Stroke Treatment

Debate between Lord Markham and Baroness Pitkeathley

Wednesday 27th March 2024 Lords Chamber

[Lord Markham (Con)]

The noble Lord is right to point that out, and I hope we are correcting it. I have seen the mobile app and digital being used to do all these things—I have even seen applications which can measure your blood pressure and pulse as you look at it. We need to check some of the accuracy around that, but it is all part of the programme. However, we need to make sure that it is in everyday English.

[Baroness Pitkeathley (Lab)]

My Lords, many family carers who provide care for stroke patients are also of working age. If they have to give up paid employment, it results often in the kind of debt that is currently in the news as a result of having to pay for care. What help can be given to those carers? I acknowledge that the Carer’s Leave Act was a welcome step forward, but that is only unpaid leave. What else can the Government provide for carers in these circumstances?

[Lord Markham (Con)]

The noble Baroness is right: carers are the hidden army who give so much support, not just in the area of strokes but across the board. As the noble Baroness said, we have put in place some steps, such as enabling leave and enabling people to claim benefits. I accept that that is not the whole enchilada, so to speak, but it is a step along the way.

Mental Health Patients: Discharge

Debate between Lord Markham and Baroness Pitkeathley

Tuesday 5th March 2024 Lords Chamber

[Lord Markham (Con)]

Again, like many noble Lords, I understand the disappointment that there has not been the time for the mental health Bill. This is what the round tables are about: exploring with Maria Caulfield, the Mental Health Minister, how we can ensure that we implement as many of these things as possible. We had round 1 and we will set up round 2 shortly. I suggest we take it up then.

[Baroness Pitkeathley (Lab)]

My Lords, one of the problems that carers in these circumstances always report at the point of discharge is that the professionals dealing with the patient are reluctant to share information with the person who is expected to provide care. Although I recognise the sensitivity of these issues and the need for confidentiality, does the Minister agree that if you expect someone to provide care in these circumstances you should at least provide them with the requisite information?

[Lord Markham (Con)]

In a word, yes. We had the rapid review of data in mental health settings. Not surprisingly, in mental health, as in a lot of other settings, ensuring that there is the flow of information so that carers get the right information is paramount.

Care Home Staffing

Debate between Lord Markham and Baroness Pitkeathley

Thursday 18th January 2024 Lords Chamber

[Baroness Pitkeathley]

To ask His Majesty’s Government how they are planning to address current staffing levels in care homes, and any connected delayed discharges from hospital wards and the impact on NHS waiting times.

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

We estimate that the number of adult social care filled posts increased by 70,000 in the last 18 months. The Government remain committed to the 10-year vision to put people at the heart of care, making up to £8.1 billion available over two years to strengthen adult social care provision and discharge. Funding is enabling local authorities to buy more care packages, help people leave hospital on time, improve workforce capacity and reduce waiting times.

[Baroness Pitkeathley (Lab)]

I thank the Minister for that reply, but I am not sure that I find it very reassuring. Your Lordships’ House will know that delayed discharges and long waiting times are largely the result of shortcomings in the care sector, especially the shortage of staff in care homes, where international recruitment has been a lifeline. It was therefore a surprise when the Government elected to put further pressure on this sector by increasing the minimum annual salary required for employees applying for a visa, banning them from bringing dependants to the UK and requiring care firms to be regulated by the CQC if they are to sponsor these visas. Far from being broadly relaxed about these proposals, as the Secretary of State for Health claimed, the care sector is most alarmed about how this will affect recruitment, especially as no consultation at all took place before the policy was announced. Will the Minister please further explain to the House how the Government intend to ensure that there are enough staff in the care sector to cover the enormous and growing need?

[Lord Markham (Con)]

The whole point of the title People at the Heart of Care is the recognition that staffing is critical to this. While it is early days, I believe the 70,000 increase in staff over the last 18 months, as I mentioned in my Answer, is a positive step. We had a very positive announcement just last week about the care pathway, setting out a career structure, which has been welcomed. For instance, ADASS, the Association of Directors of Adult Social Services, said that these are

“positive steps to help make adult social care a real career choice now and in the future”.

We really are making advances in this space.

Adult Social Care: Staffing

Debate between Lord Markham and Baroness Pitkeathley

Tuesday 12th December 2023 Lords Chamber

[Baroness Pitkeathley]

To ask His Majesty’s Government, further to the report of the National Audit Office Reforming adult social care in England published on 10 November (HC 184), how much of the £265 million allocated to reforming social care staffing between 2022–23 and 2024–25 has been spent so far, and what problems they have encountered in spending the allocated money.

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

The Government have made up to £8.1 billion available this and next year to strengthen adult social care provision. Specifically, we have invested over £15 million so far this year in supporting our workforce reform programme. The Government remain committed to our 10-year vision to put people at the heart of care and make long-term sustainable investment to future-proof the sector. Further announcements of support will be made shortly.

[Baroness Pitkeathley (Lab)]

I thank the Minister for that reply. He will know that the NAO’s report said that only £19 million of the very welcome £265 million that was originally allocated has thus far been spent. Even if the Minister does not agree that this is an utterly inadequate response to the crisis in social care, as the King’s Fund has said, he must admit that the slowness of progress is somewhat frustrating. Is it because there are not enough staff in the DHSC to distribute the money? I understand there are about 100 vacancies. Alternatively, is it because there have been many ministerial changes in his department, or because—as many in your Lordships’ House will suspect—social care is simply not a priority for this Government and, once again, millions of unpaid carers will be left to prop up a crumbling system?

[Lord Markham (Con)]

I share the noble Baroness’s concern about the speed of deployment. At the same time, it is fair to say that we are developing a whole new set of social care qualifications, which we think we can all agree are key to this. We are also developing a whole new payment mechanism, because there are 17,000 independent providers and we need a mechanism to allow payment. It is a complex programme, but I agree that we need to do everything we can to speed it up.

Adult Social Care

Debate between Lord Markham and Baroness Pitkeathley

Wednesday 22nd November 2023 Lords Chamber

[Lord Markham (Con)]

Always at this point, I find that the best tactic is to offer my noble friend a meeting. The People at the Heart of Care 10-year plan is exactly what we are trying to design here. I mentioned some of the progress that is being made: we have seen recruitment go up and an increase in staffing, and we have a put in place a qualification for staff, so that they feel there is a career structure for them. The number of people is going up year on year. Yes, there is a lot to do, but we are getting there.

[Baroness Pitkeathley (Lab)]

My Lords, according to the same survey cited by the right reverend Prelate, 68% of directors reported unpaid carers having break- downs because of burnout from stress, and half a million home care hours had not been delivered because of a lack of staff. Carers UK published a survey showing that 25% of unpaid carers are going without food and heating because of the demands of caring. When will the Government commit to a national strategy for carers to address some of these problems?

[Lord Markham (Con)]

We realise that they are the hidden army, and they are tremendously valued. I think noble Lords know that I have some personal experience of this. We have tried to put some measures in place for payments; I perfectly accept that it is not the same as a full wage, but payments have been put in place. We are also introducing respite care, so we are taking steps in that direction to recognise the vital service they all provide.

Dementia Palliative Care Teams

Debate between Lord Markham and Baroness Pitkeathley

Thursday 15th June 2023 Lords Chamber

[Lord Markham (Con)]

I thank the noble Lord. I have an auntie with dementia in care in Derbyshire. The noble Lord is correct that it is a perfect example of a wraparound service that takes in all the facilities that people need. The intention is that we want to spread that everywhere. It is the responsibility of each ICB to set the right commissions in their local area, but we are spreading knowledge of the dementia model as far as we can. A big example is that we promoted it at the recent national clinical excellence celebration day in the Midlands.

[Baroness Pitkeathley (Lab)]

My Lords, I am not sure the Minister actually answered the question about where co-ordination happens, which is the essential part of this. He will know that much care and palliative care for dementia patients and their families is provided in the voluntary sector and by charities. What support can we give to charities, which often are acting in a co-ordinating role? Can the Minister update us on newspaper reports that his department intends to recruit an army of volunteers to help solve the social care crisis?

[Lord Markham (Con)]

The voluntary sector is a key element of this. On behalf of the department, I thank it for all the work it does. The direction of travel is very much to engage the sector and enlist its support as much as possible. The ICBs do the commissioning, and Derbyshire is a fantastic example of commissioning all the different strands, including the voluntary sector, hospices and palliative care to deal with clinical need. It is an excellent example of how to do it well and one that we need to spread everywhere.

Adult Social Care: Challenge Procedures

Debate between Lord Markham and Baroness Pitkeathley

Wednesday 19th April 2023 Lords Chamber

[Lord Markham (Con)]

The main point is that we already have two levels of appeal. In the first instance, someone can appeal to a local authority and if they are not satisfied with that, they can appeal to the local ombudsman. Thousands of people do this every year, and compliance in terms of replies to them is very high. I must admit that I am not sure whether an additional, third level of appeal is really necessary in this case.

[Baroness Pitkeathley (Lab)]

My Lords, once again, a Question in your Lordships’ House has pointed out the inadequacy of the social care system, be it funding or personnel. In answer to an earlier Question, the Minister teased the House a little about the workforce strategy. Can he be more specific in answer to this Question?

[Lord Markham (Con)]

First, I take issue with the inadequacy comment. Some 89% of people expressed a high level of satisfaction with the social care provided, which, although not 100%, is pretty good, as I think everyone would agree. As I said, the workplace plan has been drafted. I am afraid I cannot give an exact date of publication—I believe there are local purdah issues now—but I can say that it will be soon.

Social Care: Workforce Strategy

Debate between Lord Markham and Baroness Pitkeathley

Wednesday 22nd March 2023 Lords Chamber

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

The Department of Health and Social Care will shortly publish a two-year plan for how it will reform the adult social care system. That publication will confirm the Government’s commitment to the 10-year vision set out in the People at the Heart of Care White Paper. It will provide specific detail on how we will implement workforce proposals, including funding activity and milestones.

[Baroness Pitkeathley (Lab)]

I thank the Minister for that Answer, but note that he has not assured me about the proposed or rumoured cuts to the current investment in the social care workforce. As he knows, these rumours have caused great distress to those trying to provide decent care to some of the most vulnerable in our society, against the background of a 13% vacancy rate—so one in eight posts is vacant—with subsequent difficulties in recruitment and retention. The money that has been promised seems very slow in reaching the front line, according to local authorities and carer organisations.

I am very glad to know that we are going to see the plan for the social care workforce; we have waited for it a long time. When we finally see it, which I hope will be before the House rises for the Easter Recess, will it ensure that those who work in social care are properly recognised, rewarded and trained so that, at last, their status is comparable with those who work in the NHS?

[Lord Markham (Con)]

I apologise because, in some ways, the timing is slightly unfortunate with the report coming out before the Recess, as is my understanding. I am not allowed to steal much of Minister Whateley’s thunder on that, but I will answer as best as I can. I hope that noble Lords will be pleased that questions around training, recognition of the importance of the service and career structure are all addressed in the report.

Physiotherapy: Rehabilitation Services

Debate between Lord Markham and Baroness Pitkeathley

Thursday 23rd February 2023 Lords Chamber

[Lord Markham (Con)]

Totally. I am sorry to hear that case, and I think that we would all agree that that is not the sort of service we would want to see. As I said, we have put increases in staff in place—there have been 3,300 extra staff since 2017—but, clearly, we need to do more. That is why I was very pleased to read that this area is an important part of the workforce plan, which noble Lords will be happy to hear we are now seeing drafts of.

[Baroness Pitkeathley (Lab)]

My Lords, if stroke survivors are imprisoned at home with a bed and a commode, as my noble friend’s Question suggests, does the Minister agree that their unpaid carers are similarly imprisoned? Is the lack of rehabilitation services part of the reason why the numbers of people giving more than 50 hours a week unpaid care is increasing rapidly, as the latest census figures suggest?

[Lord Markham (Con)]

As I said, physio is key to rehabilitation, whether for strokes, as we have discussed, or for any one of the number of reasons that people are in hospital and trying to come out. As I mentioned, we have seen increases: there are about 7% more people now in training each year, and that figure increases each year. We now have about 50,000 physios in the public and private sectors who are providing those types of services. Clearly, there are examples where we need to do more, but we are also making progress.

Times Health Commission

Debate between Lord Markham and Baroness Pitkeathley

Thursday 19th January 2023 Lords Chamber

[Lord Markham (Con)]

My experience of royal commissions is that they take a couple of years to report. I do not want to wait a couple of years. I want to get on with it now. We have some very good minds in the department working on it, with access to all of this. I am always willing to take on new ideas from new minds but we do not need a two-year report; we need action now.

[Baroness Pitkeathley (Lab)]

My Lords, does the Minister agree that, in any investigation of health and social care, the voices of patients and users must be loud and strong? How are the Government going to ensure that this happens?

[Lord Markham (Con)]

Clearly, the patient has to be at the centre of everything. That is what the plan for patients is about. It is also what patient choice is about; we are using other ways to make sure that people can get treatment quickly when they need to. It involves using the independent sector, as pioneered by colleagues in this House, and learning lessons from that so that we can get on top of waiting lists, which we all agree we need to do.

Care Homes: Staffing

Debate between Lord Markham and Baroness Pitkeathley

Wednesday 11th January 2023 Lords Chamber

[Baroness Pitkeathley]

To ask His Majesty’s Government how they will ensure that care homes where they block-buy places to assist with hospital discharges are adequately staffed.

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

On Monday, this Government announced an additional £200 million of funding for short-term NHS step-down care packages to help ease the pressure on local hospital beds. ICBs will work closely with local authorities to purchase places in care homes and other settings. Using their knowledge, they will commission appropriate beds where there is sufficient capacity, including workforce capacity, to meet patient needs.

[Baroness Pitkeathley (Lab)]

I thank the Minister for that response, although it seems a bit more knee-jerk than it does a coherent strategy and it poses as many questions as it answers. For example, are the Government planning to pay care homes directly to pay recruited staff or to work through ICBs and local authorities only? What rates are to be paid? Will it be more than care workers currently earn, so as to compete with the retail sector? Given that there are 160,000 vacancies in the care workforce currently, where are those workers to come from, without pulling staff away from an already understaffed NHS?

[Lord Markham (Con)]

Before we went ahead with this, we spoke to many care providers to make sure that there was capacity within the system to do it. It was understood that the capacity is there. In fact, there is potential underused capacity of as much as 40,000. We are confident that the staffing is in place and that the care packages are there to really make a difference.

Excess Deaths in Private Homes

Debate between Lord Markham and Baroness Pitkeathley

Tuesday 10th January 2023 Lords Chamber

[Lord Markham (Con)]

My noble friend makes a challenging point. This will be a subject of the inquiry, on which I look forward to hearing more.

[Baroness Pitkeathley (Lab)]

My Lords, does the Minister agree that one of the elements here may be the lack of support to family carers, who are often the element most involved in providing care at the last stages of life, and in particular the lack of willingness to engage with family carers, who are the people who know most about the condition? I have lost count of the number of family carers who have said to me, “They just didn’t want to know my side of this element.”

[Lord Markham (Con)]

I thank the noble Baroness. We have spoken before about this in the House. I agree with the general point that family carers, probably more than anyone, have great knowledge to bear, and so absolutely that should be an important component.

Hospital Beds: Social Care

Debate between Lord Markham and Baroness Pitkeathley

Monday 19th December 2022 Lords Chamber

[Lord Markham (Con)]

Of course, the noble Baroness is aware that it is the third parties, whether it be the local authorities or the private sector, that employ them. But what we have done in terms of setting the national living wage, which I believe is around that amount, is exactly making sure that there is a minimum amount that these people can get. About 65% of the funding going into the system goes through to wages, so the £2.8 billion increase next year will flow largely into wages and salaries.

[Baroness Pitkeathley (Lab)]

Every one of the interventions we hear about points to the inadequacy of the social care system and every one of the interventions that the Minister makes, however well intentioned—and I do not dispute that they are well intentioned—concerns piecemeal reforms. Will the Government ever accept that the only thing that is going to solve this ongoing problem, which is only going to get worse, is a wholesale reform of the social care system?

[Lord Markham (Con)]

There are a lot of questions that we need to answer in this space—I absolutely accept that—and lots of things that need long-term thought. I think and hope that noble Lords are starting to see that thinking emerge. A lot more needs to be done at the moment, but I think that we accept that this is a long-term issue that needs to be resolved with help from all sides of the House.

Care Homes: Severely Disabled People

Debate between Lord Markham and Baroness Pitkeathley

Wednesday 30th November 2022 Lords Chamber

[Baroness Pitkeathley]

To ask His Majesty’s Government what assessment they have made of reports that some care charities have been forced to evict severely disabled people from their care homes because of disputes with local authorities about fees.

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

The disruption of care where it negatively impacts vulnerable service users is unacceptable. Under the Care Act, local authorities have a duty to shape their markets and provide services to those with eligible needs. The Government are providing up to £7.5 billion over the next two years to support adult social care and discharge. This historic funding boost will help local authorities to start addressing waiting lists, low fee rates and work- force pressures in the sector.

--- Later in debate ---

[Baroness Pitkeathley (Lab)]

I thank the Minister for that Answer, but I cannot say that any of it was a surprise to me. Will he acknowledge that this is just the latest manifestation of a long-standing problem? For years, the social care system for adults with complex disabilities has been held together by charities and not-for-profits that have poured literally millions from their reserves into subsidising the services they provide for the NHS and local authorities. Now these organisations are in financial trouble and can no longer afford to do so. Those who are suffering are those in greatest need. Does the Minister agree that the whole system of funding for social care is broken and that the only solution is complete root-and-branch reform, not the piecemeal solutions offered by the Government?

[Lord Markham (Con)]

I thank the noble Baroness and echo the sentiment of thanks to the charitable sector for the work it is doing in this vital space. We have shown that we have listened in this area through the £7.5 billion—a 22% increase over two years, which I think everyone would agree is substantial. At the same time, we are in touch with these bodies; we reached out to the charity Leonard Cheshire, which is involved in this, to try to understand the issues. If there are ways in which we can directly help, we will do so.

Social Care Sector: Staff Shortages

Debate between Lord Markham and Baroness Pitkeathley

Monday 21st November 2022 Lords Chamber

[Lord Markham (Con)]

I agree with my noble friend. Overseas and Commonwealth recruitment is a key area here, which is why I am delighted that we have addressed the visa restrictions and entered social care on an essential workers list. We have already seen 15,000 people come in this space, and that figure is increasing month on month. My noble friend is correct that this is a critical area for recruitment for us.

[Baroness Pitkeathley (Lab)]

My Lords, does the Minister agree that the more problems there are with paid workers in social care, the more difficulties fall on the nearly 10 million unpaid carers. Of those who are receiving the carer’s allowance, 40% say that they are already in debt and not sure how they will manage through the winter. Does he also agree that, in view of the myriad problems in social care, it is time to listen to what the noble Lord, Lord Forsyth, asked the House last Thursday, and think about a proper review of the whole of social care?

[Lord Markham (Con)]

My Lords, I thank the noble Baroness. The new funds mentioned recognise that this is critical to the health of our National Health Service and the flow. As part of that, as I mentioned in my Answer, we are looking at staffing plans across allied health professions in the health and social care space, and it is vital that we get the recruitment to this area to solve the overall issue of flow and NHS wait times.

NHS: Discharge to Assess Policy

Debate between Lord Markham and Baroness Pitkeathley

Tuesday 8th November 2022 Lords Chamber

[Lord Markham (Con)]

Carers are well valued, and the need to ensure that our social care workers are well valued was the subject of a lengthy debate that your Lordships will remember from a couple of weeks ago. In that, we set out our plans for recruitment—not only domestically but internationally. I am glad to say that, even since then, we have seen a further uptick in the number of people recruited from overseas. Overall, it is understood that this is a vital area as part of the ABCD—which still exists. The “C” for carers is still very much part of this, so we are actively monitoring those recruitment plans and making sure that we are trying to provide every element of support.

[Baroness Pitkeathley (Lab)]

My Lords, I hope the Minister will forgive me for correcting his figures but the figure we generally use for unpaid carers now is nearer 10 million since the pandemic. In view of the truly shocking statistics in the Carers UK report that was published today—I am glad that the Minister said it will inform the department’s policy—have the Government given any consideration to revisiting the carers action plan, which went out of date two years ago, or, better still, reviving the idea of a national carers strategy? The first one was published more than 20 years ago.

[Lord Markham (Con)]

My understanding is that part of the guidance will be informed by making sure that action for carers is there but, when I see the guidance, I will make sure that it covers those elements. I agree, as we all do, with the premise. If the carers action plan is out of date—again, this is legislation that this Government have brought forward to show that we understand the importance of carers—clearly it is something that I will take up.

Skills for Care Report

Debate between Lord Markham and Baroness Pitkeathley

Thursday 13th October 2022 Lords Chamber

[Baroness Pitkeathley]

To ask His Majesty’s Government what steps they plan to take in response to the report by Skills for Care The state of the adult social care sector and workforce in England 2022, published on 11 October, which shows that there are 165,000 vacancies in the social care workforce and that this workforce has shrunk for the first time in 10 years.

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

My Lords, we are investing in adult social care. We have made £500 million available to support discharge from hospital into the community and bolster the workforce this winter; that is on top of record funding to support our 10-year plan as set out in the People at the Heart of Care White Paper. We are backing recruitment at home and abroad with a £15 million international recruitment fund and a new domestic campaign, which we will launch shortly.

[Baroness Pitkeathley (Lab)]

I thank the Minister. I expected him to mention the £500 million workforce fund, of course, but he will know that it has been described as a drop in the ocean and that councils are calling for far more to be pumped into better pay and recruitment in the social care workforce. I do not want to be disrespectful to the new Minister, who I know has a lot on his plate, but I wonder whether he and the Government really understand the scale of the crisis in social care. Some 50,000 people left an already inadequate workforce last year; that is not surprising when they can get better pay and conditions in Tesco, and when one in five care workers is in poverty despite being in full-time work.

The previous Prime Minister told us that he would fix social care. The current Prime Minister has withdrawn the levy that would eventually have provided extra funds, with no indication of how those funds will be replaced. Is the Minister aware that, meanwhile, thousands of older and disabled people, both in their own homes and in care homes, are being neglected and deprived of services in a way that no decent society should tolerate? Will he acknowledge both the depth of the crisis and the fact that we need a step change in the way we value social care and the dedicated people who provide it?