Adult Social Care in England

Baroness Pitkeathley Excerpts

Tuesday 10th October 2017 Lords Chamber

[Lord O’Shaughnessy]

The noble Baroness makes an excellent point. We will certainly look at those funding models. Co-ordination, as we have been saying, is the way forward, because if you are a user of care in your eighties, you may be visiting a GP, you may be based in a nursing home, and to you, it ought to be one system and you ought to be travelling through it smoothly. Of course, we know that that is not the case at the moment, and the noble Baroness is quite right to highlight that there are great gains to be made, whether from having pharmacists in nursing homes or from having GPs coming to visit. Her point about technology and data is a good one. We still have an argument to win in reassuring people that their data are safe within the NHS so that they can be confident that they are used wisely for their direct care. That is the policy area I am now responsible for, since the election, so I am focused on providing that reassurance so that we can unlock the kind of innovation she is talking about.

[Baroness Pitkeathley (Lab)]

My Lords, is the Minister able to give us any idea about when we may see the Green Paper for which some of us feel we have been waiting 40 years? Will it contain any revisiting of the Government’s response to the so-called Dilnot proposals about a cap on social care costs, about which there was so much confusion in the general election?

[Lord O'Shaughnessy]

I am sorry to disappoint the noble Baroness but I am not able to give her any more details on the timing of the consultation.

Health: Sepsis

Baroness Pitkeathley Excerpts

Thursday 14th September 2017 Lords Chamber

[Lord O'Shaughnessy]

That is absolutely right: there was an issue with coding. The noble Lord will be pleased to hear that from April this year NHS Digital published new guidance on coding for sepsis to deliver exactly the kind of improved reporting he wants.

[Baroness Pitkeathley (Lab)]

My Lords, as a survivor of total-body sepsis, I very much endorse what my noble friend Lord Turnberg said about the speed and danger of this illness. What was so difficult for both my family and the professionals who treated me to understand was that it could lead to a total failure of all the body’s organs—as it did in my case—within, literally, hours. The urgency of this must be emphasised in any public awareness campaign.

[Lord O'Shaughnessy]

I am very sorry to hear that the noble Baroness suffered that but am obviously delighted that she is still here. Just to re-emphasise the point about speed, I encourage noble Lords to look at the quality standard because it is very stringent about the speed at which treatment must be administered. Of course, the critical thing is making sure that there is proper triage and assessment ahead of that. That is where we still need to make some progress.

Adult Social Care Services

Baroness Pitkeathley Excerpts

Thursday 6th July 2017 Lords Chamber

[Baroness Pitkeathley (Lab)]

My Lords, the Minister has reminded us just how many consultations there have already been on this subject, most of them not moving us very far forward, sadly. It is welcome news, therefore, that the consultation will focus on solutions, not just problems. Does the Minister agree that if we are doing this for the long term—and it essential that we are—a whole-population solution and, dare I say it, a cross-party solution is required?

[Lord O'Shaughnessy]

The noble Baroness is quite right. We need to move forward on the basis of consensus, which is one thing that has been lacking in the past. There is no doubting the point we have reached: we cannot wait any longer and we need to move ahead. That is why we will do so, on the basis of consensus.

Queen’s Speech

Baroness Pitkeathley Excerpts

Thursday 29th June 2017 Lords Chamber

[Baroness Pitkeathley (Lab)]

My Lords, in the 20 years that I have been in your Lordships’ House I have spoken in and led many debates on social care. Each time my hopes were raised by the interest in the subject, and subsequently dashed because no real change came about. But the last time I led such a debate, in December last year, I ventured to express some hope. That was because, in spite of the terrible headlines and analysis we were constantly seeing—“Social care is at a tipping point”, “Bed-blocking crisis reaches a new high”; your Lordships will be familiar with the headlines—there seemed at last to be some agreement across all sectors about the extra resources needed and about the fact that healthcare cannot be sorted out and delivered efficiently without the same attention to social care.

Alas, the election and its aftermath have dashed my hopes once again. It was very welcome that the Conservative manifesto focused on social care, even though the proposals were so poorly thought through. The belated pledge to introduce a cap on the lifetime costs of care—also pledged, I remind noble Lords, in the 2015 manifesto—offered the prospect of protection from the catastrophic costs faced by many. Now, though, there seems to be doubt about these proposals, and the agreement with the DUP has apparently taken up all the money that was due to be allocated in this area.

So we are left with a single line in the Queen’s Speech about a consultation on social care—to add to the endless consultations we have already had. The royal commission, the Wanless review, the Dilnot commission, the Barker review—I could go on. Is that what the Government intend: another fruitless exercise, as all of those have apparently proved to be? For heaven’s sake, we know what the problems are; we do not need another consultation to tell us. If we need a consultation at all, we need it on the proposed solutions to the problems.

So I am going to help the Government take a short cut. There is no need for us to spend time finding out the difficulties; I can tell them what they are now, could probably could any Member of your Lordships’ House. I am going to give the Government some simple “dos and don’ts”. I shall start with the “don’ts”. “Don’t” use the consultation as a delaying process; deal with the shortfall in funding now. As we have heard, it is at least £2.5 billion, four out of five councils do not have enough provision and at least 1 million people in urgent need of care are not getting it. That is in spite of the enormous efforts of the dedicated staff who work in this field and of the vast contribution of the unpaid—usually family—carers, whose contribution, I never tire of reminding your Lordships, is worth over £130 billion to the economy.

“Don’t” assume that this is just a problem with an ageing society. Of the people receiving long-term care in the last financial year, nearly 33% were under 65.

“Don’t” rely on a sticking-plaster solution. The Government talk endlessly about the benefits of the better care fund, but I am tired of being offered that by successive Ministers as a solution every time I raise the issue. Of course we should be trying to do more with less and promoting efficiency and collaboration, but basically we manage demand at the moment by ignoring it and putting undue pressure on family carers, 2 million of whom take on these responsibilities each year and are usually shocked to find how little support is available to them.

I now turn to the “dos”. I have only two: do be honest and do be bold. First, on honesty, no Government, of whatever colour or combination, have ever made it crystal clear to the public that responsibility for paying for care and for arranging it rests with individuals and their families, with public funding available only for those with the least money and the very highest needs. As a consequence, no one prepares or plans for care, and they have to scrabble about doing it when a crisis arises and the awful truth dawns on them. In addition, the expectation has grown that savings and the considerable assets now contained in property can be passed on to family without being touched. We must rethink this and be honest about it.

Secondly, we must please be bold. The Conservative manifesto committed to act:

“Where others have failed to lead”—


so now is the time for action. Every independent review of the last 20 years has recommended that the future funding of social care, as well as healthcare needs, should come from public, not private, finance. The needs of individuals cannot be divided up neatly into health or social care needs, as those of us who have tried to fathom the difference between a health bath and a social care bath have long acknowledged. Now is the time for us as a society to acknowledge that the funding cannot be neatly divided, either.

To those who say that this is not the time, with public finances in such disarray, all the Brexit difficulties and so many other problems around, I remind noble Lords that our forebears tackled reform in the middle of a world war when the country was pretty well bankrupt and not the fifth-richest nation on earth. We must embark on a frank and open debate about how to fund health and social care on a sustainable basis into the future. We must remind everyone that such a debate will not be settled in a single Parliament, so we need to secure cross-party consensus on shared principles to guide that reform. We have enough research and excellent material to enable us to do so; we just need the will. We know all the questions about social care. We just need the answers and the solutions. Will the consultation consult on proposals and solutions?

Social Care in England: Older People

Baroness Pitkeathley Excerpts

Monday 20th March 2017 Lords Chamber

[Lord O'Shaughnessy]

I of course associate myself with the comments made by the noble Baroness and apologise for not saying so before. However, I am not going to sing in tribute.

Around 17% of the care workforce comes from abroad and some 7% of the total are from the EU. The key is to make sure that we have, as far as possible, a care system that attracts workers domestically. We are doing that through improving the training packages available and through better pay under the national living wage, which I mentioned.

[Baroness Pitkeathley (Lab)]

My Lords, we heard this morning that the domiciliary care scene is under pressure and many domiciliary care agencies are in fact not tendering for contracts. The care home sector is also under pressure. The people who are not giving up, as the Minister points out, are the family carers— 6 million of whom are picking up the pieces from an inadequate social care system. May I press him a little more on the carers strategy, please? It was due to be published last September. Has he a date yet?

NHS: Sustainability and Transformation Plans

Baroness Pitkeathley Excerpts

Monday 20th March 2017 Lords Chamber

Asked by

[Baroness Pitkeathley]

To ask Her Majesty’s Government what assessment they have made of the impact of any hospital closures resulting from the implementation of Sustainability and Transformation Plans on Accident and Emergency departments.

[The Parliamentary Under-Secretary of State, Department of Health (Lord O'Shaughnessy) (Con)]

My Lords, sustainability and transformation plans, or STPs, are about local health stakeholders coming together to make sure that NHS services are placed on a sustainable footing and are being transformed for the future. Any significant changes outlined in the STPs will have to meet the four reconfiguration tests of strong public and patient engagement, a clear clinical evidence base, support for patient choice and support from clinicians.

[Baroness Pitkeathley (Lab)]

I thank the Minister for his reply but, in view of the problems about which we heard in the last Question and the fact that accident and emergency departments and other hospital services deal with many social care needs, does the Minister agree that it is vital that there is sufficient capacity in the community to manage the demands for community services which closures will inevitably cause, and that this must be established before any closures take place? Will the Minister therefore tell the House specifically when, by whom and how this assessment of the adequacy of community services will take place?

[Lord O'Shaughnessy]

As the noble Baroness has pointed out, it is important that there is sufficient capacity in the social care service and in the NHS. In fact, the NHS accounts for more of the delayed discharges, for example, than does social care. Simon Stevens, the head of NHS England, has been clear that, in addition to the four reconfiguration tests, any bed closures would need to show that there was redundancy in the system, that there is alternative provision—to come to the noble Baroness’s point—and that there is clear potential for efficiency. It is clear that the STPs must be able to plan ahead and provide alternatives if there are going to be changes to A&E or other services.

Adult Social Care: Funding

Baroness Pitkeathley Excerpts

Thursday 16th March 2017 Lords Chamber

[Lord O'Shaughnessy]

The noble Lord has done much work on the sustainability of social care, including his work on the Dilnot commission. He is quite right to point out that there are lessons to be learned from other countries, and certainly we will be learning them from Japan, Germany and elsewhere. He will know that the measures announced in the Budget are specifically designed not only to help adult social care but also to help the interface between the NHS and social care to provide exactly the kind of sustainability he is talking about.

[Baroness Pitkeathley (Lab)]

My Lords, some of us in this House are veterans of social care reviews that have led to very little change. Can the Minister therefore tell the House whether he is confident that the Green Paper will lead to urgent action? Will it consider controversial issues such as helping families prepare for care, savings products in the insurance market and perhaps even care vouchers?

National Health Service: Nurses

Baroness Pitkeathley Excerpts

Wednesday 22nd February 2017 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness is quite right to raise the issue of retaining nurses and bringing them back into the profession. That is why, last year, to aid retention, there was an average 3% increase in pay for nurses. Health Education England has also introduced a return to practice campaign, which has brought 900 nurses back to the front line in the last three years.

[Baroness Pitkeathley (Lab)]

My Lords, we hear constantly that better integration between health and social care is the way to solve the problems that both services are currently experiencing. What progress is being made with training nurses who can work across both health and community services?

[Lord O'Shaughnessy]

The noble Baroness makes a very good point. In fact, the workforce figures out today, which show the increases I have described, also show an increase in the number of nurses with general qualifications who are capable of working across multiple specialties and different sectors.

Residential Care

Baroness Pitkeathley Excerpts

Monday 6th February 2017 Lords Chamber

[Lord O'Shaughnessy]

I thank my noble friend for making a very important point. Clearly, the capacity in the care home sector is important for ensuring that there is a proper flow of patients out of hospitals and into a more appropriate setting. In regard to the county that she was talking about, North Yorkshire, I think the overall number of beds has been broadly flat over the period in question, but there has been an increase in domiciliary and supported accommodation, which is increasingly the way that care is being structured across the country.

[Baroness Pitkeathley (Lab)]

My Lords, does the Minister agree that where there is a shortage of residential or, indeed, nursing home care beds, the onus on care falls on the families? Will he take this opportunity to update his honourable friend in the other place, the Minister for Health, who last week exhorted the nation to care for its elderly relatives? He apparently forgot that there are 6.5 million people who already do so at great personal cost to themselves.

[Lord O'Shaughnessy]

The noble Baroness is quite right to highlight the work that carers do. There is now, of course, a national carers strategy to support those who are supporting their families, often in very difficult circumstances. The point that my honourable friend in the other place was trying to make was that there is an important role for families to continue doing so—in the way that parents care for children, children should do the same for their parents in return.

Mental Health and NHS Performance Update

Baroness Pitkeathley Excerpts

Monday 9th January 2017 Lords Chamber

[Lord O'Shaughnessy]

I thank the noble Lord for his question. There are many strategies, going forward. One is the reform of social care, which includes additional funding, with the precepts being front-loaded now. The second is making sure that, in hospitals, those people in beds who would be better served in a different care setting are able to leave through step-down services, or other such services. Of course, the other factor is to make sure that there is appropriate general practice, and not simply A&E departments, although these can be effective in some areas. We want to make sure that there are more GPs and that we spend more on general practice, as we will in the spending review period, for patients who would be better dealt with without going into A&E, if the kind of care that they are receiving would be more appropriate in a primary care setting. We have to remember that, for patients such as those with dementia, the prospect of going into A&E could in itself be frightening and worrying.

[Baroness Pitkeathley (Lab)]

My Lords, I cannot resist the opportunity to remind the new Minister, as I always used to remind his predecessor, about the importance of Britain’s 6 million family carers, when we look at both the issues that he has brought to our attention today. First, he talks about speeding up discharge. You cannot speed up discharge in the social care sector unless you also provide support to the family carers, many of whom are elderly themselves, who will provide that care, when somebody comes out of hospital who is still barely recovered and those carers are expected to perform nursing functions, such as changing catheters. As for mental health, carers are often expected to be full-time carers for young people with very challenging behaviour, and they are often deprived of any information that would help them, on the grounds of confidentiality. What is the Government’s position on helping those informal carers in both these situations?