Covid-19: Care Homes

Baroness Tyler of Enfield Excerpts

Thursday 17th June 2021 Lords Chamber

[Baroness Tyler of Enfield (LD) [V]]

My Lords, respected health commentators and statisticians say that excess deaths—that is, deaths above the expected number—is a more accurate way of looking at the scale of deaths in care homes due to Covid. Care home residents make up just 0.7% of the population. In the first wave of the pandemic, deaths in care homes accounted for 44% of all excess deaths for that period in England and Wales. What does the Minister think this says about the effectiveness of the so-called protective ring thrown around care homes and what lessons have been learned?

[Lord Bethell (Con)]

My Lords, we were never in any doubt from the very beginning that the virus presented a huge threat to care homes. They are where the elderly and the vulnerable are housed, in conditions where it is extremely difficult to enforce infection control and where there is a large amount of intimacy between residents and staff. We knew from the experience of other countries that care homes were very likely to be an area where infection and severe illness, and potentially death, would be highly prevalent. There is no doubt that care homes suffered the brunt of this virus, and for that matter I am extremely sad indeed. Noble Lords should realise that we put every measure in place that we humanly could have done. We gave a huge amount of resources, including £2.8 billion via the NHS specifically to support enhanced discharge processes and the implementation of the discharge to assess model.

Covid-19: Proof of Vaccination

Baroness Tyler of Enfield Excerpts

Monday 14th June 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I am very alive to the concerns of the disabled. We have to balance the need to limit the spread of this virus to save lives, but in a way that is fair and just to all people. We are very much engaged with disability and other charities to ensure that that works. The noble Baroness is right that there will be some people for whom the vaccine does not work and who could yet catch the disease. We need to make provision for those people, and we are working on that.

[Baroness Tyler of Enfield (LD) [V]]

My Lords, I am concerned for the significant numbers of people with existing mental health problems who often do not feel comfortable with smartphone devices, as the information overload such phones can provide can exacerbate their feelings of stress and anxiety. I am pleased to hear the Minister say that other channels will be available to these people, but what arrangements are the Government putting in place to ensure that they are aware that options other than smartphones exist that they will be able to use?

[Lord Bethell (Con)]

My Lords, all the promotions for vaccine certificates through travel agents and GPs make very substantial reference to the availability of paper letters and the channel of being able to call 119 to receive them. I completely sympathise with those who do not want to use their mobile phones for everything, and some will prefer a letter in the pocket to an app on their phone.

Health Protection (Coronavirus, Restrictions) (Steps and Other Provisions) (England) (Amendment) Regulations 2021

Baroness Tyler of Enfield Excerpts

Monday 7th June 2021 Grand Committee

[Baroness Tyler of Enfield (LD) [V]]

My Lords, at the risk of sounding like a broken record, I start by pointing out that we are yet again debating whether to approve a statutory instrument that came into effect three weeks ago, as part of a road map that was set out months ago. At this point in the pandemic, the urgency rationale just does not hold water, so it has become either a bad habit that the Government are unable to kick or simply contempt for parliamentary scrutiny. Neither is a good sign for a healthy democracy.

Turning to the substance, it feels somewhat ironic that these regulations bring back international travel for leisure. In recent days we have witnessed chaos over last-minute changes to the green list, causing huge problems for passengers and the travel industry alike. With long queues at packed airports in Portugal as people try to purchase tickets, often at vastly overinflated prices, on planes packed to seating capacity, and with people reporting difficulties getting pre-departure tests, is this really the best we can do?

As far as I can see, the amber list is simply causing confusion as to whether or not it is okay to travel to a country for leisure. We would not want to encourage people to drive through amber at traffic lights, so why are we giving this option for travel? Is not a straightforward “Yes, you can travel there” or “No, you can’t” easier for all to understand and plan around? Can the Minister say what plans the Government have to review the effectiveness of the traffic light system and our border control measures, including verifying test results for international travel?

Like others, I am sure, I was interested to read that the Chancellor of the Duchy of Lancaster is now participating in a pilot offering daily lateral flow testing for seven days as an alternative to isolation, following his trip to Portugal. It appears from press reports that other football fans receiving similar such texts from NHS Test and Trace were told to self-isolate for 10 days. Can the Minister explain the criteria to qualify for this pilot, when it was introduced and when its results will be published?

Test, trace and isolate remains a hugely important weapon in our armoury for fighting this virus. As restrictions ease, surely we should adapt our isolation support and testing strategies to incentivise isolation. From these Benches, we have called time and again for financial support to enable people on low incomes to isolate effectively. With cases now thankfully at lower levels, can the Minister say what resources are being provided, and to which local authorities, to allow the isolation pilots he referred to—he referred to payments of £500—to happen?

Much store is being placed on the announcement the Government will make on 14 June regarding step 4 of the road map, currently scheduled for 21 June. Over the weekend, some leading scientists have been calling for the easing of restrictions to be delayed. We have been repeatedly told that the Government will be driven by the data on the four tests, including the risks posed by new variants of concern, rather than simply the dates in the road map. With some regulations due to expire on 20 June, as my noble friend Lord Scriven pointed out, what is the scope for extending these regulations if the data requires it? Will we have fresh legislation? What is the contingency plan? Finally, what additional resources are being given to handle variants of concern? I hope the Minister can reassure me on these points in summing up.

Finally—I think I am in very much the same place as the noble Lord, Lord Lansley, on this—the stark truth is that the virus, with its inevitable mutations and variants, is not going away any time soon. Like it or not, we will have to find a way of living with Covid-19 for some time to come. That will mean changes in how we conduct our everyday lives, including how we do our business in this Chamber. This may be an inconvenient truth to some, but the alternatives are far worse. We need to get away from the current narrative that a so-called freedom day is coming fast and that everything can go back to precisely how it was pre-pandemic. We will have to learn to do things differently, and that needs a more grown-up, nuanced conversation which does not revolve around the two extremes of dropping all measures immediately or returning to lockdown. I think that is what most people want and expect.

Care Homes: Insurance Indemnity

Baroness Tyler of Enfield Excerpts

Wednesday 19th May 2021 Lords Chamber

Asked by

[Baroness Tyler of Enfield]

To ask Her Majesty’s Government what assessment they have made of the merits of underwriting insurance indemnity for all care homes on an equivalent basis to the National Health Service.

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

My Lords, the differing indemnity and insurance arrangements for the NHS and for care homes reflect the different systems of securing health and adult social care. For the NHS, there are established indemnity schemes, administered by NHS Resolution. In the care sector, providers purchase insurance from commercial insurance markets. This is a requirement of registration with the Care Quality Commission.

[Baroness Tyler of Enfield (LD) [V]]

My Lords, due to Covid, many care homes have found insurance prohibitively expensive, hard or even impossible to find, and that which is available often not covering Covid. Yesterday, I spoke to a care home manager who was told that renewing his existing insurance would cost 880% more than the previous year, and just one Covid claim could result in the care home having to close its doors, causing great distress and disruption to residents and their families. Against this backdrop, can the Minister say what plans the Government have to extend indemnity to all care homes for a reasonable period, not simply the small number now covered as part of the designated care site schemes, to put them on an equal footing with the NHS and ensure that they are able to help the NHS during any third wave? Will the Minister agree to meet me to discuss the options?

[Lord Bethell (Con)]

My Lords, I acknowledge the challenge faced by care homes on the insurance market, but CQC statistics suggest that, in fact, the insurance industry has done an enormous amount to meet the needs of care homes and that many of the pressures on care homes have been the result of Covid outbreaks. We have brought in the designated settings indemnity support, as the noble Baroness knows, and we have given £6 billion to local authorities to support care homes. Putting care homes on the same footing as the NHS would not meet the needs of the care home sector, so that is not something we are looking at currently.

Covid-19 Update

Baroness Tyler of Enfield Excerpts

Tuesday 18th May 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I am a big supporter of the “fast and hard” principle. In our response in Bolton, Bedford, London and elsewhere, we have demonstrated that principle in our handling of the Indian variant. I point out that the use of testing and social distancing measures in schools has been enormously effective. One of the remarkable aspects of the infection rate so far is that transmission levels among school-aged children have not increased in the way that SAGE and others, including myself, once feared. We should take a “glass half-full” moment to applaud that fact. I reassure the noble Lord that we will absolutely make these decisions on the data. Space has been put in between the steps for exactly that reason, and we are not going to rush it.

[Baroness Tyler of Enfield (LD) [V]]

My Lords, could the Minister outline the Government’s plans for test and trace as lockdown is lifted, particularly in areas such as Bolton and Bedford where surge testing is currently being deployed? With former centrally based Public Health England staff being disbanded and senior civil servants returning to their own posts, what financial resources are being passed to the local resilience teams, run by local directors of public health, to operate test and trace, which will be so critical to controlling the spread of the virus alongside the vaccine rollout?

[Lord Bethell (Con)]

My Lords, the outbreak in Bolton, Bedford, London and elsewhere has demonstrated, if that were needed, the paramount importance of keeping resources for test and trace at a critical level, and that is what we have done. Since the national infection rate is lower, there is a much greater emphasis on the kind of surge activity and outbreak management that the noble Baroness describes. Sequencing has proved to be an essential part of that process, and we have brought sequencing from the back of the laboratory to the front line of test and trace operation. Every single positive case is now treated as though it were a VOC, with the same amount of tracing and sequencing that a VOC would have had a few weeks ago. We have the full operation on standby. Should another wave of infections arrive, as it may well do with the relaxing of social distancing, we have the systems in place to be able to deal with it.

Health Protection (Coronavirus, Restrictions) (Steps and Local Authority Enforcement Powers) (England) (Amendment) Regulations 2021

Baroness Tyler of Enfield Excerpts

Monday 17th May 2021 Grand Committee

[Baroness Tyler of Enfield (LD) [V]]

My Lords, as has been said, even by recent standards the timing of this debate is particularly ironic. On the very day that we move to step 3 of the easing of lockdown restrictions, here we are debating the move to step 2, which happened five weeks ago. To make matters worse, given the much more transmissible Indian variant, which the Health Secretary Matt Hancock said at the weekend could “spread like wildfire”, this easing now feels fraught with risk. I very much support what the noble Lord, Lord Bourne, just said about the need for us to scrutinise regulations in advance.

The Indian variant has caused great anxiety in recent days. For many people it feels as if, just when the sunlit uplands were coming into view, they are being snatched away by a new variant when more efforts could and should have been taken to avoid it. The Sunday Times reported this weekend that at least 20,000 passengers who could have been infected with the new variant were allowed to enter the UK because the Prime Minister delayed imposing a travel ban from India. I add my voice to those of other noble Lords asking whether the Minister can explain why India was added to the red list only on 23 April, three weeks after the announcement of a ban on flights from Pakistan and Bangladesh, both of which had lower case rates than India.

The combination of moving up the steps and the Indian variant makes having an effective test, trace, isolate and support system ever more critical. I place particular emphasis on the last two words—isolate and support—which is where things are still breaking down. The major problem reported by local resilience forums is that people are still not self-isolating and will not until they get their income paid. It is those on zero-hours contracts, those doing jobs that you cannot do from home and families living in multigenerational households who need the support most. People do not want vouchers; they want their earnings reimbursed. Reimbursing earnings is substantially cheaper than running the test and trace functions and, if a serious case of Covid occurs, the cost to the NHS.

I end by asking what planning is under way for a third wave, especially for paediatric care, given that as more adults are vaccinated it is possible that a variant may affect much younger children than in previous waves. Both the USA and Canada are reporting much higher cases in children than before and are starting to vaccinate children in the 12 to 15 age range. What plans are being developed for vaccinating children in this country?

Care Home Occupancy Rate

Baroness Tyler of Enfield Excerpts

Wednesday 28th April 2021 Lords Chamber

[Baroness Tyler of Enfield (LD) [V]]

My Lords, a recent National Audit Office report highlighted how the Covid pandemic has adversely impacted the financial viability of care home providers, with occupancy rates falling significantly, as we have heard. Given this, could the Minister say what steps the Government are taking to ensure that the much-needed financial support he has referred to, to stabilise this highly fragmented and fragile sector, gets to the front line and that there is equal treatment for all care home services, irrespective of whether they are local authority-funded or NHS-funded or whether residents are older people, younger adults of privately paying residents?

[Lord Bethell (Con)]

My Lords, we have written to local authorities to make it clear what the funding is there for and to make recommendations on the sort of financial support that may be needed to bridge this moment when occupancy levels have been reduced because of concerned families taking their loved ones out of care homes. That funding is in place, and it is up to local authorities to make their decisions on the matter.

Care Homes: Guidance

Baroness Tyler of Enfield Excerpts

Wednesday 21st April 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, these protocols are not tied to the road map because we hold them under constant review. We hear loud and clear the case made by the noble Baroness and others who make the case for change. We are open to making that change when the evidence says that the situation is ready. We expect care home workers to behave in a way that is responsible and keeps infections to a minimum, but we cannot have protocols for every aspect of their lives.

[Baroness Tyler of Enfield (LD) [V]]

My Lords, I declare an interest: I have a close family member who is a care home resident. People living in care have endured over a year of rules keeping them separated from family and friends, with the double isolation of relatives being unable to go into the home and residents being unable to leave. Although I welcome the recent relaxation of the rules on visiting out of care homes, the guidance states that the requirement for a 14-day isolation period on return

“is likely to mean that many residents will not wish to make a visit out of the home.”

What is the point of pretending that it is being allowed? Does the Minister understand why imposing a blanket quarantine on visits out feels to many arbitrary, unfair and as though it is interfering with their liberty? Can he explain why it is not possible for a resident who has been outside for visits to be tested on return and again after a specified number of days, rather than enduring a 14-day isolation during which they are often confined to a small room?

[Lord Bethell (Con)]

I can only express complete sympathy for the noble Baroness’s points. She puts them extremely well. Undoubtedly, the pressure put on residents and their family members is profound and I regret it enormously. However, this is not an arbitrary or thoughtless measure from the Government; it is to protect residents who have shown themselves to be highly susceptible to the disease. We have instances of serious illness and death to remind us how important these measures are. The noble Baroness is entirely right that the protocols are in place in order to deter external visits. In terms of testing, the unfortunate truth is that the virus can harbour in someone’s body, undetectable, for days. We know from protocols around international travel that pre-travel testing catches only about 15% or 20% of those with the disease and it is for that reason that we cannot turn to testing as an alternative.

Covid-19: Update

Baroness Tyler of Enfield Excerpts

Tuesday 20th April 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I join the noble Lord in commending the people who work at Macmillan and all the other important diagnostic centres that have remained committed to their work throughout Covid under extremely difficult circumstances, delivering hugely important healthcare services. The noble Lord is stretching my knowledge of vaccination with this question, but it is my understanding that most of our flu jabs are grown in eggs in East Anglia and we do not rely on Indian supplies for the flu jab. This may seem like an extraordinary fact, and I doubt it, even as I stand here at the Dispatch Box, but I would be glad to write to him to confirm the point.

[Baroness Tyler of Enfield (LD) [V]]

My Lords, I welcome the Government’s consultation on whether vaccines should be required for care staff working with older adults. To make this easier, could the Minister say what plans the Government have to ensure that care staff are paid for time spent being vaccinated, particularly if they have to come in when not on shift or have to take time off because of any short-term reaction to the jab? Also, are the Government prepared to support care homes financially to enable staff who cannot have the vaccine for clinical or other specified reasons to be redeployed to non-front-line work?

[Lord Bethell (Con)]

My Lords, the vaccine is typically seen as personal medical hygiene. I am not sure if arrangements have been made for people to be paid while they get vaccinated, but I would be glad to write to the noble Baroness to confirm that. She makes an extremely sensible point about redeployment; I do not know the precise details, but would be glad to write to her.

Covid-19: One Year Report

Baroness Tyler of Enfield Excerpts

Thursday 25th March 2021 Lords Chamber

[Baroness Tyler of Enfield (LD) [V]]

My Lords, I support the Motion in the name of my noble friend Lady Brinton. As we reflect on the past year and think about life as we start to emerge from lockdown, I want to focus on two issues: the loneliness and social isolation caused by the restrictions and the impact of the lockdown on our national mental health. While the road-map regulations offering the prospect of easing the lockdown will bring hope after such a difficult year full of personal sacrifice, we should be mindful of those who have experienced extreme isolation, in particular people who have been shielding, single parents, older people living alone and care home residents who have been deprived of contact with their loved ones. Many people are also grieving the loss of loved ones. There is much to be done by government, local authorities, the voluntary sector and local communities to support mental well-being and help people to reconnect with their community.

The All-Party Parliamentary Group on Loneliness published a report yesterday calling on the Prime Minister to commit to helping people to reconnect socially and to plan for England’s recovery from coronavirus. A raft of individual recommendations highlighted the need for public spaces to be more welcoming, and for more public toilets and better street lighting to make it easier for people to meet informally and safely. It also calls for long-term funding for charities which help those who are isolated. Can the Minister say how and when the Government will respond to these important recommendations?

The past year has left an indelible mark on everyone’s mental health. Not being able to travel abroad to see family members and loved ones, including not being able to see new arrivals to the family or attend family funerals, has been particularly tough. While we all look forward to the day when international travel is possible again without endangering public health, we need clarity and, above all, fairness. The current exemptions that allow trips for the purchase, sale, letting or rental of a residential property are, in my view, unlikely to pass the fairness test in most people’s minds.

I know from personal experience how difficult it has been not being able to visit loved ones in care homes and the impact that has had on the well-being of residents. Can the Minister say what plans the Government have to make the vaccination of care home staff mandatory, both to help speed up the reopening of contact visiting and to give relatives the reassurance that their loved ones are being protected from harm?

With all the anxiety, grief, loss, loneliness and social isolation of the past year, I am disappointed that the Government’s report has little to say on mental health, barring a brief mention of Section 10 of the Mental Health Act changes, which, thankfully, have never been brought into force and have been scrapped. There was no mention of mental health staff in the section on increasing the available health and social care workforce and no reference to a mental health recovery plan for the nation.

In England, recent Centre for Mental Health well-being modelling has predicted that up to 10 million people— 20% of the population—will need either new or additional mental health support, including for depression, anxiety or post-traumatic stress disorders as a direct result of the crisis. Some 1.5 million of them will be children and young people aged under 18. With some hospital A&E departments reporting that they are now seeing daily cases of children self-harming, and with a senior clinician reporting yesterday in the Health Service Journal that there is “no capacity anywhere” to deal with the unprecedented surge in admissions of children with mental health problems, it is clear that the current system, which was already under strain before the pandemic, simply will not cope.

I end by paying tribute to the NHS workforce. People have been working flat out for a year now. Their dedication, professionalism and personal sacrifice have inspired the whole nation, but vacancies stood at over 100,000 before the pandemic. The NHS is now facing a huge backlog of operations with an exhausted workforce, many of whom are suffering from burnout, and increasing levels of sickness absence.

I recently had the privilege of speaking to two senior nurses working in London intensive care units. They told me that what they wanted more than anything was time off for recovery and additional nurses to provide pre-pandemic levels of patient care, as well as tangible recognition of the value of the work they are doing. With the Scottish Government now offering a 4% pay rise to nurses alongside a £500 thank you payment, can the Minister say what plans the Government have to think again about this issue and ensure that nurses south of the border get the pay rise they so richly deserve?