Adult Social Care

Baroness Howarth of Breckland Excerpts

Wednesday 11th July 2018 Lords Chamber

[Lord O’Shaughnessy]

The noble Lord speaks with great wisdom and he is absolutely right to highlight Salford, as he always does, because it is the root of the integrated care service being put in place in Greater Manchester with unique devolution powers, and we want to see that model rolled out across the country. Of course, the point of that is to ensure a better interface between the National Health Service and social care, so that one of the problems that bedevils us at the moment—delayed transfers of care—does not get in the way of proper care.

[Baroness Howarth of Breckland (CB)]

My Lords, it is good to be back, but very depressing to find that some of the things that were happening when I left are very much the same as I return—in particular, in respect of the Green Paper. The world may be changing radically in other ways, but I find that we have yet another Green Paper to add to the pile of other reports on adult social care.

I briefly pay tribute to the health service, particularly in Norfolk, which has saved my life and put me partly back on my feet. When I came out of the health service and had to use social care, however, I found myself spending thousands of pounds of my savings on carers. Many others, like me, find themselves uncertain about what the future will bring when they come to the end of their savings because we do not have the answer in the Green Paper. I am asking the Government not only to look very carefully at the issue of people who need carers, but to tell us the timeframe so that people are not left in a state of uncertainty about what the future will bring.

[Lord O’Shaughnessy]

I am very pleased to welcome the noble Baroness back to the House, and am glad to see that she is on the mend. She highlights a critical point about certainty, which she makes movingly from a personal insight. It does not matter what age someone is; there is a great deal of uncertainty about what the system will look like when they retire—whether that is in five or 50 years. Providing that security and certainty is one of the principles underpinning the reform. It will be in the Green Paper. I know that successive Governments have had Green Papers, but we need to seize the chance of a long-term plan for the NHS and a Green Paper coming together to try to make it work.

NHS: Primary and Community Services

Baroness Howarth of Breckland Excerpts

Monday 7th November 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I am not sure we could go so far as to say that one should always have their agreement—sometimes, discharges from hospital are incredibly complex and difficult—but there is no doubt, arising from the Carers UK report, that where there is proper communication with carers, the discharge procedure is much better for everyone, from the point of view of the carer, the patient and the hospital. If proper arrangements are not put in place, delays arise long after the patient should have been discharged home. It could be to do, for example, with a care package or altering the patient’s home.

[Baroness Howarth of Breckland (CB)]

My Lords, I have recently become a carer myself and therefore have experience of a number of hospitals. Why is there such a postcode lottery in terms of where one finds oneself? West Suffolk Hospital, where my partner found herself, has given excellent service and—we must not run it all down—we have had fantastic aftercare in that area, whereas the London hospital does not even answer the telephone. Why is there such a difference? She was also in a mixed ward, the use of which I thought had already stopped.

[Lord Prior of Brampton]

My Lords, I am surprised that the noble Baroness’s friend was in a mixed ward because their use is supposed to have stopped unless there is an absolute emergency when only one bed is free. Unless there were exceptional circumstances, it is very disappointing to hear that that happened. Perhaps the noble Baroness would like to write to me about it. On her first point, there is variation in pretty much every aspect of health and social care around the country, which is inevitable. To some extent, it is not a bad thing, because it drives up standards if those who are not delivering great care can see how best it can be done. The STP process is designed to build in best practice, but I am afraid that a degree of variation is inevitable.

NHS and Social Care: Impact of Brexit

Baroness Howarth of Breckland Excerpts

Thursday 21st July 2016 Lords Chamber

[Baroness Howarth of Breckland (CB)]

My Lords, when one gets to this point in the list—and it seems to happen to me quite regularly—most of the statistics have been quoted and the arguments made, but it is worth repeating quite a number of them. I will concentrate particularly on social care, rather than the health service, because that is the area of my expertise.

The Minister knows that, before we get to the Brexit question, it is quite clear that social care services—and the health service—are in crisis in relation to the demand that is being produced and the number of staff and resources there are to meet that crisis. I am not saying that that is anyone’s fault, but it is a reality that the Government will have to grasp. Looking at the settlement in relation to health, I notice they are beginning to grasp it, but unless we look at the two together, which seems to be being delayed, we will not make a great deal of progress.

Because it is useful to say something different, I will start with where we are now. If we are going to face the Brexit staffing crisis, we have to be sure that we are doing everything now to make sure that we get staff in post. One tiny example of what we seem to be incapable of doing is that we have to wait 130 days at the moment for the police to clear safeguarding checks. For those 130 days, staff are not in post in care homes or local services—and I speak from experience of this—which means that there is bed-blocking at the other end, because patients cannot be moved out of beds into appropriate facilities. That is a microcosm of a number of issues that I will not go through, but if we are not doing very well at that sort of issue, how much more difficult will it be if we find the worst scenarios in relation to Brexit?

The Skills for Care national minimum dataset for social care holds information on about 23,000 care-providing establishments and 730,000 adult social care jobs. In 2015, 82% had British nationality, 12% had non-EU nationality and Skills for Care estimates that workers with EU nationality made up 6% of the adult social care workforce—which is about 80,000 jobs, as the noble Baroness, Lady Ludford, quoted. We should hold that number in our minds very clearly. Add to that the 5% of social workers who come from the EU—about 900 in total—which is another area where there are already severe shortages. It is often these staff who are making home and residential assessments as well as being responsible for safeguarding, so that is another area where we will find difficulty.

Immediately after the Brexit vote, the National Care Forum convened a meeting of a wide range of sector leaders and providers to consider five core issues: workforce; older and disabled people and their carers; funding; costs; and development. But central to their concern was what might be called soft issues. It is essential that the leadership in organisations address the concerns of staff who are becoming extremely anxious—these are people who are employing the staff, so they have direct experience. Staff are already questioning their right to stay. On the other side of the coin, those who are receiving services fear that the services might cease because the staff will have no rights. Will the Minister give leadership and support in ensuring a really clear message about ongoing entitlements and legal rights? We know that we will not leave for two years or more, but unless we reassure people now, two years will be too late.

At this point, I want to congratulate my noble friend Lady Watkins on securing this debate. Not only that, she has made an extraordinary contribution in her first year and I have learned a great deal from her. Her sheer enthusiasm for the needs of NHS staff and how they should be acknowledged, valued and reassured is something that is very clear.

If the workforce is to be maintained, the anxiety about the right to stay must be addressed; otherwise, people will not be willing to join the sector, as was indicated by the noble Lord, Lord Crisp. In addition, the fall in the value of the pound may well make working in the UK social care sector less attractive than working in other European countries. There are a number of risks that we have not looked at. Moreover, there is a less obvious financial issue. Many residents in care homes are self-funders. The financial shocks to the stock market may have a significant impact on their pensions and investments, and thus their ability to pay for their care. That is something which we have not really looked at and indeed have not felt the impact yet.

During the referendum debate, many voices were not heard. Much of the fear of immigration might have been more balanced had information from organisations like the National Care Forum been heard. The kind of statistics that we did not hear about were as follows. In London and the south-east, more than 10% of all jobs are filled by EU workers—and London voted remain. By contrast, only 1% of jobs in the north-east—around 1,000 in total—are filled by EU workers, yet most of the region voted to leave. The disunity in some communities has been widely reported. The Government must take their safeguarding role seriously at this time, when the elderly and disabled who are non-EU citizens become easy prey. Other noble Lords have given examples, and I have heard about a number of incidents where people have attacked the staff who are caring for them. Who, I would ask, do they think is going to care for them in the future if they are so unpleasant to those who are caring for them now? Many already complain about their eligibility for adult social care being removed or reduced for financial reasons, and if staff costs rise due to shortages, there will be an even deeper crisis.

There are also implications for legal rights, as a significant proportion of the UK’s law comes from the EU, including laws covering the employment rights of the care workforce and the rules and regulations which govern how services are conducted. In theory, the UK Government could repeal some or all of those laws once the exit takes place. Can the Minister confirm that this is unlikely and that EU law will continue to exercise significant influence, recognising that disentangling the UK from its EU commitments will be a lengthy process? These include matters such as rest breaks, statutory leave, compliance with night working limits and the 48-hour working week. Again, theoretically, following Brexit, the Government could change some of the working time legislation. Does the Minister think that this is likely, in view of his party’s search for better conditions, including the living wage for these staff?

In the worst-case scenario, some 55,000 health workers could face leaving the UK, but, as has been said, there are 88,000 such workers in our care services. Residential homes would cease to function and ongoing home care would be at an even higher premium. As I said earlier, discharges from hospital and community care are inextricably linked, so hospitals would be full of the elderly and disabled in entirely inappropriate care. Those who have fuelled some of the racial tension by saying that EU nationals are taking British jobs should remember that active recruitment has taken place over the years because vacancies could not be filled from the pool of existing UK citizens.

Sorry, I apologise for my cough. I did see the doctor this morning—he was a very nice Indian.

The charity Livability, which provides services for disabled people and for which I serve as a senior vice-president, currently has 50 vacancies. That is one medium-sized provider.

Nor is the Australian system the answer. Basic health and social care workers often start their careers in low-paid caring jobs and gain qualifications and promotion along the way. Can the Minister say where this pool of workers will come from, and will the demographic crisis we face be matched by an even bigger crisis in care? In my view, Brexit was bad news for most of us, but it could be fatal for those in need unless we deal with the issues of confidence and employment at speed.

NHS England: Pre-exposure Prophylaxis for People at Risk of HIV

Baroness Howarth of Breckland Excerpts

Tuesday 7th June 2016 Lords Chamber

[Lord Prior of Brampton]

I do not know how long a judicial review will take. I guess that it will be months rather than years, but I simply cannot answer that question as I do not know the answer to it. Again, this is a legal issue, not an efficacy issue. This is a question not of the Government saying that we do not want to fund this prophylactic, but of NHS England simply saying that it has been advised it does not have the power to do so.

[Baroness Howarth of Breckland (CB)]

My Lords, can I ask a simple social question? If there are to be trials, how will the decision be made as to who gets into a trial and who gets left out, as that could be a matter of life and death for some HIV sufferers?

[Lord Prior of Brampton]

My Lords, NHS England and PHE are consulting on how those trials should be constructed. Clearly, they will be focused on high-risk individuals but choosing who goes on to the trial will be up to PHE and NHS England.

Dental Health: Children

Baroness Howarth of Breckland Excerpts

Tuesday 7th June 2016 Lords Chamber

[Lord Prior of Brampton]

I am afraid that I cannot answer that question as I simply do not have the knowledge. I will research it and write to my noble friend.

[Baroness Howarth of Breckland (CB)]

My Lords, this used to be picked up through schools and nurseries, where most children are seen. What happens now in education establishments, particularly academies, where children’s teeth are found to be poor and action needs to be taken?

[Lord Prior of Brampton]

Schools clearly have an important role to play. Interestingly, in Bradford the Building Brighter Smiles programme involves not just a community-based fluoride varnishing application but also supervised tooth-brushing in schools and nurseries. I am sure that that has a very important role to play.

Health: Neural Tube Defects

Baroness Howarth of Breckland Excerpts

Monday 21st March 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, the evidence given by the SACN is that it affects between 15% and 30%. My honourable friend in the other House, Jane Ellison, is bringing together a round table of all stakeholders interested in preconception health to discuss this matter.

[Baroness Howarth of Breckland (CB)]

My Lords, does the Minister think that the resistance to this is in the general public or among the food producers? My discussions with many young women across the country do not give me the impression that it is among the general public. If it is among the food producers, of course they would be resistant if it does not benefit their profits. Where does the Minister think that attitude is, and can he advise us where we should put our energies in order to change it?

[Lord Prior of Brampton]

My Lords, I am not aware that the food industry is opposing the introduction of folic acid into white bread flour, but I will investigate that and write to the noble Baroness.

Accident and Emergency Services: Staffing

Baroness Howarth of Breckland Excerpts

Tuesday 23rd February 2016 Lords Chamber

[Lord Prior of Brampton]

The noble Lord will know that we are consulting on the proposals to remove bursaries and replace them with student loans. All the indications are that this will enable us to increase the number of nurses because the current system means that many young men and women who wish to become nurses are not able to do so. I think that three out of four people who apply are not able to get on the right courses. We hope that the new system will increase the number of nurses available to the NHS.

[Baroness Howarth of Breckland (CB)]

My Lords, will the Minister tell me why, when they are qualified, it is safe for young nurses to do five 12-hour night shifts on the trot when we would not allow lorry drivers to do five 12-hour nights on the trot?

Social Care and Support: Funding

Baroness Howarth of Breckland Excerpts

Monday 19th October 2015 Lords Chamber

[Lord Prior of Brampton]

What we are saying is that we have to fundamentally transform the health and social care sector so that it is fit for the kinds of patients living in today’s society, not those living in, frankly, 1948.

[Baroness Howarth of Breckland (CB)]

My Lords, it seems an extraordinarily unreal situation—the present circumstances that people find themselves in. Day after day, as the noble Baroness, Lady Pitkeathley, pointed out, we hear about people having their hours cut, people finding that they no longer have carers and local authorities having huge cuts in their budgets. What is the Government’s plan if we do not get the settlement that we need from the spending review?

[Lord Prior of Brampton]

I am afraid that I can only repeat what I said earlier: our plan is for health and social care to become more integrated and for more budgets to be pooled, and that by doing so we can transform the care we deliver to the very vulnerable people in our society.

NHS: Mental Health Patient Assessment Needs

Baroness Howarth of Breckland Excerpts

Monday 12th October 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, I think spreading best practice is a perennial problem in the NHS. The noble Baroness gave an example of that but I could give many, many others: we are not good in the NHS at spreading best practice. I hope that the newly reformed combination of the TDA and Monitor into NHS Improvement will be a very useful repository of good practice, in the same way as the IHI is in the USA.

[Baroness Howarth of Breckland (CB)]

My Lords, I find that reply singularly disappointing, as the Minister will know that any child exhibiting the kinds of problems that have been described today could be seriously ill—they could have a brain tumour or hydrocephalus. In addition, he also knows that the availability of good mental health services for young people, adolescents and those in their 20s is in serious difficulty at the moment. What are the Government doing to ensure that NHS England is improving these services and making a real effort so that we do not have cases such as this, for I am sure that it is not an isolated incident?

[Lord Prior of Brampton]

In picking up the general point that the noble Baroness made, the Government have committed a great deal of extra resource to the mental health needs of young people. For example, I cite the NHS mandate and the Health and Social Care Act 2012, in which there is a duty to establish parity of esteem between mental health and physical health. It is also true that one can never do enough, and when one hears about a tragic case such as that described by my noble friend earlier, one has to look very carefully in the mirror and ask whether one could do more. That is why I have offered to meet my noble friend outside this House to discuss the matter in more detail.

Health Funding

Baroness Howarth of Breckland Excerpts

Thursday 9th July 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, prevention is very important to the Government and a very important part of the NHS Five Year Forward View. The reduction of £200 million in the grant to local authorities should be seen in the context of a total grant of £3.2 billion; it is a 6% reduction. Public Health England has a campaign to raise awareness of the damage that sugar and salt, as well as smoking and alcohol, can do to people’s lives.

[Baroness Howarth of Breckland (CB)]

My Lords, if the noble Lord takes into consideration not only the cuts to this budget but those to other local authority budgets, he will see that this will mean a reduction in youth services, the closure of young people’s centres and a range of preventive services for children being reduced. Will that not have a cumulative effect on the general health of the nation, and certainly on the protection of children?

[Lord Prior of Brampton]

My Lords, the NHS is facing a challenge over the next five years to achieve productivity savings of some £22 billion. If we wish to have a sustainable, tax-funded health service in the long term, we have to make these savings. I have no doubt that over this time this will cause difficulties, but, again, it has to be seen in the context that we have a national debt of more than £1 trillion and a public sector borrowing requirement that must come down.