Social Care Funding: Intergenerational Impact

Baroness Bennett of Manor Castle Excerpts

Thursday 16th September 2021 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, I thank the noble Baroness, Lady Greengross, for securing this debate.

First, a minute of history. In 1987 the NHS had more than 127,000 acute hospital beds and more than 52,000 geriatric beds. Some 20 years later, geriatric bed numbers had been cut by over 60% and acute beds by 20%. In 2010 the category of “geriatric beds” disappeared altogether. That followed a 1981 White Paper, Growing Older, and a DHSS consultation paper in the same year, Care in the Community, which both planned for transferring patients from hospital settings into the community. That meant handing over the frail elderly to be units of profit for the financial sector. For all the wonderful compassion of horribly underpaid, highly skilled care workers, that is their real status. Many care homes are loaded with unsustainable debt, owned by private equity and reliant on risky financial structures. A 12% return is expected, yet this should be, without the debt, an extremely low-risk financial sector, where a 5% rate of return is considered reasonable.

I look forward to the speech of the noble Lord, Lord Sikka, who I believe will be setting out further detail on this, but I want to look at the question posed by the noble Baroness, Lady Greengross. Where is the intergenerational problem here? We have a system problem: the exploitation of each generation in turn by the financial sector, and the exploitation of the workers whose caring humanity leads them to labour for utterly inadequate wages in poor conditions. The elderly today are being treated as cash cows, and the young are being expected, through national insurance, to pay in, before in their turn being forced into the same dysfunctional, exploitative system.

I saw some debate that insurance might fill this gap, but why do we not insure all generations, and all of our futures, as we do with a still inadequate and inequitable but basic state pension, by providing free social care to all who need it, funded—in another term, insured—by all of us through general, fair, progressive taxation; far more progressive taxation than we have now? That is society taking responsibility for all its members, sharing the responsibility for all who need care.

The Green Party calls for national insurance to be replaced with a single, unified income tax to reduce loopholes and raise £24 billion to fund social care. All income, including rental and investment income, would be taxed at the same rate, and this, of course, would remove the unjust loophole whereby earnings above £50,000 are charged only at the 2% national insurance rate. As with medicine, so with care: there should be no place for the profit motive in its provision.

Calorie Labelling (Out of Home Sector) (England) Regulations 2021

Baroness Bennett of Manor Castle Excerpts

Thursday 22nd July 2021 Lords Chamber

[Baroness Bennett of Manor Castle (GP) [V]]

My Lords, I am in favour of both regret amendments and commend the noble Baroness, Lady Bull, and the noble Lord, Lord Brooke of Alverthorpe, for tabling them. I recognise that at first glance, backing both these amendments might appear contradictory. One regrets the regulations while the other seeks to expand them, but what we are talking about here are two different sets of products. Eating is something we all have to do and need to do collectively in a far healthier manner than we do now. I hardly need to rehearse our place as world-leading in obesity and subsequent morbidities and mortality. It is one league table we certainly do not want to be high-ranking in.

Eating out, eating in the community with friends and family, can and should be healthy, happy occasions but we know, as the noble Baroness, Lady Bull, has powerfully outlined, that for those with eating disorders—between 1.25 million and 3.4 million people in the UK—they can easily be fraught, difficult and immensely stressful. There is strong evidence that calorie labelling will only add to that. There is little evidence of the effectiveness of calorie labelling in tackling our obesity crisis, as the noble Baroness, Lady Parminter, outlined.

The science tells us that counting calories in food consumption is a far from exact or useful approach. We need a nutrient-rich, calorie-appropriate national diet based on vegetables, fruit, and wholegrains, giving us a range of important nutrients, as the noble Lord, Lord Moynihan, just outlined. A calorie label tells us nothing about that. All calories are not equal and the values of two servings of food with identical calorie counts could be at opposite ends of the health scale. An artificially sweetened, flavoured and coloured dessert may be very low calorie but it also has virtually no nutritional value, and increasingly we understand that artificial sweeteners, as well as raising serious questions about their safety, contribute to increased risk of metabolic conditions such as type 2 diabetes and heart disease, even if the mechanism for that is as yet poorly understood.

We also increasingly understand that the thermic effect of food depends on a whole range of consumption factors, such as the size of the meal, the pace of eating and the time of day. Relying on counting calories is a simplistic—potentially dangerously simplistic— approach to achieving a healthy diet. There is also the issue of our microbiome—damaged and reduced by our national diet of ultra-processed pap that is 68% of the calories that we consume—that we are increasingly understanding has a significant impact on appetite and consumption. We need a joined-up public health approach to tackling our obesity issue, as the noble Baroness, Lady Bull, said.

I was very tempted to use this debate to deplore the Government’s immediate, negative, knee-jerk, populist reaction to Henry Dimbleby’s excellent and important proposed national food strategy which proposes such an approach while also taking account of the disastrous environmental impacts of our broken food system. However, I decided that there was not really the proper space to do that, but I must note a question that I asked during the passage of the Agriculture Bill debates: what constitutional place does Mr Dimbleby occupy? We kept being told throughout that debate when issues of food and public health came up to “wait for Dimbleby”. How can Ministers say that about something they are signalling that they plan to ignore, essentially?

On the simple proposition that if we have calorie labels on food, they should also be on alcohol, even if we did not, alcohol is of limited nutritional value; however, most drinkers do not understand how it might contribute to obesity, as the noble Baroness, Lady Finlay of Llandaff, outlined. I declare an interest, as I do drink alcohol. I try to drink in moderation and take account of the energy intake from it. What the Government are regulating here is inconsistent between alcohol and food. We know that the alcohol sector has a large amount of lobbying muscle, as seen in its resistance to advertising restrictions. Unfortunately, we are seeing this effect further here.

Covid-19

Baroness Bennett of Manor Castle Excerpts

Wednesday 21st July 2021 Lords Chamber

[Lord Bethell (Con) [V]]

I am grateful for my noble friend’s kind remarks. Her question is extremely complex, and difficult to answer briefly but I will rest on one particular answer. As I said before, this is a question of getting the disease transmission to a point where R is below one. If that can be done on a national basis, we have contained the disease. We can then turn to local outbreak management. That is when test and trace resources will come into their own and local deployment will make a big difference. That is when we can consider the virus to have been beaten. We are not quite there yet, but vaccination rates are incredibly impressive and I am hopeful that we are near to that point.

[Baroness Bennett of Manor Castle (GP) [V]]

My Lords, the Statement given in the other place said that

“our wall of protection must be more than just vaccines alone”.—[Official Report, Commons, 19/7/21; col. 688.]

Yet it made no mention of ventilation despite its obvious importance, given that I am hearing, as I am sure many others are, about double-vaccinated people becoming infected every day, and about the widespread transmission of Covid-19 in schools among children of all ages. The noble Baroness, Lady Thornton, asked, without answer, whether air filtration was being installed over the holidays in every school. I add—this could be done rather more cheaply—can schools be given help over the summer to do a ventilation plan for every classroom? Strategic placement of fans, and the choice and manner of window-opening, could be crucial. I see from media reports that the Government plan to replace the “hands, face, space” slogan with the slogan “keep life moving”. If it is not too late, may I suggest that “keep air moving” would be far more useful?

[Lord Bethell (Con) [V]]

I am grateful to the noble Baroness for giving me an opportunity to address this issue, and I hope the noble Baroness, Lady Thornton, will forgive me for overlooking it in my opening answers. The noble Baroness, Lady Bennett, is entirely right: ventilation is critical—but it is also challenging. On air filters, we have to understand better the science of whether filtration really makes an impact on the spread of the virus. I would not want investment in a large amount of ventilation infrastructure that did not actually have an impact. I agree that we have a lot to learn from the Victorians, who understood these matters very well. We must understand how modern buildings, which are often airtight to achieve environmental qualifications, may need to be adapted to get fresh air within them. We may also need to change our lifestyles, so that more socialising, eating and drinking is done outside—something that I, as an outdoorsy person, would very much welcome.

Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) Regulations 2021

Baroness Bennett of Manor Castle Excerpts

Tuesday 20th July 2021 Lords Chamber

[Baroness Bennett of Manor Castle (GP) [V]]

My Lords, I preface my remarks by noting that I have had two vaccinations, which I got at the earliest opportunity. I recommend that everyone who possibly can do the same.

What we have in these small but extraordinarily significant regulations is a collision between the Government’s social care policy—the one we were told was “clear” and “prepared” two years ago, but which, we have learned this afternoon, is not expected to be available until the autumn—and their Covid policies. These are two areas of the greatest government failure—two areas of confused, confusing, contradictory and clearly disastrous policies, which, when put together in these regulations, produce what could be a disaster as well as a severe procedural tangle. The likely outcome of this policy is a dangerous diminution of care provision for some of the most vulnerable in our society, and great stress, worry and possibly loss of employment for those—mostly low-paid, too often insecurely employed, mostly women, many from minoritised communities—who care for them.

As is all too often the case, I regret that the regret amendment, which I support and which the Green group will back, is only that and not stronger. In this, I may be in rare agreement with the noble Baroness, Lady Noakes. Nearly two years ago, the first vote I took part in in your Lordships’ House—in that strange, archaic procedure of trooping down long corridors, attaching myself to another Peer to check I was heading in the right direction—was on a regret amendment. That Peer, a Lib Dem, kindly explained that it was a vote but it would not change anything, to my considerable disappointment.

We talk a lot about affirmative and negative instruments and wrestle with the Government about converting the latter to the former. But really, if we are not prepared to actually stop something that is as clearly wrong and chaotically mismanaged as this, should we not think about what is askew with our constitutional arrangements —those antique, accidentally accreted structures, which we have managed to demonstrate, through the Covid-19 pandemic, can be quickly modernised when there is the will?

I am sure many noble Lords will have received, as I did, a briefing from Neil Russell, chairman of PJ Care Ltd. I do not know Mr Russell, but I know a cri de coeur when I read one, and that is what his briefing was. He calculates, believably, with figures that broadly reflect the scant information we have from the Government, that 5% of staff may, as a result of this, leave the sector—75,000 staff in a sector that already has 100,000 vacancies. There is clearly a risk that some homes will be able to poach workers from those that cannot keep them.

We have a disastrously financialised care home sector—something that the Financial Times, among other unlikely media outlets, has increasingly been highlighting—with a significant degree of ownership concentrated in the hands of hedge funds that have, on their classic model, loaded them with debt while shipping out massive profits of 12% to 16%, usually off to tax havens. However, that situation could be even further worsened by this measure, with large chains being able to ship staff around while smaller, independent family businesses and the few remaining homes run for public good not profit do not have that option.

Workers in this sector have made their views clear. The UNISON briefing says this measure is

“counterproductive, risks serious staff shortages and could drive the problem underground.”

I am not suggesting doing nothing. I note the article titled “Excess mortality for care home residents during the first 23 weeks of the COVID-19 pandemic in England” in the BMC Medicine journal. Up to 7 August 2020, there were, tragically, nearly 30,000 excess deaths in all care homes: 65% of those were confirmed or suspected Covid-19.

To protect the residents of care homes—as the Government so comprehensively failed to do last year exactly when Germany was applying strict testing and quarantine requirements for residents returning to or entering homes, meaning far fewer deaths—is obviously crucial. But the London School of Hygiene & Tropical Medicine study, to which other noble Lords referred, emphasises

“the importance of COVID-19 vaccination remaining voluntary.”

It says:

“Feeling pressurised had damaging effects, eroding trust and negatively affecting relationships at work, and often exacerbated COVID-19 vaccination concerns and hardened stances on declining vaccination.”


That is not surprising. It is human to think that if you are being forced to do something, there is a reason why that force is necessary.

Many, presented with the evidence and given time to think it over, are likely to come on board—the right way for any medical procedure to be given—with full informed genuine consent. UNISON presents a half-page list of useful voluntary measures that could and should be undertaken. I particularly highlight the need to remove any financial disincentives.

I started with my personal experiences. After both doses, I felt pretty rotten for three or four days and less than perky for a few more. I say that not as a discouragement, but as an honest account. That is the kind of honesty we need to build trust and confidence. It is obviously vastly preferable to catching Covid or passing it on to others, but I am lucky; I have a job where I can mostly work sitting down or, if I suddenly need to bail out of the day, I can. For a low-paid care worker, one struggling to pay the rent and put food on the table and knowing vulnerable people depend on them, those luxuries are not available. We need to make sure people who work in care homes can choose to have these vaccinations, and are not forced into them.

Covid-19

Baroness Bennett of Manor Castle Excerpts

Thursday 15th July 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I thought I had answered the questions put by the two noble Baronesses. I will seek to answer the noble Lord. He is absolutely right: our hospitals are working flat out but this is not mainly because of Covid. As of 11 July, hospital admissions in England were running at 502 a day. As of 13 July, there were 2,970 patients in hospital in England with Covid, of whom 470 were on mechanical ventilation. Catching up on all the backlog—not Covid—is what is consuming the hospitals and making them run so red hot. This is the focus of our healthcare system at the moment, and it will remain so for some time to come. We are under no illusions: there is a massive backlog which includes many people who have not come forward with symptoms of severe disease and will need to be addressed and treated. This is a huge national project that we are undertaking.

[Baroness Bennett of Manor Castle (GP) [V]]

My Lords, in his answer to the question from the noble Baroness, Lady Wheatcroft, the Minister made a comparison which suggested an equivalence between mask-wearing and sneezing. The website MedExpress says:

“Sneezing is…an involuntary release of air that helps the body to get rid of irritants in our nose and throat”.


Does the Minister wish to reconsider that comparison and acknowledge that mask-wearing is a voluntary action available to everybody?

[Lord Bethell (Con)]

The noble Baroness obliges me to confess that, as a young man, I mastered the art of controlling my sneezing, and I am pathetically proud of this. I should be glad to share the skill with her should we have the opportunity to spend some time together.

Covid-19 Update

Baroness Bennett of Manor Castle Excerpts

Thursday 8th July 2021 Lords Chamber

[Lord Bethell (Con)]

The bottom line is that we believe that any rise in the infection rate will not have an impact on hospitalisation in a way that will disrupt the NHS. This is something that we have worked on with NHS colleagues, the clinical directors, the CMO’s office and the JBC, and we have taken into account a large variety of advice, including from SAGE. At the end of the day, it is our belief that, despite the rise of a third wave, hospitalisation rates will be manageable.

[Baroness Bennett of Manor Castle (GP) [V]]

My Lords, following on from the question from the noble Lord, Lord Rooker, about the 3.8 million patients on the shielding list, will there be special provision for them to have antibody testing? Many of them may have had the vaccine but will not be sure whether it has been effective. Will there also be practical support for them? For example, if they do not feel that it is safe to go out, will there be help with shopping, special arrangements for medical appointments and other practical help?

[Lord Bethell (Con)]

We have committed to issuing guidelines for the vulnerable and immunosuppressed before 19 July. I cannot share with the noble Baroness at this stage exactly what those guidelines will say, but her points are very well made. We have not made a decision on antibody testing yet, but she raises an important point. We have a number of therapeutics and antivirals that may provide either prophylactic protection or support in the case of infection. Knowing whether somebody has antibodies before they go into the winter is one of the things that should really help to provide reassurance as well as important clinical data on how treatment might pan out. We are looking at the use of antibody tests for that reason.

Women’s Health Outcomes

Baroness Bennett of Manor Castle Excerpts

Thursday 8th July 2021 Lords Chamber

[Baroness Bennett of Manor Castle (GP) [V]]

I thank the noble Baroness, Lady Jenkin of Kennington, for securing this debate—a timely update a year on from the brilliant report of the noble Baroness, Lady Cumberlege, as the noble Baroness, Lady Bottomley of Nettlestone, just said.

Today’s debate led me to look back over our debates on the Medicines and Medical Devices Bill, during which the Government conceded, after Scotland led the way, on a patient safety commissioner for England. We were promised then that serious consideration was being given to the report’s other recommendations to support victims of disastrous medical procedures and to prevent future avoidable damage. I follow the noble Baroness, Lady Walmsley, in pointing out that the victims of sodium valproate, pelvic mesh implants and Primodos are still waiting. The First Do No Harm report concluded that thousands of lives were ruined because officials failed to listen to female patients. I hope we might hear some good news on that issue from the Minister.

In three minutes, there are many issues I could cover, but I want to extend the conclusions of the noble Baroness, Lady Cumberlege, to broader issues. I note that women wait longer to be diagnosed for many conditions, including cancer, and that heart disease in women is more likely to be misdiagnosed. Mental health is likely to be the diagnosis for a wide range of conditions that have a clear physical cause, often discovered only after many years of suffering.

I note too that intersectionality is at sometimes deadly and always damaging play here, and that women from BAME backgrounds and the LGBTIQA+ community are more likely to report poor treatment from their GP and receive inadequate support from services.

In the brief time left to me, I thought I would focus on an area still getting far too little attention and, like so many others, that is being exacerbated by the Covid-19 pandemic. That is musculoskeletal disorders. I point the House to the excellent briefing for this debate from the Chartered Society of Physiotherapy, which covers that as well as many other important issues. I should perhaps declare a personal interest here, having relied over many decades on physiotherapists to keep me going and repair damage wrought on the sporting field and in the workplace.

As I read that briefing’s recommendations on preventing musculoskeletal problems through access to occupational health physiotherapy, I thought of some women I met in Sheffield working at picking up baskets for a major supermarket’s home delivery service from midnight to dawn. I heard from them how physically challenging it was and how tough it was in the chiller and freezer sections.

We have to think about the many women who are doing what is often a double shift in the home with child and elder care. They also suffer musculoskeletal damage from that, and would greatly benefit from musculoskeletal first contact physiotherapists in primary care being available to all.

COVID-19 Variant: Travel Guidance for Local Authorities

Baroness Bennett of Manor Castle Excerpts

Wednesday 26th May 2021 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, given the long, arduous months of confinement suffered by the city of Leicester, compounded by the confusion caused by the apparent secret lockdown, and then the recognition that the city of Leicester should not have been included on the list, according to the figures—that arose as a result of a faulty calculation—can the Minister explain how the error came to be made in the case of the city of Leicester and how it will be avoided in future?

[Lord Bethell (Con)]

My Lords, guidance for people in Bolton and Blackburn with Darwen was published on Friday 14 May. It was then extended on 21 May to Bedford, Burnley, Hounslow, Leicester and North Tyneside. That guidance has now been fine-tuned, in response to feedback from the local directors of public health and, as the noble Baroness will know, the website has been updated. The chronology of that is relatively straightforward. It could have been done better—that I have made plain to the noble Baroness, Lady Thornton—and we are with working directors of public health, local authorities and others to ensure that we get smoother systems for that kind of thing.

Covid-19 Internal Review

Baroness Bennett of Manor Castle Excerpts

Thursday 20th May 2021 Lords Chamber

[Lord Bethell (Con)]

I am extremely grateful to my noble friend for his comments. He is entirely right. The battle against anti-vaxxers has been very successful. We have used a spirit of dialogue with people who have very personal and legitimate questions about a vaccine that requires an injection of fluids into their body. People quite reasonably have detailed questions about its impact. I applaud officials and partners of the Government who have been so effective at conveying the message on the safety and efficacy of the vaccine. It really has demonstrated the power of government and NHS communications at their best.

[Baroness Bennett of Manor Castle (GP) [V]]

My Lords, I join the chorus of welcome to the noble Baroness, Lady Merron, who referred, as have other Peers, to the National Audit Office report on the handling of the pandemic. Commenting on that, Gareth Davies, the head of the NAO, stressed the need to “learn lessons at speed”. The Minister has often expressed how useful and informative he has found the contributions in your Lordships’ House. Would those contributions not be better informed if Members could absorb and reflect on the findings of the internal review as the country and the world continue to deal with what is, certainly on the global level, a raging and deeply dangerous pandemic?

[Lord Bethell (Con)]

I am enormously grateful to the NAO for the powerful report that it has published. It said many complimentary things about the Government’s handling of the pandemic. I am grateful to noble Lords for the counsel and challenge that they have given here in this Chamber. I point out the vast amount of data and information that we have published, which is at the disposal of the public and parliamentarians. However, confidential advice from officials to Ministers on a means-of-working review is not the kind of thing that I think adds to this sort of debate, and for that reason it is most appropriately kept confidential.

Covid-19 Update

Baroness Bennett of Manor Castle Excerpts

Tuesday 18th May 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I enjoyed the contemporary dance at Sadler’s Wells, which really lifted my heart, but I rather wish I had been at Saracens for that thumping victory and to see my favourite team doing so well after a difficult year. I very clearly hear the concerns of noble Lords about social mixing of amber and red route passengers at airports, and one reads about it in the papers. I reassure noble Lords that the amount of segregation in place in the airports is the focus of both Border Force and the Home Office. We are absolutely doing our best. We are looking at red list terminals, but the practicalities of that when there is a relatively low level of flights are very challenging indeed. I reiterate my point that if you are travelling you are putting yourself at risk, and there is no way we can pretend otherwise. If you are travelling, you should isolate yourself for a substantial amount of time when you touch down in the UK. This question of mingling in airports is, to some extent, a red herring.

[Baroness Bennett of Manor Castle (GP) [V]]

My Lords, it is clear that the B16172 variant of SARS-CoV-2 is now established in the community, but that only highlights the need to keep out further variants of concern that will inevitably arise around the world as the coronavirus runs rampant. Following the question of the noble Baroness, Lady Watkins of Tavistock, can the Minister reassure me about the security arrangements in quarantine facilities given the number of cases of transmission in New Zealand and Australia, who have long practised quarantine? How often are staff being tested? Are they being paid in ways that mean they do not have to take other jobs, particularly jobs where they may have contact with large numbers of people? Are ventilation systems being checked regularly?

[Lord Bethell (Con)]

My Lords, the noble Baroness is entirely right to cite the examples of Australia and New Zealand and the challenges they have had with staff manning managed quarantine facilities. I am extremely grateful to officials from both Australia and New Zealand for the very thorough briefings we had when we set up our managed quarantine facilities. We totally took on board their profound insight on that area and that was the number one thing they told us to get right. We focused on it, we have invested in it, and that has worked well to date.