Social Care Strategy

Baroness Tyler of Enfield Excerpts

Thursday 10th October 2024 Lords Chamber

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[Baroness Tyler of Enfield]

That this House takes note of the state of social care in England, and the case for a comprehensive social care strategy and further support for unpaid carers.

[Lord Kennedy of Southwark (Lab Co-op)]

My Lords, before this important debate gets under way, I thought it would be useful to remind the House and all Back-Bench speakers that the advisory speaking time is four minutes. This means that when the Clock has reached three minutes, noble Lords should start making their concluding remarks, and at four minutes their time is up. I have asked the Government Whips to remind noble Lords of this fact during the debate, if necessary. I thank all noble Lords in advance for their understanding, which will allow everyone to contribute to the debate fairly within the allocated time.

[Baroness Tyler of Enfield (LD)]

My Lords, it is a privilege to be opening today’s debate on such a vital issue to our national life: social care. I am very grateful to the many organisations that have sent me such excellent briefings. I particularly thank the unpaid carers who shared with me their personal experience of caring for a loved one at the drop-in event organised by Carers UK on Tuesday. It was a humbling experience. I look forward to hearing from other noble Lords who have such expertise in and commitment to this issue.

I want to start by making some general points that I feel too often get overlooked. First, social care is a hugely valuable public service in its own right, at best allowing millions of our fellow citizens to live independent and fulfilling lives, improving their well-being and that of their families. It is not simply an adjunct to the NHS. Yes, fixing social care will help the NHS address its current problems, and two of the three big shifts articulated in response to the Darzi review—moving from hospital to community and from treatment to prevention—can certainly be assisted by an effective social care system, but bailing out the NHS is not, I contend, its primary purpose.

Secondly, the social care market makes a significant contribution to local economies. Skills for Care estimates that the sector contributes more than £50 billion to the English economy.

Thirdly, social care is not all about older people, or preventing people having to sell their properties to pay for care, as the debate is too often so unhelpfully characterised. Support for working-age adults and lifelong disabled adults, particularly people with learning disabilities, has become the largest area of spend in adult social care and is growing faster than any other part.

In short, we need to frame the debate in a different way: valuing the sector as a contributor to economic activity, as fundamental to promoting the health and well-being of people in local communities and as contributing to the preventive agenda that the NHS on its own has, according to the noble Lord, Lord Darzi, and others, failed to deliver. Despite all the very real problems, there is some good and innovative practice at local level, often involving integrated neighbourhood working between social care, community health and the voluntary sector.

All that said, social care has been described— I think rightly—as one of the biggest public policy failures of our time. The last 25 years have seen six government and independent commissions, seven Green and White Papers, 14 parliamentary committee reports and innumerable other reports on social care policy. They have identified policy options to address many of the problems and, time and again, commitments have been made but then reneged on. In particular, the funding has been subject to much analysis—not least by Select Committees of this House—and the options for reform are clear. It certainly does not need a royal commission to crawl all over it again.

There is wide consensus that things cannot carry on as they are. Our adult social care system is not fit for purpose and needs radical reform, following decades of political neglect and underfunding. Indeed, the noble Lord, Lord Darzi, in his recent report, described it as “dire”. With an ageing population and a growing number of disabled people of working age, demand is increasing but funding is not keeping pace. In reality, publicly funded social care is available only to those with the highest needs and the lowest means.

Recent analysis from Age UK found that more than 2 million older people are now living with some form of unmet need. Healthwatch recently estimated that up to 1.5 million working-age disabled people could be missing out on the social care they are eligible for. Only last week, the County Councils Network pointed out that persistent underfunding of local government in the last decade means that some councils now spend as much as 80% of their budget on care for adults and children.

Looking forwards, the Care Provider Alliance estimates that at least 1.7 million more adults will require social care over the next 15 years. In big-picture terms, the Health Foundation has estimated that meeting growing demand for care, enabling more people to access it and improving services could cost an extra £18 billion by 2032. This is serious stuff indeed.

In short, we have a system struggling with myriad problems, including: an overly stringent means test; catastrophic costs, leading to some people having to sell their homes; high levels of unmet need, so that people go without the care and support they need; a high reliance and unrealistic expectations placed on unpaid carers; patchy quality of care; poor workforce pay and conditions; a fragile and highly fragmented provider market; and a postcode lottery of access.

All these issues have solutions, as the plethora of reports on social care demonstrates. I hope that we will hear lots of potential solutions in today’s debate, but this needs to be addressed in the round, not in a piecemeal fashion with last-minute sticking-plaster solutions.

Far too often, the crucial role of unpaid carers comes last in the list, but today I will deal with it first. It is vital that we recognise the challenges that the UK’s 5.7 million unpaid carers are facing and the critical role they play in supporting people and, frankly, propping up our health and care systems. Finding appropriate support can be extremely challenging, and many carers report having to fight to get the support they need. One unpaid carer I spoke to on Tuesday said that she had found it impossible to get an assessment for her own health needs—despite the fact that this was legislated for in the Care Act 2014—and felt totally burnt out.

The lack of accessible and affordable social care hinders carers’ ability to juggle work and care. The extra expenses associated with caring for a loved one with a complex condition, coupled with the inability to work, can have a massive adverse effect on family finances. The development of a new national carers strategy—which I strongly support—should be a priority for the Government as part of their wider reforms of social care and, crucially, be seen as integral to the development of the national care service. We need to be ambitious here. From these Benches, we want to see it include paid carers’ leave and a statutory guarantee of regular respite breaks, as well as increasing carer’s allowance, by expanding eligibility to it, and bringing to an end the overpayments scandal.

I turn to the social care workforce. According to Skills for Care, last year there were around 130,000 vacant posts and 1.7 million filled posts. That is a vacancy rate of some 8% and a turnover rate of just under 25%. This is about three times higher than for the wider economy. Skills for Care attributes turnover and vacancies in the sector to a range of factors including low pay, zero-hours contracts and difficulty accessing full-time work. Today’s debate is timely because only this morning, Skills for Care published its annual report, which shows some modest improvements in filled posts and a slightly lower turnover. However, these improvements were mainly driven by international, rather than domestic, recruitment, and there are signs that the supply of international recruits is declining, not least due to changes in visa rules debarring migrant workers from bringing family dependants with them. So domestic recruitment and retention problems continue.

As many in this Chamber have said, the silence in the King’s Speech on social care was deafening, and many people felt badly let down. It felt, once again, as though social care had been pushed to the back of the queue. The Government must, as a matter of urgency, produce an updated vision for social care that tells us what good looks like and then start work immediately on finding a long-term, cross-party solution to putting social care on a sustainable footing. I hope that this House, with all its expertise, can make an important contribution to that debate.

I ask the Minister what plans the Government have to publish a comprehensive reform package for social care with a clear timeline attached for action in this Parliament. I note that the Nuffield Trust has called for a rapid diagnostic exercise similar to the Darzi NHS review to build urgency and the case for change. Can the Minister say whether such an exercise is being considered, and, if so, what the timescale would be?

I recognise the financial constraints the Government face, but that is not a reason for silence or inaction. A comprehensive plan for social care reform can be framed according to short-term, medium-term and long-term actions. The most pressing priority is for the Government to provide an immediate uplift in social care funding in the upcoming Budget to stabilise the sector in the short term. However, there are also a number of short-term and relatively low-cost actions, such as setting up a mandatory professional register of adult social care staff in England, which already exists in Scotland and Wales; requiring direct adult social care representation on all integrated care systems in England; establishing a new commissioner for adult social care to promote the rights of those relying on care; and developing a more simplified, consistent and efficient approach to how councils commission care. These are simply examples of things that could be put in place relatively quickly.

In the upcoming comprehensive spending review, the Government must commit to multiyear settlements to local government, so that the social care system can plan with confidence over the medium term and provide further stability. The Government also need to provide clarity on their plans for social care—including, I hope, more detail about developing a national care service and the fair pay agreement—and what they hope to achieve by when, and how that will be funded. I look forward to hearing more from the Minister on this today.

Credible longer-term reform plans must, at the very minimum, cover funding, a workforce plan and support for unpaid carers, which I have already talked about. On the workforce, social care is a job requiring skill, insight, compassion and commitment, but that is not recognised in the terms and conditions on offer. Front-line roles typically attracted only £11 an hour in March this year—58p higher than the national living wage then. I also find it staggering that care workers with five or more years’ experience were earning just 10p more per hour that those with less than a year’s experience. In short, there is no progression. More than 80% of jobs in the economy pay more than social care, so it is scarcely surprising that employers find it hard to attract and retain people already resident here. If you do a similar role in the NHS, you are paid appreciably more.

We need a social care workforce plan sitting alongside the NHS workforce plan with equivalent government commitment to implement its recommendations. Pay is hugely important, but it is not the whole story. Social care needs a formal career structure, along with training and development to help people advance and be appropriately rewarded for doing so. The Liberal Democrats are calling for a royal college of care workers to improve recognition and career progression, and a higher minimum wage for carers.

The Government’s plan to broker a fair pay agreement for social care is welcome in principle—and it is timely, as it is part of the Employment Rights Bill published today—but we need to understand how it will be funded. Will there be commensurate increases in local authority funding, or will the cost be passed on to care providers and self-funders? I would welcome clarification from the Minister on this point.

We need to think about the workforce in the widest possible sense. There is an obvious role for the voluntary sector to provide a lot more of what is often called wraparound support. There is scope for the sector to do so much more and for every area to have a stronger safety net in place.

On funding reform, transformational reform cannot happen without us working out and agreeing, as a society, how we can fund it, both in the short term and into the future. So far, efforts to achieve this have been half-hearted at best and egregious at worst. The lesson from other countries that have successfully grasped the nettle of modernising social care is the need to have a pretty honest conversation with the public about the options for funding it and how the costs are shared between the individual and the state. We need a cross-party commission to look at the realistic options for sustainable long-term funding, not least to try to future-proof the outcome and lessen the risk of a successor Government undoing decisions made.

As the Government develop their approach to social care reform, they should draw on the significant body of existing policy analysis. The main options—free personal care, which of course has my vote, a cap and a comprehensive NHS-style care—are well known and costed. Respected independent commentators such as the Health Foundation have set out the options and costs, so we are not starting from scratch. The sooner work begins on thinking through the options and engaging with the wider public, the better. The nearer we are to the next election, the harder the task will be.

To conclude, despite countless commissions and reports, successive Governments have failed to enact meaningful reform. With many of the policy options already on the table, and a clear willingness for cross-party talks, the Government have the chance, finally, to implement social care reform and to improve the lives of older and disabled people and their carers. This does not need a lengthy royal commission, simply a substantial injection of political will. Social care reform is a top priority for the Liberal Democrats and, as I hope I have demonstrated, we have plenty of ideas to bring to the table. I look forward to hearing the wisdom of other noble Lords on this thorniest of public policy challenges.

--- Later in debate ---

[Baroness Tyler of Enfield (LD)]

My Lords, this has been an excellent debate with some moving and heartfelt contributions that will live long in my memory. I congratulate the noble Baroness, Lady Keeley, on her maiden speech; she will make a tremendous contribution to this House. I am grateful to noble Lords who were able to touch on subjects such as housing and digital transformation data, which I could not cover.

I thank the Minister for the tone of her response, which was comprehensive and covered a number of points I was hoping to hear about. I particularly welcome the emphasis she put on working collaboratively and on a cross-party basis; that is important. I understand the need for 10-year plans and long-term planning, but they make me a bit nervous because I worry that they mean nothing will happen very quickly. If there is one message from today, it is that action needs to start now.

Wonderful ideas and solutions have been generated by noble Lords from across the Chamber, and I hope the Government will look carefully at the ideas put forward. A lot of them—I tried to do this myself—could happen in the short term, relatively quickly and at a relatively low cost, to kickstart things and get some real momentum. I very much hope that we can continue to have debates in this Chamber in this vein and that we can make a real contribution to the social care debate. Noble Lords can rest assured that these Benches have many things we want to put on the table. We want to work collaboratively, but we will be holding the Government’s feet to the fire.

Motion agreed.

Levelling-up and Regeneration Bill

Baroness Tyler of Enfield Excerpts

Wednesday 3rd May 2023 Lords Chamber

[Lord Young of Cookham (Con)]

My Lords, it is a pleasure to follow the noble Lord, Lord Russell, and add a brief footnote to the speech he made on Amendment 290, to which I have added my name. As he said, the amendment makes it explicit that the infrastructure levy can be used to make childcare accessible and affordable.

I will make four brief points. First, in standing back and looking at total expenditure on all ages of children under 18, I believe we spend too low a percentage on under-fives and too great a percentage on older age groups, in terms of outcome both for society as a whole and for the individual child. I believe that a pound’s worth of investment spent earlier yields a greater return than if spent later. This is not the time to defend that assertion, but it is relevant to the debate.

Secondly, I therefore welcome the priority the Government have recently given to childcare, with £204 million of additional funding this year increasing to £288 million by 2024-25, on top of the £4.1 billion previously announced, together with earlier announcements about family hubs.

Thirdly, in expanding free entitlement, if that additional funding is inadequate, there is a risk that, as the noble Lord just said, providers continue to remove themselves from the market or reduce the quality of care provided. If the latter happens, it would place the priority of providing employment opportunities for parents above the purpose of child development. Increasing the demand for childcare places by making it cheaper without increasing funding for staff salaries may make it harder to find a nursery space in the first place. At the moment, it is not at all clear where the extra places will come from. Sam Freedman, an author and political columnist, posted the following on Twitter:

“we haven’t been given a figure for the new hourly rate but based on the overall cost for 3+4 year olds (£288m for 2024/5) it looks way too low. We proposed adding in £2bn to make it sustainable”.

Fourthly, the current business model for much of childcare relies on cross-subsidy from the better-off parents who can afford the extra hours to make good the gap in statutory funding. I was rereading the report of the Lords Select Committee on Affordable Childcare, published in February 2015, which said this about cross-subsidy:

“There is evidence that the funding shortfall in the rates offered to”


private, voluntary or independent

“providers for delivery of the free early education entitlement is met in some settings by cross-subsidisation from some fee-paying parents. This means that parents are subsidising themselves, or other parents, in order to benefit from the Government’s flagship early education policy”.

At the moment, of course, nurseries subsidise the too-low, free, hourly rate by charging more for one and two year-olds, hence the high prices. But, if one and two year-olds get free hours, as proposed, you cannot get the cross-subsidy. As free entitlement is expanded to more of the market and more of the week, it undermines the current business model for those who are providing childcare. If we want to achieve the Government’s policy on childcare and levelling up, we need to ensure that extra resources are available. That is what this amendment does.

[Baroness Tyler of Enfield (LD)]

My Lords, I will speak to Amendment 290, in the name of the noble Lord, Lord Russell, and to which my name is attached. I pay tribute to the noble Lord’s leadership on this issue and apologise to the Committee, as I was unable to speak at Second Reading. I will just make a few additional points to those already made by the noble Lords, Lord Russell and Lord Young. As a member of the Lords Select Committee on Affordable Childcare, to which the noble Lord, Lord Young, just referred, I very much want to underline the points he made about cross- subsidisation.

This amendment, which makes it explicit that childcare services are considered a proper use of developer contributions by local authorities, is incredibly important. We need to see it written down. At the moment, there is nothing in legislation or guidance, and this would be only an option for local authorities—not something they are required to do. As the noble Lord, Lord Russell, said, it is hardly a surprise that so few local authorities are spending any of their developer contributions on childcare services. To reiterate his point, in the last five years, only 22 local authorities have spent anything on them.

Levelling Up White Paper

Baroness Tyler of Enfield Excerpts

Monday 15th November 2021 Lords Chamber

[Lord Greenhalgh (Con)]

My Lords, I am not sure that is the way to think about these problems. We need to recognise that, as well as the income disparity, there is the cost disparity. Admittedly, living in a great capital city comes at a price. We want to level up some of the areas that have been left behind. That does not mean we want a reduction in income in places such as London. We need to ensure that we lift all boats—that is the philosophy behind levelling up.

[Baroness Tyler of Enfield (LD)]

My Lords, does the Minister agree that financial inclusion—that is, ensuring that people have access to essential banking services and financial products that are fairly priced—is particularly important for areas that the Government are looking to level up, and that incorporating a clear financial inclusion strategy into the levelling-up agenda could make a big difference? Can the Minister say whether Treasury and DWP Ministers who lead on financial inclusion are part of the Government’s levelling-up agenda?

[Lord Greenhalgh (Con)]

My Lords, financial inclusion is very important in particular areas, and it is important in addressing it to bind together different departments. That is why there is a new levelling-up task force under the leadership of Andy Haldane that brings together the Department for Levelling Up, Housing and Communities and the Cabinet Office, precisely because we need that Whitehall join-up.

Net Zero: Social Market Foundation Report

Baroness Tyler of Enfield Excerpts

Monday 1st November 2021 Lords Chamber

[Lord Greenhalgh (Con)]

The Government are providing many mechanisms to support rural areas. I point to the community energy projects, through the rural community energy fund, which is a £10 million fund to support community-run projects in England that benefit the transition to net zero. Net zero is half the story; adaptation to the consequences of climate change is equally important, and the Government are committing £2.8 billion in a six-year capital investment plan to reduce flood and coastal erosion risk.

[Baroness Tyler of Enfield (LD)]

My Lords, local authorities are critical to achieving the Government’s net-zero target, but will struggle to do so without sufficient resources. Some 95% of local authorities have said that funding is a barrier to them tackling climate change. The Climate Change Committee recommended increased resourcing for local government as a priority. Can the Minister say whether and when the Government intend to give local authorities new capital-raising and revenue-raising powers to support the transition to net zero, as recommended in the SMF report?

[Lord Greenhalgh (Con)]

My Lords, I point out that the Government have committed £1.2 billion for local action on climate change. There are currently no plans to devolve additional tax-raising powers, but the Treasury will keep this under review.

Inclusive Society

Baroness Tyler of Enfield Excerpts

Wednesday 14th April 2021 Grand Committee

[Baroness Tyler of Enfield (LD) [V]]

My Lords, I pay tribute to the noble Baroness, Lady Lister, for securing this vital debate and refer to my social work interests in the register.

This has been a global pandemic, so I start my remarks at a global level. The World Bank has recently said that the current health crisis has

“put the spotlight on deep rooted systemic inequalities”

within societies, particularly for some of the most marginalised groups. Crucially, the bank has argued:

“The crisis is also an opportunity to focus on … rebuilding … more inclusive systems that allow society … to be more resilient to future shocks, whether health, climate, natural disasters, or social unrest.”


Our debate focuses on the UK. In March, the British Academy produced a series of reports addressing the long-term societal impacts of Covid-19. Its evidence report listed nine interconnected areas, which included: worsened health outcomes and growing health inequalities and the greater awareness of the importance of mental health.

In responding to this new opportunity and trying to reshape the way we do things, we must recognise that the pandemic has had a disproportionate impact on certain groups, particularly black and minority ethnic communities and disabled people. It has exposed deep inequalities in our health and care systems. In February, the Marmot 10 Years On report was published and made for sober reading. In short, it showed that life expectancy in England has stalled for the first time in more than 100 years and even reversed among the poorest people in certain regions: the more deprived the area, the shorter the life expectancy.

Professor Marmot says that the worsening of our health cannot be written off as the fault of individuals for living unhealthy lives; rather, their straitened circumstances and poor life chances are to blame. His institute’s work has established that healthy lives depend on early child development, education, employment and working conditions, adequate income and a healthy and sustainable community in which to live and work. Surely these are all things that an inclusive Covid recovery plan should prioritise.

The Government’s commitment in their 2019 election manifesto to extend healthy life expectancy by five years by 2035 and to narrow the gap between richest and poorest is to be welcomed. However, as the Lords Public Services Committee recommended in its first major report on the impact of Covid on public services, the Government should now publish their strategy to achieve that manifesto commitment and their response to the prevention White Paper. Can the Minister say when the Government plan to do that?

As we have already heard, many children have been particularly badly affected by the pandemic, and life was already difficult for many vulnerable children. In 2017, the all-party group for children, of which I am co-chair, published two reports looking at the state of children’s social care. In brief, they found that children often have to reach crisis point before social services step in and that decisions over whether to help a child—even in acute cases—are often determined too largely by budget constraints. I join others in calling for the £1.7 billion lost from the early intervention grant since 2010 to be restored.

I turn finally to mental health. Recent Centre for Mental Health modelling predicts that up to 10 million people in England will need either new or additional mental health support as a consequence of the crisis. Some 1.5 million of those will be children and young people under 18. It is abundantly clear that the pandemic is taking a huge toll on children’s mental health and that the current system—already under great strain pre-pandemic—simply will not cope with the scale of demand coming down the track. Without the right mental health support in schools, the significant investment that the Government have rightly made in academic catch-up risks being undermined. While the extra £79 million announced in March for mental health in schools is welcome, it simply will not be sufficient to keep up with urgent need. Tackling this unprecedented mental health crisis will need more ambitious action, including every school having access to counselling services. I look forward to hearing the Minister’s response on this point.

[Baroness Bloomfield of Hinton Waldrist (Con)]

I intervene at this juncture to remind noble Lords that there is a four-minute speaking limit. I would be grateful if people could try to observe this so that everybody gets the chance to speak.