Health and Social Care
Baroness Pitkeathley Excerpts(12 years ago)
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Earl Howe
The essence of the answer to that is that improved outcomes will be achieved only when all parts of the system work together. If you have shared measures within the outcomes frameworks and measures that are complementary to each other, you will shine a light on areas of inequality and inform local and national action to advance equality. This focus on outcomes rather than processes enables an innovative approach to health and care services that is driven essentially by the needs of the local population. I will just add that local Healthwatch has a role to play in working with partners to make sure that the views of vulnerable and seldom heard groups in the population are heard.
Baroness Pitkeathley
My Lords, is any work being done on the outcomes of preventive work? I speak, for example, of installing a handrail to prevent a fall that results in an unnecessary and expensive hospital admission. These are often overlooked in terms of outcomes. Will the Minister tell the House if any work is being done on preventive work?
Care Bill [HL]
Baroness Pitkeathley Excerpts(12 years, 1 month ago)
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Baroness Pitkeathley
My Lords, like the noble and learned Lord who has just spoken, I—and several noble Lords speaking today—was a member of the Joint Scrutiny Committee. Like the noble and learned Lord, I join the thanks to the officials, the chairman and my fellow members. I very much welcome the changes that the Government have made to the draft Bill as a result of the committee’s report.
Your Lordships will many times have heard me and others—whom I have a habit of referring to as the usual suspects—detail how inadequate social care systems are for meeting the needs of the increasing numbers who need them. “The system is not fit for purpose”, “out of date”, “confusing” and “a lottery”—all those are familiar phrases to your Lordships’ House. So it is a great pleasure to welcome a Bill which attempts to address some, though by no means all, of the problems. Importantly, it addresses the issue of the law relating to social care. It encapsulates proposals made by the Law Commission report in May 2011. The Law Commission pointed out that the law relating to adult social care stretched back to the Beveridge reforms of the 1940s and included a plethora of other Acts, including the National Assistance Act 1948, parts of which are still in force. The law relating to people with disabilities and carers, as we have heard, is similarly contained in a variety of parts of Acts and Private Members’ legislation.
The Law Commission originally proposed that there should be a tightly defined process for determining the scope of adult social care. But when it consulted very widely, it decided instead to define the purpose of adult social care as promoting or contributing to the well-being of the individual. That recommendation was accepted by the Government and is central to the new policy. The whole of the new policy structure is shaped by the well-being provision, although I share with the noble and learned Lord, Lord Mackay, anxiety about the accountability of the Secretary of State for Health in this regard.
The enactment of the Care Bill will not just consolidate and streamline into a single statute 60 years of piecemeal law-making, it will place on a statutory footing for the first time both the principle and practice of self-directed personal care based on individual assessment. Particularly pleasing is that the well-being principle is also to be applied to the individual’s carers. It is around carers that I want to base the majority of my remarks this afternoon.
In the draft provisions it was not clear whether the important duty on local authorities to put the promotion of well-being at the heart of their delivery of care and support also applied to carers. The new reference to “individuals” rather than to “an adult”, which appeared to refer to an adult receiving care, now rectifies this and removes any doubt that carers are qualified. This is an important and welcome distinction.
The Bill also adds a new landmark duty that local authorities should have a duty to ensure that they plan for sufficient care and support services when enabling carers and disabled people to be supported, especially with regard to them being able to undertake paid employment.
A Private Member’s Bill was introduced by another member of the Joint Committee, Barbara Keeley MP, which would have put in place this sufficiency of support duty. Although the Bill did not progress, its vision has now been accepted by the Government who have responded in the Care Bill by placing a new requirement on local authorities to ensure that there are sufficient care and support services to meet current and future needs. This would have a particular focus on supporting carers to undertake paid work and caring where this is possible, although when we come to the issue of carers’ resources to provide that sufficiency, we will no doubt have many debates.
The new provisions in the Bill set out a framework for the development of more modern services that can help family members. As well as being hugely important in preventing financial hardship for families, this can also be seen as of great benefit to the wider economy. It has been estimated that carers giving up work costs the economy up to £5 billion a year.
Another very important change that has been made for carers is with regard to finance. The draft Bill did not make it clear that, as in the case of the person with care needs, a carer’s need for support should be assessed before their financial circumstances are considered. I am pleased to see that the Bill has been amended to put an assessment of support needs before financial assessment. Again, that is very important.
The draft legislation could have meant that carers could be wrongly charged for services provided to the person they care for. The Government have said that this was not their intention and they have made it clear that carers must not be charged. However, what is a carers’ service and what is a service for an older and disabled person are not yet clearly set out in the Bill. We will need to make further changes that will define what they are and prevent confusion and disputes down the line.
Two other areas about carers will need careful scrutiny as the Bill goes through and I hope that the Minister will comment on these. The first is the issue of young carers, as has already been mentioned. The Joint Committee that scrutinised the legislation called for amendments to ensure that young carers get equal rights to assessments and support in law, both in this Bill and the Children and Families Bill currently before Parliament. The Government have made some limited changes that mean that where a young person receiving care is in transition between children's and adult services, the circumstances where they or a young carer would be covered by provisions in the Bill would ease this transition.
However, the changes do not alter the fact that young carers will have lesser rights to assessment and support than adults caring for adults. The same thing will apply to parent carers, because we have to ensure that parent carers—those who look after disabled children—do not also end up with lesser rights, because the changes made for carers, and we hope for young carers, are very positive. Parent carers now have an imbalance of rights because they are not included, and we shall need to give this careful attention as the Bill proceeds.
Others have commented on the Dilnot proposals and I will not do so, except to say that, for many of us, the level of the proposed cap is disappointing. The effects of bringing many who are currently self-funders into the assessment system have not yet been sufficiently recognised.
In conclusion, there is no doubt that the Care Bill has the potential to make major improvements to how social care is delivered. However, we shall have to focus very carefully on several issues, apart from those I have mentioned already, if it is to achieve that potential. I will just list them now. The first is national eligibility criteria and where they are to be set: there is a great deal of anxiety about that. The second is the role of advocacy in helping people negotiate a system which, by the Government’s own admission, is complex and difficult to understand. The Joint Committee thought that advocacy ought to be part of the element of information and advice, but the Government have not accepted that. There is also, of course, the old issue of integration of health and social care, which we all know is so vital; the Government have recently made renewed commitments to such integration. Also under this heading, we need to look at the role of prevention, which is similarly such a vital part of integrated services. There is also the vexed issue of funding, on which I look forward to spending many happy hours. In order to make the vision encapsulated in this Bill a reality, the Government and the nation simply have to make resources available. Not to do so is a false economy and will store up many more problems for the future.
I hope our debates will enable us to look at a broader vision too, such as that encapsulated in the Ready for Ageing? report from the committee chaired by my noble friend Lord Filkin. If anyone imagines that the Bill before us today provides a long-term solution to all the problems in social care, they are very much mistaken. I hope the Minister will be able to acknowledge this. Recently I gave a lecture at King’s College entitled, “Social Care: Our Biggest Problem or Greatest Opportunity?”. My conclusion was that it was both. My noble friend Lord Filkin’s report is the clearest call yet that we have had for a new vision for social care—a different settlement for the older people we will all become. This is not just a matter for health and social care, but for whole communities, the whole of government and all political parties. This Bill is a welcome first step towards that new vision—or new settlement—but we must never lose sight of the fact that it is only a first step.
Mid Staffordshire Foundation Trust Inquiry
Baroness Pitkeathley Excerpts(12 years, 3 months ago)
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Earl Howe
I reassure the noble Baroness that all the concerns that she rightly raised are very much in our sights, not least the need for proper supervision of nurse trainees and the practical aspects of having the right level of support on the ward. This is why we believe that this idea should be piloted first, so that lessons can be learnt. Yes, we will involve the NMC, and indeed the Royal College of Nursing, in these plans. As regards ratios, having the right staffing in terms of numbers and skills is clearly vital for good care, but minimum staffing numbers and ratios, if laid down in a rigid way, risk leading to a lack of flexibility or organisations seeking to achieve staffing levels only at the minimum level. Neither of those is good for patients. However, I do not dismiss the general concept. It is ultimately up to local organisations to have the freedom to decide the skill mix of their workforce, based on the health needs of those on the wards.
Baroness Pitkeathley
My Lords, the principle of putting the needs of patients first will be welcomed by every Member of this House. However, does the Minister agree that this means looking at care in an integrated way, since the patient experience is very rarely one of either hospital or social care but a mixture—sometimes a very haphazard mixture—of the two? Can the Minister therefore give the House more detail about how the government proposals will facilitate the integration of care services across health and social care, particularly as there will be two separate inspectors and as the ability of the CQC to put the shortcomings right is apparently going to be passed to Monitor?
Earl Howe
My Lords, the main drivers and levers for increased integration will come from other directions, such as: the systems we are putting in place at local authority level and health and well-being board level; more sophisticated tariffs; better commissioning arrangements between the NHS and social care; and the financial imperative that all commissioners and providers now face. That will mean an imperative to ensure that resources are not wasted and are deployed to the best effect of patients.
We must also remember that the NHS outcomes framework will be the benchmark by which the success of the service is judged, just as the social care outcomes framework will act in that sphere in an equivalent way. The major domain in both areas is the patient experience. If we believe that integration is above all to be defined by reference to the patient’s experience, we can expect commissioners across the piece to address commissioning in a way that avoids disjointed care.
Care Services: Elderly People
Baroness Pitkeathley Excerpts(12 years, 3 months ago)
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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.
Social Care Funding
Baroness Pitkeathley Excerpts(12 years, 4 months ago)
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Earl Howe
My noble friend is absolutely right. One of the tasks that faces us over the next two or three years is to ensure that every member of the public has easy access to information which enables them to make plans and take decisions about their own or their family’s future. We will therefore be working very closely with local authorities on that front. It is important that there are websites. My department is already devoting a section of its website to appropriate information on this front. More generally, we need to ensure that the system is not only fair to people, but clear to people.
Baroness Pitkeathley
Following the question from the noble Baroness, Lady Jolly, I believe it is the Chinese who say that a journey of a thousand miles starts with a single step. We have certainly made more than a single step today, on which I congratulate the Government. Two major problems remain, as other noble Lords have said. First, there is not enough money in the system, and secondly, people do not know about it. They do not know that they have to pay for social care, never mind up to £75,000. Is the Minister confident that what he said about information and advice—and this is yet another responsibility for local authorities, which are already strapped for cash—will enable people to plan in the way to which he is so clearly committed?
Earl Howe
I quizzed my officials very closely on that very point only this morning and received very firm reassurances on that front. I completely agree with the noble Baroness about how important this is. She is right; there is a widespread lack of knowledge among the general public about what they are entitled to and what they may not be entitled to. Collectively, we need to put that right. I take her point about additional burdens on local authorities, but ultimately I hope that they will see it as in their own interests to inform the public before they are inundated with questions that will take them a lot of time and effort to answer. I can assure her that work on these lines will be very vigorous, and I will be happy to keep her up to date on the work we are doing over the months ahead.
Social Care: Funding
Baroness Pitkeathley Excerpts(12 years, 5 months ago)
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Earl Howe
My Lords, the main benefit of the Dilnot proposals is to protect people from unpredictable and catastrophic costs of long-term care. While the noble Lord could interpret the raising of the means test as a way of protecting the rich, I see the combination of the cap and the threshold as a way of giving greater certainty and predictability for all concerned, because none of us, whether we are rich or less rich, can know whether we will be subject to catastrophic care costs at a later stage in our lives. That is the inherent unfairness which Dilnot and the rest of the commission attempted to address.
Baroness Pitkeathley
My Lords, following on from that answer, does the Minister accept that uncertainty is the most difficult thing for vulnerable people and their families to cope with? They are uncertain about the level of services that they will have because of problems with local authority budgets and they are absolutely uncertain about what their financial liability will be. Therefore, saying that the Government will accept the Dilnot proposals but not saying when or at what level is only adding to that uncertainty in a most unacceptable way.
Earl Howe
My Lords, I might have hoped that the noble Baroness would welcome my initial Answer, which at least gives her the certainty that an announcement will be made before the Budget. As the noble Lord, Lord Warner, said, that is progress and, I hope, welcome progress. However, I take the point that the noble Baroness makes and the sooner we can introduce the certainty that she desires the better.
Carers
Baroness Pitkeathley Excerpts(12 years, 5 months ago)
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Earl Howe
My Lords, my noble friend makes an extremely important point. Our report, Recognised, Valued and Supported: Next Steps for the Carers Strategy, had four key priorities, one of which was to identify carers earlier. Healthcare professionals undoubtedly have a role to play in supporting those with caring responsibilities to identify themselves as carers in the first instance. We therefore made around £850,000 available in the previous financial year to the Royal College of General Practitioners, Carers UK and the Carers Trust to develop a range of initiatives to increase awareness and understanding of carers’ needs in primary care. We are building on that further.
Baroness Pitkeathley
My Lords, I remind the House that the figure usually given is £119 billion that is being saved from public funds. Since the census now shows that the number of carers has increased by 11%, no doubt that figure will go up. Since many carers give up paid work to become carers and only 600,000 of them receive the carer’s allowance, does the Minister agree that many of them will be building up poverty for themselves in the future? What guidance must be given, therefore when carers’ assessments are being made to enable them to stay in paid work for as long as possible?
Earl Howe
My Lords, the latest figure I have for carers from the census is that there are 5.4 million unpaid carers in England. The noble Baroness was right to mention the figure of £119 billion, although it is a figure we can argue about. It is probably an overestimate as regards the cost to public funds. However, she makes a very important point about employment. The Government fully recognise the importance of supporting carers to remain in work. The Department of Health has established a task and finish group with employers for carers to explore how to improve support for carers to remain in employment. Jobcentre Plus provides practical assistance for carers seeking work; in particular, it can offer practical support for all carers who are employed for less than 16 hours a week.
World Sepsis Declaration
Baroness Pitkeathley Excerpts(12 years, 6 months ago)
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Earl Howe
My noble friend makes an important point. Public awareness is a key focus of the Global Sepsis Alliance’s declaration. On raising awareness, the NHS Choices website has extensive information about sepsis, its causes, symptoms and treatment. I do agree, however, that it is important to empower both patients and the public to ensure that everybody is on their guard against this very serious illness.
Baroness Pitkeathley
My Lords, since sepsis accounts for more deaths than bowel, bladder and breast cancer put together and for one-third of all the expenditure on critical care in the NHS, would the Minister agree that early diagnosis is the key here? I declare an interest as someone who recovered from full-body sepsis, thanks to early diagnosis.
Earl Howe
My Lords, I absolutely agree with the noble Baroness. The need to rapidly identify sepsis when it occurs is vital to ensure that unnecessary death is prevented. A crucial measure to tackle sepsis when it appears is early treatment with broad-spectrum antibiotics. My understanding is that once the bacterium has been identified, the treatment of choice is to have a more focused antibiotic, but rapid reaction is of the essence.
Autism
Baroness Pitkeathley Excerpts(12 years, 6 months ago)
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Earl Howe
Yes, my Lords, the autism strategy is a cross-government strategy and is already having an impact in areas such as employment and education. It includes activity to help adults with autism into work. The mandate to the NHS Commissioning Board particularly mentions those with learning disabilities and autism and their need to receive safe, appropriate and high-quality care. From 2014, when necessary, young people up to the age of 25 with special educational needs, which would include autism, will have an education, health and care plan. I assure my noble friend that work is going on across government in this area.
Baroness Pitkeathley
My Lords, last week on Carers Rights Day I spoke to a great many parents who raised the same matter as the noble Baroness, Lady Browning—the transition period for young people with autism. Does the Minister consider that it is a problem that parent carers are not yet referred to in the draft Care and Support Bill, which we are about to start scrutinising? What role does he think local Healthwatch and local well-being boards can have in this regard?
Earl Howe
My Lords, local health and well-being boards and local Healthwatch will be instrumental in ensuring the improvement of the quality of services for people with autism. As regards the transition from childhood to adulthood, the Department for Education is working with my own department to make the transition recommendations in the strategy the success that we all want them to be. A project funded by both departments and led by the University of York will report before the end of the year and will inform good practice in service at the point of transition.
Social Care
Baroness Pitkeathley Excerpts(12 years, 7 months ago)
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Baroness Pitkeathley
That this House takes note of the impact of changes in local authority budgets on the provision of social care and its integration with other health, housing and care services.
Baroness Pitkeathley
Well, my Lords, here we are again. It is almost exactly a year since I last introduced a debate on social care, and once again I feel like Captain Renault in my favourite film, “Casablanca”, rounding up the usual suspects. Noble Lords speaking today are once again those with form on this issue, although I am pleased to say that we have some new recruits to our numbers as well.
Last year’s debate focused on the report of the Dilnot commission, and it is a matter of great regret to me—and to many others, I am sure—that, in spite of general agreement around the House at that time that doing nothing was not an option, still no decision has been taken about these important proposals. Andrew Dilnot and his colleagues continue to press the issue with hope and enthusiasm, and we hear lots of rumours that we may have an announcement in the Autumn Budget Statement, next spring, next Budget or in the next spending review—but still no actual commitment.
In his response to the debate last year, the Minister said that we have an opportunity to get this right and we must not miss it. No one could possibly disagree with that but I must begin this debate by recording my intense disappointment that, one year on, we are no further ahead with implementing a long-term solution to the problems of social care.
However, we are focusing today on the immediate problems faced by local authorities and the impact of those on the rest of the system. When we discuss integration, as we often have during the past year, we usually focus on the particular interface between health and social care services. The topic of this debate is deliberately wider, though, acknowledging that care needs do not come in discrete packages but are stretched across the whole of an elderly or disabled person’s life, including their housing, their families and their income.
We must acknowledge that we are not in exactly the same place that we were last year. The Health and Social Care Bill that we were debating then is now an Act, and many promises were made about how it would make integration between health and social care easier. It perhaps is too early to say whether this is becoming a universal reality but none of the reports coming out of local authorities and the NHS fill one with hope. In a recent survey by the NHS Confederation, for example, 66% of NHS leaders said that shortfalls in local authority spending had impacted on their services last year. Delayed transfers of care cost the NHS about £200 million a year, and the human distress that such delays cause to patients and families is incalculable.
I know that the Minister will remind us that in last year’s CSR the Government transferred an extra £2 billion to social care by 2015, £1 billion of that coming from the NHS. Local authorities were grateful for that, of course, although it has been called a sticking-plaster solution. Even if it were to be allocated on a permanent basis, £2 billion is not nearly adequate to meet the needs of the social care system. While the transfer of funds from the NHS to social care has been crucial, not all areas have been able to use the money in the way intended—for example, on hospital discharge, reablement and intermediate care. These have made a difference in some areas but too often they paper over cracks in a system that is groaning and only storing up more problems for the future.
In summary—I will say this briefly since I know that the usual suspects are only too familiar with it—the system is not fit for purpose and we spend inadequate amounts on care and support both publicly and privately. Social care funding has totally failed to keep pace with demographic change. Since 2004, while spending in the NHS has risen by £25 billion, spending on social care has risen by just £43 million.
I am always aware of saying how inadequate our care provision is, lest it be seen as criticism of the many dedicated people who work in the system providing care and sometimes pushing the boundaries to focus on prevention and innovative ways of meeting need. We cannot avoid recognising that the way in which local authorities have dealt with the fact that need has far outstretched funding has been to increase charges and rapidly to raise the threshold at which you can qualify for care. You get care only if your needs are seen as substantial or critical.
In too many areas, services are provided only to those whose care needs are the most severe. The LGA has stated that it expects a funding gap for local authority services of £16.5 billion a year by 2019, or a 29% shortfall, between revenue and spending pressures. It further estimates that in the not-too-distant future, social care and waste spending together will absorb such a huge percentage of their funding that other services will have to take an 80% cut.
Without action on funding and integration, even very basic care—those basic 15 minutes a day, which is all that many elderly and disabled people can expect—will not be available in future. Only this week, the weather sees us having to factor into local authority budgets the huge extra costs that many of them will have as a result of the floods. Not only is this level of care completely inadequate but the fact that it is provided only to those with severe or critical needs makes a nonsense of the prevention that all sides say is the key to ensuring that care needs do not escalate to crisis point.
Moreover, this takes no account at all of the many people who currently meet their own care needs in full. Not only may they have to use local authority services in future but no attempt to preserve the quality of the services can be made for those people. Mencap provides clear evidence that local authorities are struggling with reduced funding from central government and increased demand for services. Over the past three years, one in three local authorities has closed day services and 57% of people with a learning disability no longer receive any day-service provision. Carers UK reports that carers are being affected by the closure of council-run services and by the cuts to grants to the voluntary sector, which provides vital services locally. One carer said that getting respite care service nowadays is like getting blood out of a stone.
When people’s care needs are not met by social care systems, what happens? They turn, of course, to the NHS. This results in increased demand for unplanned and emergency services and delays in hospital discharge. In addition, 88% of GPs surveyed recently by Carers UK report that their patients are being put at risk due to a lack of social care support.
These extra pressures come at a time when the NHS is already under severe financial pressure. The CSR protected NHS funding to some degree but did not take account of rising demand and rapidly increasing healthcare costs. We all know that the NHS is expected to make £20 billion of savings and efficiencies by 2014-15, and the recent report from the CQC paints a sad picture of how cost-cutting is being put ahead of patient welfare, with 16% of hospitals surveyed not meeting the CQC standards for having enough staff on duty to care properly for patients, and warns that this may lead to a culture in which unacceptable standards of care become the norm. Yesterday’s report from the King’s Fund paints a similar picture for the NHS of bed closures, lost services and low morale.
No one could possibly disagree that the NHS and all care services must be run as efficiently as possible. One of the most important ways in which to make efficiencies in either health or social care is through integrating services, an issue that we have debated many times in your Lordships’ House. The money transferred to local authorities from the NHS has helped to stimulate integration and certainly to develop interest in it, but evidence given by the King’s Fund to the Health Select Committee notes that a lack of urgency in delivering integrated care remains and, indeed, that the huge upheaval that we have seen in the NHS since last year has hampered progress and resulted in lost momentum. In this context, it was a positive step to see a paragraph in the recently published mandate emphasise the role of the Commissioning Board in driving and co-ordinating engagement with local councils. For the sake of the increasing numbers of people in urgent need of co-ordinated services, we must hope that the mandate delivers.
The other significant development since last year is, of course, the draft Care and Support Bill. I am honoured to be a member, along with my noble friend Lord Warner, of the pre-legislative scrutiny committee considering this. We shall spend many happy hours with colleagues from this House and another place hearing evidence, testing proposals and debating provisions. There is not time to go into the detail of that Bill here, save to say that there are many welcome proposals in it, and the Government are to be congratulated on an excellent attempt to achieve co-ordination of the many disparate strands of care legislation and to give greater recognition and more rights to users and carers.
In terms of the issue that we are debating today, it is hard to feel anything but anxiety about the extra duties placed on local authorities and on how on earth they are to be funded. Do not mistake me—I could not be more delighted that support for carers will be strengthened or that there will be an obligation on local authorities to provide information and advice to promote diversity and quality, or with the references to assessments and care and support plans, as well as a very much to be praised reference to national eligibility criteria. But even those far-reaching reforms could be viewed as a sticking-plaster solution if we do not tackle the fundamental problem of how social care is funded. The inconsistency between fully funded NHS care and means-tested social care not only confuses users and carers but inevitably hampers the delivery of a comprehensive care package.
Noble Lords may have noticed thus far my subtle references to a need for more money in the system. In conclusion, I want to focus on money. I know that the Government’s response to calls for more money in the system is always, understandably, “There is no more money”. As Andrew Dilnot frequently says, though, it is a question not of “can’t afford it” but of “won’t afford it”. Our GDP shows that we are five times better off than we were in 1948. Time and again, we find that social care properly delivered, of good reliable quality and with an emphasis on preventive care is a better way of caring for older and disabled people than healthcare, especially in a hospital bed, could ever be. If we pool the risk—after all, only one in five of us will ever need high levels of social care—and give it the priority that it deserves, we can afford it. It is a matter of priorities. We can easily find several billion pounds by stopping tax avoidance if we really put our minds to it.
We need to start thinking long-term about the real costs of failures in social care and think more broadly about what those failures will mean to the economy as a whole. I shall give an example. Diminishing social care from councils has hit business productivity. As fewer older and disabled people are able to access social care services, growing numbers of family members are being forced to give up work to care for their loved ones. An estimated 1 million people have given up paid work or reduced their working hours to care for their loved ones. The LSE tells us that the public expenditure cost of families giving up work is £1.3 billion a year in additional expenditure on carers’ benefits and lost tax revenues. If lost earnings are taken into account, the figure rises to £5.3 billion. These are the sort of long-term effects of the current shortages in funding that we should be considering.
I know, as do all noble Lords, that the Minister cannot make a commitment here today to put more much needed money into the system. However, I know him to be a man of commitment and vision, as well as a very busy one today—I also know that the whole House will be delighted with the award that he received last night—and I ask that he commits to taking the message from your Lordships’ House back to his department and to the coalition Government and tries to persuade colleagues to see that investing properly in social care is just that—an investment, not a drain. It saves costs down the line, assuages one of the worst worries of citizens and will earn the thanks of the nation, both those in need of care at present and all of us who may need it in future.
As for the argument that says that times are hard and this is not the time to enter into major extra commitments, I remind your Lordships that the Beveridge report of 70 years ago was published and accepted in the middle of a world war, yet our forebears had no problem with the vision and commitment to take on those far-reaching changes even though the country was, in the words of one noble Lord in this House this week, absolutely skint. We are not skint. We live in a time of relative peace and prosperity. Should we not be prepared to follow in the footsteps of those courageous forebears? I beg to move.
Baroness Pitkeathley
My Lords, it is a comfort to me that the number of usual suspects swelled gratifyingly for this debate—a sign, perhaps, that we are getting nearer to understanding that this is the pre-eminent social issue of our times, in terms of both the current gap and the need for long-term solutions.
We have had a wide-ranging debate and a powerful set of speeches. There is agreement that there is a crisis—or rather a series of crises, in the short, medium and long term—and suggestions for how to tackle those. We have had ideas and examples focusing on innovation, integration, efficiency, and we have even had ideas about how we can get more money into the system. We also have agreement about the urgency of the need and about the importance of that old chestnut for many of us, integrated care.
The Minister has given us his usual thoughtful response, for which I thank him, and we all know his sincere commitment to finding a solution to the problem of social care, although I find it hard to recognise the picture of local services he paints from the ones presented to me. I shall take pleasure in checking this out with the group of 200 carers whom I am addressing tomorrow at a carers’ rights day. I shall ask them for their opinion of the situation.
I return to my original thought—which others have echoed, including the Minister—that social care should be seen as an investment, as a way of saving money, especially for the NHS. But this needs much more sharing of money and much less silo thinking, and more focus on the consequences of not doing it rather than on the cost of doing it. For example, if we just take Dilnot—and I am grateful for the calls from many Peers for Dilnot to be implemented—we know that the cost of implementation is about £2 billion. It is not the whole solution, as many noble Lords have said, but no one has yet found a better place to start. To set that £2 billion in context, family carers are contributing care worth at least £119 billion a year. If only 10% of them give up because they are too exhausted, stressed and poor to continue, that will cost £12 billion—six times the cost of Dilnot. Can we not afford to make the investment that local authorities, the NHS and, above all, the users and carers deserve?
The issue of social care needs radical thought and change, and leadership at national level. As has been said, the inexorable arithmetic of the demographics means that we cannot ignore it and put it into the “too difficult” box, however tempting that may be. Without tackling the resource issue, things will only get worse. Will we be here again next year, reporting on how the situation has deteriorated further? I sincerely hope not. I thank all noble Lords who have spoken, and beg to move.