Social Care in England

Baroness Pitkeathley Excerpts

Thursday 14th October 2021 Lords Chamber

Moved by

[Baroness Pitkeathley]

To move that (1) this House takes note of the challenges facing Social Care in England following the pandemic, and (2) further notes the effect that (a) the Health and Social Care Levy, and (b) Her Majesty’s Government’s Social Care plans, may have.

[Baroness Pitkeathley (Lab)]

Well, my Lords, here we are again. In the 24 years I have been in your Lordships’ House, I have lost count of the number of debates on social care in which I have participated, joined by the intrepid band to whom I usually refer as the “usual suspects”. In fact, at times we have found it difficult to fill a debate, so unpopular was the topic. I am glad to note that it is very different this time; many want to speak. Of course, the Minister is very much not a usual suspect, so we welcome him and hope he will be accommodating and bold in answering this debate, as I have always asked Ministers from all sides to be.

The debate, like Gaul, is in three parts and reflects the new situation in which we find ourselves since our last debate in April 2020. We have come through a pandemic and at long last—at very long last, many of us would say—have some government proposals addressing the crisis in social care which in the past we all agreed—the degree of consensus on this was remarkable—was bad for everyone concerned.

The Public Services Committee, of which I am a member, concluded that while the crisis in acute care during the pandemic was dealt with relatively successfully it was followed by a devastating crisis in adult social care. Older people and working-age disabled people with care needs were left particularly vulnerable. The large number of deaths in this group may have been the most significant public service failing in the pandemic. These were due to the pre-existing weaknesses to which we have been pointing for years, including the lack of integration between health and social care, and successive Governments prioritising the NHS while neglecting to fund social care adequately.

These problems are far from new. Many inquiries, including parliamentary inquiries such as that by the Economic Affairs Committee, have focused on the need to fund adult social care properly, put more focus on prevention and address the poor integration between health and care services. The Covid crisis highlighted the effects of all these long-standing problems between health and social care and, as Age UK put it, “laid bare” the stark inequalities of the current social care system and

“revealed the true extent of the impact underfunding, structural issues and market instability have had on the system’s ability to respond and protect … people at a time of crisis.”

The initial pandemic response made protection of the NHS a priority, which had a detrimental effect on social care. The rapid clearing of hospital beds revealed too little consideration of the fragility of care settings and resulted in too many deaths.

Inevitably, I must focus on the effect on unpaid carers—as your Lordships know, I always emphasise them—who are propping up whatever system of care we have. Let us be clear about the numbers, which are provided by Carers UK. There were 9 million unpaid carers across the UK before the Covid pandemic, providing everything from a few hours of support a week to intensive and complex round-the-clock care. The pandemic has resulted in about 4.5 million new carers, 2.5 million of whom are trying to juggle paid work with caring. This takes the estimated total number of carers to 13.5 million and the annual value of what they contribute is now estimated to be £193 billion every year.

Carers have been particularly hard-hit by Covid and many have had to make extremely difficult decisions about work and family. Some 81% say they are providing more care because services were closed or not available due to lack of PPE and care staff self-isolating or having caring responsibilities themselves. Yet the Build Back Better plan hardly mentions unpaid carers or how they will be supported. The Government have assured us that the forthcoming White Paper will address this, but when the Secretary of State for Health and Social Care said in his speech to the Conservative Party conference that care “begins at home” and people should turn to family first, it was hard to believe that the Government understand that this is precisely why there are 13.5 million carers. They do turn to their families first. His remarks were seen as uncaring and disrespectful to the millions of carers who never questioned their duty to their family.

Let us try to be positive and thankful that at least the pandemic has made us focus on social care more than ever before. The government proposals for which we have been calling for years have now come out, so I will turn to those.

That the social care sector needs more money and that this money should be found from taxation is never in doubt. However, there is puzzlement, even bewilderment, in most agencies about the Government’s chosen method of raising these taxes, using a levy on national insurance. Let us face the stark fact that not a single penny of the money raised by this method will go to front-line social care. We know that it will initially go to the NHS, for at least two years. I do not begrudge the NHS the money. Having just been told that I have to wait 42 weeks for a telephone conversation with a consultant, of course I do not begrudge it. I just do not want anyone to be conned into thinking that the tax raised by the levy will solve social care problems.

Even after social care—endlessly the poor relation whenever reforms are discussed—gets any of the money, it will go to helping a small number of families be relieved of care costs and the need to sell their houses. How will this stop the 15-minute visits by overworked and underpaid care staff, or give them even slightly better pay? Indeed, those overworked and underpaid staff will be paying towards this levy in their wage packet, as will their employers, largely in the private sector, whose profits—the only thing which keeps them in business—will be further eroded.

It is now 10 years since this House passed the legislation for the Dilnot review. Many of us spoke in favour of it at the time. However, the cap has been set so much higher than recommended that it is far from clear whether many people will actually benefit. I must point out—few people understand this—that the cap applies to the cost of nursing in residential homes only and does not include the so-called hotel costs. It will help a few better-off families, leaving most to pick up the bill, or subject to the vagaries of local authority funding.

In addition, it will add to the complexities of an already far too complicated funding system and add to the danger that any money coming to social care will be spent on bureaucracy, making assessments, testing eligibility and explaining to bewildered families why care costs so much, and why the picture in the social care sector is very different from that in the health care sector. Moreover, it will do nothing to improve the standards of care received by older people or those working-age adults with disabilities who make up at least one-third of those needing care, a fact which often seems to be overlooked in the emphasis on older people.

The debate in your Lordships’ House on 11 October makes interesting reading regarding how the levy proposals are viewed. It is hard to find any support for the proposals and there is great disappointment in the failure to address the promises which have been made about “fixing” social care. Surely fixing requires two things above all: enough money and better integration.

As to the former, the Institute for Fiscal Studies, quoted by my noble friend Lord Eatwell in Monday’s debate, says that

“it is clear that the extra funding will not be sufficient to reverse the cuts in the numbers receiving care seen during the 2010s.”

The IFS also points out that

“many people with care needs not considered severe enough will continue to miss out.”

Moreover, the latest IFS report published this week says that the £12 billion which will be raised annually by the tax rise is sufficient only to fix the immediate shortfall faced by the NHS and would need to double by 2025 to have any hope of keeping up with NHS, let alone social care, needs.

Integration with the NHS is seen as a vital need. There has always been political agreement across the board on this, yet I am mystified as to how these proposals will address it. At a time when waiting lists for the NHS are growing longer by the minute, should it not be a priority to ensure that no one stays in hospital longer than they have to by having discharge procedures which provide a seamless transition and making sure that the all too frequent readmission because of inadequate co-operation between the NHS and local authorities is guarded against?

We heard again only yesterday that care jobs are unfilled and requests for care are being turned down because of staff shortages. Local authorities are struggling terribly to recruit enough workers to meet increasing demands. That is no wonder when you can earn far more by filling shelves in Sainsbury’s.

The minute someone is admitted to hospital, health services, social care and the often ignored but very significant voluntary services should plan between them for what will happen on discharge. Sadly, the usual pattern is for a conflict to emerge, on a Friday afternoon, between a hospital ward desperate to empty beds and social care services inadequately prepared or even informed. The Government’s plans should include commitment to such planning and co-operation. Thus far, they do not.

As I turn to the third part of the Motion, the effect that Her Majesty’s Government’s plan for social care will have, I feel more regret than anger, because these proposals represent such a failed opportunity and once again see social care as the poor relation—the Cinderella, as some have called it. Social care could be at the heart of a levelling-up agenda, if we had a vision for its workforce and for the impact it has on the health of a community in its broadest sense. Care providers could be encouraged to diversify their businesses and to reach out creatively into the community by providing tax incentives, for example, or a reduction in business rates.

If we want a high-skill, high-wage economy, as we are increasingly told we do, what better place to start than social care, with its huge workforce, badly paid but certainly not unskilled? Those skills could be developed by providing training, and retention could be dealt with by better career progression and recognition of qualifications. If you provide more support to unpaid carers, you get the very best out of that huge but unrecognised workforce, and if you help them combine paid work with caring responsibilities, you not only help them financially now but save them from poverty in future. Surely that makes good economic sense, as well as being morally imperative.

It is possible that the Government intend to address those issues in the forthcoming White Paper, and I hope that the Minister can assure us about that. I also hope that he can assure the House that integration between health and social care will be seen as a priority, as there is a sad lack of any such incentive in the current proposals. Has he considered an integrated workforce with cross-discipline skills? How about integrated budgets and data sharing? Will all those failed opportunities be addressed in future policies? If they were, I really do not think it would be difficult to get the cross-party agreement and support that Ministers say they are aiming for.

Above all, I regret that there seems to be no attempt anywhere to address the causes of the difficulty in both health and social care, leaving the Government open to the charge of a sticking-plaster solution. Levelling up must surely include addressing the health inequalities which are the result of poverty and inadequate services, and which, sadly, have increased after a decade of public spending cuts.

The most efficient way to ensure that our health and social care services are not overwhelmed by demand is to make sure people do not need them as much. As Sir Michael Marmot has said:

“We need to adopt a health and social care system which prioritises not just the treatment of illness but how it can be prevented in the first place. The pandemic has made it crystal clear over the last 18 months why public health and … the social determinants of health, are so important. The health and social care agenda must be re-balanced … towards prevention”.


That, surely, is the sort of vision we should have for social care.

We eagerly await the White Paper, but I must tell your Lordships that the current proposals, with their inadequacies and lack of understanding and vision, do not fill me with hope. I beg to move.

--- Later in debate ---

[Baroness Pitkeathley (Lab)]

My Lords, I am sure that your Lordships’ House would like me to thank the new boy on your behalf for his tour de force in answering his first debate. We do not doubt his commitment to this issue and we can promise him that this will not be the last time that he replies to a debate of this kind.

Far be it from me to try to sum up all the things that have been said today. There has been much consensus—consensus that we have reached before—that social care is a mess and does not provide to vulnerable people who need it, who work in it or who participate as carers or volunteers, services which allow them dignity or satisfactory and adequate care. Resources are completely inadequate and funding systems far too complex—we have heard quite a lot about that today.

We have heard concerns from all over about the workforce and the lack of integration between health and social care and a lack of understanding of the reality of people’s experience of what it is really like on the front line. I am afraid that that consensus also extends to our opinion of the reforms proposed so far. They will not do—they are not the promised fix. However, this debate has also thrown up something else. Here I echo what others have said about your Lordships’ experience. This debate has thrown up a wealth of constructive ideas about what is needed for that fix if we have not got there yet. The Minister has talked about listening, so I hope that those preparing the White Paper and the next steps in this reform will take into account the wisdom and experience expressed by your Lordships today.

Motion agreed.