Health and Social Care

Baroness Brinton Excerpts

Thursday 24th November 2016 Lords Chamber

[Baroness Brinton (LD)]

My Lords, I add my gratitude to that of other noble Lords to the noble Baroness, Lady Finlay, for nominating this debate on a vital matter. For me, it does not matter that we have debated this issue already this month; until the Government start to hear and understand the serious concerns, we shall be repeating it regularly.

Although most of my comments will be on social care, I want to start with a conversation I had with two nurses at St Thomas’ Hospital yesterday as I was leaving. They said to me, “You work over the road, don’t you?”. I said that I did, and they continued by saying, “We are just struggling to understand what on earth Brexit is all about. We knew during the campaign that that £350 million a week was not real, but we do not understand why people believed it”. Patients still talk to them about the extra money that the NHS is going to get. They said that they see crisis after crisis going on around them in what is an absolutely excellent hospital. I make no more comment than that, but it is clearly something that is troubling the workforce.

Others have commented on the size of the social care sector—a 1.3 million workforce. As other speakers have already outlined, struggling with the demography alone in Great Britain would put it under pressure, but it is facing a perfect storm. We need to add in the cuts to local government funding, the inability of the Government to commit to delivering Dilnot to really harmonise health and social care, and the Government’s relentless focus on reducing immigration. That is before we even start to consider the financial consequences of Brexit, as outlined yesterday by the OBR.

Independent Age and ILC UK research has looked specifically at social care workforce issues and their modelling shows that the closing off of migration will have a dramatic effect. There will be a social care workforce shortfall of 750,000 people if the Government achieve their objectives of only tens of thousands of immigrants into this country. Even under the high migration scenario, a shortfall of 350,000 is likely purely because of our ageing population. London and the south-east would be worst hit, because one in nine of the capital’s care workers are at risk of losing their right to work here.

There is a further problem in the sector of a very high turnover rate of around 25%, and an estimated vacancy rate of 5.4%, which rises to 7.7% in domiciliary care. The King’s Fund paper, Five Big Issues for Health and Social Care after the Brexit Vote notes that, immediately after the referendum,

“Bruce Keogh, NHS England’s Medical Director, and Jeremy Hunt, the Secretary of State for Health, have both publicly sought to reassure European staff working in the health service”.

They said:

“We endorse these views but would go further: providers of NHS and social care services should retain the ability to recruit staff from the EU when there are not enough resident workers to fill vacancies”.

Can the Minister provide encouragement not just to doctors, nurses and other clinical healthcare professionals but to those who absolutely fill the important jobs in the healthcare sector who have either low or no skills, such as healthcare assistants, cleaners and catering staff, so that they will also have the facility to come to work in the UK to provide vital services?

I turn to the specific experience of people in the social care system, which at the moment is really struggling with seven older people per care worker. By 2037, the projections show that that figure will almost double to 13.5 older people per care worker. That is very alarming, especially as we are relying on the care sector to relieve the pressure on hospitals. How on earth we expect the service to be able to be delivered with even fewer staff is quite extraordinary. London, as I have already mentioned, is especially reliant on migrant care workers. Nearly three out of five of its social care workforce were born abroad and, in recent years, the percentage of EEA workers has increased. Although the overall average does not look particularly large, EEA migrants now make up more than 80% of new entrants to the profession. With the turnover rates to which I have referred of one in four, the consequence of any restriction on EEA workers will be severe and rapid.

On the effect already of the pressures in the social care system, Age UK says that the number of older people in England who do not get the social care that they need now has soared to 1.2 million, up by 48% since 2010. Nearly one in eight older people are struggling with the help that they need to carry out everyday tasks, such as getting out of bed, going to the toilet, washing and getting dressed. Among that 1.2 million, nearly 700,000 do not get any help at all because, as we know, the moment there is pressure on services, the criteria for accessing help keep getting harder and harder.

My right honourable friend Norman Lamb has said that the health and social care systems are “living on borrowed time”, with more providers moving from publicly funded systems to focus entirely on private care. He said:

“The social care system always loses out in comparison with the NHS, and that’s the case even when the money was flowing”.

Under the later years of a Labour Government, there was a real disparity between the NHS and social care; in one Budget, the NHS was awarded 4% and social care just 1%. That is why the Liberal Democrats continue to call for a cross-party commission to address the problems of health and social care funding. We need to address that, and the impact of Brexit on both sectors.

The better care fund, in the coalition, was a small but helpful start, but it remains only a small contribution. Implementing Dilnot is urgent and overdue. Yesterday’s Autumn Statement failed completely to mention health and social care funding. The Alzheimer’s Society in its very helpful briefing made the very important point that, regardless of any changes in migration policies, the Government must make social care an attractive career pathway. Shortfalls in staffing are leading to social care providers failing. Already there is evidence, not just in the health and social care sector but more widely, that EU and EEA workers are leaving the UK because of the uncertainty following the referendum results. With a rapid turnover in the workforce, the consequences will be felt very quickly.

Finally, after all the doom and gloom, I wanted to end on one positive note about the diversity of social care staff. My mother, after one of her strokes, suddenly started speaking French—she had spent a lot of time in France in her childhood. The home went out of its way to find a French healthcare assistant to be moved to her ward and, as a result, she understood them and, importantly for her, someone understood her, and she was able to communicate easily. That is the social care system at its best. We need as a nation to understand that we have to resource it effectively to do its job; it cannot do it on thin air.