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Coronavirus and Care Homes

Volume 676: debated on Tuesday 19 May 2020

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on coronavirus and care homes.

I call Matt Hancock to answer the urgent question. The Secretary of State should not speak for more than three minutes.

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.[Official Report, 20 May 2020, Vol. 676, c. 2MC.]

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.

In welcoming the hon. Member for Leicester West (Liz Kendall) to the Front Bench, I asked her to speak for no more than two minutes.

Over 23,000 more people have died in care homes in the first four months of this year compared with last year. This virus is the biggest health challenge of our lives, but Ministers have been too slow to tackle the problem in care homes, social care has not had the same priority as the NHS, and these services have not been treated as inextricably linked.

Will the Secretary of State explain why guidance saying that care homes were “very unlikely” to be infected was not withdrawn until 12 March, given that the chief medical officer warned about community transmission and the risks to the elderly on 4 March? NHS England rightly asked hospitals to free up at least 30,000 beds to cope with the virus, but will the Secretary of State explain why there was no requirement to test those being discharged to care homes—the very group most at risk—until 15 April? Care providers had serious problems getting personal protective equipment, as their normal supply was requisitioned by the NHS, when both are equally important. Why did that happen?

It took until mid-April for the Government to produce a social care plan, until the end of April for them to say that all residents and staff should be tested, and until 11 May for them to set a deadline for achieving this—and that deadline still is not until 6 June. Will the Secretary of State explain how he squares all that with his claim that Government have thrown a “protective cloak” around care homes right from the start? Despite all the warnings, care homes in my constituency told me over the weekend that they cannot access the Government’s new online testing portal, that tests are not being picked up and that it is often weeks until they get results back. When will this be sorted out?

Finally, the Government have said that the NHS will get whatever resources it takes to deal with this virus. Will the Minister now make the same commitment to social care and guarantee that no provider will collapse because of this virus? No one denies how difficult this is, but instead of denying problems and delays, Ministers should learn from their mistakes so that they can put the right measures in place in future and keep all elderly and disabled people safe.

I welcome the hon. Lady to her post and to her first question in this new role. I know that she enjoys a good working relationship with the Minister for Care, my hon. Friend the Member for Faversham and Mid Kent (Helen Whately), and that cross-party working during this crisis has gone on throughout. I thank her for that and for the approach that she is taking. She is right and perfectly reasonable to ask questions about how we can further improve the support that we are giving to the care sector, and, as I have said from this Dispatch Box before, and before her appointment, we have made social care a priority from the start. The first guidance went out to social care in February. She referred to the 13 March guidance. That was only a matter of days immediately after the risk to the public was raised on medical advice. The guidance that was in place until then, as she probably knows, explicitly stated that that guidance was in place while community transmission was low and that it would be updated as soon as community transmission went broader. That is exactly what we did.

More importantly, the hon. Lady raised the question of discharges, and I understand the questions that have been asked about discharges into care. It is important to remember that hospital can be a dangerous place for people. As well as saving lives, it can also carry risks, and does so, so it is an appropriate clinical decision in many cases for people to be discharged from hospital, and safer for them to go to a care home. What is important is that infection control procedures are in place in that care home, and those infection control procedures were put in place at the start of this crisis and have been strengthened, exactly as she says, as we have learned more and more about the virus all the way along. As the clinical understanding of coronavirus has strengthened, so too have we updated and strengthened our guidance.

The hon. Lady asked about PPE. As she and every Member of the House knows, there has been an enormous global challenge with the global shortage of PPE and the need to get PPE distribution out to tens of thousands of settings. The guidance that we have put out again, which is guided by clinical expertise, states the level of PPE that is required, and we are now delivering against those standards. We have processes in place so that all care homes that have shortages—the numbers are coming down, I am glad to say—can get in contact with their local resilience forum and make sure that they can get that PPE. Those processes are in place. It has been a huge challenge. It was called the biggest logistical exercise of the last 40 years by the head of the Army, and I think he was right.

The hon. Lady also asked about resources. Of course, if more resources are needed, we are open to those discussions. The fact that we put through £600 million more that will go directly to social care—it will not be able to be held by councils; rather, it will go directly into social care—is right, but we have also learned some really big things about social care, confirming some of the things many of us thought before. For instance, it is true that we need to have a more co-ordinated policy between health and social care. These social care reforms, which are long overdue and have not been put in place by Governments of all colours, absolutely must happen.

Clearly, tackling this virus in care homes is a very difficult thing, but the chief executive of Hertfordshire Care Providers Association is on record as saying that care providers in the county feel well supported during the pandemic. Does the Secretary of State agree that what is required to achieve this, as in Hertfordshire, is a very close working relationship—a partnership—between care homes, the councils, the Care Quality Commission and, of course, the clinical commissioning groups?

I entirely agree. We have seen much better partnership working in most parts of the country during this crisis. The partnerships between local authorities, with their statutory responsibilities, and, as my right hon. and learned Friend mentioned, all parts of the NHS, with its statutory responsibilities—clinical commissioning groups, trusts and the integrated care systems—are very important. They have worked much better over the last few months than they had hitherto. We need to make sure that that coming together—in a very difficult circumstance, which has broken down boundaries—continues. I look forward to working with him and others in making sure that the boundaries that exist in social care can be brought to the ground.

The London School of Economics reported that there were over 23,000 excess deaths in care homes in England and Wales, but only 12,000 were put down as due to covid. How does the Secretary of State explain the other 10,000? Testing of care home staff is critical to reduce the spread, but how will he improve the return of results to local GPs and public health teams? Concerns have been raised that a quarter of tests are false negatives, which could send staff with the virus back into care homes and hospitals. It is a difficult sample to take, so is any comparison being made between self-administered tests and those carried out by healthcare staff? Finally, where is the Green Paper that was promised in 2017?

On the point about tests, absolutely, work was done to assess the difference in efficacy between professionally administered and self-administered tests, and it found that their efficacy was very similar and not significantly different. That is why across England and Scotland, and indeed the whole UK, we use home tests, which are an important part of our testing regime.

The hon. Lady asks about the increased number of deaths, sadly, that there have been in care homes. She is absolutely right that there has been an increase. We analyse the causes of all the different factors that may have had an impact, which is something our clinical advisers are looking at. The same is true in Scotland, and I am sure that the Scottish medical advisers are looking into the same. When it comes to a Green Paper, at the moment we are working on crisis response, and I think that is the appropriate thing to do.

In Harrogate and Knaresborough, and across North Yorkshire, the county council has established a step-down facility for patients being discharged from hospital, using care homes with segregated spaces, and in Boroughbridge an entire care home, effectively as a form of quarantine facility. That is in addition to the testing and protective arrangements, not as a replacement. I view this as a welcome and valuable addition to the tools available for keeping some of the most vulnerable people in our community safe. Does my right hon. Friend agree, and can the idea of this facility be replicated further across the country?

Yes. I pay tribute to those working across Harrogate to improve services in exactly the way in which my hon. Friend describes. He is quite right to, and I would love to look into more details.

The Select Committee on Health and Social Care has just heard evidence that there has been not one single care home death in Hong Kong or South Korea, despite their proximity to China and shorter time to prepare for this crisis. In comparison, the UK has now tragically seen over 10,000 deaths of loved ones in care homes. How can Government describe this as a success? Is it not time now to learn from other countries that have genuinely put a protective ring round their care homes?

Yes, absolutely it is important to learn from everywhere around the world. This epidemic has had a different shape in different parts of the world and, as the hon. Lady knows, a significant impact throughout Europe.

It is good to see my right hon. Friend bearing up so well under the considerable burdens of his office. Can he reassure me that the PPE supply into the UK and within the UK is now flowing into all care homes in a timely and comprehensive manner? I am concerned that those who are running our care homes so well in Sutton Coldfield should have the security of knowing that they can rely on continuous supply.

Yes, I can reassure my right hon. Friend—I thank him for what he said about the work we are doing in the Department—first, that supplies of PPE into the country and buying around the world have improved significantly, and we have put huge amounts of effort into improving that. Secondly, the supply, once the equipment is in the country, out into the care homes and where it needs to be is improving all the time. The number of care homes reporting that they are within 48 hours of a stock out, which is the measure we use, has been falling and is less than half what it was a month ago, but we of course keep working to get that number down. When a care home is within two days of a stock out, we immediately work to get it the PPE that it needs.

At this morning’s Health and Social Care Committee, Care England said that care staff were suffering a constant cycle of bereavement. With so many deaths in care homes, staff are not only caring for, but comforting those they know well who are dying alone. So will the Secretary of State take steps this week to provide a 24-hour mental health phone line for all care staff, as well as fast-track access to professional mental health services, as is the case for the military?

The Secretary of State is doing a phenomenal job. It is a huge crisis and a huge thing to mobilise everything that has needed mobilising.

I have spoken to most of my care homes and most of them are doing very well, but one, Milford Care, is having a problem with getting test kits. Six people in the home have died recently. The home requested test kits on 12 May through the Government portal, but they were told there was a very limited supply. They may get them on Wednesday this week, if they are lucky, but if not they will have to re-register for them. Staff and residents may be infected, but they are not aware. They have had somebody who was tested and seven days later was told they were positive, even though they had no symptoms, so clearly, the virus is spreading. What can my right hon. Friend suggest that they do?

I think the best thing they can do is raise it with their very effective local MP, who can bring it to my attention, and that is exactly what they have done. I will get right on to it, straight after this session in the House of Commons. We have the testing capability. Of course, making sure you get exactly the right test to exactly the right place and the right care home at the right time is itself a huge logistical challenge, but I will look into this immediately.

CQC data revealed a 175% increase in deaths of people with autism and learning difficulties last month, yet the new care home testing portal is only available to homes whose residents are aged 65 and over. What is the Minister doing to ensure that all care homes are able to access tests? Will the Government conduct a review of why there has been such a sharp increase in deaths among these groups?

I addressed this point in my opening response to the urgent question. We will roll out testing to care homes of all ages. This is an area that I take very seriously indeed. We are looking into the statistics that have been mentioned in the public domain. Some of the statistics are not quite as they first seem. We will make sure that we publish accurate and full statistics, because transparency is absolutely vital in this area.

Thank you, Mr Speaker. The Resolution Foundation has detailed that 61% of frontline careworkers in England are paid less than the real living wage. The Scottish Government introduced a real living wage for carers in 2017. Will the Secretary of State therefore follow their lead and instead of a badge or round of applause finally give frontline careworkers in England a real living wage?

I am a massive supporter of the living wage and, of course, the increase in the living wage that we have seen since its introduction in 2015 has had a very positive impact on the pay of the lowest paid people in our country right across the board, including many in care homes. I think it is an excellent policy and I am delighted that we have brought it in.

The £600 million presented by the Secretary of State for infection control is very welcome, and having a named clinician to help support care home staff is particularly important. That came out in the Health and Social Care Committee when Professor Lum talked about what happens in Hong Kong. One of the lessons they learned several years ago was to have a named person in a care home, but also to do yearly, effectively, virus drills, like a fire drill. Would the Secretary of State consider putting that in place to help to deal with the impact of possible second waves?

Yes, we are doing a huge amount of work now to ensure that there is protection in the future should there be a further increase, and in particular in advance of winter in case there is strong seasonality to this disease. As a clinician himself, my hon. Friend understands the importance of these areas and we will absolutely take the idea he put forward and run with it.

Brent Council was at the epicentre of the initial covid outbreak, with one of the highest hospital death rates in the country, but back in February it spent £1.5 million to purchase PPE, which it made available to its care homes. In March, it established a separate care facility to provide 14 days’ isolation for any patients discharged from hospital back into the care system, whether or not they had tested positive for coronavirus. Now Brent has one of the lowest number of care home deaths in London. I know the right hon. Gentleman will want to congratulate Brent, which actually did put in place a protective ring around its care homes, but what he must answer is: if Brent Council had the good sense and foresight to get this right, why didn’t he?

The hon. Gentleman makes a really important point and it comes to the nub of the challenge around care home policy. I do want to congratulate Brent. I think that the work it did was important, but, of course, formally and in the law responsibility for care homes is for local councils and some local councils, like Brent and others, have done a magnificent job. However, I also understand that it is a reality of political life and our constitution that I as Secretary of State for Health and Social Care am also responsible, and I take that responsibility very seriously. However, when it comes to longer-term reform, this does bring a conundrum because the policy levers that I have as Secretary of State are only through councils, which themselves have to then act.

On the funding side we have seen this challenge. We put in £1.6 billion at the start of this crisis through councils without a ring fence, and there are questions being raised about how much of that has got to the frontline, so for the £600 million we put through on Friday we have put in a very firm ring fence, so it must be paid in a timely manner through to care providers. I think this actually raises a question not just for the crisis but for the longer term. When I am held accountable at this Dispatch Box for the actions of local authorities, I can give support, but we do not have the direct levers. We have not even had the direct data flows through to the centre, and we are putting that right too.

On behalf of the care homes in Worcestershire, I thank the Secretary of State for the extra £7 million that will be reaching them to help them to tackle infection control. Can he confirm that that money will also be available to support the domiciliary careworkers, who regularly visit homes of individuals who need that care?

My constituent Sonya Kaygan lost her life to coronavirus. She was a highly skilled and committed careworker, but worked in a low-pay sector, caused by the near £8 billion cut to its funding in the past decade. Will the Secretary of State commit to ending the scandal of low pay in the care sector and reverse a decade of cuts to social care budgets, in honour of my constituent and others who have died doing their job, so that all careworkers are paid a fair wage and have the equipment to do their job safely?

We have put an unprecedented amount of funding into social care during the crisis. There is the important challenge of ensuring that that reaches the frontline through local councils. We have also increased, through the increase in the living wage, the pay of the lowest paid across society and in social care. I am proud to have supported that.

The Secretary of State is doing an extraordinary job in the most challenging of times. He will be aware that we have a testing centre down in Bexhill that is available to care home workers for testing, but if they follow the Government advice and go on the website, they will be directed further afield to Brighton or Gatwick. Will he help me to ensure that that testing centre is made available to care workers so that they have more protection locally?

Yes, absolutely. My hon. Friend texted me about that last week. I should have fixed it by now, then I would not have had the question. It absolutely needs to be sorted. We are working on it. We rolled out the testing centres at an unbelievable pace during April, so I hope he will forgive me and allow me to take a couple more days to fix the problem.

The Secretary of State may be aware of the comments of Martin Green, the chief executive of Care England, to the Health and Social Care Committee. He said:

“We should have been focusing on care homes from the start of this...What we saw at the start was a focus on the NHS”.

He also criticised the discharge of patients from hospitals into care homes and said that there were,

“people who either didn’t have a covid-19 status or were symptomatic who were discharged into care homes”,

which were

“full of people with underlying health conditions”.

Ministers, however, have said that fewer care home residents were discharged into care homes in March than in previous months this year. Will the Secretary of State commit to publishing those figures and the figures of how many people were discharged from hospital with covid-19 into care homes?

I am happy to look into that. Martin Green also said:

“It has become clear that in such a crisis we need further direction from Central Government.”

That is what we have tried to put in place by working with colleagues in local authorities to try to make sure that we get the best infection control procedures across the board.

Will the Secretary of State join me in praising the work of the Hampshire and Isle of Wight local resilience forum, which has meant that no care home has been without personal protective equipment during the pandemic? Will he also join me in thanking the resilience and hard work of all the careworkers in Meon Valley?

As the Secretary of State has already mentioned, the coronavirus crisis has highlighted the importance of the joined-up approach between the NHS and the social care sector. He has assured me that we will continue to build a more cohesive structure. Will he also consider appointing a social care commissioner to lead that work and be the voice of the social care sector?

Yes. I join my hon. Friend in paying tribute to Hampshire and I am interested in talking to her more about her idea.

A resident contacted me whose mum is classified as clinically extremely vulnerable and is in a care home. The care home has interpreted the Government’s guidance to mean that her mum must be kept in solitary confinement for three months for her own protection.

In 2011, the United Nations concluded that solitary confinement beyond 15 days constituted a cruel and inhumane punishment. The resident is heartbroken. Her mum is deteriorating and has no quality of life. We believe that the care home has the best of intentions, but can the Secretary of State urgently give clear and unequivocal advice on exactly how care homes should treat residents listed as needing shielding?

The hon. Lady is right to raise that heart-rending case. I would be happy to look into the specifics if she writes to me with the details. Of course, the shielding programme is there for the protection of the shielded. If somebody who is being shielded would prefer to do things differently, that is not clinically recommended, but so long as it is within the broader social distancing guidelines, of course we understand why that might be the case. In particular, people coming to the end of their life may want to consider ensuring that they enjoy their last few weeks and months as much as they can. A proportionate approach is required here, and one that is guided by the individual clinical circumstances of that person. I very much hope that the care home will take a proportionate approach. I am sure, as the hon. Lady says, that it has the best intentions at heart, and I would be happy to take up that individual case.

Testing for my constituents in care homes has begun, but can the Secretary of State tell me when all care home staff and residents will be tested? Secondly, it has become apparent that some residents of care homes are refusing tests due to a fear of what the results could mean. Can he reassure them that getting tested will not affect their treatment and is the right thing to do, in the best health interests of everyone?

Yes, absolutely—being tested is the right thing to do if that is what you are asked to do. It is really important. We are rolling out testing both for people with symptoms and asymptomatic people, to try to find all the coronavirus in our care homes, to be able to trace it and then end this epidemic.

This being Mental Health Awareness Week, can we spend some time considering and reflecting on the mental health impact that the coronavirus pandemic will have on the frontline health and social care workers charged with tackling it? In particular, would it not be a great example of the good working of our four Governments if an action plan on mental health was constructed with the support of all four Governments?

The right hon. Gentleman is right to raise that. This is Mental Health Awareness Week, and I have front of mind the mental health impacts of coronavirus, particularly on staff but across the board. We work closely through the chief medical officers of the four nations of the UK and between Ministers to try to ensure that clinical advice is co-ordinated. After all, it is based on the science. I am happy to look at the proposals and discuss them with the CMO.

We welcome the announcement by the UK Government of a £60,000 payment for care home workers who sadly lose their lives due to covid-19. Can the Secretary of State confirm that acceptance of that payment precludes subsequent legal action if that death is thought to be due to negligence, and will he outline the thinking behind that?

Will my right hon. Friend pay tribute to the owners and managers of care homes who put the safety of their residents first and refused to admit any of the 15,000 hospital patients who had been exposed to covid-19, whom the Government were forcing to be discharged from hospitals at the end of March?

I say happy birthday to my hon. Friend and pass on the best wishes, no doubt, of the whole House. The question he raises is a difficult one, because in many cases, the best place for somebody is not in a hospital. Indeed, people can catch diseases in hospital, so it needs to be done on a clinical basis. That is why we have put in place the testing, isolation procedures and infection control of people who are leaving hospital to go into care homes.

At the Health and Social Care Committee on 5 May, the Government chief scientific adviser told me:

“We need to get on top of it in care homes. We have been clear about that.”

He added:

“What SAGE does is try to distil the scientific advice into a form that then others need to operationalise and take accountability for”.

Will the Secretary of State commit to publishing all the SAGE advice that his Department has received throughout this outbreak about infection control in care homes?