Elderly Social Care (Insurance) Bill [HL]

Lord Flight Excerpts

2nd reading
Friday 16th July 2021 Lords Chamber

[Lord Flight (Con)]

My Lords, I, too, congratulate the noble Lord, Lord Lilley, on his Bill and on addressing territory that Governments should have addressed long before now. I agreed very much with my noble friend Lady Altmann’s speech.

The noble Lord, Lord Lilley, argued that social care provides two competing challenges to government. The first is the increased pressure on local social care budgets that comes with an ageing population, the increases in the national living wage and the risk of care homes closing. The second is resentment from homeowners and their relatives who risk having to sell their homes to pay for social care. He advises that both problems could cost billions to solve and that, where there is more placating of homeowners, less finance will be available to provide decent care for those in greatest need.

Under the Bill, a state-owned insurance company would be set up and guaranteed by the state. The cost of insurance would be calculated to be actuarially sufficient to pay for all the care. If they wished, people would be able to pay for the insurance via a charge on their homes, which would be realised when they died. That charge would typically be a modest fraction of the value of any home and nobody would be required to take out such insurance. Based on updated figures and the calculations from the Dilnot commission, the noble Lord, Lord Lilley, calculated that a theoretical premium would be approximately £16,000 and the average cost to social care, supported by local authorities, would be £25,000, as he said. I question whether the noble Lord’s insurance premium of £16,000 per annum will be sufficient.

The Bill does not address the point that there is a perceived unfairness, with those who have worked hard and saved having to pay their care costs while those who have spent all their incomes get their social care costs paid for. Those people should arguably get state-provided care, which would be of a more basic nature than the care that individuals purchase. The main objective of the noble Lord, Lord Lilley, is to weaken the political pressure from homeowners for the state to provide them with free social care, but his arrangements entail the state insurance body realising its charge on a property on the death of the insured person or the sale of that property—the charge being the fraction, set aside at the time of the purchase of the policy, of the value of the property at the time of death, net of mortgage.

The terms of the Bill do not therefore fully avoid the much-disliked arrangement of the public sector taking value from a deceased citizen’s property, even though it would be much less under the noble Lord’s system. The insurance arrangement would operate such that the insured persons would be entitled to social care from their local authority, which would be reimbursed for the cost of the care provided. The weakness here is that there is no incentive for the local authority to keep the care costs as low as possible.

The proposals of the noble Lord, Lord Lilley, are complicated and do not—

[Baroness Penn (Con)]

I must remind the noble Lord of the advisory Back-Bench time limit for this debate.

[Lord Flight (Con)]

They do not include the cost of care homes. In my view, what is needed is a less complicated and more standardised approach.

Social Care and the Role of Carers

Lord Flight Excerpts

Thursday 24th June 2021 Lords Chamber

[Lord Flight (Con)]

My Lords, it is clear that the occasion of a pandemic means that reform of carers and social care cannot be put off, but it is a big and difficult task. There are big regional differences in patterns of social care and care arrangements, mostly determined by local authorities and the shape of the population. Care is also provided to all groups: children, the young, people of working-age and those who are older. Carers can be provided by local authorities, private companies and charities and, most of all, informally by families and neighbours. It is estimated that 1.6 million people work in the adult social care sector and 7% of the population provides unpaid family-type care services. The biggest territory is the old, although there are still significant differences in longevity around the UK, which affects care needs.

There is major reliance in the UK on family carers, which consists of one partner in a marriage looking after the other and children helping. There is nothing wrong with that. I remember that my parents looked after each other and all my grandparents looked after each other, but they had to be in a position and willing to do so. Post-pandemic, the UK simply cannot afford huge increases in care costs, but spending on care is more justified than spending on the NHS, which is already huge. There is the problem that care home costs have risen substantially over the past 20 years, largely reflecting regulatory costs.

I was very interested in the comment made by the noble Baroness, Lady Blower, about children. While working as a councillor, my wife found that there were child providers, some as young as eight, whose parents were bedridden. They were wonderful young children and pleased to do it.

I fear that the major political issue will be whether individuals have to sell their houses and use the proceeds to finance the provision of care until the funds run out. The free provision of care where individuals do not have such savings is clearly some incentive not to save during working life and one reason why the UK savings rate is, surprisingly, massively less today than it was 100 years ago. I think the Foresight report is crucial to reform. I agree with it and am disappointed that it has not been implemented sooner. I also think there is scope for state provision of insurance, but we need to get a move on.

Covid-19: Proof of Vaccination

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Monday 14th June 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, vaccine data is held in the vaccine database and in the patient’s record. We abide by the principle that the data is owned by the patient.

[Lord Flight (Con)]

My Lords, the Minister has really answered this question already, but may I add that it surely would be possible for vaccination units to have supplies of certificates that they could issue to people when they come to get their first or second vaccination?

[Lord Bethell (Con)]

My noble friend alludes to having pre-printed certificates. In fact, each vaccine certificate has a tailored two-dimensional QR code that is designed for each person. Therefore, it is necessary to print the certificate for the person because it has their specific details on it.

Covid-19 Internal Review

Lord Flight Excerpts

Thursday 20th May 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I am enormously grateful to my noble friend for his comments. I know he has been a vocal critic of some things, and I take his comments in very good measure. On his point on guidance, this is not how the public have presented things to us. They want clear, easy-to-understand guidance. We have learned the importance of publishing in many languages and now regularly publish in 10 spoken languages. The public are in fact hungry for detailed guidance, which is why we have published more than 400 pieces of guidance on GOV.UK, covering everything from funerals, care homes and schools right through to smokers, vapers, houseboat dwellers and singing with children. That is because the public would like to have this kind of advice and recommendation.

[Lord Flight (Con)]

My Lords, I congratulate the noble Lord, Lord Bethell, on how professionally he handles his responsibilities in the Lords. I am sure he will support the Prime Minister’s announcement that a full inquiry will be held next year, beginning in the spring, which will place the state’s actions under the microscope. The existing internal lessons-learned review was an informal exercise, not a public-facing work, which I believe will not be published. It would be wrong to publish it. While there have inevitably been some mistakes, I congratulate the Government and the noble Lord, Lord Bethell, on having got Covid-19 vaccinations moving significantly faster than the EU. I hope he will exceed the speed limit even more.

[Lord Bethell (Con)]

I am enormously grateful for my noble friend’s kind comments. On his point on vaccines, I emphasise the enormous contribution of the whole union behind the vaccine project. It has been a union project to deploy vaccines to every person in the UK at amazing speed and with consistency right across all parts of the union. For that we should be enormously grateful.

Covid-19: Resuscitation Orders

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Wednesday 24th March 2021 Lords Chamber

[Lord Bethell (Con)]

No, my Lords, I do not accept that the report is simply the tip of the iceberg; it is very thorough and goes into the matter extremely carefully. However, there are important lessons on training to be learned and they will be driven by the ministerial oversight group.

[Lord Flight (Con)]

My Lords, the Care Quality Commission wrote up its findings at the time of the outbreak of Covid-19, which may have made them less reliable. A number of factors have served to raise exposure to decisions on whether or not to accept DNACPRs, and these were taken for groups rather than individually. Such groups included individuals suffering with dementia and learning disabilities who needed briefings that they could understand. The Care Quality Commission report is about how hospitals, care homes and doctors should support people to make decisions properly about how to restart. Are the Government satisfied that the decisions in this territory are now being taken properly?

[Lord Bethell (Con)]

My Lords, the report is crystal clear that we accept that more training is needed. Front-line care support workers need to be given more support in their interactions, and we will be putting that in place.

Covid-19: Brazilian Variant

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Tuesday 2nd March 2021 Lords Chamber

[Lord Bethell (Con)]

I endorse the noble Lord’s observation that tracing is important. I pay tribute to the Operation Eagle team. The noble Lord will note that the South African variant, which made landfall in the UK, is currently being contained through the immense work of this team. They are throwing a blanket over communities and doing a huge amount of forensic, detective work in tracing variants. As to his specific point, it is possible for someone to walk up to a testing station, take the test, be handed a form and not fill it in. We are trying to understand if those were the circumstances in this case.

[Lord Flight (Con)]

My Lords, are there risks that the Brazilian variant may not provide adequate protection against reinfection and that vaccinations are less effective against this strain? It carries the same mutation as the Kent variation, which is rated 70% more transmissible than previous strains.

[Lord Bethell (Con)]

My noble friend is stretching my immunological skills to the limit. The Brazilian variant has a number of mutations. It is not clear to us whether those are mutations of transmissibility, vaccine-escape mutations or reinfection mutations, and therefore which we should focus on. All are possible and we are keeping a careful eye on this. An enormous amount of investment and research is going into understanding this more carefully.

Health Protection (Coronavirus, Restrictions) (Self-Isolation and Linked Households) (England) Regulations 2020

Lord Flight Excerpts

Thursday 7th January 2021 Lords Chamber

[Lord Flight (Con) [V]]

My Lords, it is politically healthy that the UK system has the ability to correct and polish statutory instruments, and that such changes made by government need to secure the approval of both Houses of Parliament. The House of Lords has a useful role in investigating and debating changes to the law made under the affirmative procedure. It is particularly useful that a large number of eminent lawyers sit in the Lords.

The two relevant key instruments currently being addressed reduce the self-isolation period from 14 to 10 days for people in England who have had close contact with someone who has coronavirus. This change also applies to the minimum period of isolation for households switching their support bubbles. The regulations also make changes to the starting date for calculating the isolation period. The Government made the changes following a review by the chief medical officers of the evidence on self-isolating. The regulations shortened the infectious period to 10 days after contact; it was defined as being low, although it was higher than the likelihood of being infectious after 14 days.

The changes to self-isolation period starting points in England were made to bring them in line with the rest of the UK. While there has been some professional questioning of these changes to the regulations, I observe that they have, in the main, been accepted as necessary and appropriate.

Face-to-Face Medical Appointments

Lord Flight Excerpts

Thursday 19th November 2020 Lords Chamber

[Lord Flight (Con)]

My Lords, my personal experience of online doctor appointments is that they are most satisfactory, efficient and time-saving, but I do understand that many older citizens may want and often need to have traditional face-to-face appointments. Appointments on demand are surely not practical, but does the Minister support citizens having the legal right to request one-to-one doctor appointments?

[Lord Bethell (Con)]

I agree with my noble friend that the terms of service should be clear, although I am not sure that we necessarily have the scope for or benefits of a legal right per se. However, perhaps I may disagree with him on one point. He said that there is a greater demand among older citizens for face-to-face contact, but that is not our experience. Older citizens are often very engaged digitally, prefer to engage with their clinicians, on occasion, from the comfort of their own homes, and can often be early adopters of such technologies.

Covid-19: Vaccine

Lord Flight Excerpts

Wednesday 11th November 2020 Lords Chamber

[Lord Bethell (Con)]

I am grateful to my noble friend for the question on international vaccines. He is right that no single country holds the keys to victory against this invisible enemy and we must work together. I point out in particular the work of the ACT Accelerator, which estimates that $38 billion is needed by the end of next year for equitable access to vaccines. This will be an important part of our chairmanship of the G7, which starts at the beginning of next year, and which will be a helpful platform for Britain’s advocacy of fair and equitable distribution of vaccines.

[Lord Flight (Con) [V]]

I thank all involved for the achievement of a successful vaccine. What, if any, is the effect of the vaccine if taken when the recipient is already testing positive for coronavirus?

[Lord Bethell (Con)]

My Lords, my understanding at the moment is that it is not necessary to take a coronavirus test before having the vaccine. This has been one of the subjects of the trials that have taken place so far. I do not believe that there is any effect at all but I am happy to check that, seeing as it is a detailed clinical point that is beyond my personal experience, and revert to my noble friend with confirmation of it.

Covid-19: Dental Services

Lord Flight Excerpts

Tuesday 10th November 2020 Lords Chamber

[Lord Bethell (Con)]

The noble Lord asked for a general commitment on dentists and their staff. I reassure him that we value the dentist profession and their staff, and the Covid pandemic has only emphasised the importance of dentists in the community and to the nation’s health. He asked me a specific question about where they stand in the vaccine prioritisation list and whether they are on the healthcare list. I will write to him with a precise answer to that question.

[Lord Flight (Con) [V]]

My Lords, there are three big factors that are causing these problems. First, there is the potential patient’s caution and the worry of contracting Covid-19, which leads them to put off treatment and save the money until normal times return. Secondly, dental sessions are taking much longer, partly because of the fall in the number of patients per session and lower throughput. The principal barrier to resuming services is the issue of the fallow time required following aerosol-generating procedures. The solution is greater ventilation. The key need is to increase the patient throughput and to reduce—

[Lord Ashton of Hyde (Con)]

Could the noble Lord put the question please?

[Lord Flight (Con) [V]]

Will the Government be willing to put up any funding to deal with the issue of fallow time between treatments?

[Lord Bethell (Con)]

My Lords, I agree with the noble Lord’s analysis, but it is too early to make commitments on funding.