Funding of Care and Support

Baroness Tyler of Enfield Excerpts

Thursday 24th November 2011 Lords Chamber

[Baroness Tyler of Enfield]

My Lords, I rise as a very recent recruit to the usual suspects and as someone still very much serving her apprenticeship but very proud to be a member of this group. First, I congratulate the noble Baroness, Lady Pitkeathley, on securing this hugely important debate. I do not think that I am exaggerating when I say that, despite all the challenges the country faces, the funding and the future of social care is the greatest social challenge facing the country, which we know we will all face in a very personal way as we move through our lives. I very much agree with the noble Baroness that it is a matter that has been put into the too-difficult-to-deal-with in-tray for far too long.

I should like to explain why this issue must be at the top of the political agenda. It is impossible to escape the fact that chronic underfunding of care has led to a crisis in our social care system and is putting huge pressure on existing care services, the NHS and, in particular, on families providing care. As we think of the challenges we face, a couple of statistics have really brought that home to me. The first is the fact that the number of over 85 year-olds is set to double over the next 20 years. The second is that 11 million people who are alive today will live to the age of 100. The third is that the number of carers is expected to rise from 6.4 million in 2011 to 9 million in 2037.

The extent to which social care funding has failed to keep pace with demographic change—in marked contrast to NHS funding—has already been well covered, so I do not intend to repeat those comments. Instead, I want to say a word or two about who is really feeling the burden of this underfunding. First of all, there is the cost to families. The result of demographic changes outpacing spending is that growing pressure is placed on family members who provide care. I was interested to see that statistics produced by the NHS Information Centre show that the proportion of carers providing over 50 hours of care a week has doubled in the last 10 years. That has all sorts of implications for people’s health, finances, their availability for work and, indeed, for the economy.

I turn next to the issue of the cost to businesses, which we hear less about. The peak age range for caring is 45 to 65, which often represents employees’ peak of training, skill and experience. Employers are at risk of losing these employees at short notice if the social care system cannot enable families to juggle work and care, and the average cost to businesses of recruitment, training and lost productivity is around £11,000 per staff member lost. As we know, there are many enlightened employers who are working hard to try to promote flexibility and workplace support for employees who are juggling work and care responsibilities, but flexibility in the workplace cannot compensate for poor quality, unreliable or inaccessible social care, and over 40 per cent of carers who have given up work say that they did so due to the lack of sufficiently reliable or flexible services.

Lastly, I mention the cost to the NHS. As we all know, an insufficient supply of social care in the community also results in additional pressures and unavoidable costs for NHS services, particularly through things like emergency admissions and bedblocking—a term that I absolutely hate, but recent statistics show that these issues are currently getting worse.

Like many other noble Lords, I am attracted to the recommendations made by the Dilnot commission. I notice that they have also attracted the support of many influential bodies in the sector and beyond. I believe that, if implemented properly, the recommendations have the potential to help people to prepare and plan for a better older age and take away the terrible fear that so many have. I will not run through the individual recommendations in detail because others have done so, but what is important is protecting families from catastrophic care costs by capping lifetime care bills, and we have already heard very interesting arguments about the level at which the cap might be set. I also welcome the commission’s clear recognition of the need for additional resources for social care to overcome the historical shortfall, as well as the proposed national system of eligibility and portable assessments in order to create a more standardised system across London and across England. That will help families if they move to different parts of the country. Another recommendation has been made which perhaps is not very sexy—we have not heard about it so far today, but I think it is potentially very important—is for a new awareness, advice, information and advocacy strategy to help families plan for care and to access private, state and voluntary sector support.

So where is the money going to come from in the very difficult current climate? I shall highlight a couple of possible areas. First, those of us who are involved in the consideration of the Health and Social Care Bill have heard a lot recently about the importance of the integration of health and social care, and I thought we had a good debate on the subject earlier in the week. The Bill is entitled “Health and Social Care”, which is very good, but I have to say that we do not talk that much about the social care aspect, and it still often feels like the country cousin. It was said earlier this week that it will require a really big shift of existing resources from the NHS to the social care system to make a reality of integration, and that is going to require huge political will at both the national and the local level.

There is also the issue of investment in more preventive work, which covers all sorts of things these days. We have reablement packages, telecare and the like that can make a big difference to older and disabled people and their families in terms of enabling them to remain in their homes. That is very welcome, but where is the money for these preventive services going to be found? Is it really going to be made available from ring-fenced public health budgets? We also need to do more to stimulate the care market and to think carefully about what these proposals will mean for current providers. It was interesting to note that a poll carried out in February 2011 of the social providers of community care showed that 25 per cent of them expected to face closure before the end of this year because of cuts in local authority fees. Finally, we need to do more to improve the quality of care available, in particular by supporting the development of a skilled, flexible and valued workforce. The point about members of the workforce feeling valued is so important.

I shall finish by saying that I believe we must be brave both as politicians and as a political class, and here I offer my apologies to the Cross-Benchers. We need a real political consensus on this. The report sets out the basis for a lasting and long-term settlement, and as a class we will not be forgiven if we duck the challenge because it is too difficult.