Drug-related Deaths in England and Wales

Baroness Pinnock Excerpts

Tuesday 26th November 2024 Lords Chamber

[Baroness Merron (Lab)]

I understand what the noble Lord is saying. Synthetic opioids, as he will know, are certainly more potent, and indeed can be more deadly, than other forms of drugs. We are working with other government departments to enhance the surveillance to which he refers and to improve early warning in response to the threat of synthetic opioids, and we will continue that work.

[Baroness Pinnock (LD)]

My Lords, many charities that support those with drug addiction are raising concerns about the increased costs that they will have to fund as a result of the increases in national insurance charges. What assessment have the Government made of the impact on those critical services being able to support those with drug addictions?

[Baroness Merron (Lab)]

The noble Baroness will have heard me say before that we had to take some tough decisions at the Budget to fix the foundations in the public finances, and that enabled a settlement for the Department of Health and Social Care of some £22.6 billion. As she knows, the employer national insurance rise will be implemented in April 2025, and in due course the department will set out further details of the allocation of the funding I referred to for next year.

King’s Speech

Baroness Pinnock Excerpts

Thursday 9th November 2023 Lords Chamber

[Baroness Pinnock (LD)]

My Lords, it has been a really interesting, wide-ranging and well-informed debate. I hope Ministers have been listening carefully, because they have been given plenty of ideas, freely given, for them to take up and introduce as part of their bid to create a better Britain—or whatever the phrase is. What has become crystal clear during this debate is the disappointment expressed by many at the paucity of the Government’s ambition. The Government have run out of energy and ideas, but what has not diminished is the scale of the challenges facing people who are delivering vital public services. For people who are waiting for an operation, waiting for years on the housing list or waiting for a GP appointment, these challenges have direct and personal consequences. The failure of the Government to show some understanding of the situation many people face by addressing the immediate issues they are facing in the gracious Speech is leading so many to complete despair.

As my noble friend Lady Barker said, there is not a strategy in sight in this gracious Speech. As the right reverend Prelate the Bishop of Gloucester said, where is the long-term vision that is promised? That leads me to the NHS. We are all now going to remember the wonderful image provided by my noble friend Lord Allan of the Government in the driving seat of the NHS car. It is veering across all the lanes, doing many U-turns, running out of fuel and failing to reach its destination. It is memorable, but what is sad is that it resonates so much to so many: that that is where we are with our National Health Service.

On the long-promised reform to the Mental Health Act, I had not realised it was 40 years since the previous Mental Health Act was passed. That has raised concerns across the House, including by my noble friends Lady Tyler, Lady Walmsley and Lady Burt—all my noble friends and many others as well. There does not seem to have been any justification for not introducing that in the gracious Speech. There is cross-party support and consensus has been arrived at, so where is the Bill? It will be genuinely important for us all to hear why the Government have chosen not to include it in their programme for government.

My noble friend Lady Barker made the very important point about data sharing across the health service, local government, social care and children’s social services; I hope the Minister will respond to that query.

There is growing pressure on primary care, which some Members have raised. We know that there is a grave recruitment struggle for general practitioners, which obviously has a consequential impact on hospital care. We have the long-term workforce plan for the NHS, but we also need some short-term change to fill the gap until we reap the benefits of it. Meanwhile, people across the country are not able to get a GP appointment when they need one. My noble friend Lady Harris spoke eloquently—as did the noble Baroness, Lady Bull—about long Covid and the impact it is having on many people across the country. The Government perhaps need to give more attention to dealing with that.

I was pleased that my noble friend Lord Shipley raised dentistry and the failure of many families to find NHS dental care. It is shameful that some communities where I live rely on a third-world charity called Dentaid to access free dental care. Perhaps we all ought to be ashamed that this is the case in the seventh richest country in the world, so I am really pleased that my noble friend drew attention to that.

My noble friends Lady Burt and Lady Barker and the right reverend Prelate the Bishop of London all raised the issue of the Bill to ban conversion therapy: where is it? I will leave it at that because it is very important for a section of our society, and for some of us who have a commitment to equality across all our communities. I repeat, where is it?

One area that received good support across the House was the plan to reduce the availability of tobacco and to ban vapes for children. My noble friends Lord Rennard and Lady Walmsley, who have been constant campaigners on this issue, have spoken for us all. We are going to welcome it because we believe in cutting disease and early death. There is a green light for it. I will reflect what the noble Baroness, Lady Jay, said about the 26% cut to the public health grant. Without public health you cannot reduce health inequalities, which was raised by the right reverend Prelate the Bishop of London.

This brings me to adult social care. Reform has been promised and promised, but where is it? Too many families tell me that they are struggling to find appropriate home or residential care, particularly for those suffering from dementia. Somebody has to grasp this issue. There is not enough funding going into it and it is causing councils to teeter on the brink of bankruptcy. We are asking council tax payers to pay into this social care premium. In my council area, people are paying an average £200 a year extra on their council tax for adult social care that is not being reformed. That is disgraceful and needs to change.

I will say a word on local government finance, which is important and I hope will be addressed in the Autumn Statement. Today, another major council is on the brink of issuing a Section 114 notice of impending bankruptcy. Without local government to deliver public services locally, we are all bereft. My noble friends Lord Wallace of Saltaire and Lord Shipley both pointed to the importance of local democracy and the need to shake off the shackles of central control to allow it to flourish and do what it does best.

That brings me to housing. We are all glad that tents have not been banned, but we are not happy about everything in the Renters (Reform) Bill. Although the Bill is good, it is not good that Section 21 evictions are not being ended and banned straight away and will still be hanging over private sector tenancies.

The noble Lord, Lord Best, was right to talk about the housing crisis, as we did all through the debates on the levelling-up Bill and we are still having to deal with it. I agree with the noble Lord, Lord Young of Cookham, that it is about time the local housing allowance is thawed and raised, so that people do not have to sub the cost of their rent from meagre benefits.

The leasehold reform Bill gets a muted welcome from me, because it does not deal with the abolition of leasehold for flats. Without that, we cannot deal with the other big issues that are raised in that potential Bill about the Building Safety Act, which is unfinished business.

It has been a really good debate. It is a pity that the Government’s programme is not as good as the debate we have heard.

Health and Care Bill

Baroness Pinnock Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Baroness Pinnock (LD)]

My Lords, in the absence of the noble Baroness, Lady Donaghy, I will speak next. I draw the attention of the House to my relevant interests as a vice-president of the Local Government Association and a member of Kirklees Council. I intend to concentrate on those elements in the Bill that impact on local government.

In West Yorkshire and, I suspect, other parts of England, planning is well advanced for establishing integrated care boards. There is a flavour here of a reorganisation that is already a done deal, yet there are important issues that remain unanswered by the proposals in the Bill. The first of these is that the Government proposed three reform programmes: this Bill; the adult social care White Paper, which was published last week; and the missing one—the care integration White Paper, which has been delayed yet again and will be vital as a part of all these reforms. I do not see how you can do this Bill without the White Paper that is missing. Another missing piece of reform is any detail at all about the delivery of health and care at the level defined as “place”. A further, major missing element is an adequate increase in funding for local government delivery of adult social care. You cannot have one without the other: reform without the funding will simply not work.

The final missing piece is democracy and accountability to local people. An opportunity to bring explicitly elected local voices into the governance of health and care at a local level has been ignored. Robust governance models that reflect the people and places served and allow for transparency and accountability provide the best outcomes in the end. However, the model proposed provides for even greater central powers and even less for the people for whom the service is provided.

I now turn to the issue of who pays what towards the cost of their care. There are a number of anomalies in the current proposals beyond the issue of the cap; this is not about the cap. If you are in residential care, you will need to pay a contribution towards the hotel costs; that has been fixed at £200 per week. This means that, if you are living in an older care home in a part of the country with low property values, your fees might be, say, £800, of which £200 might cover the accommodation costs, as these are lower. However, in a new, modern care home, in an area of high property values, your fees per week might be £1,000, of which £400 are accommodation costs. Bear with me—the maths is coming. Under the new rules, both people would pay £200 towards the hotel costs. This is important because the individual in the modern care home would then count £800 towards the cap on their contributions, whereas the second person, in the older care home, would count only £600 towards the cap, even though the value of the care that they receive is the same. In other words, the current proposals favour people in parts of the country with higher property values. I wonder how this approach reflects the so-called levelling-up agenda.

Finally, I refer to the clause related to adding fluoride to the water supply. This is obviously in order to combat tooth decay, which is caused by an excess of sugary foods. However, prevention is better than cure, and substantially reducing sugar intake is surely a better way forward—besides which, adding fluoride to the water supply is not as straightforward as it may first appear because water can be, and is, piped from one water company to another and from one part of the country to another.

I now look forward, with immense expectation, to the maiden speech of the noble Lord, Lord Stevens of Birmingham.

Health and Social Care

Baroness Pinnock Excerpts

Monday 6th December 2021 Lords Chamber

[Lord Kamall (Con)]

In terms of tackling the social care workforce, there are a couple of things: £162.5 million is going on a number of different schemes to make the social care sector an attractive place to work and we are looking, longer term, at professionalisation, so that people feel valued. At the same time, the minimum wage will help lift the pay of many people in social care work, but in the longer term we want to make sure that social care is not seen as the poor relation of other parts of the health service. We want to make sure that we have professionalisation and that it is all joined up. Some of these things will not be tackled in the short term, but we have a short-term programme called Made with Care, which is aimed at targeting and recruiting people to come and work in the social care sector. We realise that we have to do the long-term things, but also to promote short-term measures to tackle the issues we have at the moment. On specific statistics, as I am sure the noble Baroness can imagine, I do not have the details at hand but I commit to write to her.

[Baroness Pinnock (LD)]

My Lords, I draw the attention of the House to my registered interests as vice-president of the Local Government Association and as a member of Kirklees Council. I want to pick up on issues raised already by the noble Baroness, Lady Thornton, and my noble friend Lady Brinton, and the point that the Minister himself has just made about professionalising the workers in social care. On one hand, as the noble Baroness, Lady Thornton, said, there are no spaces in social care for older people to be discharged into, because of a lack of availability of staffing, and we have heard already about some care homes being closed. The issue at the heart of all this is the great chasm of funding being made available for social care.

In my own council area in West Yorkshire, the pandemic has resulted in a 36% rise in demand for social care by adults in the last year, yet the funding from the Government is nowhere near going to meet that demand. What we have then, as a consequence, is older folk who have first gone into hospital because of ill health, and there is then nowhere available for them to be discharged into to continue their recovery and gain back their independence. The chasm of funding is at the heart of this. Can the Minister confirm that the Government will no longer impose the social care precept on the council tax payer, which, since 2016, has been at either 2% or 3% per annum? This is a totally regressive tax and has cost taxpayers in my part of the world well over £200 a year. What is needed is proper funding from the Government, not the bits and pieces that the Government have announced so far.

[Lord Kamall (Con)]

When you look at our health and social care sector, you see that one of the issues is a lack of joined-up thinking over the years. We have seen report after report about the future of adult social care gathering dust on the shelves—not forgetting that lots of people who are not older are also in the social care system. The White Paper we published last week was a first attempt to try to tackle the problem long term. We recognise that you have to look at the long-term issue—which, frankly, successive Governments have kicked down the road for years, and not really tackled—and we have made an attempt to do that with the 10-year vision we published last week. But we have also committed to the first three years of funding, to realise that vision. We now have a framework against which to judge future progress in adult social care, so that, overall, it is no longer seen as a poor relation of the rest of the health system and is properly joined up on a number of different levels—not only career paths but also the data that can be shared, so that you do not have the drop-off that happens when someone leaves hospital and enters a social care home and you have to find all that data again; the home is prepared to accommodate that patient with all their specific needs at the beginning.

In the longer term, with increases in technology, we hope that, instead of patients leaving hospital to go to a residential home, they will be able to return to their own home with the help of technology. All that will take time, but we have laid out that vision.

In the short term, we have laid out the winter plan, which includes looking at how we tackle some of these social care issues and how we recruit more social workers via the £162.5 million. The Made with Care plan will make sure that social care seems more attractive. For a long time, no one has really “sold” social care as a career. We want to ensure that it is seen to be just as valid a career as any other and offers a real career path. We also want to see a professionalisation of the industry, so that people feel valued.

Covid-19: Plan B

Baroness Pinnock Excerpts

Wednesday 20th October 2021 Lords Chamber

[Lord Kamall (Con)]

The Government are consulting widely on the measures to be taken, balancing and looking at the trade-offs not only in health but with wider societal factors.

[Baroness Pinnock (LD)]

My Lords, nearly 1,000 people are dying every week from Covid. What is the trigger in deaths before plan B comes into effect?

[Lord Kamall (Con)]

I am not sure I agree with the noble Baroness on the figure she cites; I will double-check and write to her. On the triggers, it is clear that we have to look at a range of factors before deciding whether to move to plan B.

COVID-19 Variant: Travel Guidance for Local Authorities

Baroness Pinnock Excerpts

Wednesday 26th May 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, as I sought to explain to the noble Baroness, Lady Brinton, there is a huge amount of consultation with directors of public health. There are meetings on these matters on a daily basis through the chief medical officer, the silver/gold process and the local outbreak teams. However, the right reverend Prelate refers to a serious issue. We are seeking to avoid the kind of legal lockdowns that the public are quite understandably exhausted by and naturally quite resistant to. Therefore our message to the public is that we are asking them to behave in a responsible fashion, to act with caution and to use their common sense, as he had to in his decision about whether to come to London. We are not seeking to legislate on that, and we are asking people to make those decisions for themselves. I completely sympathise with those who find that challenging and who in some cases would prefer to have some certainty. However, that is what people have asked for and it is the right approach to keep the British public on side during this difficult period.

[Baroness Pinnock (LD) [V]]

My Lords, I refer the House to my relevant interests. I live in Kirklees, one of the affected areas. Yesterday, the new guidance on the Government’s website said, “Avoid meeting inside”. Today, the amended site says, “Meet outside where possible”. Perhaps the Minister can help me. Does it mean that, in Kirklees and elsewhere, pubs, cafés and restaurants must turn customers away from service inside? The Minister has just said, “We must use common sense”. Does that mean that council meetings must be held virtually, not face-to-face, which is what the other part of the Government now demand?

[Lord Bethell (Con)]

My Lords, the noble Baroness has given some very good examples of exactly where we are asking the public, and legislatures, to use their common sense. We are saying, “Avoid meeting inside”, but we are not closing the pubs. We also say, “Avoid smoking”, but we do not ban smoking.

Covid-19 Update

Baroness Pinnock Excerpts

Wednesday 1st July 2020 Lords Chamber

[Lord Bethell]

My Lords, there is very wide access to tests. Anyone who wants a test can apply for one today and, in almost any location in the country, will get one this afternoon. Whole-population testing is not the Government’s strategy, because testing at this level of prevalence would throw up more danger of wrong results than positive results. In terms of private and university labs, I absolutely pay tribute to the Crick, the University of Birmingham, the University of Cambridge and all other university and private labs that have contributed to the test and trace programme.

[Baroness Pinnock (LD) [V]]

I am a councillor in Cleckheaton, where there was a significant outbreak in a meat-processing factory, with 165 positive cases identified. The Secretary of State has, rightly, praised the local response. However, the national testing response has been described as “shambolic”, and it hindered an effective local response. What has been learned from the incident? Apart from belatedly sorting data-sharing, how will government actions change as a result?

[Lord Bethell]

The noble Baroness talks of an incident that I do not know the details of, but I do not deny that we are on a learning curve. We will publish new guidelines tomorrow on our local outbreak response; we are publishing guidelines on the opening of venues for 4 July; and we are working extremely hard to stitch together much better relations between the centre, where a lot of the data inevitably ends up in a big system, and the insight of local actors in local PHE, local infection, NHS and local authority bodies. This has been happening for many weeks and we have already made huge progress, but there is still more to do.

National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2020

Baroness Pinnock Excerpts

Monday 8th June 2020 Lords Chamber

[Baroness Pinnock (LD) [V]]

I support the increase in pay for nurses working in the nursing sectors of care homes and, indeed, the Motion tabled by the noble Lord, Lord Hunt. Care home staff also need an increase in pay. There is a significant annual turnover in care home staff and a consequent reliance on agency staff. Many homes depend on staff from EU countries, who are less likely to be available from 2021. Both these factors point to a need for better pay for care home staff. The focus on care homes and the amazing commitment of care staff during Covid-19 has shown us all how much the country depends on them.

Care homes are under enormous financial pressure, whether they are run by charities or for profit. A report released last week by the Directors of Adult Social Services, the Care Provider Alliance and the Local Government Association estimated that care homes need an additional £6.6 billion to meet the costs of Covid-19 by September. Further, the tragically high number of deaths in care homes as a result of discharging patients from hospitals back to their care homes without being tested for Covid-19 has resulted in residential places remaining vacant. The Government have given councils £3.2 billion to fund the additional services needed, including, but not exclusively, for increasing care home fees. Using this funding, councils have indeed increased the standard rate for care homes where they fund residential places, but clearly it is nowhere near enough to bridge the gap. Can the Minister confirm that additional funding will be made available to local authorities to underpin care home finances and prevent many of them closing their doors?

There is a desperate need to resolve how residential care is funded. The consequence of constantly kicking this difficult issue into the long grass is the crisis now unfolding. For too long the care of vulnerable adults has been in the shadows. Covid-19 has thrown a spotlight on how we as a society absolutely rely on care homes for the care provided. Too many care staff and residents have died unnecessarily. Perhaps we will all now recognise that care home lives matter too.

NHS: Targets

Baroness Pinnock Excerpts

Thursday 6th February 2020 Lords Chamber

[Baroness Pinnock (LD)]

My Lords, I draw the House’s attention to my registered interests as a councillor and a vice-president of the Local Government Association. I thank the noble Lord, Lord Hunt, for instigating this important debate. As this is such a wide-ranging issue, I want to concentrate my contribution on adult social care. As the wording of the debate indicates, a significant part of the increasing pressure on the NHS is a direct consequence of the Government’s failure to find a solution to the social care funding crisis.

Two years ago, the House of Commons Library produced an excellent briefing paper on adult social care funding in England. The report stated:

“A lack of suitable care services can delay hospital discharge, putting pressure on acute NHS services. Between 2014 and 2016, delays in discharging patients from hospital increased by 37%.”


The two main reasons given for this increase—not a surprise to any of us here—were patients waiting for care packages at home or in residential care. The report went on to say that

“the National Audit Office estimates that the gross annual cost to the NHS of treating older patients in hospital who no longer need to receive acute clinical care is in the region of £820 million.”

I have no doubt that both of those figures have risen substantially, as so little has been done to alleviate the pressures.

In December last year, Age UK updated its Care in Crisis figures for older people and reported that, in the last five years, there has been a £160 million cut in total public spending on older people’s social care, despite rapidly increasing demand; 1.5 million people aged 65 and over do not receive the care and support that they need; and cuts in local authority care services have placed increasing pressure on unpaid carers. Of course, there is also a growing number of young adults with severe disabilities for whom long-term care is provided by local authorities, hence the estimate from the Local Government Association that there will be a £3.6 billion funding gap in four years’ time unless there is an immediate and substantial increase in funding.

In summary, we therefore have what is currently described as a perfect storm, although I see nothing at all perfect in this crisis. People are becoming less independent and not receiving the support that they need to retain their independence. When they reach a crisis point—for example, following a preventable fall—and are admitted to hospital, where their care needs are assessed after treatment, there is often no residential care package or home care team to meet their new need. This is a situation where nobody wins: not the elderly person, who has unnecessarily lost a degree of independence; not the NHS, which is unable to transfer such patients to home or community settings; and not public services, whose funding is not being used efficiently and effectively.

What then are the potential changes that could help resolve this? There have been numerous reports and commissions to seek answers to the funding of adult social care. The Prime Minister declared himself committed to solving the problem, yet there were no proposals for reform in the latest Queen’s Speech. All we have is a relatively small amount of additional funding and a requirement for council tax payers to find an extra 8% on top of the capped limit over the last four years. This is no more than chicken feed in the face of the challenge.

The human cost is unacceptable; the additional, preventable pressures that are piled onto the NHS are unacceptable; the inability of the Government to propose a solution is unacceptable. The options for the future are clear. The Government have a duty and an electoral mandate to act—and act they must.

Queen’s Speech

Baroness Pinnock Excerpts

Thursday 9th January 2020 Lords Chamber

[Baroness Pinnock (LD)]

My Lords, I draw the attention of the House to my registered interests as a councillor and a vice-chair of the Local Government Association. I too want to raise the issue of social care.

This is what happened in the town where I live just before Christmas. There was an elderly couple in their 90s, well known in the community, and sadly the woman had developed dementia and was in need of considerable care and support. This care was provided by visits from social care and by her husband, who was himself frail. Sadly, he too became a victim of dementia. There was then what is described as a full care package, but for long periods of the day this increasingly vulnerable couple was regarded as being independent. One afternoon, the husband wandered out of the house in a confused state. At the next social care visit, the discovery was made that he had gone. It was dark. The police response was amazing; local people turned out to search. The next morning he was found in a side street, dead—a death without dignity, a social care tragedy.

I recount this because it amply illustrates the scandalous omission in this gracious Speech. In the past 20 years, there have been numerous commissions, reports and independent reviews on social care in England. We are still waiting for the Green Paper promised three years ago. The plan now is for more delay when what is needed is urgent action. Will the Minister at the very least assure the House that the Government will bring forward a Green Paper on the future funding of social care as a starting point for development of consensus on what has become a care service in crisis? For once, I agree with the noble Lord, Lord Forsyth.

The Government’s response to this desperate funding shortage for social care is to pile an increasing burden on to council tax payers via a 2% precept specifically for social care, on top of the annual tax increase. This provides additional funding along with a welcome promise of £1 billion a year, but that is to be shared by adult and children’s services, and we know that the funding gap for both services will be £7 billion in five years’ time, so this extra funding will fail to bridge the gap.

That brings me on to funding for local government as a whole. It is also at a critical stage, and business rates provide a large part of the funding. While the larger rebates in business rates proposed for retailers and others are very welcome, will that mean an equivalent reduction in income for local government? If that is the case, the already critical state of local funding will become even more perilous. Will the Minister provide local government with an assurance that it will be compensated in full for loss of business rate income?

The Government’s strategy for local government appears to be to starve it of funds but to fail to make provision to enable local government to develop other sources of income. The results are there for all to experience: potholed roads; fly-tipping on the increase; youth services cut to the bone or cut altogether; libraries closed; and vulnerable people not adequately cared for. Will the Minister be able to share with us the Government’s plans for the future funding of local government?

Finally, I remain concerned that the Government are gradually removing the “local” from local government by creating more large unitary authorities. It would be prudent of them to recall that one of the drivers of the existing national mood is that people no longer feel that they can influence decisions that directly affect their lives. The cry to “take back control” is a powerful one, and local people may well take up that call—to the discomfiture of the current Government.