Men’s Health Strategy

Baroness Greengross Excerpts

Monday 25th October 2021 Lords Chamber

[Lord Kamall (Con)]

The Government have launched the Office for Health Improvement and Disparities and part of its remit is to make sure that we look at inequalities within the health system, particularly gender inequalities or those to do with income strata, and at how people in different income brackets are affected differently. That is why the word “disparity” is in the name of the office.

[Baroness Greengross (CB)]

I declare my interest as co-chair of the APPG for Bladder and Bowel Continence Care. Will the Government consider making it a statutory requirement that in men’s public toilets there are appropriate bins for the disposal of stoma and other continence products, as well as personal care products? Currently, toilets used by women are usually provided with suitable means for the disposal of sanitary dressings, but why are there not similar requirements for male toilets?

Ageing: Science, Technology and Healthy Living (Science and Technology Committee Report)

Baroness Greengross Excerpts

Wednesday 20th October 2021 Grand Committee

[Baroness Greengross (CB)]

My Lords, I thank the noble Lord, Lord Patel, for his opening remarks and for highlighting the important issues raised in this report. I also thank the many noble Lords who have spoken this afternoon. Ageing is an area I have worked in for most of my adult life. I am grateful for the work done by the committee on these important topics, and for it inviting me to speak to Members on the issues raised.

I declare my interest in the register as chief executive of the International Longevity Centre UK. In its 2020 report, Health Matters: Why We Must Commit to Delivering Prevention in an Ageing World, the ILCUK warned that the average number of years people will live in poor health is set to increase by 17% over the next 25 years. We know that the 2019 Conservative Party manifesto made a commitment to ensure that people lived at least five extra healthy and independent years of life by 2035. The report we are discussing has a similar goal of wanting an increase of five years in disability-free life expectancy at birth for both males and females by 2035.

Sadly, in many parts of the UK, we are in fact going backwards in terms of healthy years lived. Sir Michael Marmot’s 2020 report for the Institute of Health Equity found that, for the first time in a century, life expectancy had fallen for women in the poorest communities in the UK. Overall, we have seen low rates of life expectancy increases compared with most European and other high-income nations, which is very sad news to read. Further, Sir Michael’s report found that, since 2010, the percentage of life spent in ill health has increased for both men and women.

Given this, to achieve the 2035 goal stated in the Science and Technology Committee report and the 2019 Conservative Party manifesto, there will need to be significant investment to stop health inequality and support people to live longer lives free of illness and disability. Do the Government still stand by their manifesto commitment of five extra healthy and independent years of life by 2035? If so, given the recent evidence of increased health inequalities throughout the UK, what will they do to address this?

Another area of the report that I am very interested in is the section on housing and the built environment. Paragraph 287 states:

“A basic requirement of independent living is the ability to move around the home and undertake the tasks of daily life. However, we heard that many homes are poorly suited to life in old age.”


According to the charity Habinteg, only 9% of homes in England are suitable for people living with disabilities.

I have for a long time been a supporter of housing with care, where older people can enjoy independent living in a community setting where care and support can be provided if needed. Yet only 0.6% of the over-65s in this country live in housing with care settings—about one-tenth of the levels seen in countries such as the US, Australia and New Zealand.

I agree with the report’s recommendations that the Government should use planning rules to ensure that homes and communities are accessible for people with limited mobility and adaptable as their needs change with age. Promoting housing with care and using planning laws to ensure that developers are able to build these sorts of living situations would be an extremely effective way to achieve this recommendation.

I conclude by once again thanking the noble Lord, Lord Patel, for the opportunity to debate this report today. Longevity and technology change are both transforming the human life course in profound ways. The Covid-19 pandemic has in many ways accelerated some of these changes in technology and highlighted the health inequalities that still exist. This report makes a number of important and timely recommendations to which I hope the Government will give serious consideration.

Social Care Funding: Intergenerational Impact

Baroness Greengross Excerpts

Thursday 16th September 2021 Lords Chamber

Asked by

[Baroness Greengross]

To ask Her Majesty's Government what plans they have to address the intergenerational impact of proposed changes to social care funding.

[Baroness Greengross (CB)]

My Lords, I draw attention to my entry in the Lords register. I hope the Government will reflect further on this issue and commend them on bringing forward proposals to address the challenge of funding social care sustainably—something that has been ducked for far too long.

The Intergenerational Fairness Forum, which I am honoured to chair, in 2018-19 held a year-long inquiry that considered sustainable funding for social care and intergenerational fairness. I thank the noble Baronesses, Lady Altmann and Lady Watkins of Tavistock, Baroness Howe of Idlicote and the noble Lords, Lord Howarth of Newport and Lord Willetts, in particular, for the support they gave to that work.

Our inquiry report, Grasping the Nettle: Sustainable Funding for Social Care and Intergenerational Fairness, supported the Dilnot recommendations on a threshold below which people should not have to contribute to their care costs and a £35,000 cap on the total care costs that people should have to pay, which would rise in line with inflation. This lower cap than that planned by the Government would help more people with relatively modest total assets—for example, those whose homes are less valuable.

We recommended that the resources needed to fund social care should be raised by a distinct new, mandatory social care insurance contribution levy at a rate of 1%, which could rise to 2% for those aged 50-plus if additional resources are needed to meet rising care costs.

We also proposed that this new levy should apply only to adults over the age of 40 and that it should then be paid by all adults for as long as they continued to work. We proposed this age threshold because our aim was to develop a system for funding social care that met our test of intergenerational fairness—one in which all generations contribute, no one generation is impacted unduly and costs are not simply left for future generations to bear. Our recommendations would also ensure that the heaviest burden falls on those best placed to contribute.

We recognised that funding free social care through 1% social care insurance contributions on working adults over the age of 40 alone fails to meet the test of intergenerational fairness because the burden for paying for social care would then fall too heavily on these workers, while retired people would contribute little or nothing.

Like the Government, we rejected the use of income tax to fund better social care, because this is the system that has been tried, and has failed, in recent decades. Funding social care through income tax would mean that it continues to be at risk of suffering from rationing as a result of spending restrictions or when social care is not a high political priority in comparison with competing public services or tax cuts. A hypothecated, mandatory system of social care insurance is not exposed to this risk.

Apart from the absence of an age threshold for the Government’s new health and social care levy, my two major concerns about the Government’s proposals are that they will not deliver additional resources to the social care sector quickly enough and that, of the £36 billion that they expect to raise, only £5.4 billion is earmarked for social care. Yet again, the social care sector is playing second fiddle to the NHS, when its need for additional resources is at least as urgent.

Like many others, I also believe that, politically, it may be very difficult in the future for the Government to claw back from the NHS the money raised by their health and social care levy to allocate it to social care. Our recommendations also aimed to ensure that sufficient resources were raised to extend the provision of social care so that more of the people whose needs are currently unmet would be covered. So, in addition to a 1% social care insurance contribution levy, we recommended additional measures that would allow the Government to increase funding for social care significantly in the short term. These recommendations fell into two broad categories: those raising additional funds for the Government, which we wanted to be ring-fenced for social care, and those saving the Government money that we wanted to be redeployed to social care.

We recommended that people working beyond the age of 65 should pay national insurance contributions, albeit at a reduced rate of 6%. We recommended that the Government should replace higher-rate tax relief with a lower flat rate of tax relief. Some experts estimate that, if this were set at the rate of 20%, it could save up to £10 billion a year. We also recommended that the pensions triple lock be replaced by a double lock, whereby it rises in line with average earnings or inflation but not by at least 2.5% every year. We recommended rolling the value of the winter fuel payment up into a higher state pension, which would be taxable, making the system more progressive.

We also wanted the Government to incentivise people to save for their potential care costs—so we recommended that the Government should introduce a care ISA, with an annual contributions limit of £20,000 and a lifetime cap on contributions of £100,000. This would also have the benefit of raising awareness of the importance of saving for care costs—something that too many people fail to consider. To help people whose only savings—apart from their homes, if they own them—are their pensions, we also recommended that the Government should allow tax-free withdrawals from private pensions to fund the costs of care.

We did not recommend that employers should pay insurance contributions for social care because of the potential impact of this on jobs. We also did not recommend complicated new wealth taxes or increases in inheritance tax because we did not want to discourage people from saving for their retirement and possible later-life care costs. We also noted that the OECD estimates that, in 2017, the UK collected the second largest amount of property tax of any OECD country—more than double the average of OECD countries.

I hope that the Government will consider introducing an age threshold for their levy as soon as possible to mitigate the effect on young people. I hope that they will also make it a social care-only insurance contribution levy as soon as possible and that they will supplement their proposals with further measures to broaden the impact of their fundraising and to enable significantly more spending on social care much more quickly than under their current plans. The sector cannot afford to wait. If it does, a package of proposals will emerge for funding social care that better meet the test of inter- generational fairness, making it more politically and financially sustainable so that a change of Government will not see this work undone.

NHS: Hospital Visiting

Baroness Greengross Excerpts

Wednesday 15th September 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, the noble Lord makes an incredibly powerful point. I agree with him. The point about visitors to the dying was one of the most poignant and hurtful aspects of the pandemic. The stories I have heard personally and in the Chamber on that point have been some of the most moving I have heard in the entire year. He is right that being ill is horrible; being ill and away from the people you love is doubly horrible. We are trying our hardest. Infections in hospitals cost a lot of lives last year. We are mindful of that damage. Another area where we are very mindful is maternity units, where to prevent post-birth depression it is really important that partners are there. We have put in allowances for all partners to be at scans and at the birth, but we are working to try to balance these two competing difficulties.

[Baroness Greengross (CB)]

My Lords, have the Government considered using vacant hospital land owned by the NHS or unused buildings near NHS hospitals for patient accommodation while rehabilitating, rather than having long stays in medical wards? Have the Government considered the benefits for patients and families? Visiting may be safer and more suitable in this type of accommodation compared with visiting medical wards.

[Lord Bethell (Con)]

The noble Baroness’s point is entirely right. The focus on hospitals puts huge pressure on hospital administrators to have safe, contagion-free environments. That makes visiting extremely difficult. That is why we are trying to move as much care and diagnostics as we can back into the community, where we have smaller hubs and visiting is much more accessible. Some of that can be done on vacant NHS land. There are also opportunities on the high street, which is not as occupied as it used to be, for those kinds of services. We have £3.3 billion available for discharge. If we have safe, quick discharge, that also achieves the same objective.

Calorie Labelling (Out of Home Sector) (England) Regulations 2021

Baroness Greengross Excerpts

Thursday 22nd July 2021 Lords Chamber

[Baroness Greengross (CB) [V]]

My Lords, I speak in favour of the calorie labelling regulations being set by the Government and, with some difficulty, against the amendments to the Motion tabled by the noble Baroness, Lady Bull, and the noble Lord, Lord Brooke. I do so as someone who had severe anorexia as a teenager, before it was even fully recognised; later, one of my teenage daughters had a similar disorder. These two episodes profoundly affected the whole of my life, and certainly represent the most difficult time of my life, as they do for my daughter. The noble Baronesses, Lady Parminter and Lady Walmsley, described very movingly the sort of effect this kind of illness can have on the whole family and on many others.

It is important that we as a society talk about these issues openly and honestly, as they do in many schools now. For people with eating disorders, it is important that they have access to full information, especially if they can see that the calories for healthy food are in fact quite low. If young people are fully informed, they will eventually know the difference between a healthy, balanced diet and one that puts you on track to make you abnormally thin. Its only through providing all the information in a balanced way that people of all ages can eventually make rational and healthy choices. We should not be withholding information or creating a situation where people are not given all the facts. Much of the information we receive about food products at present is in fact advertising or marketing, so what is needed for everyone, of all ages, is full and accurate information at all times.

Although I do not support the amendment to the Motion in the name of the noble Baroness, Lady Bull, I agree with the second part of it, which calls for timely reviews of the impact of these regulations for both obesity and eating disorders, as both have such serious consequences. A significant proportion of the adult population is living with obesity or is overweight, according to research from Public Health England in 2019. By the age of 55, 70% of adults in the UK have at least one obesity-related health issue, as the All-Party Group for Longevity recorded in 2020. In the UK, obesity-related conditions currently cost the NHS £6.1 billion a year, as Public Health England recorded a few years ago. We desperately need a strategy to tackle eating disorders and obesity.

I conclude by asking the Minister for an update on the Government’s strategy of supporting people to live five extra healthy years by 2035. Are these regulations part of this strategy, and what other actions will the Government be taking in terms of food labelling to support it? These experiences profoundly changed my life, and I want other people’s lives to be profoundly changed too, by knowledge, understanding and full information at all times.

Elderly Social Care (Insurance) Bill [HL]

Baroness Greengross Excerpts

2nd reading
Friday 16th July 2021 Lords Chamber

[Baroness Greengross (CB)]

I welcome the opportunity provided by this Bill to discuss funding adult social care, but I cannot support the Bill, which offers only a partial, voluntary solution to this challenge and offers nothing to renters. Instead we must develop a sustainable system for funding social care, one that commands enduring support from the whole of society and which gives young people confidence that it will be there to support them in future.

The Intergenerational Fairness Forum, which I chair, held a year-long inquiry to consider a sustainable means of funding social care which meets the test of intergenerational fairness: one in which all current generations share the cost burden, with the heaviest burden falling on those best placed to contribute, so that the costs are not imposed unduly on future generations.

We recommended that a state-hypothecated, mandatory system of social care insurance should be established, overseen by a social care contributions agency. Under our system, the Government would be the insurer of last resort, protecting people against the risk of catastrophic care costs. This will be affordable because risks will be pooled at a population level. We proposed that mandatory social care insurance contributions should be set at the rate of 1%, to be deducted alongside income tax and NICs from the incomes of all working adults from the age of 40 until they stop working. This could rise to 2% for those aged 50 and over if additional resources were required to meet rising care costs. As contributions would be set at a percentage of income, it would be a progressive system.

Sadly, it will take years to accumulate enough resources through social care insurance contributions to pay for current care costs, so, at least for a transitional period, additional revenue-raising policies will be necessary to support public expenditure on adult social care. Our forum recommended a number of additional revenue-saving and revenue-raising measures, with the revenues raised to be ring-fenced for social care.

Even with a sustainable system for funding social care, the state will still be able to provide only a decent, basic level of care—akin to the role of the state pension in our pension system. A more sustainable system of funding social care will be a mixed system with an insurance element and a savings-based element and, for as long as individuals have to make a financial contribution towards the cost of their social care, it makes sense for the Government to incentivise personal saving for those costs.

The time to act is now because the problem is urgent, and a solution is long overdue.

Women’s Health Outcomes

Baroness Greengross Excerpts

Thursday 8th July 2021 Lords Chamber

[Baroness Greengross (CB) [V]]

My Lords, I welcome today’s debate on women’s health outcomes and thank the noble Baroness, Lady Jenkin of Kennington, for bringing this Motion to the House today in an extraordinarily moving way.

We know that there are many conditions where women are overrepresented—for example in mental health, where 26% of young women have experienced anxiety, depression or eating disorders. We know that with gynaecological conditions it often takes seven to eight years to receive a diagnosis of endometriosis, with 40% of women needing 10 or more GP appointments before being referred to a specialist.

In one area of women’s health, I became aware late last year that there was a national shortage of widely used contraceptive preparations and hormone replacement therapy products. In response to my Written Question, the Minister, the noble Lord, Lord Bethell, responded that this shortage was due to

“Issues such as regulatory or manufacturing problems, problems accessing supplies of pharmaceutical raw ingredients and commercial decisions to divest certain products”,


which

“can affect the supply of medicines.”

Throughout 2020, thousands of women were not able to access their normal oral contraceptive or hormone replacement therapy products. This is one recent example of women not having access to the pharmaceutical products they regularly used, though this also happens, as we know, with various medicines that both men and women take.

I declare my interest in the register as co-chair of the All-Party Parliamentary Group on Bladder and Bowel Continence Care. Women are five times more likely to develop urinary incontinence than men. This is something many women feel uncomfortable talking about or raising with their GP. For many women, bladder continence issues can result in a loss of independence, as they feel unable to leave their homes unless they know there are accessible public toilets near to where they are going. Much like gynaecological conditions, issues with continence care can take time to diagnose and cannot always be treated. Much greater awareness is needed of these conditions and, in particular, how they impact on women’s lives.

My final point is to draw attention to some depressing findings from the 2020 Marmot report, about which the noble Lord, Lord Rooker, spoke so movingly just now. According to Sir Michael’s 2020 report on health disparities, women living in the most deprived 10%—

[Baroness Penn (Con)]

My Lords, I am afraid I am going to have to remind the noble Baroness of the time limit for Back-Bench contributions, given the number of speakers we have in this very important debate.

[Baroness Greengross (CB) [V]]

Can I finish or not?

[Baroness Penn (Con)]

My Lords, I suggest to the noble Baroness that perhaps she is already over the time limit and that we move on to the next speaker.

[Baroness Greengross (CB) [V]]

Okay.

Covid-19 Update

Baroness Greengross Excerpts

Tuesday 6th July 2021 Lords Chamber

[Lord Bethell (Con)]

I am extremely sympathetic to the situation that my noble friend and a large number of other people find themselves in. I reassure him that we are seeking a solution to this issue with the EMA, and I am hopeful that we will get there some time soon.

[Baroness Greengross (CB) [V]]

My Lords, given the significant increase in Covid-19 infection rates in the UK in recent weeks, what assurances can the Government give to people in the social care sector that there will not be a repeat of what happened in early 2020, when 30,000 people in care homes died of Covid-19? What is the difference between making people wear a seatbelt in a car and a face mask on a train? Both are in the interests of health and safety and are surely in the spirit of community consideration.

[Lord Bethell (Con)]

My Lords, I completely understand the noble Baroness’s concerns about those in social care. In the provisions that we have put in place for the vaccine, I reassure her that we have those who are elderly and vulnerable absolutely at the top of our minds. As she knows, we are putting in place arrangements for a third shot for those who were early on the prioritisation lists, and we are working on booster shots, should those prove to be necessary. The vaccine is our absolute front line in the battle against the virus. We are seeking to protect most those who are in social care, the elderly and the vulnerable, which is why the vaccine arrangements have been prioritised in that way.

Care Homes: Insurance Indemnity

Baroness Greengross Excerpts

Wednesday 19th May 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, in terms of monitoring, Care Quality Commission data indicates that pressures are being felt by the insurance industry, but these are not translating into reduced capacity, service closures or quality concerns. There is, in fact, a growth in the number of home care agencies since March 2020; for instance, in the east Midlands, there has been a growth in capacity of 9.4%. These are reassuring figures and we are monitoring the situation extremely closely.

[Baroness Greengross (CB) [V]]

My Lords, there are still many inconsistencies between the NHS and social care. Specifically, will the Government ensure that there is a level playing field between the two in terms of insurance and indemnity?

[Lord Bethell (Con)]

My Lords, I do not need to remind the noble Baroness that there are profound inconsistencies between the NHS and social care. They are organised completely differently, and the insurance arrangements reflect that. The noble Baroness is right that we are looking for parity of outcome between the two. That is very much our commitment and this is one area in which we are striving to achieve that.

Care Home Occupancy Rate

Baroness Greengross Excerpts

Wednesday 28th April 2021 Lords Chamber

Asked by

[Baroness Greengross]

To ask Her Majesty’s Government what assessment they have made of the care home occupancy rate.

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

My Lords, occupancy levels are hard to measure precisely. However, data from providers indicate that occupancy rates in care homes for older people have been adversely affected by the pandemic. We have made over £6 billion available, through grants that are not ring-fenced, to help councils tackle the impact of Covid-19 on services, including adult social care. We have made it clear to councils that this funding can be used to help offset the impact of temporary reductions in occupancy.

[Baroness Greengross (CB) [V]]

My Lords, I thank the Minister for that Answer. The Alzheimer’s Society is reporting that because of care home deaths and restrictions on visits during the pandemic, some families have had to defer placing their loved ones into care homes. Given this, how will the Government support the sector to ensure that occupancy rates rise again, other than by what he just said? How will this be monitored, given that I recently received an Answer to a Written Question that said the occupancy rates in care homes were not held by central government?

[Lord Bethell (Con)]

My Lords, I note the intelligence from the Alzheimer’s Society, but I emphasise it is not the responsibility of central government to raise the occupancy rates of care homes. This area is supplied mainly by the private market. Players may choose to leave the market if occupancy rates fall, and local councils have been provided with more than £6 billion that should be drawn on to support the sector.