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.

Covid-19: Plan B

Baroness Altmann Excerpts

Wednesday 20th October 2021 Lords Chamber

[Lord Kamall (Con)]

I am not sure I agree with the noble Baroness on the figure she cites; I will double-check and write to her. On the triggers, it is clear that we have to look at a range of factors before deciding whether to move to plan B.

[Baroness Altmann (Con)]

My Lords, clearly these are very difficult issues, but can my noble friend help the House—if not today then in writing—by explaining some of the statistics being used to judge what is happening with Covid right now? For example, the use of a Covid-positive test within 28 days of death is not necessarily indicative of what is happening, and the vaccine programme seems to have ensured that those who are seriously ill or sadly dying of Covid are those who are not vaccinated or have serious underlying other conditions—in which case, the statistics may be misleading us somewhat.

Covid-19

Baroness Altmann Excerpts

Wednesday 21st July 2021 Lords Chamber

[Lord Bethell (Con) [V]]

My Lords, this is the clinical advice given to us by clinicians. I cannot answer the whole question in the round in this brief session, but a number of considerations include not only that vaccines offer a significantly reduced rate of infection but that the level of infection is much lower, the viral load is much lower, and therefore the infectiousness is much lower. The aggregate effect is that a group of people who have been vaccinated, with a few who have the disease, is less infectious than a group of people who have been tested, however good the test.

[Baroness Altmann (Con)]

My Lords, I echo the words of appreciation for my noble friends Lady Penn and Lord Bethell and congratulate them on all the work they have been doing. I also want wholeheartedly to support the aims of the policy that we have now, with so-called freedom. Indeed, I encourage the Government to consider going even further. This is about managing risk, not just of Covid but of all other illnesses, so I have to ask, having listened to this debate, when will be the right time? If all the most vulnerable and two-thirds of all adults are vaccinated, and if the mass numbers of infections do not lead to mass hospitalisations and deaths, and if zero Covid is unachievable, when will we learn to live with the virus and stop government interference with individual citizens’ lives in the way that has been, in my view, so frightening over the last period?

[Lord Bethell (Con) [V]]

I am grateful for my noble friend’s kind remarks. Her question is extremely complex, and difficult to answer briefly but I will rest on one particular answer. As I said before, this is a question of getting the disease transmission to a point where R is below one. If that can be done on a national basis, we have contained the disease. We can then turn to local outbreak management. That is when test and trace resources will come into their own and local deployment will make a big difference. That is when we can consider the virus to have been beaten. We are not quite there yet, but vaccination rates are incredibly impressive and I am hopeful that we are near to that point.

Elderly Social Care (Insurance) Bill [HL]

Baroness Altmann Excerpts

2nd reading
Friday 16th July 2021 Lords Chamber

[Baroness Altmann (Con) [V]]

My Lords, I am grateful to my noble friend Lord Lilley for introducing this Bill, and he is absolutely right that social care is in crisis and that successive Governments have ducked the difficult decisions. But the heart of this crisis, as others have said, is not the worries about selling homes. The origins of this issue are, first, the artificial distinction between what counts as NHS care and what is called social care, and, secondly, the demographics of our ageing population, which we have not prepared for. This is not really like home or motor insurance, so I find it difficult to relate to the figures that my noble friend used to illustrate his scheme.

The proportion of people needing care for their everyday living is potentially one in two of every couple, and that makes the cost of insurance so prohibitive. Private insurance cannot be an option when you have a 50% or even a 30% probability of needing to call on the insurance, and possibly needing to spend tens of thousands of pounds for insurance against something that you may or may not experience.

My noble friend is right that we need social care insurance and that it needs to be run by the state. However, we already have social care insurance, only we do not call it that. We are artificially assessing illnesses such as cancer as being worthy of NHS free care, while others, such as dementia, get no payment and are excluded. But the National Health Service is about care. That is why what we really need is to incorporate social care into the NHS, providing free care for all citizens who are not well enough to live without assistance, funded by a national social care insurance premium, which would take the NHS and social care together outside the so-called tax system, but with its own national contribution from everybody’s income, so that everybody contributes.

I believe that if Beveridge were designing our welfare state now, he would include what we currently call elderly care needs in both the state pension system, where no provision is made for the cost of needing support in later life, and in the NHS. Life expectancy has increased; that is great news. Medical advances help keep people alive longer; that is great news. But at the moment, our system does not adequately support the rising numbers of elderly people who need care and are being refused.

Women’s Health Outcomes

Baroness Altmann Excerpts

Thursday 8th July 2021 Lords Chamber

[Baroness Altmann (Con) [V]]

My Lords, recent ONS figures show that there is a gap of more than 20 years in the healthy life expectancy of women between the least and most wealthy parts of the country. For men, the gap is around 15 years. In the most deprived parts of the country, women will only stay healthy to just over age 50, while for the best-off areas it is around age 70 or a little above. Women are also more prone to poverty, financial insecurity, interrupted and low-paid employment, and mental health problems, all of which obviously impact their health outcomes.

Covid-19 risks accelerating women’s health inequalities, for example due to delays in regular screening that are likely to increase the number of women with pelvic and breast cancers detected and diagnosed too late. Also, as the pandemic has placed so much more strain on women in their family roles as carers, whether combining home schooling with home working or caring for elderly loved ones, the added responsibility and loss of wider support that they had previously relied on will all take a toll on women’s health, in both the short and longer term.

I therefore congratulate my noble friend Lady Jenkin on her excellent timing on this debate, and her most brilliant introduction—what a tour de force. In fact, I have been concerned for a time about older women’s health deteriorating since 2010. Cuts to council budgets have led to reductions and delays in social care provision, as well as the removal of preventive measures in many areas such as meals on wheels, day centres and early-stage care support. This obviously poses a risk to the health of older women both directly, because there are more elderly women than men and they are not receiving the care they need, and indirectly because of the added burdens on family carers, who tend to be predominantly daughters and mothers. Social care reform is important for women’s health outcomes and I hope there is an increased recognition of this.

Finally, problems faced by older women in the workplace are troubling. In certain sectors they face more age discrimination at work than men, particularly women who have challenging health issues when they go through menopause. Even though menopause systems tend to affect women’s health only temporarily, the lack of understanding of the impacts too often lead women to either leave work or lose their jobs. There is insufficient appreciation that a change to performance and efficiency, whether due to a lack of sleep after night sweats or hot flushes and hormonal changes that undermine concentration, will not be permanent. Therefore, I hope my noble friend the Minister will address some of these issues of menopause at work that could allow women to return or stay in their jobs. Currently, they are too often leaving work.

Covid-19 Update

Baroness Altmann Excerpts

Tuesday 6th July 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I do not have the figures to hand, but I reassure the noble Baroness that the policy on masks was very diligently imposed and a large number of people did get fined. We have to ask ourselves as a society whether we really want to live in a country where simple behavioural habits, such as wearing a mask or not, make you susceptible to arrest or fines. That is a very uncomfortable place for a country to find itself. The noble Baroness is right: that does introduce ambiguity, but we are sophisticated people and can live with a degree of ambiguity. We need to learn how to live not only with this disease but with each other. The dilemma that the noble Baroness points out is one that we will all have to debate, understand and learn to live with. We are not in any way letting this disease get on top of us. We are fighting it through the vaccine, we are supporting the vaccine with test and trace, and we have a tough borders measure. We are taking the battle to the virus and will continue to do so.

[Baroness Altmann (Con)]

My Lords, I welcome this Statement. As my right honourable friend Sajid Javid says, he is Health Secretary not just Covid secretary. The successful vaccine programme means that we must urgently address the shocking build-up of other health damage, physical and mental. Not opening now would cause more deaths from non-Covid causes. I have two questions for my noble friend. First, will he confirm that the Government recognise that so-called zero Covid is unachievable and we cannot stop people catching it? Secondly, will he provide details of the Government’s winter contingency plans for the NHS and Covid?

[Lord Bethell (Con)]

My Lords, I wish zero Covid was possible. I wish we had never had it at all in this country, but it is a fiendishly clever virus and it gets around the measures we put in place to try to fight it. I can, very sadly, confirm that zero Covid is not something we can plan for in this country. What we can plan for is the winter. I reassure my noble friend that the NHS has extremely thoughtful and diligent plans for the winter. It has a specific winter plan and I would be happy to write to my noble friend with a copy.

Covid-19 Update

Baroness Altmann Excerpts

Tuesday 29th June 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, the noble Lord’s testimony is very moving and I have no doubt that the red-list system has put a lot of pressure on a lot of families. I personally sign off on these exemptions, and every evening as I go through them and read about the stories people have, it breaks my heart—and I do it with huge regret indeed. However, the noble Lord needs to understand that we put the red-list system in place to protect this country. People simply cannot expect to travel in large family groups as if the pandemic had not happened, and they cannot expect the testing system to work as some kind of barrier to infection. We have tried that. It did not work. The proof is absolutely categoric.

If I may be honest with noble Lords, it is likely, unfortunately, that we will have to live with some red-list countries for some time to come. That is one aspect of the unwinding of this pandemic that is not likely to go away very quickly. I completely take on board the noble Lord’s guidance. If he would like to write to me about the specific examples, I would be happy to correspond with him. However, I would not be levelling with him if I did not make it clear that this is something that we are extremely committed to.

[Baroness Altmann (Con)]

My Lords, I welcome my right honourable friend Sajid Javid to his new role and also offer my public endorsement of the integrity of my noble friend the Minister. I echo the words of this Statement that we must learn to live with Covid, so that our country benefits from the fantastic vaccine success. I fear we have lost perspective on real life. Zero Covid and stopping people being ill with just one disease among the myriad diseases around us all our lives are wholly unreasonable—and indeed unattainable —aims. Can my noble friend comment on when we will take more seriously the mental health damage that lockdown and deprivation of freedom to see all our loved ones is causing, and the importance of trusting the British people to decide for themselves who they need to meet and hug and who—as the noble Earl, Lord Clancarty, and my noble friend Lord Cormack said—they feel safe to sing with?

[Lord Bethell (Con)]

My Lords, I hear my noble friend’s comments loud and clear, and I think that we have hit some kind of inflection point where our focus is now much more on the learning-to-live rather than the saving-life dimension. I say that with unbelievable caution, having, as noble Lords know, been through all sorts of rollercoasters of expectation over the past year. I am extremely hopeful that the vaccine has laid out a clear path out of this pandemic. It is one that is fragile, delicate and could be overturned at any point, but, so far, the vaccine has seemed to be extremely durable.

On the mental health of the nation, I completely agree with my noble friend. It has put huge pressure on families, loved ones and communities. There have been positive benefits—my honourable friend Nadine Dorries spoke movingly about that to the Health and Social Care Committee the week before last. Some families in some communities have been drawn closer together— there is good evidence for that—but, for a great many, there has been a huge amount of pressure. I, for one, look forward very much to some lessening of that burden.

Social Care and the Role of Carers

Baroness Altmann Excerpts

Thursday 24th June 2021 Lords Chamber

[Baroness Altmann (Con)]

My Lords, I too congratulate the noble Baroness, Lady Jolly, and echo the thanks for the wonderful work done by carers. Our care system is broken: every part of it is in need of radical change, from the arbitrary distinction between what counts as social care and what qualifies you for NHS healthcare, the healthcare lottery; to the way in which care is provided, the postcode lottery; to the standards applied to the workforce of 1.5 million people, such as social care nurses relative to NHS nurses, an employment lottery; to the lack of funding that has increasingly rationed care; to the draconian means test and funding shortfalls, which force the entire cost of care on to the most vulnerable, who pay not only significant sums for their own care but usually a 20% or 30% surcharge to subsidise council underfunding as well, whereas those who do not need care pay nothing; to the lack of support for unpaid carers; and to the financial fragility of care home operators, who can load their business with debt, extract equity, take rental income to their offshore companies, and have provided handsome profits to hedge funds, which buy and sell their distressed debt.

Each of these parts of the system needs reform, and there is no silver bullet. Extra funding is of course needed, but system redesign is also required. Leaving social care to cash-strapped councils leaves more than 1 million people who need care. The demographics are such that, within the next 10 years, the enormous bulge of baby boomers will start to enter care needs. At the moment, the current cohort is rather small. Social care seems to have been the forgotten front line at the start of the pandemic, and it was used by the NHS as an overflow service, perhaps being considered as part of the private sector rather than part of the health service. If someone has a health problem, however, and they need social care, why should that not qualify for free basic care at the point of need? It could be modelled on the lines of our pension system.

Carers have suffered significantly; unpaid carers have often been taken for granted. They have lost, according to Carers UK, an estimated 25 hours per month of extra support that they would have had before the pandemic from support services, family and friends. I am keen to see how we can better recognise their needs. Will the Minister agree to meet Peers from across the House and Carers UK to learn from the new measures that have brought together for the first time the various parts of our service to help vaccinate carers?

Folic Acid

Baroness Altmann Excerpts

Wednesday 23rd June 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, the noble Baroness is entirely right: medical opinion on this matter has absolutely consolidated around support for it, and the consultation in September 2019 was extremely positive indeed. I am extremely grateful to mill owners, both the large industrial ones, which make a lot of the white flour, and the artisanal mill owners, which had complexities of their own. The engagement with them has been enormously positive, and I cannot see any obstacle on that front. However, there is a machinery of government point that needs to be addressed: we have to work it through the devolved nations and other arm’s-length bodies, and we are doing that at pace.

[Baroness Altmann (Con) [V]]

My Lords, from my noble friend’s responses, the House will be clear that this decision is under way. Could my noble friend give some idea of whether we might expect an announcement before the Summer Recess? We know that hundreds of children being born with spina bifida and anencephaly, which can be so damaging to themselves and their families, could be avoided. The sooner we do this, the sooner we can stop such problems occurring.

[Lord Bethell (Con)]

I agree with my noble friend; she is right that this is a priority. However, it is not within my gift to simply grant a decision on it; it needs to be worked through both industry and government. We are making progress on this. It is a huge national undertaking for us to put substances literally in the bread of the nation. The public deserve to feel confident that that decision has been made thoughtfully and responsibly, and it is entirely right that we take care to dot the “i”s and cross the “t”s.