Social Distancing: Two-metre Rule
Baroness Finlay of Llandaff Excerpts(4 years, 5 months ago)
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Lord Bethell [V]
No, I do not accept my noble friend’s analysis. In fact, social distancing, which is central to our strategy, has had an incredible impact on saving lives and protecting the NHS. You have only to look at the spike that is occurring in places such as Texas, Florida and, according to today’s news, Beijing to see what happens if you do not tackle the underlying prevalence of the disease and you allow the lockdown to end too early.
Baroness Finlay of Llandaff (CB) [V]
My Lords, do the Government recognise that if the blanket rule is relaxed for some, such as most primary school children, who appear to have a lower rate of infecting others, people who are shielding someone will be terrified that reducing the distance will endanger the life of the person they are protecting? Their need to maintain a greater physical distance will need to be clearly signalled—for example, through an officially issued lapel badge or lanyard, as I suggested yesterday—and they will need to have antibody testing.
Lord Bethell [V]
The noble Baroness is entirely right. The kind of differential shielding that she suggests may well play an important role in what we do going ahead. We must do our utmost to protect those who are shielded. However, we are also aware of the challenge of having confusing regulations. That is why we are currently holding the line. We are aware of the effects on the economy, and that is why a review is on the horizon, but until then we are focused on reducing the prevalence rate and protecting those who are most vulnerable.
Health Protection (Coronavirus, Restrictions) (England) (Amendment) (No. 2) Regulations 2020
Baroness Finlay of Llandaff Excerpts(4 years, 5 months ago)
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Baroness Finlay of Llandaff (CB) [V]
As regulations change rapidly, I want to focus on PPE, particularly the supply of FFP3 high-level protection masks for clinical staff. The Royal College of Physicians—I declare my interest as a fellow—has conducted four surveys of members about their continuing experiences, and the latest, on 3-4 June, has shown welcome improvements, but problems persist. Just 10% feel ready for services to return to normal, while 31% think it would take a year to 18 months for the NHS to get back on an even keel. Access to PPE and testing have improved but 16% of doctors still report being unable to access the PPE they need for managing patients with Covid-19, and almost a third report not having been properly fit-tested. Shortages continue: 11% found themselves in the last two weeks unable on occasion to access the PPE that Public Health England advises. Only 26% have had access to antibody testing, and of those, 30% report the results as positive.
As Test and Trace gets established, the requirement for contacts to self-isolate for two weeks risks returning to the pressures of staff absences. Current guidance about PPE is that staff should always wear a mask, which decreases the risk of asymptomatic spreaders and protects the patients. But staff are not adequately protected. An FFP3 mask is only allowed in high-risk areas and for certain procedures. Patients on ordinary wards, waiting for admission and on whom results of tests are not yet back, often cough, splutter or vomit and it is inevitable that clinical staff are showered with droplets. Can the Minister say how secure are supplies of FFP3 masks, are we now producing them in the UK, and will they be issued to all front-line clinicians to try to ensure that a second peak does not pull down staffing numbers to critical levels as the lockdown eases? As people move around more, the risks to those shielding or with visual difficulties will make them more anxious. Will the Minister explore with me the idea of Dr Iliff, an anaesthetics Bevan Health Technology Exemplar trainee in Wales, for a lapel badge that those who need more protection can wear to make them visible to others when in public places, and which could go on a lanyard?
The Deputy Speaker (Baroness Garden of Frognal) (LD)
I understand that the noble Baroness, Lady Hussein-Ece, has scratched, so I call the noble Lord, Lord Holmes of Richmond.
Covid-19: Cancelled Medical Operations
Baroness Finlay of Llandaff Excerpts(4 years, 5 months ago)
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Lord Bethell [V]
The noble Baroness is entirely right to focus on those who are the most vulnerable. Data for March 2020 shows that cancer referrals began to drop although treatment levels did remain high, with 15,363 patients starting treatment following an urgent referral. That is the highest figure on record in a single month. So, although some treatments may have been cancelled, as she rightly describes, what I would like to convey is that a large number of treatments did continue, and we will be working hard to address any backlog.
Baroness Finlay of Llandaff (CB) [V]
My Lords, following on from a previous question about bed capacity, I declare an interest in that my son was involved in setting up the Nightingale Hospital Excel. What assessment has been made of bed requirements to keep non-surgical care completely separate from surgical care that needs to happen in Covid-light or Covid-free areas, and to ensure the frequent testing of staff, in particular highly skilled trauma surgical staff who may be moving between these two zones, so that they do not themselves become a cause of transmitting infection?
Exercise Cygnus
Baroness Finlay of Llandaff Excerpts(4 years, 5 months ago)
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Baroness Finlay of Llandaff (CB) [V]
My Lords, after operation Cygnus were estimates of the requirements for PPE checked against the 2006 influenza pandemic stockpile, given that this store was found to contain no gowns or visors, and 21 million protective FFP3 masks were missing when the store was opened for the current pandemic?
Lord Bethell [V]
The noble Baroness is right—if I understand her correctly—that the needs of PPE for a flu pandemic were quite different from those for Covid. It is also true that the planning did not anticipate a breakdown in global trade and a failure of the business-as-usual supply of PPE. No one could have imagined that flights would be grounded and factories shut and that the global supply chains for these key and vital products would have ground to a halt in the way that they did.
Covid-19: Care Homes
Baroness Finlay of Llandaff Excerpts(4 years, 6 months ago)
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Lord Bethell
The noble Lord makes a comparison that history will have to judge on, I am afraid to say. I think that I am making a fair point when I say that Britain can really only benchmark itself against its close neighbours. The experience of Asian countries taught them an enormous amount, but it is not one that has seemed proximate or relevant to us in recent times. I am afraid that I can only leave it to history to judge whether we made mistakes. It would be wrong for me to prejudge that at this moment.
The Deputy Speaker (Baroness Finlay of Llandaff) (CB)
My Lords, I must apologise because I allowed everybody to come in. I had mistaken the timing and had allowed this to run for 15 minutes instead of 10. I must make it clear that this does not set any precedent. It was my error.
The Virtual Proceedings will now adjourn until a convenient point after 7 pm for the second Urgent Question repeat.
Covid-19: BAME NHS Staff
Baroness Finlay of Llandaff Excerpts(4 years, 6 months ago)
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Baroness Finlay of Llandaff (CB)
Given the association that there seems to be between a wide range of factors, are these being centrally collated? Are the Government producing guidance on, for example, vitamin D supplementation in the event of deficiency being detected, so that the national results are rapidly rolled out, and those cases where risk is discovered can be managed and supported?
Lord Bethell
I reassure the noble Baroness that the data is being centrally aggregated. ONS has published figures on ethnicity and the CMO and PHE are both scrutinising them. On their list of issues to consider is the role of vitamin D, where the evidence is interesting but unproven.
Covid-19: Testing
Baroness Finlay of Llandaff Excerpts(4 years, 6 months ago)
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Lord Bethell
My Lords, workplace testing for not just Peers but all workers is an important part of our return-to-work strategy. We need to work with employers of all kinds and the diagnostics industry to put in solutions so that people can go back to work with confidence that they are not infectious and that the person sitting next to them is not infected.
Baroness Finlay of Llandaff (CB)
My Lords, what national policy control mechanisms will be used to monitor and report on false negatives and false positives as testing is rolled out to complement a contact tracing app?
Lord Bethell
I did not hear all the question, but I think I understand what the noble Baroness is asking. The truth is that, however strong the sensitivity of the machines, false negatives and false positives are an inevitable part of the testing process. However, PHE conducts extremely thorough validation processes so that these are kept to a minimum and we will use algorithms to ensure that rogue test results are picked up as soon as possible.
Covid-19: Vulnerable Populations
Baroness Finlay of Llandaff Excerpts(4 years, 6 months ago)
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Lord Bethell
My Lords, mental health advice is very clearly available, most of all from GOV.UK/coronavirus, where there is a huge amount of practical and pastoral advice, and access to resources.
Baroness Finlay of Llandaff (CB)
My Lords, I declare that I am an honorary fellow of the Royal College of Emergency Medicine. How will the Government ensure that emergency departments never again become the crowded places that they were, which act as a source of nosocomial infection—hospital-acquired infection—for the vulnerable and those caring for them, especially child carers, who might present with acute injuries, particularly once they are out and undertaking more activities?
Lord Bethell
My Lords, a strange and peculiar feature of the epidemic has been that accident and emergency wards are, surprisingly, below normal capacity since people have sought to avoid them because of the obvious threat of the disease. That said, nosocomial infection is of grave concern. It is an inevitable and frequent feature of any epidemic, but we are applying new ways of working and seeking to section off those with the disease to ensure that the infection does not spread in our hospitals and from there into the community.
Health Protection (Coronavirus, Restrictions) (England) Regulations 2020
Baroness Finlay of Llandaff Excerpts(4 years, 6 months ago)
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Baroness Finlay of Llandaff (CB)
My Lords, I declare an interest as chair of the National Mental Capacity Forum. I want to highlight the tension between public health measures and protection of an individual’s rights, as defined through the Mental Capacity Act.
Those with learning difficulties, dementia and brain injury through disease or trauma often also have conditions that make them vulnerable to Covid, yet society has come to realise that the vulnerable are valuable—they enrich our lives. It has been difficult to explain to them why, and which, restrictions were needed, and it is now even less clear which parts of the guidance are statutory requirements. Is there now a need for a personalised app that tailors legally-apt guidance to the risk factors of a person and those in their household?
Going forward, people with capacity impairments will need more support to adapt to the lessening of the restrictions that were imposed for public health measures. The lockdown routines, creatively structured to keep people mentally and physically well, will change again as “isolation” becomes a nuanced word. Simply saying “use common sense” will not be enough. It will be hard work supporting those who are vulnerable as they adapt to widening and changing physical freedoms. Tasks such as keeping a 2-metre distance must be learned, using bank cards instead of cash makes people more vulnerable to fraud and exploitation, keeping a face mask on is difficult, and some have lost physical strength through decreased activity. The very vulnerable, and those with physical care needs, have carers coming and going. The plan of test, trace and isolate will keep them safe only if testing is rapidly and easily available, for both the person and those who care.
Will public health plans require that all testing facilities are local to the person and get results out rapidly? Which national external quality assurance systems are commissioned labs required to adhere to? Are false positives from RNA contamination, and false negatives from specimen decay in transit or from error-prone gene tests, being detected through audits? Unless those supporting the vulnerable are maintained virus-free, our second wave may be worse than the first.
Covid-19: Social Care Services
Baroness Finlay of Llandaff Excerpts(4 years, 7 months ago)
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Baroness Finlay of Llandaff (CB)
My Lords, I thank the noble Baroness, Lady Wheeler, for this essential debate. This pandemic has become a palliative care emergency. I declare my role as vice-president of Hospice UK and Marie Curie. Care sector staff are providing extensive end-of-life care. They are skilled, compassionate and motivated, but low paid and, until now, unnoticed and unappreciated in society. Yet the mark of a civilised society is the way it cares for its vulnerable. The care sector is a bedrock of such a society.
Some of the most vulnerable can be difficult to care for. The Mental Capacity Act framework supports delivery of essential care and treatment, but safeguarding is harder. Covid guidance on the deprivation of liberty safeguards, DoLS, needs to cover greater responsibility for care staff while reducing bureaucracy.
Chairing the National Mental Capacity Forum, an interest that I declare, I see the care sector adapt with enthusiasm and profound caring to the challenges. Yet the care home staff feel abandoned. Personal protective equipment and weekly testing for all care home staff and residents are critical in controlling cross-infection. When will this happen? Staff from minority populations seem at higher risk of serious or fatal Covid-19. They are not deserting—far from it—but showing humanity and compassion in care. As a nurse said:
“I’m like a policeman who is facing a terrorist attack … ready to face it, but what will happen to our family? … That’s the only worry I have.”
Who is responsible for staff death-in-service financial support?
Dying residents need medication for symptom control. For care homes, without easy and rapid access to medicines, why has the repurposing of medicines not yet been approved? I tabled Questions on it on 7 April. Draft guidance was produced on 14 April and issued in Northern Ireland on 20 April. Why not England and Wales? Has every clinical commissioning group been instructed to achieve integration with its social care providers in the long term? Is it time to develop nursing home medicine to support social care delivery as a distinct discipline, and to fully integrate health and social care? It should have happened a long time ago; it must happen now.
Baroness Watkins of Tavistock (CB)
My Lords, I welcome this debate and thank the noble Baroness, Lady Wheeler, for securing it. It is clear from yesterday’s NHS Providers briefing that the social care sectors, including hospices, care homes and domiciliary providers, are beginning to consider closing to new admissions or taking on new people for support in the community. This is due to worries about the need for PPE to protect residents and staff from cross-infection by Covid-19. As of 13 April, nearly one-sixth of care homes reported expected outbreaks of Covid-19. This means that many care homes do not have enough staff. Other noble Lords have spoken eloquently on this issue, but it means that it would be very difficult to discharge people from hospital care if either care homes cannot give short-term care or domiciliary care cannot be organised.
The shortage of PPE is more extensive, serious and difficult to overcome in some places than others. It appears that care homes which are members of large chains are beginning to find solutions to short-term procurement. However, even these larger companies are extremely concerned about the increased costs of PPE. It is therefore almost impossible for small domiciliary care providers supporting vulnerable children, people with mental health problems and older people in their own homes to purchase the necessary PPE in a timely and cost-effective manner. Can the Minister explain the Government’s approach to these providers, and how the Government intend to make access to PPE available through either national or local procurement and delivery in a cost-effective manner?
If social care is to be successful and sustainable in taking on new clients, as well as providing high-quality care to those who receive it, we must reduce the feelings of fear about employment and the right to remain among carers from overseas. The Government’s new post-Brexit immigration scheme is based on treating health and social care workers differently. The Home Office’s plan will enable doctors and nurses to apply for fast-track NHS visas, but care workers will have to apply to come under the points-based system. Nearly a fifth of all care workers in this country come from overseas. Many of them may choose to return home in the next year, yet the Home Secretary does not at the moment see a need to apply a fast-track system for care workers. Please can the Minister comment on this approach and inform the House whether it is to be reviewed?
I also have to ask, as other noble Lords have: will the Government consider scrapping the £400-a-year NHS surcharge for health and social care workers? If we are to recruit and retain our workers, doing so is vital at this point in our history.
The Deputy Speaker (Baroness Finlay of Llandaff) (CB)
I ask the noble Baroness, Lady Warwick of Undercliffe, to stop sharing her screen by clicking the box with an arrow in the command bar, please. I call on the noble Lord, Lord Turnberg, to speak next.
Lord Turnberg (Non-Afl)
My Lords, I want to raise three questions with the Minister. None of them is entirely novel since they concern testing, how we treat care home staff and the logistics of government control. Those who are gifted with hindsight can see clearly now where the Government have gone wrong. But you do not need to have much of a retrospect-a-scope to know that we have been extraordinarily slow in recognising that care homes were ticking time bombs, full of closely gathered and extremely vulnerable elderly people, being looked after by carers who had long been the most underappreciated and undersupported of health workers. One might have thought that this combination was a disaster waiting to happen but, rather than getting into the blame, we must look at what is needed now.
First, in order to get a much firmer grip the Government should appoint a Minister or, better still, a well-respected authority to oversee the logistics of providing protection to care home residents and staff. Whoever is appointed should have that as his or her sole responsibility. It is no good dissipating responsibilities between different parts of the Government. It should be one person with no other responsibilities, focused entirely on co-ordinating the response and reporting regularly to Ministers. Is this already happening and, if not, can it be undertaken sometime soon?
Secondly, it is now clear that we seem to have more capacity to test people for the virus than people able to access the tests. The reasons why care workers and residents cannot do so have been well rehearsed in the debate so far, and the answer is obvious: we must take the test to those who need it. I hear that the Government intend to set up a system of mobile testing units, which can go around care homes and elsewhere, and that the Army will be involved. That is a step in the right direction, but can the Minister say how quickly that can be scaled up? Why do we need the Army when taking samples from staff and residents requires only about an hour or so of training, and we have a huge number of volunteers ready to help?
Thirdly and finally, we have been debating in this Chamber—for ever, it seems—the parlous position of care home staff: how underappreciated, poorly paid and unregulated they are. Several noble Lords, including my noble friends Lord Hain, Lord Hunt, Lady Pitkeathley and Lady Wheeler, talked about the terrible position they are in. The coronavirus is now transforming our neglect of them into a form of hero worship. We must take advantage of this new-found recognition to change the way we show our appreciation as we come out of these horrible times. Whatever we do, we must recognise that a majority of our care homes are in the private sector, where they have long struggled to keep their head above water. We must include them in the rescue. Local authorities need support now. I ask the Minister: when the Government at long last come to their review of social care, will they put the conditions of care workers right at its heart?
The Deputy Speaker
I apologise, but I ask the noble Baroness, Lady Warwick of Undercliffe, to close the box that has a small cross on it, in the middle of the command bar. If she could do that, that would help, as the screen is distracting for others.
Lord Farmer (Con)
My Lords, I, too, congratulate the noble Baroness, Lady Wheeler, on initiating this important and well-timed debate. I will speak today about children’s social care and how supporting those on the edge of it can prevent this crisis from being the tipping point when they become looked after by the state. First, however, we should acknowledge the families who are flourishing now that they are no longer in the time famine of normal life, even though money and space are tight. Many children are enjoying being with their fathers, for example.
On those in social care, the Government are consulting on reforms to the use of unregulated care homes which include banning this provision for under-16s and introducing national quality standards. In these strange times, young people currently in such accommodation are out of the sight of social workers and others, who have high case loads. I have heard that these professionals are seeing only the highest-need families face to face. Some have adapted well and are catching up with young people directly, for example through WhatsApp, but such flexibility might be patchy. Can the Minister inform me whether a national assessment has been made of the welfare of those in unregulated accommodation during this crisis?
More broadly, the Government have committed to reviewing the care system. For the system to be sustainable going forwards, this review requires what I call the prevention pipeline. It should establish how we can best prevent, first, children from coming into care in the first place and, secondly, the care system from being a runway into educational underachievement, unemployment, criminality and prison, early parenthood, addiction and poor physical and mental health.
Early family support is essential to prevent children from tipping across care thresholds. Many local authorities have set up family hubs where families with children of any age can access help. I have set up the Family Hubs Network, which has held several virtual round tables with providers, who report that hubs have come into their own in this pandemic. They are offering food, maternity appointments, a rich programme of online family support and more. I understand that the DfE is leading on family hubs, but can the Minister inform me whether and how it is supporting their spread?
The Deputy Speaker
I call the noble Baroness, Lady Blower. She is not here. We will move on to the noble Lord, Lord Addington.