Social Care in England

Baroness Finlay of Llandaff Excerpts

Thursday 14th October 2021 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, I congratulate the noble Baroness, Lady Pitkeathley, on obtaining this debate, her important opening speech and her constructive suggestions. I welcome the Minister to his crucial role in the future well-being of the nation. I must declare that I chair the National Mental Capacity Forum and am vice-president of Marie Curie, which provides a great deal of care to people in the community as they are approaching the end of life.

Looking forward, we must fix social care properly. I have worked for decades with social carers in an integrated way through the hospice movement, where it is evident that those providing social care are an essential support to people with severe and life-limiting illness, and to their families. Without input from social care, families would break. Where there is a young parent who is ill, their children need to know the person who is coming to provide support to their parent—a person to whom they often look for emotional support also. Where a child or young person has learning difficulties compounded by physical problems, their social care is literally a lifeline for all in the family. Let us not forget the underage carers in so many families.

No one should think that social care is simply about washing, dressing and eating. It plays a vital role to enable the carers of people at home to cope with their own lives, go to work, go to school and study, and manage all aspects of the home. For the person, social care can make all the difference between feeling a burden, worried that one’s family is being worn down, and being able to function still in one’s role within the family and society. Where good social care is in place, people with profound disabilities are often still able to work with the support of different aids and adaptations, and I have been struck over the years by the number who have run businesses, written papers and even books. It is their carers who they praise as the person enabling them to do this.

Sadly, Marie Curie found that, during the pandemic, 61% of carers said that the person who had died had not had all the help that they needed with personal care before dying at home. More than three-quarters of carers said they did not receive all the care and support that they needed. It is the carers who spot when somebody is less well and when things are deteriorating, and is often the person who triggers the call to the GP or district nurse to come in and diagnose what has changed, alter medication and review the way in which an illness is managed. No one should think that these carers are unskilled or low skilled; they are not. They are very skilled and often have a wealth of experience.

When I was medical director of the hospice in Cardiff, I often looked to the care assistants just as much as the trained staff for important information on patients and families. They spotted whether families were behaving oddly. They would alert me to changes in a person’s condition because, when they took them to the bathroom or helped them with the meal, they spotted changes early. Patients talk to carers because they are not part of the power differential between professionals and patients. Patients often tell doctors and nurses what they think they want to hear, but will be much more open and frank with carers about worries and concerns that they may feel are too trivial to trouble trained staff with but are crucial.

Social care is essential to free up places in hospital. Carers should be there when somebody comes home; that transition from hospital to home is a vulnerable time both physically and psychologically, particularly for those who live alone. If hospital discharges do not happen, the backlog right through the system to the ambulance at the front door of A&E only worsens. It has been estimated that NHS bed days lost to delayed hospital discharges rose by 50% between 2015 and 2017—before the pandemic—when the number of beds available was decreasing in the hospital sector. This, of course, produced greater pressure.

Social care work is hard work. There is a workforce turnover of more than 30% and we must be able to retain skilled and experienced care workers by making sure that this is an important, high-status job, and that the travelling time between clients’ homes is recognised. For those who are unpaid family carers, we should consider carers’ leave, particularly when they are caring for someone who is dying at home.

As we move forwards, the reforms set out in the Health and Care Bill should ensure that every part of England is covered in an integrated care system, with close collaboration between the NHS, local government and other partners. However, it is deeply concerning for people living with terminal illness that there is no requirement on integrated care systems to ensure that they commission palliative care services. I therefore give notice that I will be bringing forward an amendment to the relevant Bill and I hope that the Minister will be able to assure me that the Government will consider carefully amending the Health and Care Bill to include a requirement for every integrated care system to arrange for the provision of specialist palliative care services to meet the needs of the population. Everything must be integrated for the benefit of all.