Adult Social Care: Staffing

Baroness Pitkeathley Excerpts

Tuesday 12th December 2023 Lords Chamber

Asked by

[Baroness Pitkeathley]

To ask His Majesty’s Government, further to the report of the National Audit Office Reforming adult social care in England published on 10 November (HC 184), how much of the £265 million allocated to reforming social care staffing between 2022–23 and 2024–25 has been spent so far, and what problems they have encountered in spending the allocated money.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

The Government have made up to £8.1 billion available this and next year to strengthen adult social care provision. Specifically, we have invested over £15 million so far this year in supporting our workforce reform programme. The Government remain committed to our 10-year vision to put people at the heart of care and make long-term sustainable investment to future-proof the sector. Further announcements of support will be made shortly.

[Baroness Pitkeathley (Lab)]

I thank the Minister for that reply. He will know that the NAO’s report said that only £19 million of the very welcome £265 million that was originally allocated has thus far been spent. Even if the Minister does not agree that this is an utterly inadequate response to the crisis in social care, as the King’s Fund has said, he must admit that the slowness of progress is somewhat frustrating. Is it because there are not enough staff in the DHSC to distribute the money? I understand there are about 100 vacancies. Alternatively, is it because there have been many ministerial changes in his department, or because—as many in your Lordships’ House will suspect—social care is simply not a priority for this Government and, once again, millions of unpaid carers will be left to prop up a crumbling system?

[Lord Markham (Con)]

I share the noble Baroness’s concern about the speed of deployment. At the same time, it is fair to say that we are developing a whole new set of social care qualifications, which we think we can all agree are key to this. We are also developing a whole new payment mechanism, because there are 17,000 independent providers and we need a mechanism to allow payment. It is a complex programme, but I agree that we need to do everything we can to speed it up.

National Health Service: 75th Anniversary

Baroness Pitkeathley Excerpts

Thursday 30th November 2023 Lords Chamber

[Baroness Pitkeathley (Lab)]

My Lords, I too thank my noble friend Lord Hunt for introducing this debate in his typically tub-thumping and inspiring manner.

I owe my life to the NHS—quite literally. Without the NHS’s resources and the commitment and skill of those who work in it, I would not be standing here making yet another speech on health in your Lordships’ House to join the many I have made since I became a Member at same time as my noble friend. It is no exaggeration to say that it causes me emotional distress to hear the phrases that people are now using about our beloved NHS—“The NHS is not what it was”, or, “You can’t rely on the NHS now”—or to see friends in my village spending their life savings on paying for surgery in the private sector because they are no longer able to tolerate the pain in their knee, or cope with being off work for a year or even two because they cannot get their hip done. That is what 7 million on the waiting list means.

I will not repeat what other noble Lords have said about the length of the waiting lists. They must be fixed, but we cannot fix them without fixing what causes them. Is it any wonder that you have to wait at the front door of the hospital when you have a traffic jam at the back? The NHS and social care are inextricably bound together—how many times have we said that in your Lordships’ House—yet we are no nearer to solving the problem than we were 25 years ago. In fact, it has only got worse. As we know, people are living longer with more comorbidities. We should rejoice in that because it is an NHS success story, but, as we know, local authority budgets, which have been so constricted for so many years, are unable to provide the services we need. The problems in social care are just the same as they have always been: not enough money, too little integration and fragmented services. That is what a previous Prime Minister promised to fix. As my noble friend said, “That went well, didn’t it?”

I know that the Minister, when he comes to reply, will give us statistics on how much more money this Government have put in, but it is spent on the wrong thing: on hospitals instead of primary, community and social care, which are the services that keep people out of hospital. As the Association of Directors of Adult Social Services reminded us:

“National policy and investment has predominantly focused on addressing issues relating to discharge from hospital”—


there we go with hospitals dominating again. Consequently, people are sicker and have a higher level of need, so more resources are needed. ADASS says that we can fix this system only

“by shifting policy and investment towards early intervention and prevention”.

Hurrah for that, but preventive work—the stuff that keeps people out of hospital—is always the Cinderella when money is being dished out because it is long-term policy.

I have just had the privilege of chairing a special inquiry into integration between community and primary care services. Our report will be published shortly, and I hope it will not only give a useful insight into what the problems are due to a lack of integration are but draw conclusions about how they could be addressed.

Our focus on hospitals as the embodiment of the NHS blinds us to the other services, which are much more important to the patient and much more effective in sorting out the waiting list problem. Primary and community care services are what most people have contact with in the NHS. If we are really serious about improving NHS performance, then that should be our focus. Your community physiotherapist can prevent the need for a knee replacement, and your community occupational therapist can prevent the fall that results in hospital admission. I hope the Minister will assure the House that the Government understand the great importance of prevention in tackling any problems in the NHS.

I will mention two more elements in the NHS that we ignore at our peril when it comes to performance. The first is the voluntary and community sector, which provides so many services that contribute to good health, both mental and physical: the plethora of disease-specific organisations, support groups and information services, which are vital and make such an important contribution in healthcare, as we saw during the pandemic, that are now under threat because of a lack of funding from local authorities and pressure on their volunteers. Only one-third of directors of adult social services were able to invest in community and voluntary services.

Secondly, your Lordships would expect me to flag up the vital contribution of families to health care—those millions of unpaid carers. I quote from the State of Caring 2023 report from Carers UK on carers’ health and well-being. The report shows that

“carers’ mental and physical health is getting worse, and for some it’s at rock bottom”.

It says that

“42% of carers said they needed more support from the NHS or healthcare professionals, and …better recognition from the NHS of their needs as a carer”.

The report also says:

“35% of carers said they were waiting for specialist treatment or assessment, either for themselves or the person they care for”,


and that they were therefore worried about their ability to go on providing that vital amount of care. One carer, talking about the challenges with their mental health, said:

“I know I could ask for counselling, which I’ve had several times over the years through my GP and other organisations. But the waiting lists are very long”—


too long for me.

The Government’s vision should be that we have an NHS which is the most carer-friendly health service in the world, both for the unpaid carers and for the one in three staff who work in the NHS and are juggling caring responsibilities themselves. I hope that when the Minister replies, he will reiterate the Government’s commitment to having a clear and deliverable strategic approach to improving carers’ health and well-being, and the structures which enable carers to get the support that they so much need.

Adult Social Care

Baroness Pitkeathley Excerpts

Wednesday 22nd November 2023 Lords Chamber

[Lord Markham (Con)]

Always at this point, I find that the best tactic is to offer my noble friend a meeting. The People at the Heart of Care 10-year plan is exactly what we are trying to design here. I mentioned some of the progress that is being made: we have seen recruitment go up and an increase in staffing, and we have a put in place a qualification for staff, so that they feel there is a career structure for them. The number of people is going up year on year. Yes, there is a lot to do, but we are getting there.

[Baroness Pitkeathley (Lab)]

My Lords, according to the same survey cited by the right reverend Prelate, 68% of directors reported unpaid carers having break- downs because of burnout from stress, and half a million home care hours had not been delivered because of a lack of staff. Carers UK published a survey showing that 25% of unpaid carers are going without food and heating because of the demands of caring. When will the Government commit to a national strategy for carers to address some of these problems?

[Lord Markham (Con)]

We realise that they are the hidden army, and they are tremendously valued. I think noble Lords know that I have some personal experience of this. We have tried to put some measures in place for payments; I perfectly accept that it is not the same as a full wage, but payments have been put in place. We are also introducing respite care, so we are taking steps in that direction to recognise the vital service they all provide.

Dementia Palliative Care Teams

Baroness Pitkeathley Excerpts

Thursday 15th June 2023 Lords Chamber

[Lord Markham (Con)]

I thank the noble Lord. I have an auntie with dementia in care in Derbyshire. The noble Lord is correct that it is a perfect example of a wraparound service that takes in all the facilities that people need. The intention is that we want to spread that everywhere. It is the responsibility of each ICB to set the right commissions in their local area, but we are spreading knowledge of the dementia model as far as we can. A big example is that we promoted it at the recent national clinical excellence celebration day in the Midlands.

[Baroness Pitkeathley (Lab)]

My Lords, I am not sure the Minister actually answered the question about where co-ordination happens, which is the essential part of this. He will know that much care and palliative care for dementia patients and their families is provided in the voluntary sector and by charities. What support can we give to charities, which often are acting in a co-ordinating role? Can the Minister update us on newspaper reports that his department intends to recruit an army of volunteers to help solve the social care crisis?

[Lord Markham (Con)]

The voluntary sector is a key element of this. On behalf of the department, I thank it for all the work it does. The direction of travel is very much to engage the sector and enlist its support as much as possible. The ICBs do the commissioning, and Derbyshire is a fantastic example of commissioning all the different strands, including the voluntary sector, hospices and palliative care to deal with clinical need. It is an excellent example of how to do it well and one that we need to spread everywhere.

Adult Social Care: Challenge Procedures

Baroness Pitkeathley Excerpts

Wednesday 19th April 2023 Lords Chamber

[Lord Markham (Con)]

The main point is that we already have two levels of appeal. In the first instance, someone can appeal to a local authority and if they are not satisfied with that, they can appeal to the local ombudsman. Thousands of people do this every year, and compliance in terms of replies to them is very high. I must admit that I am not sure whether an additional, third level of appeal is really necessary in this case.

[Baroness Pitkeathley (Lab)]

My Lords, once again, a Question in your Lordships’ House has pointed out the inadequacy of the social care system, be it funding or personnel. In answer to an earlier Question, the Minister teased the House a little about the workforce strategy. Can he be more specific in answer to this Question?

[Lord Markham (Con)]

First, I take issue with the inadequacy comment. Some 89% of people expressed a high level of satisfaction with the social care provided, which, although not 100%, is pretty good, as I think everyone would agree. As I said, the workplace plan has been drafted. I am afraid I cannot give an exact date of publication—I believe there are local purdah issues now—but I can say that it will be soon.

Social Care

Baroness Pitkeathley Excerpts

Thursday 30th March 2023 Lords Chamber

[Baroness Pitkeathley (Lab)]

My Lords, it is a pleasure to speak in this debate today, and I congratulate my noble friend Lady Andrews. I have lost count of the number of debates on social care in which I have participated in my 25 years in your Lordships’ House, and it has often been a rather depressing experience. I would often have to cajole, persuade or even beg people to take part. I took to calling the few stalwarts who could always be relied upon to speak—the “usual suspects”. We were a small but devoted band. For me, the best thing about today’s debate is the number of your Lordships speaking and the attention that is being drawn to social care, at last. To be able to call my noble friend Lady Andrews and the most reverend Primate the Archbishop of Canterbury “usual suspects” is a measure of the progress being made. Their influential reports mark, in my view, a step change in views about social care, which for so long has been the poor relation or the Cinderella vis-à-vis the NHS.

That is not to say that the social care scene is any better than the dire situation to which I have drawn attention over the years. On the contrary, it is worse, as the statistics and examples cited in the debate today illustrate. There is not enough money, not enough integration, too many broken promises, and too many vulnerable people and their families neglected. I, like others, had hoped that we would have the long-promised plan from the Government today, but in its absence we must once again rely on promises and assurances that the Government hear our pleas and will answer our questions.

Your Lordships will understand that, for me, the most important recommendations in both the reports we are discussing today were about unpaid carers. I thank the noble Lord, Lord Polak, for sharing his moving personal experience on the issue of being an unpaid carer. Our social care system relies heavily on the care and support from these carers. In fact, they outnumber the paid health and care workforce by at least two to one. Many live in poverty or on its margins, often building up poverty for the future because of a lack of access to pensions and paid employment. Their health suffers physically and mentally, as we have heard.

The House of Lords report makes a series of sensible and modest recommendations, recognising that carers have to deal with a baffling range of organisations and agencies, which is stressful and time-consuming. For example, the report recommends that carers should be properly identified and have mechanisms for getting information. It states that carer’s allowance is inadequate and should be reviewed—hurrah—and recognises how important respite care breaks are and that there should be ring-fenced funding to provide them.

The recommendations from the Archbishops’ Commission are summed up as a new deal for carers which ensures that they have the practical, financial and emotional support to be able to provide care, maintain a loving relationship and live a full life themselves. These are modest enough demands which surely every carer deserves so that they have opportunities for a rest, better advice, better financial support, and coproduction so that they are involved in planning. None of these recommendations is rocket science, and neither are any of them unreasonable. They are simply actions and commitments which would help unpaid carers do what they want to do, willingly and with love: provide care for their loved ones, as well as caring for themselves.

It is a great disappointment that the Minister is unable to respond to all these recommendations today in the absence of the Government’s plan. I acknowledge that their White Paper, People at the Heart of Care, published in 2021, set out a 10-year vision for adult social care in which unpaid carers were recognised as equal partners in care. I cannot fault the Minister for the words he has shared many times in your Lordships’ House when acknowledging the vital role played by carers. I was delighted by the support his noble friend, the noble Lord, Lord Johnson, gave to the Private Member’s Bill that would give carers access to unpaid leave, which we hope will receive Royal Assent very soon. However, carers are at breaking point. I ask the Minister to assure the House today that he knows that more funding and better integration is vital for their support. Warm words are not enough.

Beyond carers, can the Minister assure the House that when we finally see this long- awaited plan, it will have some vision in the spirit of that 10-year plan, and that it will make some attempt to address the causes of the difficulties in health and social care and not leave the Government open to charges of yet another sticking-plaster solution? Health inequalities must be addressed. They are the result of poverty and inadequate services, which are in turn the result of many years of spending cuts. The most efficient way to ensure our health and social care services are not overwhelmed is to make sure that people do not need them. If we could rebalance the agenda towards the prevention of ill health, that is the sort of vision and focus that could give some hope for the future of social care and reassure the carers who are its main providers.

Social Care: Workforce Strategy

Baroness Pitkeathley Excerpts

Wednesday 22nd March 2023 Lords Chamber

Asked by

[Baroness Pitkeathley]

To ask His Majesty’s Government what plans they have, if any, to reduce their £500 million investment in the social care workforce; and when they will publish their strategy for increasing the size of that workforce.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

The Department of Health and Social Care will shortly publish a two-year plan for how it will reform the adult social care system. That publication will confirm the Government’s commitment to the 10-year vision set out in the People at the Heart of Care White Paper. It will provide specific detail on how we will implement workforce proposals, including funding activity and milestones.

[Baroness Pitkeathley (Lab)]

I thank the Minister for that Answer, but note that he has not assured me about the proposed or rumoured cuts to the current investment in the social care workforce. As he knows, these rumours have caused great distress to those trying to provide decent care to some of the most vulnerable in our society, against the background of a 13% vacancy rate—so one in eight posts is vacant—with subsequent difficulties in recruitment and retention. The money that has been promised seems very slow in reaching the front line, according to local authorities and carer organisations.

I am very glad to know that we are going to see the plan for the social care workforce; we have waited for it a long time. When we finally see it, which I hope will be before the House rises for the Easter Recess, will it ensure that those who work in social care are properly recognised, rewarded and trained so that, at last, their status is comparable with those who work in the NHS?

[Lord Markham (Con)]

I apologise because, in some ways, the timing is slightly unfortunate with the report coming out before the Recess, as is my understanding. I am not allowed to steal much of Minister Whateley’s thunder on that, but I will answer as best as I can. I hope that noble Lords will be pleased that questions around training, recognition of the importance of the service and career structure are all addressed in the report.

Physiotherapy: Rehabilitation Services

Baroness Pitkeathley Excerpts

Thursday 23rd February 2023 Lords Chamber

[Lord Markham (Con)]

Totally. I am sorry to hear that case, and I think that we would all agree that that is not the sort of service we would want to see. As I said, we have put increases in staff in place—there have been 3,300 extra staff since 2017—but, clearly, we need to do more. That is why I was very pleased to read that this area is an important part of the workforce plan, which noble Lords will be happy to hear we are now seeing drafts of.

[Baroness Pitkeathley (Lab)]

My Lords, if stroke survivors are imprisoned at home with a bed and a commode, as my noble friend’s Question suggests, does the Minister agree that their unpaid carers are similarly imprisoned? Is the lack of rehabilitation services part of the reason why the numbers of people giving more than 50 hours a week unpaid care is increasing rapidly, as the latest census figures suggest?

[Lord Markham (Con)]

As I said, physio is key to rehabilitation, whether for strokes, as we have discussed, or for any one of the number of reasons that people are in hospital and trying to come out. As I mentioned, we have seen increases: there are about 7% more people now in training each year, and that figure increases each year. We now have about 50,000 physios in the public and private sectors who are providing those types of services. Clearly, there are examples where we need to do more, but we are also making progress.

Times Health Commission

Baroness Pitkeathley Excerpts

Thursday 19th January 2023 Lords Chamber

[Lord Markham (Con)]

My experience of royal commissions is that they take a couple of years to report. I do not want to wait a couple of years. I want to get on with it now. We have some very good minds in the department working on it, with access to all of this. I am always willing to take on new ideas from new minds but we do not need a two-year report; we need action now.

[Baroness Pitkeathley (Lab)]

My Lords, does the Minister agree that, in any investigation of health and social care, the voices of patients and users must be loud and strong? How are the Government going to ensure that this happens?

[Lord Markham (Con)]

Clearly, the patient has to be at the centre of everything. That is what the plan for patients is about. It is also what patient choice is about; we are using other ways to make sure that people can get treatment quickly when they need to. It involves using the independent sector, as pioneered by colleagues in this House, and learning lessons from that so that we can get on top of waiting lists, which we all agree we need to do.

Care Homes: Staffing

Baroness Pitkeathley Excerpts

Wednesday 11th January 2023 Lords Chamber

Asked by

[Baroness Pitkeathley]

To ask His Majesty’s Government how they will ensure that care homes where they block-buy places to assist with hospital discharges are adequately staffed.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

On Monday, this Government announced an additional £200 million of funding for short-term NHS step-down care packages to help ease the pressure on local hospital beds. ICBs will work closely with local authorities to purchase places in care homes and other settings. Using their knowledge, they will commission appropriate beds where there is sufficient capacity, including workforce capacity, to meet patient needs.

[Baroness Pitkeathley (Lab)]

I thank the Minister for that response, although it seems a bit more knee-jerk than it does a coherent strategy and it poses as many questions as it answers. For example, are the Government planning to pay care homes directly to pay recruited staff or to work through ICBs and local authorities only? What rates are to be paid? Will it be more than care workers currently earn, so as to compete with the retail sector? Given that there are 160,000 vacancies in the care workforce currently, where are those workers to come from, without pulling staff away from an already understaffed NHS?

[Lord Markham (Con)]

Before we went ahead with this, we spoke to many care providers to make sure that there was capacity within the system to do it. It was understood that the capacity is there. In fact, there is potential underused capacity of as much as 40,000. We are confident that the staffing is in place and that the care packages are there to really make a difference.