Care Services: Elderly People

Baroness Pitkeathley Excerpts

Wednesday 6th March 2013 Grand Committee

[Baroness Pitkeathley]

My Lords, I am grateful to my noble friend Lord Turnberg. When I knew I was going to be able to speak in this debate, I went back to a book I wrote in 1988 and there I found a quotation from Kathleen Jones in 1972. This is what she says about community care:

“To the politician, ‘community care’ is a useful piece of rhetoric; to the sociologist, it is a stick to beat institutional care with; to the civil servant, it is a cheap alternative to institutional care which can be passed to the local authority for action—or inaction; to the visionary, it is a dream of a new society in which people really do care; to social services departments, it is a nightmare of heightened public expectation and inadequate resources to meet them. We are only just beginning to find out what it means to the old”,

and “the chronic sick”. When I read that, I was so depressed that I thought, “Have we moved on at all since 1972?”.

What has changed hugely, as many noble Lords have reminded us, is the numbers. There are many more people now in need of community care, but we can agree that the key thing needed for the care of the so-called rising tide is a sufficient supply of good quality community care focused on the needs of the user and their carers. I hope the Minister will agree that this is the most urgent problem facing our society today. It is bigger than education, defence or, above all, the acute sector of the NHS, although sometimes one feels like a traitor for saying that.

The Francis report on Mid Staffs may be a very worthy document, but I submit that it has done us no favours by focusing our attention on the care of elderly people in hospital. Just sort it out, goes the view: appoint a hospital supremo and all will be well. As we all know, that is nonsense. Hospital care provides a tiny proportion of the need, and the real problem so far as older people are concerned is that far too many of them languish in hugely expensive hospital beds, as we have heard, simply because not enough care in the community is available. As one of the witnesses to the Joint Committee on which several of our colleagues have been serving said, community care is always the poor sister of the NHS. The social care system is in crisis, as we have heard, and we shall never solve it, perhaps, unless we learn to rebalance spending and attention between NHS care and social care.

Social care is very good value if we do it right. Am I hopeful? Do I still feel as depressed as I did when I read that quote from Kathleen Jones? I think some progress has been made. The Government have made a step—perhaps a small one—towards accepting the proposals of the Dilnot commission. The Care and Support Bill will come to us during the course of this year, we hope, which gives not only new rights for users and carers but new responsibilities to local authorities to give information, advice and advocacy when assessments are being done. The committee called more than 60 witnesses, and every one of them raised the issue of resources.

When it comes to community care, we always hear that we cannot afford it, but as Andrew Dilnot has powerfully said, it is not a question of cannot afford it but of will not afford it. The noble Lord, Lord Turnberg, has given us some ideas about how we could find the money, and I remind the Committee, as I have done before, that when we accepted the proposals of the Beveridge committee, we were absolutely skint as a nation. We were in the middle of the Second World War and had no money and no prospect of getting any, but we still accepted that visionary report. I maintain that we can do it again. I also maintain that getting care in the community right could be a vote winner because it is no longer about poor services for poor people. It touches everybody. I am sure that everybody in this Room has experienced trying to find community care for themselves or their relatives—or they will within the course of the next year or so. I believe it is something that affects everyone, and therefore it is a very attractive idea for political parties to embrace as we approach a general election. I am sure many of us will be looking at what is said in manifestos about that.

Finally, care in the community, however we improve it, largely means care by the community, and community largely means your family, so I must point out, as I do at every opportunity, that the contribution of unpaid carers is £119 billion. It makes sound economic as well as moral good sense to support them as the main providers of care in the community.