would prevent a lot of the travel we are seeing, with many people moving from different parts of the country into our area, which is increasing infection rates. Whatever the Minister decides, I ask her to take that away. When the police have used their powers in terms of mixing within hospitality venues or households, that has been very effective, and the word has gone round quickly. It would have a similar effect if we started to fine people for travelling without good cause.

We also need to look at the financial side of things now that we are in a higher tier. The monthly grants should be increased for businesses that are required to close and those that can stay open but are affected by covid, and the job retention scheme does not allow those who were employed after 30 October to access it, so I ask the Treasury to look at that.

These regulations allow for changes between tiers. I speak as a veteran of tier 4, and this is an example of the pace of change in public life and the pace at which the virus has affected us all. Milton Keynes has been in tier 4 since 20 December, and it is a fortnight since I lost a night’s sleep on a Tuesday because I was worrying about Milton Keynes going into tier 3. On the Friday we were in tier 2, by Saturday we were in tier 3 and by Sunday we were in tier 4. That is how quickly these things happen. That is the pace at which this virus can overtake our lives. It has been a storm, and it feels like Milton Keynes has been the eye of the storm for most of this time.

Back in February, I remember being taken aside by the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), who put her arm around me—as you could, then—and said, “Darling, I’ve got news for you. There’s a repatriation centre in Milton Keynes, and we’re bringing British nationals and their dependants back from Wuhan. I’m sorry, but it’s on your patch.” Soon after, we had the second recorded death of covid in Milton Keynes University Hospital. Soon after that, we had the Lighthouse lab with the robot freezers, which is very on-brand for Milton Keynes, and the mobile testing centre. Then we had Ross Kemp visiting Milton Keynes Hospital, and more recently we had a vaccination centre in the hospital, which is now vaccinating up to 400 people a day.

That hospital is amazing. All the staff there are working so hard. They are heroes, and I want to thank them. Currently the intensive care unit is full in Milton Keynes Hospital. They have a contingency plan, but the ICU is full. Bed occupancy is 98%, and 60% of general beds in Milton Keynes Hospital are filled with covid patients. They have more than 200 patients in the hospital with coronavirus, which is twice as many as during the first peak. Everybody at the hospital is working incredibly hard, and I want to thank them from the bottom of my heart, because it is our healthcare professionals who will help us get through this. With vaccinations, with new treatments and with this tiered system, we will get through this.

This morning’s news that the Oxford-AstraZeneca vaccine has been approved really is the best late Christmas present any of us could ask for. It is our best chance for the world to come out of the pandemic. It is testament to the genius and innovation that is possible when academic research works so effectively with the private sector in pursuit of a common goal. But the strong position the United Kingdom is in, getting early doses of the Pfizer vaccine and being well placed for the Oxford vaccine, and having robust contracts for all the leading vaccines under development, is due in large part to Kate Bingham and her fantastic team, as well as the effective leadership at the Department of Health and Social Care.

The vaccine provides a bright glimmer of hope after what has been the grimmest of years for families and businesses around the country. While there is light at the end of the tunnel, and very clear light, the tunnel ahead of us is still very long and the path still uncertain. Our immediate challenge is to minimise the number of tragic avoidable deaths until a vaccine can be fully rolled out and effective, but also to prevent our national health service from being overwhelmed by new waves and new variants of this debilitating virus.

Scepticism about national statistics and experts’ projections is not uncommon, particularly if one reads mainstream media or so much social media. There will never be a counterfactual that we can use as a control group and we will never know what would have happened if action had not been taken, but we can see what is happening in our local communities. When my local hospital in Dudley tells me that it risks being overwhelmed if numbers continue to rise at the rate they were last month, and when it tells me that a couple of weeks ago it had just four in-patient beds available in the whole of the hospital—and that is after relying on surge capacity—it would be the very height of irresponsibility and indeed callousness to dismiss those direct and dire warnings out of hand.

It is clear that action has been needed to tackle the virus. Looking at the rising infection rates we still see today, including in Dudley South, it is clear that further action is needed. However, we need to be clear about why the scientific and medical experts believe so firmly that the particular measures we are being asked to consider are necessary and, more to the point, why they would be effective.

In September, we were told that much of the spread was due to hospitality. As we know, most of that sector has been shut in much of the country for nearly two months, yet infection rates still rise. We have been told at other times that it is because of schools and universities, but most have been closed for two weeks, during which infection rates do not seem to have dropped off. We have been told that some of the transmission has been through retail, but in tier 4 areas, where shops have been closed for nearly a fortnight, we still see very high infection rates that are, in some areas, still rising. So we need to know where the infection is spreading, why it is spreading and why these measures will help to stop it. We know that the measures taken so far, and the new restrictions that are going to be introduced in Dudley South and throughout much of the country tomorrow under tier 4, are devastating for many families and many businesses—for economic, social and mental wellbeing. So we need to be sure that what we are doing is both proportionate and necessary for the very real and serious challenge we face. For us to be sure of that, we need to be sure that these measures have the best chance of being effective in helping to save lives and reduce the pressures on our national health services.

I am sorry we lost a bit of the video there, Mike, but we heard you loud and clear, with a nice picture on the screen.

At the end of a year like no other, for the people of Aylesbury constituency, this was a Christmas like no other. Little did I know when I described Buckinghamshire’s entry into tier 3 as heralding the bleakest midwinter that just a few days later, a new tier 4 would bring an even more bitter chill, with many local businesses forced to close and long-wished-for festive reunions cancelled.

I do not believe that a single Member of this place came here wishing to impose restrictions that curtail our livelihoods, our liberty or our democracy, but nor did a single one of us anticipate a pandemic that would sweep the world, putting unprecedented pressure on our health service. Ensuring that the health service in Buckinghamshire can care for not just those with covid, but those with other conditions or serious illnesses, such as cancer, heart disease or stroke, has consistently determined how I vote. It does so again today.

I pay tribute to all local NHS staff who have continued to work over Christmas, particularly the brilliant team at Stoke Mandeville Hospital. The pressure on that hospital has escalated in recent days. Critical care beds are full and more wards have had to be dedicated to covid patients. That illustrates that, unfortunately, the previous restrictions of tiers 2 and 3 were not enough, especially given the new variant of the coronavirus, whose increased transmissibility is extremely alarming. Indeed, Buckinghamshire Council, in conjunction with its health partners, this afternoon declared a major incident amid fears that the rapid rise in the number of covid-19 cases could overwhelm the county’s health and social care services. So although I do not like the retrospective nature of voting for the regulations, I recognise that they were and are necessary as a short-term means of trying to hold back the escalating spread of the virus.

I have received the most vitriolic criticism for previously voting for the tier system of restrictions because of their broader societal impact—criticism that included being likened to a murderer. However, it is precisely to save lives that I found myself continually voting against my Conservative instincts in the desperate hope of a vaccine that would permit a gradual return to normality.

Today, we are a step closer to realising that hope, with the wonderful news of the approval of the Oxford/AstraZeneca vaccine. I look forward to its roll-out and that of the Pfizer vaccine in the Aylesbury constituency as soon as possible. Constituents understandably want to get the protection that the vaccines afford and their need is all the more urgent given our early tier 4 status and the very serious infection rates behind it. It is especially difficult for local people to understand why those in neighbouring areas with a lower incidence of coronavirus are ahead of them in the queue to be vaccinated. I am grateful that my hon. Friend the Minister for Care is now addressing that challenge.

Recognising the need for greater restrictions means that we must also recognise the greater impact on businesses, especially those that would usually have enjoyed their most lucrative time of the year in the immediate run-up to Christmas. I therefore ask my right hon. Friend the Chancellor to consider new ways in which he might be able to help such firms, especially those that have not been able to benefit from his generous financial support package or from the excellent schemes that Buckinghamshire Council is now running, perhaps missing out because of their place in the supply chain, their size or because they needed to help customers obtain refunds and could not therefore furlough staff, despite receiving no revenue.

I conclude with not my words, but those of members of the crews of South Central Ambulance Service, to whom my constituents and I owe a great debt of gratitude. In a virtual meeting just before Christmas, one told me bluntly, “It really is a silent killer. It doesn’t matter who you are. Anyone can get it.” Another paramedic said, “I would love to give the country one simple message: please follow the rules.” Message delivered.

It is a pleasure to follow my constituency neighbour, my hon. Friend the Member for Aylesbury (Rob Butler).  I have spoken in previous debates on covid about my belief that we need to look for a better balance in our response to what is undoubtedly a horrendous virus. We need greater analysis of the impact of the restrictions that we are asking people to abide by—the detailed analysis that my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer) spoke of so eloquently a few moments ago—to ensure that we have the most proportionate possible response to covid-19.

I have voted with the Government in all the votes on our response so far. I have to say that I did so reluctantly on the last occasion, but I did so on the commitment that we could have a more granular approach—that my Buckingham constituency, which has consistently had lower infection rates than surrounding areas such as the south of Buckinghamshire, could be looked at on its own. Unfortunately, that did not happen, despite the numbers continuing to be low before Christmas. Instead, as my hon. Friend the Member for Milton Keynes North (Ben Everitt) mentioned, we went from tier 2 to tier 4 in just a matter of days. That brought with it significant devastation for business and, I fear, a long-term mental health crisis that will be with us for generations.

I cannot be alone in this House in having received many emails and letters from constituents highlighting that devastation. A restaurant owner in Buckingham wrote to say that a lot of businesses, including theirs, are suffering in silence, some resigned to failure. I have visited wet pubs that are grateful for the £1,000 but, when they are losing £3,500 a week, are in a very grim place indeed.

Perhaps this email from Mrs M will bring it into perspective. She wrote:

“I live alone. I lost my father earlier this year, during the first lockdown. No proper funeral. No family other than my Stepmum. His ashes are still with the undertakers. I haven’t been able to process my grief properly as the rites of passage haven’t happened. I feel as if I’m in solitary confinement without any reason to prolong my…existence.”

Or this from Mrs H, who wrote: “I live on my own and I’ve been self-isolating much of the year. I suffer from complex PTSD as well as diabetes and other disorders. My anxiety and depression linked to my mental health issues are a constant battle, and spending Christmas alone and worrying about my mother has been too much to bear.” I could go on; I have literally hundreds of such emails outlining the level of devastation suffered.

I offer those as examples of why we need that detailed analysis and a real understanding of the impact of the restrictions on real people’s lives, beyond covid. We need an understanding of how it can be that in Buckinghamshire, we went into the second lockdown in tier 1, came out in tier 2 and then had that rapid rise to tier 4, yet with each restriction that has been added it seems that the infection rate has got worse. We need to understand why that is. Why is it that lockdowns do not appear to be working?

As my hon. Friend the Member for Aylesbury mentioned a few moments ago, my local council declared a major incident today. I have talked to our hospital trust, and it is full; it is at a capacity crisis. Likewise, my hon. Friend the Member for Milton Keynes North spoke passionately about the situation at Milton Keynes Hospital, which is used by many of my constituents.

With that in mind, and without the detailed analysis that really shows what these restrictions are doing, I cannot vote for the Government’s measures tonight, but I cannot vote against them either. It is hard for me to abstain, as I always like to be for or against something, but I urge the Minister to bring forward that analysis so that we can move forward with the hope that the vaccine brings.

I heard the news that Peterborough would enter tier 4 restrictions in a rather peculiar situation. I was dressed as Santa, delivering donated toys and presents to families in my city. I joined other volunteer Santas and elves from the Coronaheroes Peterborough Facebook group, helping those in need. Like my hon. Friend the Member for Milton Keynes North (Ben Everitt), Peterborough went from tier 2 to tier 3 to tier 4 in what seemed like 24 hours. I was not happy.

I thought it was perhaps best that I got home and changed before accepting invitations to discuss the restrictions on local television, but another thought did strike me. When I told the other volunteers about the tier 4 restrictions, as disappointed as they were, they doubled down and pledged to continue to help those struggling during this pandemic. My reaction to the news became, “We will get through tier 4 together.” That is exactly what will happen.

While Peterborough’s most unconvincing Santa will put the costume back in the drawer, groups such as the Coronaheroes Peterborough Facebook group will continue their work. The Light Project and the Garden House will continue to look after rough sleepers and families in temporary accommodation. Charities such as Care Zone will provide household furniture. The WestRaven café will provide food parcels, and churches, mosques and temples will offer support.

Businesses will also do what they can for our NHS and frontline social care staff. Takeaways, restaurants and pubs will continue to step up, but it is for hospitality and retail that I want to make a case. Tier 4 has been justified because of the increase in infections, the strain now being placed on our NHS and the new strains of covid-19 that have been identified. Peterborough’s rate stood at 403 cases per 100,000 on Christmas Eve, which I note is around the England average, but that statistic is not the fault of the hospitality industry. Public health officials in Peterborough have told me as much.

Spikes in Peterborough have not been caused by pubs, bars or restaurants. There is not this magic trade-off between schools and hospitality. Hospitality businesses have been forced to close before their busiest time, which is costing jobs, viable businesses and livelihoods. If they are to remain closed in Peterborough and other tier 3 and tier 4 areas, I urge those on the Front Bench and the Minister listening to my speech please to protect them. Will she at least lobby her colleagues at the Treasury to protect them? When a pub closes, it can have a detrimental impact on a community. It has a huge impact on supply chains and other elements of the local economy.

Furlough has been useful, there is no doubt about that. Business rates relief has been crucial, but pubs and the hospitality industry need more support. While they can open for delivery or takeaway, in many cases that is just not cost-effective. They need more support, so I urge the Minister to make representations to the Treasury for further support for hospitality.

When I visited the vaccination centre in Peterborough yesterday, I felt hope. When I heard my right hon. Friend the Secretary of State for Health and Social Care at the Dispatch Box earlier, I felt hope again, because the prospect of vaccinating millions of people throughout January and February is incredibly positive. Some are talking about a figure of 2 million a week. That would be a tremendous achievement, and we have done that before in procuring millions and millions of items of PPE and ramping up testing when we needed to. It is fantastic to end this year on a note of hope and a positive vision for the future, because while 2020 has been a wretched year for many places in our country, 2021 offers hope not just for Peterborough, but for our country.

I join colleagues from across the House in welcoming the approval of the AstraZeneca vaccine. As I might have mentioned a couple of times, AstraZeneca has its global headquarters in my constituency. We often call it the Oxford vaccine, but I will call it the Oxford-Cambridge vaccine, for fairness.

I pay tribute to all the scientists, and to the Secretary of State for Health and Social Care, the Health Ministers and their team, for making sure that the UK has led the way in the fight against coronavirus. We are a world leader, not only in vaccination—we had the first approval, and now have the Oxford-Cambridge vaccine, which will be rolled out across the world—but in testing: we do more of it than any other European country. We are also world-leading in genomics. A colleague mentioned genomic surveillance. That is done largely in my constituency by the Wellcome Sanger Institute; we do more than the rest of the world put together. We are also world-leading in developing a clinically proven drug against coronavirus. The pandemic has shown that the UK is a life sciences superpower, and that is something of which we should be proud.

The new vaccine has been hailed as a game changer. When the announcement was made this morning, I could almost hear the sigh of relief across the country; finally, there was a light at the end of the tunnel. It was a great end to an absolutely horrible year, but as we have discussed this evening, the number of infections is rising as I speak. It is far higher than it has been, and so is the number of hospitalisations. NHS managers tell us that their hospitals are at the tipping point; they are creaking under the strain and may not be able to cope. That is why the Government announced new tier regulations just before Christmas and today. I support those regulations with a heavy heart, because I know the damage that they do to businesses, mental health and people’s lives, but having gone through all the data, I cannot see any alternative. I am very keen, though, for us to get out of them as quickly as possible. That, hopefully, is what the vaccine will allow us to do.

We now have a race between the infection rate, which is rising rapidly, and rolling out the vaccination as quickly as possible. The vaccination programme will change the dynamic of the pandemic, which means that we should change how we assess the restrictions and the tiers in future. At the moment, our focus is mainly on infection rates. That makes good sense, because infection leads to hospitalisation, and hospitalisation leads to death as night follows day; there is a clear link. As we vaccinate those most at risk—the elderly and the vulnerable—the death rate will come down rapidly. We could end up with infection rates staying quite high, particularly among unvaccinated young people, but death rates plummeting. There will be a breakdown in the relationship between the death rate and the infection rate, and that relationship has guided policy so far. The Government’s focus, in their policy on restrictions, should be not on infections, but on the death rate.

Let me give an example. Some 95% of deaths from coronavirus have been of people over the age of 60. Only 5% of deaths have been of people under that age. If we vaccinate all people over 60, which we can do by mid-February, it will lead to a 90% fall in the death rate, which is really quite astonishing. That is why, in recent months, I have been urging the Government to publish the case fatality rate—the proportion of people with coronavirus who end up dying. That rate has been plummeting. Our World in Data, an independent and highly respected website, does charts on countries around the world, and it says that the case fatality rate for coronavirus in the UK has dropped 75% since September. As the vaccine is rolled out, that rate will fall further and further.

One thing that we can all agree on in this House is that we do not want these restrictions longer than is absolutely necessary. I see at first hand in my constituency their impact on pubs, businesses, the events industry, wedding planners, and people’s social lives. We have to get out of the restrictions as quickly as possible. That is why I urge the Government, in the new year, to think not so much about the rate of infection as about the number of deaths. If deaths are going down, we can lift the restrictions.

I am 53 and in cohort 9—[Interruption.] Honestly! I know I do not look it. I have my own hair. In short, my point is: do not wait for people my age to get vaccinated before allowing the pubs of South Cambridgeshire to reopen. There is light at the end of the tunnel; let us make sure that we get there as quickly as possible.

It is a pleasure to follow a typically excellent speech from my hon. Friend the Member for South Cambridgeshire (Anthony Browne). I thank the House staff for all they have done to make today possible. It has been a momentous day both in this Chamber and in plenty of living rooms around the country. Not only have we had the Brexit Bill, but we have been discussing some of the most serious matters on the domestic front for many years.

I also pay tribute to all the NHS and testing centre staff who have been working not just throughout the whole pandemic, but particularly over the Christmas period. It is noticeable from the figures that we have kept up our testing rate over Christmas, whereas other countries have not necessarily done that, so I pay tribute to everyone who has given up their Christmas to try to make our lives a bit better.

We started today with the welcome news about the vaccine. It is a huge triumph for British science—I say to my hon. Friend the Member for South Cambridgeshire that I am going to call it the Oxford vaccine—but I just wonder whether the world as a whole may look back and consider whether we could have proceeded differently with the vaccine. I was struck by a recent article saying that Moderna actually had its vaccine produced in January. Perhaps if we had taken a different approach, maybe using supersized trials once we prove the basic safety of a vaccine, we might have mitigated some of the enormous costs of the pandemic this year.

That is perhaps a question for the Science and Technology Committee, on which I sit, and I praise the Committee’s staff for letting us hold an emergency evidence session on 23 December, in which we had three witnesses from NERVTAG, led by the excellent Professor Peter Horby, who explained the new variant and all its details. I have to say that, as we have all heard, the numbers about how quickly it can spread are pretty worrying.

Before I move on to talk about tiers more generally, I want to welcome the statutory instrument on self-isolation that we are debating today. Again, it is something we have discussed in our Committee, and moving from 14 to 10 days is an evidenced-based and probability-based move. I do not think that those final four days of isolation have been cutting out many cases at all, and they cannot really be justified, so I am glad that the Government have moved on that.

I am no lockdown enthusiast. How can I be with Newcastle-under-Lyme being put into tier 4 today? It is a decision that will cause a lot of hardship. Indeed, I said in my first ever virtual speech in this Chamber on 4 May, when we were debating the first coronavirus SIs, that

“any future calculus needs to recognise properly all the costs of lockdown: health, economic and social.”—[Official Report, 4 May 2020; Vol. 675, c. 464.]

That still holds, but I have to be a lockdown realist as well, and we must look at both sides of the equation. Contrary to some commentators, the figures, especially from the November national lockdown, are clear that lockdowns and strict measures do actually work and that they can get things under control. We will have to wait and see whether they will be sufficient for the new variant, because we do not yet have all the data, but the vaccine has changed the calculus. We are no longer looking at an indefinite lockdown. We have light at the end of the tunnel, and we have a clear goal to aim for.

Some of the commentators who are so prominent on social media—often in the comments on our own pages—are dead set against lockdowns, but they keep moving the goalposts. First, they were asking, “Where are the cases?” and then there were cases. They asked, “Where are the hospitalisations?” and, sure as night follows day, there were hospitalisations. Then they said, “But where are the deaths?” Well, 981 deaths were reported today, and I am afraid to say that number is only going to increase based on everything we know about this virus and the lags involved.

In recent days, those commentators have taken to the rather tasteless statistic that only 388 under-60s with no underlying condition have died with coronavirus in the UK. First, 388 is quite a large number, and we should be worried about that, but what about the over-60s? What about those who have underlying conditions? What about people with manageable underlying conditions such as mild asthma? Are we really saying that the people over 60 or people with underlying conditions are somehow worth less in this calculus? People who make that case should think about what it says about their value system. It is right that the Government have rejected that approach throughout and have sought to protect the most vulnerable, and it is right that society has done that, with people who are not at much risk from coronavirus making sacrifices.

As others have said, we have had two major changes since we last met to discuss coronavirus in this place: the variant and the vaccine. They really have changed things. Before, we were perhaps in what you might call a siege— an unpleasant one that was certainly driving people stir crazy. Now, we are in a race instead. Given that we are in a race—the variant is spreading more rapidly and the vaccines are coming on board quicker and quicker—the Government must use all their tools to slow the procession of the virus and that, unfortunately, includes tighter lockdowns and measures such as today’s. Just as importantly, the Government must use all their tools to speed up the vaccinations, and I urge them to do that.

The year 2020 has been grim for so many of us. Nobody wants the restrictions, but they are necessary and I welcome them, and I will therefore be voting with the Government this evening on all the motions.

The retrospective nature of this legislation has been difficult to stomach. Going on recess and then facing this on the Friday was difficult for me, as it was for all MPs and constituents, but this measure is not being imposed for any reason other than the public health imperative. At the back of our minds, we must always remember that.

I say all the time to constituents who write to me, “This is not personal. The fact that you can’t go and see family at Christmas, the fact that you are locked away for this awful winter—there is nothing personal there at all. It is simply the Government doing what they have to do to keep people safe.” I have had many letters from people in Bracknell and the wider constituency over the past few months. I understand their frustrations completely and I empathise with them. Having Christmas plans curtailed at the last minute was awful. Nobody takes any pleasure at all in restricting people from seeing their loved ones, but it is the duty of any responsible Government to take tough and unpopular decisions to protect lives. It is a sign of good leadership that the Government are making these decisions.

I again commend my constituents. The public have been resolute in the main in abiding by the rules, and the self-discipline we have seen across the UK this year has been phenomenal. We welcome today’s news of a second vaccine—it is fantastic—so there is light at the end of the tunnel, and we must look forward to a more positive 2021.

It has been a difficult few weeks in my constituency. Bracknell went from tier 2 to tier 4 in a matter of days, which was a bitter blow to the morale and mental health of so many. As of today, we are at a rate of 568 cases per 100,000. It is no exaggeration to say that it has septupled in the past month. Over a six-week period, that is a 1,000% increase in the rate in my constituency, and it is mirrored elsewhere locally. In Wokingham it is 413, in Reading it is 452, in Windsor and Maidenhead it is 509, and in Slough it is 646. The fact is that the virus is ripping through the constituency and beyond. This is the wave that we were fortunate not to have had so far.

Locally, our hospitals are really struggling. Wexham Park, Royal Berkshire and Frimley Park Hospitals are at max capacity, and today the Thames Valley Local Resilience Forum was almost at the point of declaring a major incident in Berkshire because it has got that bad. When the stats are presented, it is irresponsible not to react to the exponential increase in cases, however tough it is to stomach. A decision not to act would have been a grave dereliction of duty.

To be a critical friend to the Government, there are three areas that I would like to concentrate on very quickly. First, on gyms, we need to make sure we do not curtail freedoms to the extent that people cannot exercise. We have known about the restrictions on the fitness and leisure industry for some time, so I ask the Government please to review the rules on gyms and all forms of exercise and sport so that life can continue as best it can for many.

Small businesses have also had it really bad and some are on their last legs. We have seen giant online corporations such as Amazon and Google dominating the market, continuing to sell goods with impunity and making it increasingly difficult for the high street to survive. There must please be more support for those businesses. We have also heard about the excluded, and we cannot ignore them. It is important that we do whatever we can, even at this stage, to help them.

I welcome the Government’s stance on keeping schools open. That is a necessity for our children and their parents, many of whom need to go back to work, but I implore the Government to maximise testing in schools and roll out vaccinations for teachers at the earliest opportunity.

Notwithstanding the grim nature of 2020, we have much to look forward to, and we must keep the faith. Last week, I visited the fantastic Bracknell vaccination centre, run by the East Berkshire clinical commissioning group, and what I saw there was simply amazing. I saw people in their 80s and 90s who had left home for the first time. I want to share with my hon. Friend the Member for Peterborough (Paul Bristow) the hope that I saw, which was quite staggering. What I saw there was magnificent, and I commend everyone in the NHS, key workers and other key staff across the UK for what they are doing. We will get through this.

Thank you very much, Mr Deputy Speaker. Like many Members on the Government side of the House, and I am sure on both sides, the last thing I want to do is to be here again insisting on further lockdowns and further measures to restrict the freedom of my constituents. It is certainly not what I came into politics for.

We have had some good news today: the vaccine coming forward looks like it will put us in the final furlong for furloughed Britain, which is a really good place to be, but we are not there yet, so I will reluctantly support these measures today. I know that the Health Minister has been getting it in the neck from both sides of the House, and it is right that we as Back Benchers challenge the Government on the measures they are taking, but I have spoken to my local NHS hospital trust chief executive today and the trust is seeing a massive surge. Durham is going back into tier 4. It has seen a real spike in cases and a real spike in hospitalisations just over the last couple of weeks, after we had been seeing a real reduction in cases in tier 3 over a very prolonged period of time. It is quite clear that there is a real issue, so everything that can be done to get this vaccine out needs to be done. We really need to get it there as quickly as possible.

Like other hon. Members, I support SI No. 1518—the move from the Government on self-isolation from 14 to 10 days. We must do anything that can be done to improve the freedoms of my constituents at the earliest opportunity. I know that the support has been huge from the Government, but this is taxpayers’ money. It has been absolutely massive, with the furlough, self-employed income support and grants to businesses.

Like my hon. Friend the Member for Bracknell (James Sunderland), I want to speak about gyms. I have had a huge number of people in my constituency again getting in touch with me today, really concerned about the impact that this is going to have. I have had gym owners getting in touch because January and February is the time of year when they finally make some money, so any extra support from the Government for them would be particularly welcome. Anything in terms of instruction, via the Ministry of Housing, Communities and Local Government, on discretionary grant schemes from councils for gyms would be particularly helpful. If I can make a targeted suggestion that those on the Treasury Bench can pass on to the Treasury, perhaps, when we get through this, we could push out a scheme such as “Work out to help out” or something similar for this sector.

High streets more generally, from beauticians to bookshops, have been particularly hammered. They have not suffered like some of the massive international companies, and it is those guys on the frontlines running small businesses—the hearts and souls of our communities —who have been really affected. Anything more to push support, either discretionary or across the board, would be particularly helpful.

I cannot not mention the hospitality sector. I was particularly struck by what the hon. Member for Hackney South and Shoreditch (Meg Hillier) said. Whether it is on Shoreditch High Street or South Street in Crook in my constituency, or Sherburn Terrace in Consett, or Stanhope town centre, the hospitality sector across the country has been absolutely mullered by this disease, so anything that can be done to help them now will be particularly helpful. I also urge the Front-Bench team to look particularly at on-sale beer duty cuts come the Budget and at whether there is anything such as a further targeted scheme around eat out to help out, when they are able to reopen, to help them to restart again, just to give them the confidence to get going again. That would also be particularly welcome.

As hon. Members across the House have said, keeping schools open is important, but it is also right that we treat teachers as essential workers. If we can get the vaccines out to them, that would be really helpful. So many of my school leaders have been getting in touch with me. I thank the Government for the extra cash for schools and, if necessary, the military support, but we have to get some more support to them to help, because they are really doing everything they can, on the vaccine levels.

Just on the NHS, I had fantastic visits to both Shotley Bridge Community Hospital and Weardale Community Hospital in my constituency in the run-up to Christmas to see some of the staff there on the night shift. It is quite clear, however, that staff are really knackered, so if there is anything that can be done to support our NHS staff, particularly in terms of mental health, that would be particularly helpful.

Finally on the vaccine, and in reference to my hon. Friend the Member for South Cambridgeshire (Anthony Browne)—

This has been an excellent debate. We have heard lots of different views and perspectives about how to wrestle with this knotty crisis—the great national question of the day—but I do not mistake the disagreement and points of difference for a lack of faith or a lack of love of community or country. All hon. Members and right hon. Members have attacked the question with a commitment to wanting the best for our country, even if sometimes we disagree on the conclusions.

That is particularly important today. Today has been a momentous day and the past 12 hours and five minutes of parliamentary business will be remembered—perhaps that is one for your book, Mr Deputy Speaker, and please be kind if I do anything to earn a place in there. Who knows how I could do that? There will be some for whom today is a day of great joy, and there will be some for whom today is a day of pain. Whatever people feel about what has happened here today, we have to come together. We have had four years—longer, really—of significant disagreement and division and what we have seen in the pandemic is that the UK is at its best when it is united and comes together. I hope that we will move forward from today in that spirit, and tackling the virus reminds us why we ought to do that.

Let me reflect on the contributions from colleagues. My hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) made the point about ensuring that NHS staff are vaccinated. As I said in my opening speech, that is important because it is the right thing to do and because of the sacrifices they make and the risks they run on our behalf, but also because of the need for a resilient workforce.

My hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy) made a very important point: when the right support is not in place, whether that is for the individual to self-isolate or for businesses to shut their doors in challenging times, it undermines people’s confidence and faith in the overall process. That is why the Government’s economic support package needs to move hand in hand with increased regulation to protect public health.

My hon. Friends the Members for Hackney South and Shoreditch (Meg Hillier) and for Birmingham, Selly Oak (Steve McCabe) both referenced an important theme about honesty. I will reiterate what I said to the Minister—the British people are ready for candour. If we are in tier 4 from now until the vaccine, now is definitely the time to tell us.

I am not going to itemise all the Government Back-Bench colleagues who spoke—there were too many. We really ought to do something about that at the next election; at least I can commit to that. I particularly want to mention the speech made by the right hon. Member for South West Wiltshire (Dr Murrison), because he referred directly to my speech and suggested that when I talked about SI No. 1646 I was a bit churlish. I do not think I was; I was a bit saddened by that. I shadowed the right hon. Gentleman when he was a Minister for international development and I was never churlish then, and I was not churlish now. My point about SI No. 1646 was that we were concerned—and said so at the time—that the three-tier restrictions would not go far enough, but in that SI in particular it is not clear how to get out of a tier. I have not heard anything in the subsequent speeches, and I doubt we will hear anything from the Minister, that gives a clear set of criteria even around the five metrics for exiting tiers. That remains a significant problem for public confidence in the process.

I wanted to pull out two quick themes from Government Back-Bench contributions. The first is about tiers. In the contributions from the right hon. Member for New Forest West (Sir Desmond Swayne) and the hon. Members for Bolton West (Chris Green), for Thirsk and Malton (Kevin Hollinrake) and for Buckingham (Greg Smith), they all put admirable scrutiny and pressure on their Minister, as I have heard them do before, and I know that she will be keen to respond. I would be keen to enlist that support for matters beyond tiers. Tiers are a symptom, not a cause, of the challenges of the restrictions of liberty we are making today. Tiers are put in place when we lose control of the virus. Some of that can be accounted for by the mutant strain, which is 56% more potent, but the issues existed before then. We needed tiers before that, and tiers that constantly increased in strength, because we do not have the fundamentals right, particularly on test and trace. I implore those Members to apply that level of scrutiny and pressure on their Ministers on that, too, because it would make a real difference.

The second theme was vaccines. Many colleagues, including the right hon. Member for Forest of Dean (Mr Harper) and the hon. Members for Mid Derbyshire (Mrs Latham), for Runnymede and Weybridge (Dr Spencer), for Dudley South (Mike Wood), for Aylesbury (Rob Butler), for South Cambridgeshire (Anthony Browne) and for Newcastle-under-Lyme (Aaron Bell)—everyone, in fact, but particularly those Members—expressed joy about the plan. The right hon. Member for Forest of Dean made a particularly detailed and powerful case for the levels he felt that the Government should be aspiring to. I hope the Minister will engage with that directly and say whether it is realistic. If it is not, can she say why not and what a more realistic level is?

I want to reiterate the point on schools that was made by a number of colleagues. Not that Members would ever look at social media during a colleague’s contribution, but if they did, they will have seen that there is significant anxiety as a result of the announcement by the Secretary of State for Education this afternoon. It just will not do to say that some schools will be open and that some schools will not be open and then not to publish the list, and then when the list is eventually published, it is incomplete. This has caused a significant amount of anxiety. We must not forget that we are—what—five days away from those schools opening. Parents need to know. Schools need to know. It really will not do and I hope the Minister might be able to give some clarity on that and, if not, a sense of when the Government will return to finish off that job.

I just want to finish by reiterating three key questions to the Minister. I know that she will have an awful lot to cover, so I wanted to make sure that I left her the lion’s share of the winding-up time—whether she will thank me for that I do not know. First, we do need to hear the Government say with both clarity and commitment that, based on the best scientific evidence available, they believe that the tier system is sufficient to control the spread of the virus. This is their third go at a tier system. The first two failed and we are here today because the third one is not working either. We need to hear that explicitly, because otherwise we will have to take more significant action later. We might as well be honest about that now.

Secondly, when will we see the roll-out plan for the vaccine so that we can help to build confidence and perhaps to improve it through parliamentary scrutiny? The plan should include NHS staff as a priority, but, in general, it needs to ensure that we get through the entire population. It is a wonderful and joyous moment to know that we will have access to enough vaccines for everyone who wants one. It is a wonderful moment. Now our responsibility is to demonstrate that we can get them out for people in the quickest and safest possible manner.

Finally, there should be no extra health regulations without extra support for business. Where is that support package? When will we see it? When asked that question earlier—I think by a Back-Bench colleague of mine—the Secretary of State for Health said, “Well, I’m not a Treasury Minister, I am a Health Minister.” Nobody thinks that that is how it works here. We cannot afford for it to work in that way. The two need to move in lockstep, so can we have clarity about when we will see that support package? I will sit down now, Mr Deputy Speaker. It has been a very good debate, but I hope that the Minister can now give clarity on the points that I have raised.

I thank hon. Members from across the House and those who have contributed virtually for the many truly thoughtful contributions in what has been a really wide-ranging debate this evening. In a moment, I will respond, as far as I can in the time that I have, to many of the points and questions that have been raised.

As I stated at the outset, although we have the truly welcome news of the MHRA approval of the Oxford/AstraZeneca vaccine for use, right now we face a very serious situation. We face rapid rates of covid transmission and new cases of the new variant of the virus. We began to see that before Christmas, when we brought in the measures and the introduction of tier 4, which we are debating today. No Government would want to do what we are having to do, which is to put such restrictions on people’s lives, but, as many hon. Members have recognised in their speeches, we see the pressures on the NHS and know that rises in infections and rises in hospital admissions very sadly lead to loss of life. We also know the implications of those pressures on the NHS not only for those with covid, but for those needing treatment for other illnesses. The alternative to taking measures to suppress the virus is unthinkable. These decisions are not easy to make, but the data is clear, including on the additional infectiousness of the new variant.

Some hon. Friends asked why their constituencies had been moved up tiers either in the past couple of weeks or today and sometimes moving at some pace from a low tier to as far up as tier 4. The reason is that a combination of the epidemiological evidence and hospital pressures, looking at the five criteria that we have set out, makes it clear that that is what needs to happen. I remind my hon. Friends of the five criteria. We look at the case rates for all ages, the case rates for over-60s—which particularly translate into hospital admissions—the change in the case rate, the positivity rate and pressures on hospitals such as occupancy rates and the trajectory of those. Looking at that dataset, it is clear when action is needed.

Can I look into that point a bit? I thank the Opposition spokesman for giving us so much time to deal with the things we did not have time to deal with in our limited remarks. On the point about looking at the data—I listened carefully to a number of colleagues, and I had this in my constituency—I genuinely do not understand how my constituency was put into tier 3 starting at midnight on Boxing day, and after only three days had elapsed a decision was taken to move it to tier 4. What data had changed? Nothing significant happened between those two dates. Other colleagues went through three tiers in a matter of days. The problem is that that does not engender confidence among our constituents that the decisions are being taken for understandable reasons. Will the Minister say a little bit more about the decision-making process so that we can take that back to our constituents to try to give them a little more confidence?

Something that I can say to give my right hon. Friend some extra insight is that, for instance in introducing the latest measures, one of the things that we saw was a rapidly changing situation. During the national lockdown and the weeks following that, there was some puzzling about what was going on. We were seeing a large increase in the case rate in the south-east, especially in Kent and part of my constituency. What we came to investigate and understand was the new variant playing its part in that. It is the data that tells us that we need to make an urgent change, for instance in the tier that an area is in.

I have one very specific example that I want to give, not in relation to my right hon. Friend’s constituency but in response to the question that my hon. Friend the Member for Christchurch (Sir Christopher Chope) asked about why his constituency had changed tier and what had happened in the period that we are talking about. I can tell my hon. Friend the Member for Christchurch—he is not in his place, but I hope that he is listening remotely—that we saw a 68% increase in the case rate in his area of the country between 17 and 23 December, as well as a rapidly rising rate in the over-60s and a rising positivity rate. That is the kind of story that tells us that we need to take rapid action.

My right hon. Friend the Member for New Forest West (Sir Desmond Swayne) also questioned the timing of the introduction of the new measures, and I can tell him that we saw the number of cases increasing fast—both cases and hospital admissions. There was quite simply no time to waste. The analysis was clear that that was driven by the new variant.

Some hon. Members have questioned the effectiveness of the measures. My hon. Friend the Member for Thurrock (Jackie Doyle-Price) spoke about her area now having the highest case rate in the country—something I can relate to because part of my constituency previously had the highest case rate in the country—and it is not a reason why you want your area to be famous.

In the parts of Kent that were hit hardest with the new variant a few weeks ago, we are now seeing some stabilisation in rates. I should warn that that is at a relatively high level. It is also very soon after the introduction of tier 4—just 10 days ago—for us to see its full effect. We and everyone living in those areas can play their part in making sure that the restrictions work. My hon. Friend the Member for Aylesbury (Rob Butler) said to us on the screen that he had one simple message, which was to follow the rules. The virus thrives on social contact and the restrictions reduce that, and the Government will of course continue to keep these measures and their effectiveness under review.

Many hon. Members spoke up for businesses in their constituencies, and I absolutely recognise the huge challenges that the pandemic has placed on many businesses in some sectors such as hospitality and tourism and travel in particular. We have, of course, sought to protect livelihoods as well as lives. We have spent over £280 billion this year to support businesses and individuals. That includes extra support for higher tiers, recognising the extra costs incurred in those areas. I have no doubt that my honourable colleagues in the Treasury will be taking note of many of the arguments made by colleagues today.

May I make a little progress? I did take an intervention from my right hon. Friend a moment ago, and I am trying to respond to the many points made in the debate.

My right hon. Friend the Member for South West Wiltshire (Dr Murrison) rightly referred to the unpredictability of this virus, and to how it does not follow due process, as we have seen with the new variant. Unlike many mutations, which are normal things that occur with a virus, this variant has changed the behaviour of the virus. As my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer) said, thanks to the UK’s world-leading virus surveillance capability, we were able to detect and analyse the spread of this new strain. We know that it is most evident in the areas with exponential rises in cases at the moment, and those are the areas that have been placed in tier 4, either before Christmas or with the announcements today.

Many hon. Members spoke about the vaccination programme, and they welcomed the good news about the Oxford/AstraZeneca vaccine. Some hon. Friends even sought to change the way we describe the vaccine, by claiming it for their own constituencies. The hon. Member for Strangford (Jim Shannon) said that the vaccine has put a spring or a skip in his step, which I know that Members around the House will welcome.

The NHS has done a brilliant job of already vaccinating more than 600,000 people with the Pfizer-BioNTech vaccine, and with the opportunity to now bring into play the Oxford/AstraZeneca vaccine, we are driven and committed to its rapid roll-out. We have secured 100 million doses, and the NHS stands ready to deploy them from next week. We have an infrastructure of hospital hubs, GPs, vaccination centres and pharmacies ready to play their part and, as my right hon. Friend the Member for South West Wiltshire said, they will be drawing on a workforce that includes volunteers from among our fabulous NHS returners, who stepped forward to offer their help to the NHS during the pandemic.

The Minister is being generous in giving way. I wish to ask about one issue that cropped up today at the Prime Minister’s press conference, and something that Professor Van-Tam said about what we do and do not know about the vaccine’s ability to reduce the transmission of the virus. My understanding is that once we have vaccinated those who are at most risk, and reduced the risk of people dying or being hospitalised, we will then be in a much better place. He seemed to imply that if the vaccine does not reduce the transmission of the virus, that will somehow prolong the restrictions we have to keep in place, but I do not follow why that would be. Can the Minister clarify the Government’s position on that? I think that once we have vaccinated the at-risk groups, we can remove the restrictions. Am I wrong?

I do not think that now is the moment for me to hold a remote debate on that with the deputy chief medical officer, and my right hon. Friend also asks me to see into the future regarding the roll-out of the vaccine. I can say, however, that we are following the prioritisation as set out by Joint Committee on Vaccination and Immunisation. That is first and foremost to vaccinate those who are at greatest risk of losing their lives to covid, and that is why we are starting with residents in care homes, which have been so hard hit by the pandemic, as well as care home workers. The next priority category is those who are over 80 and broader health and social care workers, and it then moves down the ages. Our approach follows the JCVI prioritisation to put the vaccine to that crucial and important effect of saving people’s lives from this cruel disease.

The hon. Member for Nottingham North (Alex Norris) asked about the publication of JCVI advice on the use of the vaccine. I can tell him that it has already been published and is available on

I want to get clarity on the point made by my right hon. Friend the Member for Forest of Dean (Mr Harper). If the reason for the restrictions on our constituents’ lives is to prevent people from getting infected, getting very sick and being hospitalised, and thereby to protect the NHS, once we have vaccinated the people who could get very sick and use the NHS, we will no longer have the problem of protecting the NHS, so we should be able to lift the restrictions. Even if the Minister cannot clarify that that is the Government’s position, does it not seem like the logical consequence, or am I just completely daft?

I am being counselled not to respond to my hon. Friend’s description of himself. I do not think I should be drawn into speculation on the roll-out and what we face ahead of us. He will have heard the good news from the Secretary of State earlier that we have an additional vaccine that we can use and that the NHS is ready and poised to roll out at great pace. We are determined to do so. That is so important, as it means that we have hope as we go through this very difficult time.

It was very good to hear so many hon. Members recognise and thank not only NHS staff but those working in social care. Care home workers in particular were mentioned by my hon. Friend the Member for Thurrock, as were the social care workforce more widely. The hon. Member for Twickenham (Munira Wilson) mentioned the mental health of the NHS and social care workforce—something about which I care a great deal. I assure her and others who are concerned about this matter that we have put in place extra mental health support for frontline NHS and social care workers, including specialist helplines that are available 24/7 so that there is always someone they can call.

In conclusion, as we go about our lives under these restrictions, we must remember the pressure the pandemic puts on that workforce. I once again thank the public for all playing their part and for the sacrifices they are making for themselves, but especially for others. The end is in sight, but we have a way to go and we must take the steps necessary to suppress the virus here and now.

Question put and agreed to.


That the Health Protection (Coronavirus, Restrictions) (Self-Isolation and Linked Households) (England) Regulations 2020 (S.I., 2020, No. 1518), dated 11 December 2020, a copy of which was laid before this House on 11 December, be approved.

Public Health


That the Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) Regulations 2020 (S.I., 2020, No. 1533), dated 14 December 2020, a copy of which was laid before this House on 14 December, be approved.—(Rebecca Harris.)


That the Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) (No. 2) Regulations 2020 (S.I., 2020, No. 1572), dated 17 December 2020, a copy of which was laid before this House on 17 December, be approved.—(Rebecca Harris.)


That the Health Protection (Coronavirus, Restrictions) (All Tiers and Obligations of Undertakings) (England) (Amendment) Regulations 2020 (S.I., 2020, No. 1611), dated 20 December 2020, a copy of which were laid before this House on 21 December, be approved.—(Rebecca Harris.)


That the Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) (No. 3) Regulations 2020 (S.I., 2020, No. 1646), dated 24 December 2020, a copy of which were laid before this House on 29 December, be approved.—(Rebecca Harris.)