Adult Social Care

Baroness Wheeler Excerpts

Thursday 2nd December 2021 Lords Chamber

[Baroness Wheeler (Lab)]

I thank the Government for the Statement, which has been a long time coming.

First, we are told that we have a health and social care Bill to deal with integration across the NHS and social care. Instead, we get a giant Bill that is largely about NHS reorganisation to undo the structures set up by this Government in 2012. We are also told that there is a plan to fix social care, but we now have a government levy that has working-class families paying for extra funding that could in any event result in the NHS swallowing up most of the money to deal with the ever-growing waiting lists for vital treatment, with little left for social care. Finally, we have the grand announcement of the care cap, for which there was strong cross-party support when it was first proposed by Andrew Dilnot in 2011 and legislated for in 2014. However, it is now due to be delayed for yet another two years and introduced at half the level recommended by Dilnot, with the terrible and deadly sting in the tail of the last-minute amendment to the NHS Bill that was forced through the Commons last week and means that state-funded care costs will not be counted towards the care cap at all.

I remind the House that we have waited for this social care White Paper for four years, with unexplained delay after delay against a backdrop of expectation that, when it finally came, the NHS and care Bill would embrace NHS and social care integration. The proposals for this and other measures in the White Paper should have been an integral part of the Bill, which we will begin to debate next week. Can the Minister tell the House how the integrated care system under the Bill will be integrated for social care? Will there be another piece of legislation? If so, what will it seek to do?

Of course, Labour has called for and supports a number of the measures in the White Paper, such as improving the housing options available to older and disabled people and the potential for technology to improve standards of care. However, there are two central flaws in the Government’s latest approach. First, Ministers have utterly failed to deal with the immediate pressures facing social care as we head into one of the most difficult winters on record. Secondly, they have failed to set out the long-term vision and reforms that we need to deliver a care system fit for the future.

Last week, we learned that a staggering 400,000 older and disabled people are now on council waiting lists for care, with 40,000 of them waiting more than a year. There are more than 100,000 staff vacancies and turnover rates are soaring. Because of these shortages, 1.5 million hours of home care could not be delivered between August and October alone, and half of all councils report care homes going bust or home providers handing back contracts. Hundreds of thousands of older and disabled people are being left without the vital support they need, piling even more pressure on their families and the NHS at the worst possible time.

Does the Minister recognise the figure, reported this week, that 42,000 care staff have left their jobs since April? How will this White Paper ensure that care homes facing huge staff shortages can stay open and recruit and retain staff? Absolutely nothing new has been announced to deal with these crucial issues. Where is the plan to end waiting lists for care? Unless people get support when and where they need it, they will end up needing more expensive residential or hospital care, which is worse for them and for the taxpayer. We know that improving access is the first step in delivering a much more fundamental shift in the focus of support towards prevention and early intervention so that people can continue to live independently in their own homes for as long as possible. Without enough staff with the right training working in the right teams, this will never be achieved.

Where is the long-term strategy to transform the pay, training and terms and conditions of care workers, and to deliver at least 500,000 additional care workers by 2030, just to meet the growing demand? Why do the Government persist in having separate workforce strategies for the NHS and social care when the two are inextricably linked? Where is the joined-up strategy for the whole health and social care workforce?

The proposals in the White Paper for England’s 11 million family carers, who provide the vast majority of care in this country, are, quite frankly, pitiful. Unpaid carers have been pushed to the limit by trying to look after the people they love. Almost half said that they had not had a break for five years, even before the pandemic struck, and 80% of them are now providing more care than ever before. However, the funding announced amounts to just £1.60 more for each unpaid carer per year. Does the Minister not agree that families deserve so much better?

What was needed today was a long-term vision that finally puts social care where it belongs: on an equal footing with the NHS at the heart of a modernised welfare state. Can the Minister explain how this White Paper does that and delivers the resources needed to bring it about? At its best, social care is about far more than just helping people to get up, wash, dress and get fed, vital though this is. It is about ensuring that all older and disabled people can live the life they choose in the place they call home, with the people they love and doing the things that matter to them most. This should have been the guiding mission of the White Paper, with clear proposals to make users genuine partners in their care by transforming the use of direct payments and personal budgets, and ensuring that the views of users and families drive change in every part of the system, from how services are commissioned to how they are regulated and delivered.

The Government’s proposals fall woefully short of the mark and the reality of their so-called reforms is now clear: it is a tax hike on working people that will not deal with the problems in social care now. It will not even stop them having to sell their homes to pay for care, as the Prime Minister has repeatedly promised. The simple fact is that, under the Government’s proposals, if you own a home worth £1 million more than 90% of your assets will be protected, but if your home is worth £100,000 you could end up losing it all. Millions of working people are paying more tax, not to improve their family’s care or stop their own life savings being wiped out but to protect the homes of the wealthiest. This is not fixing the crisis in social care, let alone real social care reform. It is unfair and just wrong.