Social Care Strategy

Debate between Baroness Tyler of Enfield and Lord Kennedy of Southwark

Thursday 10th October 2024 Lords Chamber

[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.