Social Care
(1 year, 8 months ago)
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Baroness Andrews
That this House takes note of the future of adult social care given (1) the recent reports from the House of Lords Adult Social Care Committee (HL Paper 99) and the Archbishops’ Commission on Reimagining Care, (2) the Care Quality Commission s local authority assessment duties which commence from 1 April, and (3) His Majesty’s Government’s stated intention to publish a social care plan in Spring 2023.
Baroness Andrews (Lab)
My Lords, I am extremely grateful for this opportunity to introduce a debate which has a particular resonance in this House and a real urgency. I am very pleased that so many Members of the House have been able to take part today, particularly members of the Adult Social Care Committee. I am delighted to share the debate with the Church, alongside the right reverend Prelate the Bishop of Carlisle and the most reverend Primate the Archbishop of Canterbury. We are considering two reports, in respect of which Church and state are joined in values and prescriptions. We are also anticipating some of the changes coming down the track. I regret that we do not have the national care plan today, as we had hoped, but we can anticipate the CQC changes. There is a lot to discuss, and the debate will go far wider than the two reports before us.
We have not yet had a reply to our Select Committee report, A “Gloriously Ordinary Life”, which was published last December, but I hope the Minister will be able to say something about the national care plan, not least when it will be published and when we can debate it. Perhaps he could answer one or two of the outstanding questions, such as: will the £500 million workforce funding plan be halved?
I said that this debate has a particular resonance in this House, and there can be very few noble Lords who have not had the experience of caring for someone close to them. It is estimated that one in two of us is likely to become an unpaid carer by the time we reach 50. For some people, it is a lifetime’s commitment; for others, it is an overnight change in circumstances that leaves them with a future which is darker and very different. Overall, at any one time about 10 million adults of all ages come into contact with adult social care. When it matters so much to so many people, we are bound to ask why, as a whole, it has been out of sight and off the public radar for so long. Perhaps a better question is: why do we not care more about it—sufficient to make it the social and political priority it needs to be? What do we need to change in order to care more, and to plan and provide more effectively for a fairer and more robust service? Why is it not a national imperative? The answers to these questions are rooted partly in human frailty and partly in the history of the NHS and the time in which it was born: a time when women did not work and people did not live as long.
What is significant about the two reports is not that they reach similar conclusions, but that they are rooted in similar values which start from the assumption that adult social care has so far been denied the opportunity to be what it could and should be: a service that enables people to live a gloriously ordinary life which is fruitful, active and valuable. The support provided is not transactional or contractual; it is based on a generous and mutually supportive set of relationships which reflect what, at best, being cared for and caring mean. The Archbishops’ Commission’s report, Care and Support Reimagined, describes it as a fulfilled life based on love, mutuality and interdependence, embedded in the concept of a national care covenant.
Today’s realities are very different. Many of those who need care or support in order to care, particularly as unpaid carers, battle their way through a barrage of services, systems, agencies, tests and charging regimes that seem designed to deter demand until needs become extreme. The daily realities are set out in our report in the words of those who live that reality. We were extremely privileged to hear so many witnesses share their experiences and their lives with us—people who have lost jobs, homes and health in the process of caring. That co-production helped our report to reach a wider audience, and we owe them a huge debt of gratitude, as we do our superb committee staff—Megan Jones, Daphné Le Prince-Ringuet, Alasdair Love and Abdullah Ahmad—our wonderful special advisers, Jon Glasby and Anna Severin, herself an expert by experience, and every member of the committee who gave so much time and insight and shared their own experiences. I am sorry that the noble Lord, Lord Laming, could not be in his place today. He kicked this off through the Liaison Committee and helped us settle on a topic in a very well-worked field which has not had the attention it deserves—the plight of the unpaid carer.
Caring goes on day and night, without public acclaim, in private, behind closed doors, and with pitiful reward. Indeed, unpaid carers were described by no less than Jeremy Hunt, when chair of the Health and Social Care Committee, as the least visible aspect of a service which, overall, suffers from “entrenched” invisibility. Understanding what that means for adult social was a task we undertook, and trying to work out how to dismantle it consumed much of our inquiry, because invisibility takes many forms and has many impacts. Adult social care may be a nationally funded service, but it is locally delivered. It does not have a coherent national profile; it is fragmented across 18,000 organisations. While care homes are, tragically, more in the national spotlight because of Covid, the rest of the service is below the radar until you need it—when you cannot find it. At its most graphic, although it is the same size as the health service and of equal importance to the well-being of the nation, its budget is a fraction of the NHS’s: £17 billion compared with £153 billion. As we know—this statistic is all too familiar—a third of local government funding has been lost in the past decade. Compared with the NHS, adult social care is not the national treasure it should be.
This is not a remote failure. At the start of 2022, 2.6 million over 60s were living with some form of unmet need, such as the basics of washing and eating, and 2.2 million hours of care had been lost in the first three months of that year. Half a million people are now waiting for assessment. Care support, as it was described to us, even when it comes with the best of intentions and people, can still make people feel very grudging and guilty rather than supported.
The relative invisibility of the service is compounded by a lack of information. We were astonished by what we did not know. The number of unpaid carers is estimated at between 4.2 million and 6.5 million, but there may be many more who are not registered because of the problem of identification. We know that they save the country £132 billion a year, but less well known is that they receive the lowest of all benefits—£2 an hour, or £69.70 a week. To get that, you have to work for more than 35 hours a week and fulfil a means test. It is no wonder they are worried sick about heating and food bills, and that they do not manage to stay in work—and when they do, the support they get is significantly less than that offered by other countries. Put together with a paid workforce which is not valued for its exceptional skills and which works for less than the minimum wage, it is hardly surprising that they are driven out of a job they love or that it is so hard to find a personal assistant these days.
The reports provide all the evidence any Government would need as to why this is urgent, and they set out a plan for change. Both say unconditionally that there must be a radical shift in perception and investment in all parts of the service, so that adult social care can become the transformational life-enhancing service it could have been designed to be. We heard someone say to us informally, “The NHS saved my life. Adult social care has helped me to live it.” That was a graphic description.
The greatest failure has been the failure to plan strategically for an ageing society. The result is that we see longer life as something to be borne, a burden, a nuisance—and that cannot now just be fixed. That needs to be seen together with the repeated failures to cap residential care; to implement the Care Act 2014; to integrate social care into the health service, until recently; to prepare a realistic adult workforce plan based on skills, a full pay review, and a resilient service that people feel proud to be part of; and to challenge the false economy of underinvestment in adult social care year on year, at a time when the impact on the health service alone is immeasurably worse.
Add to that the failure to honour the promises that have actually been made to unpaid carers: better leave, a better carer’s allowance, better respite. It is a catalogue of disappointment. There has been so much analysis and diagnosis, so much hand-wringing over failure and so little meaningful change.
But the future is catching up with us: we will have a population of about 2 million in 10 years’ time who will be ageing without care, with no family to look after them. Where are the plans for these people to get the support they need? At the same time, if we are smart, we have new technologies and new devices that can help reduce risk and plan for where the skill gaps are. I think of the wonderful Tribe Project we came across, which does outstanding work but which ought to be all across the country. We saw so much good practice in local authorities as different as Wigan and Somerset, and an appetite for innovation and for engagement with the community. There are tremendously creative ideas at local level, all waiting to be galvanised and shared.
The most challenging question of all is what needs to change before we care more sufficiently to make adult social care a national imperative. Four things are necessary: to raise adult social care’s voice, visibility and agency; to revisit and build on what already could work better; to build capacity through workforce skills and strategic investment; and to change the way we view it—as a unique social good in itself, not simply part of propping up the NHS.
First, and simply, adult social care has to have a louder, more coherent and challenging voice, so that it can be more powerfully championed inside and outside government. It has been too easy to get away with simply patching up adult social care in an emergency and parking the workforce strategy. It has not had the power to fight for priority, which is extraordinary when we think of the power it has to change lives, for better or worse.
We recommend what looks like an easy reach, but which could make a huge difference: a commissioner for care and support to lead that fight, to raise that voice, to hold Ministers’ feet to the fire, to do some shaming if necessary, but also to celebrate and mobilise the best. That champion will be a champion for unpaid carers as well, to make sure the Government cannot get away with any more delay and procrastination there.
Reducing invisibility means knowing more: to do better, we have to fill those information gaps. We have to have a national plan for data on adult social care, so that we actually know who is caring when and where; so we know where the gaps are, where the resources can be deployed best, and what we need to invest in most effectively. That could also be helped by creating an R&D network akin to that in the NHS, so that we could trap ideas, innovation and good practice. If we have increased visibility, we can have more and better opportunities to design more flexible services—more “choice and control”, as is described, whether through better access to better packages that work more effectively, more personal assistants with less bureaucracy, direct payments that actually get to where they are needed, or giving respect to enable unpaid carers to give their own expertise more effectively, as full partners in providing care.
I have been banging on about housing in this House for well over a decade. We need accessible and adapted housing, so that we do not have thousands of people stuck in hospitals. They should be able to go to a safe home and be looked after safely, not just at times when care is needed, but urgently, as a matter of sensible planning for an ageing society. The social care White Paper recognises the role of housing, so I very much hope we will see some funding come forward to actually meet that desire.
So much of what is in these reports is not new; so much was set out in the Care Act 2014—principles, processes, project design. It is tragic that it has been on the statute book but not implemented by local authorities, which have not been able to put the training plans in place; they have not been funded to do so. That leads to the inescapable reality that adult social care needs a national investment strategy.
Compared with the costs of failure and delay, adult social care is not expensive. Again, when the Chancellor was chair of the Health and Social Care Select Committee in 2017 he called for an annual increase of £7 billion between 2021 and 2023—this at a time when energy companies are scooping up hundreds of billions. This is the same Chancellor, though, who did not put any additional money for adult social care in the Budget. I ask the Minister what he thought of that.
In conclusion, so much of this is not about money at all; it is about moving away from the culture and perception of a service where the dominant language is not that of celebration but of “burden”, of “dependence”, of “failure” and of “crisis”, towards one which values and empowers the people it serves and those who do the caring, paid and unpaid. Among the assumptions which must change are the long-held assumptions that disabled adults and older people are not capable of living a life that is as rich and fulfilling as everyone else’s; that social care work is unskilled work; and that families will always be there to care.
Let me put it another way and quote Social Care Future:
“We all want to live in a place we call home, with the people and things we love, in communities where we look out for one another, doing what matters to us.”
It seems to be the most modest of ambitions—so many of the things that are asked for are so modest—but one that is well within reach if we choose to do it. The greatest risk, as our report says, is not to change, and the hardest question is, if not now, when? We have waited long enough to make adult social care a national treasure as well as a national imperative. I really hope the Minister agrees with me this afternoon. I beg to move.
Baroness Shephard of Northwold (Con)
My Lords, it is a privilege to follow the noble Baroness, Lady Andrews, and to have a chance to thank her for her outstanding chairmanship of the committee. I also thank our superb professional team.
Our report’s introduction describes adult social care as
“largely out of sight and off the public agenda until we need it.”
That is in strong contrast to the NHS, despite there having been, in the last 25 years, no fewer than eight Green Papers, four White Papers, three cross-parliamentary committees and two full government inquiries. We should ask ourselves why it is that a sector so vital to one in five of our population at any one time, to the overall health of the nation and to the functioning of the NHS has been so overstudied and, as we found, so underresolved over such a long period.
It is mostly, I suggest, because it has “just grown”, and is now highly and almost unmanageably complex. I give just three examples. The first is funding. Public spending on adult social care, which is around £22 billion, is a mix of central government grant and council tax. Some £11 billion comes from private expenditure. At least £132 billion is contributed by an army of unpaid carers, often family. Actual funding arrangements vary, from self-funding care home residents, through a mix of local authority or NHS top-ups, to the fully publicly funded.
The second example is commissioning. Commissioning responsibility is split, in England, between 152 local authorities and the NHS.
The third example is provision, which is equally complicated, with 95% of residential and nursing beds being in the independent sector. Agencies provide some home care, and, in all, 18,000 organisations run around 34,000 establishments. National accountability and responsibility are, of course, divided between the levelling-up department, the NHS and the Treasury.
The effect of all this on those needing social care, almost always urgently, is that they face a lack of comprehensible information even to get into the system. They then find, all too frequently, a shortage of provision, delays, confusion and unclear accountability. Our report contains wonderful examples of good practice and ingenious solutions to these problems, but also graphic evidence from people struggling to cope at the same time with grievous personal or family situations via a massively complicated system. Their courage, and that of those caring for them, is immense.
The effect on the NHS of neglecting social care must also be tackled. We all know the NHS is experiencing unprecedented problems, some resulting from the pandemic, of growing demand and staffing and funding difficulties. How acceptable is it that every single day 10% of hospital beds are occupied by patients who do not need them but cannot be discharged because social care is not available, and that preventative social care is not available to avert many hospital admissions in the first place? The NHS has got to be fixed, but it cannot be fixed without first fixing social care.
The Government know this, and, to their credit, they do have solutions, not least from reports that they themselves have commissioned, such as the Dilnot report of 2011; from legislation they have passed, such as the 2014 Care Act; and White Papers they have published, such as People at the Heart of Care in 2021. For the one in five of us, and for the health of the nation, it is now time to see some implementation.
Baroness Barker (LD)
My Lords, I have had the privilege of being a member of the Adult Social Care Committee, chaired by the noble Baroness, Lady Andrews, and I am now a member of the Select Committee on the Integration of Primary and Community Care, chaired by the noble Baroness, Lady Pitkeathley, so I have come to think of the noble Baroness, Lady Shephard, as my partner in crime on both of those, as we question a series of professionals coming in to try to tell us just how bad the situation is currently.
We are having this discussion in the run-up to a general election, nearly a decade on from the passing of the Care Act and more than two decades on from the royal commission on the future of long-term care, and I suspect we are no nearer a resolution now than we were then. But I think it is important, as we are in the run-up to a general election, to make a few recommendations to all those people in political parties who are drawing up their manifestos.
The first is that there needs to be an update of the Dilnot commission proposals. We need a realistic assessment of the needs of older people and adults with disabilities for long-term care and the extent to which that can be funded by individuals’ capital assets. A crucial element of that assessment has to be the availability and cost of trained skilled staff, because that is a huge issue in the sector. For the first time, a further element needs to be the number of people ageing without children—that is a phrase which covers a number of different circumstances. We have now got to the point where Secretaries of State for Health admit openly that we have a health and social care system predicated on the fact that the majority of care, and management of care, will be done by families. There are at least 1 million people who do not have children, and it is children we are talking about. We do not even record the number of men who do not have children; we do not have that basic data, and yet we are expecting them to manage care. Unless and until we do that, there will be a profound effect on those people when they come to moments of crisis, such as hospital discharge. We need the Government to start to really look at this issue.
The second recommendation is that we need, as a matter of urgency, the development of legislation, policy and protocols that governing the use of, and access to, data of health and social care users. Currently, we have a system in which the sharing of information just between the departments of an acute hospital is utterly random, and between the different parts of the health and social care system, between acute and community health, and social care and local authorities, is non-existent. We talk about care pathways, but they are rapidly becoming a fictional idea. I defy anybody—a professional, a user or a carer—to know what a care pathway is and how to get from one place to another. Unless and until we sort this, we will have an ineffective, expensive mess: duplication of services on the one hand and lack of access to basic services on the other.
My third point is that, as regulators of health and social care—particularly the CQC as it goes into the new single assessment framework—look at these new integrated care systems, they need to specify who is responsible not just for a single episode of care but for care pathways. We have not begun to see that yet, and it is fundamental to our ability to build a system which works in the long term.
I suspect, in the run-up to the election, there will be calls from some people to say that we ought to take care away from local authorities; that for the sake of efficiency, we either put everything under the NHS, or outsource much more to the voluntary sector, charities and faith groups because they will make better use of limited resources. I would caution against that. Local authorities have a public equality duty and access to population data, and to data about individuals within their areas. I think it is crucial that we stick with them.
Finally, as president of the National Association of Care Catering, I want to make a plug for meals on wheels: old-fashioned, much denigrated, but an absolute lifeline to people. I had the privilege of being an undercover meals-on-wheels volunteer a couple of years ago—I said I was a trainee; I do not think most of them would have given me the job. The immense value of low-tech services to older people cannot be overestimated. We really should make sure that those services which give great value are maintained for older people.
The Archbishop of Canterbury
My Lords, I am very grateful to the noble Baroness, Lady Andrews, for securing this important debate, for her Select Committee’s outstanding report on adult social care and for including the recent report of the Archbishops’ Commission on Reimagining Care in the debate title. I am also very grateful to my noble friend the right reverend Prelate the Bishop of Carlisle, who co-chaired the commission. He will be addressing some of its specific recommendations later. I would like to speak about the motivation for its commissioning by the most reverend Prelate the Archbishop of York and myself.
First, in common with those of almost every political, religious or social belief, we think the current care system is broken. It cannot be tweaked; it needs reimagining. We have had the same reason for the Church reports on housing and, I regret to say, the same indifference to them from the Government, despite the enthusiasm of the industry in both cases.
Secondly, each of the reports we commissioned is based in Christian values which have guided this country at its best for centuries but overlap almost exactly with those of other faith groups and those of humanists. We were discussing this, over an Iftar meal on Monday evening, with Muslim leaders from across the country. Anything like housing, care, households, families, ethnicity or race has to have a value base which is realistic, mitigates possible harms and exalts the value of human dignity. The values must also maintain a healthy realism on the tendency of individuals and institutions, including government and the Church, to look for short-term fixes in their own interests, not long-term solutions for the common good. The list of reports and White Papers, so eloquently put by the noble Baroness, Lady Shephard, which really should have ended with “and a partridge in a pear tree”, illustrates this point finely.
Thirdly, each report makes demands of government but also of every other aspect of society. In terms of care, it may be companies and businesses, charities, families and households, and we always point to the needs for the Church of England to improve and up its game. Every part of society is needed to be involved in care.
This commission was started in April 2021 and produced its final report in January of this year. We need an understanding that care and support is not an end in itself but the means by which every person can begin to fulfil their potential as a human being as it varies through life. The commission’s central recommendation is for the development of a national care covenant. This would clarify the mutual responsibilities of us all—individuals, families and communities, alongside local and national government—in relation to care and support.
Funding matters. If it is our starting point, we will fail. Once we know what kind of care system we are aiming for, we can begin to see how it could progressively be paid for. Much as I admire His Majesty’s Treasury, if we start with it, we will be pragmatic but are unlikely to be imaginative.
The revolutionary value that should be at the heart of our social care system is interdependence. In the report, it replaces the myth of autonomy for each person. No one is autonomous; we all rely on others at every point of life and death. We must recognise that reality, with its beauty and dignity. Interdependence builds community; autonomy creates atomisation. Atomisation is painfully described in a book with that name as the title in the English translation but which in French is called Les Particules Élémentaires, by Michel Houellebecq. Autonomy takes us to Huxley’s Brave New World; interdependence overcomes differentials of class and power and offers the prospect of robust compassion. Autonomy ends up with dependence on the state, because we all need support. It is a myth, and the truth is found in the prayerbook phrase
“whose service is perfect freedom”.
Interdependence takes us away from a narrow argument about who should provide care and instead says that responsibility lies with all of us to different degrees: with families and communities; with government, with regard to funding and implementation; and with NGOs, the voluntary sector and community actors such as churches, with regard to participation.
So I ask the Government and the Minister: will they begin, as we move forward, to reimagine the care system and to look at setting out clearly through a national care covenant the mutual responsibilities we all have?
Baroness Fraser of Craigmaddie (Con)
My Lords, I, too, start by thanking the noble Baroness, Lady Andrews, for securing this debate today, for her very sensitive chairing of the Adult Social Care Committee, on which I was privileged to serve, and for her tireless commitment to improving the landscape of care, which is a real conundrum of our time. We must “reimagine” it, as the most reverend Primate urges, and, while many have claimed that they will fix it, it remains unfixed.
No one chooses to be cared for, or to become an unpaid carer. If the noble Lord, Lord Laming, was here, he would tell us that either could happen to any one of us at any time. But, as our report points out, both are invisible. This invisibility leads to confusion around what social care is and who delivers it. While the NHS is there “from cradle to grave”, individuals who do not currently need care cannot imagine they ever will and therefore fail to plan for such a time.
I draw your Lordships’ attention to my interests as laid out in the register, in particular my work as chief executive of Cerebral Palsy Scotland and also with people with neurological conditions. My lived experience says that we must not view social care through the prism of the NHS. Many of the people I work with are neither ill nor old; they just need help to be able to live what our committee’s report called
“a gloriously ordinary life”.
I know people who choose to study with the Open University and miss out on all those extracurricular experiences that I am sure many of us look back on with fond nostalgia, because they cannot be confident that they will be properly supported to get around campus and get to lectures like their contemporaries. I know parents who have to give up their own professional lives when their adult child leaves formal education because the system assumes that they will; and I know people who remain living with elderly parents because there is no suitable accommodation for people under the age of 65. Our committee heard from many witnesses who were not ill or old but could not get the right support. Worse than that, they were worried that, if they contacted their local authority for a review, the support they did have would be reduced.
For many of working age, what they want and need are good PAs, personal assistants. These are professional enablers who help you do what you want, whether it is getting to work, feeding you, taking you to the pub or, in a case highlighted to us during the course of our inquiry, enabling someone to pay their respects to Her Majesty Queen Elizabeth II at the gates of Balmoral—something that could never be assessed as an outcome by a local authority care package.
Yet there are not enough PAs. You are really stuck if your PA is ill or does not turn up, and the challenges of becoming an employer and dealing with recruitment, PAYE and pensions too often just puts people off. We heard evidence in our committee from Enable Scotland, a charity which works with local authorities across Scotland delivering their PA model of care, where the charity deals with all of those employer issues and provides a personalised service to people who want it. I encourage the Minister to look at this model.
For too many, as we have heard, contact with social care services is forged in crisis and fraught with difficulty. The providers of last resort are family and friends, who are thrust into roles they neither sought nor are supported to fulfil as unpaid carers. I believe the Minister himself has been a carer and appreciates the challenges. He has called unpaid carers
“the backbone of the system”—[Official Report, 20/2/23; col. 1434.],
but I am afraid that, despite warm words, unpaid carers continue to be taken for granted.
As the noble Baroness, Lady Andrews, pointed out, carer’s allowance is the least generous benefit and considerably less than the minimum wage. There is little respite, little support and severe financial implications, but too many families feel they have no other options.
If we do nothing else in the Government’s forthcoming social care plan and future work, I urge the Minister to improve identification of unpaid carers, including children who care. Self-identification is not working and neither are the formal systems set out in the Care Act. There are still so many gaps. We heard about the No Wrong Door initiative successfully employed in Liverpool. How can the Minister ensure initiatives such as this are more widely adopted?
As others, particularly my noble friend Lady Shepherd, have said, over the years, Ministers have been given a veritable shopping list of solutions. I hope these two reports and our debate today can add to the impetus the Minister needs within government, because the last thing people who rely on care want is yet another plan that fails to be backed up with action.
Lord Bradley (Lab)
My Lords, as another member of the Adult Social Care Committee and declaring my interests in the register, I am pleased to make a short contribution to this very important debate. I too congratulate my noble friend Lady Andrews on securing this debate and, more importantly, I praise her knowledgeable and passionate chairing of the committee and her opening speech today, which I fully endorse.
The evidence we received throughout our inquiry was for recognition and support for social care in general and unpaid carers in particular, as a largely hidden workforce. The evidence was compelling, inspiring but also at times harrowing, and I praise all the contributors. As the committee stated at the beginning of our report:
“Creating a sustainable social care system in which people, their families and friends can thrive is a national imperative”.
A sustainable adult social care service must be seen as
“an indispensable partner to the health service”
and clearly and genuinely integrated with it. Surely no one can disagree with that. As we further noted, the new integrated care boards and systems must be at the forefront of realising this ambition.
As we have heard, to achieve it, investment and resources must be forthcoming. Again, the committee made clear that the Government must increase the financial settlement for adult social care over three years and then commit to sustaining realistic, long-term and protected funding for the sector to enable the robust planning of services. So it was clearly disappointing that there was no mention of sustained funding in the Budget, or any recognition of the need to reform the social care funding system based on the laudable principles established by the Dilnot inquiry.
Linked to this funding settlement is, as we have heard, access to the key benefit for carers—carer’s allowance. It is the lowest benefit rate of its kind—I do not apologise for repeating that—and it is not reflective of the extraordinary value of unpaid carers, as we have already heard today. Some of the most shocking evidence we heard from unpaid carers was about families’ lives being suddenly and unexpectedly overturned by some catastrophic event, perhaps a critical or terminal illness or a life-changing accident, with their immediate income and long-term financial planning in absolute turmoil.
So access to carer’s allowance must immediately be made easier by lowering the threshold of carers’ hours and ensuring that the earnings limit is uprated in line with the national living wage and in law. Further, the DWP should fundamentally review the carer’s allowance and report back to Parliament within one year to give some hope of financial support for this army of unpaid carers—I would be very grateful for the Government’s views on that today.
Touching very briefly on workforce, we wait expectantly for the Government’s social care plan and the workforce proposals within it. The current situation of low pay, limited career opportunity and thousands of vacancies in the sector is an utter disgrace. The committee’s recommendation that the Government must produce, with people who work in and draw on adult social care, a comprehensive, long-term, national workforce and skills plan, is an absolute priority.
Finally, it is essential that a laser focus is maintained on adult social care, and particularly on the incredible work and dedication of unpaid carers. To this end, the committee strongly believes in the establishment in the next 12 months of a commissioner for care and support to act as a champion for older adults, disabled people and unpaid carers. Critical early priorities for such a commissioner would be to include oversight of a government-commissioned, independent public review of the Care Act 2014, working with local authorities to ensure that the Act is fully implemented, and also to set up, as we have heard, the identification of the millions of invisible unpaid carers, perhaps through NHS patient records—with their permission—to ensure a mechanism to provide carers with information, self-care and digital resources to support them. They deserve nothing less.
Baroness Campbell of Surbiton (CB) [V]
My Lords, I declare an interest as the recipient of a personal health and social care budget. It was a great pleasure to serve on the Adult Social Care Committee last year, and I congratulate the noble Baroness, Lady Andrews, on her very skilful chairing, which ensured that the voices of all those involved in social care were heard and listened to.
One of our significant recommendations is that the Government work with local authorities, the voluntary sector and social care providers to embed the principles of co-production. That will give staff the necessary skills and the balance of power to the individual receiving care.
Co-production bloomed with the passing of the Community Care (Direct Payments) Act 1996, which was initiated by the noble Lord, Lord McColl of Dulwich, in his 1993 Private Member’s Bill. I remember watching the late Baroness Masham of Ilton championing the legislation with skill and wisdom; I think I can speak on behalf of all of us when I say that we miss her fierce presence today and I pay tribute to her inspirational legacy.
The Act enabled disabled adults to purchase social care tailored to our individual needs, giving us choice and control; it is what enables me to be a Member of your Lordships’ House today. Under the Act, disabled people established local centres for independent living and worked with their LAs to educate and support other disabled people in employing personal assistants to meet their needs using the co-production model. Regretfully, the committee heard evidence that this essential support has eroded with a lack of investment. Older, disempowering models of social care provision such as institutional care and threadbare support at home are now commonplace—we need to get back to co-production.
Our report proposes specific funding to ensure that local authorities commission peer-led, independent organisations to promote innovation and capacity building. Information, advice, advocacy and peer support are key; local authorities already have duties under the Care Act 2014 to provide information and advice. Part of the funding identified in the current White Paper should also be allocated to making direct payments and personal assistance a realistic option.
This is an urgent problem. In a survey of 1,000 people by the LGA last year, 77% found it more difficult to recruit a PA—that has been my own experience. Not enough is known about the role of PAs. One witness told us that if it were recognised as a valuable and skilled role, “many will intuitively see that as a vocation—as a career”. Raising its profile would attract more people to the profession. The report recommends that a government-led workforce revaluate the pay and working conditions of PAs, and appropriate training.
To conclude, our committee endorsed Social Care Future’s simple challenge for social care: to make possible the ambition of people who “want to live in the place we call home, with the people and things we love, in communities where we look out for one another, doing what matters to us”. Indeed, our report is titled A Gloriously Ordinary Life—that was how one witness described their aspiration. The Government have the power to ensure that this is not a pipe-dream.
Lord Polak (Con)
My Lords, it is an honour to follow the noble Baroness, Lady Campbell. I learned so much from her. It was also an honour to have served on the Adult Social Care Committee under the expert chairmanship of the noble Baroness, Lady Andrews, and I also pay tribute to the excellent support staff that we had. When I joined the committee, I thought it would be an important learning experience in an area that I was not particularly familiar with. However, as we met and listened to witnesses, it became apparent that this was not an academic exercise but, sadly, a practical guide for me and my family, as it is in one way or another for every family in the country.
I will concentrate on just one area of the report, on page 45 with the heading “Navigating the social care system: a constant fight”. Paragraph 147 states:
“Whether it is trying to get support for themselves or for the person they provide care for, unpaid carers often find that they are left to their own devices when it comes to navigating the adult social care system”.
As stated in our report, witnesses found it difficult to organise formal support for the person they care for.
Because of the difficulty of accessing care and support, social workers and local authorities are seen as gatekeepers, and there is little trust in the system’s ability or willingness to provide help. How sad, as my noble friend Lady Fraser said, that some unpaid carers told us that they live in fear of assessments which they see as a process designed to minimise their needs so as to deny them support.
I totally understand. My mother is suffering from brain cancer and has 24/7 care at home in Liverpool. We have experienced, and are experiencing, both some of the best and the worst that the system has to offer. On the positive side, the care and attention of the Marie Curie Hospice in Woolton, Liverpool, led by the deeply sensitive and professional palliative care doctor Dr Mark Mills and his team, has been exemplary. While mum is at home, the staff at the hospice have been an enormous comfort and help, not just to my mum but to my sister and brother too.
On the other hand, the experience we have had with the local authority assessors has been woeful. On 9 February, my mother was assessed by a nurse via Zoom. The nurse was in Kent and my mother was over 200 miles away, unable to communicate, in her bed in Liverpool. The assessment was to decide what the immediate next step for her care plan should be. The report, compiled by a nurse who has never met my mother, was then to be sent to an unknown panel of people who also have never met her to decide the best course of treatment and care. This absurd assessment was executed over a three-hour Zoom call seven weeks ago, and as I stand here today, we have heard nothing. The system is sadly broken. As we speak, we should consider that people up and down the country are battling to understand an incomprehensible system at the same time as trying to care for their loved ones as best they can.
During the committee’s deliberations, we understood that we were not going to be able to change a system that desperately needs an overhaul, but we were attempting to move the dial a little to bring some clarity to people doing their utmost to care. Our committee has made 36 recommendations, and that only scratches the surface. Each one is important. My own experiences have made me think more carefully, for example, about the point forcefully and powerfully made by the noble Baroness, Lady Barker, about people without children ageing. Like the noble Baroness, Lady Andrews, and the noble Lord, Lord Bradley, I urge my noble friend the Minister to look carefully at recommendation 9, where we ask the Government to establish a commissioner for care to bring about a more accessible adult social care system. I concur with the suggested actions on page 45 of the Archbishops’ report that assessment and budget planning should be simple and consistent, and that care planning services should be focused on what matters to people.
I appeal across this House to all parties and to none to help that commissioner to take the politics out of care. We must come together to find and implement an urgent solution so that people up and down the country can fulfil with dignity what the late Lord Sacks wrote in his book Celebrating Life—that the supreme act of caring is to make a difference to someone else’s life. In his book the Dignity of Difference, he said, “To care is to look into the face of the other and see their uniqueness, their vulnerability and their pain”.
Baroness Pitkeathley (Lab)
My Lords, it is a pleasure to speak in this debate today, and I congratulate my noble friend Lady Andrews. I have lost count of the number of debates on social care in which I have participated in my 25 years in your Lordships’ House, and it has often been a rather depressing experience. I would often have to cajole, persuade or even beg people to take part. I took to calling the few stalwarts who could always be relied upon to speak—the “usual suspects”. We were a small but devoted band. For me, the best thing about today’s debate is the number of your Lordships speaking and the attention that is being drawn to social care, at last. To be able to call my noble friend Lady Andrews and the most reverend Primate the Archbishop of Canterbury “usual suspects” is a measure of the progress being made. Their influential reports mark, in my view, a step change in views about social care, which for so long has been the poor relation or the Cinderella vis-à-vis the NHS.
That is not to say that the social care scene is any better than the dire situation to which I have drawn attention over the years. On the contrary, it is worse, as the statistics and examples cited in the debate today illustrate. There is not enough money, not enough integration, too many broken promises, and too many vulnerable people and their families neglected. I, like others, had hoped that we would have the long-promised plan from the Government today, but in its absence we must once again rely on promises and assurances that the Government hear our pleas and will answer our questions.
Your Lordships will understand that, for me, the most important recommendations in both the reports we are discussing today were about unpaid carers. I thank the noble Lord, Lord Polak, for sharing his moving personal experience on the issue of being an unpaid carer. Our social care system relies heavily on the care and support from these carers. In fact, they outnumber the paid health and care workforce by at least two to one. Many live in poverty or on its margins, often building up poverty for the future because of a lack of access to pensions and paid employment. Their health suffers physically and mentally, as we have heard.
The House of Lords report makes a series of sensible and modest recommendations, recognising that carers have to deal with a baffling range of organisations and agencies, which is stressful and time-consuming. For example, the report recommends that carers should be properly identified and have mechanisms for getting information. It states that carer’s allowance is inadequate and should be reviewed—hurrah—and recognises how important respite care breaks are and that there should be ring-fenced funding to provide them.
The recommendations from the Archbishops’ Commission are summed up as a new deal for carers which ensures that they have the practical, financial and emotional support to be able to provide care, maintain a loving relationship and live a full life themselves. These are modest enough demands which surely every carer deserves so that they have opportunities for a rest, better advice, better financial support, and coproduction so that they are involved in planning. None of these recommendations is rocket science, and neither are any of them unreasonable. They are simply actions and commitments which would help unpaid carers do what they want to do, willingly and with love: provide care for their loved ones, as well as caring for themselves.
It is a great disappointment that the Minister is unable to respond to all these recommendations today in the absence of the Government’s plan. I acknowledge that their White Paper, People at the Heart of Care, published in 2021, set out a 10-year vision for adult social care in which unpaid carers were recognised as equal partners in care. I cannot fault the Minister for the words he has shared many times in your Lordships’ House when acknowledging the vital role played by carers. I was delighted by the support his noble friend, the noble Lord, Lord Johnson, gave to the Private Member’s Bill that would give carers access to unpaid leave, which we hope will receive Royal Assent very soon. However, carers are at breaking point. I ask the Minister to assure the House today that he knows that more funding and better integration is vital for their support. Warm words are not enough.
Beyond carers, can the Minister assure the House that when we finally see this long- awaited plan, it will have some vision in the spirit of that 10-year plan, and that it will make some attempt to address the causes of the difficulties in health and social care and not leave the Government open to charges of yet another sticking-plaster solution? Health inequalities must be addressed. They are the result of poverty and inadequate services, which are in turn the result of many years of spending cuts. The most efficient way to ensure our health and social care services are not overwhelmed is to make sure that people do not need them. If we could rebalance the agenda towards the prevention of ill health, that is the sort of vision and focus that could give some hope for the future of social care and reassure the carers who are its main providers.
Baroness Jolly (LD)
My Lords, I considered myself fortunate to sit on the Select Committee, most able chaired by the noble Baroness, Lady Andrews, and joined by experts and enthusiasts for the subject, along with brilliant witnesses. A few years ago, I would have had to declare my interest as the chair of a national charity providing services across England for adults with a learning disability. That is where my heart is. I echo the question posed by the noble Baroness, Lady Andrews, to the Minister about the national care plan.
Everyone has a right to the best life possible, and that includes people with learning disabilities, but they face obstacles that are hard to imagine. Their challenges can be complex and certainly lifelong. Even so, with the right care, support and encouragement, everyone with a learning disability can find more enjoyment, comfort and satisfaction in their lives. We saw evidence of this on our several visits. I also met pensioner children: children of our age being cared for by their parents. I met 70 year-olds being cared for by 90 year-olds. They would have had it no other way. I just cannot imagine that.
The Care Act 2014 changed the way that adults in England who require care due to old age, illness or disability receive their support. It replaced most existing legislation on this issue. The Guardian called it
“the most significant change in social care law for 60 years.”
I remind noble Lords that it received its Second Reading in the House of Lords when Jeremy Hunt was Secretary of State. Its authors were Health Ministers Paul Burstow MP and Norman Lamb MP. At its heart was the well-being principle, which established local authorities’ responsibility to safeguard and further the well-being of those under their jurisdiction. It introduced new ways of supporting adult social care. A set of national minimum eligibility criteria was introduced to ensure that people across the country received the same care for the same needs. It rather begs the question of whether local authorities and the CQC ensure that these criteria are being delivered now. That would make a good Oral Question to the Minister; I have put a marker down.
The Care Act 2014 is governed by six principles to safeguard vulnerable adults from harm: empowerment, protection, prevention, proportionality, partnership and accountability. They are as important now as they were nearly 10 years ago, and they are all to be found in the Select Committee’s report, A “Gloriously Ordinary Life”.
Looking back, why did we need the Care Act 2014? Previously, there were lots of different laws on care and support in England, and it was difficult to know what support and care one could get. The Act brought them all together under one new law and determined what type of care people should get. The Act also gives guidance and information for authorities on how to use its provisions appropriately. It gives clear and simple rules and advice on care and support for adults. The Act helps to improve people’s independence and well-being. It aims to protect vulnerable adults from any kind of mistreatment, giving people who need support more control over what happens. Consequently, it has improved their quality of life by keeping them safe and protected.
My noble friend Lady Barker brought up the issue of costs. Alongside that Act was a discussion about paying for care, influenced by Andrew Dilnot, now warden of Nuffield College, who was also a witness to our committee. Back then, he was chairman of the UK Statistics Authority and of the Commission on Funding of Care and Support, which reported in 2011.
The six principles I mentioned that govern the Care Act 2014 to safeguard adults were first introduced by the Department of Health in 2011, and they are embedded in the Act to apply to all health and care settings. It is the law that sets out how adult social care in England should be provided. It requires local authorities to make sure that people who live in their areas receive services that prevent their care needs becoming more serious or delay the impact of their needs.
Disabled adults and older people, as well as unpaid carers, frequently pointed to the vision described by Social Care Future. With the right care, support and encouragement, I believe that everyone with a learning disability can find more enjoyment, comfort and satisfaction in their lives—their glorious lives, as the title to the report realised.
Baroness Donaghy (Lab)
My Lords, I thank my noble friend Lady Andrews for initiating this debate, and congratulate her on the Select Committee report. It has been said before, but the report follows other distinguished predecessors. When preparing for this debate, I pulled out my well-thumbed copy of the Dilnot report and the Economic Affairs Committee’s report—otherwise known as “Lord Forsyth’s report”—together with speeches made by my noble friend Lady Pitkeathley. Here we are again: the needs are more desperate and the achievements are less. Some 58,000 fewer older people now receive long-term care, compared with 2015-16. There will be no major development until after the general election, as the introduction of a cap on lifetime care costs and changes to the means test have now been postponed until October 2025. As has been said, these changes were contained in the Care Act 2014, yet we know that 10 years will have gone by before we even start to build a system.
Those providers in the social care industry—if they are caring and conscientious—are seeing diminishing profits and worse deficits. More than half of providers had to turn down admissions and 20% of them have closed services. Those that are less caring and conscientious are making good money out of human misery. Local government funding is half of what it was 10 years ago. What help will the Government give to providers in their remaining two years? In particular, will they continue the enhanced support for energy costs at least to assist providers to stay in business?
With no long-term policy changes in prospect, we have to turn to the short-term mitigations, with the top priority being staffing. Can the Minister tell the House whether it is correct that the Government’s promise in the social care White Paper to dedicate £500 million for
“investment in knowledge, skills, health and wellbeing and recruitment policies”
has been cut by 50%? The executive chair of the National Care Association, Nadra Ahmed, representing the independent carers, believes that the report of these cuts is correct. Martin Green, the chief executive of Care England, commenting on the rumour of cuts, said that
“it will set back social care for many years to come.”
The number of vacancies in the care sector is 165,000. The number of additional social care workers required is estimated to be 480,00 by 2035. Skills for Care has predicted that the UK will lose 430,000 carers in the next 10 years if those aged 55 and over take retirement. Hft and Care England published the 2022 Sector Pulse Check report, which covers, among other things, how the care sector is mitigating staff shortages. The “refer a friend” scheme, international recruitment and increasing use of agency staff each contains its own problems.
“Refer a friend”—a scheme where existing members of staff refer friends or relatives in exchange for financial reward—was the most popular method of recruitment, selected by 24% of respondents. In my view, this method contains real risks that suitability and skills will take second place to the loyalties of relationships. We have seen the consequences of this in various cover-ups of mistreatment of the most vulnerable. I have been a fellow of the CIPD for more than 20 years. Unless the right checks and balances are in place, the “refer a friend” scheme could be seen as a sub-optimal recruitment method.
The second method is international recruitment, used by 15% of respondents. In February 2022, the Government expanded the shortage occupation list; that was welcome but the primary barrier here is pay. The minimum wage that the Government have set for care workers employed from overseas is £10.10 per hour, which causes a disparity in pay between overseas workers and the existing workforce. Obtaining a certificate of sponsorship is bureaucratic and time-consuming, often taking up to 12 weeks. Visa applications are also an issue, with costly legal services beyond the reach of smaller providers. Even the agencies that provide these staff can no longer guarantee to provide workers, which has broader implications for the NHS. Many NHS nurses are doing extra shifts in adult social care rather than working overtime in the NHS. The report concludes that
“failure to manage this market will see nurses leave both the NHS and adult social care and become agency nurses at a few, select high-paying agencies.”
In conclusion, if you are in need of social care and money is not a worry, you can probably still receive a good experience. If you are poor, growing old will be the biggest challenge in your life at a time when you are least able to cope.
The Lord Bishop of Carlisle
My Lords, I have had the great privilege of sitting on both the Adult Social Care Committee and the Archbishops’ Commission on Reimagining Care. I also pay tribute to the outstanding work of their respective chairs, the noble Baroness, Lady Andrews, and Dr Anna Dixon.
When the two reports were published, it came as no great surprise that there were huge areas of overlap. In fact, a careful analysis has revealed at least 17 different points of congruence, ranging from providing everyone with the opportunity to lead a full life, through to appointing a commissioner for care and support and properly implementing the Care Act 2014—all of which have already been mentioned.
As we have heard, the role of unpaid carers, including children, was highlighted in particular by both reports. Because that became such a central feature of the Select Committee’s investigation and report, it is being fully addressed by many noble Lords speaking in this important debate. Rather than repeating their valuable contributions, I, like the noble Lord, Lord Polak, and the noble Baroness, Lady Shephard, want to focus on another area of concern raised by both reports, namely the current difficulty experienced by those who try to navigate the statutory care and support system. Phrases such as a “baffling range of organisations” and a “fog of confusion” abound. As we heard from the noble Baroness, Lady Pitkeathley, whose long-term contribution to this debate we so value, dealing with the complex and circular bureaucracy is time-consuming and frustrating.
As we heard from the most reverend Primate the Archbishop of Canterbury, the commission’s central recommendation is the development of a national care covenant. This covenant would emerge from a major programme of public engagement with cross-party support and significant co-production, as with the NHS constitution. It would reflect four main themes. The first is the empowering of communities, which have a vital role to play in all this, not only in addressing practical needs but in combating loneliness and social isolation and fostering physical and mental well-being. Both the committee and the commission witnessed many good examples of that happening in practice, but we all know that supportive and inclusive communities do not just happen by accident; they need investment and nurturing. They also need local authorities to work in partnership with them, to provide a network of community-based support for everyone.
The second theme is a new deal for carers that includes recognition of their value. We applaud that recognition in the White Paper, People at the Heart of Care. As we have heard, as well as respite and, where necessary, financial support for unpaid carers, care for carers is essential to the future of social care.
The third theme is a universal entitlement to care and support, including the pooling of risk, to ensure that everyone is able to lead what the committee calls a “gloriously ordinary” life.
The fourth theme is the acceptance of our mutual responsibility as citizens. A covenant of this kind would make it abundantly clear that social care is not just the state’s responsibility. As citizens, our rights come with corresponding responsibilities; the principle of interdependence, mentioned by the most reverend Primate the Archbishop of Canterbury, emphasises the simple fact that, in this arena, all of us have a vital part to play.
The commission began its report with a call to rethink attitudes and values, several of which have already been mentioned. It concluded that, ultimately, the whole care system needs to redesigned rather than merely adjusted. However, a national care covenant that would rebalance roles and responsibilities was its key proposal. I very much hope that His Majesty’s Government might consider this alongside their other plans for implementing the recommendations in People at the Heart of Care, which we all look forward to seeing in the very near future.
Lord Lipsey (Lab)
My Lords, social care is the Passchendaele of the welfare state. It is now 25 years since I sat on the royal commission on this subject. Since then, there has been a veritable snowstorm of excellent reports—including the two in front of us today—with, often, government promises and, sometimes, government policy statements. However, all have melted the moment they touched the ground.
I cannot hope to cover the whole subject in the time available to me so I will concentrate on one issue that is very close to my heart. After that royal commission, my noble friend Lord Boateng called me into his office; he was in charge of funding long-term care. He asked me a very good question: “If you had a bit of money to spend in the social care field, where would you spend it?” I replied, unhesitatingly, “On increasing the pay of social care workers.” Then, I said by £1 an hour; now, it would be more like £2. It is a scandal what goes on now for both the workers involved and the people for whom they care.
In January this year, Skills for Care reported that 10.9% of posts—around 170,000 of them—were vacant, meaning people will not be properly cared for. According to the latest figures, a care worker in the independent sector earns £9.66 an hour; in local authorities, it is £11.03. Care workers’ pay has dropped behind that in other sectors. In 2012-13, retail assistants earned 16p an hour less than care workers; today, they get 21p an hour more. One care manager is quoted by the Commons Health and Social Care Committee as saying:
“I dread hearing Aldi opening up nearby, as I know I will lose staff.”
Being a social care worker does not just involve hard skills, though there are those. It also involves soft skills in getting on with people. Do we really want those soft skills transferred to behind cashier points in supermarkets?
There are also problems of low promotion. People love the job but cannot see the way forward. There is also the problem of local authority finance. Councils are trying to push care home fees down. Homes make it work because they charge the councils the marginal cost of putting up with someone and get the rest of the money back off the private payers. The Government said that they would tackle this. Can the Minister kindly tell us where they have got to? I would be most grateful.
This problem is going to get worse and worse, for the simple reason of demographics—an increasing elderly population with increasing care needs. The overall population in England grew by 7% in the 10 years between 2011 and 2021. The number of people aged 85 or over rose by 16%, so nearly three times as fast. Many of those people will need care. By 2038, 57% more adults in the population will be 65 or over, compared with today. How are we going to care for them?
I make this final point. There is a crude choice in social care. You can spend the money that you have available on helping people to pay their care home fees, which helps the top half of the population, or you can spend it on providing better care. The Government plan to prioritise a cap. Fortunately, the proposal for that has now been ditched, or postponed indefinitely. However, they should have prioritised the first, with better care for all, starting with better care for those who give their lives to these difficult but rewarding tasks.
Baroness O'Grady of Upper Holloway (Lab)
My Lords, I congratulate my noble friend Lady Andrews and her committee, and the most reverend Primate the Archbishop of Canterbury, on two excellent reports, and address my contribution to the urgent recommendation for a proper social care workforce strategy.
I declare an interest. When I was general secretary of the TUC, we sought and secured core participant status in the Covid public inquiry. We worked closely with Covid bereaved families’ campaigns throughout. I believe that the evidence is there that many Covid deaths in care homes and among front-line workers—disproportionately among black and ethnic-minority workers—were entirely preventable. From the start, the Cinderella status of the social care service was symbolised by that failure to provide staff with proper PPE. The absence of proper sick pay also put staff and service users at terrible risk. Statutory sick pay is still far too low, at just £99 a week, and 2 million people in this country do not earn enough to qualify at all. No worker should be forced to choose between going into work and risking spreading a virus, or staying home but being unable to feed their family.
Many hoped that the pandemic would spark a sea-change in our social care service, and that severe cuts to local authority budgets, inflicted over many years, would be restored, but today the service is still subsidised by the love, the labour and the low pay of unpaid carers and the social care workforce, predominantly women. In my experience, staff care deeply for those whom they care for, and find their work profoundly satisfying. While progression routes are poor and training needs to be improved, be in no doubt that this is skilled work. However, that vocation is being exploited. Nearly a quarter of the workforce are on zero-hour contracts. Most care workers earn barely above the national minimum wage, which is currently £9.50 and due to rise to just £10.42 in April.
The Government rebranded the national minimum wage, calling it a living wage, but the real living wage, calculated according to how much it costs to lead a basic decent life, is much higher: £11.95 in London and £10.90 in the rest of the UK. The Resolution Foundation, along with many others, has argued that the bottom rate of pay for care workers needs to be significantly higher even than that, just to tackle the crisis in recruitment, retention and turnover. Service users, their families, and decent employers, know that even with the potential of new technologies, the heart of the service is human. How we treat and reward care workers reflects how much we, as a society, value those who receive care. No doubt the Government will ask how we pay for it. Part of the answer must be a fairer taxation system. It cannot be right that a care worker pays a bigger share of her income in tax than the private equity chief who buys up care homes, saddles them with debt, and then sells them on for profit.
I am proud that as part of its New Deal for Working People, Labour is committed to a policy of sectoral fair pay agreements, just as the New Zealand Government have introduced, and as is common across Europe. It is only right that first in the queue for a UK fair pay agreement should be social care workers. I hope that we can build a broad consensus for this approach, bringing Governments, employers and unions together to lift the status of social care as well as the pay, conditions and morale of staff. Investing in our social care service would relieve pressure on the NHS and, I hope, act as a catalyst for creating the decent and properly staffed and funded service that those in need of care deserve, and that care workers themselves have well and truly earned.
Baroness Bennett of Manor Castle (GP)
My Lords, I agree with the noble Baroness, Lady O’Grady, that social care jobs—indeed, all jobs—should pay a real living wage. It should be a foundation of our social contract. I thank the noble Baroness, Lady Andrews, and her committee, for this report, which shows great compassion and sense, as does the report from the Archbishops’ Commission on Reimagining Care. We can hope only that the Government will follow their lead. There is little that I could disagree with in the intentions of either report, but as Greens we always aim to go further, so I particularly acknowledge the interrelationship of other policy natures and the nature of our society, rather than looking at social care as a stand-alone unit or looking simply to join it up with healthcare. This is really systems thinking.
First, I give a personal reflection. The noble Baroness, Lady Barker, referred to the 1 million people who do not have children. This is personal to me, since I am one of the 18% of women of my age, and most ages now since those born in the 1950s, who do not have children. I have no brothers and sisters—no living relatives at all. That reflects the position of increasing numbers of our society, something that we are entirely unready for. Civil society is generating solutions. I note particularly the Older Women’s Co-Housing project in north London.
The Government do not need to direct these, but they must do far more to enable them to happen, for we have now a society that does not care for the vulnerable. Any of us could be left in that situation, at any time. That is why Green Party policy is free social care to all who need it. Provision of free social care must be central to any green new deal. When you hear that phrase, you might think of hard hats and solar panels, but you should equally think of a person caring for someone and meeting their needs—someone holding another’s hand when they need it.
That would be central to what the most reverend Primate referred to as a fulfilled life, which we should be offering everyone. Care must be provided, as the noble Baroness, Lady Andrews, said, in a way that is “not transactional, not contractual”. That is our vision, and why the Green Party says that the profit motive has no place in any form of care provision—health or social. The terrible state of our care system owes a great deal to privatisation, which has taken public and individuals’ money and often put it into the hands of hedge funds and other tax-dodgers, while exploiting our workers and providing terrible care.
A study this week from the Guardian showed that the five largest private care chains are taking £150 million a year in taxpayers’ money for places in elderly care homes rated as “inadequate” or “requiring improvement”, including some classed as “not safe”. The leading earner from public funds is HC-One, a chain of 285 care homes majority-owned by a US private equity company. It was paid £50 million, the Guardian calculated, by town halls in 2022 for homes in the two lowest CQC categories.
Many noble Lords have referred to unpaid carers. Another Green promise is a universal basic income—a foundational, secure payment to every member of our society. If they chose to be a carer, we would top that up. This is a system in which everyone would have the security to care without fear of poverty. That truly is system change.
As the noble Baroness, Lady Barker, alluded to, we are that point in the electoral cycle where parties are drawing up their manifestos. I am not expecting other parties to adopt wholesale the Green vision—although I would be happy if they did—but I will offer a couple of smaller-scale policies that I would be very happy if any party wanted to steal.
First, I was speaking earlier today about the concessionary bus travel scheme. How about we extend free public transport to family carers? That would be a modest acknowledgement of the contribution they make to our society. Secondly, young carers are far too often ignored. They often start at a terribly young age, with huge responsibilities. The pupil premium should be applied to them to help their schools support them. Thirdly, on housing, we were talking this week in the levelling-up Bill about the need for vastly better housing, both newbuild and refit, and every new home should be built to lifetime homes design standards. That would mean that people could stay longer in their own homes.
I have a final thought on technology. There is no doubt that it can help a lot, particularly in medical care, by providing security and reassurance and notification of when help is need. But please, let us not assume that a robot, no matter how snazzy, can actually provide human care—the comfort of a human touch, the thoughtful listening to a cry of pain. If noble Lords are tempted by the technological care vision, I point them to the Isaac Asimov novel The Naked Sun. There is a great deal of robot “care” in that, and I promise you it is a dystopia.
Lord Prentis of Leeds (Lab)
My Lords, I declare an interest: I was the general secretary of Unison, the public service union, which represents over half a million health and social care workers—members who worked throughout the pandemic.
As we have heard today, despite all the inquiries, reports and initiatives, no matter what the Government may say, social care has not been fixed—far from it. As we have also heard today, it is quite simply broken. This has been said not just in this Chamber. The King’s Fund states that there is no credible programme to address the issues and that the workforce is in crisis. The social care ombudsman highlights an underresourced system, unable to consistently meet the needs of those whom it is designed to serve. The Care Quality Commission, the independent regulator, despite its own workforce challenges, states that the workforce crisis in adult social care needs to be addressed urgently.
I do not detract from the issues involved in kinship care and unpaid care, which have to be addressed as a matter of urgency, but there is also consensus across social care that nothing can be achieved in the sector until the workforce crisis is addressed. A third of staff leave every year. There are over 165,000 vacancies—more than in the NHS. Vacancy rates are at over 10% and are growing by the day. Many staff are on zero-hours contracts and many have no sick pay arrangements. Many people who work in domiciliary care are not even paid travelling time between visits to people in their care, meaning that they earn less than the minimum wage. There is alarming exploitation of migrant workers, with repayment clauses tying them to their jobs and employers. This is done throughout social care.
A small number of councils do show the way, agreeing ethical care charters with their providers and unions that cover training, pay rates and standards of care. A small number are sharing best practice. But these councils are few and far between. In too many areas, career development and progression are simply non-existent. The pay differential between a new starter and an experienced, long-serving member of staff in social care has been squeezed down to a measly 7p an hour. This feeds the increasingly high turnover rate of staff and reinforces the image of care work as a low-skilled, unregulated profession.
Astonishingly, despite the massive problems, the social care sector has no workforce plan and the Government lack ambition to deal with the crisis in care. What is needed more than anything is a Government committed to a national care service. Call it what you want, but we are crying out for a national care service, with a Government who recognise the beneficial impact that social care could have on the economy. It would boost the independence of those who receive care and allow more women who deliver the bulk of unpaid care to play a larger and more active role in our economy.
We need to raise the status of the care sector in our society, with a new deal for care workers, making social care an attractive sector to work in. Caring for the future is an integral part of any industrial society moving forward, and something that is long overdue. We need a Government who will ensure that no private equity firm is able to profit from running care homes where they are failing residents and underpaying staff. We need a Government who care for carers; a new Government who will boost the status of social care, making it the profession it really should be—one that people want to work in. We need a new Government who will change the perception of social care from being merely a drain on resources and make it a crucial component of the drive to boost economic growth. That is where the future of social care should lie. It is a massive challenge to all of us, but one that we have a duty to tackle together.
Lord Turnberg (Lab)
My Lords, I also thank my noble friend Lady Andrews for introducing this debate in such an inspiring way. I was not a member of her committee and nor was I, for obvious reasons and much to my regret, a member of the Archbishops’ Commission, but I can hardly express ignorance of the reports or of the many reports that have come out before this, so I am fairly well informed.
We have become so used to debating a situation that has been a disgrace for so long that it has become a sort of constant background noise that we have managed to ignore. For example, we are all fully aware that, for many years, large numbers of patients have been stuck in acute hospital beds quite unnecessarily, when they would be much better cared for in the community, but they cannot be moved, sometimes for weeks, because there is no one out there to look after them. Nowadays, it is almost as difficult to get out of hospital as it is to get in. If that phrase sounds familiar, it is because I have used it many times before in the more than 20 years that I have been in this House. I may be a bit of a bore on the subject, but I will emphasise a few more obvious facts.
As others have mentioned, the number of patients who need care in the community is rising as the population ages, yet the number of staff available to support them is going down. No one seems surprised by that anymore. In my few remarks, I will concentrate on the workers on whom this whole shaky system is dependent; it is they with whom the buck stops.
The care workers’ lot is not a happy one. Recruitment is difficult and retention is worse. The turnover rate of care home staff is 35%; that is a third of staff leaving every year. I have heard various figures, such as 105,000 adult care worker vacancies advertised every day and 15,000 fewer filled posts last year than eight years earlier. As we have heard, pay is a significant factor in this poor recruitment and retention. An average of £9.60 an hour means many can earn more in jobs at Tesco or Amazon, and about a third of them are on zero-hours contracts, as we have heard.
But it is not just about pay. We must pay them at a rate commensurate with their responsibilities, but it is about much more than that. These workers are at the bottom of the feeding chain: they are underappreciated, underrated and underrespected. We know that nurses and doctors are widely respected in the community, but not care workers. There are no media articles extolling their virtues and no TV programmes or films with them as heroes. They are the neglected end of the health and social care system. “Entrenched invisibility” was the phrase I heard today, yet we absolutely depend on them. So many of the problems in the NHS—bed blockages, ambulance queues, long waits in A&E and departments on trolleys waiting for beds—are due directly to the paucity of care in the community. So it is here, with the care workers, that we should begin.
As we have heard today, we must give them the recognition and respect that they deserve, by not simply giving them a salary that recognises their important roles but much more than that. We must offer them a training programme that is both mandatory and nationally recognised. We must then give them a professional qualification and a place on a national register. Only in this way will they hold their heads up as qualified professionals, along with the prospect of career progression within care work or even on to a nursing career as, for example, nursing auxiliaries. Will the Minister please ensure that something along those lines is included in the long-awaited social care plan?
I know that this is not a novel set of proposals. I recently took a rather unrewarding look back at some of the speeches I have given on this topic in the Lords over the very many years that I have been here. I am more than used to not being listened to—how could I not be, having been married for more than 50 years? On this occasion, at least, I hope the Minister will give me a little more encouragement.
Baroness Tyler of Enfield (LD)
My Lords—follow that. As the excellent reports we are debating today make clear, we are failing those in our society most in need of our care. As we have heard powerfully in today’s debate, the social care sector is in crisis due to chronic underfunding and the repeated deferral of hard decisions. Fundamentally as a society, we are sending the message that we do not truly value caring and caregivers.
The care that people, both older people and those of working age, need to have a good quality of life is often either unaffordable or unavailable. People who could be supported to stay in their own homes are being moved into residential care and people who are medically ready to leave hospital are unable to, because the care they need in the community is just not there. This has knock-on effects throughout the NHS. We know from the CQC’s latest State of Care report that the health and care system is gridlocked and is unable to operate effectively or, in some cases, at all—as we heard so poignantly from the noble Lord, Lord Polak.
As we have also heard, demand for care is rising as people live longer and often with more complex needs. As my noble friend Lady Barker explained, we now have a growing number of people without children of their own. Recent analysis from the King’s Fund showed that overall requests for social care have hit an all-time high.
At the same time, as we have heard, the workforce is in near meltdown. I want to explain why I use that term. We know that there are severe staff shortages and problems both in retention and in recruitment, which mean that current needs are not being met. Without major change, things are going to get worse as demand grows. As we have heard, according to the King’s Fund, the current social care staff vacancy rate is the highest since records began: 165,000 unfilled posts is a huge number.
Looking ahead, Care England estimates that the number of adult social care jobs will need to increase by 27%, to around 2.3 million, by 2035. In reality, we are looking at the prospect of further workforce reductions over the next 10 years as the current care workforce, more than a quarter of whom are over 55, retire and are not replaced. Poor pay and conditions are key drivers affecting recruitment. One in three care workers is paid the minimum wage, or less as their travelling time between clients typically goes unremunerated. At the same time, other sectors are offering far higher rates for, frankly, less demanding work.
It is a scandal that the social care workforce is among the lowest paid in our economy and zero-hours contracts are prevalent. The Health Foundation has found that staff experience much higher levels of poverty and deprivation than other UK workers and health workers. For many in the sector, career progression is simply non-existent. Given all this, it is not a surprise that the workforce is in near meltdown.
The impact of these workforce shortages on both patients and the wider NHS is devastating. First, increasing numbers of people, especially the elderly, have unmet care needs. Due to a shortage of care workers, 170,000 hours a week of home care could not be delivered during the first three months of 2022. That is seven times more than spring 2021.
Secondly, there is a backlog in initial assessments and long waiting times for many people to have their needs assessed. Shockingly, people are dying while waiting for care. Age UK found that some 37,000 people died in 2020-21 without receiving the care that they were waiting for. According to the CQC’s recent State of Care report, only two in five patients are able to leave hospital without delay when ready for discharge.
Many of these problems, which so many noble Lords have talked about, are rooted in funding, which has been inadequate for many years. According to the Health Foundation,
“When the pandemic hit … government spending per person on social care was lower in real terms than in 2009/10”.
This is compounded by how social care funding is often piecemeal, with crisis cash in winter making planning harder. This is exacerbated by the fact that the actual costs of providing care, either in the home or in running a care home—wages, Covid expenses and the increased costs of food and heating—are rising, but many local authorities are rationing social care to those in greatest need due to inadequate funding from government. This point was underlined last year by the Local Government and Social Care Ombudsman. At an individual level, a failure to introduce a cap on lifetime care costs means that one in seven people over 65 faces catastrophic costs of more than £100,000.
Like other noble Lords, I was particularly alarmed to read recent press reports suggesting that the Government are poised to cut £250 million from investment in the social care workforce in England. I join the noble Baronesses, Lady Andrews and Lady Donaghy, in asking the Minister, when responding, categorially to either confirm or deny that this is the plan.
Of course, all of this results in an overreliance on informal unpaid carers, as demonstrated vividly in the recent report of the Select Committee chaired by the noble Baroness, Lady Andrews. According to Carers UK, in England the number of unpaid carers outnumbered the paid health and care workforce by at least two to one. Many other speakers have pointed this out passionately in our debate today. Millions of unpaid carers are having to bear the negative effects of social care workforce shortages and a lack of funding for social care. This leaves far too many of them with very little support, often feeling isolated and undervalued in the face of the relentless demands of caregiving.
Too many unpaid caregivers face financial hardships themselves, as they receive little financial support. Many find it hard to juggle staying in paid employment with caring. That is why I was so pleased to support the Private Member’s Bill put through the Commons by my honourable friend Wendy Chamberlain MP; it had its Second Reading here recently. It creates a new entitlement for employees to take up to a week of unpaid leave a year in order to provide or arrange for care. Yes, it is a very small step forward in improving employment rights for unpaid carers, but it is important none the less.
The most depressing thing in today’s debate has been the litany of broken promises of reform over the past decade. We had Dilnot, endlessly postponed; and White and Green Papers that never materialised. As my noble friend Lady Jolly reminded us, the Care Act 2014 was a seminal piece of legislation, but key provisions in it have been indefinitely postponed. The Government’s “Build Back Better” plan for health and social care, published in 2021, led to the passing of a law to collect a health and social care levy, but this was then reversed and the charging reforms outlined were subsequently delayed—again.
Despite all this doom and gloom, I want to end with some solutions to add to the others that have been put forward. There are five things on my immediate wish list which I am very much hoping to see in the long-awaited government social care implementation plan.
First, we need to invest in the workforce, pay wages people can live on and offer career progression by professionalising the care sector. That is why I am so pleased that Liberal Democrats are calling for a legal obligation to provide a carer’s minimum wage, to be set at a rate of £2 an hour above the national minimum wage. This much-needed boost is long overdue, and I know others have referred to it.
Secondly, the Government need properly to fund local authorities so they can continue to provide the social care services they are legally required to, and ensure that care homes are paid a realistic rate rather than relying on excessive cross-subsidisation by self-funders.
Thirdly, we desperately need to integrate services, so that there is a joined-up preventive approach which reduces the risk of reaching crisis point and needing care home placement or hospital admission. I hope the development of 42 integrated care systems can help bring this about, but concerns remain that social care sector providers struggle to get their voices heard within these systems.
Fourthly, we must provide more support for informal carers and introduce a statutory guarantee of regular respite breaks for unpaid carers.
Finally, as others have said—including, very powerfully, the noble Lord, Lord Bradley—the carer’s allowance must be reformed so that it no longer discourages carers from remaining in paid work. The carer’s allowance is the lowest benefit of its kind and does not reflect the contribution of unpaid carers; it must be increased.
I therefore ask the Minister: what assurance can he give me that the vital issues that I and others have underlined will indeed be addressed in the Government’s plan?
Baroness Wheeler (Lab)
My Lords, I thank my noble friend for securing this important debate and for her excellent introduction, and I sincerely endorse noble Lords’ praise for her expert chairing of the Select Committee. She was just the right person to lead this authoritative cross-party group, whose spotlight on adult social care could not be timelier as we are now in sight—we hope—of the Government’s long-promised follow-up White Paper. It is a moment that many of us cannot quite believe in, having waited so long for something to come out of the oven-ready, back-pocket social care plan promises made since this Government took office. We have had a decade of social care reform failure and have become used to hearing that world-leading proposals are on the way, only for them to be delayed, substantially changed and delayed again.
We were led to believe that the White Paper would be the national plan we have been promised, and that we would have it as the backdrop for today. Now we understand it will be published in the recess, that it is a two-year update rather than a plan, and that next week we may have the promised workforce plan—or a bit of it—and a key policy document on primary care. Like other noble Lords, I hope the Minister will be able to enlighten us on what is happening. Can he explain why all this has to be in recess, rather than when Parliament is sitting? We are still awaiting the Government’s response to the Select Committee report. Can he say when that will be published, so that, post-recess, we can have an urgent and full debate on the report as well as the White Paper?
When we get the White Paper and any workforce proposals, we will examine them in detail to judge whether they are anywhere near being the comprehensive national plan for social care we have been led to expect, with the milestones for reform the Minister has promised, including on workforce, data and technology. The first White Paper was strong on vision—on what social care could look like—but only partial in terms of the issues it addressed and the mostly short-term sticking plaster funding it came up with. It was also decidedly lacking on how today’s and tomorrow’s demands for social care could be met, addressed and funded, or how it fitted in with the then proposed cap on care costs, or the fair costs of care proposals.
The urgent need for a comprehensive national plan is where the Lords Select Committee report comes in. It is a giant piece of work that leads the way on reform, with clear stepping stones. I congratulate the whole committee on its depth of analysis and its understanding of the extent and reach of social care, impacting 10 million of us at any one time. The report focuses on giving disabled people drawing on care and support the same choice and control over their lives as other people, on fair pay and recognition for care workers, and on support for unpaid carers. These are the key fundamentals of social care reform which we fully support.
I welcome today’s contributions by so many noble Lords, including eight other Select Committee members, and in particular the contribution from my noble friend Lord Bradley, who spoke from these Benches with his usual wisdom and expertise. Contributions have ranged across key social care issues; we could not have had a more comprehensive debate. I hope the Minister will make sure that he promises to follow up with a written response on any issues he does not have time to address, and will forgive me because I have so much to say and do not have the time to say it.
I want to underline five key issues. First, the Lords committee’s report underlines the imperative for a fundamental rethink and a change in society’s perceptions of and attitudes to social care. It builds on the current legislative framework for care eligibility and entitlement achieved through cross-party support for the Care Act 2014 and promotes social care’s positive benefits as an essential service which benefits individuals, society and the economy, not just as an ancillary to the NHS, as my noble friend Lady Andrews has so ably stressed.
In this context, I welcome the Reimagining Care Commission reflections of the most reverend Primate the Archbishop of Canterbury and the right reverend Prelate the Bishop of Carlisle, which strongly reinforce the Lords committee’s ambition of making social care the national imperative it needs to be. In particular, the commission demonstrates the breadth and reach of social care across communities, and I applaud the vital work that faith communities do which helps to plug the enormous gaps locally in social care provision. In the words of Labour’s shadow Minister for care, Liz Kendall, the report is “refreshingly bold”, which is exactly what is needed. I also commend the commission’s work on the national care covenant, and look forward to continuing dialogue on this.
Secondly, I emphasise the importance of choice and control by disabled adults over their care and support, which was strongly supported by speakers from across the House, in particular in the forceful contribution by the noble Baroness, Lady Campbell, underlining what she has been saying for years, and especially the importance of coproduction. Of course the care of older people is vital, but working-age adults with disabilities make up one-third of social care users and half the budget for social care.
The committee’s spotlight on the more than 1 million people living on their own, without families or children, is also welcome. The noble Baroness, Lady Barker, spoke strongly on this, as did a number of other noble Lords. As a carer, I know how thoroughly the current system relies on advocacy, usually by relatives who are unpaid carers navigating their way for their loved one’s entitlement to care services, which so often fail to speak to each other. I always fear for people living on their own who are receiving domiciliary social care; they are often without other visitors or friends and are utterly dependent on the system working well and seeing to their needs. Their well-being has to be a key part of what a good service looks like.
Thirdly, it is important to value care workers with proper career progression and the pay, training, and terms and conditions that they deserve. Every speaker has made a strong case for this and for the comprehensive workforce plan that is urgently needed. We have today had added expertise and weight from the former general secretary of the TUC, my noble friend Lady O’Grady, and the former general secretary of UNISON, my noble friend Lord Prentis. Record levels of staff vacancies, with the highest rates in domiciliary care, for registered managers and for nurses, need an urgent and long-term solution, not just short-term funding or reliance on local councils to raise funding to meet costs, with all the difficulties and inequities that brings.
Fourthly, I strongly echo the deep concerns of all noble Lords, especially my noble friend Lady Pitkeathley, that unpaid carers are at breaking point. In reality, they have received very little concrete support to date, apart from government backing for the Private Member’s Bill giving them one week’s unpaid leave from work. How are the Government going to address unpaid carers’ huge daily problems of poverty and exhaustion, and the lack of available and affordable respite care?
Fifthly, the key message from today has to be that reform and change for social care must be whole-system wide: a long-term, joined-up comprehensive plan. On residential care, for example, which a number of noble Lords mentioned, every day it becomes glaringly obvious that urgent reform and fundamental changes are needed to the current business model, and this must be an essential part of any comprehensive national plan. Only last week we saw reports of councils spending half a billion pounds over the past four years, buying up beds in care homes rated as inadequate or as requiring improvement by the Care Quality Commission, driving up profits and dividends for private investors at the same time as residents suffer unsafe treatment, mostly because the homes cannot fill their chronic staff shortages in many areas. Poor-quality providers which put private profits before care should not be tolerated. Does the Minister consider that the current business model for residential care is fit for purpose? What are the Government’s plans to ensure that public money is spent caring for residents?
This situation starkly underlines the precarious position local authorities continue to find themselves in as providers of care, care homes and domiciliary care. As noble Lords have said, this is all in the context of a 29% overall reduction in funding since 2010—one-third of the funding has been lost.
The Government have had 13 years to deliver on providing a concrete future for social care, but their measures have, for the most part, been disjointed, stop-start, short-term crisis reactions. They have failed to identify and deliver on the root causes of the issues facing older and disabled people. Demand for social care is now hitting a record high, and the current picture was graphically painted by noble Lords today. The King’s Fund’s excellent briefing sums it up by stressing that key trends in social care are all going in the wrong direction: demand up, access down, financial eligibility tighter and charging reform put back, the costs of delivering care rising with local authorities paying more for care home places and home care support, the workforce in crisis, unpaid carers receiving less support, and public satisfaction with social care lower than ever.
A national plan for social care has to be just that: national. It must be comprehensive, long-term and cross-system to provide joined-up integrated care in the home and community, tackle fundamental inequalities in the current system, and deliver a new deal for care workers and support, care and respite for unpaid carers. Step-by-step investment and reform is the only away to provide the stability, certainty and long-term planning to achieve the fundamental shift towards early intervention, prevention and rehabilitation that is so desperately needed.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
My Lords, it is my pleasure to respond to the excellent debate today, to follow so many distinguished speakers and, probably most of all, to hear, in my noble friend Lord Polak’s words, the politics being taken out of care. Today has been an excellent example of that, and I hope I can follow in that vein.
I regret that our social care report has not been published today. As noble Lords will be aware, we were hoping it would be published yesterday, and we were going to offer an embargoed copy of the report so that everyone could contribute. That is the reason for the delay in responding to both committee reports. I undertake that we will respond to both reports after we publish our social care report, and I personally offer a round table to everyone who is interested, where I will seek to bring the relevant officials along as well. I hope we can have a productive conversation in a similar vein to this one, where we all get around the table as people who care about this issue and, as mentioned, take the politics out of care.
I thank the noble Baroness, Lady Andrews, for securing today’s debate, all noble Lords across the Chamber for their thoughtful and considered contributions, and all those who have sat on the committees that have been mentioned. I feel that they have really added impetus to this whole debate. I hope the report that we offer will answer many of these points, build on the progress made so far in this space and bring a vision into reality.
Before I go into detail and respond to the reports, starting with the Lords Select Committee report, I would like to say how fitting the words “gloriously ordinary life” are. I was struck by the whole sense that, if I caught the phrase right, we can live in a place we call home, with the people we love and the things we care about. That is something that we can all agree with and commit to as our North Star and vision for what we hope to do.
Not only is it vital that we allow people to live in the way that they want but it is a vital part of our health service, as mentioned by my noble friend Lady Shephard and the noble Lord, Lord Turnberg, who had many brave words to say today. We all know it is vital to unblock the system. Some 13% of our beds are blocked at the moment, to answer my noble friend Lady Shephard’s point. As the noble Lord, Lord Turnberg, said, it is often as difficult to get out of hospital as it is to get into it. We have put in funding to help with this issue: £700 million of funding this year alone to help with discharge and £1.6 billion over the next two years. This whole debate shows that it is vital not just to the well-being of our people that we have a good system of social care but to our health service in improving the whole flow of the system.
On that, I reassure noble Lords that the Government recognise the importance of responding to the Lords Select Committee report. As mentioned, we will release a response shortly after the social care report is published—I hope, as I say, next week. I assure the committee that the Government agree with the vision in the report. We particularly welcome the committee’s view that social care does not have the voice and the visibility that it deserves. That often means that people are not supported to meet their ambitions. By rethinking attitudes to care and support, we can ensure that people access the care and support that meet their needs.
Equally, I thank the most reverend Primate the Archbishop of Canterbury, the right reverend Prelate the Bishop of Carlisle and the Commission on Reimagining Care for its recent report, Care and Support Reimagined: a National Care Covenant for England. I was struck by the words, “care based on faith and values”, where we recognise that we all have a mutual responsibility in delivering that. That struck a chord with me, along with the idea of the need to develop a national care covenant, where we all look to do our part in delivering the system. I look forward to developing those thoughts more at the round table.
It is important that we recognise the important contribution that communities and faith organisations make to adult social care. We echo the commission’s vision for care and support that is inclusive, universal and fair, and recognises our mutual responsibilities as citizens. The Government are keen to work collaboratively to make change a reality, and, having spoken to Minister Helen Whately, I know how much she enjoyed the meeting she had with the commission and how keen she is to drive forward the report.
I turn to the Government’s vision for adult social care. Again, I apologise; I feel that my hands are slightly tied behind my back, having to make this speech prior to the publication of our report. As we all know, back in December 2021 the Government published People at the Heart of Care. This set out a 10-year vision that put people at the centre of social care to make sure that everyone who draws on care and support feels empowered to have the choice, control and support they need to live independent and fulfilling lives. This is a vision that aims to make social care fair, accessible and of high quality, and to lead to better outcomes for people who draw on, work in and provide care and support. This Government remain committed to that vision.
I am pleased to report that the Government’s upcoming plan will outline how we will make progress towards this vision. It will also provide the clarity asked for by this House on key policy areas, including outlining how we plan to allocate the funding set aside for reform. Ahead of that publication, I would like to share some of the progress that the Government have made so far.
I start with the workforce, the importance of which the noble Lords, Lord Lipsey and Lord Prentis, and the noble Baronesses, Lady O’Grady and Lady Tyler, to name just a few, focused on. This was a point reiterated by our Prime Minister the other day. We all know that the social care workforce is one of our biggest assets, but we recognise the challenge we have right now to recruit a workforce of the right size, with the right skills, that feels appropriately motivated and rewarded. The Government have taken action to boost workforce capacity with recruitment opportunities both at home and abroad, with over 55,000 visas granted for care workers and senior care workers last year. This is complemented by our national recruitment campaign, Made with Care.
To respond to the points made by the noble Lord, Lord Turnberg, and the noble Baroness, Lady Wheeler, our upcoming plan for adult social care will include proposals for a new adult social care workforce pathway, building on our commitments in the People at the Heart of Care White Paper to give a career structure for people in this vital sector. Our chief nurse champions and raises the profile and visibility of nursing in social care, working alongside the Chief Social Worker for Adults to increase the recognition and appreciation of all our care workers.
On funding in this space—this is a point noble Lords have heard me make many times before but it is worth reflecting on—the £7.5 billion increase over the next two years will flow through to workers. The vital point is that it will largely flow through into the workforce.
Many noble Lords talked about technology. We all know that to increase workforce capacity we have to significantly increase the use of digital tools. Last year, we made £35 million available to the integrated care systems to support sector digitisation, including the adoption of digital social care records. As a result, approximately 52% of providers now have a digital social care record, up from 40% in December 2021, and we have plans to extend this much further. These records can provide up to 20 minutes per care worker per shift, and allow more time to provide care and support. Good data is fundamental to the delivery of high-quality care and, as the noble Baroness, Lady Barker, mentioned, sharing that data is vital as well. Our use and understanding of adult social care data is better than it has ever been, but we know there is a lot more to do.
From next month, our flagship client-level data project will become mandatory for local authorities in England. This will transform our understanding of people’s experiences and outcomes. For the first time, we will be able to track an individual’s journey through the health and care system to aid with navigating its difficulties—again, as mentioned by the most reverend Primate the Archbishop of Canterbury and my noble friend Lord Polak. Also as of Monday, the Care Quality Commission will begin to assess local authorities’ delivery of their Care Act duties, including those for unpaid carers. This will make good practice, positive outcomes and outstanding quality easier to spot locally and share nationally, while identifying where improvement and additional support is needed. But as much as data and technology could help, I totally agree with the point made by the noble Baroness, Lady Bennett: there is no substitution for the loving care of a human.
To ensure that care and support is personalised to people’s needs, our White Paper rightly sets out our ambition to support high-quality, safe and suitable homes, recognising that they can help people of all ages stay independent and healthy for longer. That is why, alongside the Department for Levelling Up, Housing and Communities, we will shortly launch the older peoples’ housing taskforce. It will bring together experts from across the sector to make recommendations on how people can access the housing they need.
I turn to the area of unpaid carers, which we all agree is the backbone. As noble Lords are aware, it is something that I have personal experience of. The point was brought out very well by my noble friend Lady Fraser, among others, because it is important that we recognise the vital role that unpaid carers play in our communities. We all owe them a debt of gratitude. Under the Care Act 2014, local authorities are required to undertake a carer’s assessment for any unpaid carer who appears to have a need for support, and to meet their eligible needs on request from that carer. This year, we have earmarked over £290 million for unpaid carers through the better care fund, including to provide short breaks and respite services. It is a step in the right direction; I use those words advisedly because carers are a vital area, as many noble Lords, particularly the noble Baroness, Lady Pitkeathley, have recognised, and there is a lot more that we need to do.
I hope that I have addressed many of the questions as I have gone through. I will try to pick up a few others and, as ever, follow up in writing in detail. It will be after the reports are published next week—and, to answer the noble Baroness, Lady Andrews, yes, we are planning to publish more on people at the heart of social care next week.
In answer to the noble Lord, Lord Bradley, yes, the ICBs will be at the forefront of this system for the planning and provision of social care. However, I will need to come back in writing on his question around the role of the DWP in analysing and reporting in this space.
In answer to the noble Baroness, Lady Campbell, we definitely embrace the principles of co-production. I hope that will come out in the report itself, as we work with 200 stakeholders in the provision of it all. We really hope to see the ICBs at the forefront of this and the better care fund being a key part of co-production.
I was struck by the point made by the noble Baroness, Lady Jolly, about 90 year-olds caring for 70 year-olds. I await my next Oral Question after the Recess.
The noble Baroness, Lady Donaghy, asked about help for providers on energy funding. Again, I hope noble Lords would agree that we have provided significant help. I am glad to see that, the last time I looked, gas prices were lower than last summer, when the action was prompted. They are moving in the right direction, but it is probably an example of needing to watch this space, while being mindful of the issue at stake there.
I hope that I have answered many of the questions raised. In conclusion, over the past year, the Government have invested significantly and have secured another £7.5 billion of funding for over the next two years—but this is only the start of the journey.
Baroness O'Grady of Upper Holloway (Lab)
Before the Minister sits down, can he provide an answer to the question about the media reports on cuts to the £500 million workforce budget?
Lord Markham (Con)
This is one of the areas covered in the report that will be published next week. At this stage, I can say only that the need for the training and development of our social care staff is understood and recognised in that report. I hope that it will give a response to the noble Baroness’s question, and that she understands why I cannot say more at this point.
Taking the words of the Select Committee’s report, I hope that these actions show that we are moving in the right direction
“to live in the place we call home, with the people … we love”,
based on faith, value and our own mutual responsibility in delivering that aim. Once again, I thank the noble Baroness, Lady Andrews, for securing the debate and this valuable opportunity to discuss the future of adult social care. I reiterate the hope that we can all gather at a round table to discuss this once the report has been announced and we have responded to the various other reports. Finally, I extend my thanks to everyone who works in the social care sector and to the unpaid carers for everything they do to support others.
Baroness Andrews (Lab)
My Lords, I am very grateful to the Minister for his response, for the compassion he shows and for the shared values we clearly hold across the Chamber. He had a difficult job trying to sum up and satisfy the consensus of opinion and expertise across the House while not being able to tell us what the national plan will contain. We regret that it will be published in the Recess. We would like an immediate opportunity to debate it. I hope that business managers will give us that opportunity as soon as possible when we come back, and that we can have a substantial debate on it, as well as on the Select Committee’s report. In the meantime, I think that everyone would be very grateful to join him and officials around a table, not least because it signals the inclusivity which marks the debate and marks what my noble friend Lord Turnberg called the “noise” that has been associated with the debate for so long. We want to take up that offer.
I thank the noble Lord, Lord Polak, for identifying the need to take politics out of social care, because that is only too evidently what needs to happen. We must be as committed to finding the investment, particularly in the workforce, as we are to making sure that we understand the values we share.
I thank everyone who has taken part; it has been an exceptional debate. I thank noble Lords for their generous response to both reports. It was very good that we had the opportunity to listen to the most reverend Primate and the right reverend Prelate on the notion of a covenant and the very specific overlap in the consensus about what needs to be done—it has been an incredibly valuable opportunity because of that.
There have been very valuable speeches from across the Chamber, including from my noble friend on the Front Bench. It has been a comprehensive debate, but it has been as broad and rich as it has been deep because of the personal experience that it has called up, as well as the range of professional experience and the types of caring that people know about—learning disabilities, elderly care, disabled people. We heard from the trade union perspective the challenge of reconstructing a workforce that is modern and fit for the future. We heard from the unpaid carers’ perspective.
It has been an extraordinarily important debate for the Minister, because the challenges that have been articulated and the detail have been rooted in real experience over many years across this House. This House has a very long memory, having been here before, time and again. This is the time for change. Whatever is in that national care plan will be tested to destruction against our experience of 20 to 30 years of waiting and hoping for something better and bringing it to the boil in different ways. Nothing about this is easy and nothing will be particularly quick, but let us have some clarity, total transparency and reality, but let us also have that vision. The most reverend Primate started by asking who is responsible. That is such a fundamental question, and the answer is that we all are. That is something that has come out in the inclusive nature of this debate as well. With that, I beg to move.