Social Care

Lord Dubs Excerpts

Wednesday 8th July 2020 Lords Chamber

Asked by

[Lord Dubs]

To ask Her Majesty’s Government when they will publish their White Paper on social care.

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

My Lords, we all agree that social care needs to be put on a sustainable footing where everyone is treated with dignity and respect. That is why the Prime Minister made clear commitments in the manifesto and the election, and why the Secretary of State wrote to other parties to begin the process of cross-party talks. We must now come together to find a common solution to this challenge: a long-term plan for social care that enjoys cross-party support.

[Lord Dubs (Lab) [V]]

My Lords, will the Minister confirm that the Prime Minister, said in his first speech in office that

“we will fix the crisis in social care once and for all with a clear plan we have prepared to give every older person the dignity and security they deserve … I will take personal responsibility for the change I want to see”?

Is that still the policy, or will the Prime Minister again claim that he has been misunderstood, as with his recent unpleasant attack on social care, for which he has refused to apologise?

[Lord Bethell]

My Lords, that is very much the policy, but I emphasise the following. No plan can succeed unless it gains the support of a wide number of stakeholders, including cross-party support. Attempts to foist a plan from one group on to another simply will not work. That is why a bridge-building exercise is needed and why the Secretary of State has invited others to cross-party talks. I invite all those players to go into that process with a spirit of collaboration.

Covid-19 Update

Lord Dubs Excerpts

Wednesday 1st July 2020 Lords Chamber

[Lord Dubs (Lab) [V]]

We have frequently been told that the key figure to look at is the R figure. Will the Minister confirm that whereas after lockdown the national R figure was 0.84, it is now 0.94—so we are on a bit of a knife edge? Secondly, can he explain why the R figure is not released locally at the same time as the national figure is released?

[Lord Bethell]

The noble Lord is right that the R figure is important, but in many ways, at this stage of the epidemic, the prevalence figure—the total number of people who carry the disease—is more meaningful. A higher R on a smaller prevalence is less worrying than a smaller R on a higher prevalence. As to having regional Rs, the data to date has not been strong enough for that to be a reliable figure. However, we are working towards that situation and I can envisage a moment when it would happen.

Covid-19: Care Homes

Lord Dubs Excerpts

Wednesday 20th May 2020 Lords Chamber

[Lord Bethell]

My noble friend Lady Blackwood is quite right that the Roche and Abbott antibody tests are a great step forward. It shows how diagnostic technology is progressing very quickly. We are determined to use all the benefits of modern technology in the fight against Covid. Our announcements on antibody testing in the NHS, in the care service and for key workers will be announced shortly. When it is, I assure her that NHS and social care workers will be on an equal footing.

[Lord Dubs (Lab)]

My Lords, in answer to an earlier question, the Minister said that it was not appropriate to compare us with what happened in Hong Kong, South Korea and Singapore, which had no deaths in care homes at all. He preferred to compare us with Europe. Is the truth not that we took our eye off the ball and that as a country we failed to learn from what was happening elsewhere? We failed to learn good practice and we actually lost two months, where we did nothing very much until we tried to catch up just now. Surely we failed pretty badly.

[Lord Bethell]

The noble Lord makes a comparison that history will have to judge on, I am afraid to say. I think that I am making a fair point when I say that Britain can really only benchmark itself against its close neighbours. The experience of Asian countries taught them an enormous amount, but it is not one that has seemed proximate or relevant to us in recent times. I am afraid that I can only leave it to history to judge whether we made mistakes. It would be wrong for me to prejudge that at this moment.

Covid-19: Social Care Services

Lord Dubs Excerpts

Thursday 23rd April 2020 Lords Chamber

[Lord Dubs (Lab)]

I congratulate my noble friend Lady Wheeler on initiating this debate and on her very powerful speech. I should declare an interest, in that a member of my family has been in care homes over the years and now has support in his own home, so I have some experience of how these things work.

The first problem, I think, is the poor statistics on this whole sector. We are beginning to get more information together, but it seems to me that, unless we have clear statistics so that we know what the provision is, we cannot easily change policy for the better. We know that many of the problems of social care are long-standing and existed for years before the present pandemic crisis hit us, but they meant that this sector was ill prepared for the difficulties that we now face.

One example that has been often cited is the long journeys that care home workers need to take to get tested. I was told that one person had to travel from Bournemouth to either Gatwick or Chessington— 100 miles each way—to be tested. That is an impossible journey for people who are hard-pressed to get to their places of work.

We all know that social care has for too long been the underdog. Acute services have tended to get the money, albeit not enough—I would not take away a penny from acute services; I would rather put more in—but social care has still tended to be the underdog, as characterised by the very low levels of pay earned by people in the sector.

We know that there are wonderful people working in social care, we know how hard they work and we know about the wonderful long-term relationships that they establish with the people they care for—making the death of such a person even more painful. Of course we must ensure that they have security in this country, and the issue of visas must be dealt with.

Of course we need more testing, as has been said, and of course that should have happened a long time ago. I understand that residents with symptoms and those being transferred to care homes will now be tested. I wonder when that will be completed and when all workers in care homes and domiciliary care will have had the chance to be tested.

I should mention in passing that not all people in care are elderly; there are young people who need help as well, and their problems are slightly different from the needs of the elderly but are still important.

I turn to domiciliary services, which tend to be forgotten. Visits by care workers to homes where a single isolated person is on their own are crucial—not just for their health and needs but to lessen the sense of isolation. Domiciliary workers who call on people’s homes often provide their only link with the outside world. If that were to stop because of the present crisis, that would be a disaster. Of course, as a society and a country we depend very much on family members to provide care. If one falls ill, there is an even more difficult situation for the care workers who have to come in; that appears to be the difficulty at the moment. I know of one care worker who has a long journey by Tube every day to his place of work. Until recently he was given two masks per day, which was hardly enough given that he visited many people per day and per week.

In the long term, surely the social care sector needs a sustainable funding settlement so that it can look forward sensibly to the future. We have to reform the social care system, ensuring that the long-awaited Green Paper says something about it—although I suppose that is a long way away. Finally, in many health sectors there are the royal colleges—the Royal College of GPs, the Royal College of Physicians and so on. Would it not be right if social care workers, both in care homes and in the domiciliary sector, had a royal college of social care to speak for them? Would that not be a good idea? It would be able to fight their corner better than it is being fought at the moment.

Queen’s Speech

Lord Dubs Excerpts

Thursday 9th January 2020 Lords Chamber

[Lord Dubs (Lab)]

My Lords, it is a great pleasure to follow my noble friend Lady Blower and to congratulate her on her maiden speech. She was being unduly modest, because she has an enormous amount of educational experience, not just, as she said, as general secretary of the National Union of Teachers; she has also taught in a number of comprehensive schools in the London area. To say that other noble Lords have more knowledge of education than she has is to be unduly modest. She will make an enormous contribution to educational debates, thinking and policy in this House, and we look forward to hearing from her on many future occasions.

I will speak about social care. The gracious Speech included a reference to social care and the Government seeking cross-party consensus. That is fine, but we have been waiting for something to happen on social care for years. There have been reports, commissions and bodies talking about social care. What has happened to the long-awaited White or Green Paper that the Government promised quite a long time ago? Could the Minister tell us whether it is still going to happen and, if so, when?

If one talks to people of our age or older, one will know that most in this country are concerned about what will happen to them when, or if, they get to the point that they cannot look after themselves unaided. There is a deep concern. According to the British Social Attitudes survey, only 23% of people are satisfied with social care. There is a real gap in the system and concern for the future. Of course there is a need for more money. The Government are talking about an extra £1 billion a year, but most people who have looked at it say that we are nearer to needing about £8 billion a year, rather than £1 billion, to provide a decent standard of care. That is the sum required to return to the standards of 2009-10.

Eligibility for social care is very much a postcode lottery. It depends on which local authority one lives in and all sorts of random factors. No wonder there is concern. It also depends a great deal on unpaid carers. They give up their jobs to do care work and get £60 a week for that. It is pretty miserable. Care staff are not always able to work on Christmas Day or New Year’s Day. Retention is poor and many are non-UK nationals. I wonder what will happen to them post Brexit.

Everybody talks about better integration of health and social care. We hear the expression “bed blocking”. There are enormous costs to bed blocking. If there is no seamless transition from hospital to social care, which is provided by local authorities, people tend to stay in hospital. I know of the experiences of people who were in hospital for quite a long time—probably unnecessarily, had there been better transition to care outside hospital. I heard one estimate that a night in hospital costs £350, a night in a care home £85, and a night at home with care support under £20. People often have to contribute to their care but, because by staying in hospital they do not have to so, paradoxically, they save a bit of money, but it is not an efficient and humane way of proceeding. It is also erratic, because people with dementia have to pay for everything themselves and people with other illnesses do not. I understand that a good model has been developed in Manchester, which has a better way of integrating health and social care. It would take legislation to bring it about fully, but it needs to be looked at.

I looked into some other things, such as records. We have very little information about social care and few hard facts. Most of what we know is based on estimates—approximations, almost guesswork. For example, local authorities have different methods of collecting data. Nothing is standardised, so one cannot even compare one local authority to another. I challenge anybody to look at the form for eligibility for social care produced by a local authority. I have seen one—it probably takes a PhD or two to complete. They are very difficult, and people who are deprived and disadvantaged cannot always do that. There is a terminology difference as well between NHS support and social care. Surely we all agree that reform must be evidence-based.

There is pressure in the system, because the health service dominates, in a way. The health service needs far more money, but it has power to attract more money than local authorities can for social care. Local authorities are hard-pressed enough as it is. I urge that we should have proper records; be generous in saying that social care has to work properly; and that we must integrate health and social care. We would save money and provide much better care. For heaven’s sake, let us get on with it.

Childhood Obesity

Lord Dubs Excerpts

Monday 15th July 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I thank the noble Lord for his question; I hope that we can occasionally think cleverly in government. He is absolutely right that obesity is strongly correlated with socioeconomic deprivation, and that is why chapter 2 of our plan tries to target those areas that are most affected by delivering a childhood obesity trailblazer programme, working with local authorities to address this. They have been provided with £100,000 in the first instance to try to improve the impact of the childhood obesity plan. We shall see how that goes, but I am very happy to pass on his suggestion.

[Lord Dubs (Lab)]

My Lords, the Minister will no doubt be aware that the British-Irish Parliamentary Assembly some time ago produced a report on childhood obesity. Does the Minister agree, dipping into that report, that we need not only a national strategy but—as demonstrated to the committee in Amsterdam—a local strategy, where the local authority can take the initiative, and there can be education and pregnant mothers can be helped to see their way through their own diets and therefore to help their children? Does she agree that we need a local strategy as well, and can the Government initiate that with local authorities?

[Baroness Blackwood of North Oxford]

The noble Lord is quite right that the national plan must be implemented locally. Public Health England works with local authorities to do that and has set up a number of tools, such as the Change4Life plan, which includes food scanners that have been downloaded several million times to help parents and families make better food choices. We have more to do on this, and we very much welcome proposals to do it. I know that the Amsterdam model has been particularly effective; indeed, my noble friend raised this with the previous Public Health Minister, and I am sure she will continue to raise the issue.

Childhood Obesity

Lord Dubs Excerpts

Thursday 13th December 2018 Lords Chamber

[Lord O’Shaughnessy]

That is an excellent suggestion. Before this debate I looked at the Veg Power campaign, the ITV campaign to promote the eating of vegetables, which looks excellent. ITV has demonstrated its commitment and certainly shows an example to other broadcasters.

[Lord Dubs (Lab)]

My Lords, the British-Irish Parliamentary Assembly produced a report some months ago on childhood obesity, covering all the jurisdictions it represents. Could the Minister take another look at that, because a number of issues came out of it—for example, the need for local authorities to take action, the need for action in schools and the need for action in the voluntary sector? Could the Minister come back when he has looked at what further action could be taken on those recommendations?

[Lord O’Shaughnessy]

I should certainly be happy to do so. It is worth pointing out that that document and others have informed chapter 2 of the Government’s obesity strategy, which was published recently. Because the problem is not yet being dealt with, as we know, and we have an ambition to halve obesity, we are determined to act on things such as banning promotion of sugary foods and further restricting advertising.

The NHS

Lord Dubs Excerpts

Thursday 5th July 2018 Lords Chamber

[Lord Dubs (Lab)]

My Lords, I congratulate my noble friend Lord Darzi on initiating the debate and on his speech.

Exactly 70 years ago today, I was a patient in Stockport Infirmary. I was quite ill. In those days, when the consultant did his rounds it was like God visiting, with a team of doctors, matron and so and, if I remember rightly, one was supposed either to stand to attention if one was well enough or lie to attention if one was not. I was lying to attention. The consultant came by and I said, “Just a minute. I have a question to ask you”. One did not ask consultants questions like that, so he turned around and said, “What is it?”, and I said, “Are we having a party today?”. He said, “What for?”, and I said, “The hospital’s ours. Isn’t it terrific?”. He walked on. I was the only child in the ward and the other patients asked me what was going on. I explained and I think I got a few Labour supporters out of that.

I should declare that, more recently, I was a member of an area health authority and, even more recently, I was a member of a mental health trust, and I found it a privilege to serve on both those bodies.

I welcome the Government’s recent announcement of a bit of an increase, although it is only a standstill increase and does not increase the resources going into the health service. For all the criticism of the health service, I think we get fantastically good value for money out of it. If we look at the percentage of GDP spent on health, we compare extremely well with many other countries. Most of the major European countries spend more of their GDP on health than we do, and the Americans are way ahead. The trouble is that we get all this on the cheap. It is to the detriment of the health service that it is too easy for the Government to turn off the financial tap for reasons of austerity, and there are no safeguards to protect the health service against a Government’s short-term need to save money. My noble friend Lord Winston made that point earlier. I believe the value for money is incredibly good.

I hope that the Government will tackle the problem of social care. It is all too clear that so much bed-blocking takes place and that the health service would benefit if people could be moved out of hospital when they are well enough into their home with support or into other forms of residential support. It is to the detriment of the health service that we allow this to continue. We have to tackle it.

At a local level, Charing Cross Hospital in West London, which is much loved and much appreciated, is still under threat. There has been a big campaign to save it. The local health authorities wanted to close it down. At the moment, it is still there, at least until 2021. In the meantime, the Government have added £7 million to the A&E services, which are very important, but there is no point in putting money into A&E in the short term unless we have some assurance that the hospital will continue. The trouble is that we have to get out of the position in which the Government can too easily cut off the money so we do not have any long-term assurance about the health service.

Finally, I believe this most sincerely: the British people would accept an increase in taxation in order to fund the health service more securely. They would accept that, provided it was hypothecated for the health service. I know the Treasury does not like that, but I believe that if the people of Britain were told that more money from taxation would be used directly for health and social care, they would accept that.

Childhood Obesity: Yoga

Lord Dubs Excerpts

Thursday 21st June 2018 Lords Chamber

[Lord O’Shaughnessy]

I am glad that my noble friend has highlighted that. I can confirm that the next chapter of the plan will be coming very shortly. We will be discussing some proposals on the Daily Mile in that plan.

[Lord Dubs (Lab)]

My Lords, while yoga is undoubtedly important—although I know nothing about it—surely there is one simple point about childhood obesity: excessive sugar consumption, in drinks or elsewhere. We have to tackle that much more positively. I hope that the Government’s new plan will do that.

Hospitals: West London

Lord Dubs Excerpts

Wednesday 18th October 2017 Lords Chamber

Asked by

[Lord Dubs]

To ask Her Majesty’s Government what are their plans for the future of hospitals in West London, particularly in relation to their proposals to sell off much of the site of the existing Charing Cross hospital.

[Lord Dubs (Lab)]

My Lords, when the local London elections took place in 2014 everybody was surprised that Hammersmith and Fulham went to Labour—everyone except those of us who were knocking on doors like mad to try to win the council for Labour, which was of course the outcome. It was clear from knocking on those doors that the issue of Charing Cross Hospital was very much in people’s minds. After Labour won the Conservatives, who lost, complained that the health service was not directly a local government issue, to which the answer was that the outgoing Conservative council campaigned to support the closure of Charing Cross Hospital so it was not surprising that it became an issue. The Minister shakes his head but they certainly did; I was there. I understand that the NHS is under serious financial pressure. If it were not, the argument about the future of Charing Cross Hospital and other hospitals in north and west London would not apply.

I want to make three arguments. First, it is wrong in principle to close and demolish Charing Cross Hospital; secondly, the method of doing so was less straightforward than it should have been; and thirdly, public opinion is very much on the side of keeping the hospital. Public opinion was ably led by Andy Slaughter, the local MP and Councillor Stephen Cowan, the leader of Hammersmith and Fulham Council.

In 2013, we had the “Shaping a Healthier Future” policy. The NHS agreed plans to close A&E departments and acute care beds in four hospitals in north-west London. These plans continue to be implemented. The Government’s reconfiguration of those services is ironically entitled the “Shaping a Healthier Future” plan for north-west London. It was signed off by the Secretary of State, Jeremy Hunt. It showed that the plan was to demolish the current Charing Cross Hospital; sell off most of the Charing Cross Hospital site, leaving just 13%; replace the current hospital with a series of clinics on a site no more than 13% of the size of the current hospital; rebrand the clinics as a local hospital; replace the current A&E with an urgent care clinic; rebrand the urgent care clinic as a class 3 A&E; lose more than 300, possibly all, of the acute care beds; halt all complex and emergency surgery; and close the renowned stroke unit, which was possibly the best in London.

Since September 2014, the A&E departments at Hammersmith Hospital and Central Middlesex Hospital have been closed as part of the overall plan for the area. This had an immediate impact on waiting times at other A&E departments across north-west London. The figures are quite dramatic. Before September 2014 hospitals across north-west London were hitting their target of seeing 95% of patients within four hours. After the closures of the A&E departments at Hammersmith Hospital and Central Middlesex Hospital, the figure in December 2014 was 90% and by February 2017 it had reached 87%. As recently as September—last month—the combined figure for Charing Cross Hospital and St Mary’s Hospital had fallen to 69.7%, suggesting that there was a great deal of pressure on A&E services which would only get worse if the plans for Charing Cross were proceeded with. I should add that, among other hospital closures, in July 2015 the maternity unit at Ealing Hospital was closed.

Five London boroughs—Brent, Ealing, Hammersmith and Fulham, Harrow and Hounslow—got together to set up an independent healthcare commission, commonly called the Mansfield commission. The commission spent a year gathering evidence and published its findings and recommendations in December 2015. It said:

“There is still no completed, up to date business plan in place that sets out the case for delivering the Shaping a Healthier Future programme, demonstrating that the programme is affordable and deliverable … There was limited and inadequate public consultation on the original SaHF proposals and the proposals themselves did not provide an accurate view of the final costs and risks to the people affected … The escalating costs of the programme does not represent value for money”,


and were a waste of precious public resources. It said that NHS facilities delivering important public healthcare services had been closed without adequate alternative provision having been put in place, and that,

“the original business case seriously underestimated the increases in population being experienced in West London”,

and failed to address the increasing need for services. The main recommendation by the Mansfield commission was that the “Shaping a Healthier Future” programme itself should be halted.

The implications of the programme for protected groups were disturbing. The commission noted that the hospitals targeted for closure were those located in areas with high concentrations of deprived black and minority ethnic communities while the hospitals favoured for expansion were located in more affluent areas of north-west London. Significantly, the population of Hammersmith and Fulham is expected to increase by almost 12,000 between the 2011 and 2021 censuses. There is also a projected target of 22,000 new homes to be built in the borough by 2035.

We then had the Naylor review, which showed that, due to increasing demand on health services as a result of an ageing and expanding population, the Nuffield Trust estimates that an additional 22 hospitals of 800 beds will be needed over the next 10 years—not in London, but more widely. The review accepted that, even if new models of care are successful, this expansion and ageing of the population will require the same level of hospital capacity as at present. Most of the sustainability and transfer plan is pretty good; it is desirable to keep people out of hospital and to enable them to leave hospital when they are medically fit to leave so they do not block beds, and it is important that there are joined-up social care and health services.

I turn to urgent care centres. The UCC at St Mary’s was rated inadequate by the CQC and placed into special measures. I understand that there is now a bid from the private sector to buy it. What assurances do we have, if the Charing Cross proposals were proceeded with, and I hope to heaven they are not, that its UCC would not be privatised if the main proposal went ahead? We do not want this just to be a back door for achieving more privatisation.

Both Hammersmith and Fulham and Ealing councils have refused to sign up to the proposal regarding Charing Cross and Ealing hospitals. The reason they did not sign up to the whole proposal is the threat to those two hospitals; otherwise they would have signed up. The councils have said that the sustainability and transfer plan has good elements in it, but they will not sign up to it simply because it endorses the plan to close those two hospitals.

There are key questions that need to be answered so that local residents know what is going on. What is the timetable for service closures at Charing Cross Hospital? I understand that the original plan has been dropped and it is now to be in at least 2021. The problem is that a long period of uncertainty over the future of the hospital is very demoralising; it affects staff and the ability of the hospital to get staff, and it is unhealthy for the local community. Of course, the important thing is that the closure should not go ahead at all but, if it does, there should at least be a sensible timetable.

When will part two of the “Shaping a Healthier Future” strategic outline case be published? We need to know that to see what will happen. We need an assurance that those part 2 plans will be subject to widespread consultation.

Finally, and very importantly, I have mentioned the likely population figures. My question is: what population projections and modelling data are being used to estimate future patient demand for acute hospital services across north-west London generally, and in Hammersmith and Fulham specifically? We need answers to those questions.

I appreciate that this is a very party-political issue, but it is party political because local people want the hospital to remain. They do not want it to close. Many of us have used the services of the hospital and we do not want it to go. If it does, there will be no local hospital. There will be a clinic and one or two minor services, with most of the beds going, and all the good features of Charing Cross Hospital will simply disappear. I hope that will not happen.