Care Homes: Staffing

Baroness Pitkeathley Excerpts

Wednesday 11th January 2023 Lords Chamber

Asked by

[Baroness Pitkeathley]

To ask His Majesty’s Government how they will ensure that care homes where they block-buy places to assist with hospital discharges are adequately staffed.

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

On Monday, this Government announced an additional £200 million of funding for short-term NHS step-down care packages to help ease the pressure on local hospital beds. ICBs will work closely with local authorities to purchase places in care homes and other settings. Using their knowledge, they will commission appropriate beds where there is sufficient capacity, including workforce capacity, to meet patient needs.

[Baroness Pitkeathley (Lab)]

I thank the Minister for that response, although it seems a bit more knee-jerk than it does a coherent strategy and it poses as many questions as it answers. For example, are the Government planning to pay care homes directly to pay recruited staff or to work through ICBs and local authorities only? What rates are to be paid? Will it be more than care workers currently earn, so as to compete with the retail sector? Given that there are 160,000 vacancies in the care workforce currently, where are those workers to come from, without pulling staff away from an already understaffed NHS?

[Lord Markham (Con)]

Before we went ahead with this, we spoke to many care providers to make sure that there was capacity within the system to do it. It was understood that the capacity is there. In fact, there is potential underused capacity of as much as 40,000. We are confident that the staffing is in place and that the care packages are there to really make a difference.

Excess Deaths in Private Homes

Baroness Pitkeathley Excerpts

Tuesday 10th January 2023 Lords Chamber

[Lord Markham (Con)]

My noble friend makes a challenging point. This will be a subject of the inquiry, on which I look forward to hearing more.

[Baroness Pitkeathley (Lab)]

My Lords, does the Minister agree that one of the elements here may be the lack of support to family carers, who are often the element most involved in providing care at the last stages of life, and in particular the lack of willingness to engage with family carers, who are the people who know most about the condition? I have lost count of the number of family carers who have said to me, “They just didn’t want to know my side of this element.”

[Lord Markham (Con)]

I thank the noble Baroness. We have spoken before about this in the House. I agree with the general point that family carers, probably more than anyone, have great knowledge to bear, and so absolutely that should be an important component.

Hospital Beds: Social Care

Baroness Pitkeathley Excerpts

Monday 19th December 2022 Lords Chamber

[Lord Markham (Con)]

Of course, the noble Baroness is aware that it is the third parties, whether it be the local authorities or the private sector, that employ them. But what we have done in terms of setting the national living wage, which I believe is around that amount, is exactly making sure that there is a minimum amount that these people can get. About 65% of the funding going into the system goes through to wages, so the £2.8 billion increase next year will flow largely into wages and salaries.

[Baroness Pitkeathley (Lab)]

Every one of the interventions we hear about points to the inadequacy of the social care system and every one of the interventions that the Minister makes, however well intentioned—and I do not dispute that they are well intentioned—concerns piecemeal reforms. Will the Government ever accept that the only thing that is going to solve this ongoing problem, which is only going to get worse, is a wholesale reform of the social care system?

[Lord Markham (Con)]

There are a lot of questions that we need to answer in this space—I absolutely accept that—and lots of things that need long-term thought. I think and hope that noble Lords are starting to see that thinking emerge. A lot more needs to be done at the moment, but I think that we accept that this is a long-term issue that needs to be resolved with help from all sides of the House.

Care Homes: Severely Disabled People

Baroness Pitkeathley Excerpts

Wednesday 30th November 2022 Lords Chamber

Asked by

[Baroness Pitkeathley]

To ask His Majesty’s Government what assessment they have made of reports that some care charities have been forced to evict severely disabled people from their care homes because of disputes with local authorities about fees.

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

The disruption of care where it negatively impacts vulnerable service users is unacceptable. Under the Care Act, local authorities have a duty to shape their markets and provide services to those with eligible needs. The Government are providing up to £7.5 billion over the next two years to support adult social care and discharge. This historic funding boost will help local authorities to start addressing waiting lists, low fee rates and work- force pressures in the sector.

--- Later in debate ---

[Baroness Pitkeathley (Lab)]

I thank the Minister for that Answer, but I cannot say that any of it was a surprise to me. Will he acknowledge that this is just the latest manifestation of a long-standing problem? For years, the social care system for adults with complex disabilities has been held together by charities and not-for-profits that have poured literally millions from their reserves into subsidising the services they provide for the NHS and local authorities. Now these organisations are in financial trouble and can no longer afford to do so. Those who are suffering are those in greatest need. Does the Minister agree that the whole system of funding for social care is broken and that the only solution is complete root-and-branch reform, not the piecemeal solutions offered by the Government?

[Lord Markham (Con)]

I thank the noble Baroness and echo the sentiment of thanks to the charitable sector for the work it is doing in this vital space. We have shown that we have listened in this area through the £7.5 billion—a 22% increase over two years, which I think everyone would agree is substantial. At the same time, we are in touch with these bodies; we reached out to the charity Leonard Cheshire, which is involved in this, to try to understand the issues. If there are ways in which we can directly help, we will do so.

Social Care Sector: Staff Shortages

Baroness Pitkeathley Excerpts

Monday 21st November 2022 Lords Chamber

[Lord Markham (Con)]

I agree with my noble friend. Overseas and Commonwealth recruitment is a key area here, which is why I am delighted that we have addressed the visa restrictions and entered social care on an essential workers list. We have already seen 15,000 people come in this space, and that figure is increasing month on month. My noble friend is correct that this is a critical area for recruitment for us.

[Baroness Pitkeathley (Lab)]

My Lords, does the Minister agree that the more problems there are with paid workers in social care, the more difficulties fall on the nearly 10 million unpaid carers. Of those who are receiving the carer’s allowance, 40% say that they are already in debt and not sure how they will manage through the winter. Does he also agree that, in view of the myriad problems in social care, it is time to listen to what the noble Lord, Lord Forsyth, asked the House last Thursday, and think about a proper review of the whole of social care?

[Lord Markham (Con)]

My Lords, I thank the noble Baroness. The new funds mentioned recognise that this is critical to the health of our National Health Service and the flow. As part of that, as I mentioned in my Answer, we are looking at staffing plans across allied health professions in the health and social care space, and it is vital that we get the recruitment to this area to solve the overall issue of flow and NHS wait times.

Long Covid

Baroness Pitkeathley Excerpts

Thursday 17th November 2022 Lords Chamber

[Baroness Pitkeathley (Lab)]

I offer warm congratulations to my noble friend on securing this debate and on the way in which she introduced it. She and other noble Lords will know that, by the time you get to this stage of a debate, there is not much new to say. However, I have been listening very carefully, and there is no doubt that there is a great deal of agreement about the fact that long Covid provides a new challenge for an already much-challenged health sector. In listening to the excellent speeches that have been made, I see three main problems about long Covid. There is the issue of recognition and awareness, the issue of treatment, and the issue of its impact.

The first problem seems to be knowing whether you have long Covid or not. The same could be said of Covid itself. When I tested positive for Covid last year, no one was more surprised than I; I thought I had a little head cold, and was astonished to find when I was tested here at your Lordships’ House that I was positive. I know many people have had the same experience. This very uncertainty of knowing whether you have long Covid adds to the anxiety of sufferers. Just this morning, I was speaking to a young man in his 30s who had such awful brain fog, as he called it, after getting long Covid, that he thought that he had senile dementia coming on. I am glad to say that he is now recovering.

This also applies to treatment. There seems to be no agreed accepted programme of treatment for long Covid sufferers and availability of treatment is patchy in the extreme. In many areas, it seems to depend on the chance of finding a sympathetic doctor or nurse. If you have had symptoms for more than four weeks that is supposed to be an indicator, but it is not always accepted that these are the same symptoms and that they are always present, as we have heard many noble Lords mention. There does not seem to be any agreement about that and we are all reminded of the experience of those with ME, which noble Baronesses have brought to our attention. Many people suffered for many years with what was called “yuppie flu”, and it was seen as the last resort of malingers, causing much distress to sufferers.

That brings me to the impact of long Covid. Much has been said about its effect on the labour and employment market. The Institute for Fiscal Studies has been mentioned by many. It said that

“long COVID shows some persistent labour market effects, with impacts being felt at least three months after infection”—

I emphasise “at least”. I remind your Lordships that we must consider these possible effects on the ability to work in the light of the terrible workforce problems that many noble Lords have mentioned, particularly in the health and social care sector. There are nearly 170,000 vacancies in social care alone already, and so many people are burned out and leaving the workforce. If long Covid further affects these shortages, as seems likely, we must be fearful of the ability of the NHS and social care to provide even the minimum care which citizens have a right to expect. As others have said, the need for further research and for action as a result of research already commissioned is urgent.

I must draw noble Lords’ attention to the particular problems faced by unpaid carers in this regard. We all know that many carers have been extremely careful with the possibility of catching Covid and have been shielding for much longer than the general population so that they do not pass it on to the person they care for. From a benefits perspective, people with a new illness, such as long Covid, who are of state pension age, must have evidenced health needs for six months before they can even claim attendance allowance. The cost of being impaired by long Covid will not be offset for this group or for their carer. As one carer said: “My husband may not be able to return to work due to long Covid, so the loss of half the monthly income, coupled with the rise of everything from fuel to heating costs and a new baby, will be devastating for us as a household”. One carer who themselves had long Covid said: “I am a carer who has long Covid and I am on a long waiting list to get help. I have been told that I will most likely have to wait for nine or 10 months before my initial appointment. I asked for my situation as a carer to be taken into consideration but I was told this was not considered as a circumstance that would merit any special consideration.” This is not acceptable.

There is no doubt that long Covid is having a negative impact on our nation, especially on the most vulnerable. We must take it seriously. We must give support in the benefits system, in practical support and in long-term policy around how this is going to affect us in the future. I hope the Minister will be able to confirm that the Government are committed to many of the things that have been called for today—better diagnosis, better collection of data, more consistent messaging and, above all, an understanding of the wide-ranging impact of long Covid on the health, both physical and mental, of our whole nation.

NHS: Discharge to Assess Policy

Baroness Pitkeathley Excerpts

Tuesday 8th November 2022 Lords Chamber

[Lord Markham (Con)]

Carers are well valued, and the need to ensure that our social care workers are well valued was the subject of a lengthy debate that your Lordships will remember from a couple of weeks ago. In that, we set out our plans for recruitment—not only domestically but internationally. I am glad to say that, even since then, we have seen a further uptick in the number of people recruited from overseas. Overall, it is understood that this is a vital area as part of the ABCD—which still exists. The “C” for carers is still very much part of this, so we are actively monitoring those recruitment plans and making sure that we are trying to provide every element of support.

[Baroness Pitkeathley (Lab)]

My Lords, I hope the Minister will forgive me for correcting his figures but the figure we generally use for unpaid carers now is nearer 10 million since the pandemic. In view of the truly shocking statistics in the Carers UK report that was published today—I am glad that the Minister said it will inform the department’s policy—have the Government given any consideration to revisiting the carers action plan, which went out of date two years ago, or, better still, reviving the idea of a national carers strategy? The first one was published more than 20 years ago.

[Lord Markham (Con)]

My understanding is that part of the guidance will be informed by making sure that action for carers is there but, when I see the guidance, I will make sure that it covers those elements. I agree, as we all do, with the premise. If the carers action plan is out of date—again, this is legislation that this Government have brought forward to show that we understand the importance of carers—clearly it is something that I will take up.

Skills for Care Report

Baroness Pitkeathley Excerpts

Thursday 13th October 2022 Lords Chamber

Asked by

[Baroness Pitkeathley]

To ask His Majesty’s Government what steps they plan to take in response to the report by Skills for Care The state of the adult social care sector and workforce in England 2022, published on 11 October, which shows that there are 165,000 vacancies in the social care workforce and that this workforce has shrunk for the first time in 10 years.

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

My Lords, we are investing in adult social care. We have made £500 million available to support discharge from hospital into the community and bolster the workforce this winter; that is on top of record funding to support our 10-year plan as set out in the People at the Heart of Care White Paper. We are backing recruitment at home and abroad with a £15 million international recruitment fund and a new domestic campaign, which we will launch shortly.

[Baroness Pitkeathley (Lab)]

I thank the Minister. I expected him to mention the £500 million workforce fund, of course, but he will know that it has been described as a drop in the ocean and that councils are calling for far more to be pumped into better pay and recruitment in the social care workforce. I do not want to be disrespectful to the new Minister, who I know has a lot on his plate, but I wonder whether he and the Government really understand the scale of the crisis in social care. Some 50,000 people left an already inadequate workforce last year; that is not surprising when they can get better pay and conditions in Tesco, and when one in five care workers is in poverty despite being in full-time work.

The previous Prime Minister told us that he would fix social care. The current Prime Minister has withdrawn the levy that would eventually have provided extra funds, with no indication of how those funds will be replaced. Is the Minister aware that, meanwhile, thousands of older and disabled people, both in their own homes and in care homes, are being neglected and deprived of services in a way that no decent society should tolerate? Will he acknowledge both the depth of the crisis and the fact that we need a step change in the way we value social care and the dedicated people who provide it?

Care Homes: Energy Costs

Baroness Pitkeathley Excerpts

Thursday 8th September 2022 Lords Chamber

[Lord Kamall (Con)]

As my noble friend will be aware, many care homes are privately owned and run. Quite often, we do not get into that level of detail but I will take the question back to my department once we are aware of the package that is announced.

[Baroness Pitkeathley (Lab)]

My Lords, to add to the problems of care homes to which noble Lords have referred is the report in today’s newspapers that the new Secretary of State for Health intends to use them as places to discharge people who cannot have a social care package in their own homes. Can the Minister assure the House that, if this happens, all attention will be paid to the huge problem that care homes already have in recruiting enough staff to carry out their existing functions?

[Lord Kamall (Con)]

All noble Lords will be aware of the challenges facing care homes and their owners, including recruiting sufficient staff. People have referred to a number of different issues; one is vocation and feeling valued—quite often they feel as if they are poor relations. Another issue is supply, which is one reason we have looked at a visa to try to encourage more workers from overseas. If we make it a proper vocation, people will want to train in it, get those qualifications and feel they have a valued career.

Primary and Community Care: Improving Patient Outcomes

Baroness Pitkeathley Excerpts

Thursday 8th September 2022 Lords Chamber

[Baroness Pitkeathley (Lab)]

My Lords, I am grateful to the noble Lord, Lord Patel, for leading this debate and, beyond that, for the leadership that he provides to this House on all matters health related. Although he used the words community care to refer to community care health services, I know that he will forgive me if I slip over into the other bits of community care, which are so vital when we consider healthcare and which work in collaboration with primary care.

Patients and carers must be the focus of this debate, because improving outcomes for them is what primary and community care services are all about. But I must put in a word of warning here on behalf of those patients and carers: if you ask a typical patient or carer to define primary or community care, they would struggle, as the noble Viscount so ably and vitally reminded us. I must say it is a pleasure to see him with us, not at all past his sell-by date. A typical patient simply does not know the difference and why should they? They refer to “my doctor”, “the hospital” or “the carers who come in to see my mother”. They do not know about different streams, different types of training or regulation; they are puzzled only by why test results take so long to reach their GP, why some care is free and other care has to be paid for.

I have lost track of how many friends and neighbours I have advised should be in receipt of NHS continuing care funding for their elderly parent, when they have immediately been advised to seek a place in a private and very expensive nursing home, without any reference to possible alternatives. What puzzles patients and carers most of all is the lack of communication and integration between services. “Why on earth do they not talk to each other?” they say. “Why do I have to tell my story all over again to every new person I see? Why did my GP not know that I was being discharged from hospital?” Every time I speak to a patient or carer, I find myself at a loss to explain why these things happen.

It is not as though they are new problems or that we do not know how to solve them. We know about integration, shared budgets, joint training initiatives, more realistic funding and better workforce support. We had great hopes when the integration White Paper was published earlier this year: it promised shared planning and delivery for health and social care and making access easier. But there was little to explain how a joined-up system would be managed, be accountable to the public and balance what is delivered locally with national standards and entitlements. That is another cause of bewilderment among patients: “Why does my sister in Devon or Doncaster get something that I have been told I can’t have where I live?”

I must turn to the disaster area of social care, because you cannot focus on any problems in the NHS without fixing social care. I was amazed, as many of your Lordships would have been, to hear the outgoing Prime Minister claim, on Tuesday, that he had fixed it. You could have fooled me or anyone else who works in the system. Why are ambulances in short supply and taking longer to reach those in need? It is obvious: they are queuing at hospitals because there are no beds to move people into from A&E. One in seven hospital beds is now occupied by a patient who is fit to be discharged but cannot be, because there is nowhere for them to go, because of chronic underfunding in the system. With such long-term shortages in the workforce, even those who have a care home place may be neglected, while unpaid carers carry even more burdens, as I have reminded your Lordships on all too many occasions.

I was grateful that the Minister was able to secure a concession for carers in the recent Health and Care Act, enabling them to be consulted at the point of discharge. However, all too often, local services to support them are sparse or non-existent. The charitable sector, which is often the main source of support, is also under severe pressure.

One reason is Brexit—so many former employees were from the European Union—while another is poor wages and another is lack of respect for the social care professions, which are always seen as the poor relation when compared with health services. The Minister referred to that in his Answer to a Question earlier.

The new Prime Minister said that she will stop the health and social care levy, which was meant to fund, first, backlogs in the NHS and, secondly, social care. Will she now give all that money to social care? If so, how much will it be and how many constraints will be placed on how it is used?

The lack of attention to and funding of preventive services is a constant problem, as the noble Lord, Lord Bethell, reminded us. Small amounts of money spent early in a patient journey can head off many problems, but too often we wait for a crisis, which requires far more resources and has poorer outcomes anyway. GPs can be vital in identifying such early-intervention opportunities, but are often denied the opportunity to do so. We must remember too that the cost of living crisis will only make problems of access worse and there will be more demand because of cold homes and inadequate diets.

Many have mentioned problems with primary care and the supply of GPs. The reason there are so many patients who walk into A&E is often the difficulty they experience getting a GP appointment. I know this is a major problem in many areas, but I must put in a word for some GP practices, such as my own, which provide services way beyond those we expect and attempt to support their communities with services and initiatives for the homeless, the lonely and those with mental health problems.

I turn to the reforms needed. We need more progress on integration, taking note of some of the local initiatives, which are fine examples, and not being constrained by the “not invented here” syndrome, which is a problem for many people who work in the health service. We must also face up to the workforce crisis. The Public Services Committee, on which I serve, has been mentioned, and it showed that no recruitment targets are being met. It was a great pity that the Government did not accept the amendments for regular reviews of the workforce put forward by the noble Baroness, Lady Cumberlege, when the Health and Care Act was going through. To address shortages, Governments, regulators and employers must succeed in retaining existing professionals and recruiting and training additional ones. This may mean that they have to challenge conventions about education and training and be far more flexible in how we deploy that workforce. How many times have I heard calls in this House for integrated training across health and social care, but has any real progress been made?

Being more flexible about patient need requires some professions to give up their protected status and to recognise that a nurse, physiotherapist, pharmacist or healthcare assistant can meet patient needs as well as or—dare I say it?—even better than a doctor. It is a pity that radical reforms of the regulation of the health professions have never been tackled, in spite of many promises.

The new Prime Minister said that the NHS will be a strong focus for her Administration. She will always find those who work in health and care committed, dedicated and willing to embrace change. What they ask for in return is honesty about the problems they face and recognition of their devoted service.