Covid-19: UK Arrivals

Baroness Warwick of Undercliffe Excerpts
Tuesday 16th November 2021

(9 months ago)

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Lord Kamall Portrait Lord Kamall (Con)
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I share the frustration of the noble Baroness and others. This is not great for our international, global outlook, or for the fact that we want to attract the best students from around the world, not just Europe. We are a global country and we have to address this. I am pushing the NHS on this because it is really important. The problem is the national immunisation management system, to use the technical term, and the inability to validate the data of overseas visitors.

Baroness Warwick of Undercliffe Portrait Baroness Warwick of Undercliffe (Lab)
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My Lords, I can sense the Minister’s frustration in this, but we have been aware of it for some time; this should have been sorted out a long time ago, yet here we are now in November. Does the Minister accept that all departments must play their part in achieving the Government’s aim of increasing the number of international students? Will he assure us that his department will be both flexible and creative—with the emphasis on “creative”—in resolving this and other similar problems that may arise?

Lord Kamall Portrait Lord Kamall (Con)
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I assure the noble Baroness that when I was pressing this issue yesterday with officials in preparation for this Question, I stressed the importance of flexibility and creativity. We need to think outside the box on many issues. One issue we are looking at is: if passenger locator forms can do this, why can the NHS Test and Trace system not? I am told that is because it is based on self-certification. I am pushing the NHS to address and analyse the different options as soon as possible. It is really important we send a message to the rest of the world that we are open to the brightest and the best from across the world.

Health Care and Adult Social Care

Baroness Warwick of Undercliffe Excerpts
Wednesday 27th October 2021

(9 months, 3 weeks ago)

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Lord Kamall Portrait Lord Kamall (Con)
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I thank my noble friend for his question and for the advice he has given me to date. Even though I have size 11 feet, I am finding it rather difficult to fill his large shoes. On the funding announced, local authorities have a key role in supporting recruitment and retention in their local areas. We are working with them to make sure that they support local providers by identifying workforce shortages, developing workforce plans and encouraging joined-up services. We also continue to work closely with providers, councils and our partners to assess the situation and consider what further action may be necessary.

Baroness Warwick of Undercliffe Portrait Baroness Warwick of Undercliffe (Lab)
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My Lords, the CQC’s annual report highlights the challenges faced by people with learning difficulties, their families and their informal carers. Does the Minister acknowledge this problem? The CQC accepts that its inspection procedures require more emphasis on the knowledge and experience of family and informal carers, following Professor Murphy’s report on the failures and abuse in Whorlton Hall. How can we hope that the CQC and other agencies in health and social care will give priority to the role of family and informal carers when the Government’s main policy statements and papers still virtually ignore their existence?

Lord Kamall Portrait Lord Kamall (Con)
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The Government recognise the valuable role that paid and unpaid carers play in social care. We are looking at how we can make sure that we recruit and retain staff. We understand the challenges that many care homes, quite often those in the private sector, face when trying to recruit and retain staff, given the competitive pressures around the jobs market. The Government certainly take seriously the role of unpaid and paid carers.

Social Care in England

Baroness Warwick of Undercliffe Excerpts
Thursday 14th October 2021

(10 months ago)

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Baroness Warwick of Undercliffe Portrait Baroness Warwick of Undercliffe (Lab)
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My Lords, I congratulate my noble friend Lady Pitkeathley on her devastating opening speech, which set out vividly the challenges facing social care and the inadequacies in the Government’s proposed response. I am glad to join in noble Lords’ welcome to the Minister.

This is, I think, the fourth time in the last month that this House has expressed its concerns about the Government’s approach to social care. On Monday, the noble Lord, Lord Agnew of Oulton, introduced the Health and Social Care Levy Bill, when speakers from all sides of the House expressed real anxieties that the Government’s proposals will not address the key issue: that too few people are getting the level and quality of care that they need. Given that this is the Government’s flagship Bill to resolve one of the biggest challenges facing the country, the lack of confidence in your Lordships’ House and elsewhere is desperately worrying. I hope that, in replying to this debate, the Minister will seek to assure us all that the Government are listening to these concerns and that they will be reflected in the next stage of their plans for both resources and social care reform.

Successive Governments have neglected social care, and the pandemic has dramatically shown that the sector has been brought to the brink of disaster. Report after report has shown that many vulnerable people died in care homes because the problems of care homes simply were not part of the Government’s thinking. Millions of unpaid carers were left completely unsupported as support services were withdrawn overnight and they were left to struggle alone as best as they could. The impact of that on carers and those for whom they care has clearly been devastating, although I fear that it is as yet largely undocumented. Carers UK is beginning to gather this grim evidence.

Only today, Skills for Care published its annual report, The State of the Adult Social Care Sector and Workforce in England, which documents the impact of the pandemic. It reports that sickness rates “nearly doubled”,

“occupancy levels in care homes have fallen”

and workforce numbers started to fall from March. It states:

“As of August 2021, vacancy rates are now back above their pre-pandemic levels”


and are increasing. The report estimates that, if the workforce is to increase at the same rate as the proportion of over-65s in the population,

“by 2035 the sector may need 490,000 extra jobs”.

How will they be provided?

I say all this to emphasise the urgency of providing the resources to right this terrible wrong now. It is not clear that the Government’s present proposals will do this, however good their intentions. The NHS clearly needs money to tackle waiting lists; this will help families looking after relatives with worsening health conditions. However, the recent announcement does not suggest that there will be any immediate direct investment in social care. The Commons Health and Social Care Select Committee advised that £3.9 billion is needed just to deal with the sector’s wage increases to the national living wage and ageing pressures. The LGA estimates that £1.5 billion is needed each year just to stabilise the care provider market—the difference between what it costs providers to deliver care and what councils pay.

Where will vulnerable patients from hospitals go if there are no care places? In all the public pronouncements and speeches in the House and elsewhere, the Government have scarcely mentioned unpaid family carers. If they are not mentioned in descriptions of how policies will be made in future, that probably means that they will be left out of the picture altogether. Carers UK is concerned that, although the Government’s proposals will help some families, they will not help carers who need help now. For instance, there is no indication that the levy will secure an immediate increase in funding for breaks or respite support for carers. Nor will it help those with the lowest means who cannot afford to pay for their own services and have no other recourse but help from the state or charities.

Can the Minister tell us whether the Government plan to provide immediate and significant cash injections to local authorities for the delivery of adult social care services, including support for unpaid carers, in the forthcoming spending review on 27 October? How will the health and social care levy deliver the funding for underlying social care support so that carers can juggle care and work? Without this investment, it is unlikely that the Prime Minister will be able to deliver on his promise to fix social care.

In adding one final point on supported housing, I declare my interest as a chair of the National Housing Federation. I have stressed many times in this House the essential role of supported housing in delivering independence and well-being for many people with long-term care and support needs. Supported housing takes the pressure off public services and saves public funds. Housing associations, like care homes, are struggling to fill vacancies. The value of local authority contracts is so low that it is not possible to increase wages or reward staff financially for their dedication and the sacrifice made over the pandemic to keep residents safe. The Government have promised ring-fenced funding for the NHS and social care. Can the Minister consider reinstating the £1.6 billion ring-fenced funding for housing-related care and support services and use the opportunity of social care and NHS reform to prioritise preventive services, give security to people with care and support needs, guarantee funding and enable housing providers to continue responding to the impact of coronavirus?

Social Care and the Role of Carers

Baroness Warwick of Undercliffe Excerpts
Thursday 24th June 2021

(1 year, 1 month ago)

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Baroness Warwick of Undercliffe Portrait Baroness Warwick of Undercliffe (Lab)
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My Lords, the forensic, measured and moving opening speech of the noble Baroness, Lady Jolly, demonstrated that there are a number of pressing issues to be addressed within the wide topic of social care. The Government have committed themselves to resolving the issue of who pays for residential care in old age, and we are all eager to learn of their plans as hundreds of families face this challenge every month. I shall focus in my three minutes on two points: social care provided by the not-for-profit sector; and social care provided by family, friends and others who are unpaid—what is called informal care.

As chair of the National Housing Federation—I declare that interest—I have taken a keen interest in housing associations’ provision of not-for-profit care and housing, and seen the amazing work they do not just for the elderly but for those with disabilities, learning difficulties and physical and mental illness. I echo the call from Anchor Hanover, England largest not-for-profit provider, on the need to tackle the negative perceptions of social care in terms of low pay and lack of career progression. This is not new: before the pandemic, there was a shortfall of 1.1 million care workers in the next 15 years. With a current workforce estimate of 1.6 million, that is a massive challenge. What will the Government do to deal urgently with these negative perceptions and begin to address the shortage challenge?

On my second point, about informal carers, my noble friend Lady Pitkeathley has consistently and passionately advocated their cause in this House; I look forward to hearing her contribution shortly. In my experience, the majority of all social care is provided by family or friends caring for their loved ones. In most cases, they do not even label themselves as carers; they do it because they are husbands or wives, daughters or sons, sisters or brothers. It is what they do, and it is what we do. This vast army of carers increased dramatically during the pandemic. In most areas, services for carers, including young carers, vanished overnight, and there are real concerns that they will not be reinstated. There are an estimated 13.6 million of them, plus 800,000 young carers, yet they are often invisible when it comes to public policy and they have to fight every inch of the way for support, often at the cost of their own health or financial security.

Despite their warm words, the Government entirely missed the opportunity in their health and social care White Paper to recognise the contribution of informal carers. The Minister will be well aware of the mounting criticism of the Government’s response to the pressures on social care provision and on carers as a result of the pandemic. Can the Minister assure us that carers will be specifically included in any forthcoming legislation, and that carers themselves will be directly involved in its preparation? The Government now have an historic opportunity to make changes that will at last deliver parity of esteem between social care and the NHS.

Covid-19: Variant B.1.617.2

Baroness Warwick of Undercliffe Excerpts
Wednesday 26th May 2021

(1 year, 2 months ago)

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Lord Bethell Portrait Lord Bethell (Con)
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My Lords, there is an enormous amount of data published. I draw the noble Lord’s attention to table 6 in the table test conducted on 28 May 2020, which has an enormous amount of weekly collection data for schools. In that week, 1,967,904 LFTs were taken by schools, and they yielded 1,806 positive results. Those were all examples of where we have cut the chains of transmission. Tests are delivered through a variety of channels, including the community testing channel. Reports on infections in schools are analysed by the tracing programme, and they are then taken through to PHE and JCB. We are looking at ways in which we can aggregate all that schools data into more specific tables. But until we do that, there is already a very large amount of data.

Baroness Warwick of Undercliffe Portrait Baroness Warwick of Undercliffe (Lab) [V]
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My Lords, my noble friend has pointed out that cases are substantially concentrated in school-aged children and young adults, who of course have not yet been vaccinated. Does the Minister agree that it was premature to announce last week that face coverings will no longer be required in secondary school classrooms and communal areas? Does he accept that this policy could drive an increase in infections in our unvaccinated children and young people, as well as in school staff, families and wider communities?

Lord Bethell Portrait Lord Bethell (Con)
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I share the noble Baroness’s concern, but I can reassure her on a couple of things. It is, I think, a real tribute to the hard work of parents, teachers and the pupils themselves that the infection rates in schools have been relatively contained, and certainly have not shown the same kinds of behaviours that they did in September of last year. But we remain extremely vigilant, for exactly the reasons the noble Baroness explained. On the question of face coverings, it is a very difficult balance to strike—they are intrusive and disruptive but, on the other hand, they are an effective way of minimising infection. It is an area that we keep a very close watch on.

Health and Social Care Update

Baroness Warwick of Undercliffe Excerpts
Monday 22nd March 2021

(1 year, 4 months ago)

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Lord Bethell Portrait Lord Bethell (Con)
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My Lords, I simply do not recognise the characterisation that the noble Baroness has just presented. The view of our treatment of the elderly and vulnerable taken by Amnesty during the pandemic is completely inappropriate and inaccurate. Huge steps have been taken to protect those who are vulnerable and elderly. I cannot think of a country that could have done more under the circumstances. I therefore reject its analysis.

Baroness Warwick of Undercliffe Portrait Baroness Warwick of Undercliffe (Lab) [V]
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My Lords, this is a Statement on health and social care. I am astonished that the Minister has confined the Government’s policy on adult social care following the pandemic to a couple of sentences. He must know that most of the adult social care in this country is provided by family carers. They are regularly ignored in such Statements, but many of the 6 million carers looking after vulnerable adults, including those with learning difficulties, have been pushed to breaking point by the pandemic. Is there nothing to say to them about access to support services or respite care and nothing on carer’s allowance? Without support for these essential carers, policies such as enhanced hospital discharge, as mentioned in the Statement, will not be feasible. What is the Government’s strategy for dealing with this crisis in care?

Lord Bethell Portrait Lord Bethell (Con)
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My Lords, I endorse completely the noble Baroness’s remarks that we depend on the generosity, public spirit and kindness of family carers who provide an enormous amount of support for their loved ones. Without them, the system could not possibly exist and the world would be a much graver place. I recognise that many carers have been pushed very hard by the pandemic. We have put a huge amount of resource into local authorities, which are responsible for providing support for those families, and that includes the kind of respite support that the noble Baroness has rightly pointed to. I am sure that more could be done and I would welcome any correspondence on this by way of follow-up that she would like to send my way.

Dentists: Covid-19

Baroness Warwick of Undercliffe Excerpts
Thursday 11th February 2021

(1 year, 6 months ago)

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Lord Bethell Portrait Lord Bethell (Con)
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My Lords, the noble Baroness is entirely right; ventilation is a key issue. I took my daughter to the dentist this morning, and there were indeed long gaps between each appointment. I am not aware of the ventilation system she alludes to, but if the BDA would like to write to me, I would be happy to have a closer look at it.

Baroness Warwick of Undercliffe Portrait Baroness Warwick of Undercliffe (Lab) [V]
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My Lords, can I follow up on the Minister’s point about the new activity target imposed on dentists to reduce the backlog? It seems to have had the reverse effect. It has resulted in one of the biggest dental chains in the country instructing its dentists to focus on band 1 check- ups and reduce urgent treatments to meet the targets, reducing access for those who need it most. Other practices are reported to be doing the same. What assessment have the Government made of the impact of this target on patients who need urgent and complex treatment? Dentists have continued working, like doctors, nurses and other health professionals, in a high-risk environment during the pandemic. But their contribution seems to have been ignored. Can the Minister confirm the Government’s appreciation of the commitment of dentists and their staff during this pandemic?

Lord Bethell Portrait Lord Bethell (Con)
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I join the noble Baroness in paying tribute to dentists. As of 18 December, 88% of NHS dental practices were open, and that is a huge tribute to the hard work, determination and skills of dentists. She is right that they offer a spread of services; more triaging is going on, and that has successfully made a big contribution to getting through the lists. As of 13 January, 6.9 million dental patients have been triaged on the AAA service—advice, analgesics and antibiotics—but urgent dental care centres, of which there are 695, have picked up the difficult and time-consuming work for those who have an emergency need.

Cannabis Oil

Baroness Warwick of Undercliffe Excerpts
Tuesday 12th January 2021

(1 year, 7 months ago)

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Lord Bethell Portrait Lord Bethell (Con)
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My Lords, I am grateful for the noble Baroness’s kind words, and I will indeed take that patient feedback back to the department. I reassure her that this is an area where patients have undoubtedly led the way, and clinicians have to catch up. In doing so, there will need to be a meeting of minds and regulation in areas that are open to patient interpretation. In that period, there will undoubtedly need to be compromises on all sides.

Baroness Warwick of Undercliffe Portrait Baroness Warwick of Undercliffe (Lab) [V]
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My Lords, the law changed over two years ago. The then Home Secretary said:

“We have now delivered on our promises … we will work with the NHS to help support specialists in making the right prescribing decisions.”


But they have not; it has been a hollow promise for terminal brain cancer sufferers such as my nephew. NHS doctors will not prescribe medical cannabis, and the BMA advises medics not to prescribe it, yet I understand that the UK is the largest producer of medical cannabis in the world. Just how many prescriptions have been issued for unlicensed cannabis medicines, other than those subject to randomised control trials, in the last 12 months?

Lord Bethell Portrait Lord Bethell (Con)
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My Lords, the noble Baroness is being a little unfair; Health Education England published a medicinal cannabis education package on 8 August 2019. But we cannot force clinicians to make prescriptions. That is not how the health service works. We need to work on clinical trials to put in place the correct authorisations and to give marketing authorisations for these important and promising drugs. That will require collaboration between government, the regulator and industry, and I call on industry to step up to that challenge.

Covid-19: Vaccinations

Baroness Warwick of Undercliffe Excerpts
Thursday 17th December 2020

(1 year, 8 months ago)

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Lord Bethell Portrait Lord Bethell (Con)
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My Lords, the mathematics done by the noble Lord are interesting but not quite a reflection of the strategy. It is undoubtedly true that the NHS is, wisely, taking the start of the deployment with great care. This is an extremely complex vaccine to deliver, but hospital hubs, local vaccination services and vaccination centres will be rolled out around the country. The kind of ambition that the noble Lord describes—quite rightly—is exactly what we seek to deliver; we will update the House as that deployment plan rolls out.

Baroness Warwick of Undercliffe Portrait Baroness Warwick of Undercliffe (Lab)
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My Lords, I want to urge early access to the vaccine for the terminally ill. On Tuesday, in response to my noble friend Lady Thornton, the Minister said that there was a powerful case but any further refinements to the priority list will “create profound operational challenges”. That is not a good enough answer for my nephew, Matthew Walton, who has stage 4 brain cancer. Surely his two young children should be able to spend their remaining time together without the additional threat of an early death, which could so easily be averted by a vaccine—unlike his cancer. Will the Minister please press this powerful case?

Lord Bethell Portrait Lord Bethell (Con)
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The noble Baroness makes the case extremely well; I pay tribute to her personal testimony. I looked into this matter after giving my answer to the question last week. I assure the noble Baroness that those who are terminally ill are, of course, clinically vulnerable by nature. We will ensure that those who are clinically vulnerable will get the vaccine when it is clinically appropriate to do so, which I hope brings her some reassurance.

Covid-19: People with Learning Difficulties and Autism

Baroness Warwick of Undercliffe Excerpts
Monday 5th October 2020

(1 year, 10 months ago)

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Lord Bethell Portrait Lord Bethell (Con)
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My Lords, the noble Baroness puts it extremely well, and it is an area we are deeply concerned about. We have commissioned Public Health England to carry out an analysis of the existing data on those who have suffered under Covid. We will be reviewing that data extremely carefully to understand the phenomenon more deeply. In the meantime, the Chancellor has announced £750 million to support the charity sector in response to the pandemic. Some of that money has been targeted specifically at charities that are supporting those with learning difficulties to ensure that they get the support that they need.

Baroness Warwick of Undercliffe Portrait Baroness Warwick of Undercliffe (Lab)
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My Lords, many families really struggled to get effective support or even to know where to go to find out what is available. I understand that evidence gathered by concerned charities like Carers UK and Carers Trust shows that many family carers have had no effective support or advice since the end of March, yet they look after some of the most vulnerable in our society. Will the Minister and his colleagues at the Department of Health and Social Care meet with these organisations to discuss what could be done to improve this very sad state of affairs?

Lord Bethell Portrait Lord Bethell (Con)
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My Lords, I would like to pay tribute to the work of the learning disability and autism advisory group for its social care task force. Its recommendations have informed the development of the social care winter plan, which provides specific provisions for those with learning disabilities and autism. I would be very glad to meet whichever groups the noble Baroness recommends, because this is an important issue that we care about immensely and are determined to get right.