Ambulance Queues: Health Outcomes

Lord Forsyth of Drumlean Excerpts

Thursday 13th January 2022 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Baroness for giving me the opportunity to say what the Government are doing right now. We are working closely with ambulance services, NHS England and the Association of Ambulance Chief Executives to reduce the handover delays. The 10-point plan I referred to earlier goes into detail about how we handle this, both in handling calls at call centres—some calls are not emergencies, for example, and patients are directed elsewhere—and in making sure that the wider system is available to make sure that patients are unloaded within the 15-minute target and that ambulances are turned around as quickly as possible. Where we have spotted disproportionate pressures in the system, as in the 29 hospital trusts across 35 sites, we have focused more resources there.

[Lord Forsyth of Drumlean (Con)]

My Lords, I appreciate that my noble friend has to read out what he has in his brief, but would he take time to read the report on social care published by the Economic Affairs Committee of this House, which received pretty well universal endorsement? Will he then discuss with his colleagues whether we really have fixed social care and whether the resources he is claiming are sufficient to meet the problem?

[Lord Kamall (Con)]

I thank my noble friend for drawing my attention to the report and the work of that committee. I will commit to reading the report and look forward to future discussions with my noble friend and many noble Lords across the House.

Care Workers: Professional Register

Lord Forsyth of Drumlean Excerpts

Monday 10th January 2022 Lords Chamber

[Lord Kamall (Con)]

As the noble Lord says, pay is one of the important issues when people consider what career to take, but also how much that career is valued. One of the reasons we are looking at this voluntary register, but also the skills passport, is to understand the current layout of the sector. There are a number of different qualifications at the moment and before we consider what should be mandatory and make sure that everybody is aligned in terms of qualifications, we want to understand the care force out there. Some 56% of those in the care sector, for example, do not have any qualifications and we want to make sure that we address that.

[Lord Forsyth of Drumlean (Con)]

My Lords, the Economic Affairs Committee report of some two years ago estimated that £8.6 billion was needed just to get back to where we were 10 years ago. This money, which the Government are promising, is not available now. The need is now and the Government themselves have said that they want to deal with the problem of beds that are blocked in the NHS. That can happen only if the care workers are there and encouraged to be so, and that is about training and pay. At the moment, really good, wonderful people get paid more for stacking shelves in Tesco than they get for carrying out this work. Will my noble friend persuade the Treasury that this money needs to be made available now?

[Lord Kamall (Con)]

My noble friend makes a very important point that we need to make sure that this is an attractive career and that people feel valued. One of the reasons we launched the Made with Care campaign in November, which is running over five months, is to attract more people to the sector. Some of the money we have made available is to make sure that the sector is more attractive to people who want to work in it and that people in local authorities push the care home owners to pay their staff more.

Hospital Beds and Social Care

Lord Forsyth of Drumlean Excerpts

Thursday 6th January 2022 Lords Chamber

[Lord Kamall (Con)]

I begin by wishing the noble Lord and all your Lordships a happy new year. We have started the national discharge task force, with membership from local government, the NHS and national government, and we have looked at the different pathways. There are four pathways: one is direct discharge, one is interim discharge, and one is for those who need a bit more support. But then sometimes individual cases are quite different; sometimes a place is offered, but the family may not be happy, so we have to find other ways. One thing that the national discharge task force has been doing is to look for spaces, wherever they may be, across the health and social care system to see whether they would be suitable for interim—but we are looking at all sorts of solutions in partnership with local authorities.

[Lord Forsyth of Drumlean (Con)]

My Lords, while I welcome the very substantial additional resources given to the health service, will my noble friend revisit the decision to delay making money available for social care purposes? That money is needed now to finance the care workers and finance those places in care homes. Without it, we will continue to see bed-blocking, so it is a policy that is self-defeating.

[Lord Kamall (Con)]

My noble friend makes an important point. In the White Paper, People at the Heart of Care, we have set out our vision for adult social care and outlined our priorities. Throughout the pandemic, we made available nearly £2.9 billion in specific funding for adult social care—£1.75 billion for infection prevention and control, £523 million for testing and £583 million to support workforce capacity and recruitment, as well as all the other measures that I have previously referred to as part of the task force.

Social Care and the Role of Carers

Lord Forsyth of Drumlean Excerpts

Thursday 24th June 2021 Lords Chamber

[Lord Forsyth of Drumlean (Con) [V]]

My Lords, I am grateful to the noble Baroness, Lady Donaghy, for that reference to the all-party Economic Affairs Committee report. It is now becoming rather ancient, but it set out a basis upon which the Government could act and the Prime Minister could fulfil his promise to fix social care. We described the situation as a “national scandal”; I have described it as a disgrace and the Government’s position as a breach of trust. Yet in debate after debate, Ministers tell this House that they have been distracted by Covid or that it is necessary to get all-party agreement before we can make progress. As the months go by, nothing is done to convene talks to get all-party agreement. We all know that the reason action is not being taken is that the Treasury does not want to spend the money.

For me, politics is first and foremost about protecting the most vulnerable in our society. The Government should provide a safety net below which no one will fall, and social care is absolutely central to that. The statistics that the noble Baroness, Lady Donaghy, has just reiterated are something that all of us should be ashamed of—the Government should certainly be ashamed for not having acted before now.

It is a real pleasure to take part in this debate and to speak alongside formidable campaigners such as my noble friend Lady Browning and the noble Baroness, Lady Pitkeathley, and indeed the noble Baroness, Lady Jolly. I am really grateful to her for giving us yet another opportunity to remind the Government that procrastination is the thief of time and is creating real misery.

I want to emphasise how important it is to raise the professional standing and status of carers. I can see nothing that the Government have done in engaging with the professional bodies to achieve that purpose. We are talking about big sums of money, but in one year we increased the NHS’s funding by more than the total cost of social care, and the NHS—as so many speakers have already pointed out—is very dependent on social care. In Scotland, we saw people who had tested positive for Covid being transferred to nursing homes and care homes, with disastrous consequences.

We have a situation where the Government are committed to levelling up, but why then is the responsibility for funding being put on to local authorities? They can raise their local taxes in order to fund social care, but the local authorities with the most need often have the narrowest tax base. There is real pressure, which results in people not getting the care and support they need, as the noble Baroness, Lady Donaghy, pointed out.

There is a huge need for additional recruitment in the care sector. That will not be fulfilled if people are not properly paid, properly rewarded and properly treated for the fantastic job they do for our country. Frankly, the Minister is letting them down by coming back repeatedly to this House and saying, “We will produce proposals soon, perhaps by the end of the year”, and making excuses. We all know that the Prime Minister must tell the Chancellor to stump up the cash, because this is one of the first duties of government.

Covid-19 Update

Lord Forsyth of Drumlean Excerpts

Tuesday 15th June 2021 Lords Chamber

[Lord Forsyth of Drumlean (Con)]

My Lords, what is the point of this Statement? It was briefed to the newspapers over the weekend and the contents were given to members of the press for scrutiny. So Laura Kuenssberg has done the job and there seems to be little for us to do—which may account for the grumpiness I see around the Chamber. Has my noble friend seen the excellent report of the Constitution Committee of this House published on 10 June, entitled COVID-19 and the Use and Scrutiny of Emergency Powers? It is damning of the Government’s use of secondary legislation without proper consultation—of which today we have yet another example. Will the Government mend their ways and accept the recommendations in this excellent report?

[Lord Bethell (Con)]

My Lords, I absolutely pay tribute to the Constitution Committee. It was generous enough to have me appear in front of it, and I gave several hours of evidence. I am glad to see that my noble friend read the report; I hope he enjoyed my evidence in it as well. In that evidence I made it absolutely crystal clear that the Government work with the laws at our disposal; that is what we have to hand. There may be a time when Parliament chooses to review those laws. Now is not the time, but when it is we will do it.

Covid-19

Lord Forsyth of Drumlean Excerpts

Wednesday 26th May 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I must admit that I am not aware of a large number of people having to repeat their 10-day isolation, so let me look into that and I should be glad to write to the noble Baroness.

[Lord Forsyth of Drumlean (Con) [V]]

My Lords, in the light of the extraordinary personal vendetta that Dominic Cummings is pursuing against the Health Secretary and the Prime Minister, is it not obvious that the Government must now bring forward the official inquiry into the handling of the pandemic promised by the Government so that the public do not have to rely on a partial, self-serving account, fortified by hindsight?

[Lord Bethell (Con)]

I am extremely grateful for my noble friend’s remarks. The inquiry will, as he says, provide an important moment to look at the lessons that we can learn from the response to the pandemic. The Prime Minister has given extremely clear reasons why the timetable is as he described and we should stick to the timetable that he has suggested.

Health and Social Care Update

Lord Forsyth of Drumlean Excerpts

Monday 22nd March 2021 Lords Chamber

[The Deputy Speaker (Lord Haskel) (Lab)]

My Lords, the House will now resume with questions on a Statement made in the House of Commons on 18 March: Department of Health and Social Care Update.

[Lord Forsyth of Drumlean (Con) [V]]

My Lords, what contingency plans do the Government have in place should the EUC/EU pursue its outrageous threats to prevent the export of vaccines under a legal contract with the NHS? In that event, can my noble friend say what estimate he has made of the delay, if any, to completing the undertaking he gave earlier that all adults in the UK will have had their first dose by the end of July?

[Lord Bethell (Con)]

My Lords, from the beginning, we have put in place arrangements for the UK manufacture of vaccines, which, in the light of events, has proved to be a pragmatic and sensible move. We are hopeful that the EU will continue in the spirit of partnership and will respect contract law. I stand by the statement I made on our expectations on the supply of the vaccine to cohorts one to nine and all adults that I articulated earlier.

Covid-19 Update

Lord Forsyth of Drumlean Excerpts

Thursday 4th March 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, we are taking a leadership role in COVAX, CEPI, ACT, Gavi and all the international, multilateral initiatives to roll out vaccine around the world. We are looking at what to do with our own stock of vaccines, and the Foreign Secretary has made it very clear that distribution of the vaccines we have bought is very much on the agenda. The AstraZeneca vaccine is being used as probably the default vaccine of choice around the world, as it is low- cost and easily distributed. Through our G7 chairmanship, we entirely support the agenda of preventing further pandemic by ensuring that vaccines are fairly and widely distributed around the world.

[Lord Forsyth of Drumlean (Con) [V]]

I join others in congratulating my noble friend and his colleagues on the brilliant success of the vaccine programme. However, why is everyone in the United Kingdom, on receiving the vaccine, not being issued with a card to show that they have had it?

[Lord Bethell (Con)]

My Lords, they are issued with a certificate. It is a digital certificate that is put in their patient record. In the modern day, that is by far the most effective way to ensure that people know that they have had the vaccine. A physical card has the potential for fraud. We have looked that extremely carefully, but we think the digital approach is the right one. Most people will receive a small card with their second dose appointment on it, but if my noble friend did not get one, I am sorry about that.

Social Care Funding (EAC Report)

Lord Forsyth of Drumlean Excerpts

Thursday 28th January 2021 Grand Committee

Moved by

[Lord Forsyth of Drumlean]

That the Grand Committee takes note of the Report from the Economic Affairs Committee Social care funding: time to end a national scandal (7th Report, Session 2017-19, HL Paper 392).

[Lord Forsyth of Drumlean (Con) [V]]

My Lords, I am pleased to introduce the Economic Affairs Committee’s report, Social Care Funding: Time to End a National Scandal.

We published our report in July 2019, and yet, 18 months later, we still await the Government’s response. The Government are accountable directly to Parliament. They have a duty and a responsibility to reply to committee reports in a timely way, usually within two months. Some 18 months ago, we said:

“With each delay the level of unmet need in the system increases, the pressure on unpaid carers grows stronger, the supply of care providers diminishes and the strain on the care workforce continues.”


Just 20 days after our report was published, the Prime Minister stood on the steps of Downing Street and said

“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.”

Now, more than ever, urgent government action is required.

Before I explain our conclusions, I would like to thank the committee staff who produced the report: Sam Newhouse, Luke Hussey, Michael Berry, Ben McNamee and Lucy Molloy. Especial thanks go to our special adviser Professor Richard Humphries, whose support was invaluable. I also thank my noble friend Lord Tugendhat, the noble Baroness, Lady Bowles, and the noble Lord, Lord Burns, who leave the committee today under our rotation rules. All of them have made a huge contribution to our deliberations and participated in no fewer than nine inquiries.

I must begin by praising our care workers. They have been on the front line of the pandemic. They have put their own health and safety to one side to care for and protect the most vulnerable among us. Care workers have performed an immeasurable service for our country but clapping alone will not help put in place the major reform that the sector so desperately needs.

In May 2020, I wrote to the Chancellor to press the case that this report deserves renewed attention now that the needs of the sector, and the heroic service and sacrifice of its workforce, have come to the fore of the nation’s priorities. In response, the Chancellor said:

“The Government’s number one priority for adult social care is for everyone who relies on care to get the care they need throughout the COVID-19 pandemic.”


In July 2020, I exchanged letters with the Minister of State for Care in which she assured me that the Government were due to meet shortly to discuss our report and any further reflections on reform. Finally, in October 2020, the Minister, my noble friend Lord Bethell, said that the pandemic had delayed the Government’s work on designing a sustainable social care funding model—words, words, words and broken promises.

Let me be clear. It is quite wrong to suggest that the Government could not have, and cannot, bring forward a plan for social care reform because of the pandemic. The opposite is the case, and I hope my noble friend will not repeat this calumny when he reads out his departmental speech this afternoon. The pandemic has revealed the centrality of social care and the need for no more dithering, no more Green Papers, no more delays; major reform must take place now.

We held a private meeting with care workers, and the stories we heard were truly humbling. We heard of frustration at being described as “just a carer” and that the sector is no longer seen as attractive. We heard from burnt-out workers, who cannot afford to run a car, forced to take multiple train journeys to get to work, working 14- to 15-hour days with take-home pay less than can be obtained for stacking shelves in a supermarket. Social care workers deserve better than this. They should be rewarded and treated as a highly skilled and caring profession. We concluded that career structures, training and the establishment of a professional structure were urgently needed.

Social care is a job-rich sector at a time when, sadly, unemployment is soaring as a consequence of the Covid-19 pandemic. The Resolution Foundation said that it would take an extra 180,000 care workers just to bring the ratio of carers to the over-70s population back to its 2014 peak. That is 180,000 just to get back to where we were in 2014. In our most recent report, on employment and Covid-19, we repeated that the Government should expand the number of care workers by increasing funding to the sector, with stipulations that it should be used to raise wages and improve training and conditions. It is time to turn our hands from applause to actions which give our social care workers the deal they deserve.

We have had enough of excuses for procrastination such as “The Government cannot bring forward plans for reform without cross-party consensus.” Everyone knows there is a consensus in Parliament and the country that we need to commit the resources that are desperately needed to support our most vulnerable citizens, young and old.

In May 2020, when our committee held its annual session with the Chancellor, we pressed him on the problems faced by the care sector. He said that the absence of a consensus over funding is a significant barrier to reform, along with its expense. That translates from Treasury speak to “I don’t want to spend the money.”

Since then, the Government have continued to kick the can down the road. More speeches have been given accepting the need for reform, yet cross-party talks have been delayed, and the proposals the Government have promised have been pushed back again. There was consensus in our cross-party report on a fully costed, long-term solution. The duty now falls upon the Government to bring forward a plan that reflects the cross-party consensus that does exist.

We drew attention to dwindling access to local authority funding, and the increasing pressures that result in the rationing of care to people who are in desperate need. Recent figures from the IFS show that between 2009-10 and 2017-18, per-person spending on social care for the over-65s fell by 31%. Significant investment is needed to buck that trend. We examined various options for how funding social care can be made sustainable. Having done so, we recommended that social care be funded largely from general taxation.

A central theme of our inquiry was the question of fairness. Our report identified three ways in which the present system is unfair: disparities between adult social care and the NHS, between those who fund their own care and those who receive local authority funding, and between different local authorities.

On the first of these, the UK has an ageing population, and many people have complex and difficult social care needs which they must fund themselves. The disparity with the NHS, which is free at the point of use, is striking. Why should support be free for cancer patients but not those suffering from motor neurone disease, for example?

Dementia was cited by several witnesses as an example of this disparity. The costs of caring for dementia can be long-lasting and, in some cases, catastrophic. The Alzheimer’s Society told us that the typical dementia care costs are £100,000, rising to £500,000 in some cases.

Secondly, care homes charge self-funders more in order to make up the inadequate amounts paid by local authorities. The Competition and Markets Authority estimated that self-funders paid 41% higher fees than the local authority rate. Witnesses said this amounted to a cross-subsidy that is unsustainable. We concluded that there is a real danger of a two-tier market emerging, in which care homes are driven to market to self-funders, reducing the availability of places for individuals sponsored by local authorities.

Thirdly, local authorities differ in respect of the cost pressures they face and their ability to raise funds. The result is that a postcode lottery has emerged. These disparities are growing with every day of government inaction. Reports suggest that the Government have been looking at private insurance as a way forward. I am grateful to the Association of British Insurers for the briefing that it sent to colleagues for this debate and which reflects the committee’s conclusions. No country relies primarily on private insurance to fund adult social care costs. It cannot provide the amount of funding required by the social care system, not least because roughly half of public social care funding is spent on people who are of working age; it is not just about the elderly.

Instead, we concluded that social care must be brought closer to the NHS by introducing free personal care. Personal care is about funding the basic activities of daily living: help with washing, bathing, dressing, mobility, eating and drinking. It does not include other, more expansive, activities, such as assistance with housework or shopping. Those in care homes would still pay for their accommodation and assistance with less critical needs. Those receiving care in their own homes would not have to pay accommodation costs, which may encourage care users to seek essential help with personal care early.

As the ABI says in its brief, a universal offer from the state would provide a clearer foundation on which people can plan and make their own provision where they need to top up. If personal care was free, individuals would likely be expected to top up their hotel costs with private funding. An insurance or asset-based top-up market could grow to support this. We concluded that the costs of care should be shared between individuals and the taxpayer. We were told that basic entitlement to publicly funded personal care would cost around £7 billion, if introduced in 2020-21.

We concluded that the Government should adopt a staged approach to providing the additional funding. We said that they should immediately invest in adult social care to restore quality and access to 2009-10 levels, estimated now to cost £10 billion. They should then introduce free personal care over the next five years.

In July 2018, the then Prime Minister announced that NHS funding would be increased by £34 billion over the next five years. This amounted to a spending increase in real terms of £20.5 billion. That increase alone is almost as much as the total spending on social care. It is time Cinderella was taken to the ball.

I have been a Conservative for nearly 50 years. I served in local government for five years, in both Houses of Parliament for 36 years and as a Minister for more than a decade. Of course, during that time, I have supported policies that I was uncomfortable with and promoted others that I regret, but I have never felt the sense of shame that I feel today at our failure to act on the funding of social care and to tackle, in the words of the title of our report, “a national scandal”. I beg to move.

--- Later in debate ---

[Lord Forsyth of Drumlean (Con) [V]]

My Lords, this has been a brilliant debate and I thank everyone for taking part. I am slightly embarrassed by the tributes paid to me—I just chair the committee. It is a fantastic committee; we reached a consensus and we did so by listening to people and acting on the evidence before us. One thing I can guarantee is that this brilliant debate in the House of Lords will not even be acknowledged by our critics, who present us in a quite different light.

A number of key points have been made, drawn from the report, about the importance of raising the standing, status and training of care workers. The noble Baronesses, Lady Kingsmill and Lady Finlay, my noble friends Lady Fookes, Lord Lancaster, Lord Taylor, Lady Eaton and Lord Randall, and the right reverend Prelate the Bishop of Carlisle all made these points. I must say to my noble friend the Minister that the answer is not to issue people with a badge, but to take direct action in order that people are properly rewarded in a proper career structure with proper training.

Points were made about the litany of reports and broken promises and the requirement for action this day by my noble friend Lord Young of Cookham, the noble Baroness, Lady Jolly, and the noble Baroness, Lady Pitkeathley—who has been on to this, as she said, for years and has led the way, describing herself as something of a lone voice. She must be reinforced by the degree of consensus that she has heard today. My noble friend Lady Browning and the noble Baroness, Lady Brinton, pointed to that.

I ask my noble friend the Minister: what did the Prime Minister mean when he said

“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”?

That was in 2019. This is 2021. Saying, “We will bring forward proposals this year”, when we are still in January is not really reassuring, given the urgency and the strength of feeling shown in this debate. I am also grateful that my noble friend Lady Pidding and the noble Baronesses, Lady Hollins and Lady Brinton, all pointed out that this is not just about the elderly; it is about young people of working age, on whom half the budget is spent.

One point that has come out very strongly is that it will be necessary to spend this money. We all know that the reason why this has been delayed and we have had endless Green Papers and so on is that the Treasury simply does not want to spend the money—a point that my noble friend Lord Lansley underscored and which was also raised by the noble Lords, Lord Hunt, Lord Truscott and Lord Campbell. The Minister surely can see that the overwhelming message from this Committee is: “No more delays”.

Something that I think is very important and which came out in our report is that many people are completely unaware of the services that will be available to them until the point that they themselves need care or a relative needs care—it comes as a profound shock. People across the country do not realise how limited the services are, which is one reason why politicians of all parties have been able to get away with not addressing this problem—a problem that hits people and causes enormous stress at the time that they are probably most vulnerable.

There has been a universal cry that local authorities are being asked to do the impossible and do not have the resources. I say to the Minister that sticking plasters brought in for particular situations do not deal with the systemic problem of funding and the pressure that local authorities are under. These points were made by the noble Lords, Lord Razzall and Lord Shipley.

I am grateful to my noble friend but he is pretty lucky that we are having to hold this debate virtually and are not able to intervene to challenge some of the points in his departmental speech. If he seeks consensus then he should look around him: there is consensus in this Committee; I have never known a debate where this was the case with almost every single speech. There were arguments about the odd detail here and there, but only one speech did not praise the report, which came from my noble friend Lord Sarfraz, who said that he was impressed with the proposals coming from the Government—I do not know whether he has inside information or has had a look at what lies ahead. The message from this debate is absolutely clear: no more delays, no more Green Papers, no more proposals. Let us have a White Paper and legislation, and let us move forward and say thank you to those people whom the Minister rightly praised but who need more than the recognition of a badge. They need to be given a proper career, and we need to attract people to that career, which offers prospects for many of our young people who face unemployment as a result of the impact of Covid-19.

Motion agreed.

Covid-19 Update

Lord Forsyth of Drumlean Excerpts

Monday 30th November 2020 Lords Chamber

[The Deputy Speaker (Baroness Morris of Bolton) (Con)]

The noble Baroness, Lady Noakes, has withdrawn. We are not sure whether we have the noble Lord, Lord Rooker. We do not. I now call the noble Lord, Lord Forsyth of Drumlean.

[Lord Forsyth of Drumlean (Con) [V]]

My Lords, could my noble friend comment on reports in today’s press that four hospitals only, in the whole of England, are busier than last winter? Could he explain how on Saturday Michael Gove warned that, unless the latest regulations were implemented, every hospital in England risked being overwhelmed by Covid-19 cases? Before our debate tomorrow, could he publish the modelling on which this assertion was based?

[Lord Bethell (Con)]

My Lords, I saw the press reports to which my noble friend refers. I remind him that their suggestion that we should be running our hospital system at 99% capacity during a pandemic is not reasonable. It would put our flexibility to deal with any increase in infections over the winter months in an incredibly precarious state. Running at around 88%, which is the current rate, is pragmatic. It would take very little for the 600,000-plus group of people who carry the Covid infection at the moment to have an impact on those bed numbers before the NHS was overwhelmed. That was the point that the Chancellor of the Duchy of Lancaster made, and I thought he made it very well.