Social Care

Baroness Tyler of Enfield Excerpts

Thursday 30th March 2023 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords—follow that. As the excellent reports we are debating today make clear, we are failing those in our society most in need of our care. As we have heard powerfully in today’s debate, the social care sector is in crisis due to chronic underfunding and the repeated deferral of hard decisions. Fundamentally as a society, we are sending the message that we do not truly value caring and caregivers.

The care that people, both older people and those of working age, need to have a good quality of life is often either unaffordable or unavailable. People who could be supported to stay in their own homes are being moved into residential care and people who are medically ready to leave hospital are unable to, because the care they need in the community is just not there. This has knock-on effects throughout the NHS. We know from the CQC’s latest State of Care report that the health and care system is gridlocked and is unable to operate effectively or, in some cases, at all—as we heard so poignantly from the noble Lord, Lord Polak.

As we have also heard, demand for care is rising as people live longer and often with more complex needs. As my noble friend Lady Barker explained, we now have a growing number of people without children of their own. Recent analysis from the King’s Fund showed that overall requests for social care have hit an all-time high.

At the same time, as we have heard, the workforce is in near meltdown. I want to explain why I use that term. We know that there are severe staff shortages and problems both in retention and in recruitment, which mean that current needs are not being met. Without major change, things are going to get worse as demand grows. As we have heard, according to the King’s Fund, the current social care staff vacancy rate is the highest since records began: 165,000 unfilled posts is a huge number.

Looking ahead, Care England estimates that the number of adult social care jobs will need to increase by 27%, to around 2.3 million, by 2035. In reality, we are looking at the prospect of further workforce reductions over the next 10 years as the current care workforce, more than a quarter of whom are over 55, retire and are not replaced. Poor pay and conditions are key drivers affecting recruitment. One in three care workers is paid the minimum wage, or less as their travelling time between clients typically goes unremunerated. At the same time, other sectors are offering far higher rates for, frankly, less demanding work.

It is a scandal that the social care workforce is among the lowest paid in our economy and zero-hours contracts are prevalent. The Health Foundation has found that staff experience much higher levels of poverty and deprivation than other UK workers and health workers. For many in the sector, career progression is simply non-existent. Given all this, it is not a surprise that the workforce is in near meltdown.

The impact of these workforce shortages on both patients and the wider NHS is devastating. First, increasing numbers of people, especially the elderly, have unmet care needs. Due to a shortage of care workers, 170,000 hours a week of home care could not be delivered during the first three months of 2022. That is seven times more than spring 2021.

Secondly, there is a backlog in initial assessments and long waiting times for many people to have their needs assessed. Shockingly, people are dying while waiting for care. Age UK found that some 37,000 people died in 2020-21 without receiving the care that they were waiting for. According to the CQC’s recent State of Care report, only two in five patients are able to leave hospital without delay when ready for discharge.

Many of these problems, which so many noble Lords have talked about, are rooted in funding, which has been inadequate for many years. According to the Health Foundation,

“When the pandemic hit … government spending per person on social care was lower in real terms than in 2009/10”.


This is compounded by how social care funding is often piecemeal, with crisis cash in winter making planning harder. This is exacerbated by the fact that the actual costs of providing care, either in the home or in running a care home—wages, Covid expenses and the increased costs of food and heating—are rising, but many local authorities are rationing social care to those in greatest need due to inadequate funding from government. This point was underlined last year by the Local Government and Social Care Ombudsman. At an individual level, a failure to introduce a cap on lifetime care costs means that one in seven people over 65 faces catastrophic costs of more than £100,000.

Like other noble Lords, I was particularly alarmed to read recent press reports suggesting that the Government are poised to cut £250 million from investment in the social care workforce in England. I join the noble Baronesses, Lady Andrews and Lady Donaghy, in asking the Minister, when responding, categorially to either confirm or deny that this is the plan.

Of course, all of this results in an overreliance on informal unpaid carers, as demonstrated vividly in the recent report of the Select Committee chaired by the noble Baroness, Lady Andrews. According to Carers UK, in England the number of unpaid carers outnumbered the paid health and care workforce by at least two to one. Many other speakers have pointed this out passionately in our debate today. Millions of unpaid carers are having to bear the negative effects of social care workforce shortages and a lack of funding for social care. This leaves far too many of them with very little support, often feeling isolated and undervalued in the face of the relentless demands of caregiving.

Too many unpaid caregivers face financial hardships themselves, as they receive little financial support. Many find it hard to juggle staying in paid employment with caring. That is why I was so pleased to support the Private Member’s Bill put through the Commons by my honourable friend Wendy Chamberlain MP; it had its Second Reading here recently. It creates a new entitlement for employees to take up to a week of unpaid leave a year in order to provide or arrange for care. Yes, it is a very small step forward in improving employment rights for unpaid carers, but it is important none the less.

The most depressing thing in today’s debate has been the litany of broken promises of reform over the past decade. We had Dilnot, endlessly postponed; and White and Green Papers that never materialised. As my noble friend Lady Jolly reminded us, the Care Act 2014 was a seminal piece of legislation, but key provisions in it have been indefinitely postponed. The Government’s “Build Back Better” plan for health and social care, published in 2021, led to the passing of a law to collect a health and social care levy, but this was then reversed and the charging reforms outlined were subsequently delayed—again.

Despite all this doom and gloom, I want to end with some solutions to add to the others that have been put forward. There are five things on my immediate wish list which I am very much hoping to see in the long-awaited government social care implementation plan.

First, we need to invest in the workforce, pay wages people can live on and offer career progression by professionalising the care sector. That is why I am so pleased that Liberal Democrats are calling for a legal obligation to provide a carer’s minimum wage, to be set at a rate of £2 an hour above the national minimum wage. This much-needed boost is long overdue, and I know others have referred to it.

Secondly, the Government need properly to fund local authorities so they can continue to provide the social care services they are legally required to, and ensure that care homes are paid a realistic rate rather than relying on excessive cross-subsidisation by self-funders.

Thirdly, we desperately need to integrate services, so that there is a joined-up preventive approach which reduces the risk of reaching crisis point and needing care home placement or hospital admission. I hope the development of 42 integrated care systems can help bring this about, but concerns remain that social care sector providers struggle to get their voices heard within these systems.

Fourthly, we must provide more support for informal carers and introduce a statutory guarantee of regular respite breaks for unpaid carers.

Finally, as others have said—including, very powerfully, the noble Lord, Lord Bradley—the carer’s allowance must be reformed so that it no longer discourages carers from remaining in paid work. The carer’s allowance is the lowest benefit of its kind and does not reflect the contribution of unpaid carers; it must be increased.

I therefore ask the Minister: what assurance can he give me that the vital issues that I and others have underlined will indeed be addressed in the Government’s plan?