NHS: Targets

Baroness Pitkeathley Excerpts

Thursday 6th February 2020 Lords Chamber

[Baroness Pitkeathley (Lab)]

My Lords, do not be confused, I am not my noble friend Lord Brooke; I am grateful to him for swapping places with me—noble Lords will be hearing from him later.

I am grateful to my noble friend Lord Hunt for securing this debate; nobody knows more about this than he does. I am particularly pleased with the wide range of his topic: we can focus on the performance of the NHS in relation to its targets but also recognise the impact of adult social care pressures on those targets and that performance—I am glad that so many noble Lords who have spoken realise this.

My noble friend draws attention to a whole-system failure, and we can see evidence of that in the shocking statistic that shows how life expectancy in the United Kingdom is falling, contrary to what the noble Lord, Lord Bates, said to us. Life expectancy had been rising for decades, but has now started to decline, with the elderly, poor and newborn worst affected. Life expectancy for those over 65 has dropped by more than six months. Why? Academics have said that it is a direct result of the austerity measures imposed by the coalition Government in 2010. These cuts, which removed more than £30 billion from welfare payments, housing subsidies and social services, were some of the severest made by any nation after the 2008 financial crisis. They triggered dramatic reductions in social care, meals on wheels, rural transport, health visitors and district nursing services.

Community and voluntary services, which have always been so important in the care of the elderly and isolated especially, suffered similar reductions. If no one visits an isolated older person, no one notices if they have stopped eating or are having trouble moving about. They fall over, are finally discovered, and are then admitted to hospital where they have to be given more serious interventions than would have been the case if services had been available earlier. Then there is difficulty in discharging them because social care services are not available or are inadequate, and so the whole sorry cycle starts again, inevitably leading to shorter lives.

The cancelled operations, the ambulances queueing outside A&E and the patients dying in corridors are in fact a crisis in social care. NHS budgets may have been ring-fenced, but social care has lost £6 billion from its total spend and the 50% rise in elderly people and others stuck in hospital is because there is nowhere for them to go in the community. Thousands of care homes have closed and more than 30,000 places have been lost because providers can no longer afford to operate on the money they receive from the state. Even those homes that keep going—and there are many of high quality—face a constant battle to keep staff, since the starting wage for a care assistant is about £2,000 a year less than you could earn if you went to work in Asda or Aldi.

I mentioned a whole-system failure, and part of that whole system is of course the huge contribution of unpaid carers to our health and social care system—many noble Lords have mentioned this. Noble Lords would expect me to remind them that this contribution is worth £132 billion a year, or the cost of another whole NHS. But let us not forget the cost to the carers themselves, in terms of their own physical and mental health and the financial strain on them, which is not just the extra costs associated with providing care but the loss of future income because of lost earnings and pension provisions. I acknowledge with pleasure the commitment to carers’ leave in the gracious Speech, but it is to be unpaid so, frankly, it will not help much.

Your Lordships will be familiar with all the arguments about social care that some of us have been making ad nauseam for many years. I will not call that group the “usual suspects”, but after her wonderful maiden speech today I am delighted to welcome my noble friend Lady Wilcox to that group. We are familiar with reports followed by endless delay and indecision about how to tackle the complete unpredictability of the cost of care so that we pray we will die of cancer quickly rather than dementia slowly.

The Minister will quote the £1.5 billion given to local authorities for adult social care. That is a sticking plaster on an open wound, as I have said before in this House. I urge political consensus, as others have done, but we cannot get away from the fact that a very large chunk of money is required immediately to prevent more deaths in a situation which is surely the most pressing problem facing our nation. I have urged the Government before to be honest and bold about tackling this problem. I do so again. I ask the Minister to confirm that we will have an honest and bold proposal before the end of this year.

Young Carers: Health and Well-being

Baroness Pitkeathley Excerpts

Monday 13th January 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

I thank my noble and learned friend for his question. The Government changed the law to improve how young carers and their families are identified and supported, to simplify the legislation relating to this. In addition, in 2016 we funded the Carers Trust to develop and run the Making a Step Change project for young carers and their families. It was designed to embed best practice to champion and identify support for young carers and their families and to provide an effective and integrated way for voluntary and statutory sector partners to identify young carers. We are working even harder to make sure that GPs and other professionals do the best for young carers. NHS England has recently introduced a new framework of quality markers in when identifying carers for GP practices so that they can improve both their health and their well-being throughout the care pathway.

[Baroness Pitkeathley (Lab)]

My Lords, the noble Baroness will remember from her previous role at the Department for Health and Social Care that, when carers were consulted prior to the Carers Action Plan, 67% of young carers said that they were not receiving any support at all. Does she have any statistics to show that this situation is improving?

[Baroness Blackwood of North Oxford]

We have now delivered all 12 of the commitments and recommendations in the Carers Action Plan to improve the situation for young carers, but the noble Baroness is absolutely right that the way we will improve on that is by improving identification. As I have said, with support from the Carers Trust and the Children’s Society, we are focusing on making sure that we embed not only early identification but also the right support throughout our work with young carers. We know that we have further to go but we are determined to do so.

Queen’s Speech

Baroness Pitkeathley Excerpts

Thursday 9th January 2020 Lords Chamber

[Baroness Pitkeathley (Lab)]

My Lords, I had a bit of a waiting-for-a-bus moment when I listened to the Queen’s Speech, because I felt I had waited 30 years for a mention in the gracious Speech, and then two came along at once. I refer to the two issues on which I contribute most in your Lordships’ House: social care and carers.

I hope that a mention in the Queen’s Speech, even if only a fleeting one, about ensuring that everybody has the dignity and security they deserve and that no one has to sell their home to fund care, means that the crisis in social care may finally be given the attention it needs so urgently. We have had five independent commissions, four White Papers, two Green Papers and endless other reports, yet no progress has been made, even though, as my noble friend Lord Hunt referred to, we have proposals agreed on the statute book in the form of the Dilnot commission. I hope that the noble Lord, Lord Warner, will say more about that.

I was heartened when the Prime Minister told us, when he became Prime Minister, that he had a “clear plan” to fix the problem. There was no plan. Instead, he pledged an extra £1 billion a year—the equivalent of yet another sticking plaster on an open wound of the kind we have seen before. The Local Government Association estimates that there will be a £3.6 billion gap in adult social care funding by 2024. Now the Prime Minister says that he will seek cross-party consensus. I hope that all parties will treat this with an open mind. We have had enough of the type of politicking that led to talk of the Labour death tax in 2010 and the Tory dementia tax in 2017. Such talk betrays the people who are vulnerable, lonely and in dire need. While Parliament has endlessly put this issue into the too-difficult box, tens of thousands of people have died waiting for a care package and tens of thousands of carers have sacrificed their own health and finances on the altar of the prevarication of legislators.

Carers contribute £132 billion to our economy, yet too many are burning out while they prop up an underfunded system. We must stop this now. The crisis is acute and growing worse by the day. The consensus that the Prime Minister says he is seeking is largely already there. There is broad agreement that public funding for social care needs must be significantly increased and that a balance needs to be struck between individual and collective responsibility for care costs. I draw your Lordships’ attention to the excellent report by the noble Lord, Lord Forsyth, to which I hope he will refer.

When will the Government publish their plans for long-term reform? How will carers and those they care for be consulted? How will the Government seek this political consensus that they are talking about? This will of course take time and, as an urgent priority, the Government must invest the funding required to keep the social care system afloat until longer-term reforms are implemented. Will the Government meet the short-term funding gap for social care?

I turn to the welcome mention in the Queen’s Speech of the employment Bill and measures to support working carers. Carers UK—I declare an interest as a vice-president—welcomed the announcement of the introduction of a new entitlement to one week’s leave for unpaid carers. To be most effective, this entitlement must be paid and should be for up to 10 days per year. For the 5 million people in the United Kingdom who juggle working and unpaid caring, combining these responsibilities can be a real challenge, as is shown by the fact that 2.6 million people have already left their job to care for a loved one. Carers’ leave would be beneficial for both carers, by helping them to stay in work, and for employers, by helping to improve staff well-being. Of course, this has a very good economic knock-on effect, by enabling carers to maintain their incomes, so as not to build up poverty for the future and therefore have another generation of poor pensioners. Do the Government agree that the new entitlement to carers’ leave should be paid, and that the ability to have flexible working for carers makes very sound economic—as well as moral—good sense?

Healthcare: Brain Tumours

Baroness Pitkeathley Excerpts

Thursday 24th October 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble and learned Baroness is quite right that people should have a choice in end-of-life care. The long-term plan recognises that we need to improve that choice and the quality of discussions around it. That is at the heart of the drive to improve personal health budgets and help staff identify personalised care planning for end-of-life care. I hope that reassures the noble and learned Baroness that this is seen as a top priority in end-of-life care planning.

[Baroness Pitkeathley (Lab)]

My Lords, the Minister has mentioned NHS support, but she will know that by far the majority of support for carers in these circumstances comes from local authorities. How does she react to all the current research showing that not only are services diminishing for carers in local authority areas but also the number of assessments, in contradiction to obligations under the Care Act and the carers action plan?

[Baroness Blackwood of North Oxford]

The noble Baroness will know that this has been identified as a priority, not only from the call to action from carers themselves that services and systems that work for them should be improved, but also because it is one of the 64 actions in the carers action plan. It is something the Government are determined to take action on. We are concerned by the reports and taking action to improve it.

Adult Social Care

Baroness Pitkeathley Excerpts

Thursday 25th July 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Baroness is quite right that the better care fund has been considered a great success. It is an important part of the integration proposals between health and social care, which the Government and the NHS are committed to. It is under review to see how it can work better. That will conclude later this year so that certainty can be given to local councils, which I hope she welcomes. On market instability, I reassure her that the overall number of social care beds has remained more or less constant over the past nine years. There are also over 3,700 more home care agencies now—so, while there will inevitably be some exits from the market, we are more reassured than we would otherwise have been.

[Baroness Pitkeathley (Lab)]

May I take the noble Baroness back to her reference to personal responsibility? There is a great deal of agreement across the House and elsewhere that personal responsibility is important as far as social care is concerned, but does personal responsibility extend to subsidies for those on local authority placements in nursing homes? Those paying for themselves privately are actively subsidising those places because local authorities cannot afford adequate rates.

[Baroness Blackwood of North Oxford]

The noble Baroness has got to the nub of the challenge, which is how we get the balance right. This is why we have brought forward the work we have been doing to make sure that, while we have the safety net in place and an element of personal responsibility, it becomes fairer. That is why the Prime Minister and the Secretary of State have made it clear that they are determined to drive this work forward faster and with more urgency than has been done until now. That has been put forward as a key priority of the incoming Cabinet.

Social Care: Free Personal Care

Baroness Pitkeathley Excerpts

Wednesday 26th June 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I thank my noble friend for her question. We should pay tribute to those who work very hard in the social care system under very challenging circumstances. Swindon, for example, has brought in a co-designed service with users and an increase in reablement of 150%, bringing an annual saving of £1.9 million to the health and care economy, while also reducing DTOC. Services and improvements such as these should be spread across the system. That is exactly what the better care fund is designed to do, and it is what the new models of care commitment within the NHS long-term plan will spread across the system so that we can improve social care for all.

[Baroness Pitkeathley (Lab)]

My Lords—

[Baroness Brinton (LD)]

My Lords—

Carers: Support

Baroness Pitkeathley Excerpts

Monday 17th June 2019 Lords Chamber

Asked by

[Baroness Pitkeathley]

To ask Her Majesty’s Government what proposals they have to guarantee support for family carers following the cuts made to local authority and voluntary sector support services.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, the Government have given councils access to £3.9 billion in dedicated funding for adult social care in 2019-20. Last June, we published the carers’ action plan, a cross-government programme of targeted work to support carers, including a £5 million carers’ innovation fund to encourage new and creative ways of doing so. We are also working with local government to ensure that carers can access the support that they deserve and promote best practice in carer breaks provision.

[Baroness Pitkeathley (Lab)]

I thank the noble Baroness for that Answer, which I listened to with great interest. I am the first to acknowledge that much progress has been made for carers in recent years, especially winning rights for them under the Carers Act. But I wonder how the noble Baroness would respond to the carer I spoke to on Friday. She is 79, recovering from cancer that has left her with severe back pain and caring for her 91 year-old partner, who has vascular dementia. Fourteen times she has asked her local authority for the assessment, to which she knows she is entitled. Fourteen times she has either been ignored or refused. Her local carers’ group, which was a support to her, has closed down because its funding has been cut. “It is no good telling me I have a right to services”, she says. “There are no services. There is only me and I am about to go under”. How does the noble Baroness respond to her?

[Baroness Blackwood of North Oxford]

The noble Baroness has raised an important point, which is that we need to provide carers with the support they need, because they do an amazing job. Unpaid care is a vital part of a sustainable health and social care system. This is why the long-term plan has put in place an ambition to ensure that we provide sustainable support across the public health system, and will ensure that we have a quality mark for primary care to highlight best practice. I am very sorry to hear about the experience of the carer in the case that the noble Baroness highlighted and would be pleased to follow this up with her directly, after today’s Question Time.

NHS Funding: Mental Health Services

Baroness Pitkeathley Excerpts

Wednesday 1st May 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I shall have to write to my noble friend in order to answer her question with the best accuracy possible. However, my understanding is that the ring-fenced funding will be spent on health professionals rather than probation professionals. One of the most effective measures introduced under the five-year forward view, which has delivered very effective outcomes, has been liaison services. I shall investigate the point that she has raised and come back to deliver the response that she deserves.

[Baroness Pitkeathley (Lab)]

My Lords, does the Minister agree that continuity is what is important here? That means continuity of care and of services across the NHS, social care and family support. In the absence of any coherent plan for social care, which is needed by mental health patients almost as much as medical care, have we any hope of achieving this continuity? And if the Minister could say anything about the Green Paper, I am sure the House would be delighted.

[Baroness Blackwood of North Oxford]

The noble Baroness is right to identify the need for continuity of care and the fact that community care is essential to ensuring good mental health outcomes. That is exactly why the focus in the long-term plan is on ensuring prevention and early intervention and on targeting the support of liaison services—for example, support for mental health training in the context of schools as well as for liaison services in policing and other areas. She is right that we must endeavour to deliver on the social care Green Paper. It is imminent, and I look forward to the debates in this House when it is produced.

Brexit: Health and Social Care Workforce

Baroness Pitkeathley Excerpts

Thursday 13th December 2018 Lords Chamber

[Lord O'Shaughnessy]

I recognise the picture that my noble friend paints. It is of course incredibly important that money gets to the front line. I am sure that she is aware of this, but I would point out the operation of the Better Care Fund, which brings together local authority and NHS funding specifically to support social care provision. The amounts of money going through that have been increasing over recent years.

[Baroness Pitkeathley (Lab)]

My Lords, the statistics quoted by my noble friend on the Front Bench are pretty frightening, but the knock-on effects on the 6.5 million unpaid carers upon whom our health and social care system depends are even more alarming. In a recent survey, 70% of them doubted their ability to continue caring if more support, much of which comes from these care workers, is not available to them. Will the Minister assure the House that the forthcoming Green Paper, which we know is imminent, and the NHS plan, will take full account of the needs of carers?

[Lord O'Shaughnessy]

I am grateful to the noble Baroness for raising the matter and for her persistence in doing so; she is quite right to. We were pleased to publish the action plan earlier in the year and I can tell her that the Green Paper, as I have said before at the Dispatch Box, will contain more policy on supporting carers.

Domestic Abuse: General Practitioner Charges

Baroness Pitkeathley Excerpts

Thursday 15th November 2018 Lords Chamber

[Lord O’Shaughnessy]

My noble friend is right to say that domestic abuse can affect anyone, although of course it happens predominantly to women. The police, local authorities and the third sector are there to provide support for both men and women when they are abused.

[Baroness Pitkeathley (Lab)]

My Lords, further to the question put by the noble Baroness, Lady Greengross, I understand that it is becoming more common for some general practitioners to see older people with a similar illness in groups. Would this not be quite prejudicial to the idea of having a confidential interview with one’s GP if abuse has been threatened?

[Lord O’Shaughnessy]

This would be for the discretion of the GP. I would be amazed if any GP would want to see someone who has come to them with a confidential matter, such as saying that they have been the victim of domestic abuse, in a group situation. That seems to be quite wrong. There is a role for group GP appointments for totally different issues, and indeed some of the emerging evidence shows that, for certain illnesses, they can be quite successful.