Social Care in England

Baroness Brinton Excerpts

Thursday 14th October 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, I declare my interest as a vice-president of the Local Government Association and a vice-chair of the All-Party Parliamentary Group on Adult Social Care. I am disabled as the result of a long-term condition and my husband is my unpaid carer.

I congratulate the noble Baroness, Lady Pitkeathley, on securing this vital and timely debate today. As she said, it is a repeated debate and, frankly, it will continue to need to be repeated until the Government tackle the issues raised in it. Her speech cogently set out both the long-standing problems and the current emergencies that are tipping the social care sector into real crisis, with our extremely vulnerable citizens now finding that it is harder to get social care support and, even more worryingly, vacant beds in homes along with homes closing meaning that some geographic areas face a real crisis.

The right reverend Prelate the Bishop of Oxford spoke movingly of the role of families in supporting their loved ones, and the dignity that this gives to both the person receiving the care and their carers. We on these Benches agree. People should be encouraged to stay in their homes and with their families for as long as is practicable.

The noble Baroness, Lady Finlay, reminded us that access to professional care is in extremely short supply. That so many people in that survey approaching the end of their lives could say that they felt they needed more help was not a criticism of the care that they received but a demonstration of how broken the system is.

My noble friend Lady Thomas of Winchester spoke from personal experience of the reality of the problems faced by the domiciliary care staff who work for her, and of how they are so low-paid yet highly skilled. This is an iniquity that needs to be remedied.

Care workers need to be paid at least at the same rate as an NHS healthcare assistant. If they were, they would receive an instant £2 per hour rise, which would cost the country £40 million. Healthcare assistants in the NHS are not particularly well paid either, but the key fact is that there is no wriggle room to pay those extra funds from the limited resources allocated to the social care sector. We should not have private beds in care homes helping to subsidise state funding; that is another iniquity.

Workforce issues are already forcing homes to refuse to take patients because they just do not have the staff to look after them safely. We know that these staff are skilled beyond measure but they are paid at the minimum wage because, shamefully, we as a society still regard social care as unskilled. The funding rates for residents are based on most staff being on the minimum wage, making it impossible now for employers in the sector to compete with retail, hospitality and even agriculture, where employers can charge customers more and therefore pay their staff more. Worse, these dedicated staff will be paying the increase in national insurance, which will further reduce their income at the exact same time as they face a cut in universal credit and an increase in energy costs and food and many other items.

The noble Lord, Lord Astor, spoke of the pressures on local commissioning. He spoke of staff territorialism and empire-building, but I think that is the wrong way to look at it. The current assessment system requires the NHS and local authorities to fight over whether personal care needs are caused by health issues or ageing, and this is demeaning at best. Staff with limited budgets argue over whether incontinence was caused by dementia or by a health issue, because of course in their eyes dementia is not paid for by the NHS. I think what he is referring to is not staff empire-building but staff with limited budgets desperately trying to protect their funds for the many more people who need it.

Over the last five years the public funding for social care via local authorities has not increased in line with demographic demand, so that now most councils say they are spending three-quarters of their funds on social care. Skills for Care forecasts that if the adult social care workforce grows proportionate to the projected number of people aged 65 or over in the population between now and 2035, an increase of just under 30% —around 500,000 extra jobs—will be required. That is an eye-watering number. The health and social care levy and the Build Back Better: Our Plan for Health and Social Care report do not even start to address that. What are the workforce plans? I understand that the specific extra amount for the next three years in workforce is about training, not for wages, let alone for pay rises.

Build Back Better: Our Plan for Health and Social Care, published last month, is not a plan for health and social care: it is a funding plan for the NHS, looking at how individuals pay for their social care and which elements will be paid for by the state. We have seen that the structures for paying the costs of these will need support beyond the proposed cap and, as others have mentioned in this debate, will not cover the accommodation and food costs laughingly called hotel costs. That means the public, who think the new arrangements that they are paying tax for mean they will not have to sell their homes, are in for a shock: they are going to have to sell their homes even if they get the health element paid for by the state.

Last week the Secretary of State for Health and Social Care told the Conservative conference that we did not need the care sectors, as families should just look after their own. It is as if he does not know that the cost of inaction and delay is already falling on the 11.5 million unpaid carers in the UK whose contribution to the current social care system is almost completely ignored. The cost of reform to the Government may seem large, but it is a fraction of the true cost to families across the countries. Carers UK has estimated that unpaid carers save the Treasury £193 billion a year already.

What analysis have the Government made of the Dilnot reforms? How will what they are proposing help unpaid carers with the challenges that they face —for example, in securing breaks from their caring responsibilities? Are the Government planning to put in place a cross-departmental and comprehensive carers strategy or action plan to ensure that those providing unpaid care get the support that they urgently need as we emerge from this pandemic?

My noble friend Lady Tyler of Enfield movingly explained the reality of the pandemic for those in care homes, with some 40,000 deaths of residents. That is deeply shocking and, as she said, a real national scandal. It has undoubtedly made the serious crisis in the sector much worse.

We have spent decades waiting for reforms. Fifty years ago, we still had remnants of provision in former workhouses; I know that because I visited elderly residents while I was still in school. Twenty-five years ago, too many local authorities had to close their homes as they did not have the resources to upgrade their accommodation, and that is when the private sector began to blossom. Ten years ago, though, austerity cuts started, not just in social care but in all the vital ancillary services that keep people independent and managing at home: supported housing, adult day services and community nurses. So it was hopeful 10 years ago when the three major parties all came together to support the report by Andrew Dilnot’s commission—but in 2014 the Conservatives walked away, and the crisis in the sector has worsened considerably.

The noble Lord, Lord Cashman, was right to highlight these services. Meals on wheels or lunches at day centres are often now a thing of the past in too many areas because the councils just do not have the resources. There are some good examples. In Cornwall, some services for school lunches for children are now combined with what was meals on wheels. In some really innovative areas, they are beginning to have lunch together. We know that it keeps people active to mix with younger people as well. Why are we not learning from good practice elsewhere? In the Netherlands, some care homes recruit students to live in and work part-time there to help fund their degree studies. That has been noted to reduce the progress of dementia. It keeps residents active and, vitally, changes the career choices of the students who take part in it.

We know that there are limits on publicly funded costs, and the position regarding privately funded beds must stop now, but this means that real rates need to be paid to reflect that cost. By the way, from these Benches we also echo the urging of the noble Lord, Lord Cashman, for real funding for local authorities to recognise their key role in commissioning services to keep people active and healthy. The Government’s proposed council tax increase of 5% per annum for three years to help fund social care is also iniquitous. Council tax is even more regressive than national insurance and, frankly, for some councils that 5% will not touch the sides of their new responsibilities under the reforms for assessment and commissioning.

The worry is that the Government are doing everything upside down. On Monday, your Lordships’ House debated and completed consideration of the Health and Social Care Levy Bill, but we have not yet seen the White Paper on social care that the PM promised on the steps of No. 10 Downing Street two years ago. We heard leaks over the weekend from the Government that there may also be an integrated services White Paper, streamlining health and social care. That is rich, given that the health and social care Bill is going through the House of Commons at the moment and is due in your Lordships’ House before the end of the year.

What is it about this Government that means they subvert the parliamentary process and force parliamentarians to vote on proposals before the details are published for wider consultation? I am afraid that just sets the real context of this debate about social care. For decades, social care has faced a crisis. The pandemic has exacerbated that. We face a real emergency and the Government need to act now.

Virginity Testing

Baroness Brinton Excerpts

Tuesday 12th October 2021 Lords Chamber

[Lord Kamall (Con)]

We completely agree with my noble friend’s sentiments. It is really important that we ban virginity testing and hymenoplasty as soon as possible. The issue on hymenoplasty in particular is that, unfortunately, because it is classified as a cosmetic procedure, introducing legislation in this space might take away the right for women to make decisions about procedures that they wish to have and be counter to current regulation on cosmetic surgery. It is important that we work out how we can ban this practice, but those objections have been raised—and if those legal objections have been raised, we have to be careful that we work properly to make sure that we ban these procedures.

I give the commitment that I shall push as much as possible to make sure that we ban both virginity testing and hymenoplasty as soon as possible. My noble friend mentioned the amendments in the other place. The Member who submitted those amendments has been in consultation with the Department for Health and Social Care, and we hope to be able to introduce those changes, particularly those bans, as soon as possible.

[Baroness Brinton (LD) [V]]

My Lords, I also welcome the noble Lord, Lord Kamall, to the Dispatch Box. I want to pick up on points that the noble Baroness, Lady Sugg, raised. Some private clinics advertise these procedures to women, which perpetuate myths around virginity, falling way below the standards of honesty and integrity that are rightly expected of doctors. Indeed, the GMC ethical guidance on communicating information explicitly outlines that, when advertising your services, you must make sure that the information that you publish is factual, can be checked, and does not exploit patients. We have waited far too long for this to be made illegal. Can the Minister please press to make this happen sooner rather than later?

[Lord Kamall (Con)]

I thank the noble Baroness for her question, but also for having a meeting with me to discuss some of the issues that we will debate in future weeks and months. All preparation and revision are welcome.

I give a pledge that I will push back at my department and push to have both these practices banned as quickly as possible. However, as I said, some concerns have been raised from a legal perspective, given that hymenoplasty is a cosmetic procedure. All of us would agree that this is an awful thing and that it should be banned, but I want to make sure that in doing it we are very careful. A few years ago, I was a research director for a think tank, and one issue that I always considered with any change of law was unintended consequences. We have to be clear that we do this in a proper way, and I hope that we can introduce these bans as soon as possible.

Social Care Funding: Intergenerational Impact

Baroness Brinton Excerpts

Thursday 16th September 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, I declare my interests as a vice-president of the Local Government Association and a vice-chair of the All-Party Parliamentary Group on Adult Social Care. The quality of contributions from around the House demonstrates that this is a complex issue.

I agree with the IFF, the Resolution Foundation and my noble friend Lady Tyler that using national insurance is not equitable to those coming behind us baby boomers. That is why, on these Benches, we believe that income tax should be the mechanism, despite what the IFF says, given the combination that many people who retire after their retirement date pay tax up to that point, while many pensioners pay income tax because of the level of their private pensions, while the poorest pensioners do not. That is also progressive, as well as more generationally fair in terms of raising income.

By way of illustration, I want to make two brief comments about those affected badly by these proposals. The first is children who need to access social care and their families. If we think that the funding adult of social care is in crisis, social care provision for disabled children is much worse, with exhausted parents having to pick up the care 24/7. Can I ask the Minister, not for the first time, what plans there are to remedy that situation as a matter of urgency as such provision is excluded from these proposals?

My second point relates to those who care for our vulnerable elderly—the wonderful care home and domiciliary staff who will also be badly affected by the levy proposals. The 2020 Skills for Care workforce survey states that their average age is 44, average pay is £8.50 per hour and over a quarter are on zero-hours contracts. Worse, some are about to see £20 per week disappear from their universal credit at a time when energy and food bills have substantially increased in recent months. Now, they will also have to pay the increased national insurance contribution.

Worse, it appears that, unlike the NHS, social care providers will not get extra budget to cover the increased employer national insurance contributions, which means that there will be less funding available to increase the basic rate of pay of staff or spend on staff development and training.

However, the final unfairness for our younger staff and older people using social care is that it appears that, after the NHS has taken the bulk of the levy funding, virtually all the remaining levy will go towards the funding structures—as the noble Lord, Lord Lipsey, outlined—and not into care homes, meaning that funding for the essential front line of social care service just will not happen.

Covid-19

Baroness Brinton Excerpts

Wednesday 15th September 2021 Lords Chamber

[Baroness Thornton (Lab)]

Normally, of course, we would have taken these Statements separately but on this occasion, we can take them together. I hope we are working towards taking Statements on the day they are made in the Commons wherever possible.

I looked back at this week in 2020. This time last year, the Prime Minister introduced the rule of six—and really confused the nation. Covid marshals were introduced and the offence of mingling appeared on the statute book. We had infection rates rising, from the young to the middle-aged, and we were very concerned that that meant that they would move into the older cohort of the population. I of course acknowledge that vaccine and testing regimes have made a huge difference, but the lesson we need to learn from last year, and which is signalled in the recent SAGE report, is the need to take action in a timely fashion—which, I am afraid, the Government failed to do from time to time last year.

On Monday, we had confirmation of the vaccine programme for children, and we on these Benches welcome that and support the decision and recommendation of the CMO. Children may not have been the face of this crisis, but they have certainly been among its biggest victims. Yesterday, the Secretary of State also confirmed a booster jab and again, we on these Benches welcome and support that. The obvious question is: how will all this be done? In addition to the issues of our young people, booster jabs and the flu vaccine, we have areas of the country where vaccine take-up remains relatively low. For example, in Bradford, where I am from, second doses are running at 65%; in Wolverhampton, 65%; in Burnley, 69%; and in Leicester, 61%. The first question has to be: what support will be given to those areas and others so that they can boost their vaccine take-up?

Can the Minister explain to the House what the next stage in the children’s vaccination programme will look like and by what date he anticipates that children will be vaccinated? Will it be the responsibility of parents to arrange their children’s vaccination, or will the local NHS arrange it with schools, year by year, or class by class? Will the flu vaccine, which is this year being expanded to secondary schoolchildren, be delivered at the same time as the Covid vaccine or separately? Can the Minister explain what steps will be taken to ensure that parents are informed of the benefits and risks of the vaccination? Can he confirm the Government’s position in rolling out the vaccine and whether the consent of parents will be necessary, because surely the Gillick principle will come into play here? Can the Minister explain why, 470 days since SAGE warned about the importance of ventilation in schools and colleges, it looks as though not a huge amount of action has been taken?

Yesterday, in Grand Committee, I raised the issue of anti-vaxxers demonstrating outside our secondary schools. Given the creation of safety zones around hospitals to prevent harassment and bullying from anti-vaxxers and ensure the safety of our healthcare workers, patients and their caregivers, what will we do about our schools? Can the Minister confirm that the duty of schools, their leaders and the Government is to protect vulnerable children from any form of intimidation or demonstration at their school gates? What is his view of this matter?

Despite the success of the vaccine rollout, the delta variant continues to pose a considerable threat to people. Those who are sick with the delta Covid variant are twice as likely to need hospital care as those who contract the alpha variant. Of course, the UK has not yet experienced delta in the winter. The Government have acknowledged that there is a “plausible” risk of cases rising to an extent that would place the NHS under “unsustainable pressure”. Can the Minister advise the House at what point different measures in the plan will therefore be introduced?

The Government—and, indeed, the scientists—note that

“the epidemic is entering a period of uncertainty … It will take several weeks to be able to fully understand the impact of any such changes.”

In its report, SAGE stressed the “importance of acting early” if cases rise to stop the epidemic growing. It warned:

“Early, ‘low-cost’ interventions may forestall need for more disruptive measures and avoid an unacceptable level of hospitalisations … Late action is likely to require harder measures.”


Given that deaths are currently five times what they were a year ago, with hospitalisations four times as high, why are the Government not already pursuing light-touch measures, such as mandatory masks? The CSA, Patrick Vallance, said that the UK is now at a “pivot point” where, if the situation worsens, it could do so rapidly—so would light-touch measures not be prudent?

The Autumn and Winter Plan states that the Government want

“to sustain the progress made and prepare the country for future challenges … by … Identifying and isolating positive cases to limit transmission”.

Yet the Health Secretary said that no decision has yet been taken as to whether pupils in England will continue to undergo regular testing. Does the Minister share my concern that ending regular testing for pupils is contrary to that key plank in the winter plan?

Although we are still waiting to hear what changes will be made to Covid travel rules, the Health Secretary implied that PCR tests for fully vaccinated travellers will be replaced with lateral flow tests. What will this mean in terms of possible delays in identifying cases involving variants of interest or concern to the UK?

The Health Secretary also confirmed that, although the plans for mandatory vaccine-only Covid-status certification have been shelved for now, the Government may well pursue them in future under the plan B scenario. Can the Minister provide further details about which settings and scenarios will be involved? Can he confirm whether this will require primary legislation?

[Baroness Brinton (LD) [V]]

My Lords, the publication of the 33-page Covid Autumn and Winter Plan, including plans A and B, rightly talks about the need to resume life as normally as is possible while Covid is still around, but to move into restrictions faster if cases surge and the NHS is pressured. The World Health Organization’s special envoy on Covid, Dr David Nabarro, has said that the UK is right to find a way to live with the virus. However, he added:

“Speed is of the essence. We’ve been through this before and we know, as a result of past experience, that acting quickly and acting quite robustly is the way you get on top of this virus, then life can go on. Whereas if you’re a bit slower, then it can build up and become very heavy and hospitals fill up, and then you have to take all sorts of emergency action.”


Why does the Statement talk about the vital importance of mitigations, such as meeting outdoors where possible, ensuring ventilation if inside and wearing face coverings? Why are there no clearer, repeated messages for the general public about all these vital interventions, especially what we can all do now to slow down the increase in cases and hospital admissions?

At the No. 10 press conference on Monday, Professor Chris Whitty said:

“Anybody who believes that the big risk of Covid is all in the past and it’s too late to make a difference has not understood where we are going to head as we go into autumn and winter.”


He is right to be concerned. The seven-day rolling figure for daily hospital admissions is now around 1,000, with an average of 8,400 Covid patients in hospital beds. These numbers are considerably greater than they were this time last year. SAGE is very concerned that, as rules are further relaxed and people start coming back into work, the number of Covid patients going into hospital is set to increase substantially. This would put the NHS under real pressure, with perhaps as many as 7,000 admissions a day in six or so weeks, so it says.

The Statement announces the final decision on the booster scheme for those aged over 50, healthcare staff and the clinically extremely vulnerable, following the third dose for the half a million people who are severely clinically vulnerable. We welcome this. However, the World Health Organization reminded us that we should also be providing doses for low-income countries, but I see that the Government are planning only 100 million doses over the next few months. That is a drop in the ocean given that only 2% of the populations of low-income countries have been vaccinated. Will the Government agree to review and increase this number?

We on these Benches welcome the news on 12 to 15 year-olds getting vaccines. We accept that this was a difficult and complex decision, but we are pleased that there finally is one. There was an excellent slot on the “Today” programme this morning, with a group of 12 year-olds asking a paediatrician some questions; he had to look one answer up on Google. I hope that all parents and children will be able to access this sort of information because we know that it makes all the difference in coming to a decision.

However, as the noble Baroness, Lady Thornton, said, anti-vaxxers are causing serious problems. Good on Chris Whitty for what he said about one celebrity who attacked the idea of 12 to 15 year-olds having vaccines. However, today, yet another celebrity attacked him on social media, saying that he should be hanged. That is disgraceful. What are the Government doing about public servants like Professor Whitty being threatened in this way? As importantly, what will the Government do about the disinformation that people are now spreading at school gates, including leaflets with the NHS logo on them?

Ten days ago, Dr Jenny Harries announced that all clinically extremely vulnerable children in England—even those still on chemotherapy—would be removed from the CEV list and expected to return to school as term was starting, regardless of their underlying condition or the fact that there are no masks, bubbles or even, in many schools, proper ventilation. Although it is really important to have all children back in school, this cohort of children is at particular risk. Their consultants and GPs are as bemused as their parents, so why is Jenny Harries’s letter to the parents of these children, explaining why they are being removed from the CEV list, not on either the NHS or UKHSA website? Will the Minister write to me to explain this decision? We are hearing confusion from parents and medics alike.

Finally, last week, I commented on the continuing farce of Ministers U-turning daily on the use of vaccine passports for clubs. It is confusing to keep up with the U-turns on U-turns; I note that the Statement is trying to have it both ways. I suspect that Ministers could do with some new flip-flops.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)]

I thank the noble Baronesses, Lady Thornton and Lady Brinton, for such thoughtful questions. I am very pleased to be here to answer questions on both these Statements, and I thank the noble Baroness, Lady Thornton, for her kind remarks earlier.

I too welcome the decision to bring forward the vaccination of children. I reassure the noble Baroness, Lady Thornton, that it will be done in the same way that a large number of other vaccinations are run through the school process. As I am sure she knows, vaccinations for things such as HPV and flu have been done at primary school for some time and there are extremely well-established and thoughtful protocols for handling them. They are handled not by school nurses but by nurses employed by the local authority or on contract by the local CCG to deliver the vaccinations, and the consent forms are handled directly with the parents. There is an extremely well-established process for the very rare occasions where there is a difference of opinion between the child and the parents. It is important that we get that right. I reassure the Chamber that this process for vaccinations has been handled for years. The professionals who deal with such disagreements are extremely well trained and the Gillick principles, which are extremely well known, will be applied to the Covid vaccination. I think all noble Lords agree that that is entirely right. Children aged between 12 and 15 will be provided with information, usually in the form of a leaflet, for their use. The school- age immunisation provider will, prior to vaccination, seek consent for all the vaccination programmes.

The noble Baroness, Lady Thornton, quite rightly raised the question of children being pressured into taking or not taking the vaccine. I reassure her that the school-age vaccination programme and the clinicians involved are very well equipped and are well versed in dealing with vaccines in schools; this will not be a new thing for the schools or professionals involved. Their ability to gain consent and to communicate exactly why the Chief Medical Officer has gone ahead is an important element of the decision to accept the recommendation from the CMO on the back of the JCVI recommendation. The four CMOs have said that it is essential that children and young people aged 12 to 15 and their parents are supported in their decisions, whatever decisions they take, and are not stigmatised for accepting or not accepting the vaccination offer. Individual choice will be respected.

The rollout is starting immediately, at the beginning of next week, and we expect that it will end in schools by the end of November. The advice from Dr June Raine of the MHRA is that the flu and Covid vaccinations can happen contemporaneously—studies have supported that—but that will not necessarily happen in every case. The practicalities of the supply of Covid and flu vaccines are, as noble Lords know, extremely complex, and we do not want to make a complicated situation any worse by trying to force a combination if it is not possible.

The noble Baroness, Lady Thornton, asked about our arrangements for the current winter period and particularly about mandatory masks. I completely understand the concern of noble Lords in the Chamber about making masks mandatory. The noble Baroness, Lady Thornton, referred to it as “light touch”, but our feeling is that it is not light touch to mandate the wearing of masks; in fact, it is an intrusion into people’s life in the most intimate way. That is not to say that it should not happen at all, but we are at a stage of the pandemic where we are trying to move the responsibility for individual choices, such as wearing masks, on to people to take it for themselves. Of course, if the worst happens and we have to move into plan B, we have the legal and influential role to be able to mandate masks, but at this stage it feels proportionate to try to use persuasion rather than mandation.

I remind noble Lords that the messaging around the pandemic is not the only thing we are trying to do right now. In response to the remarks of the noble Baroness, Lady Brinton, about public messaging, I reassure her that I am the Minister who signs off the marketing around Covid and other health messaging. We are currently spending a substantial sum communicating our messages on Covid. The fact that she thinks they do not exist is an example of the public exhaustion that is an inevitable result of 18 months of relentless campaigning on Covid. We have to recognise that the public can hear us only so many times before they start tuning out the message.

There are other very important messages that we have to get through to the public, the most important of which is for those who show symptoms of other diseases to step forward to get their tests, so that we can catch people who are ill with non-Covid diseases. We have a massive backlog of diagnostics; the NHS figure on the expected numbers of people who have diseases such as cancer, and need to be seen by GPs and specialists, is huge. We need to get those messages across to people as well and, while it is not a zero-sum game, to be aware that these messages compete with each other. We are using this moment where there is a pause in the Covid epidemic to try to get people back into the GP surgeries and the diagnostic hubs—back into hospital—to try to catch diseases and reduce the lists. That fightback is extremely important and is one of the reasons why we are focused on the “Help us to help you” messaging.

The noble Baroness, Lady Thornton, asked about testing in schools. I reassure her that we have not only put a huge effort into the double supervised testing which, as she knows, kicked off the school term but are sustaining the support for school testing. There will be a review at the end of September but there are no current plans to end regular testing in schools. We have to ensure that there is value for money and that the testing is effective, but it is extremely well supported by schools. I believe it has made a serious impact on the spread of disease within schools and pay tribute to teachers, headmasters, parents and pupils for the high rates of uptake in schools. Around one-third of all positive cases are tracked down through asymptomatic testing, which is a really good indication of how effective it is at breaking the chains of transmission.

There is a review of our border arrangements in play, and I believe the Secretary of State for Transport will be making a Statement tomorrow. However, I reassure the noble Baroness that we take border control extremely seriously. We are very conscious of the threat from variants of concern. At the same time, however, we have to recognise that vaccination makes a big difference and be proportionate in our border arrangements. We are conscious that although travel is regarded as a voluntary matter, people may have strong family roots or good business reasons. Being able to travel is one of the great joys and loves of people’s lives, so we are seeking to be proportionate and reasonable in our travel arrangements. The Secretary of State will make further announcements on that tomorrow.

On the point made by the noble Baroness, Lady Brinton, on public servants, I could not agree more. The rhetoric that has been directed at public servants such as Chris Whitty and JVT sometimes leaves one feeling quite cold and disappointed at the British public. As she probably knows, we have made arrangements to put a big arm around those people who have been threatened and improve the security arrangements for them. I call on everyone to express support for our public servants, who have a very tough job. They are often communicating unpalatable, difficult truths to the public and challenging some of the assumptions and preconceptions of those who would like life to be slightly different from what it really is.

In particular, I noted the physical attack on the MHRA headquarters in Canary Wharf 10 days ago. Videos of that attack really disturbed me; it was brutal, nasty and ferocious. I pay tribute to the Metropolitan Police, who responded extremely quickly and emphatically, and to professionals at the MHRA who had steady nerves on that Friday afternoon. We cannot operate in a society where differences of opinion about public health policy lead to physical violence on the streets of London. I absolutely condemn those who participate in physical attacks of that nature, along with the kind of violent extremism that calls for people to be hanged. This is no time for that kind of extremism. Those who participate in it are trying to divide society. They really need to move on and find something else to do.

I am extremely pleased to hear what I think was the implicit support of the noble Baroness, Lady Brinton, for the principle of vaccine passports. It is right that we hold such an intimate and strong measure in reserve in case we need it for plan B. The technical and regulatory arrangements for the measures have been put in place but we have held off the implementation because it is not felt that it is needed right now. However, should it be needed either to break the chains of infection and restrain the spread of the virus or to encourage vaccine uptake, which is one of the benefits of such a measure, we will turn to it as part of our plan B measures. That is a proportionate treatment of that potent but very heavy state intervention.

NHS: Hospital Visiting

Baroness Brinton Excerpts

Wednesday 15th September 2021 Lords Chamber

[Lord Bethell (Con)]

What a touching piece of testimony from my noble friend. The feelings he had as a child are felt by a great number of people, not only those in hospital and social care but their loved ones. We are mindful of the impact of visiting on the mental health and the good feeling of those in hospital. Visiting was suspended on 4 April last year, but that suspension was lifted on 5 June. Since then, we have sought wherever possible to put careful visiting policies in place. In October last year, the number of visitors was limited to one family contact or somebody important to the patient; since then, we have made huge strides in trying to lift those restrictions wherever we can. It is left to trusts to implement exactly those restrictions that are suitable to maintain infection control in their area.

[Baroness Brinton (LD) [V]]

My Lords, in his Answer to the noble Lord, Lord Farmer, the Minister said it was vital to keep hospitals safe from Covid infections. There are now over 8,400 Covid patients in hospital with around 1,000 daily admissions and rising. SAGE is concerned that, in a month, there could be 8,000 patients a day. Paragraph 36 of yesterday’s autumn and winter plan says that the UK HSA is reviewing easing specific infection prevention and control and social distancing to better manage activity. Can the Minister give assurances that this will not happen while cases in hospital continue to increase at this rate?

[Lord Bethell (Con)]

We are trying to have visiting policies that are proportionate to the situation. To reassure the noble Baroness, as she probably knows, the number of visitors at the bedside is currently limited to one close family contact and somebody important to the patient. Those are the guidelines we have in place. As I said, we leave it to trusts to run their own infection control measures. She is entirely right that the potential for nosocomial infections within hospitals, which was such a serious feature of the pandemic last year, is one that we are extremely wary of and careful about.

Commonwealth Fund Report: NHS Ranking

Baroness Brinton Excerpts

Tuesday 14th September 2021 Lords Chamber

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, we will now have a virtual contribution from the noble Baroness, Lady Brinton.

[Baroness Brinton (LD) [V]]

My Lords, the report points out that, although the UK is fourth overall in the rankings, we are ninth out of 11 on health outcomes. As the noble Baroness, Lady Thornton, outlined, the top three countries are particularly good at investment in preventive services and primary care, but the report also talks about wider social care, including housing, nutrition, transportation and early years services. All these investments tackle inequity and deprivation, as covered in both the Leadsom report and the Marmot report. Given the Chancellor of the Exchequer’s statement that there is no money for anything other than the NHS and social care, what are the Government proposing to do to address investment in these vital areas?

[Lord Bethell (Con)]

My Lords, we are investing a tremendous amount in preventive care, and I agree with the noble Baroness that this is key to the future—to better and longer lives and, on my noble friend’s point, to increasing the productivity of our healthcare system. I have already mentioned the key components of our preventive agenda and I add to that list the £325 million that we have allocated to the diagnostic fund precisely to catch disease earlier, to give people the treatments they need earlier, and to bring down the cost of our healthcare service.

Social Care: Family Carers

Baroness Brinton Excerpts

Monday 13th September 2021 Lords Chamber

[The Deputy Speaker (Lord Haskel) (Lab)]

My Lords, we will now have a virtual contribution from the noble Baroness, Lady Brinton.

[Baroness Brinton (LD) [V]]

My Lords, the Disabled Children’s Partnership reports that parents of disabled children say that two-thirds were not able to access care at home during the pandemic. In the two years prior to the pandemic, large numbers of respite care beds for disabled children had already been shut down. Given that none of the new social care levy is targeted towards disabled children and young people, can the Minister say whether urgent funding will be provided for this vulnerable and too-often forgotten group, where unpaid carers are often on duty 24/7?

[Lord Bethell (Con)]

My Lords, I do recognise the problem: 23% of carers—1.3 million—provide care for 50 hours or more a week. That is an absolutely astonishing figure, and I pay tribute to the contribution they make. The overall contribution by carers is around £56 billion a year. We cannot undervalue that contribution in either emotional, care or financial terms. The precise allocation of funding for this new financial package is not yet confirmed. When it is, I will make sure that the reasonable points the noble Baroness made are heard clearly in the department.

Covid-19 Update

Baroness Brinton Excerpts

Thursday 9th September 2021 Lords Chamber

[The Deputy Speaker (Baroness McIntosh of Hudnall) (Lab)]

My Lords, the noble Baroness, Lady Brinton, is taking part remotely. I invite the noble Baroness now to speak.

[Baroness Brinton (LD) [V]]

My Lords, yesterday 38,486 new daily cases were reported. That is equal to daily cases in mid-January and there are now just under 8,000 people in hospital, with 1,000 on ventilators—and yesterday 191 deaths were also reported, equal to the daily numbers at the beginning of March. The consequence of removing all mitigations and life returning to the new normal means Covid is still very much with us, especially the delta variant. Members of SAGE appear, according to the press, to be advising that preparations for an October lockdown should now be made.

It appears that Ministers are reliant on vaccination as the main mitigation, until the NHS is overwhelmed again. But we are already hearing of hospitals having to dedicate more wards just to Covid, with the complexities of double staffing for hot and not-hot wards. These numbers also make it much harder for the NHS to catch up on the long waiting lists, which have been talked about a great deal during the week, with the health and social care announcements.

The Statement talks about test and trace being another pillar. That is right, but the advice to the public is complex and there is evidence that many are not taking tests even when they have symptoms or have been in touch with a positive case. For example, you have to hunt quite hard online if you have had a negative PCR test but still have some residual symptoms to find out whether you should release yourself from self-isolation. Are there plans to make it clearer exactly what people should do, because we all know that sometimes the first PCR test is a little early and a second one is necessary?

Are the news reports true that there is about to be an announcement that anybody double vaccinated will not need to take a PCR test if they come into contact with a Covid-positive person? The delta variant can and is being caught by double-vaccinated people, and—importantly—they can transmit it too. That can have difficult consequences for those not vaccinated, or those who are clinically extremely vulnerable. The noble Baroness, Lady Thornton, referred to the mu variant. If it is true that the Pfizer vaccination is ineffective in holding it back, that is serious and we may need to think about mitigations again sooner rather than later.

The Statement explains the partial changes on policy for vaccinating 12 to 15 year- olds with underlying conditions. It is good to see that those with blood cancers, sickle cell, type 1 diabetes, congenital heart disease and poorly controlled asthma are now added to the list. Actually, it is vital, given Gavin Williamson’s removal of all mitigations in schools. But other children are omitted from this list, who may be on immuno-suppressants or immunocompromised, and who are now expected back in school. The Statement refers to

“no more home schooling, no more bubbles, teachers vaccinated, and all 16 and 17 year-olds offered a first dose”.

But the removal of bubbles and facemasks, and the Government’s shameful lack of movement on providing proper ventilation interventions in classrooms, means that Covid can and will spread, and not just among the children—they may well take it home. While most children will not have a problem, some—those with underlying conditions—will.

Can the Minister explain why all children with serious underlying conditions have been removed from the clinically extremely vulnerable list of shielders? Parents are already getting threatening letters from schools, yet their questions about why their at-risk child has been taken off the list have not yet been properly answered. The evidence in America is that these children are occupying more paediatric hospital beds and more intensive care beds.

Turning to clinically extremely vulnerable adults, it is good that the 500,000 severely clinically extremely vulnerable are to get a third dose as soon as possible. But delaying the decision on a booster jab for the remaining clinically extremely vulnerable, who number just over 3 million, is worrying. Guidance online for them is still 10 pages long, muddled in with advice to the general population, but the key parts are still not to go into any environment with people who are not yet double jabbed or might breach social distancing, and if they come inside your home they should have had a lateral flow test first. As I have said, that amounts to a stay-at-home order but without the support that government provided before. When will the booster decision be made for this particular group of people?

Care home providers are warning that they are already losing staff ahead of the 11 November deadline for all staff to be double vaccinated. This is in addition to the staff shortages that they are already trying to manage, which include the perfect storm of losing staff through Brexit and increased pay in retail and agriculture. Losing more staff who are unvaccinated will be catastrophic. They have asked for a delay to the start of the scheme, particularly now that a new consultation has started for NHS staff on a scheme which would start at a later date. What plans are there to delay this implementation date?

Finally, the Minister for Vaccines came a real cropper in the House of Commons yesterday when trying to justify Covid vaccine passports, when he was on record in the past as not supporting them. Can the noble Lord update the House on the Government’s plans regarding vaccine passports in light of yesterday’s debate, which demonstrated that the relevant Minister could not even explain his own policy credibly?

NHS: Nursing Workforce

Baroness Brinton Excerpts

Wednesday 8th September 2021 Lords Chamber

[Lord Bethell (Con)]

I pay tribute to the noble Lord’s great experience and expertise in this matter. He will be aware that we have a social partnership forum, where we work extremely closely with the professions on how to improve retention. But I think that the motivation of those in public service and, in particular, in healthcare is much more complex than he describes. We have come to a 3% pay agreement with the nurses, and they have demonstrated huge support for the healthcare service during the pandemic, which suggests that it is more complex than he describes.

[Baroness Brinton (LD) [V]]

My Lords, current NHS nursing vacancies in England are now thought to be over 40,000. Nurses have recently reported concerns that a number of nursing posts at a standard that require a registered nurse or midwife are now being advertised to those not registered with the Nursing and Midwifery Council, presumably because of the shortage of nurses. What steps will the Government take to ensure that only properly qualified nurses and midwives are recruited to these posts that require registration?

[Lord Bethell (Con)]

My Lords, there are vacancies in nursing, as there always are. The vacancies at present are not hugely higher than they are normally and, in fact, we have more nurses today than we did two years ago. What I can report to the noble Baroness is that UCAS data shows 27,720 acceptances to nursing and midwifery courses in England as of 7 September. That is extremely good news; it shows the commitment of our graduates to the nursing profession and our commitment to making sure that more nurses are trained.

Residential Social Care: Staff

Baroness Brinton Excerpts

Monday 6th September 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I am enormously grateful for the insight of the noble Lord in this matter, in which I know that he is a great expert. However, he should of course remember that social care is provided through independent providers and local authorities. Social care workers are free to organise themselves as they wish, but that is not the arrangement that we have in this country.

[Baroness Brinton (LD) [V]]

Last week, three-quarters of providers in the United Kingdom Homecare Association said that recruiting social care workers is the hardest that it has ever been. In July, they warned that they faced a perfect storm of losing staff through Brexit and increased pay in retail and agriculture making their wages uncompetitive. They are at breaking point. One-third said that they are handing back some or all of their care contracts to local authorities because they cannot fulfil their contracts now—this is before they lose any unvaccinated staff—so what steps are the Government taking to urgently help the elderly in our care homes, the care homes and their staff going through this crisis?

[Lord Bethell (Con)]

My Lords, I am aware of the anecdotes that the noble Baroness alludes to, but they have not been seen through the figures that we have in the department. However, we are providing support to providers: we have a national recruitment campaign that is running in the autumn; we have put in free and fast-track DBS checks for staff recruited in response to the pandemic; and we have the promotion of adult social care careers in our jobcentres.