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Independent Residential Care

Volume 804: debated on Tuesday 7 July 2020

Private Notice Question

Asked by

To ask Her Majesty’s Government, further to the remarks made by the Chief Executive of NHS England on 5 July, what measures they plan to put in place to assist independent residential care providers should any such provider face (1) financial, or (2) operational, difficulties.

My Lords, this disease has targeted the vulnerable, and those working and living in social care have faced daunting threats. The Government have intervened with £3.7 billion for local authorities, including specific funds such as the £600 million infection control fund and the £500 million announced on 2 July. Delivery is being supported by our social care Covid-19 task force.

My Lords, I am grateful to the Minister for that reply, but he will know that, nowadays, residential care homes are provided not by local authorities but by thousands of independent organisations. It is now thought that some of these organisations may be in financial difficulties. Can the Minister tell the House what plans are in place to protect the residents of a home which ceases to operate, especially as these residents are not only very vulnerable but, frankly, have nowhere else to go?

My Lords, the noble Lord is entirely right. The protection of residents is our number one priority and our responsibilities under the Care Act 2014 remain in place. The care home economy is mixed. We are looking very carefully at the financial resilience of all the providers involved. We are providing the funds necessary to see them through this epidemic and we will do whatever it takes to protect residents.

My Lords, given the unfortunate words of the Prime Minister last night, where he seemingly blamed care homes for high rates of Covid-19, when will the Government actually produce the long-promised proposals for the future of social care, which will guarantee quality through acknowledging the need for a skilled, stable and trained workforce, properly valued?

My Lords, we are enormously grateful to all those working in the care home sector, who have protected residents through this awful epidemic, and we continue to support them. We have increased recruitment in the area, and are in the midst of an enormous recruitment marketing campaign to bring new, qualified people into the care home sector. The Secretary of State wrote to relevant stakeholders on 14 May, inviting them to cross-party talks on the care home sector. We are continuing those conversations and hope to bring them to a head at the earliest opportunity.

Yesterday, our Prime Minister said that

“too many care homes didn’t really follow the procedures”.

In March, the care sector asked for testing for patients discharged from hospital. The Government’s reply—not necessary. The sector could not get the promised PPE as government supplies failed to appear. All our amazing 1.6 million care home workers needed testing from March—it took the Government three months. Complex government guidance changed frequently, sometimes even daily. Our care homes have had to cope with 30,000 excess deaths in three months and massively increased costs. Does the Minister agree with our Prime Minister, or with the National Care Forum, which said that Boris Johnson’s remarks were, “frankly, hugely insulting”?

I thank all those who work in the care home sector for the enormous amount of sacrifice and commitment that they have shown to protecting residents. The noble Baroness, I think, portrays the situation unfairly. Guidelines have changed quickly because the situation changed quickly. PPE demand could never have been expected at the levels it reached; the Government responded incredibly quickly to move PPE into both NHS and social care. On testing, we started from a very low base; testing has now been introduced in care homes for both patients and staff. The Government will continue to be committed to protecting both staff and residents in the care sector.

My Lords, is the money that the Government give to local authorities for social care ring-fenced for that purpose?

My Lords, the money that my noble friend refers to is not currently ring-fenced. Local authorities have been written to, to explain that the money should be prioritised for Covid—but, at the request of the local authorities themselves, the money was not ring-fenced.

My Lords, the Vivaldi project found that, in care homes where staff received sick pay, there were lower levels of infection in residents. During the next pandemic, will our priority to be to save the NCS—the new national care service—as well as the NHS, or will we have an integrated NHCS national health and care service, or, what other urgent measures are Her Majesty’s Government considering to protect care?

The noble Baroness puts her question extremely well, but I am afraid it is beyond my ability to predict as she asks exactly what the shape of the national care provisions will be. What I can say is that the role of agency staff was always, from the very earliest stage, one of the gravest concerns we had. The CMO flagged it very early, and we moved as quickly as we could to tackle the difficult issue of itinerant staff, and to put in place both the funding and the procedures to anticipate problems of infection around staff who move from one home to the next.

My Lords, I return to the question raised by my noble friend Lady Armstrong and the noble Baroness, Lady Brinton, because, while it is obviously welcome for the Minister to thank those who work in care homes for the sacrifices that they have made, he needs to acknowledge the hurt that the Prime Minister has caused with his words. Will the Minister clarify which procedures care homes are accused of disregarding? Are they procedures related to the Government’s policy of allowing hospital patients to be discharged without testing, to the failure to provide the required PPE or, perhaps, to setting up the testing programme so late?

My Lords, it is not the role of a junior Minister to speak on behalf of the Prime Minister, but I can say that the Prime Minister, the Secretary of State and I are all enormously grateful for the huge amount of work that social care staff have put into this epidemic. I have seen with own eyes the commitment and expertise that they have provided during these very difficult days. We are, as a nation, enormously grateful for their hard work and skill.

My Lords, the pandemic has placed a very harsh spotlight on the resilience of the care system, with 30,000 excess deaths in care homes in England and Wales in a three-month period. At the weekend Sir Simon Stevens made it crystal clear that we just do not have a fair or properly resourced social care system with proper workforce support. With some homes already running close to bankruptcy due to the additional costs and occupancy rates slipping below 87% when many smaller homes become financially unviable, what immediate steps are the Government taking to protect these smaller homes?

The noble Baroness is entirely right that the issue of excess beds is an unfortunate and unwelcome added pressure on an already pressured system. Sir Simon Stevens was echoing the sentiments of the Government and the Secretary of State when he said that we need to move towards a long-term settlement for social care. That was very much the commitment of the Prime Minister during the election and in the manifesto. Steps have been taken towards working on that but we have been interrupted by Covid-19. It remains a number one priority for the Government. In the meantime, we will be putting in the financial resources necessary to provide the resilience for those smaller homes of which the noble Baroness speaks.

My Lords, does my noble friend think it reasonable that, 12 months after the Economic Affairs Committee produced the report Social Care Funding: Time to End a National Scandal, we have not had a debate on the report or a response from the Government? He talks about providing resources for social care. That report identified an £8 billion gap just to get back to the standards we had in 2010. Does he not think that instead of the occupants of Nos. 10 and 11 Downing Street standing on their doorsteps and putting their hands together to clap the achievements of social care workers, their hands should be put in the Treasury’s pocket to find the money now urgently needed to prevent the collapse of nursing homes and to prevent us continuing to rely on the good will and hard work of people who are being pressed beyond endurance? This delay cannot go on longer and longer, which has been the pattern for the last decade.

My noble friend asks the question extremely well. The Lords Economic Affairs Committee report is an extremely thoughtful and respected piece of work. Under normal circumstances we would certainly have had that debate and moved forward on this incredibly important issue, which was flagged both in the election and in the manifesto as a major government priority. However, I cannot hide from my noble friend that the Covid epidemic has disrupted progress, particularly on this delicate issue, which requires a huge amount of management time by senior healthcare officials, who are utterly consumed by Covid at the moment. Please be under no illusion that this is a major priority for the Government. Once the preparations for winter are in place, it will be at the top of the list.

The Covid crisis has revealed the crucial role that care homes and care workers play in our national life. Does the Minister agree that it is high time to take a radical look at the role of care homes and of social care more generally, especially the status and the pay of care workers, who have revealed their worth so wonderfully over these last few months?

The noble and right reverend Lord is entirely right: the value and contribution of care home workers to society and to the communities that they work in go way beyond the actual monetary value of their salary. We completely respect and pay tribute to the contribution that they have made, particularly during this epidemic. We have sought during the epidemic to run recruitment campaigns to bring in new workers and to help plug any skills gaps, but this is the kind of issue that needs to be addressed in a long-term plan. We have already started work on that plan and look forward to bringing it to Parliament when the kind of cross-party support that is needed is in place.

My Lords, I welcome the initiation of cross-party talks. The Minister will know now that more than two-thirds of the public want to fund health and social care through higher taxation. Will he now accept that as a principle if that is the result of the cross-party talks, instead of his Government ruling out tax increases?

The noble Baroness makes her case well. There are a large number of considerations in this matter—my noble friend Lord Forsyth has already made a strong case for the recommendations of the Economic Affairs Committee—and we need to look at all of them. It is an extremely complicated area. We need to get buy-in from cross-party support and from a wide number of stakeholders and the businesses involved. Once we are in that position, we will be able to make a plan that delivers a long-term solution to this knotty problem.

My Lords, we must welcome Sir Simon Stevens’ promise to help independent care providers, but will we make sure that when the money goes to those providers they pay their staff properly, give them protective equipment and do not let them go on working in an unsafe and underpaid profession?

My Lords, the role of the staff is essential. We have put in place an infection fund of £500 million to help to provide a safe working environment for staff, and we are looking at mobilising a huge PPE effort, led by my noble friend Lord Deighton. The protection and payment of staff are essential. However, a long-term solution for staff will depend on a long-term deal. We are working on that but I cannot give any assurances until the important work of building cross-party support has been fulfilled.

Sitting suspended.