Covid-19: Social Care Services
Baroness Wheeler Excerpts(5 years, 8 months ago)
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Baroness Wheeler
That the Virtual Proceedings do consider the short- and long-term impact of Her Majesty’s Government’s approach to the COVID-19 pandemic on the provision and delivery of social and domiciliary care for disabled and vulnerable adults and children, and the case for ensuring the sustainability of social care services.
Baroness Wheeler (Lab)
My Lords, I will start today’s important debate in the way I know noble Lords from across the House will want me to: by recording our deep sadness and regret for the loss of the now 19,609 people across the UK who are known to have died from this terrible disease in hospitals, care homes and their own homes. We know that the true figure, due to delays in recording and reporting, is likely to be considerably higher. Our sympathy and thoughts are with their families, friends and the people who will have cared for them: relatives, NHS and social and community care staff. As a dedicated care manager in a small Nottinghamshire home, where deaths to suspected Covid-19 had reached a total of nine residents—a third of the people under her care—put it, she thought of them as “family”. “It’s just soul destroying,” she said, adding:
“We have deaths normally, but they are good deaths with their family around them.”
As the weeks go on, Parliament will rightly focus on the continuing fight across health and social care to halt the spread of the disease and on the care of patients and staff currently suffering from it. Staff across these services have been putting their lives on the line, and sadly we see reports that over 100 have now died as a result of this dedication. Our thoughts are also with their families, friends and colleagues, and of course we are for ever grateful to all our NHS and social care staff, who are working tirelessly to help us deal with the crisis.
Today’s debate is the time to take a hard look at the short and long-term impact of Covid-19 on social care. It is vital to continue to step up the pressure on the Government to deliver on what have too often, sadly, been woefully inadequate and seriously belated promises and actions on social care. We also need to take stock and identify what the current social care response to this pandemic tells us about how a similar crisis must be handled in the future, and how, in the years to come, social care is organised, funded, delivered and staffed, and properly mainstreamed into our health and care system.
We know that there is widespread frustration and dismay in the social care sector that once again it has been a plan-B afterthought. The Government’s social care plan was finally published last week, five weeks after the plan for the NHS. From the outset, Labour has made it clear that we want the Government to succeed in dealing with this huge crisis and we have pledged to work constructively with them. But we have also made it clear that we will challenge where there are mistakes that can be put right and where we think something is not happening that needs to, and we will closely scrutinise the decisions made. It was in that spirit of constructive engagement that we fully co-operated with the Covid-19 Bill before the Recess, and in which we want today’s debate to be framed.
In the same vein, we have repeatedly called for urgent action on the supply and delivery of personal protection equipment and for the testing of all NHS and social care staff for the virus, and we have proposed ways that will help to turn the situation round. Last weekend’s Public Health England announcement, changing guidelines on the need for full-length protective gowns for doctors and nurses treating Covid-19 patients because supplies were due to run out, has just added to the despair felt by staff in the NHS and social care over not having the essential equipment that they need to keep patients and themselves safe. Being told to reuse equipment, or not to waste it, and the stop-start big announcements of targets or shipments on their way just decreases morale still further and makes the situation even worse.
On care homes and domiciliary services, even the most ardent of cheerleaders for the Government, such as the Daily Telegraph and the Daily Mail, have recognised and been highly critical of the chaos surrounding testing and PPE. Key charities—the Alzheimer’s Society, Marie Curie, Care England and Age UK—have talked about the “devastation” in the care system, with the lack of testing and PPE meaning that staff are putting their lives at risk while also carrying the virus to vulnerable groups.
On 16 April, ADAS—the Association of Directors of Adult Social Services—summed up the PPE situation as “shambolic”, with early PPE drops in the care sector “paltry” and more recent deliveries “haphazard”, with “confusion and additional workload” resulting from the mixed messages and poor communications between the two key government departments: local government and health. We know that care home managers have been desperately driving miles around trying to buy masks, gloves, gowns and other vital PPE to try to halt the spread of the disease in care homes, with many staff making their own masks or having to use the same masks and other items all day. All this involves huge extra costs for care homes. The care provider MHA, for example, had to purchase 200,000 masks at five times the usual cost.
Full PPE is just as important to staff in care homes nursing residents with suspected Covid-19 as it is in hospital and NHS care settings. It is also vital if families are to be allowed into care homes to be with their very ill or dying loved ones. The recent change in government guidance on this is very welcome, but it can happen only if homes have full PPE, testing and other important procedures in place to protect staff, residents and their relatives. Can the Minister now provide an exact date by which all those working in social care will have the continual, adequate supply of PPE of the required standard so that they can do their jobs in safety?
From the outset, care homes have underlined that patients should be transferred from hospital only after they have been Covid-19 tested, but this essential requirement was not in the original guidance and has not been followed in many areas. Can the Minister confirm that new guidance will be issued on this very basic requirement, with accompanying levels of PPE? Will care homes and care home providers be refunded the full and crippling extra costs for PPE, including covering the spiralling prices which the shortages have led to? We know that residential care is in a precarious financial state, with many homes facing closure, and that the UK Homecare Association fears that financial pressures resulting from Covid-19 could force a significant number of the UK’s 8,000 home care providers to close within weeks.
On funding, the Government have rightly said that the NHS will get whatever resources it needs to deal with the Covid-19 pandemic. Can the Minister categorically state that this also applies to social care? This means covering the extra costs not just of PPE but of staffing in care homes and home care to pay for increased staff, staff sickness and vacancies, and other care costs.
On testing, Labour has strongly stressed the urgent need for testing of patients and staff in care homes, and for a clear and detailed plan on how this is to be actioned and achieved. Not testing new or returning residents, for example, risks contaminating care homes where elderly and vulnerable people are supposed to be “shielded”—a policy described by care home providers as
“importing death into care homes.”
New testing for all residents with symptoms and for all those being transferred into homes has been announced. Can the Minister tell the House how and where those who have tested positive will be effectively isolated? Will extra resources be provided to care homes for this? Since the lockdown began, care homes have sealed themselves off, banning visitors and introducing social distancing for staff and residents, but caring for Covid-19 residents is staff-intensive, requiring barrier nursing of residents in single rooms.
In home care, which is widely acknowledged to be the most fragile part of the social care system, Covid-19 presents a particular challenge for care workers who visit multiple clients a day, every day, in their homes. Routine testing and access to PPE are essential. With no centralised record of the numbers of people needing support, there are fears that people might be left without care or even dying alone at home without care. What action have the Government taken to prevent this happening?
A detailed plan is also needed for how and when the Government will test all the 1.4 million front-line social care staff, to include domiciliary home care staff and staff working as personal assistants, who are doing a vital job of looking after disabled and mentally ill people in their homes through direct payments. Only 505 social care staff have so far been tested. How will this number be escalated to meet the needs? Can testing centres cope with the proposed volume of testing? What plans are there for providing testing arrangements locally for staff who cannot drive or do not have time to drive the often very long distances involved? What will the criteria be for social care staff being eligible if, for example, they do not have symptoms but have been in contact with someone who has tested positive for Covid-19?
Under the emergency Covid-19 Bill, there was deep consternation and fear across the House that the temporary suspension of rights under the Care Act 2014 on care and carer assessments, eligibility and care packages would result in care standards being lowered or even ended, putting disabled and vulnerable adults and children at risk.
As a carer of a 75 year-old stroke recover, I know how much carers depend on vital social care support in the home and the community and many carers have spoken to me about their concerns. Can the Minister tell the House what national monitoring arrangements and oversight mechanisms have been put in place to keep this situation under close review? Does he have any national data on the number of councils that have had to revise existing care packages and arrangements in the light of Covid-19?
For the future, Labour’s new leader, Sir Keir Starmer, this weekend called for a new settlement for social care: an ambition for society that puts dignity and respect at the heart of how we care for the most vulnerable, and how we properly reward our key health and social care workers and repay the debt we owe to all those who have sacrificed so much during the Covid-19 crisis.
We must learn from the current crisis about how social care should be valued, resourced and delivered in the future. Under Covid-19, the broken care system is at least getting some of the long-overdue attention it needs and deserves. Surely the public cannot be in any doubt any longer about how essential it is. Treating social care needs as secondary to NHS needs has almost become a default system for the sector. As so often in the past, the current crisis sees yet again stakeholders, staff and charities warning the Government that older people’s lives are not worthless and that care home staff are not second-class carers. This is the reality of how the sector has had to struggle for recognition and funding.
I hope the Minister will reassure the House that the Government now recognise that we must have proper planning for pandemics on the scale of Covid-19, a system that goes across health and social care, for the future. Clear responsibilities must be given to the key NHS, social care and public health lead agencies and, as used to happen in the past, sufficient stockpiles of protection and testing equipment must be regularly monitored and updated. We have now seen all too well that this is not money wasted, to be first in line for austerity cuts or dumping in favour of no-deal Brexit planning. Integrated data across health and social care which accurately reflects what is happening on the ground is a key requirement for any future plan.
Secondly, we have to address the overall health and social care structure. The commissioning, duplication and bureaucracy of the Lansley NHS structure, the fragmented multi-provider structure of residential, home and community care and the precarious method of funding have to be addressed if we are ever to have fully integrated care. As we have learned from this pandemic, public health provision and planning needs to be across health and social care.
Thirdly, local authorities must be properly resourced for the social care duties they undertake under the Care Act. We know that £7.7 billion has been cut from council budgets since 2010. Of the £2.9 billion welcome extra funding for councils for Covid-19, only 10% of the initial £1.6 billion was allocated to social care. The additional money, however welcome, allocated to a desperately underfunded service which was in crisis before the pandemic, barely touches the cash crisis that social care faces.
Fourthly, we must treat staff with the respect that they deserve as the professionals they are. Home and domiciliary care pay rates do not match those of NHS staff, who themselves do not receive the pay which reflects the vital work they do. Some 1.4 million people work in the social care sector. Care workers are often employed by agencies on zero-hours contracts. It is hardly surprising that, even before the Covid-19 outbreak, there were 122,000 care worker vacancies and that annual staff turnover is 30%. More than one-third of care home staff are currently believed to be off work or self-isolating.
Finally, future social care planning has to include basic personal care support in people’s homes for those in need, including the 1.4 million older people that Age UK has identified who need help with washing, dressing and going to the toilet that they currently do not get. This is why Labour strongly supports a national care service and we know that the Lords Economic Affairs Committee rightly supports this, too.
I am so grateful that so many noble Lords are contributing today, covering many issues that I just have not had time to cover. In conclusion, the coronavirus pandemic has brought the deep crisis in social care to the fore. We no longer live in a society where social care can be delivered on a shoestring budget, under a system routinely starved of funding that relies on periodic cash boosts to prop it up and save it from total collapse, and in which care workers are overworked, undervalued and underpaid. In other words, we cannot just applaud the front-line workers every Thursday and then go back to business as usual. I beg to move.
Baroness Wheeler
My Lords, I thank all noble Lords who have participated in this excellent and powerful debate. I thank the Minister for his thoughtful response, but however thoughtful it was it is clear that many questions remain unanswered and that we will need to ensure that they continue to the brought to the fore and be dealt with by the Government in future Questions, Statements, debates and legislation.
Noble Lords have stressed the need to be open and honest about the challenges that social care faces and about the good and bad news. I am sure the Minister will take that message to heart. Despite the challenges, I want to stress that it is truly heartening to know that this terrible disease has at least been a wake-up call for the Government and the public about the importance of adequate social care for millions of adults and children in need of it and about the value, respect and decent pay that the 1.4 million staff deserve and must be given.
The Deputy Speaker (Baroness McIntosh of Hudnall) (Lab)
My Lords, it is a privilege to be the first—I think—to put the question in a virtual Chamber that this Motion be agreed.
Covid-19: Care Home Deaths
Baroness Wheeler Excerpts(5 years, 8 months ago)
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Baroness Wheeler
To ask Her Majesty’s Government what assessment they have made of the analysis by Care England which suggests that there have been significantly more deaths caused by Covid-19 in care homes than have been reported.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, the need for daily figures means that there are two official publications: first, the daily figure that is used in the No. 10 presentation, which includes deaths of care home residents in hospitals but not those who die in the home; and, secondly, a weekly figure produced by the ONS which covers all locations of death, including care homes, but which has an 11-day lag.
Baroness Wheeler (Lab)
I thank the Minister for his response. Both Care England and the National Care Forum report an alarming increase in the number of care home deaths, with estimates of more than 6,000 deaths above this week’s official ONS figure of 1,043; we already know that these figures are 12 days out of date when they are published. The National Care Forum has called for the Government to build a ring of steel around care homes to safeguard the most vulnerable among us, with providers suggesting that doctors and nurses should be urgently deployed to fight Covid-19 in homes for older people. They rightly stress that an unprecedented situation calls for an unprecedented plan, as we have had in hospitals. What is the Minister’s response?
Lord Bethell
The noble Baroness is entirely right. This is an evil disease which strikes the elderly and those with pre-existing conditions the worst, and those who live in care homes are the most vulnerable. The Government have sought to put a ring of steel in place. We have resourced care homes enormously. Testing is now being focused on care homes to try to reduce the prevalence of the disease, and we will continue to focus on protecting our care homes.
Dementia: Accident and Emergency
Baroness Wheeler Excerpts(5 years, 10 months ago)
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Baroness Wheeler
To ask Her Majesty’s Government what steps they are taking as a result of the analysis published by the Alzheimer’s Society on 22 January showing a 34.5 per cent increase in the number of people with dementia being admitted to accident and emergency departments in 2017–18.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, we are implementing our Challenge on Dementia 2020 commitment to make this the best country in the world to live with dementia. The NHS long-term plan commits the NHS in England to improving the care provided to people with dementia and their carers, including through supporting people in the community and avoiding unnecessary admissions to hospital. People should receive high-quality care in hospital and be discharged in a timely and appropriate way.
Baroness Wheeler (Lab)
I thank the Minister for his response and congratulate him on behalf of these Benches on his confirmation in his post. We look forward to continuing the good and constructive working relationship we have had with him since he took up this brief.
These findings from the Alzheimer’s Society research are truly shocking. The 34% increase in emergency admissions of dementia patients to A&E departments represents an increase of 100,000 patients over five years—the equivalent of over 1,000 patients each day. Much of this is the result of the scarcity of appropriate care support in the community or of care home places able to provide the specialist dementia care that is needed. Does this not also underline the scale of the problem the NHS faces in freeing up hospital beds to address demands from future coronavirus hospital admissions? What is the Government’s strategy for ensuring the continuing care for people with dementia in the coming months and in the longer term? Will further guidance and funding be issued to hospitals and care homes specifically to deal with this situation?
Lord Bethell
The noble Baroness will be aware that the identification of dementia patients in England has risen dramatically from 42% to 67%, which more than accounts for the increase in the Alzheimer’s Society’s numbers. We are, however, concerned about this issue and remain focused on pulling together a new challenge on dementia strategy for the next five years and on ensuring that beds are liberated in a timely and reasonable fashion.
Coronavirus is naturally a matter of high concern in our preparations. Care of existing vulnerable and lonely people and the elderly is a massive priority, and we are putting in place plans to provide that care.
Coronavirus
Baroness Wheeler Excerpts(5 years, 11 months ago)
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Baroness Wheeler (Lab)
My Lords, I thank the Minister for repeating the Statement and once again pay tribute to the medical, public health and NHS staff who are working so hard to deal with this crisis, both in the UK and internationally. Last week, the Minister underlined the importance of all public health authorities and the NHS working closely together to ensure clear co-ordination. Now that the World Health Organization has declared the virus a public health emergency of international concern, this is more important than ever.
As we have heard, 93 British nationals have now been repatriated to the UK and transferred to a dedicated NHS facility in the Wirral as a precautionary measure. Can the Minister update us on the health and well-being of those people in quarantine? There have also been reports that 15 health workers have been diagnosed in China. We know that the virus mainly spreads through contact with an infected person. Can the Minister outline what protections are in place for health workers, particularly for those in the Wirral and in Newcastle, who are in close contact with those in incubation?
One of the disturbing findings from the early stages of the virus so far has been reports that a number of the people who have sadly died had pre-existing conditions. Does the Minister have any further information on this, including on the particular types of pre-existing conditions and what steps will be taken here to advise and support these very vulnerable people in the UK?
On vaccine development, there have been suggestions that human trials of a vaccine could start soon and be progressed with unprecedented speed. I welcome the reference to this in the Statement. The Times today reports that the head of the Coalition for Epidemic Preparedness Innovations has mentioned that an investigational vaccine from gene sequencing of the pathogen through to clinical testing could happen in 16 weeks, with the earliest stages of clinical trials taking two to four months. We welcome the Government’s £20 million contribution to the coalition’s research to speed up development of a vaccine. Has the Minister any specific further information on how quickly they expect the vaccine to be available and ready to distribute?
The Minister will be aware that many east Asian people living in the UK have reported being the target of racist abuse linked to the outbreak, while Chinese businesses are suffering from bogus claims that Chinese culture is to blame for the coronavirus. Their community leaders have expressed concern about repercussions, as Chinese students, workers and tourists in Europe become a focus of fear and confusion about the virus. What steps are the Government taking to combat racism, stereotyping and making assumptions during the outbreak of the virus?
Finally, we fully support the Government’s public information campaign centred on simple preventive measures to minimise the risk of the virus spreading, such as by washing hands and using tissues when you sneeze. Can the Minister reassure the House that the campaign will be proportionate to the risk currently faced by the general UK population? While we need to alert the public, we all want to avoid causing unnecessary stress or creating a panic.
Baroness Brinton (LD)
I echo the thanks to medics, staff involved in logistics and especially the scientists working so rapidly to sequence the genome of the coronavirus. I support many of the points made by the noble Baroness, Lady Wheeler.
Our concerns are more about some of the very practical arrangements and the fact that the UK seems to be responding 24 or 48 hours behind some other countries. I note the Statement says that
“anyone who has travelled from Wuhan or Hubei province in the last 14 days should immediately contact NHS 111 to inform it of recent travel.”
It also says:
“Anyone who has travelled to the UK from mainland China in the past 14 days and is experiencing a cough, fever or shortness of breath should self-isolate”.
It is interesting that the Philippines, New Zealand, the USA, Singapore and Australia are now barring all foreign nationals from mainland China from entering their countries at all. I know that the World Health Organization is not yet saying that we should follow that, but I noticed that a report at the weekend said that about 340-odd people had come in from Wuhan just before the arrangements were put in place and that the Department of Health was now trying to track these people. Given that we now know that the disease can infect people prior to symptoms emerging, has the Department of Health been able to identify those people who arrived prior to the Government’s arrangements being put in place? Do the Government now have absolutely clear procedures to identify people coming not just from Wuhan and Hubei province but from mainland China so that they can contact them urgently if there are issues? Is everyone travelling in from China getting specific advice about who to contact and what to do?
Finally, what are the numbers of cases in regions outside Hubei? The press is reporting that at least 24 provinces, municipalities and regions in China have now told businesses not to resume work before 10 February at the very earliest. These account for 90% of exports from China. Given that many of our businesses rely on just-in-time manufacturing, I wondered whether the Government were assessing what the impact on our businesses would be if there was a gap in production and exports from China.
Wuhan Novel Coronavirus: UK Citizens
Baroness Wheeler Excerpts(5 years, 11 months ago)
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Baroness Blackwood of North Oxford
I am very happy to look at the advisory from the Canadian Government. I hold in high regard the CMO from that nation, whom I have met. The action that this Government have taken in putting in place enhanced measures at ports and giving advice to nationals has been proportionate but robust. So far, we can be pleased that all of the 131 cases tested for in the UK have been negative.
Baroness Wheeler (Lab)
My Lords, I underline the support from these Benches for the plans for organised quarantine. Both the medical evidence on the incubation period and the limited evidence of spread from people not yet showing symptoms highlight the need for this. Keeping evacuated people together is important. We also strongly support the recognition by government that dealing with this is a top priority, and give our praise and thanks to the medical, public health and NHS staff who are working hard to ensure that preparations are in place in the UK.
Can the Minister explain a little more about the evacuation arrangements and what discussions have taken place? What discussions has the UK had with the World Health Organization on difficulties with evacuation? Can the Minister advise what action the Government are taking to ensure the safety and welfare of British nationals stranded in Wuhan due to the delay in evacuation if they are unable to board a flight as they display symptoms of the virus? Those who make it on board will have to sign contracts agreeing to the 14-day quarantine at an NHS facility on their return to make sure that they do not have symptoms of the virus. What staffing resources will be available to carry out quarantine and screening procedures? What happens if various people refuse to sign the contract? Clearly, these teams will be of great importance in preventing the spread of the virus to the UK. I look forward to the Minister’s response.
Baroness Blackwood of North Oxford
I thank the noble Baroness for her extensive questions. We are doing everything we can to get British people in Wuhan safely back to the UK. A number of countries’ flights have been unable to take off as planned. We will continue working urgently to organise the flight to the UK as soon as possible. We are working with British nationals who wish to leave and we are developing a package for them once they arrive. The plane will have medical staff on board to assess and manage the passengers; obviously, this is on the direct advice of and with support from our Chief Medical Officer, who has specific expertise in this area. A team from Public Health England and the NHS will meet passengers, and any passengers who have developed symptoms will be assessed and transferred to NHS care, as appropriate. Asymptomatic passengers will be transferred to an isolation centre; we do not want to provide details on that at this stage. We are working with the Chinese authorities to unlock the issues to allow the plane to take off.
Young Carers: Health and Well-being
Baroness Wheeler Excerpts(6 years ago)
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Baroness Wheeler
To ask Her Majesty’s Government what plans they have to ensure that young carers receive the social care, family, mental health and financial support they need to ensure their own health, development and well-being.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)
My Lords, we are committed to supporting young carers to ensure that they maintain their health and well-being and have the same life chances as their peers. We will continue to carry out the commitments made in the Carers Action Plan. These aim to increase the identification, support and recognition of young carers. This year, we will publish reports on young carers identification and work on carers from seldom-heard groups.
Baroness Wheeler (Lab)
My Lords, there are now an estimated 800,000 young carers delivering care to family members, and there has been an alarming 83% increase in children as young as five, six and seven undertaking this role. Is it not clear that the Government’s continued failure to tackle the social care funding crisis means young carers having to undertake care and support, at great cost to their own well-being, education and mental health, that should be available in the social care system? In particular, short breaks for respite care funded by local authorities are vital for disabled children and their families, including their siblings, many of whom are young carers. What action are the Government taking to make sure that they fill the annual £434 million funding gap in local authority funding for social care for disabled children in England, identified by the Disabled Children’s Partnership?
Baroness Blackwood of North Oxford
The noble Baroness will know that we take with the utmost seriousness the need to put social care funding on a sustainable footing. I heard the serious debate about this that we had on Thursday in the Queen’s Speech debate, and took back the seriousness with which this place takes those issues. On carers’ leave, the Government want to combine rewarding careers and the education of young carers with being able to care, and do not want young carers to take on inappropriate levels of caring. Therefore, the Government have committed to supporting unpaid carers with a leave entitlement of one week per year, which will be taken up in the employment Bill. In addition, I take the noble Baroness’s point about respite care and I will provide her with further detail in a note.
Healthcare: Brain Tumours
Baroness Wheeler Excerpts(6 years, 2 months ago)
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Baroness Wheeler
To ask Her Majesty’s Government what steps they are taking (1) to improve access to palliative care, rehabilitation and psychosocial care for people living with a brain tumour, and (2) to provide support for their carers and families.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)
My Lords, the NHS Long Term Plan sets a clear ambition that, where appropriate, every person diagnosed with cancer will have access to personalised care by 2021. Personalised care includes support planning based on holistic needs assessments, end-of-treatment summaries, health and well-being information and support and a cancer care review with GPs. These interventions align with the comprehensive model for personalised care and should be made available for all cancer patients, including those in need of end-of-life care.
Baroness Wheeler (Lab)
My Lords, International Brain Tumour Awareness Week starts on Saturday, so it is timely to remember both patients and carers. Living with a brain tumour often means coping with life-changing symptoms, such as mental and emotional health issues, communication and mobility problems. Carers also need support in adjusting to these changes in the person they care for, including coping with difficult behaviour and personality changes, disorientation and confusion. Both Marie Curie and the Brain Tumour Charity have highlighted strong concern about inadequate support for carers and the impact on the care journey that carer breakdown in these circumstances can have, often leading to emergency hospital admission. What action are the Government taking to ensure that people with brain tumours, their carers and their families receive care and support that meets their needs and wishes?
Baroness Blackwood of North Oxford
The noble Baroness has raised a very important issue. Obviously, the Government are working to deliver the Carers Action Plan, which retains the strategic vision of recognising, valuing and supporting carers. It includes a commitment to 64 actions across five priorities to ensure that we improve support for carers, including recognition and support, and build evidence to improve outcomes, especially in these very difficult areas. We are also working hard with the Tessa Jowell Brain Cancer Mission to ensure that we improve pathways for those with very challenging brain tumour diagnoses.
Queen’s Speech
Baroness Wheeler Excerpts(6 years, 2 months ago)
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Baroness Wheeler (Lab)
My Lords, I am focusing on health and social care. My noble friend Lady Sherlock’s excellent speech made clear the context in which the Government’s recent rush to show their concern and commitment to the NHS needs to be seen. There have been swingeing cuts since 2010—just to remind ourselves how long this Government have been in office—staff vacancies in key areas such as GPs, nursing, psychiatrists and vital specialities such as radiography are at a record high, and there is still no specific funding allocated to implement the NHS staffing plan, which was finally published earlier this year after a two-year wait. There are some 4.4 million people on NHS waiting lists, nearly 65,000 people have been left stranded on hospital trolleys for four hours or longer, and thousands are waiting in anguish and distress for cancer treatment. Five out of eight of the cancer waiting-time targets were missed in August, including the 62-day waiting-time target which has not been met since December 2015.
The CQC’s state of care report warns of a perfect storm across health and social care, where people cannot access the services they need or where care is provided too late, pushing the NHS and social care nearer and nearer to the tipping point it warned of last year.
We know that two definite health Bills are promised. One is on patient safety investigations and the other is on medicines and medical devices, to try to pick up the pieces after we fall out of EU regulation on clinical trials and access to medicines post Brexit, and to develop new ways of regulating personalised medicine and medical AI. We welcome both Bills and will work constructively with the Government and noble Lords across the House to ensure the vital improvements to patient safety and the access to innovative treatments that are so urgently needed.
We are also promised new laws, although the timescale is unspecified, following last month’s proposal from NHS England for an NHS integrated care Bill, in its words,
“to free up different parts of the NHS to work together and with partners more easily”,
but in reality to dismantle the heavy, laden and bureaucratic structures set up under the Government’s flagship Health and Social Care Act 2012, which have proved such a huge and costly disaster for the NHS. We currently have the ludicrous situation of authorities across the country desperately working around the 2012 Act to try to build the integrated primary and acute care and multispeciality community systems across local authorities and NHS and community settings which implement the NHS long-term plan. Can the Minister tell the House what work has been done with NHS England to develop legislative proposals on a new statutory framework? What is the proposed timescale for the Bill? Is she confident that the work currently being undertaken through CCGs on integrated care system, PACs and MCPs will proceed effectively within the legal and statutory authority contained in the 2012 Act?
I remind the House, too, that it was this Act that abolished the National Patient Safety Agency, against strident opposition from noble Lords across the House. From an initial reading of the Bill, many of the functions of the proposed new Health Service Safety Investigations Body were undertaken successfully by the NPSA. Does the Minister accept that abolishing that body has proved to be yet another damaging retrograde step under the 2012 Act?
On social care, we have had shameful and inexcusable inaction and delay since the Government abandoned the Care Act and the Dilnot provisions for capping the costs of care in 2016, despite strong cross-party support. Successive Prime Ministers and Health Ministers have all given hollow pledges about “getting on with the job” and have told us that a Green Paper is “imminent”. Now Boris Johnson has promised to fix it all, “once and for all” with the “clear plan” that he has prepared. But we now see that there has been no preparation: he has nothing new to offer. Indeed, recent press reports have revealed that No. 10 is still mulling over all the familiar options, including going back to the care cap and free personal care to match Labour’s long-standing commitments on this.
Meanwhile, the social care crisis continues to get worse. Age UK estimates that more than 1 million older people have died in the past two years either waiting for a care package or having been turned down; nearly 1.3 million have developed an unmet need for basic care support such as washing, dressing or going to the toilet. Macmillan research shows that 8% of people living with cancer who have a critical or substantial need and who should qualify for council support receive no practical help at all, with 60% of their carers experiencing stress, anxiety or depression.
The Alzheimer’s Society estimates that, over the past 26 months, there have been more than 500,000 delayed transfers of care for people affected by dementia; nearly 3 billion hours of unpaid care have been provided; and, at any one point, more than 120,000 people with dementia in England receive no help from social care or family carers. Where is the PM’s “clear plan”? Does this mean the Green Paper has actually been drafted? What is holding it up? The recent IPPR report showed that free personal care would treble the number of older people with access to state-funded care, improve their health and well-being and save billions of pounds in hospital costs.
Your Lordships’ economic committee produced an excellent report on what it recognised as the “national scandal” of social care, advocating free personal care for the over-65s. Surely this is one of the first steps to solving the care crisis. What plans are there in place to fulfil Mr Johnson’s pledge to provide older people with the dignity and security they deserve and prevent them from having to sell their homes to meet crippling care costs? In the Minister’s response, I hope she will not simply repeat the Government’s stock answer that we have heard today on so-called extra funding. The King’s Fund, Nuffield Trust and Health Foundation have independently identified both the huge scale of government and local authority social care cuts and the £2.5 billion investment needed just to keep the system afloat in the short term. Emergency cash injections do not address the chronic underfunding of local services, change the eligibility criteria or help people plan for their future care needs.
Finally, on a more positive note, we welcome the pledge to continue the work on the reform of the Mental Health Act following the excellent review last year. However, we are very disappointed not to see a detailed timetable for the actual Bill that has been promised. The CQC State of Care report is again a sharp reality check on the deteriorating state of mental health care. Can the Minister explain why the Government’s NHS capital announcements so far have failed to mention or include urgent funding for mental health hospitals and trusts, which the review has made clear are the worst estate in the NHS?
Personal Healthcare Budgets: Sheffield
Baroness Wheeler Excerpts(6 years, 4 months ago)
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Baroness Blackwood of North Oxford
Personal health budgets play a really important role, not only in supporting individuals to have personalised care but by making sure that we can seek support from social prescribing and community care, just as the noble Baroness mentioned. These plans are designed not only between the general practitioner and the supporter, but with the patient; therefore, the right information is provided to the patient in an open and transparent manner so that they can ensure they get the right care. It is important to note that those in receipt of this care have an 87% satisfaction that they are receiving the care they want in a much more effective way than they were before.
Baroness Wheeler (Lab)
My Lords, NHS continuing healthcare is supposed to provide a lifeline when older people and their families are at their most vulnerable and face sky-high costs as the result of chronic health conditions. However, this system is confusing and the rules arbitrary, resulting in a significant postcode lottery. Since 2015 more than 4,000 adults have died while awaiting a decision on their care to be made. What action are the Government taking to ensure that every person in need gets the support they need promptly, regardless of where they live?
Baroness Blackwood of North Oxford
One of the actions we have taken today is increasing funding to local authorities to relieve some of the pressures on them, increasing real-terms spending on public health, and also £1 billion for social care. In addition to that, there is a clear impetus from the long-term plan to increase personal health budgets, which are a very important aspect of the solution, because it will lead to an integration of spending and an integrated assessment of NHS care and social care. This is a real gap within the solutions for those who receive this support, which is why we want to make sure that we roll this out much faster than we have before. There is a commitment to have 200,000 people on personal health budgets and we are ahead of our ambitions on that.
Adult Social Care
Baroness Wheeler Excerpts(6 years, 5 months ago)
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Baroness Wheeler
To ask Her Majesty’s Government what assessment they have made of the Association of Directors of Adult Social Services Budget Survey 2019 on the state of adult social care.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)
My Lords, we recognise many of the issues highlighted by ADASS. People of all ages are now living longer, sometimes with complex care needs. Social care funding for future years will be settled in the spending review, where the overall approach to funding local government will be considered in the round. Meanwhile, we have given local authorities access to up to £3.9 billion for more dedicated funding for adult social care this year, and a further £410 million is available for adult and children’s services.
Baroness Wheeler (Lab)
My Lords, the ADASS survey results provide yet more evidence of the ongoing crisis in social care caused by persistent underfunding and a fragile and failing care market. As the report says, there are planned cuts of £700 million to adult social care budgets in the current financial year and there have been cumulative cuts of £8 billion since 2010. On the last day of our current Session, can the Minister update the House on the timing of the social care Green Paper, which has been delayed six times and is now two years overdue? Given this inexcusable delay and the widespread consensus across social care about what needs to be done, why can the Government not commit to publishing a White Paper with actual proposals? Has the Lords Economic Affairs Committee report calling for £15 billion of extra funding, to include free personal care for people needing basic washing and dressing support, not done the Government’s job for them?
Baroness Blackwood of North Oxford
I share the noble Baroness’s impatience on this issue and I agree with the overall conclusions of the ADASS report that older and disabled people need dignified, high-quality care and support. When properly resourced it does work, and as a nation we must make this an immediate priority. That is why I very much welcomed the incoming Prime Minister’s statement that,
“we will fix the crisis in social care once and for all with a clear plan ... To give every older person the dignity and security they deserve”.
He will make it a priority of the incoming Government and there will be an imminent announcement from the incoming Health Secretary. As I do not know whether I will be part of the department, I am afraid that I cannot commit to this, but I am sure that whoever is in this place when that comes forward will be very happy to do so.