Covid-19 Update

Lord Dubs Excerpts

Wednesday 1st July 2020 Lords Chamber

[Lord Dubs (Lab) [V]]

We have frequently been told that the key figure to look at is the R figure. Will the Minister confirm that whereas after lockdown the national R figure was 0.84, it is now 0.94—so we are on a bit of a knife edge? Secondly, can he explain why the R figure is not released locally at the same time as the national figure is released?

[Lord Bethell]

The noble Lord is right that the R figure is important, but in many ways, at this stage of the epidemic, the prevalence figure—the total number of people who carry the disease—is more meaningful. A higher R on a smaller prevalence is less worrying than a smaller R on a higher prevalence. As to having regional Rs, the data to date has not been strong enough for that to be a reliable figure. However, we are working towards that situation and I can envisage a moment when it would happen.

Covid-19: Care Homes

Lord Dubs Excerpts

Wednesday 20th May 2020 Lords Chamber

[Lord Bethell]

My noble friend Lady Blackwood is quite right that the Roche and Abbott antibody tests are a great step forward. It shows how diagnostic technology is progressing very quickly. We are determined to use all the benefits of modern technology in the fight against Covid. Our announcements on antibody testing in the NHS, in the care service and for key workers will be announced shortly. When it is, I assure her that NHS and social care workers will be on an equal footing.

[Lord Dubs (Lab)]

My Lords, in answer to an earlier question, the Minister said that it was not appropriate to compare us with what happened in Hong Kong, South Korea and Singapore, which had no deaths in care homes at all. He preferred to compare us with Europe. Is the truth not that we took our eye off the ball and that as a country we failed to learn from what was happening elsewhere? We failed to learn good practice and we actually lost two months, where we did nothing very much until we tried to catch up just now. Surely we failed pretty badly.

[Lord Bethell]

The noble Lord makes a comparison that history will have to judge on, I am afraid to say. I think that I am making a fair point when I say that Britain can really only benchmark itself against its close neighbours. The experience of Asian countries taught them an enormous amount, but it is not one that has seemed proximate or relevant to us in recent times. I am afraid that I can only leave it to history to judge whether we made mistakes. It would be wrong for me to prejudge that at this moment.

Covid-19: Social Care Services

Lord Dubs Excerpts

Thursday 23rd April 2020 Lords Chamber

[Lord Dubs (Lab)]

I congratulate my noble friend Lady Wheeler on initiating this debate and on her very powerful speech. I should declare an interest, in that a member of my family has been in care homes over the years and now has support in his own home, so I have some experience of how these things work.

The first problem, I think, is the poor statistics on this whole sector. We are beginning to get more information together, but it seems to me that, unless we have clear statistics so that we know what the provision is, we cannot easily change policy for the better. We know that many of the problems of social care are long-standing and existed for years before the present pandemic crisis hit us, but they meant that this sector was ill prepared for the difficulties that we now face.

One example that has been often cited is the long journeys that care home workers need to take to get tested. I was told that one person had to travel from Bournemouth to either Gatwick or Chessington— 100 miles each way—to be tested. That is an impossible journey for people who are hard-pressed to get to their places of work.

We all know that social care has for too long been the underdog. Acute services have tended to get the money, albeit not enough—I would not take away a penny from acute services; I would rather put more in—but social care has still tended to be the underdog, as characterised by the very low levels of pay earned by people in the sector.

We know that there are wonderful people working in social care, we know how hard they work and we know about the wonderful long-term relationships that they establish with the people they care for—making the death of such a person even more painful. Of course we must ensure that they have security in this country, and the issue of visas must be dealt with.

Of course we need more testing, as has been said, and of course that should have happened a long time ago. I understand that residents with symptoms and those being transferred to care homes will now be tested. I wonder when that will be completed and when all workers in care homes and domiciliary care will have had the chance to be tested.

I should mention in passing that not all people in care are elderly; there are young people who need help as well, and their problems are slightly different from the needs of the elderly but are still important.

I turn to domiciliary services, which tend to be forgotten. Visits by care workers to homes where a single isolated person is on their own are crucial—not just for their health and needs but to lessen the sense of isolation. Domiciliary workers who call on people’s homes often provide their only link with the outside world. If that were to stop because of the present crisis, that would be a disaster. Of course, as a society and a country we depend very much on family members to provide care. If one falls ill, there is an even more difficult situation for the care workers who have to come in; that appears to be the difficulty at the moment. I know of one care worker who has a long journey by Tube every day to his place of work. Until recently he was given two masks per day, which was hardly enough given that he visited many people per day and per week.

In the long term, surely the social care sector needs a sustainable funding settlement so that it can look forward sensibly to the future. We have to reform the social care system, ensuring that the long-awaited Green Paper says something about it—although I suppose that is a long way away. Finally, in many health sectors there are the royal colleges—the Royal College of GPs, the Royal College of Physicians and so on. Would it not be right if social care workers, both in care homes and in the domiciliary sector, had a royal college of social care to speak for them? Would that not be a good idea? It would be able to fight their corner better than it is being fought at the moment.

Queen’s Speech

Lord Dubs Excerpts

Thursday 9th January 2020 Lords Chamber

[Lord Dubs (Lab)]

My Lords, it is a great pleasure to follow my noble friend Lady Blower and to congratulate her on her maiden speech. She was being unduly modest, because she has an enormous amount of educational experience, not just, as she said, as general secretary of the National Union of Teachers; she has also taught in a number of comprehensive schools in the London area. To say that other noble Lords have more knowledge of education than she has is to be unduly modest. She will make an enormous contribution to educational debates, thinking and policy in this House, and we look forward to hearing from her on many future occasions.

I will speak about social care. The gracious Speech included a reference to social care and the Government seeking cross-party consensus. That is fine, but we have been waiting for something to happen on social care for years. There have been reports, commissions and bodies talking about social care. What has happened to the long-awaited White or Green Paper that the Government promised quite a long time ago? Could the Minister tell us whether it is still going to happen and, if so, when?

If one talks to people of our age or older, one will know that most in this country are concerned about what will happen to them when, or if, they get to the point that they cannot look after themselves unaided. There is a deep concern. According to the British Social Attitudes survey, only 23% of people are satisfied with social care. There is a real gap in the system and concern for the future. Of course there is a need for more money. The Government are talking about an extra £1 billion a year, but most people who have looked at it say that we are nearer to needing about £8 billion a year, rather than £1 billion, to provide a decent standard of care. That is the sum required to return to the standards of 2009-10.

Eligibility for social care is very much a postcode lottery. It depends on which local authority one lives in and all sorts of random factors. No wonder there is concern. It also depends a great deal on unpaid carers. They give up their jobs to do care work and get £60 a week for that. It is pretty miserable. Care staff are not always able to work on Christmas Day or New Year’s Day. Retention is poor and many are non-UK nationals. I wonder what will happen to them post Brexit.

Everybody talks about better integration of health and social care. We hear the expression “bed blocking”. There are enormous costs to bed blocking. If there is no seamless transition from hospital to social care, which is provided by local authorities, people tend to stay in hospital. I know of the experiences of people who were in hospital for quite a long time—probably unnecessarily, had there been better transition to care outside hospital. I heard one estimate that a night in hospital costs £350, a night in a care home £85, and a night at home with care support under £20. People often have to contribute to their care but, because by staying in hospital they do not have to so, paradoxically, they save a bit of money, but it is not an efficient and humane way of proceeding. It is also erratic, because people with dementia have to pay for everything themselves and people with other illnesses do not. I understand that a good model has been developed in Manchester, which has a better way of integrating health and social care. It would take legislation to bring it about fully, but it needs to be looked at.

I looked into some other things, such as records. We have very little information about social care and few hard facts. Most of what we know is based on estimates—approximations, almost guesswork. For example, local authorities have different methods of collecting data. Nothing is standardised, so one cannot even compare one local authority to another. I challenge anybody to look at the form for eligibility for social care produced by a local authority. I have seen one—it probably takes a PhD or two to complete. They are very difficult, and people who are deprived and disadvantaged cannot always do that. There is a terminology difference as well between NHS support and social care. Surely we all agree that reform must be evidence-based.

There is pressure in the system, because the health service dominates, in a way. The health service needs far more money, but it has power to attract more money than local authorities can for social care. Local authorities are hard-pressed enough as it is. I urge that we should have proper records; be generous in saying that social care has to work properly; and that we must integrate health and social care. We would save money and provide much better care. For heaven’s sake, let us get on with it.