Social Care

Thursday 24th November 2022 Westminster Hall

[Rushanara Ali in the Chair]

15:01

[Damian Green (Ashford) (Con)]

I beg to move,

That this House has considered the matter of social care within local communities.

I thank the Backbench Business Committee for allowing me this debate, and it is a great pleasure to serve under your chairmanship for the first time, Ms Ali. I am particularly pleased to see the Minister back in her rightful place, although she will know that now she has taken on responsibility for care, she will have me on her back for as far ahead as the eye can see while she is doing this job.

Much of what I want to say will be unusually positive about what social care offers communities. I am conscious that the social care debate is often surrounded by crisis and difficultly—quite rightly—but there are so many positive aspects to it that I want to touch on. As co-chair of the all-party parliamentary group on adult social care, I am struck by how underrated the positive effects of good care can be, not least economically. Given the recent decision to delay the introduction of the payment cap, as recommended in the Dilnot report, I should also take the opportunity to urge the Government to take wider action. I hope they take the chance to conduct a full review of the whole system, not just funding. I welcome the extra money committed by the Chancellor, but it is clearly yet another temporary solution to try to tide local authorities over. I hope Ministers can be creative in finding a stable and sustainable way of increasing the money available to the care sector. I have my own ideas, but this is not the time for them.

Funding is one key issue, but I emphasise to the Minister that it is not the only one. I will identify four other areas where we need new thinking if we are going to “fix” social care, to go back to the phrase used by the last Prime Minister but one. The first is the workforce. It needs to be bigger, by more than 100,000, eventually. To achieve that, it needs to be better paid and have a higher status. I would like to see, for example, nurses in the care sector on the same “Agenda for Change” pay scales as nurses in the NHS. Otherwise, we will continue to lose nurses from the care sector to the NHS.

The second area is the voice of care within the new integrated care boards. This change is a chance to improve the integration of health and care systems without creating another massive bureaucracy, which is too often the effect of integration. At the moment, I fear that the new ICB system is settling down with the voice of care providers being relatively unheard. Local authorities are clearly key players in the system, but so are other providers.

The third issue I hope Ministers can concentrate on is the use of technology, both for sharing information between different parts of the system and for giving those in receipt of care more control over their daily lives. We are not exploiting widely available technology anything like enough, and the prize for getting it right is that more people will be able to stay in their own homes for longer. That is much better for them—it is what the vast majority of people want—and of course for the taxpayer. Given both those imperatives, I think it ought to be a high priority. It is particularly important for people living with dementia, which is a subject worthy of its own debate.

The fourth issue that I want to bring to the Minister’s attention, which expands on the idea of people being able to stay in their own homes for longer, is the provision of housing. I have written to the Minister and the Housing Minister about how we are failing to build anything like enough supported housing for older people, particularly in the form of retirement villages. Our provision is something like 10 times smaller than that of comparable countries. That is another issue that is worth a debate in itself, so I will refrain from going down that rabbit hole, but it could be a hugely important contributor to improving our care system.

The Minister will be aware that the current problems facing the NHS would be greatly reduced if there were a proper plan for social care. Each month, there are 400,000 delayed discharges from hospitals because of a lack of social care support. That has knock-on effects on NHS capacity and on ambulance delays. Something like 13,000 patients should be receiving care in the community but are blocked in hospital beds. At the end of April, some 540,000 patients were waiting for assessments, care packages, direct payments or reviews, so fixing social care will take some of the strain off the NHS and free up capacity for others. In that regard, I am delighted that the Minister is responsible both for care and for hospital discharges. Having those responsibilities in the same ministerial portfolio is an outbreak of sanity and common sense in Whitehall that we should all welcome.

I promised to be more positive than is usual in social care debates, so I want to spend a few minutes highlighting the value of social care to local communities. First, it has a big economic value to local communities. Skills for Care found that it contributes £51.5 billion in added value to the economy of England every year. Although half comes from the wages of social care staff, a large proportion of the economic value comes through harnessing local business to support the provision of social care through access to transport, maintenance, activities and equipment. That creates a cycle of local spending, benefiting local industries and communities.

I am not just talking about professional care. Carers UK estimates that unpaid care provision saves the economy £132 billion a year, which would otherwise be a cost to the state. In other words, it saves an amount approaching what we spend on the NHS every year. The thought of that money being added to taxpayer-funded provision is unthinkable.

Care provides economic value by supporting people to live independent lives. It gives people the ability to control their own finances and in many cases gets them back into employment. Of course, it contributes to overall economic provision. That in turn reduces the number of people relying on benefits, which reduces the welfare budget.

Interestingly, Skills for Care’s figure of £51.5 billion contrasts with the amount that local authorities spend on care, which was £21.4 billion in 2021-22—less than half the economic value. That is instructive, because the wider public perception is always that social care is a drain on public finances, but it is not. It actually has a net economic benefit.

As I said, the care workforce is one of the key areas where we need investment—not just in the recruitment of staff, which is often the focus of these debates, but in the retention of staff. Social care is about much more than having to fix a broken system or act as a bed-clearing service for the NHS. It is about ensuring that there is support to enable older and disabled people to lead the best lives they can, and with as much control over their own lives as possible. The social care workforce is key to enabling that.

Some 1.79 million people work in social care in England, in something like 39,000 different establishments. The problem of recruitment and retention is evident, because we have 165,000 vacant posts in social care, which is the highest number on record and has increased by more than 50% in recent years. The word “crisis” is overused, but it can be legitimately applied in this case, not least because the number of posts filled has dropped by 50,000—the first drop ever in the number of social care workers.

Average vacancy rates across the sector are nearly 11%, which is twice the national average, at a time when we are finding it difficult to fill posts in many areas of the economy. The reasons are not hard to find. A care worker with five years’ experience is paid 7p per hour more than a care worker with less than one year’s experience, and the average care worker pay is £1 less per hour than that of healthcare assistants in the NHS who are new to their roles. It is not surprising that people in the social care workforce are turning to employers who offer more attractive pay rates.

Because of the issue with pay, the providers of social care increasingly have to rely on short-term agency staff. That has an impact on the standard and continuity of care, but it also has a high cost. A market report by Cordis Bright estimates that there will be a 157% rise in agency costs, which will increase from £56 million in 2021-22 to £144 million in 2022-23. If the trend continues, agency staff costs are likely to increase by between £175 million and £220 million by 2023-24. I suspect that the huge cost will result in services being handed back to local councils by providers, which simply cannot cope with such staffing prices.

A report by Public Policy Projects, which I chaired, recommends a number of things that would help the situation, including raising the minimum wage for social care workers, mirroring the NHS “Agenda for Change” pay scales, and positively promoting social care as a technically skilled and fulfilling career. I would support something similar to the Teach First scheme in order to get some of our brightest and best young people into social care and to raise its status, so that people can see that it is fulfilling work and will provide not just a job, but a career. In the coming months, I hope I can persuade Ministers to commit to bringing forward a full workforce plan for social care, with pay progression in line with the NHS, better terms and conditions, training and other structures.

Apart from that, the sector needs support through long-term funding. The Prime Minister and the Chancellor have understood the importance of a long-term strategy and funding base for the sustainability of social care.

It is always a pleasure when Ministers move straight out of Select Committees into ministerial jobs, because there is a public record of everything they think about individual issues. That is particularly helpful with the Chancellor: while he was Chair of the Health and Social Care Committee, it produced numerous reports setting out the need for an additional £7 billion a year for social care. That is why I have high hopes in this policy area.

I welcome the fact that the Government have outlined their intention to provide £500 million in discharge funding from the NHS to social care. I hope we receive more detail on that and about when, where and how that funding will be made available.

Just like every other sector, social care is suffering from inflation. According to a cost of living survey by Methodist Homes, 94% of its community schemes had heard members or residents express concerns about the rising costs of living, while some 49% of respondents said that increased transport costs were a significant issue among their members.

Social care providers expect their energy costs to increase up to sixfold next year. There is a real danger that rising energy costs could significantly reduce the number of services available and will have an immediate impact on discharges from hospitals into the community.

The Association of Directors of Adult Social Services has reported that nearly half of all directors of social care services are not sure that unpaid carers will be able to cope financially with the inflation problem. That could lead to more demand for professional social care services. I urge the Government to guarantee that adult social care providers are defined as a vulnerable sector in respect of the energy bill relief scheme after April 2023.

An analysis by the County Councils Network found that inflation could cost councils £3.7 billion in extra costs if they keep social care services running. I fear that is not sustainable and the quality of care will decrease. That is just one example of why it is unfair to rely on local council tax payers to fund so much of social care. The pressure should be taken off local budgets and social care should be funded through national taxation. That would be both fairer among different areas of the country with different tax bases and, in the long run, much more sustainable.

The Government made a number of welcome commitments in their “People at the Heart of Care” White Paper, but that was published nearly a year ago. Many of us are eagerly waiting for those commitments to be put into practice. As I have said, the care sector is not only a completely essential service in a civilised society but a positive economic and social force in local communities throughout the country. We need a coherent plan to address the many problems of the sector, but we should never forget that those who need care are often the most vulnerable among us, and those who provide the care are often the best of us. They deserve the best we can offer them.

15:18

[Liz Kendall (Leicester West) (Lab)]

It is a pleasure to serve under your chairmanship, Ms Ali. I congratulate the right hon. Member for Ashford (Damian Green) on securing this debate.

It is about time that we celebrated the huge value and potential of social care, and about time that we see the fact that we are an ageing society, and all living for longer, as something that we should be excited about, proud of and look forward to, not something that is simply a problem and a drain. However, we must also be realistic about how we get from where we are to fulfilling the full potential of social care.

I shall make three broad points today about the value of social care, first, to those who draw on it, secondly, to the communities they live in, and thirdly, to the wider economy—a point the right hon. Member for Ashford rightly touched on.

At its best, social care is about ensuring that every older and disabled person can live the life they choose, in the place they call home, with the people they love, doing the things that matter to them most, as Social Care Future has so powerfully argued. Put simply, social care is—or should be—about ensuring that every older and disabled and person can live an equal life to everybody else. That is its intrinsic value.

I would go further. We all benefit when we have a decent social care system, not just because we may all end up using it or relying on it because of having to care for and support our own parents, but because we ourselves may live to require social care. This is not going to happen to somebody else: it is going to happen to us all, so we had better get it right.

I also argue that our communities massively benefit when we have a decent system of social care. We lose out when older and disabled people cannot make their full contribution in the workplace, in our voluntary and community organisations, and in being part of our lives, like everybody else. It is a tragedy that so many older and disabled people feel shut away and shut off from the rest of their communities. They lose, and we lose too.

I am optimistic about social care. I believe that in the 21st century—the century of ageing—social care is an essential part of a modernised welfare state and our economic infrastructure. But I am also realistic about the challenges we face. The truth is that social care is in a worse situation than it has ever been, after a decade of cuts, the pressures of covid and now the cost of living crisis.

I recently heard directly from members of the Care & Support Alliance about the quite frankly awful choices facing users and their families: disabled people trapped in their own homes because they cannot afford fuel to go out, and their care packages are being cut; older people skipping meals or only eating cold food because they do not want to use their gas and electricity; tens of thousands of people waiting for care assessments, seeing their health worsen day by day; thousands more trapped in hospital, where neither they nor their families want them to be; and families having to spend even more money on care, or cutting back support and giving up their own jobs because they cannot afford the help they need for their loved ones.

As the right hon. Member for Ashford said, at the heart of it all is the absolute crisis in the care workforce. Vacancy rates are up by more than 50% in the past year. There are a record 165,000 vacant posts. Employers are simply unable to recruit or retain the staff they need, especially when people can earn more in hospitality and retail. The Government have still failed to produce a proper, long-term workforce plan. I was very interested in the right hon. Gentleman’s comments—I agree with them—about how we could look at how the care workforce might link up with “Agenda for Change” so that we can get a decent workforce system and plan across health and social care.

Recently, we finally heard details of how the £500 million social care discharge fund will work. I understand that £300 million is going to the integrated care boards and £200 million to local authorities. How much of that will go directly on paying more for the workforce? We cannot do the discharges without the staff. We may need beds, but it is really about the staff. Will the Minister say more about that, because it is an absolutely essential point?

Alongside what I call the intrinsically moral case for care is the increasingly strong economic case. I believe that our care system is, like the NHS, the bedrock of our national prosperity. If the care sector is struggling, other parts of the economy will begin to break down, as those who need care see their own health suffer and the demands on families and friends mount. Having more and better paid care workers in every village, town and city will probably make the biggest contribution to levelling up the economy and getting growth into every part of the country, because we know that care workers do not save their money but spend it locally. Not every rural village can have a solar factory, but every village, town and city needs decently paid care workers. That would make a huge contribution to women’s equality too. We know that the workforce is predominantly female, often from black and minority ethnic communities, and always low paid.

First, then, having more and better paid staff could help to boost jobs and growth. Secondly, it is about helping the rest of us stay in work. Almost 5 million people are already juggling work and care. That is one in seven of all workers. Half have to give up work because they cannot get the support they need to look after their loved ones. Families lose their incomes. Businesses lose their talents. The Government lose their taxes. We would not accept half of all new parents completely exiting the workforce, so why do we accept it for family carers?

The truth is that in modern Britain social care and, I would argue, childcare are as much a part of our economic infrastructure as the roads and the railways. They should be at the heart of our economic policy and strategy for growth. That is why Labour has made improving care one of the four missions of our industrial strategy. We understand its centrality to the workforce and economic growth. We are calling for a 10-year plan of investment and reform, and a new deal for care workers to ensure they get the pay, terms and conditions, training and career progression they need. We need to improve access to care early on, because the quicker people get help, the more likely it is they will stay living independently for longer.

Thirdly, although we will always need care homes, we need a fundamental shift toward prevention and early intervention, with a new principle of “home first”—putting the home first every time. That includes greater housing options, home adaptations, technology to help people to stay living independently and, critically, work with local voluntary and community groups to do things such as tackle loneliness and isolation. People do not always need to turn to the state for the help and support they need.

Fourthly, for disabled people, who are all too often completely cut out of this debate, social care is not all about helping them to get up, washed and dressed—vital though that is. It is about them living independently, having fulfilling lives and having the same sort of access to friends and work that everybody else takes for granted. We need to ensure that working-age adults with disabilities have greater choice and control over their support and personal budgets. We need to make direct payments really work and give people the power to change services, as they know what is best.

Finally, I want to talk about unpaid carers—an issue that has been going on for years and years. Carers say they have to battle their way around the system, telling their story time and again. They need joined-up services; one point of contact, information and advice; proper breaks; and flexibility at work. I think the family friendly and flexible working agenda for the future is absolutely about people in their ’50s and beyond, and I am not just saying that from a selfish perspective.

In conclusion, in the 21st century and in one of the richest countries in the world, the goal of ensuring that all old and disabled people live the life they choose should not be regarded as extraordinary. It is the missing part of the jigsaw of the welfare state. It was never part of it when it was created, because back then life expectancy was 65 and women stayed at home. We need to change our thinking so that social care is at the heart of the modernised welfare state and an essential part of our economic infrastructure. We cannot do it all at once, but with a 10-year plan of investment and reform we can achieve it.

I have to say that it beggared belief that the Chancellor, when Chair of the Health and Social Care Committee, said that his greatest regret as Health Secretary was not putting in place a long-term plan for reform, but then put the final nail in the coffin of reform in his autumn statement. I urge the Minister to make the case again. Yes, we need to tackle the immediate challenges, but we need a long-term vision to be implemented. I look forward to her comments.

15:29

[The Minister of State, Department of Health and Social Care (Helen Whately)]

I congratulate my right hon. Friend the Member for Ashford (Damian Green) on securing this debate. I thank him for all the work he does as Chair of the all-party parliamentary group on adult social care and for his long-standing dedication to the social care sector—not least by calling debates such as these. I look forward to more. I thank him for his words earlier. I took away from what he said a phrase that sounded very similar to him saying, “I’ve got your back when it comes to social care.” His dedication to social care is with good reason. Social care is too often overlooked, yet it is so important. It is important to people across the country, important to those who need care to live and vitally important to their families. Social care employs around 1.5 million people across the country and it is a significant part of the economy.

I agree with so much of what my right hon. Friend the Member for Ashford has said this afternoon. I agree with him on the importance of the social care workforce, including the important point about status. I agree with him on the importance of the voice of social care within integrated care systems, not just with regard to local authorities but care providers too. I agree with him about the potential of technology, particularly to help people stay in their own homes, and on housing for older people and those of working age who need care. That in itself would be worth another debate. Indeed, I have recently spoken to our colleague the Housing Minister about that and I know she is interested in taking the matter further. He also rightly talked about the economic value of social care and the importance of unpaid carers, as did the hon. Member for Leicester West (Liz Kendall) today and on other occasions.

I will pick up on some of those points and talk about what we in Government and I as Social Care Minister are doing, starting with what social care does and what it is for. Social care starts with the person who needs care and, closely alongside that, those who may care for them unpaid—usually a family member. Our ambition in Government is to make sure that all those who need care get it and get it in a way that works for them, meeting their own needs and circumstances to a standard that we would rightly expect in our society.

Care should enable people to live their lives to the full, with the greatest possible independence, while recognising that caring can also place great demands on unpaid carers. We need to be able to support carers themselves to live their own lives, alongside caring for those they love. While we are on the subject, it is also worth mentioning the significance of social care for working-age adults and remembering that social care is not just about older people living in residential care homes. That is often what people think about but it is far from it. It is about helping many thousands of people earlier in their lives to live life to the full. Many of us will only really consider social care when we or a loved one need to draw on that support—often in a time of crisis. However, we should not wait until that point to realise how important social care is to all our lives.

The scale of the social care workforce stands at around 1.5 million people and the size of social care in our economy is valued at around £15 billion per annum. We all know that health and social care are intrinsically linked. While I am always determined to talk about the value of social care in its own right, we also know that one of the reasons we have around 13,000 patients in hospital at the moment who could and should be somewhere else, usually their own home, is because of the pressures on our social care system.

My right hon. Friend the Member for Ashford mentioned funding. I will say to him and the hon. Member for Leicester West that last week’s autumn statement showed that the Government recognise the importance of social care. The Chancellor of the Exchequer, my right hon. Friend the Member for South West Surrey (Jeremy Hunt) announced up to £2.8 billion of additional funding in 2023-24 and up to £4.7 billion in 2024-25, specifically for social care and also discharge from hospital into social care. That was the biggest funding increase that social care has ever had and that is despite the difficult decisions that had to be made in the autumn statement to ensure broader economic stability.

In the run-up to that statement, the Government had listened to the concerns of local government and took the difficult decision to delay the planned adult social care charging reform from October next year to October 2025. Crucially, the funding that was in place for that reform over that period will be retained in local authority budgets to help them meet some of the current pressures in social care.

The substantial funding settlement that social care received in the autumn statement will do three things. First, it will help social care afford the extra costs the system faces, which I have heard loud and clear from local authorities and care providers. Secondly, it will ensure that more people can be discharged from hospital when they are ready to leave, and that they get the social care and recovery support they need. That builds on the £500 million adult social care discharge fund, which will go to local care systems this winter. Thirdly, and importantly, it means we can proceed with ambitious reforms to the social care system. That involves investing in the workforce, better data and technology, and increasing the oversight of the social care system. That will improve access and quality. My right hon. Friend the Member for Ashford urged us to take wider action, and I assure him that we are doing that.

Our 10-year vision for reform was set out in the “People at the Heart of Care” White Paper, and we are already acting on that. In fact, some of the work I kicked off last time I was social care Minister has already made great strides. For instance, the introduction of social care assurance at local authority level, led by the Care Quality Commission, will be launched next year, giving local authorities, the public, hon. Members and the Government much more insight into the vital part that local authorities play in commissioning and overseeing the provision of social care in their areas. The next steps for us are to set out in more detail the plan for some of the other areas of reform—most notably the workforce, data and care records, technology and, with the Department for Levelling Up, Housing and Communities, housing.

I assure hon. Members that our reforms are ambitious and will lay the foundations for generations to come. Our wider reforms to social care will go hand in hand with the establishment and development of our integrated care systems. Forty-two ICSs across the country bring together NHS organisations, integrated care boards, local authorities and, importantly, care providers in integrated care partnerships. We are ambitious about doing that crucial thing that many hon. Members have talked about—joining up social care and the health services more effectively.

In the work that I am doing as Minister with oversight of hospital discharge—I see myself as important in joining up the two systems at the level I am at—I am already looking to integrated care systems and their leaders to be the lynchpins in joining up the NHS with social care more effectively than ever before, so that people are cared for in the best place for their needs. That is often not hospital. In turn, that ensures that hospitals have space for those who really need to be cared for there.

I want to spend a moment talking about the workforce in the near term. Our passionate, compassionate, skilled and dedicated social care workforce, including local authority social workers and occupational therapists, makes such an important contribution to our communities. I truly want social care to be a rewarding career with clear opportunities for progression, where people are rightly recognised for the important work they do. In our reforms, I want to address some of the problems that my right hon. Friend raised for those working in social care—for instance, career progression.

Right now, in recognition of the shortages in the workforce and the vacancies, we are working hard with the Department for Work and Pensions to promote adult social care careers to jobseekers. Earlier this month, we launched a new domestic national recruitment campaign. Anyone who has been watching “I’m a Celebrity”—some colleagues may have been—will have seen some of those very effective adverts. I look forward to them helping more people go into social care in the short term. We are also doing some work to support international recruitment to help with some of the near-term pressures on the workforce.

I want to talk a bit more about carers, because for most people care begins at home with their families. Many millions of people across the country care for loved ones, and I recognise what that commitment means for them and their own lives. In fact, today is Carers Rights Day, and I am therefore glad that the Health and Care Act 2022 gave carers new rights. They include new duties on NHS England and the new integrated care boards to involve carers in their public engagement; new provisions on the integrated care boards to involve carers in relation to some of the services that they oversee, such as prevention services and the diagnosis, care and treatment of the person for whom the carer cares; and responsibilities for NHS trusts to involve patients and carers, including young carers, at the earliest opportunity in discharge planning for people who may need care and support as outpatients. Discharge is a moment when there can be a real worry of significantly greater burdens on carers, so involving carers in those decisions is important. I should also flag the importance of respite and support for unpaid carers, which is recognised by the nearly £300 million of funding this year for respite services through the better care fund.

I thank all hon. Members for their well-informed and thoughtful contributions to the debate. We are deeply committed to supporting adult social care, the millions of people who rely on it for themselves and their families, and those who work in it. I am committed to supporting social care, reforming social care and making sure that, as a society, we recognise social care for what it is: essential, important and truly valued. Finally, I thank everyone providing care on the frontline—people who go the extra mile, day in and day out. I thank them for what they do.

15:41

[Damian Green]

I will cheer everyone up by not taking the opportunity, which I think would be available to me, of winding up for the next 45 minutes; I will simply make two brief points that have come out of the debate. I am very grateful for the commitment made by the Minister.

The first is the degree of consensus that underlies this difficult subject. Frankly, the hon. Member for Leicester West (Liz Kendall) said almost nothing I disagreed with, and I suspect that I said almost nothing that she disagreed with—and, of course, I agreed, definitionally, with everything that the Minister said. We all know what the problems are and what we need to do to solve them. It is a matter of political will and drive.

That is the other, less cheerful, point. I have personal reasons for my interest in the issue. My father died of dementia, and therefore spent the last few years of his life in the care system, which inspired a deep personal interest, as it does in many other people. However, I was responsible for this matter when I was First Secretary of State. That was five years ago now, and five years later we are still going round the same course again.

Having arrived for the end of the previous debate, on the contaminated blood scandal, I was struck that colleagues across the House were complaining that things were moving very slowly. I set up that inquiry in Government. That problem obviously goes back a long way, but the solution started five years ago, and it clearly has not got there yet. When we have such intractable problems, too often the whole machinery of government—this is not remotely an attack on Ministers—moves incredibly slowly, even when there is large-scale political consensus on what we need to do.

Finally, Godspeed and good luck to the Minister and her ministerial colleagues, because this issue needs to be driven by Ministers. Across the House and within the political parties, we do not particularly disagree about the solutions, but the issue needs the active pursuit of energetic Ministers if the necessary changes are to be made. Those changes are desperately deserved, both by those who provide care and by those who receive it. I wish all the best to the Minister in dealing with this.

Question put and agreed to.

Resolved,

That this House has considered the matter of social care within local communities.

15:45

Sitting adjourned.