Dementia: Accident and Emergency

Lord Forsyth of Drumlean Excerpts

Wednesday 11th March 2020 Lords Chamber

[Lord Bethell]

The noble Baroness will be aware that the identification of dementia patients in England has risen dramatically from 42% to 67%, which more than accounts for the increase in the Alzheimer’s Society’s numbers. We are, however, concerned about this issue and remain focused on pulling together a new challenge on dementia strategy for the next five years and on ensuring that beds are liberated in a timely and reasonable fashion.

Coronavirus is naturally a matter of high concern in our preparations. Care of existing vulnerable and lonely people and the elderly is a massive priority, and we are putting in place plans to provide that care.

[Lord Forsyth of Drumlean (Con)]

My Lords, if the care of people with Alzheimer’s and other conditions is such a priority, why have the Government not responded to the Economic Affairs Committee report on social care which came out seven months ago, and why was there nothing in an otherwise excellent Budget speech on social care, which we have been promised now for year after year after year?

[Lord Bethell]

The noble Lord is quite right to point out the delay in providing an answer on social care. That is why the Secretary of State for Health and Social Care wrote to Peers earlier this month, initiating a round of cross-party conversations and putting in the diary the beginnings of a process to pull together cross-party agreement. That cross-party agreement is essential to providing a long-term solution to this important problem.

Covid-19: Deep Cleaning

Lord Forsyth of Drumlean Excerpts

Wednesday 11th March 2020 Lords Chamber

[Lord Bethell]

My Lords, the noble Lord, Lord Kennedy, makes an important point. Cleaning and cleansing will be uppermost in all our minds, and I assure the House that it is a source of great focus in the efforts to combat Covid-19. However, I will try to persuade the noble Lord that we have only limited resources, time of those involved in the cleaning processes and good will from the public, so timing is essential when we are delivering measures to combat the spread of Covid-19. The CMO has been very clear on this: personal hygiene in washing hands and avoiding the spread of the virus to the face and skin should be the priority for us all. That is the focus of the Government’s efforts at this stage.

[Lord Forsyth of Drumlean (Con)]

My Lords, I declare an interest as chairman of a bank. The issue that the noble Lord has raised is very important. If someone is diagnosed with coronavirus, good practice means that no staff are allowed back into the building until it has been deep cleaned. An alternative would be to deep clean the building every night, so that if there were a case people could continue in their work, but to be able to pursue such a policy you need to know exactly what needs to be done to maintain the welfare and safety of the workforce.

[Lord Bethell]

The noble Lord is entirely right that cleaning is important, but the kind of deep cleaning protocols he described are not those recommended by the CMO at this stage of the epidemic. The SAGE group of statisticians and epidemiologists is modelling the outbreak of the virus very closely. Its computer models track the behaviours of the virus, the demographics of the country and the behaviours of people in different circumstances. Its focus is to try to ensure that we channel all our efforts into effective measures and do not explore red herrings or distracting policies that might prove counterproductive or distract from effective measures.

Nursing and Midwifery

Lord Forsyth of Drumlean Excerpts

Thursday 30th January 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

I thank the noble Lord for his important question. I am envious of his tartan and I definitely identify with his praise for nurses, who work long hours and serve the most vulnerable at the moments of their greatest need. To answer his specific questions, as part of the NHS people plan, we are committed to supporting career development for nurses, which includes supporting a diverse range of careers. An example would be the advanced practitioners within multi-professional teams. This is an important point that the noble Lord raises. We are also developing a plan for district and community nurses to work with healthcare providers, practitioners and higher education institutions. The plan will set out how we will grow the community nursing workforce, which includes mental health and learning disability nurses, and it is expected to be published later this year.

[Lord Forsyth of Drumlean (Con)]

My Lords, might my noble friend not mark this important bicentenary by enabling those nurses who have been in the profession for, say, five or 10 years to have their student loans written off, given that the cost to the taxpayer of not doing so will be greater? The write-off in 30 years’ time for the taxpayer will be £1.2 trillion in cash terms, so why not help the profession and the taxpayer by doing this now?

[Baroness Blackwood of North Oxford]

The noble Lord has made this point before and I have taken it back to the department before. He will know that we are providing additional financial support to nurses, including the maintenance grant of £5,000 in non-repayable funding, with specific targeted support of £3,000. However, I am very happy to take back his proposal once again, as we have an upcoming Budget.

Health: Sepsis

Lord Forsyth of Drumlean Excerpts

Wednesday 22nd January 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

That is an extremely helpful and constructive proposal. If the noble Baroness would like to raise it with me outside the Chamber, I will take it up as a matter of priority.

[Lord Forsyth of Drumlean (Con)]

My Lords, does my noble friend accept that public education has an important role to play here, so that people are aware of the symptoms—following the question asked by the noble Lord, Lord Patel? Can we congratulate the BBC, those of us who are fans of “The Archers”, on the work it has done in this respect?

[Baroness Blackwood of North Oxford]

I am very happy to congratulate the BBC. I do not know that I heard “The Archers” storyline in question, but I shall make sure that I update my education in this respect. I want also to congratulate Public Health England on its national Start4Life information service for parents. It has worked with Mumsnet to make sure that awareness is spread to those most likely to need it, because those most at risk are the young, the elderly and those who have underlying conditions. Targeting the messaging at those who need it most is very important.

Queen’s Speech

Lord Forsyth of Drumlean Excerpts

Thursday 9th January 2020 Lords Chamber

[Lord Forsyth of Drumlean (Con)]

My Lords, it is a pleasure to follow the noble Lord, Lord Rees of Ludlow. I was particularly impressed by his argument that we can influence climate change more than our contribution to carbon through research. It is a very powerful argument and certainly a new one to me. He is, of course, a cosmologist. I want to concentrate, in the short time I have, on social care. Sometimes I feel that officials in the Treasury have the noble Lord’s perspective on time in respect of this issue.

I think it was Winston Churchill who first said that the state has a duty to provide a net below which no one can fall and a ladder to help them get out of the net. Like the noble Baroness, Lady Janke, I believe that very strongly. Social care policy is about protecting our frailest and most vulnerable people, who cannot climb any ladders and whose quality of life depends on that net. Sadly, as several speakers have said, it is wholly inadequate, full of holes and now disintegrating under the inexorable pressure of demand. By 2040, for every working adult there will be almost one person over the age of 65. The cost of care for older people will double between now and 2035. This is not just an issue of an increasingly elderly population either. Almost half of expenditure on social care goes on people of working age, and that population will increase too. By 2025, there will be 150,000 more working-age adults with moderate or severe disabilities and 16,000 more with learning disabilities.

The system is completely broken, with Age UK estimating that 14% of elderly people have an unmet care need. The number of people receiving publicly funded care has actually fallen in recent years. In England there were 40,000 fewer such people in 2013 than there were in 2009—a 26% fall, despite an increase in demand. The fact is that it is the impact on the budget, not well-being, that now determines whether needs will be deemed eligible for support by local authorities. Just to get to where we were 10 years ago in quality and access to care would cost around £8 billion.

What is to be done? Since I left the Government at the invitation of the electorate in 1997, 12 Green Papers, White Papers and other consultations and five independent reviews have attempted to solve the issue of social care funding. All have pointed to the same answer: we need to find considerably more money and achieve a consensus between the Government and the Opposition to underpin a long-term, stable system. I very much welcome, therefore, the commitment in the gracious Speech to achieve that.

Last year, the Economic Affairs Committee, which I do the best I can to chair, was able to reach unanimous agreement on a way forward. Its membership included two former Chancellors of the Exchequer, two former Permanent Secretaries to the Treasury, a former Cabinet Secretary, a distinguished economist of the left, a retired FTSE 100 CEO, a non-executive director of the Bank of England and other highly experienced members. If we could find agreement, why can the political parties not? It would mean the state writing a big cheque and providing clarity about the future structure, and it would require a determined effort to simplify the system and remove many of the unfairnesses from it. Above all, it would require a major effort to educate the public.

The fact is that most people do not have a clue about the level of support they can expect if they are struck down by illness or fragility and find themselves unable to meet their own basic needs for washing, feeding, continence and mobility. The problem becomes apparent to the voter only when an elderly parent or perhaps a family member has a severe disability. The Local Government Association survey found that 48% of English adults did not even know what the term “social care” meant. The King’s Fund found that people were shocked when the means test, the extent to which they were responsible for paying for their own care and the complexity of the system were explained to them.

There are real injustices in the system which need to be addressed. Self-funders in residential care are being charged 41% more than those who are publicly funded. It is a hidden tax on people who have saved throughout their working lives. In England, it is quite scandalous that access to basic free care is limited by diagnosis and not need; a person with cancer will be helped but someone with dementia or motor neurone disease will not until they have spent every penny down to £23,500. The means test does not include the family home as an asset if domiciliary care is provided, but it is counted for residential care, leaving some families faced with catastrophic costs losing everything.

The pay, treatment and training of the care workers is woefully inadequate. Care homes regularly lose dedicated men and women to stacking shelves in supermarkets and the turnover among staff is approaching 40%. There is a desperate need to invest in the social care workforce and ensure a joined-up approach to workforce planning. I know how wonderfully committed and poorly rewarded care workers are. It is a vocation for most of them, not just a job, and they deserve a proper career path and professional status, like nurses.

Today, yet another Bill or Green Paper is awaited from the Government and, like Billy Bunter’s postal order, it has been endlessly delayed. With each delay the suffering increases, the pressure on unpaid carers grows, the supply of carer providers diminishes, the availability of qualified carers is reduced and the ability to put in place a system of social care that is sustainable and worthy of a civilised country is prejudiced.

To the Government’s credit, the Secretary of State for Health and Social Care wrote to me in September promising that the Government will set out plans in due course to fix the crisis in social care once and for all—to give every older person the dignity and security that they deserve and to protect children, parents and grandparents from the fear of having to sell their home to pay for the cost of care. These words are reflected in the gracious Speech. I hope and pray that they are soon turned into action.

NHS: Nurses

Lord Forsyth of Drumlean Excerpts

Tuesday 7th January 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

My Lords, first, I thank the NHS staff who have worked so hard over the Christmas and new year period. I point the noble Lord to the recent record; the NHS now has over 20,300 more nurses on our wards than in 2010 and over 52,000 more nurses in training. We have increased our training places by 25% since September 2018 and made available 3,000 more midwifery places to ensure that we can achieve this outcome. We have put in place several actions on recruitment and retention, because we need to retain our extremely experienced and excellent nurses and to recruit more nurses to support them. That is why we have announced this new package, which will not only increase nurse payment by 12% but provide support for those in training, attracting more nurses in to support those already in place.

[Lord Forsyth of Drumlean (Con)]

My Lords, from the point of view of both retention and recruitment of nurses, would my noble friend not think it a good idea to allow student nurses who stay in the profession for a period of time to have their fees written off, given that because of their levels of pay they will not pay back the student loans required for the profession? That would save the taxpayer a good deal of money and encourage people to come into the profession.

[Baroness Blackwood of North Oxford]

I always take very careful note of proposals from my noble friend. At the moment, that is not under consideration, but it will certainly be looked into. As the entry salaries rise, it is more likely that student loans will be repaid, but what is important at this stage is that we attract the most nurses into the profession. At the moment students are able to access student loan funding for maintenance as well as the non-repayable funding from the DHSC, which means that we will meet our target of 50,000 more nurses by 2025, which is what we need to be able to deliver a sustainable NHS.