Health Protection (Coronavirus, Restrictions) (England) Regulations 2020

Baroness Altmann Excerpts

Tuesday 12th May 2020 Lords Chamber

[Baroness Altmann (Con)]

My Lords, I absolutely recognise the difficult balancing act for the Government in grappling with the trade-off between public health protection and individual liberty—between the economy and the resources to support our population in the future, and the national health. I would like to highlight two vital elements that are part of these regulations and the ministerial thinking that has been clearly outlined by my noble friend.

I turn first to liberty and health. The regulations state explicitly that “vulnerable person” includes

“any person aged 70 or older”.

It is not clear that there is medical or statistical evidence to support the implication that anyone over the age of 70 is more vulnerable to Covid-19 than other age groups. We have done so much to improve the lives of older people, extending working life and life expectancy, so that those aged over 70 are now fitter and healthier than many younger people. While I congratulate the Government on their decision not to relax the lockdown rules in any way that discriminates against older people, these regulations contain that implication.

The latest ONS data undermines the arguments made by some that age is a predictor of fatalities from this virus. The most recent information shows that the proportion of people aged over 70 who have died with Covid-19 is 81.5%, but the annual death rate for the over-70s in the UK is normally 82% of all deaths. This does not support age alone being a relevant factor. Of course, older people are at any time more likely to pass away than younger people, so I wonder if the Government will reconsider the position of the over-70s that is indicated in these regulations and remove any age discrimination from our reaction to this virus. We must differentiate between elderly people who are at extreme risk, particularly if they have previous medical conditions, and the rest of the population.

That leads to my second point. I listened carefully to my noble friend who introduced these measures. His words each time were that they protected the NHS and ensured that it had spare capacity. However, I am deeply concerned that, as other noble Lords have mentioned, this extraordinary focus on NHS capacity, which has now reached a significant high, has resulted in discharging people who are the most vulnerable to this illness back into the community or into care settings, putting others who are also vulnerable—and the staff—at risk too. I hope that my noble friend can confirm that the department will consider the importance of upholding our national values, which reject age or any other form of discrimination, and increase the parity of esteem between the NHS and social care, which is so important for the management of this illness.

Covid-19

Baroness Altmann Excerpts

Thursday 23rd April 2020 Lords Chamber

[Lord Bethell]

The noble Earl, Lord Clancarty, is right that our present guidelines state that those arriving in Britain should isolate if they have symptoms and seek a test from a hospital if it develops seriously. It is clear to me that the way we travel around the world is set to change dramatically in the future, but the CMO has reviewed our airport and port guidelines. He is happy with them, and the evidence suggests that this is not currently a source of new infections in the UK.

[Baroness Altmann (Con)]

My Lords, may I press my noble friend on treatment, particularly with convalescent plasma? As I understand it, other Governments are urgently looking into this. France has put its medical staff into LFB. Have we put any pressure on BPL, which is the only fractionating company available in the UK, to produce pure, hyperimmune immunoglobulins, rather than the whole plasma, so that we can start parametric testing of IVIG and injections of convalescent plasma in the pure hyperimmune form?

[Lord Bethell]

I reassure my noble friend Lady Altmann that we are making this a massive priority. It has huge advantages over other therapeutics because it is plasma and can therefore have an accelerated regulatory advance. I signed for procurement of £20 million-worth of fractionating machines last week to help the blood transplant service create the hyperplasma to which she alludes.

Covid-19: Social Care Services

Baroness Altmann Excerpts

Thursday 23rd April 2020 Lords Chamber

[Baroness Altmann (Con)]

I, too, congratulate the noble Baroness, Lady Wheeler, on securing this debate and on her powerful introduction. I will focus on social care for the elderly and I draw attention to my interests in the register. I recognise the unprecedented challenges faced by the DHSC and know that it is easy to criticise, so I congratulate my noble friend the Minister on initial action taken to distribute PPE free of charge for use by private social care providers. However, we cannot deny that the Government’s initial approach prioritised the NHS over social care, following the traditional attitude that treats social care as a second-class Cinderella health service—out of sight, out of mind.

We also need a wholesale shift in the approach to elderly people. Lumping everyone above a specific age into one group, implying that all older people are infirm, is dangerously misguided. Will my noble friend confirm that government policy will not discriminate purely on age grounds when it comes to exiting the lockdown? The physical and mental health impacts of isolation and inactivity are at least as damaging for old people as for other age groups. As others have said, we knew from the start that older people who are infirm were most at risk. We knew where the most vulnerable were: in care homes or receiving home care. Yet there were no special measures for the protection of staff or residents, priority testing, PPE or treatment. Elderly deaths outside hospitals are being revealed only belatedly.

Regardless of short-term failings, we have opportunities to improve things for the future. Will my noble friend reassure us that the Government are now devising urgent plans for radical care reform? If time does not permit today, perhaps he could write to me. In particular, what is his department doing on the following five points: first, integration between and staffing for national health and local care provision, ensuring parity of esteem between the NHS and social care; secondly, taxpayer funding for basic personal care, and incentives for individuals to save to provide a higher standard or earlier access to care than can be offered by the state, as we do for pensions; thirdly, immigration rules that prioritise workers desperately needed by care providers; fourthly, attention to the viability of care providers so that the future of vulnerable elderly citizens is not at risk from the collapse or bankruptcy of highly indebted providers; and, fifthly, focus on the prevention of care needs, funding incentive measures to help people to stay safe at home and avoid needing social care in later life?

NHS Pensions: Taxation

Baroness Altmann Excerpts

Tuesday 9th July 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I can confirm that it has been made absolutely clear that NHS clinicians have been impacted by these reforms, and front-line care has been impacted. This is unacceptable and that is why we are bringing forward the review to find a solution as quickly as possible. The noble Baroness is right to raise the issue and we are determined to resolve it.

[Baroness Altmann (Con)]

My Lords, I am sure the Minister agrees that this was an unintended consequence of changes to the tax system. The reality is that the cliff edge of the taper is forcing consultants to pay tens of thousands of pounds for doing one small extra shift, sometimes voluntarily. Could she look at offering financial advice to each individual consultant who may be affected? They will not all face this tax charge, but they are all frightened that they might, so they are not undertaking the extra shifts we need them to undertake. Can she also note to her departmental colleagues that high-paid people potentially affected by the taper in other areas of the public sector received some assistance and mitigating measures from their departments, whereas it has been almost impossible for consultants to plan ahead? We are now seeing the problems occurring belatedly.

[Baroness Blackwood of North Oxford]

My noble friend speaks with particular expertise on this issue. As the whole House will appreciate, NHS consultants are often asked to take on additional shifts at short notice and they face peculiar challenges when calculating the consequences for their pensions. This is one of the reasons why the BMA has put up its calculator. However, the pension rules we are discussing today mean that some who take on extra work may find they have inadvertently incurred a substantial tax charge in moving into the taper. This is why we have brought in the consultation. It is obviously important that those facing pension charges should seek advice. NHS England is considering this issue closely at its most senior levels and working with the department to better understand the impact on clinicians, but also on NHS performance, and we are determined to resolve the situation to get it right.

Health: Cancer

Baroness Altmann Excerpts

Thursday 29th November 2018 Lords Chamber

[Lord O'Shaughnessy]

One reason that our cancer survival rates are not where they should be is that there is huge variation. The truth is that in some communities cancers are detected far too late as a matter of course. One way in which we are trying to address this problem is through the cancer strategy, which has provided about £600 million, £200 million of which has been to support cancer alliances in every corner of the country to make sure that we eliminate some of that variation and ensure that there is much more care for anybody suffering from cancer.

[Baroness Altmann (Con)]

My Lords, does my noble friend agree that the best cancer strategy is prevention? In that regard, I congratulate the Government on their recent decision to extend the HPV vaccination to all young boys as well as girls. I know that my noble friend has had great influence in that area. Does he also agree that this decision has the potential to save thousands of lives that would otherwise be lost to cancer in the future?

[Lord O'Shaughnessy]

I am grateful to my noble friend, not just for her recognition of that fact but for her campaigning on this issue. It is a really important step forward. The rollout of HPV vaccinations to boys will make a big difference to cancer rates, as it is doing for girls and women. It is part of a world-class screening programme in this country. A few issues need to be dealt with, and Mike Richards will be looking at those, but we are determined to make sure that our screening programmes get better and better.

HPV Vaccinations

Baroness Altmann Excerpts

Monday 26th March 2018 Lords Chamber

Asked by

[Baroness Altmann]

To ask Her Majesty’s Government, in the light of the recent decision to offer HPV vaccinations to gay men, whether they plan to provide HPV vaccinations to all boys; and if so, when.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O'Shaughnessy) (Con)]

My Lords, following a consultation, our expert group, the Joint Committee on Vaccination and Immunisation, is reviewing the evidence for vaccinating adolescent boys against HPV. We are awaiting its final advice, and it is important not to pre-empt the decision of the joint committee.

--- Later in debate ---

[Baroness Altmann (Con)]

I thank my noble friend for his reply. HPV-related oral cancers are the fastest-growing type of malignancy and affect thousands of men each year. Recent studies suggest that the vaccination of boys is cost effective, and I congratulate the Government on their decision to vaccinate gay men. Does not my noble friend agree, however, that the only way in which to protect men directly is to vaccinate them before they become sexually active, as they already do in many countries, including Australia, Canada, Austria or the United States? Would he also agree that we have a duty and responsibility to protect these boys, rather than leaving them vulnerable to potentially fatal cancers when it will be too late for them to do anything about it, because we neglected them when young?

[Lord O'Shaughnessy]

My noble friend makes an important point, that vaccinations against the HPV virus brings wider health benefits beyond defending against cervical cancers. It is important to state that it is not my judgment that matters here but that of our expert group, and in its interim advice it did not recommend an extension of the HPV programme to boys as being cost effective, not least because of the high levels of immunity and uptake among girls, with the indirect benefit that that has. But that was its interim advice; the final advice is being considered at the moment, and I can tell the House that that advice and the underlying assumptions on cost benefit will be published when the decision is made.

NHS: Winter Crisis

Baroness Altmann Excerpts

Wednesday 7th February 2018 Lords Chamber

[Lord O’Shaughnessy]

I agree with the noble Baroness that bed occupancy is higher than we want it to be and in some hospitals it is far too high. The question, of course, is what we do about that. It necessitated the difficult decision, for which the Prime Minister apologised, to cancel non-urgent elective surgery. Happily, that has not been repeated and rolled forward into February. We think and hope that the situation with flu, in particular, has stabilised and that that will start to relieve the pressure. I absolutely understand the hard work that staff are having to put in under tremendous pressure and I know that we all appreciate that.

[Baroness Altmann (Con)]

My Lords, I congratulate the Government on finding extra money for the National Health Service but does my noble friend agree that just putting more money in is not going to solve the crisis? Until we manage to sort out the social care system and the care of elderly people in our population the crisis will continue. We need convalescent places for older people who do not need to be in hospital in order to free up beds. I would also welcome an update on the thinking on integration between health and social care, which I so much endorse.

[Lord O’Shaughnessy]

My noble friend is absolutely right to highlight integration. I point to two things, one that is happening now and one for the long term. In the short term, the better care fund is a pot to which local authorities and the NHS contribute and it has more money than ever before, precisely to make sure that that interface between NHS care and social care is as good as possible and people can be discharged safely home as soon as possible, which is of course what they want. We also know that we are going to have a social care Green Paper this summer. It is a really important moment; we know how many missed opportunities there have been in the past to reform care in this area and I know that noble Lords are really keen to contribute to this. I urge them to do so and in that way we can build a consensus for change.

Social Care

Baroness Altmann Excerpts

Thursday 7th December 2017 Lords Chamber

[Lord O'Shaughnessy]

That is a novel suggestion. We usually talk about young people going off the rails, but I did not realise that that was true of the prison population. I have not heard such a proposal. I shall certainly take it back to my colleague, the Parliamentary Under-Secretary of State for Community Health, who is leading the carers strategy, so that we can look at whether it might be possible.

[Baroness Altmann (Con)]

My Lords, in the context of our demographics, with the current baby-boomer generation foreseeably entering the age at which they will need care in the next 10 to 15 years, no money has been set aside, either at public sector or at the private sector level, to cope with the rising costs of care. Councils have increasingly rationed care so that they exclude preventive expenditure to help people avoid extreme need. Whatever happens with this review, does my noble friend agree that families will need money set aside if they are going to pay for care? There is no automatic provision. There is a state pension; there are huge incentives for private pension provision, but there is nothing to build up money that would pay for care. Will my noble friend comment on the urgency of helping families understand the importance of, for example, using some of their ISAs as an allocated fund for future care? People in their 60s and 70s have ISAs and pensions. Perhaps we might allow tax-free pension withdrawals for care, so that, at some point soon, we help families put money into a fund that can last into their 80s and 90s and be there for care—in case it is needed—or perhaps be passed on to the next generation, thus starting an ethic of saving for care as well as pensions.

[Lord O'Shaughnessy]

As ever, my noble friend makes excellent and wise suggestions, which I am grateful for. She highlights an important point, which is that social care is a co-funded service for most people. Most people make a contribution to their social care and the state will often make a contribution, too. Therefore, vehicles that allow people to save up in advance, whether through pensions, ISAs or the other means that my noble friend has suggested, are an excellent idea. I am sure that they will be part of considering the financial sustainability and build on products that are already in the market, whether equity release or deferred payments, so that people can go into their old age with confidence that, whatever their care needs, they will be able to afford them.

Health and Social Care: Falls Prevention

Baroness Altmann Excerpts

Thursday 30th November 2017 Lords Chamber

[Lord O’Shaughnessy]

I do not have the specific details that the noble Baroness has asked for; I will write to her. The figures are not good; there are still around a quarter of a million falls in hospitals and mental health trusts each year, which is equivalent to the emergency admissions, so it is still a significant problem. NHS Improvement is working with the poorest-performing trusts and is reporting that those interventions have seen improvements, but we clearly need to phase out some of the poor practice that exists in order to reach higher standards.

[Baroness Altmann (Con)]

My Lords, does my noble friend accept that the social care system is in crisis? As council budgets are squeezed and the number of elderly people keeps rising, councils have had to withdraw preventive spending on such things as handrails, home adaptations and meals on wheels. This may save money in the short term—the focus on those with extreme need is understandable—but will my noble friend please relay concerns from these Benches back to the department that there has been insufficient urgency in adopting a long-term, strategic approach and introducing meaningful reforms rather than a sticking plaster on this ever-growing problem, which will result in more frail, elderly people costing more money to the NHS?

NHS: Sustainability and Transformation Plans

Baroness Altmann Excerpts

Monday 20th March 2017 Lords Chamber

[Lord O'Shaughnessy]

The noble Countess is right. Additional funding in the Budget will mean that local authorities and the NHS have more resources to account for things such as travel costs and unit care costs for care workers. Some of the STPs are dealing with urban areas and some with more rural areas. All the plans within those configurations have to take account of public engagement. As I have said, there cannot be changes without meeting the reconfiguration tests that we have set out, which must account for local circumstances.

[Baroness Altmann (Con)]

My Lords, can my noble friend assure the House that the reviews of social care will include looking at the impact of the withdrawal by councils of help for those with moderate needs in order to focus social care on those with substantial needs? Has the emergency admission of elderly people who were not given the care that they might have needed had an impact on A&E services in certain areas? Further, will the demographics of ageing populations be taken into account when looking at the closure of A&E departments?

[Lord O’Shaughnessy]

My noble friend is quite right to bring the attention of the House to the effect of standards. The Care Act 2014 introduced for the first time national standards as well as much greater transparency in the provision of care. What the announcement in the Budget of additional funding for social care allows for is particularly a focus on the interface between the NHS and social care, which is where the issue of delayed transfers can arise. I can provide my noble friend with a reassurance that the Green Paper will be looking at this issue in the round, carrying on from the work done in the Budget to try to address the interface between the social care and health systems.