Care Homes: Guidance

Baroness Tyler of Enfield Excerpts

Wednesday 21st April 2021 Lords Chamber

[Lord Bethell (Con)]

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 (LD) [V]]

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 (Con)]

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 Lords Chamber

[Lord Bethell (Con)]

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 (LD) [V]]

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 (Con)]

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 Lords Chamber

[Baroness Tyler of Enfield (LD) [V]]

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?

NHS: Staff Numbers after Covid-19

Baroness Tyler of Enfield Excerpts

Thursday 4th March 2021 Grand Committee

[Baroness Tyler of Enfield (LD) [V]]

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?

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

Baroness Tyler of Enfield Excerpts

Monday 1st March 2021 Lords Chamber

[Baroness Tyler of Enfield (LD) [V]]

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?

Covid-19: Vaccination Programme

Baroness Tyler of Enfield Excerpts

Wednesday 24th February 2021 Lords Chamber

[Lord Bethell (Con)]

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 (LD) [V]]

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 (Con)]

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 Lords Chamber

[Lord Bethell (Con)]

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 (LD) [V]]

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 (Con)]

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 Grand Committee

[Baroness Tyler of Enfield (LD) [V]]

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.

Covid-19 Update

Baroness Tyler of Enfield Excerpts

Thursday 4th February 2021 Lords Chamber

[Lord Bethell (Con)]

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 (LD) [V]]

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 (Con)]

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.

Social Care Funding (EAC Report)

Baroness Tyler of Enfield Excerpts

Thursday 28th January 2021 Grand Committee

[Baroness Tyler of Enfield (LD) [V]]

My Lords, I commend the noble Lord, Lord Forsyth, and his committee on this excellent report, proposing clear recommendations in what is a very complex area. I agree with many of them and underline the strong sentiment that we do not need further reviews, consultation or Green Papers; we need government action now or a White Paper with a clear implementation timescale.

Covid has cast a harsh spotlight on a highly fragmented, fragile and underfunded sector reliant on unpaid carers and piecemeal local arrangements, with care providers going out of business or handing back contracts. Other serious flaws in the system include a widespread lack of awareness that social care is not free at the point of use, underpaid staff with little career progression or professional development—leading to high vacancy rates and turnover—and a postcode lottery which leads to unjustifiable variations between places in access to care and its quality, often depending on a local authority’s ability to raise revenue.

The adult social care winter plan commits to providing free PPE to care homes until after the pandemic. What plans do the Government have to extend this pledge until at least late spring? Despite some short-term injections of government funding since 2017, years of significant underfunding, coupled with rising demands and costs, have combined to push adult social care services to breaking point. The Select Committee report points out that funding for adult social care in 2017 was below 2010 levels. It calls for an immediate injection of £8 million to restore care quality and access to 2010 standards, with free personal care available universally by 2025. I fully support these recommendations.

Any long-term reform must take account of the needs of working-age adults, who account for nearly half of the total social care budget, and unpaid carers as well as older people. Many working-age disabled people do not own their own houses—which, unfortunately, is how this political debate is mainly couched—and have not been able to save for care costs.

When it comes to paying for a new system that includes free personal care as a universal entitlement, it will have to be a partnership of public funding and private contributions by the citizen. Like the noble Lord, Lord Lansley, I believe that we should look for a solution through the prism of intergenerational fairness—a way in which all generations contribute but no one generation feels unfairly burdened. The Select Committee report touches briefly on this issue, which is to be applauded.

However, there is one aspect on which I take a different view from the committee. Rather than our relying primarily on raising the money needed from general taxation, I would like to see a funding solution with some element of hypothecation. I had considerable sympathy with the recommendation of the Barker commission that an additional percentage point of employee national insurance contributions for those aged over 40, raising some £2 billion in total, be earmarked for adult social care. This is similar in concept to the proposal put forward by the Intergenerational Fairness Forum of a new system of social care insurance contributions, at a rate of 1%, from the incomes of all working adults from the age of 40 until they stop working. Looking to the over-65s, as I argued in our debate earlier this week on inter-generational fairness, the case for individuals who continue to work beyond state pension age continuing to make national insurance contributions should also be part of the equation.

The shockingly high number of deaths in care homes in the first wave of the pandemic is a matter of national shame. We owe it to those who died and their families to ensure that a properly funded social care system, providing quality care to all, is a fitting legacy.