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

Baroness Watkins of Tavistock Excerpts

Wednesday 20th October 2021 Grand Committee

[Baroness Watkins of Tavistock (CB)]

My Lords, it is an honour to follow the noble Lord, Lord Crisp, and a pleasure to speak in this debate on the report of the committee chaired by the noble Lord, Lord Patel, who has been my mentor since I entered this House and encouraged me to speak today. He introduced this debate so effectively and outlined the challenges that face society in relation to ageing.

Many noble Lords have developed and will continue to develop the important themes of science and technology research investment as an essential building block in developing treatments, AI and robotics to assist people in older age and to target specific illnesses through effective new drugs. I intend to discuss the challenges and opportunities outlined from social care and a “happiness and health” perspective in later life.

The report notes that the proportion of the UK population that is older than 80 is expected to increase from 4.9%, or 3.3 million people, in 2018 to 10%, or 7.6 million people, by 2065. The Chief Medical Officer for England, Professor Chris Whitty, explained to the committee that it is anticipated that older age groups will be

“highly concentrated … in places where delivery”

of care and health services

“is more difficult than it is in cities.”

I recently attended a lecture that he gave at the University of Plymouth. He outlined the particular challenges of reaching people in rural communities and seaside towns, where many young people leave for work but return to retire, leaving a very small young workforce pool to provide paid care work to support older people.

This morning, the current challenges of providing enough care workers to support people as they come out of hospital were made clear by several speakers on the “Today” programme, including Vic Rayner, chief executive of the National Care Forum. There is insufficient modern accommodation, particularly in the social housing sector, to provide supportive living in a cost-effective manner to older people. Yet there is huge opportunity to build units with appropriate technology to enable more independent living, even for people who have multiple morbidities.

I am amazed that it is now possible to wear a watch with a tracking device that records a person’s whereabouts and, if their routine changes, enables alerts to a central hub and/or a named relative or carer within seconds. As a district nurse in the 1970s, I had to return to base to phone a patient I was worried about. If they did not answer, I had to go back to see them. Think of the difference for district nurses today because of mobile phones and modern technology. In addition, Housing 21 and Bath University work to link innovative engineering to do what appear to many to be simple interventions, such as a kettle that can never boil dry, due to a switch-off mechanism, or baths and showers that control the water temperature so that people cannot scold themselves when bathing. People can therefore stay independent.

Can the Minister please explain how the Government intend to promote investment in social housing that will meet the needs of the most deprived older people, so that they can live healthier, more independent lives? The boom of such housing available to those who can afford to buy age-specific homes of this kind illustrates that many older people enjoy living in such communities and are often less lonely as a result. Will the Government also invest in research designed to identify the potential benefits of such interventions on a longitudinal basis to provide data to inform future investments for older people?

I turn from housing as a key social determinant of health to the NHS and social care. Loneliness is a risk factor for both physical and mental health, as is adequately detailed in paragraph 34 of the report. What role should the NHS and care services play, possibly through social prescribing, to reduce extreme loneliness in old age? In the village where I live, the local post office and shop have just closed and, other than school transport, the bus operates twice a day—that is, two buses one way and two back, without a timetable focused on getting people to and from work. There is no bus that enables a 10 am departure and a return before 4 pm, so that someone of 70 years old can use their pass to go to the nearest town to shop, visit the library and perhaps have coffee. These are real issues for people, yet here in London I can pretty well go anywhere anytime. Could further investment in transport from central and local government overcome these issues and thus promote the health of older people?

Can the Minister explain whether Health Education England is exploring the need for specialist health and social care workers to work with older people? There are few Admiral nurses to support people with dementia, yet this is the highest cause of death in women and the second-highest cause of death in men in England, as illustrated by table 1 in the report. The report also highlights the need for more regular medication reviews for people as they get older and the fact that Age UK reported to the committee that

“care packages can only focus on the essentials such as meals and toileting, without any time for help with mobility”.

That is a damning indictment of our individualised care interventions. The noble Lord, Lord Kakkar, outlined the need to provide co-ordinated, compassionate care. It is essential at the moment, let alone in the next 20 years.

Promoting independence is vital if people are to live longer, healthier, happier lives in old age. I suggest that the recommendation outlined in paragraph 275 of the report—

“that the Government clearly defines the roles and responsibilities for healthy ageing among national and local government and their agencies”—

is as essential as blue-skies research. The report clearly outlines the differences in life expectancy between different socioeconomic and ethnic groups. Why is my life expectancy estimated to be nine years longer than that of someone living nine miles away from where I reside, in the most deprived ward of Plymouth?

Finally, can the Minister comment on whether the ageing society grand challenge needs revision, or is to be completely reviewed from the current term, to ensure

“that people can enjoy at least five extra healthy, independent years of life by 2035, while narrowing the gap between the experience of the richest and poorest”

and enable all older people to have high-quality support and care in the last five years of their lives, as necessary, to reduce loneliness and thus promote health and happiness irrespective of income? The new social care levy could, I argue, be used in part to achieve this aim.

Social Care Funding: Intergenerational Impact

Baroness Watkins of Tavistock Excerpts

Thursday 16th September 2021 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I draw attention to my interests as outlined in the register, particularly as chair of Look Ahead, a housing association that works with vulnerable and homeless people. I congratulate the noble Baroness, Lady Greengross, on securing the debate and on her excellent introduction. Together with other noble Lords, I am committed to ensuring that social care is put on a secure financial footing to protect vulnerable people who rely on these essential services.

Many have argued that the younger members of our society should not be expected to contribute towards the extra funds to be raised through the addition to NICs. I think this is partly because the Government’s presentation has dwelt on the funding challenges of older people when they experience the need for social care associated with frailty and dementia. However, a high proportion of social care budgets is spent on supporting younger people with long-term conditions, including, for example, multiple sclerosis, acquired brain injury and significant mental health and learning difficulties. Can the Minister explain how the proposed levy will be associated and allocated to improve the lives of these sections of society?

Crisis recently published an excellent report Home for All: the Case for Scaling Up Housing First in England. Rapid access to stable housing for young people, including care leavers and those already homeless, is demonstrably cost effective. Will the issue of housing for young people be a priority, together with developing supported-living housing for those over 65 years of age, which in turn can promote independence and reduce or delay the need for help with the activities of living?

Many young people cannot save the deposit to purchase a home, and access to social-rent accommodation is in very short supply, yet the future direction appears to be to enable older people to keep the value in their home if in need of significant social care, while, as other noble Lords have said, younger people are having difficulty getting on the housing ladder. The younger generations will become increasingly frustrated with making significant financial contributions towards health and social care, while also, in the case of recent graduates, paying student loan contributions, if they cannot see that their needs are taken into account in the provision of health and social care service development.

Can the Minister explain how intergenerational fairness in the provision of services will be made explicit in the strategy to fund social care from 2023? I believe we have time to resolve these issues before the full allocation of the levy goes to social care.

Covid-19

Baroness Watkins of Tavistock Excerpts

Wednesday 15th September 2021 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I join other noble Lords in congratulating the Government on the last two Statements and the decision to encourage vaccination in 12 to 16 year-olds. However, some teachers who have been very involved in assisting pupils with swabbing are concerned that there might be an expectation that they do inoculations. Can the Minister confirm that that will not be expected of teaching staff? I think he implied that it will not be in his discussion of nurses.

Will the Government seriously consider alternatives to quarantining in hotels by giving individuals the choice to be tagged and remain in one centre if they travel back to the UK? This is particularly important for British citizens working abroad who have been doubly vaccinated.

[Lord Bethell (Con)]

My Lords, I absolutely reassure the noble Baroness that teachers will not be involved in the vaccination programme. I pay tribute to the work that teachers have done in organising pupils and, on occasion, administering the swabs themselves. It has been an impactful programme and we are enormously grateful. There is an established vaccination programme that, as I mentioned, makes use of professional nurses. That is the route we will take in this instance.

When it comes to the MQS programme, the bottom line is that hotel quarantine is extremely effective. It really does stop the spread of the disease as it comes into the country. That is absolutely relevant when we have the threat of variants of concern. We keep the question of tagging in sight. It is a very intrusive measure and we are not convinced that it will necessarily be, in current terms, as effective as hotels, but I take the point the noble Baroness made and will continue to look into it further.

NHS: Nursing Workforce

Baroness Watkins of Tavistock Excerpts

Wednesday 8th September 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I completely acknowledge the phenomenon of burnout that the noble Lord rightly points out; the NHS people recovery taskforce, appointed to tackle exactly that problem, is very much focused on it. It works in conjunction with the NHS retention scheme and has led to the appointment of new well-being guardians, which have made a huge impact. The statistics suggest that the leaving ratio, previously at 10.3%, has now been reduced to 8.3%. That is an encouraging sign, but we have a number of other measures in place to ensure that retention remains upward at a time when, as he pointed out, nurses are under huge pressure.

[Baroness Watkins of Tavistock (CB)]

My Lords, a group of Nightingale scholars has informed me that nurses are experiencing greater levels of abuse verbally, on social media and physically, together with racism; they attribute this in part to the long waiting lists and their duties in encouraging Covid vaccinations and mask wearing. Will the Government commit to furthering zero tolerance against violence and racism towards NHS staff, which the scholars argue would aid retention significantly?

[Lord Bethell (Con)]

My Lords, the noble Baroness raises a really important point. We addressed it nearly 18 months ago, before the pandemic, when we had a crackdown on racism and abuse from patients. I would be very grateful if she could send me the details of her correspondence, and I shall look into whether we need to do more on that immediately.

Residential Social Care: Staff

Baroness Watkins of Tavistock Excerpts

Monday 6th September 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I do not completely recognise all of the noble Baroness’s figures, but I acknowledge that recruitment in many sectors of the economy is tough at the moment, and that is why we are putting in the measures that I mentioned to the noble Baroness, Lady Brinton. I add that we are doing an enormous amount to fund: we have put £1 billion of additional funding into social care for 2021-22, on top of the significant support provided to the sector during Covid-19 over the last year. This is money directly to address the issues that she is concerned about.

[Baroness Watkins of Tavistock (CB)]

My Lords, Plymouth’s university trust had to shut to new admissions, except for emergencies, partly because 100 beds had people in them who would have been better off at home or in residential care. This was only last week. Does the Minister agree that any CCG or local authority contracts let to provide social care in residential settings should include allowances for the cost of staff, their training, PPE, sickness and annual leave, and be funded at least at the equivalent of the local living wage, so that we can get back to a normal NHS care situation?

[Lord Bethell (Con)]

My Lords, I take on board the anecdote that the noble Baroness has just mentioned—I will look into that. I did not know about the arrangements at the Plymouth trust. On the whole, the arrangements for discharge have moved on a long way during the pandemic, and the financial arrangements for discharge have improved dramatically, so I am disturbed to hear the story that she tells, and I will definitely look into it.

Elderly Social Care (Insurance) Bill [HL]

Baroness Watkins of Tavistock Excerpts

2nd reading
Friday 16th July 2021 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I declare my interests as outlined in the register, but particularly as a NED of a housing association that provides care in people’s homes and residential care.

The noble Lord, Lord Lilley, has, I am certain, brought the Bill for our consideration for highly principled reasons; namely to try to reassure older people who are home owners that if they are insured against care home costs through a Government-owned company, they will be protected against having to sell their homes in future. I cannot, however, support the Bill, because I believe that if enacted, it would protect a small minority of people who have been fortunate enough to purchase a relatively valuable home, and it would fail to address the real and urgent problem regarding social care funding. There are people who need assistance in their own homes, as well as those who need residential facilities in later life.

The Government have promised to bring a Bill on social care funding policy to Parliament before the end of this year. But, as others have reported, the papers today tell us it might be here on Tuesday. It is essential that this is achieved and that the suggestions in any Bill are properly debated in both Houses and achieve cross-party support. If this is effectively achieved, there will be a long-term solution for the whole of the United Kingdom, enacted and supported by successive Governments, irrespective of which party is in power.

This was announced in the Conservative party manifesto, which was clear to voters, who demonstrated that they wanted a long-term policy that would be fair to older people today and to their families in the future through their resounding support for the manifesto, resulting in a majority of 80 in the other House. Failure to deliver on that promise would lose significant support for this Government, and therefore I believe that the Bill will be forthcoming.

I hope the Government’s Bill will be based on some of the principles laid out in the Dilnot report, which received overwhelming support from the majority of health and social care organisations. We need, as the Bill from the noble Lord, Lord Lilley, implies, long-term funding strategies that may involve some kind of government-backed insurance solution. Others have spoken about the insecure employment of care workers. It is essential that care work is properly funded and that care workers themselves have good contracts in order to facilitate high-quality care.

In summary, I thank the noble Lord, Lord Lilley, for the work he has done to prepare this Bill and trust that it can be used to assist the Government in their own planning for their intended social care reforms. I ask the Minister to outline a more detailed timetable for when the Government’s reforms are to be brought to Parliament, which would make the Bill before us today unnecessary. We need a strategy that will support not only home owners but renters with savings and those on low incomes, rather than a piecemeal approach, which I fear would be an unintended consequence of this Bill.

Social Care and the Role of Carers

Baroness Watkins of Tavistock Excerpts

Thursday 24th June 2021 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I congratulate the noble Baroness, Lady Jolly, on securing the time to discuss this vital topic. I draw attention to my interests in the register, particularly as a qualified nurse. Despite extensive knowledge and expertise as a country, we have moved forward at a snail’s pace in trying to address the real problems and opportunities that face us in the domains of respite and support for carers and readily available social care support, as other noble Lords have said.

Social care is funded and paid for differently in the four nations, yet we have a central funding system for the NHS. Unless more resources are allocated for social care, the NHS will continue to attract staff much more readily because of the employment terms there compared with the zero-hour contracts on which many care staff are employed. Today I looked for a job that I would apply for in social care, and noble Lords will be pleased to know that I found one on Housing Today, but it requires me to be the Swiss army knife of care: to work flexibly, and to use the salary-sacrifice system in order to have a pass to go around the city in which I would work. In return, they will give me a regular full day’s work—which are actually really good terms for many people. When will the Government take initiatives to drive the parity of esteem between the NHS and social care employment so that we can recruit, train and retain an excellent social care workforce with the skills and compassion needed for this intimate personalised work? The Government have a real opportunity to correct this by providing apprenticeships and meaningful, secure employment, while demonstrating to the current social care workforce how much we value its work through career development opportunities and fairer terms and conditions of employment.

Respite for carers is particularly important at this time, because most family-based carers have managed with little or no respite or external assistance during lockdown. Many are now exhausted and need respite to rest and recuperate in order to continue with their caring responsibilities. Some are young carers who have had particularly difficult challenges: for example, supporting a single parent with issues including mental illness, addiction and long-term physical disabilities.

It will surprise noble Lords to know that Bumble, the social dating platform, has given all its staff an extra week off for respite, due to the demands of the increased workload associated with the gradual reduction of lockdown and people seeking new partners. How will the Government instigate and monitor policy to guarantee a similar respite for all informal carers? Will they give young carers the right to have breaks? How will their support be prioritised, promoted and guaranteed?

Covid-19 Update

Baroness Watkins of Tavistock Excerpts

Tuesday 18th May 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I am extremely grateful to my noble friend for her insight. She is entirely right; this awful pandemic does have a silver lining, which is that it can be an inflection point for a complete transformation in our public health messaging. The work we are doing on communicating the threat of the variants is one example of that. The next front line will be the flu jab rollout in the autumn, where take-up rates have been okay but not great. I hope that, when the flu jab campaign begins this autumn, a completely different generation and spread of people will step up to that opportunity. We are working extremely hard to use the public mood and sentiment behind preventive medicine to full effect to ensure that the flu jab works, that therefore a much smaller proportion of the population will transmit flu, and that deaths and severe disease from flu will be reduced. That can be the legacy of this awful pandemic.

[Baroness Watkins of Tavistock (CB) [V]]

My Lords, I welcome the vigilant focus described in this Statement that has been adopted by the Government, and that the response is being co-ordinated through the UK Health Security Agency. Could the Minister explain how England is working with the other three countries in the UK to ensure that a proactive approach is taken to the new virus variant, that the uptake of vaccines increases, that the monitoring of transmission continues, and to enable early intervention should the number of cases increase? In particular, what data are the Government collecting on the number of people in quarantine hotels testing positive for coronavirus and how many people have absconded from quarantine? Would the Government consider adopting a process similar to the electronic tagging undertaken in South Korea, to more accurately monitor the movement of people in and out of the country at its borders?

[Lord Bethell (Con)]

I am enormously grateful to the noble Baroness for that creative and thoughtful question. The good news is that the number of absconding residents from managed quarantine is minimal; it can be counted on one hand and many of them have been retrieved. The bad news is that the positivity rate in managed quarantine is far too high. I do not have the precise number in front of me and do not want to guess at it, but it is clearly true that far too many people are getting on planes when they are infected and far too many people are catching the disease on their travels. When we think of how to manage any vaccine-evading and highly transmissible variants, we have to look to the red list for secure protection for this country. She asked another question I cannot remember, but I will be glad to write to her about it.

Social Care: Person-centred Dementia Care

Baroness Watkins of Tavistock Excerpts

Monday 17th May 2021 Lords Chamber

[Lord Bethell (Con)]

I pay tribute to those who deliver person-centred care. The noble Lord referred to hospices, and I am extraordinarily touched and impressed by the way in which they delivered on an enormously difficult task during the pandemic. We debated earlier the financial arrangements around hospices and the delicate state of their finances. We continue to be in touch with the industry and will take whatever measures necessary to ensure its financial stability.

[Baroness Watkins of Tavistock (CB)]

My Lords, will the Minister explain what plans the Government have to invest in socially rented supported housing for people with early dementia? It is very clear that this would reduce short-term admissions to acute hospital beds, which will be necessary in order for us to meet the challenges that the NHS faces with current waiting lists. If the Government have no plans for considering this kind of supported housing, which many people who can afford it purchase for themselves, can the Minister assure us that he will ask the Government to consider this issue?

[Lord Bethell (Con)]

My Lords, the noble Baroness puts the case for supported housing social care for those with low levels of dementia extremely well. It is slightly beyond the purview of the Department of Health, but the case she makes is strong. I would be glad to go back to the department and find out if any measures are taking place.

Office for Health Promotion

Baroness Watkins of Tavistock Excerpts

Thursday 29th April 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, as my noble friend knows, the publication of the consultation on advertising is due soon, and I look to it very much. She is entirely right that obesity, seriousness of illness and death from Covid are clearly related; this has been a wake-up call and we are stepping up to the challenge as of now.

[Baroness Watkins of Tavistock (CB)]

My Lords, the Royal College of Nursing has called for a substantial increase in the number of school nurses to ensure the monitoring and promotion of healthy lifestyles for pupils, so that they are better prepared for learning after substantial absences associated with Covid-19 lockdowns. Can the Minister outline how the Office for Health Promotion will work with the Department for Education to co-ordinate and lead improvements in children’s health, including in school nursing reform?

[Lord Bethell (Con)]

My Lords, I am grateful to the Royal College of Nursing and the noble Baroness for that extremely constructive and thoughtful suggestion. That is exactly the kind of cross-government, inter- departmental suggestion that the OHP will focus on. I will be glad to take that to the OHP and make it clearly.