Covid-19 Update
Baroness Hollins Excerpts(4 years, 9 months ago)
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Lord Kamall (Con)
I thank the right reverend Prelate for his advice, and for pointing out the very important role that faith communities paid played helping many people get through the lockdowns. They play an important role in this country; many people often assume that it is down to the state, but faith communities play a really important role and complement many of the things we do.
In answer to the right reverend Prelate’s specific question, it should not be seen as plan A or plan B; it is sequential. The Government would prefer that plan A works and that we vaccinate more and make sure that we reach those who have not yet been vaccinated. But if the figures, and the various factors we are looking at—scientific, but also socio-economic—suggest that we have to go to plan B, then we will. At the moment, we are hoping that plan A will work, but we are reliant on the advice that we get from the various scientific advisers that I outlined, but also the other stakeholders, to ensure that we test plan A. Hopefully, it will work, but if it does not, we will move to Plan B.
Baroness Hollins (CB)
My Lords, I have recently returned from Germany, where medical masks are worn indoors in settings such as shops, restaurants, theatres, conferences, churches and, of course, on public transport. To enter, you have to show a Covid green vaccination pass—the QR code is checked—or, alternatively, a same-day antigen test performed and certified in a pharmacy. It is easy, it is acceptable, it is working and people feel safe. The death rate is much lower. Will plan B provide the same security and reassurance to British citizens as I experienced in Germany by mandating face masks and green passes, and will this happen soon enough to prevent more deaths? We started the pandemic with a first lockdown that was too late; plan B may be too late.
Lord Kamall (Con)
I thank the noble Baroness for sharing her experiences from Germany. We are relying very much on a range of scientific advisers to tell us whether we need to move to plan B but at the moment, because we are not where we were last winter and because we have broken the link between cases, hospitalisation and deaths, we would prefer to try plan A. If we have to move to plan B, we will—on the advice of our range of scientific advisers—but there are also some concerns, as the House can imagine. I think it was Professor Mark Pennington of King’s College London who said, when assessing Covid-19 and the response to it, that you have to look at it as a complex system. When one thing happens, there might be a reaction elsewhere but also unintended consequences.
One concern we have heard about mandating face masks at the moment is: who enforces that? Do we suddenly have more police enforcing it and become a police state? Transport workers are also concerned about having to approach certain people and ask them to put their mask on in the proper place, for fear of abuse, so we have to get the balance right. We will try to stick to plan A, given that we have broken that link between cases, hospitalisations and deaths, and encourage more people to get vaccinated while reaching out to those hard-to-reach groups. But if the numbers and the various indicators are there and the scientific advice tells us to move to plan B, we will do so.
NHS Update
Baroness Hollins Excerpts(5 years ago)
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Lord Bethell (Con) [V]
My Lords, I am grateful to my noble friend for highlighting this important development. The cancer drugs fund was a great success, and we are building on it with a substantial investment. The new fund will support patients with any conditions, including those with rare and genetic diseases. Dementia is one area where we are extremely interested in looking at investing further, and I hope that this would be captured, but we are waiting for recommendations from NICE and the data that it will provide before we set the right prioritisations. In terms of the date, I do not have that at my fingertips, but I would be glad to write to my noble friend with the details.
Baroness Hollins (CB)
My Lords, the strategy promises millions to prevent mental health crises for autistic people and to help people detained in hospital back into the community. The Written Ministerial Statement responding to my 2020 independent report about people with learning disabilities and autistic people detained in long-term segregation was laid in the other place after the Minister’s Statement had finished. My report emphasised the urgency of these strategy promises. Will the noble Lord commit to meeting me, with the Secretary of State, to discuss the full implementation of my recommendations?
Lord Bethell (Con) [V]
My Lords, I am enormously grateful to the noble Baroness for her hard work in this area. We are taking a range of actions to drive further, faster progress on reducing the number of autistic people and those with learning disabilities in in-patient mental health settings, including robust action by the CQC, work on our new cross-government “building the right support” delivery board, and reform of the Mental Health Act. I would be very glad to meet the noble Baroness and her colleagues to discuss these and other measures in more detail.
Social Care Reform
Baroness Hollins Excerpts(5 years, 1 month ago)
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Lord Bethell (Con)
My Lords, the point made by my noble friend is entirely thoughtful and persuasive. Indeed, there may well be a role for insurance rather than any other mechanism, and it will be one of the options that those who define the policy will look at extremely carefully. The point that he makes about the desire of homeowners to pass on their homes to future generations is completely understandable and human, and one that will take into close consideration.
Baroness Hollins (CB) [V]
My Lords, further to my noble friend Lady Campbell’s question, will the Minister commit to mentioning working-age disabled adults every time social care reform is discussed? The needs of older people living in care homes are important, of course, but that is an easier focus for improvement. The real challenge is to improve care and support for disabled adults living in their own homes, including people with learning disabilities and autistic people.
Lord Bethell (Con)
I am extremely aware of the point the noble Baroness is making. A very large proportion of those in care are not elderly at all but the young and adult disabled who need some care for some condition, whether physical or mental. Their needs are paramount in these reforms. We will not forget the people the noble Baroness describes; the financial arrangements for supporting them are one of the things we absolutely want to take on in these reforms.
Social Care and the Role of Carers
Baroness Hollins Excerpts(5 years, 1 month ago)
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Baroness Hollins (CB) [V]
My Lords, I remind the House of my interests as chairperson of the independent care, education and treatment review process for people with a learning disability or autism in in-patient settings, as president of the Royal College of Occupational Therapists, and as a carer for my adult son.
There is a growing number of households of elderly carers who may have their own health and support needs but who still support adult children with a learning disability, themselves approaching retirement age. Mencap’s survey of such carers during the pandemic found that the majority experienced significant reductions in social care, including a lack of continuity of social worker input. Knowing that parents are ageing is a reason to make plans and to have good support in place, rather than waiting for a crisis. Too many crisis admissions to residential care or hospital occur after a last surviving parent has died or following some other trauma.
Last week, some families shared their stories in a report, Tea, Smiles and Empty Promises, to mark the 10th anniversary of the BBC “Panorama” documentary which revealed the abuse and neglect of people with a learning disability and autistic people at Winterbourne View hospital. Tens of thousands of pounds are spent detaining people such as these in hospital, rather than using the money to provide community-based support. Working-aged disabled adults account for half the total social care spend in England, and of this, learning disability accounts for one-third. Is the money being spent well? The answer is mostly no.
Far too often, our social care system ignores the real needs of disabled adults of working age for skilled support to live an ordinary and decent life. They absolutely do not need to be locked up, warehoused, or kept out of sight. This debate is not just about who should pay but about the very nature and quality of the support provided.
Social care exists for a purpose: to provide personalised care that ensures well-being in line with the Care Act 2014. When it is good, it is very good, but a system based on crisis management is a failing one. Of the workforce, currently 604,000 of the 1.5 million care workers in this country are paid less than the real living wage—that is nearly half. The social care people plan framework, launched at a major summit with politicians from all parties, this afternoon, argues for a real living wage for care staff, a national register and nationally prescribed training. Does the Minister agree? I believe that the case for a social care people plan to mirror the one already in the NHS for a similar sized workforce is unassailable. The Royal College of Occupational Therapists agrees.
NHS Digital: Primary Care Medical Records
Baroness Hollins Excerpts(5 years, 2 months ago)
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Lord Bethell (Con)
I am grateful for the noble Lord’s anecdote. It is no coincidence that he got the text yesterday. We have energetically promoted this opportunity to patients and we are grateful to those who have engaged. He is entirely right. Patient data played a critical role in the development of the shielding list during Covid, in the recovery clinical trials programme and in the vaccine priority list. Clinical data is essential for patient safety. That is why we are modernising the system by which we access it.
Baroness Hollins (CB) [V]
My Lords, the choice on the opt-out preference form is either:
“I do not allow my identifiable patient data to be shared outside of the GP practice for purposes except my own care”,
or:
“I do allow my identifiable patient data to be shared outside of the GP practice for purposes beyond my own care.”
The big question is: what is identifiable? For some people with disability, mental health and/or trauma histories, data might be easily identifiable. I knew nothing of this until last week. I await with interest the noble Lord’s reply.
Lord Bethell (Con)
The nature of the data is very explicitly described in the documents that the noble Baroness will have referred to. If she likes, I would be very happy to send her a full set of details. Of course, many patients have engaged with the process and, like the noble Lord, Lord Young, have made the wise decision to remain enrolled in the system.
Covid-19
Baroness Hollins Excerpts(5 years, 2 months ago)
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Lord Bethell (Con)
My Lords, the noble Baroness alludes to a dilemma that we face. It is not possible to organise surge testing and have pinpoint outbreak management in 120 different areas. That is just too many and our resources do not stretch to that. Many of the outbreaks are substantial clusters. Sorry—let me phrase that better. There is a small number of very substantial clusters in the towns and cities of which noble Lords will be aware. That is where we are focusing the surge testing and surge vaccination. In the other areas, we are working with DPHs to ensure that they know the best way to target the particular behaviours of the India 2. That means that it has very high transmissibility, which requires an extremely quick reaction to school and workplace outbreaks, and within specific communities. That kind of briefing and guidance has been channelled through the Chief Medical Officer’s department and the kinds of infrastructure that I described in my answers to previous questions. The response has been extremely strong and I hope we are making some impact on the spread of the India virus, but we remain extremely vigilant.
Baroness Hollins (CB)
My Lords, my question is about the implementation of quarantine regulations. How many travellers have been required to repeat the 10 days required in a designated quarantine hotel for a second 10-day period, with or without a positive Covid test? What appeal arrangements are in place because public guidance does not mention any? Is there any risk of exploitation?
Covid-19: Resuscitation Orders
Baroness Hollins Excerpts(5 years, 4 months ago)
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Baroness Hollins (CB) [V]
My Lords, given the significantly higher number of excess deaths among people with learning disabilities last year, will the Minister commit to finding out what proportion of those deaths were associated with DNACPRs? Does he agree that the use of blanket DNACPRs for people with learning disabilities is an indication of the extent of the lack of confidence and competence among healthcare staff to accommodate their needs, and adds to the urgent need to introduce the Oliver McGowan mandatory training currently being piloted? A timetable for the widespread introduction of that training would be very welcome.
The Lord Privy Seal (Baroness Evans of Bowes Park) (Con)
My Lords, I am afraid that we are having questions that are far too long. Can people please keep their questions brief?
Health and Social Care Update
Baroness Hollins Excerpts(5 years, 4 months ago)
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Lord Bethell (Con)
My noble friend is entirely right: this is a considerable dilemma not just for the Government, but for everyone. We in the UK have an enormously valuable project in our vaccination programme. Who does not relish the potential freedom from this horrible disease that it gives us? Yet we need only look overseas to see infection rates rising and the variants of concern spreading. The bottom line is that we do not know the impact of the variants of concern on the vaccine. Anyone who says they do for sure is simply not representing the truth. We have to be patient and figure out and fully understand the threat from the variants of concern. When we have that information, we can make a pragmatic, sensible and informed decision on foreign travel, as the Prime Minister has promised.
Baroness Hollins (CB) [V]
My Lords, I am so pleased that all people with learning disabilities who are known to their GP are now in either group 4 or 6 for vaccination. Will the noble Lord commit to reporting on the take-up of Covid immunisation for people on the register, both nationally and locally? Will he also report on the implementation of visiting policies for people with learning disabilities in both supported living and residential settings, and whether those residents are able to choose their one visitor?
Lord Bethell (Con)
Those were two extremely thoughtful and well-informed questions. I do not have the statistics at my fingertips, but I would be glad to go back to the department and write to the noble Baroness with the information she has asked for.
Covid-19: Vaccination Programme
Baroness Hollins Excerpts(5 years, 5 months ago)
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Baroness Hollins (CB) [V]
My Lords, I welcome today’s announcement that all people with a learning disability on their GP learning disability register will now be included in group 6. However, we know that these registers are incomplete. How will the Government and the NHS ensure that those in England not currently on the register can be added so that they can be offered a vaccine too? Will the Minister confirm that family carers and home carers will be offered vaccination at the same time?
Lord Bethell (Con)
We have to work with what we have. The existing register, while not perfect, is the tool that we have for our task. GPs had been encouraged to update registers in advance of the vaccine, as we had several months of knowing that it was coming. I understand that considerable work has gone into that. With regard to carers, my understanding is that they are not currently included in the clarification that came out today, but I am happy to confirm that point with her.
Covid-19 Update
Baroness Hollins Excerpts(5 years, 6 months ago)
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Lord Bethell (Con)
My Lords, I am grateful for the reminder from the noble Baroness. The analysis we have done of the Pfizer vaccine, and indeed of all vaccines, is extremely encouraging and the impact it has on the body’s antibody production rate is profound. In fact, for many vaccines it might be that a longer delay, of 12 weeks, to the second dose might have an improved impact on the body. The second dose is really important for longevity rather than for efficacy, and therefore, with the data we have at the moment, we do not have any plans to change the pace of the rollout, but we are making sure in absolute terms that the second dose is delivered to all those who have had a first dose, promptly and on time.
Baroness Hollins (CB) [V]
My Lords, the Minister repeated the statement earlier that said that all care home residents and staff have been offered vaccination, but this is not true for homes for people with learning disabilities. I was pleased to hear in the Minister’s reply to the noble Baroness, Lady Andrews, that the JCVI is still considering priorities for groups 5 and 6. Is the Minister aware that 80% of the deaths of people with learning disabilities in England were Covid-19 related in the week ending 22 January, compared with 45% of the general population? Does he anticipate that all people with learning disabilities will be included in group 5 or 6?
Lord Bethell (Con)
My Lords, I have taken the noble Baroness’s insight on this to the department where it is being plugged into the Vaccine Taskforce and the JCVI. Her championship of this cause is to be lauded. The statistic she just cited is heart-rending, and I will definitely return to the department this afternoon and follow up, to ensure that it is being taken seriously.