(3 years, 5 months ago)
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Baroness Jolly
That this House takes note of social care provision in the United Kingdom, and the role of carers in that provision.
Baroness Jolly (LD)
My Lords, it is a great pleasure to open this debate on social care. I am sure it will be rich and varied, and that the Minister will struggle to sum up the points made in the time he is given. I am sure we will welcome a letter from him with his responses to our more trying queries. This debate also doubles as my health and care swansong, as I now move to defence.
I start by putting on record my, and our, utmost thanks to all those who work in social care systems, from carers to cleaners and caterers, to management in care homes and domiciliary care, and those who provide so much care for friends and family, expecting nothing in return.
I want to cast our minds back to the time of the coalition, when the Liberal Democrats made reform of social care an absolute priority, and the Dilnot commission provided a framework for us to fix the inherent unfairness in how social care is funded and provided. Cross-party talks were promising and it felt as though progress was being made. Not so. Later, both Prime Ministers May and Johnson said that they would sort it. But somewhere along the way this issue has been pushed into the long grass again and again, despite two Conservative Prime Ministers pledging to make it a priority. Of course, Covid has not helped.
So will it be Dilnot, Forsyth or something completely different? How will it be funded? We have seen, over the last year, what is possible when resources and energy are mobilised to address a crisis. We know that this an issue exercising the Chancellor. I want to be clear: what is happening in social care is a crisis, and we need to approach it as such.
Looking at the sector since the onset of Covid, we see that the Government have provided significant short-term support to help care providers through Covid-19, but it is vital that the Department of Health and Social Care now sets out how it will help providers move beyond it. The costs of the pandemic and the dramatic fall in care home occupancy, from around 90% at the start of the pandemic to 80% in February this year, puts many providers at risk of failing. In response, the Government provided short-term funding through local authorities and the infection control fund. This support has stabilised the market and kept most providers from falling over. However, the department does not have a strong grip on the variable levels of support that individual providers received, and there have been some reports of providers struggling to access some of the additional funding. The commitments around extra funding and free PPE—personal protective equipment—until the end of next March are welcome, but the department does not yet have a road map outlining how long extra funding and support will be in place. Can the Minister tell us please?
The Care Quality Commission warns that ongoing support is likely to be required in 2021-22 if care home admissions remain low or costs are inflated. Can the Minister tell the House whether the Department of Health and Social Care, working with the Ministry of Housing, Communities and Local Government, has an assessment process in place to determine how much support providers need in the short to medium term to deal with Covid-19 and lower occupancy in care homes?
I want to address the role of carers, both paid and unpaid. For those who work in social care, it is time for parity to become a reality. This relates to a number of issues. As I am sure carers themselves would say if they were here, the first issue is pay. Noble Lords will remember the outrage over a mere 1% pay rise for some of our NHS workers earlier this year, but the reality is that this is something our social carers can only dream of. Of course, the sector is far more fragmented, and much of it private, but the Government need to be ambitious in providing a fair, living wage to our social carers for all the hours that they work. This means leading the way on developing a framework that outlines what social care staff should be paid.
Secondly, along with pay, our carers need recognition and career progression. During the first stage of the pandemic, on Thursday nights, we all went outside and clapped to support all the NHS workers and care workers who were doing their very best. But care work, as many of us know, can be immensely rewarding and challenging in equal parts. Our workers need to know that their skills are valued and there is space for them to grow and progress in their career. We know that retention is an issue, when pay matches that in a supermarket. Greater recognition and regulation are needed. In both Wales and Scotland, care work is acknowledged as a profession. Would the Minister explain why care workers in England are not regulated and their pay derisory? What is stopping their recognition and regulation in England, as for those working in Wales and Scotland?
Turning now to unpaid carers, I draw on family experience, which is typical. For five years, my brother was my mother’s carer. He was able to get out of the house and shop when her carers came to get her up or get her ready for bed. His main breaks came when I got back at weekends, or when she went into a care home while we all went on holiday. Caring for a loved one is hard work, particularly when dementia is involved.
A Carers UK report found that, during the pandemic, 72% of carers have had no breaks from their caring role, with an average of 25 hours of support lost each month. Caring for someone can be a 24/7 job, and more. Research suggests that a third of unpaid carers now feel unable to manage their role. What assessment have the Government made of the impact on unpaid carers of the closure of respite care during the pandemic?
Will the Minister tell the House when the Government last looked at the issue of family carers? Family carers deserve breaks, so will the Minister commit to making sustainable funding available, to ensure that respite and day care centres can provide these much-needed breaks? If we fail to do this, we risk seeing an increase in burnout and mental health problems among carers, many of whom are old. This will lead to a vicious circle, where we find ourselves asking the question: who cares for the carers? Many day centres were run by organisations such as Age UK and funded by local authorities, but that funding was pulled five or six years ago by stretched local authorities. We cannot continue to rely on the unpaid labour of women—it is most frequently women—to prop up a social care system that is not sustainable or fit for purpose.
The devolved nations have instituted occupancy guarantees where they are falling, due sadly to the deaths of residents and hesitancy of individuals to move into care settings during the pandemic. In England, occupancy rates have fallen 7% to below 80%. Will the Government follow the example of Scotland, Wales and Northern Ireland and intervene with this short-term measure before wider reforms of funding and provision are announced? If not, I fear there will be no social care system left to reform.
The issue of indemnity for care homes has also been raised in this House many times. This comes back again to the theme of parity. As we hope to enjoy more freedoms over the next few months, these need to be extended to homes, with visits from family and friends and trips out. However, homes will not be able to provide these experiences if they are not adequately insured. Will the Minister please agree to look into this issue as a matter of urgency?
Looking to the future, our current model of care provision is unfair and unsustainable. Funding is one obvious issue. With the sector so fragmented, cuts to local authorities and a postcode lottery, we need to find consensus on how to fund the system. Government funding for local authorities fell by 55% in the decade between 2010 and 2020. Where there are cuts, we now see self-funders picking up the tab, but also subsidising the care of others in the care homes they live in. This is not fair, nor is it sustainable.
Workforce planning is another issue. We need to commit to a 10-year workforce plan that will adequately fill vacancies but also allow care providers to aim higher, providing continuity of care and allowing relationships to develop, to the benefit of both staff and those receiving care. The ideas have all been laid out and opposition parties are ready to work with the Government on the solution. What are we waiting for?
Through Covid-19, the Government provided significant short-term support to help providers. It is vital that the Department of Health and Social Care now sets out how it will help providers to move beyond it. The costs of Covid-19 and the dramatic fall in care home occupancy, from around 90% at the start of the pandemic to 80% by February 2021, puts many providers at risk of failing. In response, the Government provided short-term funding through local authorities and the infection control fund. This support has stabilised the market and kept most providers from failure. They are very grateful but still fear for the future. However, the department does not have a strong grip on the variable levels of support that individual providers received, and there have been some reports of providers struggling to access some of that additional funding.
Commitments around extra funding and free PPE until the end of March 2022 are welcome, but the department does not have a map out. The Care Quality Commission warns that
“ongoing support is likely to be required … if care home admissions remain low or costs remain inflated.”
It recommends that the Department of Health and Social Care, working with the Ministry of Housing, Communities and Local Government, should assess and outline by the end of July—next month—how much support providers need in the short to medium term to deal with Covid-19 and lower occupancy in care homes. Can the Minister outline how this work is progressing?
For several years, I was the chairman of one of the large charities that provide residential care for people with one learning disability or more. We cared for more than 1,000 people across England. Local government pays their fees and essentially what they get is a roof over their heads, full bed and board and care. More often than not, their homes are in large semis in residential parts of town with access to public transport. Supported people are in receipt of benefits, and the older ones a pension. This helps them to save for an annual holiday. They use their buying power to go out in the evening with their carers for a pizza, to the bowling alley or to a film. A day at the seaside is a favourite. Many are helped to find local jobs. Some of the large coffee chains will pay and train people with a learning disability to work the espresso machine, make milkshakes and clear tables. Job placements are carefully chosen and it is rare that the arrangement fails due to lack of commitment. The skill set and temperament that is required to care for someone with a learning disability is very different from what we expect from the carers of older people.
Many of us have seen at first hand the work of care homes, carers in our locality or those caring for family or friends. Many of us have seen people with a learning disability out with their friends enjoying themselves. All that points to dedicated carers in that sector. I know that there will be much expertise and wisdom in this debate today; I look forward to hearing noble Lords’ contributions and the Minister’s responses. I beg to move.
Baroness Warwick of Undercliffe (Lab)
My Lords, the forensic, measured and moving opening speech of the noble Baroness, Lady Jolly, demonstrated that there are a number of pressing issues to be addressed within the wide topic of social care. The Government have committed themselves to resolving the issue of who pays for residential care in old age, and we are all eager to learn of their plans as hundreds of families face this challenge every month. I shall focus in my three minutes on two points: social care provided by the not-for-profit sector; and social care provided by family, friends and others who are unpaid—what is called informal care.
As chair of the National Housing Federation—I declare that interest—I have taken a keen interest in housing associations’ provision of not-for-profit care and housing, and seen the amazing work they do not just for the elderly but for those with disabilities, learning difficulties and physical and mental illness. I echo the call from Anchor Hanover, England largest not-for-profit provider, on the need to tackle the negative perceptions of social care in terms of low pay and lack of career progression. This is not new: before the pandemic, there was a shortfall of 1.1 million care workers in the next 15 years. With a current workforce estimate of 1.6 million, that is a massive challenge. What will the Government do to deal urgently with these negative perceptions and begin to address the shortage challenge?
On my second point, about informal carers, my noble friend Lady Pitkeathley has consistently and passionately advocated their cause in this House; I look forward to hearing her contribution shortly. In my experience, the majority of all social care is provided by family or friends caring for their loved ones. In most cases, they do not even label themselves as carers; they do it because they are husbands or wives, daughters or sons, sisters or brothers. It is what they do, and it is what we do. This vast army of carers increased dramatically during the pandemic. In most areas, services for carers, including young carers, vanished overnight, and there are real concerns that they will not be reinstated. There are an estimated 13.6 million of them, plus 800,000 young carers, yet they are often invisible when it comes to public policy and they have to fight every inch of the way for support, often at the cost of their own health or financial security.
Despite their warm words, the Government entirely missed the opportunity in their health and social care White Paper to recognise the contribution of informal carers. The Minister will be well aware of the mounting criticism of the Government’s response to the pressures on social care provision and on carers as a result of the pandemic. Can the Minister assure us that carers will be specifically included in any forthcoming legislation, and that carers themselves will be directly involved in its preparation? The Government now have an historic opportunity to make changes that will at last deliver parity of esteem between social care and the NHS.
Baroness Finlay of Llandaff (CB)
I congratulate the noble Baroness, Lady Jolly, on securing this timely debate. I declare my interests with Marie Curie, the Motor Neurone Disease Association and other charities; I also chair the National Mental Capacity Forum.
There are two main groups needing social care: those with long-term chronic conditions, both physical and mental disorders, often both; and those who are terminally ill and dying. The first group often slips into the second as disease progresses. I want to focus on those families providing unpaid informal care. More than three-quarters of those carers bereaved during Covid reported that they were not offered the care and support they needed, and Carers UK data suggests that one in three may be nearing breaking point. Pre pandemic, it was no better. The Motor Neurone Disease Association found that more than 75% of unpaid carers had not had a carer’s assessment and a third spend more than 100 hours a week caring. When caring for other conditions, the average hours are less, but more than 1 million people are providing 50 or more hours of care per week. Marie Curie estimated that there were 6.2 million carers in the UK in 2018 and 500,000 were looking after someone with a terminal illness, which is about 8% of all carers.
Most informal carers are not professionally trained, and of the 1 million people eligible for attendance allowance, it is estimated that about a third do not claim it. When someone is nearing dying, a prognosis of six months is impossible to provide with accuracy, so the DS1500 form for funding is sometimes filled in relatively late, leaving the financial burden on the family even greater. For many, the care of a person who is critically ill, whose recovery is unpredictable or who has been in intensive care is particularly difficult. These family carers need to be taught some basics of caring and they need to know who to call for immediate support 24/7. The current systems of even supporting them are not adequate.
Those millions of people providing care usually do it well and willingly, but they are exhausted and are becoming more exhausted as there seems to be less support available. What consideration is being given to creating eligibility for a total of up to one month’s paid leave from work for informal carers when someone is critically ill or dying? This could be leave taken flexibly as required for the individual circumstance. After all, we recognise maternity and paternity leave. Why do we not recognise carers’ leave?
Baroness Browning (Con) [V]
My Lords, I declare my interests as a vice-president of the National Autistic Society, as an ambassador for the Alzheimer’s Society and as an informal carer. I congratulate the noble Baroness, Lady Jolly, on securing this debate. I shall miss her contributions in this area, which we have shared over many years. I am going to leave to others today discussion of the urgent need to reform social care for the elderly and flag up how important it is that reform, when it comes, includes those of working age.
According to Rethink Mental Illness, from 18 to retirement age, those with mental illness, learning disabilities, autism, as well as physical disability and declining mental health, are among a third of adult social care users. Half of the spend of the adult social care budget is with this group, which gives a good idea of the numbers. Services are stretched and, since March 2019, they have been reduced due to Covid. Legislation that we already have on the statute book—the Care Act 2014, the Mental Health Act, the Mental Capacity Act, and the long-awaited strategy to go with the Autism Act 2009—is meant to provide statutory services for all those people. People have a right to expect them to be provided. This House has supported that legislation along with the codes of practice and some of them are not even implemented. I hope that when we see the new reform, there will be a review of everything on the statute book to make sure that it is being used in practice.
Perhaps I may say a word about informal carers. Informal carers of working-age adults struggle. It is estimated that they are over 7% of the population. Parents and carers battle to advocate for adult children when services are not provided. That leads to mental health breakdown of both carers and those cared for. We have yet to learn the lesson of making cuts to low-hanging fruit in this area. It is all too easy to cut out some of the low-budget issues such as advocacy, befriending, welfare rights and employment—to name but a few. They are easy things to remove, but there are big consequences when they are. We are being made to wait and wait for the long-promised social care reform, So, when it is presented, there should be no excuse if it is not comprehensive, fair and fit for purpose. I say to the Minister: bring it on.
The Lord Bishop of Carlisle [V]
I congratulate the noble Baroness, Lady Jolly, on securing this timely debate. I should declare an interest as co-chair of a newly formed archbishops’ commission on reimagining social care. Understandably, much of the current discussion of social care involves the issue of funding. That is fundamentally important, but I believe the time has also come for a radical—in the sense of going to its roots—reappraisal of the values and principles underlying social care, not only for the elderly but for those with disabilities and severe mental illnesses. It has been clear for many years that we need an inspiring, cross-party, long-term vision for social care which involves rethinking how we want it to be understood as well as delivered, with those in need of care valued for who they are rather than simply regarded as an inconvenient burden. It has also been clear that that should include reference to some of the underlying societal conditions that contribute to the overall need, such as deprivation, lack of family support and loneliness.
Within this general framework, I want to focus on two specific areas that have already been raised and must demand our attention. One concerns the status, recruitment and retention of paid carers, especially in care homes. This issue has of course been highlighted by the particular burdens placed on care home staff during the pandemic. Quite often, those staff have had to work in more than one care home, with attendant implications for both their health and well-being and that of residents. It is essential that we raise the status of paid carers to ensure that caring, like service in the NHS, becomes a viable career choice rather than a last resort. Being a carer should be as much a source of pride and dignity as being a healthcare professional. This would involve the registration of carers, a suitable suite of qualifications, agreed national pay scales and realistic career progression structures.
The other specific area is the role of informal unpaid carers, including family members, who enable people, as we have just heard, to stay in their homes and who need better recognition. This applies in particular to the 750,000 or so young carers in England, many of whom, as we have recently been reminded in your Lordships’ House, regularly miss school and have little or no extra support. They, together with unpaid carers of all ages, need to be identified and properly supported if the UK’s standards of social care are to become world class.
Baroness Thomas of Winchester (LD) [V]
My Lords, I shall speak about home carers which is something I know about as I have them myself. So, I declare that interest. I feel strongly that being a carer is not a low-skilled job. Even helping to dress a frail, elderly or disabled person safely is a skill which should be recognised. Disabled people might be under the care of well-paid hospital consultants, but the consultants could not do their job without the day-to-day work of competent but low-paid carers. Half-hour-only visits are common, with no travelling time paid. It is not uncommon for carers to be the first people to find that a client has fallen or even has died in the night. Carers, particularly in large cities, are often from overseas and have to get used to difficult clients who sometimes resort to mild racial abuse, particularly if those clients are slipping into dementia. Good carers are like gold dust. They should be much better rewarded.
Lord Hunt of Kings Heath (Lab) [V]
We are in a vicious cycle. After decades of reviews and failed reforms, the level of unmet need rises, the pressure on unpaid carers grows, the supply of care providers diminishes and the strain on undervalued care workers ever increases. Yet, far from having an “oven ready” social care deal, the Government are seemingly paralysed and constantly postpone the hard decisions they need to make.
Paid carers make up a 1.5 million workforce, but there are millions more unpaid carers. As a society, we rely on unpaid carers and exploit them while giving them a lack of personal support, respite care or funding. Carers UK has carried out research on the impact of the pandemic on unpaid carers. It shows that 81% of carers provided more care during the pandemic, 64% have not been able to take any break because of a lack of respite care, and 74% feel exhausted and worn out. If we are to support these amazing people, we have to reform social care, starting with implementation of the Dilnot proposals by putting a cap on care costs, but that is not sufficient. As Dilnot himself has said, additionally we need a pay rise for social care staff and extra cash for the current system to increase the numbers eligible for care. It will cost: the Health Foundation says £11 billion a year, but I suspect that is an underestimate. Rather like the experience of the NHS at its formation, there is a huge level of unmet need that will emerge if the current tight eligibility criteria are relaxed, as they must be. It will cost, but if our experience of the last 15 months has taught us anything it is that it is imperative to sort this out.
Why then have the Government postponed a decision time after time? It appears that the latest setback is due to the Prime Minister’s financial illiteracy in refusing to allow any increase in income tax, VAT or national insurance to pay the additional cost. He may think it is smart politics. He may think it is best to waste money on vanity projects such as the ludicrous proposal for a new royal yacht—I wish the noble Baroness, Lady Jolly, much joy in focusing on that and other defence matters in the future—but the Prime Minister’s ultimate legacy will be to be remembered as a man who ducked the most pressing public policy issue of the day.
Baroness Altmann (Con)
My Lords, I too congratulate the noble Baroness, Lady Jolly, and echo the thanks for the wonderful work done by carers. Our care system is broken: every part of it is in need of radical change, from the arbitrary distinction between what counts as social care and what qualifies you for NHS healthcare, the healthcare lottery; to the way in which care is provided, the postcode lottery; to the standards applied to the workforce of 1.5 million people, such as social care nurses relative to NHS nurses, an employment lottery; to the lack of funding that has increasingly rationed care; to the draconian means test and funding shortfalls, which force the entire cost of care on to the most vulnerable, who pay not only significant sums for their own care but usually a 20% or 30% surcharge to subsidise council underfunding as well, whereas those who do not need care pay nothing; to the lack of support for unpaid carers; and to the financial fragility of care home operators, who can load their business with debt, extract equity, take rental income to their offshore companies, and have provided handsome profits to hedge funds, which buy and sell their distressed debt.
Each of these parts of the system needs reform, and there is no silver bullet. Extra funding is of course needed, but system redesign is also required. Leaving social care to cash-strapped councils leaves more than 1 million people who need care. The demographics are such that, within the next 10 years, the enormous bulge of baby boomers will start to enter care needs. At the moment, the current cohort is rather small. Social care seems to have been the forgotten front line at the start of the pandemic, and it was used by the NHS as an overflow service, perhaps being considered as part of the private sector rather than part of the health service. If someone has a health problem, however, and they need social care, why should that not qualify for free basic care at the point of need? It could be modelled on the lines of our pension system.
Carers have suffered significantly; unpaid carers have often been taken for granted. They have lost, according to Carers UK, an estimated 25 hours per month of extra support that they would have had before the pandemic from support services, family and friends. I am keen to see how we can better recognise their needs. Will the Minister agree to meet Peers from across the House and Carers UK to learn from the new measures that have brought together for the first time the various parts of our service to help vaccinate carers?
Baroness Watkins of Tavistock (CB)
My Lords, I congratulate the noble Baroness, Lady Jolly, on securing the time to discuss this vital topic. I draw attention to my interests in the register, particularly as a qualified nurse. Despite extensive knowledge and expertise as a country, we have moved forward at a snail’s pace in trying to address the real problems and opportunities that face us in the domains of respite and support for carers and readily available social care support, as other noble Lords have said.
Social care is funded and paid for differently in the four nations, yet we have a central funding system for the NHS. Unless more resources are allocated for social care, the NHS will continue to attract staff much more readily because of the employment terms there compared with the zero-hour contracts on which many care staff are employed. Today I looked for a job that I would apply for in social care, and noble Lords will be pleased to know that I found one on Housing Today, but it requires me to be the Swiss army knife of care: to work flexibly, and to use the salary-sacrifice system in order to have a pass to go around the city in which I would work. In return, they will give me a regular full day’s work—which are actually really good terms for many people. When will the Government take initiatives to drive the parity of esteem between the NHS and social care employment so that we can recruit, train and retain an excellent social care workforce with the skills and compassion needed for this intimate personalised work? The Government have a real opportunity to correct this by providing apprenticeships and meaningful, secure employment, while demonstrating to the current social care workforce how much we value its work through career development opportunities and fairer terms and conditions of employment.
Respite for carers is particularly important at this time, because most family-based carers have managed with little or no respite or external assistance during lockdown. Many are now exhausted and need respite to rest and recuperate in order to continue with their caring responsibilities. Some are young carers who have had particularly difficult challenges: for example, supporting a single parent with issues including mental illness, addiction and long-term physical disabilities.
It will surprise noble Lords to know that Bumble, the social dating platform, has given all its staff an extra week off for respite, due to the demands of the increased workload associated with the gradual reduction of lockdown and people seeking new partners. How will the Government instigate and monitor policy to guarantee a similar respite for all informal carers? Will they give young carers the right to have breaks? How will their support be prioritised, promoted and guaranteed?
Baroness Pitkeathley (Lab)
My Lords, in the olden days when I was first in your Lordships’ House, it was very difficult to get anyone to be interested in a debate on social care, still less on the role of carers. I used to call the valiant Peers who turned up the usual suspects, and we tried to bring the problems of social care and the difficulties of carers to the attention of your Lordships. Today, however, so many of us want to speak that our time is very limited and there is an agreement on the social care situation on all sides of the House. I am sure that we shall hear that the Minister himself is in agreement that the situation is bad for everyone: it is bad for councils, because local authorities cannot meet their obligations; it is bad for the NHS, because hospital beds are filled with people who should and could be treated at home; it is bad for care homes, which even before all the problems brought about by Covid were finding it increasingly difficult to balance the books; and it is very bad for family carers.
We all now know that families and friends are holding the social care system together by providing support for the most vulnerable in society. Many were at breaking point before and the Covid crisis has further exacerbated that: many are now saying that they are sick with worry. We are asking even more of these carers than ever before, and they urgently need to be supported and recognised. A recent ADASS survey said that there was now greater awareness of carers among local authorities, which is very good news; but a majority of directors are pointing to increased carer breakdown and requests for more complex support, a result of carers having gone without support for so long.
In all the years I have been banging on about this issue in your Lordships’ House, I have always been amazed that the economic case for supporting carers has not been more acknowledged. I have regaled your Lordships often with the billions saved for the Exchequer by carers, whose care is given willingly and with love. During the pandemic, carers are estimated to have provided care worth £530 million per day. It dwarfs any funding the Government could contemplate. Many carers have given up paid jobs to care, and want to return to work, but the services are not yet there to help them. That, of course, results in a loss of tax returns to the Exchequer. We now estimate that there are 13 million unpaid carers of every age, and they are by far the most cost-effective way of providing care, so it must make sound economic sense to support them and prevent the breakdowns that are going to happen.
Let me tell you about Shelly, who I spoke to during Carers Week. She is caring for both her parents, one with dementia, and her 30 year-old son who has severe learning disabilities. Before Covid, she was just about managing—a bit of respite here, a daycare place there, provided by the voluntary sector. All those services have now gone and she is going to break down. When she does, four people will need state support. Surely the Treasury, naturally concerned about the cost of social care reform, will take note of this. If Covid and what followed brought anything to the party, it is that we will finally be forced to take bold decisions about the funding and provision of social care. That is what I want to hear from the Minister: that “bold” is the watchword when we finally see the reforms.
Lord Astor of Hever (Con) [V]
My Lords, it is a real honour to follow the noble Baroness, who does so much for carers. I declare an interest as the father of a profoundly autistic daughter. My experience with our daughter, whose residential care was disrupted during the pandemic, was a real eye-opener. It is an exhausting business looking after a disabled adult, tending to their well-being 24/7. I have nothing but admiration for the carers who dedicate themselves to this task and I join the noble Baroness, Lady Jolly, in thanking them all.
Greater than the physical demand is a concern that our loved ones will be properly looked after when we are no longer around. A social care system for the 21st century needs to make us feel more secure on that score. Others are far worse off than my wife and me. I know a family with two profoundly disabled sons, aged 28 and 32, the elder in a wheelchair—sadly not electric because the parents are not disabled, so do not qualify. They have relied on carers provided by their local council to help with this full-on exhausting care, day after day. There is a chronic shortage of carers, who are on very low wages, in the care industry, so I join other noble Lords in asking the Minister how the Government plan to address this. Will the Government consider increasing the carer’s allowance to the minimum wage?
The closure of day centres, which provide much-needed respite from the constant, round-the-clock supervision, as well as swimming pools and places of worship, was a blow to this couple. Could special exemptions be considered in future lockdowns for disabled people and their families in well-supervised, safe environments? The imposition of strict procedures to limit the spread of the pandemic has weakened an already fragile and fragmented system, causing untold suffering. Covid exposed a plethora of gaps and shortfalls, in addition to contradictory and counterproductive measures, which unwittingly endangered people’s physical and mental well-being. In short, instead of social care, we had social carelessness.
The NHS will continue to suffer, as long as the social care structure is neglected, whether we are facing killer viruses or not. How do the Government propose, in practical terms, to better integrate adult social care services with services provided by the National Health Service?
Baroness Tyler of Enfield (LD) [V]
My Lords, I congratulate my noble friend Lady Jolly on her excellent opening speech and declare an interest, as I have a close family member in a care home. As we have just heard, the pandemic has cruelly exposed the plight of those dependent on social care. The NHS provides free care for all, based on need, but there is no equivalent care service to which families can turn when they or their loved ones need help, causing untold heartache. Only countless money and time from individual families is stopping the system from complete collapse. Age UK has estimated that more than 1.5 million people are missing out on the care they need, and the cost of inaction is falling on the shoulders of 11.5 million unpaid carers, some aged 80 and above. This national scandal is no longer hidden from view due to Covid, but it is something the country increasingly understands and feels is grossly unfair.
Not just the elderly are affected. Younger disabled adults make up half the costs of the adult social care budget and generally do not own their own houses. The NHS provides insurance against the cost of health- care, primarily paid for through taxes, but there is currently no way for individuals to insure themselves for social care. Addressing this requires bold action and a strong political will. We need a comprehensive programme of reform for social care, both now and in the future, and I believe that programme needs three key pillars.
The first is to shore up a fragile and highly fragmented sector reeling from the impact of Covid, increased costs and low occupation rates, with some care homes becoming increasingly unviable financially. Immediate funding is needed to improve the quality of care and introduce minimum standards.
The second is individual funding. A cap on individual social care costs, as proposed by the Dilnot commission 10 years ago, alongside a more generous means test for access to publicly funded social care, would at least fix one of the system’s big problems: the lack of protection for people and their families against potentially catastrophic care costs. The architecture for doing this already exists; Dilnot’s proposals were put into legislation in 2014, with cross-party support.
Thirdly, we urgently need a new deal for the care workforce, with action on pay, training and development, career progression, professionalism and recognition. Care staff, who have given so much during the pandemic, deserve to be paid well above minimum wage.
A reform package including all these elements, as we heard from the noble Lord, Lord Hunt, is estimated at around £12 billion or 0.6% of GDP. How are we going to pay for it? That needs to be the subject of a separate debate but, at this stage, I think we need a solution that takes intergenerational fairness into account. During the pandemic, tens of thousands died before their time in care homes from Covid. The best possible legacy we can give all those who lost loved ones is to ensure that we fix the care system, so a similar tragedy can never happen again.
Baroness Donaghy (Lab)
I congratulate the noble Baroness, Lady Jolly, on initiating this important debate, and the Care & Support Alliance on launching its campaign to make the Government act to reform the social care system. Since Mr Johnson made his well-known pledge to “fix the crisis” 100 weeks ago, 35,000 people have sold their homes to pay for care and 2 million requests for care support for older people have been turned down by local authorities. Councils are turning down 21,000 requests a week.
It is important to remember that social care is not just about the elderly; children with disabilities and people of working age with severe mental illness are part of any consideration, as the noble Baroness, Lady Browning, and the noble Lord, Lord Astor, both pointed out. Working-age adults account for a third of social care users and half of the so-called spending, according to Rethink Mental Illness. As my noble friend Lord Hunt said, there is an estimated gap between funding and need of £6.1 billion. That does not take account of unmet need due to the pandemic or the vital issues of enhancing the status and pay of care workers, as pointed out by the noble Baroness, Lady Watkins.
Everyone taking part in the debate knows all this; we have been here before. What are the political incentives to do something about it? If Mr Johnson fails to deliver, will he lose an election because of it? Will he take to heart that he has broken this particular promise? In any new arrangement, there will always be winners and losers. It is well-known that the Prime Minister hates taking unpopular decisions, so let us make it easier for the Minister to bolster Mr Johnson: simply hand him a copy of the Dilnot report and the report of the noble Lord, Lord Forsyth.
Lord Forsyth of Drumlean (Con) [V]
My Lords, I am grateful to the noble Baroness, Lady Donaghy, for that reference to the all-party Economic Affairs Committee report. It is now becoming rather ancient, but it set out a basis upon which the Government could act and the Prime Minister could fulfil his promise to fix social care. We described the situation as a “national scandal”; I have described it as a disgrace and the Government’s position as a breach of trust. Yet in debate after debate, Ministers tell this House that they have been distracted by Covid or that it is necessary to get all-party agreement before we can make progress. As the months go by, nothing is done to convene talks to get all-party agreement. We all know that the reason action is not being taken is that the Treasury does not want to spend the money.
For me, politics is first and foremost about protecting the most vulnerable in our society. The Government should provide a safety net below which no one will fall, and social care is absolutely central to that. The statistics that the noble Baroness, Lady Donaghy, has just reiterated are something that all of us should be ashamed of—the Government should certainly be ashamed for not having acted before now.
It is a real pleasure to take part in this debate and to speak alongside formidable campaigners such as my noble friend Lady Browning and the noble Baroness, Lady Pitkeathley, and indeed the noble Baroness, Lady Jolly. I am really grateful to her for giving us yet another opportunity to remind the Government that procrastination is the thief of time and is creating real misery.
I want to emphasise how important it is to raise the professional standing and status of carers. I can see nothing that the Government have done in engaging with the professional bodies to achieve that purpose. We are talking about big sums of money, but in one year we increased the NHS’s funding by more than the total cost of social care, and the NHS—as so many speakers have already pointed out—is very dependent on social care. In Scotland, we saw people who had tested positive for Covid being transferred to nursing homes and care homes, with disastrous consequences.
We have a situation where the Government are committed to levelling up, but why then is the responsibility for funding being put on to local authorities? They can raise their local taxes in order to fund social care, but the local authorities with the most need often have the narrowest tax base. There is real pressure, which results in people not getting the care and support they need, as the noble Baroness, Lady Donaghy, pointed out.
There is a huge need for additional recruitment in the care sector. That will not be fulfilled if people are not properly paid, properly rewarded and properly treated for the fantastic job they do for our country. Frankly, the Minister is letting them down by coming back repeatedly to this House and saying, “We will produce proposals soon, perhaps by the end of the year”, and making excuses. We all know that the Prime Minister must tell the Chancellor to stump up the cash, because this is one of the first duties of government.
Lord Rooker (Lab) [V]
My Lords, we know what the problem is. We have just heard that the Lords Economic Affairs Committee spelled it out in detail in July 2019, and the House debated it in May this year. In the meantime, of course, the Prime Minister has more than once told us that he has a plan—famous for social care plans is our Prime Minister. I will use just one speech, made in Dudley, on 30 June last year, as an example, when the Prime Minister said
“we won’t wait to fix the problem of social care that every government has flunked for the last 30 years … We are finalising our plans and we will build a cross-party consensus”.
There is another chance today to hear from a Minister the excuses for no action being taken on the plans that the Prime Minister has more than once said were finalised.
The Lords Economic Affairs Committee said that an injection of £8 billion was needed—of course, that was two years ago—just to restore the level that the coalition Government of Tories and Lib Dems inherited from the Labour Government in 2009-10. The Mencap brief for today’s debate gives one example of a £180 million gap in local authorities for people of all ages with a learning disability to be able to live a decent life.
The question is: how do we get the cash? Not from people selling their homes, as the Prime Minister is against that—but it is happening every week. It has to be a national effort, shared as we share the funding for the NHS. The Government want to be consistent with their manifesto, so here is my solution. Yes, it will involve more tax, but it will save money and misery in the end. My bid is simple: the over-40s pay an extra 2% on income tax as a social care supplement. As for national insurance, why on earth does it cease at the age of 65? I was on a salary until I was 72, and paid no national insurance after the age of 65. Today, I am an 80 year-old, 40% taxpayer, yet I pay no national insurance. You could keep the rate the same, or tweak it after 65, and stay in line with the Tory manifesto, and you could get this social care supplement from employers as well. The extras for pensioners, such as winter fuel and bus passes, are all great and convenient, but we should make them taxable. As the Minister who introduced the 75p pension increase in 2000, while ensuring that the poorest pensioners got £3, I say we need only the double lock introduced by Labour; the triple lock cannot be justified any longer.
Baroness Hollins (CB) [V]
My Lords, I remind the House of my interests as chairperson of the independent care, education and treatment review process for people with a learning disability or autism in in-patient settings, as president of the Royal College of Occupational Therapists, and as a carer for my adult son.
There is a growing number of households of elderly carers who may have their own health and support needs but who still support adult children with a learning disability, themselves approaching retirement age. Mencap’s survey of such carers during the pandemic found that the majority experienced significant reductions in social care, including a lack of continuity of social worker input. Knowing that parents are ageing is a reason to make plans and to have good support in place, rather than waiting for a crisis. Too many crisis admissions to residential care or hospital occur after a last surviving parent has died or following some other trauma.
Last week, some families shared their stories in a report, Tea, Smiles and Empty Promises, to mark the 10th anniversary of the BBC “Panorama” documentary which revealed the abuse and neglect of people with a learning disability and autistic people at Winterbourne View hospital. Tens of thousands of pounds are spent detaining people such as these in hospital, rather than using the money to provide community-based support. Working-aged disabled adults account for half the total social care spend in England, and of this, learning disability accounts for one-third. Is the money being spent well? The answer is mostly no.
Far too often, our social care system ignores the real needs of disabled adults of working age for skilled support to live an ordinary and decent life. They absolutely do not need to be locked up, warehoused, or kept out of sight. This debate is not just about who should pay but about the very nature and quality of the support provided.
Social care exists for a purpose: to provide personalised care that ensures well-being in line with the Care Act 2014. When it is good, it is very good, but a system based on crisis management is a failing one. Of the workforce, currently 604,000 of the 1.5 million care workers in this country are paid less than the real living wage—that is nearly half. The social care people plan framework, launched at a major summit with politicians from all parties, this afternoon, argues for a real living wage for care staff, a national register and nationally prescribed training. Does the Minister agree? I believe that the case for a social care people plan to mirror the one already in the NHS for a similar sized workforce is unassailable. The Royal College of Occupational Therapists agrees.
Lord Pendry (Lab)
My Lords, I welcome the opportunity to take part in this important debate. As a result of it, I hope the Government will recognise their duty to carers and provide the necessary means to remedy the disastrous situation we find ourselves in.
Of course, we have all been around this block many times before, especially my friend, the noble Baroness, Lady Pitkeathley—my mentor and a great champion of carers. With her assistance, I piloted the Carers and Disabled Children Act 2000 through this House and the Commons. I am delighted to have heard her words in this debate. I hope the Government will take them on board and act accordingly.
I will draw attention to the vulnerability of carers in our society. In a recent Carers UK survey, 72% of unpaid carers said that they had suffered from mental ill-health and 61% had suffered physical ill-health as a result of caring. It is not surprising that these are the results of the carers’ condition if we look at the facts. For unpaid carers to get the carer’s allowance, they must work for more than 35 hours a week. In doing so, they will receive an income of £62.25 a week, or less than £2 an hour. Paid workers will receive the minimum wage, with three-quarters earning less than the real living wage. Both those statistics are disgraceful.
My union, UNISON, is one of the principal carer unions and for many years has fought for their needs. It tells me that the Covid-19 pandemic has had a devastating impact on receiving and providing social care. Thousands have died from this deadly disease in care homes, as have many more in their own homes. We know of at least 1,500 staff members who have died across the health and social care sector. Covid has highlighted many of the problems that have worsened the plight of care workers. No wonder UNISON describes them as the “forgotten front line” of the pandemic.
Time does not allow me to go on any more, but I hope that the Government will act on the voices that we have heard, lest all that cheering and clapping on the doorstep of No. 10 praising the heroic work of health service workers during recent months will have a hollow ring with those workers.
Lord Lilley (Con)
My Lords, the first duty of the state in social care is financing its provision to those who cannot pay for themselves. Yet local authority budgets have been cut to the bone, despite rising costs and increasing numbers.
This primary duty has been eclipsed politically by the natural fear of home owners and their heirs that potentially catastrophic costs of social care will consume the value of the parental home. Most proposals to deal with this involve setting a maximum amount anyone has to pay—say £80,000—after which the taxpayer would meet the costs. That gives the greatest benefit to those with the most valuable homes, particularly in the south. The owner of a modest or a partly mortgaged house who needs three years’ care would still lose nearly everything, while someone in a London home worth £1 million could bequeath more than £900,000 even if they spend more than 20 years in care. How is that fair, popular or levelling up? Moreover, extending free social care to some, let alone all, home owners would pre-empt public funds desperately needed to ease the pressure on councils’ social care budgets and on the many care homes that were barely viable even pre-Covid.
Yet there is a solution to the risk of catastrophic costs of elderly social care that does not pre-empt funds needed by the existing care system. It is insurance, which was one of the first solutions to be considered by Dilnot and others but was rapidly dropped because the insurance industry said that it would not provide policies to protect people from having to sell their homes. It could not do so because of uncertainties about future government policy and possible medical advances prolonging frail longevity. Moreover, working people will not pay for such policies on top of saving for their pensions and repaying their mortgages.
But an alternative to private insurance has been ignored: that the state offer such insurance. The alternative to asking people to contribute during their working lives is not taxing them but enabling them to pay for such insurance after they retire by taking a charge on their homes. The state insurer would then be reimbursed when they die or sell their homes. I have set out the details in the Civitas pamphlet Solving the Social Care Dilemma, and in a Private Member’s Bill coming before this House on 16 July, when I hope to see all noble Lords once again. Meanwhile, can my noble friend the Minister confirm that this option has been considered by his department, to which I sent it many months ago?
Baroness Blower (Lab)
My Lords, I commend the noble Baroness, Lady Jolly, for securing this debate on such an urgent issue. I fully endorse the remarks of other noble Lords about the urgent need for proper pay, conditions and employment arrangements for employed care staff. There is an urgent need for a national care service.
However, in the time available I will focus on young carers. As we all know, much social care is provided informally by family, friends and neighbours. Estimates vary, but there might be as many as 800,000 young carers, some of whom are very young indeed. These children often support a family member, often their mother, who is unable to look after not just themselves but the rest of the family. This might be on a short-term or a longer-term basis, and the emergence of long Covid might well mean an increase in the amount of such care being undertaken by young carers.
Prior to the pandemic, it was estimated that young carers missed as much as 48 days’ schooling. That is more than nine weeks, and it is not at all clear how young children were ever able to catch up. Regrettably, their school experience might also, according to work done by YoungMinds, have been blighted by bullying. In addition, they would certainly have been more tired and stressed by their responsibilities than their peers who are not carers. Moreover, the range of tasks that young carers have to carry out means that they have less time to devote to their homework or self-study, let alone time for social or recreational activities with friends.
This role is a huge responsibility for young carers throughout the country, but it is also a huge and probably underrecognised contribution to adult social care nationally. I hope that many schools and colleges have systems in place to support young carers in their roles, but I fear this may not always be the case. According to YoungMinds, young carers can experience feelings of guilt, anger, anxiety and low self-esteem. With overstretched GP services and children and adolescent mental health services at capacity and beyond, does the Minister agree that access to a qualified school or college counsellor able to offer support to these young carers is the very least support that they should be afforded?
Baroness Walmsley (LD) [V]
My Lords, it is a pleasure to support my noble friend, Lady Jolly, who laid out so well the importance of social care to all of us. It is clear that the crisis in social care must be addressed urgently and a cross-party consensus reached on a fair system of funding. That will happen only if the Government liaise with other parties, not just the Chancellor. The pandemic has highlighted the interdependence of social care and the NHS, but there has been a damaging shortfall in social care funding over the past few years—currently at £6.1 billion—and local authorities have struggled to subsidise social care from other funds.
The social care workforce is dedicated, but its pay is on average 25% less than that in the NHS. No wonder some are moving into retail and agriculture: the Brexit shortages in those workforces has meant that they can earn a lot more if they work in those sectors. There were 112,000 vacancies before the pandemic, and a shortfall of half a million care workers is predicted by 2035 unless something is done. The public support parity of esteem with NHS staff. I agree with the noble Baroness, Lady Hollins, that we need a social care people plan similar to that for the NHS. What is the Government’s plan for this?
Domiciliary care workers are particularly hard hit as they are not paid for travel between clients and have too short a time to carry out their duties. They are in some respects even more important than those working in residential care because they contribute to keeping clients out of hospital and preventing their move to more expensive residential care. Related to this but slightly beyond the scope of the Minister’s department—but just as crucial to the objective of keeping elderly people safely at home—is housing design and adaptations. Can the Minister tell the House who in government takes responsibility for this?
The shortfall in funding means that the burden of care has fallen on the shoulders of 11.5 million unpaid carers, family and friends. Their care allowance is a pittance and must be increased. Although their rights to support were laid down in the Care Act 2014, they have not been met because of the requirement that local authorities remain within their budget. Can the Minister say when those rights will be fulfilled?
Many people are unaware that half the cost of social care is for working-age adults with physical and mental disabilities. During the pandemic there has been even more pressure on services for them. Is the Minister aware that, although the emergency powers to modify entitlement to services have not been overtly used, organisations that speak for these groups report that their services have indeed been curtailed? Will he look into that?
Lord Flight (Con)
My Lords, it is clear that the occasion of a pandemic means that reform of carers and social care cannot be put off, but it is a big and difficult task. There are big regional differences in patterns of social care and care arrangements, mostly determined by local authorities and the shape of the population. Care is also provided to all groups: children, the young, people of working-age and those who are older. Carers can be provided by local authorities, private companies and charities and, most of all, informally by families and neighbours. It is estimated that 1.6 million people work in the adult social care sector and 7% of the population provides unpaid family-type care services. The biggest territory is the old, although there are still significant differences in longevity around the UK, which affects care needs.
There is major reliance in the UK on family carers, which consists of one partner in a marriage looking after the other and children helping. There is nothing wrong with that. I remember that my parents looked after each other and all my grandparents looked after each other, but they had to be in a position and willing to do so. Post-pandemic, the UK simply cannot afford huge increases in care costs, but spending on care is more justified than spending on the NHS, which is already huge. There is the problem that care home costs have risen substantially over the past 20 years, largely reflecting regulatory costs.
I was very interested in the comment made by the noble Baroness, Lady Blower, about children. While working as a councillor, my wife found that there were child providers, some as young as eight, whose parents were bedridden. They were wonderful young children and pleased to do it.
I fear that the major political issue will be whether individuals have to sell their houses and use the proceeds to finance the provision of care until the funds run out. The free provision of care where individuals do not have such savings is clearly some incentive not to save during working life and one reason why the UK savings rate is, surprisingly, massively less today than it was 100 years ago. I think the Foresight report is crucial to reform. I agree with it and am disappointed that it has not been implemented sooner. I also think there is scope for state provision of insurance, but we need to get a move on.
Lord Monks (Lab)
My Lords, I must declare an interest. Like others, my wife and I are carers for our son, who has advanced multiple sclerosis. That takes up a lot of our time.
Members of this House who follow rugby—there are some, I know—will have noted that in the past year or so two prominent players have contracted motor neurone disease: Doddie Weir from rugby union and Rob Burrow from rugby league. Both have been generously supported by their respective games. For example, Rob Burrow’s colleague at Leeds Rhinos, the admirable Kevin Sinfield, ran seven sponsored marathons in seven days and raised £2 million for the Burrow family and medical research. As Rob Burrow said, everyone needs a friend like Kevin.
However, not everyone has the profile of these rugby lads, nor does everyone have a friend like Kevin. That is why having a social care system to be proud of is so important. We must make sure that the most vulnerable and fragile in our society are properly supported. As others have said—I will not labour the point—we are far from that at present. We have been reminded of the landmark report by the Economic Affairs Committee of this House, which has made a notable contribution to pushing forward this debate. Now, after years of delay and dither, we are promised that a plan is imminent. It would not be the first promise on social care that has been broken, but let us take the Government’s word for it this time round.
I have two questions. First, I stress that the expected plans should address the plight of working-age adults as well as the aged and children. Working-age adults already account for half of social care spending. Will the Minister explain whether they will be covered in the first part of the plan or deferred, as I understand was the case in Scotland, until a later date? We need to move forward on the working-age population, and I would like an assurance that that will be the case.
My second question is about the position of the staff in the care sector. Other noble Lords have said what the situation is. There are many unfilled vacancies, high turnover and low pay. Will the Government commit in their plan to lead on measures to improve pay, training and career prospects? If we have learned anything from the Covid crisis, it should be about the need to protect and fairly reward front-line medical and care staff. They have supported us and we must support them.
Baroness Cavendish of Little Venice (CB) [V]
My Lords, I congratulate the noble Baroness, Lady Jolly, on securing this important debate. I think all the speakers know what all the issues are. I shall not try to tackle the whole issue of social care in three minutes, but I shall make two points.
My first point is on the paid workforce. The pandemic brought a new influx of workers into the social care sector, many from the hospitality industry, so some of the statistics we are hearing today are probably slightly out of date, but that does not mean that there are not huge issues of retention and attrition. It is important to think about how we are going to keep that new group of people and the existing staff, who have shown in this pandemic that they are extraordinarily dedicated. We need to emphasise that care is, as others have said, not low-skilled. The further you are from a hospital setting and that kind of supervision, the more maturity you need to handle the very real challenges you face in going into someone’s home, trying to figure out what they need and trying to connect with children with learning disabilities, elderly people with dementia and so on. We have heard a great deal about funding in this debate, and it is vital, but we also need to think about what we want to spend the money on. I do not think that throwing more money into an unreformed system will give us the quality of care that we all want.
I want to talk a bit about commissioning. We need a care service which does not just work on a time-and-task basis but gives front-line staff the autonomy to assess what they think is needed and to do what they think is right. Their vocation is to care. Many who drop out of the social care workforce are some of the best people. They have real problems because they are underpaid, but they also have emotional problems because of not being able to give the care needed. We ought to allow that autonomy. We ought to commission for outcomes and not always ask staff to refer to a social worker if they want to change a care package by as little as 15 minutes. That would be a revolution in the way in which we provide care. In Holland, a million patients are cared for by staff who organise themselves and who do what they think is needed. They provide far higher satisfaction levels. They have enabled some vital cost savings, ploughing back money into the service and into staff wages. In this country we do not learn enough from other places. I ask the Government to look at that. Yes, we need better pay, training, career progression and much else that has been mentioned in this debate, but we also need staff autonomy.
Lord Brooke of Alverthorpe (Lab)
My Lords, I am grateful to the noble Baroness, Lady Jolly, for giving us this debate, and for the contributions made by other noble Lords. In particular, I picked up what the noble Baroness said about care homes and the number of unfilled beds. Having watched television and seen people who have gone through the difficulties of Covid, I am not surprised that many questions are now being raised about care homes and what people should do with their loved ones. Looking to the longer term, maybe we should ask whether people working at home, being remunerated at home and, in turn, caring for loved ones there is the way forward. The best quality of care we can give anyone—young or old—is love. In the first instance, this comes primarily from family members and friends all around.
The right reverend Prelate the Bishop of Carlisle set a challenge. I was interested to hear that the Church is looking at this. I hope that it will be radical. A radical solution is available, though the Government would certainly not embrace it. Back in the 1990s, the Government would not embrace the national minimum wage. We now need to move towards a universal basic income. In due course, we shall be faced with AI and a lot more people will be unemployed. Many more will want to work from home. Many would be willing to spend their time caring for and looking after loved ones if they were remunerated, as the noble Lord, Lord Monks, has just said.
I am looking for a radical response in the longer term. If the Government do not have that within them, I would hope that my own party might start looking at something as radical as a universal basic income. We might try to start a conversation with the Lib Dems, the Greens and the SNP, as well as with Cross-Benchers. We should bring together a crowd of people who see that we need really radical and fundamental solutions that address future changes and some of the lessons that we have learned from Covid.
There needs to be a levelling up, and levelling up means a redistribution. The noble Lord, Lord Rooker, spelled out very clearly the whole range of available options. There are many more. We cannot run away from it. If we are to do the job and care for people properly, we have to pay for it. Those of us who can afford to pay should do so willingly and be prepared to see that the problems of the past are not repeated. When AI comes in the future, much money will be spent on unemployment benefit. That could be redirected into a positive return, which would be about better lives at home, people working from home and looking after their loved ones.
Baroness Scott of Needham Market (LD) [V}
My Lords, I will focus my remarks on the wonderful work done by voluntary and community groups during the pandemic—as well as the rest of the time—particularly in the area of social care. We owe them an enormous debt of gratitude.
I declare an interest as a trustee of Community Action Suffolk, the infrastructure body for the county. I am also a member of the advisory body of the Institute for Volunteering Research in Norwich. I can recommend that all Peers with an interest in these matters take a look at the research being done there.
Volunteers bring a user-based focus and use their personal commitment, time and skills to make the social care system more resilient. In this way, society becomes more resilient. However, they are complementary to—and not a substitute for—properly resourced public services and professional staff. Volunteers can play a significant role, but government needs to use the existing knowledge and evidence as the basis on which to build effective and sustainable volunteering efforts.
Covid-19 has highlighted much of what we already knew from this evidence. The voluntary sector best supports individuals when it is linked with statutory services and not kept disconnected from them. A key achievement of Community Action Suffolk throughout the pandemic has been to have a seat at the table to ensure that the response of all the voluntary organisations in the county is dovetailed with statutory services. That way, we have been able to link volunteers with shielded individuals, support food banks, assist school testing programmes, and much more.
The Institute for Volunteering Research has shown just how important these infrastructure bodies are. As the demand for their services and the volunteer base grew, their role became more important. But not all areas have these. They are underfunded and not universal.
As people return to work, the sustainability of the volunteer base is in question. Older people are re-evaluating their lives in the same way as are so many of us. Further research by the IVR has shown that attempts by national government since 1948 to direct volunteer efforts centrally have been largely ineffective. Further research by the ESRC has shown how the devolved Administrations have taken a significantly different approach during the pandemic.
Levelling up should not just be about infrastructure in certain geographic areas. There are huge variations in social capital, access to community assets and people’s capacity to help one another. Government departments need to use the available evidence and consider working with funders to create an observation study to find a clearer picture of the disparities which exist and to build a response to them.
Baroness Uddin (Non-Afl) [V]
My Lords, I wish to take a moment to reflect in honour of all those who lost their lives under this Government’s watch and their loved ones who mourn their absence. I want also to record my thanks to all front-line staff for their perseverance during what was a dangerous time.
I too welcome the work of the Care & Support Alliance and place on record my respect for the outstanding advocacy of Carers UK, Rethink and the Disabled Children’s Partnership. I salute the valiant leadership of my noble friend Lady Pitkeathley. I humbly thank the noble Baroness, Lady Jolly, for enabling this conversation.
Speaking as a parent, I can say that caring for someone you love is a lifelong, all-encompassing devotion. According to Carers UK, during the pandemic more than 13 million people provided unpaid care—72% without any break or support. There was a 78% increase in demand for their care, with no response. An estimated 1.2 million carers live beyond poverty. The Government cannot say that they do not know these facts. Even with the time constraint, the detrimental underfunding of social care cannot be overemphasised. It has resulted in an enormous toll on individuals not having their most basic and urgent care needs met, as well as on those who do everything they can for their loved ones.
The system is failing more than 1.5 million of those who need urgent care as a result of government policies and constraint on local authorities. Services are crippled, including voluntary organisations that have been and are a lifeline for the most disadvantaged in our communities.
I wish briefly to speak about the dire situation of hundreds of thousands of families caring for their loved ones with disabilities and autism, which was recently highlighted by the Disabled Children’s Partnership report No End In Sight. I commend it to your Lordships. I have heard first-hand testimonies from several of the parents panel families, who have felt broken, ignored and abandoned over recent years—more so over the past months because they have not received their most basic care services and cannot access what they regard as crucial physical and language therapies and mental health support, with significant adverse consequences for their families’ well-being.
In my social work career, I have had the privilege of managing care homes. I appreciate their invaluable resilience, which was so evident during the early months of the pandemic. I also am fully aware of, have witnessed and have managed at first hand the fallout of the ugliness of abuse of the elderly and the disabled, much of which remains unreported—markedly so in unregulated care homes. Will the Minister assure the House, in the light of the recent case against the National Autistic Society, on what additional safeguards and monitoring are in place to prevent such abuse occurring yet again?
The time for integrated care, free at the point of delivery, is now. As the noble Lord, Lord Forsyth, and other noble Lords have eloquently said, we need political will and leadership, as well as a willingness to work alongside local authorities and leading organisations to cherish the fundamental principles of choice, control and—
Baroness Penn (Con)
My Lords, I am afraid I am going to have to remind the noble Baroness of the time limit for the debate.
Baroness Uddin [V]
Thank you. We want the dignity of independence for those who are living with disability and their carers.
Viscount Chandos (Lab)
My Lords:
“I have heard members of political parties on both the left and the right describe this as an incredibly difficult problem, and my response is that it is not a terribly difficult problem.”
Those are the words of Sir Andrew Dilnot in giving evidence to the Economic Affairs Committee two years ago during its inquiry into social care funding. Although I am a current member of the committee, the excellent report resulting from this inquiry predates my membership.
The Chancellor of the Exchequer told the committee a year ago that one of the reasons for the lack of progress in delivering on the Prime Minister’s promise on his first day in office was the “absence of consensus” over funding. Yet, as Harry Quilter-Pinner of the IPPR told the committee, there is
“a consensus growing behind free personal care”.
The IPPR, the Social Market Foundation, the Institute for Fiscal Studies and the Policy Exchange think tanks, spanning the full range of philosophical and policy approaches, were united in their support for this. With the cancellation this week of the advertised summit between the Prime Minister, the Chancellor and the Secretary of State for Health and Social Care, I suggest to your Lordships that the lack of consensus on funding is within the dysfunctional Government and between government departments more than across the political and ideological spectrum.
In focusing on funding, I do not wish to miss the opportunity to pay tribute, as has every speaker this afternoon, to the extraordinary commitment, skill and kindness of individual carers, both professional and unpaid. The urgent need to improve the terms of employment of the professionals and increase the support for the unpaid is precisely why the funding problem must be solved—and solved without further delay.
I shall finish, therefore, by reiterating the recommendations of the committee and the policy of the Labour Party that this urgent need should be wholly or substantially funded from general taxation. I quote Sir Andrew Dilnot’s evidence again:
“One way of describing the current system is that it is a very high inheritance tax, but only on people who have high social care needs.”
The fundamental unfairness of the current system is hard to address through trying to modify the established model, and hypothecated taxes and insurance schemes—such as the one advocated by the noble Lord, Lord Lilley—exacerbate the challenge of gaining both political and popular acceptance. I have argued to your Lordships in a broader economic context that a radical overhaul of inheritance tax, creating progressive taxation of both inter vivos gifts and inheritance with complex loopholes and allowances eliminated, is an obvious opportunity to increase revenue to the Exchequer. Does the Minister not agree that this would be a compelling challenge to the Treasury’s refusal to loosen its purse strings to address this national scandal?
Baroness Barker (LD)
My Lords, I salute the noble Baroness, Lady Jolly, as she makes her way off to her new defence portfolio. I want to follow the noble Baroness, Lady Donaghy, in turning the House’s attention to the often forgotten part of social care: mental health social care.
I put it to the Minister that, as we sit here watching, as we have done for the past year, an unfolding mental health crisis with an unprecedented level of mental health problems in the general population, and waiting for the legislation following Sir Simon Wessely’s review and the Government’s response to it, now is the time, with popular support, to change radically the way in which we fund and devise mental health support. We need to ensure that adults of working age have access to skilled mental health support, to enable them to remain in work. We also need to do what my colleagues in Sutton local authority have done: find the money to support mental health staff in schools so that children can get through this challenging period with some resilience.
In mental health, it is often said that the NHS gets lots of resources and local authorities get lots of responsibilities. They do. They have huge responsibilities for commissioning mental health social care. At the moment, they are running those on resources that are pretty well exhausted. We need a system whereby people have quick access to emergency preventive support and to crisis support of the kind that we provide very well when we have resources; and whereby, when people have had episodes of acute care in hospital, their Section 117 aftercare, to which they are entitled, is actually there, and they are supported back into work. If we do not have that, we will simply have a generation of people who are not earning the capital to fund their future care needs when they are older.
I also want to do one thing that I do not think we have done today: acknowledge that communities of people of colour and LGBT communities are disproportionately hit by all this, as they have been disproportionately affected by Covid.
I finish by asking the Minister two specific questions. First, what assessment have the Government made of his department’s convened Mental Health and Wellbeing Advisory Group’s recommendation that we need £1.1 billion of investment in mental health social care budgets? Secondly, when will the Government publish their response to that group’s recommendations, after committing to review them in a mental health winter plan? If we leave this, it will become more than urgent; it will become an acute and endemic problem. We need to seize the time now to deal with it radically.
Lord Dubs (Lab) [V]
My Lords, I should first declare an interest, in that my son has MS and his wife is his full-time carer, although my wife and I have also helped out at intervals. I thank the noble Baroness, Lady Jolly, for the clear way in which she set out the argument.
The crisis in social care existed before Covid and will exist long after Covid unless we take urgent action. This is no time to tinker at the edges; we have to deal with it fundamentally. My noble friend Lord Rooker gave good examples of how to fund social care. The Government could take those to heart; they would probably work. We have heard successive promises from the Government. The usual argument for delay is that they cannot do anything because of Covid. It is time that these promises stopped and the Government got on with it.
We have all heard how, in the residential and domiciliary social care sector, there is low pay, poor status and desperate staff shortages. Then we have the unpaid carers: I do not know how many there are, but estimates vary between 4 million and 13 million people. I have also seen an estimate that they are worth £100 billion a year, given the contributions that they make. Besides that, the actual cost of social care, large as it is, has to be seen in proportion. Unpaid carers have often given up their jobs and work long hours. They are desperate for respite care. A week’s respite care for a full-time unpaid carer is worth its weight in gold. It can change her—it is usually a woman—attitude to life, give her a lease of energy and enable her to go on doing the difficult job she is doing. We have to be reconciled to the fact that demand for social care is going to increase, partly because we are living longer and partly because of dementia and other illnesses. We need to prepare for an increase, not just try to cope with the present demand.
If run effectively, social care would actually save the National Health Service money by reducing pressure on hospital beds. I wonder how many people are occupying a hospital bed because there is not the care and support in the local community. I do not blame local authorities for that; they do a fantastic job and a pretty difficult one. But I will say that the forms one has to fill in to apply for social care are formidable. They still run to pages and pages; I think one needs two PhDs to fill them in. They are pretty difficult for people, but there it is.
We also need better data and statistics on the whole social care sector if we are to make sensible decisions about the future. I do not believe those exist. Sometimes local authorities get together to share their statistics, but I think the Minister will confirm that we could do with better data and statistics. Finally, I believe that we need a national care service, parallel to the National Health Service and introduced with all the imagination shown by the 1945 Labour Government when they introduced it.
Baroness Brinton (LD) [V]
My Lords, I declare an interest as a vice-president of the Local Government Association. I thank my noble friend Lady Jolly for instigating this debate and for her wonderful service to the Liberal Democrats’ health team, and to your Lordships’ House, in speaking calmly and authoritatively on health issues for over a decade.
The right reverend Prelate the Bishop of Carlisle was so right to start with the suggestion that we need to go back to the absolute fundamentals of social care, because the current system is plainly not working. Over the last two hours we have heard many stories alongside examples and statistics of how the system is failing. As my noble friend Lady Walmsley said, this needs to extend to housing too. Habinteg has produced homes for life standards that cost only a fraction more when a place is built new but can mean people then stay in one place for their entire life, with very minor and cheap adaptations.
The noble Baroness, Lady Cavendish, is right that we need to think in completely different ways. I, too, want to mention an exemplar from the Netherlands, where students are now living alongside residents in care homes. In return for accommodation, they are also providing some support. Not only has it proved career-changing for the students but the record of dementia has reduced because of regular contact with younger people. That is the sort of radical idea we need to think about.
From these Benches, we are calling on the Government not to delay any longer but to engage urgently in cross-party talks on the future of social care. Our Prime Minister, Boris Johnson, pledged during the 2019 election and then from the steps of No. 10 to
“fix the crisis in social care once and for all”.
With social care services in such crisis, it is time that he and the Chancellor acted. People are selling their homes to pay for care and more than 1.5 million people are missing out on the care they need. Others are stranded in hospital, unable to leave because the follow-up care just does not exist. This is putting an increasing strain on the NHS, which also does not have the cash to cope.
The Dilnot review has been repeatedly referenced, including by my noble friends Lady Jolly and Lady Tyler, and by the noble Viscount, Lord Chandos, who is right that Dilnot’s proposals demonstrated that this is not difficult. I also agree with the noble Lord, Lord Rooker. In 2010, all three major parties agreed on proceeding with Dilnot and then the Conservatives pulled out. A decade further on, nothing has happened.
The noble Lord, Lord Forsyth, might feel that his committee is long in the tooth now but its report was exemplary and will last the test of time. He is right that this is all about money. As many other speakers have said, people’s lives are being damaged because the system has fallen apart. If the Treasury is the block, we must now commit to extra funds to make this work. We cannot continue with this broken system.
In England, publicly funded but means-tested adult social care is primarily funded through local government. It constitutes the biggest area of discretionary spend for local authorities, which are already cash-strapped due to repeated cuts and extra responsibilities. If the adult social care workforce grows at the same rate as the projected number of people aged 65 and over, the number of jobs in that sector will increase by one-third to around 2.17 million by 2035. We are not even thinking about the growth in our demographics and its consequences. Everyone is thinking about mending the short-term problem.
As the noble Baroness, Lady Donaghy, pointed out, new analysis for the Care & Support Alliance found that since the Prime Minister stood in Downing Street and promised to fix social care once and for all, 2 million requests for formal care and support from adults aged over 18 have been turned down by their local councils. This is equivalent to about 3,000 requests being turned down every day, putting immense pressure on unpaid carers as well as the NHS. These numbers show the human cost of the Government’s dither and delay. Will Ministers please stop their internal spats and off-the-record briefings, and start the urgently needed cross-party talks, involving the sector, so that we can look at fixing this urgently?
The cost of inaction is also far higher, as 11.5 million unpaid carers are bearing the brunt of the Government’s failure to reform social care. The pandemic has exacerbated the immense pressures they were already under; many have not had a single break since the crisis began. It is clear that any reform of social care must consider the impact on unpaid carers and include ways to alleviate the pressures that they face. Will the Government commit today to the emergency funding that would give unpaid carers across the country at least a weekly break? Will the Minister also commit to involving unpaid carers and carer organisations in talks on reforming social care services?
Last week, 50 organisations wrote to the Prime Minister, calling on him to fix social care. They wrote in the letter:
“During the pandemic tens of thousands died before their time in care homes from COVID-19. The best possible legacy we can give all those who have lost loved ones would be to ensure that we fix the care system so that a similar tragedy cannot happen again.”
The Local Government Association tells us that the ongoing recruitment and retention problems show that a high vacancy and turnover rate is really affecting service quality. As others have outlined, many staff have uncertain incomes because of the prevalence of zero-hours contracts. Temporary shifts in these patterns due to Covid-19 have highlighted the need to deal with these issues permanently. A recent Skills for Care report on the state of the social care market found that pay in adult social care is on average 25% lower than in the NHS, that the adult social care sector in England still needs to fill more than 100,000 job vacancies on any given day, and that the staff turnover rate of directly employed staff in that sector was 30% in 2019-20.
The ability to attract and retain staff with the highest skillset is hampered by poor pay, poor reward and a lack of coherent career structures that allow people to think beyond temporary work in social care. We need better pay and rewards to form part of a package of reforms and to transform the sector. All this means that we should have a 10-year workforce plan. It is vital that this is part of any proposals made by the Government. Professionalism is key but so is the registration of healthcare professionals in the social care sector, along with proper pay scales and funding for the sector, so that local government is not put in impossible positions. The pressure should certainly not end up with care providers.
My noble friend Lady Thomas of Winchester is right: being a carer is not a low-skilled job. The skill must be recognised. I noted she said that carers are often from overseas and face racial abuse, especially from clients as they slip into dementia. That is another reason why carers need to be trained properly: to help and understand their clients in what is and is not appropriate.
Thanks so much to my noble friend Lady Scott for talking about the role of volunteers in our communities; her speech was very powerful. The noble Baroness, Lady Uddin, referred to disabled children. I repeat her question about proper funding for respite care for the families trying to manage the most vulnerable children in our society.
Unpaid carers can also be children. Our own experience as foster parents to two children who lost their mother through a long terminal illness demonstrates that in addition to missing school, which was already reported on, there are other long-term psychological issues in having to face the death of a parent when they are your sole parent. I give particular thanks here to CAMHS, which provides a service but, as my noble friend Lady Barker said, mental health support is woefully limited at the moment and needs to be tackled.
The cost of inaction and delay is also falling on the shoulders of the 11 million unpaid adult carers in the UK, whose contribution to the current social care system is almost completely ignored by government. The cost of reform may seem great, but without these carers—particularly if they themselves break down—the burden will fall further on government itself.
The Lib Dems are also calling on government to immediately raise the carer’s allowance by £1,000 a year to support unpaid carers and to recognise the huge financial pressure that many of them are facing during this pandemic.
The noble Baroness, Lady Browning, noted that half the social care budget is going on working-age disabled people. That is also important, because there are not often houses to sell afterwards. That is why we have to review everything and completely rethink the way our social care system works. I will end on another point on which I agree with the noble Baroness, Lady Browning. Everybody today has said that we have waited far too long for these reforms. The only block to progress is the Government, specifically the Treasury. Act now. Bring it on.
Baroness Wheeler (Lab)
My Lords, I too congratulate the noble Baroness, Lady Jolly, on securing this debate and on her usual very thorough and thoughtful introduction. Of course, it is deeply frustrating for us all to be yet again debating the ever-deepening crisis in social care in the absence of any sign of the Government living up to their promises of reform and “once and for all” change, in the words of the Prime Minister.
The excellent “national scandal” report of our Economic Affairs Committee was our last major debate on this vital issue and is still an authoritative source for this debate. The committee warned, and it is worth repeating, that:
“With each delay the level of unmet need in the system increases, the pressure on unpaid carers grows stronger, the supply of care providers diminishes and the strain on the care workforce continues.”
That is why it is so important for us all to keep up the pressure, as noble Lords have done this afternoon, hammering home the scale of the crisis and the substantial extra funding urgently needed. This must be sustainable long-term funding, not just the welcome but wholly inadequate plugging-the-hole periodic cash injections that Ministers trumpet at every opportunity as the solution to the deep crisis we are in.
I am also grateful to the noble Baroness, Lady Jolly, for specifying unpaid carers. As usual, her words were movingly reinforced by my noble friend Lady Pitkeathley and by almost every speaker; it is a most welcome and essential focus. They drew on the extensive surveys and reports produced by Carers UK for Carers Week. In these we heard from carers themselves on the huge challenges they have faced during the pandemic—not just the absence of essential breaks and respite but the impact on their own health and well-being and their worries about when the key daycare and other services, vital to the loved ones they care for, will come back.
Many routine but essential services came to a halt during the pandemic, as noble Lords have spelt out. For example, I am a carer and the excellent services at our local community centre—stroke clubs, memory clinics for people with dementia, community meals and support groups—show no sign of reopening until at least September. For carers of disabled people, people with learning difficulties and disabled children and their families, this daily or week-by-week support is so important. It is devastating when it is not there. It helps carers cope, gives them a chance to get on with the other things they have to do and, most important, helps to keep the person they are caring for well, active and engaged.
A longer break for carers and the cared-for is just as important. As Care England has said, respite care provided by many care homes has been withdrawn because of the 14-day isolation requirement. For younger adults with learning disabilities living at home with parents, a few days of respite every month or even week, or care home provision if the carer falls ill, is a key part of their care plan. It helps carers continue to cope. The Minister has promised us a meeting with Carers UK; I hope he is arranging it with the urgency it deserves. Can he please update us on the progress of the department of health and local authority talks and work he referred to last week to ensure that daycare centres and care services are reopened?
We know that the Minister’s response today will contain all the elements we are used to hearing about government funding support for carers, the care workforce and social care during the pandemic, and the now-familiar “later this year” promise of the social care reform proposals. But it is clear from today’s debate that, nearly two years after the Prime Minister’s Downing Street doorstep pledge, such is the despondency, scepticism and doubt about this latest deadline that it is almost not worth asking the Government how they are getting on with it—particularly with the recent press reports on cancelled meetings and the Prime Minister’s obdurate blocking of various funding options.
On the issue of cross-party consensus, raised by a number of speakers, rather than just his usual passing reference it is time for the Minister to explain today just what he means by this. To repeat for the record, we had cross-party consensus on the Care Act 2014 setting up the care cap on funding costs recommended by the Dilnot commission, the eligibility criteria for social care and many other important reforms, such as legal rights for carers to assessment and support. The consensus on the cap was there during the 2015 general election, councils were given lead-in preparation funding for implementation in April 2016, and £6 billion was allocated for care cap costs. But we know the rest of the story: delayed implementation and then cancellation —too costly—the £6 billion gone and huge sums of implementation funding just wasted.
The same cross-party consensus was reinforced in the “national scandal” report, as the chair of that committee, the noble Lord, Lord Forsyth, made clear in the previous debate. On these Benches we have strongly welcomed this report as a fully costed and solid basis for moving forward. It shows the scale of extra funding needed to break the cycle of chronic underfunding and unmet need, and to begin to address the unfairness and disparity in entitlement to care between the NHS and social care.
Many noble Lords have today again articulated the committee’s fundamental principles, which have the widespread support among the social care stakeholders and community that the Government say they want—for example, the top priority of restoring local authority funding for social care to 2010 pre-austerity levels; an end to councils’ dependence on locally raised funding for social care; a new £7 billion-a-year system for providing free personal care to help people with basic daily needs such as washing and dressing; and a major investment in a new deal for the social care workforce and joined-up workforce planning with the NHS. That is an excellent consensus on which to move forward, and the Minister knows it; it makes the current delays and dithering inexcusable.
On the vital issue of a new deal for social care staff, like all noble Lords I add my heartfelt tribute to them, not just for the pandemic but for the year-on-year dedication they have shown in the face of low pay and lack of public understanding and appreciation of the value of their work. They are a skilled profession and need and deserve the training, career and pay structures that properly reflect this. Raising the status and standing of care staff has to be a key part of social care transformation.
The positive signs of the impact that Covid has had on the public’s awareness and perceptions of care work are welcome. For example, the recent survey with care providers, stakeholders, care workers and candidates by the Work Foundation and Totaljobs reinforces this, showing an increase of 39% in people applying for social care roles in the last two years; younger candidates more likely to pursue a career in social work; and 56% of new starters in care joining from other sectors. This is promising, but these staff will stay in the profession for the medium and longer term only if there is fundamental reform to social care staff’s pay and professional status.
One of the key features of today’s debate has been the range of speeches across social care provision—I very much welcome this—not just on adult social care and the care of older people but on working-age disabled adults and children, people with learning difficulties and the importance of mental health social care, so often overlooked. This was referred to by my noble friend Lady Donaghy and the noble Baroness, Lady Barker.
The excellent briefing from the charity Rethink Mental Illness has been referred to in relation to the vital role that this should play in supporting people living with severe mental illness to help them to recover from hospital care, stay well and not go back into crisis. I hope that the Minister’s response will include reassurances that their needs will be included in social care reform. The parliamentary briefings that the seven leading charities representing working-age disabled people are organising for July will be very valuable in increasing our understanding of how social care should be working for this vital group. I hope that as many noble Lords as possible are able to attend.
During the debate, we were constantly reminded that half of local authority public social care funding is spent on working-age people and that local authorities also deliver children’s social care. This was so sharply brought into focus by the publication earlier this month of the first stage of the MacAlister independent review, which called for major reform and investment to ensure the effective protection of young people at risk. Alas, there is no time to debate this today, but we sadly see the same fragmented, disjointed system across multiple government departments and agencies, with the life chances of vulnerable children paying the price.
On residential care, noble Lords have rightly pressed the Minister on the issues that have so dominated our consideration of the SIs, Statements and Questions during the pandemic—on testing, PPE, hospital discharges to care homes, visitor access, indemnity insurance and occupancy guarantees. I look forward to hearing the Minister’s response on this, particularly on how care funding will be provided when the infection control fund ends at the end of this month.
We have had yet another powerful debate today. Noble Lords have made it clear that we cannot build a better future for our country after Covid-19 without transforming social care, and that real progress is needed now. If the press reports and rumours are correct and government focus is on reintroducing the care cap after all, five years after it could have started, this would address only part of the problem. It would not be the comprehensive plan for the reform and sustainable funding of social care that is so vitally needed.
I echo noble Lords’ good wishes to the noble Baroness, Lady Jolly, in her new role. My noble friend Lady Thornton and I have always enjoyed working with her, and we very much value her contribution and work.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, I join other voices in congratulating the noble Baroness, Lady Jolly, on securing this debate on a subject that is absolutely at the top of the agenda, both here in the House and more widely. I wish her godspeed in her journey to other climates in the defence sector—I wish her very well in that new brief. I also genuinely commend noble Lords for an enormously moving and persuasive debate, with very personal and thoughtful contributions from all sides of the House.
Any Minister who listened to today’s debate, or to any of the interventions that we have had on social care in the last year, would want to start by paying tribute to carers, both unpaid and paid, for all the work that they do in care homes, people’s homes, day centres and other settings, year after year, during this awful pandemic and, as many noble Lords have noted, in the difficult period in the near future of getting back to normal life. I have heard and completely acknowledge the testimony about the significant personal and structural challenges faced by the sector from those who live and work in it. These challenges were exacerbated and highlighted in the pandemic. I do not pretend that they have not put pressure on the 290,000 who live in care, the 630,000 who depend on care, the 1.5 million who work in care and the many millions of family carers who contribute to care.
I will take a moment to reflect on the huge amount that we have done to provide support, at pace, to the social care sector during the pandemic. As we went into it, there were both strengths and weaknesses across the sector, but we started from a point where the quality and satisfaction with the care sector was high, and there was a range of provision for those who needed care. That point is sometimes lost in a debate such as this. As of March 2020, 84% of all social care settings were rated good or outstanding by the CQC, and 89% of those receiving local authority-funded support were satisfied with it, with 64% saying that they were very or extremely satisfied. The importance of raising this point is to pay tribute to the hard work and dedication of those who work in social care: the social care workforce, the care assistants, the care home managers, the social care workers and the family members, who have all contributed to those incredibly impressive statistics.
I will take a moment to remind my noble friend Lord Astor, and all the many noble Lords who quite understandably questioned our efforts to protect the sector during this awful pandemic, of a few of the things that we did. We published bespoke, tailored guidelines on how to safely provide care and protect those we love during the outbreak; these were used by families, care homes, care providers, domiciliary carers, unpaid carers, local authorities and others. From a standing start, we built up a huge capacity for regular testing: to date, we have sent out more than 35 million PCR swabs and 85 million LFTs to care homes, and we have done more through community testing in the NHS. We set up a massive PPE supply chain, completely from scratch, and through the PPE Portal, we have provided 2.4 billion items of PPE free to providers. As of 30 May 2021, we have provided 440 million items through local resilience forums and local authorities.
We have prioritised health and care workers and older care home residents in the UK vaccines delivery plan, offering vaccines before 15 February to residents in care homes, to older adults and their carers, those over 70, the clinically extremely vulnerable and, very importantly in this debate, front-line health and social care workers on an equal footing. We moved quickly to provide financial support, and have now provided £1.8 billion in specific Covid funding for adult social care. We set up regional assurance teams, and have supported safe discharge with £2.8 billion—a colossal sum—including an extra £594 million announced earlier this year. With this in mind, I very gently challenge the implication made by some noble Lords that, during the pandemic, we overlooked social care, the vulnerable or the elderly.
To address the specific subject that the noble Baroness, Lady Jolly, has raised in this debate, I turn to the social care workforce. The 1.5 million people who make up the paid social care workforce provide an absolutely invaluable service to the nation, working tirelessly to support people of all ages who need care. As the pandemic has made clear, we as a nation are totally indebted to their selfless dedication and compassion. Like other noble Lords, I pay particular tribute to the moving personal testimony of the noble Baroness, Lady Thomas, who spoke so engagingly about her carers. I thought of the carers who looked after my father and other loved ones, and I was really moved by the way in which she spoke about this. As she and the noble Baroness, Lady Cavendish, said, these people may be low paid but they are extremely highly skilled. I want to make sure that all noble Lords pay tribute to them.
What we heard from the noble Baroness, Lady Thomas, and in other very moving personal testimonies, was completely consistent with what I heard in my meeting with Carers UK and Care England earlier this week. They brought other carers, who talked about their very challenging and difficult lives in the last few months, and I found engaging with them extremely moving indeed.
I completely hear the noble Lord, Lord Pendry, who pointed out the impact of the pandemic on those who work in social care. Perhaps I may reassure him that we have taken steps to support social care workers during the pandemic. We identified paid carers as key workers in response and gave them much-needed acknowledgement of their critical role in keeping people safe and supported. Through the infection control fund, we ring-fenced funding for providers to be used for measures such as helping to maintain normal wages of staff who may need to self-isolate.
More recently, in December 2020, we appointed Deborah Sturdy as the chief nurse for adult social care to provide professional leadership to the workforce, delivering clinical and professional advice across the social care sector. Huge thanks are owed to her for that.
I have heard loud and clear the words of noble Lords on parity, education, recognition, career progression and autonomy, points that were extremely well made. To the noble Baronesses, Lady Donaghy and Lady Barker, I completely acknowledge that the well-being and mental health of the social care workforce are paramount and have been under threat during these challenging times. We have invested over £1 million in social care well-being and worked alongside the NHS and other organisations to provide a package of emotional, psychological and practical resources for the workforce in a way that has not been done before and I hope has made a difference.
There are at least 6.5 million unpaid carers—around 10% of the entire population, according to the census. Other noble Lords mentioned other equally impressive figures. As my noble friend Lady Browning and the noble Baroness, Lady Watkins, rightly pointed out, that number is even bigger if we include informal carers. The life of those looking after those with terminal diseases is particularly difficult, as was rightly described by the noble Baroness, Lady Finlay. As she rightly and positively made the case for a carers’ allowance, I should reassure her that the consultation on carers’ leave last year demonstrated huge interest in this area—there were 800 submissions—and we will reply in due course, as per our manifesto commitment on that.
Of those unpaid carers, 23% have high-intensity caring responsibilities of more than 50 hours a week. I clearly heard the personal testimony of noble Lords. I have met some of those carers and acknowledge that their life has been incredibly challenging during the lockdown when day centres and other forms of respite were closed, and when the full burden of care fell heavily on their shoulders—month after month, night after night.
We recognise the impact that the pandemic has had on carers and we responded. Perhaps I may single out four areas. First, there was the provision of free PPE to unpaid carers living separately from the people for whom they care. Secondly, there was funding to charities, such as the £500,000 to the Carers Trust and £122,000 to Carers UK to extend its helpline. Thirdly, we gave them priority for vaccines, which I have mentioned already, with carers being put into cohort six, in line with the JVC advice. Fourthly, we published guidance tailored to carers, enabling them to identify themselves and their needs so that those could be more easily met, with ongoing work to help carers on respite and breaks.
To the noble Lord, Lord Dubs, and my noble friend Lady Browning, I completely acknowledge that the challenge continues as we try to return to normal. Day services in particular have been raised by a great many noble Lords, as well as by Carers UK and carers England. The services provide an important form of respite for carers, and allow people with support to meet others and have a break from their obligations. The noble Baroness, Lady Wheeler, and my noble friend Lord Astor gave moving, precise personal testimony on that and I completely acknowledge the point. I wish to reassure all those noble Lords that we are helping to ensure the safe continuation and restarting of day services. We are working with the Social Care Institute for Excellence to publish guidance. We have undertaken work with ADASS and local authorities to understand the barriers. Specifically in answer to the question of the noble Baroness, Lady Wheeler, there is now a joint ministerial task force between DHSC and MHCLG, working specifically on that initiative.
Moving on to workforce development, perhaps I may reassure the right reverend Prelate the Bishop of Carlisle that I agree with him completely that this is a key element of how we can improve social care. As we come out of this pandemic, it is essential that we make sure that we continue to have a workforce with the right values, skills and knowledge, and with real prospects for career progression, if we are to provide a high-quality service for those with need of care services.
I reassure my noble friend Lord Forsyth that we are continuing to commission and fund a range of training opportunities and other programmes to help recruit people in this sector. To give a couple of examples, we have provided £27 million to expand the Think Ahead programme to train 360 graduates in career switches to become mental health social workers; and there is the workforce development fund, which distributes about £12 million a year for training and qualification at all levels. That has helped almost 3,000 establishments to support more than 14,000 learners in 2018-19. The 2020-21 fund will continue to focus on key sectors.
I can only agree with the noble Lord, Lord Pendry, that Covid-19 has exposed some of the long-term inequalities in our society. Research from PHE and others continues to show those disparities.
To the noble Baronesses, Lady Jolly and Tyler, and my noble friend Lady Altmann, I agree that there have been some home closures, but so far there has been no major overall impact on bed numbers in the care sector. The largest regional loss of beds since March 2020 has been a 1% loss in London. Perhaps I may therefore reassure noble Lords that the Care Quality Commission is closely monitoring the financial health of the largest and most difficult-to-replace adult care providers. This allows the commission to warn local authorities if a provider is likely to fall over.
In response to my noble friend Lady Browning’s call, perhaps I may reassure her that a plan for reform absolutely is under way. We have before us the building of foundations, which will be laid in the social care measures in the health and care Bill, which will support us in working together. It will increase integration, reduce bureaucracy and enhance public confidence in accountability. I reassure the noble Baronesses, Lady Tyler, Lady Hollins and Lady Watkins, that these measures will include a new enhanced assurance framework to improve oversight of how social care is commissioned and delivered to people.
To the noble Lord, Lord Dubs, the measures will help us to get much better data from providers on what is going on at a local level so that we can, as he rightly described, follow the evidence of what works and what does not. The health and care Bill will also introduce a new place for social care in the integrated care systems, which will capture and build on some of the joined-up working that has accelerated in some areas already during the pandemic where local collaboration between health and local government, and between different parts of the NHS, has previously been essential to supporting people. With that in mind, I reassure the noble Baronesses, Lady Hollins and Lady Watkins, that we are developing enhanced assurance frameworks.
To my noble friend Lord Lilley and all those who raised the long-term reform of financing social care, it absolutely remains a government priority and all options are being considered, including those of my noble friend. The Prime Minister will be making an announcement on this before the end of the year. To the noble Baroness, Lady Pitkeathley, I say that boldness will be our watchword.
By way of conclusion, I thank those who have spoken so eloquently on this important topic. I know that noble Lords are all deeply committed to supporting the social care sector and would once again wish to join me in thanking all those on the front line providing care and going the extra mile every day. I am enormously proud of their efforts and immensely grateful to them all. We absolutely must not lose sight of what is important. This means doing our utmost for people who rely on social care and their families. In the words of several noble Lords, bring it on.
Baroness Jolly (LD)
My Lords, this debate has been as far reaching, well informed, well supported and inspirational as I expected. The message is absolutely clear. The Minister has probably has it, but I would be grateful if he would pull together all our thoughts—I do not think there has been any disagreement across the House on any of these issues—and tell his right honourable friend the Secretary of State that this is what needs to happen and ask him to go and chat to his friend the Prime Minister.
As I said at the beginning, this is my swansong. I say for those noble Lords who might not take part in health debates regularly that there is a sort of core team of “healthies”, and I will miss working with them. I will miss the camaraderie that exists in the core health and care community, and I look forward to working with an all-party defence team. That might take a bit more work to make it all-party, but we will work at it. I thank the Minister very much for his time.