Family Visits in Health and Social Care Settings: Covid-19

– in Westminster Hall at 11:29 am on 11th November 2020.

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[Esther McVey in the Chair]

Photo of Esther McVey Esther McVey Conservative, Tatton 2:30 pm, 11th November 2020

I remind hon. Members that there have been some changes to normal practice in order to support the new call list system and to ensure that social distancing can be respected. Members should sanitise their microphones using the cleaning materials provided before they use them, and then place those materials in the bin. They should also respect the one-way system around the room. Members should speak only from the horseshoe, and they can speak only if they are on the call list—that applies even if debates are undersubscribed.

Members cannot join the debate if they are not on the list. Members are not expected to remain for the wind-up speeches. I remind hon. Members that there is less of an expectation that they stay for the next two speeches once they have spoken—that is to help manage attendance in the room. Members may wish to stay beyond their speech, but they should be aware that if there are lots of speakers, doing so might prevent Members in the seats in the Public Gallery from moving to the horseshoe.

Photo of Joy Morrissey Joy Morrissey Conservative, Beaconsfield 2:31 pm, 11th November 2020

I beg to move,

That this House
has considered family visit access in health and social care settings during the covid-19 outbreak.

It is an honour to serve under your chairmanship, Ms McVey. My main focus in speaking today is to highlight the need for improved patient advocacy and adult safeguarding via visitation rights for family members of working-age disabled adults in full-time residential care, including those admitted to hospital. Such patients often cannot speak for themselves and need additional access to family members who are able to advocate and communicate on their behalf.

I applied for the debate because of an awful situation of a mother in my constituency—a mother, much like me or any hon. Member present, who has had to endure a situation that I hope no mother has to face in the future. She is a teacher, a local community advocate, a single mother and someone who has tirelessly fought for her child’s care needs. She was prevented from caring for her son, Jamie, and forced to abandon him to a care home that did not live up to its name. At 21 years old and with no visitors, he was left isolated, bewildered and depressed, often calling out in anguish, “I want my mum. I want my mum.”

Jamie was a warm and affectionate young man who loved touch, kinaesthetic learning and being with people. His mother was denied access to her child, and I cannot begin to imagine what it must have felt like, knowing that her son was denied the care of his family for months—denied a hug, denied the comfort of a warm hand holding his, and denied dignity in his suffering. As a mother, my constituent felt powerless but sure that, had she been able to see him, she would have identified his decline and been able to intervene.

Underfed, Jamie wasted away, getting thinner and thinner in his confusion and isolation. Separated from those he loved and trusted, with multiple bedsores and open wounds left untreated, he began to withdraw within himself and into a catatonic state of unresponsiveness—a young adult with complex disabilities and care needs, left to suffer in silence. By the time his mother was able to see him, it was too late. She reflected on the lack of status that she felt as a mother, which she felt was shared by many family members. It felt to her as though families are often seen as a nuisance or even a threat, and they are sidelined and ignored by some in adult care homes. This mother also felt strongly that some adult care homes do not embrace the care of the whole person.

Jamie entered full-time care at age 13. As a child in a care setting, it was wonderful. The care was holistic and helped support Jamie in every aspect of his daily life and learning. He thrived in that environment, but the change came when he moved into adult social care. Many adult care homes are excellent and highly skilled in supporting adults with complex disabilities, but others—it might be a very small minority—seem reluctant to work with families or to provide adequate levels of transparency and care. It is an ongoing problem, which existed well before the covid pandemic; that has only highlighted these issues.

Disallowing visits or video links that allow families to see and interact with patients takes away a level of scrutiny that makes those already vulnerable chronically so. Depriving vulnerable working-age disabled adults who have complex disabilities and needs, especially those who already struggle with communication, of the love and support of their families is inhumane and cruel. As a society, we lessen our dignity and humanity when we allow our loved ones to perish alone and to wither away and give up on life. Jamie had no voice, so I am here today to speak on his behalf, and on behalf of his mother and grandmother, to make sure that his story is remembered and that other deaths can be prevented this winter.

I welcome the Government’s support for care homes and adult social care during the pandemic and I thank the Minister for reaching out to me the moment that I applied for this debate. She has been incredibly helpful and I thank her for her active participation in finding a solution and justice in Jamie’s case. I thank the Government for their care home support package in March that announced £1.6 billion funding for local government and £1.3 billion to go to the NHS and social care. In April, a further £1.6 billion was announced for local government and for the adult social care action plan and, in September 2020, the Government published “Adult social care: our COVID-19 winter plan 2020 to 2021”, which was shaped and recommended by the adult social care taskforce. The plan set out key elements of national support available for the social care sector for winter 2020; I welcome everything that was outlined in it.

Finally, I welcome the Government’s announcement on visiting guidelines from 5 November. Allowing visitation is so important for patient care, advocacy, safeguarding and mental wellbeing, particularly for disabled vulnerable patients who may not be able to advocate for their own care needs. Allowing family members to visit could save many lives during the winter months and prevent other vulnerable disabled patients from being neglected, abused and left to suffer and die in silence, while restoring a level of compassion, empathy and humanity to patient care both in hospital and in the care home setting.

Now that we are in the second lockdown I ask the Minister and others to consider what lessons we have learned from the excess deaths in care homes and from the adult safeguarding issues raised during the first lockdown. I understand that the main goal of the Department of Health and Social Care is to protect the NHS, particularly during the winter months, but we also need to save the lives of the vulnerable disabled by allowing each patient to have a family member with them as their advocate and carer. That would be aided by the improvement in mass testing in the coming months and the availability of personal protective equipment. This cohort needs a special exemption. A carer would allow for lives to be saved and, with mass testing and the arrival of a vaccine, that could help safeguard many other lives in the future.

If the NHS reaches capacity, as it often does in the peak winter months of January and February, another alternative would be for a family member or carer of the vulnerable patient to care for them directly in a home, a hospital or care home setting. A family member or loved one can also help with caring for the vulnerable person at home, further reducing the burden of care to the NHS. Many of these family members are able-bodied adults who are at a lower risk of developing serious health problems from covid-19 transmission. We also have to allow people to care for those they love.

I welcome the Government’s announcement in the winter care plan that local authorities should work with social care services to reopen safely, especially day services and respite services. Reopening such day centres would allow families to manage a disabled loved one’s care more effectively, while perhaps reducing the need for full-time residential care and lightening the burden on full-time carers who do not have access to vital daycare facilities. The Relatives and Residents Association, which is an advocacy group, reported that helpline callers had been concerned about the standard of care falling as already stretched services face staff shortages and burn-out. Stopping visits from family and friends restricts the ability for oversight and advocacy.

One of the callers to the association’s helpline said that his wife

“starved herself to death. Her death was due to the pandemic but she did not die from the virus itself. It wasn’t coronavirus—it was death due to a refusal to eat. She was isolated and alone.”

Perhaps the Minister could provide clarity as to whether families are now permitted to remove their loved ones from residential care home settings, and what the protocol for that would be, moving forward.

Jamie’s care home was in a neighbouring county, but his mother and grandmother lived in my constituency. Buckinghamshire County Council and the NHS are excellent and I worked extremely closely with them during the pandemic and the first lockdown to protect care homes and elderly residents, and to reduce the rate of transmission and death in care homes. I was proud of the work that we all did to protect the elderly in South Bucks.

However, the issue of working-age adults with complex disabilities in residential care facilities completely passed me by in the first lockdown, because many of my residents had additional needs and were at home. They were reliant on day centres and respite care. That was the issue I was seeing, not the issue of the long-term residential care crisis.

I did not learn about Jamie’s treatment during lockdown until the week before his death, when it was too late for me to help. That is why I am raising the matter now. This patient cohort cannot speak or advocate for their own care. They require extensive care and support from care home and hospital staff, and could run the greatest risk of being sidelined during a spike in hospital admissions, when staff resources are spread more thinly and they have to prioritise patient care.

Because these patients require the most care it is important that they have a family member who can be with them as their patient advocate and carer, to help ensure that they make it through these winter months. I welcome the Government’s announcement of a vaccine and I know that, with the highlighting of safeguarding, we can get through these winter months, and that Jamie’s memory will not be forgotten.

Photo of Esther McVey Esther McVey Conservative, Tatton

It might be helpful to colleagues to know that I intend to call the Front Benchers by 3.30 pm at the very latest. I would like to ensure that all colleagues get to speak today.

Photo of Christian Wakeford Christian Wakeford Conservative, Bury South 2:42 pm, 11th November 2020

It is a pleasure to serve under your chairmanship, Ms McVey. I thank my hon. Friend Joy Morrissey for securing this debate on such a hugely important topic.

Throughout the pandemic I have received devastating correspondence from my constituents, as I imagine all Members have, regarding the inability to see their loved ones in care homes. Although the restrictions placed on care homes are for the protection of the most vulnerable and their carers, the loneliness and isolation that people feel, especially those with dementia, has increased due to covid-19 preventing them from seeing their family and friends.

Although more needs to be done for residents with dementia and other diseases, I welcome the guidance that was provided by the Government last week, which sets out plans on how our care home residents and their families can be reunited. For areas such as mine that have experienced heightened restrictions for more than three months, the measures will help tackle the mental health and wellbeing of care home residents and reunite families.

Prior to those tougher restrictions being imposed in July, the images of family members being able to see one another again were truly heartwarming. The joy in the faces of residents and their families will stay with me for a long time. To have that taken away seems not only heartbreaking but cruel. I truly sympathise with all families and care workers who have had to endure that hardship.

Some care homes in my constituency are extremely limited as to what contact between families they can provide, with either limited window space for window meetings or limited telephones to speak to family members. One care home, which I will not name, has only one phone for residents, and that frequently does not work or is not answered.

Along with all Members, I agree that we need to tackle this pandemic but we also need to be fair in tackling it. I fear that is one factor that we are forgetting. It is more important than ever to use technology to help mitigate some of those issues, but a lack of understanding of how to use technology, on the part of residents and even staff, has prevented it from being fully utilised. What is being done further to mitigate those issues?

There is no greater need than to spend time with one’s loved ones. That need is even stronger for our most vulnerable and we must go further in addressing that need. The Government’s announcement last week was a big step in the right direction, but we need to carry on our journey to tackle the issues of loneliness and mental health.

I will put on the record my thanks to all the care workers across Radcliffe, Prestwich and Whitefield for the immense work that they have undertaken during the pandemic, for the work that they continue to undertake, and for the hardship that they must endure in having to deal with the frustrations and heartbreak that they see on a daily basis.

Photo of Alex Sobel Alex Sobel Shadow Minister (Digital, Culture, Media and Sport) 2:45 pm, 11th November 2020

I thank Joy Morrissey for securing the debate and I congratulate her on her moving speech on Jamie’s behalf. I lived in her constituency through my teens, and in fact I stood against her predecessor a long time ago. My mother is still one of her constituents. She is living very much independently, but maybe one day I will need to go to the hon. Member for help with my mother regarding the issue that we are debating today.

I will also place on the record my thanks to those working in the social care sector. Their courageous work during the pandemic, delivering quality care in horrendously difficult circumstances, has not gone unnoticed. The pandemic has been difficult for everyone, but for those residing in care homes, or for those with loved ones living in them, it has been nightmarish. Over 40% of covid-19 deaths have taken place in care homes—more than 26,000 deaths. The combination of fear and isolation, coupled with a dearth of familiar emotional support, is creating a mental health crisis in our care home settings.

Recently, I received this letter from a constituent:

“Dear Alex, my letter is concerning my bedbound 81-year-old mother. who is currently resident at a care home in Leeds North West. My mother, Patricia, has been a resident for many years. Along with many families, we had no contact with mum over the course of the pandemic, apart from a very short video, which lasted around a minute, sent when requested at desperation in the early months of the pandemic.

We requested that should a window room become available, could mum be moved, so we could at least visit her from a safe distance without entering the premises. Six weeks ago, a room did become available and we have been visiting mum at a window since. Today, however, I was contacted by the care home manager to inform me that we can no longer visit mum.

We are devastated that our family is being so cruelly torn apart. I thought that, as a strong woman, I would be able to deal with the mental impact, but it is destructive. Surely, there are humane options which can keep families together.”

I am thankful to the Minister and to the Government that guidance has now been released that says visiting through screens or windows is allowed, which is welcome news for my constituent. However, for many residents with dementia or other cognitive impairments, the distress that would cause makes it untenable. Similarly, the British winter makes outdoor visits impractical for older and vulnerable visitors.

In addition, the cost of implementing measures that have been suggested to create environments that are safe from covid-19 are to be met by care providers. There is no commitment of additional money, excluding the infection control fund, to cover the costs associated with purchasing screens or visiting pods. Government shortcomings will doubtless result in convenient finger-pointing at individual care homes, which are unable to front the additional costs for safe visiting.

We also need to give family members the same rights as key workers, who are afforded regular access to testing and trained to wear personal protective equipment. The Government must know that that is the best way forward, as they promised a pilot scheme on those lines, but that was nearly a month ago and no date for the pilot has been forthcoming. I look forward to hearing the Minister say when we can expect to see that pilot begin.

The wellbeing of residents must be placed at the forefront of the Government’s plans. That should include a recognition of the important role that social workers play in facilitating providers’ and residents’ decision making about visits. Social workers must be recognised as professional visitors, to ensure that residents’ views and wishes are central to decision making about visits, and to support care providers to explore thoroughly rights and risks alongside all the other factors that must be considered in making bespoke visiting arrangements.

Practice is different across the care sector. Hospices such as the Sue Ryder Wheatfields Hospice in my constituency have given social workers access, unlike many care homes, which have denied them access. Social workers are mentioned briefly in the guidance issued for lockdown, which states:

“Social workers can assist with individual risk assessments, for visits, and can advise on decision-making where the person in question lacks capacity to make the decision themselves.”

But social workers do so much more, and are pivotal in promoting strengths-based human rights models of good practice. Social workers undertake a variety of statutory and non-statutory functions on behalf of public bodies. Recognition of the importance of safe access to care and health settings for social workers as professional visitors is essential. I look forward to hearing the Minister’s comments on this matter.

Residents, staff and the families of those in care homes have been failed by this Government since the beginning of the pandemic. From woefully inadequate PPE—I had to deliver PPE myself to care settings—to inadequate testing, I am afraid that the social care sector has been treated with contempt. On top of a decade of underfunding, that has created a crisis within a crisis that is entirely of the Government’s own making.

Beyond the pandemic, long-term reform of the social care system is urgently needed. But for now, at the very least families should be able to see their loved ones, so I urge the Minister for Care to press forward with the pilot, to ensure that it begins as quickly and safely as possible.

Photo of Holly Lynch Holly Lynch Shadow Minister (Home Office) 2:49 pm, 11th November 2020

It is a pleasure to serve under you as Chair in this important debate, Ms McVey. I thank Joy Morrissey for securing it and for sharing the harrowing story of Jamie from her constituency. It will stay with every single person who heard it.

I will begin my remarks, as others have done, by sharing a passage from a letter from a constituent called Penny Hutchinson. Her mother, Yvonne, is living with dementia in a care home in Halifax. She said: “Imagine that you had not seen your mum for eight months because she has been locked away in isolation with no meaningful family contact. Then imagine the huge feeling of relief and elation as restrictions are lifted and the vulnerable are told they no longer need to shield. Now imagine the feeling of complete desolation when you discover that those freedoms and privileges don’t apply to your mum and dad. Add to that the overwhelming feeling of guilt when you try to explain to your loved one why you can’t come in to see her, hold her hand or give her a hug, and that there is no end in sight.” I sent that letter on to the Secretary of State for Health and Social Care because it said more than I could have done on her behalf.

Like Penny’s mum, more than 70% of people living in care homes have a form of dementia. Visits from family members have a really important part to play in the cognitive state of those residents, but instead of being able to be close to loved ones at this anxious time, the best they can hope for is a socially distanced meeting behind plexiglass or outside in this weather. Although that is well intentioned, it can often cause confusion and distress.

Efforts to protect those who are older and clinically vulnerable by managing contact diligently will still of course have to be a priority in the coming weeks as we strive to avoid outbreaks in care homes and manage them where they have occurred. The Alzheimer’s Society has been keen to make it clear that for those with dementia, limiting visits in that way can lead to their symptoms increasing and their condition deteriorating more rapidly, ultimately leading to premature death, so a rebalancing of those risks is required.

I want to put on the record my thanks to Calderdale’s director of public health, Debs Harkins, who has worked tirelessly throughout the pandemic alongside her colleagues, including the director of adult services and wellbeing, Iain Baines. They have both met Penny and others to try to make progress.

Before I move on to the solutions, I want to point out that when I received a response to Penny’s letter from the Minister’s civil servants, it said: “The Government’s guidance for visiting arrangements for care homes published on 22 July allows for local decision making based on the assessment of the director of public health and the care provider. Further details can be found at the gov.uk website by searching for ‘visiting care homes during coronavirus’.”

I followed that link, and at the time it stressed that:

“For local areas with a high local COVID alert level (high risk or very high risk)”—

Halifax has been in tier 2 equivalent restrictions since July—

“visiting should be limited to exceptional circumstances only”,

such as end-of-life care. That gives no discretion for directors of public health, and puts them in an impossible position with family members desperate to see loved ones. Some clarity on decision making for visits would be incredibly welcome.

I imagine that everybody in this debate feels that the situation is far from acceptable—we have heard from many hon. Members already—so what would make a difference? I have been pleased to see news this week of mass testing, rapid testing and vaccines being developed at pace. We must ensure that residents of care homes, those working in care homes and designated family members are the first in line to access them as they become available. Treating designated family members as key workers would be a logical step. It would not overwhelm the system and would ease the distress of so many care home residents and their families.

We all know that social care workers have been among the many heroes of this crisis. They have carried themselves with dignity, honour and respect in the face of unimaginable pressures. However, as they tell us, not even they can provide full care to their residents without the support of family members. For those with dementia, family visits are not privileges or luxuries but a vital part of their care and treatment. Therefore, it seems appropriate to consider measures such as this—the shadow Minister has also been calling for it—which would ease the considerable pressures that social care workers have been placed under and the mental anguish faced by separated families. We must work together to reach a better settlement for care home staff, residents and their family members.

When this is all over, we will bring the economy back from the brink, but there will be some opportunities that we will never get again. Let us not regret not doing everything possible when we had the chance.

Photo of Daisy Cooper Daisy Cooper Liberal Democrat Spokesperson (Education) 2:54 pm, 11th November 2020

It is a pleasure to serve under your chairmanship, Ms McVey. I offer sincere thanks to Joy Morrissey for securing this vital debate.

It is clear that many MPs have been contacted by worried—often terrified—constituents whose parents, children, relatives or friends are in care homes. I for one have felt utterly heartbroken listening to some of them describing the fear and isolation that they know their loved ones are experiencing, and I, too, have an example—one of many. The mother of my constituent Steph is in a care home. Steph is one of five children and for a long time they have each spent hours on end with their mother. They lovingly held her hands, combed her hair, remembered stories together and reminisced about the past. They were not just visiting their mum; they were providing essential care.

Eight months on from the arrival of coronavirus, Steph still cannot touch her mum. People like her all over the country cannot hug their mothers or fathers, children, siblings or friends. They still cannot hold their hands to comfort or reassure them. All that they can do is watch their often rapid decline, for just half an hour at a time, from a distance—perhaps from a structure in a garden, or sometimes through a closed window, or maybe a screen if they are lucky. Like Steph’s mum those vulnerable people are struggling to understand why their children and families cannot be with them. An entire lifetime of love and closeness is ripped away from them and torn apart. For every person affected, every single passing day is a precious day lost.

Now, as winter approaches and, predictably, we are in the second wave, there are still no guidelines in place to protect loved ones from dying not only in loneliness and isolation, but from it. The Government like to talk up their ambition in many other areas. We have all heard of Operation Moonshot, Nightingale hospitals and world-beating apps, but there has been barely a whisper about allowing family carers to be with their loved ones. The announcement of a trial period was welcome, but for many people it created an even greater desperation, because they could not see any end in sight for the enforced separation.

Last week I co-ordinated a group of 40 MPs from across the House who wrote to the Secretary of State with a real plan. It would allow a designated family or friend carer to have the same key worker status as someone paid to work in a care home. They would have the same access to tests and PPE, and the same access to their loved ones. A number of groups have been calling for various measures of that kind for some time. They include the National Care Forum, Age UK, One Dementia Voice and the British Association of Social Workers. We are pleased to give them and the people they represent our full backing and a strong voice today.

I want to be clear: care workers have been magnificent throughout the pandemic, but the care that our families give is no less important for health and wellbeing. The cruel 30-minute time limit on visits must be scrapped, and care homes must have protection from legal action if covid is introduced to a home by a designated visitor. Those are the same protections that have been agreed for the NHS. Time is running out. With every day that passes, isolation, loneliness and deterioration grow for many of the most vulnerable in society, and friends and family carers experience more anguish. They pass another day of separation from their loved ones as they slip away faster, and more painfully, than they should.

It is often said that the true test of a country is how it treats its most vulnerable. For as long as the Government hold out and do not implement the plan I have described, they are failing that test, and failing the thousands of families who experience anguish every single precious day.

Photo of Huw Merriman Huw Merriman Chair, Transport Committee, Chair, Transport Committee 2:59 pm, 11th November 2020

It is a pleasure to serve under your chairmanship, Ms McVey. I, too, thank my hon. Friend Joy Morrissey for securing this vital debate and opening it so well. I also want to join in with the calls of thanks to the staff across the social care sector who have worked so hard for residents across the country. I send my thoughts and best wishes to all the residents, and their families and friends.

East Sussex has the highest proportion of care homes in the south-east, and yet our county has the lowest covid rate. That suggests that our care homes have stood up to the challenge and done a great job, despite the enormous task that was in front of them.

The challenge before us now is as follows: keeping vulnerable people safe without taking away their right to live their years in dignity, and in the company of family and friends. I have been helped by many residents across my constituency to put that dilemma into words. A contribution from Heathfield sums it up:

“In the care home where my partner resides, they allow two half-hour visiting slots a day. There are forty residents, that will give each resident one half-hour visit every ten days, even so it is still not enough. On each visit the loved one sits at one end of a room, the visitor at the opposite end and the carer in between…My partner’s mental health has remarkably deteriorated in the last few months, apathy and depression are more dominant on each visit. Every time we visit she seems more and more withdrawn and most likely feels abandoned by her loved ones because of the limited visiting.”

Last week, the Government issued revised guidance for visiting arrangements in care homes, to ensure safe access and visits by families and loved ones. The guidance proposed a range of options to create covid-19-secure care home environments and visits, including visits taking place outside and the installation of wall-to-ceiling screens.

I recognise that we have now liberated care home visits, compared with the last lockdown. I also recognise the dilemma for the Minister, because she has been a target for some. We try to do the right thing by residents, and yet here we are saying, “Open up!” If we do so, we need to protect the Minister—the onus, if we take more risk, is based on a cross-party decision.

I hope I am not overdramatising, but some of the measures read to me as more akin to a prison visit than a care home visit. They are also costly, in a system that is already financially constrained. Furthermore, the measures could be avoided with the introduction of testing for designated family and friends.

I want the Government to consider the following seven measures: regular testing for at least one designated family member and all visiting health professionals; the vaccine—when ready, as we hope it will be—to be prioritised for care home residents, and given to the designated family member and the staff of the care setting when given to the resident; a recognition that with testing and PPE, safe and closer contact can be permitted, and that we have learned from the devastating impact of the first lockdown; additional funding to support care providers to create covid-19-secure environments to enable members of the wider family to visit; national and local monitoring, and a reporting process for any blanket decision to ban visits; an acceptance that virtual technology, as good as it is, cannot replace human in-person interaction; and, finally, for providers at a local level actively to promote the safe visits.

This Friday, I will partake in my regular care home quiz with the residents at Ardath in Bexhill. Sadly, we cannot be physically together, but will join on Zoom. Our quiz master, the remarkable resident Georgie Farrow, always sets a tough challenge for me and brings laughter to the room. That residential care setting, like many others I visit, demonstrates the love, fun and spirit that can exist. It is vital that we do not lose that ethos while rightly seeking to keep residents safe.

We should not shy away from the real danger. In seeking to protect vulnerable residents, we might not only diminish their quality of life, but end up prematurely ending it altogether. The ingredients of love, care and protection, which loved ones deliver, are vital to keep vulnerable people alive and with a life. On that note, I very much hope that the Government and all of us, across parties, will work together as one to give more life into our care homes.

Photo of Andy Carter Andy Carter Conservative, Warrington South 3:04 pm, 11th November 2020

It is a pleasure to speak under your chairmanship, Ms McVey. I thank my hon. Friend Joy Morrissey for securing this important debate.

One of the harshest features of the restrictions that we introduced many months ago to stop the spread of covid has been for our constituents not to be able to visit their loved ones in care homes. I have received—as I am sure has every colleague in this place—many letters expressing the real frustration and angst that they feel because of the restrictions that we have introduced. The updated guidance released last week is welcome, and it attempts to address some of the concerns, but we need to bring an element of humanity and empathy to the guidance. I know that many in this room, and our constituents, will feel that something has gone wrong over the last few months.

I want to talk briefly about a family in my constituency whose situation is very similar to those already raised by other Members. There is a young man whose family live in my Warrington South constituency, but his care home is in Greater Manchester. While we did not have any restrictions in Warrington, he was existing under restrictions in Greater Manchester, and different approaches were being taken. I tried many, many times to speak to the director of public health in Greater Manchester about the issues facing this family. I must say, it was a real nightmare to communicate across different county boundaries and to try to have a one-to-one conversation with someone from the care home and with the people regulating that care home.

The young man did not get to see his parents for about five months in total. That is simply wrong. Not only did the young man not get to see his mum and dad, but mum and dad did not get to see their son. I can only imagine how awful it would be, as a dad, not to see my son for that length of time. I think we do need to think again about the way we have interpreted some of these rules.

I want to recognise—we cannot forget it—how badly the first wave hit care homes. Therefore, everything I have just said is tempered against the fact that far too many elderly residents passed away as a result of covid-19. Some of the most awful conversations I have had in the past 12 months were with family members—daughters, sons, wives and husbands—who had lost a loved one in a care home.

At the beginning of the coronavirus pandemic, there were around 66,000 deaths of care home residents, and around 19,500 were covid-related. That means around 30% of all deaths in care homes were related to covid-19. Therefore, it is no surprise that we have had to put measures into place to try to protect residents in care homes, but they are not prisons; they are care homes—the clue is in the word “care”. Care is not just about protecting someone from a virus, but about ensuring that their mental health is maintained.

At the same time, we all know that being able to offer more visits will help everyone’s mental health and wellbeing. That is why we need to look further than the visits that are being carried out today. We need to be able to define the importance of the therapeutic impact that visits can have or, equally, how the suspension of visiting can damage the mental health of individuals and their families.

Dementia or Alzheimer’s disease was the most common pre-existing condition found among those people who sadly died as a result of covid-19 within care homes—around 50% of all deaths. For people who suffer with dementia, a lack of social contact not only is bad for their mental health, but has a significant impact on the progression of that dementia. This is a real priority for those who care for people suffering with dementia. Family and friends must play a significant role in the care of those people. Interpreting their needs and providing that personal care is incredibly important, but also very challenging in very difficult circumstances.

I welcome the announcement of a pilot scheme to enable informal carers to be given key worker status, and I am looking forward to the Minister giving us more details on that. The introduction of the lateral flow rapid tests for Warrington—10,000 being given to Warrington this week—is very welcome. I am encouraging the director of public health in Warrington to make sure that she is in touch with care homes, to ensure that those family members who need to get into care homes can get those frequent tests.

I will finish with a brief mention of a constituent who wrote to me earlier this week—a gentleman who, I think it is fair to say, is in his mature stage of life—to say that he had purchased a piece of technology and had installed it in a window in his wife’s care home. He told me that it was similar to the system used in a post office, with a microphone and a speaker, and it made a world of difference to him and his wife. He could now do a visit in complete safety, with no risk whatsoever. The window remains sealed, but he does not have to shout or practise sign language. He has been able to share his ideas with other people in the care home, and other visitors and relatives have taken on board his ideas and introduced them in other care homes.

I finish by paying tribute, and recording my thanks, to those who work in care homes in Warrington South. They have done an incredible job over the last 12 months. I also thank the members of the social care team in Warrington who look after elderly residents in their own homes by going into a home every day to ensure that they are well cared for.

There are many issues that we need to tackle for families and people in care, and I hope the Minister can take back to the Department some of the things that we have talked about today, so that it can come forward with some more ideas.

Photo of Rachael Maskell Rachael Maskell Shadow Minister (Digital, Culture, Media and Sport) 3:10 pm, 11th November 2020

It is a pleasure to serve under your chairmanship, Ms McVey. I should say to Joy Morrissey that I was really moved by the way she opened the debate, particularly the way she described Jamie’s story. It will be imprinted on my mind and, I am sure, on the minds of all hon. Members present.

When things do not add up, I ask questions. During the first lockdown, I had to jump through hoops just to obtain data to find out what was actually happening in our care homes. I spoke to managers, the local authority, relatives, staff and whistleblowers, then I put the jigsaw together. In the vast majority of care homes, residents were kept safe, and I thank the staff for their extraordinary work and for the ends that they went to in order to care for the residents. However, some care homes stood out. In the first period, around half of covid-related deaths in York were in care homes. Discharging patients into care homes—something I pleaded with the local authority not to do—seeded the infection. It then spread with the lack of PPE and no training in barrier nursing.

However, there was another conclusion to my inquiry: care homes became closed environments. One thing that we know about closed environments is that they are also unsafe. We have heard so many times in this place about the bitter experience of that. The plethora of informal inspectors were not there—GPs, community pharmacists and other professionals. They did not go in and see for themselves. Families did not go in either.

Families notice things. They notice if mum cannot reach a cup of tea, is looking unwell, has not eaten or is confused, and they notice if dad is slightly more unsteady on his feet, upset or withdrawn. But they were not there do that. However, one family noticed the eerie silence at one care home. Having been told that everything was fine, they learned that 15 people had died over a fortnight. They were not informed of the risk, only that the deaths had occurred. By the time it came to their deathbed visits, of course, it was all too late. During a deathbed visit to their mum, who had been fine, they found her emaciated, as if she had not eaten since their last visit in previous weeks. On another visit, they noticed that mum’s mobile was uncharged. On another, she had a fractured pelvis on discharge. That is why visits must occur; if they do not, these things go unnoticed.

It was whistleblowers who informed me that, at one care home, people contracted covid but their death certificates with marked with their underlying health condition. Covid was not put on the death certificate, because there were fears of reputational damage to the care home. The staff’s concerns were dismissed, and they were bullied. Even when the CQC came at my calling, they were shifted out of sight or moved to other shifts. Families would have noticed such issues.

Families must be proactively communicated with at all times and supplied with the information that they need to make care choices. As one relative said,

“We would have brought mum home had I known there was covid. It took her life.”

I am sure we were all distressed to see a nurse who went to take her 97-year-old mum home being arrested for doing what any of us would do in those circumstances. Families must visit and must have the choice where care is provided.

A constituent wrote to me this week, having celebrated his 60th wedding anniversary in September. He and his wife are both in their 80s and were told they could not visit. He said:

“When your whole existence is dedicated to the love you have for one another, it tells you something is very wrong.”

A distressed daughter told me this week that her father “couldn’t visit mum”. What are we doing to people? This is just so wrong. People are separated because our care system does not allow spouses to join their life partners unless they pay extortionate fees that they cannot afford.

I urge the Minister to look at that issue in the care sector. Not only must we give choice around visiting, but it must become a human right for older people. Visits can be facilitated with dedication and focus, PPE supply, and lateral flow testing to open up more opportunities and create safe spaces. We need to ensure that indemnity insurance does not prohibit the care home sector from pursuing that.

On the vaccine, the most vulnerable and those wishing to visit them must be prioritised. We must also ensure that there are clear and easy routes for staff, residents and relatives to raise any concerns they may have. We all know that we need to look into the eyes of those we love—hold them, and know that they are safe.

Photo of Dan Carden Dan Carden Labour, Liverpool, Walton 3:16 pm, 11th November 2020

It is a pleasure to serve under your chairmanship, Ms McVey. This debate matters so much to so many people. Like colleagues, I have been touched by correspondence and have taken to heart so many of the difficult personal circumstances that my constituents have been through in recent months. I congratulate Joy Morrissey on securing the debate, because I do not think that the issue has had enough attention in the House, especially with so much changing guidance over recent months.

We know the headline coronavirus figures because they are so stark: we are reaching 50,000 deaths in this country. Families are grieving loved ones, and people across the country are losing their livelihoods and facing hardship through no fault of their own. Let us remember that almost 30,000 of those deaths were excess care home deaths in the first wave of the pandemic, when residents of care homes were so tragically failed.

Behind the numbers, there are countless personal stories: families forced apart; special moments with loved ones missed; and the grief of losing family members. Visits to care homes and to health settings are just one of those sacrifices. Visits play a vital role—not just for families, but for ensuring the proper running of care homes and the protection of their residents. The first set of guidance, published on 2 April 2020, stated:

“Family and friends should be advised not to visit care homes, except next of kin in exceptional situations such as end of life”.

In the summer, when restrictions were eased slightly, further guidance was issued for limited visits. The most recent and up-to-date guidance puts the ball in the court of care homes providers, families and local professionals to work together to ensure that visits are covid secure.

In reality, care home visits are a lottery. Relatives tell me that it is still proving difficult for them to secure consistent visits. That lottery means that one home in my constituency facilitates window and garden visits and arranges Facetime and Zoom calls. Another home had facilitated window visits when they were allowed, but found that residents were left upset and agitated as they did not understand why they could not see their family as normal, and Facetime and Zoom calls often led to more confusion and upset. That home now has a designated area so family members can visit during the winter, and has created an action plan to put that in place.

I want to share the words of one constituent, who has kept in touch with me throughout recent months as she has tried to visit her mother in a care home. She wrote to me this week to say:

“I was allowed in the care home on Thursday to see her, poor mum, its heartbreaking see her wither away to nothing. I was not allowed to hug or touch her, she kept getting up from the chair to come to me and I had to walk away and around the table, she was following me. Gut wrenching, all she wanted was her daughter, to feel safe, feel reassured and be with me.”

Of course, people have so many questions that need answering to ensure safe visits. As it stands, some visits are happening, but the practicalities and ability of some care homes means that visits are just not possible and too many families are still being left out. As colleagues will know, Liverpool is now piloting mass testing and I welcome the fact that Liverpool City Council is exploring how we can use the Mast lateral flow testing to support more direct visiting. I encourage the Minister to touch on that point.

Nothing can replace being able to visit a loved one in person, and nothing is more important to the people suffering the heartache of being separated from them week after week, month after month. I implore the Minister to do everything possible—I am sure she will—to ease that pain for my constituents and the millions across the country who have been affected for too long. There is no excuse for the inhumane treatment of care home residents in this country. Care homes need funding, PPE, testing and expert advice to set up safe visiting.

Photo of Patricia Gibson Patricia Gibson Shadow SNP Spokesperson (Consumer Affairs) 3:21 pm, 11th November 2020

I am very glad to participate in this debate. I thank Joy Morrissey, who set out the importance of social and family contact for older and vulnerable adults. She made specific reference, in disturbing detail, to her own constituent in a way that sums up the difficulties that we face.

I have found this debate difficult. The issue before us, and certainly before the Minister, is very fraught—every choice in this situation brings its own serious challenges. I am conscious that these matters are devolved to the Scottish Parliament, but I speak in the spirit of common areas of concern about the issue. Specifically, how do we support the emotional and social needs of our older people while taking due cognisance of our need also to keep them safe? We have shared that goal today across the Chamber. I put on the record that those working in our care sector, I think we can all agree, do sterling work and deserve our thanks and recognition. I declare an interest: my sister Kathleen and my niece Chloe both work in the care sector.

Keeping older people safe and allowing them access to loved ones is something that every participant has highlighted. The balance is very difficult to strike, I think; we have heard about the tensions as we try to work through how we strike that balance correctly. I speak as one with some personal insight into the issue: my mother-in-law is in a care home in Saltcoats. She has dementia and lockdown has caused a dramatic and shocking decline in her condition. She has simply stopped eating. Her decline has been so great that I do not, in all honesty, believe that it can be reversed, or perhaps even halted, in her case; I accept that that may not apply to many people in her position, of whom I know there are many.

I have also heard from staff in several care homes that older people are suffering very badly from their lack of social interaction with other residents, their lack of contact with family and their missing out on the kinds of exchanges and conversations that could once have been taken for granted as a normal part of their day.

The lack of stimulation for many older people—it is horrible to say it—is akin to a slow death and is very upsetting. It is upsetting for the families of those who live in care homes and for the staff who work in them, who, throughout the pandemic, have coped with enormous challenges in a way that I hope they know we are very grateful for and of which they can be proud. Care home residents with dementia do not really know or understand why they cannot see their loved ones, which only adds to their distress and that of their relatives, as Dan Carden illustrated for us.

Conversely, many people who have elderly parents in care homes are very keen and anxious that their elderly relatives should be kept as safe as is possible at this time, until there is a vaccine for the virus or it subsides. We need to be mindful that the average age of those dying from covid is 83 years old. That stark statistic reminds us of the kinds of choices that we are trying to balance.

We are now in a position whereby visits to care homes to see elderly relatives can resume—obviously, with strict measures in place to ensure that they are as safe as they can be. Residential care homes have made use of screens and windows, and outdoor and virtual visits. However, there is some concern among care home owners —we have heard a bit about this today—that they will face litigation over covid deaths as their insurance premiums soar in the midst of this pandemic. I think that, just as the NHS has some protection in that regard, so too must care homes.

We have all heard of the distress and loneliness, the destructive sense of isolation, that older people have felt, particularly but not exclusively in care homes, as they miss that very important contact with loved ones. A phone call or a Zoom connection is a substitute, but it is much less satisfactory in terms of emotional connection. There is no substitute for an isolated older person having a cup of tea while sitting in their favourite chair just across from a loved one, having a hug and seeing the smiling faces of their grandchildren. A virtual substitute can never replace that.

As our older people wait in a limbo of loneliness, missing loved ones, they do not know—we do not know —how long this limbo will last. That uncertainty is very distressing, because if someone is at the very advanced stages of life, their fear is that they will never again have close contact with their family. That awful prospect must leave people despairing.

In all this, we must not forget the staff in care homes. They dedicate their days to looking after our elderly relatives. They see every day how some of our older people are simply not coping with the restrictions, and it is very distressing for them; I am sure that it takes an emotional toll on them as well. They feel very keenly their duty to keep their charges safe and they, too, often feel torn and helpless, as so many of us feel in the face of this cruel pandemic.

The biggest fear as the pandemic rumbles on—turning our lives, as we knew them, upside down—is that we save our older people from covid only to lose them to despair. Most residents in care homes have dementia, and I fear that they are utterly bewildered and confused by the current situation. They cannot understand why they cannot mix freely with others, as they used to.

Expanding testing to include designated visitors to care homes—we have heard a bit about this today—as soon as capacity allows will, of course, be part of the solution as we try to make inroads into this difficult situation. We also have the prospect of a vaccine, which we all hope will be available before too much longer. However, we need to continue to look for creative ways, such as that pointed out to us by Andy Carter, to navigate the road ahead. For as long as restrictions are in place, we need to find ways to combat the despair, distress and isolation of our older people, who feel very keenly this separation from loved ones.

Last week, Scotland’s Cabinet Secretary for Health and Sport met again with families of people in care homes. Like all of us, she is acutely aware of the importance of visits for the health and wellbeing of care home residents and their families. Indeed, leaders of all parts of the UK are grappling with these very human issues in which lives are at stake and every choice they make needs to be very finely balanced and is fraught with potential danger. I am sure that these matters give those leaders and the Minister sleepless nights. I do not envy them their task. During these terrible times, a stark and difficult set of choices and decisions have to be made which could literally mean the difference between life and death. Across the UK, guidance for social care settings continues to be under review so all that can be done, will be done, to support safe visiting.

I look forward to hearing the Minister’s views on these important matters and how she thinks we can better support our older people in care homes. Theirs is a generation whose lives were blighted by war in their youth and are now blighted by this cruel virus in their old age. Of course, we need to protect them and look after them, but for many the cost of isolation from loved ones and of restrictions on stimulation, is very high, as they lose their sense of who they are and their dementia takes greater hold of their lives.

Photo of Liz Kendall Liz Kendall Shadow Minister (Health and Social Care) 3:30 pm, 11th November 2020

It is a pleasure to serve under your chairmanship, Ms McVey. I, too, congratulate Joy Morrissey on securing this important debate and on her brilliantly powerful speech. I am particularly grateful that she focused on working-age adults with disabilities who have all too often been ignored in this debate so far.

Since mid-June, I have been calling for a way forward that will keep residents safe and get family visits going again. I will come on to that later, but I start by paying tribute to all those who have been working so hard to bring families back together: the local authorities that have championed face-to-face visits throughout lockdown, including Leeds, Sheffield and my own Leicester City Council, and the organisations that have campaigned on the issue, such as Age UK, the Alzheimer’s Society, the National Care Forum, the Care and Support Alliance and the National Care Association.

In particular, I thank and pay tribute to Jenny Morrison and Diane Mayhew from Rights for Residents. After their own terrible experiences, they started their campaign to give a voice to all the other care home residents and families who have been prevented from seeing their loved ones since the first lockdown started more than eight months ago. They have had a phenomenal reaction to their campaign, and rightly so, because the issue really matters. It matters because of the anguish it causes families to be separated from the people they love most and because of the increasing evidence that the physical and mental isolation that results from restricting family visits is causing serious harm to a large number of care home residents. In a recent survey by the Alzheimer’s Society, 80% of care home managers said that lack of social contact is causing deterioration in the physical and mental health of residents with dementia. That is unacceptable.

All hon. Members present have spoken on behalf of constituents who have contacted them about the desperate agony they are going through and their real fears for their mums, dads, husbands and wives. I have also been contacted. A woman called Trudy got in touch to say,

“Today I’ve had to try to comfort my terminally ill mum in a video call, she’s scared and she needs us. Not on a screen or behind a screen—but with us stroking her hand. It is destroying us that the end of her life is like this. It’s destroying my family. I feel I am breaking every promise we ever made on looking after her.”

My constituent John rightly asked me,

“What quality of life do residents have if they can’t go anywhere, see any of their family and friends or have meaningful relationships? My family are absolutely distraught by the fact that we are not being allowed to see our family member but are having to hear them sobbing on the telephone and being told by staff how agitated they are and how ‘lockdown’
is affecting them and causing their condition to deteriorate. We can’t get this time back with our family member and time is precious”.

That point is really important, because the average length of stay in a care home for an older person is two years. After eight months of visitor restrictions and lockdown, there is simply not enough time for many of those living in care homes to wait and watch for a pilot scheme or another set of guidelines.

We need action now, because husbands, wives, sons and daughters are not just making social calls to their loved ones in care homes; they are playing a fundamental role in the everyday care of the person they love. Residents and their loved ones have human rights, both as individuals and as a community, and a ban on visiting arguably denies them those rights, as the Minister will know.

What should the Government do? I always hope to be practical in putting forward solutions. I and the 60 organisations that recently wrote an open letter to the Minister and the Secretary of State about this issue understand why the Government are so worried about the risk of covid-19 in care homes, given the catastrophic suffering and loss of life during the first wave of the pandemic, but the Minister will know that the Government’s own independent scientific advisers, the Scientific Advisory Group for Emergencies, and its working group on social care said in evidence published on 21 September that the risk of family transmitting the virus from visitors to residents was low. Those 60 organisations, which include the Royal Society for Public Health, the British Geriatrics Society and the Social Care Institute for Excellence, which is responsible for promoting good-quality care, say that

“there is no evidence that a blanket ban on visiting, or near ban, is the right response. It is also the case that homes are much better equipped now to manage any risk. There is much greater knowledge of transmission and infection prevention and control practices than there was in March. Homes should be fully supported to enable visiting.”

Opposition Members—indeed, Members on both sides of the House—agree, which is why Labour has been calling for families to get the regular testing and PPE that they need since 17 June, when I first wrote to the Health Secretary warning about the impact of isolation on care home residents. I wrote again to the Health Secretary on 14 September, specifically calling for families to be designated as key workers, so that they can get the regular testing that they need to safely visit, alongside the regular testing of care home staff. That, as the Minister will know, is precisely the approach advocated by the 60 organisations that recently wrote the open letter.

The Government still have not really listened. Their latest guidance says that indoor care home visits will need floor-to-ceiling screens, which will keep residents and their families separated throughout. Alternatively, families can meet outside a care home window. I am afraid that that guidance fails on many levels. It fails to understand that it will not be possible for many care homes to put such screens in place. Even if they could, having a screen will not work for many residents, especially if they have Alzheimer’s or dementia. That is before making the frankly obvious point that the winter weather and dark afternoons make outdoor visits very difficult indeed.

It is little wonder that the Alzheimer’s Society says it is “devastated” by the new guidance. Its chief executive officer says that

“this attempt to protect people will kill them…
The prison style screens the government proposes—with people speaking through phones—are frankly ridiculous when you consider someone with advanced dementia can often be bed-bound and struggling to speak.”

Age UK agrees, saying:

“In practice we fear it will result in many care homes halting meaningful visiting altogether, because they will be unable to comply with the requirements laid down.”

I know that the Minister will say that we are going to have a pilot to test families, but when will that pilot start and how long will it take? It has been eight months since lockdown began. Why has this not been a greater priority and why has more progress not been made? The bottom line is that a pilot is not good enough or quick enough. We need those visits now. Will the Minister finally agree to prioritise family members for testing, including with the new lateral flow tests that are being used to mass test people in Liverpool and students across the country?

I understand that those tests have low numbers of false negatives and can be turned around in 20 or 30 minutes, making them a good option for testing families with loved ones in care homes, as my director of social care in Leicester is calling for. I know that families, including my own, are desperate to get their children back from university for Christmas, but what about families who have not seen their loved ones for eight months? They want to know where they are in all the extra testing that is going on.

We all know this pandemic has had unimaginable consequences for care workers and for families and their loved ones. Care workers have made immense sacrifices to look after our loved ones, and they deserve not just our praise and admiration, but to be properly valued and paid. However, we have to understand that families are an integral part of the care system too. I believe you cannot have good-quality social care without the real involvement and active participation of families. People who have dementia lose their memory; their families are their memory, and the best possible quality help and support cannot be given without families. I hope the Minister will listen to the concerns that I and other hon. Members have raised and I look forward to her response.

Photo of Helen Whately Helen Whately Minister of State (Department of Health and Social Care) 3:40 pm, 11th November 2020

It is a pleasure to serve under your chairmanship, Ms McVey. I congratulate and sincerely thank my hon. Friend Joy Morrissey for securing this debate. My thanks also go to all those who have come here today and made such powerful speeches, talking about the really difficult situation of visiting restrictions in care homes. My hon. Friend spoke extremely powerfully on behalf of Jamie, acting as his advocate in this tragic situation. I thank her for discussing this with me in advance of the debate; I am looking into that case.

As many hon. Members have said this afternoon, and as Minister for Care I strongly agree, visiting is incredibly important for those living in care homes. It is hard to put into words how paramount, how crucial, contact with their loved ones is for residents in care homes, but let me offer three reasons. First, for the individual in residential care, it can be what makes life worth living. The chance to see a loved one—a husband, wife, son, daughter, grandchildren or oldest friend—these visits are things to look forward to.

Secondly, visits to see their loved ones are important for family members. I have recently heard about a couple, both in their 90s; the wife is living in a care home and her husband always used to go to see her, but he has not been able to do so for months. This is actually affecting him more than it is his wife, who sadly has much less awareness of the situation due to her advanced dementia. It is affecting him because he is not able to see her. So the visits are important for the family who want to visit as well.

The third reason is the role that families and visitors play in making sure their loved one living in the care home is safe and well—the role they play in their care, in fact. Hon. Members have spoken today about the problem of residents, especially those with dementia, who are deteriorating without the visits they are used to. The advocacy role is also important, as my hon. Friend mentioned.

To step back a moment, the Government’s overall aim is to keep people in care homes safe and well—as safe and well as possible in the extremely difficult circumstances of a pandemic of a virus that is so cruel in in how it affects the old and most vulnerable. As Patricia Gibson said, it is an incredibly hard balance to strike, and I appreciate the way she spoke about that. On the one hand we want to enable visits to care homes, to enable people to have the things that make life worth living, but on the other hand, we know that when covid has got into care homes, when there have been outbreaks, it has been extremely hard for care homes to control it. That we have seen so many deaths of people in care homes is tragic. The hon. Lady is absolutely right; it is a cause of sleepless nights for me and others who are trying to make the right decisions.

In my remarks, I intend to speak first about what has happened, then say where we are now, and finally look ahead. I will do my best to pick up some of the questions and comments from colleagues.

When the pandemic hit us, it is true to say that visits were stopped, other than in exceptional circumstances such as end of life. The problem was so bad and there seemed to be such a risk for care homes that visits were stopped. During that period, I spoke to care workers who really went the extra mile to support care home residents through that time—to try to make their lives still worth living and to have positive moments, and to use technology to keep people in touch.

I am not naïve—I know that having a screen is not the answer to the problem of visiting, but for some people in some circumstances it has enabled more contact between those living in residential care and their families. It certainly does not work for everybody. It is not the whole answer.

That is one reason why, as covid rates came down during the summer, new guidance was published on 22 July to encourage the opening up of care homes and to enable more visiting. It supported local discretion; the director of public health and the local authority would work with care homes to agree a reasonable level of safe visiting, using PPE and social distancing and so on. I was very keen to see care homes opening again. Many people did have the chance to see their family members in care homes during that period. Unfortunately, not every care home managed to open its doors at that point and, as Holly Lynch mentioned, those in tier 2 or tier 3 high-risk areas still maintained strict restrictions on visiting.

As Rachael Maskell mentioned, there is a real problem of closed environments. One of the things that visitors do is raise a concern if there is a situation in a care home. She and I have spoken about an issue in her constituency a while ago, which was of great concern. That is why, when we went into the current lockdown, I was determined that we should not return to the situation of the first lockdown, where care homes were closed. I was determined that we should continue what visiting we could safely allow, and continue to have the Care Quality Commission crossing the threshold of care homes to identify and investigate where concerns had been raised. That is why the current visiting guidance is to encourage care homes to enable covid-secure visits, using screens, windows, visiting pods and so on.

Some care homes have been incredibly creative and innovative. My hon. Friend Andy Carter had a great example of a care home in his constituency. The guidance draws on methods that we have seen care homes using over the last few months, with the aim of getting others to follow suit. It is supported by being able to draw on the infection control fund. We have put £1.1 billion into funding to support care homes with the extra costs of providing covid-secure care.

I absolutely hear the message. This is not where we want to be. I want people to be able to hold hands again, hug again and have the physical contact we all need, which is particularly important for those with dementia and those for whom this whole situation is confusing or frightening. We know it has been bad for their health and wellbeing. Right now, however, to allow such contact goes strongly against the clinical advice I have received.

I have been advised that every single additional person going into a care home takes with them the risk of taking covid into that setting. In some parts of the country, one in 40 people have covid. If there is a care home with 40 beds and each person has a visitor, one of those visitors may well be carrying covid into that care home, unbeknownst to them, because they may well have no symptoms. When it gets in, it can be extremely hard to control. That is why we have taken a cautious approach, but I absolutely want to open up care homes to allow for the kind of visiting that people want. I am looking ahead.

Hon. Members have asked about testing, which will be so helpful in reducing the risk that someone going into a care home is taking covid with them. We have a huge testing programme in place in care homes for staff and residents. Staff are tested weekly, and the vast majority of staff are now undergoing that. That is really valuable in catching covid outbreaks early. Residents are tested every 28 days, and the next step is testing for visitors. A trial will be launched this month in four local authorities in areas of lower prevalence, where the risk is lower. That will launch on 16 November in a range of 30 different care homes both to assess the practicalities of testing and to make sure that we are confident in its safety. That will trial both the polymerase chain reaction—PCR—test that has been used for some time and the newly introduced lateral flow test that can be turned around quickly.

Trialling both will enable us to see which is the best to enable visiting, and we then plan to roll that out more widely across the country in December to see how many visits testing will enable. I am optimistic that that, combined with the lower covid rates that our national self-discipline during the lockdown should achieve, will make it much more feasible to enable more testing. Looking ahead, the prospect of a vaccine that may be effective against covid, alongside testing and a supply of PPE, should put us in a much better position to achieve the level of visiting that we all want.

Photo of Dan Carden Dan Carden Labour, Liverpool, Walton

Mass testing is taking place in Liverpool and many people are hopeful that that will allow for more visits to care homes in the weeks ahead. Will the Minister comment on what talks she has had with Liverpool about that?

Photo of Helen Whately Helen Whately Minister of State (Department of Health and Social Care)

I am happy to do that, because I have been looking into that issue as well. The guidance I have been given is that Public Health England and those running the trial want it to take place first in the 30 care homes, which I mentioned. That will enable us to have confidence that those who have had a lateral flow test will be able to visit. There is sequencing to be done, but the issue is at the top of my mind. Lateral flows tests are already being used, and we should make the most of that to enable visiting. I hope to be able to put that more formally in writing in due course.

In the time available, I wish to pick up on a few of the other points that were made in the debate. Daisy Cooper referred to the 30-minute time limit. I believe that that must be something that the care home in question has chosen to put in place. Our guidance advises that one should book a visit with a care home, but does not stipulate a 30-minute limit.

My hon. Friend Huw Merriman set out an excellent list of things for me to take forward. Many of them are indeed in train, such as testing and work on the vaccine. The Joint Committee on Vaccination and Immunisation has proposed that care home staff and residents should be at the top of the list for that. He mentioned a reporting mechanism, which I am also taking forward.

Dan Carden referred to the lottery of visits. On the one hand, we responded to local authorities and care homes when they asked for more discretion and a local say in how we respond to the pandemic; on the other, we can find that in one area there is far more access than in another, so we need to combine allowing local discretion with being able to investigate whether somewhere is not being so supportive of visits. We need to ask what is going on and how can we bring this about.

My hon. Friend the Member for Beaconsfield focused on the situation of those of working age living in a residential care home. As she said, they have been talked about less during the pandemic than those of an older age, but the people of working age living in residential care are absolutely at the top my mind. As we have seen during the pandemic, those with learning disabilities might be at greater risk if they catch covid, and, like those of an older age with dementia, they need family visits and the support, love and advocacy of a family member.

As my hon. Friend also said, the pandemic has shone a light on some of the problems that existed in our social care system before the pandemic. Yes, the pandemic has been hard for social care, but there were problems before. Although the vast majority of care homes have provided wonderful supportive care—indeed, loving care—for those who live in their buildings, some have sadly let down those they care for. We must continue to identify, intervene and prevent cases where there is neglect or, worse, the abuse of those living in residential care.

We are in the thick of a pandemic that has made life so hard for those living and working in the social care sector. We have to step forward, get on the front foot and really achieve the social care reform that everyone has been crying out for, for so long. This is an, “If not now, when?” moment. We will seize this moment not only to support social care through the pandemic, but to bring about a system of social care where we can hold our heads up high and be happy for the care of our loved ones, our friends and family, or indeed for ourselves, should the time come when we need it.

Photo of Joy Morrissey Joy Morrissey Conservative, Beaconsfield 3:58 pm, 11th November 2020

I thank the Minister for her kindness and humanity, and for how she and her Department reached out to me personally. That demonstrates her care and her compassion both for this subject and for those working age adults with complex needs and disabilities whose voices might not have been heard over the years. I appreciate her one-on-one attention and the engagement she has dedicated to the topic. I am incredibly grateful.

I want to highlight the excellent contributions of all hon. Members today. Although we come from different parties, we are united in wanting to highlight the needs of the most vulnerable and wanting to thank our care workers.

I also thank the Scottish National party spokesperson, Patricia Gibson, for her incredible weighing up of the impossible situation that every Government, every Member of Parliament and every public health official finds themselves in. We did not even know what the devastating effects of the virus would be. It attacks the elderly and those who are already in care. We have the impossible situation of their mental wellbeing versus the actual preserving of life. No matter what party we are from and no matter our background, this is one of the most difficult challenges that any generation of politicians has ever had to face. I thank her for reminding us of the humanity involved.

Motion lapsed (Standing Order No. 10(6)).

Sitting suspended.