Health Protection (Coronavirus, Restrictions) (England) (No. 3) Regulations 2020

Baroness Altmann Excerpts

Thursday 3rd September 2020 Lords Chamber

[Baroness Altmann (Con)]

My Lords, I congratulate the Minister on laying these regulations, his explanation for them and all his hard work in connection with the current emergency. I support the idea that the Government should not impose more nationwide controls, and the Minister’s words about people needing to get on with their lives as much as possible around the country. Targeted local measures to manage health locally are vital.

However, I echo concerns about these regulations being debated only weeks after they came into force. I am also concerned that we do not have adequate localised testing and that results from testing, where it is done, are received with such delay in too many cases. The consequence of that makes it very difficult for local authorities, or indeed the national authorities, to understand the serious and imminent threat to public health from Covid-19 and what measures are necessary and proportionate to protect public health. These very blunt instruments are all that we have at the moment. I hope that we will improve the ability to track and trace local outbreaks in the coming weeks.

The idea of using flu jab appointments as an opportunity for widespread testing is an excellent one, and freeing up local authorities to do some testing rather than being straitjacketed into a national system would encourage local authorities to use whatever local facilities are available to them to serve their local population as best they can in tracing and testing.

Health Protection (Coronavirus, Restrictions) (No. 2) (England) Regulations 2020

Baroness Altmann Excerpts

Friday 24th July 2020 Lords Chamber

[Baroness Altmann (Con) [V]]

My Lords, I echo other noble Lords: these regulations seem to make a mockery of parliamentary scrutiny. I also express my deep concern at the level of micromanagement of people’s everyday lives that they have represented. Can my noble friend comment on the implications for our western liberal democracies of constant government diktats about whom people can see, which family members they can hug and how they must live?

Does a plastic visor that covers the nose, mouth and eyes, while allowing the person’s face to be seen, fulfil the requirements of these regulations? Finally, will my noble friend ensure that the needs of young adults with disabilities, including autism, who live in care settings but are not especially vulnerable to Covid, are fully considered?

National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2020

Baroness Altmann Excerpts

Monday 8th June 2020 Lords Chamber

[Baroness Altmann (Con) [V]]

My Lords, I welcome the opportunity to debate the social care sector, and I welcome the increase in rates that the NHS and CCG commissioning authorities will pay for nursing care. I congratulate the noble Lord, Lord Hunt, and echo some of his comments about the sector. What assessment have the Government made of the financial stability of firms promising to house the most vulnerable elderly citizens of our country for the rest of their lives? Is the department looking into the financial strength of care providers, with a view perhaps to reforming how they are funded?

The Centre for Health and the Public Interest’s 2019 study of 830 adult care homes found that 18 of the 26 biggest providers had corporate structures that separate the firm running the home from the ownership of the buildings, representing an estimated £1.5 billion of leakage in fees to pay interest, profit or rent. For the biggest five private equity-owned providers, the cost of debt per bed represented 16% of the weekly fee.

These operators are highly geared with expensive debt, following a number of corporate transactions that would not be permitted in many other areas. If you promise to pay somebody an annuity for the rest of their life, there are strict financial reserving requirements to back that, but it seems that when operating a care home, there are no such financial requirements. Indeed, there is a precarious position, particularly after the recent crisis, because care home operators were not paid enough to cover the costs of keeping people in their care home by local authorities, and therefore private payers—self-funders—had to cover the underpayments.

Is my noble friend aware of the recent study which showed that councils were paying private providers less than £500 per week, but that in the same local authority commissioning groups were paying £720 per week for a home run by councils? Therefore, there are significant differences in the amount that councils will pay for the same type of care. The regulator is supposed to ensure that council commissioning offers fair rates to care providers, but they are now struggling to make ends meet, particularly with the extra costs of PPE and so on forced on them by this crisis. Could my noble friend comment on this situation?

Covid-19: Care Homes

Baroness Altmann Excerpts

Wednesday 20th May 2020 Lords Chamber

[Lord Bethell]

My Lords, this Government have already made a very clear commitment to review the social care sector; that was made before coronavirus. The experience of coronavirus will no doubt put a massive spotlight on our provision for social care. It is entirely right that we review all of our arrangements. The vacancy question that the right reverend Prelate raises is an important one, and that is why we have launched a massive recruitment campaign, and why we have brought in minimum wage legislation which has seen rises in the pay of social care workers that are historically at the high end.

[Baroness Altmann (Con)]

My Lords, care homes tell me that they are still being required to take residents from hospital who may have Covid-19. May I ask my noble friend whether scientific and medical advice supported the guidance issued in the action plan of 15 April that, prior to discharge into care homes, patients must be tested but will be discharged “pending the result”, despite spare capacity in the NHS? Will the Government urgently consider altering that guidance?

[Lord Bethell]

My Lords, the guidance has been reviewed by the CMO, and we stand by it. I can confirm that all patients leaving hospital for care homes are, as a routine, tested. When they arrive at a care home, they are treated as if they might have Covid, and they are put into an area of isolation, until either the test has come through or their diagnosis has been confirmed. This is a way of protecting care homes, and it is necessary to continue the traffic of people from hospital to care homes, in order to have the beds available for those who need them more.

Care Homes: Covid-19 Testing

Baroness Altmann Excerpts

Thursday 14th May 2020 Lords Chamber

[Lord Bethell]

No one working in the NHS should go to work if they feel ill or have a temperature. That is true for anyone working on the front line, but it is not necessarily true for people who work in normal workplaces.

[Baroness Altmann (Con)]

Is my noble friend aware of the guidance released to the NHS on 24 April announcing that all residents of care homes must be tested before admission? In paragraph 1.30, the guidance specifically states that:

“Where a test result is still awaited, the patient will be discharged and pending the result, isolated in the same way as a COVID-positive patient will be”.


Even now, this has resulted in care homes being required to take people out of hospital without knowing whether they have the virus and without necessarily having the appropriate PPE.

[Lord Bethell]

I am aware of that guidance. It is sensible guidance. It is necessary to free beds in our NHS hospitals to make them available to those who need them more. It is also necessary to isolate people when we are not sure whether they have Covid. These are 80uncomfortable truths and I do not deny that this will result in uncomfortable outcomes for some patients. One aspect of the disease is that it targets care homes and I make no apology for those arrangements.

Health Protection (Coronavirus, Restrictions) (England) Regulations 2020

Baroness Altmann Excerpts

Tuesday 12th May 2020 Lords Chamber

[Baroness Altmann (Con)]

My Lords, I absolutely recognise the difficult balancing act for the Government in grappling with the trade-off between public health protection and individual liberty—between the economy and the resources to support our population in the future, and the national health. I would like to highlight two vital elements that are part of these regulations and the ministerial thinking that has been clearly outlined by my noble friend.

I turn first to liberty and health. The regulations state explicitly that “vulnerable person” includes

“any person aged 70 or older”.

It is not clear that there is medical or statistical evidence to support the implication that anyone over the age of 70 is more vulnerable to Covid-19 than other age groups. We have done so much to improve the lives of older people, extending working life and life expectancy, so that those aged over 70 are now fitter and healthier than many younger people. While I congratulate the Government on their decision not to relax the lockdown rules in any way that discriminates against older people, these regulations contain that implication.

The latest ONS data undermines the arguments made by some that age is a predictor of fatalities from this virus. The most recent information shows that the proportion of people aged over 70 who have died with Covid-19 is 81.5%, but the annual death rate for the over-70s in the UK is normally 82% of all deaths. This does not support age alone being a relevant factor. Of course, older people are at any time more likely to pass away than younger people, so I wonder if the Government will reconsider the position of the over-70s that is indicated in these regulations and remove any age discrimination from our reaction to this virus. We must differentiate between elderly people who are at extreme risk, particularly if they have previous medical conditions, and the rest of the population.

That leads to my second point. I listened carefully to my noble friend who introduced these measures. His words each time were that they protected the NHS and ensured that it had spare capacity. However, I am deeply concerned that, as other noble Lords have mentioned, this extraordinary focus on NHS capacity, which has now reached a significant high, has resulted in discharging people who are the most vulnerable to this illness back into the community or into care settings, putting others who are also vulnerable—and the staff—at risk too. I hope that my noble friend can confirm that the department will consider the importance of upholding our national values, which reject age or any other form of discrimination, and increase the parity of esteem between the NHS and social care, which is so important for the management of this illness.

Covid-19

Baroness Altmann Excerpts

Thursday 23rd April 2020 Lords Chamber

[Lord Bethell]

The noble Earl, Lord Clancarty, is right that our present guidelines state that those arriving in Britain should isolate if they have symptoms and seek a test from a hospital if it develops seriously. It is clear to me that the way we travel around the world is set to change dramatically in the future, but the CMO has reviewed our airport and port guidelines. He is happy with them, and the evidence suggests that this is not currently a source of new infections in the UK.

[Baroness Altmann (Con)]

My Lords, may I press my noble friend on treatment, particularly with convalescent plasma? As I understand it, other Governments are urgently looking into this. France has put its medical staff into LFB. Have we put any pressure on BPL, which is the only fractionating company available in the UK, to produce pure, hyperimmune immunoglobulins, rather than the whole plasma, so that we can start parametric testing of IVIG and injections of convalescent plasma in the pure hyperimmune form?

[Lord Bethell]

I reassure my noble friend Lady Altmann that we are making this a massive priority. It has huge advantages over other therapeutics because it is plasma and can therefore have an accelerated regulatory advance. I signed for procurement of £20 million-worth of fractionating machines last week to help the blood transplant service create the hyperplasma to which she alludes.

Covid-19: Social Care Services

Baroness Altmann Excerpts

Thursday 23rd April 2020 Lords Chamber

[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?

NHS Pensions: Taxation

Baroness Altmann Excerpts

Tuesday 9th July 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I can confirm that it has been made absolutely clear that NHS clinicians have been impacted by these reforms, and front-line care has been impacted. This is unacceptable and that is why we are bringing forward the review to find a solution as quickly as possible. The noble Baroness is right to raise the issue and we are determined to resolve it.

[Baroness Altmann (Con)]

My Lords, I am sure the Minister agrees that this was an unintended consequence of changes to the tax system. The reality is that the cliff edge of the taper is forcing consultants to pay tens of thousands of pounds for doing one small extra shift, sometimes voluntarily. Could she look at offering financial advice to each individual consultant who may be affected? They will not all face this tax charge, but they are all frightened that they might, so they are not undertaking the extra shifts we need them to undertake. Can she also note to her departmental colleagues that high-paid people potentially affected by the taper in other areas of the public sector received some assistance and mitigating measures from their departments, whereas it has been almost impossible for consultants to plan ahead? We are now seeing the problems occurring belatedly.

[Baroness Blackwood of North Oxford]

My noble friend speaks with particular expertise on this issue. As the whole House will appreciate, NHS consultants are often asked to take on additional shifts at short notice and they face peculiar challenges when calculating the consequences for their pensions. This is one of the reasons why the BMA has put up its calculator. However, the pension rules we are discussing today mean that some who take on extra work may find they have inadvertently incurred a substantial tax charge in moving into the taper. This is why we have brought in the consultation. It is obviously important that those facing pension charges should seek advice. NHS England is considering this issue closely at its most senior levels and working with the department to better understand the impact on clinicians, but also on NHS performance, and we are determined to resolve the situation to get it right.

Health: Cancer

Baroness Altmann Excerpts

Thursday 29th November 2018 Lords Chamber

[Lord O'Shaughnessy]

One reason that our cancer survival rates are not where they should be is that there is huge variation. The truth is that in some communities cancers are detected far too late as a matter of course. One way in which we are trying to address this problem is through the cancer strategy, which has provided about £600 million, £200 million of which has been to support cancer alliances in every corner of the country to make sure that we eliminate some of that variation and ensure that there is much more care for anybody suffering from cancer.

[Baroness Altmann (Con)]

My Lords, does my noble friend agree that the best cancer strategy is prevention? In that regard, I congratulate the Government on their recent decision to extend the HPV vaccination to all young boys as well as girls. I know that my noble friend has had great influence in that area. Does he also agree that this decision has the potential to save thousands of lives that would otherwise be lost to cancer in the future?

[Lord O'Shaughnessy]

I am grateful to my noble friend, not just for her recognition of that fact but for her campaigning on this issue. It is a really important step forward. The rollout of HPV vaccinations to boys will make a big difference to cancer rates, as it is doing for girls and women. It is part of a world-class screening programme in this country. A few issues need to be dealt with, and Mike Richards will be looking at those, but we are determined to make sure that our screening programmes get better and better.