Social Care: Person-centred Dementia Care
Baroness Pitkeathley Excerpts(3 years, 7 months ago)
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Lord Bethell (Con)
My Lords, I am extremely grateful to my noble friend for raising Dementia Action Week, a time to celebrate the contribution of those who care for people with these conditions. I know from my own experience the incredible importance of personalised care and of being able to have loved ones at home for as long as they can safely and reasonably be cared for there. My noble friend puts the experience of living with dementia for families and carers extremely well. I entirely endorse her sentiments.
Baroness Pitkeathley (Lab) [V]
Does the Minister agree that person-centred care for dementia sufferers must include support for those who care for them? Since today’s survey by the Alzheimer’s Society says that carers are at breaking point and 95% of carers say that their caring has affected their physical or mental health, how and when is that support to be provided? Will support for carers be an essential element in the proposals for social care reform when they eventually appear?
Lord Bethell (Con)
My Lords, I completely acknowledge the pressure the pandemic put on both formal and unpaid carers. That is why we put £6 billion into local authorities, to help support them in the care they gave to carers. However, I acknowledge the concerns of the noble Baroness about the pressure of the last year and reassure her that the full spectrum of social care will be considered in the forthcoming review.
Future of Health and Care
Baroness Pitkeathley Excerpts(3 years, 9 months ago)
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Lord Bethell (Con)
My Lords, the objectives outlined in the White Paper are reasonably clear. The four headline objectives are to make it easier for different people in the system to join up to find ways to address complex issues, to remove unnecessary bureaucracy, to empower local leaders to make the best decisions for the populations they serve and to facilitate a range of other improvements held back by existing legislation.
This is a large Bill with a very large number of measures. It is not, and does not pretend to be, unified by a single thought or held together by an ideology or motivation of any particular philosophy. It is the application of a very large number of recommendations that have come out of a huge engagement with the NHS family, patients and other stakeholders. As such, it is a pragmatic, thoughtful and restrained approach to an important piece of legislative housekeeping of this much-loved healthcare institution.
Baroness Pitkeathley (Lab) [V]
My Lords, I share the concerns of my noble friend Lady Thornton about these proposals, but I take issue tonight with one particular assertion in the Statement that health and social care are
“part of the same ecosystem.”—[Official Report, Commons, 11/2/21; col. 506.]
As far as patients are concerned, this has never been the case as healthcare is free at the point of use whereas social care is and always has been charged for. In a debate in your Lordships’ House on 28 January, to which the Minister replied, virtually every speaker from all sides of the House said that this is the anomaly which must be addressed. Will the Minister add to his previous remarks about money and charging issues and assure the House that the Government will address this issue in the long-promised reforms of social care and recognise that warm words about integration and collaboration are simply not enough?
Lord Bethell (Con)
The noble Baroness is right that there are distinctive qualities to social care and medical care, but the lived experience of most patients and residents is that those living in social care are very often heavy consumers of the NHS. As far as most of them are concerned, the support and treatment they are given needs to be much more closely linked. For instance, it is a strange anomaly that many living in residential social care have a completely different budget and sometimes completely different staff providing their medical treatment and their care treatment. This is not a functional distinction that we are seeking to overturn; what we are seeking is to get those teams of people and the decisions made about the care of individuals working much more closely together. We are not seeking to introduce a revolution in the funding of social care, and the financing of social care by local authorities and private individuals will continue, but we would like to see the distinction between social care and NHS medical care become more seamless, more joined up and, therefore, more effective.
Covid-19: Over-75s
Baroness Pitkeathley Excerpts(3 years, 10 months ago)
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Lord Bethell (Con)
My Lords, we have now reached more than 80% of over-80 year-olds. Local vaccination services, of which there are more than 1,000 in England, co-ordinate the delivery of vaccinations to people who are unable to attend a vaccination site, including visiting homes, the personal homes of housebound individuals and other settings such as residential facilities for those with learning difficulties. The rollout of the vaccine to those at home is progressing at great pace and we are getting great feedback from the front line.
Baroness Pitkeathley (Lab) [V]
Is the Minister aware that many people over 75, notwithstanding their age, are providing care for family members—a spouse or an adult child with special needs, for example? Research by Carers UK shows that two-thirds of these older carers are providing more than 90 hours’ care a week, having had to take on more duties during the pandemic. One-third of them say that they are reaching breaking point and that their own health, physical and mental, has been severely affected. How will the Government ensure that sufficient support is available to these older carers, on whom so many depend?
Lord Bethell (Con)
My Lords, I pay tribute to all those elderly carers, who, as the noble Baroness quite rightly points out, provide a huge service to society, to their loved ones and to the community. We have put in place a tremendous amount of support for carers, including PPE support. We have changed the arrangements for domiciliary care so that we can restrict the spread of the virus, and we have changed the way in which domiciliary care is paid for. The noble Baroness is entirely right: we should not forget the considerable contribution made by a large number of unpaid carers, many of whom are themselves elderly.
International Year of Health and Care Workers
Baroness Pitkeathley Excerpts(3 years, 10 months ago)
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Lord Bethell (Con)
My Lords, I pay tribute to the work of the noble Baroness in this important area. Her implied insight is exactly correct. We cannot be healthy and safe here in Britain if there are diseases raging around the world. It is both in our pragmatic self-interest and aligned with our values of partnership with other countries that we should indeed invest in the kind of training and support to which the noble Baroness alluded. I will definitely look into how we could do this better.
Baroness Pitkeathley (Lab) [V]
My Lords, the WHO puts health and care workers in the same category. Does the Minister agree that we in the UK do not see them as the same, since workers in the care sector are habitually worse paid, less recognised and more poorly trained and supported than those who work in the NHS? Would not the best way to celebrate care workers be to remedy these discrepancies in the proposals for the reform of social care, which the Minister has assured the House will be brought forward this year?
Lord Bethell (Con)
My Lords, the noble Baroness makes a completely fair point. Her observation is entirely right and her recommendation is one that the Prime Minister has made clear is part of his thinking. Social care workers have done a phenomenal job during this pandemic. Their role in supporting the elderly and infirm is extremely valuable to the whole country. It is only right that they should be treated fairly; a review of their pay and circumstances will be part of the social care package when that is announced.
Social Care Funding (EAC Report)
Baroness Pitkeathley Excerpts(3 years, 10 months ago)
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Baroness Pitkeathley (Lab) [V]
My Lords, I declare my interest as vice-president of Carers UK. I am greatly indebted to the noble Lord, Lord Forsyth, for finally securing this debate and very pleased to participate—as pleased as I was, in fact, when I first read the report in July 2019, not just with its content but mostly that it existed at all.
In the 23 years I have been in your Lordships’ House, I have taken part in many debates on social care and have been wont to call those who join me “the usual suspects”. We were a relatively small band who banged on about this subject whenever we got the opportunity and frequently used the expression “a national scandal”, as it is used today. I have to tell your Lordships that it makes pretty depressing reading to go back to those other debates on social care because the problems remain the same and so little progress seems to have been made. But the noble Lord, Lord Forsyth, and his colleagues are not the usual suspects and they reached the same conclusions.
The committee found a situation which, I think it is safe to say, shocked its members. If it was bad in the summer of 2019, how much worse is it now after the ravages wrought by the pandemic? The situation is bad for everyone: for local authorities, for the NHS and for care homes. It is very bad for family carers, as the report acknowledges. We all know now that families and friends are holding the social care system together by providing support for the most vulnerable in society. Many were at breaking point before the current crisis and are now sick with worry. We are asking even more of these unpaid carers than ever before. They urgently need to be supported and their contribution, worth billions of pounds, recognised.
If Covid-19 and the additional focus it has brought on the inadequacy of the care system have any positive outcome, it may be that we are finally forced to take bold decisions about the funding and provision of social care. Over the years, we have all witnessed the endless recommendations about how to reform the system: the reviews, the royal commission, the unenacted legislation and, of course, the endless broken promises. What we need now is a decision of the level and quality that our forebears took in relation to the NHS, but this time it must be about reshaping health and social care around today’s needs, not those of the population of a post-war Britain.
We cannot go on as we are, trying to do more with less, managing demand by simply not meeting it and by being dishonest with the public and the voters. No Government have ever made it clear to the public that responsibility for paying for and arranging care rests with individuals and their families. If they are not prepared to reform the system, the Government must at least be prepared to promote clearer public understanding of how the system works, what people can expect and, more importantly, what they cannot expect.
This problem is not going to go away; it is only going to get worse. The question is not whether these costs will arise, but how they will be met. Will they be met by the public purse or by private individuals? Every independent review of the past 20 years has recommended that 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. The time for debate is surely over. We have enough research and experience to enable us to take this decision—to decide on reform. All we need is the will to do so. If we have the will, we can end this national scandal now.
The Deputy Chairman of Committees (Lord Bates) (Con)
I now call the next speaker, the noble Lord, Lord Campbell, after whom I will call the noble Lord, Lord Lansley.
Health: Brain Tumours
Baroness Pitkeathley Excerpts(3 years, 10 months ago)
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Lord Bethell (Con)
My Lords, the noble Lord makes an excellent suggestion. Indeed, I am pleased to report that exactly such a strategy is in place by working with the Tessa Jowell Brain Cancer Mission, to which the department, the NIHR, NHS England and NHS Improvement are all active contributors. As part of the mission the department is funding new research through NIHR, encouraging new researchers to become involved, and we will be supporting the delivery of research as a key part of the new Tessa Jowell centres of excellence.
Baroness Pitkeathley (Lab) [V]
My Lords, many experts conclude that without new discoveries the outlook for patients with brain tumours is bleak. Given that many sufferers are in their teens or twenties and reliant on the support of their parents or carers, do the Government see it as a priority to support families, both during treatment processes and during the all-too-frequent bereavements?
Lord Bethell (Con)
My Lords, the noble Baroness is right that brain tumours and brain cancer are some of the most awful situations, particularly because they so frequently affect the young. That is why infrastructure spend on brain tumour research has increased. I am pleased to say that we received 62 applications for research funding between May 2018 and 2020, 10 of which have been funded so far, but more can be done in that area. Supporting families is, of course, part of the responsibility of the charities and trusts involved, and I wish the best to all those families who have been hit by this awful condition.
Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) (No. 2) Regulations 2020
Baroness Pitkeathley Excerpts(4 years ago)
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Baroness Bennett of Manor Castle (GP) [V]
My Lords, it is a pleasure to associate myself with the comments just made by the noble Baroness about the risks of deregulation and self-regulation. We have seen a great deal of concerning and tragic events flowing from that in the building industry. However, my first question, of which I have given prior notice, addresses what follows from testing: self-isolation. The Minister himself is self-isolating today, and I wish him and his family all the best. It is very difficult for many people to do, for financial reasons, because of care responsibilities, or for other reasons. In recognition of that fact, the Government have brought in a £500 payment for people ordered to self-isolate, with the money paid through local authorities. I credit Martin Lewis’s MoneySavingExpert website for what I understand is its original research, published yesterday, in doing spot checks and identifying at least five local authorities where the allocation of money has run out. It is reported that therefore people are being told they cannot get a payment. Can the Minister confirm that? If so, do the Government plan to fix this as a matter of urgency?
On my second point, I appreciate the fact that the Minister took time to explain in his introduction how he saw the idea of a market operating in Covid-19 testing. I have problems with the whole idea of a market in healthcare, but at least it was outlined clearly. In that outline, he said that everyone should have access to affordable tests. The explosion in the use of food banks started before Covid-19 but has certainly increased. People are unable to afford to buy even food. It is clear that lots of people would not be able to afford the price of a Covid test that they might have very good reason to want. Will the Minister consider perhaps approaching the suppliers of these tests and seeing if they could supply some to each food bank in the land, so that they would be genuinely available to everyone who might have good cause to need them?
Secondly on the issue of markets, the purpose of trading in a market is generally to make a profit on the good or service provided. Given the clear high demand and need for Covid tests, how are the Government ensuring that windfall profits are not made? Indeed, I ask the Minister directly: what percentage profit does he consider it would be reasonable to make on a Covid test?
Finally, given that this statutory instrument is essentially a deregulatory one, how are the Government ensuring that the use and promotion of lateral flow testing, which has been reported in the real world to have up to a 50% false negative rate, is used appropriately? Clearly it can be useful at population level to identify asymptomatic infections, but does the Minister agree that it would be deeply dangerous if it was used to give people an all-clear to mix and mingle, with or without precautions?
The Deputy Chairman of Committees (Baroness Pitkeathley) (Lab)
The noble Lord, Lord Randall, has withdrawn, so I call the noble Lord, Lord Bourne of Aberystwyth.
Baroness Wheatcroft (Non-Afl) [V]
My Lords, I thank the noble Lord, Lord Bourne, who always makes very perceptive comments and asks piercing questions, and I thank the Minister for introducing these statutory instruments. I echo the feeling that he works very hard and now has an extra burden; I hope that his family will recover soon.
I understand why there is a need for private sector testing—the NHS simply cannot cope—but I have concerns about the risk that these instruments could enable widespread private sector testing. Too often during the course of this pandemic, we have seen the private sector as the first port of call, with massive contracts going, for example, to Serco and Deloitte. Deloitte, it should be remembered, was running the testing centre at Chessington World of Adventures. Perhaps it was in the spirit of adventure that it approached the task, but it came in for criticism after losing the test results of NHS staff.
I share concerns that the private sector will see this as a money-making opportunity and cut corners. Like the noble Lord, Lord Hunt, I wonder whether the UKAS has the scope to cope with policing the new burdens being placed on it. I echo the fears of the noble Baroness, Lady Altmann, that there will be scope for fraudsters to enter this market.
There was some consultation before these proposals were made, and we are told that the feedback was “largely” in favour. Can the Minister tell us the concerns of those who were not in favour and how they are being addressed? I think, for instance, that the BMA has grave concerns about this. While we are told that the list of gold-standard providers will be available on the government website, I wonder how the Government propose to make all those who want tests aware of this. Certainly, on my very brief attempt, I failed to find the information on the website.
Can the Minister address the issue of costs? Will there be an upper limit or will providers just be able to prey on those who are desperate for a test for various reasons?
The Deputy Chairman of Committees (Baroness Pitkeathley) (Lab)
The noble Baroness, Lady McIntosh, has withdrawn, so I call the next speaker, the noble Baroness, Lady Uddin.
Baroness Uddin (Non-Afl)
My Lords, I express my good wishes to the Minister and hope his family gets well very soon. I thank him for the precise manner in which he laid out the two SIs for our consideration.
I share the concerns expressed by the noble Baronesses, Lady Bennett and Lady Altmann, and, like others, I do not share the Minister’s confidence that adequate safeguards exist to effectively monitor private companies —some of them at least—given the fiasco that was impactfully detailed by the noble Baroness, Lady Wheatcroft.
I have a couple of general points to make. On social care for children and adults living with disabilities and autism, it is being widely reported anecdotally and in the media that families and carers are suffering an intolerable burden without adequate support from organisations and local authorities which, because of serious budget shortfalls, are failing in their statutory obligations and to safeguard their duty to protect the most vulnerable who may be experiencing abuse and neglect. Noble Lords will be equally concerned to learn that organisations such as Barnardo’s, the NSPCC and Include Me TOO, which provide specific services for ethnic-minority children, are overwhelmed with demands for services, as many families have depleted resilience to cope and to navigate the new maze of inconsistent and inadequate access to their rightful services.
The Minister speaks with confidence about the critical importance of effective testing services being available to those who require them. My inquiries in my local area, particularly among Bangladeshi communities, continue to alarm me. Many of them remain confused about at what point to trigger testing and what options might be available to them, therefore overwhelming GPs and local hospitals. I have spoken about this in the House on a number of occasions, and to the Minister personally, because there is simply not enough information being relayed to the communities in a bilingual format. I have also spoken to the Minister about re-examining the messaging and what else might need to be done to ensure that there are proper, consistent and effective messages going out about what needs to happen and where the services can be accessed.
Finally, I hope the Minister’s department is collecting adequate data on the kinds of communities—particularly their ethnicities and age ranges—where there are serious gaps in both testing and services. It is high time that we have effective equality impact assessment of all these different SIs as well as the provisions that the Government are providing.
The Deputy Chairman of Committees (Baroness Pitkeathley) (Lab)
My Lords, the noble Lord, Lord Wei, has withdrawn, so I now call the noble Baroness, Lady Jolly.
Health Protection (Coronavirus, Testing Requirements and Standards) (England) Regulations 2020
Baroness Pitkeathley Excerpts(4 years ago)
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The Deputy Chairman of Committees (Baroness Pitkeathley) (Lab)
I remind Members to sanitise their desks and chairs before leaving the Room.
Social Care Workers
Baroness Pitkeathley Excerpts(4 years, 2 months ago)
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Baroness Pitkeathley (Lab) [V]
My Lords, when there is a shortage of care workers, as there clearly is, the need for care does not go away; it simply falls disproportionately on the families and neighbours—the unpaid carers. Some 70% of these say that they have had to give more care than previously during the pandemic, with an average of 10 hours extra a week. How will these extra burdens on unpaid carers be recognised and supported both in the long-term plan and in social care reform, when we eventually get it?
Covid-19 Update
Baroness Pitkeathley Excerpts(4 years, 2 months ago)
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Lord Bethell (Con)
My Lords, I thank the noble Baronesses, Lady Thornton and Lady Barker, for their remarks. The noble Baroness, Lady Thornton, is entirely right about the situation that we face. The latest update, as of 4 o’clock today, is that we have 14,542 daily positives today: 2,833 are in hospital with Covid; of those, 496 are on ventilators, and I am sad to report there were 76 deaths.
These are numbers that make us extremely focused on the challenge of Covid. Earlier today we debated the rule of six, when there was a large amount of challenge about whether such rules on social distancing were really necessary. We were reminded in clear terms about the social impact of separating those who love each other. Here we are talking about the impact on the health of the nation and the threat presented to those who are vulnerable, elderly and have pre-existing conditions. Getting the balance between these two things is extremely challenging, but that is the strategy of the Government—to bear down on the virus while protecting the NHS, education and the economy until we can see a way out through the vaccine, through therapeutic drugs and through mass testing. That is our approach.
I make no bones about it; the errors made over last weekend with the data was extremely regrettable. It undoubtedly causes grave concern among those in Parliament and the general public. I cannot hide from anyone the importance, impact, and severity of the situation. However, I would like to say a few words in mitigation. First, I pay tribute to those at PHE who have pulled together a remarkable system in extremely difficult circumstances, across the length and breadth of the country, integrating many systems into one. I know that that may seem like a trivial challenge and beside the point when we are dealing with a national emergency like this, but these are incredibly complex and difficult tasks. They have involved extremely committed personnel on the technology side of things who have personally checked a huge amount of the numbers. As my noble friend Lady Harding explained, it was through the perseverance of some of those personnel that the mistake was identified.
Between 17 and 23 September, 87,000 were identified through our testing and tracing programme; that is a phenomenal number of contacts where we had the opportunity to intervene and break the chain of transmission. Some 83.7% of those were reached and asked to isolate. I completely appreciate the concerns of those speaking in the Chamber today about the test and trace programme, but those figures are remarkable. That we have set up a system that can intervene in the lives of so many who are carrying coronavirus and can bring to bear such pressure on the disease after such a start as we had at the beginning of the epidemic is a phenomenal achievement. I know that the last thing one wants to be, at this stage of things, is a hollow champion of empty achievement, but that is a hell of a thing for this country to have got to.
There have been questions about the collaboration between the centre and northern leaders, and I cannot hide the fact that there are some quite fruity discussions on the pages of the newspapers and news channels between different community leaders. However, we have to be adult about this and acknowledge that there are different roles for different parts of government. The mayor of a city simply does not have a huge laboratory in which to do tens of thousands of tests a day. The mayor of another city simply does not have a control room filled with PhD analysts who can crunch the numbers and run massive supercomputers with complex algorithms to look at millions and millions of items of data within minutes. These are not the functions of local government, nor will they ever be.
Likewise, the JBC, the Department of Health and Social Care and the Cabinet Office do not have the local knowledge of what is going on on the ground and are not expected to speak a wide range of languages. We do not know what the behaviours are of people on a street-by-street basis. That is the role of local government, and it is through the collaboration of the local and national that we will beat this disease. To try to throw up a false dichotomy and set up test and trace as a scapegoat to blame and punish for the frustrations we all feel about the disease is counter- productive and reveals a shallow understanding of a complex situation.
The noble Baroness, Lady Thornton, said that perhaps care home testing should be sent to hospitals. In many cases, hospitals are involved in care home testing and handle the staff of care homes, but hospitals have to cover their own clinical demands, and pillar 1 is stretched to do the testing of hospital staff and patients. Landing that additional burden is not something that the NHS would welcome.
With regard to the northern leaders and their running commentary on the work of test and trace, I reassure the House that the conversations held in private on a daily—and sometimes hourly—basis have an altogether more collaborative tone. I have been privy to a large number of those conversations; there is a huge amount of expertise on both sides of the conversation, and one should not take too seriously the knockabout commentary in the newspapers and on TV.
The noble Baroness, Lady Barker, asked for an update on contact tracing, and she is entirely right. To have missed a substantial number of contacts during those days was a really big disappointment, but we have moved a huge amount of resources in order to catch up. There has been a phenomenal catch-up already, and I understand that my right honourable friend the Secretary of State will be updating the other place on the progress of that shortly.
I reassure the Chamber, however, that all those who had a positive test were informed promptly. There was no omission in that respect. Therefore, the primary index case, and the person of greatest threat to community transmission, was identified and isolated, and that chain of transmission was shut down.
I will now address the questions about the CMO and the JBC and their analysis of our numbers. I reassure the noble Baroness, Lady Barker, that the integrity of the CMO is unimpeachable; if he judges that the change in numbers has not changed policy, I reassure the Chamber that that is a good judgment that is completely consistent with the way in which we have behaved over the last few weeks.
The noble Baronesses, Lady Thornton and Lady Barker, both asked about Project Orbis. This is a welcome move, enabling the UK to join an international framework to provide concurrent submissions and regulatory views of oncology products, which may allow UK patients to receive earlier access to medicines in the future. I pay tribute to colleagues at the MHRA, who I know have worked really hard on collaborating with American, Canadian and Australian regulators. I am extremely optimistic about the dividends from this collaboration. It augurs, promisingly, similar future collaborations across the health sphere.
The Deputy Speaker (Baroness Pitkeathley) (Lab)
My Lords, we now come to the 30 minutes allocated for Back-Bench questions. I ask that questions and answers be brief, so that I can call the maximum number of speakers.
Lord Bethell (Con)
My Lords, I will tackle those in reverse order. I would not seek to be patronising for a moment. We value the contribution of local leaders enormously, and if I hit the wrong note then I regret that. What I was trying to get across is that the rhetoric in the public media and the realities of the day-to-day conversations between government and local government are not exactly as they might appear. The roles performed by both are complementary, rather than a zero-sum game. It is worth in this Chamber remembering that.
On procurement, the noble Baroness is entirely right; there is a real tension between the absolute requirement to move quickly to meet the challenge of Covid—to stand up facilities and services that did not previously exist—and to move on a national population-wide scale in a way that is not frequently seen in the health system. I can reassure the noble Baroness that a huge amount of work is being done on the auditing, checking and supervision of these contracts. They are not entered into in either a naive or flaky way—quite the opposite. We have put a huge amount of audit and legal resources into striking the right contracts. Cabinet Office colleagues provide a huge amount of analysis and challenge to the way in which these contracts are drafted and in checking against the delivery of the products and services involved.
The Deputy Speaker (Baroness Pitkeathley) (Lab)
The noble Lord, Lord Robathan, has scratched, so I call the noble Baroness, Lady Bennett of Manor Castle.
Baroness Bennett of Manor Castle (GP) [V]
My Lords, questions in your Lordships’ House on this Statement have understandably focused on Covid-19, but the Statement as delivered in the other place is a broad-ranging survey. It starts by talking about treatments for Covid and then shifts to approvals for new cancer treatments; it looks at the expansion of urgent and emergency care; and those mysterious 40 new hospitals appear yet again, as the noble Baroness, Lady Barker, alluded to. In that context, I ask the Minister whether this Statement is sufficiently balanced. If this is a survey, where is the public health element?
Covid has exposed, even more than we recognised before, a deeply unhealthy society with terrible diets, inadequate opportunities for exercise, poverty, stress, and a mental health epidemic. We know from Victorian and early 20th-century times that it is public health measures that really make the difference. In facing up to tackling Covid, surely that is the direction in which we need to be looking. For example, new research today showing the impact of air pollution includes some very stirring suggestions that childhood exposure has an impact on the rates of dementia and Alzheimer’s. My questions to the Minister are these. Are the Government paying enough attention to public health? Is their strategy sufficiently balanced? Are they funding and doing enough on the broad measures that will create the healthier society that is so clearly desperately needed in the time of Covid or at any other time?