Social Care and the Role of Carers
Baroness Tyler of Enfield Excerpts(5 years, 1 month ago)
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Baroness Tyler of Enfield (LD) [V]
My Lords, I congratulate my noble friend Lady Jolly on her excellent opening speech and declare an interest, as I have a close family member in a care home. As we have just heard, the pandemic has cruelly exposed the plight of those dependent on social care. The NHS provides free care for all, based on need, but there is no equivalent care service to which families can turn when they or their loved ones need help, causing untold heartache. Only countless money and time from individual families is stopping the system from complete collapse. Age UK has estimated that more than 1.5 million people are missing out on the care they need, and the cost of inaction is falling on the shoulders of 11.5 million unpaid carers, some aged 80 and above. This national scandal is no longer hidden from view due to Covid, but it is something the country increasingly understands and feels is grossly unfair.
Not just the elderly are affected. Younger disabled adults make up half the costs of the adult social care budget and generally do not own their own houses. The NHS provides insurance against the cost of health- care, primarily paid for through taxes, but there is currently no way for individuals to insure themselves for social care. Addressing this requires bold action and a strong political will. We need a comprehensive programme of reform for social care, both now and in the future, and I believe that programme needs three key pillars.
The first is to shore up a fragile and highly fragmented sector reeling from the impact of Covid, increased costs and low occupation rates, with some care homes becoming increasingly unviable financially. Immediate funding is needed to improve the quality of care and introduce minimum standards.
The second is individual funding. A cap on individual social care costs, as proposed by the Dilnot commission 10 years ago, alongside a more generous means test for access to publicly funded social care, would at least fix one of the system’s big problems: the lack of protection for people and their families against potentially catastrophic care costs. The architecture for doing this already exists; Dilnot’s proposals were put into legislation in 2014, with cross-party support.
Thirdly, we urgently need a new deal for the care workforce, with action on pay, training and development, career progression, professionalism and recognition. Care staff, who have given so much during the pandemic, deserve to be paid well above minimum wage.
A reform package including all these elements, as we heard from the noble Lord, Lord Hunt, is estimated at around £12 billion or 0.6% of GDP. How are we going to pay for it? That needs to be the subject of a separate debate but, at this stage, I think we need a solution that takes intergenerational fairness into account. During the pandemic, tens of thousands died before their time in care homes from Covid. The best possible legacy we can give all those who lost loved ones is to ensure that we fix the care system, so a similar tragedy can never happen again.
Covid-19: Care Homes
Baroness Tyler of Enfield Excerpts(5 years, 1 month ago)
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Baroness Tyler of Enfield (LD) [V]
My Lords, respected health commentators and statisticians say that excess deaths—that is, deaths above the expected number—is a more accurate way of looking at the scale of deaths in care homes due to Covid. Care home residents make up just 0.7% of the population. In the first wave of the pandemic, deaths in care homes accounted for 44% of all excess deaths for that period in England and Wales. What does the Minister think this says about the effectiveness of the so-called protective ring thrown around care homes and what lessons have been learned?
Lord Bethell (Con)
My Lords, we were never in any doubt from the very beginning that the virus presented a huge threat to care homes. They are where the elderly and the vulnerable are housed, in conditions where it is extremely difficult to enforce infection control and where there is a large amount of intimacy between residents and staff. We knew from the experience of other countries that care homes were very likely to be an area where infection and severe illness, and potentially death, would be highly prevalent. There is no doubt that care homes suffered the brunt of this virus, and for that matter I am extremely sad indeed. Noble Lords should realise that we put every measure in place that we humanly could have done. We gave a huge amount of resources, including £2.8 billion via the NHS specifically to support enhanced discharge processes and the implementation of the discharge to assess model.
Covid-19: Proof of Vaccination
Baroness Tyler of Enfield Excerpts(5 years, 1 month ago)
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Lord Bethell (Con)
My Lords, I am very alive to the concerns of the disabled. We have to balance the need to limit the spread of this virus to save lives, but in a way that is fair and just to all people. We are very much engaged with disability and other charities to ensure that that works. The noble Baroness is right that there will be some people for whom the vaccine does not work and who could yet catch the disease. We need to make provision for those people, and we are working on that.
Baroness Tyler of Enfield (LD) [V]
My Lords, I am concerned for the significant numbers of people with existing mental health problems who often do not feel comfortable with smartphone devices, as the information overload such phones can provide can exacerbate their feelings of stress and anxiety. I am pleased to hear the Minister say that other channels will be available to these people, but what arrangements are the Government putting in place to ensure that they are aware that options other than smartphones exist that they will be able to use?
Lord Bethell (Con)
My Lords, all the promotions for vaccine certificates through travel agents and GPs make very substantial reference to the availability of paper letters and the channel of being able to call 119 to receive them. I completely sympathise with those who do not want to use their mobile phones for everything, and some will prefer a letter in the pocket to an app on their phone.
Health Protection (Coronavirus, Restrictions) (Steps and Other Provisions) (England) (Amendment) Regulations 2021
Baroness Tyler of Enfield Excerpts(5 years, 1 month ago)
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Baroness Tyler of Enfield (LD) [V]
My Lords, at the risk of sounding like a broken record, I start by pointing out that we are yet again debating whether to approve a statutory instrument that came into effect three weeks ago, as part of a road map that was set out months ago. At this point in the pandemic, the urgency rationale just does not hold water, so it has become either a bad habit that the Government are unable to kick or simply contempt for parliamentary scrutiny. Neither is a good sign for a healthy democracy.
Turning to the substance, it feels somewhat ironic that these regulations bring back international travel for leisure. In recent days we have witnessed chaos over last-minute changes to the green list, causing huge problems for passengers and the travel industry alike. With long queues at packed airports in Portugal as people try to purchase tickets, often at vastly overinflated prices, on planes packed to seating capacity, and with people reporting difficulties getting pre-departure tests, is this really the best we can do?
As far as I can see, the amber list is simply causing confusion as to whether or not it is okay to travel to a country for leisure. We would not want to encourage people to drive through amber at traffic lights, so why are we giving this option for travel? Is not a straightforward “Yes, you can travel there” or “No, you can’t” easier for all to understand and plan around? Can the Minister say what plans the Government have to review the effectiveness of the traffic light system and our border control measures, including verifying test results for international travel?
Like others, I am sure, I was interested to read that the Chancellor of the Duchy of Lancaster is now participating in a pilot offering daily lateral flow testing for seven days as an alternative to isolation, following his trip to Portugal. It appears from press reports that other football fans receiving similar such texts from NHS Test and Trace were told to self-isolate for 10 days. Can the Minister explain the criteria to qualify for this pilot, when it was introduced and when its results will be published?
Test, trace and isolate remains a hugely important weapon in our armoury for fighting this virus. As restrictions ease, surely we should adapt our isolation support and testing strategies to incentivise isolation. From these Benches, we have called time and again for financial support to enable people on low incomes to isolate effectively. With cases now thankfully at lower levels, can the Minister say what resources are being provided, and to which local authorities, to allow the isolation pilots he referred to—he referred to payments of £500—to happen?
Much store is being placed on the announcement the Government will make on 14 June regarding step 4 of the road map, currently scheduled for 21 June. Over the weekend, some leading scientists have been calling for the easing of restrictions to be delayed. We have been repeatedly told that the Government will be driven by the data on the four tests, including the risks posed by new variants of concern, rather than simply the dates in the road map. With some regulations due to expire on 20 June, as my noble friend Lord Scriven pointed out, what is the scope for extending these regulations if the data requires it? Will we have fresh legislation? What is the contingency plan? Finally, what additional resources are being given to handle variants of concern? I hope the Minister can reassure me on these points in summing up.
Finally—I think I am in very much the same place as the noble Lord, Lord Lansley, on this—the stark truth is that the virus, with its inevitable mutations and variants, is not going away any time soon. Like it or not, we will have to find a way of living with Covid-19 for some time to come. That will mean changes in how we conduct our everyday lives, including how we do our business in this Chamber. This may be an inconvenient truth to some, but the alternatives are far worse. We need to get away from the current narrative that a so-called freedom day is coming fast and that everything can go back to precisely how it was pre-pandemic. We will have to learn to do things differently, and that needs a more grown-up, nuanced conversation which does not revolve around the two extremes of dropping all measures immediately or returning to lockdown. I think that is what most people want and expect.
Care Homes: Insurance Indemnity
Baroness Tyler of Enfield Excerpts(5 years, 2 months ago)
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Baroness Tyler of Enfield
To ask Her Majesty’s Government what assessment they have made of the merits of underwriting insurance indemnity for all care homes on an equivalent basis to the National Health Service.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, the differing indemnity and insurance arrangements for the NHS and for care homes reflect the different systems of securing health and adult social care. For the NHS, there are established indemnity schemes, administered by NHS Resolution. In the care sector, providers purchase insurance from commercial insurance markets. This is a requirement of registration with the Care Quality Commission.
Baroness Tyler of Enfield (LD) [V]
My Lords, due to Covid, many care homes have found insurance prohibitively expensive, hard or even impossible to find, and that which is available often not covering Covid. Yesterday, I spoke to a care home manager who was told that renewing his existing insurance would cost 880% more than the previous year, and just one Covid claim could result in the care home having to close its doors, causing great distress and disruption to residents and their families. Against this backdrop, can the Minister say what plans the Government have to extend indemnity to all care homes for a reasonable period, not simply the small number now covered as part of the designated care site schemes, to put them on an equal footing with the NHS and ensure that they are able to help the NHS during any third wave? Will the Minister agree to meet me to discuss the options?
Lord Bethell (Con)
My Lords, I acknowledge the challenge faced by care homes on the insurance market, but CQC statistics suggest that, in fact, the insurance industry has done an enormous amount to meet the needs of care homes and that many of the pressures on care homes have been the result of Covid outbreaks. We have brought in the designated settings indemnity support, as the noble Baroness knows, and we have given £6 billion to local authorities to support care homes. Putting care homes on the same footing as the NHS would not meet the needs of the care home sector, so that is not something we are looking at currently.
Covid-19 Update
Baroness Tyler of Enfield Excerpts(5 years, 2 months ago)
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Lord Bethell (Con)
My Lords, I am a big supporter of the “fast and hard” principle. In our response in Bolton, Bedford, London and elsewhere, we have demonstrated that principle in our handling of the Indian variant. I point out that the use of testing and social distancing measures in schools has been enormously effective. One of the remarkable aspects of the infection rate so far is that transmission levels among school-aged children have not increased in the way that SAGE and others, including myself, once feared. We should take a “glass half-full” moment to applaud that fact. I reassure the noble Lord that we will absolutely make these decisions on the data. Space has been put in between the steps for exactly that reason, and we are not going to rush it.
Baroness Tyler of Enfield (LD) [V]
My Lords, could the Minister outline the Government’s plans for test and trace as lockdown is lifted, particularly in areas such as Bolton and Bedford where surge testing is currently being deployed? With former centrally based Public Health England staff being disbanded and senior civil servants returning to their own posts, what financial resources are being passed to the local resilience teams, run by local directors of public health, to operate test and trace, which will be so critical to controlling the spread of the virus alongside the vaccine rollout?
Lord Bethell (Con)
My Lords, the outbreak in Bolton, Bedford, London and elsewhere has demonstrated, if that were needed, the paramount importance of keeping resources for test and trace at a critical level, and that is what we have done. Since the national infection rate is lower, there is a much greater emphasis on the kind of surge activity and outbreak management that the noble Baroness describes. Sequencing has proved to be an essential part of that process, and we have brought sequencing from the back of the laboratory to the front line of test and trace operation. Every single positive case is now treated as though it were a VOC, with the same amount of tracing and sequencing that a VOC would have had a few weeks ago. We have the full operation on standby. Should another wave of infections arrive, as it may well do with the relaxing of social distancing, we have the systems in place to be able to deal with it.
Health Protection (Coronavirus, Restrictions) (Steps and Local Authority Enforcement Powers) (England) (Amendment) Regulations 2021
Baroness Tyler of Enfield Excerpts(5 years, 2 months ago)
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Baroness Tyler of Enfield (LD) [V]
My Lords, as has been said, even by recent standards the timing of this debate is particularly ironic. On the very day that we move to step 3 of the easing of lockdown restrictions, here we are debating the move to step 2, which happened five weeks ago. To make matters worse, given the much more transmissible Indian variant, which the Health Secretary Matt Hancock said at the weekend could “spread like wildfire”, this easing now feels fraught with risk. I very much support what the noble Lord, Lord Bourne, just said about the need for us to scrutinise regulations in advance.
The Indian variant has caused great anxiety in recent days. For many people it feels as if, just when the sunlit uplands were coming into view, they are being snatched away by a new variant when more efforts could and should have been taken to avoid it. The Sunday Times reported this weekend that at least 20,000 passengers who could have been infected with the new variant were allowed to enter the UK because the Prime Minister delayed imposing a travel ban from India. I add my voice to those of other noble Lords asking whether the Minister can explain why India was added to the red list only on 23 April, three weeks after the announcement of a ban on flights from Pakistan and Bangladesh, both of which had lower case rates than India.
The combination of moving up the steps and the Indian variant makes having an effective test, trace, isolate and support system ever more critical. I place particular emphasis on the last two words—isolate and support—which is where things are still breaking down. The major problem reported by local resilience forums is that people are still not self-isolating and will not until they get their income paid. It is those on zero-hours contracts, those doing jobs that you cannot do from home and families living in multigenerational households who need the support most. People do not want vouchers; they want their earnings reimbursed. Reimbursing earnings is substantially cheaper than running the test and trace functions and, if a serious case of Covid occurs, the cost to the NHS.
I end by asking what planning is under way for a third wave, especially for paediatric care, given that as more adults are vaccinated it is possible that a variant may affect much younger children than in previous waves. Both the USA and Canada are reporting much higher cases in children than before and are starting to vaccinate children in the 12 to 15 age range. What plans are being developed for vaccinating children in this country?
Care Home Occupancy Rate
Baroness Tyler of Enfield Excerpts(5 years, 3 months ago)
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Baroness Tyler of Enfield (LD) [V]
My Lords, a recent National Audit Office report highlighted how the Covid pandemic has adversely impacted the financial viability of care home providers, with occupancy rates falling significantly, as we have heard. Given this, could the Minister say what steps the Government are taking to ensure that the much-needed financial support he has referred to, to stabilise this highly fragmented and fragile sector, gets to the front line and that there is equal treatment for all care home services, irrespective of whether they are local authority-funded or NHS-funded or whether residents are older people, younger adults of privately paying residents?
Lord Bethell (Con)
My Lords, we have written to local authorities to make it clear what the funding is there for and to make recommendations on the sort of financial support that may be needed to bridge this moment when occupancy levels have been reduced because of concerned families taking their loved ones out of care homes. That funding is in place, and it is up to local authorities to make their decisions on the matter.
Care Homes: Guidance
Baroness Tyler of Enfield Excerpts(5 years, 3 months ago)
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Lord Bethell (Con)
My Lords, these protocols are not tied to the road map because we hold them under constant review. We hear loud and clear the case made by the noble Baroness and others who make the case for change. We are open to making that change when the evidence says that the situation is ready. We expect care home workers to behave in a way that is responsible and keeps infections to a minimum, but we cannot have protocols for every aspect of their lives.
Baroness Tyler of Enfield (LD) [V]
My Lords, I declare an interest: I have a close family member who is a care home resident. People living in care have endured over a year of rules keeping them separated from family and friends, with the double isolation of relatives being unable to go into the home and residents being unable to leave. Although I welcome the recent relaxation of the rules on visiting out of care homes, the guidance states that the requirement for a 14-day isolation period on return
“is likely to mean that many residents will not wish to make a visit out of the home.”
What is the point of pretending that it is being allowed? Does the Minister understand why imposing a blanket quarantine on visits out feels to many arbitrary, unfair and as though it is interfering with their liberty? Can he explain why it is not possible for a resident who has been outside for visits to be tested on return and again after a specified number of days, rather than enduring a 14-day isolation during which they are often confined to a small room?
Lord Bethell (Con)
I can only express complete sympathy for the noble Baroness’s points. She puts them extremely well. Undoubtedly, the pressure put on residents and their family members is profound and I regret it enormously. However, this is not an arbitrary or thoughtless measure from the Government; it is to protect residents who have shown themselves to be highly susceptible to the disease. We have instances of serious illness and death to remind us how important these measures are. The noble Baroness is entirely right that the protocols are in place in order to deter external visits. In terms of testing, the unfortunate truth is that the virus can harbour in someone’s body, undetectable, for days. We know from protocols around international travel that pre-travel testing catches only about 15% or 20% of those with the disease and it is for that reason that we cannot turn to testing as an alternative.
Covid-19: Update
Baroness Tyler of Enfield Excerpts(5 years, 3 months ago)
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Lord Bethell (Con)
My Lords, I join the noble Lord in commending the people who work at Macmillan and all the other important diagnostic centres that have remained committed to their work throughout Covid under extremely difficult circumstances, delivering hugely important healthcare services. The noble Lord is stretching my knowledge of vaccination with this question, but it is my understanding that most of our flu jabs are grown in eggs in East Anglia and we do not rely on Indian supplies for the flu jab. This may seem like an extraordinary fact, and I doubt it, even as I stand here at the Dispatch Box, but I would be glad to write to him to confirm the point.
Baroness Tyler of Enfield (LD) [V]
My Lords, I welcome the Government’s consultation on whether vaccines should be required for care staff working with older adults. To make this easier, could the Minister say what plans the Government have to ensure that care staff are paid for time spent being vaccinated, particularly if they have to come in when not on shift or have to take time off because of any short-term reaction to the jab? Also, are the Government prepared to support care homes financially to enable staff who cannot have the vaccine for clinical or other specified reasons to be redeployed to non-front-line work?
Lord Bethell (Con)
My Lords, the vaccine is typically seen as personal medical hygiene. I am not sure if arrangements have been made for people to be paid while they get vaccinated, but I would be glad to write to the noble Baroness to confirm that. She makes an extremely sensible point about redeployment; I do not know the precise details, but would be glad to write to her.