Queen’s Speech

Baroness Bakewell Excerpts

Tuesday 22nd October 2019 Lords Chamber

[Baroness Bakewell (Lab)]

My Lords, I regret the cursory reference in the gracious Speech to the social care needs of the old in this country. The Minister’s statement this afternoon has been confined to sums of money, some of which have already been announced. It was money that she spoke of; there was no substantial commitment to make changes to the system at a time when so much needs to be done. I will make two points which apply to the core issues of the care of the seriously old.

First, when I served as the Voice of Older People between 2008 and 2010, I received many letters asking for help with a problem concerning residential retirement homes and villages: many elderly people had come to rely on the expertise, availability and friendship of the wardens appointed to their care. These wardens were being phased out in favour of electronic alarms, buttons and telephone responses. Years later I sat on this House’s committee looking into AI and its potential. It became clear that artificial intelligence and robotic systems would increasingly offer an efficient and economical way of caring for the isolated old. I wish to issue a warning: old people want and need human contact; it helps them fight depression and loneliness in a way that machines cannot. I ask that future provision, while making strategic use of mechanics, has written safeguards about sustaining human contact with the old and isolated.

My second point is on a larger scale and concerns the business model that underpins the provision of residential care homes across the country: this needs a major rethink. I can only hope that the repeated delay of the long-promised Green Paper is because someone somewhere has woken up to the fact that the system is broken. The well-being and sense of security of frail, old people is at the mercy of the private equity-style business model, with the risk of companies carrying heavy debt burdens and paying extremely high interest rates.

The care home market, as noble Lords will know, is currently dominated by four major care providers: HC-One, Four Seasons, Care UK and Barchester. Between them, they operate some 900 of the country’s 11,000 care homes. Some 95% of the country’s care beds are provided by the independent sector, catering for self-funders and the local authority-supported. Recent austerity cuts to local council funding and the introduction of the living wage have added to pressure on all these companies. Between 2015 and 2019 the big four declared losses totalling £900 million. In their 2017 published accounts their total debt was £2.2 million—I am quoting figures from their own statements as reported by Opus Restructuring. Noble Lords will remember that Southern Cross collapsed in 2011. Currently all four companies are up for sale. A deal for the sale of Barchester collapsed in July this year and Four Seasons put two of its top companies into administration in April this year. Now I am not a banker, and for all I know this is a really healthy state of affairs in the City, but it is not a safe, reliable model for the ongoing care of our older people.

Let us consider it from their point of view. The need for a care home often hits a family very suddenly: the death of a married partner may leave the children looking to provide for the survivor as soon as possible; a frail old person living alone may sustain a sudden injury or a sudden deterioration in health. They need to find somewhere quickly and to meet the complex financial arrangements that have to be made. There is now evidence that companies prefer to set up care homes in the country’s most affluent areas, where there will be more self-funders in their potential market. The market will thus fail to supply the needs of the poorer old, and sudden changes in company finances can leave old residents suddenly bereft and bewildered. Family decisions made quickly in the shadow of bereavement or illness can be the wrong choices, but making complaints or seeking redress is not easy when you are dependent on the staff of the care home. I hope the Minister will address the issue of embedding consumer law in the regulatory regimes of care homes.

Growing old is not an option we can exercise: the alternative is worse. No sector in our society is crying out for reform more than our care of the elderly—and, incidentally, their dedicated and underpaid care workers. Will the Government address these concerns with the greatest urgency, and can they give us a timescale?