Social Care Reform

Baroness Wheeler Excerpts

Tuesday 29th June 2021 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, in last week’s very powerful debate on social care, noble Lords from across the House made it clear that we cannot build a better future for our country after Covid-19 without transforming social care, but instead of a firm date for the Prime Minister’s clear plan, we had the usual reassurances from the Minister that it was still absolutely under way, we would see some social care foundations in integrated care systems under the NHS and care Bill but that it would still be the “end of the year” before the Prime Minister reveals his clear plan to all.

Over these nearly two wasted years we have had delays and broken promises. Almost 42,000 care home residents have died from Covid-19, 2 million people have applied for support but had their request refused, tens of thousands have had to sell their home to pay for care, millions of families have hit breaking point and staff have been appallingly let down. Even after all the horrors of this pandemic, nine out of 10 councils say that they face care budget cuts this year.

While the Government dither and cancel key meetings and the Prime Minister blocks various funding options, the social care funding crisis deepens. Now we see in the Daily Telegraph that the new Secretary of State considers that we are completely at the wrong stage of Parliament to launch a new social care strategy. What is going on?

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

My Lords, the commitment to publishing a review of social care is absolutely heartfelt. We have delivered on Brexit and the vaccines, and we will deliver on social care. The Prime Minister has made it crystal clear that that will be done by the end of the year; that commitment remains in place. It will require enormous financial commitment by the whole nation at a time when our finances as a nation are extremely stretched. Therefore, it is entirely right that very careful consideration is given to it. It will also involve a very large amount of engagement with other parties and the relevant stakeholders. Again, this is not something that has been rushed. We have just been through the most awful pandemic; it is not possible to do a review of this generational nature at the same time as fighting this awful disease, but we will be true to our commitments and deliver the plan as promised.

Social Care and the Role of Carers

Baroness Wheeler Excerpts

Thursday 24th June 2021 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, I too congratulate the noble Baroness, Lady Jolly, on securing this debate and on her usual very thorough and thoughtful introduction. Of course, it is deeply frustrating for us all to be yet again debating the ever-deepening crisis in social care in the absence of any sign of the Government living up to their promises of reform and “once and for all” change, in the words of the Prime Minister.

The excellent “national scandal” report of our Economic Affairs Committee was our last major debate on this vital issue and is still an authoritative source for this debate. The committee warned, and it is worth repeating, that:

“With each delay the level of unmet need in the system increases, the pressure on unpaid carers grows stronger, the supply of care providers diminishes and the strain on the care workforce continues.”


That is why it is so important for us all to keep up the pressure, as noble Lords have done this afternoon, hammering home the scale of the crisis and the substantial extra funding urgently needed. This must be sustainable long-term funding, not just the welcome but wholly inadequate plugging-the-hole periodic cash injections that Ministers trumpet at every opportunity as the solution to the deep crisis we are in.

I am also grateful to the noble Baroness, Lady Jolly, for specifying unpaid carers. As usual, her words were movingly reinforced by my noble friend Lady Pitkeathley and by almost every speaker; it is a most welcome and essential focus. They drew on the extensive surveys and reports produced by Carers UK for Carers Week. In these we heard from carers themselves on the huge challenges they have faced during the pandemic—not just the absence of essential breaks and respite but the impact on their own health and well-being and their worries about when the key daycare and other services, vital to the loved ones they care for, will come back.

Many routine but essential services came to a halt during the pandemic, as noble Lords have spelt out. For example, I am a carer and the excellent services at our local community centre—stroke clubs, memory clinics for people with dementia, community meals and support groups—show no sign of reopening until at least September. For carers of disabled people, people with learning difficulties and disabled children and their families, this daily or week-by-week support is so important. It is devastating when it is not there. It helps carers cope, gives them a chance to get on with the other things they have to do and, most important, helps to keep the person they are caring for well, active and engaged.

A longer break for carers and the cared-for is just as important. As Care England has said, respite care provided by many care homes has been withdrawn because of the 14-day isolation requirement. For younger adults with learning disabilities living at home with parents, a few days of respite every month or even week, or care home provision if the carer falls ill, is a key part of their care plan. It helps carers continue to cope. The Minister has promised us a meeting with Carers UK; I hope he is arranging it with the urgency it deserves. Can he please update us on the progress of the department of health and local authority talks and work he referred to last week to ensure that daycare centres and care services are reopened?

We know that the Minister’s response today will contain all the elements we are used to hearing about government funding support for carers, the care workforce and social care during the pandemic, and the now-familiar “later this year” promise of the social care reform proposals. But it is clear from today’s debate that, nearly two years after the Prime Minister’s Downing Street doorstep pledge, such is the despondency, scepticism and doubt about this latest deadline that it is almost not worth asking the Government how they are getting on with it—particularly with the recent press reports on cancelled meetings and the Prime Minister’s obdurate blocking of various funding options.

On the issue of cross-party consensus, raised by a number of speakers, rather than just his usual passing reference it is time for the Minister to explain today just what he means by this. To repeat for the record, we had cross-party consensus on the Care Act 2014 setting up the care cap on funding costs recommended by the Dilnot commission, the eligibility criteria for social care and many other important reforms, such as legal rights for carers to assessment and support. The consensus on the cap was there during the 2015 general election, councils were given lead-in preparation funding for implementation in April 2016, and £6 billion was allocated for care cap costs. But we know the rest of the story: delayed implementation and then cancellation —too costly—the £6 billion gone and huge sums of implementation funding just wasted.

The same cross-party consensus was reinforced in the “national scandal” report, as the chair of that committee, the noble Lord, Lord Forsyth, made clear in the previous debate. On these Benches we have strongly welcomed this report as a fully costed and solid basis for moving forward. It shows the scale of extra funding needed to break the cycle of chronic underfunding and unmet need, and to begin to address the unfairness and disparity in entitlement to care between the NHS and social care.

Many noble Lords have today again articulated the committee’s fundamental principles, which have the widespread support among the social care stakeholders and community that the Government say they want—for example, the top priority of restoring local authority funding for social care to 2010 pre-austerity levels; an end to councils’ dependence on locally raised funding for social care; a new £7 billion-a-year system for providing free personal care to help people with basic daily needs such as washing and dressing; and a major investment in a new deal for the social care workforce and joined-up workforce planning with the NHS. That is an excellent consensus on which to move forward, and the Minister knows it; it makes the current delays and dithering inexcusable.

On the vital issue of a new deal for social care staff, like all noble Lords I add my heartfelt tribute to them, not just for the pandemic but for the year-on-year dedication they have shown in the face of low pay and lack of public understanding and appreciation of the value of their work. They are a skilled profession and need and deserve the training, career and pay structures that properly reflect this. Raising the status and standing of care staff has to be a key part of social care transformation.

The positive signs of the impact that Covid has had on the public’s awareness and perceptions of care work are welcome. For example, the recent survey with care providers, stakeholders, care workers and candidates by the Work Foundation and Totaljobs reinforces this, showing an increase of 39% in people applying for social care roles in the last two years; younger candidates more likely to pursue a career in social work; and 56% of new starters in care joining from other sectors. This is promising, but these staff will stay in the profession for the medium and longer term only if there is fundamental reform to social care staff’s pay and professional status.

One of the key features of today’s debate has been the range of speeches across social care provision—I very much welcome this—not just on adult social care and the care of older people but on working-age disabled adults and children, people with learning difficulties and the importance of mental health social care, so often overlooked. This was referred to by my noble friend Lady Donaghy and the noble Baroness, Lady Barker.

The excellent briefing from the charity Rethink Mental Illness has been referred to in relation to the vital role that this should play in supporting people living with severe mental illness to help them to recover from hospital care, stay well and not go back into crisis. I hope that the Minister’s response will include reassurances that their needs will be included in social care reform. The parliamentary briefings that the seven leading charities representing working-age disabled people are organising for July will be very valuable in increasing our understanding of how social care should be working for this vital group. I hope that as many noble Lords as possible are able to attend.

During the debate, we were constantly reminded that half of local authority public social care funding is spent on working-age people and that local authorities also deliver children’s social care. This was so sharply brought into focus by the publication earlier this month of the first stage of the MacAlister independent review, which called for major reform and investment to ensure the effective protection of young people at risk. Alas, there is no time to debate this today, but we sadly see the same fragmented, disjointed system across multiple government departments and agencies, with the life chances of vulnerable children paying the price.

On residential care, noble Lords have rightly pressed the Minister on the issues that have so dominated our consideration of the SIs, Statements and Questions during the pandemic—on testing, PPE, hospital discharges to care homes, visitor access, indemnity insurance and occupancy guarantees. I look forward to hearing the Minister’s response on this, particularly on how care funding will be provided when the infection control fund ends at the end of this month.

We have had yet another powerful debate today. Noble Lords have made it clear that we cannot build a better future for our country after Covid-19 without transforming social care, and that real progress is needed now. If the press reports and rumours are correct and government focus is on reintroducing the care cap after all, five years after it could have started, this would address only part of the problem. It would not be the comprehensive plan for the reform and sustainable funding of social care that is so vitally needed.

I echo noble Lords’ good wishes to the noble Baroness, Lady Jolly, in her new role. My noble friend Lady Thornton and I have always enjoyed working with her, and we very much value her contribution and work.

Covid-19: Care Homes

Baroness Wheeler Excerpts

Thursday 17th June 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I completely sympathise with the point on those in care homes receiving a very tough challenge when they have been prevented from seeing loved ones. We have had to take extremely severe infection control measures, many of which are still in place for the reasons that have been discussed in this Chamber before. But I challenge the noble Lord’s point on testing. We brought in testing when asymptomatic infection was recognised and when the capacity was available.

[Baroness Wheeler (Lab)]

My Lords, can the Minister explain why the Secretary of State continues to justify himself by quoting the seriously underestimated PHE January to October 2020 data assessment on hospital discharges to care homes of 286 Covid deaths? The National Care Forum of care providers has repeatedly made clear how fundamentally flawed and incredibly partial that data is. Only limited numbers of symptomatic patients in hospitals and care homes were tested, and cases not tested before death are not included. Even the chair of the House of Commons Science and Technology Committee has said that relying on this for a full picture of the situation is a stretch of the imagination. We owe it to the people who have died, their relatives and care home providers to have full, accurate and independent information. How is the Minister going to ensure that it is urgently provided, so that we can genuinely learn from what happened?

[Lord Bethell (Con)]

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.

Carers: Support

Baroness Wheeler Excerpts

Thursday 10th June 2021 Lords Chamber

Asked by

[Baroness Wheeler]

To ask Her Majesty’s Government what steps they are taking to ensure that carers get the support and breaks they need.

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

My Lords, the love, commitment and sheer hard work of Britain’s unpaid carers have saved lives and made a huge difference to the country’s most vulnerable. The nation is hugely grateful. I completely recognise the impact the pandemic has had on access to support and breaks. Local authorities have an important responsibility to assess carers’ needs, and I pay tribute to the efforts of local authorities as we work together to reopen day and respite services.

[Baroness Wheeler (Lab)]

My Lords, I commend to the Minister Carers UK’s excellent 40-page report produced for Carers Week. In it, we hear from carers themselves, not just on the lack of essential breaks and respite but on caring during the pandemic, their own health and their worries about when key day care and other services vital to the loved ones they care for, and suspended during lockdown for over a year now, will be reinstated. If he reads the report carefully, he will see the reality of everyday life for thousands of carers. Funding given to councils during the pandemic has not been anywhere near enough for the vital role they have been expected to play, and the funding the Minister repeatedly refers to has simply not reached carers. How will the Government address this appalling situation and ensure that unpaid carers are given the funding and support they need and deserve?

[Lord Bethell (Con)]

My Lords, I too pay tribute to the Carers UK report. I read the very moving personal testimonies in that report and for that reason I took a call with Carers UK this morning in order to understand the recommendations it has made. There is an enormous amount to do. The practical role of the department is to work with local authorities to ensure that day centres and care services are reopened. There are massive infection control issues, but we are working extremely hard with local authorities to ensure that that reopening can happen quickly so that carers get the support they need.

Care Homes: Insurance Indemnity

Baroness Wheeler Excerpts

Wednesday 19th May 2021 Lords Chamber

[Lord Bethell (Con)]

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.

[Baroness Wheeler (Lab)]

My Lords, the Financial Times warned in January that care homes were having to turn away new patients as they struggled and failed to get liability insurance to cover Covid-related claims. There is also huge speculation that a flood of claims is coming as pre-existing claims management companies and many set up purely to deal with Covid-19 cases are vying for business for personal injury claims and compensation for the loss of a loved one. What assessment has the Minister made of the risk that Covid-related litigation poses to the sustainability of the whole social care sector?

[Lord Bethell (Con)]

My Lords, in the year from March 2020, the number of patients has in fact increased from 457,000 to 458,000. The CQC is monitoring the situation extremely closely and its data from the insurance industry suggests that, although there has been some pressure on some companies, there have also been new entrants and the amount of support available to the social care sector is resilient.

Social Care: Person-centred Dementia Care

Baroness Wheeler Excerpts

Monday 17th May 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I entirely agree with the extremely touching way the noble Lord put that. To take a glass-half-full approach for a moment, I have been struck in the pandemic by the huge amount of public support for the protection of those who are older and vulnerable, including those with dementia. It has been a very touching feature of the national response to the pandemic that the country has come together to protect the most vulnerable, and I think there has been a national rethink about how we relate to those in that condition.

[Baroness Wheeler (Lab)]

My Lords, we know that the costs for families of caring for those with dementia can be long-lasting and catastrophic, as the Commons Health and Social Care Committee has emphasised in setting up a new inquiry, and from our excellent Economic Affairs Committee report on social care, which found that the typical cost of an individual’s dementia care is £100,000. According to the Alzheimer’s Society, two-thirds of this cost is currently being paid for by people with dementia and their families, either in unpaid care or in paid-for private social care, in contrast to other conditions, such as heart disease and cancer, for which the NHS provides care free at the point of need. People with dementia should not bear the sole responsibility for saving and paying for their care. When will this Government address this key parity of esteem issue, end this disparity and protect people with dementia from the catastrophic costs of care?

[Lord Bethell (Con)]

My Lords, the Prime Minister has made it very clear that he is committed to bringing forward proposals to address this issue before the end of the year. He stands by that commitment. I look forward to the kind of cross-party and cross-society collaboration that will be necessary to address that massive generational challenge.

Care Home Occupancy Rate

Baroness Wheeler Excerpts

Wednesday 28th April 2021 Lords Chamber

[Lord Bethell (Con)]

The noble Baroness makes a good point. There is always a tension in having enough beds in care so that those who need somewhere to be supported are not sent to hospital, thereby occupying valuable beds that should be used for elective surgery or other more complex and important procedures. We are working closely with the CQC to ensure that the right strategies are in place to deal with that.

[Baroness Wheeler (Lab)]

The Minister knows we have continually raised our strong concerns about the financial stability of care homes. Now, the possibility of increased closures due to falling occupancy rates and the extra costs stemming from the pandemic have exacerbated the precarious situation the sector is in. With the downward trend in the registration of new care homes and the upward trend in closures, is not the resulting net reduction in the number of beds available deeply worrying at a time of known growth in the need for social care provision for older people? Can the Minister reassure the House that in the Queen’s Speech we will, at last, find out about the Prime Minister’s plans for how he is going to fix all this and what is going to be done to deliver long-term funding and sustainability for the social care sector?

[Lord Bethell (Con)]

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.

Care Homes: Guidance

Baroness Wheeler Excerpts

Wednesday 21st April 2021 Lords Chamber

[Baroness Wheeler (Lab)]

Can the Minister explain why the visiting out guidance is not aligned with the road map for the national lockdown? Is there not a gaping discrepancy between the advice for care home residents, who are advised to keep the number of contacts to a minimum, and the advice for care workers, who can go to the hairdresser’s, sit outside a pub, meet up in groups of six and then go back into a care home to provide personal care?

[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.

Botulinum Toxin and Cosmetic Fillers (Children) Bill

Baroness Wheeler Excerpts

2nd reading
Friday 16th April 2021 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, I too congratulate the noble Baroness, Lady Wyld, on sponsoring the Bill and on her excellent introductory speech, which clearly set out the overwhelming need for urgent and longer-term action to bring the regulation of botulinum cosmetic fillers for under-18s in line with other appearance-related procedures, such as tattoos and sunbed use, for which there is already a statutory minimum age of 18. This is what we know the public would expect and, as we have heard, mostly assume we already have.

Like other noble Lords I was shocked to realise that this crucial area is as unregulated as it is and that in 2018 an estimated 100,000 under-16s underwent cosmetic enhancements. It is also important to note that Sir Bruce Keogh’s 2013 review was also shocked, and that shock was reinforced by the 2017 Nuffield Council on Bioethics review, which highlighted major safety concerns. Everybody has been shocked ever since then, but now we are at last able to begin the process of remedying this deeply worrying situation,

Progress is obviously due to the tireless work and determination of Laura Trott MP in the Commons and the Bill’s many supporters, in particular the co-chairs of the All-Party Group on Beauty, Aesthetics and Wellbeing, Carolyn Harris MP and Judith Cummins MP. They have highlighted the lack of age restrictions for these procedures and concerns about advertising and social media promotion that leave young people at risk. The APPG’s inquiry is ongoing and has brought together people from across the sector to talk about the lack of robust, consistent and enforceable standards. It is a tribute to the cross-party work that has taken place across both Houses on these vital issues, and when it reports it will be a valuable tool to build on the initial measures in the Bill.

Like other noble Lords, I pay tribute to the pioneering Save Face charity for its campaigning and awareness-raising, its voluntary register and its work to build the necessary standards and safeguards through its accreditation with the Professional Standards Authority for Health and Social Care.

The Bill is an important step forward and fully supported by Labour. It is welcome because it prohibits specific procedures being performed on young people under the age of 18, except under the direction of a registered health professional, and prevents businesses arranging or performing procedures on under-18s on their premises. Most importantly, its provisions do not affect the vital medical use of Botox or fillers by appropriately qualified medical practitioners, such as Botox treatment for conditions such as Bell’s palsy, which will remain available where there is an assessed need.

During the course of the Bill and in today’s speeches we have heard about the horrific consequences for vulnerable young people when procedures go wrong, including the worst-case scenarios of infection, permanent scarring and tissue death, as well as serious psychological and mental health problems for young people whose lives have been seriously impacted by botched procedures undertaken by unqualified and improperly trained staff who bear no responsibility or accountability when malpractice occurs.

As the British College of Aesthetic Medicine stresses:

“Dermal fillers in particular are plain dangerous in the wrong hands”.


Its call for

“a wider regulatory regime, which supports controlled access to prescription medicines, and which differentiates aesthetic medicine from beauty therapists, spas and salons”

is the vital work that will need to follow from the Bill.

Noble Lords, especially the noble Baroness, Lady Bull, have spoken movingly of the pressure on young people to conform to the body images they see around them, especially on social media, which holds so much power over today’s youth and is flooded with adverts for treatments claiming to make them look younger, thinner and prettier. The Childline, Mental Health Foundation, YoungMinds and Save Face surveys all show an alarming picture of the impact of all this on young people’s sense of self-worth and their physical and mental health. The thousands of young people who view procedures such as lip fillers as easy, temporary and comparable to getting a haircut or manicure are deeply concerning when the results can have a profound and extensive impact on so many lives.

Under Clause 4, there are significant new responsibilities for local authorities to reinforce the provisions of the Bill using their powers available under Schedule 5 to the Consumer Protection Act, which we welcome as local councils are best placed to monitor local businesses and developments. The Explanatory Notes to the Bill acknowledge that it may result in an increase in revenue support under the Local Government Finance Act 1988, and the Commons has agreed a money resolution to give effect to any decision on this. Noble Lords have expressed serious concerns, which we echo, about what new money will be made available to local authorities to meet these responsibilities in the light of the huge funding cuts they have faced in the past decade. Can the Minister reassure the House that new money will be made available to implement the provisions of the Bill? Without additional funding it is hard to see what local authorities will actually be able to achieve.

I also seek clarification about the scope of the Bill. As I understand it, the Bill applies only to procedures carried out in England, reflecting the fact that public health is devolved. In so doing, it amends the Consumer Rights Act and the Human Medicines Regulations 2012, both of which have wider England and Wales or UK territorial scope. The Human Medicines Regulations also cover Northern Ireland. I would be grateful if the Minister or the noble Baroness, Lady Wyld, could confirm whether this would be solely for the purpose of making consequential amendments and what work and consultation with appropriate devolved bodies is envisaged in this respect.

As we have said, the Bill is a welcome first step to address the growing threat of unregulated cosmetic treatments to young people’s mental and physical well-being, but it is just that: a start which lays the groundwork for future change. We strongly support the Bill and look forward to the Minister’s response to noble Lords’ questions on how its provisions are to be taken forward, the timescales for implementation, the proposals for the review of regulations and guidance that has been spoken about, and the next steps that need to be taken to ensure effective future monitoring and regulation.

Crohn’s Disease and Ulcerative Colitis

Baroness Wheeler Excerpts

Thursday 15th April 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I agree with the noble Baroness. A lot of late diagnoses are caused by the kind of delicacy the noble Baroness refers to. My noble friend talked about the challenge of diagnosis, which is made more complex by patients finding a lot of these subjects extremely delicate. The approach taken in primary care to handling such delicate issues has improved dramatically over the years. We are working with GPs and clinicians to make their bedside manner more delicate, so that they are able to broach such delicate issues more sensitively. That, I believe, is at the heart of the problem.

[Baroness Wheeler (Lab)]

My Lords, Covid-19 has widened the huge cracks in the quality of IBD care, with patients facing even longer waits for elective care, surgery, investigations and a personalised care and support plan to support their daily lives. Surveys have shown nearly one in five IBD patients have suffered a flare-up crisis during the pandemic because they were unable to obtain specialist advice. We know that many have had to continue shielding because Crohn’s disease compromises the immune system and they have to wait for their two vaccines. What recognition and support of their particular care needs is being given at primary care and community level?

[Lord Bethell (Con)]

I completely sympathise with all those with IBD and associated conditions. The situation the noble Baroness described is exactly right and it is extremely challenging. I have particular concern for those shielding for a very long period, although I hope many of them will not be waiting long for their second vaccine. Those with all conditions have endured some waits because of Covid, but the NHS is working incredibly hard on the catch-up. Huge progress has already been made and there is a massive focus on diagnosis in particular, to ensure that we catch up with all those presenting with problems who need diagnoses.