Future of Health and Care
Baroness Armstrong of Hill Top Excerpts(3 years, 11 months ago)
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Lord Bethell (Con)
My Lords, the noble Lord makes a very wise observation. The challenge of reducing bureaucracy has confounded many Ministers in the past, and I would not want to suggest in any way that this is an easy challenge. However, it is our belief that, by getting those involved in primary, secondary and social care, and in public health, working more closely together in integrated care systems, with a culture of collaboration and clearer accountability for the outcomes of the populations in their areas, we can reduce the friction of paperwork, duplication and oversight that has cost the health system dearly, and can build a more effective way of providing healthcare services for individual populations.
Baroness Armstrong of Hill Top (Lab) [V]
My Lords, much of the laudable ambition of this White Paper is in the integration of the two sectors, but the truth is that you cannot have integration of health and social care without parity of esteem. With a social care system that the Government themselves have called dysfunctional, we know, certainly from all the evidence of Covid, that there is no such equality between the two structures. The legislation to implement this White Paper—I fear the Minister has it ready, considering the number of times he has talked about a Bill tonight—should not come before the desperately needed reform of social care.
The Secretary of State voted for the Lansley reforms more than 20 times in the Commons and they are what he now wants to undo. Unless this integration becomes a real possibility through dealing with social care first, this will look and feel like a vanity project for the Secretary of State. I therefore ask the Minister to assure us that we will know what will happen in social care before he brings a Bill on structural change of the National Health Service to this Chamber.
Lord Bethell (Con)
My Lords, I agree with the noble Baroness that there is a challenge around parity of status. The pandemic has vividly brought alive the challenging circumstances of those who work and live in social care. It is a tremendous tribute to the British people that they have given the lives of the elderly and the vulnerable such a high priority by putting the life of the country on hold to protect the health of the vulnerable and elderly, and that they have thought carefully and thoughtfully about those who live in either residential or domiciliary social care, for instance. It has brought alive for the whole nation the circumstances of those who live in social care.
I have heard loud and clear those in this House who have made the case for those who work in social care, often in low-paid roles but with a huge amount of responsibility and a massive task ahead of them, to receive better training, have clearer career paths, and, as the noble Baroness rightly points out, have a higher status. However, I do not agree with her that the sequence should be financial reform followed by structural reform. With this Bill, we are trying to put in the correct structural circumstances for social care so that it has parity with the NHS and a collaborative jigsaw fit with those in clinical and public health roles. Therefore, when the financial reforms are put in place, they will be done most effectively and with the largest impact.
Covid-19 Update
Baroness Armstrong of Hill Top Excerpts(4 years, 4 months ago)
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Lord Bethell (Con)
My Lords, I am extremely grateful for my noble friend’s recommendation. It is a source of huge frustration, and amazement to me on some level, that the precise nature of transmission in all cases is not crystal clear. I am not sure that I would completely agree with my noble friend that it has been thoroughly disproved that the disease can never be transmitted from surfaces. In fact, there are others who think that this may actually be a very important vector of transmission. We certainly do not understand the full nature of the way in which aerosol transmission behaves, and it is likely that it is a mixture of them both. That is why we urge the country to comply with the Hands, Face, Space protocols.
Baroness Armstrong of Hill Top (Lab) [V]
My Lords, it is significant that, in what can only be seen as a gloomy Statement, no reference has been made to the most vulnerable, many of whom were in the shielded category. National Voices has been listening to these people over the summer and published its report today. Too many in the most vulnerable category say that they feel, and felt, abandoned. They say, for example, that they want to be:
“given information that is relevant to me, in a way I understand.”
That is what many in the country, around all of this, are actually asking for. If we get it right for the most vulnerable, we might begin to get it right for the rest. When are the Government, after promising that they were going to issue more guidance and support to those shielding, actually going to do that?
Lord Bethell (Con)
My Lords, I am touched by the testimony of the noble Baroness. I pay tribute to the work of National Voices, which has presented an extremely thoughtful and helpful guide and presented the testimony of those who have been under the extremely harsh regimes of shielding. She is entirely right that those who have had to go into the most extreme forms of lockdown depend the most on government guidelines. Those guidelines can be complex, and people can feel confused or lonely and separated because of their status. We have invested a huge amount in local authorities and in charities specifically to reach those groups. It is through that kind of civic and public service support that we can work with those people. It is not properly the role of central government to have individual communications with those who are shielding at home. We rely on our partners, and we have provided an enormous amount of resources to ensure they can do that job properly.
Covid-19
Baroness Armstrong of Hill Top Excerpts(4 years, 5 months ago)
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Lord Bethell (Con)
My Lords, my noble friend is entirely right that confidence in attending NHS venues is hard hit by Covid. One of the inspiring and interesting things that has happened has been the switch to using telemedicine—video and telephone calls—for referrals. This has been particularly and interestingly used in mental health, where attendance at clinics is something that many patients would wisely seek to avoid, but in fact the delivery of mental health therapy through telemedicine and calls has proved to be incredibly effective and has worked very well. We are working hard, through the NHS, to try to de-weight attendance at venues, particularly big central hospitals, and move much more towards attendance in the community, or through technology, in order to give patients a choice and to increase our engagement at a time when people are fearful of going back to their GP surgeries.
Baroness Armstrong of Hill Top (Lab) [V]
My Lords, one of the reasons for the Statement is to look at lessons learned. As the Minister and others have already discussed, the trust of the British people in what they are being told and advised is important. Therefore, what was said yesterday about Bolton and Trafford and their local spikes was not very helpful. Because transparency is really important in building trust, can the Minister tell us what happened between 9 am and the Statement from the Minister after noon to change his mind? He tells us that it was data. What was the data?
Lord Bethell (Con)
The noble Baroness is entirely right that trust is critical, and we have to forge a system where local authorities, local MPs and central government work together on these local restrictions. The only thing that changed was that that group of people sat down at 9 am yesterday and looked at the data, and the data was deeply uncomfortable—it did not tell the story that everyone wanted it to tell. No one wanted to lock down those areas, but the data pointed in only one direction. That is the story that is playing out in communities around the country and it is a story that we will all have to get used to. One of the frustrating aspects of this epidemic is that the disease moves incredibly quickly and does not always go the way one would like it to go. That creates turbulence, as discussed earlier, but that turbulence is something that we have to get used to. Politicians, local officials and central government mandarins are all learning to work together in order to interpret that data and apply its implications in a thoughtful and trusted way.
Independent Residential Care
Baroness Armstrong of Hill Top Excerpts(4 years, 7 months ago)
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Lord Bethell [V]
My Lords, the noble Lord is entirely right. The protection of residents is our number one priority and our responsibilities under the Care Act 2014 remain in place. The care home economy is mixed. We are looking very carefully at the financial resilience of all the providers involved. We are providing the funds necessary to see them through this epidemic and we will do whatever it takes to protect residents.
Baroness Armstrong of Hill Top (Lab) [V]
My Lords, given the unfortunate words of the Prime Minister last night, where he seemingly blamed care homes for high rates of Covid-19, when will the Government actually produce the long-promised proposals for the future of social care, which will guarantee quality through acknowledging the need for a skilled, stable and trained workforce, properly valued?
Lord Bethell [V]
My Lords, we are enormously grateful to all those working in the care home sector, who have protected residents through this awful epidemic, and we continue to support them. We have increased recruitment in the area, and are in the midst of an enormous recruitment marketing campaign to bring new, qualified people into the care home sector. The Secretary of State wrote to relevant stakeholders on 14 May, inviting them to cross-party talks on the care home sector. We are continuing those conversations and hope to bring them to a head at the earliest opportunity.
NHS Long-term Plan
Baroness Armstrong of Hill Top Excerpts(5 years, 7 months ago)
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Baroness Blackwood of North Oxford
As ever, the right reverend Prelate is insightful in his question. He is right that although we have made a lot of progress in improving services, we were coming from a low base. One of the challenges is not understanding why there is such an increase in the challenges we face. This is why the NIHR has dramatically increased the amount of funding it provides to mental health research, and why other important organisations, such as the Wellcome Trust, are prioritising mental health research as a matter of urgency.
Baroness Armstrong of Hill Top (Lab)
My Lords, does the Minister recognise that while welcoming the emphasis on mental health—as the right reverend Prelate did—the Women’s Mental Health Taskforce, which reported in December 2018, recognised that more women are becoming the real issue in mental health work, that many more women are presenting, and that many of them, particularly those who have suffered abuse and trauma, require a gendered approached? The Women’s Mental Health Taskforce recognised this as an issue for the workforce and the way women engaged with treatment, particularly that group of women. I recognise that not everything can be reflected in plans, but it would be a tragedy if that message was not communicated to localities and to those providing mental health services. Unless that happens, many women will simply be let down.
Baroness Blackwood of North Oxford
The noble Baroness has communicated an important message and it is one reason why we have prioritised perinatal mental healthcare. Specifically, services for young girls, who are particularly at risk of self-harm and suicide, recognise this risk. I would be interested to see the findings of the task force she mentions to ensure that those concerns are communicated.
People with Disabilities: Reporting Abuse
Baroness Armstrong of Hill Top Excerpts(5 years, 7 months ago)
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Baroness Blackwood of North Oxford
The noble Baroness has raised a very important issue: she is absolutely right that those with learning disabilities are more at risk from hate crimes and less likely to report those crimes. This is exactly why a number of programmes have been introduced to support those with learning disabilities or autism to raise a complaint, such as the Ask, Listen, Do programme. I am very interested to hear about the report she mentioned: I will take that away in order to learn more about whether its recommendations can be implemented.
Baroness Armstrong of Hill Top (Lab)
My Lords, during consideration of the draft domestic abuse Bill, the Joint Committee heard evidence from disabled groups about abuse in the home, sometimes from family members, sometimes from carers. I hope that the Minister’s department will join in consideration of the report of the Joint Committee, which was published last Friday, to ensure that the needs of disabled people with regard to domestic abuse are properly considered and addressed.
Baroness Blackwood of North Oxford
I am happy to give the noble Baroness that commitment. Domestic abuse in any situation is absolutely unacceptable and we are happy to commit to supporting her.
NHS: Health and Social Care Act 2012
Baroness Armstrong of Hill Top Excerpts(8 years, 5 months ago)
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Baroness Armstrong of Hill Top (Lab)
My Lords, it is a pleasure to be involved in today’s debate, although it is a troubling area of policy. The Minister has heard me on this before. The introduction of this legislation and the way that things have gone have not been a happy tale for the National Health Service—and, most importantly, for too many patients who look to the National Health Service and rely on it.
We know that one of the biggest challenges facing the NHS is the change in the nature of the population. Those changes in the population, and therefore the patient profile, were not addressed in this legislation, which was about structures. I am the last person to say that structures do not matter, but in the National Health Service people work with what they are given. They have to spend so much time trying to sort out what the legislation means in terms of structures and who is responsible for this, that and the other that they have not been tackling the issues that really affect patient care.
I am concerned particularly, as the Minister will not be surprised to hear, about the integration of the different sectors—the integration of the National Health Service with social care—which is one of the real priorities at the moment. They are two totally different systems and the changes in the Act have not enabled and helped those two systems to work more closely together. It is a real problem. There are many other problems but I am leaving it to other people to talk about them. I will concentrate on this issue.
What has happened is that there has been a greater concentration on trying to sort out hospital provision, and subsequent government policies have added to the total inability properly to deal with social care. It is social care that is absolutely critical to hospitals in terms of bed blocking, but also to the most vulnerable: the elderly and people with disabilities. Their voice is not as loud as other people’s in the system—it would not be, for obvious reasons—and their ability to have choice and quality of care differs hugely across this country.
I could weep over the Government not having worked more effectively across government on this issue. The idea that 40% cuts in local government—when so much of local government money is spent either on the elderly or on children—would not affect social care and not have consequent effects on the NHS, and not to have worked that out before the Government initiated certain policies, is risible.
As I uncovered in written PQs, the position is particularly difficult in the north-east—I suspect the Minister knows what I am going to say. I applaud the Prime Minister’s ambition that no area should feel left behind and that no individuals should feel that they do not have an equal opportunity to prosper. But look at what has happened and what is happening in the north-east. The actions that the Government have taken have exacerbated the problems and not eased them.
Poverty affects health. We should not need to say it but we still need to. The incredible reports from Marmot and so on show us just how much they affect health. In the north-east we have many more people who do not have the financial means to assist their own healthcare, so we have a much higher proportion of the population who are dependent on public subsidy in social care. As the Minister knows, I uncovered through these Parliamentary Questions that we have the highest proportion of people who are reliant on public funding for their care needs and the lowest ability to raise money in council tax because of the low value of housing.
The Government took a decision that one of the main ways of further funding social care would be through a 2% levy. When that happened, not a single authority in the north-east gained sufficient money from the 2% levy even to meet the rise in the minimum wage that the Chancellor announced on the same day. Whereas some authorities—I am told—have as a little as 1%, 2% or 3% of their social care users who are reliant on public funds, in South Tyneside, as one example, 89% of those who are dependent on social care rely on public funding. That authority got some £794,000 from the 2% increase and it nowhere near covered the costs in the social care sector of the minimum wage.
There is also, as the Minister knows, a crisis among the private sector providers of residential social care because they are not getting enough money. The Government have made a small attempt to alleviate that. But I am saying to the Minister that he really has to persuade his colleagues that if they want to get anywhere near meeting the Prime Minister’s ambitions, there has to be an urgent national review of how they fund social care and not to push it on to impoverished people in local authorities that have taken the cuts and do not have the council tax base that other parts of the country do. This is unfair, it is unequal and it has to change.
Health: Adult Psychiatric Care
Baroness Armstrong of Hill Top Excerpts(8 years, 11 months ago)
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Lord Prior of Brampton
My Lords, if we can improve home treatment and crisis resolution at home it will free up in-patient beds and solve the other problem as well, as people will have to travel less far. That is absolutely critical. I cannot tell the noble Baroness today what NHS England is proposing to do with financial incentives, but I can reiterate that treating more people outside hospital, at home, is a priority for the Government.
Baroness Armstrong of Hill Top (Lab)
My Lords, does the Minister realise that there are real problems in many regions? I chair a charity which deals with the most vulnerable—people with complex needs. We have evidence that the number of people whose mental health needs have increased has risen significantly over the past five years, and yet three centres in Tyneside—both residential and day care—which deal with the mentally ill are closing this year. How will we meet those people’s needs in such circumstances?
Lord Prior of Brampton
My Lords, reading the noble Lord’s report, I was struck that he said in the foreword that he went through times when he was very depressed and times when he was deeply impressed. In a way, that sums up the mental health system—it is fragmented, and there is a high level of variation. We provide fantastic care in one place but terrible care for somebody else, and very often it is not related to cost. I do not know about the particular instances that the noble Baroness has referred to, but I can fully understand that in certain areas it is much worse than in others.
Sex-selective Abortion
Baroness Armstrong of Hill Top Excerpts(9 years, 2 months ago)
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Lord Prior of Brampton
My Lords, I have a long list of stakeholders, which covers all the usual suspects in this area, if I can put it like that. In the way that the methodology was developed to assess whether there was a population basis for gender abortions taking place, we took advice from the Office for National Statistics and a number of the royal colleges.
Baroness Armstrong of Hill Top (Lab)
My Lords, has the Minister yet had the opportunity to consider the judgment made last week about abortion in Northern Ireland? What advice and work are the Government going to do with the devolved Administration to ensure that women in Northern Ireland get the same human rights as women in the rest of the United Kingdom?
Lord Prior of Brampton
My Lords, it is a devolved matter for the Northern Ireland Executive and not really for me or for us.
General Practitioners
Baroness Armstrong of Hill Top Excerpts(9 years, 7 months ago)
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Lord Prior of Brampton
The noble Baroness will know that NHS England recently published its Five Year Forward View, which is a five-year plan for the future. It will encourage much more care, delivered outside hospitals, in the community, and that will require larger input from general practice. I am very pleased to tell the noble Baroness that we are committed to 5,000 more doctors working in general practice.
Baroness Armstrong of Hill Top (Lab)
My Lords, I, too, welcome the Minister to the Dispatch Box. I wonder whether he agrees that the Government are being very complacent on this issue. I passed my GP surgery in a small ex-mining town in the north-east this weekend. On the door I read that there were 11 or 12 sessions in the next month when the GP practice would not be open—that is, from Monday to Friday. Is it not true that the model is broken and that young doctors coming into GP practice do not want to be partners and have the responsibility of running a small business as well? Is not the model broken? When we look at what is going on in areas where health outcomes are poorer, is it not urgent that the Government pay more serious attention to that?
Lord Prior of Brampton
The noble Baroness speaks a good deal of truth. The model that we have been working with since 1948 in this country is largely broken. We have to deliver more care through vertically integrated units of care, not just independent hospitals. Over the next five to 10 years we will see a huge consolidation of primary care. The old cottage industry model of general practice is probably broken. The Five Year Forward View recognises that and the Government have committed £8 billion to see that forward view put into practice.