12.33 pm
(Leicester West) (Lab)
(Urgent Question): To ask the Secretary of State for Health and
Social Care if he will make a statement on coronavirus and care
homes.
Mr Speaker
I call to answer the urgent question.
The Secretary of State should not speak for more than three
minutes.
The Secretary of State for Health and Social Care ()
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 need 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.
Mr Speaker
In welcoming the hon. Member for Leicester West () 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 (), 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.
(North East Hertfordshire) (Con) [V]
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—is
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.
(Central Ayrshire) (SNP)
[V]
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.
(Harrogate and Knaresborough)
(Con)
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.
(Luton North) (Lab) [V]
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.
(Sutton
Coldfield) (Con) [V]
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.
(Twickenham) (LD) [V]
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?
I will absolutely look into the proposal that the hon. Member
puts forward.
(Mid Derbyshire) (Con)
[V]
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.
(Lewisham, Deptford) (Lab)
[V]
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.
Mr Speaker
has withdrawn, so we go to
.
(Aberdeen South) (SNP)
[V]
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.
(Bosworth) (Con) [V]
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 North) (Lab) [V]
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.
(West Worcestershire) (Con)
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?
Yes.
(Enfield North) (Lab) [V]
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.
(Bexhill and Battle) (Con)
[V]
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.
(Streatham) (Lab)
[V]
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.
(Meon Valley) (Con) [V]
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.
(Kingston upon Hull West and
Hessle) (Lab) [V]
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.
(North West Durham)
(Con)
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.
(Orkney and Shetland) (LD) [V]
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.
(Wolverhampton North East)
(Con) [V]
[Inaudible.]
Mr Speaker
We will have to move on to .
(Stirling) (SNP) [V]
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?
I will write to the hon. Member with the full details.
Mr Speaker
We now go to birthday boy .
(Christchurch) (Con)
[V]
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.
(Ealing North) (Lab/Co-op)
[V]
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?
We do regularly publish SAGE advice.
Mr Speaker
We now go back to .
[V]
[Inaudible.]
Mr Speaker
We tried. Sorry about that.
