Adult Social Care

Daisy Cooper Excerpts

Wednesday 1st December 2021 Commons Chamber

[Gillian Keegan]

I thank my hon. Friend for all her work in this area. Obviously, I have just come in at the end of the journey and many, many people have been working on this issue for many, many years. They should all take credit for that work and for reaching this point. She has my firm commitment that the Government are absolutely committed to fixing social care. As I said, we cannot level up without fixing social care, and of course we all have a vested interest in having a very good social care system.

[Daisy Cooper (St Albans) (LD)]

This statement is incredibly thin. It feels as though the Government are trying to fiddle with the light bulbs on the Titanic as it is starting to go down. We have an enormous crisis, where people who need care cannot get it and end up going into ambulances, ambulances are now queueing up outside hospitals, and hospitals cannot discharge patients back into their homes or the community because the care is not there. The statement and the White Paper do not address the fundamental problem of fragmentation and integration. The Minister has already accepted that this is now just a first step. Will she be clear with us today on when she will bring forward concrete proposals for how to tackle the problem of fragmentation and integration between the NHS and care?

[Gillian Keegan]

The hon. Lady is absolutely right that the complexity is broad. We have always anticipated that we would have winter challenges to deal with. With the global pandemic, there is a backlog of all kinds of things that people need—diagnosis, operations, electives and so on—plus all the other challenges such as winter flu and new variants of covid, which are still here. That is why we have specifically put a winter plan in place; we have also set out hundreds of millions of pounds of extra funding to look specifically at the winter challenges and the discharge process. It is not easy, because of the absolute growth in demand. We knew that it was always going to be challenging, and we regularly monitor and measure it with our NHS colleagues.

The hon. Lady mentions a fundamental pillar: the integration of health and social care. That will be subject to another White Paper, which will come early next year and will have more details about integration. She is absolutely right that it is another solid foundation on which social care reform will stand.

Public Health

Daisy Cooper Excerpts

Tuesday 30th November 2021 Commons Chamber

[Maggie Throup]

I find it quite intriguing that the Labour party has been calling for this measure for some time and, now we are introducing it, it is unhappy about it.

[Daisy Cooper (St Albans) (LD)]

Will the Minister give way?

[Maggie Throup]

I must make some progress.

In July, when we lifted most of the remaining restrictions at step 4 across England, we made it clear that our response to the pandemic was not over. The vaccination programme continues to be a huge success and vaccines remain the most important weapon in our fight against the virus. However, as we enter this uncertain time, we must do more and we must do it quickly.

--- Later in debate ---

[Maggie Throup]

My right hon. Friend makes a very good point. I would like to reassure him that we will continue to update the House over the next few weeks, that we will not continue to have these regulations in place for any longer than is necessary, and that—[Interruption.] If I may just finish. The type of regulations he is referring to are reviewed under legislation every four weeks and are more likely to be reviewed every three weeks. I understand his point and I do take it very seriously. I wish we were not in a situation where we have this conflict, but I reassure him that I take his point very seriously and these measures will not be in place for any longer than is absolutely necessary.

[Daisy Cooper]

rose—

[Dr Murrison]

rose—

[Maggie Throup]

I give way to the hon. Lady, who has been trying to intervene.

[Daisy Cooper]

I am grateful to the Minister for giving way. The hon. Member for Sheffield South East (Mr Betts) raised a question about the enforcement of mask wearing. One of the major problems being faced by GPs in my constituency of St Albans is that some people are refusing to wear masks because, “The Prime Minister didn’t have to when he went to a hospital”, so could I ask the Minister how she intends to lead by example when half of her own colleagues are still refusing to wear masks on the Benches opposite?

[Maggie Throup]

As I said earlier, we are mandating the use of face coverings. I think we are in a different situation now with regards to that.

--- Later in debate ---

[Daisy Cooper (St Albans) (LD)]

The Liberal Democrats will support the regulations, but we have grave concerns about whether the Government are doing enough to protect people, to protect the NHS, and to buy scientists the time that they need in order to learn more about the new variant.

We know that masks are effective. We know that they reduce transmission, and they are a small price to pay for the guaranteeing of all our other freedoms. They also allow the clinically extremely vulnerable to leave their homes, which many of them have not done for a very long time. They continue to shield, cut off from society, because they do not have the confidence even to enter a shop or board a bus. I am worried by the Secretary of State’s pledge to abandon masks in a few weeks’ time if omicron proves to be no more dangerous than the delta variant, because the delta variant is still dangerous, and the NHS is already on its knees before we go into the worst of the winter.

I wish there were more support for those in self-isolation. For too long, the support has been too stingy and too hard to access. We must create a sense among people that it is their civic duty to self-isolate if they are asked to do so, and if the Government ask people to self-isolate, they must step up and provide proper financial support. I would also like to see the reintroduction of the encouragement to “work from home if you can” from the Government. The colleagues have also mentioned ventilation, on which the Government have been far too slow to act. In schools right across England, people have been crying out for ventilation for months and months, but the Government have been dragging their heels.

[Alec Shelbrooke]

I want to pick up on the hon. Lady’s comment about working from home. I say gently to her that a great many of my constituents have businesses that thrive on footfall in the city centre of Leeds, and that the working from home encouragement had a devastating impact on their ability to earn a living. When people say, “Let’s just work from home again”, they must recognise that there would be a very large economic impact on a great number of my constituents if that were to happen.

[Daisy Cooper]

I take that point. We know that many of these measures often result in a lose-lose situation. A real problem over the past 18 months has been the way in which people have tried to frame this as public health versus the economy, because for me, having a strong and healthy workforce and a strong and healthy economy are two sides of the same coin. Notwithstanding that, I am encouraging the Government to ask people to work from home where they can, in order to strike the right balance that would reduce levels of transmission. I am not suggesting a blanket mandate for everybody to stay at home; I am suggesting encouraging people to work at home where they can, in a balanced way.

[Dr Murrison]

I am listening carefully to what the hon. Member has to say. Does she agree that the group in society that has really borne the brunt in the past 18 months is young people? They have been particularly affected by so-called work from home, and their mental health in particular—which I know her party takes a close interest in—has in many cases been devastated. I commend to her the best available evidence as published last week. As the hon. Member for Central Ayrshire (Dr Whitford) pointed out, that evidence suggests that two interventions—that is to say, mask wearing and cleaning our hands properly—may well have some impact, but to be honest the evidence for social distancing is pretty thin. Would the hon. Member for St Albans (Daisy Cooper) perhaps like to reconsider the sort of swingeing measures that she appears to be recommending?

[Daisy Cooper]

I thank the right hon. Member for his intervention, but I respectfully disagree with him. What we have learned over the past few months, from public health directors in particular, is that the more measures we take, the better protection we have. It is not an either/or. If we wear a mask, wash our hands and limit the amount of time spent in close proximity to someone else, we limit our overall chances of either catching covid or passing it on. The more measures we can take, the better. Notwithstanding that, when I was talking about working from home, I was not referring to children studying at home. I was talking about the working population. I recognise that there have been enormous impacts—

[Dr Murrison]

I was talking about university students.

[Daisy Cooper]

Ah, okay. I thought the right hon. Gentleman was talking about schools and young people. Of course there have been major issues for young people, but when I was talking about working from home, I was talking about the working population. On the question of students at universities, of course there needs to be a balance. Many universities got it wrong during the pandemic, and I said so at the time. I was utterly appalled when some universities put railings around the student accommodation. We need to strike a balance. This is about reducing our contacts to reduce transmission. There is nothing to prevent university students from going in to study, if that is the point that the right hon. Gentleman was trying to make.

[Dr Murrison]

How on earth does the hon. Lady think that we can mandate or suggest that people work from home but then expect students to tip up? University is about being taught, and being taught requires people to go to work. Or have I missed something?

[Daisy Cooper]

Something appears to have been lost in translation here. I am not entirely sure whether the right hon. Member is referring to students or to the academics who teach them. I am talking about encouraging people to work from home where they can. There are of course examples where people will need to go into work, and they can change the ways in which they work, but working from home has been proven to reduce levels of transmission.

I am concerned that we are talking solely about the new variant, and that the mantra around putting in place restrictions to protect the NHS appears to have stopped. I worry that the Government appear to have lost their tongue. Ambulance services across the whole of England are at their highest alert level: level 4, or code black. That means that there are people in the back of ambulances who cannot get into hospitals. The NHS 111 line has had more than 1 million calls abandoned after 30 seconds this year, when they should be answered within 20 seconds. We have GPs who are reducing their hours or resigning because of the workload and the abuse. Some of them are really worried and saying that they will not to take on the contracts to deliver the booster jabs because of the expectation that they will still have to do the same amount of work seeing their patients and that if they are required to do the booster jabs as well, that will mean longer waits for other appointments. They are not getting the support they need in that regard, and I hope that the Minister will respond to this point. We have record backlogs—

[Simon Hoare (North Dorset) (Con)]

I very much agree with the hon. Lady’s comments, and I wish that she had amplified them more in regard to the ambulance service. I represent a large rural constituency, as many colleagues do, and if people are waiting for ambulances because people are queueing at the acute sector because others cannot be discharged, that is going to lead to huge problems during the winter months. Does she agree that that is something we should all keep at the forefront of our minds?

[Daisy Cooper]

I am incredibly grateful to the hon. Gentleman for raising that point. I have tried to raise that issue as often as I can through various means, and that is probably all I can say on the matter. Back in October, I tabled a written question to the Government to ask how many ambulance services were at level 4, and it took a couple of attempts at chasing that up before I got a response. I believe that hon. Members would benefit from having time to debate the issue in this House. In my own constituency of St Albans, there have been some incredibly tragic cases. A woman lost her baby because she was stuck in the back of an ambulance for many hours without being able to get into the local hospital. Another constituent lost their partner because they were stuck in the back of an ambulance for 12 hours and then died a week later because they had not been able to get that emergency treatment—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. Important though this matter is, the hon. Lady does appear to be straying. Could she please get back to the regulations that we are discussing?

[Daisy Cooper]

The point that I am trying to make is that the Government are framing the introduction of these specific restrictions in terms of whether or not there is extra transmissibility from the new variant. My concern is that they are not talking about whether we need these restrictions, and perhaps others in the future, because of the pressures on the NHS in its broadest sense.

[Sammy Wilson]

The hon. Lady is making an important and relevant point. Would she not accept, however, that these restrictions place a burden on businesses, on people’s individual freedom and on the operation of the education system, all to deal with a problem that is not going to go away as long as we have patients going to accident and emergency because their GPs are not seeing them, and as long as we have patients taking up beds in hospitals because they are not going into care? This will not be solved simply by introducing more regulations that put the burden on private industry because of the failures of the health service.

[Daisy Cooper]

I disagree with some of those points. As a liberal, I believe fundamentally in giving people the most personal freedom they can have up to the point at which it interferes with the personal freedom of others. We hear a lot in this House about personal freedom, particularly from those on the Conservative Benches, but there is very little discussion about our broader responsibilities to others. That is the challenge that we as legislators have in this House: it is about getting the balance right. I do not think this is about putting restrictions on businesses because of the failures of our health service. GPs in particular are struggling with their workloads and with the abuse resulting from campaigns against them that are being led by national newspapers. If we had a stronger workforce to deal with these issues, and if the NHS had not been run into the ground, we would have more frontline health workers to deal with these problems right now. However, I am mindful of the Deputy Speaker’s entreaty to stick to the regulations, to which I now want to return.

As I said at the start, we will support these regulations. I agree with other Members that it is vital we have full scrutiny of any decision to repeal, extend or renew the regulations in any shape or form in the coming weeks. I implore the Government to take action and consider these restrictions in the light not only of this new variant but of the overall pressures across our NHS, whether on GPs, ambulance services or elsewhere.

--- Later in debate ---

[Daisy Cooper]

Does the hon. Gentleman not accept that the major incentive for people to be vaccinated is to reduce their own chances of hospitalisation and death, not just so they can go to the local pub, shop or anywhere else?

[Sir Christopher Chope]

I hope the hon. Lady accepts that people should be free to make their own decision on whether they wish to be vaccinated. I am therefore extremely nervous about backdoor proposals to require vaccine passports. I do not believe people’s freedom should be conditional on taking compulsory medication, which is why I am against the provisions in the Health and Care Bill on compulsory fluoridation. To that extent, I am probably on the same side of the argument as she is.

A mood of increasing intolerance is being engendered towards those who have a reasonable excuse for not wearing a face covering. Paragraph 7.8 of the explanatory memorandum makes it clear

“people do not need to show proof of this reasonable excuse”

but that is not being promoted by the Government. Regulation 5 says:

“For the purposes of regulations 3(1) and 4(1), the circumstances in which a person (“P”) has a reasonable excuse include”—

this is the important point—

“those where P cannot put on, wear or remove a face covering because of any physical or mental illness or impairment, or disability…or without severe distress”.

That is one reasonable excuse, but there are many others. The Government seem to be rather conflicted or muddled, because paragraph 7.8 of the explanatory memorandum says:

“Nobody who has a reasonable excuse and is therefore not wearing a face covering should be prevented from visiting any setting because of the requirements in these Regulations. Furthermore, people do not need to show proof of this reasonable excuse under the Regulations.”

In other words, people do not have to show a face covering exemption certificate, such as this one from Hidden Disabilities. I see quite a lot of people wearing these certificates but, as soon as people have to wear them, they are asked questions, “Well, what are your disabilities?” Most of my disabilities are well hidden, and I intend to keep them hidden. It is unreasonable that we should be creating an environment in which people are being challenged, and being encouraged to be challenged, on their personal and private health.

That brings me to the conflicting content of paragraph 12.3 of the explanatory memorandum. It may just be a misprint, but it says:

“The Department has also included a range of exemptions to ensure that this policy does not unfairly discriminate against those with protected characteristics. Furthermore, the policy will be supported by a communications campaign that will make clear that some people are exempt from these regulations and people should be challenged by members of the public for not wearing a face covering.”

Surely it should say “should not be challenged”. I do not understand it, because paragraph 15.3 says:

“Maggie Throup, the Parliamentary under Secretary of State”—

she is sitting on the Front Bench—

“can confirm that this Explanatory Memorandum meets the required standard.”

If it was indeed a misprint, the explanatory memorandum does not meet the required standard. If it is not a misprint, it is a serious contradiction within the explanatory memorandum and seriously undermines people’s freedom to go about their business without having impertinent remarks and questions put to them by busybodies acting on behalf of enforcement authorities.

--- Later in debate ---

[Mr Mark Harper (Forest of Dean) (Con)]

I shall endeavour to be mindful of that, Mr Deputy Speaker, and shall try to put some of those questions on the record for the Minister.

As many Members have said, and the chief scientific adviser agrees, covid is going to be with us forever and variants are going to be with us forever. This is the first test that we—the Government, the House and society—face in respect of how we deal with covid in a post-vaccine world, where we have vaccines and have vaccinated most of our population. It is important that we do not mess this up and fail that test. It seems to me that we need to respond calmly and proportionately, so I give the Government credit for resisting the calls for the economically damaging measures in plan B. Working from home, for example, does have significant economic consequences, as we saw from the Treasury’s own analysis. Vaccine passports are both illiberal and, as we have seen from the evidence—or lack of evidence—from Scotland, ineffective, so they are the worst of all worlds. They are an ineffective and illiberal policy, and we certainly do not want them introduced here.

Before I deal with the measures, I want to pick up on the point about the NHS made by the hon. Member for St Albans (Daisy Cooper), the deputy leader of the Liberal Democrats. She is absolutely right that the NHS is facing significant pressure, but it is not facing pressure from the number of patients in hospital because of covid, which is around 6% of total bed capacity. The NHS is under enormous pressure dealing with the significant number of patients who were both unable to be treated and scared away from the national health service during the pandemic. We must be careful not to repeat the mistake and scare away a whole new set of patients, as it will take the NHS another very significant period of time to deal with them. There is nothing about the measures that she suggested that will deal with those pressures; they will just make them worse.

[Daisy Cooper]

Although I recognise the right hon. Gentleman’s assertion that covid accounts for 6% of patients in hospitals, I urge him to think about the impact that covid in-patients have in the hospital setting. We know, for example, that for every one patient being treated, an entire ward can be taken out, because it has to be cleaned and if a staff member catches covid, they have to take time off work. I have asked the Government to produce an assessment and provide this House with the details of the impact of covid patients on the availability of beds, staff and elective procedures. Will he support me in asking the Government again to provide that assessment so that we can take an informed decision in this House as to whether these restrictions are necessary and how they may or may not help?

[Mr Harper]

I support the hon. Lady’s general call for transparency, but my point about the numbers is not an assertion; it is about looking at the data and seeing how many patients are in hospital because of covid. That information is published. It is not an assertion, but a fact. Secondly, if hospital trusts do what my trust does, they put covid patients together in hospital. My trust currently has one ward full of patients. It clearly has an impact, but it is not the thing that is causing the biggest problem. The biggest problem in my trust is that it has at least three or four times the number of patients who are not able to be discharged because of inadequate social care. That is the point that I have made several times in the House.

Mindful of your admonition to be relatively brief, Mr Deputy Speaker, let me touch on the regulations in front of us. On the face-covering regulations, they are relatively not damaging economically. I listened carefully to the speech of my hon. Friend the Member for Altrincham and Sale West (Sir Graham Brady), and I agree that it is disappointing that we have moved away from a model where the Government lay out the evidence and the arguments and allow people to make their own decisions. That was a big choice that the Government made last year, and I am very disappointed that they have moved away from it. Weighing against that—this was set out very clearly by the Chairman of the Transport Committee, my hon. Friend the Member for Bexhill and Battle (Huw Merriman), and my hon. Friend the Member for Winchester (Steve Brine), a distinguished former public health Minister—is that at least those regulations have quite a tight expiry date, and they will expire in three weeks’ time. Although I do not like the move back to mandating, I am prepared on this occasion—balancing up the pressures, and because there is an expiry date—not to oppose the regulations, but I will not support them either.

On the self-isolation regulations, I am afraid to say that I am much more concerned, as was my hon. Friend the Member for Winchester, for two reasons. First, while Ministers have been clear that the regulations will be reviewed in three weeks—I will press the Minister on what we might learn in those three weeks—the regulations are not time limited; they amend another set of regulations that do not have an expiry date until March next year. Although the Minister tells me that they will not be enforced for a day longer than necessary, she must recognise that, given the events of the past few weeks and how Ministers handled, among other things, the standards measures, there has been a diminution in trust between Back Benchers and Ministers. Ministers must work hard to rebuild that trust. Having open-ended statutory instruments that do not expire for many months—when they are telling us that the measures only need to be in place for a few weeks—is not, I say respectfully to the Minister, how to build that trust.

Secondly, there is the point that my hon. Friend made. Let us remember that we are making the law, which should always be clear, precise and specific so that people know what their legal responsibilities are and what they are not. I am afraid that reference in the regulations to people who are “suspected” or “confirmed” as having the omicron variant, with no detail about what that is, is simply not good enough. I was trying to be genuinely helpful to the Minister when I intervened on her. I wanted to give her the opportunity to set out in her opening remarks—and I hope she will do so in her closing remarks—how the Government determine whether someone has the suspected omicron variant and what measures have been taken in terms of the scripts that are used by NHS Test and Trace, the information provided to people whom it contacts, the training that staff undergo, and, indeed, whether the app is to be changed to deal with the new regulatory approach. I am afraid that nothing in the regulations that I have seen gives me any confidence that those matters have been properly thought through. Despite what the Minister may or may not say at the Dispatch Box, the law should be clear in the regulations, and it simply is not. On that basis—how the regulations are drafted—I will oppose them.

Mindful of your instructions, Mr Deputy Speaker, I have only a couple more points. When I said that I was worried that the regulations would trigger a new pingdemic, it was picked up in a number of publications. Politico’s London Playbook, which is much read in the Westminster village, said that a Government insider, trying to allay concerns about a pingdemic, had argued that, because people no longer check into restaurants or pubs, they will not be contacted by NHS Test and Trace. They said that contact tracers are really only interested in catching contacts of cases coming into the country on planes. If that is true, I would suggest that the £30,000 million-odd we spend on Test and Trace is not terribly useful. I would be grateful if the Minister confirmed at the Dispatch Box whether what that Government insider has said is Government policy.

It has also been reported in the Financial Times that officials in the Department of Health and Social Care are drawing up contingency plans to require masks in many indoor settings, with a possible work-from-home order over Christmas. Apparently, these plans are being worked on by officials. Will the Minister confirm whether officials are working on such contingency plans? If they are not working on them under instructions from Ministers, can she, as a Minister, instruct them to stop working on such contingency plans and focus on the Government’s actual policies?

My final point is the one that I made yesterday. Ministers have said that they will review the measures in three weeks’ time, as of yesterday. That would be 20 December, when the House will have risen for the Christmas recess—I touched on this in my intervention on the Opposition spokesman. If any of the measures are to be extended, or if further measures are to be brought in, it would be unacceptable for Ministers to do it by decree, which is effectively what the Minister at the Dispatch Box did with these two orders. They should be brought forward to this House for a debate in advance of their coming in. If we have to sit in the days running up to Christmas, so be it. Many people in this country work over the Christmas period in many industries serving the public. We are better paid than most of those people, so if we have to come here and do our jobs, working on behalf of the public, to scrutinise the laws that affect their lives, then I for one am very happy to do so. It would be a failure of the responsibilities that Ministers have if they do not seek to keep the House sitting or recall it if they wish to take those powers. Ministers are accountable to the House and to our constituents through us, and they would be wise never to forget it.

Covid-19 Update

Daisy Cooper Excerpts

Monday 29th November 2021 Commons Chamber

[Sajid Javid]

I can confirm that the new regulation on close contact will be anyone who is a close contact of someone with a confirmed positive case of suspected omicron. The UKHSA is working at speed on the best ways to determine a suspected case. One way is the so-called S-gene drop-out test, but there are other quick ways to ascertain that. The tracing work will be carried out by Test and Trace.

[Daisy Cooper (St Albans) (LD)]

It is often said that how a society treats its most vulnerable is a measure of its humanity, yet a quarter of the clinically extremely vulnerable have yet to receive their third primary dose because of confusion that persists about the third primary dose and the booster. One in five of the clinically extremely vulnerable are still shielding without any Government guidance or support. For them, the uncertainty of the new variant is terrifying. Will the Secretary of State or one of his Ministers please meet me and patient groups to discuss our five-point plan on how we can protect the clinically extremely vulnerable this winter?

[Sajid Javid]

The vaccines Minister, the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Erewash (Maggie Throup), is meeting patient groups this week and she is also happy to meet the hon. Lady.

Health and Care Bill

Daisy Cooper Excerpts

Report stage
Tuesday 23rd November 2021 Commons Chamber

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I rise to speak to amendment 73, which would introduce safeguards around the discharge-to-assess process.

The discharge-to-assess process may have been a necessary element of the NHS’s pandemic response, but it contains gaps in safeguarding that leave unpaid carers vulnerable to financial impact and risks to their health. Many unpaid carers have to begin caring overnight, when their relative or friend, who may be quite unwell, is discharged from hospital without a plan for their care at home. Without a carer’s assessment to check whether a person has the capability or capacity to take on such a commitment, weeks can pass before any plan is made, leaving carers and the people they care for struggling in a desperate situation.

The Government’s own impact assessment on discharge to assess states baldly:

“There is an expectation that unpaid carers might need to allocate more time to care for patients who are discharged from hospital earlier. For some, this could require a reduction in workhours and associated financial costs.”

Organisations that support unpaid carers are outraged by that statement. The Government’s expectation that carers can just drop everything to take on a new caring burden is insulting, particularly given the extra caring burden that 3 million people have already taken on during the pandemic.

I recently queried that point with the Secretary of State at the Health and Social Care Committee. In response, the he wrote to the Committee to say that the Government do

“not expect unpaid carers to need to give up work or reduce their working hours to look after friends or family while their long-term health and care needs assessments are completed”.

When the impact assessment says one thing and the Secretary of State, after being questioned about it, says another, I have to question the understanding in the Department and among Ministers of the discharge-to-assess policy and its impact on the 13 million carers in the country.

[Daisy Cooper (St Albans) (LD)]

Does the hon. Member agree that it would be helpful if the NHS had a duty, as I have attempted to capture in new clause 63, to identify carers, so that their health and wellbeing is taken into account when decisions are made about the people for whom they care? Does she agree that it would be helpful if the Minister responded to new clause 63 in winding up?

[Barbara Keeley]

I do indeed. The hon. Member may not know that, a few years ago, I introduced a Bill to try to persuade the Government to accept that the NHS should have a duty to identify carers. I have tried to introduce it on two more occasions since then, and I will send her a copy. I hope that the Minister will respond to what she has said.

Carers UK has reported high levels of fatigue and stress among unpaid carers, three quarters of whom feel exhausted and worn out because of' caring responsibilities during the pandemic. It would constitute a poor recognition of the sacrifice and dedication of those carers if discharge to assess was left without adequate safeguarding measures for them. Although discharge guidance already states that unpaid carers must be involved in discharge planning decisions when a patient has new or additional care needs, more than one in four are not consulted prior to discharge, and 60% say that at the point of discharge they received insufficient support to protect the health and wellbeing of the patient, or their own health.

Amendment 73 would protect carers from being left waiting an indefinite amount of time for care plans it would ensure that integrated care boards held responsibility for monitoring and reporting on any failures. I support its inclusion in the Bill, and, like the hon. Member for St Albans (Daisy Cooper), I hope that the Minister will respond to these points when he sums up the debate.

Oral Answers to Questions

Daisy Cooper Excerpts

Tuesday 23rd November 2021 Commons Chamber

[Maria Caulfield]

I know that my hon. Friend has a personal interest in improving stroke services. I can reassure him that the national stroke service model was published by NHS England and NHS Improvement in May this year, and that as of 1 April there are 20 operational integrated stroke delivery networks, bringing together key stakeholders to improve the diagnosis, treatment and rehabilitation of those who have suffered a stroke.

[Daisy Cooper (St Albans) (LD)]

Ambulance response times are at their highest since records began. A month ago, on 22 October, I tabled a parliamentary question asking the Secretary of State how many ambulance trusts had moved into level 4—the level at which potential failures creep into the service. I am still awaiting an answer. Will the Minister answer that question today, please?

[Edward Argar]

If the hon. Lady supplies the number of the question, I will ensure that it is dealt with today. As for her broader point, yes, ambulance services across the country are under significant pressure this winter, which is one of the reasons why we have already invested an additional £55 million in helping them to cope with that pressure.

Health and Care Bill

Daisy Cooper Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[Caroline Dinenage (Gosport) (Con)]

I rise to speak on new clause 49. For 40 years, successive Governments have tried desperately to address this issue, and successive Governments have put it in the “too difficult” pile. It is incredibly expensive, it is hellishly complicated and, to put it simply, there is no silver bullet to address all the concerns surrounding it. That is why I am so proud that this Government have made an attempt to grip this issue.

The fact is that what happens to us in old age is entirely random, and whether we incur catastrophic care costs that wipe out everything we have worked for in our lives is often down to luck. The current system is complex, it is unfair, many people simply do not understand it, and that has been compounded by the fact that successive Governments—nobody is blameless—have used unhelpful language such as “death tax” and “dementia tax”, which have made people terrified of the issue and blown any Government’s attempts to try to solve it out of the water.

Such language strikes fear into people’s hearts about what will happen to us when we are elderly, when we are vulnerable, when we cannot look after ourselves any more. As humans, this is something we do not want to talk about. We do not want to consider it or think about it happening to us; not for us the slow decay, the hellishly expensive degeneration, which affects perhaps four in 10, with the catastrophic amounts of money involved affecting perhaps one in seven. That is why insurance models have never really worked.

The new clause looks to amend the cap on care, basically, where the local authority costs should contribute to the metering towards the cap. I have to be honest: I thought really hard about whether I could support this. Many people, including the brilliant Andrew Dilnot, have pointed out the financial inequalities and some of the geographical inequalities of removing the local authority contribution. As local authority contributions differ by area already—they are much higher in better-off areas—there is already a postcode lottery of care depending on where someone lives. We have to address that. The key thing here is not the cap, but the floor. Those with lower property values will be protected by the floor, not the cap. The reforms increase the threshold above which people must meet the full cost of their care from £23,000 to £100,000—more than four times the limit. The daily living costs limit of £200 per week means that more people will keep more of their income and assets and the package includes domiciliary care, which many others have not done. It is not perfect—it is far from perfect—but everyone who is contributing towards their social care today, and those of us who face the uncertainty of this possible spectre in our future, will be better off than they are now. That is why we have to move forward in a way that is deliverable and that we can finally, for once, get over the finishing line, after 40 years of trying.

There are details that need to be fleshed out. The White Paper just cannot come soon enough and I wish to mention two burning issues in particular. The first is how we support working-age adults, who make up more than half of those who need adult social care. Some people need that care throughout their lives; for others it happens to them unexpectedly. How do we support the people of working age for whom care costs are not paid out of a nest egg, which they might have been able to build up over decades of work? Finally, the biggest issue facing adult social care is the workforce. This job is significantly undervalued. It is too often described as “unskilled”. That drives me mad. These people have unbelievable skills. They have experience and passion, and we entrust our most valuable and precious family members into their care and their hands. Frequently, they just make more money in hospitality or retail. How do the Government create a society that values these heroes for what they are? I look forward to reading the White Paper and seeing how the Government will tackle some of these thorny issues, the most intransigent challenges facing our adult social care system, because for those money alone will not be enough.

[Daisy Cooper (St Albans) (LD)]

I would like to start by talking about social care. The Liberal Democrats have long called for reform to properly integrate health and social care services, but this Bill does not do that. As others have mentioned, it seeks to reorganise parts of the NHS, but it pays lip service only to social care. That is why the Lib Dems think that the Bill should be put on hold until the proper social care reforms are brought forward.

As others have mentioned, it has been months since the Prime Minister announced his plan to fix social care. It is unforgivable that this new clause was sneaked out during the sleaze row last week, in a move that changed the goalposts. The Minister would do well to listen to the unease among his Back Benchers as well as among Opposition Members.

Struggling families now face being hammered by a double whammy of unfair tax rises and the prospect of losing their homes to fund care costs. The right hon. Member for West Suffolk (Matt Hancock) is no longer in his place, but I noted that he selectively quoted Andrew Dilnot. He did not quote Andrew Dilnot’s comments on new clause 49. Andrew Dilnot said that that proposal was not welcome. He said that he was very disappointed and that this represented “a big change” that

“finds savings exclusively from the less well-off”.

That is two promises from this Tory Government now broken.

There is also no mention in this Bill of the millions of people who are unpaid carers in the UK, even though we know that carers are twice as likely to experience ill health as a result of caring. That is why I have tabled new clause 63 for debate tomorrow. It is supported by Carers UK and it calls for the NHS to ensure that the health and wellbeing of unpaid carers is taken into account when decisions are made concerning the health and care of the person for whom they care. I hope the Government will support it. I know it is grouped for debate tomorrow, but I reference it now to highlight again the fact that the Bill does not present a comprehensive plan to reform social care.

The Bill also represents a massive and unnecessary power grab by the Secretary of State. It is simply wrong for the Government to have the power to abolish arm’s length bodies and approve or reject the chairs of integrated care systems. The public have been rightly outraged at political meddling in covid contracts, and the Government should learn their lesson. We should all be seeking to protect the independence of the NHS.

Vacancies in the NHS and social care are utterly staggering. We know the numbers: 100,000 vacancies in the NHS and more than 120,000 in social care; and 1.5 million people missing out on the care they need. We simply cannot go on like this, with the Government setting their own sporadic targets and constantly missing them. NHS waiting lists are at a record high. Ambulance services received a record number of calls in October. Major A&Es treated more than 1.4 million people in October—the third highest monthly figure on record.

The Bill will do nothing to get those waiting lists down, nothing to recruit the workforce we need, nothing to help people get seen faster and nothing for the millions of unpaid carers. The Government should delay the Bill for a few months and look properly at reforming social care, rather than doing a half-baked job now. But I do not think they will, and that is why the Lib Dems will vote against it.

[Mrs Maria Miller (Basingstoke) (Con)]

I listened carefully to my hon. Friend the Minister for Health earlier as he introduced new clause 49 because the funding of social care has been a huge concern for too many years. The people we represent deserve far more certainty about how their old age will be funded if they require social care.

We have a pension system and a system to support disabled people, but the funding of social care is a real uncertainty. I pay tribute to the Minister for bringing forward these costed proposals to provide some certainty for the future for more people. He is to be commended for being clear that no one will lose out under the proposals and that the majority will be better off because of the issues that we have already gone through—particularly because the means-test threshold is being significantly raised. He can say that with some force because of the more than £5 billion extra being put forward by the Government to fund social care in a sustainable way for the future.

However, there is still clearly some concern, as the Minister can hear from the debate. As my hon. Friend the Member for Gosport (Caroline Dinenage) said, no solution will be perfect, so I was particularly pleased to hear of the Minister’s plans to publish an impact assessment, which will clearly set out the impact of these measures across the board. That is important.

Finally, I want to speak in support of my amendment 102. We all know that the quality of support that we give victims of domestic and sexual abuse is a marker for the health of our society, and it is not just a matter for the NHS. However, the NHS plays a vital part in that support. Amendment 102 requires the joint forward plan for integrated care boards and their partners to properly set out the steps they propose to take to address the needs of victims of domestic abuse—whether domestic violence or sexual abuse, and whether it involves children or adults.

Amendment 102 does not limit the plan to addressing only the victims of domestic abuse; many other types of abuse are equally devastating, and it is permissive enough to allow innovation and improved ways of working to be developed in guidance. I hope that it can be used as a basis for guidance to integrated care boards as part of their general powers.

Amendment 102 is just part of the greater whole. The Police, Crime, Sentencing and Courts Bill in particular will require action across Government, but the amendment will help to ensure that every part of the state is pulling in the same direction when it comes to issues of domestic and sexual abuse. My amendment is similar to new clause 33, which my hon. Friend the Member for Newton Abbot (Anne Marie Morris) outlined earlier, but my amendment is more permissive and less prescriptive, so I hope the Government will find it acceptable.

Covid-19 Update

Daisy Cooper Excerpts

Monday 15th November 2021 Commons Chamber

[Sajid Javid]

We do support the proposal for an international pandemic treaty, but it is not yet fully supported by many countries, and some actually object to such a move. Many agree on the need for better international co-operation, but not all agree on the form in which it can be achieved. I would love to give my right hon. Friend more detail in response to the questions he has just asked, but I am afraid that the process, which is inevitably an international process, is not as mature as I would like it to be at this point. However, we keep working hard on it.

[Daisy Cooper (St Albans) (LD)]

Like the right hon. Member for Tunbridge Wells (Greg Clark), my constituents are concerned about the fact that the third primary vaccinations and boosters are not appearing on the NHS covid pass. GPs in my area are saying that they still cannot record the third primary jab for the clinically extremely vulnerable on the Pinnacle database, and despite my asking twice, patient groups are still waiting to hear whether the Vaccines Minister will reinstate monthly meetings with them. With less than six weeks to go until Christmas, when will the Government fix these bugs in the system and start listening to patient groups?

[Sajid Javid]

I hope I have understood the hon. Lady correctly. She mentioned “bugs in the system”. She made two separate points there. If someone has been given a third jab, whether a third part of their primary dose, a booster or otherwise, it is recorded in the NHS system. The hon. Lady referred to the Pinnacle system, but it is recorded. I am not aware of any problem with recording it or with the NHS making a record of it; if she is, she should please bring it to my attention. The second, separate point she made was the one my right hon. Friend the Member for Tunbridge Wells (Greg Clark) made, about when those doses can appear in the app. I refer her to the answer I gave a moment ago.

Covid-19 Update

Daisy Cooper Excerpts

Tuesday 9th November 2021 Commons Chamber

[Sajid Javid]

My right hon. Friend is absolutely right that parliamentary procedure is vital. As well as publishing the impact assessment before a vote, I can share with the House that we will be publishing an impact statement today. That will be followed by the impact assessment, later. He mentioned the figure of 32,000. That is the latest published number, from the end of last month. Although it has only been a few days since then, the situation is currently quite fast moving because the number might include a number of people—perhaps in their thousands—who are medically exempt but about whom the Care Quality Commission has not yet been informed. He has pointed to the need for the Government to share our thinking or that of the NHS on workforce planning with respect to this new measure. We will set out more details.

[Daisy Cooper (St Albans) (LD)]

A number of care home owners have said that the damage has already started to be done, and that some of their carers are leaving either their jobs or the sector entirely. I welcome the Secretary of State’s statement that an impact assessment will be forthcoming, and look forward to seeing the impact statement later today. In response to the hon. Member for Rochdale (Tony Lloyd), the Secretary of State also mentioned that the Department is monitoring the issue on a “day-by-day basis”. I worry that an impact statement might be too late if we have to wait two or three months for a vote. Will he commit to publishing the data that he is looking at day by day, so that Members of the House can see in real time whether the policy is going to have an impact on the workforce situation in the NHS and care homes?

[Sajid Javid]

We will be publishing the impact statement today.

David Fuller Case

Daisy Cooper Excerpts

Monday 8th November 2021 Commons Chamber

[Sajid Javid]

I agree very much with my right hon. Friend. He is absolutely right to raise those points. As he said, these appalling crimes have taken place over a number of years. I am certain that the independent inquiry will get to the bottom of that and that we can learn not just about mortuaries in hospital settings, but much more broadly. He is also right to draw attention to the vast majority of people who work in mortuaries, the morticians and those who support them, for the very difficult and important work they do.

[Daisy Cooper (St Albans) (LD)]

This is a truly harrowing case and I think many people will be shocked not just by the horrific nature of the crimes, but by the fact that many of the extra steps announced today were not already in place. Will the Secretary of State give an indication of how quickly he expects hospitals to adopt the extra steps of CCTV coverage, swipe access and DBS checks in every single hospital and mortuary?

[Sajid Javid]

I would expect that many of those steps may well be in place in many NHS trusts. The purpose of the NHS writing to all trusts is to ensure that the kinds of steps that I set out earlier, and others, are in place, so they are following the current rules and guidance that are set out by the Human Tissue Authority. What we also need to do is determine whether the current rules and guidance are right in the light of these appalling crimes and whether we need to go much further than that. That is also the purpose of having an independent inquiry.

Covid-19 Vaccinations

Daisy Cooper Excerpts

Thursday 4th November 2021 Commons Chamber

[Maggie Throup]

I think my hon. Friend has already got his message over loud and clear to his CCG, but we can have further discussions if he finds that has not worked.

[Daisy Cooper (St Albans) (LD)]

I am grateful to the Minister for having fixed the problems with the booster booking system that I raised with her two weeks ago, but the system for third jabs for the clinically extremely vulnerable is still in total chaos. Some clinically vulnerable people are saying that their GPs do not know which group they are in and, even if their GPs do know, those people who are eligible for their third dose and their jabs cannot be identified on the online system. Will the Minister commit to fixing the system in the next 48 hours and urgently reinstate the monthly meetings that her predecessor held with patient groups, which have been trying to bring these concerns to her attention?

[Maggie Throup]

The hon. Lady raises an important issue. However, it is important that, for that individual whose GP is not able to give them a jab, they have words with their hospital consultant who may have more knowledge of their condition. I will definitely look into the system.