Health and Care Bill

Baroness Watkins of Tavistock Excerpts

Committee stage & Lords Hansard - Part 1
Tuesday 11th January 2022 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I support the majority of these amendments. I declare my interests as president of the Florence Nightingale Foundation and chair of the HEE review of mental health nursing.

A lot of noble Lords have spoken about mental health in the most glowing terms in the last hour. I am extremely supportive of the amendments in the names of the noble Baroness, Lady Hollins, and our new Member, the noble Lord, Lord Stevens of Birmingham. I have put my name to Amendment 138 on keeping proper data and information on waiting lists for people not with mental health issues but mental illness problems. There are people in our country with severe, enduring mental illness who fail to get early diagnosis because they do not even get on to a waiting list to see a consultant.

I see many of these people in my work with the charitable social enterprise I chair, Look Ahead, which provides housing to people who have suffered homelessness, people with mental health problems and learning disabilities and those discharged from prison—having completed their sentence, I should say. So many of those people have had better mental health care in prison than they ever had in society, because we do not list the number of people trying to access these services. We know that the life expectancy of people with long-term mental health problems is so much lower than that of the majority of people with physical health problems, because of things such as drug-induced psychosis, if it is not treated quickly. Professor Murray of the Institute of Psychiatry has been talking about this since I did my PhD there, 30 years ago, and we have still not resolved it.

I emphasise, as an ordinary person who works and has spent nearly 40 years working on a day-to-day basis either training mental health nurses or working with people with severe enduring mental illness, that these amendments are essential if we are to provide good health services for tomorrow’s population.

[Baroness Harding of Winscombe (Con)]

My Lords, I too support this group of amendments, both the parity of esteem words and the funding actions that make it up. I will briefly address the possible objections to it: first, it is not necessary because the Secretary of State already has a duty to maintain parity of esteem; secondly, as I think the noble Baroness, Lady Tyler, mentioned, this is culture change and legislation cannot drive that. In this case, actions speak louder than words. Being clear on the financial actions, as the amendments of the noble Lord, Lord Stevens, are, is a hugely important step on our culture journey.

Even though actions speak louder than words, the words matter too. They particularly matter when, as so many noble Lords have said so eloquently, mental health is so easily forgotten. It is all too easy to forget the hidden pain, anguish and need. I fear it is still far too easy to forget the hidden waiting lists. The words in this group of amendments are just as important as the actions, to make sure that we do not forget and build on the ground-breaking work that many, like the noble Baroness, Lady Hollins, have led for decades. We are on that journey, but we are definitely not there. I urge my noble friend to consider and accept these amendments.

Covid-19: PCR and Lateral Flow Test Providers

Baroness Watkins of Tavistock Excerpts

Monday 13th December 2021 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Baroness for suggesting another price comparison website. There is an accreditation scheme, and every time companies are reported to the Government, we look at how to remove them. There is a four-stage process for UKAS accreditation, and sometimes when companies are reported, another one pops up.

[Baroness Watkins of Tavistock (CB)]

My Lords, can the Minister say what the average cost to the NHS of both a PCR and a lateral flow test is, so that that can inform people in relation to the cost in the private sector?

[Lord Kamall (Con)]

I do not have the exact numbers, so I will write to the noble Baroness. On loss-leading services, anything under £15 was removed because it was deemed that that was dishonest or underpriced.

Health and Care Bill

Baroness Watkins of Tavistock Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I welcome the noble Lord, Lord Stevens of Birmingham, to this House and enjoyed his erudite speech—and I am supportive of the fluoridisation of water. I draw attention to my interests as outlined in the register, particularly as a registered nurse and chair of a small housing association that specialises in housing for people leaving care.

This Bill is welcomed by many health and care communities, and I support its emphasis on collaboration and integration between mainstream NHS providers, public health, social care, the voluntary sector and, in some cases, the independent sector. This will be essential to meet our health challenges and increase productivity. The Bill refers to patient-focused care provision, yet future success will be achieved only if people take greater responsibility for their own health based on public health advice. For this reason, I suggest that the term “person-centred care” is substituted in many parts of the Bill to emphasise the partnership in care between service users and professionals. How can this House be assured that the structural changes proposed will reduce health inequalities and ensure parity of esteem between mental health, learning disability and physical healthcare services?

There is a concern that in ICBs there may be an overrepresentation of local acute trusts. I support amending board structures to mandate representation for mental health and learning disability providers; a member of the local community to represent users and carers; and a nominee from social services and public health. This will be vital to achieve balanced decision-making and fair allocation of resource.

In 2020 the World Health Organization launched a vision for nursing, with a clear policy committing all nations to increase the proportion and authority of nurses in senior health positions. I hope the Government will consider this in their new structures.

I support proposed amendments to ensure that the Secretary of State must lay regular reports before Parliament outlining the system in place for assessing and meeting the needs of the health, public health and social care workforce in England. Reports should include independently verified workforce numbers—in full-time equivalents, not headcount—and should indicate the proportion who have been trained in the UK and those recruited from overseas. The World Health Organization is clear that while healthcare workers’ migration can be positive, wealthy countries should not be overreliant on recruitment at the expense of lower-income and middle-income countries. Reports should identify the number entering training in the UK and the number of leavers, and should provide information on retention, including examples of best practice.

The Bill introduces the NHS payment scheme, designed to enable the integration of service delivery. To realise this ambition, there must be central prioritisation of early intervention and timely discharge. In August 2021 there were 25,836 days of delayed discharges for mental health services; 32% were attributed to social care and 11% to housing. The proposed payments system may make it easier to prioritise proactive community care, but this priority needs mandating in order to ensure that the new payments scheme drives reductions in delayed transfers of care and does not simply continue to accommodate extra bed days in hospital.

Patient safety and the relationship to safe staffing cannot be overemphasised. Amendments are necessary to promote workplace health and safety, including in community settings; the supply of PPE and other safety equipment; and clear mechanisms for staff to raise and resolve concerns. Staff teams should include relevant skill mix, adequate time for clinical supervision and access to continued professional education in data management, new research findings and interpersonal skills to provide contemporary evidence-based practice. I look forward to working with others in Committee to ensure that amendments concerning the issues that I have raised are considered.

Adult Social Care

Baroness Watkins of Tavistock Excerpts

Thursday 2nd December 2021 Lords Chamber

[Lord Kamall (Con)]

The noble Baroness, Lady Fox, makes a valid point: we have to look at not only the long-term vision but the short-term issues raised. This is why, on 3 November, we announced the adult social care winter plan for 2021-22. This was developed in conjunction with the NHS and social care stakeholders. We drew on the recommendations of the review of last year’s adult social care winter plan and listened to a number of different stakeholders in setting out the short-term issues.

As the noble Baroness acknowledges, we are the first Government to set out a long-term vision, not just from one electoral cycle to another but for 10 years. We have set out a vision with three years of commitment to specific spending, some of which is a discovery process, because we still have to know what will and will not work, and how to use and integrate technology. By doing that, we have laid down the gauntlet to whatever Government come after us, of whatever political colour, for them to continue to fulfil this vision. It is a vision against which this and future Governments will be measured.

Other politicians from other parties have known about this for many years. The noble Baroness, Lady Pitkeathley, mentioned waiting for 40 years and others have known about our post-war demographic challenge. We have finally grasped the nettle. We are not going to get everything right, which is why we have not laid out a detailed, prescriptive plan for 10 years. We have laid out a vision of integration, making sure that we use the best technology to support people in their own homes, as much as possible. At the same time, we have committed for the next three years. After that, the challenge is for us to work with all stakeholders to deliver that vision.

[Baroness Watkins of Tavistock (CB)]

My Lords, I am particularly delighted to see this White Paper and congratulate the Government on publishing it in this timeframe. However, we need to look closely at workforce needs, at the same time as we look at workforce needs for the Health and Care Bill, because there is a real mismatch between the vision we now have and the staffing for that vision. I welcome this opportunity to hear how the Government think we can tackle that and give young unemployed people good opportunities to come into a proper caring profession.

[Lord Kamall (Con)]

I thank the noble Baroness for the conversations that we have had about this, and a number of other issues, as I got to grips with my brief. She makes a very important point. We have to make sure that social care is seen as an attractive career path and not just something unskilled; we know that there are skills involved, such as empathy. There will also be an increased need for digital skills, and people management skills will be handy in other areas. For far too long, social care has been seen as the poor relation of other parts of the health system. By bringing health and social care together, we are sending a signal that our vision is to put them on an equal footing. We are also explaining how we intend to spend over the next three years. We challenge everyone—stakeholders, local authorities, everyone—to come forward and help us develop that vision for the long term, and to hold future Governments to account against that vision.

Covid-19 Update

Baroness Watkins of Tavistock Excerpts

Monday 29th November 2021 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Lord for the point he just made. If he will allow me, I will take that back and try to get an answer for him.

[Baroness Watkins of Tavistock (CB)]

My Lords, I hear from colleagues in South Africa that nasal swabs alone are not as effective at picking up the new variant and that there have been many false negatives reported. I would welcome the Minister’s comment on that, as we are moving to more nasal swabs. I also suggest that it would be more sensible to encourage the use of face coverings in offices and to encourage people to work from home wherever it is feasible in terms of employers, so that the next two weeks can be used by scientists to really identify other problems that might be associated. This would help to safeguard NHS clinical staff as well as hospitals. If people are getting false negatives and then being admitted to hospital, it puts the very staff we need to keep at work at risk.

Covid-19 Update

Baroness Watkins of Tavistock Excerpts

Wednesday 10th November 2021 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend for the question. As noble Lords will know, I see myself as a bit of a civil libertarian. Personally, I have asked a number of questions internally about the whole issue of compulsion. It is a very difficult issue, but I understand the arguments on the other side—that we want patients to feel safe and feel that they are looked after by staff who have been vaccinated. Stakeholder analysis and round-tables came out in favour of compulsion on the Covid vaccine and boosters. When it came to flu, interestingly enough, there was a significant disagreement on the practical timing of the flu vaccine supply and the vast majority of doses being available. We have promised to keep it under review, but that is not mandated at this stage.

[Baroness Watkins of Tavistock (CB)]

My Lords, I declare my interest as a mental health nurse, as outlined in the register. I am concerned about the unintended consequences of making vaccines mandatory for healthcare staff, despite the fact that I fully support the vaccine and have had three doses myself. It is a relatively small number of healthcare staff who are not vaccinated—I accept that it varies across the country—but is it right to give no authority at all to boards in trusts to decide the best way forward for the minority of staff who do not wish to be vaccinated? I am concerned that there will be unintended consequences associated with a lack of care staff, particularly nurses, in mental healthcare environments, which may result in poorer care for patients than if we carefully supported that small number of staff in working perhaps with patients who do not want to be vaccinated themselves.

Covid-19 Vaccinations

Baroness Watkins of Tavistock Excerpts

Monday 8th November 2021 Lords Chamber

[Lord Kamall (Con)]

On the noble Baroness’s first point, about the centres closing at 6 pm, this is the first time that I have been made aware of that. I welcome any feedback about what is working and what is not. This is not necessarily political; we all want it to work, so I welcome any information on that. I will double-check it.

The noble Baroness referred to complacency. It is very interesting when people say that most people are in favour of measures on masks. It is quite often like polling, when we see a difference between stated preferences and revealed preferences. It is claimed that a number of people are in favour of masks and want to wear them, but, when it comes to public transport and the revealed preferences, we see that it depends on the mode of public transport—sometimes take-up is less than 50%. I have said to people, “Make sure you get your boosters”, but maybe we have to take some responsibility for not making it clear that the boosters were important and for not pushing them as much as possible. The first and second vaccines were taken up with such enthusiasm because people wanted to return to as close to normal as possible, but when it came to the booster, it really needed all of us to push it to make sure that more people took it.

[Baroness Watkins of Tavistock (CB)]

My Lords, I declare my interest as a nurse. Would it be helpful to reinforce the message that some of the most vulnerable people should contact their specialist nurse practitioners, who in many cases are much more obtainable than both consultants and general practitioners? I would really like the Government to emphasise that.

Turning to 12 to 15 year-olds, I declare my interest in that my daughter is a secondary schoolteacher in south London. Anti-vaxxers outside schools are creating a real problem. I understand that the Government have powers to reduce their access within the area of a school. Is this being seriously considered? The uptake of vaccines in the 12 to 15 year-old age group requires the consent of an adult. Therefore, it is imperative that schools are part of that system.

[Lord Kamall (Con)]

I thank the noble Baroness for that really important point: it is about not only consultants and GPs but nurse practitioners. When you go to book a booster jab and look at availability, you might well expect it to be at a hospital or a surgery, but many community pharmacies are offering it. It is important that we have those conversations. I agree with the noble Baroness on the advice that she has given.

I also share the noble Baroness’s concerns about the anti-vaxxers. It is a difficult balance: I believe in freedom of speech, but they should not inhibit people. It is really important that we make the case. As of 2 November, 24% of 12 to 15 year-olds had received their first dose. They will have received it through school. The NHS is also working closely with schools to offer vaccines to young people as soon as parents or guardians consent. We are also expanding our programme of walk-in centres to make sure that we can provide parents with extra choice over where and when their children are vaccinated. The vaccines are safe and will protect children from Covid-19. We repeat this. The current advice is to give the majority of children a single dose, which means that they will be afforded a high level of protection.

On people protesting outside schools, the Government have explained their concerns about that. At the moment, I have no further information. As soon as there is further information, noble Lords will be informed.

Social Care

Baroness Watkins of Tavistock Excerpts

Wednesday 27th October 2021 Lords Chamber

[Lord Kamall]

The funding commits us from 2022 to 2025—it is three years’ funding. The point that the noble Baroness makes is that, of course, we are hoping that we can clear as much of the elective backlog as possible. After that, the money will be moved and will focus on social care reforms. On her specific question, I will write to the noble Baroness.

[Baroness Watkins of Tavistock (CB)]

My Lords, my question builds on that of the noble Lord, Lord Young of Cookham. Can the Minister explain how social care is to cope now, when there is a crisis, without a larger allocation of the levy in addition to funds announced, and, in particular, how delayed transfers of care from acute hospitals may be reduced? Should there be central guidance to the NHS to commission social care services to assist in safe rapid discharge?

[Lord Kamall (Con)]

In looking at how we reform the adult social care workforce, we have consulted a wide range of stakeholders, not only on what we do from 2022 to 2025 but on what we do in the short term. Further details will be announced soon.

Ageing: Science, Technology and Healthy Living (Science and Technology Committee Report)

Baroness Watkins of Tavistock Excerpts

Wednesday 20th October 2021 Grand Committee

[Baroness Watkins of Tavistock (CB)]

My Lords, it is an honour to follow the noble Lord, Lord Crisp, and a pleasure to speak in this debate on the report of the committee chaired by the noble Lord, Lord Patel, who has been my mentor since I entered this House and encouraged me to speak today. He introduced this debate so effectively and outlined the challenges that face society in relation to ageing.

Many noble Lords have developed and will continue to develop the important themes of science and technology research investment as an essential building block in developing treatments, AI and robotics to assist people in older age and to target specific illnesses through effective new drugs. I intend to discuss the challenges and opportunities outlined from social care and a “happiness and health” perspective in later life.

The report notes that the proportion of the UK population that is older than 80 is expected to increase from 4.9%, or 3.3 million people, in 2018 to 10%, or 7.6 million people, by 2065. The Chief Medical Officer for England, Professor Chris Whitty, explained to the committee that it is anticipated that older age groups will be

“highly concentrated … in places where delivery”

of care and health services

“is more difficult than it is in cities.”

I recently attended a lecture that he gave at the University of Plymouth. He outlined the particular challenges of reaching people in rural communities and seaside towns, where many young people leave for work but return to retire, leaving a very small young workforce pool to provide paid care work to support older people.

This morning, the current challenges of providing enough care workers to support people as they come out of hospital were made clear by several speakers on the “Today” programme, including Vic Rayner, chief executive of the National Care Forum. There is insufficient modern accommodation, particularly in the social housing sector, to provide supportive living in a cost-effective manner to older people. Yet there is huge opportunity to build units with appropriate technology to enable more independent living, even for people who have multiple morbidities.

I am amazed that it is now possible to wear a watch with a tracking device that records a person’s whereabouts and, if their routine changes, enables alerts to a central hub and/or a named relative or carer within seconds. As a district nurse in the 1970s, I had to return to base to phone a patient I was worried about. If they did not answer, I had to go back to see them. Think of the difference for district nurses today because of mobile phones and modern technology. In addition, Housing 21 and Bath University work to link innovative engineering to do what appear to many to be simple interventions, such as a kettle that can never boil dry, due to a switch-off mechanism, or baths and showers that control the water temperature so that people cannot scold themselves when bathing. People can therefore stay independent.

Can the Minister please explain how the Government intend to promote investment in social housing that will meet the needs of the most deprived older people, so that they can live healthier, more independent lives? The boom of such housing available to those who can afford to buy age-specific homes of this kind illustrates that many older people enjoy living in such communities and are often less lonely as a result. Will the Government also invest in research designed to identify the potential benefits of such interventions on a longitudinal basis to provide data to inform future investments for older people?

I turn from housing as a key social determinant of health to the NHS and social care. Loneliness is a risk factor for both physical and mental health, as is adequately detailed in paragraph 34 of the report. What role should the NHS and care services play, possibly through social prescribing, to reduce extreme loneliness in old age? In the village where I live, the local post office and shop have just closed and, other than school transport, the bus operates twice a day—that is, two buses one way and two back, without a timetable focused on getting people to and from work. There is no bus that enables a 10 am departure and a return before 4 pm, so that someone of 70 years old can use their pass to go to the nearest town to shop, visit the library and perhaps have coffee. These are real issues for people, yet here in London I can pretty well go anywhere anytime. Could further investment in transport from central and local government overcome these issues and thus promote the health of older people?

Can the Minister explain whether Health Education England is exploring the need for specialist health and social care workers to work with older people? There are few Admiral nurses to support people with dementia, yet this is the highest cause of death in women and the second-highest cause of death in men in England, as illustrated by table 1 in the report. The report also highlights the need for more regular medication reviews for people as they get older and the fact that Age UK reported to the committee that

“care packages can only focus on the essentials such as meals and toileting, without any time for help with mobility”.

That is a damning indictment of our individualised care interventions. The noble Lord, Lord Kakkar, outlined the need to provide co-ordinated, compassionate care. It is essential at the moment, let alone in the next 20 years.

Promoting independence is vital if people are to live longer, healthier, happier lives in old age. I suggest that the recommendation outlined in paragraph 275 of the report—

“that the Government clearly defines the roles and responsibilities for healthy ageing among national and local government and their agencies”—

is as essential as blue-skies research. The report clearly outlines the differences in life expectancy between different socioeconomic and ethnic groups. Why is my life expectancy estimated to be nine years longer than that of someone living nine miles away from where I reside, in the most deprived ward of Plymouth?

Finally, can the Minister comment on whether the ageing society grand challenge needs revision, or is to be completely reviewed from the current term, to ensure

“that people can enjoy at least five extra healthy, independent years of life by 2035, while narrowing the gap between the experience of the richest and poorest”

and enable all older people to have high-quality support and care in the last five years of their lives, as necessary, to reduce loneliness and thus promote health and happiness irrespective of income? The new social care levy could, I argue, be used in part to achieve this aim.

Social Care Funding: Intergenerational Impact

Baroness Watkins of Tavistock Excerpts

Thursday 16th September 2021 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I draw attention to my interests as outlined in the register, particularly as chair of Look Ahead, a housing association that works with vulnerable and homeless people. I congratulate the noble Baroness, Lady Greengross, on securing the debate and on her excellent introduction. Together with other noble Lords, I am committed to ensuring that social care is put on a secure financial footing to protect vulnerable people who rely on these essential services.

Many have argued that the younger members of our society should not be expected to contribute towards the extra funds to be raised through the addition to NICs. I think this is partly because the Government’s presentation has dwelt on the funding challenges of older people when they experience the need for social care associated with frailty and dementia. However, a high proportion of social care budgets is spent on supporting younger people with long-term conditions, including, for example, multiple sclerosis, acquired brain injury and significant mental health and learning difficulties. Can the Minister explain how the proposed levy will be associated and allocated to improve the lives of these sections of society?

Crisis recently published an excellent report Home for All: the Case for Scaling Up Housing First in England. Rapid access to stable housing for young people, including care leavers and those already homeless, is demonstrably cost effective. Will the issue of housing for young people be a priority, together with developing supported-living housing for those over 65 years of age, which in turn can promote independence and reduce or delay the need for help with the activities of living?

Many young people cannot save the deposit to purchase a home, and access to social-rent accommodation is in very short supply, yet the future direction appears to be to enable older people to keep the value in their home if in need of significant social care, while, as other noble Lords have said, younger people are having difficulty getting on the housing ladder. The younger generations will become increasingly frustrated with making significant financial contributions towards health and social care, while also, in the case of recent graduates, paying student loan contributions, if they cannot see that their needs are taken into account in the provision of health and social care service development.

Can the Minister explain how intergenerational fairness in the provision of services will be made explicit in the strategy to fund social care from 2023? I believe we have time to resolve these issues before the full allocation of the levy goes to social care.