Social Care
Baroness Wheeler Excerpts(2 years, 6 months ago)
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Baroness Wheeler (Lab)
My Lords, I thank my noble friend Lord Lipsey for securing this debate and the opportunity it presents to spotlight the issues he raises in his excellent opening speech on the possible role of the private sector in helping individuals to fund their social care costs. His expertise and knowledge across the whole range of social care funding issues—and on all things relating to social care—is much respected across the House and we are always grateful for his contribution and guidance.
Like others, I have drawn heavily for this debate on the very helpful—or not, depending which way you look at it—briefing from the Association of British Insurers, and on the work carried out examining private insurance as a means of funding social care by our own Economic Affairs Committee two years ago in its report Social Care Funding: Time to End a National Scandal. I emphasise that we would have liked to have seen the Government use that report as a first step and springboard to ensure adequate funding to local councils, so that they are able to provide the standards of care quality that are needed. They must recognise that a plan for future care has to include: funding the provision of personal care in people’s homes to meet the unmet needs of the estimated 1.5 million who need help with washing, dressing, toileting and other basic needs to help keep them living well in their homes and in the community; and working towards ending the disparity between entitlement to free NHS care and the adult social care system, ensuring that entitlement is based on the level of need rather than diagnosis, such as in the provision of free care for cancer but lack of free social care for dementia suffers. The noble Baroness, Lady Brinton, spoke very eloquently on this matter.
Indeed, we have a social care plan that is not a plan; does not “fix” social care, as the Prime Minister promised; places the burden of funding on people who can least afford it; and sets the care cap for two years’ time at a level much higher than the Dilnot recommendation and will not stop people from having to sell their homes—the pledge on which the Prime Minister is fixated and around which his proposals are built.
In the ABI briefing, the criteria set out for social care reforms that would help facilitate what it terms as a more “favourable environment” for insurance schemes have been cited by other noble Lords. They include the need for a clear offer on what the state will provide; an awareness-raising campaign about the means-testing and costs of social care, which it has been calling for since the discussions on the Care Act 2014; an easily understood care offer from the state; helping people to plan for social care costs; adding incentives to encourage people to save and plan for social care and removing disincentives which make saving towards a care plan worth while; and ensuring long-term, sustainable reform to social care that will provide stability for, in the ABI’s words, “decades and not years”.
These key criteria are sorely absent in the Government’s social care proposals. In the words of the ABI, following the Government’s announcement last month, the
“clearer the rules about what the state will provide, the easier it will be for insurers to respond to and support customers with what is not covered”.
Despite the ABI welcoming the Government’s measures as a “welcome step forward”, I am sure that, like many noble Lords, it also has the long memory of the prolonged but fruitless discussions during the passage of the Care Act and of the date for implementation of the care cap being set for 2016, then delayed twice to 2018, and then finally cancelled altogether as unaffordable. Can the Minster confirm that history will not repeat itself, and the cap will not be axed again in 2023 as the health and social care levy is swallowed up by the NHS’s herculean task of dealing with the pre and post-Covid backlog of treatments?
Noble Lords have asked specific questions about the types of financial products that could be made available in the future, such as equity release and intermediate and care cost annuities. On equity release, there have been interesting contributions from the noble Lord, Lord Balfe, and the noble Baroness, Lady Brinton. A lot of financial advisers will say that equity release is only ever worth while over the age of 80. That is generally seen as the only time when it should be considered.
I look forward to the Minister’s response to these issues. Clearly, taking out insurance to cover care costs is not an option for the vast majority of the 1.5 million who need but do not get social care support, which is why the need for state funding for personal care costs is such a key imperative in addressing the current social care funding crisis.
Can the Minister update the House on what discussions are under way on this important issue with the insurance industry? The Prime Minister promised that the Government would be working closely
“with the financial services industry to innovate and to help people insure themselves against expenditure up to that limit”—[Official Report, Commons, 7/9/21; col. 155.]
of the cap. Can the Minister reassure the House that discussions have started? Who is leading them? Will there be regular briefings on the key issues and progress? Most importantly, is he confident that any new products will be in place before the proposed implementation of the cap in 2023? Does he accept that the discussions with the industry are time-critical and need to make rapid progress?
Finally, my noble friend and other noble Lords, both today and in our debates and Statements so far, have asked key questions of the Minister about how the cap is to operate, its sheer complexity, what costs it will cover and other major concerns arising from the close analysis of the figures—such as that by my noble friend, which showed that it will be at least seven years from now before people with care needs in homes or at home will benefit from the Johnson cap. Time is fast running out for the Government to provide the answers that are vitally needed.
Social Care
Baroness Wheeler Excerpts(2 years, 6 months ago)
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Lord Kamall (Con)
I thank my noble friend for that important point. We have listened to the sector and prioritised the adult social care workforce. The investment of at least £500 million over three years will deliver new qualifications, progression pathways, and well-being and mental health support. This workforce package is unprecedented investment, which will support the development and well-being of the care workforce. It will enable a fivefold increase in public spending on the skills and training of our care workers and registered managers, as well as on their well-being.
Baroness Wheeler (Lab)
My Lords, the Secretary of State, Sajid Javid, has admitted that the Government cannot commit to clearing the NHS treatment backlog generated by Covid within three years. This is despite the fact that £12 billion a year raised from the levy will mostly go to fund this work and that he is also announcing another £6 billion in capital funding for the same purpose. Does this recognition of the scale of the NHS challenge mean that social care will have to wait even longer than three years for any levy funding? Can the Minister confirm, as he failed to do last week, that the £162.5 million announced for the social care workforce and recruitment fund was new money and not part of previous repackaging, as we have seen with the Chancellor’s pre-spending review announcements so far?
Lord Kamall
The funding commits us from 2022 to 2025—it is three years’ funding. The point that the noble Baroness makes is that, of course, we are hoping that we can clear as much of the elective backlog as possible. After that, the money will be moved and will focus on social care reforms. On her specific question, I will write to the noble Baroness.
Health Care and Adult Social Care
Baroness Wheeler Excerpts(2 years, 6 months ago)
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Baroness Wheeler
To ask Her Majesty’s Government what assessment they have made of the report by the Care Quality Commission The state of health care and adult social care in England 2020/21, published on 21 October, and in particular the concerns about staff shortages this winter.
A noble Lord
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
I am on a hat trick. The department welcomes the report by the CQC and recognises the challenges that providers and local authorities are currently experiencing in recruiting and retaining staff, especially social care staff. While local government has a key role to play in tackling staff shortages, the department has been monitoring the situation closely. We have already put in place a range of measures, including funding to help local authorities and care providers address workforce capacity pressures.
Baroness Wheeler (Lab)
My Lords, the CQC’s concern about the desperate social care staff shortages this winter and warning about a tsunami of unmet need unless urgent action is taken is very worrying. It is clear that the health and social care levy will not provide any real means of dealing with chronic staff shortages for at least two years. The recent £162.5 million for the workforce retention and recruitment fund gives less than £100 per social care worker, according to this week’s analysis from the Homecare Association of care providers. The CQC has echoed the Commons Health and Social Care Committee’s call in May for an urgent total overhaul of workforce planning in light of workforce burnout after dealing with Covid; a people plan for social care; and an annual independent report with workforce projections. Can the Minister tell the House what progress is being made on this and when we can expect a fully costed and funded workforce plan for this key sector?
Lord Kamall (Con)
I thank the noble Baroness for her reference to the £162.5 million of funding for social care through the workforce retention and recruitment fund to help boost staff numbers and support existing care workers through the winter. This is on top of the third infection control and testing fund, introduced in October 2021, which is providing a further £388.3 million of adult social care Covid-19 support until March 2022. This means that, during the pandemic, we have made available more than £2.5 billion in funding specifically for adult social care. We are also taking action to support adult social care providers through a national recruitment campaign.
Covid-19 Update
Baroness Wheeler Excerpts(2 years, 6 months ago)
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Baroness Wheeler (Lab)
My Lords, I thank the Minister for reading the Statement.
Yesterday, the Secretary of State said that the pressures on the NHS due to Covid-19 are “sustainable”. Today, we have the Commons Statement desperately trying to reinforce this message when, in reality, we see ambulances backed up outside hospitals, patients waiting hour upon hour in A&E, cancer operations cancelled and NHS staff worn out and exhausted. Yet still, as we head into winter, the Government refuse to trigger plan B or tell us what the criterion is for doing so. Can the Minister spell out exactly what evidence and criteria will be used?
The British Medical Association is the latest front-line body to call for plan B’s immediate implementation. Why can we not just make the wearing of masks on public transport, for instance, mandatory now? We must remember that SAGE, the Government’s scientific advisers, called for plan B-type measures when the Government’s autumn and winter plan was first launched, with Sir Patrick Vallance stressing the importance of going early with measures to stop rising cases.
Once again, the Government have failed to learn the lessons of the early stages of the pandemic. This hesitation to follow advice will lead to more cases, more hospitalisations and more deaths. The Secretary of State’s warning that cases could rise to 100,000 is chilling. Today, we have the sobering update from the Government’s own Covid dashboard showing 52,009 new coronavirus cases—the highest daily total and the first time the daily tally has topped 50,000 since 17 July.
It is obvious that plan A just is not working. The vaccination programme is stalling, particularly given the very late vaccinations for 12 to 15 year-olds and the mixed messages and worryingly low uptake of booster jabs. Ministers cannot blame the public when 2 million people have not even been invited for a booster jab, and on current trends the booster programme will not be completed until March 2022. Currently, there are just 165,000 jabs a day. Will the Government commit to 500,000 booster jabs a day and ensure that the programme is completed by Christmas, as it needs to be, particularly given the growing evidence of waning vaccination protection among double-vaccinated older and more vulnerable people? We learned from leaked data yesterday that only a quarter of care home residents have received a booster vaccination. Can the Minister confirm that this is correct and tell the House what urgent action the Government are taking to address this?
On children, where the highest rate of infections is concentrated and infections are running at 10,000 a day, only 17% of children have been vaccinated. This is a stuttering and wholly inadequate rollout of the children’s vaccination programme. Does the Minister recognise that this slowness exposes the folly of the drastic cuts over the past decade in the number of school nurses and health visitors who support these immunisation programmes in our communities? Will retired medics and school nurses be mobilised to return to schools and carry out vaccinations?
As the winter crisis looms, the rollout of flub jabs is also crucial to bringing down hospital admissions and ensuring that the NHS can cope, but it is also painfully slow. Only 6% of over-65s have been vaccinated, and across the country we hear stories of cancelled flu jabs at GP surgeries and of pharmacists running out of supplies. Why are supplies apparently running so low, with infections, meanwhile, running so high? What are the Government doing to ensure adequate stocks at GP surgeries and chemists to meet the demand? Can the Government guarantee a flu jab to all those that need it by December? We must get ahead of this virus, because otherwise it gets ahead of us.
Can the Minister also comment on reports in today’s media that as well as plan B, there is now active consideration of a plan C: no household mixing—in other words,
“a lockdown by the back door”,
as the shadow Secretary of State, Jonathan Ashworth, has called it. Can the Minister tell the House what is actually under “active consideration”, in the words of the Health Minister on Radio 4 this morning? No household mixing would be deeply concerning for many people who were prevented from seeing their loved ones for months at a time during the first and second waves of lockdown.
I am sure noble Lords will have much to say on mask wearing, as they did during yesterday’s PNQ. Ministers continue to sow confusion, including among themselves, with the Secretary of State’s comments in the Commons yesterday that politicians should “set an example” and wear masks in crowded spaces—yet the Leader of the House subsequently told MPs that there was no such advice for workplaces. Can the Minister explain what is going on?
The Statement also refers to the agreement with Pfizer and MSD on two new antiviral drugs, which we of course welcome, as they play a vital role in stopping a mild disease from becoming serious. Can the Minister tell the House about the expected timetable for MHRA approval and any provisional details on availability and rollout?
Finally, on social care funding, as usual we welcome the announcement at the end of the Statement of additional funding for local authorities to support staffing and care work through the winter, assuming that the £162.5 million workforce retention and recruitment fund is actually new money and not part of previous repackaged funding. Could the Minister confirm this? Can he provide more details as to how and when this money is to be available and how it will be allocated to local authorities?
Lord Scriven (LD)
My Lords, I too welcome the Minister’s reading the Statement from yesterday. We are discussing this on the day when more than 50,000 Covid cases have been recorded in the UK for the first time since 17 July. There have been over 52,000 cases and 115 deaths; 8,142 people are in hospital with Covid, and 870 of those are on a ventilated bed. We are discussing this just hours after the Royal Cornwall Hospitals NHS Trust has declared a critical incident because of the pressures it is under serving the people of Cornwall.
That shows why this Statement is not a master class in providing a range of effective public health measures to tackle a virus that spreads at speed, and more a master class in trying to keep the libertarian wing of the Conservative Party happy. The “jab, jab, jab” message is important but, when some people go on to the booking system now, they are not able to book. They are told to ring 119, as my honourable friend in the other place, the Member for St Albans, Daisy Cooper, said early today; when they ring 119, operators tell them that they cannot override the system. I ask the Minister what is going on with the booking system and how soon it will be repaired. The “jab, jab, jab” message is important, but it is not, in itself, going to deal with the severity of the public health crisis we face. As Professor Adam Finn, a member of the JCVI, said yesterday, vaccinations in themselves are not going to stop us falling off the edge of the Covid cliff.
I want the Minister to explain these different rates, if plan A, of vaccination, is working. The seven-day rolling averages for Covid-19 cases per 100,000 of the population are: in the UK, just under 500, and rising sharply; in France, approximately 60, and falling; and in Spain, approximately 50, and falling. Even considering the variation in testing rates, the UK is clearly an outlier. Take a look at three months ago, when the Government removed all mandatory mitigation measures. The picture tells you the true story of why “jab, jab, jab”, as a public health strategy, is not enough to deal with the Covid-19 problems. Then, the UK had approximately 300 cases per 100,000, and it now has 500; France had approximately 220, and it now has 60; and Spain had approximately 350, and it now has 50. It is because France and Spain, as well as other countries, have jabbed, jabbed, jabbed but also mitigated, mitigated, mitigated. Indecision is our greatest enemy in the fight against this disease.
Let us be clear: those of us who ask for extra mitigation measures, such as the use of mandatory face coverings, do so to stop the crippling lockdowns that have come before. The Government, as the Health and Social Care Select Committee has reported, have acted too little too late before when dealing with this virus. This means that the damage, both to public health and the economy, is greater than it would have been if the Government had listened to the expert advice and acted sooner.
On one very important mitigation measure we could take, the mandatory use of face coverings, the Minister said yesterday, answering a PNQ:
“Personally, I do believe that many people should be wearing masks and that there is evidence for this.”—[Official Report, 20/10/21; col. 145.]
If good evidence exists that wearing face masks helps to reduce the transmission of Covid-19, why have the Government stopped their mandatory use in indoor settings? Could the Minister please enlighten the House on what evidence the Government have that asking people to use self-judgment on wearing a face covering in certain indoor settings is more effective than making them mandatory? I am sure that evidence will be at the Minister’s fingertips, as it is official government policy. They would not make up such an important policy to ditch a mitigation measure that could save lives without the use of good evidence—would they?
Furthermore, can the Minister explain why, at Prime Minister’s Question Time yesterday, hardly any Tory MP sat on the green Benches had a face covering on, and why, today, a Minister sat on the government Front Bench in this House wore a mask below his chin, with both his nose and mouth exposed? Whose evidence are they following? What leadership and example does it set to the nation if the Government are, on the one hand, asking us to use our self-judgment to wear a face covering, but government Ministers and MPs in the House of Commons do not?
The evidence of experts in public health and epidemiology, and figures from Europe, show that a mixture of vaccination and mandatory mitigation measures is required, if the spread of the virus is to be contained to manageable levels, so that later in winter we do not have to slam on the brakes and have yet another lockdown.
Can the Minister clarify something that he said yesterday during a PNQ? When asked whether the Government still had confidence in SAGE and its workings, the Minister replied:
“May I write to my noble friend on that?”—[Official Report, 20/10/21; col. 146.]
I know that the Minister is new and that he did not have all the details to hand, so I am giving him a second chance. Can he confirm from the Dispatch Box that the Government do have confidence in SAGE and the advice that it gives?
It is time to be clear that the message on vaccination take-up and extra mitigation on issues such as mandatory face coverings are required. Otherwise, we will be left in a situation where, unfortunately, more people will die than is necessary, the Government will be behind the curve in dealing with the virus and much more draconian measures will have to be taken. Now is the time for plan B, not for dithering and not taking the measures that are required.
Social Care in England
Baroness Wheeler Excerpts(2 years, 6 months ago)
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Baroness Wheeler (Lab)
My Lords, on behalf of these Benches I formally welcome the Minister to his first debate in the House. I am particularly pleased that it is on social care, so that he can focus on addressing the deep concerns across the House about the Government’s social care plan, made clear during Monday’s passage of the hastily thrown together Health and Social Care Levy Bill. It also ensures that he provides much-needed responses to key issues that will not go away, however many slogans and smokescreens the Government throw up.
This has been an excellent debate. Whether from Labour, the Government, other parties or Cross-Benchers, these occasions demonstrate the level of expertise, experience and scrutiny that I am sure the Minister fully realises he will get from noble Lords. This was no better demonstrated than by my noble friend Lady Pitkeathley’s candid and honest appraisal in her powerful speech of the current crisis and what is needed to provide sustainable services in future. She reflects both the knowledge and experience of a lifetime of work on health and social care and of a strong campaigner and advocate on behalf of unpaid carers. We are all very grateful to her.
Like other noble Lords, I particularly pay tribute to unpaid carers because we need to get back to a proper recognition of their crucial role and doing more than just saying how wonderful they are. In 2009, before I joined your Lordships’ House, I was fortunate, as a carer myself, to undertake a 12-month secondment to the Department of Health’s excellent carers strategy team, which had produced the first pioneering strategy in 2008, placing carers at the heart of families and communities. Central to this was recognition and funding for vital local support and networks, regular everyday social services care support for carers and the loved ones they cared for, and ring-fenced grants via GPs and councils for regular care breaks—so crucial, given the relentless responsibility of caring for a loved one around the clock. At that time in DH, there were 10 full- time staff in the carers team. Perhaps the Minister could tell me how many staff there are now.
Today, as carers emerge worn out and exhausted from the pandemic, they have every right to expect immediate funding support. Instead, the Prime Minister’s plan contains no immediate extra funding for carers and the levy does nothing for them in two years’ time. The “health and social care begins at home” and “family first, then community, then the state” comments from Sajid Javid add insult to injury, as many noble Lords have said.
Carers need care workers and social care to support their families; their role complements that of paid staff but they are not substitutes for care workers, who are themselves chronically undervalued and underpaid. They already provide the vast majority of care and love to our vulnerable and disabled people, many of them having had to give up work to do so. That is why Labour’s “home first” principle is so important. It means the state, families and communities working together to enable and support people to live well with dignity, in their own homes, and receive the care they need. Only with “home first” can the focus of support be effectively shifted to prevention and early intervention.
Today shows that we are still in the dark about the key funding concerns raised during Monday’s debate on the Bill, such as how much of the levy will actually be spent on social care and how councils are to be funded for the care cap; ensuring that self-funded care home residents pay the same rate as council-supported residents; what guarantees social care has if the NHS’s herculean task of dealing with the backlog of treatments absorbs the bulk of the levy funding; or, indeed, what funding will flow for social care unrelated to the cap. I welcome the contributions from noble Lords today that have focused on this vital aspect of social care.
However, those of us hoping for answers from the Treasury Minister on Monday to these and other searching questions were sadly disappointed. As in Monday’s debate, several noble Lords cited today the excellent analysis by the independent Institute for Fiscal Studies—a reality check for the Government, if ever there was one, regarding how underfunded their spending plans for the NHS and social care are—particularly its stark warning that the £12 billion raised annually by the tax increase needs to rise to nearly £19 billion by 2025 to meet future NHS and social care demand. Will the Minister promise the House that the Government will respond in detail to the IFS findings, which reflect the serious funding concerns from across the sector?
With the health and social care Bill, currently in the Commons, dealing with the already up and functioning integrated healthcare systems, can the Minister explain how another radical plan by the Government for a health and social care integration White Paper, as reported in the media, will dovetail with that Bill, the social care plan we are discussing and the levy funding? Back-to-front planning and legislation is how many stakeholders have described it: raising the money first and deciding how it is to be spent later.
Can the Minister provide further details on the purpose and timing of the White Paper, and what it will cover? Will it deal with the really big issues, in the words of the noble Lord, Lord Bichard? Will it also address the absolute social care basics that the current plan ignores and that cause such suffering and despair today: the unmet social care needs of 1.5 million older people, who need help with washing and dressing that they do not currently get; the 300,000 people waiting in vain for care assessments by local councils who just do not have the resources to do them; or the needs of the disabled young people and adults of working age whose funding makes up over half of the current social care budget? I particularly look forward to the Minister’s response to my noble friend Lady Donaghy’s expert analysis of the funding issues for care homes and social housing.
Labour has made it crystal clear that Boris Johnson’s plan is not the thought-through and fully funded long-term plan for social care that is so desperately needed. In the words of the Labour leader, Keir Starmer, an unfair tax hike that does not fix social care and does not clear the NHS backlog is not a plan. Any fix for the future of social care has to transform support for older and disabled people within the wider ambition of making Britain the best place in which to grow up and grow old. This plan does not come anywhere near that: no reforms, no guarantees and no long-term sustainability. The Minister needs to provide the clear answers to noble Lords that we did not get on Monday, in particular on fairness. How is it fair and right, at a time when low-paid workers and their families are still reeling from the impact of the pandemic and are hit with rising food, energy and fuel costs, to place the burden of paying for the social care plan on them?
On social care funding guarantees and local council support, why is it not possible now to set even an ambition as to how much of the additional funding from the levy will go to social care in 2023? Less than one in every six pounds raised will go to social care in the first three years of the plan. On local council funding, as the Local Government Association stresses, relying on the continued use of council tax, the social care precept and long-term efficiency savings does not address the current crisis or future social care demand. Councils just do not have the money. Does the Minister acknowledge that, unless the spending review recognises this, even the limited scope for reform in the Government’s plan will fail?
We know that the care costs cap will not solve the huge crisis in social care, and it will not stop people having to sell their homes. We have had many searching questions from noble Lords on how it will be calculated and work, what care needs it will pay for, how much people have to pay before the £86,000 kicks in, and, of course, what rates councils will actually be able to pay that will be counted towards the cap. Why delay bringing in the cap until 2023? The legislation is in place now under the Care Act 2014. The Government have previous form on promising to introduce the cap, which was subsequently delayed twice and finally cancelled altogether. Can the Minister confirm that history will not repeat itself and the cap will not be axed again in 2023 as “unaffordable”?
On social care equality and parity with the NHS, how are the continuing inequalities and the unfairness between the systems, such as the huge financial costs involved in paying for dementia care and the often terrible injustices of who gets NHS continuing healthcare and who does not, going to be addressed? In its “national scandal” report, the House of Lords Economic Affairs Committee set out a key package of reforms to begin to address the divide between social care and the NHS. Why has it been completely ignored?
Like all noble Lords, I pay full tribute to the work and commitment of social care staff, particularly over the last year. They have been on the front line of the pandemic in domiciliary care and in care homes. Fixing social care must mean a new deal for them and the transformation of their pay and conditions. The spending review must address this. My noble friend Lady Warwick and other noble Lords have pointed to the Skills for Care workforce report, which shows beyond doubt the scale of the social care recruitment crisis and reinforces the urgent need for this.
My noble friend Lady Pitkeathley is absolutely right to express her frustration that the Government’s plan for social care is once again a missed opportunity to put social care on an equal footing with the NHS and build a post-Covid vision for social care: a plan of investment and reform, including integrated services and a well-paid, fully trained and skilled workforce. After the way social care was treated as an afterthought during the pandemic, this should have been a central part of the Government’s plan for fixing social care. Sadly, it was not.
Social Care Funding: Intergenerational Impact
Baroness Wheeler Excerpts(2 years, 7 months ago)
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Baroness Wheeler (Lab)
My Lords, I congratulate the noble Baroness, Lady Greengross, on securing this debate and on her timely reminder of the intergenerational fairness report on social care funding, which she so ably chaired.
This is the first, brief, opportunity we have had since the usual hyperbole and razzmatazz of the Prime Minister’s announcement last week to begin the step-by-step, detailed debate and analysis about what is actually in the proposals and their impact across the generations on the elderly, on working-age people, on younger people with disabilities and their families and on carers.
Reality is fast setting in, as noble Lords’ wide-ranging and thoughtful contributions in this debate have shown. After the way it was treated during the pandemic, the hope and expectation must surely have been for social care to have been an up-front and equal partner in any future health and social care funding plan, but it certainly is not in what the Government have set out.
The funding allocated to social care from the health and social care levy over the next three years amounts to only £1 in every £6 of the total £36 billion raised. Figures from the Institute of Fiscal Studies clearly show that this is nowhere near enough to offset the £8 billion of cuts in per capita spending over the last decade. Local councils, social services leaders and providers are deeply concerned that the NHS will continue to absorb and swallow up the vast majority of the proceeds from the new tax, and there is no extra funding to deal with the crisis in social care now; a number of noble Lords pointed that out. As the National Care Forum put it:
“This is a recovery plan for the NHS … The funding pot being talked about for social care is not sufficient to even address the issues of today.”
Although we do not agree with the intergenerational report’s overall recommendations on funding, many of its findings nevertheless resonate with Labour’s key concerns about the impact that the Government’s proposals will have. Many of those concerns have been underlined today by noble Lords, particularly the noble Lords, Lord Howarth, Lord Davies and Lord Griffiths, and the noble Baroness, Lady Tyler.
We have made it clear that the plan is wrong on so many fronts. First, the national insurance increase will disproportionately affect younger and lower-income workers. It does nothing to tackle the chronic workforce shortages, which are getting worse by the day, and will mean care workers ending up £1,130 worse off as a result of this increase and the £20 cut in universal credit, which many rely on.
The cap will do nothing for a third of the users and half the budget for social care, which is for working-age adults with disabilities, as a number of noble Lords— including the noble Baronesses, Lady Watkins and Lady Brinton, and the noble Lord, Lord Sikka—pointed out. The press stories of young disabled people having to stay in bed or sitting in a chair all day because their care hours and the other services they depend on stopped during the pandemic and still have not restarted are heartbreaking. Further, the cap will not kick in until 2023 and does not cover all costs. People will still need to sell their homes to fund their care and many people in care will never hit the cap, as the noble Lord, Lord Lipsey, pointed out.
Moreover, there is no commitment to addressing the urgent needs of the 1.5 million older people who are denied personal care for help with washing, dressing, toileting and other basic needs to help them to stay in their homes and be part of their local communities. Labour’s key principle of “home first” must form a key part of the plan for sustainable funding. We have made it clear that the social care plan must be fair across generations, and that those who can most afford it must be asked to contribute more. It must deal with both the immediate and long-term funding needs, and give social care the parity with the NHS that it both deserves and needs.
Social Care: Family Carers
Baroness Wheeler Excerpts(2 years, 7 months ago)
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Baroness Pitkeathley
To ask Her Majesty’s Government what consideration they have given to providing extra support for family carers given the delay to social care reforms.
Baroness Wheeler (Lab)
On behalf of my noble friend, and with her permission, I beg leave to ask the Question standing in her name on the Order Paper.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, we recognise that family carers play a vital role. When we announced an additional £4.5 billion over three years for social care, it included a commitment to take steps to ensure unpaid carers have the support, advice and respite they need. We will publish a White Paper later this year with more detail. The Health and Care Bill also places a duty on integrated care boards to promote the involvement of unpaid carers.
Baroness Wheeler (Lab)
My Lords, the Minister has acknowledged that our 1.6 million unpaid carers are reporting high levels of fatigue and stress and are worn out and exhausted by caring during Covid-19. On average, carers have lost 25 hours a month of crucial support over the past 18 months, and 81% are providing more care. Essential daily support services for them and their loved ones are still not up and running in many areas. Was it not therefore reasonable for carers to have expected immediate funding support from the Prime Minister’s health and social care funding announcements last week? The situation is desperate and needs addressing now, not just with more kind words and another “White Paper tomorrow” promise.
Lord Bethell (Con)
My Lords, I do acknowledge the pressures on unpaid carers and pay tribute to the incredible contribution they have made during these very difficult 18 months. We are continuing to work with local authorities, in collaboration with ADASS and MHCLG, to support local authorities in meeting their duties, particularly in the area of respite, which the noble Baroness rightly pointed out. We have also made contributions to Carers Trust, Carers UK and to “See, Hear, Respond” services to support unpaid carers. In the long term, our commitment is to social care reform and the financial proposition that we will bring forward in the White Paper.
Residential Social Care: Staff
Baroness Wheeler Excerpts(2 years, 7 months ago)
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Lord Bethell (Con)
My Lords, I am aware of the anecdotes that the noble Baroness alludes to, but they have not been seen through the figures that we have in the department. However, we are providing support to providers: we have a national recruitment campaign that is running in the autumn; we have put in free and fast-track DBS checks for staff recruited in response to the pandemic; and we have the promotion of adult social care careers in our jobcentres.
Baroness Wheeler (Lab)
My Lords, while we await the announcement of the Prime Minister’s social care plan, after two frustrating years of non-action and delay, the continuing crisis in care homes needs to be dealt with now. With a possible 68,000 jobs now predicted to be lost in the light of the Government’s 11 November deadline for all care staff to be vaccinated, feedback from care providers shows that both care workers and the most senior and experienced staff are leaving the care workforce, with registered nursing staff constituting a much higher proportion than other care staff. What action have the Government taken to address this potential crisis in both the staffing and the management of care homes, particularly since the number of nursing jobs, for example, has decreased by 17,000, or 33%, over the past year?
Lord Bethell (Con)
My Lords, I do not completely recognise all of the noble Baroness’s figures, but I acknowledge that recruitment in many sectors of the economy is tough at the moment, and that is why we are putting in the measures that I mentioned to the noble Baroness, Lady Brinton. I add that we are doing an enormous amount to fund: we have put £1 billion of additional funding into social care for 2021-22, on top of the significant support provided to the sector during Covid-19 over the last year. This is money directly to address the issues that she is concerned about.
Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) Regulations 2021
Baroness Wheeler Excerpts(2 years, 9 months ago)
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Baroness Wheeler
At the end to insert “but that this House regrets that the Regulations do not include any information about how the legislation will operate and that this will be left to guidance that will not be available until the end of July; further regrets that a full impact assessment has not been published including analysis of the number of current staff who may not comply and the potential impact on care homes if care home staff become ineligible for work because they are not fully vaccinated or medically exempt; notes that the Secondary Legislation Scrutiny Committee recommended that the debate on the instrument should be deferred until the operational guidance and full impact assessment has been published; and calls on Her Majesty’s Government to provide stronger supporting evidence for permanently requiring staff to have received both doses of the vaccine or, if they have not, to be banned from entering their workplace.”
Baroness Wheeler (Lab)
My Lords, I thank the Minister. I am moving my amendment in the light of the deep concerns of the Secondary Legislation Scrutiny Committee in its eighth report. I listened to its 13 July questioning of Nadhim Zahawi, the Vaccine Minister, which was held on the same day that the SI was debated in the Commons. The committee produced a further, 10th report yesterday in response to this. As its eighth report says,
“effective Parliamentary scrutiny is impossible”
by the House because crucial operational guidance and the impact assessment are not available, because none of the practical information about how the guidance is to operate is in the actual legislation before us, and because no reasons have been provided as to why the legislation is not a restricted pandemic measure rather than the permanent measure that the Government are proposing.
The Commons debate was focused on the failure to produce the impact assessment so essential for understanding the full consequences of the legislation. The Health Minister promised that we would have it before our debate today; the Vaccine Minister instead undertook to provide an impact statement, which the committee still had not had at the time of its further report. I am still not clear which piece of the last-minute information promised has been delivered, and the Minister’s speech may have confused me still further about what is and what is not available.
So we have more documentation and more information but not the full and detailed impact assessment that is needed. Overall, we still do not have the answers to the committee’s fundamental questions: why has the vaccination programme not managed to achieve the required levels despite care home staff being prioritised, and why the regional variations? Why has there been no detailed analysis of the impact the policy will have on care home staff and the possible risk to the viability of care homes as a result? We still have had no real analysis of the degree and nature of the opposition to the proposals expressed during the consultation, which could provide helpful guidance on how it is to be addressed.
This SI is muddled, confused and disjointed and, in places, contradictory—across the SI itself, the Explanatory Memorandum and in the Government’s consultation response. This makes even more urgent the publication of clear and detailed guidance which includes not just the practical detail the committee wants to see but the full policy framework. We are assured that the guidance has been produced in consultation with the sector. Can the Minister confirm that this has included care home providers from both large and small group homes, and the staff unions? Is there now a firm publication date, other than just the end of the month, in 11 days’ time, that we have been promised?
Specifically on consultation, the Government’s consultation response document itself admits that 57% of respondents were against the mandatory vaccination of staff. Nadhim Zahawi stressed to the committee how important it was to “carry people with us” and our Minister told the House on 8 July:
“We are in a consultation … it is an honest consultation. We have to take people with us: this is not something that we can impose on people against their will.”—[Official Report, 8/7/21; col. 1454.]
How will the Minister now honour that commitment, and how does he square it with the legislation that the Government have actually produced?
In its report, the committee is particularly scathing about the DHSC’s failure to provide justification for the substantial policy change from using the SAGE advice, mentioned by the Minister, of at least 80% of care home staff needing a first vaccination in order to provide a minimum level of protection against Covid-19 to the requirement for them to have two doses or they will be banned from the workplace and stand to lose their job. Why this shift and what is the detailed evidence which led to such a major policy change?
Despite our deep concern about the health and safety of care home residents, no one doubts the impact that mandatory vaccination will have on care home staff in their jobs, the risks to the viability of care homes and the confusion that will reign, especially in small care homes coping with even worse staff shortages and recruitment problems than they currently have and trying to administer and monitor the trades- person, et cetera, visiting arrangements. The National Care Forum has been particularly vocal on that latter point. We just do not know the scale and extent of the risk in a sector that already has 100,000 unfilled posts.
These are dedicated staff who have been in the front line of care through the pandemic. We need to understand why there is vaccine hesitancy among the minority of staff and build and strengthen the excellent work that has been done with so many to allay fears and assuage concerns arising from cultural or personal health fears.
Can the Minister explain how the Government will ensure that the 16-week grace period is used to intensify and ramp up the take-up campaign and ensure the targeting of regions and areas where there is relatively low take-up? Will it be extended if the impact assessment and implementation plan show that that is needed?
Paragraph 12 of the EM contains only five short points dealing with the serious staff shortages that the care sector will face, starting with the bald understatement that there will be
“the short-term cost of dealing with staff absences”.
Moreover, the EM goes back to the Care Act 2014 provision, which assumes that local authorities have a contingency plan to address workforce shortages and care provider closures. Given the Government’s sweeping council social care funding cuts for the past 10 years, we know just what state councils would be in if they tried to meet that contingency. Last week ADASS reported up to 250,000 vulnerable people across England languishing on social care waiting lists for care assessments or service reviews to check their physical and mental state. Will additional funding be made available to councils to meet the extra costs of staff shortages and turnover?
In conclusion, the House must be reassured that there will be a detailed, coherent, well-resourced and fully thought-through plan for moving forward and finding solutions for carrying and taking people with us—in the words of the Ministers—and addressing the major challenges that implementing the mandatory vaccination of care home staff will present. We must be reassured that the Secondary Legislation Committee’s rightful concerns have been fully addressed. For the record, its 10th report, published yesterday, stresses that, despite the welcome “further information and explanations” from the Government,
“we remain unclear about the justification for some of the policy choices underlying these Regulations and also the basis on which the department struck a balance between public health benefits and the impact on the rights of individuals.”
I look forward to the contributions of other noble Lords and the Minister’s response, and I will wish to test the opinion of the House on this very important issue. I beg to move.
Baroness Wheeler (Lab)
My Lords, I thank the Minister for his response and all noble Lords for their contributions on this very important SI. Of course, I join in the tributes to social care staff across the sector during the pandemic. As I said in moving the amendment, my focus is on the Secondary Legislation Scrutiny Committee’s rightful concerns about the inadequacy of the legislation and the Government’s failure to produce the essential guidance needed or the full impact assessment of the risks to the future of many care homes from the huge disruption that will take place. It is not an SI that is pandemic-restricted, a temporary measure; instead it is permanent legislation, which makes the quality of the SI even more important and reinforces the inadequacy of the legislation we have before us today on such an important issue for care homes, their staff and residents.
My noble friend Lord Hunt and the noble Lord, Lord Lansley, sought an assurance from the Minister that the measures will be temporary and time-limited, but we did not get that assurance. Once again we have an SI that seeks to extend unspecified government powers in legislation without justifying why those powers are needed. In other words, this is, as the Secondary Legislation Scrutiny Committee says,
“guidance exceeding its ancillary function and taking on the role of legislation”.
Noble Lords raised many points and I fear there is just not time now to respond to them. Overall, this SI remains an incoherent, muddled and confused piece of legislation and further last-minute information and reassurances from the Government have not made it any clearer or dealt with the key issues that need to be addressed. I wish to test the opinion of the House.
Health: Dementia
Baroness Wheeler Excerpts(2 years, 9 months ago)
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Baroness Wheeler (Lab)
My Lords, not only are there deep concerns about the sharp drop in memory clinic referrals during the pandemic; the Alzheimer’s Society also has very real fears that the virtual assessments currently taking the place of attendance at memory clinics run the risk of exacerbating inequalities in treatment and excluding large cohorts of patients. What is the Government’s overall strategy for ensuring that vital day care and hospital services are reopened and that the backlogs in referrals are addressed, for providing the rehabilitation that people with dementia need to counteract the effects on their cognitive and physical function, and for providing support for their mental health and well-being?
Lord Bethell (Con)
My Lords, guidance to help enhance best practice in dementia assessment and diagnosis was recently updated and published to support a personalised approach and choice in the delivery of remote consultation or face-to-face diagnosis. The guidance was developed in collaboration with stakeholders, including those with lived experience, and through the Dementia Change Action Network. I completely acknowledge the point that the noble Baroness makes. We are working as hard as we can to get the kind of face-to-face assessments she describes. They play an essential role in what we do.