NHS England: Waiting Lists

Baroness Donaghy Excerpts

Tuesday 16th November 2021 Lords Chamber

[Lord Kamall (Con)]

If the noble Baroness looks at the statistics relating to the waiting lists, she will see that 75% of patients do not actually require surgical treatment: they require diagnostics. We have announced an investment in community diagnostic centres— sometimes in shopping centres or sports grounds—to make diagnostics more accessible to the public, rather than having to go to a healthcare setting. Moreover, 80% of patients requiring surgical treatments can be treated without an overnight stay in hospital, so they can do that as day patients. This is where we want to focus, along with making sure that we tackle all the waiting lists right across the board.

[Baroness Donaghy (Lab)]

Nine in 10 NHS chief executives, directors and chairs reported last week that the present system and organisation have become unsustainable. We can only guess at the pain and anxiety of those waiting to be treated. That is really what this is all about. My noble friend Lord Young talked about ambulances and the time wasted waiting outside hospitals. What plan do the Government have to boost the NHS workforce and ensure that there are sufficient numbers to help bring the waiting lists down?

[Lord Kamall (Con)]

The Government are in conversations with the NHS about the workforce plan and the winter plan. We are looking at ways to tackle the waiting list in more creative ways. As I said, 80% of patients requiring surgical treatments can be treated without an overnight stay in hospital. If we take medical care out to the community, especially at diagnostic centres, we can cut down a lot of the waiting list, but also in terms of the Health and Social Care Bill. One of the reasons is that the NHS has been asking the Government for changes to make sure that it meets the challenges of the future.

Health Care and Adult Social Care

Baroness Donaghy Excerpts

Wednesday 27th October 2021 Lords Chamber

[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.

[Baroness Donaghy (Lab)]

My Lords, I conveyed my commiserations to the Minister last week. As he said, he is on a hat trick today, but he is no Salah just yet. The noble Lord is obviously not a Liverpool fan. As the report says, over the past year the pandemic has further exposed and exacerbated health inequalities. Case rates and mortality rates were higher in deprived areas—2.4 times higher than in the least deprived areas for mortality. The report stated that

“strategies to identify and tackle health inequalities were not yet well established.”

What is the Government’s strategy for this, given that deprived areas, such as those in London, are often next to the wealthiest?

[Lord Kamall (Con)]

The noble Baroness raises an important point but before I answer that specifically, I reassure her that I am a Liverpool fan, as well as an Enfield Town fan. It so happens that my middle name is Salah. I think that I can wear that name on the back of my shirt with pride. I assure noble Lords that I did not line that question up. One reason why the Office for Health Improvement and Disparities was set up in the first place was to look at disparities across a wide range of issues, not only in social care but in relation to gender inequalities, ethnic minority inequalities and some of the other inequalities and disparities between various areas. As the noble Baroness rightly says, sometimes one can find some of the poorest communities right next to the some of the wealthiest. We are hoping to address those issues through the work of the Office for Health Improvement and Disparities, by first identifying where disparities are and then addressing them.

Social Care in England

Baroness Donaghy Excerpts

Thursday 14th October 2021 Lords Chamber

[Baroness Donaghy (Lab)]

I congratulate the Minister on his appointment—or should I say commiserate? I also congratulate my noble friend Lady Pitkeathley on introducing this timely debate in her usual comprehensive and extremely impressive way.

The Government certainly took the political initiative—it was a PR triumph. However, the kindest thing the newspaper financial columns could say about it was that it was a dog’s breakfast. My noble friend’s speech and that of my noble friend Lord Eatwell in Monday’s debate on the NIC increases provide the definitive analysis of why the Government’s PR stunt will not work. I do not feel that I can add much more to those speeches, so I will concentrate on why the financial models for care homes and social housing are unsustainable in their current form.

First, on the so-called model of care home funding, we have all heard how hedge funds use them as financial vehicles, but the majority of the sector is made up of small and medium-sized businesses. The Government want banks and lenders to show them flexibility, and the banks say that they are

“actively providing support for viable businesses”—

a quote from UK Finance. The question is: what does “viable” mean?

The reality on the ground is that a growing number of care homes—it is estimated at about 20%—are under pressure from their banks and are in financial difficulty. They dare not tell their local authority or the Care Quality Commission because they fear losing contracts or being taken into special measures. The infection control fund, a pot of £600 million to pay for PPE for social care firms, ended on 30 September. Local authorities in England spent £3.2 billion on adult social care during the first year of the pandemic, including PPE, but they received only £1.49 billion of extra Covid funding from government. This is not a sustainable system for social care.

Social housing for the most vulnerable in our society also sits on precarious foundations, which threatens the existence of some housing associations yet allows City firms to pay out millions in dividends: in the case of one firm alone, £103 million was paid out in dividends over a five-year period. The City is attracted to the £265 million annual housing benefit bill for specialised support housing in England. Some 176,000 vulnerable adults live in these properties. Private companies are piling in with investment, buying up properties and leasing them to housing associations, often locking them in to 25-year leases, which in some cases are unsustainable because housing associations have to pay rent on empty properties and are therefore carrying the risk, while the private company can promise investors a 5% yield.

The Regulator of Social Housing has expressed concern about the business model. Who picks up the pieces when things go wrong? I somehow do not think it will be the investors in Civitas Social Housing, which is listed on the London Stock Exchange. It owns more than 600 homes and accommodates 4,400 people with learning or physical disabilities and mental health problems. Since the near-collapse of First Priority Housing Association, the regulator has published damning evidence on the financial stability of 19 housing associations, declaring that they are non-compliant with its standards. Eight of the 19 are Civitas tenants. The regulator’s view is that the lease-based model is unsustainable in its present form. Why are housing associations taking these risks? It is because they are strapped for cash and are selling off precious properties to make ends meet, due to the shortfall in government funding.

Civitas bought a company called TLC Care Homes. It paid £25.5 million for nine care homes in Essex. Civitas split it into two companies, caring for the residents and owning the properties. The caring bit was then sold to a third company in—wait for it—the Isle of Man, with the idea that the operator would rent the buildings from the property company. These deals are well known in the property sector. They are called OpCo/PropCo. The Isle of Man business was partly owned by two Civitas directors, although this was not publicised. I am not claiming, as the Sunday Times implied, that properties were undersold, or that shareholders were disadvantaged, or that Civitas directors were doing anything illegal by not disclosing. In fact, my problem is that it is all lawful. My criticism is that these sharks and dodgy dealers should be kept a million miles from social accommodation for the vulnerable. This is not a sustainable model. What plans do the Government have for putting care homes and specialist housing on a sustainable financial basis which prioritises the protection and care of the vulnerable?

Covid-19 Update

Baroness Donaghy Excerpts

Thursday 9th September 2021 Lords Chamber

[Lord Bethell (Con)]

I thank the noble Baroness for three extremely thoughtful questions. I will dwell on them, if I may, because they are a good opportunity to answer some of the concerns that I know many noble Lords have.

On public health messaging and behaviours, there is a question of perception. If we look closely at the analysis done by our behaviours team, we see that the public remain extremely conservative and restrained. While the noble Baroness’s perception may be that mask wearing and distancing have been given up and that hugging is not where she would like it to be, from the data it appears that the public remain extremely concerned about public transport, going to the shops and attending major events. Therefore, we are in a moment of transition, but roughly speaking we are where we would want to be.

Let us be clear: we are keen to get back to the life we once had, and vaccines are going to be the way that we do that. We want to return to intimacy and to the way in which our community likes to live. Testing, social distancing and the panoply of virus control play a role in that—but we are seeking to step back from those days and, so long as the vaccines work in the way they are working at the moment, we are keen not to disrupt people’s lives as much as we can.

On eligible children, that ball is with the CMO at the moment. I completely hear the noble Baroness; she is entirely right about the emotional burden. I also emphasise the importance of making sure that children get the education they need, while at the same time empathising with their concerns for their loved ones and those with whom they live. It is an awful position for those children and families to be in. That is why the CMO is looking at vaccination for 12 to 16 year-olds and possibly beyond.

On winter preparations, I hear the noble Baroness’s comments about the Royal College of Emergency Medicine. The statistics she gave are a matter of concern, but the medical director of the NHS monitors these questions extremely carefully. We think we are in the position we need to be in to get through this winter. We are on the balls of our feet in case there is either an uptick in the current delta variant or a new variant. A huge amount of investment has gone into the redeployment of NHS beds. The NHS has never had a bigger capacity in terms of its workforce and the number of beds available. The use of ICUs and the management of Covid patients have become much more efficient and productive than they used to be, and we believe that we are in good shape.

[Baroness Donaghy (Lab)]

My Lords, perhaps I could ask the Minister two questions. My first question is the question I asked on the day we broke up in July, about whether there are plans to do booster jabs combined with flu jabs. The Minister was not certain and said he would try to let us know. Has he got more information on that?

My second question is slightly more speculative, but it is something I am very concerned about. BBC news has been extremely conscientious about keeping everybody informed about the Covid rate, the death rate and the number in hospital. Can we have an assurance that no pressure will be put on the BBC by the Government in order to bury the worrying developments that are taking place?

[Lord Bethell (Con)]

I am very grateful to the noble Baroness for asking about the co-administration of the flu and Covid vaccines. I hope very much that I got back to her. If I did not, I shall give her an update now. JCVI’s interim advice is to plan to offer Covid booster vaccines from September 2021 to prolong the protection of the vaccines provided to those who are most vulnerable to the serious effects of Covid ahead of the winter months. This would take place alongside the annual flu vaccination programme. The NHS will continue to follow the guidance given by the JCVI on the co-administration of flu and Covid vaccines—so, yes, they will be co-administered. That is an enormously effective way of delivering the vaccines, and the reach of both programmes is amplified by the other.

On the BBC, I reassure the noble Baroness that no pressure is put on it. If we had an effective pressure mechanism on the BBC, she would certainly be the first to know about it.

Covid-19

Baroness Donaghy Excerpts

Wednesday 21st July 2021 Lords Chamber

[Lord Bethell (Con) [V]]

I hear loud and clear the concerns that members of industry and critical services have about isolation of the workforce and the impact that is having on supply chains and the provision of services. However, I cannot hide from my noble friend that the infection rates are higher. It is important that people who have been close to someone who is infected isolate themselves. If they do not, infection rates will go higher still, and if we have sufficiently high numbers of infections, although the vaccines are incredibly effective, that will roll into hospitalisations, severe disease and worse. This is a moment for holding steady and keeping the line. I am hopeful that this moment of acute discomfort for industry and services will pass soon.

[Baroness Donaghy (Lab) [V]]

My Lords, as the noble Baroness, Lady Wheatcroft, said, every contradiction by a Minister not only confuses but encourages opt-out. If even those of us who follow these issues closely are totally confused by what is happening and what the Government’s intentions are, it is hardly surprising that people are going to sit down and make their own decisions, rightly or wrongly.

My noble friend Lady Thornton asked what happens if the rates of vaccination fall. Are there any figures to support that and are there any plans to increase the urgency of vaccines? What is the situation for those involved in social care who are not in care homes but who go visiting from home to home? Will they be made to have double vaccines? Who will be the monitor? Will it be local authorities?

Finally, on the booster jab and the combination with the flu jab, the Minister was fairly definite about this and said that they can be done at the same time. Will they be done at the same time? Also, is a programme of vaccinations for flu and Covid combined already set out, or is that part of a future plan?

[Lord Bethell (Con) [V]]

My Lords, the take-up of vaccine will at some point begin to tail off among some demographics. We are redoubling our efforts with our marketing and the availability of the vaccine, particularly among younger groups. The introduction of domestic certification for major events and pubs and clubs, if that is brought about, will create a strong incentive. These are the kinds of measures that we are putting in place to see through the strategy which, as I said at the beginning, is to get the vaccination levels to such a rate that R is below 1.

In terms of social care, as I mentioned earlier, we are looking to consult on domiciliary care and other forms of the healthcare system. On booster jabs, the noble Baroness makes me want to check my notes. In my briefing it says emphatically that flu and Covid jabs can be taken together, but I will take the opportunity of her additional question to offer to write confirming that point in case I have got it wrong.

Covid-19 Update

Baroness Donaghy Excerpts

Thursday 8th July 2021 Lords Chamber

[Lord Bethell (Con)]

I am grateful for my noble friend’s kind comments. On the NHS winter plan, he is right that I implied that it would be published. I have looked into this and my understanding now is that it is not a document due to be published imminently, as a winter plan was published in the autumn of last year. There are plans in place and I am working hard to try to provide my noble friend with whatever information I can.

[Baroness Donaghy (Lab)]

I asked the noble Lord on Tuesday what assessment the Government have made of Covid deaths and long Covid rates after the proposed 19 July changes. He did not answer. Will he do so now?

What incentive is there to uphold the test and trace system when a common interest between employer and employee is keeping their workplace open, particularly if sick pay is poor and self-isolation an unaffordable choice? If, as the noble Lord says, we do not know how many people use the app, how will we know if its use is dropping like a stone? What evidence will we have that it is becoming less effective?

[Lord Bethell (Con)]

My Lords, I did not quite say that I did not know how many people use the app; I said that we do not know who is using it. We keep an eye on it and, to date, its use has not dropped, but we are naturally concerned that trust in the app will deteriorate and that is why we are looking carefully at the advice that comes out of being pinged. Some 19 million people have the app. It is an enormously valuable resource, and one that we believe has made a big impact.

Predicting long Covid and infections is extremely difficult because we do not know what the infection rate is going to be. We are in a race against the virus. I hope that very soon the impact of the vaccine will bring R below one and the disease will start going down instead of up. But I cannot tell the noble Baroness, exactly when that date will be.

Covid-19 Update

Baroness Donaghy Excerpts

Tuesday 6th July 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I do think we have an opportunity, now that the pressure has backed off a bit, to be thinking a lot more about the exactly the sort of subject that the noble Earl raised. I am an avid festival goer, and extremely sad about the way in which they have been hit so hard. The role of freelancers in the arts is absolutely critical. I know that my right honourable friend the Secretary of State for Digital, Culture Media and Sport has these points very high on his list of priorities.

[Baroness Donaghy (Lab) [V]]

My Lords, one person’s choice is another’s imposition. Even when mask wearing was mandatory on the tube, some broke the law and there was no policing. So-called choice will cause conflict and confusion. Can the Minister assure me that the Government are not reverting to type and their original herd immunity policy based not on the science but on “let us see how it falls”? Although he does not accept any deaths, as he said, what assessment has been made of the impact of this new policy on death rates and long Covid rates?

[Lord Bethell (Con)]

My Lords, I do not have the figures to hand, but I reassure the noble Baroness that the policy on masks was very diligently imposed and a large number of people did get fined. We have to ask ourselves as a society whether we really want to live in a country where simple behavioural habits, such as wearing a mask or not, make you susceptible to arrest or fines. That is a very uncomfortable place for a country to find itself. The noble Baroness is right: that does introduce ambiguity, but we are sophisticated people and can live with a degree of ambiguity. We need to learn how to live not only with this disease but with each other. The dilemma that the noble Baroness points out is one that we will all have to debate, understand and learn to live with. We are not in any way letting this disease get on top of us. We are fighting it through the vaccine, we are supporting the vaccine with test and trace, and we have a tough borders measure. We are taking the battle to the virus and will continue to do so.

Covid-19 Update

Baroness Donaghy Excerpts

Tuesday 29th June 2021 Lords Chamber

[Lord Bethell (Con)]

As ever, the noble Lord is extremely perceptive in his questions, and he is right that as we vaccinate more and more of the population, the risk will become less from highly transmissible mutants and more from those which can somehow escape the vaccine. The South African variant is the one that so far has demonstrated the greatest escapology. For that reason, we are extremely cautious about visitors who may come from areas that have the South Africa variant, including South Africa itself.

[Baroness Donaghy (Lab) [V]]

My Lords, although the Statement is upbeat, it does say that hospitalisation has doubled since May. This will not be solved in three weeks. What would it take to extend beyond 19 July on safety grounds and is the Minister ruling out restrictions this winter? Also, will the proposed top-down reorganisation of the NHS be abandoned?

[Lord Bethell (Con)]

My Lords, hospitalisations have doubled but the vast majority of them are among people who have not been double-vaccinated for plus two weeks. It is very striking, when you look at the list of who is in hospital, how many simply have not been vaccinated. That is why our focus is on seeing through the vaccination programme, particularly getting all those at-risk groups—those over 50—double-vaccinated as soon as possible.

I cannot rule out anything, but I am more optimistic today than I have ever been, and that optimism is grounded on a very careful study of the facts, having sat through the joint biosecurity presentations day in, day out, for months on end. While I cannot be 1000% confident of everything, since this virus has a lot that it can throw at us, I really am hopeful for the future.

Social Care and the Role of Carers

Baroness Donaghy Excerpts

Thursday 24th June 2021 Lords Chamber

[Baroness Donaghy (Lab)]

I congratulate the noble Baroness, Lady Jolly, on initiating this important debate, and the Care & Support Alliance on launching its campaign to make the Government act to reform the social care system. Since Mr Johnson made his well-known pledge to “fix the crisis” 100 weeks ago, 35,000 people have sold their homes to pay for care and 2 million requests for care support for older people have been turned down by local authorities. Councils are turning down 21,000 requests a week.

It is important to remember that social care is not just about the elderly; children with disabilities and people of working age with severe mental illness are part of any consideration, as the noble Baroness, Lady Browning, and the noble Lord, Lord Astor, both pointed out. Working-age adults account for a third of social care users and half of the so-called spending, according to Rethink Mental Illness. As my noble friend Lord Hunt said, there is an estimated gap between funding and need of £6.1 billion. That does not take account of unmet need due to the pandemic or the vital issues of enhancing the status and pay of care workers, as pointed out by the noble Baroness, Lady Watkins.

Everyone taking part in the debate knows all this; we have been here before. What are the political incentives to do something about it? If Mr Johnson fails to deliver, will he lose an election because of it? Will he take to heart that he has broken this particular promise? In any new arrangement, there will always be winners and losers. It is well-known that the Prime Minister hates taking unpopular decisions, so let us make it easier for the Minister to bolster Mr Johnson: simply hand him a copy of the Dilnot report and the report of the noble Lord, Lord Forsyth.

Health Protection (Coronavirus, Restrictions) (Steps and Other Provisions) (England) (Amendment) (No. 2) Regulations 2021

Baroness Donaghy Excerpts

Wednesday 16th June 2021 Lords Chamber

[Baroness Donaghy (Lab) [V]]

First, I thank the Minister for his briefing this morning, which I found extremely interesting and useful. I thought at first that I had strayed into a private seminar with the noble Lord, Lord Lilley, and the Minister, but after half an hour other people managed to get in. Having said that, the questions of the noble Lord, Lord Lilley, were very pertinent and well answered by the Minister and his officials. I also watched the debate in the other place this afternoon, so there are obviously a lot of outstanding issues.

I support these regulations with a heavy heart. I accept a lot of the things that the noble Lord, Lord Robathan, said about the impact on our economy. I want to ask, for instance, about compulsory vaccination for care home staff. Does that extend to care staff who go round various houses on the same day? If it does, what steps will the Minister take to ensure that their civil liberties are protected, that they get financial support and that the vacancy rate for care staff, which is already over 100,000, is actually tackled?

One point that came up frequently is the need to get rid of sloganising. We do not want “freedom day” or “terminus day”; we want facts and proportionality, in the way that the Minister is very good at. This sloganising does not help—it builds unrealistic expectations and diverts us from the detail.

Finally, there is an extraordinary thing about this fatal amendment. If I had read this letter from the Prime Minister and the Prime Minister was Keir Starmer and I was then moved to table a fatal amendment, questioning my Prime Minister when he said:

“By being cautious now we have a chance in the next four weeks to save many thousands of lives by vaccinating millions more people”,


it would be a very serious thing to try to kill off that statement. So, what is it about the Prime Minister that the noble Lord, Lord Robathan, does not think is to be trusted? I very much hope that the House will turn this down. It is not just an opportunity for a debate; this is a matter of life and death.