Hospital Beds and Social Care
Baroness Wheeler Excerpts(4 years ago)
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Baroness Wheeler (Lab)
My Lords, with today’s reports of hundreds of care homes closing their doors to new admissions because of the rapid spread of omicron, adding to the huge pressure on hospitals, can the Minister explain in more detail why urgent priority funding is not being directed to the provision of step-down facilities to address the escalating crisis? We are told that we have new diagnostic units and resurrected Nightingale hospitals, but step-down facilities in local NHS and community settings, where patients medically fit for discharge can be monitored and properly assessed, have been shown to be working very successfully. Would not that provide the right care at the right time, as promised in last month’s social care White Paper?
Lord Kamall (Con)
We have been looking at different pathways out of hospitals, and one of the discharge pathways is step-down care. One issue that the task force has looked at is how we improve and increase accessibility to appropriate step-down care when a patient is unable to go straight to their home.
NHS: Elective and Cancer Care Backlog
Baroness Wheeler Excerpts(4 years, 1 month ago)
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Lord Kamall (Con)
One thing that the Government are doing is looking at a number of different ways in which we can think outside the box and be multifaceted to make sure that, for example, instead of patients going directly to A&E they can be dealt with by 111 or other services. In addition, we are committed to delivering 50,000 more nurses, growing the workforce and making sure that we have a trained workforce not only in healthcare but in social care.
Baroness Wheeler (Lab)
My Lords, the NAO report clearly showed that performance against NHS waiting times had been steadily deteriorating prior to the pandemic, and that during the pandemic there were between 24,000 and 74,000 missing urgent GP referrals for suspected cancer. For the most common cancer in the UK—breast cancer—it is estimated that the disruption in screening services during Covid means that 12,000 people are living with undiagnosed breast cancer, 10,600 fewer breast cancer patients started treatment and 20,000 fewer people last year were referred for breast checks. What specific action is being taken to address this deeply worrying situation?
Lord Kamall (Con)
Even before the pandemic there was a growing number of referrals across elective and cancer care. This had been driven by a number of different factors, including people’s awareness of cancer, the symptoms associated with it and media campaigns. In addition, one of successes of having an ageing population is that people face a number of different issues. For example, over half of cancers are diagnosed in patients over 65. We know that we have to tackle this issue. That is why we have published the long-term plan with a £33.9 billion budget.
Adult Social Care
Baroness Wheeler Excerpts(4 years, 1 month ago)
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Baroness Wheeler (Lab)
I thank the Government for the Statement, which has been a long time coming.
First, we are told that we have a health and social care Bill to deal with integration across the NHS and social care. Instead, we get a giant Bill that is largely about NHS reorganisation to undo the structures set up by this Government in 2012. We are also told that there is a plan to fix social care, but we now have a government levy that has working-class families paying for extra funding that could in any event result in the NHS swallowing up most of the money to deal with the ever-growing waiting lists for vital treatment, with little left for social care. Finally, we have the grand announcement of the care cap, for which there was strong cross-party support when it was first proposed by Andrew Dilnot in 2011 and legislated for in 2014. However, it is now due to be delayed for yet another two years and introduced at half the level recommended by Dilnot, with the terrible and deadly sting in the tail of the last-minute amendment to the NHS Bill that was forced through the Commons last week and means that state-funded care costs will not be counted towards the care cap at all.
I remind the House that we have waited for this social care White Paper for four years, with unexplained delay after delay against a backdrop of expectation that, when it finally came, the NHS and care Bill would embrace NHS and social care integration. The proposals for this and other measures in the White Paper should have been an integral part of the Bill, which we will begin to debate next week. Can the Minister tell the House how the integrated care system under the Bill will be integrated for social care? Will there be another piece of legislation? If so, what will it seek to do?
Of course, Labour has called for and supports a number of the measures in the White Paper, such as improving the housing options available to older and disabled people and the potential for technology to improve standards of care. However, there are two central flaws in the Government’s latest approach. First, Ministers have utterly failed to deal with the immediate pressures facing social care as we head into one of the most difficult winters on record. Secondly, they have failed to set out the long-term vision and reforms that we need to deliver a care system fit for the future.
Last week, we learned that a staggering 400,000 older and disabled people are now on council waiting lists for care, with 40,000 of them waiting more than a year. There are more than 100,000 staff vacancies and turnover rates are soaring. Because of these shortages, 1.5 million hours of home care could not be delivered between August and October alone, and half of all councils report care homes going bust or home providers handing back contracts. Hundreds of thousands of older and disabled people are being left without the vital support they need, piling even more pressure on their families and the NHS at the worst possible time.
Does the Minister recognise the figure, reported this week, that 42,000 care staff have left their jobs since April? How will this White Paper ensure that care homes facing huge staff shortages can stay open and recruit and retain staff? Absolutely nothing new has been announced to deal with these crucial issues. Where is the plan to end waiting lists for care? Unless people get support when and where they need it, they will end up needing more expensive residential or hospital care, which is worse for them and for the taxpayer. We know that improving access is the first step in delivering a much more fundamental shift in the focus of support towards prevention and early intervention so that people can continue to live independently in their own homes for as long as possible. Without enough staff with the right training working in the right teams, this will never be achieved.
Where is the long-term strategy to transform the pay, training and terms and conditions of care workers, and to deliver at least 500,000 additional care workers by 2030, just to meet the growing demand? Why do the Government persist in having separate workforce strategies for the NHS and social care when the two are inextricably linked? Where is the joined-up strategy for the whole health and social care workforce?
The proposals in the White Paper for England’s 11 million family carers, who provide the vast majority of care in this country, are, quite frankly, pitiful. Unpaid carers have been pushed to the limit by trying to look after the people they love. Almost half said that they had not had a break for five years, even before the pandemic struck, and 80% of them are now providing more care than ever before. However, the funding announced amounts to just £1.60 more for each unpaid carer per year. Does the Minister not agree that families deserve so much better?
What was needed today was a long-term vision that finally puts social care where it belongs: on an equal footing with the NHS at the heart of a modernised welfare state. Can the Minister explain how this White Paper does that and delivers the resources needed to bring it about? At its best, social care is about far more than just helping people to get up, wash, dress and get fed, vital though this is. It is about ensuring that all older and disabled people can live the life they choose in the place they call home, with the people they love and doing the things that matter to them most. This should have been the guiding mission of the White Paper, with clear proposals to make users genuine partners in their care by transforming the use of direct payments and personal budgets, and ensuring that the views of users and families drive change in every part of the system, from how services are commissioned to how they are regulated and delivered.
The Government’s proposals fall woefully short of the mark and the reality of their so-called reforms is now clear: it is a tax hike on working people that will not deal with the problems in social care now. It will not even stop them having to sell their homes to pay for care, as the Prime Minister has repeatedly promised. The simple fact is that, under the Government’s proposals, if you own a home worth £1 million more than 90% of your assets will be protected, but if your home is worth £100,000 you could end up losing it all. Millions of working people are paying more tax, not to improve their family’s care or stop their own life savings being wiped out but to protect the homes of the wealthiest. This is not fixing the crisis in social care, let alone real social care reform. It is unfair and just wrong.
Dementia: Art and Music-based Interventions
Baroness Wheeler Excerpts(4 years, 1 month ago)
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Lord Kamall (Con)
I pay tribute to the noble Baroness for all her work raising awareness of dementia, in this House and outside of it. The Government understand the importance of non-medical and lifestyle factors in supporting people’s health and well-being, including brain health. This is why we are continuing to roll out social prescribing across the NHS, in line with the NHS Long Term Plan commitment to have at least 900,000 people referred to social prescribing by 2023-24. The Department of Health and Social Care is working closely with NHS England and NHS Improvement to incorporate social prescribing into the guidance to integrated care systems. Some of this guidance has already been included in the document implementation guidance on partnerships with the voluntary, community and social enterprise sector that was published in September 2021.
Baroness Wheeler (Lab)
Around 25,000 people with dementia are from BAME communities and this is expected to double by 2026. The Alzheimer’s Society report, The Fog of Support, found that people from these communities, and those with English as an additional language, were more likely to use BAME-led groups. The report also found that there is generally a need for interventions to be much more culturally sensitive. What action are the Government taking to ensure that people with dementia can access culturally appropriate care, including art and music-based interventions, which reflect a wide range of cultures and languages?
Lord Kamall (Con)
The Office for Health Improvement and Disparities is looking at areas where there are clear disparities. As part of developing the dementia strategy, the Government are consulting with a wide range of stakeholders and ensuring that a diverse range of views from different communities is heard and that it is not targeted just at one particularly community.
Clinical Negligence Claims
Baroness Wheeler Excerpts(4 years, 2 months ago)
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Lord Kamall (Con)
My noble friend raises an important point. The Government remain committed to continuous safety improvement, particularly on developing learning cultures in our health system and tackling the issues of denial and delay. While we strive towards this goal, we have seen that the cost of clinical negligence claims has quadrupled in the last 15 years, and there is no guarantee that reducing harm would necessarily result in fewer claims. In many cases, the overall costs are being driven by increases in the average cost per claim. Indeed, claims have recently levelled out, falling from £2.26 billion to £2.17 billion but this is largely due, in least in part, to the coronavirus pandemic.
Baroness Wheeler (Lab)
My Lords, the annual cost of clinical negligence has risen from £1 million in 1975 to £2.2 billion last year, as we have just heard. The Medical Defence Union’s evidence to the Health and Social Care committee’s inquiry into NHS litigation reform predicted that any money raised by the new health and social care levy would be entirely swallowed up by the amounts being paid out each year in NHS clinical negligence claims. What assessment have the Government made of this claim, how does it impact their plans to reduce the huge NHS waiting lists for treatments, and what money will be left for social care?
Lord Kamall (Con)
The noble Baroness raises an important point that spending more on compensation means less money for the care of patients. That is why we are committed to looking at various ways of reducing this and are working with the Ministry of Justice. Issues include the role the royal colleges play and the training they give to their medical staff, while needing to instil a culture of more openness when things go wrong. When things go right, we are ready to praise but when things go wrong, they have to stop hiding, delaying and denying, and be open.
David Fuller Case
Baroness Wheeler Excerpts(4 years, 2 months ago)
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Baroness Wheeler (Lab)
I thank the Minister for the Statement and its contents, and I fully welcome the Government’s announcement of an independent inquiry into this unspeakably vile and horrific crime. Across the House, our thoughts and hearts go out to the families of Wendy Knell and Caroline Pierce and those with deceased loved ones. These 100 victims—we are talking about the corpses of 100 women—were, as has been reported in the press, violated in the most monstrous, vile and sickening way.
Will the Secretary of State confirm that all the families impacted will have immediate access to the psychological counselling and support that they need? Will NHS staff at the hospital, many of whom will themselves be devastated, also have access to appropriate counselling and support? What steps are being taken to identify the 19 victims yet to be identified?
I also pay tribute to local Members of Parliament across Kent and Sussex who have spoken up on behalf of their communities in recent days. ln particular, the MP for Tunbridge Wells, Greg Clark, said over the weekend that authorities and politicians must
“ask serious questions as to how this could have happened and … establish that it can never happen again.”
This is why the inquiry is so crucial. Can the Minister set out its timetable and say when the terms of reference will be published? Can he confirm that its remit will allow it to make recommendations for the whole NHS, as well as for the local NHS trust?
Fuller was caught because of a murder investigation, which in itself prompts a number of questions about the regulation of mortuaries. The Human Tissue Authority, which regulates hospital mortuaries, reviewed one of the mortuaries in question as part of its regulatory procedures. It raised no security concerns, but found a lack of full audits, examples of lone working and issues with CCTV coverage in another hospital in the trust. Will the inquiry look at the way in which the HTA reviews hospital mortuaries, as well as its standards and how they are enforced? Will it be asked to recommend new processes that the Secretary of State will put in place if it is found that a mortuary fails to meet the necessary high standards for lone workers, security and care? If the HTA’s role is not to be included in the inquiry, how will this work be undertaken by the Government and within what timescales?
The requirement for NHS trusts to review their procedures and ensure that they are following current HTA rules and guidance is very welcome. This procedure must include the requirement for all mortuaries to document and record the access of all staff and visitors entering a mortuary, ensure that CCTV is in place comprehensively across all mortuaries, and that CCTV standards on usage and access records are fully enforced. Can the Minister confirm this? What is the timeframe for hospitals to adopt the extra rules that have been announced on CCTV coverage, swipe access and DBS checks in every single hospital and mortuary? Can the Minister confirm whether this will be guidance or a statutory requirement? There are, of course, other premises where dead bodies are stored, such as funeral directors, that do not fall under the regulatory remit of the Human Tissue Authority, so will the authority’s remit be extended? Will the inquiry look at regulations for other premises where bodies are stored?
The Minister will agree that the conduct of the inquiry itself will be very important for victims’ families. Will they be allowed to give evidence on the devastating impact that the crimes have had on them? When our loved ones are admitted into the hands of medical care, that is done on the basis of a bond of trust that they will be cared for when sick and accorded dignity in death. That bond of trust was callously ripped apart here. I repeat the offer from our shadow Secretary of State, Jonathan Ashworth, to work with the Secretary of State to ensure that something so sickening never happens again.
Baroness Brinton (LD) [V]
[Inaudible]—but that such a prolonged period of abuse was able to take place without it being noticed. We echo the sincere condolences to the families and friends of Wendy Knell and Caroline Pierce, as well as the many families and friends of those whose bodies David Fuller so foully desecrated.
The Statement says that the families and friends will have access to mental health support and counselling. That is good, but can the Minister confirm that it will be available for as long as they need it and will not be time limited? Will the staff at the mortuaries and hospitals, as well as the police and the over 150 family liaison officers involved in this case, also have access to counselling? They too have had to deal with this very distressing series of events.
We must obviously be very careful in our discussions today pending the sentencing of David Fuller, but we welcome the Secretary of State’s announcement for the upgrading of the trust’s independent review to an independent inquiry, to be chaired by Sir Jonathan Michael.
In August 2018, the Health Service Journal reported that 58 mortuaries that had been inspected in 2017-18 revealed that more than 500 “shortfalls” were exposed during that period. Worryingly, that included eight critical failings. At that time, the Human Tissue Authority as regulator and the various other regulated bodies undertook to look at the large increase in failings that year and to review practice. What actions were taken following those 2017-18 reports and were measures on access by staff to mortuaries among them? I ask this because, looking at the Human Tissue Authority’s codes of practice online, almost the entire focus seems to be on those whose role is to be involved with bodies. In Code A: Guiding Principles and the Fundamental Principle of Consent, the only reference I can find that does not relate to those with direct responsibilities for bodies is in paragraph 14 on page 7, which begins:
“Quality should underpin the management of human tissue and bodies.”
It goes on to say that this means that:
“practitioners’ work should be subject to a system of governance that ensures the appropriate and safe storage and use of human tissue and which safeguards the dignity of the living or deceased”,
and that
“premises, facilities and equipment should be clean, secure and subject to regular maintenance”.
One of the concerning issues relating to this case is that Mr Fuller ceased to be an employee of the Tunbridge Wells health authority in 2011 when the maintenance contract was subcontracted out. Will the inquiry look at not just whether employees of subcontractors working in sensitive areas are subject to DBS checks but whether there is a duty on their employer to report any findings to the hospital, or in this case the mortuary? Mr Fuller had a previous criminal record, but it is reported that the hospital did not know this.
There is another issue which I have not heard referred to either here or in the Statement in another place yesterday, and that is our criminal justice system’s approach to the desecration of bodies. The respected criminologist Professor Jason Roach from Huddersfield University has analysed the policing of and law in Britain towards necrophilia. He found an almost complete absence of case studies, which is not true in the rest of the world. Indeed, it was not until the Sexual Offences Act 2003 that necrophilia became a criminal offence in its own right, but he says there is no evidence that anyone has ever been prosecuted. He reports that, as part of his research in 2016, he was told by one senior police officer that it was very unlikely that the police would ever urge the Crown Prosecution Service to charge an offender.
One hypothesis that Professor Roach explores in his 2016 work “No Necrophilia Please, We’re British” is that
“the attitude of the British criminal justice system towards necrophilia echoes that of the British public, i.e. one of embarrassment, whereby those caught are either not charged with a criminal offence or, perhaps for the sake of the deceased’s family, are charged with a less degrading offence such as grave robbing. Both routes will produce less attention-grabbing stories”.
Can the Minister say if the review will look at police and criminal justice system attitudes towards necrophilia or other forms of desecration of bodies? One of the deeply unsatisfactory legacies of Jimmy Savile’s extended abuse is the suspicion of his undertaking such activities. However, perhaps through embarrassment, there has been no real examination of that case and the cultures of the places where he was able to have access to the dead.
Can the Minister say if any lessons learned so far will be reported and implemented straightaway, before the full independent inquiry reports, to give the public confidence that hospital mortuaries are safe and secured? As ever, if the Minister does not have any of the answers to my questions to hand, please will he write to me with them?
Social Care
Baroness Wheeler Excerpts(4 years, 2 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.
Health Care and Adult Social Care
Baroness Wheeler Excerpts(4 years, 2 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.
Social Care
Baroness Wheeler Excerpts(4 years, 2 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.
Covid-19 Update
Baroness Wheeler Excerpts(4 years, 2 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.