Adult Social Care

Baroness Wheeler Excerpts

Wednesday 22nd November 2023 Lords Chamber

[Lord Markham (Con)]

My noble friend is correct, in that having so many local authority and private sector providers means it is a confusing space in which to bring all this together. The People at the Heart of Care White Paper is trying to co-ordinate that and at the same time provide a career structure, because we know that the bedrock of all this is the staffing, and this needs to be an attractive space for people to work in. Therefore, giving them that recognised, transferable qualification which they can take into nursing and other areas as needed is vital in ensuring that we have the workforce to underpin this.

[Baroness Wheeler (Lab)]

My Lords, the NAO’s recent figures show that so far, only 7.5% of the much-vaunted £265 million allocated by government to addressing social care staffing shortages and recruitment for 2023-25 has been spent due to the DHSC staff recruitment freeze; and the training workforce development programme has also stalled because the department has not managed to set up the necessary systems to administer provider payments. What is the Minister’s response to this and the ADASS survey finding that government investment in social care so far has just stopped the ship sinking and has not moved local authorities out of the storm they are trying to navigate?

Autism: In-patient Care in Mental Health Hospitals

Baroness Wheeler Excerpts

Tuesday 14th November 2023 Lords Chamber

[Lord Markham (Con)]

Yes, I have some personal experience here and I know how vital it is to find out early, so you can put together the tools. I have seen some really interesting things. The Bradford pilot looked at children’s scores and whether that was an early indicator. I was at Boston Children’s Hospital a few weeks ago, which is looking at the way that children play on apps and whether that can give indications of whether there is some neurodiversity. There is absolutely the intention of early diagnosis.

[Baroness Wheeler (Lab)]

Thankfully, my Lords, understanding of and support for autism have changed substantially since the now 40 year-old Mental Health Act, especially about being clear on what an autism-friendly environment looks like and should be, although sadly that is not often found in mental health settings and ATUs. Did the Government’s decision to abandon the new mental health Bill this Session include an assessment of the impact this would have on patients? This is particularly urgent now that changes to the code of practice, recommended by the excellent report on long-term segregation by the noble Baroness, Lady Hollins, will not be considered until we deal with the Bill. How and when will the Government deliver the significant changes needed?

[Lord Markham (Con)]

I think we are all agreed on the action; there was was an intensive and involved process by the whole House when it came to agreeing the action. That is why I am keen to ensure that we implement as much of it as possible that does not require legislation, which we are doing. I am happy for the noble Baroness to join me at the meeting with the noble Baroness, Lady Hollins, when we can look at the practical steps to see what is possible.

Children’s Hospices: Funding

Baroness Wheeler Excerpts

Tuesday 14th November 2023 Lords Chamber

[Lord Markham (Con)]

Yes, absolutely. Again, there is a balance we are trying to get over here, because we are all agreed on the importance of what they are trying to do. At the same time, we believe that ICBs, generally, are the right people make provision at a local level, because they know best what is required in their area. Clearly, where it makes sense for them to band together, that has to be sensible.

[Baroness Wheeler (Lab)]

My Lords, most of us will have the amazing work of our own local children’s hospice in mind today in response to this Question. Ours in Surrey is the care and support that the Shooting Star Children’s Hospices provide for babies, children and young people with life-limiting conditions, and their families. We fully support the children’s hospice grant going directly to a hospice. It is the most cost-effective way; it overcomes the patchy performance of many ICBs and their CCG predecessors on hospice funding, and it avoids hospices having to engage with multiple ICSs when their services go across areas. What actions are the Government taking to ensure that ICBs meet the NICE standards in supporting children’s hospice care and against ICBs that have made no attempt to access the current grant arrangements?

[Lord Markham (Con)]

As I mentioned, it is a statutory requirement for every ICB. NHS England is responsible and is reviewing those arrangements in all 42 trusts. At the same time, this is an element which the CQC follows up to ensure that care is in place. I echo the House’s feelings that the results of the voluntary sector and the hospices are excellent. We need to ensure they get the proper support.

Adult Social Care (Adult Social Care Committee Report)

Baroness Wheeler Excerpts

Monday 16th October 2023 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, we have had an excellent but very sobering debate, throwing the spotlight on the current state of adult social care, against the backdrop of the committee’s landmark report on what the service could look like now and in the future—if the people needing support and care were properly enabled to live the “gloriously ordinary life” which my noble friend Lady Andrews and the committee so expertly advocate.

The report was the central focus of Labour’s major debate on social care in March, and I am pleased committee members have again spoken in support of it today, across the range of vital issues the report addresses. They have all praised my noble friend’s expert chairing of the committee and her excellent introduction. As I have stressed, there is no better person to lead this authoritative cross-party group, and I pay tribute not just to that expertise and wisdom, but to the tenacity and determination she has shown ever since in making sure its key findings and recommendations have been disseminated and discussed across the sector and in Parliament.

I am also very pleased that the right reverend Prelate the Bishop of Sheffield has reminded us about the excellent report from the Church’s Reimagining Care Commission, which very much shared the values and principles espoused by our own committee. I again applaud the vital work that faith committees do to help plug the enormous gaps locally in social care provision, and welcome further discussion on how the proposed national care covenant could help reinforce making social care the national imperative it needs to be.

Before the March debate, we were still awaiting the Government’s formal response to the report, which, as we have now heard was wholly underwhelming and disappointing when it was finally published in May. We were also expecting what was heavily trailed in the press at the time as the imminent publication of the Government’s long-awaited 10-year social care plan, which we all recall had been supposedly scrunched up in Boris Johnson’s back pocket way back in 2010. The Government’s 2021 White Paper had been strong on a vision of what social care could look like, but only partial as a future plan and on the issues it actually addressed. It was also decidedly lacking on how today’s and tomorrow’s demands for social care could be met, addressed and funded, or how it fitted in with the then proposals on the care cap costs, or with the fair cost of care proposals. These were delayed a year later in the Chancellor’s budget until October 2024, with the spending reallocated to keep the social care system afloat and to finance reform.

What we actually got in the 2023 next steps follow up, published during the April Recess, was largely more of the same—baby steps, as they have been described—a two-year plan rather than 10 years or addressing the longer term, and cuts or doubts raised over some of the promised White Paper funding. We again had the welcome—but still unplanned—sticking plaster funding solution: disjointed, stop-start, short-term crisis reactions, which continued to fail to identify and deliver solutions to the root causes facing older and disabled people. The short termism was met with universal dismay by the sector, with ADASS lamenting that the reform vision was “in tatters”.

The urgent need for a comprehensive national plan is where the Lords committee report so strongly comes in. It is a major piece of work because it leads the way on reform and the clear stepping stones that are needed. The committee is to be congratulated on its depth of analysis and its understanding of the extent and reach of social care, impacting 10 million of us at any one time, including those receiving care and support, and unpaid carers and families looking after loved ones.

Its focuses—on giving disabled people and people with learning difficulties, drawing on care and support, the same choice and control over their lives as other people; on fair pay and recognition for care workers; and on support for unpaid care workers—are the key fundamentals for social care reform, which we fully support. It builds on the current legislative framework for care eligibility and entitlement, achieved through cross-party support for the Care Act 2014, and promotes social care’s positive benefits as an essential service benefiting people, society and the economy, not just as ancillary to the NHS, as my noble friend Lady Andrews so ably stressed.

Today’s reality remains that demand for social care is now hitting a record high—the current picture so expertly underlined by noble Lords. As the King’s Fund has summed up, the trends in social care are still all going in the wrong direction: demand is up and access is down; financial eligibility is tighter and charging reform has been put back; the costs of delivering care are rising, with local authorities paying more for care home places and home care support; the workforce is in crisis; unpaid carers are receiving less support; and public satisfaction with social care is lower than ever.

On unpaid carers, I again reiterate and endorse what all noble Lords have referred to on the urgent need for action on carer’s allowance, paid leave, respite care and pensions. In particular, I commend my noble friend Lord Dubs, who is not only a wonderful person but, as we heard, a carer for many years who has, like many of us, taken on the system and negotiated around it to try to get both the services our loved ones need and the practical recognition of unpaid carers. Carers UK has called on the Government to publish an updated and comprehensive national carers strategy, which has to be part of a comprehensive plan for social care. I look forward to the Minister’s response to that.

We know that the social care staffing crisis is worsening daily, despite the tiny drop—less than 1%—in overall vacancies, largely through the increase in the international recruitment that social care has always depended on and valued. Last week’s Skills for Care annual survey reinforced the overall picture all too dramatically. Of particular concern were the 390,000 social care workers leaving their jobs annually, with a third leaving the service completely—social care’s “leaky bucket” in urgent need of repair, as Skills for Care put it. That is why our shadow Health and Social Care Secretary Wes Streeting’s landmark speech at last week’s Labour Party conference, setting out detailed future plans for gripping the NHS crisis, so forcefully stressed that there is no solution to that crisis without an integrated plan for social care running alongside.

Our new deal for care workers is our essential first step for tackling the crisis by addressing recruitment and retention and giving social care workers the professional status that they deserve and the first ever fair pay agreement for care workers, collectively negotiated across the sector. Skills for Care sums up the essential steps to recruitment and retention as paying above the national minimum wage, ending zero-hours contracts and providing access to training and relevant qualifications—all of which Labour is pledged to address.

When the NHS Long Term Workforce Plan was finally published in July, my noble friend Lady Merron questioned the Minister as to why it did not cover the social care workforce, as the two services are so inextricably linked. His response was that, as the Government were not the overall employer,

“it is not for us to make that plan”.—[Official Report, 4/7/23; col. 1178.]

Does the Minister not recognise that an NHS-only plan is likely to exacerbate the social care workforce crisis and the number of vacancies in that sector? Is it not the Government’s responsibility to ensure that local authorities are properly funded to pay social care contractors in care homes and domiciliary services at least the minimum wage, and to monitor this so that quality care can be provided? The committee identifies a massive 29% overall reduction in local government funding since 2010 and the precarious position that local councils find themselves in as providers of domiciliary and community care and care homes. My noble friend Lady Goudie spoke very forcefully on that.

Labour has also made clear the need, if elected, for fundamental reform and change to the current business model for residential care, which sees many private equity care homes, despite getting around £314 million in public funding each year, spending hundreds of millions servicing debts, giving bonuses to shareholders and avoiding tax. It is hard to understand why hundreds of millions of pounds go out of the service in that way. According to the CQC, one in seven private equity-owned care homes is not providing good levels of care. How long do the Government think that this model of funding for care homes can continue to plough money not into the social care sector but into shareholder profits?

The key message to the Government from the committee and today’s debate is still that reform and change for social care has to be whole-systemwide, long-term, joined-up, comprehensive, integrated care at home in the community to tackle the myriad fundamental problems in the system and deliver a new deal for care workers and unpaid carers. Instead of just keeping the current system afloat with short-term funding, stop/start changes and delayed reform, social care deserves much better and the step-by-step investment and reform that the Labour Party is so strongly committed to.

Paediatric Care: Wating Times

Baroness Wheeler Excerpts

Monday 16th October 2023 Lords Chamber

Asked by

[Baroness Wheeler]

To ask His Majesty’s Government what recent assessment they have made of the impact of the length of waiting times for paediatric care on children’s developmental outcomes.

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

Cutting waiting lists is one of the PM’s top five priorities, and we are aware that waiting times impact more developmentally on a younger person’s life. Given this, we are committed to ensuring that babies, children and young people are prioritised in integrated care systems, and that the reforms in the Health and Care Act 2022 to improve child health and well-being outcomes are delivered on the ground.

[Baroness Wheeler (Lab)]

My Lords, the Academy of Medical Royal Colleges has described sick children as the

“forgotten casualties of the NHS’s waiting list crisis”

across hospital and community health. NHS data shows that over 220,000 are waiting for children’s and young people’s services, including paediatrics, autism spectrum disorder diagnosis, health visiting, and speech and language therapy. Even worse, almost 20,000 have been waiting over a year—that is 8% up on the previous month. What action are the Government taking specifically to address this appalling situation, and what cross-government measures are in place to try to mitigate the huge knock-on impact on children’s education, health and well-being, and on their families?

[Lord Markham (Con)]

I thank the noble Baroness for bringing this question up; this is an important area, and we all know that a year in the life of a child aged 10 is a lot more impactful than it is to a 60 or 70 year-old. It is a question very well put. Since receiving this Question, I have been working on it with the department and talking to the relevant Ministers about what we can do specifically. We are expanding capacity generally through the CDCs and the 95 surgical hubs designed around this space, but we are putting in measures with ICSs and tiering to make sure we are specifically addressing children’s wait times as well.

Nursing Courses: Reduction in Applications

Baroness Wheeler Excerpts

Tuesday 19th September 2023 Lords Chamber

[Lord Markham (Con)]

The noble Baroness is quite correct that mental health is a particular case in point. When we introduced the £5,000 grant for all nurses each year, we gave additional add-ons, and mental health nurses get an add-on in addition to that £5,000 a year. We also increased the travel and accommodation costs allowance by 50% to cater for those who have to travel far and wide.

[Baroness Wheeler (Lab)]

My Lords, the figures on overall declining numbers are concerning, particularly since this is the second successive steep fall, with, as the Minister said, the Department of Health relying on the UCAS clearing system and future nurse apprenticeships to try to make up the numbers. What changes does the Minister consider need to be made to the NHS workforce plan in the light of escalating problems with both the recruitment and retention of key staff?

[Lord Markham (Con)]

I am sorry to keep coming back to the data, but it suggests a 45,000 increase, which shows that we are doing pretty well. A 20% increase across all the different fields since the pandemic also shows that we are doing a good job on recruitment. Clearly, we cannot rest on our laurels, so we need to look at all those routes in, but I do not understand why people characterise the numbers as dropping when in fact the data shows the overall increase is far greater.

National Health Service: Major Conditions Strategy

Baroness Wheeler Excerpts

Monday 18th September 2023 Lords Chamber

Asked by

[Baroness Wheeler]

To ask His Majesty’s Government what additional funding is being made available for the implementation of the Department for Health and Social Care’s Major Conditions Strategy.

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

My Lords, the Government are providing additional funding of £3.3 billion in 2023-24 and £3.3 billion in 2024-25 to support the NHS in England. The Government have not committed further additional funding specific to the major conditions strategy. However, as part of the strategy, we will be identifying innovative actions to help alleviate pressure on the NHS and support improvement within the current settlement, such as maximising the use of new technology to screen individuals for conditions.

[Baroness Wheeler (Lab)]

My Lords, the major conditions strategy has been well received in both approach and content, particularly the focus on primary and secondary prevention as part of a life-course approach, and bringing together a strategic framework for the six major conditions that drive over 60% of morbidity in England, including cancer, heart disease and stroke. However, key stakeholders have warned that, without adequate resources, NHS trusts and other bodies will struggle to deliver, especially given their current and future focus on trying to cope with ever-escalating waiting lists. Do the Government acknowledge this and how will January’s future strategy address it?

[Lord Markham (Con)]

We are investing about 11% of the economy—£160 billion—in the NHS, and the conditions in the major conditions strategy account for 60% of all the causes of death and long-term illness. What we are really talking about is prioritising spend around prevention and personalised care, as the noble Baroness said, and channelling the money we are already investing towards those aims, on which I think the whole House agrees.

Respiratory Syncytial Virus

Baroness Wheeler Excerpts

Tuesday 25th July 2023 Lords Chamber

[Lord Markham (Con)]

We had this question on MMR just the other day. Some groups are much harder to reach than others. Very young children are the prime at-risk group. There, it is much easier because, naturally, they are seen by their GP and medical staff either prenatally, if it is maternal, or post in terms of the baby check-ups. The group that we are talking more about here is post 75 year-olds, and there those education programmes will be put in place.

[Baroness Wheeler (Lab)]

My Lords, the JCVI advice endorses the vaccine programme for 75 year-olds and for ages above, but we know that evidence shows that there is serious underestimation of RSV infections among older adults and an urgent need to improve testing and treatment of, in particular, those with congenital lung or heart disease or spinal muscular atrophy. What steps are the Government taking to raise awareness among these key groups and to develop information and monitoring systems that identify those most at risk?

[Lord Markham (Con)]

This is where nirsevimab is very promising, in that it gives six months’ protection. The problem with the previous jab is that it needed monthly injections and was only 50% effective. We are talking about 70%-plus effective now, which makes it more practical to have that sort of rollout. To date, we have been looking at the very targeted group of 75 year-olds only, particularly as each course costs £2,000 and has to be given monthly over the winter months. Now that we are opening up to this injection, which is much cheaper and lasts for six months, we can look at a broader range, and then there is a much more general education programme to go with it.

Stroke Care

Baroness Wheeler Excerpts

Monday 24th July 2023 Lords Chamber

Asked by

[Baroness Wheeler]

To ask His Majesty’s Government how they are ensuring that integrated care systems across England implement recommended best practice in stroke care in line with the updated National Clinical Guideline for Stroke, published in April.

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

The National Clinical Guideline for Stroke, published in April 2023, is an initiative of the intercollegiate stroke working party made up of representatives from the professional bodies involved in stroke care. National regional SQuIRe managers, who are responsible for managing stroke services, are working with integrated stroke delivery networks and newly formed integrated care systems to implement the NHS integrated community stroke service and improve the provision of community-based stroke rehabilitation.

[Baroness Wheeler (Lab)]

My Lords, the update of the national stroke guidelines is welcome, particularly its now UK-wide remit, with one of its major changes being significant expansion in the number of patients eligible for thrombolysis and thrombectomy. Given that both these powerful clot-busting interventions are most effective the faster they are used following a stroke, what assessment has been made of the impact of the current NHS delays in the expansion of their respective uses and how will the Government ensure that ICSs address the huge regional variations in both thrombectomy and in the vital post-stroke rehabilitation in hospital and at home that is so necessary?

[Lord Markham (Con)]

First, I thank the noble Baroness for the work that she does in this area; I know that it is very close to her heart. I have set up a meeting with the NHS COO David Sloman and with Sarah-Jane Marsh, and would be delighted if the noble Baroness would like to join me. The benefit of these sessions is always the shining of a light on areas.

It is vital that people are seen within the first hour; currently 59% of people are, which is an improvement on the last couple of years when the figure was 55%. However, we would all agree that we want that number to be as high as possible. The SQuIRe managers’ job is to make sure that all the different integrated care boards are delivering best practice in each area.

Healthcare (International Arrangements) (EU Exit) Regulations 2023

Baroness Wheeler Excerpts

Wednesday 5th July 2023 Grand Committee

[Baroness Wheeler (Lab)]

My Lords, I thank the Minister for his introduction to the SI and the other noble Lords who have spoken to it. For the record, we wanted to look very closely at it, given the discussions, commitments and reassurances made last year by the Government and the then Health Minister, the noble Baroness, Lady Penn, about the Government’s policy intentions on reciprocal health agreements during the passage of what is now the Health and Care Act.

We had strong concerns that any provisions under the Act which reflected post-Brexit arrangements should be confined to the implementation of reciprocal healthcare arrangements, not to the negotiation of international health agreements which could be used for wider and different purposes, such as the privatisation of parts of healthcare. The Healthcare (European Economic Area and Switzerland Arrangements) Act 2019 included explicit constraints to make such agreements on the powers of Secretary of State in this regard. We also had concerns that the new arrangements should not change the definition of future reciprocal healthcare agreements.

Reassurance from the Government that the purpose of the 2019 Act was not to implement trade deals and that reciprocal healthcare agreements do not relate to the commissioning and provision of services for the NHS were very welcome. We are therefore content that the SI properly reflects this; I thank the Minister for his reassurances in his opening remarks. We are also pleased that the affirmative procedure ensures that Parliament is able to be kept up to date with developments and that these issues are properly debated.

The Explanatory Memorandum is very helpful. I look forward to the Minister’s response to the issues raised by the noble Lord, Lord Allan, about scope, because they are important.

We recognise that the regulations are vital to implement international healthcare agreements following our exit from the EU. Reciprocal healthcare agreements support people to access healthcare in the listed countries. Those faced with the stress and worry of a healthcare emergency abroad will rightly expect suitable arrangements to be in place where possible. That is particularly true of people with a disability, those who are older or who live with a pre-existing or chronic health condition.

The amendments to the Act allow the Government to implement more complex agreements with the ability to make financial reimbursement at cost, as the UK currently does with many EEA countries, and confer further powers on the Secretary of State. Can the Minister outline further details about the Government’s plans for other international healthcare co-operation outside the EEA and Switzerland and what these plans might look like?

From our understanding of the SI, we think that payments can be made only if both the following conditions are met: the healthcare treatment is in a country with which we have an international healthcare agreement, and the Secretary of State considers that exceptional circumstances justify the payment. Can the Minister explain the Government’s thinking on what would constitute exceptional circumstances and how the policy framework might work? What guidance is being issued by the NHS Business Services Authority, which has certain administrative functions conferred on it through the SI?

The public consultation on the policy has just closed but we understand that the results and an analysis of it will be published this month. An early indication of the timetable and results would be welcome.

On the role of the NHS BSA, can the Minister provide more detail on the work currently undertaken to establish and maintain the public information and advice service on healthcare provision under relevant healthcare agreements, as set out in the SI? Again, the noble Lord, Lord Allan, mentioned this important function. The importance of transparency has been underlined. It will be crucial in the future to help people understand how reciprocal healthcare agreements work and can be accessed, to ensure they are doing all the right things to be properly covered, and to make claims, as the noble Baroness, Lady McIntosh, said.

I look forward to hearing answers to the questions about the issue of EHIC and GHIC. Specifically, can the Minister update the House on how the transfer from EHIC to GHIC has worked and whether any complications have been experienced—for example, the impact of the non-application to the UK of the EU cross-border healthcare directive, which enabled UK patients to pay for qualifying private healthcare in Europe and to receive reimbursement up to the amount that the treatment would cost the NHS? UK travellers can now no longer seek reimbursement, and I wondered if there had been any instances where the lack of awareness of that has caused problems—for example, for patients needing kidney dialysis where reimbursement for private treatment has not been allowed.

I appreciate that the Minister might need to come back to me on that. I think we are about to have a vote, but I look forward to his response.

[Lord Markham (Con)]

I will try my best, potential votes notwithstanding. I thank noble Lords for their contributions to today’s debate and for the generally received welcome. To try to answer them in turn, on the point made by the noble Baroness, Lady McIntosh of Pickering, I believe the arrangements made with the EFTA countries were signed on 30 June 2023. The expectation is that they will become operational by the middle of 2024—saved by the bell.