Covid-19: Deep Cleaning
Lord Forsyth of Drumlean Excerpts(4 years, 2 months ago)
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Lord Bethell
My Lords, the noble Lord, Lord Kennedy, makes an important point. Cleaning and cleansing will be uppermost in all our minds, and I assure the House that it is a source of great focus in the efforts to combat Covid-19. However, I will try to persuade the noble Lord that we have only limited resources, time of those involved in the cleaning processes and good will from the public, so timing is essential when we are delivering measures to combat the spread of Covid-19. The CMO has been very clear on this: personal hygiene in washing hands and avoiding the spread of the virus to the face and skin should be the priority for us all. That is the focus of the Government’s efforts at this stage.
Lord Forsyth of Drumlean (Con)
My Lords, I declare an interest as chairman of a bank. The issue that the noble Lord has raised is very important. If someone is diagnosed with coronavirus, good practice means that no staff are allowed back into the building until it has been deep cleaned. An alternative would be to deep clean the building every night, so that if there were a case people could continue in their work, but to be able to pursue such a policy you need to know exactly what needs to be done to maintain the welfare and safety of the workforce.
Lord Bethell
The noble Lord is entirely right that cleaning is important, but the kind of deep cleaning protocols he described are not those recommended by the CMO at this stage of the epidemic. The SAGE group of statisticians and epidemiologists is modelling the outbreak of the virus very closely. Its computer models track the behaviours of the virus, the demographics of the country and the behaviours of people in different circumstances. Its focus is to try to ensure that we channel all our efforts into effective measures and do not explore red herrings or distracting policies that might prove counterproductive or distract from effective measures.
Dementia: Accident and Emergency
Lord Forsyth of Drumlean Excerpts(4 years, 2 months ago)
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Lord Bethell
The noble Baroness will be aware that the identification of dementia patients in England has risen dramatically from 42% to 67%, which more than accounts for the increase in the Alzheimer’s Society’s numbers. We are, however, concerned about this issue and remain focused on pulling together a new challenge on dementia strategy for the next five years and on ensuring that beds are liberated in a timely and reasonable fashion.
Coronavirus is naturally a matter of high concern in our preparations. Care of existing vulnerable and lonely people and the elderly is a massive priority, and we are putting in place plans to provide that care.
Lord Forsyth of Drumlean (Con)
My Lords, if the care of people with Alzheimer’s and other conditions is such a priority, why have the Government not responded to the Economic Affairs Committee report on social care which came out seven months ago, and why was there nothing in an otherwise excellent Budget speech on social care, which we have been promised now for year after year after year?
Lord Bethell
The noble Lord is quite right to point out the delay in providing an answer on social care. That is why the Secretary of State for Health and Social Care wrote to Peers earlier this month, initiating a round of cross-party conversations and putting in the diary the beginnings of a process to pull together cross-party agreement. That cross-party agreement is essential to providing a long-term solution to this important problem.
Nursing and Midwifery
Lord Forsyth of Drumlean Excerpts(4 years, 3 months ago)
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Baroness Blackwood of North Oxford
I thank the noble Lord for his important question. I am envious of his tartan and I definitely identify with his praise for nurses, who work long hours and serve the most vulnerable at the moments of their greatest need. To answer his specific questions, as part of the NHS people plan, we are committed to supporting career development for nurses, which includes supporting a diverse range of careers. An example would be the advanced practitioners within multi-professional teams. This is an important point that the noble Lord raises. We are also developing a plan for district and community nurses to work with healthcare providers, practitioners and higher education institutions. The plan will set out how we will grow the community nursing workforce, which includes mental health and learning disability nurses, and it is expected to be published later this year.
Lord Forsyth of Drumlean (Con)
My Lords, might my noble friend not mark this important bicentenary by enabling those nurses who have been in the profession for, say, five or 10 years to have their student loans written off, given that the cost to the taxpayer of not doing so will be greater? The write-off in 30 years’ time for the taxpayer will be £1.2 trillion in cash terms, so why not help the profession and the taxpayer by doing this now?
Baroness Blackwood of North Oxford
The noble Lord has made this point before and I have taken it back to the department before. He will know that we are providing additional financial support to nurses, including the maintenance grant of £5,000 in non-repayable funding, with specific targeted support of £3,000. However, I am very happy to take back his proposal once again, as we have an upcoming Budget.
Health: Sepsis
Lord Forsyth of Drumlean Excerpts(4 years, 3 months ago)
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Baroness Blackwood of North Oxford
That is an extremely helpful and constructive proposal. If the noble Baroness would like to raise it with me outside the Chamber, I will take it up as a matter of priority.
Lord Forsyth of Drumlean (Con)
My Lords, does my noble friend accept that public education has an important role to play here, so that people are aware of the symptoms—following the question asked by the noble Lord, Lord Patel? Can we congratulate the BBC, those of us who are fans of “The Archers”, on the work it has done in this respect?
Baroness Blackwood of North Oxford
I am very happy to congratulate the BBC. I do not know that I heard “The Archers” storyline in question, but I shall make sure that I update my education in this respect. I want also to congratulate Public Health England on its national Start4Life information service for parents. It has worked with Mumsnet to make sure that awareness is spread to those most likely to need it, because those most at risk are the young, the elderly and those who have underlying conditions. Targeting the messaging at those who need it most is very important.
Queen’s Speech
Lord Forsyth of Drumlean Excerpts(4 years, 4 months ago)
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Lord Forsyth of Drumlean (Con)
My Lords, it is a pleasure to follow the noble Lord, Lord Rees of Ludlow. I was particularly impressed by his argument that we can influence climate change more than our contribution to carbon through research. It is a very powerful argument and certainly a new one to me. He is, of course, a cosmologist. I want to concentrate, in the short time I have, on social care. Sometimes I feel that officials in the Treasury have the noble Lord’s perspective on time in respect of this issue.
I think it was Winston Churchill who first said that the state has a duty to provide a net below which no one can fall and a ladder to help them get out of the net. Like the noble Baroness, Lady Janke, I believe that very strongly. Social care policy is about protecting our frailest and most vulnerable people, who cannot climb any ladders and whose quality of life depends on that net. Sadly, as several speakers have said, it is wholly inadequate, full of holes and now disintegrating under the inexorable pressure of demand. By 2040, for every working adult there will be almost one person over the age of 65. The cost of care for older people will double between now and 2035. This is not just an issue of an increasingly elderly population either. Almost half of expenditure on social care goes on people of working age, and that population will increase too. By 2025, there will be 150,000 more working-age adults with moderate or severe disabilities and 16,000 more with learning disabilities.
The system is completely broken, with Age UK estimating that 14% of elderly people have an unmet care need. The number of people receiving publicly funded care has actually fallen in recent years. In England there were 40,000 fewer such people in 2013 than there were in 2009—a 26% fall, despite an increase in demand. The fact is that it is the impact on the budget, not well-being, that now determines whether needs will be deemed eligible for support by local authorities. Just to get to where we were 10 years ago in quality and access to care would cost around £8 billion.
What is to be done? Since I left the Government at the invitation of the electorate in 1997, 12 Green Papers, White Papers and other consultations and five independent reviews have attempted to solve the issue of social care funding. All have pointed to the same answer: we need to find considerably more money and achieve a consensus between the Government and the Opposition to underpin a long-term, stable system. I very much welcome, therefore, the commitment in the gracious Speech to achieve that.
Last year, the Economic Affairs Committee, which I do the best I can to chair, was able to reach unanimous agreement on a way forward. Its membership included two former Chancellors of the Exchequer, two former Permanent Secretaries to the Treasury, a former Cabinet Secretary, a distinguished economist of the left, a retired FTSE 100 CEO, a non-executive director of the Bank of England and other highly experienced members. If we could find agreement, why can the political parties not? It would mean the state writing a big cheque and providing clarity about the future structure, and it would require a determined effort to simplify the system and remove many of the unfairnesses from it. Above all, it would require a major effort to educate the public.
The fact is that most people do not have a clue about the level of support they can expect if they are struck down by illness or fragility and find themselves unable to meet their own basic needs for washing, feeding, continence and mobility. The problem becomes apparent to the voter only when an elderly parent or perhaps a family member has a severe disability. The Local Government Association survey found that 48% of English adults did not even know what the term “social care” meant. The King’s Fund found that people were shocked when the means test, the extent to which they were responsible for paying for their own care and the complexity of the system were explained to them.
There are real injustices in the system which need to be addressed. Self-funders in residential care are being charged 41% more than those who are publicly funded. It is a hidden tax on people who have saved throughout their working lives. In England, it is quite scandalous that access to basic free care is limited by diagnosis and not need; a person with cancer will be helped but someone with dementia or motor neurone disease will not until they have spent every penny down to £23,500. The means test does not include the family home as an asset if domiciliary care is provided, but it is counted for residential care, leaving some families faced with catastrophic costs losing everything.
The pay, treatment and training of the care workers is woefully inadequate. Care homes regularly lose dedicated men and women to stacking shelves in supermarkets and the turnover among staff is approaching 40%. There is a desperate need to invest in the social care workforce and ensure a joined-up approach to workforce planning. I know how wonderfully committed and poorly rewarded care workers are. It is a vocation for most of them, not just a job, and they deserve a proper career path and professional status, like nurses.
Today, yet another Bill or Green Paper is awaited from the Government and, like Billy Bunter’s postal order, it has been endlessly delayed. With each delay the suffering increases, the pressure on unpaid carers grows, the supply of carer providers diminishes, the availability of qualified carers is reduced and the ability to put in place a system of social care that is sustainable and worthy of a civilised country is prejudiced.
To the Government’s credit, the Secretary of State for Health and Social Care wrote to me in September promising that the Government will set out plans in due course to fix the crisis in social care once and for all—to give every older person the dignity and security that they deserve and to protect children, parents and grandparents from the fear of having to sell their home to pay for the cost of care. These words are reflected in the gracious Speech. I hope and pray that they are soon turned into action.
NHS: Nurses
Lord Forsyth of Drumlean Excerpts(4 years, 4 months ago)
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Baroness Blackwood of North Oxford
My Lords, first, I thank the NHS staff who have worked so hard over the Christmas and new year period. I point the noble Lord to the recent record; the NHS now has over 20,300 more nurses on our wards than in 2010 and over 52,000 more nurses in training. We have increased our training places by 25% since September 2018 and made available 3,000 more midwifery places to ensure that we can achieve this outcome. We have put in place several actions on recruitment and retention, because we need to retain our extremely experienced and excellent nurses and to recruit more nurses to support them. That is why we have announced this new package, which will not only increase nurse payment by 12% but provide support for those in training, attracting more nurses in to support those already in place.
Lord Forsyth of Drumlean (Con)
My Lords, from the point of view of both retention and recruitment of nurses, would my noble friend not think it a good idea to allow student nurses who stay in the profession for a period of time to have their fees written off, given that because of their levels of pay they will not pay back the student loans required for the profession? That would save the taxpayer a good deal of money and encourage people to come into the profession.
Baroness Blackwood of North Oxford
I always take very careful note of proposals from my noble friend. At the moment, that is not under consideration, but it will certainly be looked into. As the entry salaries rise, it is more likely that student loans will be repaid, but what is important at this stage is that we attract the most nurses into the profession. At the moment students are able to access student loan funding for maintenance as well as the non-repayable funding from the DHSC, which means that we will meet our target of 50,000 more nurses by 2025, which is what we need to be able to deliver a sustainable NHS.
National Health Service: Pensions Tax
Lord Forsyth of Drumlean Excerpts(4 years, 6 months ago)
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Baroness Blackwood of North Oxford
As I said in an earlier answer, we are expecting the consultation proposals to be implemented in April. However, I reassure the noble Baroness that these proposals would also apply to clinicians working in the Armed Forces and in medical schools, provided they are in the NHS pension scheme. I hope she find that encouraging.
Lord Forsyth of Drumlean (Con)
My Lords, this is not just a problem for the NHS; it applies across the public sector—to senior people in the police, the fire service, the Army and elsewhere. It is a problem of the Government’s making. It was the Government who put a limit on the size of people’s pension pots and this is the unintended consequence. We are losing the most experienced, dedicated people. It is a false economy. My noble friend answers for the Government as a whole, not just on the health service, and it is not good enough to say that the Treasury is considering this matter. It has been brought up time and again, and it is time for the Treasury to admit that it made a mistake that is costing the public service dear.
Baroness Blackwood of North Oxford
As usual, my noble friend speaks with alacrity and force. It has been made quite clear by the Treasury that it will look at the impact on front-line services across the system and not just in the NHS. I am of course speaking for the Department of Health and Social Care, but where sensible evidence is brought forward by other services, it will be looked at by the Treasury in its review.
Drugs: Methadone
Lord Forsyth of Drumlean Excerpts(4 years, 6 months ago)
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Baroness Blackwood of North Oxford
The noble Baroness in her question has outlined her expertise in this. She is quite right that the evidence base for the effectiveness of methadone is robust. It is provided for by NICE guidance and UK drug misuse and dependence treatment guidelines. Those have recently been updated in the Orange Book, which provides clinical guidance to clinicians and was published in 2017. There is also an update coming to NICE guidelines on how to manage drug dependency, which will be published in 2021. Therefore, up-to-date guidance is available for clinicians which ensures that they are able to provide both therapeutic and dependency management to those on prescription but also on withdrawal treatment. I therefore reassure the House that this is being taken extremely seriously by the Department of Health and Social Care, and by all related departments.
Lord Forsyth of Drumlean (Con)
My Lords, how can my noble friend say that it represents value for money if she does not know the cost? To go back to the question of the noble Lord, Lord Brooke, surely that cost has to be taken as an opportunity cost compared to other forms of treatment that do not continue with people being dependent on drugs.
Baroness Blackwood of North Oxford
My noble friend is quite right that we have to ensure that we prevent individuals getting addicted to drugs in the first place. That is why there is a wider drugs strategy, which ensures that we take action to reduce the number of people who become addicted in the first place, why the Home Office is holding a summit in Glasgow focused on tackling the problem of drug use, and why Dame Carol Black is working on the association between drug use and violence. However, we recognise that the use of methadone is an evidence-based and effective way to reduce the harm as cost-effectively as possible, which has been proven through extensive clinical and evidence-based trials.
Healthcare: Brain Tumours
Lord Forsyth of Drumlean Excerpts(4 years, 6 months ago)
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Baroness Blackwood of North Oxford
The noble Baroness will know that this has been identified as a priority, not only from the call to action from carers themselves that services and systems that work for them should be improved, but also because it is one of the 64 actions in the carers action plan. It is something the Government are determined to take action on. We are concerned by the reports and taking action to improve it.
Lord Forsyth of Drumlean (Con)
My Lords, has my noble friend noticed that at its conference the Labour Party adopted as its policy on social care pretty well the recommendations of the all-party Economic Affairs Committee of this House? Is there now a unique opportunity for us to get a political consensus on the need to provide free personal care? The root of this problem is that access to free personal care depends on diagnosis, not need. Is it not now time for the Government to produce a White Paper and work with the Opposition to produce the consensus that everyone concerned with this matter realises needs to be achieved?
Baroness Blackwood of North Oxford
I first congratulate my noble friend on his leadership on this issue; it has been noted by the House and very much welcomed. He is absolutely right that leadership on social care is essential and that it is time for action on this. The Prime Minister has been clear that he wants to end the suffering in social care once and for all, and will bring forward announcements on his immediate plans for that very soon.
Adult Social Care
Lord Forsyth of Drumlean Excerpts(4 years, 9 months ago)
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Baroness Blackwood of North Oxford
I share the noble Baroness’s impatience on this issue and I agree with the overall conclusions of the ADASS report that older and disabled people need dignified, high-quality care and support. When properly resourced it does work, and as a nation we must make this an immediate priority. That is why I very much welcomed the incoming Prime Minister’s statement that,
“we will fix the crisis in social care once and for all with a clear plan ... To give every older person the dignity and security they deserve”.
He will make it a priority of the incoming Government and there will be an imminent announcement from the incoming Health Secretary. As I do not know whether I will be part of the department, I am afraid that I cannot commit to this, but I am sure that whoever is in this place when that comes forward will be very happy to do so.
Lord Forsyth of Drumlean (Con)
My Lords, I welcome the statement by the incoming Prime Minister. However, does my noble friend share the concern about the unfairness of the current system? People suffering from dementia or motor neurone disease are not given access to free care, whereas people suffering from cancer are. People who choose to be looked after at home do not get free care until their assets have been run down to £23,500, but their home is not taken into account. However, if they go into residential care, their home is taken into account. As my noble friend indicated, what we need now is not another White Paper; we need the Government to write a cheque. We need to move away from a system where local authorities are asked to fund this out of business rates, which results in a postcode lottery and differences in care throughout the United Kingdom.
Baroness Blackwood of North Oxford
I thank the noble Lord for the work he has done on this issue. It is very much welcomed. He will know that, as one of his first statements, the Prime Minister said that his job was to,
“protect you or your parents or grandparents from the fear of having to sell your home to pay for the costs of care”.
This was one of the first points he made. The noble Lord will also know that one of the Government’s long-term principles is that there must be a level of personal responsibility for social care in England, as well as the safety net that supports significant numbers of people today. However, we accept that there will need to be a significant amount of funding as part of the spending review commitment. That is being considered at the moment and will be coming forward imminently.