Care Homes: Energy Costs

Debate between Baroness Pitkeathley and Lord Kamall

Thursday 8th September 2022 Lords Chamber

[Lord Kamall (Con)]

As my noble friend will be aware, many care homes are privately owned and run. Quite often, we do not get into that level of detail but I will take the question back to my department once we are aware of the package that is announced.

[Baroness Pitkeathley (Lab)]

My Lords, to add to the problems of care homes to which noble Lords have referred is the report in today’s newspapers that the new Secretary of State for Health intends to use them as places to discharge people who cannot have a social care package in their own homes. Can the Minister assure the House that, if this happens, all attention will be paid to the huge problem that care homes already have in recruiting enough staff to carry out their existing functions?

[Lord Kamall (Con)]

All noble Lords will be aware of the challenges facing care homes and their owners, including recruiting sufficient staff. People have referred to a number of different issues; one is vocation and feeling valued—quite often they feel as if they are poor relations. Another issue is supply, which is one reason we have looked at a visa to try to encourage more workers from overseas. If we make it a proper vocation, people will want to train in it, get those qualifications and feel they have a valued career.

NHS: Abuse of Nurses

Debate between Baroness Pitkeathley and Lord Kamall

Tuesday 5th April 2022 Lords Chamber

[Lord Kamall (Con)]

We are looking at the way in which abusers are treated. On 13 November 2018, the Assaults on Emergency Workers (Offences) Act 2018 came into force, and since 2020 we have also been working with the Ministry of Justice in consulting on doubling the sentence for such assaults to two years. The Government are now legislating for this through the Police, Crime, Sentencing and Courts Bill. In addition, a Joint Agreement on Offences Against Emergency Workers was agreed between NHS England and NHS Improvement and the Crown Prosecution Service in January 2020.

[Baroness Pitkeathley (Lab)]

My Lords, will the Minister outline how the training of nurses is being adjusted or extended to take account of this regrettable violence towards them? Does he agree that when we are thinking about training, we must include all nurses—not just those who work in hospitals but, most especially, those who work in communities and therefore go individually into people’s homes?

[Lord Kamall (Con)]

As well as various programmes such as the NHS violence prevention and reduction standard, against which trusts are measured and held accountable, there are a number of different local initiatives to see what works and what does not in different places. There are a number of innovative ones, and I will give one example, rather than take up too much time. The No Force First initiative at Mersey Care NHS Foundation Trust has resulted in a 46% reduction in physical assaults against staff. There are a number of other examples that I could lay out in detail.

Care Homes: Evicted Residents

Debate between Baroness Pitkeathley and Lord Kamall

Thursday 10th March 2022 Lords Chamber

[Lord Kamall (Con)]

The noble Baroness raises a very important point. When we look at the current landscape in the social care sector, it is clear that people do not really understand the overall sector. One thing that we are looking at in regard to the voluntary register is encouraging care staff to come forward to register. Registration includes their standard of education and the qualifications they have received. We will look at how we can improve and have a more consistent qualification system, so that being a care worker is a more rewarding vocation in the future.

[Baroness Pitkeathley (Lab)]

My Lords, is the Minister aware that restrictive practices about visiting in care homes extend not just to relatives and friends visiting but to the outside people who come in to provide stimulation to residents? These include people who bring in animals, for example, and people who do physiotherapy or all sorts of word games and so on. Those people are also restricted now by some homes, though not all. That results in further deterioration in the mental and emotional health of residents, as referred to by the noble Baroness, Lady Finlay.

[Lord Kamall (Con)]

One thing that has clearly upset a lot of people is that they are unable to visit. This means not just relatives but, as the noble Baroness rightly said, people who enter care homes to offer healthcare, stimulation and other services to residents. These issues were brought up, I understand, in a meeting with my colleague, the Minister for Care and Mental Health, when she met residents’ associations. It is very important that we recognise all the problems and that we tackle this in a holistic way to make sure that, as we improve the quality of our social care system, and make it more joined-up and integrated with the health system, we are aware of all these problems so that the patient experience is far better all the way through.

Health and Care Bill

Debate between Baroness Pitkeathley and Lord Kamall

Lords Hansard - Part 1 & Report stage
Monday 7th March 2022 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

My Lords, I thank all noble Lords who have spoken and particularly thank the noble Baroness, Lady Pitkeathley, for her continuing championing of carers.

Discharging people as soon as they are clinically ready is increasingly recognised as the most effective way to support better outcomes. The evidence shows that the “discharge to assess” approach reduces time spent in a hospital bed and supports people to remain independent at home wherever possible. Although the hospital discharge clause does not mandate discharge to assess, the Government are supportive of local areas that choose to implement this best practice model. We believe that carrying out long-term needs assessments at a point of optimum recovery leads to a more accurate evaluation of people’s abilities and needs and more appropriate care packages. Many people discharged from hospital require longer than two weeks to recover. Requiring social care needs assessments to be completed within two weeks of discharge would not necessarily be in the patient’s best interests.

I understand that noble Lords are concerned about safe discharge from hospital and safeguards for patients and carers. However, relevant NHS bodies are expected to ensure that patients’ health needs are met safely in hospital and in the community. Local authorities also have duties to assess patients’ and carers’ needs and, where relevant, ensure that appropriate support is put in place for them. In addition, the CQC monitors, inspects and regulates services to make sure that they meet the fundamental standards of quality and safety, which are set out in legislation.

The Government do not believe that these amendments are in the best interests of either carers or patients. They would create new burdens on NHS bodies and local authorities, and Amendment 144 would create new penalties for local authorities for failing to carry out assessments within a specified timeframe. In doing so, the amendments would undermine the entire purpose of Clause 80 and hinder the ambition, shared across the health system and by Members of this House, to ensure that people are discharged in a safe and timely manner. The creation of significant bureaucracy between local authorities and the NHS risks damaging relationships and would go against the spirit of integrated working that this Bill seeks to support. We agree, however, that accountability and transparency are key to ensuring that local systems deliver high-quality and safe discharge services, which is why we welcome the fact that NHS England now publishes hospital discharge data.

Additionally, a duty on NHS bodies and local authorities to co-operate with one another is already set out in Section 82 of the NHS Act 2006. To specify how this duty will apply to hospital discharge, we are co-producing guidance with organisations including Carers UK, the Carers Trust and Barnardo’s. This will set a clear expectation that, where appropriate, unpaid carers should be consulted during the discharge process. As noble Lords have acknowledged, this guidance will be statutory; NHS bodies and local authorities will therefore be required to have regard to it or risk claims for judicial review potentially being brought against them. We agree that, where we can do more to “think carer” across the NHS, we should. With this in mind, we can commit that we will consult with the public, staff and carers on including a stronger reference to the role and regard of unpaid carers in the NHS constitution, for which a review will be launched this year.

I am also mindful of the specific concerns that have been expressed in relation to young carers. As well as using the guidance to include a much broader definition of carers than that set out in Schedule 3 to the Care Act, I can inform the House that the new Explanatory Notes for the Bill provide clarity that young carers and parent carers are included within the everyday definition.

In response to a number of noble Lords’ questions, I repeat what I said earlier: our new guidance includes a broader definition of carers than Schedule 3 to the Care Act, which applied only to adult carers of patients requiring a long-term needs assessment before discharge. Adult carers’ rights to an assessment of their own needs, under Section 10 of the Care Act, and young carers’ rights, including those as part of the Children Act, remain unchanged under the proposed hospital discharge arrangements.

We believe that statutory guidance is more appropriate here. At the moment, current guidance is not statutory; this will be statutory. Where a young carer is identified, or staff have concerns, the local authority should be notified. Local authorities must then carry out a needs assessment if it appears that the young carer needs support. We are not imposing new duties on local authorities; the existing legislative duties placed on local authorities to assess and meet patients’ and carers’ eligible needs remain unchanged.

I recognise the good intentions behind Amendments 113 and 144, but we believe they would have the effect of undermining the ability of local areas to adopt best practice for hospital discharge. I am not confident when I say this, but I hope that, having heard what I have said, noble Lords may feel able not to press their amendments when reached.

[Baroness Pitkeathley (Lab)]

My Lords, I thank all noble Lords who have spoken and the Minister for his responses, particularly about consultation and about broader definitions and identification of carers. I was a little puzzled when he mentioned transparency, since the latest updated version of the impact assessment says:

“The level of support required as well as the associated impact on work hours and salary would vary significantly case-by-case and the impact on unpaid carers is difficult to assess. We are therefore unable to quantify the impact on unpaid carers at this stage.”


I am very concerned that, if we cannot quantify the impact on carers, we cannot really do anything to support them.

The problem with guidance, good practice guidance or statutory guidance, is that we have been here before. I have seen other bits of guidance—the identification of carers by GPs, breaks for carers—I have seen those bits of guidance fall away when another priority takes over. Therefore, I am very concerned that we need to have the rights of carers enshrined in primary legislation, and I wish to test the opinion of the House.

Health and Care Bill

Debate between Baroness Pitkeathley and Lord Kamall

Lords Hansard - Part 1 & Report stage
Thursday 3rd March 2022 Lords Chamber

[Lord Kamall (Con)]

My goodness—I thank noble Lords for their brevity. I am afraid that I shall not be as brief as I would want to be. I would like to confine myself to single-word answers, but I do not think that would give the reassurance that noble Lords are looking for.

I begin by thanking all noble Lords who have engaged with me on this, especially the noble Baroness, Lady Brinton, and the noble Lords, Lord Clement-Jones and Lord Hunt. As they know from our discussions, this issue is very close to my heart and something I feel very strongly about, so I welcome their pressing the Government on this and their continuous engagement—in fact, right up to this morning. I do not think that this is the end of that engagement but I hope to give some reassurances. I completely understand the interest in the integrated care boards’ power to disclose information that is personal data. I hope I will be able to clarify some of the intentions.

New Section 14Z61, inserted by Clause 20, recreates the section that applies to CCGs, which sets out the circumstances in which CCGs are permitted to disclose information obtained in the exercise of their functions. The clause in question already restricts ICBs’ powers to disclose information, by limiting these to the specific circumstances set out in the clause.

In addition, the existing data protection legislation, including UK GDPR, provides several key protections and safeguards for the use of an individual’s data, including strict rules and key data protection principles for the sharing of personal data. Health data is special category data—that is data that requires additional protections due to its sensitivity. For this type of data to be processed lawfully, a further condition must be met as set out in UK GDPR and the Data Protection Act.

In addition, the common law duty of confidentiality applies to the use of confidential patient information. This permits disclosure of such information only where the individual to whom the information relates has consented, where disclosure is of overall benefit to a patient or is in the public interest—for example, disclosure is to protect individuals or society from risks of harm or where there is a statutory basis for disclosing the information or a legal duty, such as a court order, to do so.

Every health and care organisation has a Caldicott Guardian—a senior person responsible for protecting the confidentiality of people’s health and care information and making sure that it is used properly. Caldicott Guardians decide how much information it is appropriate to share—they may decide that even legally permitted information may not be shared—and they advise on disclosures that may be in the public interest. They act in accordance with the eight principles, which are the framework to ensure that people’s confidential information is kept confidential and used appropriately. The UK Caldicott Guardian Council works closely with the independent statutory National Data Guardian, whose role is to advise and challenge the health and care system to help ensure that the public’s confidential information is safeguarded securely and used properly.

Nothing in the clause overrides the range of requirements in law that provide key protections and safeguards for the use of an individual’s personal data. I can also confirm that NHS England’s power to issue guidance for ICBs will apply to their functions relating to data sharing, and that may be a helpful route in making it clear to ICBs what their duties and responsibilities are, in respect of any confidential data they may hold, in a way that illustrates how legislation applies.

The effect of the amendment is to prevent the effective operation of the clause as drafted. This would prevent the ICB from effectively discharging its functions where it may be necessary to disclose personal patient data, including investigating complaints, making safeguarding referrals for patients whose welfare is at risk, complying with court orders and assisting criminal investigations. It would also risk a confusing data-sharing system where different rules apply to different organisations.

On Amendment 116, once again I thank the noble Lord, Lord Hunt of Kings Heath, for bringing this issue before this House. Our aim is to put data and analytics at the heart of NHS delivery and remove incoherence in the organisational leadership, for the benefit of patients and their outcomes. It is a solid recommendation for improving how health and social care data is used more effectively, closing that gap between delivery and the use of data to inform and improve services.

I understand that noble Lords fear that the movement of the statutory data functions from one world-class arm’s-length body, NHS Digital, to another, NHS England, which indeed runs the NHS itself, would result in a decline in the exercise of those functions. We feel that this fear is perhaps overexaggerated but I would be very happy to continue discussions on this.

However, that movement would be accompanied by the transfer of several thousand expert staff and all their supporting expertise and technology, along with the existing statutory safeguards, which would be preserved. NHS Digital and NHS England have a history of very close working on data, most recently of course in how the management of data has underpinned efforts to defeat Covid-19, through the protection of shielded patients and the management of data on vaccinations. The Government and Parliament held NHS Digital to account for the delivery of its functions, and they will continue to hold NHS England to account for the delivery of any functions which transfer.

As to the concern about a conflict of interest, the data collections which NHS Digital undertakes are the result of directions from either the Secretary of State or NHS England, and obviously the direction-making power of the former will continue to be relevant should the proposed merger take place. Directions include details of how data must be shared or disseminated. NHS Digital is required to publish details of all such directions and maintain a register of the information it collects. There is also a rigorous process for external data access requests and audits of how data is used.

The intention here is that such safeguards would continue when the functions transfer to NHS England and would make it very difficult for the organisation to suppress or otherwise refuse to make available any data which it is required to collect and disseminate in fulfilment of its statutory role. I hope, perhaps overoptimistically, that I have reassured the noble Lord, Lord Warner—clearly not—in terms of suppressing information.

There is a rigorous process for external data access requests. NHS England’s Transformation Directorate will be assuming responsibility for NHS Digital’s functions, and for accomplishing the alignment of delivery and data proposed in the Wade-Gery review. There will continue to be external, independent scrutiny—for example, by the Information Commissioner and the National Data Guardian—of the use by the NHS, and NHS England in particular, of health and care data.

I hope that I have given noble Lords some reassurance that these important issues have been considered by the department, and that they will feel able not to move their amendments when reached. Of course, given my strong interest in this subject, I am prepared and happy to have further conversations to make sure that we close any remaining gaps and for me push the department and NHS England as appropriate.

[The Deputy Speaker (Baroness Pitkeathley) (Lab)]

I now invite the noble Baroness, Lady Brinton, who is taking part remotely, to reply to the debate.

Hospital Beds and Social Care

Debate between Baroness Pitkeathley and Lord Kamall

Thursday 6th January 2022 Lords Chamber

[Lord Kamall (Con)]

All noble Lords will appreciate the work and dedication of all our social care workers, especially in these challenging times and with the extra pressure that omicron has brought. Throughout the pandemic, we have provided different types of funding. In December 2021, we announced an extra £300 million to support local authorities working with care providers to recruit and retain staff throughout the winter. This funding is in addition to the £162.5 million announced in October 2021. We recognise the issue, and it is about working with local authorities and others to make sure that this money gets into the system and achieves what it is intended to do.

[Baroness Pitkeathley (Lab)]

My Lords, following on from the question from the noble Lord, Lord Jones of Cheltenham, does the Minister agree that it will be important for the discharge team to also look at the reasons for admission, since many people would not have been in hospital at all—they would never have been admitted—if there had been adequate domiciliary care services? Will the task force focus on those issues as well as the issues for not discharging?

[Lord Kamall (Con)]

The noble Baroness makes an important point. The task force, working with all the various partners, is looking at the different pathways. Most patients can be discharged from hospital to their own home, but a number are held back because they should be discharged from hospital to their own homes but with a new additional or restarted package, which may take time. Patients might be discharged to residential care within the independent and community sector, but one issue is that a number of our care homes are owned privately and are not necessarily as joined up in the system. Patients may also have been discharged to a care home, but sometimes the family may not appreciate or approve of the first venue given and may push back and ask for another one. There are a number of issues that we are looking at; it is very complicated, which I am sure all noble Lords understand. We are trying to really push and get to the bottom of this. Another thing is to make sure that there is education across health and social care staff so that they really understand the needs of particular patients.

Adult Social Care

Debate between Baroness Pitkeathley and Lord Kamall

Thursday 2nd December 2021 Lords Chamber

[Lord Kamall (Con)]

The Government are in conversation with local authorities at the moment to look at the short-term issues. That is why we have announced increases in funding, particularly as part of the winter plan. The White Paper we are talking about today looks at the longer term, but we have also recognised the short-term issues, which is why we have announced these increases in spending.

[Baroness Pitkeathley (Lab)]

My Lords, we have been waiting for four years—sometimes I think I have been waiting 40 years—for a White Paper that contained a vision for social care that would, once and for all, rescue it from its Cinderella role in public services. I did not get that, but I am a glass-half-full person and am relieved by how many times unpaid carers are mentioned and how many warm words there are about identifying, recognising and involving carers. I thank the Government for that.

But family carers are at breaking point now. As my noble friend said, most have not had a single break since the start of the pandemic. They need immediate help, so will the Minister tell the House how the proposals in the White Paper will help stressed carers now? My second question is about integration between health and social care services, which is the only hope for real reform. It is frequently referred to in the White Paper, but there is no vision for how it will be delivered. We understand that another White Paper about integration is being prepared; I wonder why that is necessary when it could have been tackled in this one. Could the Minister update the House on progress and assure me that carers will be consulted as that paper on integration is written?

[Lord Kamall (Con)]

First, I pay tribute to the work that the noble Baroness has done for carers over many years. She has personally raised with me issues with carers, both paid and unpaid, as well. The White Paper clearly raises issues of professionalising, training and recognising carers to help make this a rewarding career for many. At the same time, it looks at unpaid carers and understands that, for a number of reasons, they are not all similar. Sometimes they are school-age children. We have looked at young carers and at elderly carers—for example my mother, who, in her 70s, looks after an 80 year-old sister who suffers from dementia. They have different needs.

We are first trying to look at how we can help make their task easier, for example through technology freeing up time. We are also looking at respite and how we can make sure they have breaks. We hope that those conversations will be had at the local level, between ICSs and health professionals having meetings directly with the individuals concerned to make sure that unpaid carers have the appropriate support.

NHS: Primary Care Surgeries

Debate between Baroness Pitkeathley and Lord Kamall

Wednesday 24th November 2021 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Baroness for her speech. In answering, as this is for judicial review, I am sure she understands that I cannot comment on it. But I saw an interesting documentary over the weekend, so let me just read some words from it:

“Yes the NHS is a public service but how it spends its vast procurement budget, how it uses IT, how it fashions new processes and pathways for patients, plainly benefit from private sector experience.”


I admit I have plagiarised these words from Tony Blair, the last Labour Prime Minister to win an election.

[Baroness Pitkeathley (Lab)]

Is the Minister familiar with the research that shows that the longer the relationship between a patient and a GP, the less likely the patient is to need out-of-hours care or emergency hospital treatment, or to die, within 12 months? Are patients not right to be afraid that profit-making will interfere with those important relationships?

[Lord Kamall (Con)]

The standards of care that CCGs expect are clear in the contracts that they sign with GPs. However it is provided, patients should continue to expect the same standards of care.

Covid-19 Update

Debate between Baroness Pitkeathley and Lord Kamall

Wednesday 10th November 2021 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Lord for that question and other noble Lords for their questions. I am not the Prime Minister’s keeper; it is as simple as that. We all decide for ourselves. I wear a mask whenever I can and when I talk to different people, I make sure that we are seen to be wearing masks. I thank noble Lords across the House who are leading by example by wearing a mask.

[Baroness Pitkeathley (Lab)]

Patients in care homes and hospitals suffered very badly from not receiving visitors during the three lockdowns. Family ties were strained and a lot of extra distress was caused. From next April, if all, or the majority of, health service staff are vaccinated, what plans do the Government have for ensuring that visitors do not bring Covid into hospitals and care homes?

[Lord Kamall (Con)]

In many cases, that decision will be left to the individual trust or care home. We know that a number of care homes and different trusts are already concerned about unvaccinated visitors. Many will know already that during the previous lockdowns it was very difficult to visit your loved ones in hospital. I was not able to see my father between January last year and when he died last September. It was incredibly challenging, but we understood the reasons given by the care homes.

Social Care

Debate between Baroness Pitkeathley and Lord Kamall

Wednesday 27th October 2021 Lords Chamber

[Lord Kamall (Con)]

It is quite clear that, if we want to make sure that the social care system is fit for purpose, we have to make sure that, in the model, enough money is going in to reform the system. Part of the funding does go to helping local authorities push for reform, but, at the same time, it is true that some of the additional productivity as a result of digitisation will help make the NHS more efficient.

[Baroness Pitkeathley (Lab)]

My Lords, is it not an unfortunate fact that not a single penny from the levy will actually go to the front line of social care to relieve those overworked and underpaid staff making 15-minute visits, which is the real urgency? Even when the money does come to social care, some way down the line, will not much of it be taken up with bureaucracy, in making assessments and testing eligibility for the cap that the Government have put into the system? Surely that is something that we have to look at. How much of the money is actually going to go to the front line, not just now but in three or four years’ time.

[Lord Kamall (Con)]

The noble Baroness makes a very important point: we have to see reforms in the social care sector. The spending of £5.4 billion includes £1.7 billion for wider system reforms, including at least £500 million to support the adult social care workforce in professionalisation and well-being. We are also working closely with providers of care, local government charities, the unions, professional bodies, and users of care and their representatives, and will respond to their views in the forthcoming adult social care system reform White Paper, later this year.

GPs: In-person Appointments

Debate between Baroness Pitkeathley and Lord Kamall

Tuesday 19th October 2021 Lords Chamber

[Lord Kamall (Con)]

My Lords, I am happy to agree with the sentiment in the question from my noble friend, but it is important to make sure that we are not overly prescriptive. Patients sometimes want face-to-face consultation, but they may also be happy with a telephone call or an online consultation. At the heart of this should be patient choice.

[Baroness Pitkeathley (Lab)]

My Lords, has the Minister heard GPs say, as I have, that the most important question a patient asks is the one as they are leaving—the one as they are walking out of the door? Will the training of GPs be amended to cover the different listening techniques that may be required for online consultations, so that these important questions are not missed?

[Lord Kamall (Con)]

I thank the noble Baroness for sharing her expertise in this area, and absolutely agree with the question she asked. I do not have the details of the training of GPs to make sure that they are best prepared for online consultations, but I will write to her.

Health: Chronic Fatigue Syndrome

Debate between Baroness Pitkeathley and Lord Kamall

Tuesday 12th October 2021 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Baroness for her warm welcome. I am new to this and, as you can imagine, I am still learning the ropes and learning about NICE and its processes. However, I agree with the noble Baroness: it is really important that we address the issues she raises and if she writes to me, I will ask for some advice and respond to her.

[Baroness Pitkeathley (Lab)]

Does the Minister agree that patient groups and charities are key in providing support to these patients? They are very concerned about the absence of guidelines, particularly as they have been involved in their production. Could the Minister offer them any reassurance about the timing of the guidelines?

[Lord Kamall (Con)]

I understand that NICE wants to publish these guidelines as quickly as possible. It is very aware that there have been two delays: first, to make sure that it took on board the various comments; and secondly, the current delay because of issues raised by some clinician groups. As noble Lords will understand, NICE is independent from the Government. It hopes to progress this issue by having the roundtable, hearing all the different views and seeing if some consensus can be reached before the guidelines are published.