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Volume 813: debated on Thursday 15 July 2021


The following Statement was made in the House of Commons on Monday 12 July.

“With permission, Mr Speaker, I would like to make a Statement on our path out of the pandemic. All the way through our fight against the virus, we have looked forward to the day when we can roll back the legal restrictions and get closer to normal life. Now, thanks to the shared sacrifices of the British people and the protective wall of our vaccination programme, we have made huge advances. Today I would like to update the House on the next decision in front of us: whether to proceed to step 4 of our road map next Monday.

As I set out to the House last week, this will be a major milestone for the country, taking us another step closer to the life that we all used to live. It means carefully removing more of the restrictions that have governed our daily lives, such as how many people we can meet, how many people can attend weddings and how many visitors people in care homes can see, bringing them together with their loved ones. We have all been yearning to get there, and we all want this to be a one-way journey, so we have acted in a measured way, taking one step at a time, and looking at the very latest data and at our four tests before deciding whether to proceed.

The first test is the success of our vaccination programme. Ever since 8 December last year, when the world’s first clinically authorised vaccine was given right here in the UK, we have been putting jabs in the arms of people at a phenomenal pace, giving over 18 million doses in just seven months. We have given more doses per capita than any other large nation. As a result, around nine in 10 adults in the UK now have Covid-19 antibodies, which are so important in helping us and our bodies to fight this virus. To bolster this protective wall even further, we made the tough but necessary decision to take a four-week pause to step 4, so that we could protect even more people before easing restrictions. Since making the decision, we have been able to give 7 million extra doses across the UK. We have pledged that, by 19 July, we will have offered every adult a first dose of vaccine and given two doses to two-thirds of all adults. I am pleased to inform the House today that we are on track to beat both of these targets, so as we make this crucial decision, we are in a stronger position than ever before.

We have looked not just at how many jabs we have put in arms, but at what impact they are having on hospitalisations and the loss of loved ones. This is our second test. There is increasing evidence that the vaccine has severely weakened this link—a link that was once a grim inevitability. Data from Public Health England estimates that two doses of a Covid-19 vaccine offer around 96% protection against hospitalisation, meaning fewer Covid patients in hospital beds and fewer people mourning the loss of a loved one. The data also estimates that the vaccination programme in England has prevented between 7.5 million and 8.9 million infections. It has prevented some 46,000 hospitalisations and prevented about 30,000 people from losing their lives, all because of the protection that the vaccines can bring.

Our third test is around whether infection rates would put unsustainable pressure on the NHS. I want to be open about what the data is telling us and why we have reached the decision that we have. Cases are rising, propelled by the new, more transmissible delta variant. The average number of daily cases is over 26,000, and this has doubled over the past 11 days. Sadly, the case numbers will get a lot worse before they get better. We could reach 100,000 cases a day later in the summer.

Hospitalisations are also rising, with sustained growth over the past month. Once again, they will rise too, but we should be encouraged that hospitalisations are far lower than they were at this point during the previous wave, just as we should be encouraged that people over the age of 65, who are more likely to have had both doses of a vaccine, made up 31% of Covid admissions last week, compared with 61% in January. This is further evidence that our vaccination programme is doing its job and protecting the NHS. As more people get the jab, our protective wall is getting stronger still.

We will stay vigilant and keep a very close eye on the data, as well as on the impact of long Covid, on which we are investing £50 million into new research. But on the basis of the evidence in front of us, we do not believe that infection rates will put unsustainable pressure on the NHS. It is so important that everyone still does their bit in helping the NHS to stand strong. The best thing that each and every one of us can do, if we have not done so already, is get the jab and, crucially, get both doses.

Our final test is that the risks are not fundamentally changed by new variants of concern. We have seen from the growth of the delta variant, which now makes up 99% of new cases in this country, just how quickly a new variant can take hold. However, although the delta variant is more transmissible than the alpha variant, the evidence shows that two doses of the vaccine appear to be just as effective against hospitalisation. But we know that the greatest risk to the progress we have made is the possibility of another new variant, especially one that can escape immunity and puncture the protective wall of our vaccination programme, so even as we look to ease restrictions, we will maintain our tough measures at the borders and we will expand our capacity for genomic sequencing, which is already one of the largest in the world, so that we can come down hard the moment we detect a new variant.

We have looked closely at the data against these four tests and we firmly believe that this is the right time to get our nation closer to normal life, so we will move to the next stage of our road map on 19 July. To those who say, “Why take this step now?”, I say, “If not now, when?” There will never be a perfect time to take this step because we simply cannot eradicate this virus. Whether we like it or not, coronavirus is not going away. Moving forward next week, supported by the arrival of summer and the school holidays, gives us the best possible chance of a return to normal life. If we wait longer, we risk pushing the virus towards winter, when the virus will have an advantage, or, worse still, we will not be opening up at all. We delayed step 4 by four weeks so that we could build the vaccine wall even higher. We believe that this wall means that we can withstand a summer wave. While the wall would be higher still if we waited until winter, we know the wave would be much more dangerous. So while we know that there are risks with any decision, this is the most responsible decision that we can take.

This step forward is about balancing the harms that are caused by Covid with the undeniable harms that restrictions bring. These restrictions were vital to protect the NHS, but we must be up front about the impact of keeping them just as we are about removing them: the rise in domestic violence, the impact on mental health and the undiagnosed cancer, to name just a few. So we will ease the restrictions next week while at the same time maintaining the defences we have built against this virus, like our vaccination programme, where we still need more young people to come forward; our work to support the most vulnerable; and the contingency plans that we have put in place to stay one step ahead of this virus.

But this is not the end of the road: it is the start of a new phase of continued caution while we live with this virus and we manage the risks. We are today publishing a plan showing the safe and gradual approach that we will be taking throughout the summer. It includes details of how we will be encouraging businesses and large events to use certification in high-risk settings to limit the risk of spreading infection, how we will use guidance for those who are clinically extremely vulnerable, and details of a review that we will be conducting in September to assess our preparedness for autumn and winter.

As we make these changes, it is so important that people act with caution and with personal responsibility. For example, everyone should return to work gradually if they are currently working from home, they should try to meet people outside where that is possible, and it is expected and recommended that people should wear face coverings, unless they are exempt, in crowded indoor settings like public transport.

I also want to take this opportunity to update the House on our policies for self- isolation. Last week I announced to the House that from 16 August double-jabbed adults and under-18s will no longer need to self-isolate if they are a close contact of someone with Covid-19. Until then, with case rates expected to rise, it is vital that we ensure that our systems for self-isolation are proportionate and reflect the protection given by our vaccine programme. As part of this approach, we will be working with clinicians and the NHS to explore what more can be done for colleagues in patient- facing roles—this would be used only in exceptional circumstances where the self-isolation of fully vaccinated close contacts could directly impact the safety of patients—so that we can keep our vital services going as we safely and gradually get closer to normal life.

Mr Speaker, 19 July will mark another step forward in our road to recovery. Getting here has been hard fought, and it has been long awaited, but this battle is not over yet. Let us move forward in a confident but measured way so that we can get closer to normal life and protect the progress that we have already made.”

I thank the Minister for taking this Statement, although I have to say—and I know this is not in his gift—that Monday to Thursday is probably too long a gap, but taking the Statement today might in this case prove useful because we have seen the reaction to the nearing of so-called freedom day, nationally and internationally. We have also seen the Government becoming progressively more cautious. That is not surprising because in England 42,000 Covid infections and 49 more deaths were recorded yesterday, hospital admissions have increased to more than 500 a day, up 50% on last week, and we now see routine operations being postponed and cancelled.

The NHS is rightly focused on waiting lists, which are at their highest level over the past decade at 5.3 million, and 336,733 people have been waiting more than a year, more than 76,000 have waited for at least 18 months and more than 7,000 have been waiting for two years. Emergency care is grappling with some of the highest summer demand ever, and this is in the context of NHS staff being exhausted and facing burnout. The NHS is also losing a significant number of staff to self-isolation, which has led to much reduced capacity due to infection control. As infection rates get worse and increase, what is the Government’s plan to deal with this situation?

Since Monday we have seen an increasing number of announcements and questions about how to safeguard against further increases in infection and the impact it is having on our NHS, schools, businesses and communities. Indeed, our own Lord Speaker wrote:

“Members are still expected to wear a face covering both in the Chamber, in indoor crowded spaces and when moving around the Estate, in line with general advice from Public Health England and the Chief Medical Officer. Members are strongly encouraged to use the testing facilities provided.”

On these Benches we intend to follow that advice, and I regret that some Members have already abandoned their masks when moving around the building and in the Chamber. We have staff to look after us who may not yet be fully vaccinated and, anyway, have no choice but to be here and who will continue to wear their masks to protect us. We should afford them the same consideration. Does the Minister agree?

On the “Today” programme a few days ago Professor Graham Medley, the chief modeller for the SAGE committee said: “Wearing face masks is worth it but only if everyone does it, not just 70%. I understand the Government’s reluctance to actually mandate it. On the other hand, if it is not mandated, it probably won’t do any good.” In other words, my understanding is that unless more than 70% wear masks, the protection for those who are still vulnerable will not work.

I fear we have been here before, with the Government back-pedalling and, in doing so, creating confusion and ambiguity—exactly the circumstances for the virus to thrive and mutate. The guidance issued by Ministers yesterday was stronger than businesses expected, many of which feel that they have been led astray, given the Government’s repeated characterisation of 19 July as “freedom day” and the end of most restrictions. The truth is that the guidance is hardly different from the current rules, except that businesses are now “encouraged” to keep many of their Covid adaptations rather than required to do so. Businesses now have just five days to decide how to implement the rules and how to communicate that to their customers. Does the Minister accept that the Government’s mixed messages have left many in legal limbo?

The new guidance gives little clarity to the 3.8 million extremely vulnerable people who are being told to avoid all unvaccinated people. How are they supposed to know whether or not someone is vaccinated? Does the Minister share the concerns raised by charities and patient groups that guidance has effectively told the extremely vulnerable to shield, without backing that up with any formal support from the Government for working or food shopping? Government advice to the clinically extremely vulnerable is to go to the shops at quieter times of the day after 19 July. I am not sure if that can be dignified as “support” for those most at risk of serious illness from Covid-19.

Is it true that the Government have not had anyone in post to deal with the clinically extremely vulnerable for three months, since Dr Jenny Harries was appointed chief executive of the UK Health Security Agency? If that is true, it is deeply concerning and it may explain why the Government have failed to prioritise support for these 3.8 million people.

What are the contingency plans for surging hospital admissions, which may remain high until the end of August, as called for by members of SAGE? The new guidance also says that businesses should encourage customers to check-in using the NHS app or otherwise leave their contact details. Can the Minister confirm reports that plans to reduce the sensitivity of NHS contact tracing have been reduced because of the surge in cases? What assessment have the Government made of the effectiveness of the app as an infection control tool, given reports that more than 20% of adults and a significantly greater proportion of young people have actually now deleted the app and many more are ignoring the advice to self-isolate?

I turn to those working from home. Despite the lifting of guidance to work from home, the Government say they expect and recommend a gradual return to offices. This is very confusing. What protection is proposed for those who are vulnerable, and for whom “freedom day” is not freedom day but a further lockdown day? If their employers demand that they return to work, even if they are immunosuppressed, for example, travel and enclosed places pose a threat to them. Under these circumstances, we need to be grateful for the good sense of the Mayor of London in following the science. Sadiq Khan has said that Transport for London will continue to enforce the wearing of face masks on services in the capital beyond 19 July.

While industry bodies said on Tuesday that no domestic train operators or major bus and coach firms will require customers to wear masks, the city mayors and others are calling for mask wearing on all public transport. Does the Minister agree with them? If Tracy Brabin, Andy Burnham and the other mayors had the power to enforce mask wearing to protect drivers and passengers, they would do so. They are doing the Government’s job for them.

What support are the Government going to give those areas with the lowest vaccination rates? Local authorities in London have, variously, 35%, 36% and 42% of their populations vaccinated. Does the Minister support the leaders of those authorities who say that they wish mask wearing to continue until they have got their populations caught up with vaccination?

My Lords, the Prime Minister told us 10 days ago that we were heading for “freedom day” and that all the data was going in the right direction; all restrictions would be lifted, and now was the time to take personal responsibility for our behaviour and for the Government essentially to step back. The Secretary of State’s Statement on Monday confirmed that, although with a marginally more cautious note about taking care. I echo particularly the comments made just now by the noble Baroness, Lady Thornton, about the mixed messaging in the new guidance for business and on returning to work, which conflicts with what was said both in the Statement and by the Prime Minister.

However, since the Prime Minister’s and Mr Javid’s confident assertions on Monday, there has been an outpouring of disbelief from senior scientists and doctors. Cases are currently doubling every nine days, and yesterday there were 42,000 new daily cases—a level last seen at the beginning of the January total lockdown. If there is no slowing of that doubling rate, we will have hit 100,000 new daily cases by the beginning of August. And that is before the Government’s expected extra cases as a result of “freedom day” on Monday.

Ministers constantly say that there are fewer people in hospital, that fewer people need ventilation and there are fewer deaths, but what they do not mention is that those numbers are a matter of ratios, and that with the current level of cases our hospitals are already reporting A&Es with the equivalent of a winter surge and more wards being turned into Covid wards for patients. A letter published a few days ago in the BMJ, initially signed by 1,000 doctors, is at over 7,000 signatures and still rising. The data is already clear that the surge in new cases from three weeks ago is increasing hospital admissions right now. So what are the Government doing to support and protect our NHS from this sharp increase and pressure on doctors, nurses and hospitals right now?

While many people are being responsible, still following the guidance and using their face masks, sadly there are many who are not. I was talking to a young security guard who told me that, this week, she is finding it impossible to persuade people to put masks on in their local shopping mall, despite the fact that the rules are still in place. Yesterday, my local community pharmacist told me in despair that two people arrived separately asking him for PCR tests as they each had Covid symptoms and thought all the previous rules had just finished. Not for the first time, much of this is about the Prime Minister’s muddled communication style. In the light of the fact that Scotland, Wales and Northern Ireland are going to retain the face mask mandate, and that the metro mayors, including Sadiq Khan and Andy Street, would like to do so, will the Government please reverse the lifting of the face mask mandate immediately, so that it remains in place, especially on public transport?

I turn to the new guidance for the clinically extremely vulnerable. I have to say that I have never read such an inconsistent and contradictory formal guidance note from the Government—and I have read a few. You should stay at home to be safe but if you cannot work from home, go in; you must remain socially distanced from everyone outside your bubble, even if they do not have to; you must not mix with unvaccinated people, outside or inside. I ask the Minister to tell me how on earth you know who is unvaccinated. As one of the CEV, do I stand in the doorway at opening time at my local greengrocer’s—a quiet time—and shout out to any customers and staff, “Anyone not vaccinated in here”? Of course not. The inevitable logic of this is the restart of shielding but without any of the previous support.

Worst of all, on Friday evening Public Health England put out a press release in which it mixed up advice to the clinically vulnerable and the clinically extremely vulnerable by citing vaccine efficiency research relating to the former in advice to the latter. That paragraph has been repeated in the formal guidance published on Monday. It is plain wrong. In a total administrative muddle, no one has gone through the nine pages of this guidance and updated it, so it is littered with references to the need to follow other rules and guidance for the general public in place at 17 May and 21 June, all of which goes next Monday. Please will the Minister ensure that the guidance is reviewed immediately to remove these anomalies?

All this, and the lack of answers to my questions last week about who the clinical lead is on the clinically extremely vulnerable, tells us 3.8 million former shielders that we have been not just forgotten but thrown to the wolves. Please will the Government actually review the guidance to keep the CEV group safe and provide the support that they need?

I also gave the Minister notice of the following two questions, as they both concern urgent and slightly unusual elements of lifting restrictions. First, for a couple of weeks now, Malta has said that it will not accept UK citizens who have received particular batches of the AZ vaccine manufactured in India, about 5 million doses of which have been given in the UK. Earlier this month, the Prime Minister reassured the press, saying:

“I am very confident that it will not prove to be a problem.”

However, holidaymakers are being turned away from Malta right now. When will the Government resolve this problem?

Secondly, those thousands of wonderful people who came forward to take part in the AstraZeneca clinical trials have been told that their vaccine status cannot be put on the NHS app, which means that they cannot go abroad, either to work or on holiday, or do certain jobs in the NHS that require this evidence. In early June, there was a blog on the BMJ website that set out these problems, but three months on from this issue being initially raised, there is still no resolution. It is utterly wrong that these publicly-minded people have now been left in limbo. Can the Minister say when this problem will be resolved and their vaccine details uploaded?

My Lords, I am enormously grateful to the noble Baronesses, Lady Thornton and Lady Brinton, for their thoughtful questions. The noble Baroness, Lady Thornton, put it extremely well: we are at a delicate inflection point. It is a moment when the whole country needs to be cautious about rushing into change, but it is also a moment when the vaccine is having an enormous impact and change is therefore appropriate.

Infection rates are rising dramatically, but we cannot avoid the fact that hospitalisations and deaths are holding relatively steady. Today, there are 2,970 Covid patients in beds and 470 on ventilators. This is a massively smaller proportion than in the pre-vaccination spikes, when the connection between infection, hospitalisation and death was much firmer and more profound. At the same time, as the noble Baroness, Lady Thornton, rightly pointed out, waiting lists are huge and the gap for diagnostics for severe diseases, such as cancer, is extremely concerning. It is our responsibility to step up to that deficit and not be wholly distracted by Covid. This is therefore a moment when we have to balance competing demands on our healthcare; we are trying to hit the right balance.

On masks, I pay tribute to the Lord Speaker for his leadership in this area and on asymptomatic testing. I saw his Twitter post where he was being swabbed for his LFD test—a commendable sign of leadership. He and the noble Baroness, Lady Brinton, are entirely right: we should wear masks out of consideration for others, including others who may not have had the vaccine or may not be able to have the vaccine. However, it is also entirely right that central government cannot mandate every aspect of human behaviour for months and years to come. I take great pleasure in the sight of local leaders using their influence to inspire the public in this matter. I remind the noble Baroness, Lady Brinton, that DPHs are able to bring in mandatory measures where there are areas of outbreak. People need to know that the wearing of masks has an impact, and we are hopeful that they will go along with that. Although legal restrictions are being removed, the guidance will recommend that masks continue to be worn in certain situations, and businesses will be encouraged to support staff and customers who continue to wear masks.

In line with businesses, public services have always been free to set their own entry policies as long as they meet their existing obligations, including under the Equality Act. Public services must continue to protect workers and others from risks to their health and safety, including from Covid. That is only right and fair.

On the very important question of the immuno- suppressed and the immunocompromised, both noble Baronesses made extremely powerful points. I want to express in very clear terms my personal sympathy for all those who have concerns about the impact of the vaccine and for whom the rise in infections presents a very real threat to their health. However, I flag the Public Health England report on the clinically extremely vulnerable group as a whole. It makes it clear that there is little reduction in vaccine effectiveness for them compared to those who are not in high-risk groups, with between 76% and 93% effectiveness after a second dose. The PHE data also suggests reduced effectiveness for the immunocompromised and the immunosuppressed, particularly after one dose, but effectiveness after two doses is much higher. These general figures mask substantial variations, which we have discussed before—we would expect this between one set of compromised systems and another—but future studies will provide much more granularity on that. It is not right, however, to suggest that all those with compromised immunities are left unprotected by the vaccine.

The guidance for those who are clinically extremely vulnerable was updated and published on 12 July, as the noble Baroness, Lady Brinton, pointed out. This confirms that changes to social distancing rules in step 4 will also apply to the CEV, who are advised to continue considering additional precautions that they may wish to take on board. I hear very clearly the noble Baroness’s points about anomalies in the guidance; I will take those back to the department and try to tidy up the documentation as she advises.

I can inform the House that we are writing to NHS clinicians to update them on them on the latest position regarding vaccine effectiveness for these groups and provide information on potential treatment options currently under development, such as monoclonal antibody therapies and novel antivirals, as well as access to antibody testing. This guidance will support clinicians in their conversations with patients. This is such a variegated group that that kind of personalised advice is critical.

The interim JCVI advice is that all clinically extremely vulnerable people, including immunosuppressed individuals and their household contacts, should be prioritised for a booster vaccine in the autumn. We are continuing to invest in the OCTAVE study, which will provide further data on patients with suppressed immune response. Interim results for the immediate response to the vaccine will be available from the middle of July.

We are absolutely focused on ensuring that the population is given clear guidance. The NHS app is undoubtedly an area that needs to evolve. Its effectiveness as a technological tool in giving people counsel and advice when they have been in close proximity to someone with the infection is extremely valuable. We are looking at ways in which that value can be enhanced.

On the specific question of the noble Baroness, Lady Brinton, about Malta, it is for member states to determine what they accept at their borders regarding vaccines. Foreign travel advice recently published for Malta misleadingly reported that it would not accept the specific batches received from the Serum Institute of India in the UK. This has now been resolved with agreement from the Maltese Government, and Malta is now accepting proof of vaccination from any Covid vaccine administered in the UK.

Turning to those who, as the noble Baroness, Lady Brinton, rightly pointed out, stepped forward for the critical AstraZeneca vaccine clinical trials, being on a vaccine trial absolutely should not disadvantage them. The Government intend to take any action available to ensure that that is the case. We are working with clinical research sites to add participant information of vaccine clinical trials to the national immunisation management service—NIMS—to allow participants to access their NHS Covid pass for both domestic and international travel purposes.

We now come to the 30 minutes allocated for Back-Bench questions. I ask that questions and answers be brief so that I can call the maximum number of speakers. I understand that the noble Baroness, Lady Watkins of Tavistock, has withdrawn so I call the noble Baroness, Lady Stroud.

My Lords, on 9 July a Department of Health and Social Care press release claimed that, for those who are immunosuppressed, vaccine effectiveness after a second dose is 74%, with

“similar protection to those not in an at-risk group.”

But this was based on an extremely small sample size. In response, Blood Cancer UK’s chief executive Gemma Peters said that

“its ‘confident, definitive assertions’ about the level of protection given to the UK’s 230,000 blood cancer patients could not yet be supported by the ‘wider body of evidence on vaccine efficacy in the immunocompromised’”.

I am aware that my noble friend the Minister has already commented widely on this issue, but could he comment specifically on those with cancer, particularly those 230,000 blood cancer patients? What intention do Her Majesty’s Government have to clarify this guidance and ensure that the immunosuppressed have access to the necessary resources to help improve their understanding and decision-making?

My Lords, the position of the immunosuppressed is one that we have a huge amount of sympathy for. Those who have blood cancer face a particular challenge. I was very grateful to meet Blood Cancer UK and discuss this matter. The PHE report makes the very clear point that those with suppressed immune systems may have a very strong vaccine response, particularly after two weeks after two doses. Just because someone has a suppressed immune system, it does not mean that the vaccine has left them completely unprotected. I completely accept that the responses of one group and another group may be quite different and it is difficult to lump everyone together. That is why we are investing in the OCTAVE study; I am hopeful it will be published by the end of the month. That will provide some, but not all, the information we need to elaborate on that guidance.

My Lords, with government scientists predicting that up to 4,800 people a day could be admitted to hospital with Covid if England rushes back to normality at the same time as health experts are predicting a surge in flu and other respiratory viruses likely to lead to severe pressures on the NHS, what contingency plans are the Government putting in place to deal with these pressures without leading to the backlog of other much-needed care and treatment growing ever bigger? Will these contingency plans be published?

My Lords, we acknowledge the risks. The noble Baroness is entirely right about flu; the relatively low levels of both flu and RSV in the last 18 months mean that many will not have the immune system that they normally would, and flu is a present danger. That is why we are working so hard on the flu vaccine programme and bundling Covid boosters and flu vaccines for those in the right prioritisation lists. I encourage absolutely everyone to make sure they get their flu vaccine when it comes around. Given the range of uncertainties, we are working with the NHS on its plans for this winter. We will ensure that the service has what it needs to meet those challenges.

My Lords, what progress is being made in negotiations with the USA for double-vaccinated citizens of both countries to travel between the two countries, with non-NHS vaccines being accepted and without quarantine being required?

My Lords, following the G7 we pulled together a joint task force with USA colleagues to address the precise point that the noble Baroness alludes to. That joint task force is working extremely hard to resolve the various practical, epidemiological and virological arrangements for the kind of green-list corridor that we would like to have between our two friendly countries. I am hopeful we will be able to make announcements on that shortly.

I would be most grateful if the Minister could follow on from the question of the noble Baroness, Lady Tyler, and tell us when these plans will be published. The statement says

“we do not believe that infection rates will put unsustainable pressure on the NHS”,

yet we know that the lambda variant, if it should come into the UK and spread, is probably antibody resistant. We know that already, last weekend, some emergency departments had waiting times of around eight hours because they were under such pressure from patients plus staff sickness. We know that it is completely inhumane to expect parents of a sick baby to go into work if the child has RSV during the winter, so those members of staff will inevitably take unpaid leave if they are not allowed to take leave to look after their child.

The challenge presented by workforce illness in the NHS is acute at the moment. It is one we are very conscious of, and the noble Baroness is entirely right that parents who have a sick child must stay at home. Not only is that humane; it is also infection control wisdom. That puts the pressure on. That is why we have prioritised vaccination among healthcare staff, and we are prioritising the boosters for staff.

In terms of managing emergency services, we are conducting a huge marketing campaign around the use of NHS 111 so that people can book their slot and be directed to the right kinds of services because, as the noble Baroness knows, many people who turn up in emergency departments are not necessarily in the right place for the conditions they present.

In terms of variants of concern, we are keeping an eye on lambda, beta and all those that may present a vaccine escape risk. We will take whatever steps necessary to address their threat.

My Lords, I remind your Lordships’ House of my interest as deputy colonel commandant of the Brigade of Gurkhas. Since I last raised the plight of unvaccinated Gurkha veterans in Nepal, I am delighted that the Government have acknowledged their duty of care to them under the Armed Forces covenant. Previously my noble friend has said that our priority is to vaccinate “our people” in the United Kingdom. Now that we seem to be struggling to find people to give the first vaccination to, since there are fewer than 50,000 per day, can I simply ask him again when we will vaccinate our people —our Gurkha veterans are absolutely “our people”—in Nepal? When will they get their vaccines?

My Lords, I pay tribute to my noble friend for his campaign on Nepal. His remarks are heartfelt, understood and heard clearly. We all recognise the debt we owe, not just to those from Nepal who have served in Her Majesty's Armed Forces, but their families and the entire nation for their contribution throughout Britain’s history. The PM has announced that the UK will donate 100 million doses over the next year, and the majority of those will be donated to COVAX. My honourable friend in the Foreign, Commonwealth and Development Office will be best placed to clarify the precise arrangements and where Nepal will stand in that supply chain.

I wonder if the Minister could help me a little with the Government’s logic. Care home workers on zero-hour contracts are to be forced to get vaccinated without even a single guaranteed paid day off to recover from side-effects. A significant step change on domestic Covid passports is to be decided on by businesses themselves and regulated by them, despite all the problems with testing and tracing. Yet something as light touch and common sense as wearing a mask in shops and on public transport is not to be a legal requirement. What is behind this mask aversion and confusion—scientific evidence or Trumpian culture wars?

My Lords, in terms of care home staff vaccination, we are in the midst of a consultation on the subject. The noble Baroness should not necessarily pre-empt the consultation. We take into account the views of those we are consulting with. It is a measure that has caused an enormous amount of concern both here in the Chamber and with the public. It feels right that we should be consulting on a measure that ultimately protects the elderly and vulnerable.

In terms of certification, the ultimate use of certification in domestic surroundings has not been fully decided. At this stage, with the country enjoying the benefit of the vaccine, it seems right to be leaving that to businesses to decide how they wish to use it themselves.

My Lords, I want to follow on from the question from the noble Baroness, Lady Chakrabarti. The Government believe that passive smoking poses risks to individuals; hence they ban smoking in offices, pubs and other public places. The science has persuaded the Government that, during a pandemic, the wearing of masks in public places helps prevent individuals from passing on Covid to others, which even those who have been double vaccinated can do. In the Statement, the Government say that it is expected and recommended that masks will continue to be worn. Can the Minister explain why smoking should be governed by government diktat, but mask-wearing should be a matter of personal choice?

The noble Baroness makes her points extremely well. I support the ban on smoking in public places for exactly the reasons she describes. However, I do not support a mandatory, legal ban on sneezing, although I do not like people sneezing in my presence. We have to strike a balance between mandation and voluntary arrangements. We also have to choose the right people to make these decisions. Central Government cannot make every single decision on every single matter. I recognise the concern of both the public and of noble Lords in this Chamber about masks. It feels right to leave it to local decision-makers, politicians and companies to take the public with them and to enforce this measure which, I entirely agree, is of benefit to us all.

My Lords, with the number of infections rising and restrictions continuing to ease, can my noble friend say whether the supplies of vaccines and the capacity to administer them allow the vaccination programme to be further enlarged? This would give us a better chance of overcoming the undoubted risks which, unfortunately, remain.

We have an established vaccine run rate and programme, and we have in place the supplies to meet those targets and to fulfil the commitment to vaccinate all those who step forward for vaccination by the end of July. My noble friend may be referring to either a third or booster shot with a variant vaccine. Negotiations and clinical studies are taking place at the moment. We are cognisant that the vulnerable, elderly and those in high priority groups may need further vaccination in the autumn. We are putting in place all the plans necessary to deliver this.

My Lords, I return to the confusing advice on masks. In the early weeks of the pandemic, some of the worst levels of deaths occurred among transport workers. They were inevitably faced with potential infection for several hours a day. It was particularly true of bus drivers, including a very good friend and neighbour of mine who died from Covid a few months before his retirement. With the advent of compulsory mask-wearing on public transport, driver hospitalisation and deaths fell dramatically. With rising infections and more unpredictable variants, what on earth is the rationale for not making masks mandatory on public transport and in other situations where staff are dealing with an increasingly maskless public?

I thank the noble Lord for that very touching personal testimony about his neighbour who passed away. It is an important account of many who have put themselves at risk. The PHE report on high mortality groups includes bus drivers, taxi drivers and many who perform an important public service that puts them in front of the general public and therefore at risk from this virus. We absolutely support the wearing of masks. Published guidance will continue to recommend that wearing a face covering will reduce the risk not only to yourself but to others, particularly in enclosed and crowded spaces. The noble Lord asked about whether mandation should be in place and for whom, and I do not wish to duck his point The mandation of masks on public transport is best left to those who run it, which is why we have moved away from legal rules to an approach that enables personal judgments and the intervention of businesses and local leaders.

My Lords, much uncertainty and changing dynamics surround travel—Malta and the EU have already been mentioned. To flip that around, can the Minister kindly explain the rationale as to why government advice has belaboured ad nauseam travelling from the UK, yet my wife is able to travel to the UK from Portugal?

My Lords, our intention is that, later in the summer, those who are fully vaccinated will not have to quarantine when arriving in England from an amber list country. This will benefit the noble Lord’s wife, and I hope she will take advantage of it. When it comes to travel, caution is still the principle because travel exposes us to proximity to people in very confined areas. It also raises the possibility that variants of concern will come back with travellers returning from abroad. We have worked so hard and done so much to keep those VOCs out of the UK that it is not just right to give up these efforts now. Those arrangements are under review and will change if the risk assessment changes.

My Lords, I have listened very carefully to the Minister but I did not quite hear the answer to the questions asked by the noble Baronesses, Lady Tyler and Lady Finlay, about the forthcoming pressures on the NHS. The hospital I was at on Tuesday morning is, I was told, working at full stretch; it is at winter levels in July. Covid is taking up ICU beds and stopping elective surgery now, even before the pressure starts. There are constant references in the Statement about not wanting unsustainable pressures on the NHS, but we are putting such pressures on it by allowing the figures to rip without seeming to have proper back-up services and resources. Can the Minister answer the questions from the two noble Baronesses?

My Lords, I thought I had answered the questions put by the two noble Baronesses. I will seek to answer the noble Lord. He is absolutely right: our hospitals are working flat out but this is not mainly because of Covid. As of 11 July, hospital admissions in England were running at 502 a day. As of 13 July, there were 2,970 patients in hospital in England with Covid, of whom 470 were on mechanical ventilation. Catching up on all the backlog—not Covid—is what is consuming the hospitals and making them run so red hot. This is the focus of our healthcare system at the moment, and it will remain so for some time to come. We are under no illusions: there is a massive backlog which includes many people who have not come forward with symptoms of severe disease and will need to be addressed and treated. This is a huge national project that we are undertaking.

My Lords, in his answer to the question from the noble Baroness, Lady Wheatcroft, the Minister made a comparison which suggested an equivalence between mask-wearing and sneezing. The website MedExpress says:

“Sneezing is…an involuntary release of air that helps the body to get rid of irritants in our nose and throat”.

Does the Minister wish to reconsider that comparison and acknowledge that mask-wearing is a voluntary action available to everybody?

The noble Baroness obliges me to confess that, as a young man, I mastered the art of controlling my sneezing, and I am pathetically proud of this. I should be glad to share the skill with her should we have the opportunity to spend some time together.

I want to return to the question of masks. As we have already heard, the ending of the mandatory wearing of masks is causing anxiety and insecurity among clinically vulnerable people. Would the Minister agree that, given that the wearing of masks reduces the spread of the virus and causes no harm to the economy, it would be sensible to make it mandatory? Secondly, guidance recommends good ventilation in enclosed spaces. What assistance are the Government giving to those who need to install air filtration systems?

My Lords, I will be crystal clear on this matter. The noble Baroness is right: the wearing of masks is important—for yourself and other people— which is why the Government continue to recommend that people wear them. However, the question was about mandation, and, as I said earlier, it is not reasonable for the Government to mandate minute aspects of our life in perpetuity. We have made a decision on that and passed the responsibility to individuals, local leaders and those who do outbreak management. I completely understand and hear loud and clear people’s concerns, but, were we to mandate it, what is the option for the country? Are we going to issue tens of millions of fines to those who do not wear masks? If they do not wear them, will we lock them up in prison? We tried extremely hard on that policy, but I am not sure whether it had any further rope to run.

My Lords, I welcome the direction in which the Government are now proceeding. I quote from the Statement:

“To those who say, ‘Why take this step now?’, I say, ‘If not now, when?’”

There is regulation fatigue, and the Government are facing up to the need for, let us say, a managed process forward. I draw the Minister’s attention to this statement in the Statement:

“We are today publishing … details of a review that we will be conducting in September to assess our preparedness for autumn and winter.”

Could a copy of that review be placed in the Library so that we can all see what it has to say and, if necessary, offer our observations to the Minister to help the further development of what is turning into a policy that I can be fully behind?

My Lords, winter is a challenging time for the NHS, and, during an average winter, seasonal respiratory conditions drive an increased demand for hospital beds, as my noble friend knows. That will add to the already intense pressure that the NHS is under. Plans are being put in place. The circumstances are changeable. If there are any plans whatever that can be published, I will ensure that they are sent to the noble Lord and placed in the Library, as requested.

My Lords, the Statement from the Minister says that the Government will

“expand … capacity for genomic sequencing”,

which would help in the detection of any new variants. Could the Minister define how and when that expansion will take place?

Enormous expansion has already taken place: we have brought together the existing dispersed genomic sequencing capacity of the country and brought it to bear, both at the PHE headquarters in Colindale and in Cambridge, where a huge array of sequencing is going on. We have also brought sequencing into Leamington Spa, where, as the noble Baroness may know, we have a large industrialised diagnostics centre, so that sequencing can be done as soon as we have turned around the PCR testing. We are running at around 30,000 or 40,000 sequences a week, which is a dramatic increase on the past, but we continue to invest in this capacity.

My Lords, would my noble friend give consideration to putting a full-page advertisement in every paper, with guidance? This must be clear, coherent and consistent. Would he also—I am sorry to press him on this again—tell me when this consultation over care-home workers will conclude? President Macron has already decided that this will happen in France. A third of the people who died were in care homes; they are the most vulnerable of the vulnerable. It is essential that those who look after their intimate needs are themselves vaccinated.

My Lords, I will definitely consider the idea of a full-page advert, and I am grateful for that suggestion. I would also be very interested to receive a submission from my noble friend to the consultation, and, if he would like to copy me in on it, I would be glad to make sure that it gets through to the right people.

My Lords, I have listened carefully, and the mask obsession here seems to mask a certain reluctance to ever allow normal to return, even if it means a terrible toll on jobs, livelihoods or non-Covid health—so I am glad to hear the Minister being more balanced. However, I will bend the stick and ask him whether he will concede that many millions are demoralised that the Government’s irreversible freedom day comes with so many caveats that it feels like parole with an electronic tag and house arrest hanging over us like a sword of Damocles? Can we not get a bit more balance? On data, according to PHE on hospitalisations, of those who spent more than one night in a hospital with the delta variant at the end of June, 39% were patients who had gone to hospital with different conditions—so could the hospitalisations data perhaps be clarified, because I think that that would reduce fear and give a bit of perspective?

My Lords, the noble Baroness slightly underestimates the significant step that the Government have made in order to take advantage of the vaccine, try to get the economy moving and address the very considerable backlog that we have in the NHS. The Prime Minister deserves some praise for the way in which he has moved emphatically in this direction. Therefore, I am a little bit surprised that the noble Baroness has not done more to recognise that point. On the data, I would be glad to look at the number that she describes. It is not one that I recognise, but I would be glad to correspond with her on it.