Social Care in England

Baroness Wheeler Excerpts

Thursday 14th October 2021 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, on behalf of these Benches I formally welcome the Minister to his first debate in the House. I am particularly pleased that it is on social care, so that he can focus on addressing the deep concerns across the House about the Government’s social care plan, made clear during Monday’s passage of the hastily thrown together Health and Social Care Levy Bill. It also ensures that he provides much-needed responses to key issues that will not go away, however many slogans and smokescreens the Government throw up.

This has been an excellent debate. Whether from Labour, the Government, other parties or Cross-Benchers, these occasions demonstrate the level of expertise, experience and scrutiny that I am sure the Minister fully realises he will get from noble Lords. This was no better demonstrated than by my noble friend Lady Pitkeathley’s candid and honest appraisal in her powerful speech of the current crisis and what is needed to provide sustainable services in future. She reflects both the knowledge and experience of a lifetime of work on health and social care and of a strong campaigner and advocate on behalf of unpaid carers. We are all very grateful to her.

Like other noble Lords, I particularly pay tribute to unpaid carers because we need to get back to a proper recognition of their crucial role and doing more than just saying how wonderful they are. In 2009, before I joined your Lordships’ House, I was fortunate, as a carer myself, to undertake a 12-month secondment to the Department of Health’s excellent carers strategy team, which had produced the first pioneering strategy in 2008, placing carers at the heart of families and communities. Central to this was recognition and funding for vital local support and networks, regular everyday social services care support for carers and the loved ones they cared for, and ring-fenced grants via GPs and councils for regular care breaks—so crucial, given the relentless responsibility of caring for a loved one around the clock. At that time in DH, there were 10 full- time staff in the carers team. Perhaps the Minister could tell me how many staff there are now.

Today, as carers emerge worn out and exhausted from the pandemic, they have every right to expect immediate funding support. Instead, the Prime Minister’s plan contains no immediate extra funding for carers and the levy does nothing for them in two years’ time. The “health and social care begins at home” and “family first, then community, then the state” comments from Sajid Javid add insult to injury, as many noble Lords have said.

Carers need care workers and social care to support their families; their role complements that of paid staff but they are not substitutes for care workers, who are themselves chronically undervalued and underpaid. They already provide the vast majority of care and love to our vulnerable and disabled people, many of them having had to give up work to do so. That is why Labour’s “home first” principle is so important. It means the state, families and communities working together to enable and support people to live well with dignity, in their own homes, and receive the care they need. Only with “home first” can the focus of support be effectively shifted to prevention and early intervention.

Today shows that we are still in the dark about the key funding concerns raised during Monday’s debate on the Bill, such as how much of the levy will actually be spent on social care and how councils are to be funded for the care cap; ensuring that self-funded care home residents pay the same rate as council-supported residents; what guarantees social care has if the NHS’s herculean task of dealing with the backlog of treatments absorbs the bulk of the levy funding; or, indeed, what funding will flow for social care unrelated to the cap. I welcome the contributions from noble Lords today that have focused on this vital aspect of social care.

However, those of us hoping for answers from the Treasury Minister on Monday to these and other searching questions were sadly disappointed. As in Monday’s debate, several noble Lords cited today the excellent analysis by the independent Institute for Fiscal Studies—a reality check for the Government, if ever there was one, regarding how underfunded their spending plans for the NHS and social care are—particularly its stark warning that the £12 billion raised annually by the tax increase needs to rise to nearly £19 billion by 2025 to meet future NHS and social care demand. Will the Minister promise the House that the Government will respond in detail to the IFS findings, which reflect the serious funding concerns from across the sector?

With the health and social care Bill, currently in the Commons, dealing with the already up and functioning integrated healthcare systems, can the Minister explain how another radical plan by the Government for a health and social care integration White Paper, as reported in the media, will dovetail with that Bill, the social care plan we are discussing and the levy funding? Back-to-front planning and legislation is how many stakeholders have described it: raising the money first and deciding how it is to be spent later.

Can the Minister provide further details on the purpose and timing of the White Paper, and what it will cover? Will it deal with the really big issues, in the words of the noble Lord, Lord Bichard? Will it also address the absolute social care basics that the current plan ignores and that cause such suffering and despair today: the unmet social care needs of 1.5 million older people, who need help with washing and dressing that they do not currently get; the 300,000 people waiting in vain for care assessments by local councils who just do not have the resources to do them; or the needs of the disabled young people and adults of working age whose funding makes up over half of the current social care budget? I particularly look forward to the Minister’s response to my noble friend Lady Donaghy’s expert analysis of the funding issues for care homes and social housing.

Labour has made it crystal clear that Boris Johnson’s plan is not the thought-through and fully funded long-term plan for social care that is so desperately needed. In the words of the Labour leader, Keir Starmer, an unfair tax hike that does not fix social care and does not clear the NHS backlog is not a plan. Any fix for the future of social care has to transform support for older and disabled people within the wider ambition of making Britain the best place in which to grow up and grow old. This plan does not come anywhere near that: no reforms, no guarantees and no long-term sustainability. The Minister needs to provide the clear answers to noble Lords that we did not get on Monday, in particular on fairness. How is it fair and right, at a time when low-paid workers and their families are still reeling from the impact of the pandemic and are hit with rising food, energy and fuel costs, to place the burden of paying for the social care plan on them?

On social care funding guarantees and local council support, why is it not possible now to set even an ambition as to how much of the additional funding from the levy will go to social care in 2023? Less than one in every six pounds raised will go to social care in the first three years of the plan. On local council funding, as the Local Government Association stresses, relying on the continued use of council tax, the social care precept and long-term efficiency savings does not address the current crisis or future social care demand. Councils just do not have the money. Does the Minister acknowledge that, unless the spending review recognises this, even the limited scope for reform in the Government’s plan will fail?

We know that the care costs cap will not solve the huge crisis in social care, and it will not stop people having to sell their homes. We have had many searching questions from noble Lords on how it will be calculated and work, what care needs it will pay for, how much people have to pay before the £86,000 kicks in, and, of course, what rates councils will actually be able to pay that will be counted towards the cap. Why delay bringing in the cap until 2023? The legislation is in place now under the Care Act 2014. The Government have previous form on promising to introduce the cap, which was subsequently delayed twice and finally cancelled altogether. Can the Minister confirm that history will not repeat itself and the cap will not be axed again in 2023 as “unaffordable”?

On social care equality and parity with the NHS, how are the continuing inequalities and the unfairness between the systems, such as the huge financial costs involved in paying for dementia care and the often terrible injustices of who gets NHS continuing healthcare and who does not, going to be addressed? In its “national scandal” report, the House of Lords Economic Affairs Committee set out a key package of reforms to begin to address the divide between social care and the NHS. Why has it been completely ignored?

Like all noble Lords, I pay full tribute to the work and commitment of social care staff, particularly over the last year. They have been on the front line of the pandemic in domiciliary care and in care homes. Fixing social care must mean a new deal for them and the transformation of their pay and conditions. The spending review must address this. My noble friend Lady Warwick and other noble Lords have pointed to the Skills for Care workforce report, which shows beyond doubt the scale of the social care recruitment crisis and reinforces the urgent need for this.

My noble friend Lady Pitkeathley is absolutely right to express her frustration that the Government’s plan for social care is once again a missed opportunity to put social care on an equal footing with the NHS and build a post-Covid vision for social care: a plan of investment and reform, including integrated services and a well-paid, fully trained and skilled workforce. After the way social care was treated as an afterthought during the pandemic, this should have been a central part of the Government’s plan for fixing social care. Sadly, it was not.