Social Care in England: Older People

Baroness Greengross Excerpts

Monday 20th March 2017 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness is quite right to point out that Dilnot was an important move. It is also fair to say that several Governments, including 13 years of a Labour Government, failed to make any significant progress on this issue. We now have a Green Paper coming forward that is, of course, looking at a sustainable and fair care system, and that must also include looking at funding.

[Baroness Greengross (CB)]

My Lords, in spite of what the Minister said, we know that many home care companies say that their biggest problem is the recruitment and retention of carers. The Centre for Workforce Intelligence estimates that at least 2 million more will be needed by 2025, both in home care and in care homes, to cope with the growing demand. Can the Minister tell us how that demand is going to be met?

[Lord O'Shaughnessy]

There are two distinct issues here: carers and care workers. To attract more care workers into the system we have introduced the national living wage, which will make a difference in pay for about 900,000 people. The noble Baroness is quite right about carers. There are millions of carers in the country, and we will be bringing forward a carers strategy this year, which will address some of the issues she talks about.

Residential Care

Baroness Greengross Excerpts

Monday 6th February 2017 Lords Chamber

[Lord O'Shaughnessy]

The number of workers in the social care sector has increased by about 165,000 over the last five years: there is an increased demand because we have a growing population. I think that we are going to have another opportunity to talk about the impact on nursing degrees tomorrow, so I do not want to spoil the party. As for the impact of the European Union, of course, a significant section of the workforce comes from the European Union but we are increasing the number of nursing training places and there is also now a nursing apprenticeship scheme which is providing 1,000 places for people who want to enter the profession by that route.

[Baroness Greengross (CB)]

My Lords, does the Minister agree that people in acute hospitals would not need to be there if there was somewhere they could go very soon after being admitted to hospital, such as rehabilitation centres? Many countries have small, nurse-led rehab centres; many of our smaller hospitals which are being closed down could be used in this way. People could go there as soon as they can out of the acute hospital sector. If we did that, we could solve some of the problems and we would have the right sort of care for a lot of frail people who are at the moment accused of blocking hospitals—they do, but it is not their fault.

[Lord O'Shaughnessy]

The noble Baroness raises an incredibly important point. Patients end up in hospitals for a variety of reasons and it is not always the best setting for them. The kind of care she describes is important; it might be rehab centres or cottage hospitals. Indeed, what we are seeing through the sustainability and transformation plans are ideas for intermediate care and step-down care that provide exactly the sorts of things she is talking about.

NHS: Primary and Community Services

Baroness Greengross Excerpts

Monday 7th November 2016 Lords Chamber

[Lord Prior of Brampton]

I think the noble Baroness will agree with me that there are very difficult choices to be made when it comes to public spending. Sometimes, there is perhaps not always a high degree of consistency from our colleagues in the House of Commons.

[Baroness Greengross (CB)]

The Minister mentioned discharge procedures. Unfortunately, carers often do not know about plans for discharge early in the period during which the one they care for is in hospital. As has been said previously, surely the discharge process should start at admission. If the carer is brought in at that point and works with people to make the discharge process work, it will be better. This has never happened. Does the Minister agree that it really must?

[Lord Prior of Brampton]

I entirely agree with the noble Baroness. Good practice means that as soon as a patient comes into a hospital, an estimated date for discharge should be agreed then with the carer, which would enable all the services to come together at the point of discharge. Where that does not happen, one can have long delays.

Breast Cancer: Innovative Drugs

Baroness Greengross Excerpts

Monday 24th October 2016 Lords Chamber

[Baroness Greengross (CB)]

As the Minister will know, there is an enormous delay in innovative drug production due to the regulatory bodies internationally not working very closely together or taking a very long time to work together. Will the Minister tell us whether there has been any progress on bringing those regulatory bodies together, as was initiated after the former Prime Minister did a lot of good work in this respect regarding dementia?

[Lord Prior of Brampton]

The noble Baroness is absolutely right. The delay in bringing a new drug to the market can very often be between 12 and 14 years, which is a huge amount of time. Part of the reason for that is indeed the regulatory process. The whole purpose of the Accelerated Access Review is to truncate that time. The report talks about reducing for some drugs the time it takes to bring them to market by up to four years, which would be very considerable progress. In terms of international regulatory bodies, if one takes the EMA in Europe and the FDA in the US, clearly they do work together at one level but probably not closely enough, and I suspect that there is too much duplication in regulation. Certainly, as we leave the European Union, we need to be very careful that we do not have a duplicatory regulatory system in this country.

NHS and Social Care: Impact of Brexit

Baroness Greengross Excerpts

Thursday 21st July 2016 Lords Chamber

[Baroness Greengross (CB)]

My Lords, it is even later in the debate so I have been crossing out more and more of what I was going to say, which is probably good. I start by declaring my interests as registered, and in particular my heading up of the International Longevity Centre-UK and the fact that I am co-president of the International Longevity Centre Global Alliance.

The noble Baroness, Lady Watkins, has introduced an extremely timely debate, obviously, and she has emphasised the importance of ensuring safe staffing levels. I think that the word “safe” is very important, both in the NHS and social care sectors. For that to happen, we need NICE to produce indicators to ensure that those safe levels are guaranteed, as Francis recommended back in 2013. I very much hope that that will happen.

We obviously cannot afford to lose the 5% EU staff who are currently working in both the health and social care sectors in the UK. As the noble Baroness, Lady Howarth, said, Skills for Care calculates that the vacancy rate in the social care sector stands at 5.1%, which is significantly higher than the UK’s labour force as a whole, and up from 4.8% just last year in 2015. That sector also faces ever-increasing demand, as the number of people aged over 80, the most vulnerable group, is expected to double in size to more than 5 million people by 2037, which is not actually very far away. That number is significant.

Social care providers also find it very difficult to retain staff, as has been said. The International Longevity Centre calculates that the sector experiences a staff turnover rate of 24.3%, which is quite shocking. So the contribution of the 77,000 social care workers from other countries in Europe is absolutely invaluable. The safety and well-being of our population is undoubtedly at risk because of that.

Indeed, the ILC estimates that there are between 30,000 and 35,000 European-born social care workers across London and the south-east alone, providing a vital public service to our rapidly ageing society. Social care workers born in Europe, working in England today, are also younger on average than social workers born in the UK, with around one in three aged between 25 and 34. They represent a huge source and a huge potential, and they need to be fostered and trained to address the skills shortages across the adult social care sector.

The NHS Confederation also calculates that a total of 57,604 NHS staff in England alone—I love the precision of that number—come from other EU countries. As 19,000 of these people work in London, both 10% of London’s NHS workforce and 10% of London’s social care workforce were born in other European countries. So it is crucial that the Government reassure the 77,000 social care workers and the 57,604 NHS staff born in other countries of Europe, working here now, that they are free to continue to care and to provide some certainty to a sector which is in a situation of crisis.

Also, in case EU citizens are ever required to meet the demands of the Migration Advisory Committee’s shortage occupation list, I urge the Minister and the Government as a whole to consider placing senior care workers in the tier 2 category and to open tier 3 for all other care workers to ensure the social care sector has the staff and skills to care for our ageing population.

Very briefly, demand for this type of care is growing as the number of older people and people with long-term conditions more broadly—with learning disabilities and mental health conditions—increases. It is estimated that at least 1.7 million more adults will require social care over the next 15 years. This could require an increase in its workforce to between 2.1 million and 3.1 million by 2025.

Some 47% of the NHS workforce is aged over 45, compared with an average of 40% for the English working population. Only 5% of the NHS workforce is under 25. Some 1.2 million people aged 65 and over are in work in England. Perhaps more should be brought into the care workforce. That is another thought: we could bring in some of those older people. I know of a very big American home care company that makes a point of employing older people because they are very good at providing that type of care.

Let us look just for a moment at what the Royal College of Surgeons has said: doctors from the EU make up about 10% of the NHS doctor workforce. We already face significant recruitment problems because 40% of advertised consultant posts remain unfilled. We know that the number of medical trainees has decreased by 2.3%, just in the last year.

In numbers, 21,000 nurses across England come from other EU countries, more than half of them work in London and the NHS has this huge shortage of nurses. We have to keep nurses on the shortage occupation list. One of the Health Select Committee’s key recommendations in its report this month is that the Government should urgently assess and set out publicly,

“the additional costs to the NHS as a result of delayed transfers of care, and the wider costs … associated with pressures on adult social care budgets more generally”.

Our ageing population presents us with huge challenges—it is good, but it is very challenging—as does the result of the referendum, which we have been talking about. These must be faced and we must overcome them if our common humanity and the values we hold dear in this country are to be safely retained. I hope the Minister will reassure us that the Government will act appropriately to avoid a tragedy that will affect the most vulnerable people in our society.

Carers over 80: Support

Baroness Greengross Excerpts

Monday 13th June 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, clearly it is essential that older people have access to at least annual check-ups from their GPs. A large part of the review that is being undertaken will be about how we signpost and inform people of the need to have these health check-ups. I am sure that will be a part of the strategy announced at the end of the year.

[Baroness Greengross (CB)]

Under the new legislation, the Care Act, carers have a right to an assessment of their needs. Will the Minister assure the House not just that those needs will be assessed but that enough resources will be put into the system so that they can be met?

[Lord Prior of Brampton]

My Lords, under the Care Act there is an assessment, eligibility criteria and a support plan. Clearly there is no point having a plan without the support.

National Living Wage: Social Care

Baroness Greengross Excerpts

Thursday 5th May 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, the better care fund should be seen in a longer-term context of bringing together health and social care. The sustainability and transformation systems that are now being developed are the logical extension of the better care fund. Until prevention, healthcare and social care are brought together in a single budget, it will be extremely difficult to ensure the right allocation of resources.

[Baroness Greengross (CB)]

My Lords, if a huge number or even a fairly large number of care homes close down—we have been reading about this in the papers—there will be huge pressure on the NHS. That will be the effect. What plans have the Government put in place to deal with what might be a really big crisis in the NHS?

[Lord Prior of Brampton]

My Lords, the Government are putting £10 billion of new money into the NHS over the five-year period. Clearly, if there is a crisis in social care, that will have a direct knock-on effect on the NHS. We fully recognise that. The CQC has an obligation to keep a very close eye on this and to produce early warnings if a major, hard-to-replace provider looks as if it is getting into financial difficulty. It is an area that we are acutely conscious of and are keeping a very close eye on.

Pharmacies: Funding

Baroness Greengross Excerpts

Wednesday 2nd March 2016 Lords Chamber

[Lord Prior of Brampton]

The noble Lord raises a very important issue. I do not have the answer to his question. If it is all right with him, I will investigate the matter and write to him.

[Baroness Greengross (CB)]

My Lords—

[Lord Mawhinney (Con)]

My Lords—

--- Later in debate ---

[The Lord Privy Seal (Baroness Stowell of Beeston) (Con)]

My Lords, we should get out of the habit of shouting “This side” when we are on our feet. I suggest that the Cross Benches would like to go next.

[Baroness Greengross]

My Lords, has the Minister considered the relationship between hospital pharmacies and local community pharmacies? At a hospital I know well 56 people are discharged every day. However, they cannot be discharged until their prescriptions are ready from the hospital pharmacy. As people wait up to four hours, beds are blocked 56 times for four hours while they wait. A closer link—which exists in one or two areas—between the two types of pharmacy might remedy that situation. Has the Minister any plans to look at that issue?

[Lord Prior of Brampton]

The noble Baroness makes a very important point. There are many delayed discharges from hospital because people are waiting for their medications and many hospitals do not have the automation within their in-house pharmacies to meet the demand to which she refers. The big driving force going through healthcare and community pharmacy today is one of integration, which means that community pharmacies must in future work more closely with their local hospitals and GPs.

NHS: Preventive Medicine

Baroness Greengross Excerpts

Wednesday 20th January 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, it is a very serious issue that over 40 years, and probably for longer, the difference between the life expectancy of the rich and the poor has always remained at about 10 years: and for healthy living it is more like 25 years. I think it is fully understood from Sir Michael Marmot’s report and thereafter that the social determinants are more important in closing that gap than anything we can do in healthcare directly, so what the noble Lord says is absolutely true.

[Baroness Greengross (CB)]

In the 2015 report Opportunity Knocks: Designing Solutions for an Ageing Society, the University of Cambridge Engineering Design Centre, the ILC-UK and the IET highlighted the vital role of good design and technology in supporting preventive medicine, particularly, but not exclusively, for older people. The OBR warned us last year that without technological innovation over the next decade, health spending in 2063 might be 5% of GDP higher than currently projected. Do Her Majesty’s Government agree that we must invest in technology to save money by facilitating the preferred solution of sustaining independent living, particularly among older people and those subject to the revolving door syndrome? Will the Government support this and invest in it?

[Lord Prior of Brampton]

My Lords, good design is very much part of any long-term strategy towards improving the lives of our citizens, so it is a hugely important part of our longer-term strategy.

Four Seasons Group

Baroness Greengross Excerpts

Monday 11th January 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, the collapse of Southern Cross in 2011 was the main reason that the previous Government gave the CQC market oversight responsibilities, which will give early warning of any failure of a large provider. It is worth noting that the LGA believes that at least 95% of all local authorities have contingency plans ready to be implemented.

[Baroness Greengross (CB)]

My Lords, the former Health Minister, Norman Lamb, called for a cross-party commission to review future funding for health and care services in this country. Does the Minister not agree that we have to start talking, honestly and openly, about what standards of health and care older people can expect now and in the future? Having a commission to look in depth at this and to come up with strong recommendations seems—to me, at any rate—a rather good idea. Does the Minister agree, and will he comment on whether such a commission might be established?

[Lord Prior of Brampton]

My Lords, the idea of having a commission has been discussed a number of times in this House, and there will be a long debate on this matter on Thursday. In the spending review the Government are enabling local authorities to increase their precept by 2% and they are increasing the contribution to the better care fund by £1.5 billion, which will see a real increase in the resources available for adult social care.