Adult Social Care (Adult Social Care Committee Report)
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
I add my thanks to the noble Baroness, Lady Andrews, and all the participants involved in putting together the reports of both the Lords committee and the Archbishops’ committee. I thank Members for an expansive and extensive debate today. We also had a good debate on this in the spring and a good round table on all this, where we were able to take to heart the point made by the noble Lord, Lord Polak, about taking the politics out of the debate. I commend all those speaking in the House on this today for having taken that approach. I know that in all our dealings, the noble Baroness, Lady Wheeler, takes that approach, and it is much appreciated.
I also say that the thrust of what we are trying to do is taking to heart the Archbishops’ report, where care is everyone’s business, whether that is citizens, families, neighbours or carers, and based very much, as the noble Lord, Lord Weir, said, on the concept of co-design, working with the local partners, the local authorities and integrated care system. I will also try to tackle head-on the challenge of the noble Baroness, Lady Bennett, about the policies we feel that, as well as implementing today, we plan to take into the next election as a whole-systemwide approach.
Of course, as mentioned by many noble Lords, this has to start with funding. We have made up to £8.1 billion more available over the next two years. To answer the point of the noble Lord, Lord Allan, I say that funding in recent years represents a real-terms increase of about 2.5% per annum. This will allow local authorities to buy more care packages, help people to leave hospital on time, improve workforce recruitment and retention and reduce waiting times for care. We are also trying to use the money to transform the adult care system, for which we have a £700 million targeted spend on improving care workers’ skills, supporting career progression and investing in technology in digitisation and adapting people’s homes to allow them to live more independently. I will give details on each of those as we go through it all. As mentioned by many speakers, key to that is our £2 billion market sustainability and improvement fund, which is designed to impact and work on reform and improvement of the whole workforce recruitment and retention. I will write to the noble Baroness, Lady Finlay, on how the funding is specifically distributed so that that detail is understood.
We really believe in this vision to transform social care in England. It is a long-term vision which puts people at the centre of adult social care, to make sure that we can draw on the care support and include the absolute necessity of unpaid carers’ role in all that. I say that as someone who was an unpaid carer to good, dear friends of mine for many years.
We want to make sure that people can access outstanding quality in tailored care and support and find adult social care in a fair and accessible way, try to make it joined up in how we do it all and, I think for the first time, really try to involve the CQC in making assessments and ratings to guide where local authorities and local ICBs are doing a good job and where there are areas of improvement. I know that there are many concerns about the burdens that sometimes puts on a system which is always stretched, but I think noble Lords would also agree that inspections are typically a force for good in analysing those areas that are good and those that really need more work and improvement.
Of course, all this would be backed by much better data provision. Therefore, we are investing about £50 million into this area. I will begin by talking more about career progression, to answer some of the staffing points raised by the noble Baroness, Lady Andrews. Key to improving workforce retention is better training, recognition and career progression. The £250 million spend that was mentioned by my noble friend Lady Fraser goes very much to the heart of the training and retention of these people.
As many noble Lords mentioned, fundamental to all that is a career structure that staff feel goes beyond the particular care home that they are in and which they can take forward. Key to that is the creation of a new care certificate qualification, allowing them to move from place to place without needing to retrain each time. It is a modular system, so if they want to they can build that into an overall nursing qualification. Alongside that, we are ensuring that we are providing subsidised training programmes to decrease the turnover. We have modelled that to show that we can improve this by about nine percentage points.
Many comments have been made about how we are going to fill these workforce vacancies. The current run rate in terms of international recruitment is about 150,000 a year. I know that many comments have been made about how good it is that these are filled largely by international people, but that is a function of having a successful economy with full employment—you look to fulfil that. This has been the background to the whole health and social care system, right back to its foundations and a substantial part of the recruitment in the 1950s and 1960s. It brought people to the UK who have been an asset to the life and society that we have today. I had better say that, being married to one of these people, but I feel and hope that this should be the backbone of it and a successful way forward.
Also, it is important to understand the key role that unpaid carers play in this all. We are trying to help in this space. I perfectly understand that whatever we do here will not take the place of a full-time wage. I accept that but I hope that noble Lords will see that we are trying to make steps in the right direction. To answer the question raised by the noble Baroness, Lady Wolf, about the ability to offer respite care, we have earmarked £327 million of the better care fund towards providing those breaks. It is £76 plus the ability to claim benefits on top of that. I will not pretend that this completely compensates for a national wage, but it is not £76 alone. On the point raised by the noble Lord, Lord Davies, about pension flexibilities, I hope that we showed in the case of the doctors that we could be quite creative in that space. I will take that back and ask people who are more knowledgeable in this space than I am to take a proper look at it.
Of course, in all of this, there is the importance of supporting all these people in terms of the digital side. We have invested almost £50 million in the last year to improve the level of digitisation. It now stands at about 55%. I freely admit that 55% is not 100% but it is a big move in that direction and, to answer the points raised by the noble Lords, Lord Dubs and Lord Allan, it is something that we see as critical to the planning and provision of care, where it really can provide that information so you can plan around it.
It can also provide information to make smarter planning decisions. Again, I have seen excellent examples of putting all this data together; places such as Redhill have used it as part of its preventive screening programmes. There is a tremendous opportunity, as we build these bigger databases and include social care, to use that as the key to the prevention programme in which I know noble Lords believe.
The point made by both the noble Baroness, Lady Goudie, and the noble Lord, Lord Polak, was how we can use that to allow people to stay in the place where they most want to be, their home environment. The answer comes from not just using the data and AI to look at prevention tools; the latest funding bid launches technologies that we want to use to help people stay in their home environments. One particularly good example I have seen is a very simple tool that looks at people’s electricity usage each day. They know from people’s patterns that there is a normally a big spike at 8 am, when they turn the kettle on. If they see that that is not the case one day, they know to make a call to that person and check whether it is not because they have had a fall; it could be because they have visited a relative. This can be done on a mass-produced scale, which would give people support and early warnings, when people are at the lighter end of the scale and do not need substantial support. Relatives, local authorities and local bodies would feel that there are those extra guard-rails around this.
I will address the point made by the noble Lords, Lord Bradley and Lord Dubs, about the champion role. This was considered as it was a large part of the report. We have a champion in place in the roles of the chief nurse and the Chief Social Worker for Adults. That is a key part of their roles. I am sure noble Lords will join me in thanking Lyn Romeo for the role she has played in the last 10 years. She retires towards the end of this year.
As ever, because of the brief time we have had, I plan to write in detail to answer all the points I was not able to cover. I have tried to set out what we see as the four pillars: stable funding, a stable workforce, digital enablement and the principle of coproduction in which everyone has a role, as was outlined in the most reverend Primates’ report—because care is everyone’s business.