(Public Pack)Minutes Document for London Assembly (Plenary), 04/02

MINUTES

Meeting: London Assembly (Plenary) Date: Thursday 4 February 2021 Time: 10.00 am Place: Virtual Meeting

Copies of the minutes may be found at: http://www.london.gov.uk/mayor-assembly/london- assembly/whole-assembly

Present:

Navin Shah AM (Chair) Susan Hall AM

Tony Arbour AM (Deputy Chairman) David Kurten AM

Jennette Arnold OBE AM Joanne McCartney AM

Shaun Bailey AM Dr Alison Moore AM

Siân Berry AM Steve O'Connell AM

Andrew Boff AM Caroline Pidgeon MBE AM

Léonie Cooper AM Keith Prince AM

Unmesh Desai AM Murad Qureshi AM

Tony Devenish AM Caroline Russell AM

Len Duvall AM Dr Onkar Sahota AM

Florence Eshalomi AM MP Peter Whittle AM

Nicky Gavron AM

City Hall, The Queen’s Walk, London SE1 2AA Enquiries: 020 7983 4100 minicom: 020 7983 4458 www.london.gov.uk v1 2015 Greater London Authority London Assembly (Plenary) Thursday 4 February 2021

1 Apologies for Absence and Chair's Announcements (Item 1)

1.1 The Chair explained that in accordance with Government regulations, the meeting was being held on a virtual basis, with Assembly Members participating remotely.

1.2 The Clerk read the roll-call of Assembly Members who were participating in the meeting. Apologies for absence were received on behalf of Gareth Bacon AM MP and Andrew Dismore AM.

1.3 On behalf the London Assembly the Chair expressed condolences to Captain Sir Tom Moore’s family following his death, noting the hope and happiness he had brought to many during the COVID-19 pandemic.

1.4 The Chair provided an update on recent Assembly activity, including: the London Assembly’s Plenary meeting questioning the Mayor on his draft 2021/22 budget; the COVID-19 and homeworking event held to explore the impact of working from home mental and physical wellbeing; and the Fire, Resilience and Emergency Planning Committee’s meeting with the London Fire Commissioner, on the impacts of COVID-19 on the London Fire Brigade.

2 Declarations of Interests (Item 2)

2.1 The Assembly received the report of the Executive Director of Secretariat.

2.2 Resolved:

That the list of offices held by Assembly Members, as set out in the table at Item 2, be noted as disclosable pecuniary interests.

3 Minutes (Item 3)

3.1 Resolved:

That the minutes of the 12 January 2021 London Assembly Extraordinary (Plenary) meeting be signed by the Chair as a correct record.

Greater London Authority London Assembly (Plenary) Thursday 4 February 2021

4 Question and Answer Session: COVID-19 Vaccination Delivery in London (Item 4)

Part A:

4.1 The Assembly put questions to the following invited guests, on COVID-19 vaccination delivery in London:  Dr Tom Coffey, Mayoral Health Advisor;  Martin Machray, Joint Regional Chief Nurse and COVID-19 Incident Director;  Dr Farah Jameel, British Medical Association; and  Nadhim Zahawi MP, Under-Secretary of State for COVID-19 Vaccine Deployment.

4.2 The record of the questions put by Assembly Members and the answers given is attached as Appendix 1.

4.3 The Deputy Chairman assumed the Chair from 11.29pm to 11.39pm.

4.4 During the course of the question and answer session the Mayoral Health Advisor undertook to:  Share the London borough level COVID-19 vaccination data, following the data’s validation by the NHS and the Mayoral Office;  Provide details of what action the Mayor and Metropolitan Police Service (MPS) were taking to address social media anti-vaxxers; and  Suggest to the Mayor that work be undertaken to investigate the spread and source of vaccine misinformation in London.

4.5 The Under-Secretary of State for COVID-19 Vaccine Deployment agreed to investigate the Government funding, and decision-making for the funding, available to the London boroughs of Enfield, Croydon, Southwark, Newham, Barking and Dagenham, and Tower Hamlets to support them in providing vaccine advice and boosting vaccine take-up.

4.6 The Joint Regional Chief Nurse for London undertook to:  Ascertain if data was available regarding vaccine take-up of blind and visually impaired people; and  Provide an estimate of the proportion of Londoners not registered with a GP.

Greater London Authority London Assembly (Plenary) Thursday 4 February 2021

Part B:

4.7 At the conclusion of the question and answer session, the Chair formally moved the motion in the agenda, namely:

“That the Assembly notes the answers to the questions asked.”

4.8 Resolved:

That the answers to the questions asked be noted.

4.9 In accordance with Standing Order 2.2D, Agenda Item 6 was considered as the next item of business by the Chair, with Agenda Item 5 to be taken as the last item of business. The remaining business was taken in the order of the agenda.

5 Petitions Update (Item 6)

5.1 The Assembly received the report of the Executive Director of Secretariat.

5.2 Resolved:

That the response received to a petition presented at the 5 November 2020 Assembly (Plenary) meeting, be noted.

6 Motions (Item 7)

6.1 At the start of the debate on the motions set out on the agenda, the Chair explained that, in accordance with Standing Order 4.2A and following informal discussions with Assembly party Groups, he had agreed to vary the time limits for speeches for the remainder of the meeting so that: the mover of each motion was permitted to speak for up to five minutes; the seconder of each motion was permitted to speak for up to three minutes; and any other Members contributing to the debate were permitted to speak for up to two minutes.

6.2 During the course of Agenda Item 7 the Chair proposed, and it was agreed, that Standing Order 2.9B be suspended to extend the meeting in order to allow motions to be put before the Assembly and for the remaining items of business on the agenda to be considered.

6.3 Caroline Pidgeon MBE AM moved, and Dr Onkar Sahota AM seconded the following motion:

“This Assembly notes the campaign for an Emergency Services Cenotaph in London to honour all who have served in the emergency services and National Health Service past, present and future. It will be the first combined memorial of its kind in the UK.

Greater London Authority London Assembly (Plenary) Thursday 4 February 2021

This Assembly further notes the two million people that currently work in our emergency services and National Health Service who show huge dedication and believe it is right that we recognise the vital role that they play and pay tribute to the commitment and sacrifice many make in the line of duty.

This Assembly also believes that in light of the Covid-19 pandemic the need to honour the dedication, bravery and sacrifice of our emergency service and National Health Service workers and volunteers is more important than ever. An Emergency Services Cenotaph will also ensure there is a place for Londoners and those across the country to come and pay their respects to all of those who have served in our emergency services past and present and to honour those we have lost.

This Assembly fully supports the Emergency Services Cenotaph and calls on the Chair of the Assembly, with the Mayor, to write to the Prime Minister expressing this support and asking for Government to provide financial support, alongside the existing voluntary fundraising effort, to the campaign to help ensure such a cenotaph can begin construction as soon as possible.”

6.4 Following debate, and upon being put to a vote, the motion was agreed unanimously.

6.5 Jennette Arnold OBE AM moved, and Dr Onkar Sahota AM seconded, the following motion:

“This Assembly is committed to eradicating and ending racial injustice and anti-Black racism. In our pursuit of these aims, the London Assembly is passing this motion to recognise formally and mark the United Nations International Decade for peoples of African Descent running from 2015-2024.

This Assembly recognises the work undertaken by the Mayor of London in promoting diversity and inclusion, and celebrating Black Londoners through Black History Month activities, the Commission for Diversity in the Public Realm, and working with the Black Curriculum to provide relevant education resources and to review the London Curriculum.

Greater London Authority London Assembly (Plenary) Thursday 4 February 2021

 Consider establishing policy directives to mainstream equality and nondiscrimination considerations in all policy-making, including measures to ensure the equal enjoyment of rights and opportunities for people of African descent; and  Ensure that the end of the decade is marked in 2024, celebrating progress made in moving towards racial justice.”

6.6 Caroline Russell AM moved and Siân Berry AM seconded, the following amendment to the motion:

To add the text set out in bold:

This Assembly calls on the Mayor of London to recognise formally and mark the UN’s Decade by embedding in policies where possible, the UN’s General Assembly resolution on the International Decade for People of African Descent. The Mayor’s work should reflect the following requests from the Programme of Activities for the Implementation of the International Decade for People of African Descent:  Work with schools and community organisations to ensure that the educational histories and narratives of Black people are properly taught and celebrated in schools across London all year round;  Work on reviewing and reworking policies that continue to have a discriminatory effect on peoples of African descent across London;  Consider establishing policy directives to mainstream equality and nondiscrimination considerations in all policy-making, including measures to ensure the equal enjoyment of rights and opportunities for people of African descent; and  Ensure that the end of the decade is marked in 2024, celebrating progress made in moving towards racial justice.

This Assembly also notes that the UN International Decade for People of African Descent 2015-2024 calls on those that have not yet expressed remorse or presented apologies to find some way to contribute to the restoration of the dignity of victims.

Greater London Authority London Assembly (Plenary) Thursday 4 February 2021

This Assembly therefore asks the Mayor to support calls for the establishment of an All-Party Parliamentary Commission of Inquiry for Truth and Reparatory Justice.”

6.7 Following debate, and in accordance with Standing Order 2.7, a named vote was taken on the amendment. The votes were cast as follows:

For the amendment: Siân Berry AM and Caroline Russell AM.

Against the amendment: Jennette Arnold OBE AM, Shaun Bailey AM, Andrew Boff AM, Leonie Cooper AM, Unmesh Desai AM, Tony Devenish AM, Len Duvall AM, Nicky Gavron AM, Susan Hall AM, Joanne McCartney AM, Dr Alison Moore AM, Steve O’Connell AM, Caroline Pidgeon MBE AM, Keith Prince AM, Murad Qureshi AM, Dr Onkar Sahota AM, Tony Arbour AM (Deputy Chairman) and Navin Shah AM (Chair).

6.8 With 2 votes being cast in favour and 18 votes being cast against, the amendment was not carried.

6.9 Upon being put to the vote, the motion in the name of Jennette Arnold OBE AM namely:

“This Assembly is committed to eradicating and ending racial injustice and anti- Black racism. In our pursuit of these aims, the London Assembly is passing this motion to recognise formally and mark the United Nations International Decade for peoples of African Descent running from 2015-2024.

Greater London Authority London Assembly (Plenary) Thursday 4 February 2021

was agreed unanimously.

7 Res triction of Public Sector Payments Regulations 2020 (Item 8)

7.1 The Assembly received the report of the Chief Officer.

7.2 Resolved:

That the GLA Oversight Committee’s terms of reference, be varied to add the following additional clause: “To receive reports from the Head of Paid Service and consider and decide on requests to relax the cap on exit payments made by the GLA, in accordance with The Restriction of Public Sector Exit Payments Regulations 2020”.

8 Petitions (Item 5)

8.1 The Assembly received the report of the Executive Director of Secretariat.

8.2 Léonie Cooper AM presented two linked petitions with the following prayers:

“There are too many loading bays, not enough 30-minute customer bays on Upper Richmond Road.

We desperately need short term parking bays as opposed to loading bays.”

and additionally:

“What all businesses need during this tricky time is customers; so let’s change the 41 loading bays on Upper Richmond to 30-minute parking bays, 10am until 4pm. This would help our lovely local businesses immensely.”

8.3 Resolved:

That the petitions be noted and forwarded to Transport for London for a response.

Greater London Authority London Assembly (Plenary) Thursday 4 February 2021

9 Date of Next Meeting (Item 9)

9.1 The next meeting of the London Assembly was scheduled to be the virtual Mayor’s Question Time (Final Draft Budget) meeting, which would take place at 10.00am on Thursday 25 February 2021.

10 Any Other Business the Chair Considers Urgent (Item 10)

10.1 There were no items of urgent business.

11 Close of Meeting

11.1 The meeting ended at 1.12pm.

Chair Date

Contact Officer: Davena Toyinbo, Principal Committee Manager; Telephone: 0208 039 1285; Email: [email protected]

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Appendix 1

London Assembly Plenary - Thursday 4 February 2021

Item 4 – Question and Answer Session: COVID-19 Vaccine Delivery in London

Navin Shah AM (Chair): We now move on to today’s principal business, a question and answer (Q&A) session on the COVID-19 vaccination delivery in London. I am pleased that joining us virtually for today’s sessions we have: Dr Tom Coffey, who is the Mayoral Health Advisor; we have Martin Machray, who is the Joint Regional Chief Nurse and COVID-19 Incident Director; we have Dr Farah Jameel, who is representing the British Medical Association; and we will have Minister Nadhim Zahawi MP, who is the Minister for COVID Vaccine Deployment. We expect the Minister to join us by around 10.40am strictly for 30 minutes, as per the arrangements we have agreed with his office.

The first question is from me, for Dr Tom Coffey. Is London now receiving its fair share of COVID-19 vaccinations and can we be confident that it will continue to do so over the coming months?

Dr Tom Coffey (Mayoral Health Advisor): Thank you for inviting me today because I think this will give us an opportunity to shine a light on the very impressive National Health Service (NHS) vaccination programme in London. I think that London, the NHS and its volunteers have stepped us enormously to deliver the capacity of the vaccination programme that is required for London’s vaccination of 1.5 million Londoners by 14 February [2021]. I am joined today by Martin [Machray] and [Dr] Farah [Jameel], and this is very much a team approach. Martin has strong oversight of the operational details, and some of the more detailed answers I might have to defer to Martin.

First, as a general practitioner (GP), I want to put in context why the pure number of vaccines is insufficient to answer your question. I am a GP, I run a practice and at the moment we are doing three things in our practice: we are seeing our normal patients, we are seeing our hot hub patients who may have COVID, and we are running a vaccination hub for up to 500 a day. When I run that hub for the vaccinations, I have to get my volunteers to be ringing up 500 - usually older - patients to plan them coming in the following day and the day after. I have my volunteers come in to run the very smooth operation of getting patients socially distanced, waiting, into the vaccination centre, sometimes waiting afterwards, and out the door. It is a rather complex programme. I have housebound patients whom I will, this afternoon, be going around visiting to deliver the vaccine to those housebound patients.

As you can imagine the need for planning for how the vaccine is delivered is vital. I need to plan ringing people, getting volunteers in, and so on. Also, very importantly now, we have learnt that some patients are rung up and they decline, they are rather hesitant. All those patients are rung by the GP who knows them best to answer their questions and see if we can persuade them to take the vaccine. Therefore, what is very important for the vaccine supply is not just that London gets its exact numbers per day, it is that it is in a way that is planned and steady so that I, as a person who delivers the vaccine programme, can do that accordingly.

I would like to take this moment to thank some volunteers, volunteers who help me run my programme but also volunteers who were used to test out the vaccine in the first place. Many Londoners stepped forward for that role and I would like to say a big thank you to them now because without them, without the 44,000 who did the Oxford programme, we would not have the vaccine that we have now.

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My feeling at the moment is that we will have enough vaccines to hit our target of 1.5 million by 14 February. Martin will have greater detail. If we do about 40,000 a day, we are likely to hit that target. On 18 January [2021], London’s share of the vaccines delivered was 10.5%. Now, on 2 February, London’s share has gone up to 11.7%. Early on in the programme, London was not getting its fair share of the vaccines. I believe it now is. That is very much because Sadiq [Khan, Mayor of London] was informed by NHS colleagues, the data and the figures, and we used that to advocate on behalf of Londoners to increase the supply. They have listened and our supply has increased, so I do feel that we are probably going to get enough vaccine to ensure we hit our target.

The Prime Minister has said he wants to vaccinate 15 million people in the United Kingdom (UK) by 14 February. Our target is 1.51 million. I believe we will get the supply to hit that. What you will understand, though, from my description of how I work, is that as important as the numbers of vaccines coming in are, a planned, predictable, steady supply is also very useful. I recognise that that cannot always be done because the logistics sometimes mean that the vaccine is ready and it just comes out. That is one of the issues, but I do believe the supply has increased and it will now probably be enough for us to hit the target we have for 14 February.

Navin Shah AM (Chair): Mr Machray, do you want to add anything to that?

Martin Machray (Joint Regional Chief Nurse for London and Covid-19 Incident Director, NHS England): Thank you, Chair. Very little, because I know Members want to ask questions. Very quickly, though, I do want to say thank you to the political leadership of London in supporting the vaccine programme. It is really important that we have that support at local authority and at London Assembly level, and we have had that. We are enormously grateful.

Secondly, I want to thank every healthcare practitioner who is spending time vaccinating Londoners today. As I said at the last [London Assembly] Plenary session we had about the pandemic, London has been hit by the two biggest waves of this pandemic more than any other part of the country. Health services and our care services are absolutely exhausted. Yet I have nurses and doctors from across the city begging to be involved in the vaccination programme because this is the key, along with ‘hands, face and space’, to getting on top of this awful virus. I need to thank them, and particularly our GPs, who have, as great primary care practitioners, stood up and delivered great primary care practice.

Two more things to say, very quickly. One is that today I can tell you we have vaccinated over 1 million Londoners. In fact, 1,114,299 people had received a vaccine by last night. That is dead on target with supply assured for that 14 February [2021] 1.5 million. That is great news, but more to do. We have to marry that with the capacity to deliver it - nurses, doctors, volunteers and others - but the thing I really want us to focus on, if we can, is encouraging everyone to take this up, to marry that capacity and that supply by maximising demand and vaccinating those who need it most. Londoners have been disproportionately affected by this virus. My job as a nurse is to make sure that they are protected from it in the future, and therefore I want to encourage who is offered the vaccine to take it up.

Navin Shah AM (Chair): Dr Jameel, do you have any opening comments that you want to make very briefly, please?

Dr Farah Jameel (British Medical Association): This is my first time before the London Assembly and I would like to begin by thanking you for the invitation to speak. I also want to thank the previous speakers for outlining just how much general practice is doing and for thanking us. This is really valued.

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I am a GP. I work in north central London. I have been given the opportunity to be able to support this programme and negotiate this programme nationally, but I have also heard the operational challenges so beautifully articulated by Dr Coffey. In the main, it begins and ends with predictability and visibility of the vaccine. I am speaking to vaccinations centres around the country and in London specifically. GPs can deliver anything between 500 to 1,000 vaccines a day, so hitting that target before 15 February is not a problem at all in terms of absolute numbers. We have just over 100 local vaccination sites, mass vaccination centres and hospital Trusts across London vaccinating. The problem is the supply and the predictability, so that we can set up our services, we can staff our centres, we can invite the patients, and get on with it. GPs are absolutely up for the job. Looking at the statistics and the numbers, we know that around the country and in London specifically, over 70% of the vaccinations delivered to date have been done by general practice.

If I just look at the numbers across north central London, it is more patients who are invited taking up that offer that is now the bottleneck and the problem. If I look across north central London, and I am just looking at statistics from 48 hours ago, of the first two cohorts, 100% of patients have been offered the vaccine but with something like 75% or 76% take-up. That is a problem, and we do need a targeted approach about how we deal with patients who are declining and how we deal with patients who are simply uncertain. I know that there is this national programme through councils to encourage Community Champions, but at the end of the day it is the GP at the heart of the community who has that relationship with the patient. I think we need to make more of that and encourage more interaction through the GP network.

Navin Shah AM (Chair): We now move to the supplementary lead questions. Can we start our first supplementary lead question from Dr Onkar Sahota AM?

Dr Onkar Sahota AM: I also am a GP and want to echo the comments about the tremendous efforts made by the NHS staff in delivering the vaccination programme, but there are challenges in London. If you look at the number of over-80s vaccinated, London had the lowest rate of vaccinations. If you look at the patchwork we have in London, I hear that some parts of London are more advanced than the others and I hear that some parts of London have been asked to slow down to let other parts catch up. There are some challenges. It is very good for us to congratulate all the frontline staff, but there are challenges.

Martin, perhaps you can start us off. What are the challenges faced by London particularly, why are we looking at the lowest number of vaccinations amongst the over-80s and why are some parts of London more advanced than others? I have people ringing me up saying, “Dr Sahota, why can’t I have a vaccine when down so-and-so they are having it?” There is a lot of variation in London. Can you explain that to us, please?

Martin Machray (Joint Regional Chief Nurse for London and Covid-19 Incident Director, NHS England): Yes, I can, or I can try to contribute to that because it is complex, as you understand. If we take the over-80s as the case example, there is variation across the city. As Dr Jameel has said, it is not because people have not been offered the vaccine. I think we need to acknowledge that London is the brilliant, diverse, fabulous city that it is, but it brings its own challenges. We hear some very real reasons why people are hesitant. I am not talking about the few people who may believe that the vaccine is not for them. I am not going to concentrate on that. I am talking about the vast majority of people, who want to look after their health but are not quite sure.

I think that word “hesitant” is useful. Let us acknowledge that in some of our communities in London, there is a lack of trust in people like me and you. Over the generations, the nursing profession and the medical profession across the world has not served their families well, so why suddenly would you trust us today? We have to acknowledge that. Secondly, and you hear this a lot, “I have been last in the queue for everything in my lifetime; why am I suddenly first in the queue for this?” I can say, “If you are most at risk of dying from

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COVID, you will be first in the queue. If you are a man over 80 from an African or Caribbean background, you are more likely to die than anyone else who catches COVID. That is why you are first in the queue”. But if for years you have been at the back of the queue, there will be a lack of trust. Historic experiences inform you. If you come from certain parts of Africa, your experience of some of these drug companies is not what it might have been. We have to acknowledge that.

What we find with most people I have conversations with is that people need time and space to be heard, and time to consider the facts and then make an informed decision. People will come through. I will give you two quick examples. First, a discussion with a care home manager only this week. 90% of her staff are of black Caribbean or black African heritage, who have really low uptake, and they said, “But when the doctor came around for the second and third time, they all decided they would have it”. That is giving people time. The other example I want to give you is the way we all message. One of the things we are seeing, as Dr Jameel mentioned, is that you must not give up on people. In Harrow, as an example - not the only ones but a great example - those patients who have not taken up the offer have had a phone call, not to say, “Why haven’t you had it?” but, “Let’s talk about your health. What would help you make an informed decision?” That has really ramped up the number of people taking the vaccine.

They are some of the reasons why older people are reluctant in London to take the vaccine.

Dr Onkar Sahota AM: Great, thank you. Did you want to come in, Dr Coffey?

Dr Tom Coffey (Mayoral Health Advisor): I was going to mention the Harrow example as well, but also make you aware that the hesitancy rate is now gradually dropping. It echoes the point Martin was making, that patients need time. When I spoke to them first, some of these patients, they said, “I’m not sure yet. It seems to have happened very quickly”. Then, as more and more of their friends and colleagues and family have the vaccine, the hesitancy rate in our surveys is reducing and they are more likely to say, “Yes, I will have it now”.

I would like to say that every single person over 80 from our practice and our neighbouring practices has been offered the vaccine, but still a number have declined it, or for a few it just is not appropriate at the time.

Dr Onkar Sahota AM: OK. Let us take that, we are well aware of hesitance, but I just want to find out why some parts of London are more advanced than other parts of London. Why is that happening? Why are some areas of London hitting different age groups than others? Why is that happening?

Martin Machray (Joint Regional Chief Nurse for London and Covid-19 Incident Director, NHS England): I think it is partly about the communities that those parts of London serve, and partly that this programme has been run for eight weeks and some of the places we are offering the vaccine from need to change over time and be more embedded in communities. We need to structurally change the way we deliver some things. It is not a lack of effort in different parts.

Dr Onkar Sahota AM: Why are we stopping supplies to those areas that are advanced to allow other areas to catch up?

Martin Machray (Joint Regional Chief Nurse for London and Covid-19 Incident Director, NHS England): Let me be really clear. We are not stopping supplies and we are not telling people to slow down.

Dr Onkar Sahota AM: That was what was in the papers yesterday.

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Martin Machray (Joint Regional Chief Nurse for London and Covid-19 Incident Director, NHS England): It is wrong.

Dr Onkar Sahota AM: That is wrong. OK, fine. Thank you very much.

Navin Shah AM (Chair): Moving on to the next lead question, that is from Assembly Member Siân Berry.

Siân Berry AM: Thank you very much, Chair. I want to start with Martin Machray if that is all right. I know that we have just discussed the fact that London has been behind in vaccinating the over-80s and the fact that there are differences between boroughs. It has, I think, been hard for both you and us to get up-to-date, detailed, borough-by-borough data collated at a London level, and I just wanted to check what your progress was on making that data available to us so that we can keep an eye on things on a more day-to-day basis, which is the level we are working at right now.

Martin Machray (Joint Regional Chief Nurse for London and Covid-19 Incident Director, NHS England): Very quickly, what data we have is now available at local authority level. There was a very helpful letter from the Secretary of State for Health and Social Care [The Rt Hon Matt Hancock MP] and the Secretary of State for Housing, Communities and Local Government [The Rt Hon Robert Jenrick MP] to local authorities this week saying that data should be used by public health with political leaders and with the officers to share that data. That does not mean that we have all the data we would like. Just to curb expectations that you will be able to analyse to your heart’s content at every different perspective, that will not be the case, but the data that we have is available to be used. When working with public health experts, that data becomes richer in its intelligence. It is there now.

Siân Berry AM: Tom, that will then go onto the dashboard that we are all able to use, is that correct?

Dr Tom Coffey (Mayoral Health Advisor): So if Martin shares it with us - I will make sure that it is all validated with us - and then with the NHS for approval, because we are very keen that we only use data that is approved.

Martin Machray (Joint Regional Chief Nurse for London and Covid-19 Incident Director, NHS England): That is fine.

Dr Tom Coffey (Mayoral Health Advisor): I will make sure it is shared with you.

Siân Berry AM: My second question is about the rollout to the next groups after we get the four priority groups finished, because those groups are larger, they are much larger in terms of numbers, and there is going to be a change in how things are organised. Things are going to come more down to the local level. Can I ask how that is being organised and prioritised? Are you confident that it is happening all over London and will happen in a more even way, and what will be the involvement of boroughs? To declare, I am a Camden councillor, and we are still keeping contingency in mind in Camden for getting more involved in this, but we are not clear yet, I do not think, exactly what is going to be happening.

I want to know that is all in hand and that we are going to be able to scale this up. I know Dr Jameel talked about capacity being not so much one of the issues now and demand being a thing, but at this point when we go to these bigger groups, it is going to be capacity, it is not?

Martin Machray (Joint Regional Chief Nurse for London and Covid-19 Incident Director, NHS England): I can quickly answer that. Planning has to be at the local level. The letter from the Secretaries of

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State also suggested that needed to be more local, and I think that is right. That needs to involve primary care networks and GPs, it needs to involve local councils, and we need to spread the capacity we have to meet the supply we will receive and to meet the demand that as you say is going to be much, much bigger.

Overall, we have very detailed plans at borough and integrated care system (ICS) level, the subregional level, on a week-by-week basis for the next phase. They are being tested now and peer-reviewed, and I expect - and please share this, as a local councillor, in your networks - local authorities to be really involved in that process, along with our GPs and so on. We cannot do any other way. Yes, the NHS gets some praise but it is a partnership, this. That is really important.

The scale is significant. London is a younger city than most other regions and although we have not done as many over-80s we have far more in the middle band. They are the next priority and that is great but also a challenge, and, of course, we have everyone who got the first dose coming back for a second. The numbers that will go through are significant. We still expect about 70% to 75% of activity will go through GPs, but we will have to start to use other sites - we are already - like local pharmacists, community centres, churches and so on. They are starting but we need to build that up and the plans are in place.

Siân Berry AM: OK. Dr Jameel, do you have anything to add on those points?

Dr Farah Jameel (British Medical Association): Thank you, I was hoping you would ask. First, we have to be clear there is capacity. The problem is being unable to plan in advance. I can stand up clinics, run them and staff them no problem, I just need to know what is expected of me, and that is changing from two to three days. That is the sort of notice period I get. If we just take crude numbers, say 100 GP vaccination sites, and if they can deliver 1,000 a day you have 100,000 vaccinations every day, 700,000 a week. That is the sort of capacity we can stand up, we just need to know in advance.

I just wanted to add a little bit about the massive confusion that is ongoing at the moment. We have these letter drops happening on patients’ doorsteps and a national booking site calling patients to book into the mass vaccination sites, to book into the pharmacy sites, while general practice is also contacting the exact same cohort of patients. There is quite a bit of confusion and quite a bit of duplication of effort, and time being wasted of clinicians. That is a problem and impacts capacity. We do need to sort this mess out a little bit.

Siân Berry AM: That does sound very worrying, if there is duplication of effort.

Dr Farah Jameel (British Medical Association): Absolutely.

Siân Berry AM: In terms of the boroughs, boroughs also have methods of contacting residents. Is that being coordinated well enough as well? I am just slightly worried now.

Dr Farah Jameel (British Medical Association): We always have room for improvement. What I would perhaps try and push forward is the need to have very much that partnership approach across the system to look at what mass vaccination sites there are, what pharmacy sites there are and what capacity there is across the system with the Trust and the local GP vaccination sites, who best is targeted and in which manner, and coordinating that. I honestly cannot say that that is happening. In some areas of the country, it is. In my patch in north central London - I am actually a Camden GP - I am not entirely clear that is happening as well as it can, although it is better than most other areas in the country.

Siân Berry AM: OK. Tom, you wanted to come in?

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Dr Tom Coffey (Mayoral Health Advisor): That might be a useful question you might wish to ask the Minister, how we ensure we have national coordination of booking with local coordination. I had a few patients who were confused. They thought they were being offered their second dose but in fact they had mistakenly been offered a first dose. It is quite important to make sure we have a clear system of how patients are invited in. The Minister probably has greater oversight of that and will be working to ensure it is as smooth as possible.

Siân Berry AM: OK, thank you.

Navin Shah AM (Chair): Thank you very much. We move on to the next supplementary lead question and that is from Assembly Member Boff.

Andrew Boff AM: Dr Coffey, do you agree with the priority list published by the Joint Committee on Vaccinations and Immunisation (JCVI)? Is it the right list?

Dr Tom Coffey (Mayoral Health Advisor): The list was very much drawn up as, “Who can we vaccinate to reduce the risk of getting serious illness and dying?” rather than, “Who do we vaccinate to reduce transmission?” They chose those groups because they had the highest case fatality rate from getting COVID- 19. Now, I would like them to consider in their second wave of vaccinations, looking down the list even further, perhaps some other groups.

I know myself and Deputy Mayor for Housing Tom Copley wrote to the JCVI to ask them to consider rough sleepers as a category for two reasons. First because they have a high level of illness, and secondly because at the moment we have an opportunity in time where a lot of rough sleepers have been moved into hotels for their safety. In a few months’ time they may well be dispersed back on the street. I would like to use this opportunity for the next two months to vaccinate our rough sleepers who are presently in hotels under the policy of Everyone In. That is what I would like to advocate, for another group to be considered, but I do recognise that the JCVI is using the assumption, “Who has the highest case fatality rate?” and the groups they have chosen do match that.

Andrew Boff AM: Would the groups you are suggesting move ahead of the existing nine categories?

Dr Tom Coffey (Mayoral Health Advisor): No.

Andrew Boff AM: Is that your recommendation, or are you saying that subsequent to those nine categories receiving their vaccinations we can then prioritise, just to be clear about what you are saying there?

Dr Tom Coffey (Mayoral Health Advisor): The JCVI met last week and is continually reviewing the categories, both to see if there are any groups it should include in their categories, and, secondly, if there are any groups they want to prioritise for the next wave. I am asking the JCVI, given the evidence that I have seen of both an opportunity and a higher risk of comorbidity, to consider this group. The JCVI will then decide whether to prioritise that within their present nine and add that to it, or to use that to decide on the next phase. It is for the JCVI to consider. I am not privy to how it is going to do the next stage at the moment.

Andrew Boff AM: Will you be providing data to support those representations?

Dr Tom Coffey (Mayoral Health Advisor): Yes, we can. One programme which shows the opportunity I might share with you today is that under the plans for Everyone In we have managed to do some outreach Hepatitis C testing on 1,100 patients. Of that we found, in fact, that 11% were Hep-C positive, 7% had active

Page 7 infection, and we managed to persuade 43 to start treatment for Hepatitis C. Previously, those patients would never have been tested, would never have found out they had Hepatitis C, and would now not be on treatment. We have evidence for how we can use this opportunity in time to work with this very vulnerable group to do a health intervention that we know will save their life. That is a similar corollary to how we should consider using the vaccination programme with this vulnerable group.

Andrew Boff AM: How has your advice changed to the Mayor since the start of the pandemic? I do not mean the medical updates in the situation, but the way in which the Mayor is informed, how has that changed since the start of the pandemic?

Dr Tom Coffey (Mayoral Health Advisor): If I can describe, because COVID is obviously an infectious disease and it is led by the public health. Professor Kevin Fenton, who is the statutory Health Advisor, has very much led on the advice that the Mayor receives. We have a weekly meeting with Professor Fenton, Martin Machray, the Medical Director and the Chief Executive of NHS London where we go through all the emerging evidence, which might change any position we may take, the emerging epidemiological information on what is happening with the virus, and the NHS data. We try to bring those three elements of advice into one place. We are meeting today, in fact, at 2.00pm.

That allows the Mayor to be fully briefed on the epidemiology, on the emerging evidence and also on the NHS position. That is how we have done that, very much on a weekly basis, for many months. When new information comes through, either from the Scientific Advisory Group for Emergences (SAGE), from academic experts or from colleagues like Martin from the NHS, that is fed in to the Mayor for him to be appropriately informed.

Andrew Boff AM: It did not work, though, did it, back in March of last year [2020]? The Mayor was publicly saying that you could not catch COVID on a train. It is clearly wrong. We know that not to be the case now. Have we looked at those shortfalls and made adjustments to ensure that the public health advice is better?

Dr Tom Coffey (Mayoral Health Advisor): What happens over time, especially in a very fast-moving situation, is that the evidence evolves. In March and February of last year, COVID was considered to have very much a droplet infection transmission. Over time, we have realised it is an aerosol-driven infection as well. The evidence that we were getting from public health and from the wider science community was the evidence that the Mayor was given. The Mayor wishes to be led by scientific and public health advice. He takes that and articulates that accordingly. The information that he was given in February and March was that which was in the scientific community at the time.

Andrew Boff AM: When the Mayor comes to make representations about certain groups receiving priority for vaccinations, that will take into account public health factors rather than anything else?

Dr Tom Coffey (Mayoral Health Advisor): No. The Mayor will take on board all elements of scientific advice; virological, epidemiological, public health issues and NHS impacts. There is no single source of information that is only used by the Mayor. Understandably, he will take a wider breadth of scientific input, which does change over time, quite rightly. We need to be open to new and emerging scientific advice and evidence, and that is what the Mayor will use. It would not be, “I will only use advice from my public health experts”. He will use it from his regional experts, the Medical Director, the virologists, and people from Public Health England on a national basis. It is wider. I would not say there is a single source of wisdom on COVID- 19. One has to get the best available collective information, up-to-date wherever possible, and that is what we try to do with the Mayor.

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Andrew Boff AM: If the Mayor comes forward in future with recommendations that particular groups are prioritised, he will be able to back that up with public health data, is that correct?

Dr Tom Coffey (Mayoral Health Advisor): He will be able to back that up with data from a wide array of sources, including public health and the NHS. Is that person likely transmitting infection? Is that person likely to become ill from that infection? Is that person in a public-facing role? There is a multiplicity of information sources that he will understandably use accordingly, and I would always support him to do that rather than taking a single view from a single piece of evidence. It is best to get as wide an array as possible, make sure it is peer-reviewed, test it with colleagues and test it with the wider London team. Before, I would have always said to colleagues, “Sadiq [Khan, Mayor of London] tries to champion and challenge the NHS”. During this COVID epidemic, the new C is “collaborate”. With the NHS, we champion, we challenge and we collaborate. Collaboration around the evidence that, Andrew, you would wish to see, is what he tries to do wherever possible.

Navin Shah AM (Chair): May I please, at this juncture, stop our current question session? I am pleased to say that the Minister for COVID Vaccine Deployment has arrived and he is with us for our Q&A. Minister Nadhim Zahawi MP has now joined us in this meeting, so can I give a warm welcome to the Minister? On behalf of the Assembly, thank you very much for joining us today. We appreciate that you can only join us for a short while, I believe for about half an hour, so I would like to call Assembly Members to pose their questions to you. We have allocated half an hour and the first question is from Assembly Member Siân Berry.

Siân Berry AM: Thank you for coming here, Minister. I have been looking at particularly the £23 million that was allocated by the Government to local authorities and charities last week on 25 January [2020]. This is money for the Community Champions to give vaccine advice and boost the take-up. Looking at the list, it seems that some of the boroughs within London who have not received money are some of the boroughs that have some of the highest populations of minority ethnic groups, in terms of numbers, and some of the most deprived boroughs. I can see Enfield, Croydon, Southwark, Newham, Barking and Dagenham, and Tower Hamlets. They have not received any money from your Department. I am just wondering if you can tell me more about the decision making that went on within your Department for allocating those direct allocations of funds.

Nadhim Zahawi MP (Under-Secretary of State for COVID Vaccine Deployment): The Community Champions programme is something that we have developed working with local government where they have put forward ways in which to identify and reach local champions. I am very happy to take that away, Siân, any boroughs that feel that they need additional support and we will look at that.

Of course, as part of this programme I have been working closely with local government. In fact, we have recruited one of local government’s own in Eleanor Kelly, who is Chief Executive of Southwark, who has joined the deployment programme as Chief Operating Officer (COO), reporting in to Emily Lawson, who is the overall senior responsible officer for the vaccine deployment programme. I am very happy to take away any concerns that you might have. Essentially, it is £23 million to work with local government to identify local leaders --

Siân Berry AM: Will there be another allocation of funding that comes forward to fill these gaps?

Nadhim Zahawi MP (Under-Secretary of State for COVID Vaccine Deployment): We always look at additional resources if we need to, not just through local government, but also directly to some of these community groups who we think are doing really worthwhile work. This is an important part of the programme. As I am sure you have seen, I have been spending a lot of time working across parties because this transcends party politics, and I pay tribute to my colleagues both from the South Asian community in Parliament and the

Page 9 black and Afro-Caribbean community, who have both really risen to the challenge when I wrote to them to say, “I need your help to get the message out”. I think both videos have gone viral of Members of Parliament (MPs) encouraging people to take the jab when it is their turn. We will always look at what more we can do to drive this message home.

Navin Shah AM (Chair): Thank you, we will now move on to the next question and that is from Assembly Member Pidgeon.

Caroline Pidgeon MBE AM: Minister, we know there is much concern over the so-called South African variant. My worry is that these concerns could lead to a noticeable decrease in vaccine take-up. At St George’s Hospital in Tooting yesterday, one in ten people did not turn up for their vaccine. Is this a trend you are noticing in London and what are you doing to assure the public that the vaccines are effective against this variant as well?

Nadhim Zahawi MP (Under-Secretary of State for COVID Vaccine Deployment): Patrick Vallance, the Chief Scientific Advisor to the Government, [Professor] Chris Whitty, the Chief Medical Officer (CMO), and his Deputy, [Professor] Jonathan Van-Tam, all would be very surprised if the current vaccines were not effective against the Kent variant or the South African variant. We have seen some data from some of our later vaccines that are going to come online - Novavax, for example, and Janssen - where they have conducted trials in South Africa where they have shown some good efficacy on those variants.

There are about 4,000 variants now worldwide and we have in the UK probably one of the best genome- sequencing ecosystems in the world. We account for just under 50% of genome sequencing of the virus, and we are keeping a library of that, working with, obviously, the different groups. You heard from the Oxford group yesterday about looking at improving their vaccine. Pfizer-BioNTech are doing the same thing, as is Moderna, which is the third vaccine that has been approved. We continue to deploy the vaccines that we have available to us at pace, of course, with accuracy, but the ultimate test is the Public Health England work that they are doing with a project in care homes, which is the Vivaldi test, and then the SARS-CoV-2 Immunity & Reinfection Evaluation (SIREN) survey with frontline health workers. We will see a report very soon in terms of both infection and transmissibility. All I would say is that vaccines protect you, and, of course, protect your community.

Navin Shah AM (Chair): Thank you, Minister. The next question is from Assembly Member Boff.

Andrew Boff AM: Minister, the Government approved the lifesaving vaccines in a record time, provided the resources for the NHS to start a vaccination programme that is the envy of the world, and is now on track to protect the most vulnerable millions, giving hope that families can be reunited and that life can get back to normal. Do you regret not following the advice of Sir Keir Starmer [MP, Leader of the Opposition] to remain part of the European Medical Agency?

Nadhim Zahawi MP (Under-Secretary of State for COVID Vaccine Deployment): Ultimately I think the Vaccines Taskforce, under Kate Bingham’s leadership - and I have to say, it is worth placing this on record - is Patrick Vallance’s brainchild. He is a modest man, does not like taking credit for much, but he absolutely should be credited for the Vaccines Taskforce coming together. We have some of the best scientists in the UK and the best technicians and industrialists in vaccine manufacture in the UK. We did not have a big manufacturing base, which we invested in as well to make sure that we are able, once the Oxford team had done their work and if they had been successful, to manufacture at scale, as we are doing with Novavax, as we are doing with Valneva in Scotland. Our vaccines will be made in Oxfordshire, in Teesside and in Scotland. It was the right decision to make.

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We engaged with the European Commission at the time and I remember very distinctly Kate Bingham, because we used to speak almost every night just to catch up, saying to me that their condition was that we had to drop all of our negotiations, which we had engaged in months before the European team had done, and hand all the negotiations over. That was not a thing that we wanted to do, therefore we declined their offer and focused on our own bilateral negotiations, which I think have led to an incredible success story in terms of discovery. People forget there were over 130 or 150 different groups saying they were going to get the vaccine. We have a brilliant team of experts to tell us which vaccines had the best possible chance of success. That has been rewarded.

We have 407 million doses on order and I am confident that we will continue to deploy at pace, of course targeting the most vulnerable first, but [JCVI priority groups] one to four are 88% of mortality and one to nine on the JCVI list are 99% of mortality. My laser-like focus is to make sure we protect those people first and then move on to protecting the whole of the country.

Navin Shah AM (Chair): Can I invite a question from Assembly Member Bailey?

Shaun Bailey AM: Good morning, Minister, it is great to see you and thank you for your hard work. The Government has done a lot of work around combatting the spread of fake news, bad information, particularly in ethnic communities. Of course, in my own community I have seen a lot of very fake news being spread around, telling people not to take the vaccine and that it will impact their health negatively. You have done some good work on it. My question is: what more can be done, what other steps does the Government have planned and how can we here on the Assembly help with that process?

Nadhim Zahawi MP (Under-Secretary of State for COVID Vaccine Deployment): I am very grateful for the question, Shaun. It is a great question. Vaccine acceptance in the UK is the highest in the world and I am very proud of that. That is, I think, driven by the science, and then the discovery, and people feeling confident that the UK is doing the right thing. The Office for National Statistics (ONS) survey suggests that 85% of adults will take a vaccine. That is great on its own, but the 15% which you quite rightly identify skew heavily towards black, Asian and minority ethnic (BAME) communities and especially the black and Afro- Caribbean community, which I am concerned about, and I look forward to working with you and other colleagues on this.

We are working, first, to identify people, because we now publish ethnicity data as well as part of the NHS publication that we do on a weekly basis, and of course we publish the daily data as well. We are sharing information with local government. We will be sharing it at ward level so that we can identify those groups. Eleanor Kelly [Chief Executive, Southwark Council; Chief Operating Officer, COVID vaccine deployment] is doing a lot of work. Siân Berry [AM] mentioned the Community Champions programme. That is £23 million going into identifying community leaders, faith leaders and ethnic community groups that we need to make sure we communicate with.

It was great to see the Prime Minister go to Batley and the Hikmah Islamic Centre, where they are now reaching, I think, 97% of over-80s in Yorkshire, which is phenomenal. We want to see the same happen in London and everywhere else in the country, because it is those hard-to-reach groups - when the virus has no one to spread into because most of the adult population is vaccinated, it will try to find those groups that are unprotected. That is my big fear, that once it gets into particular communities it will go through them like wildfire. That is what I want to prevent, which is why we are working so hard on this. I will be saying some more in Parliament in the coming days and weeks on how we are delivering this with local government, with your help.

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Shaun Bailey AM: Thank you, Minister. What would be really interesting is when it gets down to ward-level data, because people on the Assembly and councils will really be able to help with that process, approaching those groups and getting some help there. Thank you for your answer.

Navin Shah AM (Chair): Thank you. The next question is from Assembly Member Devenish.

Tony Devenish AM: Thank you, Minister, for all the hard work you are doing. I would like to pay tribute to my two London boroughs, the Royal Borough of Kensington and Chelsea (RBKC) and Westminster, for all the work they have been doing with you.

My question is quite blunt, Minister. Will you work with the Mayor and the Metropolitan Police Service (MPS) to make sure we prosecute the malicious anti-vaxxer propaganda that we are facing here in London?

Nadhim Zahawi MP (Under-Secretary of State for COVID Vaccine Deployment): Can I add my thanks to the leadership at RBKC and at Westminster, who have done a tremendous job in both the overall vaccination programme but also in identifying hard-to-reach groups? I agree with you on some of the anti-vaxxers and those who are breaking the law in any way. We should be going after the lawbreakers.

We have a unit across Government in the Cabinet Office, launched in March [2020], which is a COVID disinformation unit that works across the board with all the technology platforms. As soon as we identify any fake news, which Assembly Member [Shaun] Bailey referred to, then we can immediately reach out to Twitter, Facebook or anyone else and they should take it down immediately. Some of this information is worrying, although our focus at the moment is the top one to four categories, which is the over-80s, then the over-75s and the over-70s. Some of this information is really from their grandchildren, their children and their cousins. I have seen even in my community that some of this disinformation is not necessarily going on social media but being texted or sent personally to people. We are on top of that as well, and we will work with anyone, including the Mayor and the MPS, to make sure that we prosecute any lawbreaking.

Tony Devenish AM: Is there anything else Sadiq Khan [Mayor of London] himself could do? He is not here again today. He has missed four [London Assembly] Plenaries on COVID and the economy. I would like him to be more visible in London. Is there anything you think he should be doing? Gary Neville [football coach], who is a Labour Party supporter, actually said the Mayor has been invisible for the last 12 months.

Nadhim Zahawi MP (Under-Secretary of State for COVID Vaccine Deployment): Look, this transcends politics. I have to say I want to try to work in a cross-party way to make sure that we get the message across to all communities. I want to continue to work with Sadiq Khan, as I would work with Andy Street [Mayor of the West Midlands] and others to make sure that we deliver a successful vaccine deployment programme. We have gone through the 10 million mark. I have to get to 15 million by mid-February, so we have our work cut out, and then keep going beyond that because the top one to four categories are 88% of mortality. The top one to nine categories in phase one are 99% of mortality. If you take that and move the clock forward three weeks, we should see a real impact on hospitalisations and, ultimately, deaths. This is a race against death, which is why we really all should be pulling in the same direction.

Tony Devenish AM: Thank you, Minister. You have done a great job. Thank you, Chair, over to you.

Navin Shah AM (Chair): Can we move on to a question from Assembly Member Dr Sahota?

Léonie Cooper AM: Actually, Chair, sorry, I am just swapping with Dr Sahota because he has a couple of things that will run more smoothly if he takes them both together.

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Navin Shah AM (Chair): No problem at all. Thank you.

Léonie Cooper AM: It is Assembly Member Cooper here. It is good to see you, Alderman Zahawi. I have sat in front of that sign for some time.

My concern is, of course, about the new strains because Pollards Hill in Merton is one of the areas. We are obviously getting 10,000 tests done in a very local area. Is that going to spread out to adjoining areas if we start to find that it is loose in the community? I am concerned because I understand that the one person identified came from a test that was conducted before Christmas, so obviously the South African strain could be quite widely out in the community. I would appreciate your knowledge on that.

Nadhim Zahawi MP (Under-Secretary of State for COVID Vaccine Deployment): Thank you, Assembly Member Cooper. You are absolutely right to stress that we need to make sure that we put in the resource, and now that we have the ability - if you look at where Test and Trace was and where it is today, of course that is now an 800,000 a day capability - we will put the resources wherever the scientists deem necessary so that we understand exactly what these strains are doing in terms of control. We are also working, as I said earlier, with the manufacturers to make sure that we are fit for purpose for any outcome. There are 4,000 strains now worldwide. As I said, we will get to a place, which is why we are thinking ahead, where we will probably be vaccinating annually, or there may be a boost in the autumn, to make sure we continue to protect the most vulnerable, but also the adult population of the UK.

Léonie Cooper AM: I completely understand that, and I imagine that we will also be using some of the 2- metre distancing, masks and things going forward to carry on control, but just on your point about the variants that are loose internationally, obviously there has been a lot of talk about trying to prevent new, more transmissible variants coming in. We are talking here about the South African variant but there are others as well.

I just wondered if you were able to comment on issues like negotiating with hotels so that we can get really good quarantine arrangements in place. Obviously Australia, New Zealand, South Korea and other places have been very strong on these areas. I think the vaccination is going well but there have been issues about whether we maybe should have done that earlier. Are we going to be doing that? Are we going to be restricting more countries than is currently being talked about? People from South Africa go via Dubai, that sort of thing, plus there are variants in other countries. If you could give us your latest information on that, thank you.

Nadhim Zahawi MP (Under-Secretary of State for COVID Vaccine Deployment): Absolutely. Obviously we continue to review our border policy, as other nations have done as well. Germany and Canada, when the new variants were discovered, changed their border policy in January [2021], as did we in terms of restricting travel from those countries with those variants that are of most concern to us. We obviously then introduced the pre-departure testing and the passenger locator form. Airlines now will turn you away if you do not have a passenger locator form, which allows us to know exactly where you are when you enter the country. You have to quarantine for ten days. The fine is now running to about £43,000 or £44,000, and I do not apologise for that because I think it is important that we make sure we police the system properly. You are seeing much greater policing in both ports and airports.

The hotel quarantine is part of that overall system and that will come in. The operationalising of that you do not have to wait for long because the Secretary --

Léonie Cooper AM: Right. Soon.

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Nadhim Zahawi MP (Under-Secretary of State for COVID Vaccine Deployment): -- tomorrow --

Léonie Cooper AM: Tomorrow.

Nadhim Zahawi MP (Under-Secretary of State for COVID Vaccine Deployment): -- I will be making a statement on this to Parliament to be able to set out the operational side of the hotel quarantining, which is an addition in terms of our border controls as we continue to drive the vaccination programme every day, every week. Get to that middle of February, protect the top four cohorts, then keep moving to five, six, seven, eight, and nine, and then phase 2.

Léonie Cooper AM: Obviously, from the London perspective, because we have so many airports and so many international travellers, it is such an important issue, so I wanted to raise that although I am conscious it does go slightly into other departmental areas. Thank you, Chair, I am going to pass back, and thanks for being so flexible with me coming in before Dr Sahota. Thank you, Nadhim Zahawi.

Navin Shah AM (Chair): Thank you. Now it is time for Dr Sahota to raise your question, please.

Dr Onkar Sahota AM: Minister, thank you for coming and joining us this morning. The success of any vaccination programme relies on the willingness of people to actually have the vaccine. When trust was lost on the measles, mumps and rubella (MMR) vaccine we knew that the uptake plummeted, and, as you know, we need to get over 80% of the population vaccinated to get herd immunity.

You also know that trust is a social contract between two parties, in this case the Government and the people. While the people trust the scientists and the doctors, the Government has often ignored the advice of the scientists. For example, on late lockdowns one, two and three; the delay in getting the right personal protective equipment (PPE) to frontline staff at the right time; not closing schools and universities when SAGE advised them to do so; promising that Christmas would be all right although the Government knew very well that it would not, because we had a variant in Kent going around the country; or not controlling our airports and borders when SAGE asked to do so.

All in all, the public has no confidence and trust in the Government’s handling of the pandemic so far and for some good reason.

Nadhim Zahawi MP (Under-Secretary of State for COVID-19 Vaccine Deployment): As we spoke about earlier, other countries - whether it is Germany or Canada - are having to adjust their border policy rapidly and now their vaccination programmes as well.

There are very high levels of acceptance of vaccines. I want to go even further than 85%. You mentioned 80% was the threshold for scientists. I am a chemical engineer but not a doctor; you would know much better than I. We are running at 85%, but I want to go even higher. I want to be even more ambitious because those 15% who are vaccine-hesitant, I am reaching out to those people with your help with my colleagues from South Asian communities and from the black and Afro-Caribbean communities and, indeed, the Mayor of London and others, to make sure we give that confidence.

The best way of doing it, I will agree with you, is through medical practitioners, their GP, their community nurse, their community pharmacy. I went to visit a brilliant community pharmacy in Edgware, a brilliant, brilliant team there that were doing the vaccinations and you could just see it for yourself. They are so embedded in their community. They knew each and every person, people were queuing up to have their

Page 14 vaccines and the volunteers were all local to them. I am more optimistic, dare I say, than you are on this and I hope together we can make this happen.

Dr Onkar Sahota AM: Thank you for that response, Minister. Only before you came here, we were told London was doing very badly on the vaccination rate compared with the rest of the country because trust was a big issue. Anyway, I will leave that part for the moment.

The other thing is that the UK is the only country that has gone for the first vaccine. It is different. I am talking to you about the Pfizer vaccine. There is evidence about the AstraZeneca one, but on Pfizer we have extended the gap between the first and second dose, which is not supported by the international community and certainly the World Health Organisation (WHO) has said that there is no evidence for that.

I am particularly concerned about people who gave consent in December [2020] for the first and second vaccine to be given in 21 days. Do you think we broke our trust with those people, who gave their consent to have the second vaccine within 21 days? Then the GPs are asked at short notice to ring up all those patients to explain the change of policy, which was inconsistent with what the manufacturer said. Do you think trust was undermined on that occasion?

Nadhim Zahawi MP (Under-Secretary of State for COVID-19 Vaccine Deployment): The way I would answer that is in two parts. Part one is, I was speaking to a GP practice in Watford to congratulate them on how well they have done. He said, “Please take the message back that the CMO, [Professor] Chris Whitty, and his Deputy, [Professor] Jonathan Van-Tam, did exactly the right thing in terms of recommending with the CMOs of Wales, of Scotland, of Northern Ireland”. This is not party-political in any way and, as you know, obviously in Wales/Scotland there is a different Government. In Wales, there is a Labour administration that is delivering the vaccination programme and of course the Scottish National Party (SNP) Government in Scotland. He said, “Because ultimately, the CMO has to make a decision on the evidence”.

The evidence comes from the JCVI - these are the UK experts and some of them will be recognised as world experts - and our Regulator, which is independent of Government. [Dr] June Raine [Chief Executive] and her team at the Medicines and Healthcare products Regulatory Agency (MHRA) are totally independent of the Government. The Regulator, the JCVI and the four CMOs all agree to the dosing schedule of Pfizer-BioNTech being up to 12 weeks and that is exactly what I am deploying. Rather than say to you, “I have an opinion on this”, I do not. I rely on the expert advice of the JCVI, the Regulator and the CMOs on this.

Dr Onkar Sahota AM: OK. Minister, can we guarantee that people who were given the first Pfizer dose in December [2020] will get the second dose of Pfizer if they need it? They will need it, yes.

Nadhim Zahawi MP (Under-Secretary of State for COVID-19 Vaccine Deployment): Of course. Absolutely, Doctor. I think the NHS is the best in the world, some will say it is world-leading, one of the best in the world. I still think it is the best in the world. The NHS will do this, as it does with other vaccination programmes. Although this is the largest vaccination programme in the history of the NHS, it will absolutely deliver. If you have had Pfizer, you will get Pfizer as your second dose. If you had Oxford-AstraZeneca, you will get Oxford-AstraZeneca as your second dose.

Dr Onkar Sahota AM: Thank you, Minister, and just my last question. As you have heard previously, the first case for the South African variant test in this country was on 29 December 2020. We have only just started rolling out the mass polymerase chain reaction (PCR) testing for this, as a method to see how the virus has spread in the communities. We are asking asymptomatic people to go for the test and then, if they have tested positive, to go into isolation, but they will be getting no benefit from it. Do you think trust has been broken

Page 15 there? Why would people, who are asymptomatic, go for a test and if they test positive they have to be isolated for ten days and they will get no benefit from it? Is that not a disincentive for people to come forward to not get tested and undermine the whole programme or the PCR mass testing programme, which you have rolled out to find out the prevalence of the South African variant?

Nadhim Zahawi MP (Under-Secretary of State for COVID-19 Vaccine Deployment): First of all, Doctor, for those who test positive, who do need the additional help, there is the Hardship Fund, which delivers £500 to people who need that additional financial help, plus additional money that has gone to local government to use their discretion to help those who may not be eligible for the Hardship Fund. The other element of that is enforcement. The system that we have in place, I think, is working and working well. We can always learn and do better. Hence why we are introducing the hotel quarantine that Assembly Member Cooper asked me about earlier. It is a combination of all the support we have put into the economy. The Chancellor [of the Exchequer] has put £280 billion into the economy with another £55 billion for this year. The International Monetary Fund (IMF) - and you can look up this quote - has said that the UK has one of the best and most comprehensive economic support programmes in the world to combat the pandemic we are all experiencing.

Navin Shah AM (Chair): Thank you. We have a very, very quick question from Assembly Member Boff.

Andrew Boff AM: Is it important to complete the JCVI priority list as is?

Nadhim Zahawi MP (Under-Secretary of State for COVID-19 Vaccine Deployment): It is very important, Andrew, because they looked at all aspects of the vaccination programme, including BAME communities, they looked at professions and they looked at ONS data. They fell very clearly on the side that the evidence for those who are most vulnerable are in the one to nine categories that they advised us, we took that on board and that is exactly what we are following. That is 99% of mortality. Then we move to phase 2 where we will be asking them the question in terms of where there are policemen and women or teachers or shop workers who, through their profession, may come into contact with much greater volumes of the virus. They will respond to us with their advice and we will follow that advice in phase 2.

Andrew Boff AM: Thank you.

Navin Shah AM (Chair): Thank you very much. Minister Zahawi, I know this morning already you had a very busy schedule. I have heard you on Leading Britain's Conversation (LBC), we have seen you on Sky [Network] Television (TV) and you are here this morning with us. I cannot thank you enough.

May I just on behalf of the Assembly if you can spare another minute, ask you a question of reassurance that we are seeking on behalf of Londoners? That is: is London now receiving its fair share of COVID-19 vaccinations and can we be confident that it will continue to do so over the coming months?

Nadhim Zahawi MP (Under-Secretary of State for COVID-19 Vaccine Deployment): Yes.

David Kurten AM: Excuse me, Chair. Sorry to butt in, Chair. You have not allocated me a time for the Brexit [Alliance] Group.

Navin Shah AM (Chair): We have, indeed, allocated the time. I know that the officers have been chasing you for any input that you might want to make and only a couple of seconds, three/four seconds ago, I was still told that they have not heard from you. Thus, I have not called you. I am very happy to call you if the Minister has the time and, yes, no problem at all.

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Minister, are you able to very quickly respond to my question and then, if you have time. a question from Assembly Member Kurten?

Nadhim Zahawi MP (Under-Secretary of State for COVID-19 Vaccine Deployment): Absolutely.

Navin Shah AM (Chair): Thank you.

Nadhim Zahawi MP (Under-Secretary of State for COVID-19 Vaccine Deployment): Why do we not take Assembly Member Kurten’s question? I will respond to both questions because I have to wrap up. I have to get to the House because I am making a statement to the House of Commons.

Navin Shah AM (Chair): I appreciate that. Just the reassurances I have sought from you, thank you. Can you answer?

David Kurten AM: Minister, I just want to ask you quickly. You said yesterday in a tweet the vaccines are safe and have been rigorously tested, but there is a lot of evidence of serious adverse health effects. For example, in Norway, there were 23 people who died in a care home after the Pfizer vaccine and in this country there has been an --

Siân Berry AM: We should not be giving a platform to scaremongering.

David Kurten AM: Sorry, I heard someone else saying something.

Nadhim Zahawi MP (Under-Secretary of State for COVID-19 Vaccine Deployment): I think I get the gist of the question, David. I can answer that question and Assembly Member Shah’s question as well. I am very grateful to you both.

David, to your question, the Norwegian health service looked at that particular case and concluded that actually it was not linked to the vaccination programme. In the UK, just to let you know, we have a very vigorous recording of adverse events in vaccination, not run by the Government, not run by the NHS, but run by the Regulator, the MHRA. It is called the Yellow Card system and the MHRA publishes and will continue to publish the adverse events when it comes to vaccination. We have now vaccinated or at least given the first dose to over 10 million people and vaccines are safe. Both vaccines went through rigorous phase 1, 2 and 3 processes. [Dr] June Raine CBE, the head of the MHRA, made it very clear there were no corners cut and no shortcuts. The only difference was they paralleled the phases because so much resource was put in place to allow for that to happen, and so they are incredibly safe. They are good for you, they protect you and they protect your family and your community.

To Assembly Member Shah’s two questions, yes and yes. You will continue to receive your fair share of vaccine doses for completing categories 1 to 4 by the middle of February [2021]. That is a commitment from me and from the NHS. Then beyond that, you will continue to receive your fair share to be able to complete the categories 5, 6, 7, 8 and 9 and then we move to phase 2. Our only limiting factor is vaccine supply, but I now have very clear line of sight all the way through until the end of March [2021], week by week, of what we have coming in. Of course, we have got other vaccines that will come on board in the spring. We have got tens of millions of doses coming through and I am confident that together we will do this and we will vaccinate the adult population of London and get our lives back, our country back and our economy back.

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Navin Shah AM (Chair): Well, it is good to end on a very positive note, Minister. On behalf of the Assembly, I thank you very much for sparing your time and answering questions diligently. Thank you very much and have a lovely day. Thank you.

Nadhim Zahawi MP (Under-Secretary of State for COVID-19 Vaccine Deployment): Thank you so much, everyone. Stay safe. Take care.

Navin Shah AM (Chair): OK, colleagues, let us resume our Q&A session. Let me see who is next in that case. After you, I have Assembly Member Kurten on the list. Before I call Assembly Member Kurten, let me make it very, very clear. I have personally, as well as officers, been trying all this morning until about five or so minutes ago to see whether you wanted to come in and ask a question to the Mayor. Unfortunately, we heard nothing and that is the clear explanation as to why you were not called. Can you please for the future try to help us to help you to ask questions should you be interested in a timely manner? Assembly Member Kurten, can you ask your question, please?

David Kurten AM: I would like to ask, yes, Martin Machray if I could, back to the people who were here before. You refer to the vaccine or the injections that people are being given from Pfizer, AstraZeneca and Moderna as vaccines. However, the substances from Pfizer and Moderna are not vaccines, as people understand vaccines. They are experimental Messenger RNA (mRNA) gene technologies. Why do you continue to refer to those two substances and injections as vaccines?

Martin Machray (Joint Regional Chief Nurse for London and Covid-19 Incident Director, NHS England): I am not a scientist or a virologist; I am a nurse. The MRHA, which regulates the vaccines, describes the two vaccines we use in London - AstraZeneca-Oxford and the Pfizer-BioNTech - as vaccines. That is what I will call them because that is what they are regulated as.

David Kurten AM: You say you are following the MRHA?

Martin Machray (Joint Regional Chief Nurse for London and Covid-19 Incident Director, NHS England): MHRA, yes.

David Kurten AM: MHRA. OK, thank you. Are you aware that there has been an increase in weekly deaths in care homes in the UK from the week that the vaccine began to be rolled out on 8 December [2020] by nearly 400% from 441 in the week beginning 4 December [2020] to 1,705 in the last week of January [2021]? What does that say about the safety of the vaccines?

Martin Machray (Joint Regional Chief Nurse for London and Covid-19 Incident Director, NHS England): I do not recognise the figures. You would have to tell me where they came from.

We monitor on a weekly basis the deaths in care homes and other care settings in two ways. One is through a reporting mechanism through our local adult social services teams and local authorities, and then subsequently through ONS data that comes about four weeks later. We have seen no rise of this awful second wave of COVID in total of excess deaths for this time of year. Now that is not like we saw back in March and April [2020] in the first wave, when we did see more people dying than we had expected die on a week by week basis. We think that that is down to two reasons. One is because the care, and our scientific understanding to inform that care, of COVID is so much greater now, we are able to look after people very well. Secondly, the extra measures we have taken in place, particularly around infection, prevention and control - hands, face, space, in layman’s language - make sure that we reduce the number of deaths from this awful

Page 18 disease. I have not seen - and I am happy to look at data if you want to send it to me - a rise as you describe in deaths in care homes since the vaccines started.

David Kurten AM: Thank you for your answer. I did not specifically ask you about excess deaths; that is a different thing. Yes, maybe you do not have the figures from deaths in care homes in front of you, but I am very glad to hear from you that you say that excess deaths are not greater than normal. That is very good to hear and maybe that is a good reason to end the lockdown.

Navin Shah AM (Chair): Now we move on to the other supplementary questions on the list. Can we start with Assembly Member Pidgeon, please?

Caroline Pidgeon MBE AM: I would like to start my questions with Martin [Machray]. I would like to ask you about the take-up of the vaccine amongst blind and visually impaired people. Some serious concerns were raised on the [BBC] Radio 4 In Touch programme last week and have been powerfully highlighted by the Royal National Institute of Blind People (RNIB) relating to the challenges in accessing information and travelling to get the vaccine. In terms of getting the vaccine, I understand why places like the ExCeL centre are being used for vaccinations, but travelling when blind, at the best times, can be a huge challenge, Many blind and visually impaired people have lost some mobility skills and confidence during the pandemic. The ExCeL centre, for example, is a place where many blind people may be unfamiliar and Docklands Light Railway (DLR) has very few staff to provide assistance. Can every step be taken to ensure that blind and visually impaired people are invited to a local venue for their vaccinations?

Martin Machray (Joint Regional Chief Nurse for London and Covid-19 Incident Director, NHS England): Yes, so quickly on the three points. I will go and see if I have data on that particular group. I would be surprised if I do, but if I do I will write to you and let you know.

Secondly, it highlights, does it not, the real challenge that people living their day-to-day lives, in my limited experience, have. We are trying to accommodate a national programme. Therefore, local flexibility and making sure, back to Dr Jameel’s point in the beginning, and others, that we have local opportunities for people to pick up the vaccine is really important and that people, in this group particularly, have familiar routes to go to.

Caroline Pidgeon MBE AM: Yes.

Martin Machray (Joint Regional Chief Nurse for London and Covid-19 Incident Director, NHS England): That is really, really important. What your question does is highlight the structural unfairness that exists in society over many other things, and the vaccine shines a light on that.

The third thing is you said “when they’re invited” and we had a conversation about confusion around letters. Let’s be really clear. If you are over 70 and you have not yet been contacted, I want you to ring 119 and book an appointment, and that can be with your local pharmacist. Or go online, search online for “vaccine appointments” and book an appointment where it suits you and get that vaccine. If you are a member of staff - and that will not be in the main, although there are some of our care staff, who are blind and visually impaired - they have been offered that vaccine and we encourage them to take it up in their local healthcare setting where they are familiar. Thirdly, if you are clinically extremely vulnerable - and many people who are blind also have other conditions, which make them extremely clinically vulnerable - then I encourage them to speak to their healthcare workers, whom they work with already, to get that appointment in a place that suits them. That is the important point I think you are trying to make.

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Caroline Pidgeon MBE AM: Lovely, thank you. Will the NHS in London make sure that communication needs, which are held on health records because of the accessible information standard, are followed in all correspondence with blind and visually impaired people to ensure they get the right information?

Martin Machray (Joint Regional Chief Nurse for London and Covid-19 Incident Director, NHS England): That would be my expectation of all my colleagues working in all those healthcare settings and I will reinforce that to them.

Caroline Pidgeon MBE AM: Lovely. Farah, as one of the GPs, can you assure me that you are working carefully with this particular group of Londoners?

Dr Farah Jameel (British Medical Association): Absolutely, and I think you are right to shine that spotlight on patients more generally with disabilities and the importance that you bring about that local approach, that familiar approach, and what role the GPs, their general practice, their pharmacy, their community setting, can play in their onward care.

Dr Tom Coffey (Mayoral Health Advisor): Chair, may I just give some data to a question raised by Assembly Member Kurten, please?

Navin Shah AM (Chair): You can do so. Could you please do that in writing to Assembly Member Kurten?

Dr Tom Coffey (Mayoral Health Advisor): It was just to highlight the numbers in care homes, in fact, are dropping at the moment, not rising.

Navin Shah AM (Chair): OK.

Dr Tom Coffey (Mayoral Health Advisor): The figures in London have gone from 777 on 22 January [2021] and now it is only 541, just saying. The care home data, as the vaccine programme is rolled out, is reducing in London, not increasing.

Navin Shah AM (Chair): OK, thank you very much.

David Kurten AM: Thank you for your answer. My question was from 4 December [2020] to 22 January [2021] and you have answered for a different period since then. I am glad to hear that from 22 January [2021] onwards - I did not ask about that - though the death rate is dropping now. Thank you for that data.

Navin Shah AM (Chair): Thank you. We will move on from that. The next question is from myself so can I request the Deputy Chair to take control for my question? Thank you.

Tony Arbour AM (Deputy Chair): Please go ahead, Chairman. Go ahead.

Navin Shah AM (Chair): Right. My question is on vaccination hesitancy in BAME communities and to start with, I would like to address my question to Dr Coffey. According to the Royal Society for Public Health (RSPH), only 57% of BAME people would be willing to take a COVID-19 vaccine in comparison with 79% of white people. In particular, confidence is reportedly lowest amongst black communities, with some reports of 72% not willing to take the vaccine. The spread of the misinformation and conspiracy theories via social media networks can be identified as one of the causes of this. What can the Mayor and local authorities do to counter misinformation and boost confidence in vaccines to BAME communities?

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Dr Tom Coffey (Mayoral Health Advisor): That is a very important question because, going back to what the Minister said, we do not want the groups who are not receiving the vaccine to be in the groups who are most likely to get the infection and die from the disease. This is so important to ensure we rid London of COVID. There are few things that the Mayor and colleagues need to do.

First of all, it is about trust. How can we make sure we convey to Londoners in that community that it is safe to take the vaccine? In fact, at the moment today the Mayor is visiting a Hindu temple in North London to show support for the vaccine uptake in that community. He recognises that if you place the vaccine centres within a community, the likelihood of people from that community taking the vaccine increases. The first thing we need to do is to make sure that we reach out to those communities so the vaccine centres are embedded and based in that community.

Secondly, it is about misinformation. It is repeating again and again that vaccines are safe, they have been tested, and also that we are monitoring them on such a careful basis. The Yellow Card system, which the Minister mentioned: we look at every single day any adverse effect. I report to the independent MHRA to say a side effect has occurred so that the safety monitoring of the vaccine is of the utmost.

The third thing, I think very much, is the Mayor and the Greater London Authority (GLA) are doing paid adverts out on social media and in the main press because we recognise often that social media is the avenue used for the misinformation about vaccines. Therefore, that is the area where we must also counter that misinformation. The Minister and Sadiq [Khan, Mayor of London] over the weekend did an article for the national press, again both members of the BAME community reaching out to their fellow BAME community leaders and members to say, “This vaccine is safe”. It is much more likely that the safety will be considered as vital when the message is being given by people from that community. That goes to the idea that one of the speakers earlier said about community champions. If we are not having community champions extolling the virtues of the vaccine, it will probably fall on deaf ears.

We have got to do a multiplicity of things, but the reason it is so vital is that if this is not addressed, there is a strong risk that people in these parts of London, who are the most at risk of getting COVID and dying from COVID, will be the ones who are least vaccinated. Thank you.

Navin Shah AM (Chair): If I can move on to Dr Jameel, both as the British Medical Association (BMA) representative as well as London’s GP caring for a diverse community. If you would like to pick up the thread of the main question I had, and also I want to ask you another question. That is that the Assembly’s Health Committee stated that there was a link between vaccine hesitancy and those who are from the BAME community, from lower incomes and also there was low satisfaction rates with their own GPs. GPs are crucial to this effort. How can confidence in them be increased?

Dr Farah Jameel (British Medical Association): That is quite a loaded question, but I might just pick up on the strand from earlier.

Navin Shah AM (Chair): Sure.

Dr Farah Jameel (British Medical Association): One of the things that we have faced in terms of challenges when we got started with a local vaccination site programme was the fact that we could not move Pfizer. We were stuck with the characteristics of the vaccine and it was limited to having to be vaccinated within a very short timeframe, sort of 3.5 days from the time it arrived on site. We had to invite the patients, get them in quickly, vaccinate, and that was it.

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Now with the Oxford-AstraZeneca vaccine, the ability to move that vaccine is far simpler, far easier because of its characteristics, which means we can take it out of the local vaccination site and into the communities, which is what we are starting to see. We have got examples of temples and we have got examples of buses that are being utilised to reach our communities, reaching our hard-to-reach communities, but also just being able to take that vaccine out into a GP practice, the local GP practice, and like we are seeing at the moment, into the local pharmacy. That will be the key to increasing uptake in some of the harder-to-reach groups at this moment in time.

There is also an absolute need though. We are not coding patients who are declining, appropriately. We cannot even run searches to identify those who are uncertain. To target our approaches, we need to ensure we have got the right searches and right lists so we are able to target those patients appropriately. We do need some national support with that.

Coming to increasing GPs’ trust, gosh, I would like to say that all the stats and all the surveys suggest that the GPs are phenomenally the most trusted in the public domain by the public, but there is always more that we can do. I would like for us to work very closely with councils to improve that.

Navin Shah AM (Chair): Thank you very much. Right, that ends my questions. Can we move on to questions from Assembly Member Dr Moore?

Dr Alison Moore AM: My first question is for Tom Coffey. Phase 1 of the current COVID-19 vaccination programme covers care home residents, for example, and those over 50. Phase 2 covers the rest of the population and the JCVI has said, and I quote, “Vaccination of those at risk of exposure to SARS-CoV-2 due to their occupation could also be a priority in the next phase”. My first question is: what discussions, if any, has the Mayor had with the Government over whether to prioritise key workers’ COVID-19 vaccination programme and, if so, when should they receive their vaccination?

Dr Tom Coffey (Mayoral Health Advisor): Sadiq [Khan, Mayor of London] has, in fact, written to the Government, asking about the prioritisation, would it consider people who are very much public-facing workers? There was a lot of applause and commendation for those public sector workers, public-facing workers, especially during the first lockdown, who are going out to serve their communities. They undoubtedly, because of that face-to-face interaction, are more at risk, be it our police officers, be it our teachers, be it our shop workers. The Mayor has written to the Secretary of State for Health [and Social Care], asking that because of that added exposure they should be considered for part of the prioritisation process in wave 2 of the JCVI programme. Sadiq [Khan, Mayor of London] has done that.

Now timing-wise, I am not aware of the detail from the JCVI when the second wave will begin. Martin [Machray] is part of the group, who in fact is the most trusted group. GPs are second to nurses. I know Martin giggled when Dr Jameel commented how trusted we are. We are very trusted. Martin may know more about the date when the second wave of the JCVI process will start, because we are running a parallel process. Just as we are getting through our first 1.5 million doses, they have all got to have their second dose, so they will be running that again, and some second doses are only starting in six weeks’ time. Martin?

Martin Machray (Joint Regional Chief Nurse for London and Covid-19 Incident Director, NHS England): Yes, very quickly, Assembly Member Moore. Thank you. There are three parts to a two-part strategy, as you heard the Minister say. 1(a) is up until the middle of February [2021] and that is the top four groups. Then 1(b) is the next five. We have not got yet a target set for us about when that will be, but we are planning on the next two to three months after the middle of February [2021]. It is a planning assumption at present. Then we will go on to that third stage, which is other groups. We will be directed by the evidence,

Page 22 and if it changes and the JCVI tomorrow said, “We need you to focus your attention elsewhere because the evidence says so”, then the NHS will pivot to do that. We would like some notice, back to the point that Dr Jameel has said, but we will do as the evidence directs and the JCVI directs, and currently it is those three steps we are going to take.

Dr Alison Moore AM: Thank you very much. I had been going to move on to ask you a question, Martin, about that phase 2 vaccine rollout.

Martin Machray (Joint Regional Chief Nurse for London and Covid-19 Incident Director, NHS England): Yes.

Dr Alison Moore AM: Obviously, there are teachers and police officers and other critical workers - and, of course, as a London Assembly member I have an eye on Transport for London (TfL) frontline staff and frontline firefighters, as we heard at the [Fire, Resilience and Emergency Planning] Committee yesterday. There is a question mark about who could be in the highest category to receive that first dose, although I do recognise the challenge of giving the second doses as well. Do you have any sense where you might see the plans for that phase 2 rollout, and what sort of information is coming through at the moment about prioritisation?

Martin Machray (Joint Regional Chief Nurse for London and Covid-19 Incident Director, NHS England): Certainly, people are making really strong representation to the JCVI. They recognise that it is not a local decision and that is probably right, because you do need the world’s experts - and we are very lucky in this country, are we not, to have those - looking at this and spending time doing it and coming to a reasoned position. That is the right thing to do. It is right that representation is made for occupational groups, etc, and I have had many - as I am sure you in your caseload have - many representations made. At a personal level, as a nurse, I want to go, “Yeah, I really understand that and I see your vulnerability, Mrs Mohammed/Mr Jones, whoever you are”, but this is a public health response, not a personal health response and we have to see it in terms of the population.

Just very quickly, I come into the office into the incident centre here every day about 5.30am/6.00am in the morning and I have a brief conversation with the guy who sweeps the streets. I can make a brilliant case for that guy to have the vaccine today, but he is not in the top four groups, he is not in the next five, and therefore it is right we focus on the population. We should hear more over the next couple of weeks from the Minister and others about where we then go for that second stage.

I am sorry I am not more specific, but we are guided by what comes down.

Dr Alison Moore AM: Thank you and I will hand back to the Chair in a second, but I hope that we are going to see the particular case around London being argued because we are such a big and complex city.

Martin Machray (Joint Regional Chief Nurse for London and Covid-19 Incident Director, NHS England): We can make that case for London, absolutely, yes.

Navin Shah AM (Chair): Thank you. Assembly Member Desai?

Unmesh Desai AM: Dr Jameel, the criteria for vaccination in the UK has been to protect the NHS. Other countries have prioritised younger people to support the economy. Is that strategy working? Is it the right one? The reason I am asking this question is that it is important that Londoners know and understand the scientific and medical evidence upon which we are working.

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Dr Farah Jameel (British Medical Association): That is a very challenging, difficult question to try to answer succinctly. We must follow the scientific evidence and guidance that is being provided and that strategy is being set by the CMOs in consultation, in discussion with independent experts, who have analysed all of the evidence in front of them. That will include things like hospital capacity. It will absolutely include that.

I do not think it is helpful necessarily to suggest that that is the wrong strategy because what we do know is that there are multiple factors involved. The question earlier around looking at expanding or reviewing the guidance is important for us to ponder upon and pause. The guidance was relevant and appropriate when it was issued and what we do know is that things have moved on since. We have new data of admission trends, we have new data on intensive therapy unit (ITU) trends and we have new data on the communities and the age bands which the second wave has impacted on. That should and must inform any future strategy in terms of who we prioritise for the vaccinations.

Unmesh Desai AM: Thank you. This is a follow-up for Dr Jameel, if I may. We have heard from the Government that it is protecting for immunity rather than reducing transmission of the virus. Can you tell us what evidence there has been so far? How are you working with other countries to share learning and what room is there to manoeuvre if the evidence changes?

Dr Farah Jameel (British Medical Association): That would not be so much my job or my role. My job would be very much following the guidance that is being issued. However, I do wonder whether Martin might be able to touch upon this a little bit further.

Martin Machray (Joint Regional Chief Nurse for London and Covid-19 Incident Director, NHS England): Yes, thank you. We are constantly learning from around the world and I think your push, Assembly Member, is that we do so and I can assure you that we do. Only last week, I was in a multi-country seminar of nurses from Italy, Spain and Israel, sharing our best practice, sharing the evidence both of the vaccination programme and our response to this current wave. It is really important that we understand that because, as you have heard a number of times today, the evidence is not just accruing; it is changing as the variants of the vaccine change. We learn more and more, and we are learning different things every day.

Remember, it is only 30 January last year [2021] that the WHO declared a pandemic. It feels like a lifetime ago, but it is only a year. It is only eight weeks for the vaccine programme since England started vaccinating, the first in the world. We have got a lot to learn yet and a lot to learn from other people.

Navin Shah AM (Chair): Assembly Member Qureshi?

Murad Qureshi AM: Thank you, Chair. Can I address my question to Martin and then Tom? Martin, you informed us earlier that yesterday we had over a million Londoners vaccinated with the first jab.

Martin Machray (Joint Regional Chief Nurse for London and Covid-19 Incident Director, NHS England): Yes.

Murad Qureshi AM: That is great news, but can you give us an estimate of the proportion of Londoners not registered with GPs, and how we intend to vaccinate them?

Martin Machray (Joint Regional Chief Nurse for London and Covid-19 Incident Director, NHS England): OK, that is a great question. I could not give you an accurate figure. It is very tiny in population

Page 24 terms, but it is a really, really important question. I will write to you and give you that figure. Forgive me, I am not dodging it; I just do not have it to hand.

The very fact that people are not registered with a GP and, given the great service that I have already talked about of our general practice and primary care, it makes them more vulnerable, be that because they are homeless, because they are asylum seekers, because of all sorts of other reasons that people do not register. The younger population are just bad at registering - that is another question altogether - but that vulnerability needs to be picked up. Therefore, we have got a strategy for London that will be carried out locally with local adult social services and local authorities to make sure that we work with those communities, who we know do not normally register.

I will pick up a couple, but homelessness is one. We have over 900 people who are sleeping on our streets today, and we will work with the great charities like St Mungo’s, Médecins Sans Frontières (MSF) and others to reach those 900, and those who are couch surfing or sofa surfing. We have got other groups like traveller groups, who are not registered. We have got groups, who are in temporary, transitory accommodation, moving week to week, and we have to work with our local systems and charities and our state sector to actually reach them. We have got the facilities and it goes back again to great primary care. While we have got primary care, we reach those groups well and we will deal with the vaccine.

Murad Qureshi AM: OK, well, thank you, Martin, for that response. Can I have a GP perspective now from Tom?

Dr Tom Coffey (Mayoral Health Advisor): Yes.

Murad Qureshi AM: Tom, can I just add? Whilst Martin has highlighted some of the groups and what have you, when this question was raised in the [House of] Commons, the Minister there emphasised that the Ministry of Housing, Communities and Local Government has got a role to play. I wondered in your response you could tell us what discussions the Mayor may have had with the Ministry on this pertinent issue?

Dr Tom Coffey (Mayoral Health Advisor): OK. To give you some stats, for people who are rough sleepers, 25% are not registered with a GP and so that is a significant proportion. As a GP, what I try to do when someone is a rough sleeper or homeless and they have not got an address, is I register them at my practice. They need an address on the system, so therefore I use the practice number. Most would have a mobile phone and we are very clear in our record, “Please contact this patient by phone, not by letter”. So there are ways to get round it to make sure, even if someone has not got an address, you can still register. Very clear and actually to all Londoners: you do not have to prove your identification (ID) or your address to register in general practice. Every single Londoner, irrespective of whether they are homeless, or have got no proof of ID, have got a right to register with a GP. Some people feel that is not the case and that is not true. You can register.

Sadiq [Khan, Mayor of London] has had quite a lot of correspondence with various Ministers to try to work out how we can improve the registration of patients within London. In the GLA, we have seconded someone into the GLA Health Team, someone called Doctors of the World. They are a group who work with refugees, asylum seekers and rough sleepers who are trying to promote the idea of a registration of this vulnerable group. Sadiq [Khan, Mayor of London] has felt that we want to try to support this organisation, so someone is on a one-year secondment into the GLA to work on how we can communicate to the wider Londoners and the wider GP community, including our GP colleagues, to make sure this does occur.

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Murad Qureshi AM: Thank you, Tom. The Mayor has had discussions about flexibility in the vaccine deployment at the local level. Could you just give us some idea of what kind of flexibility he is talking --

Dr Tom Coffey (Mayoral Health Advisor): I do not think I said that. What I have said is that there is flexibility in how GPs can make sure we register this vulnerable group. The decisions of how people are vaccinated are very much part of a national programme that Martin [Machray] and his team implement in London. Accordingly, we follow this programme throughout London as GPs. We do not use flexibilities within London which will be different to Manchester or Birmingham.

Murad Qureshi AM: OK, thank you, Tom, and can I just make a final plea? We have heard the nurses’ perspective and the doctors’. I do think our chemists have a role to play. After all, when I had my flu jab before Christmas, it was not at my GP, it was at my chemist.

Dr Tom Coffey (Mayoral Health Advisor): Agreed.

Murad Qureshi AM: Thank you.

Navin Shah AM (Chair): Right. Can we have a question from Assembly Member McCartney, please?

Joanne McCartney AM: My first question is to Martin Machray. We have heard earlier that some Londoners are hesitant to get the vaccine and work is being carried out to build their trust and confidence, but are records being kept consistently across all of London’s Clinical Commissioning Groups (CCGs) of those who have declined the vaccine, and is there capacity in the system in a few months’ time to contact those people again whose confidence may have risen?

Martin Machray (Joint Regional Chief Nurse for London and Covid-19 Incident Director, NHS England): Yes. You have already heard in a previous answer, Assembly Member, that the GP systems and systems that we had when we started this on 8 December [2020] did not collect that information and that is a frustration for us all. Many practices and hospitals have set up local systems to overcome that, but what everyone is really committed to is making sure that we do not give up on any Londoner. That is a really important message. It goes back to that conversation I had with the care home manager and her staff about uptake.

You do not say, “One strike and you are out”. That is not the NHS’s or London’s approach to its population. Our approach is to work with people, with communities and, therefore, it is vital that we go back and back, not nagging, but go back and be there for when they are ready to make that decision. We are a bit stymied by some of the new systems that have come into place. They are improving day to day, but that should not override our commitment to do the right thing.

Joanne McCartney AM: OK, so there will be capacity in the system later on. That is helpful to know.

Martin Machray (Joint Regional Chief Nurse for London and Covid-19 Incident Director, NHS England): Absolutely.

Joanne McCartney AM: There are some reports that some employers are saying that they will only take new employees who have had the vaccination on a “no jab, no job” policy, and I am just wondering - perhaps this is better for Tom - what your view is of this. There are some ethical issues with regards to a lot of the debate around vaccines. What is your view on that, and in the public health sphere, is there any discussion to be had about whether it is going to be advisable for all health and front-facing workers to have had the jab?

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Dr Tom Coffey (Mayoral Health Advisor): Thank you, Joanne. The view at the moment is very much that people have a choice over whether they wish to have a vaccine or not. We have said again and again that trust is vital between the Government, the health service and the Londoner, regarding the choice to have the vaccine. I think any move towards making it compulsory will undermine that process.

Joanne McCartney AM: I agree.

Dr Tom Coffey (Mayoral Health Advisor): At the moment, I think it is vitally important that we say very clearly, “This vaccine is safe and effective, it will protect you against getting COVID and it could also protect you from passing COVID on to someone else. We now have emerging evidence for that, but a key reason we are doing it is because it protects you from getting COVID and becoming seriously unwell with COVID”. I would rather use that message at the moment than any level of coercion, because once one goes down the path of coercion you further undermine, potentially, the issues of trust which we know are the main reason now regarding vaccine hesitancy.

Joanne McCartney AM: Yes. It just strikes me that there might be some work to be done with employers then, with regards to this, because otherwise there could be some serious ramifications.

Dr Tom Coffey (Mayoral Health Advisor): Yes, that is a fair point. Indeed.

Joanne McCartney AM: The other thing I wanted to ask, and perhaps again for Tom, is that the Danish Government announced yesterday that it intends to introduce a digital Corona Pass that will allow its citizens to show airlines and other countries that they are up to date with their vaccinations. Is that something that is actively being discussed at the moment in the UK? Again, I can see there will be some implications for that as well with regard to those people who may not want to, or perhaps have medical reasons as to why they should not and could not take the vaccine?

Dr Tom Coffey (Mayoral Health Advisor): I am not aware of those discussions, but this is a discussion we should be taking at a Government level. This is something which would not be done on a city-wide basis, very much a Government-wide basis. We are very clear at the moment that even when you have had the vaccination, you must still follow the social distancing rules, you must still work from home and you must still be very careful about how you live your life because of the risk, still, of passing on an infection unknowingly. I am not aware of those discussions. Martin might be aware, but my sense is at the moment that I am not aware of any plans to do that in the UK.

Martin Machray (Joint Regional Chief Nurse for London and Covid-19 Incident Director, NHS England): No, I have not heard of any either, but you have already alluded to the significant ethical debate that would need to take place around that. As with all of this, I think that debate would be healthy.

Navin Shah AM (Chair): Thank you. Next is a question from Assembly Member Devenish.

Tony Devenish AM: Thank you, Chair. My question is to Dr Tom. Firstly, Dr Tom, thank you so much for all you have done. You have always been very responsive to my constituents on all health issues and it is really appreciated. I think now what we have heard this morning is the NHS is doing a fantastic job but we need all the team to communicate, communicate, communicate and communicate some more.

I am amazed that the Mayor is not here this morning because he was always banging on about being a son of a bus driver until we all remembered that nice, simple phrase, and I am very keen to hear what you have been saying about the hesitancy rate this morning and how we need to get that hesitancy rate down. My question

Page 27 to you, Dr Tom, is: can we follow some of the best practice across London? For example, last night Westminster Council held a cross-party communication session with Lord Simon Woolley, Professor Kevin Fenton [Regional Director, Public Health England] and Councillor Rachael Robathan [Leader, Westminster Council]. They spoke to over 350 Westminster residents to alleviate any concerns they may have.

Will you, number one, make sure all 33 London boroughs are doing similar work? Will you get various sports stars - I mentioned a footballer earlier - faith leaders and others to help us communicate this message? I noticed the Camden GP that is on the call referred to buses being used. I have not seen a bus, I must admit, with the messages going around London. Do you know how many London buses have got these reassurance measures, and is there anything else we can do with the media to try and get these measures across and repeat, repeat, repeat, repeat? Thank you.

Dr Tom Coffey (Mayoral Health Advisor): Thank you for that question, Assembly Member Devenish, and obviously you are a bit of a communications expert because I think you have just described the plan we actually are doing. The town hall type assembly meetings which you mentioned happened last night, in fact are being planned to happen throughout the boroughs in London because we feel that is a really good, local way of getting the message across that this is a safe and effective vaccine.

I am aware the Mayor today is at the Hindu temple in north London trying to communicate the message that you have described to the local communities who are most hesitant, to say this is a safe, effective vaccine. I think he would share your ambition to communicate continually through all the different vehicles, via town hall type meetings, probably on Zoom, via social media, via the mainstream media, and in interviews he does on a daily basis. Without this communication, we are not going to address the vaccine hesitancy. Without addressing the vaccine hesitancy, we will not get a coverage in London that makes it safe again for London. I think your wish, desire and clarion call for communication will land on very fertile ears for Sadiq [Khan, Mayor of London].

Tony Devenish AM: Thank you. My second and final question: what are the Mayor and the MPS doing to really clamp down on social media anti-vaxxers?

Dr Tom Coffey (Mayoral Health Advisor): I do not claim to have sufficient detail to answer that one, Assembly Member Devenish, but I am very aware that Sadiq [Khan, Mayor of London] sees on a regular basis how social media is often the main vehicle for putting out this anti-vax message, but also putting out clear and utter misinformation. It is a view which he would share with you. I cannot answer in any detail the actual exact things he has done thereafter, but I can find out for you and get back to you.

Tony Devenish AM: Thank you. I would say, if he could write to me and the Assembly on that important point, I would be very keen to hear the answer. Thank you, once again, for all you and your colleagues on this meeting are doing. It is hugely appreciated, Dr Tom.

Navin Shah AM (Chair): Thank you. Assembly Member Bailey.

Shaun Bailey AM: Thank you, Chair. I will talk to Dr Tom. I really want to follow up on Assembly Member Devenish’s question around what is being done to look at where this misinformation is coming from. There are certain communities, certainly my own, that actually feel like we are under attack. It feels like a very deliberate, very concerted effort to put this misinformation out into our community and I wonder if there is any work being done. I take your comment that it might be slightly outside of your purview, but can you go back and ask for a specific piece of work to look at where this misinformation is coming from, particularly as we still have to allow free speech?

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People are entitled to their opinions but where is this maliciously coming from? Some of the things I have seen circulated in my community are infomercials. People have sat down and taken their time to do it. My specific question is: are you aware of any work being done to see if this information is being deliberately pushed out into our communities by groups or individuals, and if not, would you make the suggestion to the Mayor that this work should be done?

Dr Tom Coffey (Mayoral Health Advisor): Thank you for that question, Assembly Member Bailey. I am aware that there is some national work. As you point out, this is not someone in a very amateurish way creating a ten-second piece for social media. Some people are sitting down and spending hours creating very malicious, very professional misinformation which is deliberately designed to undermine confidence in the vaccine, and because it is done in a very professional and serious way, it has resonance with people. It tends to try to naturally pick up a level of distrust and work on that.

I think the point you make and the description you made is so spot on. Just as I answered Tony Devenish [AM], the same for you. I will take that back to the Mayor and say there is a real, clear message here that we need to address this professional plan to undermine the confidence in this vaccine. Perhaps it will be insufficient just to say they are wrong; we have to find out how we can go to where it is coming from and address that properly. I will take that back to the Mayor and answer to Tony and to yourself about what we are going to do thereafter. Thank you for raising it. I think it is much more sinister than people think.

Shaun Bailey AM: My other point would be this. Could we argue that the Mayor could have done more before this outbreak? Of course he never knew COVID was coming, of course not, but as a nation and certainly in London we could do more for people’s comfort around flu jabs, around MMR, all of these kinds of things. The Mayor has a role in health inequalities in London. One of the biggest inequalities is the take-up of vaccines. What additional piece of work, with the learnings from the COVID uptake, can we do into the future to make sure that Londoners are just more comfortable with attending to their own health anyway?

Dr Tom Coffey (Mayoral Health Advisor): What I would say to that is that, in fact, the Mayor being very aware of that, he has had his flu jab and he has made sure it was done in a very public way to show that he, as a member of the BAME community in London who was eligible for the flu jab, will have it done, is confident in its safety and effectiveness and will have it done publicly. He does try to make sure he uses his personal behaviour to demonstrate to Londoners that vaccination is safe.

Navin Shah AM (Chair): Thank you. Assembly Member Hall.

Susan Hall AM: Thank you, and good morning. I will address the first one to Dr Coffey. Going on from what my colleague, Assembly Member Bailey, was saying, one of the problems we obviously have is that some of the anti-vaxxers genuinely believe what they are saying. I know there is a lot of mischief going on, but some of them do. Is there any prospect or is anybody thinking of getting them on to Zoom calls and saying, “Right, you throw what you are saying to me and we will explain to you why it is not correct”? We listen to our own colleague. He genuinely believes what he is saying. I do not think any of the other Assembly Members do, but we have to get to this because in some cases it might be malicious, but I genuinely believe in lots of cases it is not malicious, they just do not have the right information.

Dr Tom Coffey (Mayoral Health Advisor): Yes. What I would say is, for the vast majority of people - and this is what Martin said - it is vaccine hesitancy. There are a tiny, tiny group who are anti-vaxxers and will not change their mind no matter what you say, but a large number are people who are worried, “Is it safe? Is it effective? Am I quite ready for this vaccine?” What we tend to do is work with that population. As Dr Jameel was saying, often the trust relationship between the GP and that patient, over time, is a thing that will give

Page 29 that person confidence to have the vaccine. Vaccine hesitancy, of the group who are declining at the moment, is much larger than people who are clear anti-vaxxers. Martin might have some information about any more national work so that small group of anti-vaxxers --

Martin Machray (Joint Regional Chief Nurse for London and Covid-19 Incident Director, NHS England): There is a national team that is challenging and trying to stem false information, and that is good to have them. We have to focus on the positive message that vaccination and immunisation brings to our communities. I want to pick that up from the previous question. In London, we have to get over these structural inequalities that we have had over many years. We all have a lot to learn, not just one of us, not one particular group, all of us have a lot to learn from these last few months. I have learnt an awful lot, probably more than anyone, in truth, so I want to build on this and make sure we do that.

I want people to focus and remember that it is vaccinations and immunisations that wiped out smallpox from this world. It is vaccinations and immunisations that meant my generation, when I was born, does not have polio. It means that I did not get tuberculosis (TB) because in the 1960s, when I was born, I was inoculated against that. We still have TB but we know how to treat it now. Vaccines are world-saving. We really have to focus on those positive messages. I do not want to give airtime to lies and misinformation, I want to focus on the positives of vaccines and the COVID vaccine in particular.

Susan Hall AM: I agree with you there, Martin. The only thing is, sometimes you have to give airtime in order to disprove what is being said. It is where people pick up their information we really need to be very sure of, and then go in there. If I can stay with you, Martin, and I thank you because every week I have a discussion with you over all this, and I am very, very grateful for all that.

Martin Machray (Joint Regional Chief Nurse for London and Covid-19 Incident Director, NHS England): Yes, sure.

Susan Hall AM: What percentage of our health workers in London do you think have been vaccinated?

Martin Machray (Joint Regional Chief Nurse for London and Covid-19 Incident Director, NHS England): Not enough, but let me give you a percentage. As you know, in the JCVI cohorts, care and health workers are one of the priority groups. We are at 61.4% uptake amongst all those groups. That is everyone from domiciliary care workers who work for agencies, social workers, right through to ITU nurses. I cannot give you a breakdown in between. That is not enough, and we have two more weeks to get far more. Well, we have more than that, but in the next two weeks we are going to concentrate on that group as much as the other three cohorts.

Susan Hall AM: That is good news. How many people would that equate to, very approximately?

Martin Machray (Joint Regional Chief Nurse for London and Covid-19 Incident Director, NHS England): That is a mental health test. It is around 400,000 we are aiming to reach. It is an estimate, that, but it is around 400,000.

Susan Hall AM: A very good challenge, and you have risen to that. How soon are you expecting the ITUs to be back to some sort of normal working, because they have been greatly expanded, have they not?

Martin Machray (Joint Regional Chief Nurse for London and Covid-19 Incident Director, NHS England): Yes, they have, and they still are greatly expanded. Last night we had over 1,500 people in ITUs in London. Remember our normal bed base in a critical care unit is 800 beds in London, so there are twice as

Page 30 many as we normally have or would have capacity for. That is huge. That is nooks and crannies; that is wards converted. We hope that the demand for ITU will mirror the drop in infection rates that we are now seeing. The challenge, however, is that because we are better at treating people, people are staying longer in hospital and, therefore, the decline is going to be more gradual than the decline in the infection in the community.

Therefore, we are looking, over February, March and April, at still being enormously busy with COVID cases that have come in today. That is why it is so important that these restrictions, beyond the vaccine, continue. What we hope to see very soon is some data that will tell us how effective the vaccine has been in keeping people out of hospital. I am very confident we will see some positive news, but I have not seen it yet. It is going to be a long recovery period.

Sorry to take this opportunity, but can I thank my 70,000 nurses and midwives who work in London particularly? They, like other health professions, have absolutely given their all and are exhausted, and I am asking them to do more.

Susan Hall AM: The thanks goes from all of the Assembly, let me assure you. We are all very grateful.

Martin Machray (Joint Regional Chief Nurse for London and Covid-19 Incident Director, NHS England): I know, I appreciate that. Thank you.

Susan Hall AM: As the numbers come down on COVID, please God - and it will be very interesting to see those figures coming through - are we going to be looking for perhaps specific hospitals in London to be dealing with COVID? Obviously there is going to be such a backlog of other important things coming through where people need to go into these specialist units, and it would be good to keep COVID out of hospitals where possible. Is there any prospect of that?

Martin Machray (Joint Regional Chief Nurse for London and Covid-19 Incident Director, NHS England): I will slightly turn it but it is the same intent. When we came out of the first wave, we knew that we had a lot of people waiting for elective waiting list treatments and we needed to get on top of that, so we made sure that there were certain sites in our general hospitals that we would describe as a “green zone”, one that was COVID-secure and could keep patients going through in confidence that they were COVID-free throughout that process and could manage that.

That is not about turning our hospitals into COVID and non-COVID, but it is about making sure that specific sites within our infrastructure can deal with that COVID-safe environment. Yet when you are in the urgent care pathway, and you are waiting for your tests and all that, you have other, different sorts of restrictions. We still have those places today. If you are going in for emergency cardiac or cancer surgery, you can be sure that you are COVID-safe in going through those processes. We have worked really hard to keep them that, even in this wave.

Susan Hall AM: Thank you, Martin. One last question to Dr Tom, if I can, or perhaps Dr Jameel. We are told to constantly report anything to our doctors if we are poorly or if we think we might have cancer symptoms, and that is coming across loud and clear but I would say - and I have got this from lots of other people - that getting hold of your GP is not as easy, in any which way, as it used to be. For anybody who is watching this or hears about this, how would you suggest they go about it if they have trouble getting hold of their GP?

Dr Tom Coffey (Mayoral Health Advisor): I will start but, I think Dr Jameel might want to conclude. The reason that we have moved very much to a telephone-first system is because we did not want people in the waiting room giving each other COVID. We knew that would be an utter disaster. However, when you have a

Page 31 system of telephone-first, it puts an extra barrier between you and the patient making the appointment. We recognise that. We get stories of patients waiting on telephone lines for ages trying to get through to get that telephone assessment.

The key message is that as a GP, we are there 8.00am until 8.00pm in my practice, five days a week, and we have weekend services seeing our patients. It is, “Please call your GP. Out of hours, call 111”. We are there to see you still. Dr Jameel may have an added perspective.

Dr Farah Jameel (British Medical Association): Thanks very much. More importantly, even before the pandemic, the way patients were able to access the GP setting and services had been changing with appropriate segmentation of the patient and direction of the patient to the right person, who could help them at the right time, in the quickest possible way. Certainly with the pandemic, what happened was almost like a dawning of electronic PPE, organising a different route for how patients might access services by ringing up their GP or by filling out e-consultation forms.

The point is that the GP is still there, and the whole practice team is still there, assessing, looking through those forms, still speaking to patients and still seeing the patients who need to be seen and assessed in a timely fashion. Whilst it might look and feel slightly different at this moment in time, we are absolutely very much open. All the appointments data that has been collected nationally suggests we are up thousands and thousands more, in terms of appointments, from this time last year. We are absolutely open - like Dr Coffey has just highlighted - seven days a week, so five days a week at your GP surgery but in collections of sites it is up to seven days a week, 8.00am to 8.00pm, and we still have 111 supplementing that service in addition.

Susan Hall AM: OK. I will respectfully say I hear what you say. I have to also say, that has not been the case for very, very many people. I hope that as soon as we start easing out of this life will go back to something like it was before, because it is not working for everybody now, but thank you anyway.

Navin Shah AM (Chair): Thank you. Assembly Member Duvall.

Len Duvall AM: I just want to thank Tom Coffey for the way he answered Councillor [Tony] Devenish [AM] and Shaun Bailey’s [AM] questions. We do have to differentiate between the vulnerable and those that are playing on their fears with fake information, because we know this fake information and this very professionally organised information will cost lives. If people are taken in by misinformation, wrong information, people will die on the back of it. Chair, I hope we can go offline and help and support the Mayor of London and Government in combatting the sinister nature of some of this information and where it is coming from, because it needs to be exposed.

If I can put my questions to Martin Machray, very quickly, I think you, Chair, raised an issue about numbers and take-up. Martin, there is confusion with different figures bandied up, and I am grateful in how you answered Assembly Member Hall’s question. Can you just give us the exact take-up figures of where we are in London with the vaccine, and how they are validated? Just quickly take us through that process. I have some other follow-up questions.

Martin Machray (Joint Regional Chief Nurse for London and Covid-19 Incident Director, NHS England): The data comes from a number of sources. Just to simplify, there are three ways in which the vaccine is being delivered. One is through primary care, which we have talked a lot about today, one is through our hospital hubs, and one is through the larger vaccination centres of which there are a dozen in London at present, but this is Wembley and ExCel, etc. The data is collected through different systems. GPs use their GP system as well as the vaccine system, and it is collated.

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Your point about validating data is really important. The published data that you see from the Government is not the data I see. There are obviously delays. That is checked, validated, and the quality of the data is improved. I am more interested in the operational data that comes to me instantly so I can plan for the next week ahead. When I say, “Wembley, 114,000”, that is the data I was given last night with which to do my job today. It will be a day or two before you see that figure land nationally on a Government website, but it will be there.

Just to give you a breakdown on the four groups, I will give you percentages because the numbers will be different already. The percentages are important. I am going to have to hope my arms are long enough. It will teach me to go to the other important part of primary care, which is your optometrist. I need an eye test.

Care home residents. We have reached all care homes for the elderly and have been in and offered the vaccine to everyone who is eligible to have it. There are some people who are not eligible because they have had COVID very recently or are too unwell for other reasons. Therefore, 79.5% of the care home residents have had the first dose of the vaccine. It could be better, but we need to wait for people to be ready to have it.

Secondly, care staff, which is the figure I gave to Assembly Member Hall before, and that is 61.4%. Of the over-80s, the figure I have in front of me is 80%. Now, that is behind the rest of this country, but is a phenomenal achievement given normal vaccine uptake in this group for flu and things like that. That is much better than flu is normally.

I have the over-70s split by two age groups so forgive me, I am not going to add it up. For 75 to 79 year olds it is 80.5%, and for 70 to 74 year olds it is 68.9%. That is my operational data of last night.

Len Duvall AM: Thank you. Let me just now turn to issues around messaging. Look, we all want to come out of lockdown, but we know what happened last time. The vaccine is a game changer and it saves people’s lives, but we know this virus is highly infectious and transmissible. If you get it and you have had the vaccine or if you have not had the vaccine, there is going to be a differential impact. It is, of course, being very clear about this next stage, once people have got the vaccine, of understanding how they go about their lives and why there may well be some form of guidance regulations that we still need to have in place. We are not going to come out of this for some time. Is there work going on in Government to explain that?

My secondary issue, in terms of that, is then worrying about what this mean for key workers working in certain areas. We can save lives if you have the vaccine, and those who choose not to have the vaccine may have a disproportionately higher risk of dying, it is simple as that, is it not, depending on which age group they are in. We are even seeing younger people dying. It might not be at the numbers of the at-risk group, but these new variants are having an effect on that. We ought to be honest about that. I do not want to raise fear of that, but that has been an impact, I think you have said.

The question then is: how do we manage the workplace in the next phase of these issues, if a number of people go down with infections and are taken out of the workplace? At the moment, it seems that we have had some of that and we have managed it well. The NHS is a good example of where they have had people who have had to isolate come out of the system and we have managed to keep going. Is that still an issue that is of concern to the professionals in this area over the next phase once we roll out the vaccine?

Martin Machray (Joint Regional Chief Nurse for London and Covid-19 Incident Director, NHS England): Some of the question is best answered by public health experts, as you will understand, which I am not. I can give you a nursing professional view about how we see the application of the social measures now, and what we want to see in the future. I expect, though I do not decide this, and you would not want me

Page 33 deciding it, that some of these social restrictions that we are under will continue for some time, even as the economy opens up. Let’s all hope it opens up very, very quickly, but let’s do it in a measured way. I think social measures will be needed to make that safe to do.

I know that if you are a staff nurse coming home from ITU after a 12-hour shift on your feet in those hazmat suits that you see, wearing all that kit, and you see someone not following the rules, it either makes you want to weep or your blood boil. So many nurses, so many doctors, so many healthcare professionals have told me the emotion they feel when they see people not following the rules, having seen what they have just seen in their clinical practice.

It is always a balance between health and wealth, but the two are synonymous in many ways. We want to get back to where we have a vibrant, brilliant city in the way that we all love it, but we do need to that safely on the evidence we have, and I think we will. There are discussions going on about what those restrictions will be. They should be national, that is absolutely right, and your leadership, your political input into that is really important.

I think we need to just keep saying now, “Hands, face, space and ventilate. Follow those rules, you look after yourself and your loved ones”. We have learnt a lot, finally, from experience of it being in the workplace as healthcare professionals. I have had to be in the workplace, you can’t not be as a nurse or a doctor, and we have learnt a lot about how to restrict. The thing we have learnt most is the tenacity you need as a member of the workforce to keep following those rules.

Len Duvall AM: Lastly, with the rollout of the vaccine, which is going in the right direction, even though we are slightly behind in the rest of the country, is Track and Trace still key to tackling this infection? The testing regime has come a long way so I think we are moving in the right direction with that. I know you are not a public health official, but in terms of tracing, am I right that tracing is key now to control outbreaks of infection maybe in smaller locations? Is the tracking and tracing regime being upgraded? Are there conversations about that? We hear about conversations, partly some it is NHS-led, some of it is local government-led. Has it moved entirely to local government-led now? Should that not be, to take some of the pressure off the NHS to give us that localised issue around what the thinking may be about how this virus operates post-vaccine era, if I can call it that?

Martin Machray (Joint Regional Chief Nurse for London and Covid-19 Incident Director, NHS England): Very quickly, I have observed that move towards local partnership on Track and Trace and Isolate happening as we speak, and it is really important we do that. There is a role for national colleagues in this, but there is definitely a bigger role to play locally.

Navin Shah AM (Chair): I have not noticed or been asked about any further questions so that ends our session of question and answers.

Andrew Boff AM: Chair, I believe I have six seconds left.

Navin Shah AM (Chair): Please, go ahead.

Andrew Boff AM: Is it important to complete the JCVI priority list as is? To Tom Coffey.

Dr Tom Coffey (Mayoral Health Advisor): We need to follow the JCVI unless the JCVI changes their present advice.

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Navin Shah AM (Chair): Thank you. OK, that definitely brings an end to our Q&A session. Can I sincerely thank all our three guests for taking the time and their enormous amount of service, giving their service to keep Londoners safe in this crisis that we have of historic proportion? Thank you very much for spending your invaluable time and let us hope to see you in a better environment.

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