Health Care and Adult Social Care

Baroness Brinton Excerpts

Wednesday 27th October 2021 Lords Chamber

[Lord Kamall (Con)]

The Government recognise the valuable role that paid and unpaid carers play in social care. We are looking at how we can make sure that we recruit and retain staff. We understand the challenges that many care homes, quite often those in the private sector, face when trying to recruit and retain staff, given the competitive pressures around the jobs market. The Government certainly take seriously the role of unpaid and paid carers.

[Baroness Brinton (LD) [V]]

My Lords, in addition to the winter’s and next year’s workforce plan, the CQC reports that providers of residential care showed the vacancy rate rising month on month from 6% in April to 10.2% in September. Some care homes whose attempts at recruitment have failed are now having to cancel their registration to provide nursing care, leaving residents looking for new homes in local areas that already are at, or close to, capacity. In recent weeks, two homes in York have announced that they are closing. I appreciate the discussion about planning for the workforce but this is a current crisis. What is the Minister going to do as councils are overwhelmed trying to find beds for patients when there are none?

[Lord Kamall (Con)]

I am grateful to the noble Baroness for the specific examples that she gave. The department is constantly monitoring the workforce capacity pressures. We are continuing to gather a range of qualitative and quantitative intelligence in order to have a strong and live picture of how the risk is developing and emerging. In more detail, this includes drawing on evidence gathered by a regional assurance team and regular engagement with key stakeholders, including the Association of Directors of Adult Social Services in England, local authorities and care provider representatives. We are also monitoring data from the capacity tracker, Skills for Care’s monthly workforce reporting and wider market data. To ensure that we are aware of any emerging workforce capacity pressures, we are strongly encouraging providers to continue sharing available capacity and completing the capacity tracker.

Covid-19: Vaccinations Administered Abroad

Baroness Brinton Excerpts

Wednesday 27th October 2021 Lords Chamber

[Lord Kamall (Con)]

The noble Baroness raises a very important issue about the devolved Administrations. As the noble Baroness will know, health is a devolved matter; we are keeping the devolved Administrations informed of progress on the overseas vaccination solution and they are looking to set up similar processes within their own jurisdictions. A Northern Ireland service has just launched. Bidirectional data flows have also been set up by NHS Digital for those who have been vaccinated cross-border between England, Scotland, Wales and the Isle of Man. Bidirectional data flows between England and Northern Ireland will be live soon.

[Baroness Brinton (LD) [V]]

My Lords, in July, the Minister’s predecessor, the noble Lord, Lord Bethell, told your Lordships’ House that the problem with registering Covid vaccines—whether it was UK residents jabbed abroad or those who had taken part in clinical trials—would be resolved by August, in time for the holidays. A further problem is that the app still cannot tell the difference between a third dose and a booster dose. That is important because third-dose people need a further booster dose. To hear that only 53 people have now got their records on an app is appalling. What are the Government going to do about this mess?

[Lord Kamall (Con)]

One of the reasons for the delay has been the wide range of vaccinations that have been administered worldwide. MHRA is working to make sure that it is confident about recognising them in a Covid pass. There is also a range of issues relating to anti-fraud measures that have to be put in place to maintain the integrity of a Covid pass service. The multi-organisation approach that has been adopted has ensured a high-quality service. NHS England has engaged vaccination centres, provided training and enhanced the vaccine data resolution service capability. NHS Digital has updated the API to allow overseas vaccinations to flow from the vaccine database—the so-called national immunisation management system—to the Covid pass. Also, NHSX has built the certification rules to enable overseas vaccinations in the Covid pass.

NHS England Funding: Announcement to Media

Baroness Brinton Excerpts

Tuesday 26th October 2021 Lords Chamber

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

I thank the noble Baroness for her question. Since 2010, we have increased the clinical radiology workforce by 48%, from 3,239 to 4,797 full-time equivalent posts. Numbers of diagnostics radiographers are up by 33% since 2010 and therapeutic radiographers are up by 44%. We are offering those who want to join the radiographic workforce at least £5,000 as a non-repayable grant for each year of their training to be a radiographer. Since 2016, we have seen a 26% increase in those studying diagnostic radiography and a 10% increase in those studying therapeutic radiography.

[Baroness Brinton (LD) [V]]

My Lords, the £5.9 billion in the Chancellor’s early announcement is to pay for physical infrastructure and equipment, not for current services. The NHS Confederation says that next year’s NHS funding allocations are nowhere near enough either. Last week, the Royal Cornwall Hospital declared a critical incident in its A&E department when it had 100 patients in the 40-bed department and 25 ambulances queuing. Its ambulance service is also under intense pressure, reporting that 50 ambulances have queued at times—again, that is much larger than the actual department. This is echoed across the country. How will Ministers help A&E departments and ambulance services in crisis right now?

Coronavirus Act 2020

Baroness Brinton Excerpts

Tuesday 26th October 2021 Grand Committee

[Baroness Brinton (LD) [V]]

I declare my interest as a vice-president of the Local Government Association. I start by echoing the comments of my noble friend Lord Scriven and many other noble Lords. Regardless of where your Lordships stand on wearing masks, for example, we are all agreed that the way this Government have brought forward far too much Covid legislation as emergency items—

[The Deputy Speaker (Lord Lexden) (Con)]

My Lords, there is a Division in the Chamber. The Committee stands adjourned until all Members have cast their votes.

[The Deputy Chairman of Committees (Lord Lexden) (Con)]

My Lords, the Committee will resume. I invite the noble Baroness, Lady Brinton, to continue her speech.

[Baroness Brinton (LD) [V]]

My Lords, regardless of where your Lordships stand on mask wearing, I believe that we are all agreed that this Government have brought forward far too much emergency Covid legislation, much of which has not even been presented to Parliament before being brought into use. Why, once again, are regulations coming to the Lords for which the expiry date was well known in advance and is not an emergency at all? The Minister’s predecessor heard time after time over the last 20 months many noble Lords complaining that too many statutory instruments were being brought to us as emergency procedures, making a mockery of the scrutiny of your Lordships’ House.

The regulations talk about self-isolation. It remains vital for those who have Covid-19, but can the Minister confirm the rumours that many people are not taking lateral flow tests, even if they are symptomatic, in order not to have to report the results and to avoid self-isolation? I am also hearing that there has been a resurgence of the old problem we had last year of late pinging, presumably because of delays in a struggling test and trace system as case numbers rise dramatically.

The noble Lord, Lord Balfe, raised concerns about whether lateral flow tests are necessary and should be paid for from the public purse. Lateral flow tests are now proving extremely reliable. Actually, we are advised as Members of Parliament to have two lateral flow tests during any week in which we are present in Parliament. Many other workplaces demand even more tests per week than that. It is one of the safest ways we can catch Covid early in people, particularly if they are not yet symptomatic. If we are asking many people to have two, three or five lateral flow tests a week—as I know happens in some places—while the pandemic is still around, it should be paid for from the public purse.

I echo the Minister’s thanks to directors of public health, our local resilience forums and local authorities. Can he confirm that the funding for their work on Covid, including test and trace, is guaranteed for the next financial year and will not end, as is currently planned, in March 2022?

Once again, I ask why the messages from government Ministers repeatedly encourage us to believe that face masks are totally a matter of personal choice. Many noble Lords have expressed their concern about them and said why they do not want to wear them. Even the Secretary of State for Health, when pressed over the weekend, reluctantly said that he would use a mask. However, he refused to say that he would recommend it to his colleagues on the green Benches—although he thought that they should perhaps consider it—whereas the Leader of the House of Commons, Jacob Rees-Mogg MP, has completely eschewed the scientific advice and said that Tory MPs do not need to wear masks because they all know each other and get along so well. The new Minister for Vaccines was of a similar mind on the radio yesterday.

However, as my noble friend Lord Scriven said, vaccination on its own is not the sole answer to Covid. A third of cases at the moment are among people who have already had their vaccinations. With a seven-day rolling average of around 1,000 admissions to hospital per day and with more than 8,000 beds occupied—and with those numbers increasing—I asked the Minister just now, in the Urgent Question in the Chamber, about accident and emergency departments and ambulance services. Conversations with GPs show that they, too, are hard-pressed at the moment in dealing with the increased number of Covid patients calling them for help.

One of the advantages of vaccination is that many people do not get Covid so seriously, but anyone who listened to the “Today” programme from Lancashire this morning will have heard many people say that, even though they had Covid mildly, it was the most unpleasant thing they had had to deal with and that catching their breath all the time was very difficult. GPs are much in demand in offering advice, hopefully to turn people away from hospital and give them the help they need.

Case rates in unvaccinated children remain very high, and despite being told many times in 2020 that children do not get Covid, they clearly do.

On 17 September, Sajid Javid wrote to the 3.7 million people who are clinically extremely vulnerable; that is 5% of our population, though not as large as the 22 million of the over-50s, the clinically extremely vulnerable and NHS staff having booster shots. This group comprises those who have serious problems making antibodies and are at high risk of getting very strong Covid. I declare my interest as being within the severely clinically extremely vulnerable group. Its numbers have expanded from 500,000 to 800,000 over the last two to three months following the publication of a number of clinical trials which were able to show that more categories of people were taking immunosuppressants, which moved them into this group. The news of the antivirals is vital for the clinically extremely vulnerable, and I welcome that. However, as my consultant said to me, “We don’t want you in hospital at all; we absolutely do not want you to end up on many of the drugs coming through yet. You need to keep safe.”

For those of us who have low or no antibodies and were told on 17 September by the Secretary of State that our doctors would now tell us what we needed to do, the outside world is a worrying place. The letter from Sajid Javid said that I should ensure that I did not go into any environment where there were people who were not double vaccinated. I have joked before whether, before entering my local greengrocers, I should stand at the door and shout, “Everyone double vaccinated in here?” I do say that.

The noble Lord, Lord Robathan, can make his own decision about wearing a face mask, but 5% of the population, a mere 3.7 million people, remain at high risk even if they have had their booster jabs. They do not have the choice. I ask him please to reconsider; even when you think you are safe, you may be protecting someone as you may not know that you have Covid and are likely to pass it on.

The noble Lord, Lord Robathan, quoted our scientists in March and April 2020 as saying they did not see the evidence for face masks being helpful. He clearly missed the screeching U-turn in the summer of 2020 after our experts, both in the UK and at the World Health Organization, realised that Covid was much more airborne than they had understood. The noble Lord asked for evidence. This is from the World Health Organization in December 2020, and it is still current advice:

“Masks should be used as part of a comprehensive strategy of measures to suppress transmission and save lives; the use of a mask alone is not sufficient to provide an adequate level of protection against COVID-19.


If COVID-19 is spreading in your community, stay safe by taking some simple precautions, such as physical distancing, wearing a mask, keeping rooms well ventilated, avoiding crowds, cleaning your hands, and coughing into a bent elbow or tissue. Check local advice where you live and work. Do it all!


Make wearing a mask a normal part of being around other people. The appropriate use, storage and cleaning or disposal of masks are essential to make them as effective as possible.”


SAGE told Ministers in May that schoolchildren should wear masks. SAGE did not get rid of masks on freedom day; it was the Government. They decided against the advice. Frankly, it has not been a freedom day for the many people who have caught Covid since mid-July and been in hospital, or for the many who have died.

Sky News reported on 6 July on a report in the Lancet that showed why masks were effective. If noble Lords doubt me, they should just put “Sky News” and

“COVID-19: Do face masks work? Here is what scientific studies say”


into their browser. The evidence is there for the noble Lord, Lord Robathan. It includes that the American CDC reported an incident where two hairstylists with minor Covid symptoms

“were found to have interacted with 139 people during an eight-day period. The stylists and the clients all wore masks”

and a not a single one became infected. Sky News said that, on the USS “Theodore Roosevelt”,

“where living quarters and working environments leave little room for social distancing, a study found there was a 70% reduced risk of infection among those who used a face covering.”

The article also said:

“In Thailand, a retrospective case-control study found that among 1,000 people interviewed as part of contact tracing investigations”—


real people and real cases—

“those who reported always having worn a mask during high-risk exposures again experienced a 70% reduced risk of becoming infected compared with others.”

A quick search of the internet will produce many other examples.

The noble Viscount, Lord Ridley, said that many masks do not contain the aerosol droplets as well as the hospital-grade masks do. That is right, but too many people wear their masks insecurely—not pinching the nose frame or pulling back the ties properly. That is the point the World Health Organization was making. Worse, I am sorry to say that too many think they are protected when they wear their masks under their chins. That does not provide for any protection at all.

As before, the problem of recording third doses versus boosters remains. This is vital. The Minister’s predecessor said that this would be dealt with by the end of July. Because third-dose people need a booster in a few months, it has to be listed separately from ordinary boosters. When will the online system be able to record third doses? Those who took part in vaccine clinical trials or have had their vaccines abroad still cannot get them logged on to the systems. Again, the noble Lord, Lord Bethell, promised that this would be sorted before the summer break.

Since 19 July, when we released all mitigation measures here in the UK, why is it that France, Portugal, Spain and other countries have seen a rapid drop in case rates, while the UK has seen a rapid increase: from 320 cases per 100,000 to 488.5 per 100,000? It is very simple. Our plan B is, in fact, those countries’ plan A across western Europe. Those countries have mandates for masks, social distancing and ventilation. These are not studies but real-life examples.

The noble Baroness, Lady Foster, cited Denmark in her contribution. In Denmark, a country that has been particularly successful, there is not even a mandate but the public choose to wear masks and socially distance. They have accepted this because of the strong messaging right from the start by their Government and local government about taking personal responsibility for their friends, neighbours and community. By comparison, the UK stands alone in saying that a daily case rate of up to 100,000 and, from the Prime Minister’s own mouth, 50,000 deaths a year are acceptable. We are creeping towards those numbers right now. The noble Lord, Lord Hunt, referred to Ministers appearing to believe in UK exceptionalism. Perhaps this is exceptionalism of exactly the wrong kind.

I ask the Minister: why has SAGE been meeting only monthly since July? Who calls those meetings and, if SAGE members feel that they need to advise Ministers, do they have to wait for Ministers to seek that advice? That would be helpful to know.

I believe that every single noble Lord who has taken part in this debate would not want to see plan C having to be enacted, especially if it means that the Prime Minister will have to cancel another Christmas. Experts across our country, and even in the World Health Organization, have expressed real concern that if we do not take at least some of the mitigating measures in plan B right now, the Government will have to move to plan C. We do not want that, so please can the Ministers listen to SAGE and put in the mitigations that most of our neighbouring countries accept as normal and good behaviour, to prevent us ever having to retreat into draconian shutdowns again?

Drugs: Black Review

Baroness Brinton Excerpts

Tuesday 19th October 2021 Lords Chamber

[Lord Kamall (Con)]

In September 2020, Kit Malthouse and Jo Churchill, the then Minister for Prevention, Public Health and Primary Care, co-chaired a UK ministerial meeting focusing on UK-wide approaches to drugs misuse. The second UK drugs ministerial took place at Hillsborough Castle in Belfast on 11 October. The Government maintain a commitment to consulting the devolved Administrations—or devolved Governments in many cases—as well as a number of expert speakers.

[Baroness Brinton (LD) [V]]

My Lords, the Government’s initial response welcoming Dame Carol Black’s recommendation to create a cross-departmental approach to tackling drugs misuse and related harm is welcome. However, they have not responded to many of the key recommendations, of which the most important is the introduction of multi-year ring-fenced funding for treatment services, distributed by local need, with at least £552 million invested in the treatment system annually by the end of year 5. When will the Government’s full response be published? Will Dame Carol’s recommendations be fully funded?

[Lord Kamall (Con)]

The Government have committed to giving a full response to Dame Carol Black’s review by the end of the year and have already taken action. Since part 1 of her review, the Government have announced £148 million of investment to tackle drugs misuse, supply and county-lines activity. That also includes £80 million for drug treatment and recovery services.

GPs: In-person Appointments

Baroness Brinton Excerpts

Tuesday 19th October 2021 Lords Chamber

[Lord Kamall (Con)]

What is important here is that we leave it to the relationship between the GP and the patient to decide the best form of consultation. Sometimes that will be face to face and, if the patient wants a face-to-face consultation but the GP is unable to provide one, they have to give a good medical reason why not. However, we can balance that with online and telephone appointments.

[Baroness Brinton (LD) [V]]

Many GPs are feeling as if they have been completely thrown to the wolves by Ministers, and even Jeremy Hunt has said that the proposed plan and the £250 million winter access fund to support GPs and reduce the pressures they face is little more than a sticking plaster and will not help, given that the real problem is the shortage of qualified GPs. There are not even locums in many places and no longer applicants for many GP jobs. Has the Minister talked to GPs about their current extensive workload, and will he reconsider the assistance needed to support our exhausted GPs?

[Lord Kamall (Con)]

It is important that we listen to GPs and understand their needs and how we can support them. We have committed to growing and diversifying the workforce and boosting GP recruitment. We have also committed to recruiting an additional 26,000 primary care staff to be embedded in multidisciplinary teams. The details of the training will be left to the trainers themselves.

HIV Action Plan

Baroness Brinton Excerpts

Monday 18th October 2021 Lords Chamber

[Lord Kamall (Con)]

I am afraid I do not have a detailed answer to the question from the noble Baroness, but I commit to write to her.

[Baroness Brinton (LD) [V]]

My Lords, the Minister was right to highlight the fact that sexual health funding comes from public health budgets through local authorities. The Terrence Higgins Trust and British Association for Sexual Health and HIV report from 2019 showed that five years of cuts to public health and sexual health funding have had a direct impact on access to sexual health services. So can I push the Minister to confirm that there will be a real-terms cash increase, to fully fund the HIV action plan, to local authorities’ public health budgets for the next three years?

[Lord Kamall (Con)]

I thank the noble Baroness for her question. The department is currently developing a new sexual and reproductive health strategy and an HIV action plan, as she referred to. We plan to publish the HIV action plan later this year to coincide with World AIDS Day on 1 December. The action plan will set out clear actions to achieve the interim target of reaching an 80% reduction in HIV transmissions in England by 2025. Publication of the detailed sexual and reproductive health strategy will follow shortly afterwards.

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.