Covid-19 Update
Baroness Browning Excerpts(3 years, 4 months ago)
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Lord Bethell (Con)
My Lords, the registration of people going into events is an onerous responsibility for the hospitality industry and we have to make a proportionate assessment of what kinds of burden we are putting on the economy and society. With more than 60% of the population now having been double vaccinated for over two weeks and with the vaccination programme going along at 500,000 a day, it is the moment to start backing off on some of these obligations. That means dismantling some of the infrastructure of test and trace, which we seek to do in a proportionate and logical fashion.
Baroness Browning (Con) [V]
Given the prediction of increased infectivity, what internal guidance is being given post 19 July within the NHS? Will GP surgeries, A&E and outpatient departments revert to their former practices, or is the guidance that they should retain face masks, distancing and hand gel use?
Lord Bethell (Con)
My Lords, on the three specific locations the noble Baroness asked about, I understand that those practices will remain in place, but I am happy to check that and write to her. As for going back to where we were before, I think some things will change for ever.
Social Care and the Role of Carers
Baroness Browning Excerpts(3 years, 5 months ago)
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Baroness Browning (Con) [V]
My Lords, I declare my interests as a vice-president of the National Autistic Society, as an ambassador for the Alzheimer’s Society and as an informal carer. I congratulate the noble Baroness, Lady Jolly, on securing this debate. I shall miss her contributions in this area, which we have shared over many years. I am going to leave to others today discussion of the urgent need to reform social care for the elderly and flag up how important it is that reform, when it comes, includes those of working age.
According to Rethink Mental Illness, from 18 to retirement age, those with mental illness, learning disabilities, autism, as well as physical disability and declining mental health, are among a third of adult social care users. Half of the spend of the adult social care budget is with this group, which gives a good idea of the numbers. Services are stretched and, since March 2019, they have been reduced due to Covid. Legislation that we already have on the statute book—the Care Act 2014, the Mental Health Act, the Mental Capacity Act, and the long-awaited strategy to go with the Autism Act 2009—is meant to provide statutory services for all those people. People have a right to expect them to be provided. This House has supported that legislation along with the codes of practice and some of them are not even implemented. I hope that when we see the new reform, there will be a review of everything on the statute book to make sure that it is being used in practice.
Perhaps I may say a word about informal carers. Informal carers of working-age adults struggle. It is estimated that they are over 7% of the population. Parents and carers battle to advocate for adult children when services are not provided. That leads to mental health breakdown of both carers and those cared for. We have yet to learn the lesson of making cuts to low-hanging fruit in this area. It is all too easy to cut out some of the low-budget issues such as advocacy, befriending, welfare rights and employment—to name but a few. They are easy things to remove, but there are big consequences when they are. We are being made to wait and wait for the long-promised social care reform, So, when it is presented, there should be no excuse if it is not comprehensive, fair and fit for purpose. I say to the Minister: bring it on.
Covid-19: Proof of Vaccination
Baroness Browning Excerpts(3 years, 5 months ago)
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Lord Bethell (Con)
My Lords, that is not our approach. Our approach is to try to use whatever technologies work in order to open up our borders. The idea that 30% of tests are not correct is an unhelpful suggestion by the noble Lord. We will be using testing in the validation app.
Baroness Browning (Con) [V]
My Lords, I declare my interest as a vice-president of the National Autistic Society. My noble friend will be only too well aware that many on the autism spectrum are very IT-savvy. However, can he help those who would find it quite a challenge to phone 111? Is there any way the Government can communicate with the autism community, perhaps through the charitable sector and others, to make alternative arrangements other than just a phone call?
Lord Bethell (Con)
My Lords, we have engaged considerably with the sector on exactly these kinds of matters. GPs and pharmacies are briefed to help those with difficulties get this material. We are also conscious that some with autism may struggle to take a test and find the process of swabbing intimidating, so we are looking into workarounds for that.
Social Care: Person-centred Dementia Care
Baroness Browning Excerpts(3 years, 6 months ago)
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Baroness Browning
To ask Her Majesty’s Government what plans they have to ensure that future reforms to social care consider person-centred dementia care.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, we want a society where every person with dementia—and their families and carers—receives high-quality, compassionate care from diagnosis to the end of their life. The Government are committed to sustainable improvement of the adult care system and will bring forward proposals in 2021. We are working closely with local and national partners such as the Alzheimer’s Society to ensure that our approach to reform is informed by diverse perspectives, including those with lived experience of the care sector.
Baroness Browning (Con) [V]
My Lords, I refer to my interests in the register as an ambassador for the Alzheimer’s Society and as a carer. This is Dementia Action Week. I am grateful to my noble friend and urge him that, as people with dementia are by far the majority of users of social care, the promised reforms deliver person-centred care to enable people with dementia to live in places they call home, take part in activities they enjoy and live their lives safely with meaning, purpose and connection with others.
Lord Bethell (Con)
My Lords, I am extremely grateful to my noble friend for raising Dementia Action Week, a time to celebrate the contribution of those who care for people with these conditions. I know from my own experience the incredible importance of personalised care and of being able to have loved ones at home for as long as they can safely and reasonably be cared for there. My noble friend puts the experience of living with dementia for families and carers extremely well. I entirely endorse her sentiments.
World Health Organization: Pandemics
Baroness Browning Excerpts(3 years, 8 months ago)
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Lord Bethell (Con)
My Lords, the WHO is not a sitting member of the G7, but we have a representative attending our health track in Oxford, and we have been in dialogue with them directly with our agenda on the G7.
Baroness Browning (Con) [V]
The WHO website officially states that, on 30 January, it declared a public health emergency of international concern. It claims that not many countries took much notice and that it was not until it used the word “pandemic”, on 11 March, five weeks later, that people sat up and took notice. This is clearly unsatisfactory. Will my noble friend do all that he can, as I hope he will, to ensure that the system of notification is improved at the earliest opportunity?
Lord Bethell (Con)
My Lords, my noble friend is right in her chronology, but we want the WHO to continue to learn lessons on how to improve its response to global health emergencies in the early stage. The delay in that global response is something that the WHO needs to learn from.
Social Care Funding (EAC Report)
Baroness Browning Excerpts(3 years, 10 months ago)
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Baroness Browning (Con) [V]
My Lords, I fully support this report. There are one or two things in some of the detail of it that I would like to see tweaked, but the thrust of it is absolutely right. This is a national scandal and it is far beyond time that the Government started to put it right. I support everybody who has said that this report should be the basis of a White Paper and not a Green Paper, because action is now needed.
I want to make merely a couple of points that are perhaps not covered in the report. I was reminded, when we were talking earlier in the debate about trusts, of the not-for-profit sector, which I believe has a lot to offer, particularly in care homes. Around the country, there are many homes that are run by trusts—we heard from the noble Lord, Lord Taylor, that new ones have been set up under trusteeships. Their great advantage is that, very often, they are small and locally based and therefore serve a particular client base. One hardship of the instability of the care home sector is that, when homes close, people often need to be moved well away from their relatives and areas where they have lived for many years. Therefore, in order to provide nationally a good mix of care that is affordable and of good quality, the not-for-profit sector could play a much bigger role than it does now. I would like us to look at that in a White Paper.
I will also pick up the funding of personal care, which many speakers have mentioned. I can see why some colleagues with a big local government interest are not very keen on this because they can see the bill. We are looking at billions; this is not a penny-on-income-tax policy. But we should look in more detail at what we mean by personal care. What does the day of somebody who needs personal care look like? It is not just about whether they can get dressed or have a meal provided by somebody in the household. Very often, particularly for those with Alzheimer’s or dementia, it is a question of not knowing what clothes to put on and perhaps dressing in the most inappropriate clothes. When it comes to food, it a matter of have they eaten or have they not? People with dementia may forget within half an hour that they have in fact eaten. Maintaining nutrition is therefore very important. This is a group of people who will wake up at 4.30 am or 5 am and think it is time to get up. They need full 24/7 care.
None of this is “medical” according to the definition of the word, but the demands and effect on carers can be quite catastrophic if those basic needs are not met. A failure in nutrition or in personal hygiene—for people who cannot look after themselves as far as their personal hygiene is concerned—can cause urinary tract infections or all sorts of problems that lead quickly to the need for doctors to be called or hospitalisation. I therefore would not underestimate the importance of personal care. It is something that must be factored in.
We have heard a lot about the political parties coming together; I agree that they will need to join together if this is to be successful, but please can we still do more to bring together social services and the NHS? In my experience as a Member of Parliament, whenever I came across a problem in this area, I would have to personally call for a case conference—and who would be sat round that table? Health, social services and the people involved with the problems. There seems to be a real lack of initiative to come forward and the reason is very simple: when you get those people round a table to sort out a problem, it costs money. They will do anything to avoid getting to the point where they have to sit round a table and commit money. I understand why—it is not easy, but we have to overcome that relationship between health and social services if this is going to work; otherwise, we will have these glass Chinese walls, where it is the responsibility of one and the other one does not want to know.
Finally—I have gone over my four minutes—not all households are one-person households. Often there are two people—two elderly people; two parents, perhaps—who need the help.
Covid-19: Vaccine
Baroness Browning Excerpts(3 years, 10 months ago)
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Lord Bethell (Con)
The noble Lord alludes to a complicated dilemma that we all feel. I welcome challenge and those who query and question the basis of our policy decisions and our science. He is right: too much false information and fake news can damage trust. We have gone about the vaccine process with an approach that is as open and transparent as it can possibly be. We have sought to engage in dialogue and answer questions where there have been any. That approach has proved to be effective and it is the one we continue with.
Baroness Browning (Con) [V]
My husband, who is 84 years old, received his Pfizer vaccine before Christmas and his second one last week was cancelled. Is there any guarantee that, when the second jab comes, it will be the Pfizer vaccine? As I understand, there has been no research on mixing and matching these vaccines. Is there any way that the level of immunity can be tested at that three-month point?
Lord Bethell (Con)
The CMO has made it clear that he leans heavily towards having consistent vaccines, but it is not a requirement. Some of the immune response comes from antibodies which can be tested, but some of it is from T-cells, which are very difficult to test for. It is not possible to categorically say whether someone is immune. However, we have looked at ways to measure and understand more about the body’s immune response to develop our understanding in this area.
Care Quality Commission Report
Baroness Browning Excerpts(3 years, 11 months ago)
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Lord Bethell (Con) [V]
My Lords, I would be grateful to hear from the Rights for Residents campaign, which sounds like an important and valuable contribution. I reassure the noble Baroness that the numbers of those who have undergone restrictive practices who have autism or learning difficulties do not appear to have risen during the pandemic. That is not to say that the current numbers are acceptable.
Baroness Browning (Con) [V]
My Lords, I refer to my interests in the register. My noble friend has not mentioned—and I would like to remind him of it—that in 2009 Parliament passed the Autism Act. It is the only medically diagnosed condition, apart from mental health, considered important enough to have its own Act of Parliament. Many of the issues raised in the CQC report to do with diagnosis and failure to intervene at an early stage with appropriate and timely interventions are covered in the Autism Act. Will he ask his department to look again at that Act, which is subject to ministerial guidance, and make sure that not only is it implemented but there is sufficient funding for that Act to be put into practice?
Lord Bethell (Con) [V]
I am very grateful for the reminder from the noble Baroness, and I would be glad to take her recommendation back to the department and write to her on whether there are any measures that we need to put in place to ensure that we are fulfilling our commitments under the Autism Act. It was an important Act, and I suspect that we are well within the measures that it has enacted.
Face-to-Face Medical Appointments
Baroness Browning Excerpts(4 years ago)
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Lord Bethell (Con)
The noble Lord makes an incredibly interesting parallel with Iceland. It is not one that I knew, but I will take care to look into it, because it is instructive and informative. He is right to say that Covid has demonstrated the power of telemedicine, and we are keen to learn that lesson. We do not want the elastic band of old practice to snap back to where it was before. To reflect the words of a noble Lord who spoke previously, there will be occasions when tele- medicine is right. The key is getting the blend correct and ensuring that the right format is used in the right circumstances.
Baroness Browning (Con) [V]
I quite accept that there is a role for telemedicine, but an accurate diagnosis in cases of serious disease and illness is dependent not just on the questions that the doctor asks and the observations he makes but on the ability of the patient to give accurate information. I will give the example from my family in the past few months of antibiotics prescribed for a “lung infection” that was actually a fatal pulmonary embolism. Getting that mix right is not easy; there are very many shades of grey.
Lord Bethell (Con)
My noble friend makes a very good point. Diagnosis is phenomenally difficult and, quite often, patients who present with seemingly one condition have something altogether different. It may be that a face-to-face appointment will be the moment when that difference is spotted and caught. She is entirely right to say that we cannot omit that format for the right circumstances, but a great many patients see their GPs very regularly. Their journeys may be onerous, uncomfortable and stressful, and telemedicine might offer them an alternative opportunity. There are others for whom speed is of the essence, and having telemedicine, particularly when it is supported by apps that provide essential information about their condition, can be an important and urgent alternative.
Hospitals and Nursing Homes: Do Not Resuscitate Notices
Baroness Browning Excerpts(4 years, 2 months ago)
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Baroness Browning
To ask Her Majesty’s Government what assessment they have made of the use of Do Not Resuscitate notices in hospitals and nursing homes since March.
Baroness Browning (Con) [V]
My Lords, I beg leave to ask the Question standing in my name on the Order Paper and refer to my interests in the register.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, the department is very clear that the blanket use of DNACPR and DNR is unacceptable. An agreement to a DNACPR is an individual decision and should involve the person concerned or, where the person lacks capacity, their family, carer, guardian or any other legally recognised advocate. I can inform the House that the Minister for Patient Safety and Mental Health will be writing to the Care Quality Commission requesting that it investigates and reports on DNACPR issues.
Baroness Browning (Con) [V]
I am grateful to my noble friend and am aware of the letters written in respect of people with learning disabilities and autism during the first phase of the Covid-19 outbreak. However, with the second wave looking as though it is on its way, my noble friend will be aware that there is still concern from charities such as Mencap and the National Autistic Society, not least because of the attitude in some areas that people who have social care support needs are rather lesser human beings than the rest of us. How will the Care Quality Commission carry out this assessment as the second wave increases?
Lord Bethell (Con)
My Lords, it is completely unacceptable for any group of people to have blanket DNACPR provisions apply to them. The adult social care winter plan published on 18 September reiterates that and makes the position crystal clear. The General Medical Council is providing additional support and guidance to clinicians on how to meet the needs of patients and relatives, and the Resuscitation Council UK is creating a large amount of resources to provide training. The CQC is monitoring the situation extremely carefully.