Baroness Tyler of Enfield debates involving the Department of Health and Social Care during the 2019 Parliament

Thu 14th October 2021
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Social Care in England

Baroness Tyler of Enfield Excerpts
Thursday 14th October 2021

(1 week, 5 days ago)

Lords Chamber

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Department of Health and Social Care
Baroness Pitkeathley Portrait Baroness Pitkeathley (Lab)
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Well, my Lords, here we are again. In the 24 years I have been in your Lordships’ House, I have lost count of the number of debates on social care in which I have participated, joined by the intrepid band to whom I usually refer as the “usual suspects”. In fact, at times we have found it difficult to fill a debate, so unpopular was the topic. I am glad to note that it is very different this time; many want to speak. Of course, the Minister is very much not a usual suspect, so we welcome him and hope he will be accommodating and bold in answering this debate, as I have always asked Ministers from all sides to be.

The debate, like Gaul, is in three parts and reflects the new situation in which we find ourselves since our last debate in April 2020. We have come through a pandemic and at long last—at very long last, many of us would say—have some government proposals addressing the crisis in social care which in the past we all agreed—the degree of consensus on this was remarkable—was bad for everyone concerned.

The Public Services Committee, of which I am a member, concluded that while the crisis in acute care during the pandemic was dealt with relatively successfully it was followed by a devastating crisis in adult social care. Older people and working-age disabled people with care needs were left particularly vulnerable. The large number of deaths in this group may have been the most significant public service failing in the pandemic. These were due to the pre-existing weaknesses to which we have been pointing for years, including the lack of integration between health and social care, and successive Governments prioritising the NHS while neglecting to fund social care adequately.

These problems are far from new. Many inquiries, including parliamentary inquiries such as that by the Economic Affairs Committee, have focused on the need to fund adult social care properly, put more focus on prevention and address the poor integration between health and care services. The Covid crisis highlighted the effects of all these long-standing problems between health and social care and, as Age UK put it, “laid bare” the stark inequalities of the current social care system and

“revealed the true extent of the impact underfunding, structural issues and market instability have had on the system’s ability to respond and protect … people at a time of crisis.”

The initial pandemic response made protection of the NHS a priority, which had a detrimental effect on social care. The rapid clearing of hospital beds revealed too little consideration of the fragility of care settings and resulted in too many deaths.

Inevitably, I must focus on the effect on unpaid carers—as your Lordships know, I always emphasise them—who are propping up whatever system of care we have. Let us be clear about the numbers, which are provided by Carers UK. There were 9 million unpaid carers across the UK before the Covid pandemic, providing everything from a few hours of support a week to intensive and complex round-the-clock care. The pandemic has resulted in about 4.5 million new carers, 2.5 million of whom are trying to juggle paid work with caring. This takes the estimated total number of carers to 13.5 million and the annual value of what they contribute is now estimated to be £193 billion every year.

Carers have been particularly hard-hit by Covid and many have had to make extremely difficult decisions about work and family. Some 81% say they are providing more care because services were closed or not available due to lack of PPE and care staff self-isolating or having caring responsibilities themselves. Yet the Build Back Better plan hardly mentions unpaid carers or how they will be supported. The Government have assured us that the forthcoming White Paper will address this, but when the Secretary of State for Health and Social Care said in his speech to the Conservative Party conference that care “begins at home” and people should turn to family first, it was hard to believe that the Government understand that this is precisely why there are 13.5 million carers. They do turn to their families first. His remarks were seen as uncaring and disrespectful to the millions of carers who never questioned their duty to their family.

Let us try to be positive and thankful that at least the pandemic has made us focus on social care more than ever before. The government proposals for which we have been calling for years have now come out, so I will turn to those.

That the social care sector needs more money and that this money should be found from taxation is never in doubt. However, there is puzzlement, even bewilderment, in most agencies about the Government’s chosen method of raising these taxes, using a levy on national insurance. Let us face the stark fact that not a single penny of the money raised by this method will go to front-line social care. We know that it will initially go to the NHS, for at least two years. I do not begrudge the NHS the money. Having just been told that I have to wait 42 weeks for a telephone conversation with a consultant, of course I do not begrudge it. I just do not want anyone to be conned into thinking that the tax raised by the levy will solve social care problems.

Even after social care—endlessly the poor relation whenever reforms are discussed—gets any of the money, it will go to helping a small number of families be relieved of care costs and the need to sell their houses. How will this stop the 15-minute visits by overworked and underpaid care staff, or give them even slightly better pay? Indeed, those overworked and underpaid staff will be paying towards this levy in their wage packet, as will their employers, largely in the private sector, whose profits—the only thing which keeps them in business—will be further eroded.

It is now 10 years since this House passed the legislation for the Dilnot review. Many of us spoke in favour of it at the time. However, the cap has been set so much higher than recommended that it is far from clear whether many people will actually benefit. I must point out—few people understand this—that the cap applies to the cost of nursing in residential homes only and does not include the so-called hotel costs. It will help a few better-off families, leaving most to pick up the bill, or subject to the vagaries of local authority funding.

In addition, it will add to the complexities of an already far too complicated funding system and add to the danger that any money coming to social care will be spent on bureaucracy, making assessments, testing eligibility and explaining to bewildered families why care costs so much, and why the picture in the social care sector is very different from that in the health care sector. Moreover, it will do nothing to improve the standards of care received by older people or those working-age adults with disabilities who make up at least one-third of those needing care, a fact which often seems to be overlooked in the emphasis on older people.

The debate in your Lordships’ House on 11 October makes interesting reading regarding how the levy proposals are viewed. It is hard to find any support for the proposals and there is great disappointment in the failure to address the promises which have been made about “fixing” social care. Surely fixing requires two things above all: enough money and better integration.

As to the former, the Institute for Fiscal Studies, quoted by my noble friend Lord Eatwell in Monday’s debate, says that

“it is clear that the extra funding will not be sufficient to reverse the cuts in the numbers receiving care seen during the 2010s.”

The IFS also points out that

“many people with care needs not considered severe enough will continue to miss out.”

Moreover, the latest IFS report published this week says that the £12 billion which will be raised annually by the tax rise is sufficient only to fix the immediate shortfall faced by the NHS and would need to double by 2025 to have any hope of keeping up with NHS, let alone social care, needs.

Integration with the NHS is seen as a vital need. There has always been political agreement across the board on this, yet I am mystified as to how these proposals will address it. At a time when waiting lists for the NHS are growing longer by the minute, should it not be a priority to ensure that no one stays in hospital longer than they have to by having discharge procedures which provide a seamless transition and making sure that the all too frequent readmission because of inadequate co-operation between the NHS and local authorities is guarded against?

We heard again only yesterday that care jobs are unfilled and requests for care are being turned down because of staff shortages. Local authorities are struggling terribly to recruit enough workers to meet increasing demands. That is no wonder when you can earn far more by filling shelves in Sainsbury’s.

The minute someone is admitted to hospital, health services, social care and the often ignored but very significant voluntary services should plan between them for what will happen on discharge. Sadly, the usual pattern is for a conflict to emerge, on a Friday afternoon, between a hospital ward desperate to empty beds and social care services inadequately prepared or even informed. The Government’s plans should include commitment to such planning and co-operation. Thus far, they do not.

As I turn to the third part of the Motion, the effect that Her Majesty’s Government’s plan for social care will have, I feel more regret than anger, because these proposals represent such a failed opportunity and once again see social care as the poor relation—the Cinderella, as some have called it. Social care could be at the heart of a levelling-up agenda, if we had a vision for its workforce and for the impact it has on the health of a community in its broadest sense. Care providers could be encouraged to diversify their businesses and to reach out creatively into the community by providing tax incentives, for example, or a reduction in business rates.

If we want a high-skill, high-wage economy, as we are increasingly told we do, what better place to start than social care, with its huge workforce, badly paid but certainly not unskilled? Those skills could be developed by providing training, and retention could be dealt with by better career progression and recognition of qualifications. If you provide more support to unpaid carers, you get the very best out of that huge but unrecognised workforce, and if you help them combine paid work with caring responsibilities, you not only help them financially now but save them from poverty in future. Surely that makes good economic sense, as well as being morally imperative.

It is possible that the Government intend to address those issues in the forthcoming White Paper, and I hope that the Minister can assure us about that. I also hope that he can assure the House that integration between health and social care will be seen as a priority, as there is a sad lack of any such incentive in the current proposals. Has he considered an integrated workforce with cross-discipline skills? How about integrated budgets and data sharing? Will all those failed opportunities be addressed in future policies? If they were, I really do not think it would be difficult to get the cross-party agreement and support that Ministers say they are aiming for.

Above all, I regret that there seems to be no attempt anywhere to address the causes of the difficulty in both health and social care, leaving the Government open to the charge of a sticking-plaster solution. Levelling up must surely include addressing the health inequalities which are the result of poverty and inadequate services, and which, sadly, have increased after a decade of public spending cuts.

The most efficient way to ensure that our health and social care services are not overwhelmed by demand is to make sure people do not need them as much. As Sir Michael Marmot has said:

“We need to adopt a health and social care system which prioritises not just the treatment of illness but how it can be prevented in the first place. The pandemic has made it crystal clear over the last 18 months why public health and … the social determinants of health, are so important. The health and social care agenda must be re-balanced … towards prevention”.

That, surely, is the sort of vision we should have for social care.

We eagerly await the White Paper, but I must tell your Lordships that the current proposals, with their inadequacies and lack of understanding and vision, do not fill me with hope. I beg to move.

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD)
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My Lords, I congratulate the noble Baroness, Lady Pitkeathley, on her excellent opening speech. It is a privilege to follow her.

We debate social care today at a time when, after years in the shadows, the crisis that is social care is no longer hidden from view but at last has come into stark public and political focus. What has changed?

First, as we have heard, the pandemic has cruelly exposed the plight of those dependent on social care. Nothing illustrates this more than the number of deaths of care home residents due to Covid: in England, it was estimated at 40,000 in the year ending this March, unlikely to be an underestimate. As the journalist Robert Peston wrote after reading the damning report published this week by the two Commons Select Committees on the lessons to be learned, the section on care home deaths

“will probably make your blood boil.”

It remains a national scandal.

Secondly, we now have the bare bones of the health and care levy, which many of us debated on Monday. I shall not repeat what I said then, but if the Prime Minister and the Health Secretary read that debate, it would have been a salutary experience. Speaker after speaker—from all Benches—made plain that the much-vaunted fix for social care was, frankly, anything but, with only a small portion of the £12 billion raised likely to go into social care in the next three years. Most of the money will be sucked into existing acute NHS pressures—much needed, of course, but with no guarantee of sustainable funding beyond that.

The cost of decades of inaction has fallen particularly hard on the shoulders of the estimated 11.5 million unpaid carers in the UK, some of them aged 80 and above, whose contribution to the current system is almost completely ignored, despite the fact that they are the only thing stopping it from complete collapse. Carers UK has estimated that unpaid carers save the Treasury some £193 billion a year.

Part of the problem has been the way in which the debate is invariably framed, particularly by the Prime Minister, as being all about avoiding making people sell their homes to pay for care. In reality, it is about so much more than that, and it is not just the elderly who are affected. Younger disabled adults make up half the cost of adult social care budgets.

The social care sector is complex and little understood, and the challenges facing it myriad, but, briefly, despite spiralling demand, particularly due to an ageing population, spending is lower than 10 years ago. Government funding for local authorities fell by 55% in the decade between 2010 and 2020, and the existing means-tested system, with its high threshold for care, has resulted in many people who needed care being unable to qualify for support, either in their own home or in a care home.

The King’s Fund has described the pandemic as having a devastating effect on the quality of care, despite some short-term additional government funding via local authorities and infection control. The costs of Covid and the fall in care home occupancy put many providers at risk of failing or simply handing contracts back. Fees vary considerably, depending on geography, and people who do not qualify for free care—self-funders, in the jargon—end up cross-subsidising local authority-funded residents. Again, they are essentially propping up the whole system.

Perhaps most fundamentally, a vastly underpaid and undervalued workforce receives little or no training or professional development, resulting in high levels of turnover and vacancies. Care companies are facing acute problems in retaining and recruiting staff, including according to a report published this week by Skills for Care, which suggests that there are now more unfilled care jobs than before the pandemic. The Public Accounts Committee has described the pandemic as having

“a devastating impact on the care sector.”

Those recent injections of cash, while welcome, and the local authority precept, provided some short-term relief, but the capacity to raise money is neither sufficient nor evenly spread, leading to reduced local services, particularly in deprived areas, and minimal care packages.

Against that backdrop, can the Minister, who I welcome to his new role, tell us what plans the Government have to bring forward a sector workforce plan, similar to that of the NHS, with proposals on career progression and pay, as called for by both the NAO and Care England?

All the above, of course, causes knock-on problems for the NHS, in both increased admissions for those unable to look after themselves at home without care and long delays in discharge from much-needed hospital beds due to the lack of social care in the community. The post-pandemic NHS backlog will not be solved without an immediate injection of cash for the social care sector. Urgent action is needed to shore up a fragile and highly fragmented sector reeling from the impact of the pandemic, with some care homes, often debt-laden and with unsustainable business models, becoming increasingly financially unviable.

Immediate funding is needed for the quality of care, to introduce minimum standards for care homes and to provide respite for unpaid carers. Above all, we urgently need a new deal for the care workforce, including action on pay, training and development, career progression and recognition. As I have said before, care staff, who have given so much during this pandemic, deserve to be paid well above the minimum wage.

To conclude, social care cannot wait until 2023 for additional funding, so can the Minister tell us what plans the Government have to provide an immediate and significant cash injection to local authorities as we head into the winter months for the delivery of adult social care services, including support for unpaid carers, in the spending review in a couple of weeks’ time?

Lord Astor of Hever Portrait Lord Astor of Hever (Con)
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My Lords, I also welcome my noble friend the Minister to the Dispatch Box and wish him all the best with his new responsibilities. I congratulate the noble Baroness, Lady Pitkeathley, on securing this debate. The issue of carers is very important.

The Prime Minister set out his plans for health and social care reform in his excellent policy document last month. On the one hand, he said, it would add up to the biggest catch-up programme in the history of the National Health Service, and at the same time would address the

“long-term problems … that have been so cruelly exposed by Covid.”—[Official Report, Commons, 7/9/21; col. 153.]

These long-term problems, let us not deceive ourselves, affect each and every one of us.

One of the most challenging problems has been revealed to be the chronic shortage of care staff, a situation that endangers the well-being of the most vulnerable among the population. Also the proper management, training and deployment of care providers needs addressing. Sadly, Brexit, wholly justifiable vaccination requirements, post-Covid fatigue and the prospects of higher pay in other sectors have not helped the situation.

Covid began a nationwide debate, a tumultuous vox pop, that made people sit up, listen and respond with their own accounts of suffering. It drew people together and showed our dependence on each other in the community. Through the media, individuals and family groups up and down the country were able to share personal experiences, often shocking and heartbreaking, which revealed a range of avoidable shortcomings in the health and social care system. I can only hope that, as the past has shown us time and again, out of crises great advancements can be made. This is especially true in health and social care, and I am confident that the Government are capable of setting in motion a bold programme of reform, although it will require a great deal of organisation and commitment, in addition to funding.

Greater integration of social care provided by the National Health Service through local clinical commissioning groups and that provided by local councils is one area that is under considerable pressure; and I should like the Government to focus on that. I understand that radical plans for such integration are being actively considered by the Health Secretary. I am sure that the Minister will address that in his wind-up speech.

The experiences of a family that I know living in the West Country with two severely disabled adult sons suggest that healthcare support across the nation is patchy and variable according to postcode. They have experienced profound ignorance at junior levels as to the delivery of an effective social care service, and believe that the protective territorialism and empire-building that they have witnessed need urgent addressing, with integration managed from the top and implemented locally.

Adopting a holistic modus operandi, with an emphasis on common sense and compassion, must be the best way in which to tackle the complex and multilevel needs of the population. All of us, with our lives being extended through access to modern medicines and diagnostics, will need greater recourse to treatment and support from the National Health Service.

Health and social care reform requires the support of a complete mindset reform to enable these improvements to happen: a recalibration of the imbalance between rights and responsibilities, and the recapturing of the spirit of working together for the greater good that was present at the very inception of the National Health Service.

Social Care Funding: Intergenerational Impact

Baroness Tyler of Enfield Excerpts
Thursday 16th September 2021

(1 month, 1 week ago)

Lords Chamber

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Department of Health and Social Care
Lord Howarth of Newport Portrait Lord Howarth of Newport (Lab) [V]
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My Lords, I thank the noble Baroness, Lady Greengross, with whom it has been a pleasure to work on this issue in the past, for tabling this Question for Short Debate and for setting forth her constructive proposals.

The failure of successive Governments over many years to reform the social care system has done as much as anything else to bring government and Parliament into disrepute. Now this Government have made a stab at the funding aspect of the problem. But the solution —though we cannot properly call it that—which they have come up with is enough to make one weep. Indeed, it will make many younger, lower-paid workers weep.

Of the various possible ways to raise money for social care, to increase national insurance contributions on their existing basis is the most regressive, unjust and destructive. The cynicism of the Government’s approach is chilling. They did some polling and found that the public think, wrongly, that national insurance pays for the National Health Service. They concluded that they could get away politically with raising national insurance contributions rather than raising income tax, which would have spread the burden fairly. Here the noble Baroness and I may disagree.

Presumably, those polled did not understand that employees’ national insurance contributions kick in at earnings of £184 per week, equivalent to £9,568 per year, far below the £12,570 per year at which income tax starts. Presumably, they also did not understand that national insurance contributions are levied at a higher rate on lower earners and that retired pensioners who are comfortably off do not pay national insurance contributions at all. Therefore, the policy means that miserably paid care workers will be more highly taxed, while affluent retirees will pay no more tax. The Government’s cunning plan is that young workers, struggling on low wages to save for a mortgage, will pay the new levy to enable pensioners who need social care to retain their homes and the bulk of their wealth through the cap on personal care costs of £86,000.

While it is far from certain that more than a derisory part of this national insurance increase will end up improving funding for social care, what we do know is that social care providers, paying higher employers’ national insurance contributions, will find it harder to employ staff and those staff will find it harder to make ends meet. In seeking to ingratiate themselves with elderly homeowners at the cost of the young and low-paid, the Government will not commend themselves to the country. A far cry from one nation conservatism, this politics of division exposes the fatuity of the Prime Minister’s levelling-up rhetoric. The policy drives a wedge between the generations, while it will fail to provide the resources required to address the social care crisis, by increasing the availability of social care to match actual need and developing the social care workforce.

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD)
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My Lords, I congratulate the noble Baroness, Lady Greengross, on securing this important debate.

We live at a time when the notion of intergenerational fairness is under threat. The accepted post-war norm has been for successive generations to experience better lives than their parents. That is not true anymore for the younger generation, as they are experiencing worse outcomes in terms of pay, job security and housing.

While I welcome the fact that more money is being earmarked for health and social care—although in the first three years it will nearly all go to health rather than to social care—I am disappointed on a number of fronts. First, after so many years of inaction, we were presented with a quickly-hatched and suboptimal solution without the cross-party talks that we had been promised to secure consensus and a long-term sustainable solution. Secondly, the money will come from national insurance rather than through the broader-based and more progressive income tax, thereby hitting low earners and the young hardest. Thirdly, much of the debate has been couched in terms of preventing people from having to sell their houses at a time when so many young people are finding it impossible to get their foot on the first rung of the housing ladder. I have long argued that we should be looking for a solution through the prism of intergenerational fairness in which all generations contribute but no single generation is impacted unfairly. I think that is vital to ensure greater buy-in across the generations.

Despite the dividend taxation and the application of the new health and care levy to the earnings of working pensioners from April 2023, big intergenerational equity issues remain. Tax rises via national insurance, as we have heard, fall disproportionately on the working-age population. A typical 25 year-old today will pay an extra £12,600 over their working lives from the employee part of the tax rise alone, compared to nothing for most pensioners. Some workers earning under £10,000 a year will be affected, but only those earning £12,750 pay income tax.

The extension of the levy to the earnings of working pensioners is welcome, but only one in six pensioner households have earnings. In contrast, two-thirds have private pension income that is exempted from the levy. A levy focused on earnings leaves other sources of income undertaxed, including a lot of rental income, and the package increases the tax gap between the self-employed and employees, raising the incentive for firms to use self-employed labour rather than employees.

Looking to the future and intergenerational fairness, I still hope it may be possible to move to a fairer system, with the majority of money raised through income tax but with a top-up that comes from the over-40s. I always had considerable sympathy with the recommendation of the Barker commission in 2014 that an additional percentage point of employees’ national insurance contributions for those aged over 40, raising some £2 billion, could be earmarked for adult social care. I very much hope that that will be further considered.

Lord Lipsey Portrait Lord Lipsey (Lab)
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My Lords, the noble Baroness, Lady Greengross, rightly highlights one of the central features of the Government’s proposals—namely, the generational redistribution between poorer workers, who pay for the cap, and the older people who benefit from it. Actually, so far as I can see, in all the commentary the main redistribution that is going on here has not been noticed at all. It is not about generational redistribution; it is redistribution within the generations from the poor to the rich.

I shall try to explain this briefly. Half the recipients of care do not pay for it anyway; they have insufficient assets or income so are not affected by this measure either way. Of the remainder, half will be paying for care in a way that counts towards the cap. However, only costs that are strictly categorised as care count towards the cap—what are called hotel costs they will have to pay themselves—so it will take quite a while to reach that £86,000 cap; three years would probably be a generous estimate. On average, people are in care homes for less than three years, so most older people are not going to benefit from the cap at all. Of the rest, most will not benefit from it for long. Some people live in a care home for 10 years and good luck to them, but that is very unusual; sadly, most people will pass on soon after they reach the £86,000 threshold.

Let us think what this means. It is not these older people, for whom we probably have great deal of sympathy, who will benefit from this. There will not be a rash of cruises around the world or teas at the Ritz that they are going to enjoy: where the money actually ends up is in the pockets of their children, to whom they will bequeath it. The poor have to pay for their own homes; the better-off, because of this cap, will find it much easier to buy bigger, better homes, because they are being saved the cost of Mummy’s care by the Government with this measure. It is redistribution, yes, but it is from the poor to the better-off among the younger generations.

The Tories once described Labour’s plans to pay for care as a “death tax”. Now we have the Tory equivalent: an inheritance subsidy. That is why the case for paying for the cap through a tax on wealth—inheritance tax, capital gains tax, annual wealth tax—rather than through national insurance is so compelling.

Covid-19

Baroness Tyler of Enfield Excerpts
Wednesday 15th September 2021

(1 month, 1 week ago)

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Department of Health and Social Care
Lord Bethell Portrait Lord Bethell (Con)
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My Lords, I hear the noble Lord’s points loud and clear. We are seeking to balance the epidemiological, public health practicalities of trying to limit the spread of the disease through mask wearing with accepting the benefits of the vaccine and the limit that puts on hospitalisations and death and trying to restore confidence in the public that we live in a safe environment.

We will be debating in months to come the challenge of trying to get the country back to work and back to economic activity, to get people back into society and back into their communities. It is not that stage right now—we are going into the winter, so naturally our concerns are about hospitalisations and a possible rise in pressure on the NHS—but we must have sight of the exit from this disease. If we have a society where the Government mandate very intimate parts of people’s everyday life and where the impression given to the entire population is that a deadly disease is an imminent threat to them, I am afraid we will run into a problem in trying to get the economy moving and to get society back again.

What we are seeking to do right now is to get that balance right, and it is proportionate. I acknowledge that mask wearing is down, but people are broadly responsible, as the noble Lord rightly pointed out. Central government cannot make every decision in all of society for all time. We need transport providers to make their own decisions, which does mean that it is complicated and that TfL and overground are different. However, it feels like the right approach for right now.

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD)
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My Lords, I make no apology for pursuing the issue of wearing masks and face coverings, because I feel so strongly about it. My personal experience this morning when coming in on the Tube was that more than 50% of people were not wearing a mask; they were close to me. One man actually took his mask off and sneezed over me. The whole experience made me feel very uncomfortable and very anxious.

I contrast this experience with a recent train journey to Scotland. As soon as we crossed the border, there was an announcement making it quite clear that wearing masks was compulsory on the train. Absolutely every person was wearing a mask, and I felt so much more confident.

I do not really understand the explanation that the Minister has given; I listened to it very carefully. I think he said that it is not a light-touch measure, but, to me, it seems extremely light-touch. It costs very little; it protects others; it does not harm the economy, and ultimately it can save lives, so I genuinely do not understand what the problem is. I think it is about being considerate to others and, frankly and bluntly, not being selfish.

I would certainly add my voice to the comments of the noble Lord, Lord Faulkner. By not wearing masks in the Commons Chamber yesterday, many MPs were sending mixed messages and setting an appalling example to the country.

I want to end by asking the Minister a question asked also by my noble friend Lady Brinton about children who are clinically extremely vulnerable being taken out of that category. Can he explain why that is and what is going to happen to those children, and perhaps write to me and my noble friend on it?

Lord Bethell Portrait Lord Bethell (Con)
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My Lords, I absolutely applaud the sentiments that the noble Baroness articulated: her sense of responsibility and commitment to the community are generally exactly what we are trying to inculcate in a lot of people. But I just do not agree with her or with the noble Lord, Lord Faulkner, that having a state-mandated direction—accompanied, presumably, by fines and, therefore, court appearances for some—could possibly be described as light touch. It is the most intrusive and intimate of measures. If the circumstances require it, we are prepared to do it. We have done it, and, if necessary, we will do it again. But noble Lords really are missing the mood of the nation if they think that the vast majority of the country is in the same place.

I am afraid to say that this is a question of personal choice at the end of the day. The public health judgment—these decisions were made in participation with public health officials—does not support mandatory mask-wearing for the entire country. I agree that visiting Scotland is a completely different experience; there, policymakers have made a different decision, as they have in some other countries. But when we lifted mandatory mask-wearing on 19 July we saw a very large change in the public’s habit. Why? Because some people find it extremely intrusive and not comfortable at all, and they do not like it or are not prepared to do it. Therefore, at this stage of the pandemic it feels proportionate and right to rely on guidance and inspiration and on the leadership of both our national and civic leaders. If necessary, in plan B we will come back to the mandating of those kinds of measures. At this stage it really does not feel proportionate.

Social Care: Family Carers

Baroness Tyler of Enfield Excerpts
Monday 13th September 2021

(1 month, 1 week ago)

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Department of Health and Social Care
Lord Bethell Portrait Lord Bethell (Con)
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My Lords, I completely agree that the carer’s assessment is the building block of our system. It is incredibly important; we do a lot of work to encourage more carers to get it. I do not know specifically about the point that the noble Lord makes on this additional component, but I would be glad to enter into correspondence with him on it. The broad principle of the importance of the carer’s assessment is one with which I wholeheartedly agree.

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD)
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My Lords, research shows that, pre pandemic, 600 people a day had no choice but to leave work to manage their unpaid caring responsibilities and that, since Covid began, an additional 2.8 million workers now juggle work and unpaid care. Having access to carer’s leave would help millions of carers and support many of them to remain in work alongside their unpaid caring responsibilities. When will the Government publish their response to their consultation on carers’ leave, which closed on 3 August last year?

Lord Bethell Portrait Lord Bethell (Con)
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My Lords, I recognise the challenge referred to by the noble Baroness. Some 2.9 million carers are employed; that is more than half of all carers. One can only imagine the pressure that they feel trying to juggle their roles as carers and employees. The consultation has been tied up by the pandemic, but we are keen to get a response out soon. Now that we have announced this package, it makes that all the easier. I very much look forward to bringing the response to the House.

Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) Regulations 2021

Baroness Tyler of Enfield Excerpts
Tuesday 20th July 2021

(3 months, 1 week ago)

Lords Chamber

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Department of Health and Social Care
Baroness Wheeler Portrait Baroness Wheeler (Lab)
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My Lords, I thank the Minister. I am moving my amendment in the light of the deep concerns of the Secondary Legislation Scrutiny Committee in its eighth report. I listened to its 13 July questioning of Nadhim Zahawi, the Vaccine Minister, which was held on the same day that the SI was debated in the Commons. The committee produced a further, 10th report yesterday in response to this. As its eighth report says,

“effective Parliamentary scrutiny is impossible”

by the House because crucial operational guidance and the impact assessment are not available, because none of the practical information about how the guidance is to operate is in the actual legislation before us, and because no reasons have been provided as to why the legislation is not a restricted pandemic measure rather than the permanent measure that the Government are proposing.

The Commons debate was focused on the failure to produce the impact assessment so essential for understanding the full consequences of the legislation. The Health Minister promised that we would have it before our debate today; the Vaccine Minister instead undertook to provide an impact statement, which the committee still had not had at the time of its further report. I am still not clear which piece of the last-minute information promised has been delivered, and the Minister’s speech may have confused me still further about what is and what is not available.

So we have more documentation and more information but not the full and detailed impact assessment that is needed. Overall, we still do not have the answers to the committee’s fundamental questions: why has the vaccination programme not managed to achieve the required levels despite care home staff being prioritised, and why the regional variations? Why has there been no detailed analysis of the impact the policy will have on care home staff and the possible risk to the viability of care homes as a result? We still have had no real analysis of the degree and nature of the opposition to the proposals expressed during the consultation, which could provide helpful guidance on how it is to be addressed.

This SI is muddled, confused and disjointed and, in places, contradictory—across the SI itself, the Explanatory Memorandum and in the Government’s consultation response. This makes even more urgent the publication of clear and detailed guidance which includes not just the practical detail the committee wants to see but the full policy framework. We are assured that the guidance has been produced in consultation with the sector. Can the Minister confirm that this has included care home providers from both large and small group homes, and the staff unions? Is there now a firm publication date, other than just the end of the month, in 11 days’ time, that we have been promised?

Specifically on consultation, the Government’s consultation response document itself admits that 57% of respondents were against the mandatory vaccination of staff. Nadhim Zahawi stressed to the committee how important it was to “carry people with us” and our Minister told the House on 8 July:

“We are in a consultation … it is an honest consultation. We have to take people with us: this is not something that we can impose on people against their will.”—[Official Report, 8/7/21; col. 1454.]

How will the Minister now honour that commitment, and how does he square it with the legislation that the Government have actually produced?

In its report, the committee is particularly scathing about the DHSC’s failure to provide justification for the substantial policy change from using the SAGE advice, mentioned by the Minister, of at least 80% of care home staff needing a first vaccination in order to provide a minimum level of protection against Covid-19 to the requirement for them to have two doses or they will be banned from the workplace and stand to lose their job. Why this shift and what is the detailed evidence which led to such a major policy change?

Despite our deep concern about the health and safety of care home residents, no one doubts the impact that mandatory vaccination will have on care home staff in their jobs, the risks to the viability of care homes and the confusion that will reign, especially in small care homes coping with even worse staff shortages and recruitment problems than they currently have and trying to administer and monitor the trades- person, et cetera, visiting arrangements. The National Care Forum has been particularly vocal on that latter point. We just do not know the scale and extent of the risk in a sector that already has 100,000 unfilled posts.

These are dedicated staff who have been in the front line of care through the pandemic. We need to understand why there is vaccine hesitancy among the minority of staff and build and strengthen the excellent work that has been done with so many to allay fears and assuage concerns arising from cultural or personal health fears.

Can the Minister explain how the Government will ensure that the 16-week grace period is used to intensify and ramp up the take-up campaign and ensure the targeting of regions and areas where there is relatively low take-up? Will it be extended if the impact assessment and implementation plan show that that is needed?

Paragraph 12 of the EM contains only five short points dealing with the serious staff shortages that the care sector will face, starting with the bald understatement that there will be

“the short-term cost of dealing with staff absences”.

Moreover, the EM goes back to the Care Act 2014 provision, which assumes that local authorities have a contingency plan to address workforce shortages and care provider closures. Given the Government’s sweeping council social care funding cuts for the past 10 years, we know just what state councils would be in if they tried to meet that contingency. Last week ADASS reported up to 250,000 vulnerable people across England languishing on social care waiting lists for care assessments or service reviews to check their physical and mental state. Will additional funding be made available to councils to meet the extra costs of staff shortages and turnover?

In conclusion, the House must be reassured that there will be a detailed, coherent, well-resourced and fully thought-through plan for moving forward and finding solutions for carrying and taking people with us—in the words of the Ministers—and addressing the major challenges that implementing the mandatory vaccination of care home staff will present. We must be reassured that the Secondary Legislation Committee’s rightful concerns have been fully addressed. For the record, its 10th report, published yesterday, stresses that, despite the welcome “further information and explanations” from the Government,

“we remain unclear about the justification for some of the policy choices underlying these Regulations and also the basis on which the department struck a balance between public health benefits and the impact on the rights of individuals.”

I look forward to the contributions of other noble Lords and the Minister’s response, and I will wish to test the opinion of the House on this very important issue. I beg to move.

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD) [V]
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My Lords, this is an extremely tricky issue, and I find myself deeply conflicted. On the one hand, I strongly support the principle of mandatory vaccination of care home workers, for reasons I will explain. On the other hand, I think the Government have gone about it in entirely the wrong way. As so often in this pandemic, we are trying to reconcile forces that pull in entirely opposite directions—in this case, the public health need to safeguard some of our most vulnerable citizens, which in my view is overwhelming, pitched against the individual liberties of care home workers.

For me this is deeply personal. My mother is a long-term care home resident and in the first wave of the pandemic, when hospital patients were being transferred to the home without proper testing, there was a significant number of deaths. I need hardly say that this was deeply distressing for my whole family and, I know, many other families up and down the country.

Care homes have a duty of care to their residents, which in my view they are not fulfilling if they do not require care workers who perform close-contact and intimate tasks to be fully vaccinated, unless they have a medical exemption. In my view, anything else would be negligent. Let us never forget the human tragedy this cruel pandemic has wreaked in care homes. Some 20,000 care home residents died in the first wave, accounting for 44% of all excess deaths for that period in England and Wales. We surely owe it to all who died and their families to ensure that care home residents receive every possible protection at a time when cases are rising again with a far more transmissible variant. Today we learn from the latest ONS figures that care home deaths are on the rise too.

Months ago, Professor Chris Whitty expressed the view that front-line health and care workers have what he termed a “professional responsibility” to get vaccinated, to reduce the risk that Covid poses to patients and care home residents. It seems odd that the mandatory hepatitis vaccination for some front-line health workers is hardly, if ever, queried.

I regret that today we are not looking at both NHS and social care workers together. According to the evidence provided to the Secondary Legislation Scrutiny Committee, published only yesterday, take-up of the first dose in the care home workforce stands at 85.6% but with significant variation, as the Minister set out.

It is clear from the two reports of the Secondary Legislation Scrutiny Committee and the debate in the other place on 13 July that this SI is deficient in many respects. The confusing data provided in the Explanatory Memorandum, the lack of an impact assessment—particularly on the workforce implications—and detailed operational guidance not being available until the end of the month are inexcusable. Frankly, I also found it peculiar that the regulations cover a range of tradespeople and other service providers who are unlikely to have close contact with residents. In reality, proper parliamentary scrutiny was pretty much impossible. I totally get that.

I have argued from the outset that far more support was needed to improve vaccine take-up rates among care workers. In early days, slow vaccine take-up was partly due to practical problems, such as vaccinators coming to homes with enough vaccine only for residents, staff being expected to travel to vaccination centres but not given time off or money to get there, and those staff not on duty when vaccinators came missing out. Despite all the efforts made locally to encourage staff to have the vaccine, crucially, the Government should take more proactive steps for carers to be paid for time spent on getting vaccinated, especially if they have to come in when they are not on shift and if they have to take time off because of any short-term reaction to the jab. These things are critically important to low-paid staff, some of whom are on zero-hours contracts.

GPs spending time in care homes talking to staff who are vaccine hesitant has proved highly effective. On top of this, I feel the Government should step in to help with the costs of redeployment and retraining for staff who still refuse to have the vaccine. Without seeing the operational guidance, we do not know whether this will happen.

It is with a heavy heart and after much thought that I am unable to support the amendment in the name of the noble Baroness, Lady Wheeler. I am sympathetic to its intent and broadly support the first three elements, but I cannot support the final element, which says that stronger supporting evidence for requiring staff to be vaccinated is required. The case is clear, and we need to see both more action and more support to ensure that more lives are not lost. However, we need to see the right action.

I plead with the Government, even at this late stage, to think again and to provide the help and support I have outlined above. I also feel that it sends out the wrong message to the public, who will not be following the minutiae of parliamentary procedures and impact assessments and the like. The message will simply be that we do not support the principle of mandatory vaccine for care workers other than those with the medical exemption, which I do, and strongly. This is the right policy but, sadly, the Government have gone about it in entirely the wrong way. It should also apply to NHS workers and it was wrong to exclude them. However, two wrongs emphatically do not make a right.

Lord Lansley Portrait Lord Lansley (Con)
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My Lords, I am very glad to follow the noble Baroness, Lady Tyler of Enfield. Like her, I would not be in a position to be able to support the amendment to the Motion. I support this statutory instrument but, I have to say, with some reluctance—and it is not simply because of the procedural issues. It is a step we should take only in a health emergency. I will come back to that point before I conclude.

I am grateful to my noble friend, who explained the SI with his customary clarity, but we are especially grateful to the Secondary Legislation Scrutiny Committee, whose painstaking work has illustrated many of the issues, including those I want briefly to refer to. I am looking for my noble friend in responding to this debate to give one explanation and two sets of assurances.

The explanation is because I simply do not understand why care homes have been brought forward and legislated for in this way where other settings have not been. I cannot understand the difference between a care worker going into a domiciliary care setting with a vulnerable person and how that differs from a care worker in a residential care home. I cannot understand how the vaccination of a residential care worker is different from the vaccination of a healthcare worker in a geriatric ward in a hospital. Why are these things different? If the Government are going to move forward on this, they should have moved forward on all these settings together and should have had the clear argument presented rather than what appears to be a piecemeal argument. I hope that my noble friend will explain why the Government have proceeded in this piecemeal fashion with a further consultation to come, which may lead to different conclusions even at the margin for other settings and for care homes, which will create unnecessary confusion.

Secondly, I am looking for an assurance about support for the care home sector. My noble friend said that the statement of impact—which I found on the government website but of course not published alongside the legislation—says that the Government’s central estimate is 40,000 potential losses of staff. This is in a sector where Skills for Care reported 112,000 staff vacancies in the autumn of last year and where we know that there is a dependence on workers from overseas, some of whom have gone back home and not returned. The sector needs help. The impact statement says that recruitment on average costs £2,500, which is £100 million for the sector in consequence of this measure. That is before you begin to look for the other support it needs from the healthcare system, its general practice colleagues, and in dealing with the insurance sector and others. I hope my noble friend will be able to say that the Government will add significantly—at least that £100 million—to the infection control fund, which is £1.1 billion, and do so in close consultation with the care home sector to give it the support that it needs.

Thirdly, and finally, the point of reassurance I am looking for is that I expected, having discussed this with Ministers, that this statutory instrument would be brought forward with a sunset clause. That is transparently something that should apply during the emergency. It would be reasonable if the Government had said, “This time next year, we should be deciding whether legislation of this kind should be renewed, and a sunset clause would enable that to happen.” I have no confidence that a review, as Regulation 7 says, means that if the review concluded that legislation in this form was not needed, it would not be retained. I am sorry, but I am afraid that from the parliamentary point of view, that is unacceptable. Therefore I am looking for my noble friend to make it absolutely clear that if Ministers conclude next year that the review says that this legislation is no longer needed, they will ensure that it is repealed.

Covid-19 Update

Baroness Tyler of Enfield Excerpts
Tuesday 6th July 2021

(3 months, 3 weeks ago)

Lords Chamber

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Department of Health and Social Care
Lord Bethell Portrait Lord Bethell (Con)
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I applaud the noble Lord for his advocacy of mask wearing, but of course this issue cuts both ways. He is right that we need to build back trust in sharing space with one another, but I am not sure that mandatory mask wearing either builds trust or erodes it. If we give people the impression that wearing masks is somehow a panacea that protects everyone on a tube train or in a lift, that is a false impression. Masks are not a panacea. In fact, for some people, they can be a source of grave concern and be enough to send them back home to seek safety. I take the noble Lord’s point that we have to be clear about this, but I am not sure that mandatory mask wearing, or even ubiquitous mask wearing, is either a universal antidote to the spread of the disease or necessarily builds trust in the manner he describes.

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD) [V]
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My Lords, continuing on this theme: “masks work” is the clear message from Public Health England. Both Sir Patrick Vallance and Professor Chris Whitty have said that they will continue to wear a mask in crowded indoor spaces, primarily because it protects others. Critically, it does not hold back the opening up of the economy, but rather provides a safeguard as social distancing rules are relaxed. Can the Minister tell me why there is so little in the Statement about our social responsibility to others, including front-line transport and shop workers, and the clinically extremely vulnerable? In this scrapping of masks, we are condemning millions with poor immune systems to be trapped in their homes, too afraid to go to the shops or their workplace or to use public transport.

Lord Bethell Portrait Lord Bethell (Con)
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Since this is the second question on masks, I hope the noble Baroness will not mind if I go off on a tangent. Masks do work a bit; they are not a panacea. What is really important is that when you are ill, you stay at home. That is the big behavioural change that will make a big difference in the year to come. That is where Britain has got it wrong in the past. Too often we have put our workmates, fellow travellers and school friends at risk by heroically going into crowded indoor places and coughing all over them. I hope that is one habit that will stop and that that will be a legacy of this awful pandemic.

Covid-19 Update

Baroness Tyler of Enfield Excerpts
Tuesday 29th June 2021

(3 months, 4 weeks ago)

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Department of Health and Social Care
Lord Bethell Portrait Lord Bethell (Con)
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My Lords, the noble Lord is entirely right that the Porton Down verification team has looked extremely closely at all lateral flow tests and their sensitivity to the delta variant in particular. There is suggestion and some indication that for very low viral loads, the LFTs are not quite as sensitive, or if they are sensitive, the band is less easy to read. However, for higher viral loads—in other words, the kind of viral loads that the body needs to carry to be infectious—there is no change of sensitivity. Therefore, from that point of view the LFTs continue to perform their original purpose very effectively but we need to keep a very close eye on sensitivity with the new variants.

I pay tribute to all UK companies which are coming forward with LFT, PCR or genomic sequencing tests. I am extremely proud of the progress that the UK diagnostics industry has made. We have extremely high standards and extremely high validation and authorisation protocols through Porton Down. Those standards are very difficult to achieve but we are working extremely closely with UK companies to try to get them over the line so that they can play an important role in our response to the pandemic.

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD) [V]
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My Lords, the Statement places great emphasis on regaining freedoms but has relatively little to say on the specifics of how we learn to live with Covid, as we surely must, given the rising number of new cases and concerns about new variants. Apart from a very brief mention of care workers, there were no other details of how the planned end of restrictions on 19 July will affect care home residents and their families. Can the Minister say what thought is being given to how we learn to live with Covid in care settings and when we can expect to see detailed guidance on this which balances the need for protecting the elderly and vulnerable from infection and improving the quality of their daily lives?

Lord Bethell Portrait Lord Bethell (Con)
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My Lords, the noble Baroness’s question is entirely reasonable and I wish I could be more specific on the precise timing. The honest truth is that we look at the data every day; our experience through this pandemic is that our understanding improves every day and therefore the guidance that we provide is often provided at a relatively late stage. It is an unfortunate aspect of this awful pandemic and one that I know noble Lords have commented on with vigour in the past, but it is an unavoidable fact of life. However, the comments made very thoughtfully and persuasively by noble Lords about the conditions in care homes, the restrictions that are put on residents and the pressure that that puts on them and their families have been heard loudly and clearly by all those in the department and across government, and we will seek to address those concerns when the moment is right.

Social Care and the Role of Carers

Baroness Tyler of Enfield Excerpts
Thursday 24th June 2021

(4 months ago)

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Department of Health and Social Care
Lord Astor of Hever Portrait Lord Astor of Hever (Con) [V]
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My Lords, it is a real honour to follow the noble Baroness, who does so much for carers. I declare an interest as the father of a profoundly autistic daughter. My experience with our daughter, whose residential care was disrupted during the pandemic, was a real eye-opener. It is an exhausting business looking after a disabled adult, tending to their well-being 24/7. I have nothing but admiration for the carers who dedicate themselves to this task and I join the noble Baroness, Lady Jolly, in thanking them all.

Greater than the physical demand is a concern that our loved ones will be properly looked after when we are no longer around. A social care system for the 21st century needs to make us feel more secure on that score. Others are far worse off than my wife and me. I know a family with two profoundly disabled sons, aged 28 and 32, the elder in a wheelchair—sadly not electric because the parents are not disabled, so do not qualify. They have relied on carers provided by their local council to help with this full-on exhausting care, day after day. There is a chronic shortage of carers, who are on very low wages, in the care industry, so I join other noble Lords in asking the Minister how the Government plan to address this. Will the Government consider increasing the carer’s allowance to the minimum wage?

The closure of day centres, which provide much-needed respite from the constant, round-the-clock supervision, as well as swimming pools and places of worship, was a blow to this couple. Could special exemptions be considered in future lockdowns for disabled people and their families in well-supervised, safe environments? The imposition of strict procedures to limit the spread of the pandemic has weakened an already fragile and fragmented system, causing untold suffering. Covid exposed a plethora of gaps and shortfalls, in addition to contradictory and counterproductive measures, which unwittingly endangered people’s physical and mental well-being. In short, instead of social care, we had social carelessness.

The NHS will continue to suffer, as long as the social care structure is neglected, whether we are facing killer viruses or not. How do the Government propose, in practical terms, to better integrate adult social care services with services provided by the National Health Service?

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD) [V]
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My Lords, I congratulate my noble friend Lady Jolly on her excellent opening speech and declare an interest, as I have a close family member in a care home. As we have just heard, the pandemic has cruelly exposed the plight of those dependent on social care. The NHS provides free care for all, based on need, but there is no equivalent care service to which families can turn when they or their loved ones need help, causing untold heartache. Only countless money and time from individual families is stopping the system from complete collapse. Age UK has estimated that more than 1.5 million people are missing out on the care they need, and the cost of inaction is falling on the shoulders of 11.5 million unpaid carers, some aged 80 and above. This national scandal is no longer hidden from view due to Covid, but it is something the country increasingly understands and feels is grossly unfair.

Not just the elderly are affected. Younger disabled adults make up half the costs of the adult social care budget and generally do not own their own houses. The NHS provides insurance against the cost of health- care, primarily paid for through taxes, but there is currently no way for individuals to insure themselves for social care. Addressing this requires bold action and a strong political will. We need a comprehensive programme of reform for social care, both now and in the future, and I believe that programme needs three key pillars.

The first is to shore up a fragile and highly fragmented sector reeling from the impact of Covid, increased costs and low occupation rates, with some care homes becoming increasingly unviable financially. Immediate funding is needed to improve the quality of care and introduce minimum standards.

The second is individual funding. A cap on individual social care costs, as proposed by the Dilnot commission 10 years ago, alongside a more generous means test for access to publicly funded social care, would at least fix one of the system’s big problems: the lack of protection for people and their families against potentially catastrophic care costs. The architecture for doing this already exists; Dilnot’s proposals were put into legislation in 2014, with cross-party support.

Thirdly, we urgently need a new deal for the care workforce, with action on pay, training and development, career progression, professionalism and recognition. Care staff, who have given so much during the pandemic, deserve to be paid well above minimum wage.

A reform package including all these elements, as we heard from the noble Lord, Lord Hunt, is estimated at around £12 billion or 0.6% of GDP. How are we going to pay for it? That needs to be the subject of a separate debate but, at this stage, I think we need a solution that takes intergenerational fairness into account. During the pandemic, tens of thousands died before their time in care homes from Covid. The best possible legacy we can give all those who lost loved ones is to ensure that we fix the care system, so a similar tragedy can never happen again.

Baroness Donaghy Portrait Baroness Donaghy (Lab)
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I congratulate the noble Baroness, Lady Jolly, on initiating this important debate, and the Care & Support Alliance on launching its campaign to make the Government act to reform the social care system. Since Mr Johnson made his well-known pledge to “fix the crisis” 100 weeks ago, 35,000 people have sold their homes to pay for care and 2 million requests for care support for older people have been turned down by local authorities. Councils are turning down 21,000 requests a week.

It is important to remember that social care is not just about the elderly; children with disabilities and people of working age with severe mental illness are part of any consideration, as the noble Baroness, Lady Browning, and the noble Lord, Lord Astor, both pointed out. Working-age adults account for a third of social care users and half of the so-called spending, according to Rethink Mental Illness. As my noble friend Lord Hunt said, there is an estimated gap between funding and need of £6.1 billion. That does not take account of unmet need due to the pandemic or the vital issues of enhancing the status and pay of care workers, as pointed out by the noble Baroness, Lady Watkins.

Everyone taking part in the debate knows all this; we have been here before. What are the political incentives to do something about it? If Mr Johnson fails to deliver, will he lose an election because of it? Will he take to heart that he has broken this particular promise? In any new arrangement, there will always be winners and losers. It is well-known that the Prime Minister hates taking unpopular decisions, so let us make it easier for the Minister to bolster Mr Johnson: simply hand him a copy of the Dilnot report and the report of the noble Lord, Lord Forsyth.

Covid-19: Care Homes

Baroness Tyler of Enfield Excerpts
Thursday 17th June 2021

(4 months, 1 week ago)

Lords Chamber

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Department of Health and Social Care
Lord Bethell Portrait Lord Bethell (Con)
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My Lords, I acknowledge the noble Baroness’s concerns, but the PHE report is extremely thorough. I am not aware of it being revised, but if it is, I would be glad to share that information with the noble Baroness.

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD) [V]
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My Lords, respected health commentators and statisticians say that excess deaths—that is, deaths above the expected number—is a more accurate way of looking at the scale of deaths in care homes due to Covid. Care home residents make up just 0.7% of the population. In the first wave of the pandemic, deaths in care homes accounted for 44% of all excess deaths for that period in England and Wales. What does the Minister think this says about the effectiveness of the so-called protective ring thrown around care homes and what lessons have been learned?

Lord Bethell Portrait Lord Bethell (Con)
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My Lords, we were never in any doubt from the very beginning that the virus presented a huge threat to care homes. They are where the elderly and the vulnerable are housed, in conditions where it is extremely difficult to enforce infection control and where there is a large amount of intimacy between residents and staff. We knew from the experience of other countries that care homes were very likely to be an area where infection and severe illness, and potentially death, would be highly prevalent. There is no doubt that care homes suffered the brunt of this virus, and for that matter I am extremely sad indeed. Noble Lords should realise that we put every measure in place that we humanly could have done. We gave a huge amount of resources, including £2.8 billion via the NHS specifically to support enhanced discharge processes and the implementation of the discharge to assess model.

Covid-19: Proof of Vaccination

Baroness Tyler of Enfield Excerpts
Monday 14th June 2021

(4 months, 2 weeks ago)

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Department of Health and Social Care
Lord Bethell Portrait Lord Bethell (Con)
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My Lords, I am very alive to the concerns of the disabled. We have to balance the need to limit the spread of this virus to save lives, but in a way that is fair and just to all people. We are very much engaged with disability and other charities to ensure that that works. The noble Baroness is right that there will be some people for whom the vaccine does not work and who could yet catch the disease. We need to make provision for those people, and we are working on that.

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD) [V]
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My Lords, I am concerned for the significant numbers of people with existing mental health problems who often do not feel comfortable with smartphone devices, as the information overload such phones can provide can exacerbate their feelings of stress and anxiety. I am pleased to hear the Minister say that other channels will be available to these people, but what arrangements are the Government putting in place to ensure that they are aware that options other than smartphones exist that they will be able to use?

Lord Bethell Portrait Lord Bethell (Con)
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My Lords, all the promotions for vaccine certificates through travel agents and GPs make very substantial reference to the availability of paper letters and the channel of being able to call 119 to receive them. I completely sympathise with those who do not want to use their mobile phones for everything, and some will prefer a letter in the pocket to an app on their phone.

Health Protection (Coronavirus, Restrictions) (Steps and Other Provisions) (England) (Amendment) Regulations 2021

Baroness Tyler of Enfield Excerpts
Monday 7th June 2021

(4 months, 3 weeks ago)

Grand Committee

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Department of Health and Social Care
Lord Lansley Portrait Lord Lansley (Con)
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My Lords, I am glad to have the opportunity to follow the noble Lord, Lord Scriven, although I will not follow him in the criticism of process. I think the need for rapid legislation from time to time has meant that we are always catching up on some of the processes. I want to use this opportunity—which my noble friend has highlighted—to look at where we are and where we need to go in the week or two weeks ahead.

My first point, which I think my noble friend rightly emphasised, is that we are at the stage where we should move from legislation to guidance. One problem associated with the latest step 3 shift is that the public thought that everything the Government are asking them to do has to be in legislation. The enforcement of that has been quite burdensome from time to time. At the same time as moving to step 3, the Government added guidance, for example in relation to the eight local authorities that had the delta variant present. They did not publicise the guidance sufficiently and the confusion that arise from that was really regrettable.

Likewise, on 17 May, the ban on international travel was relaxed but at the same time Ministers were talking about the absence of international travel in ways that suggested that they were still enforcing a ban on non-essential travel. That was not the case. It is quite understandable that the public have become very confused. When the announcements are made for 21 June, we should stick with that date and make it very clear that we are shifting from a position where legislation has been required to one where guidance on future social distancing and preventive measures should be much clearer and consistent.

We should not be emphasising that from 21 June we are lifting all restrictions—we are moving to a new phase. In that respect, the noble Lord, Lord Scriven, is right, but I do not think that we need permanent legislation for this purpose. We need permanent adjustments in behaviour. We should be encouraging people to do things such as wearing masks, social distancing, working from home, ventilation, or having outdoor gatherings much more than indoor ones.

We have made enormous progress. I echo what my noble friend said about that. Obviously, vaccination is a really impressive achievement. Where testing is concerned, I do not share so many of the criticisms. The problem was not that test and trace did not expand its capacity but that people overestimated what it was capable of doing last year. We are at risk of underestimating what it is capable of doing this year.

When we shift the guidance, we should make large-scale lateral flow testing freely available, as we are doing now. On the basis of what we have seen in schools, we should encourage workplaces and employers to use lateral flow tests every other day to enable them to be confident that their staff are free of the infection. On that basis they can return to work, they can meet and they should be able to undertake international travel.

At this stage we need to make a distinction between travel for leisure and travel for work. British companies should be able to send people abroad and bring them back without long periods of isolation as long as they are having lateral flow testing. We have to get away from four PCR tests. That is a very burdensome thing to ask people to do, whether for leisure or for employment purposes. It is something approaching £400 per person, per visit and that should not be applied over the months ahead. We have a substantial vaccination programme that is giving people a high degree of protection. We are seeing every hope that we are breaking the link between infection, severe disease and hospitalisation. To the extent that that happens with doubly vaccinated people, we should go with it.

Finally, on international travel, I ask my noble friend why are we not including some countries on the green list? Look at Malta, for example. It now has no cases and the best vaccination record among European Union countries. It is iniquitous that we are not distinguishing those countries that should be on the green list and giving them the benefit of that designation.

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD) [V]
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My Lords, at the risk of sounding like a broken record, I start by pointing out that we are yet again debating whether to approve a statutory instrument that came into effect three weeks ago, as part of a road map that was set out months ago. At this point in the pandemic, the urgency rationale just does not hold water, so it has become either a bad habit that the Government are unable to kick or simply contempt for parliamentary scrutiny. Neither is a good sign for a healthy democracy.

Turning to the substance, it feels somewhat ironic that these regulations bring back international travel for leisure. In recent days we have witnessed chaos over last-minute changes to the green list, causing huge problems for passengers and the travel industry alike. With long queues at packed airports in Portugal as people try to purchase tickets, often at vastly overinflated prices, on planes packed to seating capacity, and with people reporting difficulties getting pre-departure tests, is this really the best we can do?

As far as I can see, the amber list is simply causing confusion as to whether or not it is okay to travel to a country for leisure. We would not want to encourage people to drive through amber at traffic lights, so why are we giving this option for travel? Is not a straightforward “Yes, you can travel there” or “No, you can’t” easier for all to understand and plan around? Can the Minister say what plans the Government have to review the effectiveness of the traffic light system and our border control measures, including verifying test results for international travel?

Like others, I am sure, I was interested to read that the Chancellor of the Duchy of Lancaster is now participating in a pilot offering daily lateral flow testing for seven days as an alternative to isolation, following his trip to Portugal. It appears from press reports that other football fans receiving similar such texts from NHS Test and Trace were told to self-isolate for 10 days. Can the Minister explain the criteria to qualify for this pilot, when it was introduced and when its results will be published?

Test, trace and isolate remains a hugely important weapon in our armoury for fighting this virus. As restrictions ease, surely we should adapt our isolation support and testing strategies to incentivise isolation. From these Benches, we have called time and again for financial support to enable people on low incomes to isolate effectively. With cases now thankfully at lower levels, can the Minister say what resources are being provided, and to which local authorities, to allow the isolation pilots he referred to—he referred to payments of £500—to happen?

Much store is being placed on the announcement the Government will make on 14 June regarding step 4 of the road map, currently scheduled for 21 June. Over the weekend, some leading scientists have been calling for the easing of restrictions to be delayed. We have been repeatedly told that the Government will be driven by the data on the four tests, including the risks posed by new variants of concern, rather than simply the dates in the road map. With some regulations due to expire on 20 June, as my noble friend Lord Scriven pointed out, what is the scope for extending these regulations if the data requires it? Will we have fresh legislation? What is the contingency plan? Finally, what additional resources are being given to handle variants of concern? I hope the Minister can reassure me on these points in summing up.

Finally—I think I am in very much the same place as the noble Lord, Lord Lansley, on this—the stark truth is that the virus, with its inevitable mutations and variants, is not going away any time soon. Like it or not, we will have to find a way of living with Covid-19 for some time to come. That will mean changes in how we conduct our everyday lives, including how we do our business in this Chamber. This may be an inconvenient truth to some, but the alternatives are far worse. We need to get away from the current narrative that a so-called freedom day is coming fast and that everything can go back to precisely how it was pre-pandemic. We will have to learn to do things differently, and that needs a more grown-up, nuanced conversation which does not revolve around the two extremes of dropping all measures immediately or returning to lockdown. I think that is what most people want and expect.

Lord Bourne of Aberystwyth Portrait Lord Bourne of Aberystwyth (Con) [V]
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My Lords, it is a great pleasure to follow the noble Baroness, Lady Tyler of Enfield. I very much agree with her concluding comments about the fact that there is no freedom day: we will not go back to normal, certainly not in the short term. It is, as my noble friend Lord Lansley also said, a matter of accommodating our processes and adjusting to the new realities. I also thank my noble friend the Minister for setting out so clearly and concisely, as he always does, the effect of these regulations and for updating the Committee on the four tests or factors affecting the lifting of regulations.

I support the regulations but I regret that we are not seeing them in advance of their coming into force. I hope my noble friend can say something about a future scenario where we can perhaps expect that, as we move to a position where the regulations will not be so restrictive. It would be good to hear my noble friend’s views on that.

I support the regulations and the policy of stepped moves out of lockdown. That seems the right way forward. The easing of restrictions on outside gatherings and those attending funerals is absolutely appropriate. It is right that this phased approach is taken towards restrictions and that they are relaxed as the evidence demonstrates that a letting up on restrictions is appropriate. That is the right approach.

Like others, I congratulate the Government and my noble friend on the success of the vaccination programme. It has been outstanding. It is only fair that that should be acknowledged. It is at the centre of the Government’s success in this area and a tribute to the National Health Service, volunteers and all those concerned.

What remains a major challenge, as identified by others speaking in the debate, is international travel. This area of activity is relaxed by these regulations too. I will press my noble friend on this. A potential weakness identified previously is represented by travellers coming into the country from high-risk countries, who might pass on the infection before they are quarantined. This presents a challenge principally, though not exclusively, at Heathrow. I am pleased with the red country terminal arrangements at Heathrow. Could my noble friend update the Committee on their success and how they are working? Are we ensuring that special arrangements are made to split passengers from red list countries from other destinations at other airports too, where there is unlikely to be more than one terminal? It would be good to hear that these sensible arrangements are being applied across the country.

What arrangements are being made to ensure co-ordination with the devolved Administrations, particularly in this important area of travel and the operation of our UK airports, where a consistent approach is clearly needed? Could my noble friend comment on the recent summit between the Prime Minister and the First Ministers of the devolved Administrations, and any discussion that there was on co-ordination on coronavirus actions and policy?

Lastly, I make a plea for continued efforts to ensure that COVAX is working successfully to help countries across the world, particularly those unable to act as speedily and effectively as we have done. I know that my right honourable friend the Prime Minister has this very much at the centre of his approach and is making it a central plank of the G7 summit coming up in Cornwall. It would be good to hear my noble friend’s thoughts on this. With those comments, I am very pleased to support the regulations.

Care Homes: Insurance Indemnity

Baroness Tyler of Enfield Excerpts
Wednesday 19th May 2021

(5 months, 1 week ago)

Lords Chamber

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Department of Health and Social Care
Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield
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To ask Her Majesty’s Government what assessment they have made of the merits of underwriting insurance indemnity for all care homes on an equivalent basis to the National Health Service.

Lord Bethell Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
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My Lords, the differing indemnity and insurance arrangements for the NHS and for care homes reflect the different systems of securing health and adult social care. For the NHS, there are established indemnity schemes, administered by NHS Resolution. In the care sector, providers purchase insurance from commercial insurance markets. This is a requirement of registration with the Care Quality Commission.

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD) [V]
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My Lords, due to Covid, many care homes have found insurance prohibitively expensive, hard or even impossible to find, and that which is available often not covering Covid. Yesterday, I spoke to a care home manager who was told that renewing his existing insurance would cost 880% more than the previous year, and just one Covid claim could result in the care home having to close its doors, causing great distress and disruption to residents and their families. Against this backdrop, can the Minister say what plans the Government have to extend indemnity to all care homes for a reasonable period, not simply the small number now covered as part of the designated care site schemes, to put them on an equal footing with the NHS and ensure that they are able to help the NHS during any third wave? Will the Minister agree to meet me to discuss the options?

Lord Bethell Portrait Lord Bethell (Con)
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My Lords, I acknowledge the challenge faced by care homes on the insurance market, but CQC statistics suggest that, in fact, the insurance industry has done an enormous amount to meet the needs of care homes and that many of the pressures on care homes have been the result of Covid outbreaks. We have brought in the designated settings indemnity support, as the noble Baroness knows, and we have given £6 billion to local authorities to support care homes. Putting care homes on the same footing as the NHS would not meet the needs of the care home sector, so that is not something we are looking at currently.

Covid-19 Update

Baroness Tyler of Enfield Excerpts
Tuesday 18th May 2021

(5 months, 1 week ago)

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Department of Health and Social Care
Lord Bethell Portrait Lord Bethell (Con)
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My Lords, I am a big supporter of the “fast and hard” principle. In our response in Bolton, Bedford, London and elsewhere, we have demonstrated that principle in our handling of the Indian variant. I point out that the use of testing and social distancing measures in schools has been enormously effective. One of the remarkable aspects of the infection rate so far is that transmission levels among school-aged children have not increased in the way that SAGE and others, including myself, once feared. We should take a “glass half-full” moment to applaud that fact. I reassure the noble Lord that we will absolutely make these decisions on the data. Space has been put in between the steps for exactly that reason, and we are not going to rush it.

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD) [V]
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My Lords, could the Minister outline the Government’s plans for test and trace as lockdown is lifted, particularly in areas such as Bolton and Bedford where surge testing is currently being deployed? With former centrally based Public Health England staff being disbanded and senior civil servants returning to their own posts, what financial resources are being passed to the local resilience teams, run by local directors of public health, to operate test and trace, which will be so critical to controlling the spread of the virus alongside the vaccine rollout?

Lord Bethell Portrait Lord Bethell (Con)
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My Lords, the outbreak in Bolton, Bedford, London and elsewhere has demonstrated, if that were needed, the paramount importance of keeping resources for test and trace at a critical level, and that is what we have done. Since the national infection rate is lower, there is a much greater emphasis on the kind of surge activity and outbreak management that the noble Baroness describes. Sequencing has proved to be an essential part of that process, and we have brought sequencing from the back of the laboratory to the front line of test and trace operation. Every single positive case is now treated as though it were a VOC, with the same amount of tracing and sequencing that a VOC would have had a few weeks ago. We have the full operation on standby. Should another wave of infections arrive, as it may well do with the relaxing of social distancing, we have the systems in place to be able to deal with it.

Health Protection (Coronavirus, Restrictions) (Steps and Local Authority Enforcement Powers) (England) (Amendment) Regulations 2021

Baroness Tyler of Enfield Excerpts
Monday 17th May 2021

(5 months, 1 week ago)

Grand Committee

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Department of Health and Social Care
Lord Bourne of Aberystwyth Portrait Lord Bourne of Aberystwyth (Con) [V]
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My Lords, it is a great pleasure to follow the noble Baroness, Lady Walmsley, who has made some extremely important points. I thank my noble friend for setting out the purport of these regulations, applaud his work ethic and say that what I shall say, just as the noble Lord, Lord Rooker, said, is no personal reflection on him.

These regulations are part of the road map setting the way out of lockdown, which I support; the approach is correct. I would like some reassurance from my noble friend. As we are out of the eye of the hurricane, it is about time we saw these regulations in advance of them becoming law. We are looking at these some 37 days after they became effective. Frankly, it is just not good enough. It is about time that we started to see these ahead of their becoming law rather than in the rear-view mirror, as has become the case. There may have been a time when that was justifiable, but that time has now passed.

I will take my noble friend up on some of what he said about the Indian variant. I am sure that we will look at this whole issue of why action seemed slow in relation to India when it was not so slow in relation to Pakistan and Bangladesh. It seems strange. Are flights still arriving from India in any way, as I have heard is the case? That might not be true. Could my noble friend also provide some reassurance about our border controls, which seem all too porous? People from countries where there is a known risk mingling with other travellers when they arrive is, frankly, amazing and needs to be stopped forthwith. I cannot understand why that is happening.

My noble friend the Minister spoke about action at the weekend in Bolton, which I certainly welcome. Could he tell us whether similar action has been taken elsewhere, in other communities where there is clearly a threat from this variant, such as Blackburn, Bedford and so on? Could he indicate where that is the case? If he is unable to provide a detailed list—there might be many areas that this applies to—perhaps he could undertake to write and put a copy in the Library.

In short, while the vaccine programme has been highly successful and the Government certainly deserve praise for it, it is not the sum total of what is happening. We have to look at the whole position. The position at our borders is worrying. The Minister himself said that one of the four tests, quite rightly, is whether there are variants of concern. He said that this test was being satisfied. He said later in his speech that new variants are a risk. Frankly, one of those statements has to be right; I suspect it is the latter. I would welcome the Minister taking that point up as well. I have these concerns and look forward to hearing from my noble friend on these points.

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD) [V]
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My Lords, as has been said, even by recent standards the timing of this debate is particularly ironic. On the very day that we move to step 3 of the easing of lockdown restrictions, here we are debating the move to step 2, which happened five weeks ago. To make matters worse, given the much more transmissible Indian variant, which the Health Secretary Matt Hancock said at the weekend could “spread like wildfire”, this easing now feels fraught with risk. I very much support what the noble Lord, Lord Bourne, just said about the need for us to scrutinise regulations in advance.

The Indian variant has caused great anxiety in recent days. For many people it feels as if, just when the sunlit uplands were coming into view, they are being snatched away by a new variant when more efforts could and should have been taken to avoid it. The Sunday Times reported this weekend that at least 20,000 passengers who could have been infected with the new variant were allowed to enter the UK because the Prime Minister delayed imposing a travel ban from India. I add my voice to those of other noble Lords asking whether the Minister can explain why India was added to the red list only on 23 April, three weeks after the announcement of a ban on flights from Pakistan and Bangladesh, both of which had lower case rates than India.

The combination of moving up the steps and the Indian variant makes having an effective test, trace, isolate and support system ever more critical. I place particular emphasis on the last two words—isolate and support—which is where things are still breaking down. The major problem reported by local resilience forums is that people are still not self-isolating and will not until they get their income paid. It is those on zero-hours contracts, those doing jobs that you cannot do from home and families living in multigenerational households who need the support most. People do not want vouchers; they want their earnings reimbursed. Reimbursing earnings is substantially cheaper than running the test and trace functions and, if a serious case of Covid occurs, the cost to the NHS.

I end by asking what planning is under way for a third wave, especially for paediatric care, given that as more adults are vaccinated it is possible that a variant may affect much younger children than in previous waves. Both the USA and Canada are reporting much higher cases in children than before and are starting to vaccinate children in the 12 to 15 age range. What plans are being developed for vaccinating children in this country?

Lord Moynihan Portrait Lord Moynihan (Con)
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My Lords, today signals a historic move in the Government’s approach to tackling the Covid-19 epidemic—a significant move away from detailed government regulation and restrictions; a return to personal responsibility; a renewed emphasis on individual choice; and an “up to you to decide” policy rather than the Government legislating over the intricate details of every aspect of social behaviour. While this is welcome to the population at large, to government and, in particular, to the libertarian instincts of many politicians—not least the Prime Minister—it raises a number of important questions for government.

Having decided to go ahead with a move to phase 3, the Government are in practice demonstrating their belief, driven by the evidence, that vaccination levels have now reached the point where we have decoupled the number of people in our country being infected with Covid-19, in particular variant B1617, from those who would require hospitalisation or become ill with long Covid, leaving those who, if infected, will have increased resistance and can be treated at home with improved medication to counter the illness. If the Government are absolutely satisfied that, yes, we have reached that point, we are right to take our foot off the restrictions and move to an era of personal responsibility. If not, this is the most serious risk the Government will have taken during the epidemic, and the scientific evidence they rely on will rapidly lose public confidence.

On the one hand, the evidence is strong that the time is right for phase 3. Since the winter peak, we have seen a reduction of 96% in those requiring hospitalisation. With test and trace, free lateral flow tests now available and improved medication, many will agree with the Government that the time is right. Yet, with variant B1617 potentially 40% to 50% more transmissible than the UK variant, step 3 could lead to a large resurgence of cases. Many scientists are arguing that we need more time to assess the impact this surge is having on transmissibility, infection and severity of illness.

However, my major concern today, shared by my noble friend Lady Wheatcroft and others, continues to be the transport policies: international travel and the mixed messages regarding holidays and business visits; the traffic light system; the time allowed for a massive influx of people from countries signalled to face future restrictions just days before they come into effect; and inadequate border control measures when they fly here. It is not surprising to learn that the mayor has today indicated that in London there were some 400 recent cases of the Indian variant, of which 100 were associated with travel.

I call on the Government to provide clearer and more effective travel policies, to review the policies they have set and to continue with clear restrictions on international travel. The weakest element of our overall policy since the first lockdown has been our travel policy. For all my strong support of the vaccination policy and the work the Government and my noble friend the Minister have done, especially this year, our policies on transport have been unclear, often poorly timed and, frankly, ineffective. We have encouraged tens of thousands of people back to this country on crowded flights after announcing impending travel bans.

Care Home Occupancy Rate

Baroness Tyler of Enfield Excerpts
Wednesday 28th April 2021

(6 months ago)

Lords Chamber

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Department of Health and Social Care
Lord Bethell Portrait Lord Bethell (Con)
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My Lords, I have heard the noble Baroness and others express their concerns about the sector, but I reassure noble Lords that it is not in overall long-term decline. In fact, the number of care home beds has remained broadly constant over the last 10 years, with 460,000 in 2010 and 458,000 in April 2021. But I recognise the noble Baroness’s question, and it is right that we are going to bring forward recommendations for social care reform by the end of the year.

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD) [V]
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My Lords, a recent National Audit Office report highlighted how the Covid pandemic has adversely impacted the financial viability of care home providers, with occupancy rates falling significantly, as we have heard. Given this, could the Minister say what steps the Government are taking to ensure that the much-needed financial support he has referred to, to stabilise this highly fragmented and fragile sector, gets to the front line and that there is equal treatment for all care home services, irrespective of whether they are local authority-funded or NHS-funded or whether residents are older people, younger adults of privately paying residents?

Lord Bethell Portrait Lord Bethell (Con)
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My Lords, we have written to local authorities to make it clear what the funding is there for and to make recommendations on the sort of financial support that may be needed to bridge this moment when occupancy levels have been reduced because of concerned families taking their loved ones out of care homes. That funding is in place, and it is up to local authorities to make their decisions on the matter.

Care Homes: Guidance

Baroness Tyler of Enfield Excerpts
Wednesday 21st April 2021

(6 months, 1 week ago)

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Department of Health and Social Care
Lord Bethell Portrait Lord Bethell (Con)
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My Lords, these protocols are not tied to the road map because we hold them under constant review. We hear loud and clear the case made by the noble Baroness and others who make the case for change. We are open to making that change when the evidence says that the situation is ready. We expect care home workers to behave in a way that is responsible and keeps infections to a minimum, but we cannot have protocols for every aspect of their lives.

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD) [V]
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My Lords, I declare an interest: I have a close family member who is a care home resident. People living in care have endured over a year of rules keeping them separated from family and friends, with the double isolation of relatives being unable to go into the home and residents being unable to leave. Although I welcome the recent relaxation of the rules on visiting out of care homes, the guidance states that the requirement for a 14-day isolation period on return

“is likely to mean that many residents will not wish to make a visit out of the home.”

What is the point of pretending that it is being allowed? Does the Minister understand why imposing a blanket quarantine on visits out feels to many arbitrary, unfair and as though it is interfering with their liberty? Can he explain why it is not possible for a resident who has been outside for visits to be tested on return and again after a specified number of days, rather than enduring a 14-day isolation during which they are often confined to a small room?

Lord Bethell Portrait Lord Bethell (Con)
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I can only express complete sympathy for the noble Baroness’s points. She puts them extremely well. Undoubtedly, the pressure put on residents and their family members is profound and I regret it enormously. However, this is not an arbitrary or thoughtless measure from the Government; it is to protect residents who have shown themselves to be highly susceptible to the disease. We have instances of serious illness and death to remind us how important these measures are. The noble Baroness is entirely right that the protocols are in place in order to deter external visits. In terms of testing, the unfortunate truth is that the virus can harbour in someone’s body, undetectable, for days. We know from protocols around international travel that pre-travel testing catches only about 15% or 20% of those with the disease and it is for that reason that we cannot turn to testing as an alternative.

Covid-19: Update

Baroness Tyler of Enfield Excerpts
Tuesday 20th April 2021

(6 months, 1 week ago)

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Department of Health and Social Care
Lord Bethell Portrait Lord Bethell (Con)
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My Lords, I join the noble Lord in commending the people who work at Macmillan and all the other important diagnostic centres that have remained committed to their work throughout Covid under extremely difficult circumstances, delivering hugely important healthcare services. The noble Lord is stretching my knowledge of vaccination with this question, but it is my understanding that most of our flu jabs are grown in eggs in East Anglia and we do not rely on Indian supplies for the flu jab. This may seem like an extraordinary fact, and I doubt it, even as I stand here at the Dispatch Box, but I would be glad to write to him to confirm the point.

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD) [V]
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My Lords, I welcome the Government’s consultation on whether vaccines should be required for care staff working with older adults. To make this easier, could the Minister say what plans the Government have to ensure that care staff are paid for time spent being vaccinated, particularly if they have to come in when not on shift or have to take time off because of any short-term reaction to the jab? Also, are the Government prepared to support care homes financially to enable staff who cannot have the vaccine for clinical or other specified reasons to be redeployed to non-front-line work?

Lord Bethell Portrait Lord Bethell (Con)
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My Lords, the vaccine is typically seen as personal medical hygiene. I am not sure if arrangements have been made for people to be paid while they get vaccinated, but I would be glad to write to the noble Baroness to confirm that. She makes an extremely sensible point about redeployment; I do not know the precise details, but would be glad to write to her.

Covid-19: One Year Report

Baroness Tyler of Enfield Excerpts
Thursday 25th March 2021

(7 months ago)

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Department of Health and Social Care
Baroness Andrews Portrait Baroness Andrews (Lab) [V]
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My Lords, I support these regulations but I am also glad to have the opportunity to support the regret Motion in the name of my noble friend. A year ago, we were shocked to hear that 20,000 deaths would be considered a good outcome. What, we asked, would be a bad outcome? Sadly, we know that now: 126,000 deaths, which is a dreadful figure, with so many of those deaths being avoidable. I remember vividly our first meeting with Chris Whitty in early March last year. He told a packed meeting of this House—packed into Committee Room G—that some people would have to go into isolation for three months. A year later, we are counting the costs which had not been identified at that point—in terms of mental health, domestic abuse, jobs, loss of learning and loss of life.

Vaccination is an act of solidarity as well as one of personal protection. The Motion identifies the urgent need to support those groups which are still fearful and will bring further risk to their communities. It would be fatal if Covid were to become a residual disease of poor communities. My first question to the Minister is: can he give us an update on how effective the latest campaigns have been in reaching those who are still reluctant and what other plans does he have in mind?

The Motion also recognises the challenges facing the NHS going forward: increases in waiting times and staggering waiting lists. Can the Minister tell us what the modelling shows about the relationship between bringing waiting times down within the next year and the funding that has been made available? In simple terms, how long will it take someone who has now been waiting for over a year for a hip operation, previously done in three months, to get that done?

Beyond the Motion and the many detailed and specific questions which have already been put to the Minister, I want to raise a few longer-term issues. This is indeed a moment of reflection. As we move into a cautious freedom, the exam questions include: how can we ensure that the progress that has been made is sustained and that we can mobilise quickly against dangerous variants? Here I share the anxieties of the noble Lord, Lord Lansley. Perhaps the Minister can answer the question that the Minister in the other place failed to address at all. Why is it that, according to the Explanatory Memorandum:

“Our assessment of the risks is not fundamentally changed by new Variants of Concern”?

This is particularly perplexing. This morning another scientist, Sir Jeremy Farrar, emphasised that the greatest risk currently is from imported variants. Given our vulnerability to variants, does the Minister agree that it is absolutely essential that we maintain the agility of our research base so that our amazing scientists and medics can anticipate and respond? This is a global task.

Is the Minister also aware that one of the reasons, in all probability, that we were so unprepared for Covid was because after an initial spike in funding in response to SARS and MERS in 2005 and 2015, research funding, especially in public health, dropped like a stone? I argue that if that funding had been maintained, we might have had a better understanding of Covid-19 and have had a vaccine closer to hand. Does the Minister agree that the planned cuts to the science budget of more than £1 billion—equivalent to the research and innovation budgets for the MRC and the Science and Technology Facilities Council combined —is madness? How will this help the country prepare for the next pandemic? Can he also say how the planned cuts of £120 million to the UKRI ODA funding will help the world fight further pandemics? So much for being a global science superpower and so much for being prepared for the next pandemic.

The Government did not plan for the Covid pandemic because they were too busy with Brexit, so I would like to have some confidence that they will plan for the next. That is precisely why we need a public inquiry as soon as possible, not least to clear up some of the confusions that the Prime Minister in particular seems so gifted at creating.

The Prime Minister has been saying for some time—indeed, as far back as July last year—that one of the reasons the pandemic got out of control was because the one thing nobody knew early on during the pandemic was that the virus was being passed asymptomatically from person to person. This is simply not true. The issue of asymptomatic transfer was known to SAGE in February and mentioned in the Chris Whitty meeting with us in early March. The Prime Minister was challenged on this in July. No retraction was made and he repeated it again this week at his press conference. Will the Minister correct this and put the record right in this House?

It is to expose the truth behind some of these assertions, which seem to be the Government building a case for exoneration, that we need a public inquiry as soon as possible. We need answers about how the Government intend to plan for the health security of this country, not just for the rest of this year but for the next decade at least.

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD) [V]
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My Lords, I support the Motion in the name of my noble friend Lady Brinton. As we reflect on the past year and think about life as we start to emerge from lockdown, I want to focus on two issues: the loneliness and social isolation caused by the restrictions and the impact of the lockdown on our national mental health. While the road-map regulations offering the prospect of easing the lockdown will bring hope after such a difficult year full of personal sacrifice, we should be mindful of those who have experienced extreme isolation, in particular people who have been shielding, single parents, older people living alone and care home residents who have been deprived of contact with their loved ones. Many people are also grieving the loss of loved ones. There is much to be done by government, local authorities, the voluntary sector and local communities to support mental well-being and help people to reconnect with their community.

The All-Party Parliamentary Group on Loneliness published a report yesterday calling on the Prime Minister to commit to helping people to reconnect socially and to plan for England’s recovery from coronavirus. A raft of individual recommendations highlighted the need for public spaces to be more welcoming, and for more public toilets and better street lighting to make it easier for people to meet informally and safely. It also calls for long-term funding for charities which help those who are isolated. Can the Minister say how and when the Government will respond to these important recommendations?

The past year has left an indelible mark on everyone’s mental health. Not being able to travel abroad to see family members and loved ones, including not being able to see new arrivals to the family or attend family funerals, has been particularly tough. While we all look forward to the day when international travel is possible again without endangering public health, we need clarity and, above all, fairness. The current exemptions that allow trips for the purchase, sale, letting or rental of a residential property are, in my view, unlikely to pass the fairness test in most people’s minds.

I know from personal experience how difficult it has been not being able to visit loved ones in care homes and the impact that has had on the well-being of residents. Can the Minister say what plans the Government have to make the vaccination of care home staff mandatory, both to help speed up the reopening of contact visiting and to give relatives the reassurance that their loved ones are being protected from harm?

With all the anxiety, grief, loss, loneliness and social isolation of the past year, I am disappointed that the Government’s report has little to say on mental health, barring a brief mention of Section 10 of the Mental Health Act changes, which, thankfully, have never been brought into force and have been scrapped. There was no mention of mental health staff in the section on increasing the available health and social care workforce and no reference to a mental health recovery plan for the nation.

In England, recent Centre for Mental Health well-being modelling has predicted that up to 10 million people— 20% of the population—will need either new or additional mental health support, including for depression, anxiety or post-traumatic stress disorders as a direct result of the crisis. Some 1.5 million of them will be children and young people aged under 18. With some hospital A&E departments reporting that they are now seeing daily cases of children self-harming, and with a senior clinician reporting yesterday in the Health Service Journal that there is “no capacity anywhere” to deal with the unprecedented surge in admissions of children with mental health problems, it is clear that the current system, which was already under strain before the pandemic, simply will not cope.

I end by paying tribute to the NHS workforce. People have been working flat out for a year now. Their dedication, professionalism and personal sacrifice have inspired the whole nation, but vacancies stood at over 100,000 before the pandemic. The NHS is now facing a huge backlog of operations with an exhausted workforce, many of whom are suffering from burnout, and increasing levels of sickness absence.

I recently had the privilege of speaking to two senior nurses working in London intensive care units. They told me that what they wanted more than anything was time off for recovery and additional nurses to provide pre-pandemic levels of patient care, as well as tangible recognition of the value of the work they are doing. With the Scottish Government now offering a 4% pay rise to nurses alongside a £500 thank you payment, can the Minister say what plans the Government have to think again about this issue and ensure that nurses south of the border get the pay rise they so richly deserve?

Baroness Bennett of Manor Castle Portrait Baroness Bennett of Manor Castle (GP) [V]
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My Lords, it is a pleasure to follow the noble Baroness, Lady Tyler, and to support her tribute to NHS staff and her question about pay.

I begin with a very important question of democracy affecting the operations of your Lordships’ House and the conduct of this debate. I refer to an article published yesterday in the Huffington Post, titled “Consultants Deloitte Paid To Draft Ministers’ Parliamentary Answers On Test And Trace”. It reports on a series of contracts worth £323 million to “support” the Department of Health and Social Care and the national testing programme—contracts held by the consultant Deloitte. The report says that the contracts include

“help provided with PR and communications, with a requirement to ‘draft and respond to parliamentary questions, Freedom of Information requests, media queries and other reactive requests’ and to ‘support lines to take and Q&A’s in anticipation of queries’.”

My question to the Minister is simple: does he consider this appropriate? Should a private contractor be drafting and providing ministerial answers at all? In particular, should a private contractor be drafting ministerial answers on work that it is engaged in, especially when it is marking its own homework—this is Deloitte drafting answers for the Government about the work of Deloitte? Is it achieving results in drafting answers to questions similar to the disastrous outcomes of test and trace? I ask this specifically, given that my honourable friend the Member for Brighton Pavilion is still waiting for an Answer to a Written Question in the other place, numbered 149740, which names Deloitte and which was tabled on 5 February, concerning the work of test and trace in her constituency. Will the Government next be relying on Heathrow Airport to draft answers on aviation, or on the China General Nuclear Power Group to supply answers on energy policy, or on Bayer to give the ministerial view on GMO crops? Today’s debate is not focused on test and trace specifically, but perhaps the Minister could tell how us whether any of the answers that he has in his folder have been drafted by Deloitte consultants.

To be clear, of course I am not saying that civil servants should not consult outside experts. If there is a technical question from your Lordships’ House, a civil servant consulting an expert, including an industry expert, is obviously reasonable. The question is where the direction and guidance are coming from. Has that been privatised, as so much else has? For the information of the Minister, I note that in the other place, this morning, the Minister for Implementation said that she would be looking into the Deloitte contracts, but this is also a specific matter of concern for your Lordships’ House, given that it directly affects our proceedings.

Turning to the Motion to Regret tabled by the noble Baroness, Lady Brinton, I cannot believe that there is a Member of your Lordships’ House who would not support her expression of sorrow for the massive death toll and the swathe that has been cut through communities, particularly more disadvantaged communities. Can anyone really oppose regret for the millions of self-employed people who have been left penniless and scrabbling desperately to survive, or for the continuing, still unresolved failure to provide funds for workers infected with the coronavirus or potentially exposed to it, who are denied the financial support that they need to self-isolate? How can this Motion to Regret not be supported? Were I physically in your Lordships’ House, I would be looking at the Benches around me as I speak.

I note the words in the Motion to Regret that call

“on Her Majesty’s Government to publish a comprehensive plan to manage… the number of cases of Covid-19 and any new variants”.

Compared to the chaotic slew of localised, highly confusing statutory instruments that flooded through your Lordships’ House last autumn, we have got some way towards that at least, finally, with a national road map out of lockdown, rather than a casual “it will all work out” wave of the hand from the Prime Minister. But as the Motion in the name of the noble Baroness, Lady Brinton, indicates, it is still lacking in detail, and is particularly lacking a focus on vital ventilation issues.

I saw in the New York Times a detailed plan for how open windows and fans might be used to manage airflow in a classroom to minimise risk of transmission. I have not seen similar guidance from the Government. Such guidance is urgently needed, now that we know that social distancing, screens and hand washing do not provide a Covid-safe work or social space. Only carefully managed ventilation and air filtration can do that, but I regret that my Written Questions on these issues have received scant answers.

The Green group will be supporting the Motion to Regret in the name of the noble Baroness, Lady Brinton. We are also calling for an immediate inquiry into what has happened thus far. We must understand the many things that have gone wrong, so that we can strengthen resilience and tackle poverty, inequality, overcrowding and poor housing, and set up our society to contain Covid and manage future threats in this age of shocks.

NHS: Staff Numbers after Covid-19

Baroness Tyler of Enfield Excerpts
Thursday 4th March 2021

(7 months, 3 weeks ago)

Grand Committee

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Department of Health and Social Care
Lord Clark of Windermere Portrait Lord Clark of Windermere (Lab) [V]
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My Lords, I count myself very fortunate to be introducing this Question. This is an invaluable parliamentary means whereby questions can be asked in a more discursive manner than usual and the Minister will listen and, we hope, provide answers. I shall make a couple of obvious general points.

The people of Britain love the NHS, as has been seen during the Covid-19 pandemic, but there were problems prior to the pandemic. I shall make three basic points to set the scene. The NHS is the fifth-largest employer in the world, yet we spend less on health as a percentage of our GDP than almost every other developed country in the world. To compound the situation domestically, there was a shortage of hospital beds prior to the pandemic. Indeed, we are bottom of the Euro league for intensive care beds, with 7.3 beds per 100,000 of population, compared with the best, Germany, with 33.8 beds—what a difference. Thus, prior to the previous cuts we were ill-prepared, and there have been too many cuts under the austerity measures of the early 21st century.

I am certain in my own mind that it was due only to the dedication, brilliance and sacrifice of NHS staff that we got through—and I mean all staff, from the top consultant to the most junior worker. And it has been at tremendous cost to many of them in stress, burnout and mental health challenges. We owe them a tremendous amount and I hope that, in his summing up, the Minister will confirm that this will be recognised when we have won the battle with Covid-19.

I will begin with nurses. Over the years, the Minister must have become tired of me pursuing him on the issue of nurses. I remain concerned. Currently, we are at least 40,000 nurses short. Over the next seven years we will face a shortfall of 108,000 nurses. I must ask the Minister very bluntly: will HMG drastically increase the training of fully qualified nurses? What discussions has he had to ensure the provision of the educational means to do so?

The Royal College of Nursing has conducted surveys and expressed deep concern about the exodus of qualified staff following the pandemic. I share that concern. Will the Minister push ahead and prepare plans to deliver what is necessary to persuade staff that they are valued, and to retain them in the NHS? According to the RCN survey, 35% of nurses are contemplating leaving the profession within the year. Will HMG also provide the NHS with the means to fund occupational health and psychological support, and, if necessary, breaks beyond annual leave?

Nurses are due a pay rise. They are currently worse off than they were a decade ago. Will HMG ensure that the upcoming pay settlement is really meaningful and commensurate with the ever-rising skills of nurses?

I turn now to GPs. If we are to meet the demands and expectations of the general public, we will have to increase the number of doctors, especially GPs. Does the Minister accept that we are still suffering in the training of doctors from the austerity years, over which his party presided? In spite of the modest increases of late to close the gap, does he accept that we face a shortfall of 7,000 GPs in the next two years? As a starter, we need to double the number of medical school places from 7,500 to 15,000 by the end of the decade.

I will move on from numbers to talk about processes. I am concerned about the reluctance of younger practitioners to enter general practice in many parts of the country, leaving it often to only elderly GPs to carry on as single practitioners, supplemented by agencies and bank locums. Do the Government really feel that that is satisfactory and sustainable?

I have a personal problem with this in Windermere at the surgery I am registered with. It operates from a fine purpose-built building but has been without a permanent GP for a number of years. It functions largely due to the skill, experience, training and commitment of nurse practitioners and other staff with specialist skills. Their work is supplemented by local doctors—if they can be persuaded to come. Five years ago, the practice was leased to a private company, OneMedical Group, 80 miles away in Leeds. Last autumn it took advantage of a break clause in its lease and surrendered it, and we are back to square one; it is far from a satisfactory situation.

The key issue is that younger GPs do not wish to buy into practices which might involve hundreds of thousands of pounds. I know a number of practices in Cumbria have had to undertake severe reorganisation and mergers simply to survive. In a letter to the Guardian on 1 March, a GP who has worked in the NHS for over 30 years made the same point, that younger GPs will not buy in to practices. I ask the Minister the most critical question that I am asking today: is this model, requiring such large financial commitments by individuals, suitable to the 21st century? Would the department do a preliminary examination of this problem?

The pandemic has changed so much, and we were found wanting. The years of austerity caused serious damage to our NHS. Only because of the beliefs of our NHS staff are we getting through it. One thing is clear: there is increased demand on our health service. There will have to be much change, including permanently increasing spending. The Government will have to recognise that what may have worked in the past may not do so in future. Models which have been sacrosanct may need to be examined and, if necessary, changed. All this is essential, with a radical White Paper bringing health and social care together. I ask the Minister: are the Government up to it?

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD) [V]
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My Lords, the NHS workforce has been working flat out for a year now. Their dedication, professionalism and personal sacrifices have inspired the whole nation. Vacancies stood at over 100,000 before the pandemic. The NHS now faces a huge backlog of operations with an exhausted workforce and increasing levels of sickness absence. Moving forward, a fully funded workforce plan is critical and must take priority over reforms to NHS structures.

I recently spoke to two very senior nurses working in London ICUs, who told me that what they need more than anything was time off for recovery and additional nurses to provide pre-pandemic levels of patient care.

The recent report of the Public Services Committee, looking at the lessons of Covid-19, received compelling evidence that other European countries have considerably more critical care beds per head of population than we do. Does the Minister agree that, if the pandemic has taught us one thing, it is the need to adopt the rainy day principle and build spare capacity in for future crises?

Lord Patel Portrait Lord Patel (CB) [V]
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My Lords, I recognise that the Government want to address the issue of the NHS clinical workforce. The problem is not the ambition, but in having a clear long-term strategy to achieve this. Does the Minister agree that previous attempts have failed? The intensity and stressful nature of the work related to Covid and other factors, such as the recently announced pension cap, may make retaining staff difficult?

Recent surveys by the Royal College of Nursing, the Royal College of Physicians, the British Medical Association and many others have shown a very high proportion of the workforce are unhappy about their work, with low morale and mental health issues particularly related to Covid. With advances in care, NHS England is likely to require a growth in workforce of 3.2% per year over the next 15 years. That is nearly 650,000 full-time equivalent staff over the next decade. There are also issues about managing the workforce. I hope that through the new NHS Bill we can explore a long-term solution through legislation. Maybe the Minister would welcome that.

Health Protection (Coronavirus, Restrictions) (All Tiers and Self-Isolation) (England) (Amendment) Regulations 2021

Baroness Tyler of Enfield Excerpts
Monday 1st March 2021

(7 months, 4 weeks ago)

Lords Chamber

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Department of Health and Social Care
Lord Bourne of Aberystwyth Portrait Lord Bourne of Aberystwyth (Con) [V]
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My Lords, it is a great pleasure to follow the noble Lord, Lord McCrea of Magherafelt and Cookstown, who reminds us quite rightly of the important part that faith and faith communities play in tackling this pandemic. I thank my noble friend for outlining the purpose of these regulations and pay tribute to his incredible hard work and good humour throughout this pandemic and in serving our House.

I support these regulations. I believe that the overriding need to contain the spread of the disease means that, where self-isolation is required, it should be properly enforced. I enjoy the honour of serving on the Public Services Select Committee. During our recent inquiry, one very clear fact emerged, which was the frequent need to be more open to sharing data. We saw very clear evidence that bodies which chose to share data were able to rise to the challenges of the pandemic much more readily. So I very much endorse the approach of these regulations in this regard, although, like others, I look forward to the imminent—I hope—memorandum of understanding.

On the stricter control of gatherings of over 15 people, again this seems eminently sensible. Clearly, the larger the gathering, the greater the concern. I suspect that many people would strongly support these regulations and would perhaps even favour a tougher regime. I have a question in this regard for my noble friend. Clearly, the mischief which the regulations seek to address is large unauthorised gatherings. Why then do the regulations restrict themselves to private dwellings, educational establishments or indoor raves? Clearly, they are part of the problem that we need to tackle, but what happens if there is a large gathering on business premises or in a barn, on industrial or charitable premises, or perhaps there is unauthorised use of a public building? It seems that, as drawn, the regulations do not cover these types of activity. It may well be that I have missed something or that some other regulations deal with those situations, but if the problem is large unauthorised gatherings, why are we not tackling all indoor gatherings rather than just some of them? Subject to that caveat and concern, I give strong support to these regulations and once more thank the Minister for all he does for our House.

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD) [V]
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My Lords, these regulations, dealing with the sensitive issue of medical confidentiality and data sharing with the police, are being debated 30 days after they came into force. This has become a regular pattern in our scrutiny and a very unwelcome one, not least in this case because of the centrality of medical privacy to an effective public health system. We all understand the urgency of responding to the pandemic, but democratic accountability should not suffer in the process. When considering these issues, we must surely remember that we are first and foremost dealing with a public health crisis, not a public order crisis, and our responses should be viewed through that lens.

As we have already heard, these regulations were introduced to increase compliance, which I very much support. We know that a small number of people flout the rules—compliance is estimated at about 90%. However, the issue for most people is self-isolation and the support needed to adhere to the rules. Where people can comply, generally they do. Increased support, particularly financial support, is most urgently needed, as my noble friend Lord Scriven so compellingly set out. As the human rights group Liberty has said, supporting people and helping people follow guidance is the best way to keep everyone safe. That must be right. It is worrying that, owing primarily to a lack of support, a study by UCL this January revealed that 38% of respondents said they were not isolating for the recommended number of days when they had developed symptoms, with 13% not isolating at all.

As others have pointed out, these regulations will give the police more ammunition in enforcing the rules, but, in reality, are we clear how much capacity the police have to enforce this? Also, do we know what impact data sharing and increased fines have had on improving isolation rates, and can the Minister supply the House with those figures?

I turn finally to wider issues. Having had my first dose of the vaccine earlier today, I want to thank all involved in the rollout of the vaccination programme. It has been a great success. I pay particular tribute to the volunteers who are doing such a wonderful job at the vaccination centre I attended. However, despite all this, and the much-needed morale boost that the rollout has given the country, this morning’s news of six cases of the Brazil variant comes as a serious blow. Were we not far too late in introducing the new quarantine and testing on arrival requirements? One person who did not even give basic contact details has slipped through the net completely, and this was not picked up by a basic check. Surely that suggests that the system is not working and needs some urgent re-engineering. What assurances can the Minister give us on this absolutely critical matter?

Lord Balfe Portrait Lord Balfe (Con)
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My Lords, I want to take up the point made by the noble Lord, Lord Scriven, and ask the Minister when we will see the MoU. On 17 February, the Minister wrote that it

“is currently being updated to reflect amendments to the Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) Regulations 2020 on 29 January and feedback from the Information Commissioner’s Office.”

He added that the MoU would be published

“as soon as practically possible.”

That was two weeks ago. Where is it? When will we see it?

I will make some general observations. This has become very much a middle-class debate. A lot of people in this country are not paying much attention to these regulations. Many of them do not understand what they are for—although they understand that they want to get round them. They see an increasingly authoritarian Government increasing the penalties but the police not implementing the law. There is not a single sign of the law being aggressively implemented in the city of Cambridge, where I live. I do not think the police would like to invade the middle-class enclave and I am not sure they would feel that confident going on to the council estates.

So we can keep on giving the police powers to fine and so on, but we need to understand that what is perceived as a hostile environment, backed up by an authoritarian Government, is not working. Threatening people with a criminal conviction that could stop them being employed for ever is an incentive to get around the law as much as it is to obey it, and we have not really followed that up. People will say, “Why should I take the test? I might be found to be infected. Then I would lose my income. I would have to stay at home.” It is a directive incentive not to take a test, and we do not seem to be able to face up to that.

This was made very clear by the noble Baroness, Lady Finlay, when she said:

“Crippling fines and a police record will only disincentivise people to seek testing and disclose their contacts.”—[Official Report, 22/10/20; col. 1668.]

That is absolutely true.

My final point is that I have been abroad fairly regularly during this, because I have a job that takes me to Brussels. I have regularly handed in my test and trace form. It has always been accepted but has not on a single occasion been checked.

Covid-19: Vaccination Programme

Baroness Tyler of Enfield Excerpts
Wednesday 24th February 2021

(8 months ago)

Lords Chamber

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Department of Health and Social Care
Lord Bethell Portrait Lord Bethell (Con)
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My Lords, I recommend that my noble friend and the Daily Telegraph look at the large amount of conditional material that the Prime Minister articulated in his Statement. There were no firm dates. He made it clear that data would drive decisions and he made a lot of his indicative programme remarks reliant on passing the four key tests that he laid out very clearly in his programme.

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD) [V]
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My Lords, at Monday’s Downing Street press conference, Professor Chris Whitty expressed his view that front-line health and care workers had what he termed a “professional responsibility” to get vaccinated to reduce the risk that Covid poses to patients and care home residents. With studies indicating that in many care homes well in excess of 30% of care workers have not yet taken up the vaccine, what plans do the Government have to make getting vaccinated a condition of employment?

Lord Bethell Portrait Lord Bethell (Con)
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My Lords, the Chief Medical Officer was entirely right. As the noble Baroness probably knows, there are already important requirements on health care workers who, for instance, do surgery or are in certain risky clinical situations to have the right vaccines, hepatitis being one in particular. Having up-to-date vaccines is a condition of engagement for some medical staff. The noble Baroness is right to raise the question of social care. We are looking at the right policy in that area. We want to tread carefully and to take social care workers with us. We are aware of the risks in social care, but we do not want to provide barriers for employment. Getting that decision right will be one of the most important things that we do.

Covid-19 Vaccines Deployment

Baroness Tyler of Enfield Excerpts
Thursday 11th February 2021

(8 months, 2 weeks ago)

Lords Chamber

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Department of Health and Social Care
Lord Bethell Portrait Lord Bethell (Con)
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My Lords, my noble friend is entirely right that there are many mysteries of immunity that we do not fully understand. While we have some strong evidence on the transmissibility of the disease after vaccination, it is not crystal clear. The evidence we have is that it reduces infection by two-thirds, but that still means that a third of people who have the vaccine might get the disease and be able to pass it on. That is an extremely serious risk when the vast majority of the population have not been vaccinated at all. We do not want a situation where a small minority of the population might be spared sickness and death, but a very large amount of the population become infected with a disease that might hospitalise them or lead to other infections. That is why we are cautious. We are also conscious of variants of concern, which remain a potent threat as long as the vaccine has not been rolled out.

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD) [V]
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My Lords, I will press the Minister a little further on the low take-up of the vaccine by some care home staff, which has already been raised by other noble Lords. Recent research from the National Care Forum has shown that some of the significant factors accounting for this low take-up include vaccinators coming to homes with enough vaccines only for residents, and staff being expected to travel to vaccination centres if they are not vaccinated in the home, but not being given time off. Those not on shift when vaccinators come, such as night shift staff, are missed, and some fear having to take unpaid time off if they develop a reaction to the vaccine. Could the Minister say what steps the Government are considering taking to tackle these very specific barriers?

Lord Bethell Portrait Lord Bethell (Con)
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My Lords, I do hear the noble Baroness and I would be happy to look into this matter further. However, my understanding is that the vaccination rates among care home staff are much higher than she describes. It is not unusual for care home staff to have their health provided for by the local NHS, and for them to be required to travel to receive that support. That is quite normal for anyone getting a vaccine, even if they work in social care. It is entirely in our interests to make sure that social care staff are vaccinated, so there is no way that there is any kind of policy or deliberate effort to avoid vaccinating care home staff. However, I will be glad to look into this further and, if I may, I will copy the noble Baroness into the correspondence that will clearly result from this debate.

Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) Regulations 2021

Baroness Tyler of Enfield Excerpts
Monday 8th February 2021

(8 months, 2 weeks ago)

Grand Committee

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Department of Health and Social Care
Baroness Gardner of Parkes Portrait Baroness Gardner of Parkes (Con) [V]
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My Lords, I want to comment only briefly and positively to support the application of the click and collect exception to libraries, as set out in the amended Schedule 3A. I know that reading books gives pleasure to so many people, particularly during lockdown. For many families, a trip to the library is usually a highly-anticipated weekly outing and it is important for a child’s development to help them pick out books to read and to expand their thirst for knowledge.

I have heard of families running out of books to read during lockdown having relied for reading books on libraries and schools, which are shut, and how limiting this is for a child’s development. Oxfam reported that after the first lockdown customers were desperate for books; it saw a massive rise in second-hand book sales. At a time when children in particular are spending so long in front of a screen, a book can be a magical place to escape. I welcome this provision to allow people to keep borrowing physical books from their local libraries. I urge local councils to ensure that this provision, albeit late in the day, is seized on and that local libraries expand their offerings from online to click and collect, and publicise that widely to help families and, particularly, children.

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD) [V]
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My Lords, I greatly welcome the speed at which the vaccine programme is rolling out and the boost to morale that it has provided. However, news over the weekend regarding the South African variant makes it clear that we need to be constantly vigilant and prepared to adapt our response. The vaccine is no silver bullet.

I want to focus on the impact of lockdown on the mental health and well-being of both young and old, particularly those living alone who may be socially isolated and for whom lockdown has been especially tough. We have, quite rightly, thought a lot about the impact on families, but, in my view, not thought enough about the impact on those living alone. For many, their mental health has suffered, not least due to anxiety that if they catch the virus they will have no one to look after them and check they are okay. Local community groups, charities and local authorities have played a valuable role, but they are unable to meet all demand.

Reports in the press over the weekend talked of post men and women taking on the role of checking up on the elderly, something that has been trialled in the Channel Islands. I would welcome such a trial on the mainland but was very concerned to hear that people might have to pay for this service. Surely the Government should step in to fund any such scheme, particularly for the less well-off and those living in deprived communities. What plans do the Government have in this area?

Last week, I asked the noble Lord, Lord Bethell, a question about recent scientific findings from Cambridge University showing that one dose of the Pfizer vaccine may not produce sufficient antibodies to kill off the virus, particularly for the over-80s. The scientists involved suggested that rapid antibody tests could be used to identify older people who had responded less well to their initial jab and prioritise them for a speedier second jab. What plans do the Government have to carry out such tests on older people and residents of care homes, who are currently having to wait 12 weeks for their second jab?

Like other noble Lords, I continue to be concerned about reports of care home staff not taking up the offer of a vaccine. While I understand that no one can be compelled to be vaccinated and that education and reassurance are the key, equally care homes have a duty of care towards their residents, including their well-being. I recently heard a union representative say that one reason some care home staff were refusing the vaccine was that they were fearful of having a reaction which would mean they had to take time off work. Surely the Government should be able to underwrite the pay of any care worker in this situation to encourage take-up. Unless action is taken, residents and relatives who have had a vaccination and had time to develop their immunity may still find that they are unable to visit their loved ones, which feels so unfair—a point made powerfully by the noble Baroness, Lady Massey.

The pandemic has put a huge strain on many young people who were already struggling with their mental health due to bereavement, social isolation, a loss of routine because of school closures or a breakdown in support. What plans do the Government have to provide additional funding for the rest of this academic year and the school year beginning in September to allow schools to invest in mental health and well-being support, including school counsellors, but, crucially, without having to divert resources away from academic catch-up funding which the Government have already announced?

This lockdown must be the last. The public would never forgive this Government if, by coming out of lockdown too soon or without a comprehensive strategy to defeat the virus, we once again found ourselves in a full national lockdown.

Baroness McIntosh of Pickering Portrait Baroness McIntosh of Pickering (Con) [V]
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My Lords, I draw attention to my interests with dispensing doctors as in the register. I add my congratulations to the Minister, the Government and all those involved with such a successful vaccination programme in which we can all take great pride.

I draw my noble friend’s attention to one aspect of the South African variation which is causing deep concern across the medical community: the fact that the mutation, or the variation, that we are now identifying as coming from South Africa actually arose during South Africa’s summer, but nevertheless spread quite widely and rapidly throughout the community. Does my noble friend share my concern that this shows that this particular variation—and perhaps others to come—is not a seasonal variation but could actually spread throughout the warmer months? Have the Government done any specific research on this, and do they have any plans for how to tackle this particular dimension of this variation?

Looking ahead to the fact that there will be, in all probability, a need for a booster vaccination this autumn and in years to come, what plans have my noble friend and the department made to ensure an equally smooth rollout of booster vaccinations in addition to the annual flu vaccination for the elderly and, as was the case this winter, the over-50s? Will my noble friend give a commitment today that the department will rely specifically on rural GP practices to ensure a smooth rollout of both the flu vaccination, as in previous years, and a booster vaccination this autumn and in successive years? Will he ensure that GPs, being closest to their patients in very outlying areas, will be asked to deliver these as effectively as they have this year? Can he update us about the inclement weather and what delays the department is expecting to occur—albeit in the short term—to the vaccination timetable which has been rolled out?

Through my noble friend, can we pay a heartfelt thanks to all those involved on the front line, particularly in hospitals? As my noble friend mentioned, this has been a very long winter, and those staff in hospitals, ambulance services and paramedics have been stretched to the utmost. We owe them a great debt of gratitude for all the work they are doing and will continue to do for the foreseeable future. It is important that we pay tribute to the department and all on the front line at this time.

Covid-19 Update

Baroness Tyler of Enfield Excerpts
Thursday 4th February 2021

(8 months, 3 weeks ago)

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Department of Health and Social Care
Lord Bethell Portrait Lord Bethell (Con)
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My Lords, I am not sure whether we are completely stepping back from the production of monoclonal antibodies. I am extremely grateful to the noble Lord for the briefing that he shared with me last month and for the opportunities to look at how we can onshore the manufacturing of monoclonal antibodies. He is entirely right: this is a critical area of life science production where Great Britain is frustratingly massively behind. In the resilience of our healthcare supply chains, we have a huge gap in this country, and it is one that we are keen to address. The Therapeutics Taskforce is looking at monoclonal antibodies as a way of supporting our response to Covid and we have, through Project Defend, a workstream to look at how we can encourage onshore manufacturing of these essential healthcare supplies.

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD) [V]
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My Lords, recent laboratory tests by scientists at Cambridge University show that one dose of the Pfizer vaccine may not produce sufficient antibodies to kill off the virus, particularly for the over-80s, leaving them at risk of catching the South African variant. Will the Minister say what assessment the Government have made of these findings and what plans they have to speed up the second dose of the Pfizer vaccine for the over-80s and all care home residents?

Lord Bethell Portrait Lord Bethell (Con)
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My Lords, I am grateful for the reminder from the noble Baroness. The analysis we have done of the Pfizer vaccine, and indeed of all vaccines, is extremely encouraging and the impact it has on the body’s antibody production rate is profound. In fact, for many vaccines it might be that a longer delay, of 12 weeks, to the second dose might have an improved impact on the body. The second dose is really important for longevity rather than for efficacy, and therefore, with the data we have at the moment, we do not have any plans to change the pace of the rollout, but we are making sure in absolute terms that the second dose is delivered to all those who have had a first dose, promptly and on time.

Health: Eating Disorders

Baroness Tyler of Enfield Excerpts
Tuesday 19th January 2021

(9 months, 1 week ago)

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Lord Bethell Portrait Lord Bethell (Con)
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My noble friend is right to remind us that this is not a gender-specific condition and that many men have eating disorders of one kind or another. The culture we live in does nothing but encourage that and I think we have to address the underlying causes, both psychiatric and the pressure of social media. We will be putting in place the resources necessary to support that kind of initiative.

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD) [V]
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My Lords, NHS Digital has reported that admissions for eating disorders have almost trebled since 2007, but there has been very little investment into in-patient treatments since then. With only 400 NHS beds for adult eating disorder sufferers in England, and capacity currently further reduced by the pandemic, what are the Government doing about this chronic shortage of in-patient beds for those suffering from serious eating disorders, which particularly affect young women?

Lord Bethell Portrait Lord Bethell (Con)
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The noble Baroness may not have heard my answer to the previous question, where I cited the large number of beds opened in the last year, totalling more than 30 across the country. I recognise that more beds are needed for those who have particularly acute disease, but the large prevalence of the disease among hundreds of thousands of young girls and boys also means that community care has to be at the heart of our response to this condition.

Mental Health Act Reform

Baroness Tyler of Enfield Excerpts
Monday 18th January 2021

(9 months, 1 week ago)

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Department of Health and Social Care
Baroness Thornton Portrait Baroness Thornton (Lab) [V]
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My Lords, the whole House will welcome this White Paper. The overhaul of the Mental Health Act has been long awaited. It is also to be welcomed that the Government have accepted the majority of the recommendations from Sir Simon Wessely’s independent review of the Mental Health Act. As Sir Simon Wessely’s report highlighted, there is a great need for patients to be heard, for their choices to be respected and for them to be supported to get better in the least restrictive way.

Although legislative changes are important, the best way to prevent people being detained under the Mental Health Act is to prevent them reaching a crisis point in the first place. This means bringing reality to equality for mental health, bringing in investment and training, and introducing a culture change in the NHS.

My first question is whether the investment detailed in the long-term plan will be sufficient to achieve that. Many of the organisations which have championed mental health doubt that it will. Surely we will require greater investment to implement the proposals of the White Paper.

The Government accept almost all the review’s recommendations on advocacy and tribunals, including the funding that will be required to implement them. These are key reforms affecting people’s liberty and will play an important part in making other improvements to people’s rights effective. Can the Minister assure us that planned reforms will be fully funded?

The independent review was published over two years ago. Since then, the murder of George Floyd and the growth of the Black Lives Matter movement have brought the impact of structural racism into greater focus. Among the five broad ethnic groups, the known rate of detention for the black or black British group—321.7 detentions per 100,000 of the population—was over four times that of the white group, which was 73.4 per 100,000. Men and women from African-Caribbean communities in the UK have higher rates of post-traumatic stress disorder and suicide risk and are more likely to be diagnosed as schizophrenic. Does the White Paper go far enough in tackling the racial disparities within our use of the Mental Health Act? It is very much to be welcomed that the Secretary of State has announced the new patient and carer race equality framework, which was recommended by Sir Simon Wessely. Can the Minister tell us the timetable?

On health inequalities in general, children from the poorest 20% of households are four times as likely to have serious mental health difficulties by the age of 11 as those from the wealthiest 20%. Half of LGBT people—52%—have experienced depression in the last year. One in eight LGBT people aged between 18 and 24 say that they have attempted to take their own life in the last year. Almost half of trans people have thought of taking their own life in the last year, and 31% per cent of LGB people who are not trans say the same. People living in the most deprived areas are more likely to be referred to an IAPT service by their GP but are substantially less likely to receive a complete course of treatment or make a successful recovery. Long-term funding decisions will be needed in the next spending review. What will they look like? Will the Government make a long-term commitment to invest when this is required?

I am sure we all welcome the aim to improve how people with learning difficulties and autism are treated under the Act. Will there be limitations to the scope for detention where their needs are due to learning disabilities or autism alone? Do the Government accept all the review’s recommendations on advocacy and tribunals, including the funding that will be required to implement them? These are key reforms affecting people’s liberty and will play an important part in making other improvements come about.

The emergency legislation of the Coronavirus Act 2020 represented a concerning reduction in patient rights and safeguards. While we understood the reasons for their initial introduction, I am sure that everyone is glad that they were never enacted and pleased that they have now been dropped. However, Covid-19 will prove a defining moment for the way in which we discuss and protect our mental health. A rising tide of people who have not previously experienced mental health problems now find themselves in that position. For a lot of people, the pandemic has seen a shift from merely “struggling” to becoming clinically unwell. Funding and reform will be needed more than ever.

Finally, can the Minister tell us when the legislative programme will commence? Is there to be a joint pre-legislative scrutiny committee? I believe the Minister’s right honourable friend the Secretary of State suggested that that might be the case. That would be very welcome and I hope that it will start very soon indeed. When, finally, will we see the draft Bill?

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD) [V]
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My Lords, there is much to be welcomed in this White Paper, for which we have waited so long. I am pleased to see patient voices being put front and centre of plans and proposals to address the current shocking disparities in the rates of detention of people from black and minority-ethnic backgrounds. However, the issues that were highlighted in the Wessely review two years ago have continued to scar the lives of too many people during the extremely long gestation period of this White Paper.

The original legislation is 40 years old now and out of date. It is shocking, frankly, that it has taken us so long to amend archaic processes, such as an individual’s father automatically being their advocate in a mental health crisis, whatever the nature of the relationship or preference of the individual patient.

I understand the importance of getting the details right. However, I was concerned by the lack of urgency shown by the Secretary of State when responding to questions from MPs on the Statement last week. Why do we have to wait another year before the legislation can even begin? Can the Minister give us a concrete timeframe for the further consultation? What is the timetable for taking forward the non-legislative reforms in the Wessely review, not least to achieve wholesale cultural change in mental health services?

I am similarly very concerned about workforce issues facing this sector. Many of the workforce aims laid out in the NHS Long Term Plan are not on track to be met, with 12% vacancy levels in many mental health services. Between 2016 and 2019, demand for services increased by over 20%—and that takes no account of the exponential growth in mental health problems during the pandemic. Recent forecasts suggest, for example, that only 71 additional consultant psychiatrists will be added to the NHS workforce by 2023-24, against a requirement of more than 1,000 to deliver the long-term plan. What measures are the Government taking to address the additional workforce requirements of reforming the Mental Health Act?

We then come to the issue of funding. The short-term injection of £500 million is, of course, welcome, but it is sustainable and long-term investment in services—covering the full spectrum from preventive to crisis care—that we so badly need. We need a comprehensive plan for funding all existing and new mental health services, rather than one-off injections of short-term funding. Above all, this means investment in community services. In a survey of Royal College of Psychiatrists members, insufficient access to community health services was cited as the greatest cause of increases in formal admissions. The best way to prevent people being detained under the Mental Health Act is to prevent them reaching crisis point in the first place.

Like the noble Baroness, Lady Thornton, I am deeply worried about the impact of the pandemic on the nation’s mental health. In October last year, the Centre for Mental Health estimated approximately 10 million extra people with mental health needs due to the pandemic—a staggering figure. While it is understandable that we have been focusing on the physical threat of the pandemic and protecting our acute services, when will the Government come forward with proposals to address what some are now calling a mental health emergency?

It is an unpalatable fact that black people are currently 10 times more likely to be placed on a community treatment order. In these situations, patient voices become even more important, ensuring that culturally appropriate services can be provided. The patient and carer race equality framework is a good start; I look forward to hearing more on this issue. I note that cultural advocates are currently being recruited, but can the Minister confirm how many patient and carer advocates will be involved in both the advancing mental health equalities task force and the patient and carer race equality framework steering group? Also, why are the Government not proposing to legislate for a CTO to have a maximum duration of two years or to allow tribunals to change the conditions imposed on an individual by the order, as recommended by the Wessely review?

I end by returning to the issue of prevention. The courses of action covered by this legislation represent the worst-case scenarios for individuals experiencing severe mental health problems. We have so much evidence telling us that investments in preventive measures are highly cost-effective interventions and avoid the trauma of crisis scenarios for patients. While we debate this White Paper, it is vital that we do not lose sight of the bigger picture.

Lord Bethell Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
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My Lords, I thank both noble Baronesses for their incredibly perceptive, thoughtful and detailed questions, some of which I am afraid are beyond the brief in front of me. I reassure them, particularly the noble Baroness, Lady Tyler, that I will write with detailed answers to some of their more perceptive and searching questions.

We are all enormously grateful to Sir Simon Wessely for his thoughtful, persuasive and thorough report. It has taken some time to work on it, but now that it has arrived we will act on it. I reassure the House that it is an enormous priority.

I reassure both noble Baronesses that funding is absolutely in place for mental health. If I may briefly run through that, an extra £2.3 billion a year for mental health services is committed by 2023-24. Some £500 million in mental health investment in the NHS workforce was announced in the spending review, and it will go towards addressing waiting times for mental health services.

The noble Baroness, Lady Tyler, referred to the challenge of recruiting psychiatrists. As she knows, that area is extremely challenging. The employment brand of mental health services is not as strong as it is for, say, surgeons, but we have done an enormous amount through HR and the people plan to find new ways of attracting people to rewarding and challenging roles in psychiatry, and those investments are beginning to pay off.

We have invested more than £10 million this year in supporting national and local mental health charities to continue their vital work in supporting people across the country. I will move on to the mental health effects of the pandemic in a second. We have invested £8 million in the Wellbeing for Education Return programme, which will provide schools and colleges all over England with the knowledge and resources to support children and young people, teachers and parents. We have announced more than £400 million over the next four years to refurbish mental health facilities to get rid of dormitories in such facilities across 40 trusts.

The noble Baroness, Lady Tyler, asked me about urgency and whether the Government were truly committed to moving quickly. I reassure her that money has already been announced and plans are in place to address some of Sir Simon’s most urgent recommendations.

Both noble Baronesses asked about the timetable for legislation. I reassure them that the consultation began last Wednesday; it is a 14-week consultation and we have committed to responding to it this year. If I may advertise to noble Lords, this is a terrific opportunity for all those with views on mental health to contribute to that important engagement. It is our plan to publish the Bill next year on the back of that consultation and for legislative scrutiny to take place next year. The question of whether that will be joint legislative scrutiny is not clear to me right now, but I undertake to both noble Baronesses to inquire and press the case for joint scrutiny when I return to the department. I shall write to both of them accordingly.

The noble Baroness, Lady Thornton, raised the impact of the racial dimension highlighted in the report. The numbers in Sir Simon’s report are incredibly striking and it is crystal clear that this is an issue that we absolutely have to deal with. Will we go far enough? Yes, indeed we will. The framework recommended is extremely powerful and we are already putting it into place. We have learned an enormous amount from the report. The ability for those with mental health issues to nominate their own advocate is an extremely powerful innovation that I think will have a big impact on this issue, but we still have further to go. We are engaged with those who are both representative and expert in this area to ensure that we are challenged to go far enough.

Likewise, on learning difficulties and autism, noble Lords will remember that we have had powerful and moving debates in this Chamber in the last few months on that very issue. I reassure the noble Baroness, Lady Thornton, that we note Sir Simon’s recommendation in his report for a 28-day cap on the detention of those with learning difficulties and autism. It is just not good enough for those with learning difficulties and autism to be detained under a Mental Health Act restraint for an interminable period. That point is thoroughly recognised, and the report’s recommendations are extremely well made.

On the question of the pandemic, the noble Baroness, Lady Thornton, put it extremely well: there has been a shift in many people’s response to the pressures and the isolation of lockdown, from being stressed and anxious to having genuine clinical challenges. The full effects of that have not worked their way through the system so it is difficult to get a nuanced and complete view from the numbers today, but we are very much on the balls of our feet to understand and react to the pressures

If I may draw out one issue, young girls seem to be a demographic who have particularly felt the loneliness, anxiety and uncertainty around the pandemic and lockdown. We are particularly concerned to ensure that support goes to families and individuals who present clinical mental health issues as a result of the pandemic.

On the other, very detailed questions asked by the noble Baroness, Lady Tyler, I undertake to answer them in writing at the earliest possible opportunity.

Health Protection (Coronavirus, Restrictions) (Self-Isolation and Linked Households) (England) Regulations 2020

Baroness Tyler of Enfield Excerpts
Thursday 7th January 2021

(9 months, 3 weeks ago)

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Department of Health and Social Care
Lord Reid of Cardowan Portrait Lord Reid of Cardowan (Lab) [V]
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My Lords, I will make only two points.

First, if our fellow citizens are being asked to undergo testing and tolerate restrictions, self-isolation, lockdown and so on—I support these measures—how on earth do the Government explain why so many visitors to this country have been able to fly into our airports without testing, self-isolation and lockdown? How do they explain that to people?

Secondly, what consideration is being given to the effect of the restrictive regulations on the terminally ill? Each year, some 225,000 people undergo palliative care in the United Kingdom. Some have only weeks or months to live. To them, every day is like gold dust, yet currently those undergoing such treatment outside hospices are behind some 7 million other people in the queue for vaccinations. Do not the restrictions being placed on that group cry out for a commensurate prioritisation in vaccination?

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD) [V]
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My Lords, as we debate these regulations—after the event, as ever—we are in the throes of a national emergency the like of which I have not witnessed in my lifetime. We must learn lessons from the handling of the pandemic so far. The overriding need is to act fast, early and with consistency of message. We need to treat the population like grown-ups who prefer to hear it straight, even if the news is bad.

With the new, more aggressive strain of the virus, we are in a race against time, as my honourable friend Munira Wilson said yesterday, and we need a military-style response. Above all, we must introduce a 24/7 vaccination programme, bringing the vaccine to every high street in the country, including on Sundays. We must make maximum use of volunteers for all the nonclinical tasks involved and remove unnecessary barriers to recruitment. Critically, we must make full use of the roughly 11,400 local pharmacies that already administer millions of flu jabs every year. They have the capacity to vaccinate about 1.3 million people each week, which will save the lives, particularly, I suggest, of people who are not registered with a GP. What assurances can the Minister give that this will now happen?

The next few weeks will put huge strain on the mental health of millions, particularly the vulnerable, the marginalised and young people. What assurances can the Minister give that mental health services will be fully resourced and will stay open to respond to the ever-growing mental health need?

Finally, with the number of Covid patients in UK hospitals topping 30,000, and having witnessed the harrowing scenes in last night’s news coverage of the intensive care unit at University College London Hospital, will the Minister say what specific steps the Government are taking to support the mental health needs of front-line health and social care workers who are suffering from exhaustion, burnout and flagging morale? You can only stretch a piece of elastic so far, and many are close to breaking point.

Lord Caine Portrait Lord Caine (Con)
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My Lords, given the grim statistics that the Prime Minister outlined in his address on Monday, I fully accept the need for this third lockdown, but I am also clear that it cannot last indefinitely and that we must do everything we can to avoid treading this path again. I share the concerns of many, including my right honourable friend the Prime Minister, over the impact of a third lockdown: on the economy, particularly in retail, hospitality and small businesses; on the education and life chances of our young people; and on the physical and mental well-being of the public, especially those we are asking to shield—something of which I, sadly, have direct personal experience from the first lockdown.

We must therefore find a way out of here, and that must of course be through mass vaccination. I applaud the Government’s efforts in delivering the vaccine so far and in ensuring that more people have been vaccinated here than in the rest of Europe put together, and I strongly support the ambition to have everyone in the top four priority groups vaccinated by mid-February. To achieve that, as other noble Lords have stressed, we need to use every resource at our disposal. That includes the extensive deployment of our Armed Forces, a stripping away of any unnecessary bureaucracy, and ever-more vaccination centres.

In short, we need to act as if we are on a total war footing by running this vaccination programme as a round-the-clock and precise military operation, with the production of the vaccine akin the production of munitions. Ministers and other noble Lords have rightly said that we are in a race against time between the vaccine and the virus. It is not a race that we can afford to lose.

HIV: Ending Transmissions

Baroness Tyler of Enfield Excerpts
Tuesday 1st December 2020

(10 months, 4 weeks ago)

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Department of Health and Social Care
Lord Bethell Portrait Lord Bethell (Con)
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The noble Lord speaks with great humanity and compassion, but I perhaps need to give a bit of perspective. I am not sure if our UK aid budget is enough to solve all the problems that he describes. The UK remains extremely committed to international aid. In the Covid epidemic and recession, we have reduced our commitment in a small way and have promised to revisit it at a later date. That commitment is very clear, and we will do that in due time.

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD) [V]
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My Lords, cuts to local authority public health budgets of some £700 million in real terms over the last five years have led to sexual health budgets being cut by 25% in this period. The King’s Fund has estimated that restoring spending to the former level

“would require additional investment of £1 billion.”

Given the Government’s commitment to zero new HIV transmissions by 2030, will the Minister tell the House what plans they have to increase investment in HIV preventive services delivered by local authorities? Can the Minister also confirm that there will still be national funding for a prevention programme?

Lord Bethell Portrait Lord Bethell (Con)
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The Covid epidemic has disrupted things, but I reassure the noble Baroness that in the spending review 2020 we have confirmed that the public health grant will be maintained into next year, enabling local authorities to meet pressures and continue to deliver important public services. DHSC will confirm final allocations in the coming week, including the position on HIV PrEP. I reassure the noble Baroness that PrEP has proved to be an enormously valuable contribution to our fight against transmissions, and we continue to back it.

Coronavirus Act 2020 (Expiry of Mental Health Provisions) (England and Wales) Regulations 2020

Baroness Tyler of Enfield Excerpts
Wednesday 25th November 2020

(11 months ago)

Grand Committee

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Department of Health and Social Care
Lord Blunkett Portrait Lord Blunkett (Lab)
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My Lords, I unequivocally endorse the Minister’s words of appreciation of the work of everyone, at every level, who has maintained a degree of service that has avoided the use of the powers under Schedule 8. It is an unalloyed pleasure not to be giving the Minister a hard time, given that, as far as I can see and looking back in history, no other Minister in the Lords has taken more flak for the Government as a whole for so little reward. It is therefore a pleasure to be able to say that this is a very welcome move.

Noble Lords will remember, because they were either in the Chamber or, more likely, watching, the powerful speech made by the noble Baroness, Lady Grey-Thompson, back on 25 March, when the Minister was putting the Bill through this House. On both disability and mental health, she understandably warned of the danger to the rights of so many people from the measures that were felt at the time to be needed to ensure that functioning services could continue, albeit without the safeguards that all of us would wish. This afternoon we acknowledge that those safeguards are being put back in place—their erosion has not been needed—and, as the Minister said, that is due to so much hard work and ingenuity by so many people. I am sorry that the Welsh Administration feel that they still need the measures as a backstop. I hope that they will not, after their two-week lockdown, feel that they still need to be used.

I just ask the Minister in a friendly way whether he can identify—if not this afternoon, perhaps he can write to me—any service level agreement from the Treasury in relation to the £3 billion announced by the Chancellor of the Exchequer in respect of mental health services? While the withdrawal of the powers under Schedule 8 is entirely welcome, the capacity within the system before the Covid pandemic was under enormous strain, and that has obviously been made worse by the number of people who have experienced mental health and stress issues over the past nine months. Many more will experience these over the winter until we have the vaccine onstream and can get back to some sort of normality.

Capacity will remain a major question for all of us, and I hope that the Minister will be able to confirm that a proportion of the additional resource being allocated to getting the health service back onstream and undertaking the diagnostic and treatment requirements that have so often been delayed will also apply to the capacity of the mental health services. With that, I welcome the regulations very strongly.

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD) [V]
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My Lords, removal of the mental health provisions from the Coronavirus Act, which represented a significant reduction in protection and safeguards for people subject to the Mental Health Act is, as the noble Lord, Lord Blunkett, said, very welcome. Serious concerns have been raised about whether it would ever be human rights-compliant to enact the provisions. Even before the Covid-19 crisis hit, mental health services were severely stretched, with waiting times and barriers to access which would be considered unacceptable in any other area of medicine.

Turning to the scale of need, psychiatrists have reported an increase in patients needing urgent and emergency care during the crisis, and the latest NHS Digital figures show the highest recorded figures for mental health contact. According to the Centre for Mental Health, there are approximately 10 million extra people with mental health needs due to the pandemic. A survey conducted in late spring by the charity Rethink showed that almost 80% of people with pre-existing mental illnesses reported that their mental health had got worse or much worse as a result of the pandemic, and the ONS found that almost one in five adults in Britain experienced depressive symptoms in June 2020—roughly twice the number before the pandemic. Against this backdrop, it is crucial to the nation's Covid-19 recovery that existing mental health funding commitments in the NHS long-term plan are delivered in full and that services are resourced to support those who had new or worsening mental health difficulties because of the crisis. It is not either/or, it is both/and.

It is of course welcome that eventually an extra £500 million was promised in the mental health winter plan, published on Monday, to help with discharge to community care, workforce issues and addressing waiting times. This is a good start, but unlikely to be sufficient and, crucially, does not come onstream until the next operational year, leaving a gaping hole in the tough winter period ahead. What commitments can the Minister give that some of this new money will be spent on preventive work and early intervention to stop mental health issues escalating to crisis point and putting additional pressures on expensive police, A&E and in-patient services?

In the long term, it is not just a case of mental health services surviving the pandemic; they will need drastically to expand and improve to deal with the long-term impact of social isolation, mass unemployment and pandemic-induced anxiety.

The powers we are debating weakened an Act that was already in need of major reform. The independent review of the Mental Health Act put forward proposals to improve the system and increase patient rights. Can the Minister update the Committee on when the Government will provide a full response to the independent review and publish their proposals to take forward reform of the Mental Health Act, with a clear implementation timescale? The two-year anniversary of the publication of the Mental Health Act review will be 6 December 2020. I strongly hope that the Government’s response will not be delayed beyond that point.

Lord Bilimoria Portrait Lord Bilimoria (CB) [V]
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My Lords, the coronavirus and the isolation of lockdown are impacting not just our physical health but our mental health, as people deal with loneliness, stress and anxiety. Whether we are working from home, furloughed or travelling to our workplaces, the drastic changes to our workday can take a toll. Employers must play a vital role in supporting the mental health of their workforce by prioritising and promoting a positive well-being culture.

The CBI, of which I am president, has been working with firms of every size and sector to help tackle the challenge of mental health in a pandemic. The Law Society, a member of the CBI, supports these regulations, which will expire provisions in Schedule 8 to the Coronavirus Act 2020 which would weaken Mental Health Act 1983 protections if brought into force. The Law Society states that it recognises that, at the onset of the pandemic, these exceptional emergency provisions were considered potentially necessary to support healthcare professionals in responding to the immediate crisis, but that, as they have not been used in England to date, as the Minister said, they should be expired so as to restore the full certainty of important statutory protections for vulnerable people.

The Law Society also recommends that the Government consider expiring the provisions under Schedule 12 to the Coronavirus Act alongside the expiration of those under Schedule 8 being implemented by these regulations. However, if Schedule 12 remains in force, the Law Society recommends that the Government publish improved guidance clarifying how to conduct the required process under these easements and provide detailed guidance to assist local authorities in making human rights assessments. Do the Government intend to expire the provisions under Schedule 12 to the Coronavirus Act, which weaken statutory protections for vulnerable people under the Care Act 2014 and the Social Services and Well-being (Wales) Act 2014, alongside the expiration of those under Schedule 8? Will the Minister commit to providing improved guidance on the easements under Schedule 12, clarifying how local authorities should conduct relevant processes and make human rights assessments?

Face-to-Face Medical Appointments

Baroness Tyler of Enfield Excerpts
Thursday 19th November 2020

(11 months, 1 week ago)

Lords Chamber

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Department of Health and Social Care
Lord Bethell Portrait Lord Bethell (Con)
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My noble friend makes a very good point. Diagnosis is phenomenally difficult and, quite often, patients who present with seemingly one condition have something altogether different. It may be that a face-to-face appointment will be the moment when that difference is spotted and caught. She is entirely right to say that we cannot omit that format for the right circumstances, but a great many patients see their GPs very regularly. Their journeys may be onerous, uncomfortable and stressful, and telemedicine might offer them an alternative opportunity. There are others for whom speed is of the essence, and having telemedicine, particularly when it is supported by apps that provide essential information about their condition, can be an important and urgent alternative.

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD) [V]
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My Lords, according to the June edition of the British Medical Journal, the biggest change for mental health services has been the rapid adoption of video and phone consultations, an approach that had rarely been used in a field where relationships and trust between clinicians and patients are vital and where body language and eye contact are often a key part of the assessment. Many in the sector have reported that virtual appointments are at best inferior, particularly with young people, those with learning disabilities and the elderly. What assurances can the Minister give that face-to-face appointments will continue to be made available for those who need them in this field?

Lord Bethell Portrait Lord Bethell (Con)
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The noble Baroness has raised an important point. I saw the BMJ article to which she has referred; it was a very interesting warning shot, whereby we should not overshoot in this area. But perhaps I can also emphasise that other interesting evidence shows that some mental health services have been better provided by online consultations. For instance, some young people do not like visiting clinics, where they feel uncomfortable, and prefer video conferences. I think it is too early to call it on this one, because we need to analyse closely the benefits and disbenefits in the area of mental health. We must ensure that we have the right format for the right occasion, but I completely take on board the warnings of the noble Baroness.

Suicide

Baroness Tyler of Enfield Excerpts
Tuesday 8th September 2020

(1 year, 1 month ago)

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Department of Health and Social Care
Lord Bethell Portrait Lord Bethell (Con)
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The noble Baroness refers to recent statistics, which are, as she rightly points out, subject to change, as coroners’ investigations land on the desk at PHE. I reassure her that the statistics suggest a difference between stress and anxiety, and clinical mental health issues. It seems that one aspect of the coronavirus pandemic is that it has not translated into a massive mental health tsunami, as feared. This is hugely encouraging and a great relief. None the less, we are committed to the mental health support that the Government provide, and continue to support charities such as the Samaritans and CALM, including through the £9.2 million recently given to them for suicide prevention and support.

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD) [V]
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My Lords, sadly, self-harm is a major risk factor for future suicide and is growing among young people. Later this month, the All-Party Parliamentary Group on Suicide and Self-Harm Prevention will be publishing a report of its inquiry looking at the support available for young people who self-harm. Having been closely involved in this inquiry, I ask the Minister whether he will commit to the Government looking seriously at its findings, which were informed by young people who had self-harmed, and to responding in due course.

Lord Bethell Portrait Lord Bethell (Con)
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The noble Baroness is entirely right that self-harm is an alarming, distressing and rising phenomenon among young people. I welcome the report that she describes, and commit to having a good look at it, when it is published.

Childhood Obesity

Baroness Tyler of Enfield Excerpts
Wednesday 2nd September 2020

(1 year, 1 month ago)

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Lord Bethell Portrait Lord Bethell (Con)
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The noble Baroness has a point on the importance of targeting the right populations and there are certainly some demographics that incur higher incidences of obesity and for which the health disbenefits of obesity are higher. For these, we have special programmes to support them in schools with vouchers and medical interventions. However, obesity is a national problem that affects all parts of society. In Britain we have got it wrong and we need to address this issue as a nation.

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD) [V]
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My Lords, the noble Baroness, Lady Massey, rightly emphasised the link between deprivation and childhood obesity. Therefore, while welcoming the announcement of the Government’s obesity strategy, I ask the Minister: what specific steps are the Government taking to address the links between deprivation and obesity; how will this be funded; and what plans do they have to introduce policies with a more explicit focus on early years to reduce childhood obesity rates?

Lord Bethell Portrait Lord Bethell (Con)
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My Lords, there are individual programmes specifically targeting those from deprived backgrounds. I emphasise the childhood obesity trailblazer programme, which has funding for several councils to pioneer forward-thinking ideas to address childhood obesity among those target populations.

The other area that I emphasise is exercise in school. Of course, obesity is linked to intake, not exercise, but exercise helps to get the disciplines right around looking after one’s mind and body. The £320 million going into school sports facilities is a massive bonus in this area.

Health Protection (Coronavirus, Restrictions) (Leicester) Regulations 2020

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Wednesday 29th July 2020

(1 year, 2 months ago)

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Department of Health and Social Care
Lord Faulkner of Worcester Portrait The Deputy Speaker (Lord Faulkner of Worcester) (Lab)
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My Lords, the noble Lord, Lord Wei, has withdrawn so I call the noble Baroness, Lady Tyler of Enfield.

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD) [V]
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My Lords, we are debating these regulations very late in the day and on the last day before Recess, although they were introduced on 4 July. We are doing this at a time of growing concern about a second wave of the pandemic, both at home and abroad, and when new measures have been introduced in Oldham, Rochdale, Blackburn and Pendle to address localised flare-ups.

The link between the prevalence of Covid infections and levels of deprivation is becoming ever clearer, as the noble Lord, Lord Ribeiro, explained so well. What systems have been put in place to ensure the sharing not just of data but of good practice, and the effectiveness or otherwise of localised measures both at national and local government level?

While I welcome today’s news that the Government will fund studies into why people from black and ethnic-minority backgrounds are more likely to die from Covid-19 than the white population—that is highly relevant to the diverse population of Leicester—why have we waited until now to do this, when the link has become increasingly clear since the early differential death rates first became apparent? I repeat my call for a full debate in this Chamber at the earliest opportunity on urgent action needed to tackle inequalities before a second wave, and before it is too late to act.

Relaxations had been made to these regulations, which came into force on 18 July—including to the areas covered—before they were even laid before Parliament. I join my noble friend Lady Jolly in asking the Minister to explain what process will be in place over the Recess to inform the House of the outcome of the review of regulations, which happens every 14 days, with the next one tomorrow.

Finally, looking ahead, what extra financial help will be given to people affected by local lockdowns such as in Leicester when the Government’s furlough scheme ends in October? Will the Government also think again about a temporary lifting of the benefit cap for the duration of the pandemic for those affected by local lockdowns or indeed any further national lockdown required?

Lord Roberts of Llandudno Portrait Lord Roberts of Llandudno (LD) [V]
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This morning I spoke to some of our local councillors, who all said that the areas worst affected by the virus outbreak are the poorest ones. I therefore suggest that our battle is not just against the virus but against poverty, and we must take that seriously. We must realise that even when this lockdown comes to an end and people go back to work, about 4 million are forecast not to have any work as their jobs will have come to an end, which will just add to the poverty. We must therefore now make sure that the benefits received and help given to those who are furloughed in various parts of the country continue, to stop the desperation that people must feel when their income more or less disappears and all the other help that they get has gone. We must somehow stop poverty itself, as it increases the harshness of the virus.

We could of course look at Brexit because, yesterday or the day before, the LSE forecast that the areas worst affected by the exit from Europe will be very hard-pressed, and said that they will have difficulties on top of the virus. I therefore ask the Government—I know it is late but it is possible—to cut that poverty at a stroke, and by so doing make it easier for us to recover from the virus epidemic.

Health Protection (Coronavirus, Restrictions) (No. 2) (England) Regulations 2020

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Friday 24th July 2020

(1 year, 3 months ago)

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Lord Clark of Windermere Portrait Lord Clark of Windermere (Lab) [V]
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My Lords, under official definitions, taxis are defined as public service vehicles. They are probably among the most dangerous of our public service vehicles, being small and enclosed, yet the Government have seen fit not to require the wearing of face masks in taxis. That is a very dangerous move. It is dangerous specifically to taxi drivers, some of whom have died following the government regulations. Many of our citizens have no alternative but to use taxis. Will the Government protect them by insisting on the wearing of face masks in taxis, as for other public service vehicles?

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD) [V]
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My Lords, I find it deeply troubling that, yet again, we are debating regulations that came into effect weeks before they received scrutiny in either Chamber. They have often been repealed or overtaken already. It makes a mockery of the parliamentary process and gives the unfortunate impression that Ministers are actively trying to avoid in-depth scrutiny. At the start of this pandemic, it was easy to understand why it was not possible to debate these regulations straightaway, but that is no longer the case. It follows a disturbing pattern of regulations and guidance coming far too late, with too little scrutiny. I cite the guidance that came out yesterday on face coverings, 12 hours before it came into effect, and to care home visiting, which caused such distress because it was so late. Like the noble Baroness, Lady Anelay, I want to know when and how this Chamber will be informed of the next review of these regulations. It is due on 30 July, when we will be in recess.

Baroness Kennedy of Cradley Portrait Baroness Kennedy of Cradley (Non-Afl) [V]
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My Lords, I thank the noble Lord, Lord Bethell, for his explanation of these regulations. I will ask a few questions in the short time I have. Has the regime of fines already put in place by the Government been effective? How many fines have been issued to date? What amount has been collected and where does the money go? Does the Minister think it fair to fine an individual £100 for not wearing a face mask when the Government’s advice on this issue has been so confusing? Finally, what is the Government’s advice for shop workers, who are confused and worried about their role in enforcing these fines?

Independent Residential Care

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Tuesday 7th July 2020

(1 year, 3 months ago)

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Lord Bethell Portrait Lord Bethell [V]
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My Lords, it is not the role of a junior Minister to speak on behalf of the Prime Minister, but I can say that the Prime Minister, the Secretary of State and I are all enormously grateful for the huge amount of work that social care staff have put into this epidemic. I have seen with own eyes the commitment and expertise that they have provided during these very difficult days. We are, as a nation, enormously grateful for their hard work and skill.

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD) [V]
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My Lords, the pandemic has placed a very harsh spotlight on the resilience of the care system, with 30,000 excess deaths in care homes in England and Wales in a three-month period. At the weekend Sir Simon Stevens made it crystal clear that we just do not have a fair or properly resourced social care system with proper workforce support. With some homes already running close to bankruptcy due to the additional costs and occupancy rates slipping below 87% when many smaller homes become financially unviable, what immediate steps are the Government taking to protect these smaller homes?

Lord Bethell Portrait Lord Bethell [V]
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The noble Baroness is entirely right that the issue of excess beds is an unfortunate and unwelcome added pressure on an already pressured system. Sir Simon Stevens was echoing the sentiments of the Government and the Secretary of State when he said that we need to move towards a long-term settlement for social care. That was very much the commitment of the Prime Minister during the election and in the manifesto. Steps have been taken towards working on that but we have been interrupted by Covid-19. It remains a number one priority for the Government. In the meantime, we will be putting in the financial resources necessary to provide the resilience for those smaller homes of which the noble Baroness speaks.

Covid-19: Mental Health

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Wednesday 1st July 2020

(1 year, 3 months ago)

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Lord Bethell Portrait Lord Bethell
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The noble Baroness is entirely right to emphasise the importance of longitudinal studies. The UK household longitudinal study data, which analyses the GHQ-12 scores, has been upgraded. We will continue to invest in that, and Public Health England has been tasked with monitoring the development of mental health issues across the country.

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD) [V]
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My Lords, research shows that the pandemic has had a disproportionate impact on some of the most disadvantaged, particularly those from BAME communities. During this period, many mental health and community services have moved online. While that is an appropriate first response, charities are now expressing concern that it is not an effective response for many, including the elderly, those with learning disabilities and those with severe mental illnesses. Can the Minister say what urgent steps the Government are taking to restore effective treatment and care for all, including face-to-face services, with all necessary PPE and testing in place?

Lord Bethell Portrait Lord Bethell
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My Lords, we are feeling our way in this area. There have been benefits from some of the moves online. People have been able to see more of their consultants, they have found that some of the content provided has been helpful, and the reach has gone up. However, I completely agree with the noble Baroness that it will not work for everyone. I pay tribute to mental health professionals who have maintained face-to-face contact during the epidemic, with all the threats associated, and we continue to look closely at how to fit appropriate technology and digital access to the right people and in the right format.

Covid-19 Update

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Wednesday 1st July 2020

(1 year, 3 months ago)

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Lord Bethell Portrait Lord Bethell
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My Lords, I remember the incident well and I intended no discourtesy whatever. I reassure the noble Lord that I left the Chamber and instructed my officials to draft that letter; on leaving today, I will chase it down and ensure that it goes to him speedily.

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD) [V]
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My Lords, local lockdown plans in Leicester and elsewhere are vital to ensure that a proper place-based response takes full account of existing health inequalities. At an all-party group meeting yesterday, Sir Michael Marmot explained that Covid-19 has exposed existing inequalities in society and amplified them, with Covid-19 mortality rates closely linked to health inequalities and deprivation more widely. Does the Minister agree that, before the Summer Recess, your Lordships’ House must have a full debate on tackling inequality before a second wave hits us, with a sharp focus on the disproportionate impact on specific groups, particularly the BAME community?

Lord Bethell Portrait Lord Bethell
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My Lords, it is beyond my reach to instruct the House on its debates, but I would entirely agree with the noble Baroness that one of the saddest and most challenging aspects of Covid is that it hits society where it is weakest. It has undoubtedly hit those with health issues the hardest and has exacerbated health inequalities. It is my sincere hope that this Covid epidemic will be an inflection point, when this country embraces a strong public health agenda and addresses those health inequalities with energy.

Covid-19: Mental Health

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Tuesday 16th June 2020

(1 year, 4 months ago)

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Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield
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To ask Her Majesty’s Government what assessment they have made of the report The mental health effects of the first two months of lockdown and social distancing during the Covid-19 pandemic in the UK, published by the Institute for Fiscal Studies on 10 June; and what steps they plan to take in response.

Lord Bethell Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con) [V]
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My Lords, the noble Baroness raises an important issue, and I am grateful to the IFS for this thoughtful report. It is too early to know for certain the mental health consequences of Covid, but we are deeply concerned about those who suffer from isolation, young people, those who have fears of economic uncertainty, and those with existing mental health vulnerabilities. I give thanks to mental health professionals, who have worked hard during the epidemic, despite difficult circumstances.

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD) [V]
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My Lords, last week’s report by the IFS reveals how Covid-19 and the lockdown has had a major negative impact on mental health across the population, with women and young people particularly badly hit. Pre-existing inequalities in mental health have widened yet further. The report states that the scale of deterioration in mental health is of a magnitude unlike anything seen in recent years. What immediate steps are the Government taking to prevent this looming mental health crisis turning into an epidemic in its own right?

Lord Bethell Portrait Lord Bethell [V]
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My Lords, the report is extremely helpful and throws a spotlight on an issue that we are deeply concerned about. Immediate help includes a £4.2 million support fund for mental health charities, and a £5 million fund for Mind, specifically to support charities dealing with Covid-related mental health issues. We will continue to invest in mental health in the long term, to support this important area.

Health Protection (Coronavirus, Restrictions) (England) (Amendment) (No. 2) Regulations 2020

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Monday 15th June 2020

(1 year, 4 months ago)

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Lord Campbell-Savours Portrait Lord Campbell-Savours (Lab) [V]
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My Lords, I return once again to masks. Under these regulations, it is legal to leave the place where you live to visit

“a residential property to undertake any activities required for the rental or sale of that property”.

That provision seems to be aimed at enabling property surveys to take place, as well as visits by architects, engineers, contractors and others who advise potential purchasers or vendors. Estate agents and letting agents will also be entitled to visit properties to prepare sales or letting particulars, measure properties and record footage for virtual viewings. What happens when a person carrying the disease is asymptomatic—a term defined as in a period of between 5-6 and 14 days when the virus is multiplying yet there are no symptoms but that person could still be transmitting to others—and visits a property for the purposes that I have set out?

We are given some guidance on that matter in the guidance note to employers and businesses about Covid-19. We are told that

“estate agents should enquire whether a party is showing symptoms or self-isolating, should not carry out any open house viewings, wear face masks in accordance with guidance if they undertake an accompanied visit”.

That is only guidance, however; it is not mandatory. The guidance note Working Safely During Coronavirus (COVID-19) is not a legal requirement, unlike on the Tube. The property owner or tenant is hardly going to advise the invitee to wear a mask, if only because they will be unaware of the guidance, yet the tenant or owner could be at risk from the invitee. Equally, vice versa, the tenant could be at risk as well.

The regulations need tightening up. If a person on public transport in a confined space such as the Tube can be subject to the law for failure to wear a mask, the law should equally apply to some tradespeople in certain circumstances. As we increasingly dilute lockdown and its distancing provisions, we will be more and more dependent on masks. That is the trade-off. I suggest we turn the guidance into enforceable regulation.

I remind the Government that a Minister emphasised at a press conference last week the need for masks in enclosed spaces. I do not think we need the normative ambiguity referred to by a previous speaker.

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD) [V]
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My Lords, I have no issue with the minor lifting of restrictions contained in these regulations—apart from the bizarre timing of this debate—other than to say how odd it was to prioritise being able to visit an estate agent over being able to visit family members from whom we have been separated for months.

I will focus primarily on how as a country we move out of lockdown in a way that feels fair and does not discriminate. It has been more apparent in recent weeks that we were too slow to move into lockdown and that those lost weeks in March cost precious lives. The Government have also been far too slow in getting testing, tracing and isolating up and running, as well as in providing PPE and other crucial support for care homes.

I have been particularly concerned about the impact of lockdown on the well-being of those living by themselves, for whom lockdown has been especially tough. For some living alone, there has been a limited easing of restrictions in recent weeks; they can now form a social bubble with another household. These are clearly steps in the right direction, but I am concerned about the mental health impact of long periods of isolation on both the over-70s and those of any age living alone.

Back in April, the Mental Health Foundation voiced concerns over the long-term impact of the pandemic on mental health after a quarter of adults surveyed admitted to experiencing loneliness during lockdown. Perhaps surprisingly, the most affected group was found to be young people aged 18 to 24, 44% of whom admitted to experiencing loneliness. Research has shown that loneliness has the same impact on mortality as smoking 15 cigarettes a day, making it more dangerous than obesity. More recent research from Age UK has shown that over two-fifths of people aged 70 and over say that their mental health has been affected, with those locked down alone having a particularly anxious time.

Many people over 70 who are still fit and active, contributing to the economy and society and with no underlying health conditions, are increasingly finding these blanket policies ageist and discriminatory. A growing number of over-70s are also annoyed at the implication that all their age group are equally vulnerable and have called on the Government to take a more nuanced approach. Indeed, some are starting to say that the proposed cure of a lengthy extended lockdown for older people is as bad as or worse than the disease itself.

To finish on care homes, which are never far from my mind, at the end of May social care leaders began calling on Ministers to prioritise unlocking care homes amid growing concerns that mental health problems were contributing to the deaths of residents, a call echoed by the Relatives & Residents Association. The executive director of the National Care Forum said:

“We need to put the same energy and imagination into opening up care homes as we’re putting into opening up the great British pub.”

I for one agree.

Baroness Jones of Moulsecoomb Portrait Baroness Jones of Moulsecoomb (GP) [V]
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My Lords, I find it extraordinary that we are debating Amendment No. 2 when it relates to a lockdown that is long gone. Amendment No. 3 was made on 31 May, over two weeks ago, and over the weekend Amendment No. 4 came into force, completely changing the situation again.

I am also concerned about the way in which parliamentary scrutiny has been undermined throughout this process. The Minister at the start used words such as “exceptional” and said that it would not be an inappropriate precedent. That is complete nonsense, because it is already a precedent. The regulations relate to the most extreme restrictions ever enforced in this country, yet Parliament appears to be an afterthought for this Government. Perhaps as a result, the regulations are very poorly drafted. Now they are unenforceable and likely to have unintended consequences that have not even been acknowledged yet.

The regulations, and all subsequent amendments, have been enforced as SIs, using the affirmative procedure, but without the prior authorisation of Parliament due to “urgency”. Everyone will appreciate the fast pace of the situation. However, Parliament has been in session. It is hard to think of a higher-priority business matter than these lockdown regulations, yet they have evaded timely parliamentary scrutiny on every occasion—in fact, debates are being held, as now, on old lockdown amendments, on the same day as new ones are enforced without prior parliamentary authorisation. This makes a mockery of the term “democratic process”. It remains the extraordinary case that the lockdown regulations have never yet been put in place with parliamentary approval; only outdated versions have been approved, after an amendment has already been enforced.

I recommend that the Government read Big Brother Watch’s May 2020 report, which explains the problem in detail, and might even allow the Government to understand the legal and social mess they have created. I stress that Parliament is sitting, and so rules should not now be being passed by government diktat. We need to maintain our role in scrutiny.

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

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Monday 8th June 2020

(1 year, 4 months ago)

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Baroness Healy of Primrose Hill Portrait Baroness Healy of Primrose Hill (Lab) [V]
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I thank my noble friend Lord Hunt for securing this timely debate. I absolutely agree that the long-term sustainability of care homes must be a priority for the Government both now and in the future. When will the long-promised Green Paper be published?

The pandemic has shone a fierce light on the lives of those dependent on social care. The public now understand the heroic work done by care staff, who must be rewarded with decent pay, security of employment and proper protection, with adequate PPE and access to regular testing. Can the Minister confirm that every care home has now received adequate testing kits, as promised by the Government, and can he assure me that these will be provided on a regular basis for all, with a guaranteed 24-hour turnaround time for results? Martin Green, chief executive of Care England, is clear:

“As the lockdown starts to ease … You’re going to have to have testing on a very regular basis. You might be having to test once a week in care homes.”

The Economic Affairs Committee’s radical report, Social Care Funding: Time to End a National Scandal, is still awaiting a government response. It calls for an additional £8 billion for adult social care immediately just to return it to the 2009-10 standards. Published before the pandemic, the report proved prescient by calling for proper investment in the care workforce, with a career structure which better reflects the skills required to be a good care worker and the social importance of the sector. Investment is essential now before a second surge. The Government must learn lessons from earlier mistakes and ensure that the social care sector can better protect its residents. Age UK says that residents are being charged to pay for PPE, as other noble Lords mentioned. Can the Minister confirm this?

The Health Secretary’s claim that he threw a “protective ring” around care homes already lacks credibility when research by LSE estimates that 22,000 “extra” deaths have occurred in care homes during this pandemic period. Many senior care industry figures have pointed to the decision to move some hospital patients back into care homes in mid-March, when testing was not available to them. Figures released by NHS England show that 25,000 patients were moved from hospitals to care homes between 17 March and mid-April, when the guidance formally changed to ensure that testing took place. Can the Minister confirm that, in future, no patient will be returned from hospital to a care home without being tested first?

Covid-19 has taught us important lessons about what matters and who we should value: not only our own families but those who care for them so bravely.

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD) [V]
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My Lords, I too support the long-overdue pay increase for nurses working in the social care sector. I also strongly support the regret Motion tabled by the noble Lord, Lord Hunt, who is right to draw attention to the financial instability of this deeply fragmented sector.

There are approximately 15,000 care homes in the UK, with more than 400,000 beds, run by approximately 8,000 providers. Some are very small; others provide a large network of homes. It is a mixed economy: 84% of homes are owned by the private sector, including some that are owned by private equity firms, both British and offshore; 13% are owned by not-for-profit organisations; and 3% are owned by local authorities. Funding comes from a mix of private funders, local authorities and the NHS. Despite this funding mix, care homes have been hit by a decade of cuts in social care funding. An FT investigation last summer revealed:

“Britain’s four largest privately owned care home operators have racked up debts of £40,000 a bed, meaning their annual interest charges alone absorb eight weeks of average fees paid by local authorities on behalf of residents.”

Many have argued that this debt-laden model is completely inappropriate for social care, as is one that involves paying large dividends to investors.

Many homes are already running close to bankruptcy and have expressed grave concerns about the spiralling costs of PPE and extra agency staff, as well as lost income from empty beds. It has been estimated that when bed occupancy rates slip below 87%—as many have now—operating surpluses are such that many smaller care homes quickly become unviable, particularly those with greater reliance on state-funded residents.

This virus has brutally exposed systemic weaknesses in our social care sector. The latest official figures show more than 12,000 Covid-related deaths of care home residents in England and Wales, but it has been estimated that the true figure, calculated by looking at excess deaths of care home residents in the period, could be double that. According to a recent poll, one-third of people say that they are less likely to seek residential social care for their relatives or as a future option for themselves. This brings into very sharp relief the respective responsibilities of central and local government if care home owners go under financially or simply decide to shut up shop and hand back the keys. Simply put, who is the provider of last resort?

Tellingly, that poll also revealed that the vast majority of respondents want care workers to be paid above the minimum wage. If this pandemic has revealed one thing, it is that we can no longer kick the can down the road but must take advantage of the growing public and political consensus that social care should be free at the point of need, funded largely out of taxation. There are, of course, a number of ways of doing this: general taxation, hypothecated tax, or some form of social insurance. This needs to be at the nub of both the political debate and a grown-up national conversation.

Lord Sheikh Portrait Lord Sheikh (Con) [V]
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My Lords, I will talk about the financial aspects of the care home industry, and what needs to be done after the pandemic to ensure its sustainability.

There are more than 420,000 people in care homes; there are more than 22,000 care homes; and the industry generates an annual income of about £15 billion. I pay tribute to the industry, as it has performed well under the circumstances during the pandemic. We need the sector to be stable, as we have an ageing population and some people have health issues. Care homes are of varied sizes. The smaller companies are normally well managed, particularly if there is involvement by the owners. My suggestion to them would be to curtail their borrowings, be cost effective and, importantly, have adequate reserves. In my business, I have always had adequate reserves. My concern is with the larger companies, which are making over £1.5 billion in profits, with considerable amounts going to hedge funds. There may be complex intercompany structures. It is estimated that a high percentage of the care home industry’s £15 billion income is leaked and goes towards the payment of rent, dividends, loans and directors’ fees, not towards front-line care. The situation is opaque and there is reluctance to inject money into the sector, as there may be structural complexities.

Despite the high income generated by the industry, the staff are among the lowest paid workers, with a high turnover. It is hoped that the more money that goes to front-line care the better paid the staff will be. In the last 10 years, Southern Cross and Four Seasons have failed. I worry that there may be other problems post pandemic. The care home sector’s revenue comes from local authorities, the residents and the Government. The weekly amount payable per resident is normally between £600 and £800, and the NHS will pay £183.92 or £253.02 per week for nursing care in eligible cases. As there is a contribution from the state, there needs to be transparency and accountability and we must ensure financial stability. We should, therefore, perhaps consider some form of legislation to achieve this.

Finally, my own business—insurance—is properly controlled and regulated. Would my noble friend the Minister like to comment on the issues I have raised?

Covid-19: Obese and Overweight People

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Thursday 4th June 2020

(1 year, 4 months ago)

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Lord Bethell Portrait Lord Bethell
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The noble Baroness is entirely right that chapter 2 outlines an extremely thoughtful roadmap for how to address this issue. It is currently being reconsidered. I cannot make the guarantees she asked for from the Dispatch Box, but I can assure her that we are working hard to see how we can use the example of Covid to make progress on this important agenda.

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD)
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My Lords, given the Prime Minister’s welcome recent statement that a more interventionist stance is needed to tackle obesity, is the Minister aware of a recent poll by the Obesity Health Alliance showing that 72% of those surveyed supported restrictions on shops promoting unhealthy foods in prominent areas, including checkout areas, and 63% wanted the sugar tax on soft drinks extended to other sugary foods? What plans do the Government have to introduce these measures, working collaboratively with supermarkets and other food retailers?

Lord Bethell Portrait Lord Bethell
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The noble Baroness is entirely right to suggest that Covid might be the infection point—the intervention necessary to wake up the nation to the dangers of obesity. We are keen to use that moment to make progress on this important issue.

Mental Health Services

Baroness Tyler of Enfield Excerpts
Tuesday 19th May 2020

(1 year, 5 months ago)

Lords Chamber

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Department of Health and Social Care
Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield
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To ask Her Majesty’s Government what steps they are taking (1) to protect, and (2) to support, mental health services (a) during, and (b) after, the COVID-19 pandemic.

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Lord Bethell Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
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My Lords, the NHS has issued guidance to services to support them in managing demand and capacity across in-patient and community mental health services. Services have remained open for business as usual as a result. We remain committed to the additional investment in mental health services set out in the NHS long-term plan. We have provided an additional £5 million to mental health charities to support their work during the pandemic.

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD)
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My Lords, the Royal College of Psychiatrists warned last week that the nation faces a mental illness “tsunami”. Those on the front lines of our health and social care services have gone above and beyond to tackle this dreadful virus, but now may themselves face significant mental health problems. Thousands have lost colleagues, endured serious illness or experienced major trauma. Will the Government commit to investing in a world-class mental health response to Covid-19, including by setting up specialist support services for those on the front line of our NHS and care services, mirroring the services available to our armed services personnel?

Lord Bethell Portrait Lord Bethell
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I join the noble Baroness in paying tribute to those working in mental health in the NHS. They have kept services running in extremely difficult circumstances and their impact has been extremely powerful. Although we are aware of the deep threat of a mental health tsunami, as was warned, the evidence to date is that these people have done an amazing job of addressing the concerns of those who are suffering under coronavirus and the lockdown.

Covid-19: Vulnerable Populations

Baroness Tyler of Enfield Excerpts
Tuesday 12th May 2020

(1 year, 5 months ago)

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Department of Health and Social Care
Lord Bethell Portrait Lord Bethell
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I share the noble Baroness’s celebration of Florence Nightingale Day, which is an important day for the nursing profession and for all of us. We have made huge progress on testing in care homes in the last three weeks. The new portal was made live on Monday and care homes are now massively supported by satellite care home facilities manned by the Army. I am not sure about the 6 June date of which she speaks, but I reassure the House that care home testing is the number one priority of our testing facilities and is benefiting from the large increase in capacity.

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD)
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My Lords, over the course of this crisis we have seen substance misuse and mental health services adapt their provision to better support homeless people facing multiple problems. Could the Minister say what the Government, in particular the new homelessness task force, will do to ensure that these flexibilities remain in place?

Lord Bethell Portrait Lord Bethell
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The noble Baroness is right to raise concern for the homeless—surely one of the groups suffering the most in the current epidemic. We are putting in place facilities for testing, housing and mental health support for the homeless. We envisage that these will continue for the length of the epidemic.

Covid-19: Social Care Services

Baroness Tyler of Enfield Excerpts
Thursday 23rd April 2020

(1 year, 6 months ago)

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Department of Health and Social Care
Lord Blunkett Portrait Lord Blunkett (Lab)
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First, I declare my interests in the register, including as a vice-president of the RNIB and of the Alzheimer’s Society. I am addressing noble Lords today from my experience of four years chairing the social services committee of the City of Sheffield and as shadow Secretary of State for Health in the 1990s. I want to address the future rather than the present, since I know that other noble Lords will do that. I endorse everything that my noble friend Lady Wheeler and the noble Lord, Lord Astor, said and called for this afternoon.

When the noble Baroness, Lady Grey-Thompson, spoke on 24 March, she did so from the heart in relation to the immediate situation facing people with disabilities. I want to look at what will happen in the months ahead if we do not get the exit strategy right. We are all aware that social services have been massively underfunded for very many years. The pressures and demands on the service have been way beyond what could actually be met by local authorities and private providers. That is why it is really important that when we come out of the worst of the lockdown, we have the continuing resource to be able to sustain both domiciliary and residential care. It is really important that we also sustain the volunteers who have made themselves available, both the 750,000 nationally and those with mutual aid at community level. I hope that, with data protection in mind, we might be able to keep a register and keep them involved for the future. I hope that the Government will consider that.

The real issue that I want to address this afternoon is: what happens if the lockdown continues for a substantial period? Some people have started to talk, sometimes irresponsibly in my view, about a gradual release of the isolation taking months rather than weeks. That release is crucial for mental health and for people with disabilities, but also crucial to avoid ending up with more people needing support in the years ahead because they have deteriorated over the period of the lockdown. I therefore hope that the Government will consider setting up a separate body from SAGE, which will give advice on the way in which the dragon that we are slaying in relation to the pandemic will not be replaced by an equal beast—to use a metaphor on St George’s Day—that will lead to substantial additional pressures on the system in years to come, as people who were not feeling aged, isolated or full of distress and anxiety find that they now are. In other words, let us not, with the best intentions of today, make a major problem for tomorrow.

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD)
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I thank the noble Baroness, Lady Wheeler, for securing this important debate. As the terrible and ever-rising death toll in care homes has so visibly shown, the social care sector, so long underfunded and neglected by politicians and policymakers, finds itself at the front line of this cruel pandemic. The severity of the challenge faced in care homes and other community settings is impossible to overstate. In short, care homes providing personal and close contact care need urgent access to reliable and ongoing supplies of protective equipment to protect residents and staff, rapid and accessible testing, and far greater support, with funding and equipment on an equal footing with the NHS.

If this pandemic has proved one thing, it is that health and social care are inextricably linked and cannot be treated differently. The National Care Forum has called on the Government to form a ring of steel around care homes, but what is it like at the moment? I have spent the past couple of days talking to various social care leaders running front-line social care services. It has been a humbling experience to hear what is going on.

Their stark messages include: how the rhetoric from government is hard to hear when the reality is so different; the confusing, contradictory and constantly changing nature of guidance issued by government and other bodies; the daily struggle to secure protective equipment, with government supplies sometimes being diverted to NHS facilities and homes having to source their own supplies at extortionate prices; staff shortages running at 25% alongside existing high vacancy levels that require the hiring of agency staff, which raises the risk of transmission; a serious shortage of nurses in homes and great difficulty recruiting, as nurses are deployed into the acute sector; testing arrangements which show little understanding of how the sector works, with care workers who have no car being asked to drive to centres many miles away, at times that do not fit with their shift patterns; patients being sent from hospitals into care homes without testing; much-needed financial resources from government not reaching the front line; GPs no longer coming into care homes to verify deaths, leaving such tasks to some of the lowest-paid staff; and care workers left feeling insecure and anxious when left in charge of clinical details.

Based on these conversations, I ask the Minister: why are care homes having to pay VAT on protective equipment when the NHS does not, and what urgent steps will the Government take to put them on an equal footing? What measures are they taking to ensure that some registered nurses in the newly returning workforce are deployed to care homes, which desperately need them? When will the newly established volunteer scheme be used to help care homes? Finally, when will the Government’s visa exemptions for NHS nurses be extended to those working in the social care sector?

When this terrible tragedy subsides, a long-overdue and fundamental reform of social care must be a top priority. A national health and social care system means just that: a fully integrated service, properly funded and run on an equal basis so that we are no longer, as one social care professional put it to me, simply an afterthought at the back of the queue.

Baroness Grey-Thompson Portrait Baroness Grey-Thompson (CB)
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My Lords, I draw attention to my interests in the register, in that I am a vice-president of the LGA. The Care and Support Alliance has reported thousands of people getting in touch with its members over this very issue. The questions I raised at Second Reading of the Coronavirus Bill are still valid and I will be writing to the Minister, because of our three-minute time limit today. To help proceedings, I have nine questions.

There is still a lack of adequate PPE for disabled people and their carers. One young disabled woman reported that she was verbally abused for not having adequate PPE available, even though it is difficult to obtain. Another young woman struggling with PA support was told that she should just go and live in a care home. My first question is: now that care home deaths are being reported, are HMG changing their strategy for this sector? A really serious danger is that some disabled people may be forced to move back to their families, which could be toxic or abusive, because that could appear safer than a care home.

Secondly, for transparency, will HMG report deaths in the community so that the true overall death figure is accurate; if not, why not?

Thirdly, HMG said that the delivery target was 100,000 coronavirus tests a day by the end of April. Is this on target and how many more need to be done? Was this a logistics aim or a medical aim? Will the Minister confirm that disabled people will not be excluded from testing?

Fourthly, will HMG review the carer’s allowance? Unpaid carers are also in a precarious position.

Fifthly, will HMG urgently review the guidance on direct payments? It is confusing and families are at breaking point trying to manage working from home.

However, my biggest concern is that, as I understand it, eight areas have switched on the Care Act easements. I can find the names of six: Sunderland, Middlesbrough, Warwickshire, Staffordshire, Birmingham and Solihull. So, sixthly, as a matter of urgency, can the Minister confirm that these six are correct? It was reported in the Law Society Gazette this morning—but has now been removed—that the other two are Croydon and Hertfordshire, although Hertfordshire has said that it has not triggered easement. This is very confusing for everybody. Can the Minister confirm which areas have triggered easement?

Seventhly, can he explain how these areas have apparently reached crisis point, such that they cannot carry out their duties to disabled people, but nowhere else has? Or are there more than eight?

Eighthly, how are disabled people expected to get advice if they do not know what law their local area is applying?

Finally, ninthly, does the Minister accept that HMG should publish regularly the full list of areas that have switched on Care Act easements and, if they are not prepared to do so, can he explain why not?