Social Care in England

Lord Astor of Hever Excerpts

Thursday 14th October 2021 Lords Chamber

[Lord Astor of Hever (Con)]

My Lords, I also welcome my noble friend the Minister to the Dispatch Box and wish him all the best with his new responsibilities. I congratulate the noble Baroness, Lady Pitkeathley, on securing this debate. The issue of carers is very important.

The Prime Minister set out his plans for health and social care reform in his excellent policy document last month. On the one hand, he said, it would add up to the biggest catch-up programme in the history of the National Health Service, and at the same time would address the

“long-term problems … that have been so cruelly exposed by Covid.”—[Official Report, Commons, 7/9/21; col. 153.]

These long-term problems, let us not deceive ourselves, affect each and every one of us.

One of the most challenging problems has been revealed to be the chronic shortage of care staff, a situation that endangers the well-being of the most vulnerable among the population. Also the proper management, training and deployment of care providers needs addressing. Sadly, Brexit, wholly justifiable vaccination requirements, post-Covid fatigue and the prospects of higher pay in other sectors have not helped the situation.

Covid began a nationwide debate, a tumultuous vox pop, that made people sit up, listen and respond with their own accounts of suffering. It drew people together and showed our dependence on each other in the community. Through the media, individuals and family groups up and down the country were able to share personal experiences, often shocking and heartbreaking, which revealed a range of avoidable shortcomings in the health and social care system. I can only hope that, as the past has shown us time and again, out of crises great advancements can be made. This is especially true in health and social care, and I am confident that the Government are capable of setting in motion a bold programme of reform, although it will require a great deal of organisation and commitment, in addition to funding.

Greater integration of social care provided by the National Health Service through local clinical commissioning groups and that provided by local councils is one area that is under considerable pressure; and I should like the Government to focus on that. I understand that radical plans for such integration are being actively considered by the Health Secretary. I am sure that the Minister will address that in his wind-up speech.

The experiences of a family that I know living in the West Country with two severely disabled adult sons suggest that healthcare support across the nation is patchy and variable according to postcode. They have experienced profound ignorance at junior levels as to the delivery of an effective social care service, and believe that the protective territorialism and empire-building that they have witnessed need urgent addressing, with integration managed from the top and implemented locally.

Adopting a holistic modus operandi, with an emphasis on common sense and compassion, must be the best way in which to tackle the complex and multilevel needs of the population. All of us, with our lives being extended through access to modern medicines and diagnostics, will need greater recourse to treatment and support from the National Health Service.

Health and social care reform requires the support of a complete mindset reform to enable these improvements to happen: a recalibration of the imbalance between rights and responsibilities, and the recapturing of the spirit of working together for the greater good that was present at the very inception of the National Health Service.

Social Care and the Role of Carers

Lord Astor of Hever Excerpts

Thursday 24th June 2021 Lords Chamber

[Lord Astor of Hever (Con) [V]]

My Lords, it is a real honour to follow the noble Baroness, who does so much for carers. I declare an interest as the father of a profoundly autistic daughter. My experience with our daughter, whose residential care was disrupted during the pandemic, was a real eye-opener. It is an exhausting business looking after a disabled adult, tending to their well-being 24/7. I have nothing but admiration for the carers who dedicate themselves to this task and I join the noble Baroness, Lady Jolly, in thanking them all.

Greater than the physical demand is a concern that our loved ones will be properly looked after when we are no longer around. A social care system for the 21st century needs to make us feel more secure on that score. Others are far worse off than my wife and me. I know a family with two profoundly disabled sons, aged 28 and 32, the elder in a wheelchair—sadly not electric because the parents are not disabled, so do not qualify. They have relied on carers provided by their local council to help with this full-on exhausting care, day after day. There is a chronic shortage of carers, who are on very low wages, in the care industry, so I join other noble Lords in asking the Minister how the Government plan to address this. Will the Government consider increasing the carer’s allowance to the minimum wage?

The closure of day centres, which provide much-needed respite from the constant, round-the-clock supervision, as well as swimming pools and places of worship, was a blow to this couple. Could special exemptions be considered in future lockdowns for disabled people and their families in well-supervised, safe environments? The imposition of strict procedures to limit the spread of the pandemic has weakened an already fragile and fragmented system, causing untold suffering. Covid exposed a plethora of gaps and shortfalls, in addition to contradictory and counterproductive measures, which unwittingly endangered people’s physical and mental well-being. In short, instead of social care, we had social carelessness.

The NHS will continue to suffer, as long as the social care structure is neglected, whether we are facing killer viruses or not. How do the Government propose, in practical terms, to better integrate adult social care services with services provided by the National Health Service?

Covid-19: People with Learning Difficulties and Autism

Lord Astor of Hever Excerpts

Monday 5th October 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, the role of any carer is one that we should applaud and pay tribute to, for they are often the overlooked supporters of those with learning difficulties and autism. The plight of those families during Covid has been very hard, and we recognise the tough challenges faced by older parents in particular, who have big responsibilities for children with learning difficulties. The main support will be through local government, and we have put through a huge amount of finance to local authorities and charities to support those families. The adult winter plan has £500 million for the infection control fund, and the NHS has £588 million to support those who are moving from one part of care to another. We will continue this financial support in this area.

[Lord Astor of Hever (Con) [V]]

My Lords, I declare an interest as the father of an autistic daughter. Can the Minister say when clear guidance will be provided to day centres for the disabled, and when we can expect they will reopen?

Covid-19: Social Care Services

Lord Astor of Hever Excerpts

Thursday 23rd April 2020 Lords Chamber

[Lord Astor of Hever (Con)]

My Lords, the Coronavirus Act 2020 has relaxed the duties and responsibilities of local authorities to provide care and support to a revised minimum level which would solely meet a person’s needs measured according to their human rights—a very low bar indeed in this context. In the immediate short term, local authorities have other priorities. Even in better times, it is a struggle to fund social care and it is vital that we do not lose the hard-won legal support structure ensuring that correct social care is assessed and delivered to the neediest in society. Will the Government undertake to repeal the social care provisions of the Act and reinstate the pre-existing law and regulations at the earliest opportunity?

The Government have announced £1.6 billion of additional aid to local authorities to support social care. The delivery of this money to hard-pressed providers has not been smooth, and I urge the Government to press local authorities to use this money as required by the Government. Without this financial support, many providers will fail, leading to an intense crisis in domiciliary support and in homes. Will the Government apply the greatest possible pressure on local authorities to pass the additional funding on to providers of social care? Will they consider ring-fencing some of this money?

Turning to specific cases, many hard-pressed families have family members who require significant support. The strain on the mental health of family members acting as carers frequently results in provision for respite from their duties for a few nights at specified intervals. The requirements of social isolation and quarantine mean that they no longer receive the respite needed to survive. They are now locked into a cycle of support without any break and with no additional provision forthcoming to help them in any way. In the current emergency, will the Government encourage both local government and social care provision under the NHS to look carefully at the needs of the often forgotten and unsung family carers who are already saving the Government millions in care costs?

The NHS

Lord Astor of Hever Excerpts

Thursday 5th July 2018 Lords Chamber

[Lord Astor of Hever (Con)]

My Lords, I, too, congratulate the noble Lord, Lord Darzi. I was in the Chamber when he leapt across that Bench to save the life of a noble Lord who had had a heart attack, and a very impressive sight it was. I, too, have suffered a cardiac arrest and I received life-saving care from two wonderful paramedics from the South East Coast Ambulance Service.

My personal experience, not in a way that I would have chosen, was of the NHS at its very best. Everything at every stage, from the moment the cool-headed handler took the 999 call, the paramedics who got my heart going, the surgery, to the kindnesses and the professional aftercare that I received in East Surrey Hospital, could not be faulted. I was honoured when the hospital asked me to open its wonderful new cardio wing and meet the staff. It was an emotional event for me to stand in front of the very people who had saved my life, giving me an opportunity to join this debate today.

I declare an interest, in that my sister was a state registered nurse, my brother-in-law is a retired senior surgeon with the NHS and my niece is a junior doctor training in infectious diseases. She is extremely proud to be part of the NHS and very optimistic for the future.

While we bask in the reflected glory of all that the NHS has achieved in the past 70 years, I agree with the noble Lord, Lord Winston, that we must be realistic. We need to remember the winter pressures and looming targets that put the NHS under immeasurable pressure and result in less than optimal patient care.

At this late stage of the debate, I will touch on just one challenge facing the NHS, which has been mentioned by many noble Lords: creating a sustainable workforce moving forward, particularly as we rely so heavily on European and overseas staff. Since we voted to leave the EU, there has been a dramatic reduction in the number of staff coming from Europe. Although immigration restrictions have been lifted, it is going to take time to recruit staff. The NHS must be able to offer a long-term future, or why would they come? The focus should be on making medicine and nursing attractive again and developing a long-term plan that meets workforce challenges. There is much bridge-building to do after last year’s junior doctors’ strikes if the NHS is to keep them once they have completed their training. Junior doctors welcome Jeremy Hunt’s pledge for more medical school places, but there are ongoing concerns about low morale and rota gaps in the workforce causing significant issues with retention of staff. Worryingly, junior doctors are leaving not only the NHS but the profession altogether.

With regard to nurses, this is the last year that those in training are entitled to receive a bursary and will not have to pay university fees. They will then have to pay £29,000, plus living costs, for a three-year period. This means that most nursing graduates will leave university with debts of around £54,000. I would be interested to hear whether the Minister is concerned that this issue will have a negative impact on nurses’ recruitment.

Health Inequality: Autism and Learning Disabilities

Lord Astor of Hever Excerpts

Thursday 10th May 2018 Grand Committee

[Lord Astor of Hever (Con)]

My Lords, I declare an interest as the father of an autistic daughter. I agree 100% with the noble Baroness, Lady Scott, that those on the autistic spectrum are among the most vulnerable in our society. The Government’s mandate to NHS England requires them to tackle health inequality for autistic people, and ensuring access to good quality mental health support is one important way in which this can be achieved. I have to stress that, as the noble Lord, Lord Touhig, said, autism is not a mental health condition, but more than 70% of autistic people will develop mental health problems at some stage in their lives. This is why it is one of the key drivers of the stark health inequalities faced by people on the spectrum.

The noble Lord pointed out that, in 2016, NHS England published its mental health five-year forward view, which outlines how it plans to improve mental health services in England. It includes a number of proposals, as the noble Lord said, for care pathways to help people to access the right support and, importantly, it proposes a care pathway for autism. The Government have indicated that work on designing that pathway is due to start this year, but it is now May and we do not yet have any detail on what the pathway will include. Like other noble Lords, I would welcome some clarity today from the Minister on how the pathway is progressing and, in particular, the plans they have for developing the pathway in conjunction with autistic people and their families.

The new care pathway is a welcome building block that will, in time, help to reduce the stark health inequalities that autistic people face, but it is vital that the new pathway covers timely access to autism diagnosis; autism training for all mental health staff; and making reasonable adjustments to mental health treatments so that they work for autistic people. Finally, it should also contain the capacity to research what works and then use that research to share best practice with other agencies.

Queen’s Speech

Lord Astor of Hever Excerpts

Thursday 29th June 2017 Lords Chamber

[Lord Astor of Hever (Con)]

My Lords, I want to speak briefly on the specific health issue of Lyme disease, which is a rapidly increasing health risk in the United Kingdom. If Lyme disease is not treated early, it can cause significant illness and devastate affected patients’ lives. This is what life has been like for my daughter, and I declare this personal interest.

Many noble Lords will be aware that ticks harbour Lyme disease, as well as many other equally serious infections. These infections are passed to humans and animals via the bite of an infected tick, due to and during their method of feeding. The danger is no longer confined to rural areas, with ticks now being found in every county of the United Kingdom, and increasingly so in urban parks and people’s gardens. If Lyme is diagnosed and treated early, the chances of a full recovery are good. However, failure to diagnose early and treat adequately can result in serious consequences to the patient. Tick-borne diseases that are misdiagnosed or neglected result in complicated infections, which have devastating and multisystemic consequences. Patients can be left with extremely debilitating and chronic symptoms, needing a wheelchair or completely bedridden, and enduring intense and relentless suffering.

Despite the increasing threat that Lyme disease poses to public health, there remain no suitable UK official guidelines for diagnosis or treatment. What we do have is outdated National Health Service guidance, relying on guidelines written by the Infectious Diseases Society of America and supported by the CDC. According to the National Guideline Clearinghouse of America, the IDSA-CDC guidelines are not fit for purpose. They are outdated and do not take into account recent developments in the understanding of these complex infections.

The absence of adequate guidelines is closely linked to the fact that insufficient levels of training are available to our doctors. Even if a positive test is obtained, expertise is seriously lacking, both in value of interpretation and in dealing appropriately with the illness. That stark statement is in accordance with multiple testimonies from patients. Expert patient input is crucial in turning the situation into a positive solution, not only for patients themselves but for the National Health Service as a whole.

Failure to meet the challenges of Lyme disease has led to unknown numbers of people becoming infected, but not diagnosed or treated. It could amount to tens or even hundreds of thousands of people. The UK now finds itself in a situation where patients with diverse illnesses and symptoms might actually have unrecognised Lyme disease. In these patients, the infection could have reached a stage where treatment will be difficult and lengthy and will require the supervision of expert physicians, trained and experienced in this complex disease and the frequently occurring co-infections.

The cost to the Exchequer in terms of numbers of patients unable to work and using the NHS for serious health problems must be a truly staggering amount. Neither this country, nor affected patients, can afford this. Early recognition of symptoms and early treatment would save our National Health Service a great deal of money.

Given the huge cost, both in terms of the impact on the patient’s quality of life and, in practical terms, on our health service, it is clear how important it is to prevent as many cases as possible reaching this stage. Improvements in the training available to our doctors should be made a top priority. However, awareness among the general public of the risk posed by ticks should also be prioritised. There are some very simple measures that can be taken to reduce one’s chance of becoming infected with Lyme disease. However, few people have any knowledge of this. How can we safely, and with a clear conscience, encourage children to play outside and make the most of the outdoors if we are carelessly allowing them to risk their health by contracting one of these insidious, infectious diseases?

Outdated guidelines, unreliable blood tests, insufficient training for doctors, a lack of tick-borne specialists of calibre and a widespread lack of awareness among the general public of preventive measures are all factors that are leaving us alarmingly ill-equipped to tackle a problem that poses a rapidly increasing risk to every UK citizen. In the light of this, I ask my noble friend what his department is doing to ensure that GPs receive training in Lyme disease that is mandatory and thorough enough to allow them to make clinical diagnoses. Proper awareness will prevent the number of Lyme disease sufferers growing.

Lyme patients want to regain their health. They want to get back to work. They wish for nothing more than to regain control over their lives and take part in all the activities they enjoyed before they became ill. Most Lyme patients have the will and determination to achieve this. But none of these aims can happen if they are sidelined and hobbled by misguided opinion—which includes the current health system situation, with its constraints and limitations.

Health: Detection Dogs

Lord Astor of Hever Excerpts

Thursday 17th September 2015 Lords Chamber

Asked by

[Lord Astor of Hever]

To ask Her Majesty’s Government what assessment they have made of the merits of using dogs to detect medical conditions.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

There is not, as yet, an established level of evidence to support the systematic application of the use of dogs within the NHS at this time. However, both the Department of Health and NHS England will be interested to see the outcome of the prostate cancer detection trials that recently started at Milton Keynes University Hospital with the charity Medical Detection Dogs.

[Lord Astor of Hever (Con)]

My Lords, each day that we sit in this House we trust dogs’ acute sense of smell of explosives to ensure our safety. Research shows that dogs detect human disease earlier than existing tests, which could increase survival rates and save the NHS millions of pounds. Will my noble friend’s department increase research capacity in this field and ensure that Britain remains a world leader?

[Lord Prior of Brampton]

My Lords, interestingly, the human nose contains some 5 million scent glands but a dog’s nose contains many more. In fact, the sniffing ability of a dog can be up to 10 million times that of the ability of a human being. Therefore we should not underestimate the contribution that dogs can make in this field. The trial being conducted at Milton Keynes University Hospital, which involves 3,000 patients giving urine samples, with nine dogs in a controlled environment over the three years, could indeed make a huge a contribution to the early detection of certain cancers. Therefore we will follow that trial with keen interest.

Mid Staffordshire NHS Foundation Trust

Lord Astor of Hever Excerpts

Wednesday 9th June 2010 Lords Chamber

[Baroness Knight of Collingtree]

My Lords, I believe that it is our side’s turn.

[Lord Astor of Hever]

My Lords, there is plenty of time for both sides. I think that it is this side’s turn.

[Baroness Knight of Collingtree]

My Lords, I shall be brief. I have never felt so much gratitude towards a Minister as I feel at this moment. He has created a first in my parliamentary life. Never before in 44 years have I had the requests placed so clearly in a speech met six days later: care for patients, an understanding that non-medical people are not always the people to make decisions, and safeguarding what whistleblowers have to say. In fact, there were other hospitals—Maidstone and several others come to mind—where serious problems had arisen. I have raised such cases many times with dates and all details and had no answers given as to why patients were treated so badly. In the case of Stafford, the chief executive of that hospital, who had been in command for the whole of the time during which that terrible record was amassed, was then given a very senior position with as much responsibility elsewhere. Will the Minister look at that, because we must safeguard patients, wherever they may be?