Adult Social Care (Adult Social Care Committee Report)

Lord Polak Excerpts

Monday 16th October 2023 Lords Chamber

[Lord Polak (Con)]

My Lords, it is a great honour to follow the right reverend Prelate. In the same way, it was a great honour to have been a member of the Adult Social Care Committee. I pay tribute to the noble Baroness, Lady Andrews, and the other members of the committee who took me along with them.

It was a learning experience for me, and there are one or two points that I would like to pick up. I notice that the noble Baroness, Lady Barker, is, sadly, not in her place. The thing I learned from her is something that we do not always think about: she talked a lot about the issue of ageing without children. I thank God that I have family and that we looked after my mother, who I will come on to in a minute. It is something that you do not appreciate until you hear it. The noble Baroness is a great champion for understanding that this will affect many, many people across the country. I was glad to learn that from her.

Similarly, I was very much a supporter of the suggestion, as mentioned by the noble Lord, Lord Bradley, that we ought to have a commissioner for care and support. Just as the noble Baroness, Lady Barker, is a champion for her issue, we need a champion who can help my noble friend the Minister and other members of the Government to focus on this. Otherwise, it gets trodden down and nobody really takes responsibility; it is too big and, in the end, nothing really happens.

I made a plea last time I spoke on this subject and I make no apologies for repeating it. Looking around the House, I say to everybody: the one thing I learned is that it is important to take politics out of social care. Let us get politics out of it and let us try to help.

In the end, for me, it was an experience that suddenly became practical. During the time that we were sitting as a committee, my mother took ill in Liverpool; she sadly passed a few months ago. What is overridingly important is to have something that we missed—we did not understand what to do as a family; I have just made a note to call it a “guide for the ignorant”. We need a guide so that, when people find themselves in a situation like this, they know what to do, who to ring, where to go, who to ask. Currently, it is a lottery.

As it happens, I am from Liverpool and the organisation there was pretty impressive. There was a STARS scheme, which the Marie Curie centre had put on, and they came in to see my mum four times a day while she needed help. Without that, I do not know what we would have done. I live here, my sister lives in London and my mum was in a flat in Liverpool.

The experiences we had throughout were horrendous. As I have said once before here in the House, we experienced the best and the worst. The worst was when a nurse was assessing my mum—who could not speak any more—to see what the next stage of care would be. The nurse was in Maidenhead, or somewhere in Kent, and she was in Liverpool, unable to speak, and they did it on Zoom. It was a relic of Covid, of course, but it was no help to my mum at all. It took weeks before they had to pass on their report, from Margate, to a panel of three people who had never met my mother, to decide what sort of care she would get. It is mad. I repeat: we need a guide for the ignorant. The Government need to provide something like this so that people know where to go.

To conclude that story, the Marie Curie hospice in Liverpool was amazing; the people there were amazing. They cared for my mum for three and half months, which is pretty unusual in a hospice. They could not have been nicer. I remember after she passed, I thanked them for everything they had done and then I said, “But where is the gold watch? She has been in a hospice for three and half months”. They were amazing and I shout out to them.

In conclusion, it was a deep honour to have been a member of the committee chaired by the noble Baroness, Lady Andrews, and I learned so much. Following the point made by the noble Baroness, Lady Fraser, I ask the Minister to explain the role of data and patient records, and how we can use technology to support people to stay in their homes as long as possible.

[Baroness Finlay of Llandaff (CB)]

My Lords, it is a great privilege—

Social Care

Lord Polak Excerpts

Thursday 30th March 2023 Lords Chamber

[Lord Polak (Con)]

My Lords, it is an honour to follow the noble Baroness, Lady Campbell. I learned so much from her. It was also an honour to have served on the Adult Social Care Committee under the expert chairmanship of the noble Baroness, Lady Andrews, and I also pay tribute to the excellent support staff that we had. When I joined the committee, I thought it would be an important learning experience in an area that I was not particularly familiar with. However, as we met and listened to witnesses, it became apparent that this was not an academic exercise but, sadly, a practical guide for me and my family, as it is in one way or another for every family in the country.

I will concentrate on just one area of the report, on page 45 with the heading “Navigating the social care system: a constant fight”. Paragraph 147 states:

“Whether it is trying to get support for themselves or for the person they provide care for, unpaid carers often find that they are left to their own devices when it comes to navigating the adult social care system”.


As stated in our report, witnesses found it difficult to organise formal support for the person they care for.

Because of the difficulty of accessing care and support, social workers and local authorities are seen as gatekeepers, and there is little trust in the system’s ability or willingness to provide help. How sad, as my noble friend Lady Fraser said, that some unpaid carers told us that they live in fear of assessments which they see as a process designed to minimise their needs so as to deny them support.

I totally understand. My mother is suffering from brain cancer and has 24/7 care at home in Liverpool. We have experienced, and are experiencing, both some of the best and the worst that the system has to offer. On the positive side, the care and attention of the Marie Curie Hospice in Woolton, Liverpool, led by the deeply sensitive and professional palliative care doctor Dr Mark Mills and his team, has been exemplary. While mum is at home, the staff at the hospice have been an enormous comfort and help, not just to my mum but to my sister and brother too.

On the other hand, the experience we have had with the local authority assessors has been woeful. On 9 February, my mother was assessed by a nurse via Zoom. The nurse was in Kent and my mother was over 200 miles away, unable to communicate, in her bed in Liverpool. The assessment was to decide what the immediate next step for her care plan should be. The report, compiled by a nurse who has never met my mother, was then to be sent to an unknown panel of people who also have never met her to decide the best course of treatment and care. This absurd assessment was executed over a three-hour Zoom call seven weeks ago, and as I stand here today, we have heard nothing. The system is sadly broken. As we speak, we should consider that people up and down the country are battling to understand an incomprehensible system at the same time as trying to care for their loved ones as best they can.

During the committee’s deliberations, we understood that we were not going to be able to change a system that desperately needs an overhaul, but we were attempting to move the dial a little to bring some clarity to people doing their utmost to care. Our committee has made 36 recommendations, and that only scratches the surface. Each one is important. My own experiences have made me think more carefully, for example, about the point forcefully and powerfully made by the noble Baroness, Lady Barker, about people without children ageing. Like the noble Baroness, Lady Andrews, and the noble Lord, Lord Bradley, I urge my noble friend the Minister to look carefully at recommendation 9, where we ask the Government to establish a commissioner for care to bring about a more accessible adult social care system. I concur with the suggested actions on page 45 of the Archbishops’ report that assessment and budget planning should be simple and consistent, and that care planning services should be focused on what matters to people.

I appeal across this House to all parties and to none to help that commissioner to take the politics out of care. We must come together to find and implement an urgent solution so that people up and down the country can fulfil with dignity what the late Lord Sacks wrote in his book Celebrating Life—that the supreme act of caring is to make a difference to someone else’s life. In his book the Dignity of Difference, he said, “To care is to look into the face of the other and see their uniqueness, their vulnerability and their pain”.

Social Care: Integrated Care Systems

Lord Polak Excerpts

Wednesday 11th January 2023 Lords Chamber

[Lord Markham (Con)]

This is the whole point and the way that we are moving; the real decision-makers running their local areas should be the ICBs. They know their areas and the needs of the people—including people with special needs and learning disabilities—more than anyone. It is absolutely their responsibility to understand the needs in their areas and to ensure that they are provided for under the commissions.

[Lord Polak (Con)]

My Lords, unpaid carers throughout the country are, more than often, working 24/7. The Care Act 2014 requires local authorities to deliver this high-quality care, including support for unpaid carers. How confident are my noble friend the Minister and his department that local authorities will undertake carers’ assessments for unpaid carers?

[Lord Markham (Con)]

From my experience I understand that this is a very important part of their remit and role. As we are all aware, the unpaid carer role is vital and historically has probably not been recognised as much as it should have been.

Disabled People: Personal Assistants

Lord Polak Excerpts

Wednesday 7th September 2022 Lords Chamber

[Lord Kamall (Con)]

The Government have been committed to ensuring that there is equality for disabled people, including plenty of initiatives in other sectors—transport, building new homes and offices, and retrofitting—but the issue of personal assistance is a particularly difficult one in the context of social care having been treated as a Cinderella service for years. Some of the initiatives that we are putting in place, such as the proper qualifications and recruitment from overseas, sadly do not yet apply to personal assistants because of the rules. We are looking at those barriers and hopefully will be able to tackle them.

[Lord Polak (Con)]

My Lords, I am a member of the Adult Social Care Committee in your Lordships’ House, chaired by the noble Baroness, Lady Andrews. We are looking at the invisibility of the unpaid carer, but it was timely that yesterday we went to Real, a charity in Tower Hamlets. It was a humbling and educational experience in which the difficulties and issues within the social care system for disabled people were brought to us. The difficulty of accessing PAs was very clear. My noble friend the Minister highlighted the problem in one of his answers. He said that maybe we need go to DWP or maybe we need it to be here. It needs to be coherent. To help those people, it needs to be one person, one Minister, one department dealing with this matter.

[Lord Kamall (Con)]

My noble friend makes a very important point. I have found this to be the case with a number of initiatives that I have been working on in my department. Quite often, I will have a joint meeting on an issue—with someone from BEIS, for example—and I then realise that they have to go and talk to someone else outside of the room. When I have been involved in such initiatives, I have always insisted that whoever else across government has a role or interest in them is in the room with us. This is clearly another example of what should be happening. It should be jointly DHSC and DWP. Rather than thinking about whose responsibility it is, we should work together to find a common solution.

Defibrillators

Lord Polak Excerpts

Wednesday 15th June 2022 Lords Chamber

[Lord Kamall (Con)]

If noble Lords will excuse the pun, one of the heartening things in answering this is that, when I received briefing on this, it is really important and interesting how we are working across government. It is not only in the Department of Health; we are working with the Department for Transport on transport locations, DCMS on sports grounds, the Department for Education on education settings and other departments. This is really a cross-government initiative.

[Lord Polak (Con)]

My Lords, I was privileged to be at a meeting with Jamie Carragher and Mark King of the Oliver King Foundation and Secretary of State Nadhim Zahawi only a few weeks ago. At that meeting with some senior civil servants, he more than indicated that the Department for Education would be very keen to ensure that defibrillators will be in every single school and will not be waiting for the rebuild that has been mentioned. I urge the Minister to go back to the Department for Education and ensure that this happens. The Oliver King Foundation was founded because Mark King’s son, Oliver, passed away at 11 or 12 at a swimming baths in my old school in Liverpool because there was no defibrillator. The point about sports places is right. Can he go back to the Department for Education, get this commitment which I have heard with my own ears and make sure that every school has a defibrillator as soon as possible?

[Lord Kamall (Con)]

I thank my noble friend for his question. I know he has a long-term interest in this area. Of course I will go back to my department and talk about this. The important thing is making sure that we have more locations, that there is awareness and that people are educated in how to use defibrillators and in wider CPR.

Health and Care Bill

Lord Polak Excerpts

Lords Hansard - Part 1 & Committee stage
Monday 31st January 2022 Lords Chamber

[Lord Rooker (Lab)]

My Lords, the Government should embrace this amendment. I want to concentrate on the traceability argument of goods, and in particular cotton imports. Without good traceability, the genocide convention obligations cannot be met.

To date, I have had two very poor replies on cotton traceability from the noble Lord, Lord Grimstone of Boscobel, at Question Time on 21 October, and a Written Answer on 24 January. Of course, as has already been said, we are miles away from the policies of the United States Government, who have taken a proactive approach to imports from regions of China where we know human rights abuses take place. As has been said, on 23 December, President Biden signed the legislation into law.

It simply cannot be left to commercial companies to satisfy themselves. It is crucial to understand the geographic origins of products and conditions of production. The two things are intertwined and they both need to be dealt with. There has to be a robust methodology that is reliable even when working with partners that may be untrustworthy or unco-operative. The use of middlemen such as commodity traders and the practice of blending fibre from multiple sources create additional difficulty.

Traceability—both what is termed as upstream, starting at the farm, or downstream, to map products back to their origins—is currently used. However, full visibility of the supply chain using these methods is impossible, and especially so in restricted areas such as Xinjiang Uyghur Autonomous Region. It is just impossible to do in the normal way you would look at traceability. If the Minister is in doubt about this, his department should read the report from the Center for Strategic and International Studies of November last year entitled:

“New Approaches to Supply Chain Traceability (implications for Xinjiang and Beyond)”.


My conclusion from that is that paper-based traceability and supplier information is a non-starter for effective due diligence.

In addition, there is abundant evidence that the Chinese Communist Party, which owns China, actually launders Xinjiang cotton, either semi-finished or blended, into international supply chains. This is set out in considerable detail in the November 2021 paper by Laura T. Murphy of Sheffield Hallam University entitled:

“Laundering Cotton: How Xinjiang Cotton is Obscured in International Supply Chains”.


In 2019, it was established that 85% of Chinese cotton was from Xinjiang. That means that cotton from the Uyghur region of China accounts for 22%—a fifth—of cotton worldwide. What was once grown or reared retains details of its origins—in a way, this is the test. However, it takes more than a paper trail to identify as such. It requires forensic work; chemical, isotope and genetic tracing and other methods that I will not list here are all crucial.

I will give a good example. From 1,000 garment samples collected across the world in high-street fashion shops involving nearly 50 brands, Oritain Global Ltd detected that in Vietnam, Cambodia and Bangladesh, the cotton in the garments had a mixture from Xinjiang of between 6.5% and 25%. Chinese cotton was 41% consistent with Xinjiang. Some 10% of samples of products tested in the UK were consistent with Xinjiang cotton. The UK has a high rate of imports from Bangladesh, where 25% of the cotton was from Xinjiang. It is worth pointing out that India has zero consistency with Xinjiang; India has cleared out Chinese cotton fabrication.

As to the practicalities for the health service, in 2019, the UK imported furniture, bedding and mattresses from China to the tune of £2.3 billion and imported apparel and clothing accessories to the tune of £3.7 billion. Has the NHS used beds and mattresses containing cotton from China or from suppliers using connections with China or other countries known to have a mixture of Xinjiang cotton? Where did all the Nightingale equipment appear from so quickly? As I asked last week, without any warning, how much China cotton is involved in NHS uniforms and accessories? Others have mentioned face masks, but as I pointed out last Thursday, more nurses means more uniforms.

Has the NHS supply chain used Oritain’s element analysis to check, or is it just relying on suppliers’ paperwork to check what would be only part of the supply chain? Companies and Governments need a degree of independence in assessing traceability and to not rely on companies doing it themselves. Some of the supply chains are five or six levels removed, so they cannot possibly have faith in each level and know the details from manufacturers, middlemen, traders, and agents. With the best will in the world and good corporate responsibility, checking the paper trail of five, six or seven levels will not work.

As I said earlier, the way to do it is to work on the basis that a product that was once grown or reared holds signs of its origins, and today’s advanced technology can do it. The technology of element analysis used by Oritain claims that it can tell the difference between two tea estates with a dirt road between them—it is so good and effective. For those who want more, I suggest the long read in the Guardian of 16 September 2021, which is where I came across the use of the technology. I have since met with senior reps of Oritain Global Ltd to better brief myself. Modern forensic technologies must be used, as is now required in the USA. The United States is using these technologies. Why are they not being used in the UK? The NHS, as the largest employer in Europe, should have a leading role.

It is not normal for the origin of cotton to be stated on labels. Of those 1,000 products which I mentioned were checked by Oritain last year, only 3% had the information on the label and, as a warning, the higher quality a product which attracts higher prices is more likely to be consistent with Xinjiang than cheaper items, so you must be really careful what you are looking at. Non-disclosure is almost the norm and of those who do disclose there is a high percentage of non-compliance, so labels and paperwork are not the answer.

Technology is the answer, and the ball is in the Government’s court. The old-fashioned gentlemen’s agreements and systems we are used to will not work. Modern technology is thought to be 95% accurate in identifying where an item was grown or reared. Only with that degree of information can the NHS satisfy the convention obligations. Otherwise, it will not work. The Government ought to embrace the amendment and then the new technology.

[Lord Polak (Con)]

My Lords, I pay tribute to my noble friends Lord Blencathra and Lady Hodgson, the noble Lord, Lord Alton, and the noble Baroness, Lady Kennedy of The Shaws, for tabling this important amendment. My noble friend Lady Sugg referred to last Thursday. That was 27 January, when the world came together for Holocaust Memorial Day in memory of the millions murdered under Nazi persecution. Members in the other place stood up and pledged “Never forget, never again”, while we in your Lordships’ Chamber sadly did not find a way to mark the day. Today, I repeat that promise.

Since the start of the pandemic, it seems that millions of pounds-worth of healthcare equipment have been procured from Xinjiang, despite the reports of the appalling treatment of the Uighurs. Will the Minister tell us whether our pandemic response benefited from procured equipment exported from Xinjiang?

Health and Care Bill

Lord Polak Excerpts

Lords Hansard - Part 1 & Committee stage
Tuesday 18th January 2022 Lords Chamber

[Lord Polak (Con)]

My Lords, I am pleased to speak immediately after the noble Lord, Lord Hunt. I am sure that he has, like me, a feeling of déjà vu. We were here not so long ago talking about the Domestic Abuse Bill, when I and many Members here today urged the Government to put children in the Bill. I am pleased that the Government listened, although it took some time and a lot of effort—that is why I am pleased to support the noble Baroness, Lady Meacher, on Amendment 20. It seems clear to me that children should be front and centre in this Bill, as we made them in the Domestic Abuse Bill.

We have worked closely with Barnardo’s, which has advised many of us, and I know that it raises three issues here: to protect the needs of young carers; to mandate that the child impact assessment is undertaken by the Government within two years of the Bill’s implementation to assess its impact on children; and to clarify and prioritise the better care fund so that it can be used to achieve service integration for children. I do not want to take time—I just think that my noble friend the Minister may want to look at Hansard and our debates on the Domestic Abuse Bill. I am sure that he will find a way to put children front and centre in this Bill.

[Baroness Walmsley (LD)]

My Lords, this morning the Committee has heard from the noble Baronesses who have spoken to amendments many good reasons why it would be helpful to the Government’s agenda to improve services for children, if children were referred to explicitly in several places in the Bill. I hope that the Minister will be able to consider this matter and see whether there is anything that he can do about it.

I have Amendment 142 in this group. New Section 14Z57 in Clause 20 is about performance assessment of the integrated care boards; it contains several important measures, but one is one missing. This amendment would mandate that, two years after the Bill is implemented, a child impact assessment should be undertaken by the ICS annually to assess its impact on children. This would provide the information to enable NHS England to do the assessment which Amendment 141 requires it to do. I very much support all the amendments, particularly those that would gather information, publish it and enable its sharing, because that will help. We know that early intervention works, but we do not know where to intervene unless we know what is going on, and that is why these things are very important.

There is no duty in England for government to assess and publish the effects of legislation on children—neither is there a duty in this Bill on the ICS. It was in about 2010, I recall, that the then Government committed to regularly assess the effect on children of relevant legislation, although it is not mandatory to do so and it is often not done, despite the fact that Nadhim Zahawi, now Education Secretary, when he was Children’s Minister in the Department for Education said:

“The use of children’s rights impact assessments is widely promoted across the Department and wider Government”.—[Official Report, Commons, 24/6/19; col. 447.]


Well, I hope so.

Scotland and Wales have taken a slightly different approach; they have systems to assess the effect of devolved legislation on children. I have to say, as a proud resident of Wales, that those two nations have always led the way in relation to children’s rights.

As others have said, this is a very adult-focused Bill, but there are more than 12.6 million children aged 18 and under living in England, compared to just under 10.5 million of 65 year-olds and over—people like me. As drafted, the Bill does not explicitly recognise the health and well-being needs of those children and young people, who, as we have heard, have very specific needs and no voice and are often more dependent than adults on integrated services. They could benefit from the Bill perhaps more than any other group.

We know that around half of mental health disorders start at the age of 14 to 16 and that, although research has shown that around 30% to 40% of the risk of anxiety and depression is genetic, 60% to 70% is environmental—and we can change the environment. I am grateful to Barnardo’s for these figures. In addition, this generation, from infants to older teenagers, will have had their physical health and mental well-being impacted by the pandemic, and in just over a decade, over half of this group will have left school and entered further and higher education or the workforce. Other amendments will allow the ICBs to gather information and share it. This amendment would allow them to publish an impact assessment, which would help NHS England to publish what it has to publish.

The Government cannot meaningfully address the challenge of improving overall population health without tackling child health inequalities. The success of the Bill should be measured by its practical and tangible impact in ensuring children and young people’s access to timely and appropriate health and care services, and ultimately in doing what the Government want to do: improving health outcomes for the whole population.

Brain Tumour Research

Lord Polak Excerpts

Thursday 19th November 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, I have a table of all the brain tumour research projects that we have backed over the last 10 years and I would be very glad to share it with the noble Baroness in correspondence. The short answer is, not enough. I would like there to be more grants and of higher value, but I recognise the challenge. When I speak to the scientists—even Richard Gilbertson, who is a very measured practitioner in this area—they recognise that more work needs to be done at an earlier stage to ensure that they are the kinds of projects that the NIHR system can back. We need to have a conversation about how we can encourage the early-stage science and the creative drafting of fresh ideas for that pipeline. That is something that I am very keen to get on with and have a dialogue about.

[Lord Polak (Con)]

I, too, was privileged to be present when Baroness Jowell spoke. In 1988, a 27 year-old man whose wife was eight months pregnant and who had just completed the London Marathon, was told by a neurologist that he had a brain tumour and six months to live. My Lords, that young man was me. I thank God and the doctors and nurses at the Royal Free Hospital that I am here to tell this story.

What is being done to educate and work with families and loved ones, who take the brunt of providing support for the patient and who most likely have no medical knowledge? While the Minister will be aware that not all brain tumours are cancerous, can he explain the Government’s commitment to fighting this niche but deadly form of cancer?

[Lord Bethell (Con)]

My Lords, on behalf of everyone, I thank my noble friend for that powerful personal testimony. I am sure there will be many others in the Chamber or listening who have known or lived through some association with brain cancer or cancer of some kind. It is extremely gratifying that in many areas of cancer we have made enormous progress—to the extent that it is a completely treatable disease in many respects—but in the area of brain cancer, that is not true. That is not good enough and we are working on trying to find a solution. Money has been spent, but not enough. We need more focus on this.

On my noble friend’s point on supporting families, that is something that trusts work on, but it is left to the charities and support organisations to do. In all areas of illness, that is something where perhaps we could or should be doing more and I completely take on board his comments.

Covid-19: Self-isolation Payment Scheme

Lord Polak Excerpts

Wednesday 2nd September 2020 Lords Chamber

[Lord Bethell (Con)]

The noble Lord asks a wide-ranging set of questions. We are looking at the effectiveness of the scheme. We are working with DAs to see whether the scheme could or should be extended in Scotland, Wales and Northern Ireland. Once that review is done and we have assessed its impact, we will be able to make decisions of the kind he describes.

[Lord Polak (Con)]

The headline figure of £13 can be, and has been, taken out of context. Can my noble friend the Minister reconfirm that the payment will not impact existing benefit entitlements?

[Lord Bethell (Con)]

My Lords, the payment itself will not affect existing benefits in any way. Payments through the scheme will, though, be subject to income tax and some form of national insurance contribution, in line with other support payments such as through the Coronavirus Job Retention Scheme.

Covid-19 Update

Lord Polak Excerpts

Wednesday 1st July 2020 Lords Chamber

[Lord Bethell]

I pay tribute to the NHS in the Leicester area, which has done magnificently. I understand that the facilities there are extremely resilient. In Leicester, as in many other places, a major source of concern is the spread of the disease among younger, working-age people, particularly those in their 20s and 30s, many of whom are not showing symptoms—are not touched negatively by the disease and may be socialising—but become infectious to their parents and grandparents. That is the cycle that we have seen in places such as Texas where, after the Easter break, young people led to a large outbreak of the disease. At this stage, hospitals are not facing the pressure, but we are leaning into the disease to prevent the cycle from heading that way.

[Lord Polak (Con)]

Sadly, social media is rife with speculation about local lockdowns. People are naturally anxious and often pass on the speculation, which can make matters worse. Can my noble friend the Minister tell the House what he is doing to combat fake news and false data, so that the Government’s messaging can be heard loud and clear?

[Lord Bethell]

My Lords, we have an energetic fake news and rebuttal team at the Department for Health—which I regard as an enormous shame. It is a waste of our time and indicates how dangerous speculation and false information of this nature can be. I have noticed in today’s social media a large amount of extremely irresponsible recycling of fake news by those who, frankly, should have known better. I urge all influencers, whether from the worlds of media, politics, health or other parts of society, to think carefully before recycling fake news and speculation on outbreaks in a way that wastes the time of public health officials and creates anxiety among the public.