Social Care Strategy

Baroness Brinton Excerpts

Thursday 10th October 2024 Lords Chamber

[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.