Covid-19: Social Care Services

Baroness Brinton Excerpts

Thursday 23rd April 2020 Lords Chamber

[Baroness Brinton (LD)]

I declare my interest as a vice-chair of the APPG on Social Care and thank the noble Baroness, Lady Wheeler, for securing this vital and highly pertinent debate. So many Members of your Lordships’ House have made moving contributions. On behalf of the Liberal Democrat Benches, I also thank all the staff and volunteers working across the wider social care and community sector. Frequently low paid but definitely not low skilled, these amazing people show us their professionalism and big hearts, day after day.

Back in mid-February, we on these Benches asked the Minister repeatedly about care. On 26 February, the noble Lord, Lord Bethell, said in Hansard that

“we are planning … a massive communications campaign on how to protect people, particularly vulnerable people, in our population.”—[Official Report, 26/2/20; col. 257.]

The evidence of recent weeks shows that those most vulnerable in our communities and care homes have been seriously and tragically let down.

Others have covered plenty of the detail, which is symptomatic of the centralised way in which Whitehall, the Department of Health and Social Care, and the NHS have treated anything not in hospitals as a second or even third order of priority. My noble friend Lord Shipley explained the problems that have arisen since Whitehall took over the supply chain for the social care sector and then decided to create a separate system, known as Clipper, that we were told was due to come online on 6 April, but yesterday discovered is still three to four weeks away from going operational.

Worse, where providers and local resilience forums have ordered their own PPE, it has been confiscated by government and rerouted centrally for hospitals first, leaving community settings high and dry. This includes lorries being stopped at border ports and drivers being rerouted. Consequently, a lack of PPE and a policy of moving patients from hospital into care homes without any testing has meant that Covid-19 has spread rapidly in the social care sector.

I support my noble friend Lady Jolly’s call for clarity on DNRs and echo her concerns about GPs asking disabled and learning-disabled people completely inappropriate questions. It is very clear from the government advice, NICE advice and all good palliative care advice that the way in which this happened was inappropriate. I hope that this DNR factor will be examined as part of any inevitable public inquiry. It seemed to happen in groups. Were CCGs asking GPs to ring their patients and find out whether they wanted to go to hospital? To do it all in one conversation is completely inappropriate. For many disabled people, it was completely inappropriate to even ask them this, if they do not have the clinical frailty that my noble friend Lady Jolly spoke of.

However, the Government’s lack of understanding of the wide range of other disabled people, and extremely fragile people, living within our community extends completely in the opposite direction. As a result, people who have ventilators or tracheostomies, for example, have found that their care support is entitled to only the most simple and flimsy face masks, because they are regarded as exactly the same as the standard care in residential homes. The Government’s PPE for the social care sector is almost always designed for the elderly.

Matt Hancock said last week that health and social care workers should not overuse PPE. The gasp that went through the social care community when he said that could be heard across the country. Most community orders are receiving a tiny fraction of what is ordered and needed. My noble friend Lady Barker summarised well the problem between the department and local government.

Time and again, many noble Lords have talked about testing. Testing in the social care sector has been a real problem, with very few centres where staff can go and be tested. On Sunday, an appalling story came out of a social care worker in Norfolk being asked to go to Sheffield—a five-hour round trip—to be tested. Even their nearest place was a three-hour round trip away. It is all very well saying that more and more centres are opening up, but if they are all drive-through, it becomes impossible for the many staff in the social care sector who do not drive to get to them. I hope that the Minister will be able to explain to us when really accessible testing will be available for all social care staff who need it.

The problems with PPE have demonstrated a perfect storm. At the beginning of this crisis, patients, and especially elderly patients in hospitals who may or may not have had Covid, were being pushed back into local care homes without having been tested, whether they were symptomatic or asymptomatic. At that point, staff in care homes were not able to access tests at all and, as a result, Covid started rushing through many of our care homes. Many of the workforce were already self-isolating, or, because of their symptoms, had removed themselves completely and were unable to work. The criminal lack of PPE means that Covid has had free rein. It is estimated that in London, some 50% of care homes have active cases.

Many noble Lords have talked about the future of social care, and it is absolutely vital that we look at that in the context of today’s debate. My noble friend Lady Northover set out the history of social care reform. I can remember the delight, a decade ago, when all three parties supported the Dilnot review, and the shock when the Conservative Party decided that it did not want to continue with it. As we come to the end of this crisis, we must rapidly review the future of social care, but we must not start again from scratch. There is plenty of evidence to show what needs to be done. Our social care sector was already struggling before this crisis, following cuts to local government and to providers, with many providers having gone out of business and others hanging on perilously by a thread at the moment.

The consequences of all this are visible. The Rainbow Trust supports families with seriously ill children. It has said that the risk of the Covid-19 pandemic has put the provision of social care by charities at a higher risk of ceasing altogether, because many charities depend on fundraising, which has dropped significantly. It says that, in the short term, it is unclear how government departments will divide up the modest funding package of £360 million between the so many charities which are desperately trying to provide for very vulnerable groups of adults and children. It added that, in the long term, it is vital that sustainable funding is established to reduce the vulnerability of vital charitable social care to economic shocks, so that we do not end up in this position again.

The Rainbow Trust would like to ask the Minister to please go back to the Chancellor of the Exchequer. Many charities have had to furlough staff, and those staff have been allowed to work for other charities. But in the medical sector, these staff often have exceptionally specialist skills that cannot be used elsewhere, and, as a result, some of the provision that they are trying to offer cannot be done easily.

My noble friend Lord Campbell of Pittenweem has rightly called for a judge-led public inquiry. It is clear that too many things have been going wrong. We need to recognise the contribution made by our health and social care staff wherever they are, whether in care homes, in the community or in hospices. That is why the Liberal Democrats say that we must have a proper package for them. They must have access to full and proper PPE. Moreover, those who have tragically died as a result of Covid in the line of service need proper death in service benefits. We also think that a daily allowance equivalent to the military deployment allowance should be paid during the lockdown to people who end up putting themselves at risk. Too many are doing that, and they are absolutely serving the nation.