NHS and Social Care: Winter Service Delivery

Baroness Pitkeathley Excerpts

Thursday 25th January 2018 Lords Chamber

[Baroness Pitkeathley (Lab)]

My Lords, I have lost count of how many debates on these and related topics I have taken part in during 20 years in your Lordships’ House, but that does not make me any less enthusiastic about taking part in this one or make me offer any fewer congratulations to my noble friend on securing it when both the topics and the timing are of the utmost importance.

I might shock your Lordships today if I stand here and say that there is no winter crisis in the NHS and that there are no problems in the NHS. But in one sense, many would say that is right. The cancelled operations, the ambulances queuing, patients dying in corridors and all the rest are actually a crisis of social care, not of the health service. Health service budgets may be ring-fenced, but social care has lost about £6 billion from its total spend, and a 50% rise in the number of people especially elderly people, stuck in hospital is because there is nowhere for them to go in the community. Nearly 1,000 care homes have closed and 30,000 care home places have been lost because the providers can no longer afford to operate on the money they receive from the state, especially in areas where there are fewer wealthier self-funders, who cross-subsidise the places which are paid for by the state. By the way, this is another scandal waiting to happen, as it is in effect a stealth tax.

The last time that I spoke on social care I said that I was beginning to see a bit of light at the end of this long, dark tunnel, as there seemed to be some kind of consensus, at last, about the fact that this issue had to be tackled, even if there is no consensus as to how. Since then, we have seen the Secretary of State for Health add social care to his title, which I acknowledge is a step forward, even though there has been no change in how the budget works, with the purse strings for social care still apparently held at the DCLG. The result is the chaos we have seen all too frequently.

I am sure the Minister will tell the House about areas where pooled budgets are working well. I applaud those, but let us not forget that the reason we are seeing the growth of things like accountable care strategies and strategic partnerships is that local people are having to find ways to work around the fragmented system that was set up with the disastrous reforms of the Health and Social Care Act 2012, under which nobody knows who is in charge and decision-making is complex and fragmented.

Of course, what anyone who has been in A&E this winter will tell you are tales not only of chaos and pressure but of the hard work and commitment of dedicated staff doing their best against the odds. Another lot of people doing their best against the odds are the carers, already mentioned by my noble friend—who brings such valuable experience of her own as a carer to your Lordships’ House.

We must never forget the contribution of carers to social care, which is worth £132 billion every year, but neither must we forget the cost to the carers themselves. Three-quarters of carers report that their own health—physical or mental, and mostly both—is adversely affected by their caring responsibilities, while the financial strain of caring is well documented: not just the immediate costs of extra heating, transport and specialist food but the loss of future income because of lost earnings and lost pension provision. We should also remember that many people in the health and care workforce, struggling as they are to cope at present, are also juggling that work with their caring responsibilities. How are they supposed to make arrangements when they are given no notice of hospital discharges and given no choice at all about providing care for a loved one?

However, not involving carers is short-sighted and makes neither economic nor moral sense. That is why the failure to produce the long-promised carers’ strategy has been a great disappointment and disillusionment to the carer population—two years, we have waited for it. Of course the Minister will say their needs are to be included in the Green Paper on social care, but, as my noble friend asked, where is the action plan that was promised as a stop-gap? What will it cover? How will it be implemented? When may we expect to see it? We need urgent answers, and I hope today we are not going to be fobbed off with, “It will appear in due course”, which seems to be the Government’s answer to everything at present.

The Secretary of State is now in charge of the promised Green Paper and we simply must hope that he will find a way to rectify the decades of debate followed by inaction that we have had on social care. Heaven knows, debate has not been lacking: royal commissions, Wanless, Barker, Dilnot—your Lordships will be familiar with them all. But they have been followed by indecision upon indecision about how we are to tackle the complete unpredictability of the cost of care for families. It is literally a lottery where some of us pray we will die of cancer, and therefore get our care funded by the NHS, and not of Alzheimer’s, when we or our families will have to bear the burden. The only fair solution is to pool the risk between as great a number of people as possible so that everyone loses something but no one loses everything.

Of course, how social care is to be funded in future is a political decision, and surely if this winter has shown us anything, it is that such decisions cannot be put off and kicked into the long grass as successive Governments have done for 30 years. Is a consensus emerging, for example about a hypothecated tax? The chair of the Health Select Committee believes that national insurance could be extended to those over retiring age. Could some of us better-off pensioners—I include many in your Lordships’ House in that—forgo our £200 Christmas bonus and our free prescriptions? I know there are anxieties in all parties on this topic. My own party worries about the charges of a “death tax” that were made about our proposals in 2010, and no doubt the Government are still bruised by accusations about a “dementia tax” made at the time of the last election. But with the numbers of people over 85 set to double by 2039, there is no more pressing problem that our nation faces—even Brexit, although that will bring its own problems.

The snowdrops are out, the weather is milder and the winter crisis may be receding, but the respite is only temporary. Let us not have this self-same debate next January. We need political courage and leadership, and now is the time to show it.