Older Persons: Human Rights and Care
(7 years ago)
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Lord Foulkes of Cumnock
That this House takes note of the human rights of older persons, and their comprehensive care.
Lord Foulkes of Cumnock (Lab)
My Lords, I am grateful to the Labour group in this place for giving me the opportunity of leading off in this debate on an issue which has concerned me for many years.
First, I must declare an interest. It is not my age—a lot of us might have to do that, although not the Minister, of course. I am the chair of Age Scotland, the charity concerned with all aspects of concern to older people in Scotland. As the noble Baroness, Lady Greengross, knows, in the 1970s I used to be director of Age Concern Scotland. When I was first made a trustee of Age Scotland, Brian Sloan, the chief executive, said that he remembered that, but that I had more of a vested interest in it now—rather cheeky, but he was right: I have a vested interest in it now.
I am grateful for all the submissions that we have received—I think noble Lords will also have received them—from Age UK, Age International, the Local Government Association, Independent Age and many others. I also commend the House of Lords’ Library for its excellent briefing; it really is good at this kind of briefing. All of this underlines the importance of this issue.
This debate is to look at older persons in the context of human rights, not just care and compassion—although that is important; we all need care and compassion and we must not forget that. But it is in the context of human rights that we are looking at the subject today, because it will affect us all. Assuming we avoid the grim reaper, everyone will be moving into older age. The United Nations has looked at this in the human rights context for some time, since its Second World Assembly on Ageing in 2002. The UN set up an open-ended working group—it is a pity in some ways that it is open-ended.
The Council of Europe has also been looking at this. My report, which is the basis of our debate today, was adopted unanimously by the Council of Europe Parliamentary Assembly in May this year. I thank the staff who helped me to produce that report; I could not have done it without them. The Council of Europe has been looking at the subject in this context since 1996, when it adopted the European Social Charter on the rights of old to social protection. All of that is good, but the problem is that little or nothing is done about it. All these things are agreed and adopted, but then they have to go to national Governments to be implemented which, I am afraid, does not always happen—indeed, it happens very seldom.
On 11 July, as the Minister will recall, I had an Oral Question about this. He noted it and followed on with—I was going to say the usual platitudes but, since I like the Minister, I will say the usual good and nice words that someone had written for him. I am hoping that we get better today; he has had longer to think about it and I am ever the optimist. Even in the Library earlier on, he asked me what kind of reply I would like, so I gave him a hint.
Let me outline some of the issues. First, there is the demographic challenge, which underlies all this. As Independent Age said, just to give one statistic:
“there will be nearly 16 million people aged 65 and over”,
in Britain by 2030. The number of those aged 80-plus is going up even faster and the number of centenarians is set to double. That indicates that the size of the problem is growing day by day, week by week, year by year.
A key aspect of the report which must be taken account of to ensure that, as the numbers go up, individuals are not disadvantaged but get a decent life is, first, the need for an adequate income. This is central to everything. Maintaining the triple lock is vital—and so far, so good. But when I heard my noble friend Lady Sherlock say earlier on that, because we have the triple lock, pensioners are lucky compared with some others, I worry. There is an attempt sometimes from Governments to divide and rule and to say that pensioners are okay compared with families with young children. It is not true for most pensioners, who are not all that much better off. It is this divide and rule that worries me. It occurs to me—we all saw the Panama papers—that if those with their fortunes hidden away in the Isle of Man, Bermuda or the Cayman Islands were to pay their fair share of taxes, there would be enough to provide decent incomes for people at every stage of their lives.
The second issue is appropriate housing, close to amenities. Instead, older people are often in cold houses, isolated from amenities. Age UK argued very effectively in its submission that older people want comfortable and attractive housing alternatives that promote healthy and active lifestyles. That saves money in the longer term.
I was really disappointed recently to see in Edinburgh—my home town now—more and more student houses being built, almost ghettoes of student houses. One thing that we recommend in the report is more intergenerational provision: housing for older people and younger people, including students, in the same area. I saw that in Denmark and it was working very well. They can help each other, so it can be mutually beneficial. The other type of intergenerational provision that I saw when I was preparing this report were day centres for older people combined with children’s nurseries. Not only was it good to have older people mixing with young people and vice versa, but the staff were helping each other out and learning from each other. Intergenerational provision must be looked at a great deal more.
This brings me to the central issue of social care, both residential and domiciliary. We must all recognise and acknowledge that most of it is, and will continue to be, provided by families as they look after relatives. But they need more and more help—they need respite care and domiciliary support. The scandal of less than 15-minute home care visits must end. There must be decent visits to look after older people living alone. We need proper home help services, district nurses and, above all, chiropody—it seems like a small thing, but if older people do not have proper chiropody and podiatry services, they cannot get around. It is vital. When old people are in residential homes, they must be looked after by properly trained staff. Age UK also makes some recommendations on that.
Now we come to my central point: we need a charter of rights for older people. That is what the UN said, and the submission that Age International sent to us all endorses it. For example, care in older people’s homes needs proper inspection by properly trained staff. Age UK has made recommendations on that subject as well. There are examples of abuse, such as what we saw on the Channel 4 documentary on Haringey. We only get to know about that when a whistleblower tells us about it—whereas if there were more frequent regular inspections without notice, as is advocated, and stiffer penalties for people breaking the rules, we might be treating old people better.
Let us look at abuse in a wider context. Far too much abuse, by relatives for example, is hidden, and we do not know about it. Sometimes—let us be honest—there is coercion, in relation to the drafting of wills and things like that. There is also abuse by commercial interests, especially now—the telephone calls and internet activities aimed at people who are not necessarily as clued up as younger people are, and can be taken advantage of.
In relation to social care, one of the difficulties we experience is bed-blocking. Beds that ought to be available for acute care in the NHS are being used by older people who should have been out of them some time ago, but the social care is not available—a package has not been devised. That is why the report recommends the integration of health and social care administration. At present, there are silos of NHS care and social care, with the money in their own budgets. In Scotland people are trying to bring health and social care together; in theory it is happening, but in practice it is not working on the ground. Some of the old traditions and patterns need to be broken down. That is another key issue that emerges from the report and the recommendations.
That brings me to another issue that needs to be included in the charter: an end to age discrimination. It is astonishing that age discrimination still takes place. It was supposedly outlawed in the Equality Act 2010, but although fairly strong action is taken on gender and race discrimination, that does not happen with age discrimination. One of the submissions tells us that the Royal College of Surgeons and Age UK examined the possibility that older patients may be discriminated against regarding access to surgery in England. Their first report, published in 2012, found that elective surgical treatment rates declined for the over-65s, in spite of this age group’s increased need for health interventions. The doctors say, “I’m sorry, you’re just too old. It’s not worth spending the money on you, because you’ll be dead soon.” It is outrageous that such discrimination should take place, and it must end now. I hope that the Government will pick that up.
Of course, not all older people are frail and dependent. We need to acknowledge that. I have talked a lot about those who are, but many are active, and promoting active ageing is included in the report. We need to encourage active ageing, and volunteering. Older people can and do volunteer, and they should be encouraged to do so more, partly to help even older people, but also to help younger people. They should also be encouraged to get about. I was interested in the Local Government Association’s submission about transport, which said that long-term underfunding for concessionary fares and free transport was about £200 million. Yet the best thing ever for getting older people active, and out and about—I advocated this myself when I was a councillor—is free transport. People travel from Glasgow up to Orkney, and down to the south of Scotland. That is keeping them out of old people’s homes and out of hospital, and making them less of a burden on the welfare state.
That is all included in the report, and I hope that we will get a positive response from the Minister. He may well challenge me and say, “If there was a Labour Government, what would happen?”. He is entitled to do that but, if he looks at our manifesto for the last election, he will see that we proposed substantial increases in social care funding and a lot of the things included in the report. Sometimes I get told off for bringing politics into the House of Lords; I am not sure why, because we are here as part of the legislature. A general election may or may not be around the corner, but older people cannot wait for a Labour Government to come to power before some of these improvements get under way.
I hope the Minister will indicate that the work that has been put in by all the organisations that I mentioned, the Council of Europe and the United Nations in identifying the problem and indicating the solution will at least be picked up to some extent by this Government. If it is, I for one—I was going to say I would die happy—will continue to live in increasing happiness.
The Deputy Speaker (Baroness Andrews) (Lab)
The Question is that this Motion be agreed to.
Lord Balfe
I shall try to get it right this time.
I draw attention to my entry in the register and congratulate my fellow member of the Council of Europe, George—the noble Lord, Lord Foulkes—on tabling this Motion. As he rightly said, his report was adopted unanimously, which means, of course, that our side voted for it as well. I also welcome the noble Baroness, Lady Thornton, back to the Front Bench, where I am sure she will continue to make a distinguished contribution.
As many noble Lords know, I have spent far too long in Europe and probably spend far too long following what is going on. I was interested to see that this Friday in Gothenburg there is a meeting of the Social Affairs Council to discuss social rights and the 20 principles of social rights. The Commissioner, Marianne Thyssen, has indeed said:
“We go for a Europe where our citizens come first”.
I only mention that in passing because this is yet another thing we will lose when we leave the European Union. We will no longer be part of these conversations and discussions on how to get best practice.
The report we are discussing talks about ensuring,
“appropriate assistance and support for older persons living in their homes, including medical and nursing care, meals on wheels and domestic assistance”.
I regret that, of all the briefings we have received for today’s debate, none has come from UNISON, the major trade union involved, or other representatives of what one might call the workers. Indeed, the only document I have received, which is a very valuable one, is an article from the Institute of Employment Rights on why collective bargaining is needed for workers in this sector. We often forget how many people work in social care. It is 1.1 million, the same number who work in all the pubs, restaurants, bars and cafés in England put together, but these are an unsung army. These are the people you see at 5.30 in the morning by the bus stop, going to help to get people up. They are the backbone of the social care system in this country, but sadly they often go unrecognised. Part of the reason for that is because it is very difficult to enforce individual rights if you are basically a lone employee of a privatised service.
I know that we have saved lots of money through privatisation but we have also saved much of it at the expense of the people right at the bottom of the pile—the people who dare not claim their holidays and who are afraid to put their head above the parapet because it could mean the end of their job. I do not think my next point is a party one because I think that we have both been as bad as each other, frankly. I want to hear us say that although this work is individual in nature, we need individual rights that are easier to enforce. We have one of the weakest law enforcement structures in relation to the rest of western Europe, and we have gone backwards. If noble Lords go back to the much underrated but signal figures of the Conservative Party, Stanley Baldwin and Neville Chamberlain, they will see that, during the 1920s and 1930s, with the erection of wages councils, the protection of certain groups of workers came right to the fore—and stayed there until the wages councils began to be dismantled in the late 1970s.
We need a central collective bargaining mechanism which lays down basic principles for workers within this specialist field. The issue is not just about the minimum wage; there are also questions about, for example, sleepover allowances and casualisation. When we are told that employers cannot afford to pay the minimum wage, my reaction is that there is something wrong with the system, not with the employers.
I appeal to both parties to look at the need for a system of collective bargaining and responsibilities—an end to the excessive casualisation of this sector and an acceptance that care for the older person, which is the heart of this report, has also to include respect for the carer, who puts so much into making life reasonable for many older citizens. We have a duty to them. I thank the noble Lord for introducing this report, which enables us to look at a very wide range of problems.
Lord Haskel (Lab)
My Lords, I too thank my noble friend for moving this Motion. His qualifications date back to his time as director of Age Concern in Scotland. My qualifications simply date back.
The numbers are compelling. In this country there are now 11.5 million people over 65 and this figure will be half as much again in 10 years’ time. The Council of Europe is absolutely right to draw this demographic change to our attention in terms of human rights because we have to plan for it.
The declaration speaks of integrating health and social care services, and this is where the difficulties lie. At present, in planning for this demographic change, we have to decide where the NHS ends and where social care begins. Until we have a continuum of health and social care, we shall have only short-term solutions, dealing with emergencies as they arise.
At the moment, this changeover is held together by dedicated people—in the NHS, in the caring professions and in families. I hope the Minister will join me in acknowledging this. Surveys show that most of us would pay more tax to finance an integrated system—a solution which makes the Government very nervous. There is talk of a hypothecated tax similar to the local authority precept. But after a while, as we all know, the numbers become cloudy and cease to differentiate between general taxation and a hypothecated tax. Integration may not be cheaper, but it would certainly give better results—because there would be continuity and balance in people’s lives.
Ageing is not a genetically predetermined set of events. Over the years, research has identified—and it continues to identify—the biological processes that cause ageing. This, together with improving health at all stages of our lives, means not only that we are living longer but that we are healthier as we age. Next month incidentally, POST, the Parliamentary Office of Science and Technology, will issue a note about healthy ageing, explaining how this came about.
But in spite of this, many automatically assume that having lots of older people is a problem. They tend to think about older people almost exclusively in terms of pensions and care. We have to challenge that view and change the attitude by emphasising the right for older people to continue working and volunteering. It is part of diversity. It is also part of healthy ageing, because much of our identity is expressed through the work we do and the service we give. The Council of Europe report touches on this, but I would like to see a lot more emphasis put on it. It seems a logical outcome for all the effort that we put into healthier ageing.
The good news is that things are moving in the right direction. Business in the Community has set up the Age at Work Leadership Team, and in 2016 Andy Briggs became the Government’s Business Champion for Older Workers. The Global Coalition on Aging is inviting businesses to sign up to its age-friendly business principles. BT, for instance, is an employer that has recognised the importance of this and has introduced flexible working to support older workers. Can the Minister assure us that the Government welcome these initiatives and will support them?
Finally, my noble friend, quite rightly, emphasises the human rights of older people. Of course he is right to do this, but rights are wasted unless there is awareness. Older people, their carers and employers have to know that other people have these rights, what they mean, how to exercise them, and how to seek redress. All this could well be expressed in a charter, as my noble friend suggests. Can the Minister tell us whether the Government will prepare a charter? What will they do to raise the awareness of the human rights of older people?
Lord Cashman (Lab)
My Lords, I refer your Lordships to my interests in the register and to my date of birth. I congratulate my noble friend Lord Foulkes on securing this important debate and on his excellent report. Of course, the noble Lord, Lord Balfe, will remember that I was one of the co-rapporteurs on the framework directive of 2010 from the European Parliament on combating discrimination on access to goods and services on the grounds of age, disability, sexual orientation or gender. That is still resting and blocked by Governments who do not want to take the necessary action—so there needs to be taken at national level on this important issue.
The reality is that we are failing many older people when they need us most. The Care Quality Commission’s annual state of care report of 2017 found that only 2% of adult social services were rated outstanding: 78% were good, 19% required improvement and 1% were rated as inadequate. Before we congratulate ourselves, let us remember that the 1% represents 303 locations and approximately 16,000 individuals whose care was inadequate.
The report also, importantly, reveals wide variations in quality ratings between different types of homes and services. Community social care services were rated the best overall when compared with other services. Domiciliary services and residential homes received similar ratings. However, nursing home services received the worst ratings, with 68% rated as good, 28% as needing improvement and 3% as inadequate. Within these stark statistics are hundreds and thousands of vulnerable adults whom we are failing.
I am pleased to be reminded by the noble Lord, Lord Haskel, of the issue of human rights that is predominant in this Motion. That is why I turn specifically to the issues of human rights and discrimination and other issues faced by older people—in particular, people living with HIV. The Terrence Higgins Trust report, Unchartered Territory, surveyed nearly 250 people living with HIV across the UK, all of them aged over 50. Some 58% of respondents were defined as living on or below the poverty line. Over one-third of individuals living with HIV were reliant on social security payments. Some 84% were concerned about future financial difficulties and a third of respondents were socially isolated. Some 79% were concerned about memory loss and cognitive impairment in the future and how they would cope with managing multiple health conditions.
The challenges are many and varied. There is a difference in needs and experience, depending on whether an individual was diagnosed before antiretroviral drugs were available or after. Individuals diagnosed before treatment was available were more likely to have more additional health conditions. Social care is not currently meeting the needs of people living with HIV as they grow older because they face the prospect of managing multiple long-term conditions that are made more complex by their interactions with HIV. Even those who have been able to access social care have faced discrimination from social care professionals due to their HIV status. This discrimination is fuelling myths and stigma around HIV by treating people living with HIV differently from other social care users.
The Minister and his department will also need to address discrimination faced by older LGBT people. Care providers need to recognise and respect LGBT identities and should ensure that LGBT identity is not marginalised, nor rendered invisible, and that LGBT elders are not outed deliberately or inadvertently. There are human consequences to this. Unfortunately, the problem, as evidenced in the Stonewall/YouGov research, Unhealthy Attitudes, found that a quarter of health and social care staff had never received any diversity training at all. Some 72% had not received any training on the health needs of LGBT people and, shockingly, only a quarter of staff had received any training on trans people’s healthcare. The training of health and social care staff in understanding and engaging with the particular needs of LGBT+ people is an important and deliverable objective to improve the quality of life of these people.
Time does not allow me to offer the House further examples, but I ask your Lordships to imagine what it must be like to once again have to validate your life, your love and your relationships at a time when you are vulnerable and when these have been, and should remain, the one constant in your life.
Baroness Greengross (CB)
My Lords, I congratulate first the noble Lord, Lord Foulkes. We shared for many years a mutual interest in promoting the rights of older adults and many other interests, including the legal systems of our two countries regarding children and young people. As outlined in the excellent report he has introduced, the emphasis—which I share—on intergenerational work is so important, because intergenerational relationships promote the best sort of life for both old and young.
The human rights of older people are only part of universal human rights. Older people must always be treated as adults. Their rights cover not only employment—as in the US—but, in this country, the provision of care, goods and services. When services are worse, or of a lower standard than those provided to younger adults, this is an infringement of those rights and a serious form of age discrimination. When I was a commissioner on the Equality and Human Rights Commission, I headed up an inquiry into domiciliary care in this country. We found that only 50% was of an acceptable level: therefore, 50% was not, and things have certainly not improved since we did that piece of work.
Turning to social care more broadly, we know that local authorities spend £8.8 billion a year on care for the over-65s in England, and that a further £10 billion is spent on formal care services by self-funding individuals and informal carers. If local authorities, self-funding and informal care are included, the total cost of social care is similar to the annual amount that the UK spends on the NHS. The consequences of long-term underfunding are an even more fragile provider market, growing and undermet needs, further strain on informal care, less investment in prevention, continued pressure on an already overstretched care workforce and a decreased ability of social care to help to mitigate the demand pressures on the NHS. We know that this is having a huge impact on many people supported by adult social care and support services.
The extra money for social care announced in the spring Budget was a step in the right direction, but it is only one-off funding that decreases each year and stops at the end of 2019-20; it is not a long-term solution. A report by the London School of Economics found that 1 million older people reported poor or inconsistent standards of dignity and respect when in hospital, and even not getting enough help to eat. The last CQC report found that levels of inadequate care had risen, with 25% of services not considered good enough. Stories of abuse and neglect within both residential and nursing homes are still far too common, and Health and Social Care Information Centre figures show that the majority of all safeguarding concerns relate to people of 65 and over. Inequalities in life expectancy are also very serious and have been rising, particularly for women.
So there is a huge amount that needs to be done. Supporting longer, healthier lives must be a critical priority for the Government and employers, as well as for people who experience social care. Only through such an effort will we be able to succeed in a number of key policy areas such as raising the state pension age and securing a sustainable health and care system. Human rights are universal; they do not lessen with age. If we forget that, we of all ages are equally lessened.
Baroness Massey of Darwen (Lab)
My Lords, I thank my noble friend Lord Foulkes for introducing this important debate with his usual vigour and enthusiasm. He and I are members of the UK delegation to the Council of Europe, so I have had the pleasure of following the development of this report on the human rights of older people over the last year. My noble friend has done a most thorough job of exploring many angles of the issue of ageing. I shall touch briefly on three of them today: legal and policy frameworks, the concept of “active ageing” and end-of-life care.
I remember seeing some years ago what was once a familiar road sign warning: “elderly people crossing”. Noble Lords clearly remember it. The man was bent double with a walking stick, with a helpless-looking woman at his side. It was criticised for being stereotypical. My noble friend’s report tries to counteract such stereotypes, which, like all stereotypes, are damaging and oppressive. Indeed, they may contribute to older people’s views of themselves—how they should look and behave, and so on. It must be damaging for their mental health, to say the least.
In your Lordships’ House and elsewhere, I usually discuss the other end of the age spectrum: children. Whether we are talking about children or older people, though, policy frameworks are important. Those of us involved in children’s issues have the Convention on the Rights of the Child to draw on. We use it as a kind of touchstone—a charter, to use my noble friend’s word. As my noble friend points out in section 2 of his report, there is no international legally binding instrument devoted to the rights of older persons. Many of us have called for one, including the UN independent expert on the enjoyment of human rights by older people. The European Convention on Human Rights applies to older persons, even though it is not explicit. The European Social Charter contains several articles relevant to older persons. The Council of Europe and its Parliamentary Assembly have promoted the rights of older people. The UN is actively working on this. There is concern: it needs to be pulled together.
When I talk about children’s rights, I always say that it is not only about protecting children: it is about empowering them. My noble friend is supportive of this concept for older people. A growing proportion of the population that is inactive and dependent is not only expensive for the state, but it is a waste of energy and talent. I am a great believer in prevention: we could improve systems to educate people when younger to help themselves through diet, exercise and ongoing mental activity. We should do more to support people through social systems. We know that many older people experience infringements of their human rights in later life. A recent Care Quality Commission report reveals inadequate and inappropriate levels of care and safety concerns. The noble Baroness, Lady Greengross, referred to this earlier.
Inevitably, of course, people die, and many are by no means elderly. I witnessed a dignified death when my brother died of cancer last year. Dying can be dignified for the person and, importantly, for the relatives and friends. My brother died in a beautiful hospice in Cheshire surrounded by flowers and cheerful, dedicated people after wonderful care. Some of his last words to me were: “You’ve got to sort out this hospice funding situation”. It is a situation that I was unaware of and I ask the Minister to clarify it. It seems that, if a person at the end of life goes into a care home, the money follows the patient. If they go into a hospice, however, the money does not follow the patient. Hospices are funded through their fundraising and bequests. I do not know why this should be. Hospices seem to me to be an excellent model for end-of-life care. Perhaps the Minister can explain.
Again, I thank my noble friend for raising the issue of the human rights of older people. We are talking about human dignity, support and empowerment, which are all absolutely key to any human rights.
Lord Lipsey (Lab)
My Lords, by far the worst abuse of older people is poverty. This welcome debate covers many other forms of abuse—ageism, elder abuse, inadequate care—and they are all very important. However, it behoves us to remember that, according to official figures, some 1.9 million older people live in poverty, which means that their income is below 60% of median earnings in this country. That is one pensioner in six.
Half a century ago, we were all very conscious of pensioner poverty. For one reason or another—perhaps because of better pensions and the rise in home ownership—that recognition has declined. Now, instead, people are talking about intergenerational fairness, which means giving older people less and younger people more. The research, including the excellent book by the noble Lord, Lord Willetts, has emphasised that the older generation has done increasingly well while the younger generation—generation rent—struggles. There is something in this, but it is a gross and important oversimplification. Rather than thinking of the elderly as one generation, we should think of two groups of elderly people. One group—I hope noble Lords will forgive me—is people like us, who are doing quite well. We enjoy wealth in the form of owning valuable homes that can be easily turned into cash through equity release. That wealth will be tax-privileged when we die, and on top of that we have had the chance to build pensions through our lifetimes: employer schemes, personal pensions and self-enrolment, which is now adding to our numbers. Meanwhile, the state has gone out of its way to hand us more dosh.
The noble Lord, Lord Foulkes, referred approvingly to the triple lock. The triple lock is an absolute disaster, making us richer at the expense of much poorer working people—free bus passes; at 75, free TV licences. Last night I got home to find a large tax bill and with it, guess what? A piece of paper awarding me my winter fuel payment of £100—tax free, naturally. I have dispatched it to charity.
However, another group, the 1.9 million I referred to earlier, is materially seriously deprived. They do not own, they usually rent. They may not have adequate state pensions because they have not had the earnings record to get one, so they are forced back on to means-tested help. If they need care outside their own homes, they will be forced back on to the care that the local authority can provide. Local authorities now provide care only to people in gross need—care that is so cheap that it struggles to be inadequate. Those people cannot even look forward to leaving their struggling kids an inheritance.
These problems stem, in part, from deep social inequalities affecting all generations at all ages. However, in the case of the elderly there is one other factor that we should not ignore. It is a combination of the bad effects of two aspects of our politics. From the right has stemmed extreme restraint over public expenditure—austerity, if you like. That lies, for example, at the heart of the care crisis. At the end of the day, when all is said and done, the answer to the care crisis is more money. But I fear that we on the left have also made a big mistake through our belief that all state benefits must be universal. There has been a liberal wing drifting out from academia, and it still permeates large sections of the left. So we all get these universal handouts, I get my fuel allowance, and the result is that the money is not available to target the true causes of poverty in old age.
Yesterday I and many other Members of this House attended the memorial service of the great Lord Joffe. He was my ally in this matter. When we sat on the Commission on Long-Term Care in 1999, the majority wanted care to be a universal benefit, free to all who need it, paid for in full to the rich. Joel and I argued instead that the top priority for scarce public money was to spend it on better care services for the poor, not on these huge handouts to subsidise the rich and, more particularly, their children, who would inherit the money from them. Life is about hard choices. We can have universal benefits for the elderly, or we can target the poverty among the elderly that is making the lives of so many a misery. Alas, we cannot spend the same money on both, but I know which I would put first.
Baroness Cavendish of Little Venice (Non-Afl)
My Lords, I thank the noble Lord, Lord Foulkes, for securing this very important debate with its enormous number of issues.
I do not feel I can follow that powerful argument by the noble Lord, Lord Lipsey, without addressing it, because he has an enormously important point to make. I shall make one suggestion, which I was going to make anyway, because this issue of intergenerational equity, and the triple lock that was referred to earlier, is becoming increasingly toxic in our political life and is dividing the generations. One way through it would be to look in the round at all the benefits that go to the over-65s. We need to take the pensions, the bus passes, the personal independence payments, the care allowances—a huge number of benefits go to certain people in that age group—and set them against the increasing lifetime costs that those people face, especially the group who develop multiple chronic illnesses quite early. I suspect that many of the 1.9 million that the noble Lord, Lord Lipsey, referred to may be in that category. They develop those illnesses at quite an early stage, they find it difficult to continue to work and they are stuck in what I agree is a completely different group. I just wanted to make that point.
I sat on the board of the Care Quality Commission for two years between 2013 and 2015. I assure the noble Lord, Lord Foulkes, that we inspected care homes, though perhaps not regularly enough. As other noble Lords have mentioned, the CQC has uncovered some absolutely terrible and shocking cases of abuse. That does not mean it is perfect, but at least there is now a mechanism. I was also the author of the independent review into the 1.3 million unregistered workers in health and social care. As the noble Lord, Lord Balfe, said, they are, on the whole, deserving of our respect. One thing I was trying to do in the report was raise their status and recognise what they do. This is far too often still referred to as “unskilled”, but is actually deeply, deeply skilled and requires enormous maturity. I am glad to say that the Government have implemented some of my recommendations on training and the care certificate. I encourage them to keep moving forward on the idea of there eventually being one workforce across health and social care.
Some excellent examples of progress are now being made, particularly in Manchester, in pooling budgets and services for the over-65s. One of the missing pieces, however, will be that single workforce, with a common skill set and training. Partly as a result of the multiple chronic illnesses I referred to earlier, there is now a blurring of the lines between the jobs of healthcare assistant, district nurse and domiciliary care worker. It is increasingly difficult for people in the domiciliary care space who are going into homes where medical needs are quite acute. I would encourage more work to be done on developing that sort of joint training. We might perhaps consider including in this some of the relatives and volunteers who do so much of the caring work. They might benefit from some of that basic training and gaining that status.
I have two more points to make, the first about continuity of care. This has not been mentioned and is often overlooked. It is particularly important for frail elderly people, whether they are in a hospital ward or at home. The constant turnover of people in home care is obviously a difficulty for the sector, which is partly to do with money. However, in hospitals a bit more work and consideration need to be given to nursing shifts where, for some unknown reason, the same people reappear in a different part of the hospital for their next shift. That would make a substantial difference to a lot of very confused elderly people who are disoriented and some of whom have dementia.
Lastly, I entirely agree with some of what was in the report about negative stereotypes. There has been a lot of research in the US showing that negative stereotypes about older people being a burden influence enormously the way they feel about themselves and actually accelerate the process of ageing. Those of us in the media need to take more responsibility for the way we sometimes describe people without thinking. This is not malicious—it is just the way people talk in society—but the more that those in this House can do to challenge specific examples of it, the better off we will all be.
Lord Sawyer (Lab)
My Lords, I also thank my noble friend Lord Foulkes for initiating this extremely important debate. When I reflected on what to say in my five minutes, I intended to talk about something that has not been widely covered: isolation and loneliness among old people. I am going to change tack a little, but it is important that isolation and loneliness are addressed. The impact of being lonely on old people has recently been matched to the effects of smoking 15 cigarettes a day. When talking about comprehensive care for older people, we have to include a proper understanding and examination of the effects of isolation and loneliness.
I am sure all noble Lords will have heard similar stories, but I was told about a GP’s surgery in North Yorkshire, where I spent some time recently, at which a number of regular patients have nothing medically wrong with them. They book weekly appointments with the doctor because they want someone to talk to. I am sure that situation is not unusual, but it is a damn shame that it gets to that.
There is a great example for all of us in the new Jo Cox Commission on Loneliness. If noble Lords have not heard of it, it is well worth taking note of. It works in partnership with charities, supporting older people and carers. It puts a lot of emphasis on chatting, being happy to chat to neighbours, relatives and people in need of company. I think the commission is doing a great job by emphasising the power of talking. It sounds simple, and it is, but it needs to be done.
I want to move on now to join the noble Lord, Lord Balfe, whose speech motivated me to get up and say something quite different from what I intended to say. I thought it was great advocacy of people politicians never talk about: low-paid care workers. It was amazing that it came from the Conservative Benches. Perhaps the noble Lord is on the wrong Benches. How do we know? It was a very good speech and made me realise. Why Unison has not sent the noble Lord a briefing, I do not know, but the noble Lord made me revisit in my mind as I was listening to him the importance of making sure that we pay, train and look after care workers in the way we look after any other professional and do not see them as people at the bottom of the pile who always get attention at the very end when everybody else has had an opportunity to take their share.
When I was a young union official, I used to negotiate for those people. When they were employed by local authorities, as the noble Lord will remember, they were all covered by national agreements. Their pay, conditions and holidays were all covered, and so was their training and development. It was not very good at the time, but it was still covered, and there were still opportunities that were laid down at national level. The thing that changed all that, as we all know but it has to be said again and again, was privatisation. The privatisation of the caring services led to fragmentation of employers, some of whom, to be fair, have been reasonably good at doing the right thing. Others, however, have been pretty lousy at it and have not paid people properly, motivated them or engaged them in what the real job is about. This touches on the point made by my noble friend Lord Cashman, who made another speech that really moved me. How do we expect to get a fair deal for LGBT people when we do not get it in the sector at all? There will always be that problem unless we really address the pay and conditions of people who work in that sector and value them.
I do not think this will happen under a Conservative Government because it is essentially about cash. It is about saying that we respect people and value their work enough to say that, despite all the other pressures on us, we are going to make more resources available to pay them above the minimum wage, which is basically where they are now, and pay enough money to give them proper training and development. It is not going to happen, but I think it is a good test for the next Labour Government who come along. If a Government can do something about this problem, that is a good way of sending a signal that they really want to do something to help the older population and people who need care and attention.
Lord Jordan (Lab)
My Lords, I, too, thank my noble friend Lord Foulkes for bringing forward this important subject. I will take a practical look at what I see as a highly complex issue. My noble friend tells us that those aged 65 and over are expected to number 16 million by 2030. When we consider the current impact on the health and social care system of the ageing population, with two-fifths of national health spending devoted to people over 65, we see that the implications for the NHS of the growth trend in those over 65 are quite staggering. The potential effects on tomorrow’s health services will be of crisis proportions unless today’s problems are tackled intelligently.
It is certainly encouraging that the UN and the Council of Europe have recognised the issue and the rights of older people. There is tremendous value in international charters and conventions that set out necessary human rights. I, along with others, have campaigned for many of them. But that is where the real work begins, for how many countries have signed such agreements, only to pay lip service to what they regard as international wish lists? Climate change is a good example.
I remember meeting Dr Manmohan Singh when he was the Finance Minister—later to become Prime Minister—of India and trying to convince him that a social clause was needed in world trade agreements. He said that he was convinced personally but that India and other developing nations did not believe that a social clause served their economic interests. He was a truly honourable man, but the economic interests of India came first. I tell the story because I believe that it is at the heart of what we are debating. We have to show our Government and every other Government that finding solutions to the problems of older people will be one of the most economically rewarding tasks they will ever embark on. I believe we can and I believe we must.
My long association with the manufacturing industry, together with a more recent period as president—and now vice-president—of the Royal Society for the Prevention of Accidents, has taken me on a more pragmatic path to progress this issue. The particular issue I would concentrate on is what I think older people see as their main priority: health. I have seen the remarkable results that can be achieved where prevention has been the driving force. Since the Health and Safety at Work etc Act 1974 was introduced, and prevention became less economically painful to employers than paying for damaged lives, we have seen an 85% reduction in workplace fatalities and a similarly impressive reduction in injuries, thus lifting a significant and needless financial burden from the NHS. RoSPA, with others, successfully campaigned for the introduction of seat belts in cars; the law was passed in 1989. Since that time, the number of vehicles has risen by more than one-third, but there has been a 66% fall in road fatalities. This preventive approach should be taken with some of the more serious problems that older people face.
Take the biggest preventable problem faced by older people: accidents. There are more than 250,000 fall-related emergency hospital admissions every year for serious injuries involving over-65s in England alone. Where there has been a targeted and collaborative approach, such as the one that took place in the West Midlands involving the Government, RoSPA and the local authority, aimed at preventing this type of accident among older people, significant results have been achieved—in this case, a 38% reduction in the number of over-65s attending A&E as a result of a fall.
Neither we nor the Government can solve all of the many and serious problems that older people face, but the Government must understand that acting to prevent the problems of the old is infinitely more cost effective than throwing money at their consequences. They should know also that there is an army of organisations and charities eager to partner them in a common objective of tackling the problems that older people face. I call on the Government to seize the opportunity that has been presented to them to deal with this, one of Britain’s most serious problems.
Lord Rea (Lab)
My Lords, my noble friend Lord Foulkes has done an excellent job as rapporteur for the Council of Europe’s Parliamentary Assembly, and we should thank him for presenting this report so well. It is an important contribution to the increased international concern for the human rights of older people. Your Lordships’ House is uniquely qualified to debate this issue, since exactly half of our membership is aged 70 or over. In fact, the psychogeriatrician Professor Tom Arie once described the House of Lords as an excellent model for a psychogeriatric day centre.
The report to the Council of Europe is thorough and cogent. It lists 14 measures that states should take towards,
“combating ageism, improving care for older persons and preventing their social exclusion”.
It says member states should,
“adopt a charter of rights for older persons in care settings to be used, inter alia, to empower older persons, as well as in the monitoring of long-term care institutions by an independent body”.
This has been touched on by several noble Lords already. The CQC is definitely a step in the right direction, but it needs better funding and more qualified staff. Here, I echo several other noble Lords who have spoken.
The purpose of the report is to stimulate Governments to take action to enact its recommendations, but it is not mandatory. If it were to be made part of an international convention, to be ratified by each of the states party to it, action would be more likely to follow. As the noble Lord knows, and as my noble friend Lord Foulkes mentioned, the UN has, since 2010, been hosting annual meetings of a working group on ageing. This is open ended, as my noble friend says, and is working towards the creation of a suitable UN convention on the needs of older people, to be ratified by member states.
However, a declaration such as the one we are discussing can still be influential in steering UN and national policy. I hope that it will influence the UN working group as it draws up a document to serve as a basis for an international treaty or convention. Perhaps the Minister can tell us about the progress being made by this group, and particularly the contribution of the UK representatives.
Life expectancy is increasing, but healthy, disability-free life lags behind by five to 10 years, strongly related to the level of social deprivation. Not only do those of lower socioeconomic status live shorter lives, but for more of that shorter life they live with disability, as has already been alluded to by several noble Lords. Many of the health problems of the old have their origins earlier in life. Most of their disease burden is due to chronic non-communicable disease—obesity, diabetes, cardiovascular disease, stroke, dementia and cancer—which is to a greater or lesser extent preventable, or at least whose onset can be postponed. A person with less disability in old age has usually had a lower burden of disease throughout life. Improving the health and lives of older people cannot be separated from measures needed to improve the health of the whole population. This is strongly influenced by the social determinants of health and disease, a topic which we have debated in the past in your Lordships’ House and which we will certainly debate again in the future.
Baroness Thomas of Winchester (LD)
My Lords, I speak from the Liberal Democrat Front Bench tonight. I was going to declare an interest as an older person, but I am in such good company I will just declare an interest in having a small amount of self-funded care. To the noble Lord who said we must look after our care workers, I would say that I have my care worker’s children here to do some work experience, and we are very good friends in other ways too.
This debate is extremely welcome but could last several days rather than two hours because of the number of issues raised by the excellent report from the noble Lord, Lord Foulkes. What age does age discrimination start at? What are we going to do about social isolation? Is there abuse of older people in all care settings to some extent? Perhaps, but we do not know. Then there are all the different kinds of care an older person might receive, either in a care home or their own home.
Sadly, the time we hear most about the mounting difficulties in this area is when hospitals report that an elderly person has been ready to be discharged for months but no suitable arrangements can be made. It is classic bed-blocking, as the noble Lord, Lord Foulkes, mentioned. This makes all elderly people feel vulnerable because it is entirely negative—a word referred to in the report and this afternoon in the debate. This negativity, allied to a feeling of guilt at being old at all, and therefore a burden, is not a good place for anyone’s mental health. The mental health of elderly people is one thing we have not talked about much.
Although the financing of care is not the focus of this debate, it is bound to be one of the headline issues, as we have heard from some of the telling speeches so far. I see that it is the fifth bullet point in the noble Lord’s report. There is no doubt that someone looking down at Great Britain from outer space would think we were mad to be spending less in real terms on social care than we were seven years ago, in spite of the recent injection of some money in the spring Budget. This is at a time when the number of people getting older and needing care is growing.
We must have known about this demographic for years now, as the noble Lord, Lord Foulkes, said. Is it due to the fragmentation of care services that the message does not seem to be getting through with enough urgency? Responsibility for adult social care is split, with health, local government, the benefits system and equalities all involved. Whatever the reason, the human rights of older people would be much better protected in the care system if there were more money to spend on as high quality care as possible, with properly trained and better paid care workers spending as long as is necessary to do their job.
We also need far more suitable supported housing for those who can live independently into old age. In order to put funding on a sustainable financial footing, my party would put a penny in the pound on income tax to raise some cash immediately for both the NHS and social care systems. The noble Lord, Lord Haskel, spoke particularly about that. We advocate establishing a cross-party health and social care convention to carry out a comprehensive review of the sustainability of NHS and social care finances, and a monitoring agency similar to the Office for Budget Responsibility. The latter would report to see how the whole system was getting on, and how much was needed to meet the costs of projected increases in demand and any new initiatives, in order to make sure that changes in services are properly costed and affordable.
In general, we agree with the report about bringing NHS and social care together into one seamless service, pooling budgets in every area and developing integrated care organisations—an aspiration shared by many other groups. After all, where does the NHS’s responsibility end and that of the care services begin?
We would guarantee the right of all NHS and social care service staff who are EU nationals to stay in the UK. The UK needs 1.6 million health and social care workers up to 2022 to replace those leaving the profession, including European nationals who have already jumped ship. While on the subject of care workers, the ones I know who travel to people’s homes are trying their very best to do all they can for their clients, against the odds. They are not paid for travelling between clients so they often have an impossible task, particularly in rural areas, in trying to fit an hour’s work into half an hour, or half an hour into fifteen minutes.
It is not always recognised how important home carers are in an elderly person’s life. They often have to contact a doctor, a neighbour, the next of kin, or sometimes the police, so they really are on the front line, and we pay them very poorly. They also tell me that they often have to listen to some outspoken comments from those they care for who may come from a different ethnic group. But they do not complain because they make allowances for the person’s age and state of health. If that person goes into hospital, a home, or dies, then the carer from that moment is not paid. There is no period of grace.
In many ways, talking about the human rights of older people reminds me of the debate around the human rights of disabled people, which has never sat very comfortably in the Equality Act. The aspect which is familiar to me from that agenda is the right to independent living—the right to have a life, basically—and if possible, a working life for disabled people, paying taxes rather than only picking up benefits. However, each group also needs to have a social life. It cannot be right for older people needing care not to be able to get out and about, go to events, see people, go shopping, et cetera. It should not be enough just to help them wash, dress and eat, and then for society to forget about them. This is surely where communities or neighbourhoods might step in, as they have in the remote Scottish islands of Rum, Eigg and Muck.
We are, in general, a more caring society than people think, and not as good sometimes as some much poorer countries in looking after our elderly citizens. But someone has to take a lead in taking the concept of care beyond the minimum. A lot of churches do this, but what about the increasing number of mayors in our country? Could they not be asked to oversee this sort of involvement and undertake some social activities for elderly people? When I arrived in London 42 years ago, I joined my local contact group, which took elderly people living on their own out to tea once a month to someone’s home. My cell was organised by a barrister’s wife, who managed to capture as many judges as she could as they usually lived in big houses in picturesque surroundings. They quite often opened a bottle of wine in the kitchen afterwards—though I should not say that.
The noble Lord’s report says that member states or civil society should foster and promote human rights in this field. The challenge is how to begin the process of involving the whole community in this endeavour. We owe a huge debt of gratitude to the noble Lord, Lord Foulkes, for initiating this debate today.
Baroness Thornton (Lab)
My Lords, I join other noble Lords in congratulating my noble friend Lord Foulkes on bringing this debate to your Lordships’ House today and on introducing it with his usual verve and clarity.
We have had a great debate, which has, of course, shed light on the range and challenge facing us all as we get older. I thank the noble Lord, Lord Balfe, for welcoming me back to the Front Bench. I also hope he might try to do something about zero-hours contracts and outsourcing, which he referred to in his speech and which lie at the heart of his party’s economic and public policy.
As I reached the age at my last birthday which, I gather, tipped me over into the realm of “older person”, I wondered whether I should declare an interest. Then I realised, looking around the Chamber today that, with the exception possibly of the noble Baroness, Lady Cavendish, and, of course, of my ever-youthful noble friend Lord Cashman, we are mostly in the same boat.
Longevity is a cause for celebration, as well as for the concerns that have been expressed. My noble friend Lady Massey mentioned the stereotyping of old people. Her speech made me want to go out and dye my hair purple. I am very pleased that the Labour Government championed the rights of older people and enshrined age discrimination in the Equality Act 2010. It says that you should not be treated differently because of your age. It reflects the Human Rights Act 1998, the European Convention on Human Rights and the United Nations convention on the rights of older persons. The noble Baroness, Lady Greengross, is absolutely right. Human rights do not lessen with age.
I should like to raise an issue of discrimination with the Minister—the flagrant injustice done to all women born in the 1950s who are affected by the changes to the state pension law through the 1995 and 2011 Acts. I have two sisters who are affected by it and I just missed the cut-off by a whisker. This debate is about inequality and justice. The Conservative Government’s Pensions Act 1995 included plans to increase women’s state pension age to 65—the same as men’s. I think that everyone would agree with that equalisation, but I do not agree—and neither do many women—with the unfair way in which the changes were implemented in the Pensions Act 2011. There was little or no information for those affected and no time for them to make alternative plans. Retirement plans were shattered, with devastating consequences. What are the Government going to do to mitigate this injustice to this cohort of older women?
The second matter I should like to raise with the Minister is one which many noble Lords have mentioned: the crisis of funding in the provision of social care. The old and those with serious conditions, and the co-morbidities that go with them, bear the brunt of the squeeze in funding in the NHS, the reduction in spending on social care and the Government’s incoherent strategy—perhaps I should say lack of strategy—for integrated care. Council-funded social care was reduced from £16.6 billion in 2011 to £15.6 billion in 2016-17—a real-terms reduction of 6%. I thank the Local Government Association and Age UK for their brief. Councils have worked hard to protect adult social care spending in cash terms. However, the LGA’s latest analysis on the funding gap faced by councils shows that this approach is not sustainable. The LGA estimates that local government faces a funding gap of £5.8 billion by 2020, £1 billion of which is attributable to adult social care and includes only the unavoidable costs of demography, inflation and the national living wage. The figure excludes other significant pressures, including addressing unmet need. The scale of the funding gap and the crisis of unmet need is widely documented, not just by independent think tanks such as the Nuffield Trust and the King’s Fund but by the voluntary sector: Age UK, Sue Ryder and many others.
Given the important role that social care services play in supporting elderly and disabled people, it is crucial that the Government use this autumn Budget to take immediate action to address the adult social care crisis. Although I do not expect the noble Lord to share with us or to reveal what might be in the Budget, I hope that he and his colleagues agree that this is a cause worth fighting for. Have he and his colleagues done so in this spending round?
Finally, I ask the Minister when the Government will publish their planned consultation for proposals on the sustainability of social care. Hopefully, we can then start building a sustainable system for the future.
The Parliamentary Under-Secretary of State, Department of Health (Lord O'Shaughnessy) (Con)
I congratulate the noble Lord, Lord Foulkes, on securing the debate and I pay tribute to all noble Lords who have contributed to what has been a very interesting and challenging debate at times. The Government were pleased to see the publication of the Council of Europe report on this important issue in May this year; as the noble Lord pointed out, we have had a chance to discuss it before. He is to be commended for leading such a high-quality piece of work; we would expect nothing less. I also welcome the noble Baroness, Lady Thornton, back to her role on the Front Bench. I look forward to many more of these exchanges in the months ahead; she is clearly going to keep me on my toes.
The human rights of older people are what are in question here and, of course, they are no different from those of other citizens. What differs are the means needed to uphold those rights because of the specific needs of older people themselves including, critically, the care available to them later in life. As all noble Lords have pointed out, an ageing population presents the UK, in common with the developed world, with one of our most profound challenges. It raises critical questions as to how, as a society, we enable all adults to live well into later life and how we deliver sustainable public services that support them to do so. But it presents huge opportunities, too—socially, economically and dare I say it, morally. The care and respect that we provide to older people is the litmus test of the values that we hold as a society.
I believe that the Government recognise the scale of this challenge and are responding to it. I hope that the noble Lord—indeed all noble Lords, though I have a sense that they may not have—will have seen that, at 2 pm today, my right honourable friends the First Secretary of State and the Secretary of State for Health published our plans to produce a Green Paper on social reform by summer next year. The announcement makes it clear that, to achieve reform where previous attempts have failed, we must take a broad view. The Green Paper will cover: social care funding and, of course, issues of means testing; social care services, including continuity of care, as the noble Baroness, Lady Cavendish, mentioned; wider networks of support, such as the role of carers; the role of housing; and interaction with other public services. It will consider how technology, innovation and new workforce models can deliver better quality and value. It will be underpinned by the 2014 Care Act, which introduced national eligibility criteria for access to adult care for the first time, and by £2 billion in additional funding over the next three years to support social care. Part of the purpose of that funding is of course to reduce delayed transfers of care—what the noble Baroness, Lady Thomas, quite rightly described as, in the pejorative term, bed-blocking. I completely agree with her that that is not a term that we want to use or endorse.
To take forward the work towards the Green Paper, a group of independent experts, including Sir Andrew Dilnot and Dame Kate Barker—who have both led reviews into social care in the past—and, from our own House, the noble Baroness, Lady Lane-Fox, will support government engagement with a range of stakeholders including, first and foremost, care users, their families and those providing care in whatever setting, to debate the issues and build consensus. Noble Lords are a treasure trove of expertise on this issue and it is critical that their voices are heard. That is why the First Secretary of State has written to invite the chairs of all relevant all-party parliamentary groups to meet him, so that he can to listen to their views.
An interministerial group has already been established to oversee the policy development process. Our aim is to build consensus around reforms which can last. Once the Green Paper is published there will of course be a full public consultation to provide further opportunities for all interested parties to add their perspective. The Government’s plan is bold in intent and ambitious in scope. I hope that everyone who has an interest in social care sees this as a fantastic opportunity to achieve the lasting and sustainable change that has so far eluded us.
Reform of this vital sector has been a controversial issue for many years but the realities of an ageing society—as noble Lords have pointed out—mean that we must reach a sustainable settlement for the long term. It will no doubt require difficult choices about what that system should provide and how it is paid for. But getting this right promises a better system that everyone can have confidence in, where people understand their responsibilities, can—critically—prepare for the future and know that the care they receive will be to a high standard and will help them maintain their independence and well-being.
As these plans for social care reform show, this Government’s ambition is to make the country a good place for everyone to grow old. The noble Lord, Lord Foulkes, accused me—somewhat unfairly, I thought—of lacking specifics in previous answers, so I am going to give some very concrete examples of what we are doing to support older people. We as a country are proud to lead the world in tackling age discrimination. The Equality Act provides robust protection against both indirect and direct discrimination in employment, and in February the Government published a strategy called Fuller Working Lives, which aims to increase the retention, retraining and recruitment of older workers by bringing about a change in the perception and attitudes of employers.
Many older people want to carry on working, and of course the coalition Government abolished the default retirement age and extended the right to request flexible working to all. It is therefore hugely encouraging that the number of older workers is at a record high—and not just because of the growing size of the House of Lords. I should add that I am doing my bit. Just yesterday, as happens every Wednesday, I had my parents looking after all three of my children—so I am keeping them active in their retirement, too.
Huge progress has been made under successive Governments. The noble Lord, Lord Lipsey, mentioned pensioner poverty. It is still too high, at 16%, but that is compared with 40% in the 1980s. The pension credit provides a guaranteed minimum income to help tackle pensioner poverty in Great Britain, and over time the new state pension will reduce the need for means testing.
Beyond social care, we are taking action in a number of areas to support the comprehensive care of older people. One of these is the inclusion, by 2020, of training in geriatrics and prescribing for older people within all medical curricula, so that there will be additional support throughout every part of the NHS. The 2017-18 GP contract set out a requirement for the identification and management of patients aged 65 and over with frailty, to ensure that they receive an annual medication review. Where clinically appropriate, the GP will discuss whether the patient has fallen in the past 12 months, and provide any other clinically relevant interventions.
Of course people want to be at the centre of their own care, making sure that it responds to their own needs—which is why the Government have simultaneously extended both personal health budgets and integrated personal commissioning, as well as promoting the integration of health and care services through the sustainability and transformation programme that is the centrepiece of the NHS’s five-year forward view.
The noble Lord, Lord Haskel, and the noble Baronesses, Lady Thomas and Lady Thornton, raised the issue of integration of care. All parties are aiming towards that. There are different versions of this, but bringing together care for people who experience it, and who do not want to have to distinguish between primary, secondary, community, social and so on, is essential as the health needs of our population change around ageing and comorbidity.
Personalisation is therefore behind these ambitious plans, as well as our plans to digitise health services—a passion of the Secretary of State’s. The potential for mobile technologies to support an ageing society, to combat loneliness—which, as the noble Lord, Lord Sawyer, pointed out, has such a pernicious effect in old age—and to provide real-time diagnostics is a rich seam that has only just started to be explored. New services, such as the GP at Hand pilots, hold huge opportunities for older people who need to see a GP but may be too frail to leave home.
Home is at the centre of providing for good care and for the human rights of older people. At heart, growing old safely and happily needs a good home. We know that most older people would prefer to live at home in their later years, which is why we have seen an increase in domiciliary care and sheltered housing. Others will want or need to be in a residential or nursing home, so the quality of that home and the care provided within it are everything. As the noble Lord, Lord Cashman, pointed out, the Care Quality Commission’s October State of Care report said that about four-fifths of residential homes achieve good or outstanding ratings—although I accept that only 2% or 3% are outstanding, and that could be better. For domiciliary care services the figure was 83%, and for community social care 88%.
The noble Baroness, Lady Greengross, talked about the work she did, when only 50% of care was judged to be good enough. I am not sure what year that was, but I hope that we have seen an improvement. The fact that those inspections are happening is helping to drive quality. The State of Care report highlights variation, and points to some evidence of deterioration. The CQC is looking at this quality, including the deterioration of good and outstanding providers, but it is reassuring to see that 82% of providers that had been rated inadequate had improved by their next inspection.
Providing good care in the home means supporting carers as well as care workers. That is why it is so positive that the role of carers has been wrapped into the overall social care reform programme that I described earlier. I pay tribute to all those, paid and unpaid, who look after older people and provide the dignity and respect that they deserve. Adults with dementia are particularly vulnerable, so I am sure all noble Lords will welcome the fact that over 2 million people have been trained to be dementia friends to support sufferers of this horrible disease.
As several noble Lords have pointed out, making sure that there is good care also means rooting out and, where necessary, taking professional or legal action against the despicable minority who abuse vulnerable older people. That is one reason that we introduced a new crime of wilful neglect, which came into force in April 2015. Looking ahead, the draft Domestic Violence and Abuse Bill will strengthen the Government’s powers to respond to physical, psychological and economic abuse in domestic settings, and we will launch a consultation on proposals soon. However, it is important to emphasise that this is only a minority and that the vast majority of people looking after older people work with great dedication and compassion.
Before concluding, I take the opportunity to respond to some specific questions that I have not yet had a chance to answer. I hope that I have given some specific examples to the noble Lord, Lord Foulkes, and done so politely. I say to him that there is no need to wait for a Labour Government to act on these things. Indeed, as the noble Baroness, Lady Cavendish, pointed out, we want to avoid the political toxicity that can accompany such issues.
My noble friend Lord Balfe and the noble Lord, Lord Sawyer, suggested that collective bargaining was the way forward. Perhaps that was a reminder of the past involvement of my noble friend Lord Balfe in unions and the Labour Party. However, I am not convinced that that is the right way forward. I do not think that it matters whether a provider is in the private sector, the public sector or the voluntary sector. As Tony Blair once said, what matters is what works. It is quality that counts and that is why we need to have the staff and the training to make sure that happens.
The noble Lord, Lord Cashman, talked about discrimination in medical care. That is, of course, absolutely wrong when it is done for unjustified reasons. There can be reasons why decisions are made not to operate on older people but those must always be clinical decisions based on clinical judgments and not because of any kind of prejudice. It is important to emphasise that there are routes such as HealthWatch and the health ombudsman through which people can report instances of discrimination.
At the heart of the proposals of the noble Lord, Lord Foulkes, is the idea of a charter of older people’s rights, which was endorsed by the noble Baroness, Lady Massey. It is quite right, of course, that there is such a charter for children, and, indeed, a Children’s Commissioner has come from that. I hate to disappoint them, but that is not currently part of our plans. However, we will continue to watch the UN’s work in this area, as was highlighted by the noble Lord, Lord Rea, with interest.
The noble Baroness, Lady Massey, also asked about the difference between hospice and care home funding. They are funded very differently. The periods of time that one would expect to spend in one versus the other is also different. However, I shall certainly write to her with more detail of how those could be aligned.
The noble Baroness, Lady Cavendish, asked about merging the health and care professions. That was an incredibly wise point. There are huge benefits from integration, not least because care is increasingly delivered in an integrated way, because of the complexities involved and because of the progression that integration offers. One of the criticisms of social care as a profession concerns the glass ceilings that exist within it; the opportunities for seniority are not there, whereas integration with the medical professions would provide that.
The noble Lord, Lord Jordan, asked about preventive action. I completely agree with him on that. He will be pleased to know that there are big increases in capital spending on the disabled facilities grants, which is going up year on year precisely to combat some of the very avoidable issues of the usability and safety of homes, for example, to provide the kind of preventive action that he is looking for and that ought to reduce the instances to which he referred.
The noble Baroness, Lady Thornton, asked about raising the pension age. The Government have taken action to limit the maximum change to the state pension age to 18 months, building on the 1995 Act at a cost of, I believe, over £1 billion, so the Government are taking, and have taken, action to address that issue.
In conclusion, I again thank the noble Lord for producing his report and instigating this debate. I thank all noble Lords for their wise and thoughtful contributions.
I would like to end where I started. The way we care for older people reflects our values as a society. As a country, we have a fantastic record of supporting and cherishing older people, but the challenge of making sure they can live their lives with independence and dignity is getting harder. We can meet this challenge only by working together, with imagination and compassion, to tackle the difficult decisions and choices that are needed, not least in the reform of social care services and funding. Noble Lords have a huge amount to contribute to this process and—as others have pointed out—because of the mean age quite a keen personal interest in it too. I look forward to working with noble Lords in that endeavour.
Lord Foulkes of Cumnock
My Lords, in replying very briefly to the debate, I first apologise for not having moved the Motion properly at the start. Noble Lords gave me the kind of look that made me feel very guilty. I also apologise to my noble friend on the Front Bench for not welcoming her. I was going to say that the noble Baroness, Lady Thornton, and I go back a long time together, but she is very young in comparison. Still, as fellow co-operators, we have worked closely together and I am delighted that she is on the Front Bench again.
It has been a fantastic debate. I am very pleased with so many excellent speeches, which were almost unanimous, if not quite. Like my noble friend Lord Sawyer, I welcomed the contribution of the noble Lord, Lord Balfe, who was looking after the workers again. I should also have mentioned but forgot—perhaps I should have declared another interest—that my son works in this sector. He is relatively low paid and he works very hard indeed; I know care workers work very hard.
I also found the speech of the noble Baroness, Lady Cavendish, encouraging and helpful. She is right about the Care Quality Commission; it is doing a job, but it could do better. There could be more frequent and incisive unannounced inspections. The fact that there are problems shows that it is not yet working. However, she is certainly on the ball, as it were, in getting it moving in the right direction.
I was grateful for the wisdom of my noble friend Lord Haskel and for the experience of my noble friend Lord Cashman in the LGBT sector. He also did a tremendous job on this as an MEP. My noble friend Lady Massey normally champions children and I see her as chair of the children’s committee in the Council of Europe—it is nice to have her move into this area as well. My noble friend Lord Rea and I used to work together in international development many years ago; it is wonderful to have him make such an eloquent speech in support.
It was also good to get such overwhelming support from the noble Baroness, Lady Thomas, from the Liberal Democrat Front Bench, and I appreciate it. Sometimes I can be a wee bit critical of the Liberal Democrats, but certainly not on this occasion. It was fantastic support. As the noble Baroness, Lady Greengross, said, she and I have also been working together for a number of years; it is nice to be working with her on the same subject again.
I am afraid I did not agree with the noble Lord, Lord Lipsey. I think he is falling into the trap of those people who want to divide and rule us. We will have the debate on universality versus means testing outwith this Chamber—we have a lot of debates outwith this Chamber—but when 1% of people in this country own 50% of the wealth, it is not the poor who should be fighting each other over who is a little better off than the rest. There are people who can afford to pay more in taxation; we will have to have that debate on another occasion.
I come to the Minister. I must say—and I say it with his boss present—that he is one of the Ministers for whom I have the greatest respect. He treats this House with great respect and answers Questions at Question Time properly; not every Minister does that. He does it very well and he listens carefully to what is said. I have been a junior Minister, too, admittedly in the other place, and I know it gives you a little more power, but you are always constrained by Secretaries of State, Prime Ministers and so on. But within that constraint, he has been helpful. I did not see the announcement about the Green Paper on social reform because we were all busy preparing for this debate. However, it is a welcome development. I do not normally welcome things from this Government but it is welcome. The way the Minister described it made it sound sensible, and it is encouraging. Let us say that it is a step in the right direction, but there are many more steps to take.
I should have said earlier that it is nice to see my noble friend Lord Pendry here. He had hoped to participate in the debate but I know he was called into hospital. However, I am glad that he has been discharged and is with us at the end of the debate.
I thank the Minister for that helpful response. I can only assure him that, as I said, the noble Baroness, Lady Greengross, and I have been going on about this for a long time, and some of us will keep banging on until we get more, and better. Our concern is to make sure that every old person lives in dignity, in some degree of comfort, and enjoys their last years as much as they enjoyed their early years.