Covid-19: Social Care Services

Lord Bethell Excerpts

Thursday 23rd April 2020 Lords Chamber

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

My Lords, I join the noble Baroness, Lady Wheeler, and others in remembering those who have suffered from this dreadful disease. I pay tribute to those in healthcare and other key workers on the front line who selflessly and heroically help deal with this awful epidemic. I have a personal reason to thank in particular those BAME social care staff who take a particular risk and often take on most challenging tasks.

I thank all noble Lords for the thoughtfulness and scrutiny they have brought in this digital debate to an issue which is, as many have remarked, overlooked but is now, without doubt, at the centre of our national debate. With 40 speakers and a lot of new technology to deal with, I apologise in advance if I cannot respond to all the thoughtful and perceptive questions that have been asked, but I will try to address the most immediate issues raised by noble Lords with a practical update—and I will avoid the lofty, high-level stuff, as requested by the noble Baroness, Lady Thornton.

As the noble Baroness, Lady Wheeler, rightly stated, on 15 April we published our action plan for adult social care. The plan outlines how we have committed to strengthen and support this vital network, for the carers and for the cared. The plan has four pillars, First, our number one priority is to limit the spread of the infection. It is clear, as many noble Lords have rightly said, that personal protective equipment has been an issue for many in the care sector. We recognise that and we set out a PPE plan on 10 April to deal with the issue.

We recognise that PPE is vital to protect NHS and social care staff from contracting Covid and to protect the people whom they care for, and we are acting to ensure that PPE is available where it is needed. We are running hard at procurement; the results are being felt, but there is more to be done. Public Health England has published guidance on good infection control practices, discharge processes, testing and in which scenarios to use PPE to minimise the risk of transmission. We have moved quickly to adapt guidelines to this new, complicated and deadly threat, to be clear in the way we communicate, but I accept that it is sometimes difficult to keep up. I hear loud and clear from the noble Baroness, Lady Wheeler, my noble friend Lady Verma, and the noble Lord, Lord Hain, about concerns on costs. I reassure this virtual Chamber that substantial funds have already been mandated. The question of funding remains under review and, if more is needed, this Government will step up to their responsibilities. We are taking these issues seriously, but the challenge is substantial.

This sector that is made up largely of smaller, independent providers that have historically sourced their PPE on open markets, as well put by the noble Lord, Lord Hain, so we are putting in central procurement support at pace and on the fly. We have developed a parallel supply chain across government with NHSE&I, NHS Supply Chain, Clipper Logistics and the armed services. The parallel supply chain has been established to support care homes, home care and hospices. It is done in the spirit of collaboration, as the noble Lord, Lord Shipley, has rightly recommended. This is already supplying PPE equipment to hospitals and local resilience forums. I reassure noble Lords that this improved speed and reliability of delivery is already relieving pressure on the supply chain.

We are working around the clock to ensure that staff on the front line can do their job safely. As of 20 April, we have released 29 million items of PPE to seven designated wholesalers for onward sale to social care providers. This includes 11.4 million face masks, 13.3 million aprons and 4.2 million gloves.

Let me say something on discharge. We recognise that moving someone from hospital to another area where infection control is important is incredibly delicate. That is why, last weekend, the Chief Medical Officer changed the guidelines so that all patients will be tested before being admitted to care homes, as well as all care home residents. This is welcome news.

On testing generally, I reassure the noble Baroness, Lady Grey-Thompson, and the noble Lord, Lord Hain, that, while testing was initially limited to help manage the demand for tests for the most unwell, this has changed. There is new guidance and considerably more capacity. I reassure the noble Baroness, Lady Wheeler and Lady Brinton, and the noble Lord, Lord Turnberg, that as lab capacity increases every day, we have already expanded testing to include more care home residents and staff.

It is true that the drive-in centres were the quickest to set up, as the noble Lord, Lord Shipley, rightly remarked. However, I reassure the noble Baroness, Lady Barker, the noble Lord, Lord Dubs, and other noble Lords, that this week we have started home delivery of self-administered packs, which will be organised by Amazon, pop-up mobile units organised by the Army, and we will shortly have a retail solution from Boots. This will go a long way to address the concerns of those who find the drive-in centres awkward or unavailable.

On the subject of counting deaths, I reassure the noble Lord, Lord Bilimoria, and other noble Lords that the official ONS figures, which are informed by CQC returns from death certificates, will always capture Covid deaths, whether they are from hospitals, care homes or at home, and that it is the responsibility of doctors to inform PHE of any Covid death.

The 1.5 million social care workers on the front line of the virus are crucial in delivering care to our most vulnerable citizens, so I will say a word on them. I reassure the noble Baroness, Lady Grey-Thompson, that we have capacity for every care worker to be tested, just as there is for NHS staff and their families. PHE will be administering those tests and home testing equipment will be distributed. Social care workers have been designated as key workers, which means that the children of those working in social care can continue to attend school where there is no safe option for them to stay at home.

In response to those who say that government has done nothing, I remind the noble Baroness, Lady Hollins, and other noble Lords that our action plan for adult social care sets out an ambition to attract 20,000 people into social care over the next three months. We will shortly launch a new national recruitment campaign to run across broadcast, digital and social media. The campaign will highlight the vital role that the social care workforce is playing now during the pandemic, along with the longer-term opportunity to work in care.

I am proud to recognise carers and to endorse social care branding with badges and lanyards to create a proper identity and recognition. We have formally introduced the CARE brand to sit alongside the NHS brand in England. It is right that we recognise the hard work of carers and, as the noble Baroness, Lady Wheeler, put it, ensure that they too get support such as queueing priorities like their NHS colleagues. We recognise the immense pressure that the social care workforce may be facing, which is why we have extended a package of helplines and text-based systems across the board to support the well-being of carers and other front-line staff.

Several noble Lords, including the noble Baroness, Lady Finlay, and the noble Lord, Lord Bilimoria, raised the impact of BAME staff working in the social care sector. We have commissioned work from Public Health England to understand how different factors may influence the way someone is affected by this virus.

My noble friend Lord Astor asked about respite for carers—an important point. On 8 April we published guidance for unpaid carers on GOV.UK, which includes general advice, including advice on infection control, links to other information and support and advice on caring where someone has symptoms.

Perhaps I can reassure the noble Baroness, Lady Tyler, who asked about visa exemptions for nurses in social care, and the noble Baroness, Lady Masham, who requested an update on when we might relax the immigration rules to ensure that we have an adequate number of carers, nurses and doctors. The Government are already working with the NHS to ensure that visas are extended to doctors, nurses and paramedics and where, as noted by the noble Baroness, Lady Bull, significant numbers of overseas staff are working on the front line to battle Covid. UK Visas and Immigration has now written to 270 NHS organisations to begin processing these important extensions. I will take away her valuable point that the social care workforce should be included within the scope of these discussions. Many employers across health and adult social care benefit from the skills of overseas staff. However, it is clear that international recruitment will not be straightforward at the moment, nor in the future, due to widespread travel restrictions in place around the world. We are going to have to adapt to this new reality.

The noble Baroness, Lady Sherlock, asked a very valid question on carers’ eligibility for universal credit. We are acutely aware of the issues faced by the self-employed or those on zero-hours contracts. Some individuals employed on zero-hours contracts may be entitled to statutory sick pay; those who are ineligible can claim universal credit or contributory employment and support allowance, depending on their circumstances.

The third strand of our strategy is supporting independence: supporting people at the end of their lives and responding to individual needs. I completely take on board the comment made by the noble Lord, Lord Blunkett, about inadvertently creating a monster in our efforts to slay the dragon of Covid. But I would add that it is not the Government who seek to punish older demographics and those with pre-existing conditions; it is the virus. The objective of our policies is to save lives and protect the NHS and our care services.

Let me give you a few examples. We are working alongside technology firms and voluntary organisations to assist the most at-risk and isolated people with access to vital emotional support and companionship. These efforts are beginning to bear fruit. While unnecessary visits are restricted, we are clear that visits at the end of life are important for the individual and their loved ones, and they should continue. The guidance now makes that clear.

We recognise the specific challenges that disabled people will face as a result of Covid-19, as was raised by the noble Baroness, Lady Bull. We have been taking several important steps to mitigate the impact of Covid-19 on people with disabilities and continue to engage with stakeholders to ensure that their needs are met. For instance, we are improving the accessibility of government guidance and working with the disability unit at Public Health England and NHS England to ensure that important messages reach throughout the communities.

On the DNR notices wrongly sent by some GPs, I totally endorse the comments of the noble Baronesses, Lady Brinton, Jolly and Jones, the noble Lord, Lord Alton, and many others in their condemnation of pre-emptive DNR notices. The CQC has been making that point very well and we all reject that practice.

The fourth strand of our strategy is protecting vulnerable children. The Government understand the importance of having robust social and domestic care provision for disabled and vulnerable children, and the need to ensure the sustainability of social care services. This issue was raised by my noble friend Lord Farmer, the noble Baroness, Lady Massey, and the noble Lord, Lord Addington. We are taking action to ensure that those reliant on such services are identified and supported during the pandemic. I reassure the noble Baroness, Lady Massey, that we are working closely with other government departments, local authorities and partners, such as the Council for Disabled Children, to assess the impact of Covid and local decisions on the provisions of these services.

We know that some families need more support than others and that attending education settings is an important protective factor. That is why we have not only ensured that they can continue attending school but made it clear that we expect them to, as long as it is safe for them to do so. We also encourage families with a child whose SEN needs cannot be suitably supported at home to attend school, but this will depend on a risk assessment. Many pupils with special needs are better off staying at home during the crisis.

Lastly, we are supporting local authorities and providers of care. In March, we announced £2.9 billion of funding to support and strengthen care for the vulnerable. Local government is being supported by £1.6 billion of additional funding to meet extra demands. This funding can be used across all services facing pressure. Further, we have enhanced the NHS discharge process by providing £1.3 billion of funding to allow patients who no longer need urgent treatment to return home from hospital safely and quickly. This funding will cover follow-on care costs for adults in social care or people in need of additional support when they are out of hospital and back in their home, community or care setting. We are keeping future funding under review. We announced over the weekend a further £1.6 billion package for local government to ensure that local government has the funding it needs to respond to the crisis as it develops.

A number of noble Lords asked about VAT. I confirm that providers pay VAT as private entities, but the important thing is that they have support with the costs they are incurring. This is what we are doing through the significant funding. I remind noble Lords that if adult care providers are charities they do not have to pay.

My noble friends Lady Verma and Lord Astor urged the Government to ring-fence this funding. We are taking important steps to ensure that this additional funding is making a difference. For example, as the noble Lord, Lord Dubs, asked, we are asking local authorities to provide information about the distribution of this funding to providers. The Government will continue to monitor pressures in the NHS and local government and will keep future funding under review.

We are also supporting the system through emergency legislation. The Coronavirus Act 2020 came into force on 31 March and brought significant changes to local authority duties under the Care Act 2014. I reassure my noble friend Lord Astor of Hever that the Government are committed to revoking these powers when they are no longer needed. I confirm to the noble Baronesses, Lady Wheeler and Lady Grey-Thompson, that we have received notification that six authorities are operating under the Care Act easement and that I thoroughly support the publication of the details. Those authorities are Sunderland City Council, Middlesbrough Council, Warwickshire County Council, Staffordshire County Council, Birmingham City Council and Solihull Metropolitan Borough Council.

The decisions local authorities may have to consider at this time are not simple and it does not necessarily mean that they are in crisis. The Department of Health and Social Care has issued guidance on easements, including an ethical framework and prioritisation guidance. I reassure noble Lords, including the noble Baroness, Lady Wheeler, that local authorities remain under a duty to meet needs where failure to do so would breach an individual’s human rights under the European Convention on Human Rights. Such easement measures should be used only when absolutely necessary, based on the local authority’s judgment of its ability to meet the needs of people in line with the Care Act.

The disease is a cruel enemy. It attacks the weak and vulnerable, as put very clearly by the noble Baroness, Lady Hollins. Carers and residents are put in a desperate position not because of government policy but because of the reality of this horrible killer. Let me touch on the comments made by the noble Lord, Lord Alton, on the final hours of those in care homes and funeral arrangements for them. As someone who has lost a loved one in a nursing home, I know at first hand that it is a heart-breaking reality of this awful epidemic that we cannot properly say goodbye to the ones we love.

I shall say a few words about the Government’s priorities. We have put this country on hold to save lives and to protect the NHS and our care services. The noble Lord Tyrie, made the financial commitment very clear. I reject the idea put by the noble Lord, Lord Hunt, that this Government treat those in our care homes as second-class citizens. They have been a huge priority in everything that we have done in the past months. Mitigating the impact of the Covid pandemic is the top priority of the British people and of this Government.

This epidemic has undoubtedly put a spotlight on social care. The British people and this Government will never look at social care in the same way again. Today we are working flat out to mitigate the effects of a deadly disease, but things will change. The Government have committed to a substantial review of the sector. It will come when the time is right and, as noble Lords rightly asked, it will be a moment for society to draw up a new contract for social care. It will need cross-party collaboration and a new approach. I would like to hold on to the feeling expressed in this debate. Let us all remember these commitments to a fresh start when that moment comes.