Coronavirus: New Cases

Baroness Altmann Excerpts

Monday 11th July 2022 Lords Chamber

[Lord Kamall (Con)]

I am sure the noble Lord will have been in meetings with the devolved Administrations; sometimes they want to go their own way. For example, when we reduced some of the measures in England, the devolved Administrations were sceptical of what we had done. When the data showed that the measures left in place in Scotland were no more effective than us removing some of those restrictions, it demonstrated exactly why, although we talk to the devolved Administrations all the time, we also respect the devolved settlements. We have to agree to disagree at times.

[Baroness Altmann (Con)]

My Lords, does my noble friend agree that we have lived with flu all our lives? I completely agree with his assertion that if this illness is not proving more deadly than illnesses we have lived with for a long time, what would be the purpose of upsetting the economic recovery and causing so much extra cost to the public purse—unless, as he rightly says, serious hospitalisation cases and deaths were to increase suddenly?

[Lord Kamall (Con)]

My noble friend makes a very important point. You always have to look at these things in the round and you have to look at the trade-offs. Many noble Lords will recognise that, when we went into lockdown, there were build-ups in many parts of the NHS backlog and an increase in people suffering from mental health issues—the numbers were even larger than they were before—so clearly, we have to look at this as a trade-off. We have a living with Covid strategy. We constantly get updated by the UKHSA, which is looking at all this data. We are ready to stand up should we need to.

Social Care: Adults

Baroness Altmann Excerpts

Wednesday 22nd June 2022 Lords Chamber

[Lord Kamall (Con)]

Many noble Lords recognise the challenges faced by not just this sector but all sectors, during Covid. One issue we have been looking at for many years, over subsequent Governments—we discussed this during the Health and Care Bill—is that social care was seen as a Cinderella service for many years. For the first time, thanks to noble Lords’ support, we managed to get the Health and Care Bill through to have a properly integrated health and care system. We are also looking at how we can make sure that we properly understand the health and care landscape, with the register and the hub, and that it is a vocation that more people find attractive.

[Baroness Altmann (Con)]

My Lords, I urge my noble friend, in light of the extraordinary number of vacancies in the social care sector—more and more staff are leaving to join other sectors—to urge the Government to revisit the Immigration Rules that do not allow overseas care workers, who could fill those gaps, to come in. We have a special system for agricultural workers; surely my noble friend agrees that we must not put picking fruit and vegetables above the needs of the most vulnerable in our society.

[Lord Kamall (Con)]

I thank my noble friend for the question, but make the point that it is important that we look not only to our domestic workforce but to recruit people from far and wide to fill those gaps. We have always done that. As I often say from this place, we must remember that public services in this country were saved by people from the Commonwealth after the war. They played a very important role in making sure that this country and its public services recovered after the war. On recruitment from overseas, on 15 February, we added care workers to the health and care visa and shortage occupation list, allowing these roles to be recruited from overseas. We hope that will enable us to fill thousands of eligible vacancies.

GP Access

Baroness Altmann Excerpts

Tuesday 7th June 2022 Lords Chamber

[Lord Kamall (Con)]

I thank the noble and gallant Lord for the question. The important point is that sometimes the assessment is done at a local level, sometimes it is done at an overall level and sometimes the department gathers the statistics. As we modernise and digitise the system, a lot more of that information will be able to be processed centrally, so that we can understand where we need to have better planning and to redeploy resources to meet the needs in certain areas.

[Baroness Altmann (Con)]

My Lords, my noble friend mentioned pensions. I urge him to speak to his colleagues in the Treasury about the own goal being created by the pension rules. Doctors are being hit with an annual allowance, but the lifetime allowance is then driving early retirement, with a simple 20-times multiple making it worth while for them to retire in their 50s, as soon as they can, rather than wait for a penal tax charge on a higher pension later.

[Lord Kamall (Con)]

I thank my noble friend for the question. A request I have often had at this Dispatch Box is to go and speak to my colleagues in the Treasury. We understand that early retirements are a key factor impacting GP retention. If you look at the demographics of the workforce, there are people close to retirement age who are saying, “I’m burnt out after Covid, and therefore I want an easier life.” Clearly, the other issue we are looking at is the lifetime allowance. There are some instances where the GPs may be better off staying in, but we have to make that quite clear. There has not yet been communication. We continue to engage with the Treasury on a variety of issues, and I hope to continue doing so.

Health and Care Bill

Baroness Altmann Excerpts

Consideration of Commons amendments
Tuesday 26th April 2022 Lords Chamber

Motion D says that there must be an evaluation of the trailblazer and that assessments can happen as they go along, but there is a big risk to the Government there. If there are problems, which we believe there will be—not least the financial impact on some of the most vulnerable adults in our community—they will not surface until it is too late. Therefore, from these Benches we support Motion D1 and urge the Government, even at this last minute, to reconsider.

[Baroness Altmann (Con)]

My Lords, I follow the noble Baronesses, Lady Brinton and Lady Campbell, and will confine my brief remarks to social care, which I have long worked on. Sadly, the measures in the Bill will not rise to the challenge as required to sort out the social care system in our country.

I accept and congratulate the Government on the concessions that they have made. I am delighted to see Motion C on modern slavery. However, as far as social care is concerned, I would like to understand from my noble friend, on workforce planning, whether private care homes and non-state care home staff will be assessed as to adequacy. At the moment, there are horrendous staff shortages, and the current immigration policy does not seem to include carers—an essential element of the workforce—because of the pay structures. If he could explain what the social care workforce elements of the Government’s proposals are for the non-state social care sector, I would be most grateful.

I am not planning to vote against the Government on Motion D1, but I am afraid that I cannot support them. I put on record that I agree with everything that has been said about the Government’s changes to the social care cap. I believe that the measures are regressive; they will damage the least well off—or the lower end of the middle range of people, shall we say. They may be better than the current system, but they are not a solution and are not satisfactory. We will end up having to revisit the support for social care. Having said that, and in view of the fact that this is financial privilege, I will not vote against the Government on Motion D1.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I rise very briefly to offer Green support for both Motions A1 and D1. Motion D1 has already been very amply covered, most notably by the noble Baroness, Lady Campbell of Surbiton, so I will just address my remarks to Motion A1.

I know that many Members of your Lordships’ House feel as though we do not want to be political about things—I might have thoughts about that—but this is not a political amendment at all. As the noble Baroness, Lady Merron, said, more than 100 of our major healthcare organisations have expressed support for this workforce planning approach. Just a couple of hours ago, and this addresses your Lordships’ House directly, the British Heart Foundation put out a press release saying that, without this amendment, it is

“unclear how ambitious targets laid out in the Elective Recovery Plan and other NHS delivery plans can be met.”

The chief executive said that

“the Government has missed an open goal by failing … to address the workforce shortage”.

In addition, just yesterday the King’s Fund put out a report saying that the Government—they can welcome this—are “on track” to meet their target of “50,000 extra nurses” by 2024. However, the King’s Fund points out that the level of vacancies is still the same as it was when that promise was made. Just plucking figures out of the air and going, “Hey, we’ve got this great figure”, is not enough; we need to plan for the future. That is why this amendment is absolutely crucial for our NHS.

Health and Care Bill

Baroness Altmann Excerpts

Lords Hansard - Part 1 & Report stage
Monday 7th March 2022 Lords Chamber

I am afraid that we are on the wrong course here and getting out of it will not be easy. However, this is a weight of public expenditure that is ill directed, aimed at—and indeed entirely benefiting—the better-off half of the population, and which does nothing for the worse-off half of the population, who, most of all, need better care. It is misconceived policy in today’s circumstances and I hope that the amendments, apart from my own, will not carry.

[Baroness Altmann (Con)]

My Lords, I rise briefly to support Amendment 141, which I would have added my name to had my noble friend Lord Lansley not done so himself. As he is not here, from these Benches I add my support for the deletion of Clause 155. As an adviser to the Dilnot commission at the time—around 2011—I believe it runs directly counter to the aims of the cap, which had such strong cross-party support. I am sorry to say to my noble friend that I struggle to understand the Government’s concept of fairness in this regard when Clause 155 imposes much greater losses of wealth on the least well off and forces longer waits on them while those with significantly more assets lose only a small proportion of their wealth before state funding starts.

I support Amendment 141. I hope my noble friend will either be able to accept it or that the other place will have a chance to consider this unfair change, which was added at the last moment without giving Members there an opportunity to do so.

[Baroness Greengross (CB)]

My Lords, I am in favour of deleting Clause 155, as proposed by the noble Baronesses, Lady Wheeler, Lady Brinton and Lady Campbell. I will also speak to my Amendment 182, which would lower the social care cap to £51,000 from 2023. I will not be putting my Amendment 182 to a Division but I feel that it is important to bring it back on Report as this would be the level of the cap recommended by the 2011 Dilnot report, then adjusted for care cost inflation. I understand that the Government’s cap of £86,000 is based on the increase in property values since the Dilnot report was published—can the Minister please confirm that? If so, was this for properties throughout the country and does it factor in that, while property values in London have increased significantly over the last decade, in many parts of the country they simply have not? Can the Minister please explain how the Government came up with that figure?

Clause 155 is a break with what is currently in the Care Act, which would mean that means-tested support does not count for an individual’s progress towards the social care cost cap. According to analysis from the Institute for Fiscal Studies, with Clause 155, someone with that care need who has an annual income of £16,000 and assets of £100,000 would take almost six and a half years to reach the cap, whereas without Clause 155 the cap would be reached after three to four years. I declare my interest as set out in the register as co-chair of the All-Party Parliamentary Group on Dementia. For many people with long-lasting forms of dementia who require many years of care, Clause 155 will disadvantage them considerably.

I will be voting to delete Clause 155 and for the Government to return to the sound and sensible recommendations from the 2011 Dilnot report, with numbers adjusted for inflation, and implement them.

Personal Protective Equipment: Accounting

Baroness Altmann Excerpts

Wednesday 2nd February 2022 Lords Chamber

[Baroness Altmann (Con)]

My Lords, it is understandable that in an emergency, huge amounts of taxpayers’ money may need to be written off for contracts that were not viable. I commend the Government on all they have done for the pandemic, but would my noble friend agree with me that, given that this was an emergency, and given where we are on the cost-of-living crisis, it would perhaps benefit the Government to rethink the national insurance increase that is coming in April, as the cost-of-living crisis itself is an emergency?

[Lord Kamall (Con)]

If you consider how quickly the Government, and all of us, had to act during the early days of the pandemic, it was clearly an emergency. Lives were being lost. This is a stab in the dark, but maybe some noble Lords read a newspaper called the Guardian. One of its headlines from April 2020 read:

“Hospital leaders hit out at government as PPE shortage row escalates”.


Everyone knew that it was essential to get hold of as much PPE as you could in an incredibly challenging market.

Health and Care Bill

Baroness Altmann Excerpts

Lords Hansard - Part 1 & Committee stage
Monday 31st January 2022 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I strongly support this group of amendments. I particularly endorse Amendment 269 regarding young carers, which was spoken to so compellingly by the noble Lord, Lord Young.

I wish to speak primarily about Amendment 221, to which my name is attached. It is about protecting existing rights of carers. I know that the point has already been made, but it is worth repeating. Amendment 221 would retain existing rights being taken away by this Bill as it repeals the Community Care (Delayed Discharges etc.) Act 2003. I find that a pretty extraordinary position to be in.

I want briefly to focus on the impact of caring particularly on women and employment, without in any way wishing to diminish the very important role played by male carers within the family. It is just a fact that women are more likely than men to be carers. According to some research conducted by Carers UK with the Universities of Sheffield and Birmingham, women have a good chance of becoming carers 11 years before men. Women are also more likely to reduce their working hours in order to care, and they are more likely as a result to have lower incomes and end up under-pensioned in retirement.

As we have heard, hospital discharge can be a pivotal moment for people providing care, particularly women. This amendment would ensure that assumptions are not made about carers’ ability to care, even when they may be working at the same time, that a solution is discussed and, ideally, agreed between families and services, and that carers are provided with the support they need to enable them to care safely and well. For those carers who are juggling work and care, which I can relate to personally, it is essential that their health and well-being are supported. This also has a positive benefit for employers. During the pandemic, the Carers UK research already referred to found an increase of around 2.8 million in the number of people who were juggling work and care, the majority of whom were women. Prior to the pandemic, some 600 carers a day were giving up work to care. During the pandemic, as the noble Baroness, Lady Pitkeathley, reminded us, carers have become the backbone of the care system, protecting the NHS and social care in many cases from collapse.

The Carers UK research also found that 72% of carers providing substantial care and working were worried about continuing to juggle care and work, and 77% of carers said that they felt tired all the time at work because of their caring responsibilities. During the pandemic, 23% of working-age carers providing substantial care had given up work, lost their jobs, lowered working hours or lost income if they were self-employed.

As the NHS works to reduce the backlog of care, hospital discharges will become ever more critical, as will support for carers. The two go hand in hand, and we must not fail those who have so selflessly shouldered such a heavy load.

[Baroness Altmann (Con)]

My Lords, I shall speak to all the amendments in this group, but I have added my name to Amendment 217 in the name of the noble Baroness, Lady Wheeler. There are two separate but related issues in this group of amendments, and it might be helpful for a moment to focus on them. The first is the needs of patients who are facing discharge from hospital. The second is the needs of unpaid carers in situations where patients are sent home from hospital. That second issue is covered particularly by Amendments 219, 221, 225 and 269. I support all of them, and commend the work and the words of the noble Baroness, Lady Pitkeathley, and the passionate speech from my noble friend Lord Young.

I wholeheartedly share the concerns about the repeal of the provisions in the Care Act 2014. The issue of patients needing to be discharged from hospital sometimes seems to be spoken of as if we are discussing objects rather than people.

Respiratory Viruses

Baroness Altmann Excerpts

Tuesday 11th January 2022 Lords Chamber

[Lord Kamall (Con)]

The Government have put in place a range of measures to protect children from RSV this winter, including expanding the passive immunisation programme for all at-risk infants, ensuring that the NHS has surge plans in place to respond to any increasing cases, raising awareness among parents and at schools of the symptoms of RSV and when to seek medical help, and increasing our out-of-season surveillance capacity.

[Baroness Altmann (Con)]

My Lords, given that the elderly are more susceptible to respiratory viruses in the cold, and given the number of excess winter deaths we have already seen in recent years, the reduction in the earnings link for the triple lock and the lack of availability of any increase in the cold weather support for older people, will my noble friend consider whether the Government might introduce any emergency measures to help pensioners keep warm through the winter?

[Lord Kamall (Con)]

My noble friend makes a very important point that during the winter people quite often need some help and assistance with winter fuel and other issues. For RSV and influenza, this winter we have had the continued offer of vaccination for 50 to 64 year-olds for the first time, and to additional cohorts. By 19 December, 82% of people aged 65 years and over and 48% of people under 65 years in risk groups had received a flu vaccine.

Health and Care Bill

Baroness Altmann Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Baroness Altmann (Con)]

My Lords, I too congratulate the noble Lord, Lord Stevens, on his excellent maiden speech. I am delighted that he has joined the House, with all his many years of expertise in this area. I look forward to his contributions at future stages of the Bill.

In the time available, I will focus on issues relevant to elderly social care. Some 10 million adults are affected by care needs. Some are short term and others very long term, but over the next 20 years the number of people over the age of 85 will rise from 1.4 million to 2.4 million. Estimates suggest that about 44% of the over-65s already have some form of disability. Clearly, the costs of delivering social care and the amount spent on it in our society will significantly increase.

Council expenditure on care is already over £20 billion a year, with around half of that on the over-65s. But this is almost the same in real terms as it was in 2010. What has happened is that councils are increasingly rationing care, and unmet care needs, especially among the elderly, are rising inexorably. The funding is starting from an exceptionally low base. Much more attention needs to be given to delivering social care.

There are welcome points in the Bill. I welcome the intention to provide a care and support plan to arrange services in order to help people live independently and to prevent or delay the need for care, and the recognition that it is best if people can stay in their own homes. I also welcome the new CQC duties to independently review and assess local authority performance in delivering what the 2014 Act was designed to deliver, which we still have not yet successfully done.

I echo the points other noble Lords made about the need to invest in the workforce, and the fears. What is the Government’s plan to ensure additional workforce capability and capacity now? I fear that we have had a couple of unforced errors—mandatory vaccination for care home staff before it is required in the NHS, and new immigration controls that mean we cannot get staff in from overseas. The pay for social care workers, for whom there is already a 30% turnover rate across the sector, especially front-line staff, is now lower than for shop assistants or cleaning staff, who have better working conditions. I would welcome the Government’s estimate of the number of care staff needed and how they plan to deliver those.

I welcome the extension of prevention measures and the focus on commissioning, with the CQC overseeing the payment of fair rates for care, but I note that the Government continually say that they intend to move towards the local authority paying a fair rate to cover costs. In 2017, the CMA estimated that self-funders pay an extra 41% to cross-subsidise the underpayments by those funded by the councils. Do the Government have an estimate of when councils will actually pay enough to cover the costs, so that we do not put extra burdens on the very people who need care and are funding it themselves?

Regarding the care cap, £86,000 is not a cap on the amount people need to pay for care. Clause 140 has made the inequity even worse. With a fixed cap, those of more modest wealth will inevitably lose far more as a proportion of their assets than people who are much wealthier or who live in areas with higher property values. I hope the Government will pay close attention to the needs of elderly people who do not yet receive care, and the unpaid carers who will look after them, often at the expense of their own health.

Health Protection (Coronavirus, Wearing of Face Coverings) (England) Regulations 2021

Baroness Altmann Excerpts

Wednesday 1st December 2021 Lords Chamber

[Baroness Blower (Lab)]

My Lords, like the noble Baroness, Lady Noakes, I like to spend an evening at the Royal Opera House. In fact, I have been a couple of times in the past three weeks and noticed from where I was sitting that enormous numbers of people were wearing masks—including one John Major, sitting just in front of me. I cannot see that there is any problem with sitting in the Royal Opera House and wearing a mask. In the area where I sat, there was very high compliance. It is not even just that there have been these announcements. The fact is that there was an announcement from Antonio Pappano every evening before the performance, encouraging people to wear masks. My own view is that it would have been much better if we had never stopped people wearing masks. We would not then have to start every time from a lower base to encourage people to take it up. The noble Lord, Lord Robathan, said that it may have stopped transmission on some occasions. Is that not good? That is what we want to happen.

My second point is about schools. The fact is that schools are not generally well-ventilated buildings. My daughter is a year 4 primary schoolteacher and, for the whole of last year, she had to teach with the windows open. This year, they have come back and again had to do so. It is not easy for a child to learn in a very cold classroom where they have to wear their coats, hats and gloves. It would be so much better if we had managed to get in a programme to bring in ventilation or some kind of air filtration scheme. Although there was a big concern about whether young people would be oppositional to the idea of wearing masks, people I know who are teachers—I do know a great many of them—have found that when you have the discussion with young people, they absolutely understand why it is important to wear masks: it is about protecting themselves, each other and their grandparents, who they may see out of school.

While a great number of things have been done too slowly, the reinstitution of wearing masks has been done in a speedy way. I hope it will continue beyond 20 December.

[Baroness Altmann (Con)]

My Lords, on a personal level, I do not have a problem with wearing a mask. I understand that the Government are in a difficult position, because they are almost damned if they do and damned if they do not on issues of this nature. My concern is that we started off following the science but now seem to be anticipating what the science might show, in the absence of evidence that this omicron variant is any more deadly than previous variants. We seem to be ignoring the fact that, unlike when delta started, so much of the population is now vaccinated; they are therefore protected. The Government should be given enormous credit for the vaccination programme and the booster programme.

Looking at the evidence from the delta variant, as the virus progressed it became much more contagious, as all viruses tend to, but it was much less deadly. The people for whom it was particularly dangerous were those who were unvaccinated. Since we have given everybody who could have an opportunity to be vaccinated the chance to do so, and that some people have—for reasons that they know best—refused to accept the vaccine, it seems there are implications for the wider public in continuing to try to protect those people. I recognise that there are clinically vulnerable people who cannot be vaccinated, which is an issue in itself. But I am seriously concerned about wider society, particularly as the self-isolation rules will not run out until next March and have a psychologically damaging impact on society. They frighten the public and could cause, I believe, significantly higher numbers of deaths from loneliness, mental ill-health and illnesses such as cancer, which the public may be too frightened to see their doctor about, or for which GPs may now again say that they cannot see people face to face, and therefore miss the symptoms.

I hope that this mask-wearing SI will be lifted at the end of the three weeks. We need to trust the public. I agree that we need to help people understand the risks and that they need to consider them, but it is perfectly valid for people to decide that they do not consider the risks too large to stop them seeing friends and family. I have significant concerns about mandating and fining them for not doing things, when we do not have evidence to suggest those are as damaging to the public as we previously considered them to be.

[Baroness Tyler of Enfield (LD)]

My Lords, I would like to make a few comments about the mask-wearing regulations, which I strongly support while feeling that wearing masks should never have been abandoned in England. It is with great sadness that I have to tell the noble Lord, Lord Robathan, that at exactly this time last year I attended the funeral of a friend of mine, the exact same age as me, who died from Covid. I wonder what the families of the over 1,000 people dying from Covid each week would think if they were listening to our debate now.

The questions I would like to ask the Minister are primarily about compliance and enforcement. When I got on the Tube yesterday, it was clear to me that the message had not got across to quite a few people. I was concerned that there was no one standing at the Tube station to point out to people that it was now a legal requirement and that there were no notices making it clear that that was so, rather than a condition of passage. Those things are different. Can the Minister please explain the responsibilities for enforcement, particularly on public transport, as between, for example, Transport for London staff and the police or transport police?

It is going to be hard to get the messaging back on track after people have been told that they did not need to wear masks; now they are being told they need to again. There is a good reason for it but the bit I have not heard so far in the debate today is that mask-wearing is primarily about protecting other people. Yes, I believe scientific evidence says that it confers a degree of protection on the wearer but it is primarily about protecting others—and we do not know the medical vulnerabilities and risks of the people we sit next to, be it in this Chamber or on public transport. That is the main reason I feel mask-wearing should never have been abandoned.

I also want to ask the Minister about people who genuinely have medical exemptions. Clearly, there are people who do. Yesterday on the Tube, I was standing next to a lady who was wearing a green lanyard and a badge; personally, I found that very helpful. She was making it clear that she was exempt. To help with the compliance issue at the moment, what plans might the Government have to encourage people who are genuinely medically exempt to have badges, lanyards or exemption cards, or something like that? However, it was clear to me that a number of people not wearing masks on the Tube, yesterday and today, were certainly not genuinely exempt.