Social Care Strategy

Baroness Merron Excerpts

Thursday 10th October 2024 Lords Chamber

[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.