My Lords, I thank all noble Lords for taking part in this debate. I apologise to noble Lords for getting the terminology wrong at the beginning. I will make sure that that is corrected in future.
I thank my noble friend Lady Noakes for raising this important issue, and for challenging us and rightly holding the Government to account on many procedural issues. I accept that your Lordships perform an essential role in scrutinising the measures that we have put forward today. That is one of the things that makes me very proud to be a Member of this House. I recognise the strength of feeling of your Lordships for and against what we are proposing and about the procedures thus far. I know that these feelings are sincere and heartfelt.
I now turn to some of the point raised by noble Lords. My noble friends Lady Noakes and Lord Cormack and the noble Baroness, Lady Brinton, raised questions about the red-rated impact assessment from the Regulatory Policy Committee. I hear the concerns of this House, and I acknowledge that, due to the necessity to move as quickly as possible and minimise the risk to those who are vulnerable, we were unable to publish the full impact assessment alongside the regulations being laid. We set out a statement of impacts, and the full impact assessment has now been published on GOV.UK, but I accept the argument made by noble Lords that this is rather late. We have also now published additional consideration of the points raised by the RPC in relation to private businesses.
My noble friend Lady Noakes also asked what the Government have done in response to the criticisms of regulations from the Secondary Legislation Scrutiny Committee. I reassure noble Lords that we have published the updated Explanatory Memorandum to provide additional information on the specific concerns raised. I also accept the criticisms that this could have been more timely. This includes more information on the scientific and clinical rationale for the policy, the exemptions that have been provided for, those not included, and the steps that we have taken to further encourage uptake of vaccinations and to mitigate work- force risks.
The SLSC also raised concerns about the impact assessment on process. We have worked hard and as quickly as possible to finalise the impact assessment that we feel best captures the likely impact of this novel policy in the uncertain circumstances that we are still living through and the need sometimes to react
quickly. As my noble friend Lady Noakes rightly said, this impact assessment was laid before the House in advance of this debate.
My noble friend Lady Noakes also raised the question of whether a cost of £270 million is value for money, considering the impact assessment. While it is not possible to model the non-monetised benefits that this policy would have due to the limited data available, the health benefits through reduced infections and deaths among health and care users—as well as the wider community—from the workforce being vaccinated are likely to be large and should be considered when focusing on costs.
A key benefit is the impact of reassurance to patients and care users that they are being looked after by staff who are vaccinated. This avoids the very dangerous situation of people feeling wary of going to the NHS and other health and care providers, which can have dangerous long-term implications regarding health outcomes for our society. This is non-monetised, yet it remains a highly significant factor.
My noble friend Lady Noakes also asked about the workforce impact of this legislative instrument. As of 5 December, 521,000 staff in all care homes, or nearly 96%, have been vaccinated with the first dose, and 511,000 staff, or 94%, are reported to have received a second dose based on responses from 99% of providers. Although NHS workforce figures are dynamic as people join and leave, since the Government consulted on the policy in September, the latest published figures show an overall net increase of NHS staff vaccinated with a first dose of over 55,000.
My noble friend Lady McIntosh also raised valid questions about the impact on the social care workforce. We are not aware of any care homes where VCOD is the primary reason for closure, but we continue to work with our regional assurance team, which works closely with regions across the country to understand the local and regional pressures, and offer support and advice as appropriate.
In social care, we have already put in place a range of measures to help local authorities and providers to address workforce capacity pressures; indeed, I have announced some of those in this House. As in healthcare, there will be a 12-week grace period for workers in the wider social care sector before requirements come into force, which will give all unvaccinated staff time to get their jab. We are focusing every effort on promoting and encouraging vaccine take-up across social care, and £300 million was announced for the workforce on Friday 10 December to support the care sector over winter.
My noble friend Lord Cormack, the noble Lords, Lord Cunningham and Lord Hunt, and several other noble Lords have eloquently raised points about the use of retrospective legislation and emphasised the importance of parliamentary processes. I sympathise with noble Lords who are concerned about some of the procedural aspects of the passage of this legislation.
As my noble friend Lord Cormack rightly said, in unprecedented times such as these it is right that the Government do everything in their power to protect the vulnerable. Vaccination is our best defence against Covid. It reduces the likelihood of infection and therefore
helps to break chains of transmission, as the noble Baroness, Lady Thornton, rightly acknowledged. It is safe and effective. The legislation will protect those receiving care in all health and social care settings as well as our valuable health and social care workforce themselves.
I agree with my noble friend on the point about reviewing the use of such legislation. I assure noble Lords that Regulation 5 sets out the requirement for the Secretary of State to carry out an annual review of these regulations, taking into account clinical advice and accessibility and availability of authorised vaccines, and to publish a report setting out the conclusions of this review.
On my noble friend Lord Cormack’s suggestion of an ongoing Joint Committee, I apologise if the response I suggested was inaccurate. I suggest that I discuss it with him so that I can learn from his experience of parliamentary procedures.
The noble Baroness, Lady Tyler, referenced the importance of encouraging the hesitant. I completely agree. We both come from the same part of London; indeed, she informed me that we went to the same school. We come from an incredibly diverse area, and we understand the different concerns and pressures in many of these communities; as noble Lords will recognise, I myself come from one of these communities. But as she will know, the NHS has focused in recent months on a targeted approach to improve uptake in hesitant groups by undertaking campaigns not only based on function, such as at midwifery staff, but directed at different communities, such as ethnic-minority groups and students, as well as using the booster campaign as an opportunity to re-engage staff. I repeat my gratitude to noble Lords across the House who have suggested to me ways that we can address many of these communities, including working with interfaith communities and networks which really understand these communities and have the trust of many individuals.
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To maximise uptake over the winter months, the NHS’s plan includes a range of strategies. We have increased the number and diversity of opportunities to receive the vaccine. Many noble Lords will be aware of pop-up centres, pharmacies and mobile units available. It has come to this: we have to go out and take services as close to those communities and individuals as possible.
The right reverend Prelate the Bishop of St Albans echoed the vital importance of engaging with faith groups throughout; I recognise that. That is why, to maximise uptake over the winter months, the NHS is planning further increases in engagement, targeted at the communities where uptake is the lowest. We will look to have those one-on-one conversations, and to recognise and identify people who are trusted and who can help those conversations.
The noble Baroness, Lady Walmsley, spoke about the importance of encouraging uptake, noting the challenge with the winter months ahead. This is why we are ensuring one-to-one conversations for all unvaccinated NHS staff with their line manager, which take place with clear guidance. On her point on funding, the Government are making key interventions to support NHS services over the winter. This includes £478 million
for support services, rehabilitation and reablement care following discharge from hospital, and ensuring that health and social care services are joined up. She also asked whether patients can ask whether staff treating them are vaccinated, prior to enforcement. I assure the House that there is no specific entitlement for patients in NHS facilities to ask whether the staff treating them are vaccinated but, once the regulations come into force, patients and service users will have confidence that all staff interacting with them as part of a CQC-regulated activity are either vaccinated or exempt.
The noble Lord, Lord Framlingham, noted recent data on the effectiveness of vaccinations against the new omicron variant and asked about the difference in protection between vaccination and infection antibodies. I emphasise to noble Lords that vaccination remains the best defence against Covid-19. There is also significant evidence that vaccines are effective at preventing infection and will therefore reduce transmission. We have not yet identified similar strength of evidence for natural immunity. The uncertainty around natural immunity and protection makes it difficult to consider this as an alternative to vaccination at the moment.
The noble Baroness, Lady Brinton, asked an important question about which health and care workers are in scope of policy. Those in scope include staff who have direct face-to-face contact with patients and service users in either secondary or primary care, community settings and wider care settings. This includes, for example, doctors, dentists, midwives, nurses, paramedics and social care workers. Also in scope are ancillary staff who may have social contact with patients but are not directly involved in patient care. This group includes receptionists, ward clerks, porters and cleaners. She also asked about the definition of a complete course of vaccination. The current definition is two doses, but we will keep this under active review and, in light of the omicron variant, will not hesitate to act if necessary to update that guidance at a suitable time to refer to three doses. All health and social care staff providers and staff are encouraged to follow national guidance.
The noble Baroness, Lady Thornton, asked what is meant by “registered provider”. A registered person is defined in Regulation 2 of the 2014 regulations as a person registered with the Care Quality Commission who is, in respect of a regulated activity,
“the service provider or registered manager in respect of that activity”.
She spoke of the threat that omicron poses, and I thank her for those comments. She also raised concerns about the workforce impacts. NHS workforce figures are constantly updated as people join and leave, but we can see that, since the Government consulted on the policy in September, the latest published figures show an overall net increase of staff vaccinated with a first dose of over 55,000. Our best mitigation, as identified in the advice of many noble Lords, is to encourage people to have that positive choice and take up the vaccine.
While vaccination has been and remains our best line of defence, I recognise that this is an emotive issue on many fronts. I also recognise concerns over civil liberties and parliamentary procedures. Whether in our care homes, our hospitals or any other health or care setting, it is an important duty of everyone working in health and social care to avoid preventable harm to
the people they care for. People working in health and social care are often in close contact with some of the most vulnerable people in our society. That is the nature of the job and much of the reason behind our heartfelt gratitude and respect for the work they do. However, we know that those vulnerable people are more likely to suffer serious health consequences if they catch Covid-19.
The Government hear and recognise the concerns that have been raised about the impact of these measures on the workforce, especially during these winter months, but we continue to insist that mitigation against these risks is to keep driving uptake. We continue to encourage health and care workers to protect themselves and protect the people they care for before the deadline. The 12-week grace period allows time for both workforce planning and for more colleagues to come forward and get the jab. I recognise the concerns raised by noble Lords on a number of issues.
I am grateful for noble Lords’ contributions, for their passion and sincerity, and for the advice given to me to take back to my department. In the face of this virus that has harmed countless lives and livelihoods, we must do what we can to keep the British people safe. The measures before us will help us to do that and I hope in future that we will be able to improve on the procedures that we have adopted. I take on board the legitimate concerns about the procedures and I will take these back to the department.
I commend these regulations to the House.