Covid-19 Update

Damian Green Excerpts

Tuesday 6th July 2021 Commons Chamber

[Sajid Javid]

I am pleased that the hon. Lady has raised this issue. First, I give my personal thanks to the doctor in her constituency to whom she refers and to the many other doctors and clinicians for everything that they have done for the country and continue to do throughout this pandemic. I am not aware of the details of the case that she refers to, but if the hon. Lady writes to me I will certainly respond to her and look at it carefully.

[Damian Green (Ashford) (Con)]

We all recognise that the tremendous success of the vaccine programme has changed everything—my right hon. Friend has made that point eloquently again this afternoon—but it is also clear from recent daily figures that take-up appears to be falling. Can he explain why that is happening? What is he doing to make sure that as many people get vaccinated fully as fast as possible?

[Sajid Javid]

I can tell my right hon. Friend that our take-up, compared with that of any other large country, is the best in the world. That said, of course we would like to see even better take-up. At the moment, four fifths of adults have had at least one jab, and three fifths have had two jabs. We are seeing many vaccine centres moving to walk-in; I visited the one at St Thomas’ Hospital just last week. That has certainly encouraged more people. As I announced yesterday, we are also shortening the gap between the first and second dose to eight weeks for all under-40s, which I think will help as well. We continue to push take-up, but every time the matter is raised in Parliament it is a good thing: it is an opportunity for us all, as parliamentarians, to ask our constituents to come forward, take the vaccine and help to build that wall of defence.

Social Care Reform

Damian Green Excerpts

Wednesday 23rd June 2021 Commons Chamber

[Helen Whately]

The Queen’s Speech reiterated our commitment to reform of social care, and that commitment has been reiterated many times by the Prime Minister and the Health Secretary. On the hon. Gentleman’s question about looking at other systems, of course we look and learn. We look at what works across and within England and around the UK, and in fact around the world. This is a complex thing to achieve and we are determined that we will bring forward our ambitious plans for social care reform later this year.

[Damian Green (Ashford) (Con)]

My interests are in the register.

I was delighted to hear the Minister confirm that the reform announcements will come later this year, and obviously a centrepiece of that will be the key question of how we get significantly more money into the social care system. But can she guarantee that the proposals will cover issues such as workforce planning, the need for changes in the housing stock to enable people to live in their own homes for much longer than they can at the moment, and the use of technology to ease their daily burden, all of which are essential for a sustainable and civilised social care system?

A Plan for the NHS and Social Care

Damian Green Excerpts

Wednesday 19th May 2021 Commons Chamber

[Damian Green (Ashford) (Con)]

It is always a pleasure to follow the hon. Member for Rhondda (Chris Bryant).

Like other Members across the House, I welcome the performance and incredible dedication of NHS and social care staff throughout the pandemic. In the specific context of the Queen’s Speech, I also welcome the Government’s commitment to greater integration. The NHS is a great institution full of massively dedicated people, but my observation over the years has been that it is also a series of individual institutions, all of which are tenacious in the defence of their own interests. GPs are wary of hospital trusts, community services have a separate set of interests, and so do ambulance trusts and others such as pharmacies, which play a vital role but too often do not feel engaged enough.

The integration that the promised health and care Bill seeks to bring about is exactly the right solution, in a number of fields. Technology is clearly key—not just technology at the cutting edge of diagnostics or life sciences, but straightforward stuff so that systems talk to one another and patients do not have to repeat the same set of symptoms to doctor after doctor in different settings because their records have not been passed on. That kind of frustration has no place in the 21st century and should disappear.

The biggest prize of all is proper integration between the health and social care systems. My right hon. Friend the Secretary of State is absolutely right to focus on that in one of his White Papers, and I welcome that as well, but with two caveats. This must not be a takeover by the NHS of social care. The White Paper suggests integrated care systems, which are fine, but I slightly raise my eyebrows at the proposed dual system where the NHS effectively gets its integrated decision in first and then shares it with the social care system. It is vital that social care has a voice at the table where the decisions are taken.

My second caveat is that the social care voice must be properly representative. Too often when people say, “We have consulted social care”, what they mean is, “We have consulted the local authorities.” Clearly, local authorities have a key role to play in this, but they are not the whole social care sector. There are third sector providers and private sector providers, and their voices need to be heard as well. There are 1.6 million workers in the sector—it is larger than the NHS—and their voices need to be heard.

Of course, all this will mean something only if we have a stable and sustainable solution to the social care conundrum that has defined Governments since the 1990s. On that, I want to make four quick points. The first is on funding, which lies at the root of many of the frustrations. It must come out of national, not local, taxation, and it must certainly involve extra state spending, possibly through a hypothecated national insurance increase for some people. It should also involve extra personal savings from those who can afford it, perhaps based on a small percentage of total assets rather than a flat figure for the whole country.

We need to solve the question of funding to solve this, but as well as that, we need a proper workforce plan, not just with better pay, though that is needed, but with a career structure, so that a social care career can be seen as the equivalent of a career in the NHS. The great value of social care workers should be reflected not just inside the system but in wider Government policy, including, for example, in the immigration system.

We also need changes to our attitude to housing and planning. We need to build homes so that people can live in their own homes for longer than they too often can now. Everyone prefers to live in their own home. And, fourthly, to assist that, we must do much better with technology. We need to use the technologies that are now available—it is not cutting-edge technology—to allow people to spend much more of their life in their own home, living a life in comfort before they may have to go into residential care. That is not only better for people, it is much cheaper for the taxpayer and for the families.

All these reforms are necessary if we are going to have a long-term, stable system. Along with my right hon. Friend the Member for South West Surrey (Jeremy Hunt), I have called for a 10-year plan for social care to go along with the long-term NHS plan. That is absolutely essential. It is also essential that this is the year in which we start down this path. We have talked for too long about social care: we need to act.

[Mr Deputy Speaker (Mr Nigel Evans)]

We are in for a treat now: one of two maiden speeches today. I remind everybody that, by convention, there will be no interventions. We are not putting the clock on the maiden speeches, but both Members have been told about the time constraints, so good luck! To make her maiden speech, I call Anum Qaisar-Javed.

Covid-19: Social Care

Damian Green Excerpts

Thursday 22nd April 2021 Westminster Hall

[Damian Green (Ashford) (Con)]

It is a pleasure to serve under your chairmanship, Mr Twigg. As others have said, this is my first speech in the Boothroyd Room, although I reflect, as I look at the wall and see those steely but friendly eyes staring at me, that I have been around long enough to remember that happening live in my first Parliament, with Madam Speaker, as she then was, in the Chair. I am grateful to the hon. Member for Dulwich and West Norwood (Helen Hayes), my co-chair of the all-party parliamentary group on adult social care, for obtaining the debate. I should declare that I am chairing an investigation of social care by Public Policy Projects.

There are two halves to the debate. Obviously there is the covid-19 aspect, but there is also the question of the future of social care more generally, and they clearly come together in important ways. But I shall start with the specific covid-19 aspects. I agree with much of what the hon. Member for Dulwich and West Norwood said. In particular, urgent action is required to facilitate voting by people in residential care homes, on 6 May. That obviously needs to be done in the next few days, and I hope that the Minister can take that message away from the debate.

We have seen the most terrible year ever in care homes —the figures have been put out already, so there is no point in my repeating them. It has been terrible not just for covid victims but for other residents and relatives who have seen the terrible toll of what has happened inside care homes. Happily, we have now moved on from the worst days of this time last year, and the current covid-related issues in care homes tend to relate to access for visitors and the opportunities for residents to make visits outside. Both are hugely important issues for the wider mental health of those living in care homes.

I have a lot of sympathy for my hon. Friend the Minister, for other Ministers and, indeed, for care home managers. The paramount concern must be safety at all times and I can see that there is an extremely difficult balancing act. The solution surely lies in vaccination—not just of residents, but of staff. Through discussions at the APPG working group that we have heard so much about already, I am aware that there is a great disparity of view about how best to encourage vaccination take-up among care home staff.

People argue strongly that threatening to make vaccination compulsory might not be the most constructive approach, and the Government are consulting on that. I await the results of the consultation but, whatever the best system, it is imperative that the percentage of those who work in care homes and who have daily contact with the most vulnerable people in the country should be higher than the national average and not lower, as it is in too many places. That is an urgent aspect of the current situation.

I have fallen into talking about care homes, but domiciliary care is equally important. People move from house to house where there are vulnerable people so the same thoughts apply to that sphere. Those who look after a loved one—“unpaid carers” in the sector jargon—are equally important, and they should be vaccinated as well. I urge my hon. Friend to move fast and get our care workers vaccinated as quickly as possible for the sake of those who need care as well for the comfort of loved ones who will then be able to visit. That will also help to create a sense of normality for those who will then be able to leave the care home that they may have felt trapped in over the past year. That is clearly an important mental health issue.

The crisis over the past 12 months has shone a fierce light on residential social care and has drawn public attention to it in a way that has never happened before. It could scarcely have happened in more tragic circumstances, and the only sliver of consolation from the awful death toll has been the developing consensus that we simply cannot go on putting sticking plasters on to an increasingly fragile system.

It is getting on for a quarter of a century since the first in a list of Prime Ministers said that social care was an urgent issue that needed addressing. I have done some research and I think Tony Blair said that at a Labour party conference in 1997. All his successors have agreed with him, but the problem is that none of them has yet met words with action. That is not for the want of trying.

Under Gordon Brown, Labour produced proposals for a national care service that foundered when it was dubbed a “death tax”. David Cameron put through the Care Act 2014 and a version of the Dilnot proposals. Shaky Government finances meant that was never implemented. In 2017, a new version was proposed by my right hon. Friend the Member for Maidenhead (Mrs May). It was dubbed a “dementia tax” with not great political results. Here we are in 2021 without a solution on the table and the problem is still with us. Later this year, we are promised a sustainable solution in the comprehensive spending review. Let us hope that we see it.

There are many problems to be solved, and some have been mentioned by previous speakers. At the root of them all is funding. The Health and Social Care Select Committee estimates that £7 billion extra is needed to put the system on a sustainable footing. The most intractable problem, as it has been over the past quarter of a century, is how it is raised. If it is all raised from taxation or national insurance, working-age people will, by and large, end up paying for their own care, perhaps later in life, and that of their parents’ generation. That will rightly seem unfair to them.

More promising models offer a mixture of extra public spending and more contributions from individuals—through an insurance system, through a Dilnot-style system or through variations of those models. I argued in a paper for the Centre for Policy Studies that we should look to the pension system for an example of universal state provision being successfully supplemented with private savings. As we have seen with pensions, we have established cross-party consensus under Governments of different parties.

Even when the Government come to a conclusion on how to find the extra money needed—let us hope that it is not from council tax, which is not suitable for funding care—there will be other intractable problems, including workforce planning. The demographics will dictate that we need more workers, so we must make it a more attractive sector to work in. Pay levels have already been mentioned, but the development of a proper career structure for care workers—it can be seen in the NHS, but it is much less easy to see in the care sector—is hugely important.

So much technology of all kinds is available that would improve the daily lives of those receiving care, but I fear that there is no discernible strategy for introducing and experimenting with it.

Housing is a key issue. If we built differently we could keep far more people in their own homes longer, which would make them happier in themselves, most importantly, and be less expensive for the system. I agree very much with Anchor, one of the providers, which says that there should be changes in the planning system that include older people’s housing in local plans and the creation of a new planning classification for retirement communities. That and other ideas are very worth considering.

Finally, and perhaps most importantly, there is the whole issue of what integration we want of the care system and the NHS. I am delighted that the Government produced their recent paper on integrated care systems. It will not be easy to make a reality of that, but it will be absolutely vital.

I make a plea for two things, the first of which is that the voice of the care sector is heard not just in debates on ICSs but inside ICSs when they are introduced. At present it is not clear from the White Paper that that would happen. As a subset of that, simply having local authorities, vital though they are, around those ICS tables is not enough. There are many independent, third sector and profit-making providers whose voices need to be heard.

Secondly, I completely welcome the long-term plan for the NHS—the 10-year plan—but equally it is important to have a 10-year plan for social care that fits with it so that it is seen as a system on its own. It clearly has to mesh very closely with the NHS: it has as many and as complex needs as the NHS and ought to be treated as just as importantly.

I am aware that that is a formidable set of challenges, but 25 years is too long for reaching a decision about how to tackle them. I hope and profoundly expect that this is the year when we will finally see determined and sustainable action on this front.

Covid-19 Update

Damian Green Excerpts

Monday 19th April 2021 Commons Chamber

[Matt Hancock]

The hon. Gentleman raises a very important point. The waiting list issue is very significant; it has built up because of covid, but we must tackle it and we are absolutely determined to do so. He, like me, will have seen the figures last week on the increase in the waiting list in England, but the waiting list has increased in all parts of the UK. We have put in extra funding, an extra £7 billion in total for next year in England and, through the Barnett consequentials, to the three devolved Administrations. That is there to make sure we can get through this backlog while also of course dealing with covid and the infection prevention and control needed to tackle covid. This is a vital task, the hon. Gentleman is right to raise it, and we are working very hard to address it.

[Damian Green (Ashford) (Con)]

My right hon. Friend is rightly proud of the stunning performance of the vaccination teams across the country, and of course I pay tribute to those who have been engaged in that in and around Ashford. I am sure he agrees that it is particularly important for care workers to be vaccinated, and not just care home workers but domiciliary care workers who go from house to house providing essential care. What is he doing to encourage take-up among care workers, to get as close to 100% as possible?

[Matt Hancock]

It is incredibly important that all care workers take up the jab if they possibly can, unless they have a vital medical reason not to, because the jab of course not only protects us, but protects people we are close to, and care workers are close to people who are vulnerable—that is in the nature of the job. That is why I think it is right to consider saying that people can be deployed in a care home only if they have had the jab, and we are looking into that. We have not said that for those who work in domiciliary care—caring for people in their own homes, rather than in a care home—because those in care homes are at the highest risk of all, but I would absolutely urge anybody who is a carer, whether they work in social care or are an unpaid carer, who has not already got the jab to please do get it, to protect not just them, but those to whom they have a duty of care.

Covid-19 Vaccine Roll-out

Damian Green Excerpts

Tuesday 8th December 2020 Commons Chamber

[Matt Hancock]

Thankfully, as the National Audit Office set out, they have not been a feature of any of the response to coronavirus, so that is good.

[Damian Green (Ashford) (Con)]

Those on the frontline normally face bullets, so my right hon. Friend and his entire team deserve the bouquets that they are receiving today. I am delighted that the William Harvey Hospital in Ashford is already dispensing the vaccine. Does he agree that one of the groups in greatest need who deserve it first are residents of care homes, who have faced such a miserable 2020?

[Matt Hancock]

Yes, I do, and I hope that we can get the vaccine out to residents of care homes as soon as is feasibly possible. They are in the top priority group clinically, and it is simply a question of how quickly we can operationalise getting the vaccine out to care homes. I hope that that can start before Christmas. I pay tribute to everybody working at the William Harvey Hospital in Ashford this morning, administering vaccines already and helping to protect the lives of my right hon. Friend’s constituents.

Covid-19 Update

Damian Green Excerpts

Tuesday 10th November 2020 Commons Chamber

[Matt Hancock]

Of course, we are working to ensure that, by us all working together and making sacrifices, we can come out of this lockdown and into the tiered approach we had in place beforehand. That is the goal, and the more that people follow the rules during the lockdown, the more effective it will be. We obviously monitor the data closely on that.

The hon. Lady asked about lateral flow tests and their sensitivity and specificity, which is an incredibly important question. The assessment of the tests we are using in Liverpool and now rolling out elsewhere was made at Porton Down. We then tested 5,000 lateral flow tests alongside 5,000 polymerase chain reaction tests of the same people in the field, and we have a high degree of confidence that they can find people who are infectious. In fact, the lateral flow tests have a lower false positivity issue than the PCR tests, so they are very effective for the right uses, including mass population testing.

The hon. Lady asked about isolation. Of course, isolation is important. I would mention that we have test and trace systems in place across the UK and it turns out that there are differences in how a successful contact is measured. In England, we are much stricter in requiring contact to be a confirmed contact with somebody rather than just sending them a message, which does count as contact in some of the devolved and local systems. It is really important that we measure the same thing, rather than trying to make divisions where divisions do not exist.

Finally, it is vital that people isolate when they test positive or when they are asked to by NHS Test and Trace. I gently say again that the 20% figure is not particularly robust, because it implies that 80% of people are not doing anything to isolate. That is not what the survey found. Nevertheless, we should all urge and require people to follow the rules. When someone tests positive, they must isolate, and contacts must isolate. That is part of our social duty.

[Damian Green (Ashford) (Con)]

It is indeed a relief to have some hope introduced into our discussions about covid. I am glad that the Secretary of State has announced that use of the rapid result lateral flow tests will be expanded to new geographical areas. As the roll-out continues, will he consider offering tests to specific groups and perhaps in particular close relatives of care home residents who are desperate to make regular visits?

[Matt Hancock]

Yes, of course. I have seen some heart-rending stories and I have met people who are affected by their inability to see their relatives in care homes. The lateral flow tests that we are sending to directors of public health can be used for cases that they think are important locally, so they can use them for this purpose if they so choose. But we are also looking at a broader solution to this problem, which is a conundrum we have discussed many times in this House: we need to keep people in care homes safe but at the same time, of course, we want to allow as much visiting as can be safe, which directly impacts on the health of many residents.

Covid-19 Response

Damian Green Excerpts

Tuesday 2nd June 2020 Commons Chamber

[Matt Hancock]

The hon. Lady is quite right to raise this issue and to discuss it in the way she does. Working with the council in Brent, where this disease had one of the highest impacts at the start, we have managed to bring the incidence of disease right down. For instance, ensuring the protection of those living in care homes in Brent has led to the outbreak there coming right under control. Brent is a very good example of where, when we saw a focused outbreak at the start, we put extra resources in; we have put support into Brent Council, and together we have managed to get this disease under control.

[Damian Green (Ashford) (Con)]

Along with many of my constituents, I am very concerned that the number of covid cases identified in Ashford has been one of the highest in the country. I recognise that there are complex reasons for this, but in these circumstances may I ask my right hon. Friend to fill the gap that exists in the regional testing centre network—in east Kent—by placing one in Ashford?

[Matt Hancock]

I’m on it.

Covid-19

Damian Green Excerpts

Monday 16th March 2020 Commons Chamber

[Matt Hancock]

I have seen this call and how the Australians have done this, and I discussed it with the Environment Secretary today.

[Damian Green (Ashford) (Con)]

May I ask my right hon. Friend about specific very vulnerable groups? A mother in my constituency is keeping her four children off school because her husband is a diabetic and she does not want to put him at unnecessary risk. Is she doing the right thing? More generally, what should pregnant teachers be doing? Should they be going into work now, or is that too risky?

[Matt Hancock]

Both cases are covered by the formal public health advice that will be published on the gov.uk website. For all specific questions such as that, which of course our constituents will have, I refer them to that advice, to make sure that we get the answers completely accurate.

Social Care

Damian Green Excerpts

Tuesday 25th February 2020 Commons Chamber

[Damian Green (Ashford) (Con)]

I support the Government’s amendment, particularly the line about seeking cross-party consensus. Opposition day debates may not be the ideal time to seek consensus across the Chamber, but consensus will be vital in the long term.

Governments of all stripes have tiptoed around this problem for 20 years because no credible solution is painless for everyone. It is expensive, emotive and, for those of us who have seen the current system close up through our family, often very painful, but there have clearly not been enough of us to make solving the problems less painful than allowing them to drift on with regular injections of emergency funding, which are of course welcome, but they are a sticking plaster.

To have a long-term solution, we need all parties to agree, as they have on pensions—another long-term, expensive, complex issue on which we do reasonably well as a country. Even in these divided political times, people of good will can work together across parties.

We have heard a lot about the overall problems of staffing levels, wages and the capacity of the system to cope, all of which I agree on. The vast majority of people agree that we need to spend more. At the same time, they insist that they should not pay any extra tax themselves. We need a serious conversation about this. It is easy to present solutions for those who do not accept there is a bill.

We know that social care, especially for the elderly, is often too opaque for those trying to understand it, with no apparent logic in the conditions that receive free NHS treatment and those that do not. It is also apparently unfair in not rewarding a lifetime of prudence. Those who have saved feel that their savings will simply disappear, while those who have not saved receive the same level of care, often in adjoining beds.

Less well known is the fact that funding social care out of council tax means local authorities are too often reluctant to allow new care homes to be built. An ageing population means that already more than two fifths of council spending goes on social care. That figure will only increase over the years, so councils are understandably fearful that all their other services will be swamped by the rising demands of the social care system. That is not sustainable in the long term.

Of course, all the various failures in the social care system put unnecessary extra pressure on the NHS. Indeed, the long-term plan, with all its generous funding for the NHS, depends on an assumption that we develop a social care system that keeps people out of hospital longer and discharges them faster in a smooth and timely fashion. At the moment, both halves of that assumption are questionable, as others, such as my hon. Friend the Member for Thurrock (Jackie Doyle-Price), have said. We need to solve the social care problem to solve the NHS problem as well.

A new system needs five objectives. Interestingly, I listened to the speech from the hon. Member for Leicester West (Liz Kendall) and my list does not differ hugely from hers, which suggests that a cross-party consensus is possible. First, a new system needs to provide enough money to cope with the increasing, ageing population. Secondly, it needs to be fair across generations, meaning that today’s working taxpayers are not asked to pay both for their own care in decades to come and the care of the generation above them. Thirdly, it needs to be fair between individuals by ensuring that no one has to sell their own home for care and ending the dementia lottery in which one condition is treated on the NHS and another is not. Fourthly, it needs to lead to an increase in the supply of care beds and retirement housing. Fifthly, in an ideal world it should establish a long-term cross-party consensus.

We need to look to the pension system as a model, because it has achieved many of our aims. In recent years, the state pension has been increased significantly, but at the same time most people save additionally throughout their working years to provide comfort and security in old age. Auto-enrolment has been a great cross-party success story. Similarly, just as the basic state pension has been improved, we should offer a better universal care entitlement, with a better level of care for both home care and residential care. Needs would be assessed locally, but crucially the money would come from central Government rather than local government.

We also need to encourage people to save themselves through a care supplement—a new form of insurance designed specifically to fund more expensive care costs in old age. The analogy is with the private pension system, allowing people to buy insurance at a level that they can afford to provide peace of mind. It would not be compulsory so could not be stigmatised as a death tax or dementia tax.

The ideas I have outlined would take the burden of social care funding away from local councils and, even more importantly, offer certainty and security to the increasing numbers who will need social care in old age. No one would have to sell their house and see their whole inheritance disappear; everyone would have the chance of receiving better care; and fewer people would be left unnecessarily in hospital beds as they wait for social care to be available. None of this is easy and it will take political courage, but it is absolutely necessary if we are to provide peace of mind and security to frail, elderly people and working-age people who need care. They all deserve it.