Coronavirus and Care Homes

(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.

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.

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?