Social Care Reform
Baroness Andrews Excerpts(2 months ago)
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Baroness Merron (Lab)
I understand that, whenever there is a change in direction, there is concern. I take the noble Lord’s point. The inherited commitment to implement the adult social care charging reforms, which would have been on course for next month, was undeliverable because the previous Government did not guarantee the money to do that. It would have cost nearly £1 billion next year, rising to £4 billion by the end of the decade. There were many false dawns in respect of this long—and repeatedly—promised change. It is also the case that there was not adequate preparation to implement the charging reforms. Councils warned that they were impossible to deliver in full in the previously announced timeframe. With all that in mind, I am sorry to say that we, as the new Government, had little alternative but to say that these were not funded or on course to be delivered. We will have to ensure that we offer a national care service, along with a new deal for care workers. We will continue to consult and listen to those with lived experience in order to get it right.
Baroness Andrews (Lab)
My Lords, the noble Lord was kind enough to reference the Select Committee report. I think he would agree with me that the value of that report was that we were able to reveal the extraordinary voices of those with lived experience and the many unpaid carers who live such very hard but dignified lives. I have great confidence from what the Minister has just said that the Government will listen to those voices, because they know that there is no quick fix. This is a hugely complex problem, and the fair pay agreement is a very important first step. I have great ambitions, as we set out in that report, for a coherent and systemic change in the aspirations that we hold for social care, as well as the practical delivery. I hope the Minister shares those.
Baroness Merron (Lab)
My noble friend is absolutely right that there is no quick fix, and I think that is understood. The national care service, for example, is a 10-year vision, which will mean long-term reform of the sector, underpinned by national standards, making sure that locally delivered care will be of a high quality and consistent across the country. That is what people will want. As my noble friend said, we will continue to consult those with lived experience as well as engaging with workers, trade unions and the sector to make sure that we offer a new deal for care workers.
Adult Social Care (Adult Social Care Committee Report)
Baroness Andrews Excerpts(1 year ago)
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Baroness Andrews
That this House takes note of the Report from the Adult Social Care Committee A “gloriously ordinary life’’: spotlight on adult social care (HL Paper 99)
Baroness Andrews (Lab)
My Lords, it is almost a year since the Adult Social Care Select Committee published its report. It is five months since we had the Government’s response. Although this debate has been delayed, there is no bad time to debate adult social care—it is always timely and always urgent. I am extremely grateful tonight that so many Members of this House have stayed for a late debate to share our report and to listen to the Government. I know that members of the committee particularly appreciate the contribution of the noble Lord, Lord Polak, after his highly emotional intervention in the previous Statement.
Many members of our committee could not be here, for very different reasons. I am very grateful to all of them—particularly to those who are here. We will feel the absence of the noble Baroness, Lady Campbell of Surbiton—not only because she is exceptional at what she does, and how she does it, but because she made an extraordinary contribution to our committee. I am also grateful that there are people who were not even on the committee here tonight who want to address the report. It was a great privilege to chair the committee and to have the task of asking the questions we did.
The two great transformational changes of our age are an ageing society and climate change—and they are interrelated. We have known about both for decades. They are both in the “too difficult” box, which is why it has taken so long to organise the courage to address the issues. We are trying to catch up.
In our report, we ask two questions which we thought had been particularly neglected. Why is adult social care so invisible compared to the NHS? What would make a real difference to the poverty and ill health that come all too often to the 1.5 million unpaid carers who do care work for more than 50 hours per week or the 4.5 million carers who are conscious that their own health is suffering?
There were a few differences of emphasis in the committee, but we were of a mind, and we were helped enormously by an outstanding group of officials from the House: Abdullah Ahmad, Daphné Leprince-Ringuet, Alasdair Love and Megan Jones. They shared with us a sense that this committee would do things differently and address these difficult questions and give more justice to them. In that spirit, we put a high emphasis on co-production and our experts by experience—not just our superb special advisers, Jon Glasby and Anna Severwright, but our expert witnesses who have tested our conclusions and stayed alongside us this year while we have debated this report and who will be watching this evening. We put an equal emphasis on empowering those who care and those who are cared for—whether caring for young disabled adults or elderly and chronically sick relatives.
Our recommendations inevitably prioritise the need for clearer pathways through the maze of information that people are offered, putting emphasis on them having a greater say in what they are able to access and use, and on their contribution as well as the labour of love that is caring. We put huge emphasis also on partnership with the Archbishops’ Commission. We shared our witnesses, evidence and conclusions—which often overlapped, because they were rooted in the same values.
Our recommendation, which was probably the most important, made it clear that adult social care is far and above being, as it is too often seen, a vital but secondary handmaiden to the National Health Service. It is so much more than that. “The NHS saved my life,” said one of our witnesses, “but social care enabled me to live that life to its best”. That is the difference, and it is why we say that adult social care must be a national imperative with stronger national infrastructure. This is the way to release its full potential, to make the best of its values and skills, realised not just in better processes but in the trusted relationships that underpin everything done in this area, and to make it possible for people who care, and people they care for, to live that “gloriously ordinary life”—the title of our report that has resonated so widely with everyone who has come across it; it is so modest, and yet it says so much.
Inevitably, there were some recommendations that were hardly new and did not need to be. I defend in particular the need to ditch short-term improvisation and plan courageously for the long term, whether through funding, a carers strategy, or a resilient and versatile workforce, or for appropriate housing to support ageing at home and not in hospital.
We have had a raft of reports this year that have all more or less made the same case, from the Local Government Association, the Association of Directors of Adult Social Services, Social Care Future, and Skills for the Future. Many of them ask for the Government simply to recognise the scale and urgency of the issue of the false economy that has followed from a decade of austerity and massive cuts to local authorities—the lost hours of caring, the higher cost of caring, the endless waiting lists, the exhausted carers, paid and unpaid, the profound inefficiencies in the system, and the lost opportunities that have marked this decade.
Because the people who know so much agree on so much, our report has resonated widely, and the Government will not be surprised that their response to our report has met with dismay. In November 2022, the Prime Minister announced an indefinite delay to capping care costs. The director of Silver Voices saw this as the “final betrayal” of older people. In April, the “next steps” proposals, published during the recess, were met with a genuine sense of dismay because this was a plan for only two years, not for the future. The workforce budget of £500 million had been cut in half. Many of the bolder ideas in the White Paper have been lost in transition. When the NHS workforce plan was eventually published there was not a word about social care, without which, as the King’s Fund points out, none of the ambition, which is great and serious, can be realised.
Therefore, we were not that optimistic about the Government’s response. There was much that we could welcome. For example, the Government acknowledged the central importance of the adult social care sector—how could they do otherwise? They said that they would support the Carer’s Leave Bill, at long last. We also welcomed specific commitments, for example to ensure better data collection, more and better R&D, and more investment in innovation across the sector, but that was the least we could expect, and it should have been in place at least a decade ago. The fact is that the lack of data has reinforced invisibility. It has made it so much more difficult to plan for the right, consistent, scalable and deliverable policies on a day-to-day basis, not just today but in the future. As we report, the expectation is that the family will go on caring, but by 2030 1 million people in this country will have no families to care for them.
That is why we sought to change the lens and interrogate the future, recognising that the demography and expectations of 1947 have changed beyond recognition while the assumptions of who will care have not—it is nearly always still women. Although we have just started to integrate services, health, housing and social care should be planned from the beginning to work as closely as possible together if we are to make living longer not a fearful prospect but something to celebrate.
That is why we put such a strong emphasis on a commissioner for adult social care and support: to bring voice, visibility, agency and challenge to the service. That is why the Government’s response, calling for a chief nursing officer, misses the point. That is why we recommended an urgent review of the Care Act 2014, which held so much promise, only to be told that this would be delivered through the Health and Care Act. Not so: the scope and the potential of these Acts are very different. I ask the Minister to take both these recommendations away for further consideration.
We have also had no response at all to other fundamental questions that impact deeply on the day-to-day possibilities of what carers, paid and unpaid, can expect. We asked for a review of the pay and working conditions that disable the sector and make it so difficult for disabled people to employ and pay for a personal assistant. Where they are available, they do not stay because the employment bureaucracy is so chaotic and, frankly, they can get more money working in the health service or in Asda. These recommendations were rejected. Although there is some good news in the plan for a Skills for Care workforce this week, and numbers of vacancies are slightly down, we cannot build the future of adult social care on improved immigration. It is a contradiction in terms and of the Government’s policy. It is certainly not an answer to 152,000 vacancies across the sector.
What does it mean to build a valued and versatile care force? It means that you have to pay people decent, dignified and proper wages. At the moment, many carers do not even get the national living wage. Can the Minister tell me why and what this Government, in their remaining days, can do about it?
All these recommendations would have strengthened the resilience of the whole workforce, from personal assistants to paid carers, but they would really have helped the unpaid carers, who would have known that their labour of love, which as we know saves us billions of pounds a year but costs them their jobs, their incomes, and their mental and physical health, is valid and visible. So, indeed, would our recommendations for a more forceful and consistent approach from employers towards flexibility and support in the workplace, and for mandatory housing provision and standards.
However, the recommendation that would have made the most difference to unpaid carers was an increase in the carer’s allowance—a shameful £76.75 a week, which, because they have to work a minimum of 35 hours, works out at £2 an hour. We called for an increase not only in the pay available but in the flexibility around the threshold. The Government rejected that recommendation too.
In short, the Government rejected all our key recommendations relating to funding, workforce planning, accessible housing, support for personal assistants and unpaid carers. The subtext of their response was, “We are doing it all already”. We are not.
We asked at the end of our report: if not now, when? When will unpaid carers see real change? The answer came back, “Not yet; not now”, so there is more wasted time when we face record-breaking NHS waiting lists and the distress of all those elderly people who cannot go home from hospital because it is not safe for them to do so.
Our committee’s main message is that we need a new, more positive and more confident approach to adult social care to enable it to deliver those “gloriously ordinary” lives. That means that disabled young people and older people should have more say in the support they are offered, better choice, and a service that will attract people to work in it because it is well paid, progressive, has status with recognised skills, and more capacity because it is built on stronger and sustainable partnerships between paid and unpaid workers, recognises the expertise held by both, uses the full resources of the voluntary sector, has more visibility through a national champion to challenge poor practice, and shows what change looks like. That is the way to spread best practice and innovation. If we invest in the care economy, just as we should invest in childcare, we will build not just a fairer community and strong families but a foundation for a more efficient and more resilient real economy.
Baroness Andrews (Lab)
My Lords, I thank the Minister for his thoughtful reply. I should have thanked him at the beginning for making this time available. We had a good round table, and we share a huge number of concerns and an understanding of where things need to be done and can be improved. I will briefly come on to the points where we disagree.
I re-endorse the point my noble friend Lady Goudie made about the evidence we received. Some of the stories we heard about the daily lives of unpaid carers— and we heard a lot of them—were totally astonishing. I would have liked every Member of this House to have heard what people do as a labour of love and how modest their ask is. We should simply respect that they have an expertise that is often ignored. As was eloquently said by the noble Lord, Lord Polak, they do not know who to ask or where to go, and this becomes exhausting and defeating. If we have achieved nothing else from this excellent debate, I hope that any unpaid carer listening knows that we have the experience and empathy across the House to understand this and to want to change the conditions under which they are living and caring.
There has been an astonishing range of experience around the House tonight. There has been passion, of course, and a great understanding of what caring involves, because so many people have been involved. I pay tribute to my noble friend Lord Dubs and everyone else around the Chamber who has had that experience.
I think that what we have all been saying to the Minister is that we respect what the department has been trying to do; we know that it is an extraordinarily difficult task. It is always more difficult and slower to make policy than anyone anticipates, but we are not asking for a great vision; we are asking—without false optimism, with realism but with real urgency—that we step up. We cannot do the incremental thing anymore; it is not working, and it will not work for the future. We can use all sorts of expressions such as “turning up the dial”, but we are all saying the same thing: that there really needs to be a different energy and focus. That is why I return to the point about the champion, the commissioner—there is a lot of support for it around the House and there would be if the House was full. With great respect to the post of chief nurse, it does not do what we want. It needs someone to represent all that potential and frustration and to say, “There’s the good practice; that’s how you do it.” We have heard the example of Wigan from the noble Baroness, Lady Hollins, and there was much good practice referred to in the report.
We have heard some terrific ideas which we did not put into the report, such as filling in the pension gap, and we have heard a lot about the deep complexity. The reason it has not been resolved is that it is difficult, but recognising the difficulty, the realism, is not an excuse for not dealing with it. I sense around the House, and it is common to all parties, that the time has come to make this a national imperative.
I want to thank again everyone who has spoken for their wisdom and for their practical and inspirational contributions, in every respect. It will not be the last time we debate this subject. I just hope that by the time we debate it next we will have a clearer relationship between the vision and the practical implementation of what we would all like to see.
Social Care
Baroness Andrews Excerpts(1 year, 7 months ago)
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Baroness Andrews
That this House takes note of the future of adult social care given (1) the recent reports from the House of Lords Adult Social Care Committee (HL Paper 99) and the Archbishops’ Commission on Reimagining Care, (2) the Care Quality Commission s local authority assessment duties which commence from 1 April, and (3) His Majesty’s Government’s stated intention to publish a social care plan in Spring 2023.
Baroness Andrews (Lab)
My Lords, I am extremely grateful for this opportunity to introduce a debate which has a particular resonance in this House and a real urgency. I am very pleased that so many Members of the House have been able to take part today, particularly members of the Adult Social Care Committee. I am delighted to share the debate with the Church, alongside the right reverend Prelate the Bishop of Carlisle and the most reverend Primate the Archbishop of Canterbury. We are considering two reports, in respect of which Church and state are joined in values and prescriptions. We are also anticipating some of the changes coming down the track. I regret that we do not have the national care plan today, as we had hoped, but we can anticipate the CQC changes. There is a lot to discuss, and the debate will go far wider than the two reports before us.
We have not yet had a reply to our Select Committee report, A “Gloriously Ordinary Life”, which was published last December, but I hope the Minister will be able to say something about the national care plan, not least when it will be published and when we can debate it. Perhaps he could answer one or two of the outstanding questions, such as: will the £500 million workforce funding plan be halved?
I said that this debate has a particular resonance in this House, and there can be very few noble Lords who have not had the experience of caring for someone close to them. It is estimated that one in two of us is likely to become an unpaid carer by the time we reach 50. For some people, it is a lifetime’s commitment; for others, it is an overnight change in circumstances that leaves them with a future which is darker and very different. Overall, at any one time about 10 million adults of all ages come into contact with adult social care. When it matters so much to so many people, we are bound to ask why, as a whole, it has been out of sight and off the public radar for so long. Perhaps a better question is: why do we not care more about it—sufficient to make it the social and political priority it needs to be? What do we need to change in order to care more, and to plan and provide more effectively for a fairer and more robust service? Why is it not a national imperative? The answers to these questions are rooted partly in human frailty and partly in the history of the NHS and the time in which it was born: a time when women did not work and people did not live as long.
What is significant about the two reports is not that they reach similar conclusions, but that they are rooted in similar values which start from the assumption that adult social care has so far been denied the opportunity to be what it could and should be: a service that enables people to live a gloriously ordinary life which is fruitful, active and valuable. The support provided is not transactional or contractual; it is based on a generous and mutually supportive set of relationships which reflect what, at best, being cared for and caring mean. The Archbishops’ Commission’s report, Care and Support Reimagined, describes it as a fulfilled life based on love, mutuality and interdependence, embedded in the concept of a national care covenant.
Today’s realities are very different. Many of those who need care or support in order to care, particularly as unpaid carers, battle their way through a barrage of services, systems, agencies, tests and charging regimes that seem designed to deter demand until needs become extreme. The daily realities are set out in our report in the words of those who live that reality. We were extremely privileged to hear so many witnesses share their experiences and their lives with us—people who have lost jobs, homes and health in the process of caring. That co-production helped our report to reach a wider audience, and we owe them a huge debt of gratitude, as we do our superb committee staff—Megan Jones, Daphné Le Prince-Ringuet, Alasdair Love and Abdullah Ahmad—our wonderful special advisers, Jon Glasby and Anna Severin, herself an expert by experience, and every member of the committee who gave so much time and insight and shared their own experiences. I am sorry that the noble Lord, Lord Laming, could not be in his place today. He kicked this off through the Liaison Committee and helped us settle on a topic in a very well-worked field which has not had the attention it deserves—the plight of the unpaid carer.
Caring goes on day and night, without public acclaim, in private, behind closed doors, and with pitiful reward. Indeed, unpaid carers were described by no less than Jeremy Hunt, when chair of the Health and Social Care Committee, as the least visible aspect of a service which, overall, suffers from “entrenched” invisibility. Understanding what that means for adult social was a task we undertook, and trying to work out how to dismantle it consumed much of our inquiry, because invisibility takes many forms and has many impacts. Adult social care may be a nationally funded service, but it is locally delivered. It does not have a coherent national profile; it is fragmented across 18,000 organisations. While care homes are, tragically, more in the national spotlight because of Covid, the rest of the service is below the radar until you need it—when you cannot find it. At its most graphic, although it is the same size as the health service and of equal importance to the well-being of the nation, its budget is a fraction of the NHS’s: £17 billion compared with £153 billion. As we know—this statistic is all too familiar—a third of local government funding has been lost in the past decade. Compared with the NHS, adult social care is not the national treasure it should be.
This is not a remote failure. At the start of 2022, 2.6 million over 60s were living with some form of unmet need, such as the basics of washing and eating, and 2.2 million hours of care had been lost in the first three months of that year. Half a million people are now waiting for assessment. Care support, as it was described to us, even when it comes with the best of intentions and people, can still make people feel very grudging and guilty rather than supported.
The relative invisibility of the service is compounded by a lack of information. We were astonished by what we did not know. The number of unpaid carers is estimated at between 4.2 million and 6.5 million, but there may be many more who are not registered because of the problem of identification. We know that they save the country £132 billion a year, but less well known is that they receive the lowest of all benefits—£2 an hour, or £69.70 a week. To get that, you have to work for more than 35 hours a week and fulfil a means test. It is no wonder they are worried sick about heating and food bills, and that they do not manage to stay in work—and when they do, the support they get is significantly less than that offered by other countries. Put together with a paid workforce which is not valued for its exceptional skills and which works for less than the minimum wage, it is hardly surprising that they are driven out of a job they love or that it is so hard to find a personal assistant these days.
The reports provide all the evidence any Government would need as to why this is urgent, and they set out a plan for change. Both say unconditionally that there must be a radical shift in perception and investment in all parts of the service, so that adult social care can become the transformational life-enhancing service it could have been designed to be. We heard someone say to us informally, “The NHS saved my life. Adult social care has helped me to live it.” That was a graphic description.
The greatest failure has been the failure to plan strategically for an ageing society. The result is that we see longer life as something to be borne, a burden, a nuisance—and that cannot now just be fixed. That needs to be seen together with the repeated failures to cap residential care; to implement the Care Act 2014; to integrate social care into the health service, until recently; to prepare a realistic adult workforce plan based on skills, a full pay review, and a resilient service that people feel proud to be part of; and to challenge the false economy of underinvestment in adult social care year on year, at a time when the impact on the health service alone is immeasurably worse.
Add to that the failure to honour the promises that have actually been made to unpaid carers: better leave, a better carer’s allowance, better respite. It is a catalogue of disappointment. There has been so much analysis and diagnosis, so much hand-wringing over failure and so little meaningful change.
But the future is catching up with us: we will have a population of about 2 million in 10 years’ time who will be ageing without care, with no family to look after them. Where are the plans for these people to get the support they need? At the same time, if we are smart, we have new technologies and new devices that can help reduce risk and plan for where the skill gaps are. I think of the wonderful Tribe Project we came across, which does outstanding work but which ought to be all across the country. We saw so much good practice in local authorities as different as Wigan and Somerset, and an appetite for innovation and for engagement with the community. There are tremendously creative ideas at local level, all waiting to be galvanised and shared.
The most challenging question of all is what needs to change before we care more sufficiently to make adult social care a national imperative. Four things are necessary: to raise adult social care’s voice, visibility and agency; to revisit and build on what already could work better; to build capacity through workforce skills and strategic investment; and to change the way we view it—as a unique social good in itself, not simply part of propping up the NHS.
First, and simply, adult social care has to have a louder, more coherent and challenging voice, so that it can be more powerfully championed inside and outside government. It has been too easy to get away with simply patching up adult social care in an emergency and parking the workforce strategy. It has not had the power to fight for priority, which is extraordinary when we think of the power it has to change lives, for better or worse.
We recommend what looks like an easy reach, but which could make a huge difference: a commissioner for care and support to lead that fight, to raise that voice, to hold Ministers’ feet to the fire, to do some shaming if necessary, but also to celebrate and mobilise the best. That champion will be a champion for unpaid carers as well, to make sure the Government cannot get away with any more delay and procrastination there.
Reducing invisibility means knowing more: to do better, we have to fill those information gaps. We have to have a national plan for data on adult social care, so that we actually know who is caring when and where; so we know where the gaps are, where the resources can be deployed best, and what we need to invest in most effectively. That could also be helped by creating an R&D network akin to that in the NHS, so that we could trap ideas, innovation and good practice. If we have increased visibility, we can have more and better opportunities to design more flexible services—more “choice and control”, as is described, whether through better access to better packages that work more effectively, more personal assistants with less bureaucracy, direct payments that actually get to where they are needed, or giving respect to enable unpaid carers to give their own expertise more effectively, as full partners in providing care.
I have been banging on about housing in this House for well over a decade. We need accessible and adapted housing, so that we do not have thousands of people stuck in hospitals. They should be able to go to a safe home and be looked after safely, not just at times when care is needed, but urgently, as a matter of sensible planning for an ageing society. The social care White Paper recognises the role of housing, so I very much hope we will see some funding come forward to actually meet that desire.
So much of what is in these reports is not new; so much was set out in the Care Act 2014—principles, processes, project design. It is tragic that it has been on the statute book but not implemented by local authorities, which have not been able to put the training plans in place; they have not been funded to do so. That leads to the inescapable reality that adult social care needs a national investment strategy.
Compared with the costs of failure and delay, adult social care is not expensive. Again, when the Chancellor was chair of the Health and Social Care Select Committee in 2017 he called for an annual increase of £7 billion between 2021 and 2023—this at a time when energy companies are scooping up hundreds of billions. This is the same Chancellor, though, who did not put any additional money for adult social care in the Budget. I ask the Minister what he thought of that.
In conclusion, so much of this is not about money at all; it is about moving away from the culture and perception of a service where the dominant language is not that of celebration but of “burden”, of “dependence”, of “failure” and of “crisis”, towards one which values and empowers the people it serves and those who do the caring, paid and unpaid. Among the assumptions which must change are the long-held assumptions that disabled adults and older people are not capable of living a life that is as rich and fulfilling as everyone else’s; that social care work is unskilled work; and that families will always be there to care.
Let me put it another way and quote Social Care Future:
“We all want to live in a place we call home, with the people and things we love, in communities where we look out for one another, doing what matters to us.”
It seems to be the most modest of ambitions—so many of the things that are asked for are so modest—but one that is well within reach if we choose to do it. The greatest risk, as our report says, is not to change, and the hardest question is, if not now, when? We have waited long enough to make adult social care a national treasure as well as a national imperative. I really hope the Minister agrees with me this afternoon. I beg to move.
Baroness Andrews (Lab)
My Lords, I am very grateful to the Minister for his response, for the compassion he shows and for the shared values we clearly hold across the Chamber. He had a difficult job trying to sum up and satisfy the consensus of opinion and expertise across the House while not being able to tell us what the national plan will contain. We regret that it will be published in the Recess. We would like an immediate opportunity to debate it. I hope that business managers will give us that opportunity as soon as possible when we come back, and that we can have a substantial debate on it, as well as on the Select Committee’s report. In the meantime, I think that everyone would be very grateful to join him and officials around a table, not least because it signals the inclusivity which marks the debate and marks what my noble friend Lord Turnberg called the “noise” that has been associated with the debate for so long. We want to take up that offer.
I thank the noble Lord, Lord Polak, for identifying the need to take politics out of social care, because that is only too evidently what needs to happen. We must be as committed to finding the investment, particularly in the workforce, as we are to making sure that we understand the values we share.
I thank everyone who has taken part; it has been an exceptional debate. I thank noble Lords for their generous response to both reports. It was very good that we had the opportunity to listen to the most reverend Primate and the right reverend Prelate on the notion of a covenant and the very specific overlap in the consensus about what needs to be done—it has been an incredibly valuable opportunity because of that.
There have been very valuable speeches from across the Chamber, including from my noble friend on the Front Bench. It has been a comprehensive debate, but it has been as broad and rich as it has been deep because of the personal experience that it has called up, as well as the range of professional experience and the types of caring that people know about—learning disabilities, elderly care, disabled people. We heard from the trade union perspective the challenge of reconstructing a workforce that is modern and fit for the future. We heard from the unpaid carers’ perspective.
It has been an extraordinarily important debate for the Minister, because the challenges that have been articulated and the detail have been rooted in real experience over many years across this House. This House has a very long memory, having been here before, time and again. This is the time for change. Whatever is in that national care plan will be tested to destruction against our experience of 20 to 30 years of waiting and hoping for something better and bringing it to the boil in different ways. Nothing about this is easy and nothing will be particularly quick, but let us have some clarity, total transparency and reality, but let us also have that vision. The most reverend Primate started by asking who is responsible. That is such a fundamental question, and the answer is that we all are. That is something that has come out in the inclusive nature of this debate as well. With that, I beg to move.
Care Homes: Staffing
Baroness Andrews Excerpts(1 year, 9 months ago)
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Lord Markham (Con)
That is absolutely right. In our weekly meetings as Ministers, we look at the reason for the delays in terms of the 13,000 beds. That assessment of delay is one of the key criteria that we monitor each week. The best ICBs that I have seen have teams on this—they are absolutely SWAT teams—who make sure that they do it, and measure the time in which they can do it; for example, they have got to have that assessment within 24 hours. When the patient goes in, they have an estimate of the day that they are leaving, which they will target and work towards. The best do that, and the task force is set up to make sure that it is rolled out to all the other places.
Baroness Andrews (Lab)
My Lords, the question has been put to the Minister already, but I want to put it again. Has he read the report of the Adult Social Care Select Committee, published in December, which has a raft of challenges and very good ideas on social care? I look forward to discussing it with the Minister. Specifically, does he agree that as long as we characterise adult social care workers as unskilled and pay them, quite often, below the minimum wage, we are never going to build the capacity that we need? That is a huge challenge. If he were to read the report, he would find that what we recommend is so evidently simple: we need a national workforce plan for adult social care, to raise standards, incentives, status and pay.
Lord Markham (Con)
I thank the noble Baroness. I think that the House will recall that I have mentioned on a number of occasions that this is a critical part of the workforce plan. What has become clear, even in the short time that I have been at this box, is that social care is a vital cog in the whole chain, so to speak, which goes right back to ambulance wait times and A&E, because if we do not get the flow going out of the system, we have got problems there. So I can assure the noble Baroness that it is key to my thinking, and to all our thinking.
Maternity and Neonatal Services
Baroness Andrews Excerpts(2 years ago)
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Lord Markham (Con)
As I mentioned before, we have already put this in place with the maternity quality surveillance framework. At the same time, if we feel that more needs to be done, it will be included in my review of the recommendations and report back to the House in four to six months.
Baroness Andrews (Lab)
My Lords, one of the significant things about this devastating report is that it does not deal with a list of one-off recommendations, as previous reports have. It deals with systemic issues that mean that the whole service is challenged. One of those, as we have already heard, is the difficulty in identifying risks. The other is why we do not hear what families are saying, which is clearly an issue in preventable deaths. One of the specific recommendations is that the Government should now bring forward a Bill that would place a duty on public bodies not to deny or deflect or conceal information from families. That should be a priority. Will the noble Lord take that back to his senior Ministers and get them to acknowledge it?
Lord Markham (Con)
We all acknowledge a duty of candour. That should be fundamental to the leadership and to everyone in every trust. In this case, I was pleased to see the trust completely accept the findings and its failings and apologise unreservedly. That is something we need to make sure that all trusts do. We have the framework in place to do that but, if we do not, we will not hesitate to act further to ensure that it is.
International Healthcare Outcomes
Baroness Andrews Excerpts(2 years, 5 months ago)
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Lord Kamall (Con)
I should refer Members to my interests. When I thought I had retired from politics a couple of years ago, I took up two posts: one as a professor of politics and international relations and the second as an academic research director of a think tank. That meant engaging with a number of think tanks across the spectrum, including Civitas—phew, I have got that off my chest.
I have always admired the noble Baroness for her diligence, particularly during the passage of the Health and Social Care Bill. Given that, I was puzzled by the premise behind the Question. It refers to the UK being ranked 18th out of 19 overall. I found no such ranking in that Civitas report when I was reading it for my homework last night.
Baroness Andrews (Lab)
My Lords, my noble friend asked a very specific question about workforce. We are 100,000 short of NHS staff. The last NHS workforce plan was 19 years ago in 2003 under a Labour Government. When will we have the next one?
Lord Kamall (Con)
As the noble Baroness will be aware, during the debates on the Health and Social Care Bill, we made quite clear the different approaches to the workforce strategy. Indeed, Health Education England has been asked to compile a strategy. The NHS has the people recovery task force, which involves health and well-being and is not only for retention. Also, in our recruitment, we are on track to meet our manifesto commitment of 50,000 nurses. We had over 30,000 more nurses by February 2022. We are looking at different areas, not only from the department but from the ground, bottom up.
Ockenden Report
Baroness Andrews Excerpts(2 years, 7 months ago)
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Lord Kamall (Con)
I thank the noble Baroness, Lady Watkins, for sharing a very personal story. It must have taken quite a bit of courage to share that with us so publicly.
The noble Baroness talked about the “significant other”. Sometimes we consider ourselves the insignificant other. I remember when I became a father about 20 years ago for the first time. When you watched the TV programmes, they quite often told the father, “Go and have a smoke and come back. We’ll let you know.” Clearly, nowadays, you would not advise anyone to go and have a smoke. I remember how involved I was allowed to be. I was in the room for 22 hours for the first birth. Pre-natal care was fantastic, but once the baby was born, my wife was ushered into a bathroom, and I was sent away somewhere else. I could hear her voice. She called me. When I went in, she was sinking into the bath; she was just too exhausted. She was terrified and did not have the strength, and I pulled her out. It might have been a tragedy—I do not know—but it shows that even little things like that could have made a huge difference.
We are all grateful when a wonderful new life comes into this world. Let us think about the preparation that families go through—they prepare a separate room; families buy baby clothes and toys for everyone, expecting that bundle of joy to come home. When that is cruelly snatched away from them due to incompetence, we have to make sure that it happens as little as possible in the future. We know that incidents will occur. It brings a lump to the throat.
Noble Lords will recognise that there has been a debate on workforce. There is a debate in government on it. We shall just have to see how that resolves itself. I have heard loud and clear from noble Lords that it is not only about the maternity workforce; it is also about the wider NHS workforce, as well as making sure that we learn from incidents like this and build in that culture of prevention but also openness when things go wrong.
Baroness Andrews (Lab)
My Lords, this has been a rather unusual Statement in many ways, not just because it raises such extraordinarily profound questions but because it calls up such deep experiences for everybody around the House and for everyone who has a child or grandchild who survived this still-dangerous procedure. We are indeed indebted to the Minister, to Donna Ockenden and to the parents. It must have taken huge courage to relive all that, because the trauma never fades when one has had that sort of experience. One lives with it.
It is an unusual Statement because of the quality of the experiences around the House. I cannot add to them, but I want to follow up the concern of my noble friend on the Front Bench about monitoring. It is extremely important that we have a clear idea of the trajectory of the implementation of the recommendations and the speed at which they are implemented, because “promptly” is used in the report and the Statement. It is important that we have an idea also of their impact on the ground in terms of the experience of the staff and the patients in that very hospital. That is the only way in which we will know whether these recommendations and the relationship between them are having an impact.
For example, I do want to lower the tone by talking about money, but the Statement makes reference to £127 million. Over what period are we talking about that as an investment? How will it be distributed? Where will the emphasis be placed? Some of things identified are fundamentally important but elusive. How will that be reflected in changes to the quality and quantity of leadership training available? We all know that this is a failure of leadership in so many ways. For a long time, the NHS has been struggling with ways of coming to terms with developing creative leadership which will not condone blame, evasion and avoidance but embrace the need for change and improvement, and transmit and cascade that. These are specific questions. This is such a serious point of inflection in maternity services that we need to know how this is going to come back to us from the department and the Minister, so that we will be able to understand and keep tabs on what is happening. I would be grateful if the Minister could address that.
Lord Kamall (Con)
The noble Baroness raises some important issues. Looking at the big picture, as I say, we have accepted the actions made in the report, and I have asked for a timeline for the implementation from the NHS. However, I commit to updating the House when I can. I will also go back to the department and ask some more questions and make sure that I will write to noble Lords who took part in the debate in order to fill in the gaps.
A number of different issues were raised with regard to the £127 million for next year. That is for next year and it is in addition to £95 million in 2021 to try to recruit 1,200 midwives and 100 consultant obstetricians. Work is also under way as part of the largest nursing, midwifery and allied professional recruitment drive in decades. Since September 2020, there are other initiatives, such as the new non-repayable training grant of at least £5,000 per academic year for eligible students. There is extra funding of up to £3,000 per academic year to eligible students for child dependents, and £2,000 per academic year for those studying specialist subjects. There is also a new grant of at least £5,000 in addition to maintenance and tuition fees provided by the Student Loans Company.
An extensive NHS England and Improvement support package is also being developed to allow NHS trusts to establish and expand ethical international midwifery recruitment—I know that noble Lords have raised many issues about that. Health Education England has also pledged money to fund additional clinical placements, including for nursing, midwifery and allied health professionals and healthcare science, and the Government have provided almost £450,000 to the Royal College of Obstetricians and Gynaecologists to develop a new workforce planning tool. It is very easy to talk about large sums, but these are specific examples of what we are doing. However, I will write to noble Lords with more details.
Covid-19 Vaccinations
Baroness Andrews Excerpts(2 years, 12 months ago)
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Lord Kamall (Con)
The NHS is writing to all patients who may be eligible so that they can talk through their options with their GP or a consultant if they have not done so already. I understand that that includes the option to be vaccinated at home, but I will double-check and write to the noble Baroness.
Baroness Andrews (Lab)
My Lords, two questions were put to the noble Lord that he has not had time to answer. First, I should say that, like him, I have received my booster invitation for Thursday and I am absolutely delighted. Two questions, which I do not think were technical, were asked by the noble Baroness, Lady Brinton. One was about why centres are closing. Clearly, with this big push now, spearheaded by the Government, we need to keep as many open as possible. The second relates to something the Minister said that surprised me: he talked about a level of complacency. It is indeed possible, I think, to see the failure to make masks mandatory as an indication of complacency. Will he say a little more about what he meant by the level of complacency and how making masks mandatory might help to meet that?
Covid-19
Baroness Andrews Excerpts(3 years, 1 month ago)
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Lord Bethell (Con)
My Lords, I absolutely applaud the sentiments that the noble Baroness articulated: her sense of responsibility and commitment to the community are generally exactly what we are trying to inculcate in a lot of people. But I just do not agree with her or with the noble Lord, Lord Faulkner, that having a state-mandated direction—accompanied, presumably, by fines and, therefore, court appearances for some—could possibly be described as light touch. It is the most intrusive and intimate of measures. If the circumstances require it, we are prepared to do it. We have done it, and, if necessary, we will do it again. But noble Lords really are missing the mood of the nation if they think that the vast majority of the country is in the same place.
I am afraid to say that this is a question of personal choice at the end of the day. The public health judgment—these decisions were made in participation with public health officials—does not support mandatory mask-wearing for the entire country. I agree that visiting Scotland is a completely different experience; there, policymakers have made a different decision, as they have in some other countries. But when we lifted mandatory mask-wearing on 19 July we saw a very large change in the public’s habit. Why? Because some people find it extremely intrusive and not comfortable at all, and they do not like it or are not prepared to do it. Therefore, at this stage of the pandemic it feels proportionate and right to rely on guidance and inspiration and on the leadership of both our national and civic leaders. If necessary, in plan B we will come back to the mandating of those kinds of measures. At this stage it really does not feel proportionate.
Baroness Andrews (Lab)
My Lords, if I may pursue this with the noble Lord, he has used the term “proportionate” on several occasions and has now said that the Government will be prepared to come back to this if they feel that the circumstances require it. It is worth reminding the House that the term “light touch” was not used by my noble friend Lady Thornton but by Sir Patrick Vallance.
I have several questions for the Minister. First, when will the circumstances be such that the Government will agree that “proportionate” is no longer the key and that action will need to be taken to require masks to be mandatory and people to stay at home? That is what the SAGE advice is suggesting. Secondly, exactly why have the Government not taken the advice of their own advisers in this respect, given the circumstances, which have been well described across the Chamber, of increases in the number of hospitalisations and the number of infections? Thirdly, what does the Minister think is likely to be the worst-case scenario this winter and the key risks, given that the Government have, on two or three occasions over the last 18 months, not followed the advice to act swiftly and urgently and according to the advice that they have been given? Why is it so difficult to take that advice and act on it now? It appears that we have not learned the lessons about the necessity for early intervention to stop things getting worse.
Covid-19 Internal Review
Baroness Andrews Excerpts(3 years, 5 months ago)
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Lord Bethell (Con)
My Lords, the Prime Minister promised on 12 May that there will be a statutory inquiry beginning in spring 2022, as my noble friend alluded to. Its chair and terms of reference will be announced before spring 2022, and it will be for the terms of reference and the chair to determine exactly what subjects are looked at.
Baroness Andrews (Lab) [V]
My Lords, I ask the Minister to return to the first Question asked by my noble friend—she asked two—which he overlooked. Does the Minister agree that publishing the internal review could strengthen the strategic plan to contain new variants? Does he agree with me that it would certainly raise public trust and that, because of the inordinate delay until next year in starting the public inquiry, it surely makes sense? Even if this is not a public-facing review, it is of such public interest that he should publish the internal review.
Lord Bethell (Con)
My Lords, as I said before, there was an internal ways-of-working review into the department’s early response to the pandemic, way before the threat of variants was on the horizon. None the less, it is our commitment to focus on the pandemic and the threat presented to us by its future evolution. That is why we are focused on today’s measures. We will leave reflection on the past to the inquiry.