Covid-19: Social Care

Baroness Keeley Excerpts

Thursday 22nd April 2021 Westminster Hall

[Barbara Keeley (Worsley and Eccles South) (Lab)]

It is a pleasure to speak in this important debate with you in the Chair, Mr Twigg. I congratulate my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes) on securing it and on the way she opened it. It is the first time I have spoken in a Westminster Hall debate in the Boothroyd Room as well.

The covid-19 pandemic has exposed the failings of our social care system. With more than 30,000 deaths of care home residents, the care sector has been hit very hard over the past year. Of course, it is not just care home residents who have died from the virus. We know that people with learning disabilities were around six times more likely to die from covid-19 than the general population. Every single one of those deaths was a tragedy that we must never forget.

Beyond that appalling death toll, there are staff who worked far beyond what would normally be expected of them, many of whom have also been hit hard by the deaths of people they have known for years. There are also care home residents who have been cut off from friends and family for months on end and other care users who have gone without vital support in order to avoid contracting covid.

The Government made the fundamentally flawed decision at the start of the pandemic to allow local authorities to overlook their obligations under the Care Act 2014. While these social care easements were used by only a handful of local authorities, and have now been withdrawn, the reality is that many people using social care saw their services cut back.

Over two thirds of people with learning disabilities reported that they had their care packages cut in the first wave of the pandemic. The vast majority of these will not have lived in areas that implemented Care Act easements, meaning they should not have seen changes to their care packages. As a result, four out of five family carers have been forced to take on more unpaid care for the person with a learning disability. Nearly nine out of 10 people with a learning disability have not had all their social care reinstated, so their family members and carers are still having to increase the care they give.

Where services were still provided, restrictions on visiting often failed to consider the damage that isolation does to people’s wellbeing. I accept that there were times when visiting had to be paused, but the use of blanket bans and maintaining restrictions beyond those imposed on the rest of society left residents isolated and seriously impacted their wellbeing. The issue is exemplified by the current guidance on visits out of care homes, as referred to by my hon. Friend.

The Government have finally relented on allowing the over 65s to go on visits out of their care homes, but they are expected to isolate for two weeks on their return. As I raised with the Secretary of State for Health and Social Care this week, a traveller from Brazil or India must isolate for only 10 days when they arrive in this country. Are we seriously saying that an older person on a visit, who sits outside for an hour or two with a family member who has tested negative, is more of a threat than someone coming from a country that is seeing a hundred times more covid cases than the UK? In addition, as my hon. Friend rightly raised, the issue of residents having to isolate after voting must be sorted out before election day.

Earlier in the pandemic, there was a blanket ban on visiting for people with learning disabilities living in care homes or those living in supported living settings. Many of the people covered by these bans lived alone in their own homes, with carers coming in to support them but, because of the lack of clear guidance, they were told they could not form a support bubble and they could not have visitors. This was disproportionate and it risked creating closed cultures in some services, because neither family members nor Care Quality Commission inspectors were able to visit to monitor the development of any inappropriate practices. At its worst, I heard from the mother of a young person with learning disabilities that the social worker had to ask care staff to bring the young person to the window to prove he was still alive.

I am glad that we have now moved away from the position of blanket bans, but people living in care homes and in supported living settings need a concrete reassurance that they will never again be denied fundamental rights, such as contact with family members. If this means implementing robust testing procedures for some time yet, that is what should happen.

I want to turn to care staff, whose work and commitment have gone above and beyond over the last year, because they deserve better support. As my hon. Friend said in her opening speech, at the start of the pandemic we heard about care home staff leaving their families to move into care homes full time, so they could ensure they did not unwittingly bring in the virus. Care staff also took on additional roles, because NHS staff switched to online consultations or were unable to visit due to ongoing covid outbreaks. Much of what care staff did was involved with end-of-life care.

The Select Committee on Health and Social Care heard from one member of care staff who told us this:

“We have done things that are on a par with other medical professions…we have a duty to care, and we do the job for a reason.”

If the crisis of the pandemic showed us anything, it was that without the hard work and commitment of care staff our care system simply would not work. We must remember the 470 social care staff who died from covid, including Jane Rowbotham, a care home manager in my constituency. Despite all that, care staff remain chronically underpaid and undervalued, with poor recruitment and retention rates. There is, rightly, outrage at the idea that NHS staff will get a real-terms pay cut this year, but most care staff will not get any rise either. The reality is that most of them will be asked to accept a pay freeze, at best, despite rising workloads and all the additional responsibilities.

There are 112,000 care job vacancies, and the turnover rate is 30%: those workforce issues cannot be allowed to continue indefinitely. Without extra funding, care providers are not in a place to provide extra support to their staff. Since the start of the pandemic they have taken on extra costs, from extra PPE to deep cleaning, while there has been a drastic decline in the number of care home residents. They were struggling to make ends meet before, and the additional funding provided by the Government simply has not been sufficient to meet their needs.

The Local Government Association estimates that adult social care services have faced additional costs of £6.6 billion in tackling the pandemic, with PPE alone costing more than £4 billion. The National Audit Office has reported that many local authorities will have to rely on reserves to balance their budgets this year, and there is little confidence about the setting of budgets beyond that, to meet needs that have increased during the pandemic.

It is clear that since the emergence of the virus last year, the social care sector has often been overlooked by the Government. Ministers claim to have put a protective ring around care homes at the same time as hospitals were actively discharging covid patients into care homes, without testing them. Care homes, in turn, were not resourced for the measures that they needed to control an outbreak. Residents have gone without contact with their friends and families because of limits on visits, which still involve a longer quarantine period for a care home resident who spends an hour sitting outside with a family member than there is for an international traveller coming back from a red-list country. Staff who have done so much to keep the care system going are rewarded only with the offer of a CARE badge. There is no pay rise or bonus as offered to care staff by the Welsh Labour Government.

All that is not good enough. When the Minister responds to the debate, I hope that we shall get more than warm words for social care. We need solid commitments. The pandemic has to be a turning point in the way we treat care staff. In the past year we have all seen that the work done by care staff—whether in a care home, providing domiciliary care, or in supported living—is every bit as important as the work done by NHS staff. It is time for social care staff to have parity of esteem with NHS staff, and for a workforce strategy for social care that has better pay, conditions and training for the staff who have given so much. It is way past time for the Government to take action to fix social care funding as they have promised to do repeatedly in the past 10 years.

--- Later in debate ---

[The Minister for Care (Helen Whately)]

I will do so. It is a pleasure to serve under your chairmanship, Mr Twigg. I wish the shadow Minister’s mother a happy birthday today.

I thank the hon. Member for Dulwich and West Norwood (Helen Hayes) and my right hon. Friend the Member for Ashford (Damian Green) for securing this debate on social care and covid and for the work they do as co-chairs of the APPG on adult social care, bringing the sector together and being a voice for it in Parliament and beyond.

As the hon. Lady and my right hon. Friend said—as, in fact, all speakers today have said, and as we all know —the pandemic has been cruel to those who receive social care, especially those living in care homes around the world, here in the UK, and indeed in England. Sadly, both residents and care staff have lost their lives, and each one will be missed by friends, family, and those who love them. I thank those working in social care—staff in care homes, home care workers, those supporting people in extra care and supported living, personal assistants, social workers, and millions of unpaid carers as well—for all they have done during the pandemic, and are continuing to do now, to care for those who rely on their care and could not live without it.

Members have spoken about the many challenges the sector has faced during the pandemic. I want to outline some of the things that the Government have done to support social care, with a level of intervention—a level of support—that is unprecedented for social care, and rightly so in the circumstances of the pandemic. First, the hon. Member for Dulwich and West Norwood spoke about the extra costs that social care has faced during the pandemic. We have put in £1.8 billion of specific, ring-fenced covid funding for social care during the pandemic, including £1.3 billion for infection control measures, and providers have told me what a huge difference this support has made to them and how essential it has been all the way through the pandemic.

Secondly, the Government have stepped in to provide PPE to the social care sector, and PPE has been available free for many months via a portal to meet the covid needs of social care providers on demand. Over 2 billion items of PPE have been supplied to the social care sector, and the Government have committed to continue PPE supply through to March 2022.

Thirdly, social care has been prioritised as our testing volumes have increased. Last summer, we introduced weekly polymerase chain reaction testing for care home staff, and since December, that has been supplemented by twice-weekly lateral flow device tests. That has made a difference, because we can not only quickly identify when a staff member may be covid positive but, through the introduction of the LFD tests, we are able to identify whether a member of staff is covid positive before they set foot in the care home. During this time, we have sent out over 28 million PCR tests and 47 million LFD tests to the social care sector across care homes, home care, supported living, and other parts of the sector. We have also made rapid tests available to visitors, supported by £288 million of funding for the staff costs involved in that testing, to help people see loved ones. I will say more about visiting in a moment.

Fourthly, many hon. Members have spoken about the impact of the pandemic on the social care workforce. Again, we cannot thank care workers enough for what they have done, and how they have gone the extra mile time and again. Through the virtual visits I have made to care homes and the conversations I have had, I have seen what staff have done, particularly to step in and support residents at a time when visiting has been restricted.

I also know the difficult experiences that some care workers have been through. We have specifically advised care providers to use some of the funding for paid sick leave for social care staff who have had to isolate due to covid. We have also put in place mental health support for the social care workforce, seeking as far as we can to mirror the mental health support offer to NHS staff, and we will continue to see how we can support staff through the mental health impacts of the pandemic.

As hon. Members have said, we know that there are workforce shortages within social care, and at times covid has made that harder, with staff rightly taking time to isolate. Recognising that, we provided £120 million of funding for the workforce capacity fund, which was passed to local authorities to boost staffing for the sector during the second wave.

To increase the voice of the social care sector and to give further leadership—particularly clinical leadership—to the social care workforce, we appointed the fantastic Deborah Sturdy as the chief nurse for social care. She is already doing brilliant work with the sector and the workforce, and contributing to plans for the workforce of the future.

To increase our understanding of the social care situation on the ground, we created a social care data dashboard as a single point of information for the system. We came into the pandemic with relatively small amounts of timely data about social care; as hon. Members know, it is a highly fragmented system, with over 25,000 different providers. We have built a way of having up-to-date information and self-reported data from providers, which has given us truly valuable information to which local authorities also have access. It gives a good sense of what has been happening on the ground.

We have also established a regional assurance team for social care, as this is now the Department of Health and Social Care. They are a group of people with great experience in the sector who have been able to reach out during the pandemic, working with local authorities, directors of public health, providers and others, to understand some of the challenges being faced and provide more localised support.

On visiting, on many occasions we have developed an iterated visiting guidance, responding to requests from the sector for a steer on how to manage the challenge of wanting people in care homes to be visited while acknowledging the risks to residents of more people coming through the door. We have drawn a huge amount of clinical guidance from the deputy chief medical officer of Public Health England on how we can enable safe visiting. Clearly, we have substantial caution because we know the great risks to care home residents when covid gets in and how difficult it is to stop an outbreak from spreading through a care home, even with the PPE, the testing and the other things I have outlined. One reason why we introduced visitor testing was to reduce that risk.

Since 12 April, care homes have been able to open up to two visitors, and the essential care giver scheme addresses particular need. I look forward to care homes being able to continue to open up, step by step, through the combination of lower infection rates and vaccination, to enable people to once again spend much more time with their loved ones.

Several hon. Members spoke about visits out. I recognise the importance of both having visitors at care homes and being able to leave—to go out and about. This applies to older people, but particularly to families who have relatives of working age in residential settings, who I have spoken to. Often, somebody of working age might come out every weekend to spend time with their mum and dad, and their family. Clearly, they have not been able to do that during the pandemic.

I ask other hon. Members with an interest in this subject to listen to the Joint Committee on Human Rights sitting held yesterday, when I was asked about this. With me was Dr Éamonn O’Moore from Public Health England, who explained in some detail, which we do not have time for today, the reason for the caution around visiting out and the clinical reasons for the requirement to isolate for 14 days on return. To respond to the hon. Member for Worsley and Eccles South, I should say that that is not the same as somebody coming from overseas to the UK and quarantining, because of the particular circumstances within care homes. There may be people who are very vulnerable. In the event that someone brings covid into the care home, that can lead to an outbreak, which can lead, sadly, to people dying. Therefore, rightly, the issue is taken seriously.

I assure colleagues that, as Dr O’Moore said to the Health and Social Care Committee yesterday, I have asked Public Health England to provide advice on how to make more visits possible—particularly those with lower risk, such as those outdoors—and on what could be done to reduce quarantine requirements afterwards. I am mindful of the May elections and of those who might want to vote in person.

My right hon. Friend the Member for Ashford rightly said that vaccines are the answer to allowing more visiting and for much of life to come back to normal, for those who receive social care. We prioritised the social care sector for vaccinations—and particularly care homes, who were top of the list. The vaccine was offered to all care homes by the end of January, on time. Soon, all residents who can be vaccinated will have been offered their second dose.

The impact of vaccination is already being seen, with the rates of covid coming right down in care homes. There are still some outbreaks and I would caution those listening to the debate that the vaccine is not 100% effective. Many residents have had their second dose but others are still only on their first, and it is important in that situation that the precautions continue. For instance, we are continuing to urge care homes to make sure that staff use PPE and infection control measures, even when everyone has been vaccinated. However, there are far fewer outbreaks and the consequences are much less serious. I want to use this opportunity to thank the NHS vaccination teams, and the social care workforce, who have been involved in the tremendous and lifesaving effort to vaccinate so many thousands of people in social care.

Many hon. Members spoke about the importance of reform, and how the pandemic has shone a light on the social care sector and the need for reform. I truly welcome the support for reform among hon. Members who have taken part in the debate in this room and virtually. Some steps have begun, and I urge the hon. Member for Dulwich and West Norwood to look again at some of the social care content in the health and social care White Paper, including the voice of social care in integrated care systems—and I agree with the point made by my right hon. Friend the Member for Ashford that it is not just about a local authority voice, but the wider sector.

The White Paper also proposes the introduction of a new oversight and assurance system for social care, which I see as an important part of building on the experiences of the pandemic, to give us more oversight and the ability to drive quality and outcomes more strongly for those who receive social care. It also includes steps to support better use of data and data sharing for social care.

Those things are, however, just the beginning and we need to go further. We have committed to go further and to publishing a long-term plan for social care this year.

[Barbara Keeley]

As the Minister is talking about the White Paper, I wanted to point out that we have talked quite a lot about unpaid carers in the debate, but they are not mentioned once in the White Paper. Carers’ organisations took that in a bad way and felt that all the efforts that unpaid carers put in during the pandemic were not recognised at all. The Minister and the Health Secretary need to address that.

[Helen Whately]

The hon. Member makes a really important point, and I really appreciate how she has spoken about unpaid carers during this debate. I absolutely recognise the crucial role of unpaid carers, the things that unpaid carers do and the demands on and challenges for unpaid carers during the pandemic. I absolutely see unpaid carers as part of the breadth of the social care system that we must consider for the reforms as we go forward.

I very much welcomed the expertise, in the room and virtually, on social care reform. My right hon. Friend the Member for Ashford reminded us that the reform debate has been going on for nearly 25 years. He has extremely valuable experience. My hon. Friend the Member for Ruislip, Northwood and Pinner (David Simmonds) has great experience from local government and flagged the work of Sir Paul Carter, whom I know because he is the former leader of Kent County Council and I am a Kent MP. I will indeed be looking at the work that my hon. Friend mentioned. My hon. Friend the Member for Somerton and Frome (David Warburton) called for a social care workforce strategy. Yes, absolutely, as part of the reform work, we need and plan to bring forward a strategy for the social care workforce.

I am conscious of the time and so that is probably as far as I can go today, but broadly, I truly welcome the support for social care reform expressed during this debate. I assure those in the room and all those listening to the debate that we are determined to seize this moment. We have supported social care at an unprecedented level during the pandemic; on the back of that, we are determined to bring forward the reform that we know social care needs.