(4 years, 7 months ago)
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Baroness Wheeler
That the Virtual Proceedings do consider the short- and long-term impact of Her Majesty’s Government’s approach to the COVID-19 pandemic on the provision and delivery of social and domiciliary care for disabled and vulnerable adults and children, and the case for ensuring the sustainability of social care services.
Baroness Wheeler (Lab)
My Lords, I will start today’s important debate in the way I know noble Lords from across the House will want me to: by recording our deep sadness and regret for the loss of the now 19,609 people across the UK who are known to have died from this terrible disease in hospitals, care homes and their own homes. We know that the true figure, due to delays in recording and reporting, is likely to be considerably higher. Our sympathy and thoughts are with their families, friends and the people who will have cared for them: relatives, NHS and social and community care staff. As a dedicated care manager in a small Nottinghamshire home, where deaths to suspected Covid-19 had reached a total of nine residents—a third of the people under her care—put it, she thought of them as “family”. “It’s just soul destroying,” she said, adding:
“We have deaths normally, but they are good deaths with their family around them.”
As the weeks go on, Parliament will rightly focus on the continuing fight across health and social care to halt the spread of the disease and on the care of patients and staff currently suffering from it. Staff across these services have been putting their lives on the line, and sadly we see reports that over 100 have now died as a result of this dedication. Our thoughts are also with their families, friends and colleagues, and of course we are for ever grateful to all our NHS and social care staff, who are working tirelessly to help us deal with the crisis.
Today’s debate is the time to take a hard look at the short and long-term impact of Covid-19 on social care. It is vital to continue to step up the pressure on the Government to deliver on what have too often, sadly, been woefully inadequate and seriously belated promises and actions on social care. We also need to take stock and identify what the current social care response to this pandemic tells us about how a similar crisis must be handled in the future, and how, in the years to come, social care is organised, funded, delivered and staffed, and properly mainstreamed into our health and care system.
We know that there is widespread frustration and dismay in the social care sector that once again it has been a plan-B afterthought. The Government’s social care plan was finally published last week, five weeks after the plan for the NHS. From the outset, Labour has made it clear that we want the Government to succeed in dealing with this huge crisis and we have pledged to work constructively with them. But we have also made it clear that we will challenge where there are mistakes that can be put right and where we think something is not happening that needs to, and we will closely scrutinise the decisions made. It was in that spirit of constructive engagement that we fully co-operated with the Covid-19 Bill before the Recess, and in which we want today’s debate to be framed.
In the same vein, we have repeatedly called for urgent action on the supply and delivery of personal protection equipment and for the testing of all NHS and social care staff for the virus, and we have proposed ways that will help to turn the situation round. Last weekend’s Public Health England announcement, changing guidelines on the need for full-length protective gowns for doctors and nurses treating Covid-19 patients because supplies were due to run out, has just added to the despair felt by staff in the NHS and social care over not having the essential equipment that they need to keep patients and themselves safe. Being told to reuse equipment, or not to waste it, and the stop-start big announcements of targets or shipments on their way just decreases morale still further and makes the situation even worse.
On care homes and domiciliary services, even the most ardent of cheerleaders for the Government, such as the Daily Telegraph and the Daily Mail, have recognised and been highly critical of the chaos surrounding testing and PPE. Key charities—the Alzheimer’s Society, Marie Curie, Care England and Age UK—have talked about the “devastation” in the care system, with the lack of testing and PPE meaning that staff are putting their lives at risk while also carrying the virus to vulnerable groups.
On 16 April, ADAS—the Association of Directors of Adult Social Services—summed up the PPE situation as “shambolic”, with early PPE drops in the care sector “paltry” and more recent deliveries “haphazard”, with “confusion and additional workload” resulting from the mixed messages and poor communications between the two key government departments: local government and health. We know that care home managers have been desperately driving miles around trying to buy masks, gloves, gowns and other vital PPE to try to halt the spread of the disease in care homes, with many staff making their own masks or having to use the same masks and other items all day. All this involves huge extra costs for care homes. The care provider MHA, for example, had to purchase 200,000 masks at five times the usual cost.
Full PPE is just as important to staff in care homes nursing residents with suspected Covid-19 as it is in hospital and NHS care settings. It is also vital if families are to be allowed into care homes to be with their very ill or dying loved ones. The recent change in government guidance on this is very welcome, but it can happen only if homes have full PPE, testing and other important procedures in place to protect staff, residents and their relatives. Can the Minister now provide an exact date by which all those working in social care will have the continual, adequate supply of PPE of the required standard so that they can do their jobs in safety?
From the outset, care homes have underlined that patients should be transferred from hospital only after they have been Covid-19 tested, but this essential requirement was not in the original guidance and has not been followed in many areas. Can the Minister confirm that new guidance will be issued on this very basic requirement, with accompanying levels of PPE? Will care homes and care home providers be refunded the full and crippling extra costs for PPE, including covering the spiralling prices which the shortages have led to? We know that residential care is in a precarious financial state, with many homes facing closure, and that the UK Homecare Association fears that financial pressures resulting from Covid-19 could force a significant number of the UK’s 8,000 home care providers to close within weeks.
On funding, the Government have rightly said that the NHS will get whatever resources it needs to deal with the Covid-19 pandemic. Can the Minister categorically state that this also applies to social care? This means covering the extra costs not just of PPE but of staffing in care homes and home care to pay for increased staff, staff sickness and vacancies, and other care costs.
On testing, Labour has strongly stressed the urgent need for testing of patients and staff in care homes, and for a clear and detailed plan on how this is to be actioned and achieved. Not testing new or returning residents, for example, risks contaminating care homes where elderly and vulnerable people are supposed to be “shielded”—a policy described by care home providers as
“importing death into care homes.”
New testing for all residents with symptoms and for all those being transferred into homes has been announced. Can the Minister tell the House how and where those who have tested positive will be effectively isolated? Will extra resources be provided to care homes for this? Since the lockdown began, care homes have sealed themselves off, banning visitors and introducing social distancing for staff and residents, but caring for Covid-19 residents is staff-intensive, requiring barrier nursing of residents in single rooms.
In home care, which is widely acknowledged to be the most fragile part of the social care system, Covid-19 presents a particular challenge for care workers who visit multiple clients a day, every day, in their homes. Routine testing and access to PPE are essential. With no centralised record of the numbers of people needing support, there are fears that people might be left without care or even dying alone at home without care. What action have the Government taken to prevent this happening?
A detailed plan is also needed for how and when the Government will test all the 1.4 million front-line social care staff, to include domiciliary home care staff and staff working as personal assistants, who are doing a vital job of looking after disabled and mentally ill people in their homes through direct payments. Only 505 social care staff have so far been tested. How will this number be escalated to meet the needs? Can testing centres cope with the proposed volume of testing? What plans are there for providing testing arrangements locally for staff who cannot drive or do not have time to drive the often very long distances involved? What will the criteria be for social care staff being eligible if, for example, they do not have symptoms but have been in contact with someone who has tested positive for Covid-19?
Under the emergency Covid-19 Bill, there was deep consternation and fear across the House that the temporary suspension of rights under the Care Act 2014 on care and carer assessments, eligibility and care packages would result in care standards being lowered or even ended, putting disabled and vulnerable adults and children at risk.
As a carer of a 75 year-old stroke recover, I know how much carers depend on vital social care support in the home and the community and many carers have spoken to me about their concerns. Can the Minister tell the House what national monitoring arrangements and oversight mechanisms have been put in place to keep this situation under close review? Does he have any national data on the number of councils that have had to revise existing care packages and arrangements in the light of Covid-19?
For the future, Labour’s new leader, Sir Keir Starmer, this weekend called for a new settlement for social care: an ambition for society that puts dignity and respect at the heart of how we care for the most vulnerable, and how we properly reward our key health and social care workers and repay the debt we owe to all those who have sacrificed so much during the Covid-19 crisis.
We must learn from the current crisis about how social care should be valued, resourced and delivered in the future. Under Covid-19, the broken care system is at least getting some of the long-overdue attention it needs and deserves. Surely the public cannot be in any doubt any longer about how essential it is. Treating social care needs as secondary to NHS needs has almost become a default system for the sector. As so often in the past, the current crisis sees yet again stakeholders, staff and charities warning the Government that older people’s lives are not worthless and that care home staff are not second-class carers. This is the reality of how the sector has had to struggle for recognition and funding.
I hope the Minister will reassure the House that the Government now recognise that we must have proper planning for pandemics on the scale of Covid-19, a system that goes across health and social care, for the future. Clear responsibilities must be given to the key NHS, social care and public health lead agencies and, as used to happen in the past, sufficient stockpiles of protection and testing equipment must be regularly monitored and updated. We have now seen all too well that this is not money wasted, to be first in line for austerity cuts or dumping in favour of no-deal Brexit planning. Integrated data across health and social care which accurately reflects what is happening on the ground is a key requirement for any future plan.
Secondly, we have to address the overall health and social care structure. The commissioning, duplication and bureaucracy of the Lansley NHS structure, the fragmented multi-provider structure of residential, home and community care and the precarious method of funding have to be addressed if we are ever to have fully integrated care. As we have learned from this pandemic, public health provision and planning needs to be across health and social care.
Thirdly, local authorities must be properly resourced for the social care duties they undertake under the Care Act. We know that £7.7 billion has been cut from council budgets since 2010. Of the £2.9 billion welcome extra funding for councils for Covid-19, only 10% of the initial £1.6 billion was allocated to social care. The additional money, however welcome, allocated to a desperately underfunded service which was in crisis before the pandemic, barely touches the cash crisis that social care faces.
Fourthly, we must treat staff with the respect that they deserve as the professionals they are. Home and domiciliary care pay rates do not match those of NHS staff, who themselves do not receive the pay which reflects the vital work they do. Some 1.4 million people work in the social care sector. Care workers are often employed by agencies on zero-hours contracts. It is hardly surprising that, even before the Covid-19 outbreak, there were 122,000 care worker vacancies and that annual staff turnover is 30%. More than one-third of care home staff are currently believed to be off work or self-isolating.
Finally, future social care planning has to include basic personal care support in people’s homes for those in need, including the 1.4 million older people that Age UK has identified who need help with washing, dressing and going to the toilet that they currently do not get. This is why Labour strongly supports a national care service and we know that the Lords Economic Affairs Committee rightly supports this, too.
I am so grateful that so many noble Lords are contributing today, covering many issues that I just have not had time to cover. In conclusion, the coronavirus pandemic has brought the deep crisis in social care to the fore. We no longer live in a society where social care can be delivered on a shoestring budget, under a system routinely starved of funding that relies on periodic cash boosts to prop it up and save it from total collapse, and in which care workers are overworked, undervalued and underpaid. In other words, we cannot just applaud the front-line workers every Thursday and then go back to business as usual. I beg to move.
Lord Astor of Hever (Con)
My Lords, the Coronavirus Act 2020 has relaxed the duties and responsibilities of local authorities to provide care and support to a revised minimum level which would solely meet a person’s needs measured according to their human rights—a very low bar indeed in this context. In the immediate short term, local authorities have other priorities. Even in better times, it is a struggle to fund social care and it is vital that we do not lose the hard-won legal support structure ensuring that correct social care is assessed and delivered to the neediest in society. Will the Government undertake to repeal the social care provisions of the Act and reinstate the pre-existing law and regulations at the earliest opportunity?
The Government have announced £1.6 billion of additional aid to local authorities to support social care. The delivery of this money to hard-pressed providers has not been smooth, and I urge the Government to press local authorities to use this money as required by the Government. Without this financial support, many providers will fail, leading to an intense crisis in domiciliary support and in homes. Will the Government apply the greatest possible pressure on local authorities to pass the additional funding on to providers of social care? Will they consider ring-fencing some of this money?
Turning to specific cases, many hard-pressed families have family members who require significant support. The strain on the mental health of family members acting as carers frequently results in provision for respite from their duties for a few nights at specified intervals. The requirements of social isolation and quarantine mean that they no longer receive the respite needed to survive. They are now locked into a cycle of support without any break and with no additional provision forthcoming to help them in any way. In the current emergency, will the Government encourage both local government and social care provision under the NHS to look carefully at the needs of the often forgotten and unsung family carers who are already saving the Government millions in care costs?
Lord Blunkett (Lab)
First, I declare my interests in the register, including as a vice-president of the RNIB and of the Alzheimer’s Society. I am addressing noble Lords today from my experience of four years chairing the social services committee of the City of Sheffield and as shadow Secretary of State for Health in the 1990s. I want to address the future rather than the present, since I know that other noble Lords will do that. I endorse everything that my noble friend Lady Wheeler and the noble Lord, Lord Astor, said and called for this afternoon.
When the noble Baroness, Lady Grey-Thompson, spoke on 24 March, she did so from the heart in relation to the immediate situation facing people with disabilities. I want to look at what will happen in the months ahead if we do not get the exit strategy right. We are all aware that social services have been massively underfunded for very many years. The pressures and demands on the service have been way beyond what could actually be met by local authorities and private providers. That is why it is really important that when we come out of the worst of the lockdown, we have the continuing resource to be able to sustain both domiciliary and residential care. It is really important that we also sustain the volunteers who have made themselves available, both the 750,000 nationally and those with mutual aid at community level. I hope that, with data protection in mind, we might be able to keep a register and keep them involved for the future. I hope that the Government will consider that.
The real issue that I want to address this afternoon is: what happens if the lockdown continues for a substantial period? Some people have started to talk, sometimes irresponsibly in my view, about a gradual release of the isolation taking months rather than weeks. That release is crucial for mental health and for people with disabilities, but also crucial to avoid ending up with more people needing support in the years ahead because they have deteriorated over the period of the lockdown. I therefore hope that the Government will consider setting up a separate body from SAGE, which will give advice on the way in which the dragon that we are slaying in relation to the pandemic will not be replaced by an equal beast—to use a metaphor on St George’s Day—that will lead to substantial additional pressures on the system in years to come, as people who were not feeling aged, isolated or full of distress and anxiety find that they now are. In other words, let us not, with the best intentions of today, make a major problem for tomorrow.
Baroness Tyler of Enfield (LD)
I thank the noble Baroness, Lady Wheeler, for securing this important debate. As the terrible and ever-rising death toll in care homes has so visibly shown, the social care sector, so long underfunded and neglected by politicians and policymakers, finds itself at the front line of this cruel pandemic. The severity of the challenge faced in care homes and other community settings is impossible to overstate. In short, care homes providing personal and close contact care need urgent access to reliable and ongoing supplies of protective equipment to protect residents and staff, rapid and accessible testing, and far greater support, with funding and equipment on an equal footing with the NHS.
If this pandemic has proved one thing, it is that health and social care are inextricably linked and cannot be treated differently. The National Care Forum has called on the Government to form a ring of steel around care homes, but what is it like at the moment? I have spent the past couple of days talking to various social care leaders running front-line social care services. It has been a humbling experience to hear what is going on.
Their stark messages include: how the rhetoric from government is hard to hear when the reality is so different; the confusing, contradictory and constantly changing nature of guidance issued by government and other bodies; the daily struggle to secure protective equipment, with government supplies sometimes being diverted to NHS facilities and homes having to source their own supplies at extortionate prices; staff shortages running at 25% alongside existing high vacancy levels that require the hiring of agency staff, which raises the risk of transmission; a serious shortage of nurses in homes and great difficulty recruiting, as nurses are deployed into the acute sector; testing arrangements which show little understanding of how the sector works, with care workers who have no car being asked to drive to centres many miles away, at times that do not fit with their shift patterns; patients being sent from hospitals into care homes without testing; much-needed financial resources from government not reaching the front line; GPs no longer coming into care homes to verify deaths, leaving such tasks to some of the lowest-paid staff; and care workers left feeling insecure and anxious when left in charge of clinical details.
Based on these conversations, I ask the Minister: why are care homes having to pay VAT on protective equipment when the NHS does not, and what urgent steps will the Government take to put them on an equal footing? What measures are they taking to ensure that some registered nurses in the newly returning workforce are deployed to care homes, which desperately need them? When will the newly established volunteer scheme be used to help care homes? Finally, when will the Government’s visa exemptions for NHS nurses be extended to those working in the social care sector?
When this terrible tragedy subsides, a long-overdue and fundamental reform of social care must be a top priority. A national health and social care system means just that: a fully integrated service, properly funded and run on an equal basis so that we are no longer, as one social care professional put it to me, simply an afterthought at the back of the queue.
Baroness Grey-Thompson (CB)
My Lords, I draw attention to my interests in the register, in that I am a vice-president of the LGA. The Care and Support Alliance has reported thousands of people getting in touch with its members over this very issue. The questions I raised at Second Reading of the Coronavirus Bill are still valid and I will be writing to the Minister, because of our three-minute time limit today. To help proceedings, I have nine questions.
There is still a lack of adequate PPE for disabled people and their carers. One young disabled woman reported that she was verbally abused for not having adequate PPE available, even though it is difficult to obtain. Another young woman struggling with PA support was told that she should just go and live in a care home. My first question is: now that care home deaths are being reported, are HMG changing their strategy for this sector? A really serious danger is that some disabled people may be forced to move back to their families, which could be toxic or abusive, because that could appear safer than a care home.
Secondly, for transparency, will HMG report deaths in the community so that the true overall death figure is accurate; if not, why not?
Thirdly, HMG said that the delivery target was 100,000 coronavirus tests a day by the end of April. Is this on target and how many more need to be done? Was this a logistics aim or a medical aim? Will the Minister confirm that disabled people will not be excluded from testing?
Fourthly, will HMG review the carer’s allowance? Unpaid carers are also in a precarious position.
Fifthly, will HMG urgently review the guidance on direct payments? It is confusing and families are at breaking point trying to manage working from home.
However, my biggest concern is that, as I understand it, eight areas have switched on the Care Act easements. I can find the names of six: Sunderland, Middlesbrough, Warwickshire, Staffordshire, Birmingham and Solihull. So, sixthly, as a matter of urgency, can the Minister confirm that these six are correct? It was reported in the Law Society Gazette this morning—but has now been removed—that the other two are Croydon and Hertfordshire, although Hertfordshire has said that it has not triggered easement. This is very confusing for everybody. Can the Minister confirm which areas have triggered easement?
Seventhly, can he explain how these areas have apparently reached crisis point, such that they cannot carry out their duties to disabled people, but nowhere else has? Or are there more than eight?
Eighthly, how are disabled people expected to get advice if they do not know what law their local area is applying?
Finally, ninthly, does the Minister accept that HMG should publish regularly the full list of areas that have switched on Care Act easements and, if they are not prepared to do so, can he explain why not?
Baroness Warwick of Undercliffe (Lab)
My Lords, I congratulate my noble friend on calling this vital debate at a very difficult time in our history and I thank her for all the work that she has done on this issue. I declare an interest as chair of the National Housing Federation, the trade body that represents not-for-profit housing associations in England.
The spread of this virus is indiscriminate, but its impact on our society’s most vulnerable people is pernicious. I pay tribute to all those who, despite the risks to themselves and their families, are still faithfully working to help those in their care. Many of us have reason to be grateful to them and their families for their sacrifice.
Like many, I have found the number of fatalities in care homes alarming and distressing. Earlier this month, reported deaths from Covid-19 in care homes quadrupled in the space of a week, and we know that this is not the full picture. We need a clear plan in place to reverse this trend.
Some 50,000 care home spaces in England are provided by not-for-profit providers, such as housing associations. They also provide 76% of all supported specialist and sheltered housing schemes for older people, people with disabilities and people with mental health needs. They support people in homelessness, hostels and domestic abuse refuges. All of these are vital components in our social care system beyond those services regulated by the CQC. All of these care settings are currently grappling with the enormous challenges that this virus brings. We should not let them be forgotten or neglected.
Accessing PPE is a significant ongoing challenge for all these workers who have daily contact with those people who are being shielded. While we quite rightly prioritise NHS staff, it must be extended to others most at risk. I welcome recent government guidance on testing in the community. I know that housing associations hope that it will stimulate greater availability of tests for their front-line staff. Those working with our older and more vulnerable population need to know that going to work will not put their safety and residents’ safety at risk. We owe it to people working in care settings to value and publicise their work and to put it on a financially secure footing, now and in the future.
The statistics on the effects of the virus on those in care homes must be a wake-up call to take action on the questions about our social care system that have dogged our country for so long. Housing associations are already mobilising for this. A root-and-branch review of how we provide care to the most vulnerable in society has never been more critical. Will the Minister commit to it now? Without it, we remain as unprepared for any future health crisis as we were for Covid-19.
Baroness Jolly (LD)
I join other noble Lords in commending and thanking the care sector for all it does for those in its care, in care homes and in the community. I am happy to echo the opening remarks of the noble Baroness, Lady Wheeler, and thank her for instigating this debate.
The majority of care providers are private organisations, not-for-profit organisations or charities. Their income has remained pretty well constant throughout this crisis, but their costs have soared—for replacement care workers from agencies or banks to cover staff illness, and, as we heard at Questions, the new unanticipated costs of PPE. Can the Minister confirm that no provider of care will be allowed to fail in this crisis due to lack of funding to cover these and other costs?
My comments will largely be about people with learning disabilities and others who have found themselves with “DNR” on their records. We are fortunate to live in a country where life is universally valued. For the last month or so, we have seen this play out on the news, as we witness daily the efforts of our NHS and care workers struggling to save those who are in their care. Their compassion brings us to tears, and to our doorsteps on a Thursday evening. Old, young, fit or frail—it matters not. But this Covid-19 crisis has seen parents of autistic adult children receive letters from their GP practices suggesting that these children should have a “do not resuscitate” or DNR label added to their notes.
I applaud the Care Quality Commission for its condemnation of GPs across the country for categorising people who receive care in community settings as not requiring resuscitation should they fall ill with coronavirus. Let us be clear: a DNR is a clinical decision that, in perfect circumstances, involves the doctor, patient and family. NICE recommends that clinicians use the clinical frailty scale when considering patients for intensive care. It is designed to prioritise those most likely to recover from the virus, but it is not suitable for use with people who have learning disabilities, nor for people with other kinds of disabilities or conditions that affect their ability to do things independently.
Whatever the circumstances, life or death should not depend on your age, your disability, who provides your care or where you live. Does the Minister agree? Could he please persuade the department to put this message out to all care and health providers? Perhaps we can ensure that it is part of the promised Green Paper.
Baroness Masham of Ilton (CB)
My Lords, I thank the noble Baroness, Lady Wheeler, for securing this debate. That so many people are speaking shows how important this extraordinary virus is.
I have had many disabled people contact me. One was the wife of a man who has multiple neurological problems. His conditions, because he has several, were not on the high-risk list. He was told that he should work, even though he is vulnerable. Her Royal Highness the Princess Royal is patron of the Spinal Injuries Association and I am its president. Princess Anne has written a personal encouraging letter. I shall quote one sentence: “I want to let you know that you are not forgotten.”
We do not understand why people with spinal injuries, who can be very vulnerable, are no longer on the most vulnerable list. One tetraplegic died because he was denied ventilation. Many disabled people live in their own homes and have live-in carers. With Brexit and then coronavirus, it has become very difficult to get helpers. Will the Government recognise this predicament and relax immigration rules for people coming from Europe, as they make very good carers? This is not only for people living in their own homes, it is for hospitals and care homes. We really are at risk.
Baroness Verma (Con)
My Lords, I refer to my interest as set out in the register as a provider of social care. I thank the noble Baroness, Lady Wheeler, for instigating this critical debate. She spoke about the facts on the ground and going forward.
The sector was already in crisis before Covid-19. I assure all noble Lords that high pressure and anxiety is being felt not just by managers but by all those who are delivering care within the home care and care home sector. I cannot quantify the praise I have for all those who are delivering care at the moment. It is heartbreaking to sometimes see my care staff frightened to go home; they hope that they are not taking something back home to their families.
I shall focus my comments and questions on invisible disabilities, such as mental health, dementia, Alzheimer’s and anxiety—all the disabilities that most people cannot see. Our systems are there to provide support for those people. Over the past few weeks, it has been heartbreaking that a lot of our clients and service users cannot visit day centres or go out. The only people they have contact with are their care workers. Will the Minister consider, as other noble Lords have said, the thousands of volunteers who have signed up to help? If only they could be part of the social activity of isolated people in their homes. Anxiety, mental health and dementia are not suddenly going to get better once the crisis is over. They are long-term issues that need to be dealt with.
As a provider, we are facing huge bills for PPE. We want the Government to treat us like the NHS. Let us get VAT removed for us as providers. Although the extra £1.6 billion is welcome, like other noble Lords, I reiterate that it is nowhere near enough in terms of the costs that providers face at this moment. I seriously worry that we will end up seeing a crisis emerge from another crisis in a sector that was already struggling to get people to work in a highly skilled but poorly paid part of the workforce. I urge my noble friend to respond positively to my ask and get more funding in, as well as having it ring-fenced so that it goes to the social care sector.
Lord Hain (Lab)
My Lords, I should declare that my wife is a board member of two care providers.
Even before this pandemic hit, social care in this country, with a bigger workforce than the NHS, was in crisis. During the past decade of austerity, more than £7.7 billion has been cut from adult social care budgets, leaving 122,000 vacancies, or 9% of care roles unfilled. Many providers struggle to remain financially viable despite their increased needs.
In 2017, the Care and Support Alliance highlighted that 29% of disabled people had seen a reduction in their package of care, leaving many without adequate personal care and preventing disabled people leaving the house or attending work. A full 25% were left without food. Covid-19 has massively accentuated this social care crisis, with funding pressures spiralling out of control—especially for charities and smaller care providers as they have been hit by rising operational costs, staff shortages and the collapse of fundraising overnight. Staffing shortages are severe. Between 10% and 25% of care staff are self-isolating, forcing more costly agency workers to be hired.
Costs of sourcing PPE are soaring, with government rhetoric to increase supply not matched by reality. Care providers report that the Clipper service is not delivering, with the Government’s four main suppliers of PPE all out of stock. Carers have had to source their own PPE, often at inflated prices. The charity Leonard Cheshire is spending an additional £250,000 a month sourcing PPE such as gloves and face masks; a south Wales care provider is spending £100,000 extra monthly. They are all struggling to find specialist PPE such as gowns and face masks due to national shortages, placing 4,700 Leonard Cheshire care staff and their 3,000 disabled residents at risk of infection.
Care homes and carer organisations are always on the edge of viability. That is immeasurably worsened because people are now reluctant to move into care homes, just as they are to visit A&E, for fear of infection. Managers are reluctant to take them in without proper testing. Every empty bed pushes a care home closer to financial collapse. NHS beds become clogged up and the additional £1.6 billion pledged to fund local authorities is nothing like enough to guarantee that social care can be sustained throughout the pandemic. The Government must act quickly to deliver PPE to the 1.5 million social care workers and rapidly increase access to testing. Then they must provide many billions more pounds of adequate funding to ensure quality care for all.
Instead of his shamelessly Trumpian attack on the Welsh Government yesterday, Dominic Raab should heed the latest Treasury statistics showing that public spending on social services for older people in Wales is 48% higher per head of the population than in England. Surely if the UK Government had followed the Welsh model of prioritising elderly care investment despite major austerity cuts, the truly terrible Covid-19 crisis in care homes could have been alleviated.
Baroness Barker (LD)
My Lords, I thank the noble Baroness, Lady Wheeler, for this opportunity to hold the Government to account. I return to a point I made during the emergency legislation debate on 26 March on the difference between the NHS and local government. The NHS is a top-down, centrally driven organisation which, remarkably, was able almost overnight to change everything it did and to focus on the medical emergency caused by the pandemic. Local government is much more complicated and fragmented, is dealing with a care system that was already broken, and is having to keep other vital public services going at the same time. Therefore the Government need to treat it differently.
The Government are issuing detailed guidance for social care, but it changes nearly every day. Local government and care providers need clear messages, delivered in good time, and quick responses when things do not work. For example, the testing sites are just not working in the way envisaged. The Government should now start to work with local authorities and local resilience forums to plan and roll out a series of accessible testing sites, so that people can get to them and we can get the testing numbers up.
Some 750,000 people applied to volunteer for the NHS, which has never managed volunteers terribly well. Most of them are not being used. People who signed up to GoodSAM need a clear message that they can and should volunteer via local resilience forums and local authorities. The NHS needs to start telling local authorities how many people in their area are signed up to GoodSAM and who they are, so that they can get on to the job of supporting vulnerable people in the community.
On 18 April, the Secretary of State announced a further £1.6 billion of funding for local government and described the people working in it as the unsung heroes at the forefront of the national effort to beat the virus, but £3.2 billion will not cover the costs which local authorities will have incurred during these four months, nor their loss of income. The pandemic will have a much longer tail for local government than it has done for the NHS. Will the Government now start to plan the transfer of funds and other resources from acute health services to local authorities and communities, which will struggle to deal with the effects of this virus long after the NHS has completed the majority of its work?
Lord Alton of Liverpool (CB)
My Lords, I too thank the noble Baroness, Lady Wheeler, for initiating today’s important debate.
Earlier this month I drew the Minister’s attention to the appalling death toll at Wavertree’s Oak Springs Care Home in Liverpool, where 16 people have died. For grieving loved ones and for the people who care for them, deaths in care homes are diminished when out of sight means out of mind. Even with a carer at your deathbed, it is a devastating and harrowing way to end your life in isolation. Surely more can be done to enable loved ones to visit and, where requested, to provide spiritual accompaniment, the sacraments and ministry, and for the skills of hospices and palliative care to be urgently made more widely available.
Carers have expressed concern to me—which I share—that the Government have said, in relation to the virus, “Let it run hot.” Is that still being said? Who authorised letters sent by GPs to care homes stating that their residents, including adults with learning disabilities, would be unlikely to be offered ventilation? It is impossible to say in advance that such treatment would not be appropriate or beneficial.
As we heard last week from the noble Baroness, Lady Warwick, deaths in care homes have quadrupled. The Financial Times yesterday estimated that some 10,000 have died of coronavirus in our care homes, while this morning the Daily Telegraph said it believed that the rate of attrition is about 400 every day. We have also learned that in Europe, half of all deaths have occurred in care homes. Meanwhile, only 25% of care workers have been able to access tests. Taking up a point made just a moment ago by the noble Baroness, Lady Barker, when will care homes be provided with adequate supplies of PPE and their staff routinely and regularly tested for the coronavirus? Without such tests, carers are having to self-isolate because they develop symptoms and do not want to risk killing the people they care for. No one can say that we did not know what we were facing.
Weeks ago, in Italy, it was said that the elderly in care were facing a massacre while from Spain there came deeply shocking reports of the corpses of elderly people being found in all but abandoned care homes. Given what we knew about this terrible unfolding tragedy, why were our care homes not locked down sooner, PPE not sent in immediately and tests not provided for all? Andrea Lyon, the manager of the Oak Springs Care Home, has said that the Government’s plans
“should have been ready to be actioned immediately, not three weeks down the line. I had to take care of my residents with less than 50% of my staff because the government didn’t have their action plan ready. It makes me very angry.”
That anger will have its day during an inevitable public inquiry, but if any good is to come out of this rupture in our equilibrium, there will need to be radical and fundamental change in everything from our supply chain resilience to national self-sufficiency, inequality and social solidarity. What the deaths in our care homes have made abundantly clear is that, alongside our National Health Service, we need a national care service. If a national care service emerged from the wreckage of Covid-19, it would represent a gain among so much loss comparable to the gain of the National Health Service in 1945.
Lord Hunt of Kings Heath (Lab)
My Lords, I am very glad to speak in this debate and to pay tribute to my noble friend Lady Wheeler for her excellent introductory speech. I very much agree with the noble Baroness, Lady Verma, in her praise of the amazing work being undertaken by care workers at the moment. They have been left almost defenceless by the lack of preparation and I am afraid that this is yet another indication of how far down the food chain the care sector is in the Government’s concerns.
I am particularly concerned about the financial vulnerability of so many care homes. The noble Lord, Lord Astor, asked the Minister to ensure that the money being routed through local government actually gets to those homes. However, as the noble Baroness, Lady Verma, said, even that is not enough to ensure their financial viability in the future. I hope that the Minister will reassure us on that point.
There is a great risk, with all the focus being put on the crisis today, that the fundamental reforms needed in the care sector will be put on the back burner. Yet we know from the House of Lords Economic Affairs Committee that we have a huge amount of unmet care need and that the demographics mean that that need will grow. We have a vicious cycle here. After decades of reviews and failed reforms, the level of unmet need is growing, the pressure on unpaid carers is getting stronger, the supply of care providers is diminishing because of their financial vulnerability and the strain on the care workforce just gets worse and worse. Moreover, that is before the new immigration cap comes in towards the end of the year. The Government have agreed to extend the visas of doctors and nurses due to expire on 1 October but, inexplicably, this does not apply to care workers.
We have long been promised a government response to the long-term care crisis. It was promised in 2017 and again in the 2019 general election. I urge the Minister to ensure that the Government do not backtrack on ensuring that we shall see very soon strong proposals for the kind of care system we need so that never again will we see a dreadful situation where people in the care sector are neglected and, frankly, treated very much as second-class citizens.
Baroness Northover (LD)
My Lords, I too thank the noble Baroness for securing this vital debate, and pay tribute to those working in the care sector.
Many lessons will need to be learned after this pandemic is over, but there are things we already know. We knew, for example, that a pandemic was a national threat. Epidemics have always been a global threat, but SARS showed that an epidemic could spread to all continents in the time of a plane journey.
We have long known the weaknesses in social care. Much of Beveridge’s “cradle to the grave” support was in place by the mid-20th century—free education, unemployment support, pensions and, from 1948, free healthcare—but the one huge area not covered was social care. There was report after report in the second half of the 20th century and the beginning of this one, as the noble Lord, Lord Hunt, has just made plain. Everyone agreed that health and social care needed to be seamless.
When my father was diagnosed with terminal cancer in 2007, he lived for six weeks. In the first two weeks, he was given amazing help with pain relief. The next two weeks were simply a battle between health and social care over whose responsibility he now was. Only the last two weeks of his life were spent at home, where he wished to be.
The divisions between health and social care have been shown up in lethal form in this epidemic; hence all the problems that others have mentioned—lack of co-ordination, funding, recognition, equipment and advice—and laid out so powerfully by my noble friend Lady Tyler.
There were attempts at a cross-party agreement on social care before the 2010 election, and the Minister needs to know that his party scuppered that. In the coalition, we commissioned the Dilnot report to seek more stable funding of social care and to protect people against extreme costs, as the NHS does in healthcare. Labour supported this, which was very welcome. But after the 2015 election, it was set aside.
Many of the problems that noble Lords have raised stem from the inability to integrate health and social care properly and to value both. We must indeed never be in this situation again. When we emerge, this is an area which must be urgently and radically addressed. I hope that the Minister will tell us today that he agrees.
The Deputy Speaker (The Earl of Kinnoull) (Non-Afl)
Baroness Meacher? The noble Baroness, Lady Meacher, is not responding. I call the noble Lord, Lord Dubs.
Lord Dubs (Lab)
I congratulate my noble friend Lady Wheeler on initiating this debate and on her very powerful speech. I should declare an interest, in that a member of my family has been in care homes over the years and now has support in his own home, so I have some experience of how these things work.
The first problem, I think, is the poor statistics on this whole sector. We are beginning to get more information together, but it seems to me that, unless we have clear statistics so that we know what the provision is, we cannot easily change policy for the better. We know that many of the problems of social care are long-standing and existed for years before the present pandemic crisis hit us, but they meant that this sector was ill prepared for the difficulties that we now face.
One example that has been often cited is the long journeys that care home workers need to take to get tested. I was told that one person had to travel from Bournemouth to either Gatwick or Chessington— 100 miles each way—to be tested. That is an impossible journey for people who are hard-pressed to get to their places of work.
We all know that social care has for too long been the underdog. Acute services have tended to get the money, albeit not enough—I would not take away a penny from acute services; I would rather put more in—but social care has still tended to be the underdog, as characterised by the very low levels of pay earned by people in the sector.
We know that there are wonderful people working in social care, we know how hard they work and we know about the wonderful long-term relationships that they establish with the people they care for—making the death of such a person even more painful. Of course we must ensure that they have security in this country, and the issue of visas must be dealt with.
Of course we need more testing, as has been said, and of course that should have happened a long time ago. I understand that residents with symptoms and those being transferred to care homes will now be tested. I wonder when that will be completed and when all workers in care homes and domiciliary care will have had the chance to be tested.
I should mention in passing that not all people in care are elderly; there are young people who need help as well, and their problems are slightly different from the needs of the elderly but are still important.
I turn to domiciliary services, which tend to be forgotten. Visits by care workers to homes where a single isolated person is on their own are crucial—not just for their health and needs but to lessen the sense of isolation. Domiciliary workers who call on people’s homes often provide their only link with the outside world. If that were to stop because of the present crisis, that would be a disaster. Of course, as a society and a country we depend very much on family members to provide care. If one falls ill, there is an even more difficult situation for the care workers who have to come in; that appears to be the difficulty at the moment. I know of one care worker who has a long journey by Tube every day to his place of work. Until recently he was given two masks per day, which was hardly enough given that he visited many people per day and per week.
In the long term, surely the social care sector needs a sustainable funding settlement so that it can look forward sensibly to the future. We have to reform the social care system, ensuring that the long-awaited Green Paper says something about it—although I suppose that is a long way away. Finally, in many health sectors there are the royal colleges—the Royal College of GPs, the Royal College of Physicians and so on. Would it not be right if social care workers, both in care homes and in the domiciliary sector, had a royal college of social care to speak for them? Would that not be a good idea? It would be able to fight their corner better than it is being fought at the moment.
Baroness Finlay of Llandaff (CB)
My Lords, I thank the noble Baroness, Lady Wheeler, for this essential debate. This pandemic has become a palliative care emergency. I declare my role as vice-president of Hospice UK and Marie Curie. Care sector staff are providing extensive end-of-life care. They are skilled, compassionate and motivated, but low paid and, until now, unnoticed and unappreciated in society. Yet the mark of a civilised society is the way it cares for its vulnerable. The care sector is a bedrock of such a society.
Some of the most vulnerable can be difficult to care for. The Mental Capacity Act framework supports delivery of essential care and treatment, but safeguarding is harder. Covid guidance on the deprivation of liberty safeguards, DoLS, needs to cover greater responsibility for care staff while reducing bureaucracy.
Chairing the National Mental Capacity Forum, an interest that I declare, I see the care sector adapt with enthusiasm and profound caring to the challenges. Yet the care home staff feel abandoned. Personal protective equipment and weekly testing for all care home staff and residents are critical in controlling cross-infection. When will this happen? Staff from minority populations seem at higher risk of serious or fatal Covid-19. They are not deserting—far from it—but showing humanity and compassion in care. As a nurse said:
“I’m like a policeman who is facing a terrorist attack … ready to face it, but what will happen to our family? … That’s the only worry I have.”
Who is responsible for staff death-in-service financial support?
Dying residents need medication for symptom control. For care homes, without easy and rapid access to medicines, why has the repurposing of medicines not yet been approved? I tabled Questions on it on 7 April. Draft guidance was produced on 14 April and issued in Northern Ireland on 20 April. Why not England and Wales? Has every clinical commissioning group been instructed to achieve integration with its social care providers in the long term? Is it time to develop nursing home medicine to support social care delivery as a distinct discipline, and to fully integrate health and social care? It should have happened a long time ago; it must happen now.
Baroness Meacher (CB)
My Lords, I declare my interest in the register as chair of Dignity in Dying. One of the unexpected outcomes of the pandemic has been a national awakening, albeit very late, about the vital role of care workers and their commitment and determination to continue caring for their most vulnerable of patients, risking their own lives in the terrible absence of PPE. This is surely the moment to re-evaluate the care sector, not just for now but for the longer term. We know that care home residents who contract Covid-19 are generally not encouraged to go to hospital. Their end-of-life care is left in the hands of the care staff. This may be the wish of the patient, but we do not know that this is the case. Are the wishes of the patient the determining factor in decisions about hospital admission and other end-of-life decisions?
Many noble Lords have focused on the vital issue of funding for the social care sector. I want instead to focus on the implications of the vital role in end-of-life care being played by care homes, not only during this crisis but always. The reality is that care homes sit alongside hospitals and hospices in caring for the dying. This is skilled work. Apart from physical nursing care and symptom relief, it requires skills in assessing the mental capacity of patients, undertaking sensible conversations about a patient’s wishes as their condition deteriorates, and the preparation of advanced care plans. All this has come to the fore in the Covid-19 crisis, but of course these skills are always needed in care homes. We need to revisit the training, skills and pay of care staff.
I welcome the advice from the CMO and the Chief Nursing Officer on 7 April encouraging vulnerable patients to discuss their treatment preferences and record them in an advanced care plan. Only then can we be sure that their wishes are respected. This advice should apply much more widely. None of us knows when we will be struck down by a heart attack, stroke or deadly virus. Every one of us needs an advanced care plan. A number of charities, including Prostate Cancer UK and Compassion in Dying, the sister charity to Dignity in Dying, provide excellent materials and guidance on end-of-life planning, but these services need to be supported by the Government, not just now but in the future.
In this context, I strongly support Care England’s call for a commissioner for older people. Can the Minister set out the Government’s response to this proposal? When people think about dying, they desperately want to have some control over how and when they die. A commissioner could help to achieve this. Sadly, many Covid-19 victims suffer terrible deaths. Their end- of-life wishes were never known.
Lord Wei (Con)
My Lords, I thank the noble Baroness, Lady Wheeler, for tabling this very timely debate, and I declare my interests on the Lords register. I, too, echo the praise that others have expressed for the Government and our heroic NHS and care workers, especially those on the front line.
I will focus on just two issues relating to the handling of the social care crisis during this pandemic. I am concerned at how centralised an approach Public Health England has taken on a number of fronts. I fear this may have contributed to the challenges and deaths we are seeing in the care sector and non-hospital contexts generally, including in the home. It seems that at times we have let the best be the enemy of the good, alongside a narrow focus on centralised testing and healthcare rather than what can be done by the rest of society, including business and citizens. I fear that PHE maintains such a gold standard that delays and an inability to harness the energies out there can often be the result. We need to do more to loosen regulations in this emergency to allow more localised testing operated by local labs and organisations to be enabled and then shared, open-source, as well as enabling the provision of PPE. We could even have trials of new drugs made available in and near residential homes, as well as in social care contexts.
I am therefore keen to learn from the Minister whether PHE is being instructed or, if necessary, bypassed to enable more third-party innovation and involvement, and whether a Bill or instruments could be passed to relax certain rules so that local actors can be more empowered to make decisions as they see fit. Indeed, lessons need to be learned so that we can build a more agile, decentralised model of healthcare for the 21st century, delivered closer to homes generally.
Finally, I want to ask what action is being taken and what resources are being deployed to separate elderly residents of care homes who have mild symptoms, or who have been tested as asymptomatic, from other residents, without the risks associated with admitting them to hospital. Does the Minister agree that we may need to introduce a programme akin to the Nightingale one, but more like the famed little merchant navy that complemented the naval efforts to evacuate Dunkirk? That way, we can build and create facilities close to care homes for isolating elderly and vulnerable people and those of all ages who test positive but have mild symptoms, separating them from mainstream care and the general population. These individuals do not need hospital care, but they might be at risk of infecting others fatally.
Baroness Sherlock (Lab)
My Lords, I am grateful to my noble friend Lady Wheeler for securing this debate and for her excellent introduction. I want to talk about the financial circumstances of care workers, especially when they get sick. Care workers are on the front line doing important work in highly risky conditions, usually for the minimum wage, but what happens if they get sick?
Let us look at two circumstances. The first is a carer working in a care home for 35 hours a week on the minimum wage taking home about £277 a week. If she develops symptoms and has to self-isolate, the good news is that she qualifies for statutory sick pay. The bad news is that SSP is just £95 per week, so overnight her net income falls by two-thirds. Can the Minister tell the House how she is meant to manage? Can she apply for universal credit to top up her SSP? That is not made clear in any of the Government’s web pages.
The second example is someone caring for a number of people in their own homes and travelling between them. She works for two different employers but does not earn enough in either job to qualify for SSP. If she needs to self-isolate, she would have to claim universal credit, but how long would that take? The last figures published for universal credit showed on average 40,000 people a week claiming the benefit, but in the past month 1.4 million people have applied, so can the Minister tell the House what the average wait is for someone who has applied for universal credit in the past month? Secondly, even if our care worker’s claim is processed quickly, there is a built-in wait of five weeks to get money on universal credit. She can ask for an advance, but it is a loan deducted from future universal credit payments. She is only just managing as it is and is scared of getting into debt.
Ministers have made some welcome changes to universal credit, but these case studies show that carers need more. We need action on the two-child limit, the savings threshold and the failure to uplift legacy benefits. Most urgently I want to plead again with Minsters to abolish the five-week wait in universal credit. If they cannot or will not do that, will they give everyone an advance automatically when they apply, but as a grant, not a loan?
These may not sound like health issues, but their effects really are, because if carers cannot pay their rent and feed their families they may feel that they have no choice but to carry on working when they should be self-isolating. That is bad for carers, but also, since their work takes them from one person to another, they must be at serious risk of spreading the virus to some of the most vulnerable people in our country. I urge Ministers to act now.
Lord Campbell of Pittenweem (LD)
My Lords, I, too, congratulate the noble Baroness, Lady Wheeler, on obtaining this debate and introducing it in such a comprehensive fashion. It seems to me that the Government continue to enjoy general support from the public, but there are three areas in particular where confidence is not as strong as it might be: personal protection equipment and its availability; the availability of testing; and, as this debate has eloquently demonstrated, most particularly perhaps care for the elderly. It seems to me that in these areas the Government are losing public confidence. That applies as much to their non-supporters as it does to their supporters. Thinking about how that has come about, it seems to me that it is because undertakings have frequently been given but have not proved capable of being fulfilled.
These and other issues already discussed by your Lordships seem to be ripe subjects for the inquiry that is to follow, already referred to by the noble Lord, Lord Alton. I make the point that we should be clear beyond any doubt whatever that we are not looking for a departmental inquiry here; we not even looking for a royal commission. The only possible inquiry should be one under the Inquiries Act 2005; it should be judge-led, and supported by such assessors as he or she may think appropriate. It should be an inquiry that has the power to compel the production of documents and to compel the attendance of witnesses—even perhaps of the Prime Minister himself. It must, finally, be an inquiry with an agreed timetable that is followed. I say that for this reason: this is no time for a Saville or a Chilcot.
Baroness Jones of Moulsecoomb (GP)
I, too, congratulate the noble Baroness, Lady Wheeler. This is a very timely debate and it is wonderful to hear what other noble Lords have said. I have three questions for the Government; they are very simple and I am happy to have written answers if necessary.
Like many other noble Lords, I am shocked that the Government were so late in taking action to shield those in care homes, in the same way that they were late in banning mass gatherings. Ministers focused on hospital deaths because that is what their press conference graphs focused on. The result is that at least a thousand people died in care homes prior to the Easter weekend. There was a failure to provide adequate supplies of PPE to care homes. It has been an example of how a Government really should not behave.
The government guidance provides for carers to protect themselves in the event that those they are caring for have symptoms. It provides protection where the person is classed as vulnerable due to cancer or respiratory conditions, but not if they are just old or infirm. It does not provide for the carers to regularly wear PPE when dealing with the elderly in care homes or in their own homes. This makes the shield less than watertight. It is amazing that some care home staff are sleeping in the care homes and effectively self-isolating in order to look after the people they care for, but obviously not all staff can do that.
Often a person being looked after in their own home will have contact with the outside world only via their carer and that makes the carer the sole source of any infection that occurs. The burden of responsibility on carers is huge, so the Government need to change their guidance—along with the supply of PPE—to reflect that. Will Ministers tighten up the guidance that carers operate under?
Secondly, the mass sending out of do-not-resuscitate letters to elderly patients was one of the more dubious decisions that has been made. I know that many GPs have wanted individual chats with patients and to shape their care accordingly, but Ministers need to clearly state that, if the elderly need and want hospital care, it will always be available. When entire care homes of patients are being expected to sign do-not-resuscitate notices, it can be taken as a clear message that they are expected to die in the care home and will not receive the treatment that perhaps younger people would. Has that practice stopped?
Can the Minister reassure the House that there is now real-time information about what is going on in care homes, so that we know exactly how many people are dying instead of the guesses that are coming so late? I understand the difficulties, but it is only when we really know the size of the problem that we will know how to deal with it.
Baroness Pitkeathley (Lab)
My Lords, as my noble friend Lady Wheeler indicated in her powerful opening speech, there are many shocking statistics about the care sector when it comes to delays. Like others, I was duly shocked—but in all conscience I cannot say I was surprised. When has the care sector ever been at the forefront of the news? When has it ever been top of anyone’s agenda? How many years did it take for the Department of Health to change its name to the Department of Health and Social Care?
The notion that the social care sector is somehow second class probably goes back as far as 1948 and the founding of the NHS. Back then, men died at 66 and women at 69, so why bother setting up a fail-safe care system when it would not be needed? We reckoned without the wonderful success of the NHS in extending our lives so that we see not only our monarch, but many of our most successful fundraisers, playing important roles well into their 90s.
The Government’s recent bailout plan is extremely welcome, and much needed as local authorities are pushed into insolvency by the extra demands of this crisis. At best, though, the £1 billion
“buys us a month or two”,
as one council leader said. It is now more than four years since the CQC told us that the social care sector was at “a tipping point”. If that was the case in 2016, how much more is it the case now?
We must always remember too, when we celebrate caring, the contribution of the unpaid army of at least 6.5 million family carers—rising, we think, to more than 8 million according to the latest statistics. These families and friends are holding the social care system together by providing support for the most vulnerable in society, saving billions of pounds for all of us—the cost of another complete National Health Service. Many carers were at breaking point before, and the current crisis has further exacerbated their situation. Many now say that they are sick with worry. We are asking more of these carers than ever before and they too urgently need to be supported and recognised. They need to know how to keep themselves and the person they care for safe. Many are worried that the care workers who previously supported them are bringing the virus in, so they are doing more themselves.
Many services that previously supported carers are now closed—day centres for example. Even before the virus, 40% of carers providing substantial care had not had a day’s break in more than a year, so there was already considerable unmet need. We should be concerned at the local authority and charity sectors being under such pressure. As we have heard, there is a worry that these services may never be resumed. Some carers are even finding it difficult to get food and supplies. Not all supermarkets class them as vulnerable and not all carers are as tech-savvy as we are all learning to be. When someone needs care 24/7, it is hard to find the time to learn a new skill, even if you can afford to buy a computer.
Carers UK has conducted research with carers, looking at their experiences of Covid-19. It had a large response in a very short period. If I send the Minister a copy as soon as it is published, will he undertake to provide me with the Government’s response to the issues the research raises?
It is clear that, coming out of the pandemic, we will need to have short-term funding for care to stabilise the system, but beyond that we must finally commit to a bold solution for the future funding of social care. Many of us have been calling for a such a commitment for many years. Do we dare hope that a positive outcome to what we are now experiencing will be that we finally get such a commitment?
Baroness Watkins of Tavistock (CB)
My Lords, I welcome this debate and thank the noble Baroness, Lady Wheeler, for securing it. It is clear from yesterday’s NHS Providers briefing that the social care sectors, including hospices, care homes and domiciliary providers, are beginning to consider closing to new admissions or taking on new people for support in the community. This is due to worries about the need for PPE to protect residents and staff from cross-infection by Covid-19. As of 13 April, nearly one-sixth of care homes reported expected outbreaks of Covid-19. This means that many care homes do not have enough staff. Other noble Lords have spoken eloquently on this issue, but it means that it would be very difficult to discharge people from hospital care if either care homes cannot give short-term care or domiciliary care cannot be organised.
The shortage of PPE is more extensive, serious and difficult to overcome in some places than others. It appears that care homes which are members of large chains are beginning to find solutions to short-term procurement. However, even these larger companies are extremely concerned about the increased costs of PPE. It is therefore almost impossible for small domiciliary care providers supporting vulnerable children, people with mental health problems and older people in their own homes to purchase the necessary PPE in a timely and cost-effective manner. Can the Minister explain the Government’s approach to these providers, and how the Government intend to make access to PPE available through either national or local procurement and delivery in a cost-effective manner?
If social care is to be successful and sustainable in taking on new clients, as well as providing high-quality care to those who receive it, we must reduce the feelings of fear about employment and the right to remain among carers from overseas. The Government’s new post-Brexit immigration scheme is based on treating health and social care workers differently. The Home Office’s plan will enable doctors and nurses to apply for fast-track NHS visas, but care workers will have to apply to come under the points-based system. Nearly a fifth of all care workers in this country come from overseas. Many of them may choose to return home in the next year, yet the Home Secretary does not at the moment see a need to apply a fast-track system for care workers. Please can the Minister comment on this approach and inform the House whether it is to be reviewed?
I also have to ask, as other noble Lords have: will the Government consider scrapping the £400-a-year NHS surcharge for health and social care workers? If we are to recruit and retain our workers, doing so is vital at this point in our history.
The Deputy Speaker (Baroness Finlay of Llandaff) (CB)
I ask the noble Baroness, Lady Warwick of Undercliffe, to stop sharing her screen by clicking the box with an arrow in the command bar, please. I call on the noble Lord, Lord Turnberg, to speak next.
Lord Turnberg (Non-Afl)
My Lords, I want to raise three questions with the Minister. None of them is entirely novel since they concern testing, how we treat care home staff and the logistics of government control. Those who are gifted with hindsight can see clearly now where the Government have gone wrong. But you do not need to have much of a retrospect-a-scope to know that we have been extraordinarily slow in recognising that care homes were ticking time bombs, full of closely gathered and extremely vulnerable elderly people, being looked after by carers who had long been the most underappreciated and undersupported of health workers. One might have thought that this combination was a disaster waiting to happen but, rather than getting into the blame, we must look at what is needed now.
First, in order to get a much firmer grip the Government should appoint a Minister or, better still, a well-respected authority to oversee the logistics of providing protection to care home residents and staff. Whoever is appointed should have that as his or her sole responsibility. It is no good dissipating responsibilities between different parts of the Government. It should be one person with no other responsibilities, focused entirely on co-ordinating the response and reporting regularly to Ministers. Is this already happening and, if not, can it be undertaken sometime soon?
Secondly, it is now clear that we seem to have more capacity to test people for the virus than people able to access the tests. The reasons why care workers and residents cannot do so have been well rehearsed in the debate so far, and the answer is obvious: we must take the test to those who need it. I hear that the Government intend to set up a system of mobile testing units, which can go around care homes and elsewhere, and that the Army will be involved. That is a step in the right direction, but can the Minister say how quickly that can be scaled up? Why do we need the Army when taking samples from staff and residents requires only about an hour or so of training, and we have a huge number of volunteers ready to help?
Thirdly and finally, we have been debating in this Chamber—for ever, it seems—the parlous position of care home staff: how underappreciated, poorly paid and unregulated they are. Several noble Lords, including my noble friends Lord Hain, Lord Hunt, Lady Pitkeathley and Lady Wheeler, talked about the terrible position they are in. The coronavirus is now transforming our neglect of them into a form of hero worship. We must take advantage of this new-found recognition to change the way we show our appreciation as we come out of these horrible times. Whatever we do, we must recognise that a majority of our care homes are in the private sector, where they have long struggled to keep their head above water. We must include them in the rescue. Local authorities need support now. I ask the Minister: when the Government at long last come to their review of social care, will they put the conditions of care workers right at its heart?
The Deputy Speaker
I apologise, but I ask the noble Baroness, Lady Warwick of Undercliffe, to close the box that has a small cross on it, in the middle of the command bar. If she could do that, that would help, as the screen is distracting for others.
Baroness Wilcox of Newport (Lab)
My Lords, I thank my noble friend Lady Wheeler for bringing this important debate to the House today, and for her excellent speech. I am in close contact with the Welsh Government and local council leaders in Wales; therefore, my contribution will focus on the provision in Wales and demonstrate how social care services are being sustained at this critical time.
A group of Ministers has twice-weekly calls with all council leaders. In addition, there is constant contact between central and local government officials. As noble Lords know, the Coronavirus Act 2020 allows local authorities flexibility in the provision of care, but children were not included in this for Wales, unlike in England, so the legal protection for children’s care and support is being maintained in Wales.
Some £40 million has been provided in emergency funding for social care for an eight-week period, via local authorities, and it is expected that more funding will be needed from the Westminster Government to meet the increased costs of PPE, food, staffing and ICT that are being incurred by adult social services. It comes from the £1.1 billion fighting fund created by the Welsh Government to support public services to respond to the coronavirus pandemic.
But 10 years of underfunding have seriously impeded the Welsh Government’s ability to respond financially. Their budget is billions below what they would have expected to receive based on the first decade of funding from a Labour Government. They have, however, as my noble friend Lord Hain noted, consistently spent more: 48% more on social services in Wales than in England. How much better the UK care sector would be if that focus had been taken by the UK Government.
The Welsh Government have since written to all registered providers of care home services, highlighting the need for care homes to sign up to the new care and support capacity tool, and to raise concerns with their local authority and the Care Inspectorate Wales without delay if they consider there to be imminent risks to the continuity of care.
Some 40% of all PPE now being distributed by the Welsh Government is going to social care, and the testing of social care staff and residents of care homes who are symptomatic started in Wales before it did in England. It is a shame that Dominic Raab did not mention that fact yesterday in the House of Commons when attacking the work of the Welsh Government Minister in charge of health.
Wales is the only UK country providing free childcare for all pre-school children, aged up to five, and for vulnerable children—those with social workers or a statement of special educational need.
Testing is an evolving area of work and Public Health Wales continues to increase capacity for testing through the establishment of drive-through testing facilities.
I hope that this brief but detailed account of work being undertaken in Wales brings some reassurance to Members that the Welsh Government are in close liaison with local authorities and are carrying out their duties at this critical time. I urge the UK Government to fully fund the work of the Welsh Government in dealing with this pandemic.
Lord Shipley (LD)
My Lords, I thank the noble Baroness, Lady Wheeler, for enabling us to hold this debate. I will concentrate on: emergency planning and procurement; the overall impact of government policies on the social care sector, which Age UK said last week was “an unfolding disaster”; and the lack of integration of health and social care. I declare that I am a vice-president of the Local Government Association.
Local government has mostly done a very good job in providing community leadership and supporting vulnerable people in this pandemic, but I am puzzled as to why our emergency and resilience planning generally has not worked well. It seems to result from the Government’s failure to plan effectively for a pandemic since 2016, despite advice which identified PPE shortages as a major risk; the lack of action in February to treat the pandemic as seriously as other countries were; and the Government’s policy of running a centralised procurement and distribution system, which has ended up with shortages of essential equipment.
I draw two lessons from this. First, a country of our size cannot be run out of Whitehall or its centralised agencies. We should learn from Germany, where more responsibility lies at regional and local level for procurement, and for testing, tracing and isolating. We need to be far more resilient as a country by manufacturing more ourselves. The international shortage of PPE has impacted directly on care homes, where deaths have soared.
The Government seem to have had no plan for the care sector. They should not have been surprised that PPE would be needed by so many organisations outside the NHS, nor should they have been surprised by the need to test; yet by Easter Monday only 505 social care workers had been tested, compared with 48,000 tests for NHS staff. As we have heard, the location of testing centres has meant that many on low incomes have had to travel unacceptably long distances for testing.
Despite the title the Department of Health and Social Care, the care sector seems the poor relation. We need a fully integrated National Health and Care Service. We have voluntary integration in only one-third of England. There are 430,000 residents in nursing and residential homes, with care fragmented between the public, private and not-for-profit sectors. The financial situation for many of those homes is dire, as we have heard. Reform of the financial structure of social care is urgently needed and it really is time for the Government to provide the necessary leadership to start to solve this huge problem. I am grateful for the opportunity to take part in this debate.
Baroness Uddin (Non-Afl)
My Lords, I declare my interests as a former statutory social worker and as the mother of a person living with autism. I express my heartfelt condolences to all those who have lost loved ones during the horrific and tragic past weeks. These are sad times and I thank my noble friend Lady Wheeler for leading this discussion. I agree wholeheartedly with her invaluable and detailed insights and I completely endorse the comments expressed by my noble friends Lady Grey-Thompson, Lady Pitkeathley and Lady Jolly.
Our nation is indebted to all staff at the front line of our NHS and our social care sector. Even at this unprecedented time, we have witnessed exemplary appreciation and respect for their unflinching bravery. In fact, there are infinite numbers of men and women creatively assisting their local services, including care homes, some privately purchasing protective equipment that is rapidly running out. This is reinforced by Excelcare, the national provider of 33 homes, including in my constituency. Indeed, I feel proud of the work being done by many local and national charity organisations based in my area of Tower Hamlets. Despite the lockdown, neighbours are supporting one another and organising food packages for front-line staff. By all accounts, this is being replicated in every part of our communities.
I commend to the House the work of two organisations. One is the Bangladeshi catering industry, which has used restaurant kitchens to supply free food for thousands of vulnerable families at breaking point, as well as NHS and care staff. The other is a satellite TV channel, Channel S, which is providing an outstanding public service in mobilising communities and helping people suffering extreme hardships and those who are finding it difficult to access some of the financial measures in place. The channel has ensured that government messages and instructions reach its vast bilingual audience, in addition to helping charities raise hundreds of thousands of pounds for vulnerable families at home and abroad. Each day is a forbidding challenge for many who are suffering poverty, domestic abuse and multiple frailties. Nevertheless, it has been a privilege to witness the human spirit thriving in communities coming together. As the month of Ramadan begins tomorrow, these collective efforts will intensify unabated to help all sections of the community, regardless of age, ethnicity or faith.
I conclude by asking the Government if they have undertaken an impact assessment of the current pandemic on people at special schools, day-care centres and other residential care institutions that provide services to disabled children and adults with learning disability and autism, in terms of the availability of PPE, staff and adequate resources. What protocol exists for carers accompanying disabled children and adults to hospital should they contract Covid-19? The Children’s Commissioner is concerned about the drop in the number of children on the safeguarding and child protection registers attending schools. What is being done to ensure that local authorities have adequate social work staff and resources to maintain sufficient monitoring of their safety? I thank noble Lords for their co-operation and attendance.
Baroness Bull (CB)
My Lords, I join others in thanking the noble Baroness, Lady Wheeler, for introducing this important debate. I will focus my comments on the impact on the UK’s 1.5 million people who live with learning disabilities. Their challenges have been exacerbated by this pandemic. They are already seven times more likely to be socially isolated and to suffer mental health problems, and so are at particular risk from the effects of quarantine. They are challenged to understand social distancing and they are at high risk of respiratory problems, making them more vulnerable to the virus.
While the action plan for adult social care acknowledges the Covid-related challenges of this community, disability advocates have raised a number of concerns about the plan and the sector’s specific challenges. Workforce support is a key pillar of the plan but is silent on pay increases, which is a significant factor in retention and recruitment. As the workforce includes 115,000 people from the EU, staff shortages are a long-term concern.
Concerns have also been expressed that the £1.6 billion emergency funding for local authorities to support social care providers is insufficient and that distribution across different areas is uneven. The noble Baroness, Lady Jolly, articulated concerns about guidance on the assessment of people with learning disabilities who contract Covid-19, with GPs wrongly conflating support needs with frailty and telling people that they will not be prioritised for treatment.
Finally, there are concerns about flexibilities to social protection introduced by the Coronavirus Act. Can the Minister provide reassurance that people with learning disabilities will not fall through the gaps and end up locked away in in-patient units? There are already 2,000 people in these units, often far from their families and held in inappropriate environments—sometimes confined to a single room—while awaiting the completion of their care and treatment reviews. I know personally one family in the midst of such a process, with a long-awaited solution tantalisingly in sight before coronavirus put everything on the back burner. Can the Government give this family and others like them reassurance that their needs will not go to the back of a long queue, or be forgotten altogether, once this immediate crisis is under control?
The desperate need for long-term reform of social care has been highlighted yet again by the situation we now face. In 1942, while the world was at war, the British Government produced the Beveridge report, and with it the basis for the welfare state. This crisis must inspire the same sort of visionary thinking. It is not just a question of how we react to this pandemic; it is about the legacy that this generation will leave behind.
Lord Farmer (Con)
My Lords, I, too, congratulate the noble Baroness, Lady Wheeler, on initiating this important and well-timed debate. I will speak today about children’s social care and how supporting those on the edge of it can prevent this crisis from being the tipping point when they become looked after by the state. First, however, we should acknowledge the families who are flourishing now that they are no longer in the time famine of normal life, even though money and space are tight. Many children are enjoying being with their fathers, for example.
On those in social care, the Government are consulting on reforms to the use of unregulated care homes which include banning this provision for under-16s and introducing national quality standards. In these strange times, young people currently in such accommodation are out of the sight of social workers and others, who have high case loads. I have heard that these professionals are seeing only the highest-need families face to face. Some have adapted well and are catching up with young people directly, for example through WhatsApp, but such flexibility might be patchy. Can the Minister inform me whether a national assessment has been made of the welfare of those in unregulated accommodation during this crisis?
More broadly, the Government have committed to reviewing the care system. For the system to be sustainable going forwards, this review requires what I call the prevention pipeline. It should establish how we can best prevent, first, children from coming into care in the first place and, secondly, the care system from being a runway into educational underachievement, unemployment, criminality and prison, early parenthood, addiction and poor physical and mental health.
Early family support is essential to prevent children from tipping across care thresholds. Many local authorities have set up family hubs where families with children of any age can access help. I have set up the Family Hubs Network, which has held several virtual round tables with providers, who report that hubs have come into their own in this pandemic. They are offering food, maternity appointments, a rich programme of online family support and more. I understand that the DfE is leading on family hubs, but can the Minister inform me whether and how it is supporting their spread?
The Deputy Speaker
I call the noble Baroness, Lady Blower. She is not here. We will move on to the noble Lord, Lord Addington.
Lord Addington (LD)
My Lords, I thank the noble Baroness, Lady Wheeler, for this debate—I agree with many of the things that have been said in it. The main point that I want to make is referred to in the debate’s title: the long-term impact, particularly on groups such as adults who are in care and receiving support.
We have already heard from many noble Lords about the impact that the lack of PPE and testing has had on the workforce. That group is under tremendous pressure and is having to deal with people who will react badly to the situation they are in—I am particularly thinking about those with autism, a group of people who have trouble understanding the world they are in and their relationship to what is going on and who find much of adult life overwhelming. If the workforce has to deal with people who have such problems and other mental health problems, their job will get much more difficult. Will the Government go to these groups and ensure that they get support as soon as possible?
How long the lockdown lasts will greatly affect the level of the problem. However, the Government must have some idea about their strategy for when the immediate crisis ends. We must be able to go in and say, “There will be support for your mental health and social anxiety problems”. I started with autism because I know slightly more about it, although I am acutely aware that others know more. However, all the groups, including those that the noble Baroness, Lady Bull, mentioned, will have similar types of problems. Can we please get an idea of the strategy for dealing with the long-term consequences of this huge social disruption for those who are being looked after?
Those who will take on the caring will have to deal with the problems. It will be yet another load for them to carry. They are a group that has been undervalued for a long time, although this House has been particularly good at making sure that people recognise that they have value and worth. The Government will now have to make sure, in case this immediate problem becomes a long-term one, that there is greater help for them. I will leave it there, but please can we hear from the Government about a long-term strategy, despite the overwhelming problems of today?
Lord Liddle (Lab)
My Lords, I declare an interest as a member of Cumbria County Council. I take as my text my noble friend Lady Wheeler’s excellent opening speech, where she emphasised that the Covid crisis has brought the social care crisis to the fore. To use a phrase that we are unfortunately hearing too much at the moment, the social care sector has suffered from a lot of pre-existing conditions that have sadly weakened it. It was not ring-fenced from austerity to the extent that the National Health Service was in the last decade. Recently, we have had the sticking plaster of the social care precept on council tax, but that is very inadequate. We face a rapidly ageing demographic.
I will focus on the sector’s structural problems—the fact that many of the providers of social care are on the edge of bankruptcy and that the sector has seen widespread financialisation as big companies and private equity groups have moved in. Providers have been loaded up with debt and the margin of profitability is very low. Property has been sold off at high prices because of promises of high rentals that are probably now unsustainable. It is a sector in deep crisis, particularly where there is private ownership. We have to tackle this problem.
Part of the problem is the lack of long-term stable funding for social care. It was a mistake not to go ahead with the Dilnot recommendations. In the general election, Boris Johnson promised us action in months on stable funding for social care. This crisis should be a reason to bring that forward, not postpone it. If we get more stable funding, we have to ensure that it does not just go into rescuing bankrupt companies to make them viable for their shareholders. We want to see a new deal for people working in social care. Statutory arrangements have to be made in the sector to improve pay and conditions.
My experience as a county councillor has honestly changed my mind about this: we need an expansion of local authority care. In my own county council division in Wigton, we have an excellent local authority care home. Unlike most authorities, Cumbria did not privatise all its care homes; indeed, we are building new ones. The care home in Wigton has been rated excellent two years running by the Care Quality Commission. We need a bigger role for the public sector in the provision of care. That would enable decency for workers who are doing such a valiant job in the present circumstances. It has to be backed up by action now on a long-term funding solution for the sector.
Lord Tyrie (Non-Afl)
My Lords, I agree with a great deal of what has been said. Some extremely powerful points have been made. I will confine myself to just one further point about making sure that we maximise the effectiveness of public expenditure in this environment.
The underlying objective of policy must be to minimise the loss of life from the epidemic. The challenge is to find ways to use all the resources available for that job. Some core facts help us think about that. We know that 80% of deaths are likely to be among the over-70s and that most of the remainder will be among those with underlying health conditions. It must follow from that that a very robust lockdown, with whatever financial support is necessary—substantially more than currently —to the elderly and other vulnerable groups, is needed. That funding will need to be maintained indefinitely, unless a vaccine or treatment is found or it turns out that, as now seems less likely, general immunity can develop in the population at any pace. That is the backdrop to this debate. A very high proportion of the most vulnerable people are in care homes, so they need particularly rigorous protection with a much more intensive infection control regime than is currently in place, and the public expenditure simply has to be found to pay for it.
Of course, the merits of any increase in spending among the elderly or the vulnerable will have to be set against the cost of the currently indefinite lockdown, but some basic numbers help to flag up how clear it is that the money should be spent. The overall cost to the Exchequer of coronavirus is forecast to be £218 billion, or 11% of GDP. Total local authority spending on adult social care last year was £21 billion, or 1% of GDP. I think that your Lordships can draw conclusions from those figures. Spending on infection control in care homes is affordable when seen against the backdrop of those numbers, and it would pay off in spades. Of course, analysis of that type can and should form part of an overall assessment of the health effects of the lockdown, both on morbidity and particularly on mortality. I argued for such an assessment and for greater concentration of support on care homes a month ago in the Chamber, on the last day before the Recess. In my view, it is now absolutely essential. Of course what I am describing is very difficult work, but it seems scarcely less difficult and uncertain than the work already being undertaken on the epidemiology and more widely.
I urge the Government not only to undertake that full healthcare analysis—of which care of the elderly will be a crucial part, including the funding of care homes—but to publish it. I very much hope that the Minister will tell us that it is already under way.
Baroness Bowles of Berkhamsted (LD)
My Lords,
“Adult social care in England is inadequately funded.”
That is the opening line of a strong report from the House of Lords Economic Affairs Select Committee, of which I am a member. Right now, that strained system is dealing with a virus that strikes at vulnerability, the very heart of care services. The Government’s response seems to have inadequate intelligence about how care work operates. How else could the “care homes not at risk” advice have come about, or low-paid care workers be expected to travel more than 200 miles for a test?
The virus shows how much we rely on workers in essential services. Care workers rank highly among them in terms of both society’s need and the risks the workers face. The NHS has high recognition, equipment, donations and worker visa extensions, and the care sector deserves the same. It is time to level up. Just like the NHS, care needs could affect anyone. Half the adult care budget goes on working-age adults, and that percentage is rising.
Many care provider businesses are now financially at risk, including some employee-owned and mutual businesses. I am told that some local authorities rapidly made three-month forward bookings and advanced payments, taking the financial risk if those places are not used, to help providers keep afloat for the future. Local authorities have suffered from lacking and late information in a situation that has moved faster on the ground than government decisions. New funding is welcome, but it lags behind the progress of the virus in terms of rising operational and care costs and loss of income from rates, rent and car parks. The knock-on effect of the virus will take a higher toll on the vulnerable, including the working vulnerable, which translates in the long term to a need for more care.
The rulebook on government expenditure has been torn up to support many people and businesses during lockdown. An equally open mind and a long-term approach are needed post coronavirus. Investment for growth must trump austerity, and social care underfunding must still be addressed. One good-faith way in which the Government could start right now would be to put care providers on the same VAT footing as the NHS. Be innovative—it can be done if the will is there.
Lord Bilimoria (CB)
My Lords, just today, Dr Hans Kluge, the WHO regional director for Europe, said:
“According to estimates from countries in the European region, up to half of those who have died from Covid-19 were resident in long-term care facilities. This is an unimaginable human tragedy.”
In her excellent opening speech, the noble Baroness, Lady Wheeler, said that the social care sector was overwhelmed, undervalued and underpaid. The noble Lord, Lord Alton, said that we have just heard today that, sadly, 400 people a day are now dying of Covid-19 coronavirus in care homes. It appears to be sweeping through the council and privately run care homes, with some estimating that up to two-thirds of their residents are infected.
I am an association member of Bupa, which has several care homes. Paula Franklin, its chief medical officer, said that it was only last week that,
“the effect of Covid-19 on those who live and work in Britain’s … care sector has been in the headlines.”
Until then, we did not even know whether they were being counted in the sad daily death rates being told to us; now they are. Of this attention on care homes, she continued:
“In many ways, this is welcome and long overdue. Social care is something of a ‘Cinderella sector’ within the public health system. And yet the NHS could not function without it”,
much as we are thankful for and admire the NHS.
“Covid-19 has now intensified this. Right from the start, although there was a lot that wasn’t yet known about the virus, it was clear our society’s most elderly, frail and fragile were at the greatest risk from the virus … So, while the spotlight was on the … ICU … those working in social care”
are now also in the spotlight. They are the second front line in our battle against Covid-19.
There are 1 million people in care—in care homes, in their own homes and in the community—and some 1.5 million or 1.6 million people looking after them. Can the Minister confirm how many people from ethnic minorities work in the care sector and how many from the European Union? Will we be able to recruit sufficiently after the Government bring in their new immigration policies?
As has been mentioned by many noble Lords, it is shambolic that the care sector has not had an allocation of PPE. Will that now be available? Will the Minister confirm that extra funding will also be made available?
When it comes to testing, the social care sector has been at the back of the queue. Will the Minister now confirm that all patients in care homes and all workers in care homes will be tested? This is a sector in which many workers are elderly themselves. They need to be protected and shielded as much as the residents, yet so many of them are now living in the care homes because they do not want to bring in the virus—but we hear stories of care home patients who go into hospital being sent back without being tested. Will the Minister confirm that there will be regular testing for all 2.6 million people in the care sector—every one of the 1.6 million people who work in it and the 1 million patients?
In conclusion, the 1.6 million people who work in the care sector deserve the same recognition and thanks as the 1.5 million people who work in the NHS. Tonight, when we stand on our doorsteps and applaud the NHS, we will also be applauding our care home heroes.
Baroness Altmann (Con)
I, too, congratulate the noble Baroness, Lady Wheeler, on securing this debate and on her powerful introduction. I will focus on social care for the elderly and I draw attention to my interests in the register. I recognise the unprecedented challenges faced by the DHSC and know that it is easy to criticise, so I congratulate my noble friend the Minister on initial action taken to distribute PPE free of charge for use by private social care providers. However, we cannot deny that the Government’s initial approach prioritised the NHS over social care, following the traditional attitude that treats social care as a second-class Cinderella health service—out of sight, out of mind.
We also need a wholesale shift in the approach to elderly people. Lumping everyone above a specific age into one group, implying that all older people are infirm, is dangerously misguided. Will my noble friend confirm that government policy will not discriminate purely on age grounds when it comes to exiting the lockdown? The physical and mental health impacts of isolation and inactivity are at least as damaging for old people as for other age groups. As others have said, we knew from the start that older people who are infirm were most at risk. We knew where the most vulnerable were: in care homes or receiving home care. Yet there were no special measures for the protection of staff or residents, priority testing, PPE or treatment. Elderly deaths outside hospitals are being revealed only belatedly.
Regardless of short-term failings, we have opportunities to improve things for the future. Will my noble friend reassure us that the Government are now devising urgent plans for radical care reform? If time does not permit today, perhaps he could write to me. In particular, what is his department doing on the following five points: first, integration between and staffing for national health and local care provision, ensuring parity of esteem between the NHS and social care; secondly, taxpayer funding for basic personal care, and incentives for individuals to save to provide a higher standard or earlier access to care than can be offered by the state, as we do for pensions; thirdly, immigration rules that prioritise workers desperately needed by care providers; fourthly, attention to the viability of care providers so that the future of vulnerable elderly citizens is not at risk from the collapse or bankruptcy of highly indebted providers; and, fifthly, focus on the prevention of care needs, funding incentive measures to help people to stay safe at home and avoid needing social care in later life?
Baroness Massey of Darwen (Lab)
My Lords, my noble friend Lady Wheeler has done us a great service in calling for and introducing this debate and I thank her. Today, I will talk about vulnerable children and young people and their situation after the Covid-19 crisis. There is understandably huge concern about the care of adults, particularly the elderly. However, leaving children at risk in relation to education and social care is dangerous and could have long-term implications. The Government have issued guidance regarding measures to safeguard children, but many concerned professionals in local authorities argue that this guidance is not only inadequate but illegal.
Some children are vulnerable due to disability, having mental health problems, being young carers, living in poverty, not being in education or training, suffering discrimination due to race, culture or sexual orientation, or being in the youth justice system. Of course, for these groups of children, many unresolved problems existed before the virus and professionals dealing with such children were struggling mightily to do their best. The crisis of this virus could include or expand into a crisis for children, for example through the potential closure of nursery schools and children not receiving adequate education.
UNICEF UK has recently carried out a rapid assessment of the impact of coronavirus on children, which is extremely worrying. Many children rely on schools and health and social systems to survive and thrive. These systems are under threat, and a crisis may be looming in relation to children’s welfare, development and potential. Child health services, including mental health, are stretched. There will be food insecurity due to job losses and closures of food banks. There is already stress in families, which is resulting in more domestic violence—it has doubled—and child abuse. How are services for children currently being monitored? Who is the Government consulting? Children’s welfare is not the province of only one department; are the Government working in a cross-cutting way?
Children have rights, as set out in the UN Convention on the Rights of the Child, and we have a duty to ensure that child welfare is paramount. If things fall apart for children during this challenging crisis, the consequences, particularly for the most vulnerable, could be devastating for individuals, families and society. The Government have unenviable challenges, but I hope that the Minister can reassure us that support for children and their families will be a priority.
Baroness Hollins (CB)
My Lords, the Covid-19 pandemic will be disproportionately felt by society’s most vulnerable people, including people living with learning disabilities. Care Act easements under the Coronavirus Act, which has been enacted by eight local authorities already, raise the bar for social care to the threshold of human rights violations. Despite government reassurances, people with learning disabilities are at real risk of seeing their care and support reduced or removed as the Care Act easements set a new high threshold for the provision of care.
For those with learning disabilities, Covid-19 has truly pulled the rug from beneath their feet. Visits are discouraged, employment and volunteering roles disrupted and day centres closed. These are not luxuries, they are essential components of keeping well in the community. For many of those with learning disabilities, this loss of routine, structure and meaningful human contact could be disastrous. For some, increased anxiety is leading to behavioural challenges that precipitate urgent hospital admissions under the Mental Health Act. Routine dental and other health appointments have stopped and people’s access to urgent treatment may even discriminate against them.
When the economy and people’s livelihoods were at risk, the Government announced unprecedented financial support. When more NHS capacity was needed, we built massive new hospitals across the country. But when vulnerable people saw their entire support network evaporate, the Government’s response was not to increase social care provision, but to watch it wither. I speak from personal experience and remind the House that I am a carer for my adult disabled son who is at home with me during lockdown. Three equally important areas—jobs, health, and supporting our most vulnerable people—have vastly different responses. This crisis adds urgent emphasis to the need for a properly funded national care service. I hope the Minister will say something positive about a future funding settlement. It is needed, and soon.
People with learning disabilities will need an increase in support to recover their confidence, meaningful occupation and friendships when lockdown ends. Can the Minister say what will be done to reverse the harm done by the loss of familiar support during this period, which for many will have been complicated further by other traumatic losses?
My noble friend Lady Masham spoke about the lack of recognition by the NHS of the respiratory risks faced by people with tetraplegia, like my youngest daughter. I share my noble friend’s and others’ concerns about difficulties recruiting to the care sector and our huge reliance on carers from eastern Europe, who are finding it more difficult to come here to work. I look forward to hearing the Minister’s response.
Baroness Brinton (LD)
I declare my interest as a vice-chair of the APPG on Social Care and thank the noble Baroness, Lady Wheeler, for securing this vital and highly pertinent debate. So many Members of your Lordships’ House have made moving contributions. On behalf of the Liberal Democrat Benches, I also thank all the staff and volunteers working across the wider social care and community sector. Frequently low paid but definitely not low skilled, these amazing people show us their professionalism and big hearts, day after day.
Back in mid-February, we on these Benches asked the Minister repeatedly about care. On 26 February, the noble Lord, Lord Bethell, said in Hansard that
“we are planning … a massive communications campaign on how to protect people, particularly vulnerable people, in our population.”—[Official Report, 26/2/20; col. 257.]
The evidence of recent weeks shows that those most vulnerable in our communities and care homes have been seriously and tragically let down.
Others have covered plenty of the detail, which is symptomatic of the centralised way in which Whitehall, the Department of Health and Social Care, and the NHS have treated anything not in hospitals as a second or even third order of priority. My noble friend Lord Shipley explained the problems that have arisen since Whitehall took over the supply chain for the social care sector and then decided to create a separate system, known as Clipper, that we were told was due to come online on 6 April, but yesterday discovered is still three to four weeks away from going operational.
Worse, where providers and local resilience forums have ordered their own PPE, it has been confiscated by government and rerouted centrally for hospitals first, leaving community settings high and dry. This includes lorries being stopped at border ports and drivers being rerouted. Consequently, a lack of PPE and a policy of moving patients from hospital into care homes without any testing has meant that Covid-19 has spread rapidly in the social care sector.
I support my noble friend Lady Jolly’s call for clarity on DNRs and echo her concerns about GPs asking disabled and learning-disabled people completely inappropriate questions. It is very clear from the government advice, NICE advice and all good palliative care advice that the way in which this happened was inappropriate. I hope that this DNR factor will be examined as part of any inevitable public inquiry. It seemed to happen in groups. Were CCGs asking GPs to ring their patients and find out whether they wanted to go to hospital? To do it all in one conversation is completely inappropriate. For many disabled people, it was completely inappropriate to even ask them this, if they do not have the clinical frailty that my noble friend Lady Jolly spoke of.
However, the Government’s lack of understanding of the wide range of other disabled people, and extremely fragile people, living within our community extends completely in the opposite direction. As a result, people who have ventilators or tracheostomies, for example, have found that their care support is entitled to only the most simple and flimsy face masks, because they are regarded as exactly the same as the standard care in residential homes. The Government’s PPE for the social care sector is almost always designed for the elderly.
Matt Hancock said last week that health and social care workers should not overuse PPE. The gasp that went through the social care community when he said that could be heard across the country. Most community orders are receiving a tiny fraction of what is ordered and needed. My noble friend Lady Barker summarised well the problem between the department and local government.
Time and again, many noble Lords have talked about testing. Testing in the social care sector has been a real problem, with very few centres where staff can go and be tested. On Sunday, an appalling story came out of a social care worker in Norfolk being asked to go to Sheffield—a five-hour round trip—to be tested. Even their nearest place was a three-hour round trip away. It is all very well saying that more and more centres are opening up, but if they are all drive-through, it becomes impossible for the many staff in the social care sector who do not drive to get to them. I hope that the Minister will be able to explain to us when really accessible testing will be available for all social care staff who need it.
The problems with PPE have demonstrated a perfect storm. At the beginning of this crisis, patients, and especially elderly patients in hospitals who may or may not have had Covid, were being pushed back into local care homes without having been tested, whether they were symptomatic or asymptomatic. At that point, staff in care homes were not able to access tests at all and, as a result, Covid started rushing through many of our care homes. Many of the workforce were already self-isolating, or, because of their symptoms, had removed themselves completely and were unable to work. The criminal lack of PPE means that Covid has had free rein. It is estimated that in London, some 50% of care homes have active cases.
Many noble Lords have talked about the future of social care, and it is absolutely vital that we look at that in the context of today’s debate. My noble friend Lady Northover set out the history of social care reform. I can remember the delight, a decade ago, when all three parties supported the Dilnot review, and the shock when the Conservative Party decided that it did not want to continue with it. As we come to the end of this crisis, we must rapidly review the future of social care, but we must not start again from scratch. There is plenty of evidence to show what needs to be done. Our social care sector was already struggling before this crisis, following cuts to local government and to providers, with many providers having gone out of business and others hanging on perilously by a thread at the moment.
The consequences of all this are visible. The Rainbow Trust supports families with seriously ill children. It has said that the risk of the Covid-19 pandemic has put the provision of social care by charities at a higher risk of ceasing altogether, because many charities depend on fundraising, which has dropped significantly. It says that, in the short term, it is unclear how government departments will divide up the modest funding package of £360 million between the so many charities which are desperately trying to provide for very vulnerable groups of adults and children. It added that, in the long term, it is vital that sustainable funding is established to reduce the vulnerability of vital charitable social care to economic shocks, so that we do not end up in this position again.
The Rainbow Trust would like to ask the Minister to please go back to the Chancellor of the Exchequer. Many charities have had to furlough staff, and those staff have been allowed to work for other charities. But in the medical sector, these staff often have exceptionally specialist skills that cannot be used elsewhere, and, as a result, some of the provision that they are trying to offer cannot be done easily.
My noble friend Lord Campbell of Pittenweem has rightly called for a judge-led public inquiry. It is clear that too many things have been going wrong. We need to recognise the contribution made by our health and social care staff wherever they are, whether in care homes, in the community or in hospices. That is why the Liberal Democrats say that we must have a proper package for them. They must have access to full and proper PPE. Moreover, those who have tragically died as a result of Covid in the line of service need proper death in service benefits. We also think that a daily allowance equivalent to the military deployment allowance should be paid during the lockdown to people who end up putting themselves at risk. Too many are doing that, and they are absolutely serving the nation.
Baroness Thornton (Lab)
My Lords, it is an honour to be winding up this historic debate on behalf of the Labour Benches. It is the first substantial debate to be held in our demi-virtual House.
For two reasons, it is completely appropriate that social and domiciliary care are the subjects of this debate. First, we could only suspect when my noble friend Lady Wheeler proposed this debate how important would be our scrutiny of the effects of Covid-19 on care homes, on domiciliary care, on the 6.5 million carers in our community, and indeed on the elderly and those living with disabilities, whether they are old or young. That has been mentioned by many of my noble friends, including my noble friend Lord Dubs, Lady Pitkeathley, Lord Hunt and Lord Turnberg. Secondly, my noble friend framed this Motion for debate in terms of both the short term and the long term.
I congratulate noble Lords on the brevity and eloquence of their contributions, which were outstanding, but also on their command of the virtual world in which we now operate. I also thank the many organisations that sent briefings to us and gently remind them that a briefing arriving yesterday will have less impact than one that we might have received a week ago.
It is right to separate the short term, where we all wish to work together to mitigate the worst of the crisis, from the long term, where we learn lessons and address with honesty the inertia, political cowardice and long-term cuts that have made it impossible to design and put in place a decent, modern, integrated care system. My noble friend Lady Wheeler and I—the Labour team—have lost count of the number of times we have raised the inadequacies of the Government’s response to the stress experienced on the front line in our social care system over the last five years, with no Green Paper, inadequate budgets and huge cuts to council infrastructure. It would be laughable were it not so awful in its consequences for the most vulnerable in our communities in this pandemic. The fact that in PMQs yesterday the First Secretary of State did not know how many social care workers had lost their lives to Covid-19 tells us all we need to know about the priority that the Government have given social care over many years. That must change.
Finding solutions means that issues are identified by good data, reported honestly and openly, and that all those involved, from care homes, trade associations, charities and trade unions, contribute to finding solutions. The employment and business solutions found by the Chancellor were a result of discussions with many different groups, including the CBI and the TUC. Why has that not been a model for social care during this pandemic? Will the Minister commit the Government to bringing together all the stakeholders in this sector to discuss the future, not just the immediate issues of survival?
Yesterday we learned that the current lockdown is unlikely to end soon. The CMO tells us that the probability of lifting social isolation in the next calendar year is incredibly small. We should be realistic about that. We will have to rely on other social measures which, of course, are very socially disruptive, as everyone is finding out right now. The Chief Medical Officer said that without a “highly effective vaccine” or “highly effective drugs” to treat coronavirus, Britain will have to get used to this new way of life. We do not know exactly what that means, partly because the Government have chosen not to have a national conversation about the best way forward, but to inform us of their decision about ending lockdown at some time—who knows when? We already know that, in the short, medium and indeed long term, the impact will be significant for the communities we are discussing.
I beg the Minister not to talk to us in lofty terms about how hard he and the Government are working—we know and appreciate that—but instead to be honest about the challenge we are facing as a nation and in this sector, and have some discourse about solutions with the communities affected. Perhaps Ministers have had incorrect or incomplete information, but time and again lofty promises and bold assertions have collided with reality. This risks undermining trust in the Government, which is so important at the moment. Levels of trust influence our behaviour. The lessons for our leaders are clear: to have humility to admit they do not know everything; to be authentic in their narrative; to have empathy and provide reassurance for the anxious; to have clarity and consistency of messaging; and above all, to have honesty.
On 9 March I asked the Minister the following question:
“My first question concerns vulnerable people in residential homes and the learning disabled who may be being supported, either by charities or at home by their parents. We need to include these people in the planning.”—[Official Report, 9/3/20; col. 849.]
Social care planning was published five or six weeks later, during which time Covid took hold in our care homes with continuing devastating effect. Only in the last few days have we seen testing offered to residents and staff in these homes, for which we are of course grateful. We are fortunate that the noble Lord, Lord Bethell, is the Minister responsible for testing, which will now be rolled out. Clearly, testing centres which are miles away and can be accessed only by car are inappropriate for residents and many staff. When will this testing, when it is accessible, kick in? What is the timeframe?
We must be honest and say that reports of serious failures have reached us all: vulnerable people denied the care they are entitled to expect, and some even denied life itself. Many with disabilities have expressed how strongly they fear the withdrawal of or reduction in services vital to their well-being, as mentioned by many noble Lords. Not enough has been done to reassure them.
In the short term, we have seen unprecedented action: the Care Act being effectively suspended, with only the protection of the HRA in place, and the injection of literally billions of pounds into the care system, although nobody seems to know exactly where it will end up or whether it is enough.
The loss of hard-won rights in the field of adult care, outlined by the noble Baroness, Lady Grey-Thompson, and others, is a major concern. Service user groups, lawyers and advocacy groups are questioning whether the powers taken are in fact disproportionate to the extent of compromising human rights and are wondering whether these rights will ever be returned after this period of emergency. These are major concerns, and the rhetorical downplaying of the value of low-skilled and low-paid workers has been replaced by treating them as heroes, as many have mentioned.
This really sets up a challenge for the future. It has proved hard in many places to set up proper systems for identifying who is vulnerable and how they can be protected and not fall through any cracks. The lack of good information and the absence of data-sharing are exposed. Market mechanisms, through contracts and regulation, failed to embrace the ability to react in a major crisis. The deep-seated organisational barriers between the different sectors of care and between local authorities and the NHS have been laid bare, despite heroic attempts in many places through local initiatives. We now see, finally, that there has been some recognition of how valuable care staff are, but this must be matched by giving them the pay, conditions, training and equipment they need.
Our current social care model does not work. Integration, despite laudable attempts in Manchester and some imaginative STPs—my own included—is not going anywhere fast. The move to a national well-being strategy avoiding all artificial barriers and tribalism in the NHS and between the NHS and social care is essential.
Labour has set out its vision for a long-term solution. Like everyone else, we will study what we can learn from the crisis and adapt our policies as required—we want to work across parties and nations, and believe that work needs to start sooner rather than later. The NHS and social care must be seen as two sides of the same coin and supported in their efforts to respond to the Covid-19 outbreak. It has never been more important to invest in this critical partnership.
Social care providers and their staff have had to adapt as the crisis evolved and new issues emerged, and are playing a key role in supporting vulnerable people at home and enabling people to return home with appropriate support. This pandemic has laid bare the challenges facing social care and highlights the urgent need for a sustainable, long-term funding solution. This must be a key priority for the Government.
In conclusion, I thank all noble Lords for their contributions to this important debate. I heard a care home manager say in despair on the television last night, “We were not prepared and we are not being led.” She is right. This must change for the short term and the long term.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, I join the noble Baroness, Lady Wheeler, and others in remembering those who have suffered from this dreadful disease. I pay tribute to those in healthcare and other key workers on the front line who selflessly and heroically help deal with this awful epidemic. I have a personal reason to thank in particular those BAME social care staff who take a particular risk and often take on most challenging tasks.
I thank all noble Lords for the thoughtfulness and scrutiny they have brought in this digital debate to an issue which is, as many have remarked, overlooked but is now, without doubt, at the centre of our national debate. With 40 speakers and a lot of new technology to deal with, I apologise in advance if I cannot respond to all the thoughtful and perceptive questions that have been asked, but I will try to address the most immediate issues raised by noble Lords with a practical update—and I will avoid the lofty, high-level stuff, as requested by the noble Baroness, Lady Thornton.
As the noble Baroness, Lady Wheeler, rightly stated, on 15 April we published our action plan for adult social care. The plan outlines how we have committed to strengthen and support this vital network, for the carers and for the cared. The plan has four pillars, First, our number one priority is to limit the spread of the infection. It is clear, as many noble Lords have rightly said, that personal protective equipment has been an issue for many in the care sector. We recognise that and we set out a PPE plan on 10 April to deal with the issue.
We recognise that PPE is vital to protect NHS and social care staff from contracting Covid and to protect the people whom they care for, and we are acting to ensure that PPE is available where it is needed. We are running hard at procurement; the results are being felt, but there is more to be done. Public Health England has published guidance on good infection control practices, discharge processes, testing and in which scenarios to use PPE to minimise the risk of transmission. We have moved quickly to adapt guidelines to this new, complicated and deadly threat, to be clear in the way we communicate, but I accept that it is sometimes difficult to keep up. I hear loud and clear from the noble Baroness, Lady Wheeler, my noble friend Lady Verma, and the noble Lord, Lord Hain, about concerns on costs. I reassure this virtual Chamber that substantial funds have already been mandated. The question of funding remains under review and, if more is needed, this Government will step up to their responsibilities. We are taking these issues seriously, but the challenge is substantial.
This sector that is made up largely of smaller, independent providers that have historically sourced their PPE on open markets, as well put by the noble Lord, Lord Hain, so we are putting in central procurement support at pace and on the fly. We have developed a parallel supply chain across government with NHSE&I, NHS Supply Chain, Clipper Logistics and the armed services. The parallel supply chain has been established to support care homes, home care and hospices. It is done in the spirit of collaboration, as the noble Lord, Lord Shipley, has rightly recommended. This is already supplying PPE equipment to hospitals and local resilience forums. I reassure noble Lords that this improved speed and reliability of delivery is already relieving pressure on the supply chain.
We are working around the clock to ensure that staff on the front line can do their job safely. As of 20 April, we have released 29 million items of PPE to seven designated wholesalers for onward sale to social care providers. This includes 11.4 million face masks, 13.3 million aprons and 4.2 million gloves.
Let me say something on discharge. We recognise that moving someone from hospital to another area where infection control is important is incredibly delicate. That is why, last weekend, the Chief Medical Officer changed the guidelines so that all patients will be tested before being admitted to care homes, as well as all care home residents. This is welcome news.
On testing generally, I reassure the noble Baroness, Lady Grey-Thompson, and the noble Lord, Lord Hain, that, while testing was initially limited to help manage the demand for tests for the most unwell, this has changed. There is new guidance and considerably more capacity. I reassure the noble Baroness, Lady Wheeler and Lady Brinton, and the noble Lord, Lord Turnberg, that as lab capacity increases every day, we have already expanded testing to include more care home residents and staff.
It is true that the drive-in centres were the quickest to set up, as the noble Lord, Lord Shipley, rightly remarked. However, I reassure the noble Baroness, Lady Barker, the noble Lord, Lord Dubs, and other noble Lords, that this week we have started home delivery of self-administered packs, which will be organised by Amazon, pop-up mobile units organised by the Army, and we will shortly have a retail solution from Boots. This will go a long way to address the concerns of those who find the drive-in centres awkward or unavailable.
On the subject of counting deaths, I reassure the noble Lord, Lord Bilimoria, and other noble Lords that the official ONS figures, which are informed by CQC returns from death certificates, will always capture Covid deaths, whether they are from hospitals, care homes or at home, and that it is the responsibility of doctors to inform PHE of any Covid death.
The 1.5 million social care workers on the front line of the virus are crucial in delivering care to our most vulnerable citizens, so I will say a word on them. I reassure the noble Baroness, Lady Grey-Thompson, that we have capacity for every care worker to be tested, just as there is for NHS staff and their families. PHE will be administering those tests and home testing equipment will be distributed. Social care workers have been designated as key workers, which means that the children of those working in social care can continue to attend school where there is no safe option for them to stay at home.
In response to those who say that government has done nothing, I remind the noble Baroness, Lady Hollins, and other noble Lords that our action plan for adult social care sets out an ambition to attract 20,000 people into social care over the next three months. We will shortly launch a new national recruitment campaign to run across broadcast, digital and social media. The campaign will highlight the vital role that the social care workforce is playing now during the pandemic, along with the longer-term opportunity to work in care.
I am proud to recognise carers and to endorse social care branding with badges and lanyards to create a proper identity and recognition. We have formally introduced the CARE brand to sit alongside the NHS brand in England. It is right that we recognise the hard work of carers and, as the noble Baroness, Lady Wheeler, put it, ensure that they too get support such as queueing priorities like their NHS colleagues. We recognise the immense pressure that the social care workforce may be facing, which is why we have extended a package of helplines and text-based systems across the board to support the well-being of carers and other front-line staff.
Several noble Lords, including the noble Baroness, Lady Finlay, and the noble Lord, Lord Bilimoria, raised the impact of BAME staff working in the social care sector. We have commissioned work from Public Health England to understand how different factors may influence the way someone is affected by this virus.
My noble friend Lord Astor asked about respite for carers—an important point. On 8 April we published guidance for unpaid carers on GOV.UK, which includes general advice, including advice on infection control, links to other information and support and advice on caring where someone has symptoms.
Perhaps I can reassure the noble Baroness, Lady Tyler, who asked about visa exemptions for nurses in social care, and the noble Baroness, Lady Masham, who requested an update on when we might relax the immigration rules to ensure that we have an adequate number of carers, nurses and doctors. The Government are already working with the NHS to ensure that visas are extended to doctors, nurses and paramedics and where, as noted by the noble Baroness, Lady Bull, significant numbers of overseas staff are working on the front line to battle Covid. UK Visas and Immigration has now written to 270 NHS organisations to begin processing these important extensions. I will take away her valuable point that the social care workforce should be included within the scope of these discussions. Many employers across health and adult social care benefit from the skills of overseas staff. However, it is clear that international recruitment will not be straightforward at the moment, nor in the future, due to widespread travel restrictions in place around the world. We are going to have to adapt to this new reality.
The noble Baroness, Lady Sherlock, asked a very valid question on carers’ eligibility for universal credit. We are acutely aware of the issues faced by the self-employed or those on zero-hours contracts. Some individuals employed on zero-hours contracts may be entitled to statutory sick pay; those who are ineligible can claim universal credit or contributory employment and support allowance, depending on their circumstances.
The third strand of our strategy is supporting independence: supporting people at the end of their lives and responding to individual needs. I completely take on board the comment made by the noble Lord, Lord Blunkett, about inadvertently creating a monster in our efforts to slay the dragon of Covid. But I would add that it is not the Government who seek to punish older demographics and those with pre-existing conditions; it is the virus. The objective of our policies is to save lives and protect the NHS and our care services.
Let me give you a few examples. We are working alongside technology firms and voluntary organisations to assist the most at-risk and isolated people with access to vital emotional support and companionship. These efforts are beginning to bear fruit. While unnecessary visits are restricted, we are clear that visits at the end of life are important for the individual and their loved ones, and they should continue. The guidance now makes that clear.
We recognise the specific challenges that disabled people will face as a result of Covid-19, as was raised by the noble Baroness, Lady Bull. We have been taking several important steps to mitigate the impact of Covid-19 on people with disabilities and continue to engage with stakeholders to ensure that their needs are met. For instance, we are improving the accessibility of government guidance and working with the disability unit at Public Health England and NHS England to ensure that important messages reach throughout the communities.
On the DNR notices wrongly sent by some GPs, I totally endorse the comments of the noble Baronesses, Lady Brinton, Jolly and Jones, the noble Lord, Lord Alton, and many others in their condemnation of pre-emptive DNR notices. The CQC has been making that point very well and we all reject that practice.
The fourth strand of our strategy is protecting vulnerable children. The Government understand the importance of having robust social and domestic care provision for disabled and vulnerable children, and the need to ensure the sustainability of social care services. This issue was raised by my noble friend Lord Farmer, the noble Baroness, Lady Massey, and the noble Lord, Lord Addington. We are taking action to ensure that those reliant on such services are identified and supported during the pandemic. I reassure the noble Baroness, Lady Massey, that we are working closely with other government departments, local authorities and partners, such as the Council for Disabled Children, to assess the impact of Covid and local decisions on the provisions of these services.
We know that some families need more support than others and that attending education settings is an important protective factor. That is why we have not only ensured that they can continue attending school but made it clear that we expect them to, as long as it is safe for them to do so. We also encourage families with a child whose SEN needs cannot be suitably supported at home to attend school, but this will depend on a risk assessment. Many pupils with special needs are better off staying at home during the crisis.
Lastly, we are supporting local authorities and providers of care. In March, we announced £2.9 billion of funding to support and strengthen care for the vulnerable. Local government is being supported by £1.6 billion of additional funding to meet extra demands. This funding can be used across all services facing pressure. Further, we have enhanced the NHS discharge process by providing £1.3 billion of funding to allow patients who no longer need urgent treatment to return home from hospital safely and quickly. This funding will cover follow-on care costs for adults in social care or people in need of additional support when they are out of hospital and back in their home, community or care setting. We are keeping future funding under review. We announced over the weekend a further £1.6 billion package for local government to ensure that local government has the funding it needs to respond to the crisis as it develops.
A number of noble Lords asked about VAT. I confirm that providers pay VAT as private entities, but the important thing is that they have support with the costs they are incurring. This is what we are doing through the significant funding. I remind noble Lords that if adult care providers are charities they do not have to pay.
My noble friends Lady Verma and Lord Astor urged the Government to ring-fence this funding. We are taking important steps to ensure that this additional funding is making a difference. For example, as the noble Lord, Lord Dubs, asked, we are asking local authorities to provide information about the distribution of this funding to providers. The Government will continue to monitor pressures in the NHS and local government and will keep future funding under review.
We are also supporting the system through emergency legislation. The Coronavirus Act 2020 came into force on 31 March and brought significant changes to local authority duties under the Care Act 2014. I reassure my noble friend Lord Astor of Hever that the Government are committed to revoking these powers when they are no longer needed. I confirm to the noble Baronesses, Lady Wheeler and Lady Grey-Thompson, that we have received notification that six authorities are operating under the Care Act easement and that I thoroughly support the publication of the details. Those authorities are Sunderland City Council, Middlesbrough Council, Warwickshire County Council, Staffordshire County Council, Birmingham City Council and Solihull Metropolitan Borough Council.
The decisions local authorities may have to consider at this time are not simple and it does not necessarily mean that they are in crisis. The Department of Health and Social Care has issued guidance on easements, including an ethical framework and prioritisation guidance. I reassure noble Lords, including the noble Baroness, Lady Wheeler, that local authorities remain under a duty to meet needs where failure to do so would breach an individual’s human rights under the European Convention on Human Rights. Such easement measures should be used only when absolutely necessary, based on the local authority’s judgment of its ability to meet the needs of people in line with the Care Act.
The disease is a cruel enemy. It attacks the weak and vulnerable, as put very clearly by the noble Baroness, Lady Hollins. Carers and residents are put in a desperate position not because of government policy but because of the reality of this horrible killer. Let me touch on the comments made by the noble Lord, Lord Alton, on the final hours of those in care homes and funeral arrangements for them. As someone who has lost a loved one in a nursing home, I know at first hand that it is a heart-breaking reality of this awful epidemic that we cannot properly say goodbye to the ones we love.
I shall say a few words about the Government’s priorities. We have put this country on hold to save lives and to protect the NHS and our care services. The noble Lord Tyrie, made the financial commitment very clear. I reject the idea put by the noble Lord, Lord Hunt, that this Government treat those in our care homes as second-class citizens. They have been a huge priority in everything that we have done in the past months. Mitigating the impact of the Covid pandemic is the top priority of the British people and of this Government.
This epidemic has undoubtedly put a spotlight on social care. The British people and this Government will never look at social care in the same way again. Today we are working flat out to mitigate the effects of a deadly disease, but things will change. The Government have committed to a substantial review of the sector. It will come when the time is right and, as noble Lords rightly asked, it will be a moment for society to draw up a new contract for social care. It will need cross-party collaboration and a new approach. I would like to hold on to the feeling expressed in this debate. Let us all remember these commitments to a fresh start when that moment comes.
Baroness Wheeler
My Lords, I thank all noble Lords who have participated in this excellent and powerful debate. I thank the Minister for his thoughtful response, but however thoughtful it was it is clear that many questions remain unanswered and that we will need to ensure that they continue to the brought to the fore and be dealt with by the Government in future Questions, Statements, debates and legislation.
Noble Lords have stressed the need to be open and honest about the challenges that social care faces and about the good and bad news. I am sure the Minister will take that message to heart. Despite the challenges, I want to stress that it is truly heartening to know that this terrible disease has at least been a wake-up call for the Government and the public about the importance of adequate social care for millions of adults and children in need of it and about the value, respect and decent pay that the 1.4 million staff deserve and must be given.
The Deputy Speaker (Baroness McIntosh of Hudnall) (Lab)
My Lords, it is a privilege to be the first—I think—to put the question in a virtual Chamber that this Motion be agreed.