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House of Lords Hansard
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Covid-19: Care Homes
20 May 2020
Volume 803

Commons Urgent Question

The following Answer to an Urgent Question was given on Tuesday 19 May in the House of Commons.

“One of the first things we knew about coronavirus as it began its dismal spread across the world was that it reserves its greatest impact for those who are physically weakest, especially the old. In the UK, 89% of all deaths have been of those aged above 65. From the start, we have worked hard to protect those in social care. In early March, we put £3.2 billion into social care—half through the NHS and half through local authorities—and we have repeatedly set out and strengthened guidance for infection control and support.

For anyone who has a loved one living in a care home and for all the residents and staff, I understand what a worrying time this has been. I am glad that we have been able to protect the majority of homes, and we will keep working to strengthen the protective ring that we have cast around all our care homes. As I said in the House yesterday, last week we set out a further £600 million to strengthen infection control, and this comes on top of a substantial programme of support.

First, on testing, from the start we have tested symptomatic residents of care homes, even when testing capacity was much lower, and this has always been a top priority. We are now testing all care home residents and staff in England—those with symptoms and those without—and this is being done according to clinical advice, starting with the most vulnerable, and extending to working-age residents too.

Secondly, we have strengthened the NHS support available to social care. We are putting in place a named clinical lead for every care home in England and have brought NHS infection-control expertise to the sector.

Thirdly, we are making sure that local authorities play their part. Councils are conducting daily reviews of the situation on the ground in local care homes, so that every care home gets the support that it needs every day.

Fourthly, we are supporting care homes to get the PPE that they need.

Fifthly, we have increased the social care workforce during this crisis and provided more support. Altogether, this is an unprecedented level of support for the social care system. I thank colleagues across social care for their hard work.

We have also broken down some of the long-standing barriers, including between health and social care, and we have learned the importance of making sure that money for social care is ring-fenced specifically for social care, as the £600 million agreed last Friday has been. On top of that, we are requiring much better data from social care, because partial data has bedevilled the management of social care for many years and made policy-making more difficult. Regular information returns are required in return for the latest funding, and we are looking to change the regulations to require data returns from every care provider, so that we can better prepare and support social care.

Our elderly care homes provide for people towards the end of their life. They do an amazing job and deserve the praise that they have received from the public during this crisis. Residents are looked after when they need care the most: their hands are held, their brows are mopped and they are made comfortable. As a collective result of our efforts—especially the efforts of care colleagues throughout the country— 62% of care homes have had no reported cases of coronavirus.

The figures released today by the Office for National Statistics show that the number of deaths in care homes has fallen significantly and is down by a third in just the past week, from 2,423 to 1,666. This morning’s statistics confirmed that 27% of coronavirus deaths in England have taken place in care homes, compared with a European average of around half, but whatever the figures say, we will not rest in doing whatever is humanly possible to protect our care homes from this appalling virus, to make sure that residents and care colleagues have the safety and security they deserve.”

The Answer was considered in a Virtual Proceeding via video call.

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My Lords, this Urgent Question taken yesterday in the Commons on coronavirus and care homes covered much of the ground in the Statement taken by us last night. Sadly, it is clear that Ministers’ claims to have thrown a protective ring around care homes ring hollow in the light of the latest ONS figures on deaths in care homes: 9,495 residents in England and 480 in Wales. These figures are still ringing alarm bells, as the number of deaths involving Covid-19 as a percentage of all care home deaths continues to rise this week. As Martin Green of Care England told MPs yesterday, most care home residents should have been prioritised from the start. He also stressed that there are still huge issues with testing, with results lost and staff waiting eight to 10 days to find out whether they have coronavirus.

I ask the Minister about reports on the PHE study on genome tracking to investigate outbreaks in care homes, which last month found that bank and temporary agency care workers, often employed on zero-hours contracts, had unwittingly transmitted Covid-19 between care homes as cases surged and they were moved from home to home to cover staff vacancies. Does this not raise even further doubts and questions about this ring of protection? Why was this issue not recognised early on as a crucial factor in any infection-control strategy?

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My Lords, the issue the noble Baroness raises was recognised in the very early stages. The problem of itinerant staff who move from one resident or patient to another was always going to be one of the most difficult to tackle. They perform an absolutely vital role in the care of non-domiciliary patients. That is why we put more money in to pay for more staff, provided PPE for the staff who were working and continue to upgrade the testing arrangements for both staff and patients, to ensure that they are protected.

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Yesterday, Professor Dame Angela McLean said testing had been prioritised in the NHS over care homes. Today, Justice Secretary Robert Buckland said the Government had prioritised the NHS over care homes as well. Yesterday’s Health and Social Care Select Committee also heard members of the care sector report continuing and widespread problems with PPE—chaotic, unreliable and extremely expensive, with the Clipper system promised two months ago still not rolled out. When will the Government ensure that our care sector gets the urgent priority support outlined in the Government’s social care action plan on 15 April, needed to keep residents and staff safe?

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The noble Baroness is quite right to focus on the importance of social care, but I think she unfairly characterises the effort made to ensure that social care is protected. The social care action plan announced on 15 April has been enormously important and extremely effective. Also on 15 April, we rolled out outbreak testing for all symptomatic care home staff and residents. We brought in extra funding on 16 April, with £850 million in existing social care grants. There has been new guidance and more money for local authorities, and we have launched a workforce recruitment campaign for care home staff. An enormous amount has been done. Care homes were always vulnerable, and we have sought to put every possible measure in place to protect them.

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My Lords, I am grateful for the Statement. Unfortunately, I am having hearing issues, which are overriding the voices.

Can the Minister tell us what the business model is for care homes? We are seeing so many deaths in our care homes because of Covid-19 that it highlights that there may be underlying issues. We must think of the staff who are caring for the most vulnerable in our society.

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My noble friend raises one of the key features of our social care system. It is provided by 12,000 different care home providers—or 16,000, depending on how you measure it—many of whom have very different business models. This creates a rich and diverse tapestry of provision, but it is also extremely difficult to engage with from a central campaign provision. That is one of the challenges that we have faced when rolling out support such as PPE and testing. We do not believe that the business models are inappropriate, but undoubtedly we have challenges when we are trying to reach all the care homes with an equal and central format.

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My Lords, the Statement says that 27% of coronavirus deaths in England have taken place in care homes, whereas in Europe the average is around half—but does the Minister agree that in Hong Kong, Singapore and South Korea there were zero deaths in care homes, and in Germany, a country with a population of 90 million people, 3,000 deaths? Also, can he confirm that no patients were ever sent from a care home to a hospital and then back from a hospital to a care home without being tested? Can he reassure us, as the Statement says, that the testing of all care home residents and staff, with and without symptoms, is now taking place? That is 2.5 million people. When will it be done by, and will it be done on a regular basis? Some care homes are saying that it will be necessary to test many times a week.

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The statistics which the noble Lord refers to are correct. It is probably more appropriate to compare the British care home statistics with those in Europe rather than Asia, which had previous experience and different models. With regard to care home testing, not everyone needs to be tested every day. Not every care home has an outbreak, and we must focus our resources on those that do. Regular testing may be necessary for them, but it is not correct that, for example, 2.5 million people need to be tested every week. That is not the advice from the scientists or the CMO. We want to focus our tests where Covid-19 has been found, and we must use our testing resources to expunge the disease from those locations.

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My Lords, we know how crucial the social care sector is, and the huge challenges it faced even before Covid-19, with 120,000 care assistant vacancies. Can the Minister therefore respond to the excellent suggestion from the most reverend Primate the Archbishop of Canterbury that we establish a royal commission on social care, not to blame but to learn, so that we have the right information to make the right decisions and provide the right services for these most vulnerable people?

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My Lords, this Government have already made a very clear commitment to review the social care sector; that was made before coronavirus. The experience of coronavirus will no doubt put a massive spotlight on our provision for social care. It is entirely right that we review all of our arrangements. The vacancy question that the right reverend Prelate raises is an important one, and that is why we have launched a massive recruitment campaign, and why we have brought in minimum wage legislation which has seen rises in the pay of social care workers that are historically at the high end.

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My Lords, care homes tell me that they are still being required to take residents from hospital who may have Covid-19. May I ask my noble friend whether scientific and medical advice supported the guidance issued in the action plan of 15 April that, prior to discharge into care homes, patients must be tested but will be discharged “pending the result”, despite spare capacity in the NHS? Will the Government urgently consider altering that guidance?

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My Lords, the guidance has been reviewed by the CMO, and we stand by it. I can confirm that all patients leaving hospital for care homes are, as a routine, tested. When they arrive at a care home, they are treated as if they might have Covid, and they are put into an area of isolation, until either the test has come through or their diagnosis has been confirmed. This is a way of protecting care homes, and it is necessary to continue the traffic of people from hospital to care homes, in order to have the beds available for those who need them more.

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My Lords, among the many reasons why we have done so badly in protecting our care home residents from this dreadful illness is the almost complete lack of adequate public health services at the local level. A few years ago, when I was chairman of the then Public Health Laboratory Service, we had a robust network of public health expertise in every locality which did all the testing and tracing of infectious diseases across the country. All that has been eroded over very many years, and I fear we have lost that local expertise—the doctors and the other staff that could have done the job that we are now left struggling to fulfil far too late. I ask the noble Lord whether he will make it a priority now, as a matter of urgency, to begin to fill that huge gap in our network of local public health services.

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The noble Lord is more expert on the history of public health than I am, but I do not doubt the story that he talked about. I reassure him that Covid has definitely made us all think again about the very clear priority that local public health provision must and will provide. I would like to pay testimony to those public health officials—public health directors, environmental health officers, infection control officers—who play, and are currently playing, a huge role in controlling the epidemic.

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My Lords, the Statement is encouraging on one level but very disappointing on another, since it does not recognise that initially there were delays and problems. Consequently, care workers in those homes were working in very difficult and distressing circumstances, often without PPE and on low pay, in many cases below the real living wage. Will the Minister agree that they deserve not just applause but proper protection and a real living wage?

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My Lords, we ensure that the social care system is funded so that providers can pay the national minimum and living wages to care workers. Since the introduction of the national living wage in 2016, care worker pay has increased at a faster rate than before. I share the noble Baroness’s praise for care workers. As a group, our million-plus care workers have massively delivered for the country. They deserve our praise, our thanks and a tribute from this House.

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My Lords, I congratulate the Government on publishing the data behind their assessment of the Roche and Abbott ELISA tests. The transparency is welcome, but given the latest evidence on how asymptomatic cases affect transmission and how challenging infection control has been in care homes, can the Minister say whether care workers and care home residents will now be prioritised for antibody as well as PCR tests to give them the best data to improve infection control?

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My noble friend Lady Blackwood is quite right that the Roche and Abbott antibody tests are a great step forward. It shows how diagnostic technology is progressing very quickly. We are determined to use all the benefits of modern technology in the fight against Covid. Our announcements on antibody testing in the NHS, in the care service and for key workers will be announced shortly. When it is, I assure her that NHS and social care workers will be on an equal footing.

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My Lords, in answer to an earlier question, the Minister said that it was not appropriate to compare us with what happened in Hong Kong, South Korea and Singapore, which had no deaths in care homes at all. He preferred to compare us with Europe. Is the truth not that we took our eye off the ball and that as a country we failed to learn from what was happening elsewhere? We failed to learn good practice and we actually lost two months, where we did nothing very much until we tried to catch up just now. Surely we failed pretty badly.

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The noble Lord makes a comparison that history will have to judge on, I am afraid to say. I think that I am making a fair point when I say that Britain can really only benchmark itself against its close neighbours. The experience of Asian countries taught them an enormous amount, but it is not one that has seemed proximate or relevant to us in recent times. I am afraid that I can only leave it to history to judge whether we made mistakes. It would be wrong for me to prejudge that at this moment.

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My Lords, I must apologise because I allowed everybody to come in. I had mistaken the timing and had allowed this to run for 15 minutes instead of 10. I must make it clear that this does not set any precedent. It was my error.

The Virtual Proceedings will now adjourn until a convenient point after 7 pm for the second Urgent Question repeat.

Virtual Proceeding suspended.