Gender Identity Services: Children and Young People

Baroness Wheeler Excerpts

Wednesday 19th April 2023 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, the Cass review interim report underlines that the expansion of gender identity services to regional centres can be successful only if the NHS can attract and engage the workforce within those centres and for crucial network secondary services. This week, however, as we have heard, we have seen just how under pressure these key services are. Over a quarter of a million children in Britain with mental health problems are awaiting NHS referral due to major shortages of psychiatrists and specialist nurses. How are the holistic, person-centred services that young people desperately need going to be provided in the continued absence of a clear government workforce strategy?

[Lord Markham (Con)]

I am glad to say that there is a workforce strategy, which, unfortunately, we have not been able to publish yet. I assure your Lordships that a lot of work is being done, and there is a lot of work in place. I would be happy to meet with the noble Baroness and go through the findings of that, because it needs to cover a lot of these specialisms.

Social Care

Baroness Wheeler Excerpts

Thursday 30th March 2023 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, I thank my noble friend for securing this important debate and for her excellent introduction, and I sincerely endorse noble Lords’ praise for her expert chairing of the Select Committee. She was just the right person to lead this authoritative cross-party group, whose spotlight on adult social care could not be timelier as we are now in sight—we hope—of the Government’s long-promised follow-up White Paper. It is a moment that many of us cannot quite believe in, having waited so long for something to come out of the oven-ready, back-pocket social care plan promises made since this Government took office. We have had a decade of social care reform failure and have become used to hearing that world-leading proposals are on the way, only for them to be delayed, substantially changed and delayed again.

We were led to believe that the White Paper would be the national plan we have been promised, and that we would have it as the backdrop for today. Now we understand it will be published in the recess, that it is a two-year update rather than a plan, and that next week we may have the promised workforce plan—or a bit of it—and a key policy document on primary care. Like other noble Lords, I hope the Minister will be able to enlighten us on what is happening. Can he explain why all this has to be in recess, rather than when Parliament is sitting? We are still awaiting the Government’s response to the Select Committee report. Can he say when that will be published, so that, post-recess, we can have an urgent and full debate on the report as well as the White Paper?

When we get the White Paper and any workforce proposals, we will examine them in detail to judge whether they are anywhere near being the comprehensive national plan for social care we have been led to expect, with the milestones for reform the Minister has promised, including on workforce, data and technology. The first White Paper was strong on vision—on what social care could look like—but only partial in terms of the issues it addressed and the mostly short-term sticking plaster funding it came up with. 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 proposed cap on care costs, or the fair costs of care proposals.

The urgent need for a comprehensive national plan is where the Lords Select Committee report comes in. It is a giant piece of work that leads the way on reform, with clear stepping stones. I congratulate the whole committee 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. The report focuses on giving disabled people 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 carers. These are the key fundamentals of social care reform which we fully support.

I welcome today’s contributions by so many noble Lords, including eight other Select Committee members, and in particular the contribution from my noble friend Lord Bradley, who spoke from these Benches with his usual wisdom and expertise. Contributions have ranged across key social care issues; we could not have had a more comprehensive debate. I hope the Minister will make sure that he promises to follow up with a written response on any issues he does not have time to address, and will forgive me because I have so much to say and do not have the time to say it.

I want to underline five key issues. First, the Lords committee’s report underlines the imperative for a fundamental rethink and a change in society’s perceptions of and attitudes to social care. 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 which benefits individuals, society and the economy, not just as an ancillary to the NHS, as my noble friend Lady Andrews has so ably stressed.

In this context, I welcome the Reimagining Care Commission reflections of the most reverend Primate the Archbishop of Canterbury and the right reverend Prelate the Bishop of Carlisle, which strongly reinforce the Lords committee’s ambition of making social care the national imperative it needs to be. In particular, the commission demonstrates the breadth and reach of social care across communities, and I applaud the vital work that faith communities do which helps to plug the enormous gaps locally in social care provision. In the words of Labour’s shadow Minister for care, Liz Kendall, the report is “refreshingly bold”, which is exactly what is needed. I also commend the commission’s work on the national care covenant, and look forward to continuing dialogue on this.

Secondly, I emphasise the importance of choice and control by disabled adults over their care and support, which was strongly supported by speakers from across the House, in particular in the forceful contribution by the noble Baroness, Lady Campbell, underlining what she has been saying for years, and especially the importance of coproduction. Of course the care of older people is vital, but working-age adults with disabilities make up one-third of social care users and half the budget for social care.

The committee’s spotlight on the more than 1 million people living on their own, without families or children, is also welcome. The noble Baroness, Lady Barker, spoke strongly on this, as did a number of other noble Lords. As a carer, I know how thoroughly the current system relies on advocacy, usually by relatives who are unpaid carers navigating their way for their loved one’s entitlement to care services, which so often fail to speak to each other. I always fear for people living on their own who are receiving domiciliary social care; they are often without other visitors or friends and are utterly dependent on the system working well and seeing to their needs. Their well-being has to be a key part of what a good service looks like.

Thirdly, it is important to value care workers with proper career progression and the pay, training, and terms and conditions that they deserve. Every speaker has made a strong case for this and for the comprehensive workforce plan that is urgently needed. We have today had added expertise and weight from the former general secretary of the TUC, my noble friend Lady O’Grady, and the former general secretary of UNISON, my noble friend Lord Prentis. Record levels of staff vacancies, with the highest rates in domiciliary care, for registered managers and for nurses, need an urgent and long-term solution, not just short-term funding or reliance on local councils to raise funding to meet costs, with all the difficulties and inequities that brings.

Fourthly, I strongly echo the deep concerns of all noble Lords, especially my noble friend Lady Pitkeathley, that unpaid carers are at breaking point. In reality, they have received very little concrete support to date, apart from government backing for the Private Member’s Bill giving them one week’s unpaid leave from work. How are the Government going to address unpaid carers’ huge daily problems of poverty and exhaustion, and the lack of available and affordable respite care?

Fifthly, the key message from today has to be that reform and change for social care must be whole-system wide: a long-term, joined-up comprehensive plan. On residential care, for example, which a number of noble Lords mentioned, every day it becomes glaringly obvious that urgent reform and fundamental changes are needed to the current business model, and this must be an essential part of any comprehensive national plan. Only last week we saw reports of councils spending half a billion pounds over the past four years, buying up beds in care homes rated as inadequate or as requiring improvement by the Care Quality Commission, driving up profits and dividends for private investors at the same time as residents suffer unsafe treatment, mostly because the homes cannot fill their chronic staff shortages in many areas. Poor-quality providers which put private profits before care should not be tolerated. Does the Minister consider that the current business model for residential care is fit for purpose? What are the Government’s plans to ensure that public money is spent caring for residents?

This situation starkly underlines the precarious position local authorities continue to find themselves in as providers of care, care homes and domiciliary care. As noble Lords have said, this is all in the context of a 29% overall reduction in funding since 2010—one-third of the funding has been lost.

The Government have had 13 years to deliver on providing a concrete future for social care, but their measures have, for the most part, been disjointed, stop-start, short-term crisis reactions. They have failed to identify and deliver on the root causes of the issues facing older and disabled people. Demand for social care is now hitting a record high, and the current picture was graphically painted by noble Lords today. The King’s Fund’s excellent briefing sums it up by stressing that key trends in social care are all going in the wrong direction: demand up, access down, financial eligibility tighter and charging reform put back, the costs of delivering care rising with local authorities paying more for care home places and home care support, the workforce in crisis, unpaid carers receiving less support, and public satisfaction with social care lower than ever.

A national plan for social care has to be just that: national. It must be comprehensive, long-term and cross-system to provide joined-up integrated care in the home and community, tackle fundamental inequalities in the current system, and deliver a new deal for care workers and support, care and respite for unpaid carers. Step-by-step investment and reform is the only away to provide the stability, certainty and long-term planning to achieve the fundamental shift towards early intervention, prevention and rehabilitation that is so desperately needed.

Stroke Rehabilitation and Community Services

Baroness Wheeler Excerpts

Wednesday 22nd March 2023 Lords Chamber

Asked by

[Baroness Wheeler]

To ask His Majesty’s Government what steps they are taking to address staffing and facilities shortages in stroke rehabilitation and community services, and to ensure the national integrated community stroke service is fully resourced to deliver personalised, needs-based, goal-orientated rehabilitation to every stroke patient.

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

We are increasing the number of qualified staff and ensuring a widened pool of trained staff who can work across pathways. This will help ensure that the national integrated community stroke service is fully resourced and address the workforce challenges in rehabilitation and community services. I have raised the issue of access to appropriate facilities with the CEO of NHS England, who will engage with NHS trusts to ensure access to appropriate facilities as the pressure on NHS space abates so that physiotherapists can continue their vital rehabilitation work.

[Baroness Wheeler (Lab)]

My Lords, following my previous Question on this issue, I thank the Minister for writing to ICB CEOs on the urgent need for pre-Covid hospital and community rehab facilities to be returned to their former use. Can he tell me what timescales have been set and how this will be monitored to ensure that it actually happens? Strokes cost the NHS £3.4 billion a year and social care £2.3 billion in year 1, with another £2 billion on top of that for every subsequent year. What specific plans are there to expand the national integrated community stroke service, to ensure specialist rehab within five days of a stroke and to tackle the 68% of stroke sufferers who currently do not get an assessment, let alone rehab treatment, after hospital discharge?

[Lord Markham (Con)]

I thank the noble Baroness for her question and for her tireless work in this space. I have fortnightly meetings with the NHS chief executive. One of the matters that I regularly raise with her is the timing of the return of physio space for this. As for ensuring that we are properly rolling out the services, the national integrated stroke service guarantees people individualised programmes of work and stroke rehabilitation services, in their homes if need be.

Covid Pandemic: Testing of Care Home Residents

Baroness Wheeler Excerpts

Monday 6th March 2023 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, we have heard much about the former Health Secretary’s thoughts via WhatsApp, but today’s Question is about care homes. The Government claimed early in the pandemic to have thrown a “protective ring” around care homes in response to the alarm bells that were ringing across the country about elderly, frail patients being transferred from hospitals without being tested for Covid. Tragically, over 17,000 residents lost their lives in the pandemic’s first year. Between the advice given by the Chief Medical Officer about the necessity of testing and Matt Hancock’s final decision to act, residents were left exposed and isolated, and staff put at risk.

The latest revelations will be deeply distressing for families up and down the country who lost loved ones. Why were care homes not urgently prioritised when the impact of Covid was there for all to see? Will the Government ensure that the Covid inquiry gets full disclosure of the texts, minutes and documents on this matter and receives whatever support it needs to report by the end of the year?

Physiotherapy: Rehabilitation Services

Baroness Wheeler Excerpts

Thursday 23rd February 2023 Lords Chamber

Asked by

[Baroness Wheeler]

To ask His Majesty’s Government what assessment they have made of the survey by the Chartered Society of Physiotherapy, published on 1 December 2022, which found that there was a shortage of rehabilitation services, that rehabilitation spaces had not been returned to use for physiotherapy care following the COVID-19 pandemic, and that stroke survivors were being “imprisoned at home with a bed and commode” while waiting for care.

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

We welcome the Chartered Society of Physiotherapy survey and the valuable insights it gives us regarding rehabilitation services. Integrated care systems are responsible for commissioning appropriate services for their local populations. Decisions on the use of physical estates are rightly for local organisations. Rehabilitation and physiotherapy are critical to many patients’ care and recovery. For stroke survivors, the NHS aims to deliver personalised, needs-based, goal-oriented rehabilitation to every stroke survivor in their home environment.

--- Later in debate ---

[Baroness Wheeler (Lab)]

My Lords, the CSP survey paints a dismal picture of the state of rehabilitation services: overstretched and underresourced prior to the pandemic and still struggling to re-establish physio rehab services that had their staff, space and facilities diverted to deal with the crisis and with chronic staff shortages. The recent stroke audit showed that only 10% of the UK’s stroke survivors were able to access the recommended amount of rehabilitation they need. What actions are the Government taking to address this unmet demand for the vital services that will help prevent patients deteriorating and becoming more frail and vulnerable?

[Lord Markham (Con)]

I thank the noble Baroness for bringing this to our attention; again, I believe that the advantage of these Questions is that they shine the spotlight on particular areas. As the survey pointed out, there are a lot of places which, for very understandable reasons, were swapped over to Covid uses during the pandemic and which now need to be brought back into physio use. That was one of the main recommendations from the society, and we will now write to all the NHS chief executives on the back of that. As the House will be aware, I am doing some work anyway to make more space available as part of the capital programme, so this is very much on my list to make sure that we expand that space and provision.

Adult Social Care

Baroness Wheeler Excerpts

Monday 20th February 2023 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, on that theme, the Minister makes much of the Government’s historic £7.5 billion social care funding settlement, but he knows that it has been and remains seriously underfunded—the Health Foundation’s estimate is a £12 billion a year shortfall. As the excellent Lords committee underlines, it is no good attempting to resolve the social care crisis by providing short-term funding for more care packages while still depending on local authority council tax flexibility to raise the extra funds. Is the Minister concerned that three-quarters of the largest councils in England with responsibility for social care have been left with no choice but to raise their council tax by the full 4.99% increase, just to keep current inadequate levels of service going?

[Lord Markham (Con)]

I am aware of some of the challenges raised by funding through the local authority system—and I say that as a former deputy leader of a local authority, so I am very familiar with the situations at play there. At the same time, we have put a lot of the central funding in place to make sure the security is there. As I said, we will see more measures as Minister Whately announces them in the spring, not far from here; there will be further progress in this area.

Bread and Flour Regulations 1988

Baroness Wheeler Excerpts

Tuesday 7th February 2023 Lords Chamber

[Lord Markham (Con)]

I do not know the precise number; I know there are many stakeholders in this. The devolved Administrations have been involved in all of this. Part of the delay is because, once we go ahead, we have to notify the EU, because of the Northern Ireland elements of it, and that is a six-month notification. We also have to notify the World Trade Organization. All these aspects mean that this is not as quick as we would want, and then we need to let the industry have time to adjust. It is a process involving many people, but we are getting there.

[Baroness Wheeler (Lab)]

My Lords, despite their seriously delayed decision-making, the Government promised nearly two years ago that major efforts would be made to step up awareness raising of the importance of taking folic acid supplements, particularly among at-risk groups such as Afro-Caribbean women and women under 20 years old. Can the Minister tell us what actions have been taken, and what measurable impact awareness raising has had among these risk groups and on ensuring that women whose pregnancies were unplanned are not missing out on these vital nutrients in the early stages of their pregnancies?

[Lord Markham (Con)]

The noble Baroness is correct. Key to all these things is awareness that the best advice is to take folic acid supplements, as suggested. I am happy to provide precise figures of how that has moved in recent years. I completely agree that, as ever, education and awareness are key to this.

Respiratory Syncytial Virus

Baroness Wheeler Excerpts

Thursday 19th January 2023 Lords Chamber

[Lord Markham (Con)]

The noble Baroness is correct. In fact, my maiden speech was in a debate about how we can bring life sciences to bear more. The point about NHS clinical trials and the fact that we are not using this massive potential asset was very much a feature of that. It is key to the work we are doing—I had a meeting on it just this week—so I agree with the noble Baroness and hope we will see improvements in this space.

[Baroness Wheeler (Lab)]

My Lords, we know that older adults are at greater risk of serious complications from RSV infections in children, because our immune systems weaken as we get older, which can lead to exacerbations of underlying lung and cardiac disease. What action is being taken to address the serious underestimation of older adult RSV infections and to improve testing, reporting and treatment for this key group?

[Lord Markham (Con)]

I thank the noble Baroness. The key risk groups in the elderly as well are, as I mentioned earlier, those with congenital lung or heart disease or spinal muscular atrophy. The problem is that the current vaccination needs monthly immunisation to be effective, and I think most people will agree that it can be used in only the most severe cases because it is not a very practical way forward and is very expensive. That is why I am really excited by the new treatments, particularly nirsevimab, which is 75% to 80% effective, versus palivizumab, which is more around 50%. I think we have a good way forward.

Times Health Commission

Baroness Wheeler Excerpts

Thursday 19th January 2023 Lords Chamber

[Lord Markham (Con)]

As I said, we have already announced big increases in funding, with more than 20% over the next two years. Two years is not the short term. Minister Whately is working very hard on this because we know that the flow in social care is a key element of the whole solution.

[Baroness Wheeler (Lab)]

My Lords, I welcome the Times setting up the commission. So far, it seems to have a clear and coherent view on the scale of the crisis facing the NHS and what needs to be done, which seems to be sadly lacking from the Government. In the light of all the Times research in articles this week on the resuscitation that the NHS needs, the waning faith people have that they will be cared for and the rising billions that levels of ill health are costing the country, does the Minister agree that the Government’s ABCD policy for addressing the crisis needs a complete rethink?

[Lord Markham (Con)]

No, not at all. In fact, the things I have read in the Times are about what we are implementing. The House has heard me talk about virtual wards; I saw an article on how important those are in helping with the step-down care that is needed in some social care. I have seen that in many places already and it is a way forward. It has also talked about the need for AI and robotic surgery; again, I have seen examples of that in different hospitals. The commission is taking a lot of the good ideas that are already in place throughout the health service and, as I want to do, looking at the ways in which we implement that across the board.

Social Care: Integrated Care Systems

Baroness Wheeler Excerpts

Wednesday 11th January 2023 Lords Chamber

Asked by

[Baroness Wheeler]

To ask His Majesty’s Government what plans they have to ensure that social care is sufficiently represented within Integrated Care Systems.

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

ICSs need to include social care fully in planning and strategic decision-making. Local authorities are responsible for social care and have a clearly defined role within ICSs. The Health and Care Act 2022 includes local authorities in its minimum membership requirements for ICBs, giving local government a greater voice in NHS decision-making than ever before. In July 2022, we also published guidance on how ICPs and adult social care providers should work together.

[Baroness Wheeler (Lab)]

I thank the Minister for his response but ICBs and ICSs have been fully operational only since last July—less than six months. The Minister is quite right that, when they were being set up, we argued strongly for the need for effective social care representation in both bodies to ensure that health and social care are integrated and fully embedded in both. However, this just is not happening. The ADASS spring survey found 73% of directors reporting that ICS management has had little impact on local investment in adult social care to date; some even said that ICSs were reducing investment. How does this help ICSs play a key role in their respective areas in, for example, tackling the staffing crisis in both services, prioritising adult social care and producing the urgently needed ICP integrated care strategies, which are due in June?

[Lord Markham (Con)]

First, I think we can all agree on the necessity of making sure that these are integrated and the vital role that social care plays in all this. I must say, my experience from the places I have visited is that they are well integrated, but I will take that point back and would be pleased to look at any particular examples of where we feel that is not the case because, as I think the whole House will agree, it is vital that they are completely integrated.