Lib Dem peers highlight problems with social care

The House of Lords debated how Covid-19 affected social care this week and Lib Dem peers made several contributions on such issues as DNRs being inappropriately proposed to local authority financing and the needs of charities helping seriously ill children and PPE in care homes.

Sal Brinton as Health and Social Care spokesperson summed up the Lib Dem stance on these important issues.

Here is her speech in full:

On behalf of the Liberal Democrat Benches, I also thank all the staff and volunteers working across the wider social care and community sector. Frequently low paid but definitely not low skilled, these amazing people show us their professionalism and big hearts, day after day.

Back in mid-February, we on these Benches asked the Minister repeatedly about care. On 26 February, the noble Lord, Lord Bethell, said in Hansard that

“we are planning … a massive communications campaign on how to protect people, particularly vulnerable people, in our population.”—[Official Report, 26/2/20; col. 257.]

The evidence of recent weeks shows that those most vulnerable in our communities and care homes have been seriously and tragically let down.

Others have covered plenty of the detail, which is symptomatic of the centralised way in which Whitehall, the Department of Health and Social Care, and the NHS have treated anything not in hospitals as a second or even third order of priority. My noble friend Lord Shipley explained the problems that have arisen since Whitehall took over the supply chain for the social care sector and then decided to create a separate system, known as Clipper, that we were told was due to come online on 6 April, but yesterday discovered is still three to four weeks away from going operational.

Worse, where providers and local resilience forums have ordered their own PPE, it has been confiscated by government and rerouted centrally for hospitals first, leaving community settings high and dry. This includes lorries being stopped at border ports and drivers being rerouted. Consequently, a lack of PPE and a policy of moving patients from hospital into care homes without any testing has meant that Covid-19 has spread rapidly in the social care sector.

I support my noble friend Lady Jolly’s call for clarity on DNRs and echo her concerns about GPs asking disabled and learning-disabled people completely inappropriate questions. It is very clear from the government advice, NICE advice and all good palliative care advice that the way in which this happened was inappropriate. I hope that this DNR factor will be examined as part of any inevitable public inquiry. It seemed to happen in groups. Were CCGs asking GPs to ring their patients and find out whether they wanted to go to hospital? To do it all in one conversation is completely inappropriate. For many disabled people, it was completely inappropriate to even ask them this, if they do not have the clinical frailty that my noble friend Lady Jolly spoke of.

However, the Government’s lack of understanding of the wide range of other disabled people, and extremely fragile people, living within our community extends ​completely in the opposite direction. As a result, people who have ventilators or tracheostomies, for example, have found that their care support is entitled to only the most simple and flimsy face masks, because they are regarded as exactly the same as the standard care in residential homes. The Government’s PPE for the social care sector is almost always designed for the elderly.

Matt Hancock said last week that health and social care workers should not overuse PPE. The gasp that went through the social care community when he said that could be heard across the country. Most community orders are receiving a tiny fraction of what is ordered and needed. My noble friend Lady Barker summarised well the problem between the department and local government.

Time and again, many noble Lords have talked about testing. Testing in the social care sector has been a real problem, with very few centres where staff can go and be tested. On Sunday, an appalling story came out of a social care worker in Norfolk being asked to go to Sheffield—a five-hour round trip—to be tested. Even their nearest place was a three-hour round trip away. It is all very well saying that more and more centres are opening up, but if they are all drive-through, it becomes impossible for the many staff in the social care sector who do not drive to get to them. I hope that the Minister will be able to explain to us when really accessible testing will be available for all social care staff who need it.

The problems with PPE have demonstrated a perfect storm. At the beginning of this crisis, patients, and especially elderly patients in hospitals who may or may not have had Covid, were being pushed back into local care homes without having been tested, whether they were symptomatic or asymptomatic. At that point, staff in care homes were not able to access tests at all and, as a result, Covid started rushing through many of our care homes. Many of the workforce were already self-isolating, or, because of their symptoms, had removed themselves completely and were unable to work. The criminal lack of PPE means that Covid has had free rein. It is estimated that in London, some 50% of care homes have active cases.

Many noble Lords have talked about the future of social care, and it is absolutely vital that we look at that in the context of today’s debate. My noble friend Lady Northover set out the history of social care reform. I can remember the delight, a decade ago, when all three parties supported the Dilnot review, and the shock when the Conservative Party decided that it did not want to continue with it. As we come to the end of this crisis, we must rapidly review the future of social care, but we must not start again from scratch. There is plenty of evidence to show what needs to be done. Our social care sector was already struggling before this crisis, following cuts to local government and to providers, with many providers having gone out of business and others hanging on perilously by a thread at the moment.

The consequences of all this are visible. The Rainbow Trust supports families with seriously ill children. It has said that the risk of the Covid-19 pandemic has put the provision of social care by charities at a higher ​risk of ceasing altogether, because many charities depend on fundraising, which has dropped significantly. It says that, in the short term, it is unclear how government departments will divide up the modest funding package of £360 million between the so many charities which are desperately trying to provide for very vulnerable groups of adults and children. It added that, in the long term, it is vital that sustainable funding is established to reduce the vulnerability of vital charitable social care to economic shocks, so that we do not end up in this position again.

The Rainbow Trust would like to ask the Minister to please go back to the Chancellor of the Exchequer. Many charities have had to furlough staff, and those staff have been allowed to work for other charities. But in the medical sector, these staff often have exceptionally specialist skills that cannot be used elsewhere, and, as a result, some of the provision that they are trying to offer cannot be done easily.

My noble friend Lord Campbell of Pittenweem has rightly called for a judge-led public inquiry. It is clear that too many things have been going wrong. We need to recognise the contribution made by our health and social care staff wherever they are, whether in care homes, in the community or in hospices. That is why the Liberal Democrats say that we must have a proper package for them. They must have access to full and proper PPE. Moreover, those who have tragically died as a result of Covid in the line of service need proper death in service benefits. We also think that a daily allowance equivalent to the military deployment allowance should be paid during the lockdown to people who end up putting themselves at risk. Too many are doing that, and they are absolutely serving the nation.

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19 Comments

  • John Marriott 25th Apr '20 - 9:54am

    Now, if ALL politicians could get together, stop trying to score points off each other and come up with a plan to sort out the mess that Social Care has been in for years, it might help to restore my faith in politics. It seems pretty obvious to me that we all need to make a financial contribution, especially towards our care in old age. This could come in the form of government backed, hypothecated COMPULSORY insurance, means tested if necessary, which could kick in as soon as someone starts work. I doubt whether the private sector would want to touch this with a barge pole – no money in it for them, folks – hence the government backing, and no, it should NOT be voluntary. By all means, let’s have a Royal Commission, or something similar; but we could start with the 2011 Dilnot Report, which seemed to offer a way forward. We just cannot keep putting it off any longer. I’m a great believer in the theory that you don’t get owt for nowt. So, in the words of Jamie Oliver; “Come on!”

  • Katharine Pindar 25th Apr '20 - 10:03am

    It’s heartening to know that our peers, especially Lady Brinton who used to be our extremely hardworking and effective President, have become so much engaged with the problems of the social care sector. It is heart-breaking to think of the neglect which has led to untested patients returning to care homes where staff are inadequately protected and the disease has often rapidly spread, and of the misery of the families with children needing special care where the charities who support them are in danger of going under. We must indeed seek attention and increased central funding to help all health and social-workers, now and in continuation, as well as give to these charities

    Thanks indeed to Sal for taking this up with her usual strength and tenacity. But I would like to ask her if she reads this about one other distressing aspect of present care in care homes. It has been reported that the sad people who catch the virus there and are not taken to hospital (though it is horrific if some who might be treated in hospital are not really given the choice) may not even be given the drugs they need if they are dying because doctors are not visiting the homes to provide them. Should GPs be urged to visit and prescribe as soon as any patient returns from hospital to a home, and keep in touch?

  • Whatever happens, you can bet that by the time it’s implemented the Boomers will have dodged the bullet, and the Gen Xers will be the ones selling their houses to fund old age care.

  • Well it’s certainly good to hear that Lib Dem peers are taking interest in Social Care, but unfortunately, there’s an elephant in the room which Baroness Brinton didn’t get round to mentioning.

    In part we are where we are because Social Care has been the poor relation for many years – especially since 2010 – as a report by the Association of Directors of Social Services revealed back in June 2015 :

    “Social care funding cut by a third since 2010, ADASS survey, http://www.publicfinance.co.uk › news › 2015/06 4 Jun 15

    “Local authority funding for social care services fell by nearly one-third over the last parliament, an analysis by the Association of Directors of Adult Social Services has found. The association’s annual budget survey revealed that local government social care funding will fall to £13.3bn in 2015/16, a reduction of £500m in cash terms compared from 2014/15, but a £1.1bn real terms cut once growth in demand was taken into account.

    ADASS president Ray James said the reduction meant there would be fewer hours of vital home care or fewer people receiving funding for residential care and put at risk the ability of social care services to provide for those in greatest need. “In virtually all our authorities, the number in need is growing, while the complexity of their needs is increasing,” he said.

    Although councils had attempted to prioritise adult social care funding – which now accounted for 35% of spending in the 155 local authorities in England with adult social care responsibility – further cuts would become more difficult, he added. In total over the last five years, there have been cuts of £4.6bn, representing a 31% real terms cut.”

  • Phil Beesley 25th Apr '20 - 1:01pm

    TCO: “Whatever happens, you can bet that by the time it’s implemented the Boomers will have dodged the bullet, and the Gen Xers will be the ones selling their houses to fund old age care.”

    I don’t think that intergenerational squabbling is productive. It is ridiculous to suggest that all baby boomers came out of the calamitous 1970s and 1980s with wealth and personal resources. AgeUK calculates that there are two million pensioners living in poverty, most of them Boomers. My guess is that some of them have never enjoyed prosperity.

    https://www.ageuk.org.uk/globalassets/age-uk/documents/reports-and-publications/reports-and-briefings/money-matters/poverty_in_later_life_briefing_2019.pdf

    I think you will find that many Boomers have already ‘mortgaged’ their houses and assets to pay for care.

  • Peter Martin 25th Apr '20 - 1:58pm

    @ JoeB,

    “…..so principal private residences do not have to be sold as is often the case now.”

    What’s the problem with this? If someone hasn’t long to go and they need external social care, they probably don’t need their private residence. Or if they do, and social care is being provided in it, a charge can be recouped when the property is sold. It’s not a lot different from the way death duties work.

    I’ve never quite understood why death duties are so unpopular. I’d much rather pay taxes after I’m dead than while I’m still alive!

  • Peter Martin – I’ve lived through five types of tenure over the years (private rental/co-operative/free with vocational training/free with job/owner occupation). In my naivety I thought housing was for shelter, security and a base for leading a good life. However if a house is seen as a financial investment or a family legacy then you are not going to like death duties. If death and taxes are the great inevitabilities it seems reasonable for them to be connected.

  • Phil Beesley 25th Apr '20 - 3:28pm

    Peter Martin: “What’s the problem with this? If someone hasn’t long to go and they need external social care, they probably don’t need their private residence. Or if they do, and social care is being provided in it, a charge can be recouped when the property is sold. It’s not a lot different from the way death duties work.”

    I could explain how this happens, but it makes my brain hurt. If you are a normal person with any capital, you will pay for your care. People who have money locked away in trusts don’t play by the same rules.

    “I’ve never quite understood why death duties are so unpopular. I’d much rather pay taxes after I’m dead than while I’m still alive!”

    I’m presuming that you aren’t seriously rich, Peter? Rich people think that their money was honestly earned and they should disperse it according to what they think. c.f. Bill Gates, rich benefactor and employer of tax accountants. Bill Gates has become a generous man and he has contributed significantly to ‘health programmes’ (ugh, hate the expression), but I doubt whether he has put $2,000 dollars in the hands of a homeless person in Seattle as a down payment for a flat and furnishings. No control.

  • @ Joe Bourke Yes I’m familiar with Dilnot, Joe…… and that it wasn’t implemented.

    Here’s a link to what Sir Andrew himself said last year : Sir Andrew Dilnot on social care reform: Where did it all go wrong …www.carehomeprofessional.com › sir-andrew-dilnot-on…

    Given he reported way back in 2011, why did the Lib Dems allow the Coalition to fiddle around and put it off for five years until after the next General Election and 31% Cuts later ? Answers on a post card please from Facebook HQ, California, U.S. of A.

    I remember chatting to Douglas Houghton MP way back in the sixties when he used a phrase that has stuck with me ever since , “Money makes the mare to go”, and £ 4.6 billion is a lot of dosh to cut..

  • @Joseph Bourke “the whole point of collective insurance is to spread the risk of incurring catastrophic care costs in the final years so principal private residences do not have to be sold as is often the case now.”

    I’m actually in support of using accumulated wealth to fund end of life care – after all, surely it should be spent by/on the person who accumulated rather than passed to someone who hasn’t earned it.

    The point I’m making is more that the Boomers will keep kicking the can down the road so that when it does come in it will be Gen Xers like me whom it hits. Meanwhile, like with grammar schools, limited University entrance on a full grant, index linked pensions and, finally, huge principle residence asset gains, the Boomers will have lucked out whilst the rest of us pay for them.

  • Phil Beesley 25th Apr '20 - 11:47pm

    TCO: “Meanwhile, like with grammar schools, limited University entrance on a full grant, index linked pensions and, finally, huge principle residence asset gains, the Boomers will have lucked out whilst the rest of us pay for them.”

    It is strange how people who live through misery perceive it differently from external observers.

    Pick your year for how many bright kids went from a council estate to university in the 1970s. According to the census, how close to zero per cent? How many families could top up a council grant? Ponder on why so many smart working class people pursued education the long way.

    I’m a big fan of continuing education, so I think that there is a balance — and I know that universities should not work as degree sausage machines.

    You’ve got this idea in your head that Baby Boomers are a lucky generation (multiples, actually) and that things should be better for you, Gen Xer, than for them. I don’t get it. Why assume that next generation has a better life style than the previous one?

  • @Phil Beesley “You’ve got this idea in your head that Baby Boomers are a lucky generation (multiples, actually) and that things should be better for you, Gen Xer, than for them. I don’t get it. Why assume that next generation has a better life style than the previous one?”

    They are a lucky generation; what gets me most is that they (at least in as much as represented on this board) go on about how terrible things are when they’ve done pretty well, and will continue to do so – remeber every retired Boomer is currently being paid for by someone currently in the workplace who will not get things as good as they have had them.

    As an a Xer who followed them, we were told about or have immediate comparison to a whole raft of things that Boomers have had that we didn’t have, such as:

    – bright kid form a poor background? No grammar schools for you, we benefitted but abolished them.
    – University grant? Not for you, we benefitted but abolished them
    – index-linked final salary pension? Not for you, we’ve benefitted but abolished them.
    – get rich through property price increases? We’ve benefitted but priced houses so far out of reach for you, you’ll cripple yourself with a mortgage and won’t get the second house in France or investment portfolio.
    – job for life and full employment? Nope – you now need to be flexible, no guarantee and no career for life leading to a nice fat pension for you

    And I recognise that the Millenials and Ys have it worse, but at least they’ve gone into life knowing that will be the case from the outset, rather than having false expectations raised.

  • Rodney Watts 26th Apr '20 - 3:13pm

    Just a thank you to all involved with this very, very important thread. I suddenly realised I am actually a ‘pre-boomer’ who thanks the Lord each day for my health & fitness. The latter has allowed me when aged 78 to care for my wife for over a year, see her back to reasonable health, and keep up with our four legged friend.

  • @Joseph Bourke thanks for a full and frank recognition of the facts. The point you make about the ratio of workers to non-workers is a good one, and one I forgot to make in my own. That’s another differential between Boomers and those that follow (who will be working into their 70s through necessity whilst many Boomers retired comfortably at 60).

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