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.

Folic Acid

Baroness Wheeler Excerpts

Tuesday 23rd March 2021 Lords Chamber

[Lord Bethell (Con)]

The noble Baroness’s figures are not quite the same as the ones I have in front of me. The mandatory fortification of bread flour with folic acid in Australia resulted in a 14.4% overall decrease in NTDs—although that is still a really important number, and if we are running at 1,000 a year in the UK, 50% of which are due to unplanned pregnancies, there are clearly important grounds for this measure to be considered seriously.

[Baroness Wheeler (Lab)]

My Lords, last year, a year after the consultation deadline closed, the Minister repeated his promise that, despite seriously delayed government decision-making, major efforts were being made to step up the raising of awareness of the importance of taking folic acid supplements, particularly among at-risk groups such as Afro-Caribbean women and women under 20. Can the Minister tell the House what actions have been taken? What measurable impact has awareness raising had among these at-risk groups and on ensuring that women whose pregnancies are unplanned—as we have heard—are not missing out on these vital nutrients in the early stages of their pregnancy?

[Lord Bethell (Con)]

I am grateful to the noble Baroness for reminding me of my words on that matter. I will endeavour to find an answer to her very particular question. I worry that the very large amount of engagement we have had to do on Covid, particularly around marketing, has drowned out some of the messages that we have put through to people on these very specialist issues. I will find out from the department what progress has been made and will be glad to update her.

Osteoporosis: Treatment

Baroness Wheeler Excerpts

Tuesday 9th February 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, the CMO has recently issued new guidance on the consumption of vitamin D and there has been widespread discussion about its dosage level. My understanding is that we are leaving the matter at that for the moment. I am not aware that the mandatory application of vitamin D to food is on the runway at the moment, but I am happy to check that point and write to the noble Baroness.

[Baroness Wheeler (Lab)]

My Lords, your Lordships’ House recently discussed the importance of medical research and government financial support for the fundraising and work of key charities on new brain tumour research treatments. With an estimated 3.5 million people aged over 50 currently affected by osteoporosis, many suffering chronic pain and disability, research on this is also vital. What resources does the NHS currently spend on osteoporosis research? Will the Minister undertake to consider the financial support, including match funding, that the Government can provide to the Royal Osteoporosis Society’s newly launched research academy and its potentially game-changing road map, which charts the key steps for researching a cure for this extremely debilitating disease?

[Lord Bethell (Con)]

My Lords, I do not have the figures for the precise amount that the Government spend on osteoporosis research at the moment, but I am happy to write to the noble Baroness with them if they are available. We are enormously grateful to the Royal Osteoporosis Society for its contribution to medical research. I can confirm that it has received a grant of £258,000 to support important work providing support for the vulnerable during the pandemic. That comes out of the package of £750 million that the Chancellor of the Exchequer announced to support the charity and voluntary sector during the Covid pandemic.

Hotel Quarantine for Travellers

Baroness Wheeler Excerpts

Wednesday 3rd February 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I share the noble Lord’s pride in that measure and concern that we extend a warm hand of friendship to those from Hong Kong. He raises the point extremely well. I would like to think that any system we put in place would be resilient to surge demand of the kind he indicates, but I will take his point back to the department and check that everything is being done accordingly.

[Baroness Wheeler (Lab) [V]]

My Lords, UK borders have knowingly been left open and potentially exposed people to new strains of the virus, rather than the implementation of the prompt, concerted action advised by SAGE and a comprehensive hotel quarantine system brought in for all UK arrivals. Does the Minister accept that the current 10-day self-isolation system has failed? If so, why is the policy still being pursued for the majority of travellers? We have been promised that hotel quarantine will be implemented for some countries as soon as possible, with some reports suggesting that this will not be enforced until the week of 15 February. Can the Minister confirm whether this is the target date? Will additional measures be in place for travellers from the red list of countries in the interim? Finally, does he accept that a partial quarantine is doomed to fail, given that global travellers may move across many countries during their journey, passing through multiple travel hubs and departure lounges while encountering and spending time close to many other travellers along the way?

[Lord Bethell (Con)]

My Lords, I acknowledge the detailed and perfectly reasonable questions raised by the noble Baroness, but I am unable to answer them all in detail. A Statement will be forthcoming from the Government on exactly those questions. I remind her that travel has come down by 90% in a comparative period. She is entirely right that travel patterns are complex; any measures we put in place will recognise that many travellers leapfrog from one country to another, brushing against others, and that the spread of the virus cannot be narrowly contained to travel corridors in the way one would sometimes like to hope.

International Year of Health and Care Workers

Baroness Wheeler Excerpts

Monday 1st February 2021 Lords Chamber

[Lord Bethell (Con)]

I take this opportunity to confirm to the noble Baroness that all NHS staff qualify for the vaccine. I would be very grateful if she could communicate to me any incidents where an NHS trust has said otherwise. We are enormously grateful in this country to all those who migrate to support our social care services. We are profoundly grateful for those efforts, and I want to ensure that everyone is treated well in their workplace. Generally, those in the social care workplace are treated well; there are exceptions, and we crack down on those exceptions extremely hard.

[Baroness Wheeler (Lab)]

My Lords, I express our strong support for the WHO statement in recognition of the selfless dedication of health and social care staff to providing care during and despite Covid-19. Following on from the comments of my noble friend Lady Pitkeathley, the WHO statement draws attention to the importance of workforce readiness, education and learning to manage the pandemic and its consequences. Will the Minister explain how the Government are ensuring that both health and social care staff on the front line of social care—particularly care staff, providing vital domiciliary care in the home and in the community—are being given this key support?

[Lord Bethell (Con)]

The noble Baroness is right. Those involved in domiciliary care, particularly part-time, make an extremely important contribution. We are naturally concerned about how they are contracted and their educational needs supported. We would like to think more about how part-time domiciliary care staff in particular, who make such a valuable contribution, can be further supported.

Social Care Funding (EAC Report)

Baroness Wheeler Excerpts

Thursday 28th January 2021 Grand Committee

[Baroness Wheeler (Lab)]

My Lords, I too congratulate the committee on its excellent report. We have waited a long time for this debate and, of course, for the Prime Minister’s ready plan for social care that he said he had when he took up office 18 months ago, just after the report was published. I also thank the noble Lord, Lord Forsyth, for his strong advocacy and efforts to keep the report alive and kicking, his continued pressure on Ministers on the need for urgent and long-term action, and his pushing for this debate.

Noble Lords have stressed the devastating impact of Covid-19 on social care. As October’s annual CQC State of Care report said:

“Social care’s longstanding need for reform, investment and workforce planning has been thrown into stark relief by the pandemic”,


thrusting a long-recognised crisis into public consciousness and, with it, awareness of the quality of care, unmet needs, the pay and conditions of social care staff and the lack of co-ordination between NHS and care providers. Age UK has described the “battering” of the social care system from Covid 19, which it was in no position to receive. It stresses that social care staff and the services they deliver are being stretched appallingly thin, with older and disabled people and their families left to pay the price.

Noble Lords have today brought their expertise and experience to the range of issues covered by the report in respect of both Covid-19’s impact and what needs to be done to address the current crisis and build a long-term, sustainable social care system. I want mostly to reinforce some of the issues raised about domiciliary and residential care. Let me first stress our strong support for the report. Eighteen months on from its publication, it remains a solid basis and stepping-stone for moving forward and breaking the cycle of chronic underfunding of social care, of unmet need and of the unfairness and disparity in entitlement to care in the NHS and the adult social care system.

The fundamental principles espoused by the committee have widespread support among the social care stakeholders and community: funding social care largely from general taxation; the top priority of restoring local authority funding for social care to 2010 pre-austerity levels; ending councils’ dependence on locally-raised financing for social care; a new, £7 billion-a-year system for providing free personal care to help people with basic daily needs; and major investment in a new deal for the social care workforce and joined-up workforce planning with the NHS.

Most of all, the report plays a vital role in setting out the scale of the funding required, based on Health Foundation, King’s Fund and ADASS research, just to begin to address current and unmet need and future demand. We have heard the figures repeated this afternoon: £1.5 billion extra this year to maintain the levels of service provision of five years ago and £2.4 billion extra to local authorities just to stop the funding gap from widening even further. The Minister well knows this, so I hope that his response will not just restate the Government’s cash injections into the social care system. Extra cash is always welcome but, to emphasise, periodic cash injections, announced mostly during a crisis and too late, buy only a few months of shoring up already fragile services.

Proper funding and support for domiciliary care must be an essential part of a sustainable system. It is social care’s front line, and its scale and reach are often not widely recognised. If residential care during the pandemic played a grim catch-up to NHS services, then domiciliary care was often an afterthought even to care homes. Its dedicated, low-paid care workers, nearly 700,000 of them in England, visit people’s homes daily, moving from client to client and providing a vital link with the outside world on which they depend, particularly if clients are without family or carer support and especially during the pandemic when most have been unable to leave their homes, or their daycare or support clubs, while community services have been shut down. As a carer myself, regularly in touch with many local carers, I fully support the committee’s recognition of the huge further burden that underfunding of services has placed on unpaid carers.

As with residential care, during the pandemic there have been widespread reports of desperate agency care managers ringing around to try to get the PPE they need. Government recognition and funding are needed to cover the extra costs involved in this, as well as the staff shortages and absences arising from a combination of positive Covid cases following PCR testing, self-isolation following contract tracing, shielding and childcare responsibilities. What additional funding has been provided specifically for domiciliary care, PPE, testing and additional staffing costs in 2020? ADASS estimates that an additional £480 million funding is needed in England now to increase the provision of care at home for older and disabled people so they can live independently, with good care, and be kept out of hospital.

On the key issue of free personal care noble Lords, including my noble and good friend Lord Lipsey, will be well aware that we have long advocated it as a basic entitlement for people with substantial and critical levels of need for help with washing, toileting and other daily living needs that will enable them to live safe, independent lives in the community. We applaud the committee’s recommendation on this vital issue. As it points out, free personal care is fair and better aligned with NHS entitlement than the current system, and it would help keep people more mobile and active in the community rather than needing residential or hospital care.

In England, more than 350,000 older people are currently estimated to use home care services, 257,000 of whom have their care paid for by their local council. The United Kingdom Homecare Association estimates that 249 million hours of home care are delivered each year. It is a service which a further 1.6 million older people should receive but do not, because they do not meet current eligibility criteria or there is just not the funding for it. Does the Minister acknowledge that the domiciliary care service needs urgently to be substantially expanded to meet current and future demand?

We know that there has been deep concern about the Care Act easements arising from the Coronavirus Act during the pandemic. Seven councils used this provision in the first wave, mainly to relieve them of duties to carry out care and financial assessments and care planning reviews and visits. The CQC website has not been updated since last July, so can the Minster tell us whether any further councils have used the easement during the second wave? Will the Government provide a full breakdown of the services or activities affected by them? Age UK’s November survey showed that one in seven of those receiving care before the pandemic have since seen a reduction in their care; that is, 210,000 people either receiving less care or no longer receiving any.

On residential care, the Minister is on record as saying that he sees nothing wrong with the current business model, yet he will know that one of the “big four” independent care home providers, Four Seasons, is riddled with some £50 million worth of debt and that, in any event, the big four—the others being HC-One, BUPA and Barchester—cover only around 15% of the overall market. The bulk of England’s 15,600 residential homes are small, privately owned or voluntary sector-run. Although LaingBuisson reports that no home closures were triggered by Covid-19 through the first lockdown, occupancy fell by 8%. Care England has referred to occupancy rates as “historically low”. As the property agency Knight Frank predicts, small, older care homes will be most affected, as they will find it harder to cope with this. Moreover, of more than 6,500 care homes which have 40 beds or fewer, half do not have facilities to support care during a pandemic. Future care home design will need to provide wider corridors to enable social distancing, larger rooms with full en suite and wet-room facilities as standard to promote residents’ safety and isolation, adapted fixtures and fittings to limit touch points, and safer, more separate visitor areas with enhanced communication systems.

The report strongly underlines the unsustainability of the current system of residential care, particularly fears that the number of publicly-funded care places will decline if care homes are driven to market just to self-funders because councils are unable to meet the real costs of providing care. Does the Minister agree that any future model for residential care will be sustainable only if councils are adequately funded to meet the full costs of care?

The actions proposed in this report enjoy widespread support, as today’s debate and the submissions from key stakeholders have clearly demonstrated. As a starting point, it sets out fully-costed proposals that would begin to restore social care funding to pre-austerity levels, ensure that local government was fully funded for providing care, and address the truly urgent need for people to get free personal care support to meet essential daily living needs. Noble Lords have commended the recognition that a new deal is desperately needed for health and social care staff. That is surely no longer in doubt for anyone who has seen their selfless, remarkable and dedicated response to the pandemic.

Health: Brain Tumours

Baroness Wheeler Excerpts

Tuesday 19th January 2021 Lords Chamber

[Lord Bethell (Con)]

My noble friend alludes to a situation that is grave and concerning. Hundreds of millions of pounds have disappeared from medical research charity income, particularly through the closure of second-hand clothes shops, which provide an enormous amount of income for British medical research. I pay tribute to the massive contribution of medical research charities in trying to move forward the science of medical research. This is an area we are deeply concerned about, and colleagues at BEIS and the Treasury are actively engaged with it. My noble friend is right that this a knotty situation to solve that we need to look at very carefully indeed.

[Baroness Wheeler (Lab) [V]]

My Lords, I was very privileged to be present in the Chamber when my noble friend Lady Jowell made her plea to improve brain tumour treatment, research and survival. The work since her death of the Tessa Jowell Brain Cancer Mission, referred to by the Minister and other noble Lords, on the new national strategy has been inspirational. The mission has developed clear practical steps and pathways to build the quality, quantity and diversity of research that the UK needs, such as addressing delays in opening clinical studies, programmes to train the UK’s first generation of brain tumour-specific positions, and dedicated brain tumour centres. What steps are the Government taking to make sure that the NIHR, the MRC and the UKRI work together to ensure that the progress we need comes about? What will happen to the NIHR funding money put aside for brain tumour research in 2018 that remains unallocated at the end of the five-year window announced three years ago?

[Lord Bethell (Con)]

My Lords, I also pay tribute to the Tessa Jowell Brain Cancer Mission and all its work in putting together a really thoughtful strategy for tackling this most difficult issue. NIHR cancer research expenditure has risen from £101 million in 2010 to £138 million in 2019-20, and its settlement in the recent spending review was generous. I am optimistic that there are more resources there. I reassure the noble Baroness that, although the £40 million for brain tumour research has not all been allocated yet, it is not going anywhere and we are working as hard as possible to ensure that the right kinds of research project are put forward for that money. I would like to see it allocated as soon as possible.