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.