Covid Pandemic: Testing of Care Home Residents

Baroness Wheeler Excerpts

Monday 6th March 2023 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, we have heard much about the former Health Secretary’s thoughts via WhatsApp, but today’s Question is about care homes. The Government claimed early in the pandemic to have thrown a “protective ring” around care homes in response to the alarm bells that were ringing across the country about elderly, frail patients being transferred from hospitals without being tested for Covid. Tragically, over 17,000 residents lost their lives in the pandemic’s first year. Between the advice given by the Chief Medical Officer about the necessity of testing and Matt Hancock’s final decision to act, residents were left exposed and isolated, and staff put at risk.

The latest revelations will be deeply distressing for families up and down the country who lost loved ones. Why were care homes not urgently prioritised when the impact of Covid was there for all to see? Will the Government ensure that the Covid inquiry gets full disclosure of the texts, minutes and documents on this matter and receives whatever support it needs to report by the end of the year?

Physiotherapy: Rehabilitation Services

Baroness Wheeler Excerpts

Thursday 23rd February 2023 Lords Chamber

Asked by

[Baroness Wheeler]

To ask His Majesty’s Government what assessment they have made of the survey by the Chartered Society of Physiotherapy, published on 1 December 2022, which found that there was a shortage of rehabilitation services, that rehabilitation spaces had not been returned to use for physiotherapy care following the COVID-19 pandemic, and that stroke survivors were being “imprisoned at home with a bed and commode” while waiting for care.

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

We welcome the Chartered Society of Physiotherapy survey and the valuable insights it gives us regarding rehabilitation services. Integrated care systems are responsible for commissioning appropriate services for their local populations. Decisions on the use of physical estates are rightly for local organisations. Rehabilitation and physiotherapy are critical to many patients’ care and recovery. For stroke survivors, the NHS aims to deliver personalised, needs-based, goal-oriented rehabilitation to every stroke survivor in their home environment.

--- Later in debate ---

[Baroness Wheeler (Lab)]

My Lords, the CSP survey paints a dismal picture of the state of rehabilitation services: overstretched and underresourced prior to the pandemic and still struggling to re-establish physio rehab services that had their staff, space and facilities diverted to deal with the crisis and with chronic staff shortages. The recent stroke audit showed that only 10% of the UK’s stroke survivors were able to access the recommended amount of rehabilitation they need. What actions are the Government taking to address this unmet demand for the vital services that will help prevent patients deteriorating and becoming more frail and vulnerable?

[Lord Markham (Con)]

I thank the noble Baroness for bringing this to our attention; again, I believe that the advantage of these Questions is that they shine the spotlight on particular areas. As the survey pointed out, there are a lot of places which, for very understandable reasons, were swapped over to Covid uses during the pandemic and which now need to be brought back into physio use. That was one of the main recommendations from the society, and we will now write to all the NHS chief executives on the back of that. As the House will be aware, I am doing some work anyway to make more space available as part of the capital programme, so this is very much on my list to make sure that we expand that space and provision.

Adult Social Care

Baroness Wheeler Excerpts

Monday 20th February 2023 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, on that theme, the Minister makes much of the Government’s historic £7.5 billion social care funding settlement, but he knows that it has been and remains seriously underfunded—the Health Foundation’s estimate is a £12 billion a year shortfall. As the excellent Lords committee underlines, it is no good attempting to resolve the social care crisis by providing short-term funding for more care packages while still depending on local authority council tax flexibility to raise the extra funds. Is the Minister concerned that three-quarters of the largest councils in England with responsibility for social care have been left with no choice but to raise their council tax by the full 4.99% increase, just to keep current inadequate levels of service going?

[Lord Markham (Con)]

I am aware of some of the challenges raised by funding through the local authority system—and I say that as a former deputy leader of a local authority, so I am very familiar with the situations at play there. At the same time, we have put a lot of the central funding in place to make sure the security is there. As I said, we will see more measures as Minister Whately announces them in the spring, not far from here; there will be further progress in this area.

Bread and Flour Regulations 1988

Baroness Wheeler Excerpts

Tuesday 7th February 2023 Lords Chamber

[Lord Markham (Con)]

I do not know the precise number; I know there are many stakeholders in this. The devolved Administrations have been involved in all of this. Part of the delay is because, once we go ahead, we have to notify the EU, because of the Northern Ireland elements of it, and that is a six-month notification. We also have to notify the World Trade Organization. All these aspects mean that this is not as quick as we would want, and then we need to let the industry have time to adjust. It is a process involving many people, but we are getting there.

[Baroness Wheeler (Lab)]

My Lords, despite their seriously delayed decision-making, the Government promised nearly two years ago that major efforts would be made to step up awareness raising of the importance of taking folic acid supplements, particularly among at-risk groups such as Afro-Caribbean women and women under 20 years old. Can the Minister tell us what actions have been taken, and what measurable impact awareness raising has had among these risk groups and on ensuring that women whose pregnancies were unplanned are not missing out on these vital nutrients in the early stages of their pregnancies?

[Lord Markham (Con)]

The noble Baroness is correct. Key to all these things is awareness that the best advice is to take folic acid supplements, as suggested. I am happy to provide precise figures of how that has moved in recent years. I completely agree that, as ever, education and awareness are key to this.

Respiratory Syncytial Virus

Baroness Wheeler Excerpts

Thursday 19th January 2023 Lords Chamber

[Lord Markham (Con)]

The noble Baroness is correct. In fact, my maiden speech was in a debate about how we can bring life sciences to bear more. The point about NHS clinical trials and the fact that we are not using this massive potential asset was very much a feature of that. It is key to the work we are doing—I had a meeting on it just this week—so I agree with the noble Baroness and hope we will see improvements in this space.

[Baroness Wheeler (Lab)]

My Lords, we know that older adults are at greater risk of serious complications from RSV infections in children, because our immune systems weaken as we get older, which can lead to exacerbations of underlying lung and cardiac disease. What action is being taken to address the serious underestimation of older adult RSV infections and to improve testing, reporting and treatment for this key group?

[Lord Markham (Con)]

I thank the noble Baroness. The key risk groups in the elderly as well are, as I mentioned earlier, those with congenital lung or heart disease or spinal muscular atrophy. The problem is that the current vaccination needs monthly immunisation to be effective, and I think most people will agree that it can be used in only the most severe cases because it is not a very practical way forward and is very expensive. That is why I am really excited by the new treatments, particularly nirsevimab, which is 75% to 80% effective, versus palivizumab, which is more around 50%. I think we have a good way forward.

Times Health Commission

Baroness Wheeler Excerpts

Thursday 19th January 2023 Lords Chamber

[Lord Markham (Con)]

As I said, we have already announced big increases in funding, with more than 20% over the next two years. Two years is not the short term. Minister Whately is working very hard on this because we know that the flow in social care is a key element of the whole solution.

[Baroness Wheeler (Lab)]

My Lords, I welcome the Times setting up the commission. So far, it seems to have a clear and coherent view on the scale of the crisis facing the NHS and what needs to be done, which seems to be sadly lacking from the Government. In the light of all the Times research in articles this week on the resuscitation that the NHS needs, the waning faith people have that they will be cared for and the rising billions that levels of ill health are costing the country, does the Minister agree that the Government’s ABCD policy for addressing the crisis needs a complete rethink?

[Lord Markham (Con)]

No, not at all. In fact, the things I have read in the Times are about what we are implementing. The House has heard me talk about virtual wards; I saw an article on how important those are in helping with the step-down care that is needed in some social care. I have seen that in many places already and it is a way forward. It has also talked about the need for AI and robotic surgery; again, I have seen examples of that in different hospitals. The commission is taking a lot of the good ideas that are already in place throughout the health service and, as I want to do, looking at the ways in which we implement that across the board.

Social Care: Integrated Care Systems

Baroness Wheeler Excerpts

Wednesday 11th January 2023 Lords Chamber

Asked by

[Baroness Wheeler]

To ask His Majesty’s Government what plans they have to ensure that social care is sufficiently represented within Integrated Care Systems.

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

ICSs need to include social care fully in planning and strategic decision-making. Local authorities are responsible for social care and have a clearly defined role within ICSs. The Health and Care Act 2022 includes local authorities in its minimum membership requirements for ICBs, giving local government a greater voice in NHS decision-making than ever before. In July 2022, we also published guidance on how ICPs and adult social care providers should work together.

[Baroness Wheeler (Lab)]

I thank the Minister for his response but ICBs and ICSs have been fully operational only since last July—less than six months. The Minister is quite right that, when they were being set up, we argued strongly for the need for effective social care representation in both bodies to ensure that health and social care are integrated and fully embedded in both. However, this just is not happening. The ADASS spring survey found 73% of directors reporting that ICS management has had little impact on local investment in adult social care to date; some even said that ICSs were reducing investment. How does this help ICSs play a key role in their respective areas in, for example, tackling the staffing crisis in both services, prioritising adult social care and producing the urgently needed ICP integrated care strategies, which are due in June?

[Lord Markham (Con)]

First, I think we can all agree on the necessity of making sure that these are integrated and the vital role that social care plays in all this. I must say, my experience from the places I have visited is that they are well integrated, but I will take that point back and would be pleased to look at any particular examples of where we feel that is not the case because, as I think the whole House will agree, it is vital that they are completely integrated.

Care Homes: Severely Disabled People

Baroness Wheeler Excerpts

Wednesday 30th November 2022 Lords Chamber

[Lord Markham (Con)]

The financial health of this sector is an area of interest; we all of course recall some of the problems and failures about 10 years ago. I had a meeting on this subject just this week, identifying the health of the providers to see if that is of concern. The margins made in this space are fairly typical of other industries, so they are not indicative of an area under particular stress. But I have my mind on this issue and will keep an eye on it.

[Baroness Wheeler (Lab)]

My Lords, ADASS reports that in the past four months,

“64% of councils … reported that providers in their area had closed, ceased trading or handed back council contracts”

either through an inability to recruit staff or escalating care home running costs. We all know that the extra funding to councils, which the Minister repeats in almost every response, just about props up existing services and does not provide the sustainable and long-term funding that was promised to commence with the again delayed social care cap. When will the Government fulfil their pledge to fix social care?

[Lord Markham (Con)]

My Lords, the 200,000 extra care places that this funding provides is a solid example of an expansion of supply, and I hope all noble Lords agree that that is a substantial number. I hope they also agree with the work we are doing to recruit from overseas to increase the workforce in this sector, which is indeed increasing. Areas such as these show that we are committed to expanding the supply, and we are seeing that rewarded in the increase in the last few months.

Adult Social Care

Baroness Wheeler Excerpts

Thursday 24th November 2022 Lords Chamber

[Lord Markham (Con)]

I think we all agree on the vital necessity of adult social care—I think the noble Lord has heard me say it many times from this Dispatch Box—and that is what the £2.8 billion and £4.7 billion are about over the two years. The noble Lord is correct that we need to look longer-term, because the whole health service and the care of our elderly are obviously dependent on us getting this right.

[Baroness Wheeler (Lab)]

My Lords, the backlog of care assessments, estimated at 500,000 by ADASS, lies at the heart of the complaints coming through to the ombudsman. They are all about assessment delays for people and their carers, not enough funding or staffing to deliver those assessments that are agreed and failures in home care and care home support. The latest NHS figures show that 145,226 people in England have died waiting for social care over the past five years, and nearly 29,000 previous self-funders have made a new request for council social care support because they have depleted their funds. Can the Minister tell the House exactly what impact the 200,000 more care packages to be delivered in place of the two-year cap delay will have on the huge backlog of assessments and what percentage of the original money earmarked for social care this actually represents?

[Lord Markham (Con)]

I thank the noble Baroness. As mentioned, 200,000 care packages is a significant number and will make a significant impact on everything we are talking about here, and that is in conjunction with all the other measures we have put in place, including the £500 million discharge fund this year. In terms of the precise percentages of those allocations, I will quite happily commit to write on that, but I can say to your Lordships that the £4.7 billion represents a 22% increase in 2024-25. By any standards, I think that people would agree that a 22% increase is a significant amount.

NHS: Discharge to Assess Policy

Baroness Wheeler Excerpts

Tuesday 8th November 2022 Lords Chamber

Tabled by

[Baroness Wheeler]

To ask His Majesty’s Government what plans they have to announce new measures to ensure that carers are consulted and involved in hospital decisions to discharge patients under the Discharge to Assess policy.