Adult Social Care
Lord Forsyth of Drumlean Excerpts(1 year, 11 months ago)
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Lord Hunt of Kings Heath (Lab)
My Lords, if the Government are moving in the right direction, why have they yet again delayed the implementation of the Dilnot report? Why have they taken no notice of the report from the Select Committee chaired by the noble Lord, Lord Forsyth, in 2019, which clearly gave the Government the route forward to deal with this perennial problem?
Lord Markham (Con)
It is lovely to have noble friends.
Given the conversations I am sure we will come to shortly about improving hospital flow and the 13% of beds that are blocked, we felt that the focus needed to be very much on providing beds for short-term care. That is where we wanted to put the £7.5 billion of extra funding. We thought that was the immediate priority because we knew the flow issues were impacting A&E, ambulance wait times and everything else. That is not to say that we do not intend to implement all the Dilnot reforms, but the priorities were very much around improving flow and discharge.
Noble Lords
Lord Markham (Con)
Again, we welcome the report and many aspects of it. What I and my ministerial colleagues care most about is having the results and the impact. I think—and hope that noble Lords will agree when they see the work that she is doing in this space—that Minister Whately is gripping it and providing results. Let us see how that progresses first, because I think that that will have the impact that we need.
Lord Forsyth of Drumlean (Con)
My Lords, given that the Government promised that they would fix social care, and given that in the Answer to this Question the Minister said that there were 10 million people affected, is it wise to go into a general election without having done so?
Lord Markham (Con)
As ever, I thank my noble friend for his friendly questions. No; we know that this is an area that needs to be addressed, and I think that it is an area that we are addressing. I have been up here for about five months now, and in the time that I have been here, we have announced a £7.5 billion increase in spending over two years, a £700 million discharge fund over this year, and the recruitment of thousands of people every month from overseas. Yes, there is a lot more to be done, but there have been some very solid results in the meantime.
Urgent and Emergency Care Recovery Plan
Lord Forsyth of Drumlean Excerpts(2 years ago)
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Lord Markham (Con)
I thank the noble Baroness for her question and her recognition of the 12 hours. In all these spaces, data is always the way that you give a backdrop to better services, and 12 hours is part of that. As regards capacity, I totally agree that we need more of it. I was surprised by what she said—I will find out some more about it. However, the absolute direction is a recognition that, with Covid and flu, what might have been the right number of beds a couple of years ago is not today. That is why we are committed to the 5,000 extra beds and, just as importantly—potentially more so—the 50,000 in virtual wards, because that is using technology to look at how we can expand supply, and absolutely critical to that is having the workforce.
Lord Forsyth of Drumlean (Con)
My Lords, my noble friend quite rightly pointed out that there are more doctors than ever in the NHS, but many of them are in training. As my noble friend Lady McIntosh pointed out, we are losing very senior and experienced doctors because of the rules that apply on pensions. My noble friend said that this was being addressed. I remember raising this several years ago—it is a continuing problem. What is worse is that doctors leave the NHS because of the tax implications for their pensions and then come back and cost it even more money. My noble friend says that this is being addressed, but in the autumn I heard the Chancellor say that he was going to freeze the level of the maximum amount that counts towards the pension before you pay tax for the next three years—so how is that addressing the problem? Is it not an urgent problem? We may be putting more people into the service who are in training, but we are losing people out the bottom at a greater rate.
Lord Markham (Con)
I thank my noble friend. As I mentioned just now, retaining doctors is critical, and pensions are a key issue. We had an excellent debate on this a couple of weeks ago. Again, we are working on all of that with the Treasury. However, as I said then, the simplest thing is that, while I understand the Treasury’s concern about making special rules for special groups and the potential knock-on from that, we can very quickly make sure that, if people are hitting that pension ceiling, they can get the equivalent pay in their pay package very quickly. As a health department we have the ability to do that, to make sure that no one is financially losing out from that. If it does not make sense for them to get it through their pension, they can get it through their salary instead. I am not saying that that is perfect, and more work needs to be done across the Treasury, but we can do that quickly.
PPE Expenditure
Lord Forsyth of Drumlean Excerpts(2 years ago)
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Lord Markham (Con)
In the circumstances at the time, I think we were all worried that we were going to run out of PPE. If the noble Lord remembers, it was the Wild West out there in terms of trying to purchase it, with planes gazumped literally on the runway and flying to other countries. That is why we stepped in. We bought to a worst-case projection, because we knew we could not afford for PPE to run out in our social care homes or our hospitals. We ended up buying 20% too much as a result, and that is what we are dealing with now. However, only 3% of everything that we bought ended up being faulty, which I think people will agree was a pretty good result.
Lord Forsyth of Drumlean (Con)
My Lords, will the Minister indicate how much we are paying for storage of PPE? Are the press reports that we paying for the storage of PPE on a substantial scale in China correct?
Lord Markham (Con)
Right now, less than 1% of stock is held in China—to answer that question directly. In terms of cost, we are currently paying about £700,000 per day, which is why we are writing off the stock and effectively disposing of it. We have tried to donate as much of it as possible to people who want it, but we have to bite the bullet on the rest and say, “You know what? It’s no longer required so we are disposing of it as rapidly as possible.” We are bringing down those costs; we will be saving £200 million a year through that rapid disposal.
Times Health Commission
Lord Forsyth of Drumlean Excerpts(2 years ago)
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Lord Markham (Con)
No, we are working very intensively. We have some very good minds involved in this. I know from my work with my colleagues that we work hard on developing our own plans, some of which were announced just last week. We are facing a challenge, as we all know, from the setbacks around Covid but we are tackling it. What I am saying is that there is an absolute openness to new ideas, which is why I welcome any ideas that come to the table—but, believe me, we are working on a lot of our own ideas.
Lord Forsyth of Drumlean (Con)
My Lords, if the Government or the editor of the Times want to find out what we need to do about social care or look at what has been agreed on an all-party basis, all they have to do is to read the report from the noble Baroness, Lady Andrews, and the Select Committee that was set up by this House, which sets it out clearly—or even the report that was done by the Economic Affairs Committee three years ago, which predicted the mess that we are now in. We do not need journalists doing reports; we need the Government to respond to what Parliament has demanded.
Lord Markham (Con)
I think we have responded and are responding. That is very evident in the plans and funding that we have recently put in place and from the work that we are doing, which the House will see far more about as we announce it over the coming weeks and months.
Care Homes: Severely Disabled People
Lord Forsyth of Drumlean Excerpts(2 years, 2 months ago)
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Lord Markham (Con)
My Lords, the 200,000 extra care places that this funding provides is a solid example of an expansion of supply, and I hope all noble Lords agree that that is a substantial number. I hope they also agree with the work we are doing to recruit from overseas to increase the workforce in this sector, which is indeed increasing. Areas such as these show that we are committed to expanding the supply, and we are seeing that rewarded in the increase in the last few months.
Lord Forsyth of Drumlean (Con)
My Lords, has my noble friend yet had an opportunity to read the Economic Affairs Committee report on social care, a “national scandal”, which points out that in care homes in both the private and the charity sectors, people who pay their own costs subsidise others to the tune of 40%? The local authority rates are simply unsustainable, and this issue is therefore urgent and needs to be addressed. Simply talking about inputs all of the time is no good; we need to see what is happening to the outputs, which is a tragedy.
Lord Markham (Con)
Funnily enough, the meeting on the sector’s financial health that I mentioned was precisely in response to the Question last week, so that I can make sure that proper work is being done in this space. I will not pretend to have the answers to that yet because, as my noble friend mentioned, a long-term review needs to be done. But rest assured that I am working on this.
Adult Social Care
Lord Forsyth of Drumlean Excerpts(2 years, 2 months ago)
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Lord Markham (Con)
I thank the noble Baroness. As mentioned, 200,000 care packages is a significant number and will make a significant impact on everything we are talking about here, and that is in conjunction with all the other measures we have put in place, including the £500 million discharge fund this year. In terms of the precise percentages of those allocations, I will quite happily commit to write on that, but I can say to your Lordships that the £4.7 billion represents a 22% increase in 2024-25. By any standards, I think that people would agree that a 22% increase is a significant amount.
Lord Forsyth of Drumlean (Con)
My Lords, has my noble friend read the report of this House’s Economic Affairs Committee entitled Social Care Funding: Time to End a National Scandal published some years ago? In particular, the point is made in the report that to try to fund social care by allowing for an increase in council tax is highly regressive and inequitable because the tax base of the local authorities is least where the demand is greatest.
Lord Markham (Con)
I have not read the report, which was published a few years ago—I will always stand up and say when I have read something and when I have not, and will not pretend to have read something that I have not. But I am aware of the issue. I was a local councillor many moons ago and am aware of the issue of the narrow tax base on which we are sometimes asking to draw, so it is a much wider question. That is why I am glad that a lot of this funding has come from central government as a down payment towards that. As I have mentioned many times, I accept that we need to find some long-term solutions in this space.
Health: Pancreatic Cancer
Lord Forsyth of Drumlean Excerpts(2 years, 2 months ago)
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Lord Forsyth of Drumlean (Con)
My Lords, the Government’s current campaign to encourage people to go and see their GP if they have symptoms is commendable, but how can this help when people are waiting months to get scans and then weeks to get the results of their scan? What can be done about this?
Lord Markham (Con)
This is where we see the diagnostic centres being a key area in this. We have set up 91 community diagnostic centres. In addition, in 2020 we had only 12 non-specific symptoms pathways; we are now rolling those out to 96, so that 75% of the population will be covered by March 2023, with a target of 100% by March 2024.
Social Care: Adults
Lord Forsyth of Drumlean Excerpts(2 years, 7 months ago)
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Lord Kamall (Con)
When we look at the 500,000 number, we are talking about an assessment of any kind. These are not people who are outside the system; sometimes they may be in the system but waiting for another assessment within the system. For example, they could be waiting for Care Act deprivation of liberty safeguards, occupational therapy assessments, the beginning of direct payments or a review of their care. It means they are in the system but just waiting for another part of the system to work. The other thing about the report was that there was a 61% response rate, and it was extrapolated from that. Anyone who has read behavioural economists Daniel Ariely or Daniel Kahneman will know that people are more likely to focus on losses rather than gains and, similarly, in surveys people are more likely to report bad things than things that are going well.
Lord Forsyth of Drumlean (Con)
My Lords, does my noble friend accept that what these figures show is that local authorities with insufficient resources are introducing rationing of services to some of the most vulnerable people in the country? Why did we pay more in national insurance if the money was not to be made available to social care until three years down the line and the crisis is now?
Lord Kamall (Con)
I wonder if I could correct my noble friend. The Government implemented a comprehensive review of the programme on adult social care with a £5.4 billion investment over three years from April 2022, of which £1.7 billion will be used to begin major improvements across adult social care in England, including but not limited to £500 million investment in the workforce and £150 million to improve technology. As many noble Lords recognise, for too long this sector has been neglected. In some cases, there is a lack of understanding about the breadth of the sector. We are trying to understand it and get people to register, and then we can improve it.
Covid-19: Restrictions
Lord Forsyth of Drumlean Excerpts(2 years, 11 months ago)
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Lord Kamall (Con)
If I was aware of any scientific advice that had not yet been published, I am not sure whether I would be unaware of it. I will try to find out. The Government have laid out the terms of the inquiry; only last week I sent the link to some people, which I am very happy to send to the noble Viscount, for the points that should be considered by the inquiry. During the pandemic, and even now, we continue to receive a wide range of scientific advice. The wonderful thing about scientists is that they continue to debate with and contest each other. Some say that we should never have had these measures, some that we lifted them too early, and some that you can never get the timing right, whatever you do.
Lord Forsyth of Drumlean (Con)
My Lords, as we enter an economic war, are the Government not absolutely right to balance the scientific advice with the economic consequences, and that by pursuing the policies which they have since before Christmas, they have put the economy in a strong position which guarantees that we can do as much as we can to help the most vulnerable people in our country?
Lord Kamall (Con)
I thank my noble friend for making that point. It is incredibly important, not only within the medical community, where we were asked, for example, to lift some restrictions so that we could start tackling the backlog. We were asked `by mental health experts to ensure that people were getting access to mental health care who had been unable to because of the pandemic. We have also balanced this against economic and social considerations—sometimes these things affect each other. Being unable to work and facing uncertainty can be one of the most destabilising things and can affect people’s mental health. My noble friend is right that we have had to balance a number of issues in the round.
Personal Protective Equipment: Accounting
Lord Forsyth of Drumlean Excerpts(3 years ago)
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Lord Forsyth of Drumlean (Con)
My Lords, does my noble friend not recognise that some people have very short memories? If we look back, there was huge demand globally for PPE. The press and the public were screaming for supplies to be provided. People worked round the clock, and of course they ended up paying over the odds in such a situation. Politics is fine, but to try to score points against people who did their best in the interests of public health and who were not bean-counters is really unworthy.
Lord Kamall (Con)
My noble friend makes a very important point. We should completely pay tribute to all those who worked as hard as they could during a time of panic. I remember that the leader of the British Medical Association said:
“This really is a matter of life and death. In what is an incredibly challenging time, doctors and healthcare staff should feel as equipped and supported as they need to be able to deliver care for patients.”
You cannot put a price on that. We had to buy equipment from wherever we could to help make sure that we kept our staff safe.