Social Care Reform

Helen Whately Excerpts

Wednesday 23rd June 2021 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

(Urgent Question): To ask the Secretary of State to make a statement on the Government’s plans for social care reform.

[The Minister for Care (Helen Whately)]

I thank the hon. Lady for her question, and for giving me the opportunity to talk about social care reform. I start by paying tribute to carers, paid and unpaid, for all they do in looking after people in their homes and in care homes every single day with kindness and compassion. To any who may happen to be watching or listening today, I say “Thank you for what you do.”

Over the past year in government, we have rightly focused on supporting social care through the pandemic. This has included an extra £1.8 billion of funding, sending more than 2 billion items of free personal protective equipment to care providers, distributing more than 120 million covid tests to social care and vaccinating hundreds of thousands of care home residents and most of the care workforce.

While the pandemic has posed unprecedented challenges to social care, it has also strengthened the argument for reform, and we now have the opportunity to build back better in social care. We have a once-in-a-generation opportunity to build a care system for the future, and I am hugely ambitious. I want a care system in which we can be confident, for our grans and grandads, mums and dads, brothers and sisters, children and grandchildren and, indeed, ourselves. I want people to be able to get the care that they need when they need it, and to have choices—to live life to the full in the way they want, living independently and part of a community for as long as possible, without facing an astronomical bill.

I want to join up health and care around people, so that it works as one system dedicated to meeting the needs of individuals, and giving them the personal care they want and need to live their lives to the full. I want the care workforce to be properly recognised and valued for what they do—for their skills, their compassion and their commitment. I want them to have more training, more opportunities and more prospects for career progression. I am committed to supporting unpaid carers not only in the care they provide, but with their own health and well-being, so that they can live their own lives as well as caring for others.

We are already taking steps on the road to reform. The health and care Bill will introduce Care Quality Commission oversight of local authorities’ provision of social care. It will also help to join up health and social care by putting integrated care systems on a statutory footing. We are working on our long-term plan for social care, and we will bring forward our proposals for social care reform later this year.

[Liz Kendall]

It has been 100 weeks since the Prime Minister promised to

“fix the crisis in social care”

with a plan he had already prepared, to give people the dignity and security they deserve. Since then, almost 42,000 care home residents have died from covid-19. Two million people have applied for support but have had their requests refused, and tens of thousands have had to sell their homes to pay for care. Families have hit breaking point, and staff have been appallingly let down. Even after all the horrors of the pandemic, nine out of 10 councils say that they face care budget cuts this year.

This week, we learned that Ministers cannot even be bothered to have a meeting to finally come up with the goods. That is not delivering dignity; it is abdicating responsibility, so can I try again with the Minister? When precisely will we see the Government’s plan? A vague commitment to some time later this year will not convince anyone, after all the delays and broken promises. Will the plan include a cap on care costs, so people’s life savings are not wiped out? That has been repeatedly promised and was legislated for seven years ago, but it has still not been delivered. Will there be proper proposals for people with disabilities, who make up a third of the users and half the budget for social care, but have been entirely absent from the debate? Where is the decent workforce plan to ensure that frontline carers get the pay and conditions they deserve, and that we end endemic staff shortages? Will unpaid family carers finally get the help they need, so that their own health does not suffer and they are not forced to choose between holding down a job and caring for the people they love?

In the century of ageing, we cannot build back a better future for Britain without a decent system for social care. This is as much a part of our infrastructure as the roads and railways are. Our country urgently needs a plan. The time for excuses is over. When will the Government deliver?

[Helen Whately]

Of course we have focused on supporting social care through the pandemic over the past 18 months; that absolutely had to be the right thing to do when facing an unprecedented challenge. During the pandemic we not only supported social care, including, as I said, over £1.8 billion of extra funding direct to the care sector, but supported local authorities with over £6 billion of extra funding. But yes, we are determined to bring forward proposals for social care reform. We have been absolutely clear that we shall do that. The hon. Lady asked about particular meetings. Actually, the Health Secretary and the Prime Minister talk about social care reform all the time. In fact, I spoke to the Prime Minister only last week about social care reform. These are complex matters. The hon. Lady will know that nearly 25 years ago, Labour Prime Minister Tony Blair said that we needed reform of social care, but during the 13 years of Labour government, was there a plan for social care reform? No, there was not. We are the Government who are going to bring forward social care reforms. I would welcome her support for that. We are a Government who deliver. We have delivered Brexit, we are delivering vaccinations at a phenomenal pace, and we will deliver social care reform.

[Jeremy Hunt (South West Surrey) (Con)]

I know that the Minister is working hard behind the scenes to get a resolution to these issues, and I thank her for her efforts to do that. Does she agree that the NHS will fail in its objective to deal with the covid backlog if the social care system continues to export its most vulnerable patients to our hospitals, filling up hospital beds that cannot then be used to deal with the enormous backlog of cancer and other operations that we have? Does she also agree that the founding principle of the NHS—that no matter who you are, rich, poor, young or old, you should be able to access the care you need—is fundamentally undermined by the way we treat people with dementia, whereby people who are wealthy are able to pay expensive care home fees but people of limited means find that they are cleaned out of absolutely everything when a loved one gets dementia?

[Helen Whately]

I thank my right hon. Friend for his support for our determination to reform social care. He makes an important point that we have to look at the NHS and social care together as the two parts of the system affect each other. That is one important reason why the health and care Bill needs to improve the join-up between health and social care. On his point about dementia, it is true that some people who suffer from dementia need care for very many years and this is extremely costly. That is one of the things we want to address as part of our social care reforms.

[Martyn Day (Linlithgow and East Falkirk) (SNP) [V]]

It is noticeable that while the UK Tory Government failed to mention social care reform in last month’s Queen’s Speech and have yet to deliver the long-awaited social care Bill, by contrast, under limited devolution, the SNP Government are establishing a national care service backed by a 25% increase in social care investment. What lessons has the Minister learned from this Scottish example? What recent consideration have the UK Government given to exempting the Scottish Government’s £500 thank-you payment for health and social care staff from tax and benefit deductions? As the settled status deadline fast approaches, the SNP is calling on the UK Government to automatically grant post-Brexit residence status to prevent a cliff edge for EU nationals and a black hole in Scotland’s care sector. Will the Minister urgently discuss this with Cabinet colleagues?

[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?

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[Helen Whately]

My right hon. Friend makes an important point about the breadth of the reform that is needed. I can confirm that we are looking at how we can support the workforce further, including by raising skills and improving training opportunities and career progression, and how technology can be used to support better care and more independence as well as providing more time for the workforce to do personal care rather than administration. On housing, most people want to live behind their own front door for as long as possible, surrounded by their own things and in their own communities, so that is also absolutely part of our reform.

[Munira Wilson (Twickenham) (LD) [V]]

New analysis for the Care and Support Alliance found that since the Prime Minister stood on the steps of Downing Street some two years ago and promised to

“fix…social care once and for all”,

2 million requests for formal care and support from adults over 18 have been turned down by their local council; that is the equivalent of 3,000 requests being turned down every day, putting immense pressure on unpaid carers as well as the NHS. This shows the human cost of dither and delay, so will Ministers stop their internal spats and off-the-record briefings and commence cross-party talks immediately with the sector so that we can fix this issue?

[Helen Whately]

We have of course had to focus on the pandemic over the last 18 months, but we are already working on reform. We are already consulting widely with the sector; I and the Department have together met and spoken to more than 70 different organisations and representatives of the care sector, from care providers to local authorities, and including care users and carers themselves. We will be working with this broad range of people, including parliamentarians; we need to build a consensus not only across Parliament but in society as a whole for our social care reforms.

[Mark Fletcher (Bolsover) (Con)]

Over the past couple of years I have spoken to many families across the Bolsover constituency who are affected by social care and all the challenges that we know the sector and those who work in it face. Does my hon. Friend agree that this should not be a matter of party political point scoring and that what we need is a sustainable solution? Will she commit to delivering that solution this year so that we can have a social care sector that is fit for purpose for many years to come?

[Helen Whately]

My hon. Friend is clearly having conversations in his constituency, and he makes an important point about the scale and number of people who have involvement in the care system. There are over 1.4 million people who receive care, over 1.6 million people in the care workforce, and over 5 million unpaid or family carers. The scale is huge and is growing as more people need care. My hon. Friend is absolutely right that this is not a party political issue; we need to come together and build a consensus across Parliament, but also across society as a whole—and, yes, we will bring forward proposals for reform later this year.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for her statement today on social care reform. An issue close to my heart is support for carers in the form of respite; in particular we have generations of young carers who need a break after the isolation of the pandemic. Will the Minister commit to making funding available specifically to provide respite overnights for carers who carry out their activities 24/7 and need support more than ever right now?

[Helen Whately]

The hon. Gentleman makes a really important point about respite for carers. Being a carer is hard and back-up support and respite services help make it more possible, but frustratingly, during the pandemic many of those services have not been able to function as normal. I am currently working with Ministry of Housing, Communities and Local Government Ministers to help local authorities across England ensure that day services and respite care are fully restarted as that is very important, and I would like to see that across the whole of the UK.

[Martin Vickers (Cleethorpes) (Con)]

I appreciate this is very difficult for the Minister, because until we actually know what the Government’s proposals are, she is answering questions based on assumptions and guesswork, but she will know that the main concerns of families are twofold: that they get adequate care; and that they will not have to sell their family home to provide that care. What assurance can she give that the Government will take into account the fact that people want to hold on to their family home? On the assumption that the value of assets will play some part in whatever formula we come up with, what account will be taken of the vast difference in prices of property in London compared with, for example, Cleethorpes?

[Helen Whately]

I hope my hon. Friend will forgive me if I am not drawn on the assumption point that he made in the second part of his question, but what I can say to him is that the Prime Minister has been clear that he wants a social care system where no one needing care should be forced to sell their home to pay for it.

[David Johnston (Wantage) (Con)]

On Friday I met my constituent Phil, whose mother, given the state of her dementia, has gone to into a care home. The day before I met my constituent Denise, who is trying to keep her mum, who has Alzheimer’s, in her own home. I think they are pretty typical of most of our constituents, because in addition to the cost issue, they are dealing with the complexity of a system they do not have experience of, as well as trying to get the right quality of care. Can my hon. Friend confirm that the issues of cost, complexity and quality of care will all be dealt with in the reform proposals?

[Helen Whately]

Yes, I absolutely can. We know that cost is a real problem, but there is also a real variation in quality of care. In fact, we are already taking steps on that. That is one reason why the health and social care Bill introduces an assurance or oversight system of the provision of care commissioned by local authorities. Yes, the breadth of the issues that my hon. Friend refers to is being considered in our reform proposals.

[Vicky Foxcroft (Lewisham, Deptford) (Lab) [V]]

The 2018 Equality and Human Rights Commission report, “Housing and disabled people: Britain’s hidden crisis”, found that disabled people in the UK were not getting the support they needed to live independently. Three years on, we still have not seen any sign of the national strategy for disabled people which was promised this spring. Does the Minister agree that that is long overdue, and can she tell the House what her Government are currently doing to support people to go into independent living?

[Helen Whately]

One thing I am very aware of is that often the debate about social care reform is a lot about care for older people, but that we should also make sure we are thinking at least as much about care for those of working age with disabilities. I and the Government certainly do think about that. We are working on the national disabled strategy, which I have contributed to. It will be coming forward shortly.

[Christian Wakeford (Bury South) (Con)]

The Fed at Heathlands Village in my constituency is an amazing example of what care can and ultimately should look like, so I want to start by extending an invitation to the Minister to walk around The Fed with me to see what services really should look like. What can we do to ensure that The Fed is not just a torchbearer, but the norm?

[Helen Whately]

I thank my hon. Friend for his invitation. I do my utmost to get out and about—at the moment, mainly virtually—but I am looking forward to being able to go on more visits in the weeks and months ahead. Absolutely, what I want to see is a high standard of care available for everybody across the whole country.

[Clive Efford (Eltham) (Lab)]

It is nearly two years since the Prime Minister promised to fix social care. In the intervening period, we have had the false promise that there was a ring of protection around social care homes. The Government’s treatment of people in care homes, their families and the workers in that field of public service is appalling. This is a highly politically charged issue. We tried to fix it when we were in government and were attacked by the Opposition. The Government have had a similar experience. The only way forward on this is for the Government to have cross-party talks on how we find a solution to this problem. Will she commit to doing that?

[Helen Whately]

I would just remind the hon. Gentleman of the unprecedented level of support we have given to the social care sector during the pandemic, as I mentioned a moment ago. I know it has been extremely hard, but that is why we provided over £1.8 billion-worth of funding, free personal protective equipment, access to testing, and, of course, priority in the vaccination roll-out. On his point about needing to build a consensus around social care reform, I am already talking to parliamentarians across parties. In fact, just a couple of weeks ago I had a really helpful session with the all-party parliamentary group on adult social care. I look forward to continuing to work with colleagues across the House.

[John Redwood (Wokingham) (Con) [V]]

Will the Minister ensure that quality of care for the person needing it is central to the review? Can we learn lessons over the safe discharge of people from hospital into care settings? Will the NHS ensure that in future GP and nursing care, where needed, is available to support those patients on discharge?

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[Helen Whately]

One thing I will say is that during the pandemic GPs and primary care in general have really stepped up to support those in care homes in particular, with every care home having a point of contact in primary care to ensure the support from GPs that those residents require. Yes, quality is at the centre of our proposals for social care reform.

[Alex Sobel (Leeds North West) (Lab/Co-op) [V]]

We all know that commissioning in social care is broken. The price paid for care is too low, the wages paid to carers are too small and there is a lack of training and professional development for carers. I would like the Minister to address the issue of home care being commissioned by the minute—it is the only publicly funded service commissioned or measured by time. Will the social care plans address that? She could do worse than look at the GMB’s ethical care commissioning charter to see a way forward.

[Helen Whately]

Some really interesting and important work has been done on commissioning, looking at the outcomes of care rather than being so focused on inputs, which sometimes leads to the situation described by the hon. Member. One of the opportunities of the oversight system that we propose through the health and care Bill is that it will shine a light on the different ways in which local authorities commission care and give more visibility to what works. Those ways of commissioning that do not lead to such good outcomes can therefore learn from others. We look forward to seeing an improvement in how care is commissioned and, therefore, the care that people receive.

[Robert Largan (High Peak) (Con)]

Fixing our social care system is the biggest long-term challenge facing the country. However, for all the scale and complexity of the issue, fundamentally it comes down to money. We must find a way to fund our social care system fairly and sustainably. Will the Minister assure the House that she will work on a cross-party basis to bring forward reforms as soon as possible so that we can prevent the appalling situation in which people are forced to sell their home to pay for care?

[Helen Whately]

I can absolutely assure my hon. Friend on that point. One of the things we are committed to addressing is the situation where people may have worked all their lives to purchase and own a home and pay off a mortgage but then find themselves faced with a care bill of a size that uses up the value of their home when, perfectly reasonably, they want to be able to pass something on to their family.

[Sarah Owen (Luton North) (Lab)]

When I was a care worker, I was lucky enough to work alongside care workers from across the world. We know the sacrifices that all care workers have made during the pandemic and how care home residents were put at risk by the Government’s covid response. There has now been over a decade of empty promises. When will there be a plan for social care that offers more for these heroes than just a badge, some bin bags for PPE and a failure of an NHS boss in waiting who does not value the efforts of overseas healthcare workers?

[Helen Whately]

I absolutely respect the experience that the hon. Member brings to this House, but I do not agree with quite a bit of what she said. We have done our utmost to support the more than 1.4 million members of the social care workforce during the pandemic, and our thinking about the care workforce puts them front and centre of the social care reforms that we are developing. That, of course, is because the quality of care is so much dependent on that fantastic workforce. I am determined that they continue to be front and centre of our work on reform. As I said, we will bring forward proposals for reform later this year.

[Mike Wood (Dudley South) (Con)]

A world-class healthcare system cannot exist without effective and sustainable social care. The health and care Bill is an important step, but will my hon. Friend ensure that the social care reforms go further in integrating health and social care so that everybody who needs care can get the tailored support that they need?

[Helen Whately]

My hon. Friend is absolutely right. The proposals in the health and care Bill are just a step on the road to reform, but they are an important step. That step includes the joining up of health and social care in integrated care systems and putting those on a statutory footing, and the oversight arrangements for social care provided and commissioned by local authorities. We will be building on those plans in our long-term plan for social care reform.

[Tim Farron (Westmorland and Lonsdale) (LD)]

I am sure the Minister will agree that the two conditions that people most fear getting at some point in their lives are probably cancer and dementia. Yet, if someone gets cancer, the NHS will take care of them and the taxpayer will fund their treatment; if they get dementia, broadly speaking that is not the case. As has been said already, surely the only way through this is a significant injection of money. That means being honest with the British people that, collectively, we will have to pay for it. Does she agree that we would be right to say to the British people that they should pay an extra penny on income tax for social care, so that people do not have to lose their home and their dignity if they lose their health?

[Helen Whately]

I would not want to upset the Chancellor by talking about tax policy at the Dispatch Box, but, as I have said to colleagues—and, in fact, as the Prime Minister has said—one of the things that we are committed to as part of our social care reforms is ensuring that nobody should have to sell their home to pay for their care.

[Mr Tanmanjeet Singh Dhesi (Slough) (Lab)]

People across our country will have breathed a huge sigh of relief when the Prime Minister stood on the steps of Downing Street and exclaimed that he had a “clear” and “prepared” plan to solve the social care crisis, but almost two years have passed and there is still no plan in sight. Indeed, the Minister has said today that the Government are still working on a plan. What is the hold-up? Who is obstructing the Prime Minister—or was he simply misleading the nation as usual?

[Helen Whately]

The hon. Member asks about the hold-up. As I have said quite clearly, we have had a pandemic, which has been an unprecedented challenge for our country, our Government and our social care system. In fact, all those working on social care in the Department have been focused on our pandemic response for most of the past 18 months— perfectly rightly, I think the House would say. Thankfully, as we emerge from the pandemic—thanks to the fantastic vaccination efforts across the country, meaning that a huge number of those in care homes and care workers have been vaccinated against covid—we are now able to focus our attention on social care reform. That is why we will be able to bring forward our proposals for reform later this year.

[Suzanne Webb (Stourbridge) (Con)]

Despite repeated promises by successive Governments, our social care system has not received the attention it deserves, and my constituents want to see that attention. Will my hon. Friend confirm that the Government will honour the promise that we made to the British people and deliver the long-term solution that the sector needs?

[Helen Whately]

My hon. Friend is absolutely right; reform has been talked about by many Governments. One of the challenges is that people say, “Social care is broken and we must fix it”, but different people mean different things. Some are particularly concerned about what are called catastrophic costs, including the problem of people selling their home to pay for their care. Others are much more concerned about care—and rightly so—for working-age adults and the increasing costs for those of working age with disabilities. For other people, it is about questions of housing or technology. We are hugely ambitious about our social care reforms and want to bring this all together into a long-term plan for social care.

[Margaret Greenwood (Wirral West) (Lab) [V]]

Instead of bringing forward plans to fix the social care crisis as the Prime Minister has promised, the Government intend to put in place a legal framework for a discharge to assess model, whereby NHS continuing healthcare and NHS-funded nursing care assessments can take place after an individual has been discharged from acute care, instead of before. The Government have told me that an independent evaluation of the implementation of the hospital discharge policy is currently under way, and that it is due to report this autumn. Will the Minister tell us why the Government are pressing ahead with this policy, despite not yet fully understanding the impact that it is having on patients and unpaid carers?

[Helen Whately]

I would not see this as either/or. We have said that we will bring forward proposals for social care reform. To the hon. Lady’s point about discharge, it is well known at that, particularly for an older person, spending a long time in hospital can be harmful to their prospects of recovering and living a good quality of life. I have seen that in my own family as well as knowing that it is a long-standing challenge across our health and social care system. It is absolutely right that we should take steps to support people to be discharged from hospital to home when they are clinically ready.

[Danny Kruger (Devizes) (Con)]

I very much welcome the plans for integrating the NHS, local authorities and social care providers. Can the Minister assure us that the plans will not lead to any more centralisation or bureaucracy in the system, and that, on the contrary, we will see more local flexibility, more choice and control for patients and, crucially, more support for the families and community groups that are so important in the delivery of social care?

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[Helen Whately]

Yes, absolutely. One of the strengths of our social care system is its huge diversity, with the different forms of social care and the different ways it works in different communities. In fact, that has been one of the challenges for the Government during the pandemic, because we are reaching out to over 25,000 different organisations, but actually that diversity is a positive thing, so I will continue to support it in the years ahead.

[Paula Barker (Liverpool, Wavertree) (Lab)]

Today marks 700 days to the day since, on the steps of Downing Street, the Prime Minister told the nation that

“we will fix the crisis in social care once and for all with a clear plan we have prepared”.

For clarity, this was before the global pandemic hit. I know, and the Minister knows, that the market has failed, and that that failure has been exacerbated by the pandemic, not created by it. Is it not time for the Minister to face the inconvenient truth that the only way to fund social care is through progressive taxation, with a diverse range of in-house services guaranteeing workforce standards and service user choice, under the umbrella of local government?

[Helen Whately]

The hon. Lady is right to say that when we went into the pandemic, the social care system already needed reform. That was well recognised, and that was why the Prime Minister committed back in 2019 that we would bring forward social care reforms—[Interruption.] I am not going to talk about tax policy here, but I can reassure her that we are working on our social care reforms and will bring forward the plan later this year.

[Andrew Lewer (Northampton South) (Con) [V]]

The report of the joint Health and Social Care and Housing, Communities and Local Government Committees, of which I was a part, left open the possibility of insurance-type solutions for adult care funding, as successfully operated in many countries comparable to our own. That would have advantages of finance, focus and structure. Given how hugely ambitious my hon. Friend has said she is on this, can she confirm that both insurance-based solutions and an enhanced role for local government remain options for her and the other key decision makers when determining the way forward for adult care?

[Helen Whately]

I thank my hon. Friend for his involvement on the Health and Social Care Committee, whose reports I find really helpful; they provide great insight and contribute to the conversation. He alludes to the different models for paying for social care, and clearly there are many different approaches. We have been considering them, but I am not able to go into detail here and now. I will have to ask him to wait until we publish our proposals for social care reform.

[Catherine McKinnell (Newcastle upon Tyne North) (Lab) [V]]

This pandemic has starkly demonstrated the unequal footing of social care alongside the NHS in this country. The Prime Minister’s announcement back in 2019 that he had a social care plan ready to go has been clearly shown to be untrue, and according to Age UK, 1.5 million older people are going without the care they need. People living in areas with a low council tax base, such as Newcastle, have seen their local council tax precepts rise because the Government have shifted the burden of paying for social care on to those who can least afford it. I agree with the shadow Minister, my hon. Friend the Member for Leicester West (Liz Kendall), that the time for excuses is over, so what is the Minister doing to ensure that the Prime Minister and the Health Secretary stop making empty promises so that we can start building much-needed cross-party consensus on this issue without any further delay?

[Helen Whately]

We are working on our proposals for social care reform, and we are working across the sector. As I have said, I am already talking to and meeting those across the sector—care providers, representatives and, in fact, users of the care and carers themselves. This is complex. There are reasons why there have been discussions about this for many years without proposals for reform being brought forward. We are hugely ambitious, and we want to get it right. That is why I make no apologies that we are taking some time, but as we have said, we will be bringing forward our proposals for reform later this year.

[Paul Howell (Sedgefield) (Con)]

Across Sedgefield—from Hurworth to Thornley and Piercebridge to Bishopton—many people are concerned about the cost of social care and how they are going to cope with it. With property prices in my constituency at about 30% of London ones, any use of that property value to pay for care just becomes catastrophic. The average weekly cost of care is substantially more than average earnings, so I understand the concerns they all have. Can I press the Minister again on ensuring that we do not leave them in a situation where they have to sell their house to fund such care?

[Helen Whately]

My hon. Friend is absolutely right. Care is expensive, and about one in seven people end up spending more than £100,000 on their care. Many people do not realise that care may cost them that sort of amount. It can take them by surprise, so people are not ready for that kind of cost. Yes, people who have worked hard and saved all their lives for their home can be devastated by the value of that home going on the cost of their care. That is why we are determined that this will be one thing that we address in our social care reforms.

[Bill Esterson (Sefton Central) (Lab) [V]]

The 42,000 care home residents who have died of coronavirus during the pandemic are, sadly, just a recent example of how our social care system is failing. The Prime Minister stood on the steps of Downing Street 700 days ago and promised to fix the social care crisis. The bereaved families and everyone whose family depends on our wonderful social care workers deserve answers. Social care staff cannot do this on their own. Those who need the crisis to be fixed need certainty, not the ambiguity of “later this year”. So Minister, no more delays—give us a date. Tell us: when will the Government finally publish their plan and fix the social care crisis?

[Helen Whately]

Let me say to the hon. Member: we have said we will publish proposals for social care reform, and we will; we have said we will set out a long- term plan for social care, and we will; and we have said we will reform social care, and we will.

[Scott Benton (Blackpool South) (Con)]

Residents in Blackpool spend a higher percentage of their income on council tax than those anywhere else in the whole country. Although allowing councils to implement the social care precept has brought in much-needed revenue, it has in some cases placed a disproportionate burden upon ratepayers. While the case for reforming social care is clear, does the Minister agree that we require a national funding model to meet the costs, and that they cannot fall disproportionately on councils in deprived areas?

[Helen Whately]

I thank my hon. Friend, and I recognise the situation right now. That is one reason why we are providing £3.8 billion in grants for adult and children’s social care this financial year, which has gone up from £3.5 billion in the previous financial year. Of course, looking ahead in our reforms, we do have to make sure that the way social care is paid for is fair across the country.

[Mary Kelly Foy (City of Durham) (Lab) [V]]

I was a carer for my daughter Maria for almost 27 years, so I know the demands that carers face every single day caring for those they love. Does the Minister really believe that £67 a week carer’s allowance is a fair amount for round-the-clock care, and will this amount be raised under the Prime Minister’s “prepared” plan for social care?

[Helen Whately]

I pay tribute to the hon. Member for the hours, the love and the effort that she has put into caring herself. She knows, from her own experience, the experience of carers across the country and what it takes in time, physical effort and emotional effort.

Carer’s allowance is not intended to be somebody’s income; it is intended to support people with some of the costs of caring. It is primarily led by the Department for Work and Pensions, but I can say that I am committed to ensuring that there is support for unpaid carers and family carers, and, as I said earlier, ensuring that, as well as caring for and looking after others, those individuals should be able to have time for themselves to lead their own lives.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

Does my hon. Friend agree that a Dilnot-style proposal would reward and incentivise people who had not saved or used financial planning to pass their assets and savings on to relatives or to trusts? A German-style social care premium would be a much fairer system. We would all pay a small amount to cover those who were hit by the catastrophic costs to which she has referred. When she makes proposals, will she include perhaps two or three, including a social care premium, so that we can have a proper debate on this important issue and try to achieve cross-party consensus?

[Helen Whately]

I do not on this occasion agree with my hon. Friend, but I do very much appreciate his consistency and his commitment to ensuring that we have an informed conversation about the funding options for social care, as well as his well-informed drawing on international examples.

[Matt Western (Warwick and Leamington) (Lab)]

From providers to staff to those cared for, the sector really feels abandoned, and has been abandoned, by the Government during the pandemic. In Warwickshire, we have lost 347 people during the past year or so. We have heard that two years ago the country was promised by the Prime Minister an oven-ready plan. There was nothing. Globally, we are the sixth wealthiest country. Other, less prosperous nations have resolved the issue. Why cannot we, and when will the Government publish their plan?

[Helen Whately]

I remind the hon. Member about the unprecedented support we have given social care during the pandemic: extra funding of £1.8 billion, over 2 billion items of free PPE to providers, a new system of distributing PPE direct to care homes and other care providers across the country, distributing over 120 million covid tests to care providers, and vaccinating hundreds of thousands of care home residents and the care workforce. We have been supporting the social care sector to our utmost during the pandemic, and we will introduce our proposals for reform of social care.

[Joy Morrissey (Beaconsfield) (Con)]

May I reiterate the point made by the hon. Member for Wirral West (Margaret Greenwood) about the importance of hospital discharge and of assessment happening while someone remains in hospital? As one who has experienced this at first hand, I know that in taking care of a loved one it is important that accountability and pathway care structures remain in place. Does my hon. Friend agree that the time for action on adult social care reform is now, that we must be bold and courageous, and that we must put an end to the second-class service many disabled adults and elderly people are receiving right now?

[Helen Whately]

It is really important that discharge is carefully planned and that there is care and support at home for somebody when they are discharged from hospital, but it is also really important that we ensure that people are discharged when they are ready to leave. I saw that with my own grandmother, who ended up spending months in hospital owing to problems with her being discharged. Goodness, I wish that she had been discharged sooner—that would have been so much better for her. It is right that we support people to be discharged when they are ready to go home, and we should press ahead with doing that, although we must also ensure that support is there for people in their home.

[Rachael Maskell (York Central) (Lab/Co-op)]

If we are truly to see the full integration of health and social care, that will require us also to see the full integration of the funding of health and social care—free at the point of need, contributed by all. When the Minister brings forward her proposals, will she ensure that that is an option we can consider? Will she bring forward those proposals ahead of debating the health and care Bill, so we actually know what we are trying to debate in that piece of legislation before talking about social care?

[Helen Whately]

I cannot at this point go into the details of the proposals that we are working on for social care reform. I have tried to give the House today a sense of the breadth and scale of our ambition. As to the point on timing, the way I see it is that the health and care Bill is a step on the road to reform, including the statutory role of integrated care systems and the development of the assurance system. I do not see them tied together in the timing in the way she sets out. What I can say is that we will be bringing forward our proposals for social care reform later this year.

[Mr Gagan Mohindra (South West Hertfordshire) (Con) [V]]

First, I wish the Minister a happy birthday. Can she reassure the House that the focus will remain steadfast on patient outcomes and happiness as part of the health and care Bill?

[Helen Whately]

I thank my hon. Friend very much for his birthday wishes. I was not particularly planning to spend my birthday in this way, but it is a pleasure to talk about social care reform because I feel strongly about it and am clearly spending a great deal of time working on it. What really matters is making sure that the outcomes and the experience of care are better for people. What really matters is that people get to live their lives to the full, whether they are of working age or older, and get to live as independently as possible, as part of a community and with their own front door for as long as they can. It is the outcomes of care that really matter.

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

The Minister’s responses today further confirm that social care and the millions who rely on it are simply not a priority for her or this Government. It was recently reported that the Minister leaned on Public Health England to alter its proposed advice to care homes in the pandemic, from ensuring that those discharged from hospital tested negative for covid to not requiring any testing of patients at all. That led to more than 30,000 deaths. Will she take this opportunity to apologise to those who lost loved ones?

[Helen Whately]

Actually what the hon. Member has just read out is completely untrue, completely misleading and does not reflect for a moment what has happened. I am very disappointed to hear her read it out.

[Alexander Stafford (Rother Valley) (Con) [V]]

Rotherham Council is benefiting from the £120 million that this Government are making available to councils to boost staffing levels, which helps residents across Rother Valley to receive the best quality care. Does my hon. Friend agree that, as we begin to work to build a world-class care system, ensuring care homes have the staff they need is a vital first step?

[Helen Whately]

My hon. Friend is absolutely right. At the heart of care is the workforce. They are the individuals who are providing the care and who make the difference day in, day out for those who need their important care. Absolutely, I want to make sure that we have the workforce across social care. We need to ensure we have the training there and greater career progression opportunities for those who work in social care.

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

It has been reported that the Prime Minister is in favour of finally implementing the cap on care costs legislated for in 2014. While that would be welcome, it would do nothing to support working age adults with a disability to live independently, nothing for the 1.9 million older people with unmet needs and nothing to improve pay and conditions for care staff. Does the Minister recognise that a cap on care costs alone does not go far enough, and can she confirm that further measures to deal with these other needs will be part of any reforms?

[Helen Whately]

I hope the hon. Lady will forgive me if I am not drawn on specific models of funding or paying for care, but the Government and I recognise that we have on the one hand the challenge of catastrophic costs and the problems some people face of having to sell their home to pay for their care, which many Members have mentioned already today, but also we have the other part of the system, which is those who receive care funded by the state. Many of them are of working age, as well as there being older people. She is right: in our social care reform, we need to look across the breadth of the system.

[Andy Carter (Warrington South) (Con)]

I thank the Minister for her responses to the questions so far. As part of Warrington’s £22 million town deal, the town is launching an innovative social care academy, in partnership with Warrington & Vale Royal College, to tackle the shortage of trained carers, so that residents in my constituency receive the best quality care. Does she agree that initiatives such as that, which address an identified skills gap, will mean that both care homes and in-home care in Warrington will have tailored and targeted support? Would she like to come to see the academy when it is up and running?

[Helen Whately]

My hon. Friend outlines a fantastic example: that is a really good use of town deal funding by Warrington. The academy—there are examples around the country—does an important thing in raising the profile of the social care workforce and developing their skills, which are so important. I absolutely support this initiative and, as and when the time is right, I would be delighted to visit.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I thank the Minister for responding to the urgent question, and I am suspending the House for two minutes.

Making Vaccination a Condition of Deployment: Consultation Response

Helen Whately Excerpts

Thursday 17th June 2021 Written Statements

[The Minister for Care (Helen Whately)]

On 14 April, we informed the House of our intention to consult on a proposal to amend regulations to require care home providers, with at least one resident over the age of 65, to deploy only those workers who have received both doses of their covid-19 vaccination (or have a legitimate medical exemption from vaccination).

An extensive six-week consultation, addressing both whether this change should be made and how, has now been completed. We have seen a substantial level of engagement with the consultation with care home staff, providers, wider stakeholders, residents and their families, in addition to the general public, making their views known. We have received over 13,500 responses to the consultation. We are very grateful to all those that took part. These contributions have been comprehensively analysed and carefully considered, and I now wish to inform the House of the Government’s response.

The Social Care Working Group of the independent Scientific Advisory Group for Emergencies (SAGE) has advised that a vaccine uptake rate of 80% in staff and 90% in residents, in each individual care home setting, would be needed to provide a minimum level of protection against outbreaks of covid-19.

The current overall figure of 84% for staff uptake and 95% for residents masks significant variation at a regional, local and individual care home level. As of 13 June, only 65% of care homes, with residents over 65, in England, are currently meeting this dual threshold for the first dose, and the proportion is lower in London with only 44% reaching the dual threshold. And—while the SAGE working group advice is specifically about first doses—it should be noted that, for second doses, only 41% of homes are reaching this 80% to 90% level of coverage, with London having furthest to travel on only 23%. Therefore, there is a strong case for introducing a new requirement, in order to make these very high-risk environments as safe as possible from the devastating effects of covid-19.

While a majority of respondents to the consultation did not support the proposal, the responses from the adult social care sector were mixed, with some groups (e.g. care home providers) supporting the proposed legislative change while others (e.g. members of the adult social care workforce) were opposed. While some of those who receive care and their relatives have expressed caution about vaccination as a condition of deployment, many have told us that they want themselves (or their relative) to be cared for by someone who is fully vaccinated.

We see a clear public health rationale for driving vaccination uptake in care homes. It should also be noted that significant parts of the adult social care sector (providers and workforce) do support the proposal. It is our view that the combination of consultation responses and public health evidence provides a strong foundation on which to proceed with the policy. This is based upon minimising transmission of covid-19 and protecting residents in high-risk settings who are most vulnerable to severe illness and death as a result of contracting the virus.

We will be making three key changes to the proposals set out in the original consultation document. These changes are in response to views expressed in the consultation and are made with the intention to best protect all care home residents who are clinically vulnerable to covid-19.

We will:

Extend the scope of the policy to all CQC-registered care homes in England providing accommodation for persons who require nursing or personal care, not just care homes which have at least one person over the age of 65 living in their home. This will bring into scope care homes for working age adults.

Extend the condition of deployment to include all persons working in a care home, regardless of their role (excluding residents of the care home; friends and family of residents; those entering to assist with an emergency; those undertaking urgent maintenance work; and those under the age of 18). The condition will apply, for example, to healthcare professionals, hairdressers, tradespeople and CQC inspectors. The requirement will not apply to the outdoor surrounding grounds of care home premises.

The initial proposals set out that individuals would be exempt from the requirement if they have an allergy or condition that the Green Book lists (chapter 14a, page 16) as a reason not to administer a vaccine. We will additionally provide exemptions for those under the age of 18; those who are clinical trial participants; and, in exceptional circumstances, where a person has a medical reason not to be vaccinated. Guidance will give more detail about exemptions, which will reflect the Green Book on immunisation against infectious disease (covid-19: the Green Book, chapter 14a) and clinical advice from the Joint Committee of Vaccination and Immunisation (JCVI).

The Government’s intention is to bring an amendment to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 legislation to the House, at the earliest opportunity. If approved by Parliament, there will be a 16-week grace period from when the regulations are made to when they come into force, to enable staff who have not been vaccinated to take up the vaccine.

A copy of the Government’s response to the consultation will be deposited in the Libraries of both Houses.

Intention to launch a wider consultation

The responses to this consultation made a clear case for extending this policy beyond care homes to other settings where people vulnerable to covid-19 may also receive care.

We will therefore launch shortly a further public consultation on whether or not to make covid-19 vaccination a condition of deployment in healthcare and the wider social care sector, to help protect patients and the people they care for from becoming seriously ill or dying from the virus.

The consultation will also explore whether flu vaccination should be a condition of deployment in the health and social care sector. Flu is a serious illness for vulnerable cared-for people who may suffer serious complications from infection, including death. Outbreaks of flu in care settings are common most winters and it is important we explore this option to protect those at risk.

[HCWS98]

Winterbourne View Hospital and the Transforming Care Programme

Helen Whately Excerpts

Thursday 10th June 2021 Westminster Hall

[The Minister for Care (Helen Whately)]

It is a pleasure to serve under your chairmanship, Ms McVey. I thank the hon. Member for Worsley and Eccles South (Barbara Keeley) for securing this important debate, for opening the debate and for her committed campaigning for people with learning disabilities and for autistic people. I also thank all Members who have spoken powerfully today, both in the Chamber and virtually, and shown the strength of feeling on the issue among parliamentarians. I particularly thank my hon. Friend the Member for Bexhill and Battle (Huw Merriman), as he has taken on the role of chair of the all-party parliamentary group on autism following, as he said, the very sad death of our right hon. Friend Dame Cheryl Gillan. She is missed so much by all of us, both as a colleague and for her work for autistic people, which has made such a huge difference over the years, although there is clearly much further to go.

The appalling abuse uncovered at Winterbourne View has no place in our society, and I share the shock and anger that hon. Members have expressed today. It was rightly described as heartbreaking and disgusting by my hon. Friend the Member for Broxtowe (Darren Henry), and it should never have happened, as my hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti) said. None of us accepts this kind of cruel and abusive treatment of people with learning disabilities and autistic people, and none of us wants people to be in-patients unnecessarily when they could be better off living in the community. I will use my time to talk about the work of Government, the NHS, the CQC, local authorities, and others we are working with to stop poor and—worse still—abusive care, and to improve care. As part of that, I will talk about what we are doing to reduce the number of people with learning disabilities and autistic people in in-patient units, which we know are rarely the best place for those people to be. As I do so, I will seek to respond to questions raised by right hon. and hon. Members.

First, I will talk about the approach we are taking to stopping abusive care. We are working with the NHS as care commissioners, local authorities, and of course the CQC, which plays a critical part. I fully support the much tougher approach that the CQC is rightly taking through its more robust inspection regime and updated methodology, which includes speaking more to patients and families and really digging into the culture of providers. It is in some of these closed cultures where there has been such concerning treatment of patients, and the CQC is taking a robust enforcement approach, including wasting no time in closing down services when it uncovers unsafe care. The sad truth is that this tougher approach by the CQC has exposed more cases of poor care, and I fully support the CQC in taking very robust action in those cases.

A significant number of people with learning disabilities and autistic people in in-patient units, about 59%, are autistic. As my hon. Friend the Member for Bexhill and Battle said, an in-patient unit is rarely a good environment for someone who is autistic, and can often be a really inappropriate one. I am clear that no one should be in an in-patient unit if it is not to their benefit—if they are not receiving some form of therapeutic treatment that helps them. Even then, their time in an in-patient unit should be as short as possible, and that unit should be as close to home as possible. Our target is to achieve a 50% net reduction in in-patients by 2025, from a base starting in 2015. Back in 2015, there were 2,895 people with learning disabilities and autistic people in in-patient units; that figure has come down to 2,035, which is a 30% reduction. England is divided into 44 transforming care partnership areas, 17 of which are on track to achieve the target, but that means that 27 are not on track. I take that failure very seriously.

My right hon. Friend the Member for Forest of Dean (Mr Harper) asked whether our target of a 50% reduction is ambitious enough, and whether we should be aiming for zero in-patients. That is a question that I have asked myself, and I have also asked it of the NHS and of clinicians. It has been made clear to me that there are times when people with learning disabilities and autism may need to be in an in-patient unit, when they have a mental health condition that could benefit from in-patient treatment. As such, I do not think it would be right to say that it is never appropriate, but it should be rarely considered appropriate, and alternatives should be tried wherever possible. I must also mention to my right hon. Friend that just under 30% of the numbers I am talking about are individuals who are under Ministry of Justice restrictions, so that is another challenge to discharging them. Those are net figures, however, and in the period that we are talking about, there have been more than 10,000 discharges, so it is not a static population. Of course, given that reduction of 30% and more than 10,000 discharges, there have also been a large number of admissions.

When I became the Minister for Care, with this in my portfolio, I straightaway asked the question, right back at the beginning of the pandemic, why are we behind the target? Why have we not made the progress that we should be making? Why is it taking so long? What needs to be done to fix that and to get back on track? We need to have a plan that we can all be confident in—all of us in the Chamber and the families of in-patients.

[Mr Harper]

Before the Minister moves on, may I test her? She said that she asked whether the 50% target was right. After all those conversations and yes, accepting that there might be some need for in-patient units, is the Government’s position that the 50% reduction is the right end state, or is there a different number? If it is 50%, will she publish the analysis that sets out why that is the right number?

[Helen Whately]

I can tell him that achieving the 50% will be hard. I am all for being ambitious, but in fact, from everything I have seen, achieving it will be hard, partly because some are more easily discharged—I pause as I say that, because it has been difficult to discharge many because we have complex situations here. We have seen some people continuing to be in-patients with long lengths of stay, and it has become almost harder and harder to find a way to find the right support for them in the community. Achieving the 50% will not be easy. I will get to the other part of my right hon. Friend’s question.

When I saw the position we were in and that we were not on target, I asked why and how come. Clearly, however, this is a complex system—it involves the NHS and local authorities doing things, and there are questions about housing supply, community schools and in-patient services. I therefore set up the building the right support delivery board, to which my hon. Friend the Member for Bexhill and Battle referred—I thank him for his supportive words. That board’s aim is to bring those involved together, because, much though we all like a clear line of accountability, to point a finger at somebody to say, “Solve this!”, the reality is that solving this involves bringing different organisations and different parts of our system together.

The delivery board has identified six priorities that we need to focus on to overcome the barriers to achieving lower numbers of in-patients: first, identifying the best practice models of care in the community. What does good look like? That may sound obvious, but getting the right answers is not the easiest thing to do. What is the right care for people in the community? First we have to find out what we want to see in all our constituencies that is available for that group of people.

Secondly, we have to focus on improving the transition into adulthood, in particular for autistic young people, because that is a particular problem resulting in in-patient admission. Thirdly, we have to reduce the number of people in in-patient care with judicial restrictions who, as I mentioned, are a significant proportion. Fourthly, we have to address some of the issues with funding flows and potential financial disincentives in the system, which hon. Members have mentioned, including the hon. Member for Worsley and Eccles South. Fifthly, we have to address the lack of available suitable supported housing. Housing is often cited as the most frequent barrier to discharge. Finally, we have to ensure that we have the right workforce.

Those are the priorities. Yes, we are working on a delivery plan, which will include milestones, such as my right hon. Friend the Member for Forest of Dean rightly called for—we all need to be able to see those. Specifically on the NHS role, since the pandemic, I have asked each of the 44 areas in the NHS to review where they are on delivering against our target and to come to me with what their trajectory is. Where will they get to over the coming months and years and, to the extent that they may be below the ambition, what actions will they take to close that gap?

I hope that that addresses my right hon. Friend’s question about my similar commitment to ensuring that we have clear milestones and targets, can see who is doing what, and have a grip on getting this delivered.

[Mr Harper]

Are the milestones in the plans going to be published?

[Helen Whately]

Yes, we plan to publish the delivery plan. We want to have time for the delivery board to feed into it, because we set that up earlier this year. It is complex and cross-government, so it takes a bit of time to bring that together, but broadly yes.

I want to touch on funding, because it was mentioned a number of times as one of the barriers. As part of the NHS England long-term plan, we are investing £40 million this year in improving community support and preventing avoidable admissions. There is an initial £31 million of funding for this issue as part of the NHS mental health covid recovery package. There is £11.35 million specifically to accelerate discharges from mental health hospitals, which includes funding to strengthen advocacy for people with a learning disability and autistic people, and £19.65 million to help prevent crises from occurring and to avoid admissions into in-patient care. There is also the £62 million community discharge grant, which is a fund over three years. The first tranche was issued last year, with a further £21 million to be distributed this year and next. That is particularly to cover some of the double running costs involved when a discharge happens. Someone may need care as an in-patient, but it also has to be set up in the community.

My right hon. Friend the Member for Forest of Dean also asked about the response to the CQC’s “Out of sight” review, which was requested by the Secretary of State for Health and Social Care and which reported back in October last year. It was a review of the use of restraint, seclusion and segregation. My right hon. Friend the Member for Forest of Dean asked when we would respond to it, and I can say that we will do so imminently. I hope he finds that reassuring, even if I cannot give a specific date.

I am mindful of the time, so I will wrap up. I thank all right hon. and hon. Members who have contributed to the debate. I know we are all deeply committed to ensuring that everybody with learning disabilities and autistic people get the care and support that they need. None of this is easy. Some of the individuals we are worried about have really complex needs, but I do not accept that as an excuse for poor or, worse still, abusive care. I will continue to work with the CQC, the NHS, local authorities and other Government Departments, and with the families and user representatives, who play a really important part and are part of the delivery board. I will work together with them to bring an end to this and make sure that autistic people and those with learning disabilities get the care and support that they need, and the support that their families need, to live their lives to the full.

Learning Disabilities Mortality Review Programme: Fifth Annual Report

Helen Whately Excerpts

Thursday 10th June 2021 Written Statements

[The Minister for Care (Helen Whately)]

I would like to acknowledge today the publication of the fifth annual report of the learning disability mortality review (LeDeR) programme, now known as “Learning from lives and deaths—People with a learning disability and autistic people” by the University of Bristol. A copy will be deposited in the Libraries of both Houses.

Sadly, as set out in today’s report, we know that some people with a learning disability have died from covid-19, and this report provides moving, personal stories of some of those who lost their lives. My deepest sympathies are with their families and loved ones.

This annual report recommends that the needs of people with a learning disability should be built into the national policy response by the Department of Health and Social Care (DHSC) in the case of future emergency health situations. This is absolutely essential, and throughout the covid-19 pandemic, we have taken action to protect people with a learning disability and used emerging evidence to inform our policy response. For example, in October, we added adults with Down’s syndrome to the clinically extremely vulnerable list following the identification of an elevated risk of severe outcomes for this group of people. And the Joint Committee on Vaccines and Immunisation added people with severe and profound learning disabilities to group 6 for the vaccine, and people with Down’s syndrome to group 4.

We value the insight that the LeDeR programme has brought us during the challenging time we have all faced over the past year. We have been able to use data from the LeDeR covid-19 report to inform our response to the pandemic. I would like to take this opportunity to thank the team at the University of Bristol for their invaluable work over the past years on the LeDeR programme. Past reports have prompted action across the health and care sector, including the trialling of the Oliver McGowan mandatory training in learning disability and autism.

Today’s report makes several recommendations for Government and their system partners to help to improve the care of people with a learning disability. We remain absolutely committed that people with a learning disability should, and must, receive high quality care which will in turn reduce preventable deaths and health inequalities.

NHS England has published its “Action from Learning” report alongside the fifth LeDeR report, which sets out a range of work taking place to improve the safety and quality of care to reduce early deaths and health inequalities. We welcome the ongoing invaluable work by NHS England, including during the covid-19 pandemic, in this area.

The Government’s focus in 2020 was on the covid-19 response, and our priority was to protect people’s lives. We will publish a response to both the fourth and fifth reports in late summer/autumn of this year, to allow time for us to fully consider the recommendations for the Department, and agree actions, including those on covid-19 related issues and on mandating reporting to the LeDeR programme.

This report also highlights the disparities experienced by ethnic minority people with a learning disability. It is vital that we continue to work with our partners to tackle the poor outcomes experienced by ethnic minority people with a learning disability.

Based on the evidence from completed LeDeR reviews, the fifth annual report makes 10 recommendations for the health and care system, as follows:

Recommendation 1. LeDeR reviews to be undertaken through the lens of greater racial awareness. (Audience: NHS England and NHS Improvement)

Recommendation 2. Local Authorities to ensure that joint strategic needs assessments (JSNA) collect and publish local data on the health needs of children and adults with learning disabilities, capturing any characteristics that relate to specific ethnic groups. Integrated care systems (ICSs), and their commissioned primary care networks to take actions to reduce any disparities between people from different ethnic groups when planning local services for people with learning disabilities and their families. Accountability for this to be monitored at regional level, and by NHS England. (Audience: Local authorities, NHS England and NHS Improvement, ICSs, NHS Race and Health Observatory)

Recommendation 3. A nationally endorsed standard resource is required, with local flexibility, that provides information for people with learning disabilities and their families about their legal rights and entitlements, national services available and how to access them, and local sources of support. Mechanisms must be in place for its effective distribution, particularly to people from minority ethnic groups. (Audience: NHS England and NHS Improvement)

Recommendation 4. Strategically planned, long-term, targeted, joint investment is needed to strengthen partnerships with local communities and provide support for peer-to-peer networks, to build on and future-proof existing contacts and structures within local communities and increase trusted word-of-mouth communication and information sharing. (Audience: Local authorities, ICSs, primary care networks)

Recommendation 5. Local systems, including commissioning, to be responsive and develop strategic plans that address the longstanding needs of people with learning disabilities and their families that the covid-19 pandemic has illuminated, including the availability of specialist learning disability teams in acute, primary and community care. (Audience: ICSs)

Recommendation 6. From the outset of any future public health emergency, the needs and circumstances of people with learning disabilities must be considered and built into national policy and guidance by the National Institute for Health Protection and the Department of Health and Social Care. A data collection tool should be established to capture emerging evidence relating to people with learning disabilities, which would trigger adjustments to policy, guidance, systems and processes as required. (Audience: National Institute for Health Protection, Department of Health and Social Care, NHS England and NHS Improvement)

Recommendation 7. Commissioning guidance for NHS 111 services to include a requirement for the provision of specifically tailored training to NHS 111 staff about how to respond appropriately to calls about people with a learning disability or from people with a learning disability and their families. (Audience: NHS England and NHS Improvement)

Recommendation 8. A LeDeR representative should routinely and as of right be involved with the child death review meeting/process for children with learning disabilities, in order to ensure that necessary information is collected and transferred into the wider LeDeR programme. (Audience: NHS England and NHS Improvement)

Recommendation 9. NHS England to collect and collate evidence about the needs and circumstances of people who have been subject to mental health or criminal justice restrictions and use this to inform appropriate, personalised service provision for this group of people. While waiting for this evidence, robust after-care support (as required by S117 of the Mental Health Act) must be provided. (Audience: NHS England and NHS Improvement, local authorities)

Recommendation 10. Progress on actions in response to previous recommendations about minimising the risk of aspiration pneumonia in people with learning disabilities needs to be published. (Audience: NICE, Department of Health and Social Care, NHS England and NHS Improvement)

While we have taken urgent action during the covid-19 pandemic to protect the lives of people with a learning disability, we know that there is more to be done as we begin to move out of the pandemic. We will continue to work with partners to ensure improvements are made, and to address the recommendations in the reports.

[HCWS81]

Oral Answers to Questions

Helen Whately Excerpts

Tuesday 8th June 2021 Commons Chamber

[Dame Diana Johnson (Kingston upon Hull North) (Lab)]

If he will publish a timetable for adult social care reforms.

[The Minister for Care (Helen Whately)]

I am hugely ambitious about social care reform. I want a sustainable care system that meets people’s needs and aspirations and gives them the care and support they need to live life to the full. We are working on proposals for reform and will bring those forward later this year.

[Karl Turner [V]]

This Government are responsible for over 40,000 needless deaths from covid-19 in care homes. A plan to fix social care in this country is long overdue. This crisis is not new—people are routinely forced to sell the family home to pay for care. The workers are paid peanuts, while the 13 million unpaid carers are left to pick up the pieces. Does the Minister agree that we have had far too many vague promises and that unpaid carers cannot wait a minute longer?

[Helen Whately]

I agree with the hon. Member that there are many challenges for social care, and that is one reason why many Governments have talked about social care reform. As he will understand, over the last year, we have rightly focused on supporting social care through the pandemic, but we are working on our proposals for reform and will bring them forward later this year.

[Christine Jardine [V]]

Almost two years ago, the Government promised to fix social care once and for all, but we have seen in this pandemic that it is still seriously broken. Care does not stop at the hospital exit or the GP’s door. Carers have sacrificed physical and mental health caring for loved ones during the pandemic; 72% have had no break, and 44% say they are at breaking point. In national Carers Week, will the Minister commit to cross-party talks in the immediate term to fix the social care crisis throughout the UK?

[Helen Whately]

As the hon. Member says, this week is Carers Week, which is a really good opportunity to raise awareness about the important role that carers play in supporting loved ones and to remember something that I personally am committed to: we must support carers not only in the care that they do but to live their own lives, for which respite care is really important. As part of our reforms to social care, we are listening to carers and want to ensure that their needs are met.

[Kim Johnson]

In July 2019, the Prime Minister stood on the steps of Downing Street and pledged to fix the broken social care system. Two years on, we are still waiting. There were only warm words in the Queen’s Speech a couple of weeks ago:

“Proposals on social care reform will be brought forward.”—[Official Report, House of Lords, 11 May 2021; Vol. 812, c. 2.]

Can the Minister tell us when the Government will move from rhetoric and warm words and fix this broken system for the people she has just mentioned, who need it desperately?

[Helen Whately]

I welcome the hon. Member’s support for and interest in social care reform, along with others across the House. We know that social care reform is needed. We have rightly over the last year focused on supporting social care through the pandemic, getting £1.8 billion of extra funding for social care to the frontline and providing billions of items of PPE, over 100 million tests to social care and the vaccination programme to care home residents, those who receive social care and the workforce. We are working on our social care reforms and will bring those forward later this year.

[Dave Doogan]

Many in this place and across England will be asking, “Where is England’s long-awaited social care Bill?” because they will have seen that the SNP Government are delivering a new deal for the social care sector in Scotland, building a new national care service that will improve workers’ conditions and standards of care, and increasing investment in care by 25%. Will the UK Government follow Scotland’s lead in transforming social care, and will the Minister contact Scottish Government Ministers to learn from our over a decade-long experience of integrating health and social care?

[Helen Whately]

One of the great strengths of our United Kingdom is our ability to work together and learn from different parts of the UK. We also look at the best in England and, of course, in Wales, Scotland and Northern Ireland. The hon. Gentleman mentions the care workforce. We absolutely want to make sure that this important workforce are front and centre of our social care reform plans and that they receive the training, opportunities, recognition and reward that they deserve.

[Mike Amesbury]

The Government have had 11 years to reform social care, but with cuts of £8 billion over that period, it is fragmented and costly and does not value workers and employees. Is it not time that the Minister and the Government grab the bull by the horns and introduce a national health and social care service? When are reforms going to come into play—what day, what month, what year?

[Helen Whately]

It is not just over the period mentioned by the hon. Member that social care reforms have been talked about; this goes back at least 25 years, to when Tony Blair was the Labour leader and Prime Minister. He talked about reforms to social care, but he has also said that it is not simple; these are complex problems to address. When people talk about how social care needs fixing, different people mean different things. That is why, as part of our reforms, we are going to bring forward a long-term plan for reforming social care.

[Dame Diana Johnson]

Can I just say to the Minister that I think most Members of the House of Commons will find her attitude incredibly complacent on one of the key issues that faces most families in this country? As my hon. Friend the Member for Weaver Vale (Mike Amesbury) has just said, there has been an £8 billion cut to social care since 2010. One of the steps she could take straight away is to reinstate that £8 billion to local authorities, so that they can at least provide services through the social care system that we have.

[Helen Whately]

I have huge respect for the right hon. Lady and her work in many areas, but I am disappointed by her language. She will appreciate that, together, the Department, local authorities and the care sector are working hard on how to bring forward the right package of reforms for the system. We have already taken some of the first steps on that road. For instance, the health and social care Bill includes plans to strengthen oversight of the social care system. That is an important step, but it is the beginning, not the end, of the social care reform road.

[Liz Kendall (Leicester West) (Lab)]

Six hundred and eighty-five days ago, the Prime Minister promised to fix the crisis in social care to give every older person the dignity and security they deserve. Since then, more than 32,000 elderly people have died from covid-19 in care homes, millions of care workers and families have felt abandoned and pushed to breaking point, and 300 elderly people have been forced to sell their homes to pay for their care every single week. Does the Minister think that has given people security, let alone dignity, and will she tell the country, after more than a decade in power, specifically when her Government will deliver?

[Helen Whately]

What I will say, after the enormously difficult year that social care has had through the pandemic, is that that has indeed strengthened the already strong case for reform of social care. I will say to the hon. Member that I want us to have a better social care system, whether it is for our grans and grandads, mums and dads, brothers and sisters, children and grandchildren, or, indeed, as and when we need it ourselves. We have a once-in-a-generation opportunity to reform social care. Now is the time, now is the moment and we will seize this opportunity. We will be bringing forward proposals for reform of social care later this year.

[Anthony Mangnall (Totnes) (Con)]

What recent (a) discussions and (b) meetings he has had with the Food Standards Agency.

--- Later in debate ---

[Dan Jarvis (Barnsley Central) (Lab)]

What recent assessment he has made of the effectiveness of the Organ Donation (Deemed Consent) Act 2019 in increasing the number of organs available for donation.

[The Minister for Care (Helen Whately)]

The organ donation opt-out system has increased the number of organs available for transplant and is saving hundreds of lives. Since the law changed last year, 296 people in England have donated their organs under the opt-out system. These donations account for 29% of the 1,021 donations that took place last year.

[Dan Jarvis [V]]

I am grateful to the Minister for that response. She will know that 20 May marked one year since Max and Keira’s law came into effect—a change that will give hope and save lives—but despite the tireless efforts of NHS staff, covid has had a devastating impact on patients in need of life-saving operations. Can the Minister outline how she is going to get organ transplant services back to pre-pandemic levels and tell us what additional resources will be committed in order to support an increase in organ availability?

[Helen Whately]

I would first like to thank the hon. Member for the part he played in campaigning for this life-saving change to organ donation and bringing about the increase that I mentioned earlier. The current services are now running at pre-covid levels and NHS Blood and Transplant is working with the wider healthcare system to enable as many transplants as possible. The new Organ Donation and Transplantation 2030: Meeting the Need strategy, which was launched last Tuesday, sets out the steps we are taking to increase organ availability further.

[Ronnie Cowan (Inverclyde) (SNP)]

What recent progress his Department has made on helping to ensure that medical cannabis is accessible to people who require it under prescription.

--- Later in debate ---

[Caroline Ansell (Eastbourne) (Con) [V]]

I am delighted to report back to my right hon. Friend that the University of Brighton, which has a campus in Eastbourne, has experienced a significant rise in the number of applications to study for careers in health professions. A shortage of training placements is the only real brake on the numbers of would-be students. I understand from having talked to the university that in the UK students must complete over 2,000 hours in placement. That is in contrast to Australia’s and New Zealand’s 1,000 hours. Is that seemingly high requirement under review with Health Education England so that we do not miss an opportunity to capture this new interest, build the NHS workforce of the future, open opportunities to all those who have the talent to succeed, and further secure my home town as a destination for studying?

[The Minister for Care (Helen Whately)]

My hon. Friend makes a really important point. Nurse education standards are set by the Nursing and Midwifery Council. Its current standards are based on EU law, but that no longer applies to the UK, and it has launched a survey on whether those standards should change. Acceptances for pre-registration nursing programmes at English universities for 2020-21 increased by over 5,000 since the previous year.

[Chi Onwurah (Newcastle upon Tyne Central) (Lab)]

Many constituents have con, deeply concerned by Government proposals to grab, store and share GP health data. Can the Secretary of State tell me this: if I opt out of this data grab, will my health data be available to a hospital outside my home area should I have an accident, for example? If I do not opt out of it, how can I control how my data is shared, whether individually or in aggregate? I do not want to have to choose between privacy and my health.

--- Later in debate ---

[Jessica Morden (Newport East) (Lab)]

As current Government investment in motor neurone research is not the targeted funding that is needed, will the Minister meet charities, researchers and patients to examine this discrepancy and commit to additional funding of £10 million a year for five years for a virtual motor neurone disease research institute, with a specific focus on helping us to get a world free of MND?

[Helen Whately]

I will look into the hon. Lady’s specific request, but I can tell her that the Government are actively supporting research into motor neurone disease. For instance, in April I jointly hosted a roundtable event on boosting MND research with the National Institute for Health Research/Sheffield Biomedical Research Centre, which brought together researchers and others. We are absolutely committed to this area of work.

[Mr Speaker]

Final question, Mark Harper.

Dementia Action Week

Helen Whately Excerpts

Thursday 27th May 2021 Commons Chamber

[The Minister for Care (Helen Whately)]

I beg to move,

That this House has considered Dementia Action Week.

I congratulate the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) on securing this debate to mark Dementia Action Week. I pay particular tribute to her work as co-chair of the all-party parliamentary group on dementia, and to the charities that she and I both work with, including the Alzheimer’s Society.

I know how hard the last 12 months have been for those living with dementia and their families. Living with dementia is hard in normal times, but harder still during a pandemic. It has been an incredibly difficult year. I know that, and I have seen that. There are more than 850,000 people living with dementia and around 670,000 carers looking after them. I thank everyone who is caring for someone with dementia.

While many thousands of people have dementia, we must not, and I do not, see it as an inevitable part of ageing. Although one in six of those over 80 have dementia, five in six do not. Around a third of dementia cases are estimated to be preventable. I am ambitious—ambitious about preventing dementia, ambitious about developing treatments, and ambitious about one day developing a cure. However, first I will update the House on what we have been doing under the umbrella of the challenge on dementia 2020 and in response to the pandemic.

Last year, we assessed delivery of the 2020 challenge, which showed that we now have more than 3 million dementia friends, thanks to the Alzheimer’s Society. We have 437 areas across England and Wales signed up as dementia-friendly communities. We have 137 trusts signed up to the dementia-friendly hospital charter and, thanks to Skills for Care and Health Education England, more than a million care workers and another million NHS workers have received dementia awareness training. Added to that, our commitment to spend £300 million on dementia research over five years was delivered a year early, with £344 million spent over four years.

Timely diagnosis of dementia is really important to help people to understand what is going on, find out what support is available and get advice on what happens next. Since 2016, we have consistently met the challenge on dementia target of two thirds of people living with dementia receiving a formal diagnosis. However, at the start of the pandemic many memory assessment services had to close, and the dementia diagnosis rate has dropped below the national ambition for the first time since 2016.

While we have supported remote or virtual memory assessment services, I recognise that that is not for everyone. I want to see in-person services fully functional as soon as possible, because a diagnosis can make such a difference, allowing people to access the support that they need.

[Jim Shannon (Strangford) (DUP)]

The charity Music for Dementia says that those who have started to sing or listen to music on a daily basis have

“more than doubled their quality of life…whilst halving their depressive symptoms.”

Could that charity be introduced to the Government’s strategy?

[Helen Whately]

The hon. Member makes a really important point: music is one of the things that is known to really help people who are living with dementia. It helps to improve the quality of their lives, and it has been one of things that has been hard to access during the pandemic. I am determined that we see that kind of support restarted, and develop further support along those lines in the months and years ahead.

We have allocated £17 million of funding to NHS England to get the diagnosis rate that I was talking about back up to where it should be, to support the needs of those waiting for a diagnosis and to help those who have been unable to access support due to the pandemic. Everyone with dementia should receive meaningful personalised care, from diagnosis to end of life, to help them to live with the condition and to live the fullest possible life for as long as possible.

It is imperative that we support those—often husbands, wives, partners, sons and daughters—who care for loved ones with dementia. They take on a huge burden of care, both practically and emotionally. Since the Care Act 2014, every carer for someone with dementia should have their needs assessed by their local authority and should then receive the support that they need, whether that is support with caring or respite, time out for themselves or sometimes help with extra costs. That is crucial, not only because carers are so important to the person with dementia they care for, but because they need to have a life alongside caring.

Throughout the past year, we have worked with the Alzheimer’s Society, Age UK, Carers UK, other charities, care providers, local authorities and the NHS to work out how best to support people with dementia and their carers during the pandemic and put that support in place. We have provided more than £500,000 in funding to the Alzheimer’s Society for its Dementia Connect programme, £500,000 to the Carers Trust for its support to unpaid carers, £122,000 to Carers UK to extend its helpline opening hours and £480,000 to the Race Equality Foundation.

We have provided free personal protective equipment for carers where they live separately from the people they care for, in line with clinical advice. We have given carers priority to vaccines in line with Joint Committee on Vaccination and Immunisation prioritisation, considered them time and again in guidance, worked to better identify them and supported local authorities in the restoration of day and respite services, including with nearly £12 million in funding from the infection control fund.

As we come out of the pandemic, we want not only to ensure that we restore and improve early diagnosis and support for people living with dementia and their carers, but to go further: to prevent people from getting dementia in the first place, support research to develop effective treatments and, ultimately, find a cure. The National Institute for Health Research is right now supporting several studies on dementia.

The 2019 Conservative party manifesto committed to doubling funding for dementia research and delivering a moonshot of ambitious goals. The moonshot will expand the UK’s internationally leading research effort to understand the mechanisms underlying the development and progression of dementia, develop new therapies and help to prevent the condition. We are working right now on developing a new dementia strategy to boost dementia awareness, diagnosis, care, support and research in England. As everyone knows, we are committed to wider reform of social care; we will bring forward proposals for that later this year.

We want a society where the public think and feel differently about dementia—where there is less fear, stigma and discrimination, and more understanding. We want to reduce the number of preventable cases of dementia. We are determined to support those who are living with dementia to live the fullest possible life for as long as possible, and to support those who care for them. We will lead the way in dementia research and innovation to find effective treatments and, ultimately, a cure.

--- Later in debate ---

[The Minister for Care (Helen Whately)]

I thank all Members who have spoken in the debate, and spoken so powerfully, time and again drawing on their personal experience of dementia in their family. That is a sign not only of the prevalence of dementia, but, as my hon. Friend the Member for Gloucester (Richard Graham) pointed out, of how much the stigma of dementia is being overcome.

My hon. Friend the Member for Scunthorpe (Holly Mumby-Croft) spoke about her family experience, but also about the importance of listening to family and the challenges of navigating the system and the administration involved for a family coming to terms with a diagnosis, who have to go through so many processes.

My hon. Friend the Member for Vale of Clwyd (Dr Davies) spoke about the importance of diagnosis with respect to not only the support that people need, but providing a cohort for trials and for research. He drew on his clinical experience, as well as his personal experience, and rightly mentioned the importance of the prevention of dementia and the role of diet and exercise in that.

My hon. Friend the Member for West Aberdeenshire and Kincardine (Andrew Bowie) spoke about how dementia affects the whole family. Very movingly, he spoke of how it affected him when his grandmother lost her power to speak, and of how he used to pray for her to return to being the person she once was.

My hon. Friend the Member for Stockton South (Matt Vickers) spoke about how many of those who care for someone with dementia may be frail themselves or may be holding down a job. He also spoke about Teesside Dementia Link Services and the huge difference that makes for those with dementia and their carers.

My hon. Friend the Member for Redcar (Jacob Young) spoke about his grandads’ very different experiences with dementia, and about the importance of treating those who suffer with dementia with the dignity that they deserve.

My hon. Friend the Member for Keighley (Robbie Moore) spoke about Dementia Friendly Keighley, which so effectively brings people together and provides support for patients with dementia and for carers. He particularly mentioned Barbara Wood, who he said was symbolic of the efforts of the group.

My hon. Friend the Member for Peterborough (Paul Bristow) spoke about how his grandma suffered from Alzheimer’s and referred to his experience as a result of his father running a care home. He spoke about our opportunity to take the same attitude to curing dementia as to the covid vaccination. He is absolutely right: this is a moment in time. We can look at how we have pulled together as a country and how the public and private sectors, scientists, healthcare specialists and others have come together to develop a vaccination for covid; it was forecast at the outset that that might take five or six years, yet here we are with so many millions of people already vaccinated. He also spoke about the antipsychotic medication of those with dementia during the pandemic. As he said—he has contacted me about this—we are working with the NHS to keep a very close eye on the situation.

My hon. Friend the Member for Southend West (Sir David Amess) talked about the importance of reform, including the reform of funding so that people do not have to sell their homes to pay for care. As I have said, we are absolutely determined to bring forward the reforms of social care that we have committed to bringing forward this year.

I want to touch on some of the comments by the shadow Minister, the hon. Member for Leicester West (Liz Kendall). She spoke very movingly in her winding-up speech and made important points about social care reform. She said that it is not just about reform for those who are receiving care right now—our mums and dads, for instance, or our grans and grandads. Many of us will also need care, and so will our children and grandchildren as people live longer. We need a system for ourselves and all those we love that we can be confident provides the care that we want and need.

In her opening speech, when the hon. Lady spoke about the response to the pandemic, she clearly did not hold back in what she said, which may be a sign that she shares my sorrow about the many lives lost to covid. She knows how hard this Government have worked to protect and support people who receive social care, and she knows how hard it has been for care homes in England, but also in Wales, where there is a Labour Government, in Scotland under the SNP Administration, and in many countries around the world.

In a pandemic it is impossible to get everything right, but we have provided unprecedented support to social care and care homes over the past year. Once again, I thank all those who have been involved, including the Department of Health and Social Care team, Public Health England, Skills for Care, the Association of Directors of Adult Social Services, the Local Government Association, local authorities, organisations that we have worked with, such as the National Care Forum, the National Care Association, the United Kingdom Homecare Association, Care UK, Age UK and Carers UK—I could go on, because there have been many of them. I also thank the care providers, the care users and the care workers themselves—the care workforce, who have been on the frontline and have done so much to look after those they care for, through such difficult times.

This is a moment in time, not only for social care reform but for dementia. Yes, we must restore the diagnosis rates and go further. We must make sure that the support is there for individuals with dementia and their carers. We must do more on prevention, because it is estimated that a third of dementia cases are preventable. The Government must, and will, follow through on our commitment to research effective treatments for dementia and find—sooner rather than later—a cure.

Question put and agreed to.

Resolved,

That this House has considered Dementia Action Week.

[Mr Deputy Speaker (Mr Nigel Evans)]

I will suspend the House for a brief moment for the sanitisation of both Dispatch Box covers and the safe exit and arrival of the main players.

Health Protection (Coronavirus, Restrictions) (Steps and Local Authority Enforcement Powers) (England) (Amendment) Regulations 2021

Helen Whately Excerpts

Monday 26th April 2021 General Committees

[The Minister for Care (Helen Whately)]

I beg to move,

That the Committee has considered the Health Protection (Coronavirus, Restrictions) (Steps and Local Authority Enforcement Powers) (England) (Amendment) Regulations 2021 (S.I. 2021, No. 455).

First, I thank everyone who has mobilised to fight the disease. It is not possible to namecheck everyone, but may I single out for thanks all those in the NHS, social care and the Army, as well as returned healthcare staff, who are involved in the deployment of the vaccine? I also thank scientists, pharmaceutical companies and those running clinical trials for developing new vaccines, antivirals and all manner of therapies to combat the threat of mutations.

Of course, I also thank the general public for continuing to follow the rules. It has been a difficult year, but we have made significant progress towards reclaiming our freedom, while doing all we can to protect people against coronavirus. Thanks to the collective efforts of the British public, our world-leading vaccine programme and our fantastic healthcare workers, we have been able to progress to the next stage of the road map, which seeks a balance between our social and economic priorities, and the need to save lives and avoid another surge in infections that could put unsustainable pressure on the NHS.

The decision to move to step 2 was informed by the latest scientific evidence and was based on the assessment that all four tests set out in the road map have been met. Test 1 is that vaccine deployment continues successfully. We continue to make great progress in vaccinating the most vulnerable as we move through the road map. As of 25 April, more than 33.7 million people have received their first dose of the vaccine, and another 12.9 million people have received their second dose. That huge progress means that we continue to meet the first test.

Test 2 is for the evidence to suggest that the vaccine continues to be effective in reducing hospitalisations and deaths. Public Health England’s analysis indicates that the UK covid-19 vaccination programme has so far prevented more than 10,000 deaths in those aged 60 and above in England. Furthermore, hospital admissions in the over-65s remain consistent with a vaccine effect of reducing serious or life-threatening illness from covid-19.

Test 3 aims to ensure that infection rates do not risk a surge in hospital admissions that could put undue pressure on the NHS. That is somewhat mitigated by those who are most vulnerable being vaccinated. However, I know from speaking to NHS staff how concerned they are about the risk of a third wave. Currently, the number of hospital admissions continues to decrease, and case rates among the over-60s are also falling. The NHS emergency alert level has been dropped from level 4 to level 3, mirroring how the NHS was in the summer of 2020.

Test 4 is that our assessment of the risks is not fundamentally changed by new variants of concern. As further evidence is gathered on their impact, the incidence of variants of concern, such as the South African B1351 variant or the Brazilian P1 variant, remains very low and stable in the United Kingdom, with border restrictions and testing in place. The Government will continue to monitor those and other variants closely as we ease restrictions, and we will not hesitate to take firm action as necessary to protect lives and livelihoods.

We met all four tests, so we were able to take the next cautious step along the road map on 12 April 2021. That involved the easements to restrictions set out in the regulations we are debating today and covered the reopening of non-essential retail, including personal care and indoor leisure, such as hairdressers and gyms, and the reopening of additional outdoor settings, including the hospitality sector and attractions. Outdoor hospitality is not required to provide a substantial meal alongside alcoholic drinks. Furthermore, no curfew will be imposed on pubs and restaurants, but the requirement to have table service and for customers to order via table service if the venue sells alcohol remains, and payment should be taken at the table or at another outdoor location wherever possible.

The easements also included the resumption of indoor childcare and supervised activities for children, providing they are not in private homes. That includes indoor sport and parent-and-child groups, which can take place for up to 15 people. Wedding ceremonies are permitted for up to 15 people, and wedding receptions are permitted outdoors again for up to 15 people, and should be in the form of a sit-down meal. Smaller outdoor events such as fêtes, literary fairs and fairgrounds are able to take place.

Self-contained accommodation can be used for single households or bubbles. Social restrictions will remain the same as those in place from 29 March, with the rule of six or two households outdoors only. We regret that we are only just debating these amendments now. However, it was essential to introduce them quickly, as no restriction should be in place for longer than necessary.

Step 2 is a considerable achievement and is down to the sheer dedication of all health and social care sector staff, as well as the public’s determination to beat this virus. The easing of regulations is hugely welcome and brings us a step closer to reclaiming normality. Although I am proud of our efforts that have led us to introduce step 2, I must be frank: the virus is not gone from our lives, and we must be cautious as we look to ease restrictions further. There is still the risk of a resurgence of cases such as those reported in other countries. However, if we continue to be guided by data rather than dates, and we ensure that we meet the four tests, we can safely reopen our society and claim back our lives. I commend these regulations to the Committee.

--- Later in debate ---

[Helen Whately]

It has always been clear that the path set out by the road map in February would be guided by data, not dates, and we have stuck to that commitment. Data from the Joint Biosecurity Centre, the Scientific Pandemic Influenza Group on Modelling and Public Health England indicate that the five-week gap after step 1 on 8 March enabled us to meet the four tests we had previously set out. The move to step 2 is therefore the next part of our cautious but sustainable path out of the current lockdown in England.

We recognise the impact that the restrictions have had, but the risks of not following that path are too great. By taking a cautious approach, we will protect our NHS and social care system, ensuring that it will be effective in protecting us and putting us on a sustainable footing towards normality. We must all continue to be cautious and observe the limitations that remain in place, and I ask each and every individual to continue to play their part to keep the virus rates low and the strain on the NHS even lower.

On the points made by the shadow Minister, who was critical of some of the details of the regulations, I do not necessarily accept all his criticisms, but I say to him that we are in a situation where regulations are made at pace, and we are not living in entirely normal times, as he is well aware. It may be helpful to mention that the approach taken towards compliance by the police, for instance, is to engage, explain and encourage people to follow the rules, before moving to enforcement.

Rules have been refined during the pandemic—the rule of six or of two households together in outdoor places, for example. As a member of a family of five, I, like many others, welcome that particular move. During the pandemic, we have constantly sought to assess the impact of restrictions, although we recognise that they are often applied in combination, so identifying the impact of a specific change to restrictions is not always possible to the extent that the shadow Minister might like. We have indeed sought to ensure that we understand the impact, and clearly, we have been reluctant to impose restrictions if they are not necessary for saving lives.

The shadow Minister said that he would like to have debated the regulations before, but as he knows and has heard me say before, pace is of the essence here. We wanted to remove restrictions as promptly as we could, albeit by following the steps in the cautious approach that we have taken. I am glad that he noted the slightly longer timeframe than on some of the other regulations. We have committed to following steady progress in the easing of restrictions—subject, of course, to the data and to meeting the tests that I set out earlier.

I thank each and every person for the sacrifices that they have made to keep ourselves, our loved ones and each other safe. Our road map reaffirms our commitment to protecting the citizens of the UK and to providing a credible route out of this lockdown.

Question put and agreed to.

Covid-19: Social Care

Helen Whately Excerpts

Thursday 22nd April 2021 Westminster Hall

[The Minister for Care (Helen Whately)]

I will do so. It is a pleasure to serve under your chairmanship, Mr Twigg. I wish the shadow Minister’s mother a happy birthday today.

I thank the hon. Member for Dulwich and West Norwood (Helen Hayes) and my right hon. Friend the Member for Ashford (Damian Green) for securing this debate on social care and covid and for the work they do as co-chairs of the APPG on adult social care, bringing the sector together and being a voice for it in Parliament and beyond.

As the hon. Lady and my right hon. Friend said—as, in fact, all speakers today have said, and as we all know —the pandemic has been cruel to those who receive social care, especially those living in care homes around the world, here in the UK, and indeed in England. Sadly, both residents and care staff have lost their lives, and each one will be missed by friends, family, and those who love them. I thank those working in social care—staff in care homes, home care workers, those supporting people in extra care and supported living, personal assistants, social workers, and millions of unpaid carers as well—for all they have done during the pandemic, and are continuing to do now, to care for those who rely on their care and could not live without it.

Members have spoken about the many challenges the sector has faced during the pandemic. I want to outline some of the things that the Government have done to support social care, with a level of intervention—a level of support—that is unprecedented for social care, and rightly so in the circumstances of the pandemic. First, the hon. Member for Dulwich and West Norwood spoke about the extra costs that social care has faced during the pandemic. We have put in £1.8 billion of specific, ring-fenced covid funding for social care during the pandemic, including £1.3 billion for infection control measures, and providers have told me what a huge difference this support has made to them and how essential it has been all the way through the pandemic.

Secondly, the Government have stepped in to provide PPE to the social care sector, and PPE has been available free for many months via a portal to meet the covid needs of social care providers on demand. Over 2 billion items of PPE have been supplied to the social care sector, and the Government have committed to continue PPE supply through to March 2022.

Thirdly, social care has been prioritised as our testing volumes have increased. Last summer, we introduced weekly polymerase chain reaction testing for care home staff, and since December, that has been supplemented by twice-weekly lateral flow device tests. That has made a difference, because we can not only quickly identify when a staff member may be covid positive but, through the introduction of the LFD tests, we are able to identify whether a member of staff is covid positive before they set foot in the care home. During this time, we have sent out over 28 million PCR tests and 47 million LFD tests to the social care sector across care homes, home care, supported living, and other parts of the sector. We have also made rapid tests available to visitors, supported by £288 million of funding for the staff costs involved in that testing, to help people see loved ones. I will say more about visiting in a moment.

Fourthly, many hon. Members have spoken about the impact of the pandemic on the social care workforce. Again, we cannot thank care workers enough for what they have done, and how they have gone the extra mile time and again. Through the virtual visits I have made to care homes and the conversations I have had, I have seen what staff have done, particularly to step in and support residents at a time when visiting has been restricted.

I also know the difficult experiences that some care workers have been through. We have specifically advised care providers to use some of the funding for paid sick leave for social care staff who have had to isolate due to covid. We have also put in place mental health support for the social care workforce, seeking as far as we can to mirror the mental health support offer to NHS staff, and we will continue to see how we can support staff through the mental health impacts of the pandemic.

As hon. Members have said, we know that there are workforce shortages within social care, and at times covid has made that harder, with staff rightly taking time to isolate. Recognising that, we provided £120 million of funding for the workforce capacity fund, which was passed to local authorities to boost staffing for the sector during the second wave.

To increase the voice of the social care sector and to give further leadership—particularly clinical leadership—to the social care workforce, we appointed the fantastic Deborah Sturdy as the chief nurse for social care. She is already doing brilliant work with the sector and the workforce, and contributing to plans for the workforce of the future.

To increase our understanding of the social care situation on the ground, we created a social care data dashboard as a single point of information for the system. We came into the pandemic with relatively small amounts of timely data about social care; as hon. Members know, it is a highly fragmented system, with over 25,000 different providers. We have built a way of having up-to-date information and self-reported data from providers, which has given us truly valuable information to which local authorities also have access. It gives a good sense of what has been happening on the ground.

We have also established a regional assurance team for social care, as this is now the Department of Health and Social Care. They are a group of people with great experience in the sector who have been able to reach out during the pandemic, working with local authorities, directors of public health, providers and others, to understand some of the challenges being faced and provide more localised support.

On visiting, on many occasions we have developed an iterated visiting guidance, responding to requests from the sector for a steer on how to manage the challenge of wanting people in care homes to be visited while acknowledging the risks to residents of more people coming through the door. We have drawn a huge amount of clinical guidance from the deputy chief medical officer of Public Health England on how we can enable safe visiting. Clearly, we have substantial caution because we know the great risks to care home residents when covid gets in and how difficult it is to stop an outbreak from spreading through a care home, even with the PPE, the testing and the other things I have outlined. One reason why we introduced visitor testing was to reduce that risk.

Since 12 April, care homes have been able to open up to two visitors, and the essential care giver scheme addresses particular need. I look forward to care homes being able to continue to open up, step by step, through the combination of lower infection rates and vaccination, to enable people to once again spend much more time with their loved ones.

Several hon. Members spoke about visits out. I recognise the importance of both having visitors at care homes and being able to leave—to go out and about. This applies to older people, but particularly to families who have relatives of working age in residential settings, who I have spoken to. Often, somebody of working age might come out every weekend to spend time with their mum and dad, and their family. Clearly, they have not been able to do that during the pandemic.

I ask other hon. Members with an interest in this subject to listen to the Joint Committee on Human Rights sitting held yesterday, when I was asked about this. With me was Dr Éamonn O’Moore from Public Health England, who explained in some detail, which we do not have time for today, the reason for the caution around visiting out and the clinical reasons for the requirement to isolate for 14 days on return. To respond to the hon. Member for Worsley and Eccles South, I should say that that is not the same as somebody coming from overseas to the UK and quarantining, because of the particular circumstances within care homes. There may be people who are very vulnerable. In the event that someone brings covid into the care home, that can lead to an outbreak, which can lead, sadly, to people dying. Therefore, rightly, the issue is taken seriously.

I assure colleagues that, as Dr O’Moore said to the Health and Social Care Committee yesterday, I have asked Public Health England to provide advice on how to make more visits possible—particularly those with lower risk, such as those outdoors—and on what could be done to reduce quarantine requirements afterwards. I am mindful of the May elections and of those who might want to vote in person.

My right hon. Friend the Member for Ashford rightly said that vaccines are the answer to allowing more visiting and for much of life to come back to normal, for those who receive social care. We prioritised the social care sector for vaccinations—and particularly care homes, who were top of the list. The vaccine was offered to all care homes by the end of January, on time. Soon, all residents who can be vaccinated will have been offered their second dose.

The impact of vaccination is already being seen, with the rates of covid coming right down in care homes. There are still some outbreaks and I would caution those listening to the debate that the vaccine is not 100% effective. Many residents have had their second dose but others are still only on their first, and it is important in that situation that the precautions continue. For instance, we are continuing to urge care homes to make sure that staff use PPE and infection control measures, even when everyone has been vaccinated. However, there are far fewer outbreaks and the consequences are much less serious. I want to use this opportunity to thank the NHS vaccination teams, and the social care workforce, who have been involved in the tremendous and lifesaving effort to vaccinate so many thousands of people in social care.

Many hon. Members spoke about the importance of reform, and how the pandemic has shone a light on the social care sector and the need for reform. I truly welcome the support for reform among hon. Members who have taken part in the debate in this room and virtually. Some steps have begun, and I urge the hon. Member for Dulwich and West Norwood to look again at some of the social care content in the health and social care White Paper, including the voice of social care in integrated care systems—and I agree with the point made by my right hon. Friend the Member for Ashford that it is not just about a local authority voice, but the wider sector.

The White Paper also proposes the introduction of a new oversight and assurance system for social care, which I see as an important part of building on the experiences of the pandemic, to give us more oversight and the ability to drive quality and outcomes more strongly for those who receive social care. It also includes steps to support better use of data and data sharing for social care.

Those things are, however, just the beginning and we need to go further. We have committed to go further and to publishing a long-term plan for social care this year.

[Barbara Keeley]

As the Minister is talking about the White Paper, I wanted to point out that we have talked quite a lot about unpaid carers in the debate, but they are not mentioned once in the White Paper. Carers’ organisations took that in a bad way and felt that all the efforts that unpaid carers put in during the pandemic were not recognised at all. The Minister and the Health Secretary need to address that.

[Helen Whately]

The hon. Member makes a really important point, and I really appreciate how she has spoken about unpaid carers during this debate. I absolutely recognise the crucial role of unpaid carers, the things that unpaid carers do and the demands on and challenges for unpaid carers during the pandemic. I absolutely see unpaid carers as part of the breadth of the social care system that we must consider for the reforms as we go forward.

I very much welcomed the expertise, in the room and virtually, on social care reform. My right hon. Friend the Member for Ashford reminded us that the reform debate has been going on for nearly 25 years. He has extremely valuable experience. My hon. Friend the Member for Ruislip, Northwood and Pinner (David Simmonds) has great experience from local government and flagged the work of Sir Paul Carter, whom I know because he is the former leader of Kent County Council and I am a Kent MP. I will indeed be looking at the work that my hon. Friend mentioned. My hon. Friend the Member for Somerton and Frome (David Warburton) called for a social care workforce strategy. Yes, absolutely, as part of the reform work, we need and plan to bring forward a strategy for the social care workforce.

I am conscious of the time and so that is probably as far as I can go today, but broadly, I truly welcome the support for social care reform expressed during this debate. I assure those in the room and all those listening to the debate that we are determined to seize this moment. We have supported social care at an unprecedented level during the pandemic; on the back of that, we are determined to bring forward the reform that we know social care needs.

Oral Answers to Questions

Helen Whately Excerpts

Tuesday 13th April 2021 Commons Chamber

[Antony Higginbotham (Burnley) (Con)]

What steps he is taking to support integration within the health and social care system.

[The Minister for Care (Helen Whately)]

We want health and social care to be joined up effectively, with the different parts of our system working together to meet people’s needs. The health and care White Paper sets out our plans for integrated care systems, which will not only join up local NHS organisations but strengthen collaboration among the health service, local authorities and others involved in social care.

[Antony Higginbotham]

One thing that will really help the integration of health and social care is the better use of technology and innovation, but one of the barriers we face is the sharing of information among different clinicians, general practitioners, hospitals and social care settings, so will my hon. Friend confirm that as part of the plans for better integration we are looking at how data and information can be shared much more effectively?

[Helen Whately]

My hon. Friend is absolutely right: interoperability is essential to harness the potential benefits of health and care data for individuals and to create a health and care system that is fit for the future. We are going to legislate to ensure more effective data sharing across the health and care system and will outline our plans in the upcoming data strategy for health and social care.

[Martyn Day (Linlithgow and East Falkirk) (SNP) [V]]

Despite the incredible challenges of the past year, neither the Government’s White Paper nor the Budget even mentioned social care. Health and care integration has been progressing in Scotland since 2014, and the Scottish Government have committed to developing a national care service and ensure equity throughout Scotland; will the Minister make such a commitment for England?

[Helen Whately]

Actually, I have to disagree with the hon. Member: the White Paper does mention social care and includes several steps on the path to the reform of social care. We will bring forward further information about social care reforms later this year.

[Martyn Day]

Integration and service improvement cannot be delivered without sufficient social care staff. The Scottish Government already fund the real living wage for social care staff in Scotland, have included them in the £500 thank-you bonus, and plan to standardise pay and training. Does the Minister not recognise that the only way to attract people to build a career in social care is by valuing care staff?

[Helen Whately]

I agree with the hon. Member that it is essential that we value social care staff. Just as we have valued NHS staff during the pandemic, so we have rightly recognised the vital contribution of the social care workforce. We must continue to value our social care workforce, for which we plan to bring forward proposals as part of our social care reforms.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

What steps he is taking to ensure patients are consulted on the provision of their local health services.

--- Later in debate ---

[Jon Trickett (Hemsworth) (Lab)]

What steps he is taking to increase pay and improve working conditions in the social care sector.

[The Minister for Care (Helen Whately)]

We recognise the extraordinary commitment and compassion of social care staff, especially during the pandemic. While the Government do not have direct responsibility for pay in adult social care in England, we want care providers to reward and support their staff appropriately for the vital work they do. During the pandemic we have asked care providers to pay staff full pay when they need to self-isolate and provided over £1.4 billion of extra funding to support the cost of this and other infection control measures.

[Jon Trickett]

First, I imagine the whole House will join me in mourning the 364 care workers who have died in public service since covid began. Many care workers have told me that they feel undervalued by the fact that their average salary is only £17,200. I am sure there are very few Ministers who could live on that kind of salary. They particularly feel devalued when they discover that the Government are paying nine times that salary equivalent to Test and Trace consultants. It is an outrage. Will the Minister now say how she will show that these people are valued by doing three things: first, end privatisation; secondly, insist on a proper salary rise; and thirdly, ensure that a professional career structure is instituted which recognises and rewards the professionalism, talent and commitment of these essential workers?

[Helen Whately]

I share the hon. Gentleman’s sorrow for the lives that have been lost among the health and social care workforce during the pandemic. I am determined that we will support and continue to support our health and social care workforce through these difficult times. One of the things that I want to achieve for our social care workforce, for whom I am truly ambitious, is that rather than doing something one-off for the pandemic, we should come up with a workforce strategy that will improve the opportunities for those working in social care to develop their careers, with a real career progression in working in that sector. That will be part of our social care reform proposals.

[Liz Kendall (Leicester West) (Lab)]

Despite repeated promises, the truth is that someone would be better off stacking shelves at Morrisons than caring for older or disabled people, and that is simply not good enough for our country. Can the Minister confirm that the Government’s covid infection control fund had to be used to improve pay so that staff did not have to work for more than one care home and could actually afford to self-isolate? If that is the case, will she commit to permanently enshrining these improvements across the sector to keep all care users and all care workers safe?

[Helen Whately]

In response to the hon. Lady’s question about the use of the infection control fund, it was available to providers to use in a range of ways to keep their residents safe from covid, including, for instance, reducing the movement of staff between one care home and another, which is often part of the service model of how care is provided, and also, as I mentioned earlier, funding full sick pay for staff who needed to self-isolate because of covid. I am determined that as part of our social care reforms that we will be bringing forward, we will look at how best we can support the workforce.

[Christian Wakeford (Bury South) (Con)]

What progress he has made on implementing the recommendations of the independent medicines and medical devices safety review.

--- Later in debate ---

[Claire Coutinho (East Surrey) (Con)]

What progress his Department has made on increasing the recruitment of nurses to the NHS.

[The Minister for Care (Helen Whately)]

NHS nurses have gone above and beyond throughout the pandemic. We are committed to increasing the number of nurses in the NHS by 50,000 over this Parliament through improving retention and increasing domestic supply and international recruitment, and we are on track to do that. The number of nurses in the NHS is at an all-time high of 301,491 full-time equivalent nurses employed in NHS trusts and CCGs.

[Claire Coutinho [V]]

We all know how hard our NHS nurses have had to work in the past year, many without a break and, for those with international origins, without seeing their families either. As public focus inevitably turns towards the NHS backlog, can Ministers assure me that they will work with NHS England to protect staff holidays and enable and encourage NHS staff to get the rest and recuperation they need?

[Helen Whately]

I completely agree with my hon. Friend that staff must be allowed and supported to recover from the pandemic. We have advised NHS Employers to make sure that staff can carry over annual leave. We are determined that the pace of NHS recovery must also allow staff the rest and recuperation they need.

[Ian Lavery (Wansbeck) (Lab)]

What steps he is taking to encourage health-related manufacturers to base themselves in the UK.

--- Later in debate ---

[Jim Shannon (Strangford) (DUP)]

What plans the Government have to ensure an adequate number of nurses in the cancer workforce to deliver the targets for cancer set out in the NHS long-term plan.

[The Minister for Care (Helen Whately)]

Cancer diagnosis and treatment is a priority for this Government. I am working with the Minister for prevention and public health—the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Bury St Edmunds (Jo Churchill)—to ensure that we have the necessary workforce to deliver improved cancer care. Overall, we are increasing the number of nurses in the NHS, with over 10,000 more nurses in the NHS this January than a year ago. We are training 250 more cancer nurses and 100 more specialist chemotherapy nurses.

[Jim Shannon]

I thank the Minister for that encouraging response, but will she outline what steps have been taken to ensure that Northern Ireland students educated in UK mainland nursing schemes can easily transition to fill the needs in our cancer wards both in the UK mainland and in Northern Ireland?

[Helen Whately]

I thank the hon. Gentleman for his question, and if he will allow me, I will look into that and write to him.

[Alex Norris (Nottingham North) (Lab/Co-op)]

Prior to the pandemic, cancer services were understaffed and not meeting their targets. During the pandemic, our staff have made incredible efforts, but a cancer backlog has built up. The Government are now asking the same understaffed cohort to run their normal services and to deal with the backlog at the same time. This is unfair, will lead to burn out and will not work. Will the Government commit today to extra resources specifically targeted at cancer to give those staff a fighting chance?

[Helen Whately]

I thank the hon. Member for his question. The Government have already committed significant additional resources to support the NHS in recovering from the impact of the pandemic, and that will include cancer services as well as other areas of treatment.

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

If he will make a statement on his departmental responsibilities.

Temporary Indemnity for Designated Care Home Settings: Contingent Liability

Helen Whately Excerpts

Thursday 25th March 2021 Written Statements

[The Minister for Care (Helen Whately)]

Further to the written statement made on 18 January 2021 by the Minister for Covid Vaccine Deployment, my hon. Friend the Member for Stratford-on-Avon (Nadhim Zahawi), I am tabling this statement for the benefit of hon. and right hon. Members to bring to their attention the undertaking of a contingent liability. This relates to an extension of the designated settings indemnity support (DSIS), which offers targeted and time-limited state-backed indemnity arrangements to care homes registered, or intending to register, as “designated settings”, and which are unable to obtain sufficient insurance cover.

On 18 January 2021, the Minister for Covid Vaccine Deployment announced in a written ministerial statement, and accompanying departmental minute, provision of these temporary indemnity arrangements under the DSIS. The DSIS includes cover for clinical negligence, employer’s and public liability where a care provider seeking to become a designated setting is unable to secure sufficient commercial insurance, or where an existing provider has been operating without sufficient cover. Employer’s and public liability is covered under the new coronavirus temporary indemnity scheme; clinical negligence is covered by the clinical negligence scheme for trusts. The DSIS is supervised by DHSC and administered by NHS Resolution, and, to date, has proved to be an effective package of support to designated settings.

DSIS initially provided cover for designated settings until the end of March 2021. Following a review of DSIS, it will now be extended until 30 June 2021, in order to maintain the current level of support for these vital settings. This extension will benefit current DSIS participants, as well as any additional settings who may wish to apply for the support and who meet the criteria for inclusion. A review of DSIS will take place in early June.

I regret that in this circumstance, due to the need to ensure that there are no gaps in DSIS cover after the current 31 March end-date, the normal 14 sitting days for consideration has not been possible. A departmental minute will be laid in the House of Commons providing more detail on this contingent liability.

[HCWS894]