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.

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.

NHS England Funding: Announcement to Media

Daisy Cooper Excerpts

Monday 25th October 2021 Commons Chamber

[Daisy Cooper (St Albans) (LD)]

(Urgent Question): To ask whether the Government will make a statement on the announcement to the media of £5.9 billion for NHS England.

[The Minister for Health (Edward Argar)]

Mr Speaker, I hope that you will recognise that I seek to be assiduous in my accountability to this House and in adhering to its protocols and forms, not least as a former member of the Procedure Committee. I can reassure you that what you said just now will have been heard not just by me but by colleagues in my Department and in Her Majesty’s Treasury.

Just as we are determined to keep this country safe from covid-19, we also want to tackle the backlog that the virus has brought with it. We know that “business as usual” will not be enough, so we will do whatever it takes to ensure that people get the treatment they need as quickly as possible. In September, we announced plans to spend £8 billion to tackle the elective backlog over the next three years, in addition to the £2 billion this year.

The House will have seen the announcement of £5.9 billion to tackle the NHS backlog of diagnostic tests and procedures and to support the delivery of millions more checks, scans and treatments for patients across the country. This includes £1.5 billion for increased bed capacity, equipment, new surgical hubs to tackle waiting times for elective surgeries and at least a total of 100 community diagnostic centres to help to clear backlogs of people waiting for clinical tests such as MRIs, ultrasounds and CT scans, as well as £2.1 billion of investment to modernise digital technology on the frontline.

This is an historic package of investment that will support our aim of delivering around 30% more elective activity by 2024-25 compared with pre-pandemic levels. That of course comes on top of the work we are doing to strengthen the NHS workforce, who have performed so brilliantly throughout this crisis. All of this is vital if we are to help get our NHS back on track and ensure that no one is left waiting for vital tests or treatments and that we have the right buildings, equipment and systems so that our NHS is fit for the challenge ahead.

[Daisy Cooper]

Almost every elected Member of this House woke up this morning to see the announcement of extra cash for the NHS in England to reduce the covid backlog, although it contained absolutely no details at all. There were no details on where the money will come from, no details on what this means for the almost 6 million people still waiting for treatment, and no details on what it means for our exhausted NHS staff. The Minister has reportedly said that this money is new. Well, is it? How do we scrutinise that claim? Will the Minister set out clearly today—not on Wednesday—where the money is coming from?

Many hospitals in the Government’s so-called new hospitals programme, including those in west Hertfordshire, have been waiting months for funds to be released so that they can start renovation work. Is any of this so-called new money actually part of these existing commitments? There are almost 6 million people stuck at home in pain waiting for treatment. Senior medical staff are predicting thousands of early deaths if the Government fail to act. People are desperate to know how many more weeks they have to wait for their operation. Can the Minister tell them?

Finally, it is all very well announcing money for new diagnostic tests and medical equipment, but there are tens of thousands of vacancies in the NHS. Without the trained medical staff to use these new facilities, this plan is doomed to fail. Without a serious plan to recruit the NHS staff that we desperately need, England could face an epidemic of empty wards and shiny new scanners and superfast broadband going to waste because the staff who make our NHS what it is simply are not there any more.

[Edward Argar]

The hon. Lady is right that the waiting list is 5.7 million and growing. As she will have seen, the Secretary of State has made it clear that the number could grow to more than 13 million if all those who would normally have come forward in the previous year do come forward. That is exactly why we are taking these steps. Rather than expressing concern about the announcement, I would have thought she would welcome this investment, this new money, to help tackle those waiting lists. Of that 5.7 million, around 1.36 million—I may be slightly out—are waiting for diagnostic tests, which is why this is so crucial.

The hon. Lady asks where the money is coming from. She tempts me, but I am afraid she will have to wait until Wednesday’s Budget for the Chancellor to set out how he is funding each of the announcements.

The hon. Lady touched on the single most important element of our ability to tackle the pandemic and to respond to the consequences for the elective waiting list and, as I know she would, I put on record our thanks and gratitude to those staff. Radiologists and radiographers are the key people in this space, and since 2010 we have increased the clinical radiology workforce by 48% from 3,239 to 4,797 full-time-equivalent posts. The number of diagnostic radiographers is up by 33% since 2010.

Does that mean we need to continue to do more? Of course it does, and she is right to highlight the need for continued investment in our workforce. She will have seen last month’s announcement of £12 billion of funding, a significant part of which will help to build that workforce, on top of the commitments we made at the last election and on which we are delivering.

Covid-19 Update

Daisy Cooper Excerpts

Thursday 21st October 2021 Commons Chamber

[Maggie Throup]

There will be further details of this additional funding shortly, but it will be to encourage more people to become care workers and to support those in place already, so I am sure it will achieve exactly what my hon. Friend has requested.

[Daisy Cooper (St Albans) (LD)]

Many of my constituents are desperate to get their third jabs and their boosters. The Minister said that if their invitation has not arrived, they can book on the national booking service or 119, but that is simply not working. When they get on to the national booking service, it says they are not eligible if they have not received an invitation letter. If they call 119, it is telling them it cannot override the system. Will the Minister please urgently look into that and fix the system, so that my constituents and many others can get those jabs, because they want them now?

[Maggie Throup]

Yes, I will definitely look into that. If there is a problem in the system, we will get it fixed.

Oral Answers to Questions

Daisy Cooper Excerpts

Tuesday 23rd February 2021 Commons Chamber

[Matt Hancock]

My hon. Friend is absolutely right. The court ruling in question found that we were on average 17 days late with the paperwork, but it did not find against any of the individual contracts. My team worked so hard to deliver the PPE that was needed and so, as the National Audit Office has confirmed and as my hon. Friend set out, there was never a point at which there was a national shortage. There were, of course, localised challenges and we were in the situation of a huge increase in global demand, but I think that we should all thank the civil servants who did such a good job.

[Daisy Cooper (St Albans) (LD) [V]]

The Prime Minister’s first test for easing restrictions is that the vaccine deployment continues successfully, yet GPs and pharmacists have been telling me for weeks and weeks and weeks in St Albans that they cannot get the vaccine supply that they desperately need. They could be vaccinating 14,000 people a week, but they are only getting the supplies for 1,000. Why is that and when will it be fixed?

[Matt Hancock]

As we have repeatedly explained, supply is the rate-limiting factor. The hon. Member will no doubt have seen that there have been international discussions on the rate of supply, and countries around the world are finding supply the rate-limiting factor. Thankfully, thanks to the decisions that this Government took early, we have some of the best access to the supply of vaccine in the world. That is why we have one of the best vaccine delivery programmes in the world.

Covid-19 Update

Daisy Cooper Excerpts

Tuesday 9th February 2021 Commons Chamber

[Matt Hancock]

I will look into my hon. Friend’s suggestion.

[Daisy Cooper (St Albans) (LD) [V]]

The head of the Government’s own test and trace system admitted that up to 20,000 people per day who are asked to self-isolate are not doing so. Will the Secretary of State please confirm, after 10 months of being asked for it, when he will come up with a plan to fix the isolation system, so that those who need to self-isolate have the pastoral and financial support they need to do so?

[Matt Hancock]

We have put in place that support, including £500 for all those on low incomes. Everybody who is asked to self-isolate needs to self-isolate to break the chains of transmission.