(1 year, 7 months ago)
Lords ChamberMy Lords, I declare an interest as the recipient of a personal health and social care budget. It was a great pleasure to serve on the Adult Social Care Committee last year, and I congratulate the noble Baroness, Lady Andrews, on her very skilful chairing, which ensured that the voices of all those involved in social care were heard and listened to.
One of our significant recommendations is that the Government work with local authorities, the voluntary sector and social care providers to embed the principles of co-production. That will give staff the necessary skills and the balance of power to the individual receiving care.
Co-production bloomed with the passing of the Community Care (Direct Payments) Act 1996, which was initiated by the noble Lord, Lord McColl of Dulwich, in his 1993 Private Member’s Bill. I remember watching the late Baroness Masham of Ilton championing the legislation with skill and wisdom; I think I can speak on behalf of all of us when I say that we miss her fierce presence today and I pay tribute to her inspirational legacy.
The Act enabled disabled adults to purchase social care tailored to our individual needs, giving us choice and control; it is what enables me to be a Member of your Lordships’ House today. Under the Act, disabled people established local centres for independent living and worked with their LAs to educate and support other disabled people in employing personal assistants to meet their needs using the co-production model. Regretfully, the committee heard evidence that this essential support has eroded with a lack of investment. Older, disempowering models of social care provision such as institutional care and threadbare support at home are now commonplace—we need to get back to co-production.
Our report proposes specific funding to ensure that local authorities commission peer-led, independent organisations to promote innovation and capacity building. Information, advice, advocacy and peer support are key; local authorities already have duties under the Care Act 2014 to provide information and advice. Part of the funding identified in the current White Paper should also be allocated to making direct payments and personal assistance a realistic option.
This is an urgent problem. In a survey of 1,000 people by the LGA last year, 77% found it more difficult to recruit a PA—that has been my own experience. Not enough is known about the role of PAs. One witness told us that if it were recognised as a valuable and skilled role, “many will intuitively see that as a vocation—as a career”. Raising its profile would attract more people to the profession. The report recommends that a government-led workforce revaluate the pay and working conditions of PAs, and appropriate training.
To conclude, our committee endorsed Social Care Future’s simple challenge for social care: to make possible the ambition of people who “want to live in the place we call home, with the people and things we love, in communities where we look out for one another, doing what matters to us”. Indeed, our report is titled A Gloriously Ordinary Life—that was how one witness described their aspiration. The Government have the power to ensure that this is not a pipe-dream.
(2 years, 1 month ago)
Lords ChamberMy Lords, we have a remote contribution from the noble Baroness, Lady Campbell of Surbiton.
My Lords, I have contributed to your Lordships’ House for 15 years because I am supported by PAs. Without them, thousands of disabled people could not work. Can the Minister explain how the Government are honouring their commitment to support disabled people’s UN convention rights to live independently, given the current PA employment crisis? Does he agree that fixing social care must include many different ways of attracting motivated PAs? Will he meet me and disabled experts to discuss solutions to this crisis?
The noble Baroness makes a welcome point and clearly demonstrates the usefulness of and real need for personal assistants; indeed, I have met and had conversations with her and her personal assistant. This is part of the wider issues around employing and getting more people into social care, as well as professionalisation. At the moment, some of the initiatives to professionalise a service do not extend to personal assistants, partly because of the way they are employed. When I asked why we cannot harmonise between personal assistants and other people in the care sector, I was told that conversations are going on. I will have to take this back to the department and DWP to get an answer for the noble Baroness.
(2 years, 6 months ago)
Lords ChamberTwo noble Baronesses will be taking part remotely. I first call the noble Baroness, Lady Campbell of Surbiton.
My Lords, I strongly support Motion D1, to be moved later, in the name of the noble Baroness, Lady Wheeler. It attempts to salvage something of what we set out to achieve on Report. Noble Lords will remember that I was particularly keen to achieve a zero cap for working-age adults who have or who develop eligible care needs under the age of 40. This would enable them to save enough for an ordinary life, like other people.
Amendment 80S would allow regulations to decide how costs accrue under the Care Act, including local authority costs. Not to let them count is fundamentally unfair, adding years to the time it would take to reach the cap. The amendment ensures that the trailblazer pilots are assessed and reviewed by Parliament in the light of regional variations and the impact on younger disabled adults.
Disabled people are contributing to their care from benefits intended to cover the extra costs of disability. Four million disabled people in the UK are living in poverty and are particularly hard hit by the rising cost of living. Without some easing, they will remain trapped in poverty. The Minister has told us many times that the cap is proportionate and fair. He refers to the uprating of social care allowances, meaning the minimum income guarantee—what is left after being charged for care. In practical terms, it is minimal. To someone with the highest support needs and on the highest rate of disability benefits, it amounts to £4.55 a week. That barely keeps pace with the cost of living, let alone their extra disability costs, which are estimated at £583 per month. It is also far less than older people receive. Disabled people will be simply crushed by their rising debts.
If the Government’s proposals go through tonight, young disabled people will never participate in society as equal citizens, and those totally reliant on benefits will suffer even more financially—yet we know from the evidence that investing in social care to support disabled people improves their health, enhances their independence and reduces demand on welfare benefits.
The amendment in the name of the noble Baroness, Lady Wheeler, does not thwart the primacy of the elected House. Nobody says that the current system is acceptable, but these proposals from the Government are not the answer. The public are demanding better social care and support for all those who need it so that they can thrive as dignified human beings. The Government’s last-minute changes to their reforms, sprung on Parliament with no time for proper scrutiny, will not deliver the will of the people, who want investment in social care.
We must, and we will, continue our efforts to secure a better deal, especially for those young disabled people starting out in life, who simply want a life like anyone else. The least we can do tonight is support these reasonable and modest amendments, so that that can become a reality.
My Lords, I call the noble Baroness, Lady Brinton.
(2 years, 7 months ago)
Lords ChamberMy Lords, the second beaming Baroness is the noble Baroness, Lady Campbell of Surbiton.
My Lords, I wish to speak to and strongly support Motion G1 in the name of the noble Baroness, Lady Wheeler. These amendments will ease the catastrophic effects of the Government’s proposed charging cap reforms on the lives of those dependent on social care.
Disabled people who rely on social care just to survive, let alone thrive, are deeply disappointed that the Government’s charging proposals have been overturned by the other place and are now returning to this House. Amendment 80P would help to alleviate these detrimental effects by addressing the worst affected, particularly those under the age of 40. The trailblazer pilots are also very welcome, but evaluation is key. Crucially, it must assess the impact of charging reform on a variety of social care users, including younger adults, where there is so little current data, and should cover every aspect of their rights. These people are not statistics.
A further impact assessment is also vital. The current one is totally illogical. It needs to focus on the impact on younger adults and encourage proper mechanisms for data analysis: for example, the significant impact on the under-40s of having their contributions paid from benefits. The chronic financial hardship that long-term disabled people endure, with additional costs averaging £583 a month, remains a very worrying issue.
This is a bleak time to endorse charging for social care, capped at an extortionate £86,000. Hundreds of thousands of disabled people in Britain are in crisis because of the ever-increasing cost of living. Local authorities in England are imposing stricter charging policies for care because they are basically running out of money. Disabled people are already being referred to debt collection agencies because they cannot pay their care charges.
The Government talk about levelling up for disabled people, but really they are doing the opposite. These charging reforms force them to contribute to their care and stop local authority care costs counting towards the cap. They deny disabled people the life opportunities that others take for granted.
If Motion G1 is not supported, the Government will be defying the principles of the UN Convention on the Rights of Persons with Disabilities. The UK is signed up to the convention. Article 19 recognises the equal right of all disabled people to live in the community, with the same choices as others; it requires parties to the convention to ensure that they can enjoy full inclusion and participation in the community. Yet this Bill does not respect it.
Far from ensuring the rights enshrined by the convention, I fear the Bill will lead to increased poverty, ill health and poorer life outcomes for disabled people. Some will undoubtedly die. What does that say about our moral compass, especially when disabled people have already endured two years of disproportionate suffering and death during the pandemic?
This Bill provided a small opportunity to take action before it was too late, but it was squandered by the other place. I hope the Government will think again when the White Paper on social care integration is finally published, and address this deep injustice. For now, I urge noble Lords to support Motion G1.
My Lords, the final remote participant is the noble Baroness, Lady Masham of Ilton.
(2 years, 7 months ago)
Lords ChamberMy Lords, the noble Baroness, Lady Campbell of Surbiton, is also taking part remotely. I invite the noble Baroness to speak.
My Lords, I support Amendments 127 and 141 in the name of the noble Baroness, Lady Wheeler; Amendment 143 in the name of my noble friend Lady Bull; and Amendments 144A and 182. Sadly, my noble friend Lady Bull is unwell, so I will speak to Amendment 143 and do my best to encapsulate her reasons, as well as mine, for returning to it on Report. I shall not move it later when it is called.
Unfortunately, at this hour, my voice is fading because I have had to use it a great deal today, so I shall use my speech facilitator, as allowed by the House, more than I would usually.
Although I do not accept the Government’s arguments with respect to the effect that these proposals will have on younger disabled people, and do not accept the cliff edge reason either, I will not be taking this to a vote. I hope we have learned something here tonight.
(2 years, 9 months ago)
Lords ChamberMy Lords, I support Amendments 233, 234 and 235 in the names of my noble friends Lady Bull and Lady Greengross and the notice of intention to oppose Clause 140 in the name of the noble Baroness, Lady Wheeler.
The amendments propose less punitive charging regimes for social care users, and the notice to oppose reverses the regressive changes to the existing provisions. I support all of them to highlight on this occasion the unfairness of the Government’s charging formula on one particular group in society: working-age disabled adults.
Government amendments to the Care Act disproportionately affect working-age people, especially those with lifelong disabilities who draw on support for their day-to-day needs. It is no secret that I have long campaigned against such charges. Amendments 233 and 234 propose a zero charge on disabled people between the ages of 18 and 40, and Amendment 235 replicates the Dilnot proposals adjusted for inflation.
Care and support for those who depend on it is no less fundamental than healthcare is to survival. Without my care assistant to help me eat, drink, move and breathe, I would die, as I would if I did not receive medical care. Without access to support, I could not contribute to my community, and I could not work or enjoy life, but to live like my non-disabled peers, I would have had to pay for my care until I reached an £86,000 cap from the age of 18. In effect, it is a financial penalty on disability.
Before charging was introduced, working-age disabled service users could save for their first home, provide for a family, fund a university education and afford all the extra costs of disability such as housing adaptions or an accessible vehicle—to thrive as equal citizens. I was very lucky. I grew up during that time, which afforded me the opportunity to aspire to the same ideals as my non-disabled peers aged between 18 and 40.
Coming from very humble beginnings, I did not have a financial cushion, but I worked hard, saved like crazy and spent wisely—all the characteristics that this Government want their citizens to emulate. And look, the policy succeeded, due largely to a then no-charging policy. Here I am today, participating in vital scrutiny, equal among my “peers”. If I had been born 25 years later, it would have been a very different story.
In his foreword to the Government’s disability strategy, the Prime Minister says that it is the Government’s
“determination to level up the country so that whoever and wherever you are, the spark of your talent and potential can be connected with the kindling of opportunity”,
yet this Bill introduces a social care means test which drives disabled people into poverty and places a cap on aspiration.
Those with assets of less than £20,000 will continue to pay out of their income towards the cost of their social care. This includes pensions, means-tested benefits and extra-costs benefits such as personal independence payment, disability living allowance and attendance allowance. They are all regarded as income in the social care means test. Local authorities will undoubtedly raid these entitlements, intended to fund additional disability costs, to pay for social care. The charging reforms do nothing to address this injustice.
Consequently, those without means, unable to supplement their income through work or savings, will be forced to go without vital support. With the hike in energy bills next April, some will also go without fuel. Charging for care will prevent these young people getting on with life and building up a nest egg. Once their savings reach £20,000, they will be looted and their future security denied.
Take Sarah, aged 34. She has a learning disability and lives in supported housing with social care support for meals, budgeting and running a home. She gets housing benefit for her rent, but with no assets and being unable to work, Sarah is reliant on disability benefits for all other essentials such as food, fuel, council tax, social activities and clothes. She has been paying £81 a week towards her care package but last April the council told her that this would increase to £125. It will take Sarah 13 years to reach the cap, living on only £160 a week. If she were under 25, it would be even less—£141. Sarah will pay the same as someone with assets of £55,000. How on earth can this be described as fair? Sarah, and thousands of others like her, will not be living. They will be barely surviving.
In his Second Reading speech, the Minister said:
“The Government recognise that their amendment to the adult social care charging system was considered controversial. However, it is necessary, fair and responsible.”—[Official Report, 7/12/21; col. 1779.]
What is fair about holding down disabled people in poverty? What is responsible about limiting their ability to survive and prosper? Rather than liberating them, this charging policy will undermine their well-being and lock them in a state of avoidable and costly dependency.
I ask the Minister to work with disabled people’s organisations, myself and my colleagues before Report stage to find a fairer way to enable these service users to thrive, and to consider essential care and support services as a long-term investment rather than a drain on the Exchequer. I urge Members across the House to support these amendments and, in doing so, offer younger working-age adults with care and support needs equal life chances.
My Lords, Amendments 233 and 234 are in my name and I am grateful for the support of my co-signatories and of Mencap and nine other working-age disabled adult charities, whose concerns these amendments reflect. Clause 140 would amend Section 15 of the Care Act 2014, which places a limit on the amount adults can be required to pay towards eligible costs over their lifetime. The Government intend to set that cap at £86,000, irrespective of age and income.
My amendments would “switch on” the section of the Care Act that allows different rates to be set for specific groups, and define one specific group as people between the age of 18 and 40 who are eligible to receive care and support. The effect would be to implement Dilnot’s recommendation that people entering the care system at or under age 40 have their care costs capped at zero. This would apply both to new applicants and to existing users who have accessed care and support since before the age of 40.
The Government have argued, and expert bodies have accepted, that no one will be worse off under their proposed charging reforms. But this does not make them fair and it does not make them just. They fail to recognise that people with mental, physical and learning disabilities will need additional care and support to participate equally in opportunities that many of us take for granted. They also fail to acknowledge that this inevitably leads to higher costs of living and leaves working-age disabled adults with little or no chance of accumulating assets or savings.
The Government’s impact assessment shows that savings and assets are particularly low among younger adults: 73% of 16 to 35-year-olds have made no plans to pay for social care, and ONS figures show that wealth for households where the head is 55 and over is 25 times higher than households aged between 16 and 24. But, of course, all these figures refer to the working-age population who are able to work and therefore earn, and employment rates among disabled people are shockingly low. Just 50% are in work, and this drops to 20% for those with a learning disability. This of course means many disabled people do not have access to regular earnings or career trajectories that deliver rising salaries. So, not surprisingly, disabled people have, on average, £108,000 less in assets than their peers without disabilities. According to the Joseph Rowntree Foundation, 38% of working-age disabled adults in the UK live in poverty.
On top of these limited opportunities to earn and save, most working-age care users have a long-term condition or disability that will require costly care and support long before they reach old age and, in many cases, from birth. Scope tells us that, on average, disabled people face £583 of extra cost for every month of their lives. And, of course, very few have the resources to self-fund their care. The vast majority are either below the lower capital limit or in the means-tested system. In this case, their care needs are assessed and those needs deemed eligible are part-funded by the local authority. Needs deemed ineligible are not funded, but they are still needs, and needs have to bet. Often, this is the kind of care that enables the interactions with the workplace and social and leisure opportunities that my noble friend Lady Campbell spoke about. As funding pressures on councils lead to further squeezing of eligibility criteria, as she described, more disabled people are having to fund more care from their own pockets.
But of course, as we heard when the Government introduced new amendments on Report in the other place, this contribution will not count towards the cap. Only the amount the individual contributes to the cost of their eligible care needs will count towards the cap—not the support they receive from local authorities and not the cost of ineligible needs, even though they are genuine needs and funded entirely from individuals’ own pockets. So the consequence of this controversial change is that those people least able to afford it will be spending a greater proportion of their assets and income on social care costs. Let us be clear: that income will come from benefits. The impact assessment says its calculations
“assume users do not make contributions to their care from their income and … all contributions are from user assets.”
But in the very next line, it admits:
“In reality, whilst income from employment is excluded from the means test, income from some benefits would be included.”
So disabled people not only face higher care and support costs but are less likely to be able to earn and therefore save—and they are experiencing parallel pressures on their benefits income from rising care contributions.
The Government’s analysis does not take this into account. These oversights in the analysis cast serious doubts on whether enough has been done to understand the specific needs of younger adults requiring care and how they differ from older people. No one would argue that older people do not deserve support, but it is hard not to conclude that the Government’s reforms are primarily concerned with people who develop care needs in later life, having built up assets and savings, at the expense of working-age adults with long-standing needs.
We have already heard the Minister this evening refer to the danger of unintended consequences. I urge him to consider the consequences of these reforms for those people who most need support and to consider my amendments as a fair and just way to protect them from catastrophically high costs they cannot afford for care they cannot afford to live without. “No one will be worse off” is not, I am sure, what this Government mean when they talk about levelling up. We can and should aim higher.
(2 years, 9 months ago)
Lords ChamberMy Lords, the noble Baroness, Lady Campbell of Surbiton, is also taking part remotely. I invite her to speak.
My Lords, I wish to oppose the two amendments in this group. Amendment 203 extends the scope of regulations on patient choice under the National Health Service Act to require particular services to be provided at the end of life. It is, I am afraid, clear from the speech made by the noble Baroness, Lady Meacher, on Amendments 47 and 52 in Committee that this is to include the right to assisted dying. It is directly linked to Amendment 297 in the name of the noble Lord, Lord Forsyth.
I am afraid I do believe that these two amendments are an attempt to hijack the Bill to promote a change in the law on assisted dying. I do not feel tonight is the time to discuss the merits or otherwise of assisted dying. By no stretch of the imagination is assisted dying within the scope of this Bill. There is a separate Private Member’s Bill already before this House, awaiting detailed scrutiny. That is the right vehicle to debate this issue and that is where it should be debated—not here, not tonight and certainly not at this late hour.
Moreover, Amendment 297 seeks to force the Government’s hand into requiring it to prepare a draft Bill on a subject that has not yet been agreed by Parliament. To date, the Government have, studiously and quite properly, taken a neutral stance. This amendment could be seen as a deliberate manipulation of the parliamentary process to provoke a viewpoint that is known to be contentious, and to force the pace of further scrutiny before Parliament, and before parliamentary time has been made for it.
Given the existing pressures on the Bill before us, these tactics are, I believe, truly not worthy of your Lordships’ House, so I hope that the Minister agrees with me that the amendments should be rejected and withdrawn. This is not the place to have this debate.
We have just listened to very powerful speeches by the noble Baronesses, Lady Campbell and Lady Brinton.
I would like to begin with an apology to all Members whose email inboxes have exploded over the last 48 hours. If it is any consolation, so did mine. I got the same emails, all of which were identical and came from the same email address, info@righttolife.org.uk. They began:
“Dear Lord Forsyth, I am making contact on an urgent matter. As you probably know, Lord Forsyth has tabled an assisted dying amendment to the Health and Care Bill, and this amendment will be debated next week. I am asking that you please oppose this dangerous amendment”.
The first point I would like to make is that it is very late at night, so I am going to keep my remarks brief. Contrary to what the noble Baroness, Lady Campbell, said, this has got nothing to do with the amendment of the noble Baroness, Lady Meacher. The reason that they are grouped together is because I asked for them to be grouped together; otherwise, it would have come up on a Friday when I could not be here. There is no common link in the terms of these being about assisted dying, and the noble Baroness, Lady Meacher, has explained why her amendment is not about that.
My amendment is not actually about the merits of assisted dying. It is true that I have changed my mind on this matter as a result of not just my own experience with my father but also because all the time that I opposed it I have felt a bit of a hypocrite, because if ever I was, for example, to contract motor neurone disease, I would want the right to assisted dying. I felt it was rather hypocritical to vote against something that I would want for myself. But I persuaded myself that I was doing so because there were certain protections that were needed. That is all I am going to say about that—and I was not going to say anything at all—because the noble Baroness, Lady Brinton, raised it. It is an unusual position to be proposing an amendment when it has already been opposed, before you have even spoken to it.
(2 years, 10 months ago)
Lords ChamberMy Lords, I also congratulate my noble friend Lord Stevens on his maiden speech. Our past collaborations were always so productive. I look forward to working with him as a fellow Cross-Bencher.
In this debate, I will focus on the missing part of the jigsaw in the Government’s Health and Care Bill. It requires further amendment if it is to address the care crisis for working-age disabled people. As drafted, this legislation hardly touches on the desperately needed funding reforms for that cohort. Instead, it is largely about inheritance. So much has been made of some people having to draw on their property and liquid assets to pay for social care that protecting accumulated wealth has become the overriding goal of reform. Under the reforms, the offspring of some wealthier homeowners will enjoy a more generous inheritance when they die. However, for disabled people, the Bill takes them nowhere and continues to limit their life chances. We all aspire to owning a home, providing for a family and saving for retirement—living life to the full. For thousands of disabled people, this is not possible without social care support.
Over a third of people who use social care are disabled people of working age. Their support accounts for at least half of council expenditure on social care. Persistent underinvestment by successive Governments has had two major consequences: first, fewer people have access to the support they need to live, even at a basic level, unless they can privately resource it, which means that they cannot play their part in the community either socially or economically; and, secondly, local councils, faced with ever-tighter budgets, are balancing their books by increasing charges for care. This effectively wipes out the funding that disabled people receive from the DWP to meet their extra living costs and avoid poverty.
The Care Act 2014 went some way to address this injustice. According to the Health Foundation, the amendment to the Care Act in the current Bill will not do so. It says:
“Consider a disabled person with no assets, care needs amounting to £500 per week and an income of £50 per week above the minimum income guarantee. If the £86,000 ceiling is reached taking account of their care costs, they will contribute the £50 for 3.3 years. However, if the £86,000 ceiling is to be reached using only their own contributions, it will take them 33 years to reach it. Put simply, they will be 10 times worse off under this Bill.”
This will clearly deny countless generations of disabled people the same economic opportunities. The Bill effectively favours wealthier homeowners over those with more modest assets and lifelong disabilities. That cannot be right.
As the national network Social Care Future clearly identifies in its material,
“we all want to live in the place we call home with the people and things that we love … doing the things that matter to us”.
Social care exists to support us all in that ambition. We know that government investment in social care for working-age disabled people will pay dividends. This Bill provides the perfect opportunity to do just that, if—and only if—it is amended. It is simply unfair to place some people at greater economic disadvantage because they happen to be disabled. I really look forward to working with the Minister on this Bill to make it fully inclusive and fair for all.
(3 years, 4 months ago)
Lords ChamberMy Lords, we are extremely respectful of the Dilnot commission report and the recommendations in it, particularly those highlighted by my noble friend on Sections 15 and 16. It is one of many proposals that we will look at very carefully. We cannot make a commitment to anyone in particular at this stage but, as I said to the noble Baroness, we will put forward a full plan by the end of the year and will remain true to that commitment.
Can the Minister assure the House that any proposals on the funding of social care will ensure that working-age disabled people who use care services can access the support that they need to live a full and independent life in the community and that the funding will be sufficient to ensure that they no longer have to pay for it, avoiding inequitable and unfair financial hardship?
My Lords, I hear the noble Baroness loud and clear. Indeed, the needs and priorities of those with disability and the role of care for disability and the emphasis on care in the community are things that we hear loud and clear. I am not in a position to make any commitments on finances standing at the Dispatch Box at the moment, but the noble Baroness’s points are heard loud and clearly, and I would be glad to take them back to the department.
(3 years, 9 months ago)
Lords ChamberI am enormously grateful for my noble friend’s important gesture and pay tribute to his generosity of spirit. However, it is absolutely essential that he gets his vaccine as soon as he can, because he is at the top of the list. Morbidity is determined by age, not proximity. Healthcare staff are of course of deep concern to all of us, but those who are in PPE and in protected conditions have no greater chance of getting the disease than members of the general public. It is essential that we put those who have the highest risk of morbidity—the oldest—at the front of the queue, which is why we have the prioritisation list that we have.
My Lords, I thank the hard-working Minister and his Government for listening to the most clinically vulnerable groups and for reprioritising vaccination for all care workers, ensuring their greater safety. However, I am concerned that people under 65 with learning disabilities who live in care homes are in group 6 rather than in group 1, when ONS data clearly shows that they have been disproportionately affected throughout the pandemic. It is illogical that they now have to wait longer than other people with learning disabilities—older ones—in residential care. What plans do the Government have to ensure consistency and fairness in vaccination allocation to all people in residential care, especially in this category of people?
My Lords, the noble Baroness puts her point very well. There is a huge amount of sympathy and concern for those who have underlying conditions, and she is right that ONS data on those with underlying conditions demonstrates a higher hospitalisation and mortality rate. That is why we have put all individuals between 16 and 64 with underlying health conditions that put them at a higher risk of serious disease and mortality higher up the prioritisation list than others. However, it is age more than anything else that is the greatest determinant of morbidity, and that is why the list looks the way it does.