Neurological Conditions

Baroness Wheeler Excerpts

Thursday 9th June 2022 Grand Committee

[Baroness Wheeler (Lab)]

I am very pleased that my noble friend Lord Dubs secured this important debate and grateful for his excellent speech. We know that he values every opportunity to underline the urgent need to improve services in social care for all people with neurological conditions. We have often spoken about MS, the impact the disease is having on his son and the experience of his whole family in caring for and supporting him. We also heard from my noble friend Lord Monks of his experience of the care of his son. He also spoke very movingly today.

One in three people with MS does not get the social care or rehabilitation they need to cope with the disease and be able to lead as independent a life as possible. The experience of both my noble friends over many years, sadly, reflects that. The noble Baroness, Lady Thomas, also made a compelling plea for muscle-wasting and other neurological conditions to be better and more effectively managed through timely treatment and access to rehabilitation services and specialist support, with regular access to specialist teams.

I also pay tribute to the work of the 80 charities within the Neurological Alliance. I hope yesterday’s Westminster Hall launch of its excellent survey—which I was, sadly, unable to attend—went well and received the attention and support it deserves. Noble Lords’ contributions have drawn heavily on the survey results in respect of a range of neurological conditions, including MS, dementia, migraine and Parkinson’s. My noble friend Lady Gale is always a great advocate of the work of Parkinson’s UK, but was, sadly, unable to be here today.

My special focus is on stroke, as a carer for a disabled adult stroke recoverer. Stroke strikes every five minutes in the UK and 100,000 people have strokes each year. It is a leading cause of death and adult disability in the UK, with more than two-thirds of people who have had a stroke leaving hospital with a disability. To underline the neuro survey key data highlighted by noble Lords, the one in six people in the UK who have a neurological condition have the lowest health-related quality of life of any long-term condition. One in five adults waited more than 12 months between seeing a GP and then a neurologist, and 55% experienced referral delays in routine neurologist appointments—all of which needs to change, as we have heard. The Chartered Society of Physiotherapy estimates that only 40% of people receive essential neurorehabilitation.

Workforce shortages are the biggest reason behind delays, and I look forward to the Minister explaining the Government’s specific plans to address the chronic neurological staff shortages across all key conditions. How do they account for the UK having only two neurologists for each seven that France and Germany have, and how is this situation being addressed? Does this not reinforce the urgent need for the long-term workforce plan to tackle these and other acute staff shortages, as we have been calling for? In Parliament yesterday, almost as an aside, the Secretary of State referred to work being undertaken “on a 15-year strategy”. That is the first time we have heard mention of any timeframe, so perhaps the Minister could tell us more about who is leading the strategy’s development and when it is expected to be published.

Specifically on MS, last year, NHS England’s Getting it Right First Time adult neurology report recommended that all MS teams have enough administrative staff to carry out non-clinical duties and free up clinicians’ time to treat patients. Can the Minister update the Committee on what progress has been made?

The Government’s acceptance of the alliance’s call for a UK-wide neurological task force of key stakeholders from Governments, departments, professional bodies and the voluntary sector must be a key factor in identifying how treatment, rehabilitation and social care support can be provided and improved, running alongside the strategy, resources, front-line specialist workforce and other clinicians that are vitally needed where shortages are most acute. I hope that the Minister will recognise this as a key way forward.

I have a few further points. The My Neuro Survey rightly makes much of the impact on unpaid carers and families of the lack of support available for the people they care for; a number of speakers mentioned this. In this national Carers Week, it is important that carers feature strongly in today’s debate. According to the Alzheimer’s Society, unpaid carers supporting someone with dementia save the economy £11 billion every year. On Tuesday, the Minister promised that the Government want to help carers to make sure that they are looked after while they provide a service for their loved ones. Can he say what specific immediate steps are being taken to do this?

Specifically on social care, NHS data shows that only 14% of the total social care budget is spent on people living with neurological conditions. Living well with neurological disease means getting the right home support and equipment, regular occupational and physio therapy, and eating, washing, dressing and other essential social care help. But as the latest social care directors’ ADASS survey showed, more than 500,000 people in England are waiting for a social care assessment, for care to begin or for a review of their care. Can the Minister explain how this immediate situation is to be addressed, given that the existing resources pledged for social care at best just shore up existing wholly inadequate services?

Finally, what research is being undertaken by the Government into the impact of long Covid on neurological conditions, following the two studies by Mater Hospital in Dublin that found “significant evidence” of it leading to new neurological conditions? Have the Government any further information on or assessment of this? How is this troubling link being monitored? I look forward to the Minister’s response on all these issues.

NHS: Respiratory Syncytial Virus Infections

Baroness Wheeler Excerpts

Thursday 9th June 2022 Grand Committee

[Baroness Wheeler (Lab)]

My Lords, I too thank my noble friend Lady Ritchie for her excellent speech and her tenacity and determination in drawing this important issue to the attention of the Committee. Her warning was timely when she last raised her concerns, earlier this year, about the serious impact of the Covid-19 pandemic on the epidemiology of other seasonal viruses such as flu and RSV, pushing them out of sync. It is vital that plans are in place to ensure that the NHS has the capacity and resources to cope with a potentially extended, or more than normally prolonged, winter season, in particular of RSV.

As noble Lords have underlined, raising awareness among parents about RSV and how to spot the more severe symptoms is crucial. I pay tribute to the Sanofi Pasteur Together Against RSV campaign and its excellent report from last November highlighting the costs to the NHS of RSV, which were outlined so ably by my noble friend and the noble Baroness, Lady Brinton. The Mumsnet baby health website is also doing a great job in supporting parents and linking them to the Sanofi guidance and briefings. However, the fact that its recent survey showed that 37% of parents feel that they have a lack of understanding on how to manage their child’s respiratory illness from home, while 69% have found online information from various health sources overwhelming or confusing, shows the scale of the work still to be done.

Earlier this year, the Minister assured the House that the NHS has plans in place for raising awareness of RSV among parents and at schools. I look forward to hearing the detail of those plans from him. How will be Government support the Together Against RSV awareness-raising campaign among parents? When will government guidelines be updated to adopt the much more user-friendly and accessible information provided by this campaign and parent support organisations, such as Mumsnet?

The pressures on NHS primary care from RSV in children, in terms of GP visits, hospitalisations and antibiotics prescriptions, as highlighted in the Sanofi report and demonstrated by my noble friend Lady Ritchie, are pretty stark: 450,000 GP visits, 125,000 ear infections, 416,000 prescriptions and 30,000 hospitalisations in an average UK RSV season. Hospitalisations and GP visits are substantially higher among younger children infected with RSV than among those who have flu. Last year, the British Lung Foundation warned parents of young children to be alert for signs of RSV after a sharp rise in cases. It estimated that 1,000 children in England alone had needed hospital care for it in just three months. I thank the noble Baroness, Lady Brinton, for explaining her experience with her own grandchildren and underlining how serious RSV can become, as it did in the case of her granddaughter; I am glad that she is now recovering.

Noble Lords have also underlined the global effect of RSV. Experts behind the recent Lancet study, which showed that RSV kills more than 100,000 children worldwide, believe that more children are likely to be affected in future because lockdown and mask-wearing have meant that they have little or no natural immunity to it. Again, my noble friend Lady Ritchie referred to this reduced immunity point.

In the UK, we know that 92% of hospitalisations are estimated to occur in infants under the age of two. During winter months, one in six of all UK paediatric hospital admissions are bronchiolitis-related, with RSV estimated to be the cause of 60% to 80% of those admissions. As the Sanofi guidance warns:

“It is not only the infected child who feels the burden of RSV: families, carers and the health systems are all impacted. The seasonal and contagious nature of this infectious disease has raised national concerns over the possible impact on healthcare capacity at a time when it is already over-stretched … the UK faces a future with co-circulating RSV, Covid 19 and other respiratory viruses”.


What is the Government’s latest assessment of the impact of these co-circulating viruses on primary and secondary care, and on workforce capacity?

We also know that the very young and elderly are at the greatest risk from RSV. The Government guidance points out:

“Only a minority of adult infections are diagnosed, as RSV is not widely recognised as a cause of respiratory infections in adults.”


It also explains:

“Elderly patients are frequently not investigated microbiologically, as there are fewer viruses present in their respiratory secretions compared with children.”


As a result, adult infections are underestimated. Older adults are at greater risk of serious complications from RSV than younger children because our immune systems weaken as we get older. This can lead to exacerbations of underlying lung and cardiac disease. Can the Minister explain what action is being taken to improve testing, reporting and treatment for older adults?

Obviously, the good news is that RSV infection causes mild respiratory illness for most people and can be reduced or prevented through the standard infection control measures that we all got so used to—and, I hope, permanently wedded to—for Covid, of respiratory hygiene, handwashing and cleaning surfaces. My noble friend stressed the importance of working with the devolved Governments on tackling RSV and increasing awareness of the threat it poses. I hope the Minister can reassure us on this, and on how learning, awareness-raising, prevention and treatment are being shared across the UK.

I understand from an article I read in Nature of 21 December last year that there is also hopeful news in the development of a vaccine for RSV after what researchers have called decades of failure. There are four vaccines in late-stage clinical trials involving stabilising the F protein that the RSV virus uses to fuse with cells and infect them. The structure of the F protein has been identified as the best target for making vaccine-induced antibodies that could prevent the virus entering human cells. I understand that these trials are initially testing older people aged over 60. Does the Minister have any further information on this? Can he tell us what research into and funding of RSV are currently taking place?

This has been a valuable debate, and it is clear that there must be action to stop the rampant spread of RSV post Covid—especially this coming winter—causing poor health, soaring costs for the NHS and particular threats to young children. I look forward to hearing the Government’s future plans for addressing this infectious but not widely known about virus.

GP Access

Baroness Wheeler Excerpts

Tuesday 7th June 2022 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend for that question and for highlighting the role of community diagnostic centres. When we look at the backlog and the waiting lists, about 80% of the waiting list is for diagnosis, not necessarily surgery. Of course, once they have been diagnosed, some of those people will require surgery. After that, about 80% of those who require surgery will not require an overnight stay. They can be daily in-patients, as it were. The role that CDCs will play in trying to tackle that backlog is to encourage more diagnosis in the community, so rather than people having to go to NHS settings, diagnosis will go to the people in shopping centres and football stadiums.

[Baroness Wheeler (Lab)]

My Lords, this is national Carers Week, and I am sure the whole House will want to pay tribute to the tremendous work our 6 million unpaid carers do, often at great cost to their own health and well-being. This week’s Carers UK survey highlights the alarming neglect by carers of their own health, be it mental health conditions, long-term illness or disabilities, or putting off treatment because of their caring duties, like the carer who delayed a hysterectomy for five months because of the urgent care needs of the loved one she was caring for. The Carers UK survey shows that only 23% of carers are offered health checks for themselves when they phone the GP’s surgery to make their loved one’s appointments. Rather than just flagging up on the system that a person is a carer, what action will the Government take to ensure that GP surgeries are able to do much more to monitor carers’ health and well-being and what guidance will be issued on this important matter?

[Lord Kamall (Con)]

The noble Baroness raises a very important point, as does the noble Baroness, Lady Pitkeathley, who frequently champions the role of unpaid carers. The new model of primary care is taking on some of the services that were previously provided by secondary care, and it will be a more modern, networked service. Clearly, part of that mix, not only in primary care but at the ICS level, will be how we make sure that we have a proper integrated health and care system and how we can help carers and make sure that they are looked after while they provide a service for people.

National Institute for Health and Care Excellence

Baroness Wheeler Excerpts

Monday 23rd May 2022 Lords Chamber

[Lord Kamall (Con)]

I think my noble friend will find that lots of departments and lots of public bodies are working within budgets at the moment, given the financial situation. NICE is very aware of this, and has looked at how it can do more with the same money to increase capacity and be more responsive.

[Baroness Wheeler (Lab)]

My Lords, NICE is a critical participant in the Innovative Licensing and Access Pathway, launched over a year ago. It aims to make use of regulatory freedoms post Brexit to speed up access for NHS patients to new drugs, including cancer treatments. Can the Minister tell the House how many treatments have been or are being considered through ILAP and when we might expect to see the first ILAP treatment being made available on the NHS?

[Lord Kamall (Con)]

I know I have the answer here somewhere but I cannot find it, so I commit to write to the noble Baroness.

Health and Care Bill

Baroness Wheeler Excerpts

Consideration of Commons amendments
Tuesday 26th April 2022 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, I begin by welcoming Motion B, which puts in place government Amendments 30C to 30K, laid in another place. They relate to the Secretary of State’s role in major NHS reconfigurations and are a credit to the Minister, his ministerial team and the Bill team. They have listened to the strong arguments from across this House, led so ably by the noble Lord, Lord Stevens of Birmingham, who is unable to be with us tonight. I thank the Minister for agreeing—eventually—that the powers originally proposed in the Bill were excessive, disruptive and unnecessary.

Unfortunately, we have not had such a fruitful consensus on the matter of workforce planning. We do not agree with the Commons that our workforce amendment, Amendment 29B, was unnecessary because appropriate measures already appear in the Bill. If that were so, and if the sector had had confidence in the Government’s track record in planning for adequate and safe staffing levels in health and care services, we would not have had more than 100 organisations backing our earlier attempts, led so well by the noble Baroness, Lady Cumberlege, to put in place a mandatory system for reviewing the available workforce and predicting what will be needed in future. However, here we are, with the Government having set their face firmly against any compromise on or serious discussion about the matter. One has to ask what the Government are afraid of.

Any effective workforce strategy must be based on reliable information, be regularly refreshed and have numbers in it. This House and the whole sector have no confidence that what the Government are proposing will do that. I understand that the Treasury has had a hand in the Secretary of State’s determination to just say no. Perhaps the Treasury is unwilling to foot the Bill, which will prove to be essential when all is revealed.

I put it to the Minister one last time that our proposal would be cost-effective. Staff shortages are a false economy. Missing staff are often replaced by very expensive locums and agency staff, and the stress of unsafe staffing levels causes valued staff to leave the service. Training and recruiting staff to replace them also costs money. High staff turnover is not an effective strategy for any business or service, and poor treatment for patients often has to be done again or leads to greater and more expensive needs further down the track. No efficient shopkeeper would fail to do a proper stocktake or take account of what people are buying and therefore what he needs to order to replenish his stock—but that is what the Government are doing if they fail to plan effectively for safe staffing. It is much more serious than empty shelves, because it is playing with people’s lives, as was recently demonstrated so clearly by the Ockenden report.

If the Government are determined not to carry out the reviews and consultations in Amendment 29D, I would like to ask the Minister whether they would be happy for some other organisation, such as NHS England, to do so and whether they will take note of the results of that investigation. Amendment 29D from the noble Baroness, Lady Merron, in Motion A1, is not a silver bullet; it will not solve the current staffing crisis in the NHS and care services. But it would provide a strong foundation for future safe and cost-effective staffing, which would be to the benefit of the whole population. It is our duty to ask the Government to think again—again.

[Baroness Wheeler (Lab)]

My Lords, in closing the debate before we hear from the Minister, I make no apology for concentrating on social care, on how the care cap is to be implemented, and on my Motion D1, which implores the Commons to think again on this vital issue. I thank noble Lords who have given their strong support to Motions A1 and D1.

I wish to reinforce the key point that, from the outset, social care and Parliament have been treated pretty shabbily as part of this Bill. It is essentially an NHS Bill. As we know, the social care cap and charging arrangements were added to the Bill in the Commons, with no notice and after the Bill had finalised its Committee stages, and were then pushed through, without any opportunity for full explanation, scrutiny or time to consider the impact on the hundreds of thousands of people who are desperately in need of social care and support and will not receive it under these proposals. We later also had the money-saving bombshell announcement of local authority contributions not being allowed to accrue against the care cap, which was designed to achieve savings on the Government’s original package—even before any form of scrutiny of the Bill had commenced—that will be at the expense of some of the country’s poorest and most vulnerable people.

As noble Lords have pointed out, in reality, we in the Lords Chamber have had little actual time to consider and debate these vital social care provisions, despite many hours and days being spent overall on a long and complex Bill. Worst of all, we had the blank refusal by the Government to discuss or address any of the concerns and issues expressed or put forward by noble Lords from all sides of the House, with their deep expertise and knowledge across social care, or the detailed and painstaking evidence and modelling work undertaken by key stakeholders, such as Age UK, Mencap, the Alzheimer’s Society, and the King’s Fund, Nuffield Trust and Health Foundation expert think tanks. We have instead been told that Ministers have done their best to explain their proposals, but they have absolute red lines against making any changes whatever. Is this what must now pass for parliamentary dialogue, scrutiny and debate?

For the record, I will underline some of the key reasons why opposition to the Government’s proposal for the cap implementation is so clear and strong. The cap level and implementation strongly favour the better off and would bring almost nothing to the worst off. This is unfair and the opposite of levelling up. Older people and those with modest means all fare badly under the Government’s charging proposals.

Even the Government’s own impact assessment admits that only 10% of working-age disabled adult care users will benefit, that one in five older people will not see the benefits of the cap and that poorer care users are much more likely to die before they reach the cap than others with the same care needs. Among older people, those in the north-east, Yorkshire, Humber and the Midlands will be worse off. For dementia sufferers regionally, just 16% of people in the north-east and 19% in the east Midlands would hit the cap, compared with 29% in the south-east. The overall figure, as a result of disallowing local authority contributions towards the cap, is that only 21% of people living with dementia would reach it.

The mountain of evidence produced by stakeholders and think tanks shows that social care is not being fixed, as the Government continue to try to have us believe. The “nobody will have to sell their home” promise is firmly debunked, too, despite the Government desperately clinging on to it; it is a hollow and false claim. Somebody with assets of £100,000 will lose almost everything, while someone with assets of over £1 million will keep almost everything. How can this be the fair plan that the Minister insists it is?

The reality is that, as the Government holds to their solid red line, their arguments just do not stand up but get weaker by the minute. The Minister argues that his is the only affordable plan, but, if that is the case, why do the £90 million of savings have to be paid for by those who can least afford it, and why are there not better plans to protect those with fewest assets?

Local authority care contributions counting towards the cost are presented by the Government as unfair. Instead, they insist that setting the cap at the same level for everybody,

“no matter their age, where they live in the country or the nature of the care and support they need to draw on”,—[Official Report, 5/4/22; col. 1986.]

is the fairest system. Is that not also the opposite of how levelling up should work?

The argument that no one will be worse off than under the current system is just not borne out by the overwhelming evidence from the stakeholders and think tanks. The contention that the Government are reforming and changing the system where previous attempts have failed just is not true. There was cross-party agreement on the implementation of the Care Act after detailed scrutiny of the Dilnot proposals, and it was this Government who failed to implement it. I remind the House, as someone who was heavily involved in the scrutiny of that Bill, that there was no mention of the Care Act provisions being unaffordable when the Act and its implementation proposals were agreed in 2014.

On working-age adults, as the noble Baroness, Lady Campbell, has again forcefully underlined, the Government’s proposals will mean that they remain trapped in poverty. The Minister’s previous reference to the uprated social security benefits that they will receive instead under the minimum income guarantee completely missed the point of how social care needs have to be supported.

Ministers have doggedly stuck to their responses, without either acknowledging or addressing these clear counterarguments and evidence. My Motion again reinforces the key issues that we have tried all along to get the Government to respond to: the importance of implementing the care cap under the consensus provisions of the Care Act, and ensuring that local authority care costs are allowed to accrue towards the cap to avoid the huge unfairness that not doing so will cause to key groups in need of social care.

Finally, we want to make sure that the Government’s much-vaunted but little-explained trailblazer pilots are completed before regulations on the cap are agreed, as well as including the analysis of the impact on regional eligibility and the effect of the cap on working-age disabled adults under 40 with eligible care needs. Is this not both sensible and fairer to the key groups who stand to lose so much under the Government’s proposals? Why is this so difficult for the Government to agree to? I referred to “little-explained pilots”, but I did receive a letter three hours ago from the Minister, for which I thank him, setting out information about the pilots that in fact adds very little more than the DHSC press release in March and also shows that they will not be evaluating the key areas of impact that my Motion calls for.

I will also add that I have seen recent government claims in the media that deleting the social care cap arrangements in the Bill would jeopardise the whole Bill. I emphasise that that is not so. In their place we would instead have the rest of the Bill and the Care Act 2014 provisions, which would form the basis for moving forward quickly and implementing the cap in a much fairer and more inclusive way that would benefit many more people in desperate need of social care support.

I hope that even at this late stage the Government will listen, address the overwhelming concerns and evidence from all the stakeholders and experts on social care services and delivery and accept my Motion as the best way forward.

[Lord Kamall (Con)]

I thank all noble Lords who have spoken in this debate. I will turn to the issues as briefly and succinctly as I can.

On workforce planning, I hope I can assure noble Lords that we will engage with stakeholders on the preparation of the report, which will include the regulated workforce in health, social care and public health. I hope your Lordships also understand the work being undertaken by the Government, NHS England and Health Education England to improve workforce planning and to lead the improvements we all seek. This is why we think the amendment is unnecessary. I also remind noble Lords that at local level there is an incredible amount of local planning going on much closer to the ground.

--- Later in debate ---

Moved by

[Baroness Wheeler]

Leave out from “House” to end and insert “do insist on Lords Amendment 80 in respect of which the Commons have insisted on their disagreement; do insist on its disagreement with the Commons in their Amendments 80A to 80N in lieu; and do not insist on its Amendments 80P and 80Q instead of the words so left out of the Bill to which the Commons have disagreed for their Reason 80R, and do propose Amendments 80S and 80T in lieu—

80S: After Clause 139, insert the following new Clause—
“Cap on care costs for charging purposes
(1) The Secretary of State may by regulations amend the Care Act 2014 as regards how “costs accrued in meeting eligible needs” for the purposes of section 15 of that Act are to be determined.
(2) The regulations must ensure that any costs incurred by any local authority to meet eligible needs are included within that determination.
(3) The regulations may not be made unless—
(a) an evaluation of the results of the Trailblazer pilot schemes has been completed, which takes account of regional eligibility and the effect of the care cap on disabled adults who have or have had eligible needs under the age of 40, and
(b) the Secretary of State has laid that evaluation before Parliament.”

80T: Clause 150, page 128, line 20, at end insert—
“(ca) regulations under section (Cap on care costs for charging purposes);””

[Baroness Wheeler (Lab)]

My Lords, time is short. The Minister has once again failed to respond to the evidence and the concerns that have been so forcefully expressed throughout the passage of the Bill. I wish to move Motion D1 and test the opinion of the House.

Health and Care Bill

Baroness Wheeler Excerpts

Consideration of Commons amendments
Tuesday 5th April 2022 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, I open this group from these Benches by speaking to Motion G1 on the care cap. My noble friend Lord Hunt will speak to Motion A on integrated care boards, my noble friend Lady Pitkeathley will speak to Motion E on carers, and we will leave the issue of palliative care under Motion L1 in the capable hands of the noble Baroness, Lady Finlay. I thank the noble Baronesses, Lady Brinton and Lady Campbell, for their support in respect of the social care cap.

I hope that my Motion G1 on social care will provide the opportunity that the Government so sorely need to think again about how the care cap is to be implemented—in particular, the impact that its proposed changes to the eligibility and charging rules before the cap kicks in will have on hundreds of thousands of lives across some of the most deprived areas of the country.

I remind the House that, despite the Prime Minister’s pledge that nobody should have to sell their homes, the fact is that somebody with assets of £100,000 will lose almost everything while someone with assets worth £1 million and over will keep almost everything. People with low levels of wealth will be exposed to the same care costs as the very wealthiest in society. They will end up spending the largest levels of their income on care. As my colleague, the shadow Minister Karin Smyth, succinctly put it:

“No wait for care will be shortened because of this Bill and nobody excluded from care will now receive it”.—[Official Report, Commons, 30/3/22; col. 941.]


Since the Government’s announcement of the £86,000 cap last year, and then, two months later, the body blow of not allowing local authority contributions to people’s care to accrue towards the cap, designed to save £900 million, the evidence for all this has been stacking up every day, and it is overwhelming. Extensive modelling and evidence by stakeholders such as Age UK, Mencap, the Alzheimer’s Society, and from the King’s Fund, Nuffield Trust and Health Foundation expert think tanks, prove just how badly older people and working-age disabled adults with no assets or with modest means will fare under the current charging proposals.

Even the Government’s own impact assessment figures show more than one in five older people will not see the benefits of the cap at all, and poorer care users are much more likely to die before they reach the cap than others with the same care needs. Alzheimer’s Society research shows that, without means-tested local authority funding counting towards the cap, only 21% of people with dementia will reach it, and it could take people drawing on care double the amount of time to get there, compared to the original Dilnot proposals.

On top of this—and particularly alarming in light of the Government’s professed levelling-up ambitions—the joint research from the Institute for Fiscal Studies and the Health Foundation clearly demonstrates that, among older people, those affected and worse off will be the ones with modest assets and wealth living in the north-east, Yorkshire and the Humber, and the Midlands. Regionally, just 16% of people with dementia in the north-east and 19% of people with dementia in the east Midlands would hit the cap, compared to 29% in the south-east. The Minister’s repeated claim that no one will lose out when compared to the current system, or face unpredictable care costs, flies in the face of all this. As the Health Foundation says of the new charging basis,

“the changes are poorly conceived and a step in the wrong direction”,

taking protection away from poorer home owners and working-age adults with care needs.

The Government must therefore look closely at the evidence and think again. My Motion provides a structured way of enabling them to do just that. We are calling for: regulations to be drawn up that define how the costs accrued to meeting eligible needs are determined, as well as specifying the timescale for care cap implementation; ensuring that local authority care contributions, as well as individual private contributions, count towards the care cap; ensuring that the results of the much-vaunted, but little explained, five local authority care cap trail-blazer pilots that have just been set up are evaluated and open to parliamentary scrutiny before the cap is implemented; and, just as important, ensuring the completion of a further impact assessment that provides a detailed regional analysis and breakdown of eligibility for social care and the effect of the cap on working-age, disabled adults under 40. The final point in the Motion concerns this, and the noble Baroness, Lady Campbell, has again spoken very movingly on this vital issue, which any plan to fix social care—and particularly this one—has to address.

The five trail-blazer councils—Wolverhampton, Blackpool, Cheshire East, Newham and North Yorkshire —are developing and testing the new charging system, and they will be early implementers of the cap in January 2023 before rollout in October. I noticed the DHSC fanfare press release announcing them claims that they will,

“implement a new and improved adult social care charging reform system”.

Can the Minister explain how a system which has already started cutting costs at the expense of some of the poorest people in our society can be “new and improved”?

The press release also says of the pilots that the

“insight … and lessons learned … will be useful to providers and authorities … allowing the Department of Health and Social Care to test key aspects of the reforms … The initiative will generate valuable evidence and insight to help the Government to monitor progress, identify challenges and improve understanding.”

In the light of the growing evidence of the impact that the charging proposals will have in some of the most deprived areas of the country, can the Minister explain why the trail-blazers’ remit has not been widened to look closely at these vital issues too? These pilots must focus not only on systems and implementation but also on the vital work and analysis that the impact of the revised charging arrangements will have on the communities they cover and on people desperately in need of social care support.

We must ensure that we understand the full impact of the changes before they are implemented. That is why the further impact assessment on regional eligibility and other issues such as the impact on working-age disabled adults, called for in my Motion, is also important. These are all issues not addressed in the Bill’s current impact assessment.

The savings that the Government are aiming to make by reducing eligibility for the care cap and not allowing local authority costs to accrue towards the cap will result in older and poorer people in some of the most deprived areas of the country, and working-age disabled adults, paying more towards the cost of their care, particularly those with life-long conditions. My Motion provides a structured way forward for the Government to look closely at the mounting stakeholder and independent evidence and think again.

--- Later in debate ---

Moved by

[Baroness Wheeler]

Leave out from “House” to end and insert “do insist on its Amendment 80, do disagree with the Commons in their Amendments 80A to 80N in lieu, and do propose Amendments 80P and 80Q instead of the words so left out of the Bill—

80P: After Clause 139, insert the following new Clause—
“Cap on care costs for charging purposes
(1) The Secretary of State may by regulations amend the Care Act 2014 as regards how “costs accrued in meeting eligible needs” for the purposes of section 15 of that Act are to be determined.
(2) The regulations must ensure that any costs incurred by any local authority to meet eligible needs are included within that determination.
(3) The regulations are to have effect in accordance with a timetable specified in the regulations.
(4) The regulations may not be made unless—
(a) the results of the Trailblazer pilot schemes have been evaluated, and the Secretary of State has laid that evaluation before Parliament, and
(b) the Secretary of State has completed a further general impact assessment covering distributional regional analysis, regional eligibility, and the effect of the care cap on disabled adults under 40.
(5) The regulations must ensure that no charges may be imposed under section 14 for any adult under the age of 40 with a disability.”

80Q: Clause 150, page 128, line 20, at end insert—
“(ca) regulations under section (Cap on care costs for charging purposes);””

[Baroness Wheeler (Lab)]

I wish to test the opinion of the House.

[The Deputy Speaker (Baroness Pitkeathley) (Lab)]

I should inform the House that if Motion G1 is agreed to, I will be unable to call Motion G2 by reason of pre-emption.

NHS: Pre-pandemic Facility Levels

Baroness Wheeler Excerpts

Tuesday 29th March 2022 Lords Chamber

[Lord Kamall (Con)]

That is exactly why, as technology has improved, you should be able to book a specific time. In fact, in some practices, it has gone backwards since the 1970s. When I was a child, my mother was able to phone up and ask, “Can my son have an appointment on Tuesday next week?” These days, you have to phone at 8 am hoping to get in the queue to book an appointment. Technology should improve that, and we hope that once we are able to recover, we will be able to use technology to book in advance.

[Baroness Wheeler (Lab)]

My Lords, the BMA’s Rebuild General Practice campaign has warned that GPs’ lack of time with patients, workforce shortages, heavy workloads and administrative burdens mean that patients’ safety is being put at risk when they attend a surgery. Data shows that GPs are conducting nearly 50% more appointments, but staff vacancies continue to soar and GP numbers to decline. In the light of this, can the Minister explain to the House how the Government expect to achieve their target of an extra 6,000 GPs by 2024—just two years away?

[Lord Kamall (Con)]

I thank the noble Baroness for reminding us of the target. We have been quite clear that it is important that we have as many healthcare professionals as possible and fill the vacancies as soon as possible. We made £520 million available to improve access to GPs and expand general capacity during the pandemic. That is in addition to the £1.5 billion announced in 2020 to create an extra 50 million general practice appointments by 2024, by increasing and diversifying the workforce.

NHS: Gambling Treatment Services

Baroness Wheeler Excerpts

Monday 28th March 2022 Lords Chamber

[Lord Kamall (Con)]

We take the public health aspect very seriously. Public Health England did some work with the DCMS on looking at gambling from a public health perspective, and the Office for Health Improvement and Disparities continues to do that work. While the Department for Digital, Culture, Media and Sport is looking at the gambling industry, we are also looking at this as a public health issue via the Office for Health Improvement and Disparities. I see that the seconds are running out, so I will give the Labour Front Bench time to ask a question.

[Baroness Wheeler (Lab)]

I thank the Minister for that.

GambleAware recently announced a new major public health campaign to raise awareness of the gambling harms that women experience and to highlight the warning signs and the support that is available. It is particularly focusing on women between the ages of 25 and 55 who gamble online. Can the Minister reassure the House that such vital campaigns will continue to be supported through the long-term funding settlement for NHS gambling treatment and support services?

[Lord Kamall (Con)]

I am afraid that I cannot answer on the specific initiative that the noble Baroness refers to, but I know we take very seriously that this is a public health issue that we must tackle in a holistic way. We are looking at how we can allocate funding in the NHS long-term plan to tackle gambling addiction and to ensure that we focus more on prevention rather than simply dealing with people once they have a problem.

Care Homes: Evicted Residents

Baroness Wheeler Excerpts

Thursday 10th March 2022 Lords Chamber

[Lord Kamall (Con)]

The noble Baroness has identified a potential issue that we have to address, which is drilling down into detail. One of the things that the CQC does is to look at aggregate numbers of complaints and concerns. Of course, there is a Local Government Ombudsman who looks at this issue as well. We are looking at ways where that works and where it does not work, and at how we could improve the system. This is all part of the ongoing review to build up a better, integrated health and care system.

[Baroness Wheeler (Lab)]

My Lords, on the issue of carers hesitant to make complaints to care providers, the confusion and muddle over the current complaints system and the roles of the care home, the CQC and the ombudsman compound the problem. Does this not underline the urgent need for the review of the current arrangements to ensure that people making complaints about their loved ones feel reassured and protected through the process and comforted that appropriate action will be taken?

[Lord Kamall (Con)]

Having looked at the different procedures, I am sure that the noble Baroness is absolutely right. One thing that we want to do is to ensure that the guidance is quite clear. The CQC collects certain data and the ombudsman can investigate certain cases, but the CQC cannot investigate individual cases. It clearly is confusing and one thing that we want to do to improve the system is to make sure that we have a better complaints system and, overall, a better quality of care for patients all round.

Health and Care Bill

Baroness Wheeler Excerpts

Lords Hansard - Part 1 & Report stage
Monday 7th March 2022 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, we on these Benches, as has been said, support both amendments in this group. I just ask the Minister one question. We have heard about people who might have to give up work or reduce their hours in order to care. I do not know if the Minister has ever tried to apply for benefits, but it takes a while, and it certainly takes a while for the benefits to turn up in somebody’s bank account. Given that situation, will the Minister talk to the relevant department to see if a fast-track process could be put in place for people in that position?

[Baroness Wheeler (Lab)]

My Lords, I fully endorse my noble friend Lady Pitkeathley’s excellent speech and the other contributions on Amendment 113. The amendment focuses on three fundamental issues for unpaid carers: being fully consulted and involved before their loved one is discharged from hospital; having a proper assessment both of their own needs and of those who they care for; and clinging on to the few concrete rights they have under the health and care and family legislation that refers to and defines carers, including parent and young carers, and the right of all carers to have a carers’ assessment.

I also thank the noble Baroness, Lady Brinton, for adding her name to my Amendment 144 and for her usual forensic analysis of how the discharge to assess approach is working and its impact on both carers and their loved ones being discharged from hospital. I spoke on this amendment in Committee, but the noble Baroness has underlined the key points and I will not therefore press my amendment today. We can instead concentrate on showing strong support from across the House for carers and for Amendment 113.

Speakers made this support very clear in Committee. At the very least, we could have hoped that this would lead to a commitment from the Government to reinstate the carers’ rights that the Bill deletes and to ensure that carers are consulted before the partner, husband, relative or friend they care for is discharged from hospital, as per their current entitlement under the 2003 delayed discharges Act. Instead, there have been no reassurances or movement in these crucial areas, despite some helpful meetings with the Minister. As my noble friend Lady Pitkeathley points out, we are once again having to defend existing carers’ rights rather than working to enhance them to recognise the worth of carers and reflect the vital role that they play.

If the Minister was hoping that his recent letter and the accompanying updated draft guidance on discharge to assess would address the deep concern and frustration felt by carers, then he knows today that this has not worked. The promise of statutory guidance, and of carers being able to undertake judicial review if it is breached, is not the same as legal rights. In reality, how many carers would be able to go down the judicial review route? The Government just do not seem to understand how deeply ignored, undervalued and unrecognised carers feel.

We should remember, on discharge to assess, that the evidence from key stakeholders to the Commons committee dealing with the Bill clearly showed a very mixed experience of how the approach was working. In some areas, the perennial and disruptive issues around delayed transfers have eased and it is working relatively well, whereas in others, there were calls for much tougher safeguards or for the process to be ended altogether. The Government need to recognise that the system is in its early days but that, as we have heard, the horror discharge stories are happening now—and all too often, as we see from the briefings from Carers UK.

In his response, the Minister needs to reassure the House about the action that the Government are taking now to ensure that hospitals involve and consult carers about arrangements before discharge of patients. I hope that he will also accept Amendment 113 and fully recognise that carers’ existing rights must be reinstated in the Bill.

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Moved by

[Baroness Wheeler]

127: Clause 155, page 124, line 16, leave out subsection (2)
Member’s explanatory statement
This amendment is linked with the amendment in the name of Baroness Wheeler to leave out Clause 155.

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[Baroness Wheeler (Lab)]

My Lords, I will also speak to my Amendment 141, which would delete Clause 155. I am very grateful to the noble Baronesses, Lady Campbell and Lady Brinton, and to the noble Lords, Lord Warner and Lord Lansley, for their combined support of these amendments. Sadly, the noble Baroness, Lady Bull, and the noble Lord, Lord Lansley, cannot be here, but the noble Baroness, Lady Campbell, and the noble Lord, Lord Warner, will speak to my amendments. I understand that they will move Amendments 143 and 144A.

In the Care Act 2014, we have a carefully crafted, step-by-step, cross-party agreement implementing the key recommendations of the 2011 Dilnot commission on the cap-and-floor model of social care funding, which went through the full parliamentary processes in both Houses. It built a consensus for implementing and funding the introduction of the care cap in 2016, and enshrining the key Dilnot principles of fairness and equity across all those needing social care. However, as we know, this agreement was never implemented following two separate postponements and a final cancellation in 2019.

Instead, the short Clause 155 we have before us on the Government’s proposals is a last-minute, hastily scraped together, ill-thought-through mishmash of subsections added to an essentially NHS Bill after its Commons Committee had finished, which was then bombarded through that House without any time for close scrutiny and debate. Our own Committee session on this clause started late in the evening at 10.30 pm and lasted not much more than an hour, so we fared little better on such a major and fundamental issue that will impact hundreds and thousands of lives. Moreover, the Minister, despite his offer on the record in Committee to talk to noble Lords about their questions and concerns, has been given no authority to discuss or agree any possible changes to the clause, which is so clearly ill thought through—contrast this with the fruitful discussions that have been held on a number of other important issues in the Bill.

My Amendments 127 and 141 to delete Clause 155 would ask the Commons to think again about how it implements the care cap. It presents a key opportunity for fundamental reconsideration of the Government’s proposals. There has now been time for greater analysis and scrutiny of the proposals and their impact by key stakeholders and expert think tanks, such as the Nuffield Trust and the King’s Fund, both of which have called for the clause to be removed. Its deletion would restore the full provisions on the cap under the Care Act 2014. It would mean that there would be reconsideration of how the cap should be implemented, not whether it would be implemented. Amendment 144A would reinforce this.

Labour strongly supported the 2014 negotiated care cap, its charging package and the costs involved. This has always been in the context of the care cap as part of a much wider social care reform that is needed to address the current crisis and build long-term sustainability and growth, which the Government have yet to address. We know that the Government’s proposals for the cap were discounted by Dilnot in 2011 as unfair, because they will result in people with low levels of wealth spending the largest proportion of their income on their care. The cap at £86,000 is set too high to benefit the majority of people who need to be protected, and the bombshell of abandoning the key safeguarding Dilnot principle enabling local authority care costs to count and accrue towards the cap means that poorer people will be exposed to the same care costs as the very wealthiest in society.

Despite the pledge that nobody should have to sell their homes, the fact is that someone with assets of £100,000 will lose almost everything, whereas someone with assets worth £1 million and over will keep almost everything. This is clearly shown in the extensive modelling by stakeholders such as Age UK, Mencap, the Alzheimer’s Society and the think tanks. That was detailed during our Committee debate, particularly the impact across some of the most deprived areas in the country. The Government’s own figures show that more than one in five older people will not see the benefit of the cap at all, and poorer care users are much more likely to die before they reach the cap than someone who is better off with the same care needs. Only 19% of people with dementia will reach the cap.

Moreover, Amendment 143, which will now be spoken to by the noble Baroness, Lady Campbell, and the principle of which we strongly support, reinforces the key point that a fair cap and charging system has to provide essential support to older adults and working age disabled adults, many of whom have lifelong conditions, including those with learning difficulties and who have to draw on social care support for their daily needs and support. The Dilnot proposals recognise this by seeking to ensure that adults entering the care system under the age of 40 or who were under 40 when they first entered it would have their care capped at zero.

I commend Amendment 144A from the noble Lord, Lord Lansley, to which I added my name. This fully complements the deletion of Clause 155 in restoring the current charging provisions in the Care Act. It would add a new clause to require the Secretary of State to make regulations under the Care Act to ensure that all its provisions on the care cap—Sections 15 and 16—come into force before 1 April 2023. This would mean that there would be no delays to the implementation of the care cap based on the relevant sections of the Care Act. It also means that the uprating of the care cap value from the level fixed in 2014 could take place—the concern of Amendment 182.

What is crystal clear is that the Minister’s repeated claim—or rather, as he described it in Committee, his “hope”—that

“no one will lose out when compared to the current system”—[Official Report, 31/1/22; col. 751.]

or face “unpredictable care costs” just is not borne out by the evidence proving otherwise, which is stacking up every day. Increasing the complexity of local authority charging arrangements on personal budgets, as the government amendments to the Care Act seek to do, makes an already hugely complex and system-heavy admin and technical system even worse. How many care users will be able to understand what is happening? I was particularly interested in the comment by the noble Lord, Lord Lansley, in Committee that a number of the issues that the government amendments sought to rectify or amend were never introduced in 2014 anyway.

How much more straightforward to use the sections of the Act developed for implementation than to try to patch up the provisions and hang them on a different Bill. We support the ambitions of self-funders to pay the same rate for care as local authorities pay for the people they fund, but there is absolutely no evidence of any government intention to provide cash-starved councils with the huge costs involved in this, and bearing in mind the massive underfunding of social care over the past decade.

Clause 155 must be deleted so that the key Dilnot principles of fairness and equity across all those needing social care can be reinstated. Deletion of the clause would mean that implementation of the care cap could proceed but under the provisions of the fully scrutinised Act designed to implement it: the Care Act. Under Amendment 144A, all provisions relating to the cap would be implemented by 1 April 2023.

At the appropriate time, I shall withdraw Amendment 127 and then move Amendment 141 in its place and seek to test the opinion of the House. I understand that the government amendments to Clause 155, which come before Amendment 141, will be agreed on the nod and will then fall if Amendment 141 is carried. I beg to move.

[The Deputy Speaker (Baroness Garden of Frognal) (LD)]

My Lords, the noble Baroness, Lady Brinton, is taking part remotely. I invite the noble Baroness to speak.

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[Baroness Wheeler (Lab)]

My Lords, I thank the Minister for his response, and all noble Lords who have spoken. Between them, the supporters of my amendment seeking to delete Clause 155 have all mounted the overwhelming case for its deletion, so in view of the time I will say just a few words.

The Government insist they have a social care strategy; they do not. They have the cap, hastily tacked on to an NHS Bill—a Bill that does not deal with integration across health and social care—and two subsequent White Papers on integration which set out how social care should look in the future, but with no plan, road map, timescale or massive funding injection out of the health and care levy to show how we will get there.

On the question of why Dilnot was not implemented, I absolutely endorse what the noble Lord, Lord Warner, said. As somebody who was around when the Care Act was carried, I remember that £6 billion was allocated to implement it, so I often wonder what happened to that.

The Minister still has not provided convincing evidence that nobody will be worse off under the Government’s proposals. I asked him in Committee to explain his comments that 90,000 people would be better off under the new eligibility criteria, and have since asked the Bill team, but I have still not received a response to my request to show how this figure was arrived at and, importantly, how it breaks down between older people and younger, working-age disabled adults.

The deletion of Clause 155 would enable the care cap to be reintroduced under the Care Act, under the Dilnot principles of fairness and equity across all those needing care. As I said earlier, I will withdraw Amendment 127; I will move Amendment 141 in its place, on which I wish to test the opinion of the House.

Amendment 127 withdrawn.

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Moved by

[Baroness Wheeler]

141: Clause 155, leave out Clause 155
Member’s explanatory statement
This amendment would remove Clause 155 (Cap on care costs for charging purposes) from the Bill.

[Baroness Wheeler]

I wish to test the opinion of the House.