Future of Health and Care

Debate between Baroness Armstrong of Hill Top and Lord Bethell

Tuesday 23rd February 2021 Lords Chamber

[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

Debate between Baroness Armstrong of Hill Top and Lord Bethell

Tuesday 6th October 2020 Lords Chamber

[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

Debate between Baroness Armstrong of Hill Top and Lord Bethell

Thursday 3rd September 2020 Lords Chamber

[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

Debate between Baroness Armstrong of Hill Top and Lord Bethell

Tuesday 7th July 2020 Lords Chamber

[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.