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Baroness Tyler of Enfield
That this House takes note of the state of social care in England, and the case for a comprehensive social care strategy and further support for unpaid carers.
Lord Kennedy of Southwark (Lab Co-op)
My Lords, before this important debate gets under way, I thought it would be useful to remind the House and all Back-Bench speakers that the advisory speaking time is four minutes. This means that when the Clock has reached three minutes, noble Lords should start making their concluding remarks, and at four minutes their time is up. I have asked the Government Whips to remind noble Lords of this fact during the debate, if necessary. I thank all noble Lords in advance for their understanding, which will allow everyone to contribute to the debate fairly within the allocated time.
Baroness Tyler of Enfield (LD)
My Lords, it is a privilege to be opening today’s debate on such a vital issue to our national life: social care. I am very grateful to the many organisations that have sent me such excellent briefings. I particularly thank the unpaid carers who shared with me their personal experience of caring for a loved one at the drop-in event organised by Carers UK on Tuesday. It was a humbling experience. I look forward to hearing from other noble Lords who have such expertise in and commitment to this issue.
I want to start by making some general points that I feel too often get overlooked. First, social care is a hugely valuable public service in its own right, at best allowing millions of our fellow citizens to live independent and fulfilling lives, improving their well-being and that of their families. It is not simply an adjunct to the NHS. Yes, fixing social care will help the NHS address its current problems, and two of the three big shifts articulated in response to the Darzi review—moving from hospital to community and from treatment to prevention—can certainly be assisted by an effective social care system, but bailing out the NHS is not, I contend, its primary purpose.
Secondly, the social care market makes a significant contribution to local economies. Skills for Care estimates that the sector contributes more than £50 billion to the English economy.
Thirdly, social care is not all about older people, or preventing people having to sell their properties to pay for care, as the debate is too often so unhelpfully characterised. Support for working-age adults and lifelong disabled adults, particularly people with learning disabilities, has become the largest area of spend in adult social care and is growing faster than any other part.
In short, we need to frame the debate in a different way: valuing the sector as a contributor to economic activity, as fundamental to promoting the health and well-being of people in local communities and as contributing to the preventive agenda that the NHS on its own has, according to the noble Lord, Lord Darzi, and others, failed to deliver. Despite all the very real problems, there is some good and innovative practice at local level, often involving integrated neighbourhood working between social care, community health and the voluntary sector.
All that said, social care has been described— I think rightly—as one of the biggest public policy failures of our time. The last 25 years have seen six government and independent commissions, seven Green and White Papers, 14 parliamentary committee reports and innumerable other reports on social care policy. They have identified policy options to address many of the problems and, time and again, commitments have been made but then reneged on. In particular, the funding has been subject to much analysis—not least by Select Committees of this House—and the options for reform are clear. It certainly does not need a royal commission to crawl all over it again.
There is wide consensus that things cannot carry on as they are. Our adult social care system is not fit for purpose and needs radical reform, following decades of political neglect and underfunding. Indeed, the noble Lord, Lord Darzi, in his recent report, described it as “dire”. With an ageing population and a growing number of disabled people of working age, demand is increasing but funding is not keeping pace. In reality, publicly funded social care is available only to those with the highest needs and the lowest means.
Recent analysis from Age UK found that more than 2 million older people are now living with some form of unmet need. Healthwatch recently estimated that up to 1.5 million working-age disabled people could be missing out on the social care they are eligible for. Only last week, the County Councils Network pointed out that persistent underfunding of local government in the last decade means that some councils now spend as much as 80% of their budget on care for adults and children.
Looking forwards, the Care Provider Alliance estimates that at least 1.7 million more adults will require social care over the next 15 years. In big-picture terms, the Health Foundation has estimated that meeting growing demand for care, enabling more people to access it and improving services could cost an extra £18 billion by 2032. This is serious stuff indeed.
In short, we have a system struggling with myriad problems, including: an overly stringent means test; catastrophic costs, leading to some people having to sell their homes; high levels of unmet need, so that people go without the care and support they need; a high reliance and unrealistic expectations placed on unpaid carers; patchy quality of care; poor workforce pay and conditions; a fragile and highly fragmented provider market; and a postcode lottery of access.
All these issues have solutions, as the plethora of reports on social care demonstrates. I hope that we will hear lots of potential solutions in today’s debate, but this needs to be addressed in the round, not in a piecemeal fashion with last-minute sticking-plaster solutions.
Far too often, the crucial role of unpaid carers comes last in the list, but today I will deal with it first. It is vital that we recognise the challenges that the UK’s 5.7 million unpaid carers are facing and the critical role they play in supporting people and, frankly, propping up our health and care systems. Finding appropriate support can be extremely challenging, and many carers report having to fight to get the support they need. One unpaid carer I spoke to on Tuesday said that she had found it impossible to get an assessment for her own health needs—despite the fact that this was legislated for in the Care Act 2014—and felt totally burnt out.
The lack of accessible and affordable social care hinders carers’ ability to juggle work and care. The extra expenses associated with caring for a loved one with a complex condition, coupled with the inability to work, can have a massive adverse effect on family finances. The development of a new national carers strategy—which I strongly support—should be a priority for the Government as part of their wider reforms of social care and, crucially, be seen as integral to the development of the national care service. We need to be ambitious here. From these Benches, we want to see it include paid carers’ leave and a statutory guarantee of regular respite breaks, as well as increasing carer’s allowance, by expanding eligibility to it, and bringing to an end the overpayments scandal.
I turn to the social care workforce. According to Skills for Care, last year there were around 130,000 vacant posts and 1.7 million filled posts. That is a vacancy rate of some 8% and a turnover rate of just under 25%. This is about three times higher than for the wider economy. Skills for Care attributes turnover and vacancies in the sector to a range of factors including low pay, zero-hours contracts and difficulty accessing full-time work. Today’s debate is timely because only this morning, Skills for Care published its annual report, which shows some modest improvements in filled posts and a slightly lower turnover. However, these improvements were mainly driven by international, rather than domestic, recruitment, and there are signs that the supply of international recruits is declining, not least due to changes in visa rules debarring migrant workers from bringing family dependants with them. So domestic recruitment and retention problems continue.
As many in this Chamber have said, the silence in the King’s Speech on social care was deafening, and many people felt badly let down. It felt, once again, as though social care had been pushed to the back of the queue. The Government must, as a matter of urgency, produce an updated vision for social care that tells us what good looks like and then start work immediately on finding a long-term, cross-party solution to putting social care on a sustainable footing. I hope that this House, with all its expertise, can make an important contribution to that debate.
I ask the Minister what plans the Government have to publish a comprehensive reform package for social care with a clear timeline attached for action in this Parliament. I note that the Nuffield Trust has called for a rapid diagnostic exercise similar to the Darzi NHS review to build urgency and the case for change. Can the Minister say whether such an exercise is being considered, and, if so, what the timescale would be?
I recognise the financial constraints the Government face, but that is not a reason for silence or inaction. A comprehensive plan for social care reform can be framed according to short-term, medium-term and long-term actions. The most pressing priority is for the Government to provide an immediate uplift in social care funding in the upcoming Budget to stabilise the sector in the short term. However, there are also a number of short-term and relatively low-cost actions, such as setting up a mandatory professional register of adult social care staff in England, which already exists in Scotland and Wales; requiring direct adult social care representation on all integrated care systems in England; establishing a new commissioner for adult social care to promote the rights of those relying on care; and developing a more simplified, consistent and efficient approach to how councils commission care. These are simply examples of things that could be put in place relatively quickly.
In the upcoming comprehensive spending review, the Government must commit to multiyear settlements to local government, so that the social care system can plan with confidence over the medium term and provide further stability. The Government also need to provide clarity on their plans for social care—including, I hope, more detail about developing a national care service and the fair pay agreement—and what they hope to achieve by when, and how that will be funded. I look forward to hearing more from the Minister on this today.
Credible longer-term reform plans must, at the very minimum, cover funding, a workforce plan and support for unpaid carers, which I have already talked about. On the workforce, social care is a job requiring skill, insight, compassion and commitment, but that is not recognised in the terms and conditions on offer. Front-line roles typically attracted only £11 an hour in March this year—58p higher than the national living wage then. I also find it staggering that care workers with five or more years’ experience were earning just 10p more per hour that those with less than a year’s experience. In short, there is no progression. More than 80% of jobs in the economy pay more than social care, so it is scarcely surprising that employers find it hard to attract and retain people already resident here. If you do a similar role in the NHS, you are paid appreciably more.
We need a social care workforce plan sitting alongside the NHS workforce plan with equivalent government commitment to implement its recommendations. Pay is hugely important, but it is not the whole story. Social care needs a formal career structure, along with training and development to help people advance and be appropriately rewarded for doing so. The Liberal Democrats are calling for a royal college of care workers to improve recognition and career progression, and a higher minimum wage for carers.
The Government’s plan to broker a fair pay agreement for social care is welcome in principle—and it is timely, as it is part of the Employment Rights Bill published today—but we need to understand how it will be funded. Will there be commensurate increases in local authority funding, or will the cost be passed on to care providers and self-funders? I would welcome clarification from the Minister on this point.
We need to think about the workforce in the widest possible sense. There is an obvious role for the voluntary sector to provide a lot more of what is often called wraparound support. There is scope for the sector to do so much more and for every area to have a stronger safety net in place.
On funding reform, transformational reform cannot happen without us working out and agreeing, as a society, how we can fund it, both in the short term and into the future. So far, efforts to achieve this have been half-hearted at best and egregious at worst. The lesson from other countries that have successfully grasped the nettle of modernising social care is the need to have a pretty honest conversation with the public about the options for funding it and how the costs are shared between the individual and the state. We need a cross-party commission to look at the realistic options for sustainable long-term funding, not least to try to future-proof the outcome and lessen the risk of a successor Government undoing decisions made.
As the Government develop their approach to social care reform, they should draw on the significant body of existing policy analysis. The main options—free personal care, which of course has my vote, a cap and a comprehensive NHS-style care—are well known and costed. Respected independent commentators such as the Health Foundation have set out the options and costs, so we are not starting from scratch. The sooner work begins on thinking through the options and engaging with the wider public, the better. The nearer we are to the next election, the harder the task will be.
To conclude, despite countless commissions and reports, successive Governments have failed to enact meaningful reform. With many of the policy options already on the table, and a clear willingness for cross-party talks, the Government have the chance, finally, to implement social care reform and to improve the lives of older and disabled people and their carers. This does not need a lengthy royal commission, simply a substantial injection of political will. Social care reform is a top priority for the Liberal Democrats and, as I hope I have demonstrated, we have plenty of ideas to bring to the table. I look forward to hearing the wisdom of other noble Lords on this thorniest of public policy challenges.
Baroness Thornton (Lab)
My Lords, I am very pleased to take part in this important debate. I congratulate the noble Baroness, Lady Tyler, on her excellent and comprehensive introduction. As the first Back-Bencher to make a speech, at least I will not be repeating anyone else’s. I very much look forward to my noble friend Lady Keeley’s maiden speech.
The fact that there are so many speakers and we are therefore limited in our time tells us how important this matter is. In my short time, I will not be doing the big-picture painting that the noble Baroness, Lady Tyler, did but will talk about some very specific practical things. I am a non-executive director of the Whittington Health trust, which is our local hospital in north London. We are an integrated care organisation and we face the same challenges that all parts of the National Health Service do. We provide hospital and community care services to half a million people in Islington and Haringey, as well as other London boroughs such as Barnet, Enfield, Camden and Hackney, and it is worth looking at the practical issues involved in how you do this.
Haringey and Islington have multiagency care teams, which work across health and the council to assess and support rising risk patients and avoid unnecessary hospital admissions, keeping people in the community. They are multidisciplinary, with pharmacists, housing officers, social care workers, consultants and district nurses working together. We have a single front door in Islington, which we have just launched, for healthcare and the council to share a single triage point to ensure that patients are seen by the right team and to avoid duplication of input, and to ensure the best way of sharing our limited resources. Again, this sees council staff and Whittington staff working together. We have social workers embedded in our hospital; they are in our teams and in our hospital offices.
These are the practical details that can inform how primary care locally can be further developed, as defined by the noble Lord, Lord Darzi, in his report, which points to the need to develop primary care, GP care, social care and community care together. I invite my noble friend and her colleagues to come and visit us at the Whittington, where they will be very welcome indeed. There is no doubt that effective and innovative practice exists. I make a plea not to reinvent the wheel as we work towards the much-needed reform of adult social care.
Secondly, I want to ask my Government to look at who provides care at every level in our communities and at whether it is appropriate that we have care providers that are not going to sustain their care in our communities. For example, in 2023, Beaumont Healthcare, a homecare agency providing care to people with disabilities and complex health conditions in Cambridgeshire, went out of business and handed back the care contract to the local authorities. That would not be unusual, but it was the fifth care provider in Cambridgeshire to hand back care contracts in 2023. We know that the marketisation and privatisation of adult social care following the care Act in 1990 brought with it the dangers and instability that we see today.
I have championed co-operative social enterprise and mutuals for 25 years in your Lordships’ House. Frankly, in rebuilding our economy and in the reform of our public services we need to look at organisations that can provide public services and do so in a sustainable way. I ask my noble friend that, in the rebuilding of health and social care in the UK, we look at the failures and bureaucracy that competition and marketisation have brought and positively seek alternatives, to have a diversity in the provision of social care in our communities.
Lord Young of Cookham (Con)
My Lords, I too am grateful to the noble Baroness, Lady Tyler, for initiating this debate, the importance of which was underlined by the sheer volume of the high-quality briefing that we have all had for it. There is a fairly common analysis in those representations: declining funding for the sector over many years, leading to delays in assessment and then unmet need, in turn putting pressure on carers, aggravated by workforce pressures, which is made worse by poor pay and conditions for the workforce. The whole problem is compounded by decades of indifference by successive Governments.
In the time available I want to focus on young carers. In another place, I met a group of impressive young people, Andover Young Carers. They were different from older carers. Older carers know that they are carers; they see themselves as carers. These young carers did not see themselves as carers at all but as brothers and sisters, sons and daughters, and grandchildren. They looked after their relative because that is what they had always done; for them, that was life. Unlike older carers, they had never been non-carers. A further difference was that these young people were coping with the demands of full-time school and college, and at the same time coping with the challenges of the transition from child to adult. Their needs are very different, and I hope that we will not forget them in the short debate today.
The 2021 census showed over 50,000 young carers caring for over 50 hours a week—that is more than the standard working week. Worryingly, within that figure of 15,000, 3,000 were aged between five and nine. The Carers Trust has shown that those young carers at school are at risk of a poorer attendance record and lower academic achievement, and also more liable to social isolation and, sadly, bullying.
What do we do about it? The APPG of which I was the vice-chairman did an inquiry, and we met lots of young carers last year. They told us that, on average, it took three years before their needs were identified and up to 10 years before some of them even got support. That is inexcusable. They also told us that that support came only when they reached absolute crisis point, so we need to identify their needs much earlier, downstream. There needs to be consultation between the various settings of adult services, children’s services and education. There is a memorandum of understanding called No Wrong Doors for Young Carers, which is designed to improve joint working between adult services, children’s services, integrated care boards and other statutory organisations. Despite a requirement for local authorities to have such joint working arrangements in place, recent research by the Carers Trust found that only 7% of local authorities appear to have done so. I will ask the Minister just one question. Does she agree that all local authorities should sign up to that memorandum so that young carers get the support they need?
Baroness Murphy (CB)
My Lords, the helpful House of Lords Library briefing paper by Eve Collyer Merritt started with great clarity. The opening statement was:
“Social care services help people living with illness or disability”.
That is so often forgotten. I think the people in this Chamber today know that—we would not be here if we did not. Indeed, I see assembled before us a number of what I would call the usual suspects for debates of this kind. However, vast sections of the population do not comprehend at all what social care services are. When we have a candidate for leading the Conservative Party who refers to carers recruited overseas as “bottom wipers”, I find myself in an angry rage at her astonishing ignorance, and feel that many politicians require some educating.
That problem explains, in part, the catastrophic neglect by successive Governments, who come to the elections and find that nobody is the slightest bit interested in it as a vote winner. It seems that this Labour Government, whom I expected better of, are also kicking the can down the road. That is one theme that I think will remain constant through this debate today.
The noble Baroness, Lady Tyler, set out clearly and admirably the challenges, and I can do no more than repeat her words and support her call for a long-term strategy for what should be a growing workforce and the desperate need for training of staff too—especially in dementia, I would say. In view of the fact that over half of home recipients of care and over 70% of care home residents have a degree of dementia, it is surely unacceptable that fewer than half of residential carers have any training whatever in how to manage that condition. I suppose that at this point I ought to draw the House’s attention to my lifelong professional interest in this area and current role as an ambassador with the Alzheimer’s Society.
Since the Dilnot commission report of 2011, there has been talk of capping care costs in residential care, but I am pleased to say that the one thing the Government have said is that they do not support that line. Capping costs simply transfers the burden from those who have the resources, albeit often locked up in property and capital assets, to the Government and, by extension therefore, to the working population through taxes. It has the effect of unjustifiably allowing older people who need residential care to hang on to properties and pass them on to their children, while adding an extra tax burden on to younger people, most of whom will not own homes. There are many ways to ensure that payment can be deferred so individuals and spouses do not have to pay and, in that sense, I agree with the Government’s announcement.
I do not think we can ever get away from the profound unfairness that was established in 1948, when healthcare and social care were separated. We are in danger of recreating a national care service which makes all the same mistakes as the behemoth of the National Health Service. Please do not move away from having a locally focused and locally accountable social care service. By all means have a national strategy but not, please, a national care service.
The Lord Bishop of Oxford
My Lords, I too welcome this debate. I particularly appreciated the initial appeal by the noble Baroness, Lady Tyler, for a reframing of a broader conversation. Like others across this House, I pay tribute to the many unpaid carers and those who work in social care, who invest their lives in the well-being of others. As has been said, in this debate we acknowledge together that our social care system is in urgent need of reform and that this is a key moment. I share the hope that the Government will take the first steps in that reform in the very near future. Social care impacts us all, in terms of our responsibilities and needs. It brings the most vulnerable in our society from the margins to the centre of our attention and our love.
Last year, the Archbishops’ Commission on Reimagining Care published its excellent report, Care and Support Reimagined. The commission was chaired by Dr Anna Dixon MBE and the right reverend James Newcombe, then Lord Bishop of Carlisle. The report commends the development of a national care covenant. The biblical notion of covenant is based not around commercial contract but around a wider societal promise and mutual expectation, and is focused on relationships, mutuality and partnership. It demands a shared vision across society and common values.
I particularly draw the House’ attention to the seven values and principles from the commission’s work, which I believe offer an excellent underpinning for the Government’s future work. Social care should be universal, fair and characterised by loving kindness, which, as we all know, is transformative. Social care should foster trust, be inclusive and promote mutuality. It is an expression of empathy, focused on what each individual wants or needs, rather than being paternalistic and presumptive.
A number of Lords have highlighted, or will do so, the need for workforce planning. Clearly, that is needed as part of a holistic, integrated, systemic approach. We are entering a period in wider society when new technologies are likely to lead to a rapid decline in the number of roles in many industries, such as warehousing and call centres, as many roles become automated. The renewal of social care gives us the opportunity to rethink and expand the workforce in an area of our lives which needs to remain distinctly personal and deeply humane. In social care, we must think not only of how to be efficient but of how to create communities of kindness. As the Motion implies, there is an urgent need to offer a matrix of support for voluntary carers, not least the funding of respite to enable rest and sabbath in their demanding roles.
So much that is good is offered by home carers, volunteers, partnerships with faith communities, local authorities and businesses. The Government now have a significant opportunity and responsibility to reimagine care and support, and the need to begin this task is very urgent.
Baroness Thomas of Winchester (LD) [V]
My Lords, I welcome this debate and declare that I receive NHS home care.
The whole social care landscape is unbelievably complex, as we have heard. Select Committee reports in both Houses in recent years have all stressed the need for urgency to establish a new and sustainable framework for care, yet nothing is done. My noble friend Lady Tyler is right in making the case for a comprehensive strategy. The LGA, in its White Paper in June about social care, said that stabilising and supporting the care workforce must be an immediate priority, as must measures to improve pay. According to the charity Skills for Care, more than 80% of general workers are paid more than care workers, which demonstrates how low their pay is.
Our population is getting older and those with long-term disabilities are living longer, so there is no time to lose. Sir Ed Davey has called for a social care commission, so I ask the Minister whether this is being considered as a first step and, if the answer is positive, whether it could be started as soon as possible.
I want to turn now to the status of care workers. In my experience, they are worth their weight in gold. They have to be skilled to cope with all manner of machines and appliances, from feeding pumps to bed hoists, ventilators, catheters, humidifiers and suction machines, to name but a few. They have to keep cheerful and calm, however irritated or grumpy they feel. They are all truly on the front line. Nearly all of them could get much more money stacking supermarket shelves. Home carers do not get paid for travelling between clients in London and, in some districts, they have to pay parking charges. Carers notice that healthcare professionals, such as podiatrists, get free parking and can usually choose their hours for home visits. This tells carers that society in general does not rate them as equal partners in looking after someone. We should treat them as professionals giving a vital service and pay them accordingly.
As for retaining staff, it was interesting to note from Skills for Care that care workers from overseas tended to stay longer than the domestic workforce. Simplifying the whole system of care will surely help the NHS manage hospital admissions and discharges, and take the pressure off local authorities, which have to spend a lot of their scarce resources on matters such as financial assessments.
It was disheartening that the gracious Speech did not mention care. We do not want to hear the words “in due course” from the Minister, rather the word “straightaway”, and for the Government to be prepared to put far more money into the social care we need. Thank you.
Baroness Keeley (Lab) (Maiden Speech)
My Lords, it is a great pleasure to speak in your Lordships’ House for the first time in this debate, to follow the noble Baroness, Lady Thomas of Winchester, and to listen to the comprehensive opening by the noble Baroness, Lady Tyler.
First, I thank noble Lords on all sides of this House for the warm welcome I have received. It is a pleasure to be reacquainted with former colleagues from all sides who also served in the House of Commons. I give special thanks to my noble friends Lady Hayter of Kentish Town and Lady Blake of Leeds, who were my supporters at my introduction. Thank you also to Black Rod and her team, the Clerk of the Parliaments, the doorkeepers, police officers and all the House staff who have been so helpful, supportive and welcoming.
For the past 19 years, I have represented the great city of Salford, being the first woman MP elected to represent the constituency of Worsley in 2005. I have served as a Government Whip and as deputy leader of the House of Commons, working with my noble friend Lady Harman, who was leader of the House of Commons. In opposition, my shadow ministerial roles included social care and the arts.
Before I was elected, I worked as a consultant with the Princess Royal Trust for Carers—now the Carers Trust—on a project to evaluate the then Labour Government’s national strategy for carers. We consulted over 4,000 unpaid family carers. One issue that became very clear was that carers did not receive support unless they were identified as carers, which was a particular problem for young carers, as we heard from the noble Lord, Lord Young of Cookham.
In 2010, I introduced a Private Member’s Bill on the identification of carers. Unfortunately, this did not progress and there is still a need to identify unpaid carers so that they can be supported.
Further, the national strategy for carers was not refreshed by Governments that came in after 2010, meaning that, for 14 years, we have had no high-level strategy across government departments to support carers.
I have raised these and other concerns repeatedly, particularly when I served as the shadow Cabinet Minister for Mental Health and Social Care. To my mind, support for carers has been left too much to carers groups and even to carers themselves.
Katy Styles is a full-time carer for her husband, who has motor neurone disease. Alongside her caring responsibilities, Katy has founded the “We Care” campaign to empower carers to feel visible and valued. This campaign is motivated by the belief that
“all carers deserve so much better”
and I wholeheartedly agree.
I have worked on carers issues across the years, and I acknowledge the work of my noble friend Lady Pitkeathley, who has done so much for carers. I hope that our new Labour Government will redevelop a national carers strategy and work to improve life for carers.
I have also worked for a number of years to highlight the appalling treatment of autistic people and people with learning disabilities who are held for too long in inappropriate in-patient units. The families affected need champions of their cause, which they have in the noble Baroness, Lady Hollins. It is a privilege for me to be in your Lordships’ House at the same time as the noble Baroness, so that I too can raise their concerns and issues.
My most recent roles were as shadow Minister for Music and as shadow Minister for the Arts. I have worked with many noble Lords, including the noble Lord, Lord Berkeley of Knighton, on issues related to music and the decline of music education in state schools. Music and the arts can offer children and young people so much in the way of confidence, teamwork and well-being. I look forward to working with noble Lords across the House on what can be done to bring the joy of music and the arts to all young people, not just those whose families can afford it.
I conclude by saying how happy I am to be working with noble Lords and learning from the great collective wisdom that resides in this House.
Baroness Pitkeathley (Lab)
My Lords, it is a great pleasure and honour to welcome my noble friend Lady Keeley to your Lordships’ House and to be the first to congratulate her on her marvellous maiden speech. As your Lordships have heard, we have worked together on these issues for some years and I thank her for her kind tribute.
Time does not permit me to do justice to the great experience, expertise and wisdom that she brings to your Lordships’ House. As noble Lords have heard, she was first elected to the House of Commons in 2005, as the first ever woman MP for the Worsley constituency, which later changed its name to Worsley and Eccles South. She served as chair of the Women’s Parliamentary Labour Party and held government jobs in the Treasury and as deputy leader of the Commons. In opposition, she has held an impressive variety of shadow Minister posts. Her last, as your Lordships heard, was as shadow Minister of Culture, Media and Sport, where she championed music and tourism, and worked closely with the voluntary sector as shadow Minister for Civil Society. She combined all this with close attention to her constituency and an active role in local issues, much admired by all her constituents. She begins another phase of her public service today in this House, where I know she will be a valued and valuable Member.
I thank the noble Baroness, Lady Tyler—whom I always want to call my noble friend—for her very welcome debate. I hope that she and other noble Lords will forgive me for a little trip down memory lane. I remember the many social care debates in which I have taken part in your Lordships’ House when it was very difficult to assemble a reasonable speakers list—far from the distinguished gathering that we have today. So few were those noble Lords interested in or concerned about the subject that I used to refer to them, as I have been reminded, as “the usual suspects”. Happily, the number of suspects has greatly increased today. In those days, it was also difficult to get detailed briefings; we have come a long way, with the raft of excellent material that we have from many sources today.
Your Lordships will not be surprised to know that I am especially grateful to the noble Baroness, Lady Tyler, for including unpaid carers in her Motion. Going again down memory lane, I remind your Lordships that, when I became involved in the carers movement in the 1980s, the word “carer” was not in the Oxford English Dictionary and spell-check always changed it to “career”. When I went to collect my gong at the palace in 1993, my citation was announced as “for services to careers”. We have come a long way since then.
Carers are central to legislation now and some individual bits of legislation are aimed at them specifically. Even spell-check has caught up. However, I met a carer at a drop-in this week who told me that she feels completely rubbed out by a system that makes her fight for the slightest assessment of her own needs, despite that being enshrined in legislation since 1995, as we have heard, and strengthened in the Care Act 2014. Another told me of her struggles with mental health as a direct result of all the caring stress.
Your Lordships all know what needs to be done. We cannot fix the NHS without fixing social care. We must shift resources from hospital to the community. We must focus on prevention and early intervention. We must find a way to share the risk so that catastrophic care costs do not fall in an unfair way. We have known all this for years but, above all, we must understand that you cannot fix social care without supporting the main providers of social care: not staff, care homes or care workers but the unpaid carers, who are there all the time, providing £162 billion a year, as the value of their care, to individuals in need—often at terrible cost to their own mental and physical health, not to mention their finances. If they withdrew their labour or worked to rule, they would get more attention, but they are not going to do that because they are motivated by love, duty or a combination of both.
As the All-Party Group on Carers, which I had the honour to chair, so forcefully said, carers’ problems can be addressed by developing a new national carers strategy, which would set a clear direction of travel and a long-term vision for how carers can be supported, look at the interaction between different policies and departments and ensure that their needs are recognised and responded to at the highest levels of government.
It is 16 years since the last national strategy was developed, led by Prime Minister Gordon Brown. Surely it is time for another. If not now, when? The problem is going to get only more acute as our population ages and lives with increasing comorbidities. As the increased interest in this once-neglected subject shows, this is not someone else’s problem. We are all—every one of us—a hair’s breadth, a fall, or an accident away from being cared for or being a carer. As we have heard, there is a strong economic case for supporting carers. The Government need the will and determination to do it, but the rewards will be ample, for not only 6 million carers but every one of us.
Lord Hunt of Wirral (Con)
My Lords, I first declare my interests as set out in the register, in particular as a partner at DAC Beachcroft. Last week I attended an excellent event with leaders in social care. What an impressive group they were, full of ideas and so very open to greater engagement and innovation. They easily persuaded me that innovation is the key to reforming the social care sector—and innovation must be enabled, not stifled.
Leaders in the sector are already championing a wealth of innovative solutions, from everyday innovations such as the decaffeination principle, which helps to reduce falls, to whole-system changes in approach. These should be encouraged and supported through financial support and regulatory understanding.
The new chief executive of the Care Quality Commission, Sir Julian Hartley, supported by an excellent chair, will have a testing challenge on his hands to persuade people that the CQC can indeed be fit for purpose. The sector urgently needs more effective and outcomes-focused regulation, and transparent, consistent and partnership-based commissioning. I hear encouraging things about Care Inspectorate Wales, where a spirit of partnership has been cultivated to positive effect. That may be a useful example for England to follow.
As the Darzi report forcefully points out, we must see a far greater recognition of the role that social care plays in supporting the NHS. A successful social care system is and always must be a core part of moving our cultural focus from cure to prevention and wellness, and to making the gradual shift from hospital care to community-based care. Sadly, while we tell people to stay in their homes for as long as possible, we do not then offer them the support they need.
Social care should be viewed much more positively, in this place and elsewhere, and not just as the service of last resort. It really needs to move out of the “too difficult” box, as stakeholders, including sector leaders, are brought into the discussion, to contribute to shaping the future in a more meaningful way. This includes those younger carers, instanced by my noble friend Lord Young of Cookham, and those key unpaid carers, as so clearly demonstrated by the noble Baroness, Lady Pitkeathley, and in the outstanding maiden speech by the noble Baroness, Lady Keeley.
While I welcome the new Government’s stated desire to build a consensus for reform, I find talk of a royal commission disheartening and evocative of the long-grass era. As the noble Baroness, Lady Tyler of Enfield, pointed out in her outstandingly good and wide-ranging opening speech, reform has been avoided for many years, and this cannot be allowed to continue. I hope that today’s debate will come to be seen as one of many landmarks on the route to sustainable reform of social care in England.
Lord Turnberg (Lab)
My Lords, I too congratulate my noble friend Lady Keeley for her outstanding speech. May we hear many more from her.
Of late, we have heard quite a lot of brave words about the prospects for a national care service, but I am very sorry to say that I do not have a great deal of faith in the idea of grand schemes. For example, we have seen the creation of integrated care boards, but these are yet to have much of an impact outside the Whittington Hospital. As always, it is the funding that counts. As long as we have two types of funding arrangements, one for the NHS and another for social and community care, the latter will always be the poor relation. While local authorities continue to be starved of funds, we will always have major problems—and we have very little money. We have our brave new Secretary of State, Wes Streeting, laying out his ambitious plans, but it is inevitable that he will not be able to do everything, and we will have to ask: what is the highest priority? What will give us the biggest bang for our buck? That is where funding for social and community care should come top of the list. It is least expensive but will do the most to save the NHS. Think of the advantages that it would bring not just to the NHS—we all know about those—but to all those in desperate need in the community.
There are many practical solutions that we could adopt now. First and foremost, we must repair the damage we have inflicted on the caring staff. The way they are currently treated is nothing short of a national disgrace. Not only are they underpaid, they are completely undervalued. Some 20% of new recruits leave within 12 months for better paid jobs in supermarkets. Being a carer of those in need—the elderly or disabled—can be fulfilling, but not if you feel undervalued and underappreciated. There is little prospect of career progression and, as we have heard, if you last in the job for, say, five years, your pay is just 10p an hour more than you were getting when you started. Little wonder there are such high vacancy rates, and that the total numbers have held up only because of a cohort of foreign workers that sadly is now drying up.
But we can correct the problems. I follow the noble Baroness, Lady Tyler—we have to set up a national register of care workers so that they can be registered as the professionals that they are. We should assure that they are given a recognised qualification after a nationally approved training programme. Amazingly, that does not exist—they do not have a nationally recognised qualification. We should open up satisfying career progression, possibly even leading to a career in nursing. They should, of course, be paid at a rate that reflects the vital importance of their work that they do as caring professionals. It might cost a bit of cash, but think what we could save the NHS.
Secondly, as we have heard, there is the whole issue of the inadequate recompense that we pay those who care for relatives or friends at home. If you manage to jump through the tortuous series of bureaucratic hoops, you are allowed £76.70 a week, after you have had to give up paid employment to gain the full amount. Yet we know that the value of home care to the economy is at least in the order of £5 billion a year. Talk about slave labour.
Finally, there is the cap on the costs of care beyond which those in need have to pay—set so low that few can gain any support. It is now time for the Government to at least reconsider whether the Dilnot report can offer some help. These were proposals that last the Government almost adopted but finally scrapped. We will, of course, have to consider how we might provide the money, but I am running out of time. If noble Lords want to know more about what I think, perhaps they can read my book on how to save the NHS.
Baroness Browning (Con)
My Lords, I congratulate the noble Baroness, Lady Tyler, on bringing this debate to the House today. I wish the noble Baroness, Lady Keeley, a warm welcome and congratulate her on her maiden speech.
I hold a lasting power of attorney for a younger close relative who has had a local authority package of care for over 20 years and in recent years we privately funded a homecare package for my husband, who had Alzheimer’s. So I speak from what they call now the “lived experience”. So I first say thank you to all those who work in the social care sector—and, to the Government, here are my 10 priorities for a bit of activity now that they are in office.
First, there are not enough carers—we know that. Please make this a priority. Stop talking about integrating health and social care—just make sure that it is happening. Look at where it works and where it does not; legislate if necessary. It is a postcode lottery. Put in place, through primary care, a system where those reaching the fragility of old age, or diagnosed with a disease—I am thinking particularly of dementia—are not just left to deteriorate at home without some overview.
With regard to carers, there are many vulnerable people who have no carers at all—not even relatives. Do not wait for a crisis before they come into contact with health. It will cost a lot more. For those who have carers, flag them up on GP and hospital records. Unpaid carers often get ill themselves—often brought on by exhaustion. Please stop sending very elderly people to hospital unnecessarily and then keeping them there for days or even weeks on end. Not every fall on to a carpet needs an A&E admission. Please keep people at home where possible.
A comprehensive, fairly funded care policy has been promised by all Governments but never delivered—please do it. Anyone who thinks that the country cannot afford it will soon find out what it costs their family when they need it. Please consider the plight of couples where one partner uses up all the savings on care and the second person is left with virtually no financial means at all. Please consider—I know this is a Conservative idea—using tax relief as an incentive, not a penalty, to help resolve the financial challenge of a social care policy. Please try and make out-of-home placements as local as possible, particularly where children are affected. This is more important than looking for the cheapest option.
Ten years for a plan—which I believe is what is proposed—or even a Royal Commission, is far too long. Do not say, “Nothing can be done until everything is done”. Be brave—that is what those needing care have to be every day.
Baroness Meacher (CB)
My Lords, I congratulate the noble Baroness, Lady Tyler, on her excellent speech and on initiating this debate. I thank her. It was very moving to hear the contribution of the noble Baroness, Lady Thomas, today. She was a good friend and it was very moving to see her.
I want to make just a few points. The demand for social care is absolutely colossal. Last year, more than 2 million adults needed social care support. There were some 5,485 requests per day. The social care sector faces huge workforce pressures. There were about 131,000 vacant posts in the sector last year, some 8.1%. The rate of turnover was more than 25%. Of course, these pressures are not surprising in the context of low pay, zero-hours contracts and problems gaining a full-time job.
The backdrop to paid social care is, as others have mentioned, a huge unpaid care sector involving some 4.7 million people or 9% of the entire population. Carers UK estimates that the number of unpaid carers is something like 10.6 million, some 20% of the population—absolutely huge. I think the House will agree that it is quite shocking that some 44% of working-age carers who are caring for 35 or more hours a week live in poverty. The majority of carers are women and the majority have disabilities or long-term conditions. The carer’s allowance, payable to people who provide at least 35 hours per week of care for a person receiving certain benefits, is only £81.90 per week. Is that not an unliveable wage? The level of this benefit and its restrictions in scope are utterly unacceptable. A small compensation is that some carers are eligible for council tax reduction, universal credit, pension credit and so on, but the financial position of carers needs to be comprehensively addressed.
I welcome Keir Starmer’s plans for the spring of 2025 to shift care from hospitals to communities and integrate health and social care. These reforms should greatly help patients. For the adult social care workforce, Labour has pledged a fair pay agreement to cover terms of pay, conditions and training standards. This agreement is also vital, but it has to be matched by increases in local authority spending.
Sensibly, Wes Streeting, the Health Secretary, is arguing that NHS trusts must buy beds in care homes to reduce delayed discharges from hospital and increase treatment capacity. This is all incredibly valuable. Of course, Stephen Kinnock, Minister of State for Care, is right to prioritise the involvement of people receiving care and their families in planning care services. I am sure that all Members of the House will support these initiatives.
Baroness Donaghy (Lab)
My Lords, I congratulate the noble Baroness, Lady Tyler, on securing this debate and compliment her on her excellent summary of the dire state of adult social care in the UK. I also congratulate my noble friend Lady Keeley on her maiden speech. She leapt fully armed into the role required of a second Chamber with her depth of knowledge and wisdom, and I very much look forward to listening to her future contributions in this Chamber—and was it not lovely to see the noble Baroness, Lady Thomas of Winchester, today?
And here we are again. The subject is adult care, my noble friend Lady Pitkeathley is in her place, I am her pale shadow; it must be Thursday. There have been countless Thursdays. The noble Lord, Lord Young, is quite right that for more than 14 years adult social care has been a matter of national shame. It is particularly frustrating that we are having this debate a couple of weeks before the Budget, as I realise Minister will not be able to say anything about funding today.
There are reasons to be cheerful. If the Government are preparing a 10-year plan, at least that is practical and, let us face it, realistic. Please, no more promises to fix social care “once and for all”; we know what happens to those promises. Please, no more talk of royal commissions; we know the issues, as the noble Baroness, Lady Pitkeathley, said. Solutions require money—for local government, the workforce and family support. When a politician stops talking about money and talks about reorganisation and reconfiguration, you know that nothing is going to happen.
I have been an unpaid carer, on and off, for 24 years—for my mother, my husband and my brother. I am glad I did not have to go begging to a cruel and indifferent state for financial support during that time, and I am deeply sorry for anyone who is forced to do so. The exhaustion and stress are bad enough; add poverty into that, and it is no wonder so many people have been forced out of the labour market and no wonder we have so many skills gaps. We need a task force to get on with this, and possibly an ombudsman service to deal with potential injustice.
Some improvements may save money, or at least improve another arm of our public services—for instance, releasing hospital beds or releasing people back into the labour market. But let us not kid ourselves: adequate funding for local authorities, better care homes and decent pay for the workforce will all cost money. The question is: where will that money come from?
I do not think there is a single system where everyone will be better off. To make promises about not having to sell a home was breathtakingly dishonest. We live in such an unequal society that solutions will have to be different for individuals, whether we like it or not. We have rising demand, increasing costs and 14 years of short-termism. I am tempted to say that any action will be an improvement but, if the Government do nothing else, they need to adequately fund local government, and adequately pay workers in social care.
Lord Lilley (Con)
My Lords, it is a privilege to follow such a witty, wise and moving speech from the noble Baroness, Lady Donaghy. I congratulate the noble Baroness, Lady Tyler, and agree with her that the most serious problem in social care is financing care for people who cannot pay for themselves; it is not the potent political issue that often eclipses it: the fear of home owners and, let us be honest, their heirs that catastrophic care costs will consume the value of the parental home.
Most proposals to deal with this involve the taxpayer meeting anyone’s social care costs above, say, £100,000. That was what Dilnot proposed, and both parties have flirted with it. I congratulate the Government if they are distancing themselves from it now. Extending free social care to some, let alone all home owners would pre-empt public funds desperately needed for councils’ social care budgets. If there is a way to protect people’s homes from bearing the catastrophic cost of social care in old age, it is insurance.
Andrew Dilnot noted that elderly social care looks like an eminently insurable risk. We know the average proportion of elderly people who need social care, the average length of stay and the average annual cost of that care, so it is simple to calculate the necessary premium to insure against having to sell your home. But the private insurance industry was adamant that it would not provide such policies, mainly because of the incalculable and therefore uninsurable risk that future medical advances may prolong the period during which people need such care. Dilnot therefore abandoned the idea of insurance, but there is an alternative to private insurance, which was rejected by my own party for ideological reasons. I hope the same ideological reasons will make it appeal to the Government.
The alternative to private insurance is for the state to offer or underwrite such insurance. My Conservative friends were appalled that I, who had drafted the Thatcher privatisation programme, should propose nationalising an element of insurance. What apostasy! But if a state body provides or underwrites insurance against the current known risks of long-term elderly care, the only costs which would fall on the taxpayer would be those added if advances in medical care prolong the duration that people need social care. The reality is that the state already bears that risk. If we set a cap on care costs, the taxpayer will find themselves also paying billions to protect home owners from the costs of known risks of long-term care, which could be met by insurance.
The second reason why private insurers will not provide such policies is that they believe people will not pay contributions during their working lives, on top of saving for their pensions and repaying their mortgages. The alternative to trying to persuade people to contribute during their working lives is to enable them to take out such insurance after they retire by taking a modest charge on their homes, which would be realised only when they die or sell their homes. I set out the details for this in a pamphlet called Solving the Social Care Dilemma?: a Responsible Solution. I hope that the Minister and her apparently open-minded Secretary of State will give this proposal serious consideration. If not, they will find the pressures to divert money to enable home owners to bequeath to their undeserving heirs almost irresistible.
Lord Davies of Brixton (Lab)
I thank the noble Baroness, Lady Tyler of Enfield, for introducing this debate and for her fantastic introduction. I congratulate my noble friend Lady Keeley on her excellent maiden speech and add that I would really like to give my noble friend Lady Donaghy a virtual hug.
I want to make a joint or double point: carers deserve pensions—decent pensions. I am talking here about paid carers and unpaid carers. As far as paid carers are concerned, we had this great promise in the Labour manifesto of a fair pay agreement in the care industry. It would be a sector-collective agreement that would set fair pay terms and conditions along with training standards. That has to include decent pensions. I suspect that, because of the nature of employment within the care sector, relying on existing automatic enrolment provisions will not be sufficient. I hope that, in establishing the arrangements for the fair pay agreement, the need to consider pensions is built in and not there simply as an afterthought.
The treatment of unpaid carers and their lack of decent pensions—I have addressed this issue many times before—is one of the prime reasons for the gender pension gap. Whatever we may say about shared responsibilities, in practice it is women who end up undertaking the great majority of unpaid care. They do not get any pension, yet we have a pension system which relies on people earning. The basic state pension is not enough; they need a pension in addition, but do not get one because they are not being paid. Well, the state needs to provide them with additional pension top-up. I am not going to set out too much detail now about how that should be done but, for me, the most attractive option is some form of pension credits. In addition to the normal state pension, for the years that you provide unpaid care, whether for children or parents, you should receive additional credits for additional state pension. I hope that my noble friend will acknowledge these issues, which we will need to discuss.
Baroness Fraser of Craigmaddie (Con)
My Lords, last week I was attending a conference—no, not that one. It was the Cerebral Palsy Scotland conference, where there was much talk about social care. I declare my interest as the chief executive of Cerebral Palsy Scotland.
The Government have a headline commitment, as I understand it, to create a national care service, but there is no detail about timescales or resources. Coming from Scotland, the mere mention of a national care service makes me shudder. The SNP’s plan for a national care service has already wasted £28 million. Parliamentary committees and NHS bosses have warned about its flaws. Council leaders and unions have pulled their support. It will cost more billions—that is just to set it up—and, despite this, not one person’s care across Scotland has been improved. I urge the Minister: please do not make the same mistakes down here.
At our conference last week, one of the sessions laid out a job description for unpaid carers. It included the provision of personal care, housework, mobility assistance, medication management, emotional support, transportation, advocacy, respite care, health monitoring, project management, financial support and advice. They do all this, and they remain invisible and unappreciated. The most common theme that comes up in any conversation with unpaid carers, or any carers, is: “I wish I had known about it sooner”.
As the noble Baroness, Lady Keeley, said in her excellent maiden speech, identification is key. Professionals already have a responsibility for this, but it does not seem to be working. Despite the effort put into carers’ resources, research by the King’s Fund found that it does not always translate into the support that carers want. A carers’ strategy could look at what could be done to improve this.
As the noble Baroness, Lady Tyler of Enfield, said in her excellent introduction, we must stop looking at social care through the prism of the NHS. We will never get it right if we view social care only as the application for the ill or the old. The people I spoke to at the Cerebral Palsy Scotland conference last week were neither ill nor old; they are just asking for some support to live their lives in the way the rest of us, who do not rely on assistance, take for granted.
What they need and want are good PAs, personal assistants, who help you do what you want, whether that is going to work or going to the pub. Such flexible outcomes do not fit easily into local authority care packages, and there are not enough PAs. Many of the agencies previously supplying staff did not survive Covid. People are resorting to permanent ads on sites such as Facebook and Indeed. It is a bit of a lottery who applies. People often do not turn up to interviews or trial shifts, and you are really stuck if your PA does not turn up or is ill. The challenges of becoming an employer, dealing with recruitment, PAYE and pensions, too often defeat people.
I recommend that the Minister looks at the PA model delivered by the charity Enable, which works with local authorities across Scotland. It deals with employer issues and provides a personalised service to people. It may be one example of good local practice that would benefit from support to extend it further afield. At any time, any one of us could suddenly become responsible for the care of another person, or any one of us might need to be cared for. It is time the Government moved social care up their priorities list.
Baroness Warwick of Undercliffe (Lab)
My Lords, the noble Baroness, Lady Tyler, helped us all with her comprehensive and thoughtful introduction to this debate, and with the urgency she injected into it. I thank her for that. I also thank my noble friend Lady Keeley for her marvellous maiden speech.
The Library briefing for this debate states that
“the social care sector in England is facing workforce, resource and funding pressures”.
It echoes similar comments from the Public Accounts Committee. These bald statements can scarcely convey the awful state of our social care system, which the wider public woke up to during the pandemic and which the recent report from the noble Lord, Lord Darzi, described even more trenchantly as “dire”.
At the same time, the social care sector is trying to handle unprecedented demand and is largely reliant on millions of people providing unpaid care. The service is close to cracking apart. There is universal acceptance that this is placing huge strains on people and their families, as we have heard today, as well as the health service. Yet the political will to change it has just not been there. Much has been promised but almost nothing has changed.
Along with the noble Baroness, Lady Fraser of Craigmaddie, I was a member of the Adult Social Care Committee, which reported to this House 18 months ago. We highlighted the need for support for those who cannot support themselves, which would enable them to live fruitful, active and valuable lives—what one witness described to us as a “gloriously ordinary life”. We used that as our title, to encapsulate what we believed public policy could achieve if the political will were there.
Yet our report concluded, largely based on the voices of lived experience, that many disabled adults and older people continue to be denied choice and control over their lives, largely due to a lack of resources. The cruel reality for local authorities, which provide most adult care, and for the people who rely on these services, was a 29% real-terms reduction in spending power and an estimated 12% drop in spending per person on adult social care services in the previous 10 years. That is the challenge facing the Government now.
Our new Government clearly intend to make this a priority, and they will not be short of advice. Innumerable reports have attempted to address, for example, the highly sensitive question of who pays for the unsustainable costs of social care. Unfortunately, the previous Government refused to grasp this nettle. The new Government have announced their intention to create a national care service and to improve NHS and social care integration as part of a 10-year plan. Although I understand why they are thinking of a 10-year programme—I suspect it will take at least that time to put right the huge imbalance between the funding of the health service and the social care service—the Government have the opportunity to make a real difference now, in the course of this Parliament, and to offer some hope to the millions who rely on care now. They need to show they are determined to, at last, make our social care service visible and fairer—a kinder system that enables people to live positive and valuable lives. The Select Committee report offers some signposts for action that I hope the Government will consider, including establishing a commissioner for care and support to show how adult social care, properly delivered, can have a transformational power in people’s lives.
Finally, I echo the words of the noble Baroness, Lady Tyler, on unpaid carers, as well as the wise words of my noble friend Lady Pitkeathley, our marvellous champion for carers in this House. I urge the Government to develop a system that is not based on the assumption that families will automatically provide care without any financial support because there is no other option. I hope my noble friend the Minister will agree that unpaid carers need better financial compensation if their caring duties prevent them working, or help with juggling work and care if they can remain employed. That would be a great start.
Baroness Neuberger (CB)
My Lords, I declare an interest as chair of both UCLH NHS Foundation Trust and Whittington Health NHS Trust. I thank the noble Baroness, Lady Thornton, for what she said, because I now do not have to say it—but, yes, it is an integrated care system and it actually works. I also declare interests as the former chair of Independent Age and a present trustee of the Rayne Foundation.
I say a major thank you to the noble Baroness, Lady Tyler, for initiating this debate and for what she said. I congratulate the noble Baroness, Lady Keeley, on an amazing maiden speech, and I give a virtual hug to the noble Baroness, Lady Donaghy, because she deserves one. It was wonderful to hear the noble Baroness, Lady Thomas of Winchester, speak.
We have heard a lot about how the noble Lord, Lord Darzi, described our social care system as “dire”. It is dire for many reasons. NHS hospitals cannot discharge people who are fit to receive packages of care because there is nowhere for them to go and no money with which to do that. It makes everyone feel powerless. If we had Care England’s proposal for a national tariff of £1,500 per week for intermediate care for people coming out of hospital, people would be able to get out of hospital and we would be able to free up some beds and make the system work better. That is one small thing we could do. It may be expensive, but it is not that expensive.
It is dire because the social care workforce is so often undervalued, underpaid and insecure, as we have heard. It has a fragmented provider landscape and commissioning arrangements that limit innovation and change. That means insufficient support for untold numbers of unpaid carers who are looking after loved ones day in, day out, until they too cannot cope and are in crisis. It is dire.
However, there are ideas out there of what might help, which is why I cited my interest as trustee of the Rayne Foundation, which has a new grant programme for adult social care workforce development, Better Careers for Better Care. It is based on the theory that, if you value and invest in the workforce, people will receive better care if they need it; that way there will be fewer crises and it will cost less, so that both unpaid carers and the care workforce will feel more able to cope and be more appreciated. That should lead to a better and more secure quality of care for those who need it, and I think that the Government need to look at that very closely.
Care England has produced some policy papers, with proposals so breathtakingly obvious that I am amazed that the Government have not yet taken them up. Among them is increasing the minimum wage in the sector to £15 an hour—and we know that there is a manifesto pledge to do something. I echo the noble Lord, Lord Davies, on pensions being added to that, because that is essential. The other thing is having a proper professional register of care workers, paid for by government; that way we know that the care workers are up to the job.
These are first steps. Valuing the social care workforce is fundamental to providing high-quality care and fundamental for those providing unpaid care, for whom respite is being able to step away from their loved ones for just a few hours. Can the Minister tell us how far the social care strategy has been developed and whether the urgency that we have all expressed has been acknowledged? Might she tell us to what extent, in the shorter term, the Government will examine how the care workforce is treated and valued and move to a system where development and training are the norm? That alone would make a difference in a complex landscape where we need urgent action.
Lord Dubs (Lab)
My Lords, I declare an interest, as a member of my family is a full-time unpaid carer. I suspect that many of us have unpaid carers in our families and, if we have not got them yet, we are likely to have them in future.
We have had a plethora of reports, an avalanche of committees and this, that and the other on this subject. I congratulate the noble Baroness, Lady Tyler, on initiating this debate. Why do not the Government simply take this debate—and have no more committees—and act on it? That seems to me simpler than having yet another committee, which will take time.
I hope that we will eventually get to a national care service. I am reasonably confident that this Government are going to do something about it and that we will have no more debates asking whether the Government will do this; next time, my noble friend will come to us and tell us, “This is the start that the Government have made on dealing with the problem”. That is the least that we expect of my noble friend, and I hope that she will do it.
I shall say one quick word about professional carers—and in my family I also have experience of those. If any Member of this House has seen the local authority forms that one has to fill in to qualify for care, they will know that they require two PhDs and a couple of lawyers to fill in. It is a nightmare. Could we please simplify the bureaucracy? It is not fair on those who do not have the legal background. My daughter helped somebody in my family, because she is a lawyer, but it is not fair that there should be such enormous difficulties. And of course even paid carers tend not to turn up for Christmas and New Year’s Day.
Some unpaid carers are full time. It is not just about those who are working and losing money through the bureaucracy; some of them are full time, and they do not end up with any pension at all because they have had to give up their jobs to get £81.90 a week—I think that is the amount. We are talking about something between 5 million and 10 million such people. We do not know how many unpaid carers are full time and how many have given up their jobs. It is pretty expensive having a disabled person at home, as it requires more heating and one has to use more people for repairs. It is a costly business to have a person who requires care in the house.
If there is to be one single change on behalf of full-time unpaid carers, it should be to provide them with respite care. The ones I know are desperately up against it; they just need a break—otherwise, they cannot continue. We are not talking about 35 hours a week for them; we are talking getting on for about 150 hours a week. They are full time, and they have to be there and ready at night, in case there is a need for help. We should give unpaid carers some respite care; that is what they need. If we can come away with that alone, it would make such a big change to the lives of at least some of them. A bit of respite care every few years is not enough of a break from the onerous responsibility of caring.
Let me give an example. I know of one carer and the person she was looking after had a catheter, which got blocked, and on that occasion the nurse could not clear it. It required a visit to hospital. I mentioned this to my friend the noble Baroness, Lady Neuberger, as she knows about it. The result was that the ambulance came but could not take the patient to the hospital where the consultant looking after him was. It took him to another hospital, but that was no good. The unpaid carer would have had to get a car, but could not park anywhere near UCH, so had to pay for taxis. It is a cumbersome extra burden that should not be necessary.
Finally, there is one council that still provides unpaid adult social care: Hammersmith. Noble Lords should have a look at what it is doing and at why it is so successful.
Lord Jamieson (Con)
My Lords, I draw attention to my registered interests, in particular as a councillor in Central Bedfordshire and a member of the Older People’s Housing Taskforce. I thank the noble Baroness, Lady Tyler, for initiating this important debate and congratulate the noble Baroness, Lady Keeley, on her maiden speech, which was excellent. I also express my thanks to the extraordinary contribution made by the many people employed in the sector and the carers—with that, I also pass a virtual hug across the Chamber to the noble Baroness, Lady Donaghy.
As many have outlined, social care and health are in crisis. We are all living longer, which is great news, but an ageing population means that more of us will need care for longer. We just do not have the care or health service that is up to providing the services that we need today. As has been mentioned here, it is not just pensioners; there has been a 25% increase in working-age adults needing care and a near doubling of SEN over the past 10 years.
The instinctive solution is to say that we need more funding—more money. Unfortunately, that is just not practicable. In my experience of councils, they have seen the share of expenditure taken up by social care increase from 50% to over 70% in the past 15 years—somebody said that it was 80% for some councils. If we look at government expenditure, we see that the amount spent on health, social care and social security has gone up from 30% to 45% over the past 30 years. The health and social care workforce is forecast to increase from roughly one in 10 of the current working population to one in five over the next 20 years. Unfortunately, this is simply not sustainable. We need a radical change of direction, and we need to be honest with ourselves and stop kicking this can down the road.
As a society, we need to support people to live healthier for longer and to live independently. Of current health outcomes, only 20% are down to health interventions; around 30% are down to the environment in which we live and another 30% are down to the choices we make about how we live our lives. It is outside the health system that we can make the biggest differences to our longer-term health and independence.
As the Darzi report mentioned, we need to change the NHS, focusing on prevention, early intervention and a move away from medicalisation. This means more GPs, community health, better public health and changing how we work, with things such as community health hubs that bring together a multifaceted approach and treatment outside of hospitals. We need to accept that this will mean a transfer of funds away from the acute sector and the consequences of that.
Housing has an absolutely crucial role. An active, healthy life involves having friends and living somewhere suitable that promotes independence. We do not need more mass housing estates; we need to bring people into cities, towns and larger villages, where they can be part of the community and where services are on their doorstep. It is about having the right accommodation for the right point in your life. Having the right housing saves money. In Central Bedfordshire Council, we estimate that extra care facilities save the council and the NHS around £4,000 per apartment and improve the lives of the people living in them.
Technology has a huge role to play, and innovation, as was mentioned earlier. That will happen only if we have real devolution and integration at a local level. I am not in favour of a national social service, but one locally led by local leaders, with devolution of health, housing, DWP, skills and other budgets. Underpinning all this is the need for a cultural change, personally and as a society. The state has a crucial role in supporting those who need it, but it is also there to facilitate the changes we as a society need to make as we plan for our future. It is about facilitating as much as delivering. It is not just funding, it is housing, health and social care—it is culture. We need a radical structural change.
Lord Murphy of Torfaen (Lab)
My Lords, in 1983, I almost became the Labour candidate for Worsley. I did not, and I am delighted I did not, because we might not have had my noble friend Lady Keeley as the Member of Parliament for Worsley. She had a very distinguished career in the House of Commons and we all look forward very much to working with her.
Every Government have spectacularly failed on social care, including the one I was a member of. I want to refer very briefly today to the example of my own local authority in Wales: yes, I know the debate is about England but as the noble Lord, Lord Hunt, has said, it can also take best practice from somewhere else. Torfaen Borough Council has taken an initiative on adult social care. As we all know and have heard, there will always be people who will have to go into hospital and residential care, but most people do not want to do that; most people would prefer to stay at home. The impact of people going into hospital unnecessarily is, of course, delayed discharges and the enormous social and financial costs of that. Torfaen Council’s initiative is about ensuring that people remain in their homes as long as they can. It is a type of “care in the community plus”. I do not think that care in the community worked very well all those years ago, but the idea was good, and if there is an improved care in the community, as this initiative is, we can all learn from it.
My noble friend Lord Dubs referred to Hammersmith. Of course, if we look at individual local authorities, perhaps elsewhere can learn from them. Torfaen Council employs teams of community connectors, as it calls them, and these people liaise with carers, paid and unpaid, with the voluntary sector, with community groups, with churches, with community councillors, with the NHS and with GP surgeries. In other words, the whole local community comes together to look after its people and ensure that they stay in their homes. This might not seem possible, but I assure your Lordships that over the last couple of years it has proved very successful. Of all the local authorities in Wales, Torfaen Council is the best at dealing with and tackling delayed discharge. More and more people are staying in their homes. They have the confidence to do so and the ability and finance to do it. My plea today to my noble friend the Minister is, despite the fact that her remit does not go beyond the River Wye, nevertheless to be able to look at and even come to Torfaen and see the good work that it is doing. This work has been acknowledged by a substantial grant from research organisations; it is working; it is less costly than what is happening at the moment; and, above all else, it means that we can tackle, in the community, the problem that social care is at the moment.
Lord Freyberg (CB)
My Lords, like others, I congratulate the noble Baroness, Lady Tyler, on initiating this important debate and warmly congratulate the noble Baroness, Lady Keeley, on her excellent maiden speech. My contribution will focus on a rather niche area: the urgent need to fix social care data so that an evidenced-based social care strategy can be developed apace.
The head of the Office for Statistics Regulation, Ed Humpherson, said:
“I am responsible for regulating data across economics, employment, health and more and it is social care that stands out by far for its low quality or even absent data”.
The Data That Cares report and its precursor, published by Future Care Capital, highlighted in some detail the egregious neglect of social care data, as did the OSR’s subsequent publications on the topic. However, progress in remedying the situation has been slow.
How will the Government devise a comprehensive social care strategy if they lack robust information about demand and provision, including information about the estimated 25% to 30% of adults in England who fund their own care? I stress “estimated” because we do not know for certain how many adults are currently in receipt of care. How will the Government proceed if they cannot meaningfully compare public spending on different types of social care services in different places and connected with different providers for cohorts of working-age adults with different needs; and, crucially, if they lack access to reliable data about the quality of care currently provided, as laid bare in the Homecare Association’s recent report on the subject? Can the Minister provide some reassurance and confirm whether the Government intend to continue implementing the Care Data Matters road map and, if not, let us know what will replace it?
If I were to make one suggestion, I would recommend that the Minister make full use of provisions in Part 2 of the Health and Care Act 2022 and immediately mandate the collection of timely, standardised data, including financial data, from social care providers that wish to be registered with the CQC or take receipt of public funds in connection with service provision—or, better, extend the scope of those powers to help them better understand the unregistered and private care market. This should be accompanied by a commitment to reciprocity to help providers make the most of data sharing to improve provision.
In conclusion, I emphasise the importance of investing in data-driven and tech-enabled care, otherwise we are apt to neglect a dynamo which could drive up productivity in a sector beset by growing workforce shortages and, crucially, unmet need. The Government could instead support economic growth in the UK by investing in CareTech research and development to capitalise on the one global market that is guaranteed to expand over the coming years. The Minister could usefully support initiatives such as Care City and the social care test bed anchored by the University of Liverpool’s Civic Health Innovation Labs, working in partnership with the National Care Forum, in the interests of making swift progress. The time for procrastination has long since passed.
Baroness Brinton (LD)
My Lords, it is a pleasure to follow the noble Lord, Lord Freyberg. I completely agree with him about the importance of technology and data, and will refer to it later in my contribution. I declare my interest as a vice-president of the Local Government Association. I very much enjoyed the maiden speech of the noble Baroness, Lady Keeley. She and I first got to know each other very well during the pandemic, because we were officers of the All-Party Group on Coronavirus, which had a busy time—we can probably leave the rest of it there. I also know about her passion for social care. She is a very welcome addition to your Lordships’ House.
I congratulate my noble friend Lady Tyler of Enfield on securing this important and timely debate. She rightly said that the debate must be reframed, and this has been reflected in the thoughtful contributions from so many Members of your Lordships’ House. I also thank the House of Lords Library and the many organisations that have sent us briefings.
Our Lib Dem leader, Sir Ed Davey, made social care a core policy for the Lib Dem manifesto in the recent election. His experience as a child carer when his mother was ill and dying, as well as his parental role as a carer to his lovely son John, means that he knows at first hand how vital social care is, especially the role of unpaid carers. It is good that a party leader has put forward such a comprehensive package of measures to increase support for the vital work that unpaid carers do. I think this is the first time in living memory that one party has had social care as its principal policy.
The Lib Dems also point out that the current structures of the health and social care systems, as well as the failures in the structural funding of social care, have brought the sector close to catastrophic failure. It is worth going back and reflecting briefly on the Dilnot report, commissioned by Labour and published in 2010, just as the general election happened. That led all three major parties to agree to work together to accept it; that acceptance happened by 2013. Legislation even went through, and the Queen signed the Bill. As Sir Andrew said in a podcast,
“in politics 101, you learn that once the Queen has signed the Bill, you’re over the line”,
but after the 2015 general election, the then Chancellor of the Exchequer postponed it until 2020. Five years later, there is still no change.
The Dilnot commission recommended a partnership model with a much more generous means test and a lifetime cap of between £25,000 and £50,000 on social care costs, to ensure that the state steps in when people face catastrophic costs that cannot be planned for. Sir Andrew said:
“It was a recommendation for social insurance, collective provision, with a relatively large excess”.
That is why I thank the noble Lord, Lord Lilley, for his contribution on the need for nationally funded insurance in the future. We have heard him speak of this regularly during the passage of the Health and Care Act and on various other occasions. Will the Government now look at this?
The noble Baroness, Lady Warwick, outlined the financial problems that local authorities have with the 20% drop in accessible money. This is compounded by the fact that, as a result of demographic changes, the number of those needing care is continuing to increase. We are nowhere near the peak yet.
One key point that has not really been covered so far today is that disabled people’s care is treated the same as elderly care. It is certainly completely inappropriate to use the same financial systems. When the Government come to look at whatever the new financial systems are, will they use a different frame for young adults with disabilities, who do not have years of working behind them to have their own home and other resources?
The noble Baroness, Lady Murphy, spoke of the need for dementia training for all care workers, and she is right. The social care sector needs to learn from good practice, but dementia training should be compulsory.
Many noble Lords have already commented on the workforce issues. I will not cover those again, but I note that 25% of the workforce is not British and 27% of the workforce is aged 55 or over, compared with 31% of the workforce across the economy. This is particularly worrying, as our demography means the need for skilled care workers will increase. There will be a horrible hole in a very short period.
It was good to hear from the noble Baroness, Lady Neuberger, that the Rayne Foundation will provide grants for workforce improvement. I hope that demography among the workforce will be looked at.
As many noble Lords have said, we must professionalise the roles in care. We need regulation—my party favours a royal college of care—but also progression and career pathways, including apprenticeships and innovative schemes to make it attractive to young people. In the Netherlands, some care homes now offer free accommodation and 10 hours’ work per week to local students to live on-site. Not only does this help students see the reality of social care, but there have been two unexpected benefits that may surprise us. First, some of the students have changed their entire view about what they want to do after they graduate and are now working in social care. Secondly, the engagement of young people living in the home means that residents’ health is improving, including slowing down dementia.
I am reminded of a project I saw in Japan 20 years ago, where a group of 80 year-old war widows got together to do about five hours’ work a week, to give themselves some money to be able to communicate with families who lived off the island that they lived on. Their GP said their care needs went down 30%. Why do we not learn from that?
The noble Lord, Lord Jamieson, also talked about healthy living and social prescribing. Its substantial increase over the last four or five years is one thing that the last Government got really right.
My noble friend Lady Thomas of Winchester spoke of the breadth of skills and the attitudes of excellent carers. We should celebrate them and their contribution to individuals, but we must remember that they also contribute to society as a whole.
The noble Lord, Lord Hunt of Wirral, talked about the need for outcomes regulation, but that will not happen without the shift that he also discussed. The noble Lord, Lord Murphy of Torfaen, talked about good practice in his local area, but I also argue, as my noble friend Lady Thomas did, for the need for lifetime home standards in new homes—M4(2)—which would transform the lives of elderly people and stop them having to move out of their own homes. This goes way beyond the area of social care, but it could transform it.
The noble Baroness, Lady Browning, talked about early intervention for people, and she is right that that will certainly reduce the need for care. The increasing use of fracture clinics, not just to mend the bones but to invite physios and occupational therapists to work with people after their first fall, is reducing falls in later life once people are home.
The noble Baroness, Lady Donaghy, is right that there is no need for a commission—many noble Lords have said that—but we have to reframe a national care service on a par with the NHS. It should not be the whipping boy. The noble Lord, Lord Murphy, is right that local services are vital in that. The noble Lord, Lord Turnberg, was also right to speak about funding.
I thought that the right reverend Prelate the Bishop of Oxford’s care covenant was interesting. The Church of England’s policy working group, with its excellent values-based dialogue, is really important—as is kindness, which perhaps the CQC ought to look at. If you go into a home and see kindness, you know that, if it is led from the top, it pervades everything that happens in that home.
The noble Lord, Lord Freyberg, spoke of effective data. Thanks to Skills for Care, we have excellent workforce data, but he is right that we also need demand data.
The noble Baroness, Lady Thornton, talked about an effective integrated service. She is right that it works. The problem is the funding structures; they are a real issue. For example, in my mother’s last days, my brother and I witnessed the argument between the NHS and the local authority about whether her nursing needs in the care home were as a result of dementia or the fact that her osteoporosis had cracked her vertebra. That was a ridiculous debate. She was an elderly lady who needed nursing care, and that problem should not have been going on.
The noble Baroness, Lady Pitkeathley, is also right that resources must be shifted from the NHS to social care. I do not want to hear another Minister say that delayed discharges are the problem. Every single NHS Minister says that, but they never actually tackle the problem, which is to change social care.
I thank the noble Baroness, Lady Fraser, for the warning about what is happening in Scotland. We should learn from those errors, too.
Many others have spoken about unpaid carers. Although I have already covered that with the work that our leader does, we absolutely know that we will fail our carers if we do not identify carers of all ages. We must commit to secure funding for care services, otherwise we will push them to the limits. That is particularly important for young carers because of the risk to them of losing their education and other support systems.
If we are the usual suspects on social care, it is time that Ministers started to listen. We have not discussed housing, transport or community activities—all those will also help. Labour’s response since the election has been disappointing, and I hope that the confidence of the noble Lord, Lord Dubs, that things will happen under this Government is true, because the time for action is now.
Baroness Scott of Bybrook (Con)
My Lords, I thank the noble Baroness, Lady Tyler of Enfield, for bringing this important debate to the House today. I warmly welcome the noble Baroness, Lady Keeley, to the House and congratulate her on her maiden speech.
It is estimated that 10 million of us are affected by adult care services in England at any one time. It is fair to say that there are few of us whom this issue does not touch. We saw that very clearly today when seeing and hearing the noble Baroness, Lady Thomas of Winchester. Personally, it was lovely to see her in the Chamber once again, even though she was on a screen. Also, the noble Baroness, Lady Donaghy, made it very clear how important adult social care services are. Yet this is a sector facing profound challenges, and the Government are failing at the moment to provide detailed and costed plans on how they will support the social care system as it performs this most vital role.
The Opposition have concerns about the Government’s approach to adult social care for four key reasons. Many of the Government’s pledges lack detail, including on how exactly they will be delivered and funded; the Government’s policies fail to focus on the immediate challenges faced by the sector, with very little information on how the immediate industry stressors will be resolved; the Government have failed to set out a plan to end our reliance on foreign workers to fill vacancies in the social care sector; and they have failed to set out plans to recognise and support—as we have heard clearly today—unpaid carers. I urge the Government to listen the concerns of noble Lords in today’s debate and to take a pragmatic, detail-orientated and financially sound approach to reforming the social care system in England.
We have heard several pledges from the Government. The Labour manifesto pledged a “fair pay agreement”, with terms for pay and conditions, and training standards for adult social care workers. The Labour manifesto also included an aim to create a national care service and a “new legal right” for people in residential care to see their families. While these may be admirable statements, at the moment they lack crucial detail.
The “fair pay agreement” is set to be enmeshed in the Employment Rights Bill. However, this Bill is only being introduced to Parliament today. Although we welcome the Government’s intention to ensure fairness in the pay, conditions and training of carers, it is a shame that they have taken so long to publish the Bill, thereby failing to give the House ample time to examine the contents of the Bill before today’s debate.
It is also crucial that the Government focus on those who receive care, not just the workers in the sector. Can the Minister confirm to the House what practical steps the Government are taking to ensure that social care bills are affordable and that the services that people receive in the social care system are of the highest quality?
Given this lack of detail, it is unclear whether the Government have considered the most basic of governmental truths, “What is spent must be funded”. Unless pay increases for carers are matched by an adequate increase in local government funding, as we have heard, and direct financial support for older people, care providers and local council budgets will be further squeezed.
Regarding the national care service, there is little available detail on how this will evolve, how it will be set up or how much it will cost. Can the Minister confirm when we will see further plans for this service?
The Prime Minister has said that the Government are building a 10-year plan for healthcare reform which they expect to publish in spring 2025, after consultation. Although I am sure that this House will appreciate the need for a considered and long-term approach to social care, so any new system will be equipped to handle the care needs of an ever-ageing population, there are many pressing issues facing social care now.
With the Employment Rights Bill only just introduced, scant detail on the proposed national care service and the 10-year plan not due to be published for several months, it seems that the Government have no immediate plans to improve the state of social care in England.
In the year 2023-24, there were record levels of international recruitment for social care workers, while the sector struggled to recruit and retain domestic employees. More specifically, 105,000 international recruits started direct care roles in the independent social care sector in 2023-24, whereas the number of people in the workforce with British nationality shrunk by 30,000. Over the last two years, 185,000 international recruits joined this sector and the number of British workers fell by 70,000.
Clearly, the social care sector could not function today without the wonderful contribution of workers from overseas. We must be grateful to those who come from overseas to provide these vital services. Without them, many people would simply not receive the care they need.
However, in their manifesto, the Government pledged to
“end the long-term reliance on overseas workers in some parts of the economy by bringing in workforce and training plans for sectors such as health and social care, and construction”,
and to “reduce net migration”. The Opposition must ask the Government how they intend to honour their manifesto commitment to deliver lower immigration and wean the social care sector off overseas workers?
The 2021 census found that approximately 4.7 million people were providing unpaid care in England. This represented around 9% of the entire population and, as we have heard today—I thank my noble friend Lord Young of Cookham for making this very clear—that includes children. The report from the noble Lord, Lord Darzi, noted the “huge contribution” of unpaid carers. It called for a “fresh approach” so that the NHS can provide unpaid carers with support and treat them as an “equal partner” when working up care plans. However, the fantastic work of these truly selfless and very kind people is notably absent from the Government’s social care reforms. What steps are the Government taking to better recognise the invaluable contribution that unpaid carers make in our society?
Can the Minister tell us whether the Government will provide greater detail on what the “fair pay agreement” and the National Care Service involve, and when can this House expect to see a detailed cost analysis of the proposed social care reforms? Do the Government have any policies currently in play that will ease immediate pressures on the social care sector in England? I reiterate my earlier question: how do the Government intend to honour their manifesto commitment to deliver lower immigration and wean the social care sector off overseas workers? Finally, how are the Government going to support unpaid carers and ensure that their voices are heard during the creation of care plans?
Having a functional, efficient and, above all, compassionate social care system in England is of critical importance to all of us. Without this, there will be no way to relieve the strain on the NHS, which is currently treating those who would be much better served by local community care services. The Opposition urge the Government to listen to our concerns and urgently provide this House with detailed, costed and pragmatic plans for the social care sector in England.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
My Lords, I thank the noble Baroness, Lady Tyler, for securing this important debate—and very timely it is too, at the beginning of a Government’s time. I also thank noble Lords from across the House for their contributions. There was reference to the usual suspects being an extended group, and I certainly welcome that. I have noticed how balanced the numbers of contributions from all sides have been, which is not always the case when it comes to debates, particularly of this nature, and that chimes very well with the approach of this new Government.
It is a particular pleasure to congratulate my noble friend Lady Keeley on her maiden speech. Of course she chose this debate to make it. I would have expected nowhere else, because she brings tremendous experience, insight and sensitivity to this subject, and many others, and I am sure that we will hear much from her.
I welcome the opportunity to reiterate the Government’s commitment to social care, but also to acknowledge the role of unpaid carers. Like other noble Lords, I am pleased that the noble Baroness, Lady Tyler, was very specific in her title, and I will attempt to do justice to the title as I continue.
I share, as have other noble Lords who have said similar, my tribute to all those who provide care and support for family and friends, both those who are unpaid carers and those who work as care professionals. I use the word “professionals” deliberately, because they make a vital contribution to communities and the well-being of individuals up and down the country. They show tremendous dedication and skill in doing so.
It is important to note that today also marks World Mental Health Day. As I hope noble Lords are aware, improvement of mental health outcomes is an absolute priority for this Government. My noble friend Lady Pitkeathley was quite right to speak about the impact on the mental health of carers.
I turn to what our approach will be and the state of social care. I, like other noble Lords, acknowledge the current state that we have inherited coming into government. People are suffering without the care that they need. They are fighting complicated and complex systems, as noble Lords have described, often just to receive a quality of care that is not what it should be. There are inconsistent standards and chronic staff shortages, and people are not always treated with the care, dignity and respect that they deserve. In his independent investigation into the National Health Service, the noble Lord, Lord Darzi, outlined that, in recent years:
“Social care has not been valued or resourced sufficiently, which has both a profound human cost and economic consequences”.
We are all living longer, and that is increasing the demand for adult social care services. For the first time ever, in 2022-23, over 2 million requests for adult social care support were received by local authorities. The London School of Economics projects that demand for publicly funded social care will rise by 43% between 2018 and 2038, as a direct consequence of the demographic pressures to which noble Lords have referred.
Despite growing demand, access to local authority-funded adult social care has declined, as the number of people receiving long-term care has decreased since 2015-16. This is our starting point, along with the economic situation in which we find ourselves, including the £22 billion black hole. It is against that context that we will tackle this issue.
While there is no doubt about the appalling state of adult social care at present, there were a number of questions about a royal commission. We will be setting out the next steps—I look forward to updating your Lordships’ House on this—to build consensus on a long-term plan and comprehensive strategy. That will be through a process of consensus called for by noble Lords, including the noble Baroness, Lady Neuberger, which engages stakeholders and those with lived experience, and is cross-party. That is why I take particular pleasure in hearing contributions from around the House today.
It is important to remember—the noble Baroness, Lady Fraser, and my noble friend Lady Warwick made this point—that social care includes around 300,000 working-age disabled people who, without social care, would not be able to lead their lives, contribute to society and, in some cases, participate in employment. My noble friend Lady Warwick referred to a wish to see the ability to lead a gloriously ordinary life, and the noble Baroness, Lady Fraser, talked about the need for flexibility. Both are absolutely right, because that is what social care should do. Our ambition is for care to be tailored to people’s needs and circumstances, and to be delivered by a professional, qualified and valued workforce.
It is important that social care prevents people developing more acute needs, rather than intervening just at the point of crisis. Let us also consider the contribution to the economy and the potential for growth. With more than 1.5 million staff, the adult social workforce is larger than those of the NHS and the construction and transport industries.
As I mentioned earlier, I agree with the noble Baroness, Lady Tyler, who also spoke of the need for working collaboratively. My honourable friend the Minister for Care, Stephen Kinnock MP, has already held two significant round-table meetings, one with people with lived experience and unpaid family carers, and another with key stakeholders in the sector. I mention it because this will be the way that this Government continue to address the challenge that we have before us.
What will the government action be? The 10-year plan will set out what joined-up looks like. My noble friend Lady Thornton raised some first-rate examples, particularly focusing on the way that the Whittington assists with support for social care, and I am grateful to her for that.
Here is what we will do. We will move from treatment to prevention. We will support local systems to prioritise early intervention, to begin to address unmet care needs and reduce the pressure on the health service and other services. There will also be a shift from hospital to home, which noble Lords have called for, and more care in the community. We will see more neighbourhood health centres, which bring together a range of services to ensure that, under one roof, healthcare is closer to home. There will also be a shift, called for in today’s debate, from analogue to digital: I can assure noble Lords that we are exploring how to build on existing progress towards digitising social care records.
On housing, the noble Lord, Lord Jamieson, rightly made the point that it is about having the right housing for the right time in our lives. This Government are committed to delivering 1.5 million quality homes over this Parliament to ensure that people have access to quality housing, and that will support people to live independently in a place that they can call home.
In the course of the debate, there has been much reference to the Government’s plans for a national care service: I have heard enthusiasm, caution and concern, which covers the whole range. This Government are fully committed to building a national care service. This will be one where care is delivered locally and will be what people need, but it will be based on national standards to improve the consistency of care. I believe that that will help to build trust and give reassurance on the quality of care being received by those who need it and will build confidence and trust among their families and carers.
I turn to the workforce. My noble friend Lord Turnberg was right to say that staff are undervalued. As I said in my opening speech, we want to see care and support workers regarded as professionals and for those who work in care to be respected accordingly. We will establish the first ever fair pay agreement for those working in adult social care. I am glad that the noble Baroness, Lady Thomas, described care workers as truly being on the front line—I recall that she said that they are worth their weight in gold, and I understand why she says that. We will engage with those working in the social care profession, and with the trade unions, stakeholders and providers, in order to make sure that we can have that agreement.
The noble Baroness, Lady Scott, asked how funding will happen. We will consult widely on how we design the fair pay agreement, because we have to engage with all those who will be affected by it. I can give an assurance that all voices will be heard, so we can ensure that the financial impacts on the adult social care market, local government and self-funders will all be considered. I am pleased that the Government are fulfilling a manifesto commitment to bring forward legislation in the first 100 days of entering office by introducing the Employment Rights Bill. That signals the first phase of delivering an adult social care fair pay agreement.
In addition, since entering government we have launched the learning and development support scheme, helping care workers and their managers to complete courses and qualifications, gain recognition for existing expertise and develop new skills and specialisms. We will continue to develop the care workforce pathway, which is a new national career structure for adult social care. Again, noble Lords are absolutely right to call for this.
I turn now to another crucial part of the debate, unpaid carers. There are 4.7 million unpaid carers in England providing unpaid care for those they want to ensure live the best life they can. Some 1.4 million are providing more than 50 hours per week. The noble Lord, Lord Young, talked about 3,000 of those being five to nine year-olds. I absolutely agree that their needs are entirely different, so NHS England will support the ongoing identification of young carers by producing young carer GP guidance and using data to inform greater join-up between health, education and social care, in order to support those families where it is needed.
Unpaid family carers have to look after their own health and well-being, not just that of those they care for, and they must have the support to do so. The noble Lord, Lord Darzi, was clear that a “fresh approach” is needed to improve support for unpaid carers and the outcomes for those they care for. We will be carefully considering those findings as part of our 10-year plan and as we develop the plans to reform adult social care.
I want to assure noble Lords today that we have heard the calls, including from my noble friends Lady Pitkeathley and Lady Keeley, for a cross-government carers strategy. This has to be addressed in the wider context of an urgent need for a renewed vision of adult social care. As we do that, we will consider how we can best support unpaid carers, because we are committed to ensuring that families have the support they need. We will be collaborating with our counterparts across government, unpaid carers and sector partners to make sure that unpaid carers are visible and not “rubbed out”—as the experience of one unpaid carer was described; and I am sure that they are not alone—and that they are supported.
May I, too, give a virtual hug to my noble friend Lady Donaghy? She is probably a bit overwhelmed, but in my experience you can never have too many hugs.
I recognise that many unpaid carers can face challenges in balancing employment with caring. The Government’s plan to make work pay sets out an agenda to ensure that workplace rights will be fit for modern times and empower working people, including those who provide unpaid care. This Government are committed to delivering this plan in full, reviewing the implementation of carer’s leave and examining all the benefits of introducing paid carer’s leave.
The right reverend Prelate the Bishop of Oxford and my noble friend Lord Dubs were right to emphasise the need for respite and carer breaks. The better care fund includes funding that can be used for carer support, including short breaks and respite services. I know it is not making the major difference noble Lords are seeking, and that will be part of our considerations.
The noble Baroness, Lady Meacher, referred to financial support for unpaid family carers. Understandably, unpaid carers often turn to the benefits system for financial support. We will be keeping the carer’s allowance under review because we want to see whether it is meeting its objective to give unpaid carers the help and support they need and deserve.
My noble friend Lady Donaghy, the noble Baroness, Lady Tyler, the noble Lord, Lord Jamieson, and other noble Lords asked what the Government are doing about funding pressures. We recognise that local authorities are facing significant challenges in funding adult social care. We will be working closely with them because we acknowledge that the distribution formula has not been updated for a decade, and we will be working with Ministers at the Ministry of Housing, Communities and Local Government to address that. I am grateful to my noble friend Lady Donaghy for acknowledging that the timing of the upcoming Budget constrains my ability to comment on funding, and I hope noble Lords will be kind and be sympathetic to that point.
My noble friend Lady Keeley raised the issue of those with autism. The number of people with learning disabilities or autism in mental health hospitals is unacceptable, and too many people are still being inappropriately detained. I look forward to our proposed reforms to the Mental Health Act to ensure that people get the support they need in the community.
My noble friends Lord Murphy, Lord Dubs and Lady Thornton gave great examples of good practice. I assure them and other noble Lords that we are looking at best practice and the reforms we will make for social care, the social care workforce and unpaid carers in order to change the landscape. It will not be easy. We start with a very challenging inheritance, to put it mildly, but we are determined to get there, and I am grateful to noble Lords today.
Baroness Tyler of Enfield (LD)
My Lords, this has been an excellent debate with some moving and heartfelt contributions that will live long in my memory. I congratulate the noble Baroness, Lady Keeley, on her maiden speech; she will make a tremendous contribution to this House. I am grateful to noble Lords who were able to touch on subjects such as housing and digital transformation data, which I could not cover.
I thank the Minister for the tone of her response, which was comprehensive and covered a number of points I was hoping to hear about. I particularly welcome the emphasis she put on working collaboratively and on a cross-party basis; that is important. I understand the need for 10-year plans and long-term planning, but they make me a bit nervous because I worry that they mean nothing will happen very quickly. If there is one message from today, it is that action needs to start now.
Wonderful ideas and solutions have been generated by noble Lords from across the Chamber, and I hope the Government will look carefully at the ideas put forward. A lot of them—I tried to do this myself—could happen in the short term, relatively quickly and at a relatively low cost, to kickstart things and get some real momentum. I very much hope that we can continue to have debates in this Chamber in this vein and that we can make a real contribution to the social care debate. Noble Lords can rest assured that these Benches have many things we want to put on the table. We want to work collaboratively, but we will be holding the Government’s feet to the fire.