Social Care in England
Baroness Wheeler Excerpts(4 years, 2 months ago)
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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.
Social Care Funding: Intergenerational Impact
Baroness Wheeler Excerpts(4 years, 3 months ago)
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Baroness Wheeler (Lab)
My Lords, I congratulate the noble Baroness, Lady Greengross, on securing this debate and on her timely reminder of the intergenerational fairness report on social care funding, which she so ably chaired.
This is the first, brief, opportunity we have had since the usual hyperbole and razzmatazz of the Prime Minister’s announcement last week to begin the step-by-step, detailed debate and analysis about what is actually in the proposals and their impact across the generations on the elderly, on working-age people, on younger people with disabilities and their families and on carers.
Reality is fast setting in, as noble Lords’ wide-ranging and thoughtful contributions in this debate have shown. After the way it was treated during the pandemic, the hope and expectation must surely have been for social care to have been an up-front and equal partner in any future health and social care funding plan, but it certainly is not in what the Government have set out.
The funding allocated to social care from the health and social care levy over the next three years amounts to only £1 in every £6 of the total £36 billion raised. Figures from the Institute of Fiscal Studies clearly show that this is nowhere near enough to offset the £8 billion of cuts in per capita spending over the last decade. Local councils, social services leaders and providers are deeply concerned that the NHS will continue to absorb and swallow up the vast majority of the proceeds from the new tax, and there is no extra funding to deal with the crisis in social care now; a number of noble Lords pointed that out. As the National Care Forum put it:
“This is a recovery plan for the NHS … The funding pot being talked about for social care is not sufficient to even address the issues of today.”
Although we do not agree with the intergenerational report’s overall recommendations on funding, many of its findings nevertheless resonate with Labour’s key concerns about the impact that the Government’s proposals will have. Many of those concerns have been underlined today by noble Lords, particularly the noble Lords, Lord Howarth, Lord Davies and Lord Griffiths, and the noble Baroness, Lady Tyler.
We have made it clear that the plan is wrong on so many fronts. First, the national insurance increase will disproportionately affect younger and lower-income workers. It does nothing to tackle the chronic workforce shortages, which are getting worse by the day, and will mean care workers ending up £1,130 worse off as a result of this increase and the £20 cut in universal credit, which many rely on.
The cap will do nothing for a third of the users and half the budget for social care, which is for working-age adults with disabilities, as a number of noble Lords— including the noble Baronesses, Lady Watkins and Lady Brinton, and the noble Lord, Lord Sikka—pointed out. The press stories of young disabled people having to stay in bed or sitting in a chair all day because their care hours and the other services they depend on stopped during the pandemic and still have not restarted are heartbreaking. Further, the cap will not kick in until 2023 and does not cover all costs. People will still need to sell their homes to fund their care and many people in care will never hit the cap, as the noble Lord, Lord Lipsey, pointed out.
Moreover, there is no commitment to addressing the urgent needs of the 1.5 million older people who are denied personal care for help with washing, dressing, toileting and other basic needs to help them to stay in their homes and be part of their local communities. Labour’s key principle of “home first” must form a key part of the plan for sustainable funding. We have made it clear that the social care plan must be fair across generations, and that those who can most afford it must be asked to contribute more. It must deal with both the immediate and long-term funding needs, and give social care the parity with the NHS that it both deserves and needs.
Social Care: Family Carers
Baroness Wheeler Excerpts(4 years, 3 months ago)
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Baroness Pitkeathley
To ask Her Majesty’s Government what consideration they have given to providing extra support for family carers given the delay to social care reforms.
Baroness Wheeler (Lab)
On behalf of my noble friend, and with her permission, I beg leave to ask the Question standing in her name on the Order Paper.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, we recognise that family carers play a vital role. When we announced an additional £4.5 billion over three years for social care, it included a commitment to take steps to ensure unpaid carers have the support, advice and respite they need. We will publish a White Paper later this year with more detail. The Health and Care Bill also places a duty on integrated care boards to promote the involvement of unpaid carers.
Baroness Wheeler (Lab)
My Lords, the Minister has acknowledged that our 1.6 million unpaid carers are reporting high levels of fatigue and stress and are worn out and exhausted by caring during Covid-19. On average, carers have lost 25 hours a month of crucial support over the past 18 months, and 81% are providing more care. Essential daily support services for them and their loved ones are still not up and running in many areas. Was it not therefore reasonable for carers to have expected immediate funding support from the Prime Minister’s health and social care funding announcements last week? The situation is desperate and needs addressing now, not just with more kind words and another “White Paper tomorrow” promise.
Lord Bethell (Con)
My Lords, I do acknowledge the pressures on unpaid carers and pay tribute to the incredible contribution they have made during these very difficult 18 months. We are continuing to work with local authorities, in collaboration with ADASS and MHCLG, to support local authorities in meeting their duties, particularly in the area of respite, which the noble Baroness rightly pointed out. We have also made contributions to Carers Trust, Carers UK and to “See, Hear, Respond” services to support unpaid carers. In the long term, our commitment is to social care reform and the financial proposition that we will bring forward in the White Paper.
Residential Social Care: Staff
Baroness Wheeler Excerpts(4 years, 3 months ago)
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Lord Bethell (Con)
My Lords, I am aware of the anecdotes that the noble Baroness alludes to, but they have not been seen through the figures that we have in the department. However, we are providing support to providers: we have a national recruitment campaign that is running in the autumn; we have put in free and fast-track DBS checks for staff recruited in response to the pandemic; and we have the promotion of adult social care careers in our jobcentres.
Baroness Wheeler (Lab)
My Lords, while we await the announcement of the Prime Minister’s social care plan, after two frustrating years of non-action and delay, the continuing crisis in care homes needs to be dealt with now. With a possible 68,000 jobs now predicted to be lost in the light of the Government’s 11 November deadline for all care staff to be vaccinated, feedback from care providers shows that both care workers and the most senior and experienced staff are leaving the care workforce, with registered nursing staff constituting a much higher proportion than other care staff. What action have the Government taken to address this potential crisis in both the staffing and the management of care homes, particularly since the number of nursing jobs, for example, has decreased by 17,000, or 33%, over the past year?
Lord Bethell (Con)
My Lords, I do not completely recognise all of the noble Baroness’s figures, but I acknowledge that recruitment in many sectors of the economy is tough at the moment, and that is why we are putting in the measures that I mentioned to the noble Baroness, Lady Brinton. I add that we are doing an enormous amount to fund: we have put £1 billion of additional funding into social care for 2021-22, on top of the significant support provided to the sector during Covid-19 over the last year. This is money directly to address the issues that she is concerned about.
Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) Regulations 2021
Baroness Wheeler Excerpts(4 years, 5 months ago)
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Baroness Wheeler
At the end to insert “but that this House regrets that the Regulations do not include any information about how the legislation will operate and that this will be left to guidance that will not be available until the end of July; further regrets that a full impact assessment has not been published including analysis of the number of current staff who may not comply and the potential impact on care homes if care home staff become ineligible for work because they are not fully vaccinated or medically exempt; notes that the Secondary Legislation Scrutiny Committee recommended that the debate on the instrument should be deferred until the operational guidance and full impact assessment has been published; and calls on Her Majesty’s Government to provide stronger supporting evidence for permanently requiring staff to have received both doses of the vaccine or, if they have not, to be banned from entering their workplace.”
Baroness Wheeler (Lab)
My Lords, I thank the Minister. I am moving my amendment in the light of the deep concerns of the Secondary Legislation Scrutiny Committee in its eighth report. I listened to its 13 July questioning of Nadhim Zahawi, the Vaccine Minister, which was held on the same day that the SI was debated in the Commons. The committee produced a further, 10th report yesterday in response to this. As its eighth report says,
“effective Parliamentary scrutiny is impossible”
by the House because crucial operational guidance and the impact assessment are not available, because none of the practical information about how the guidance is to operate is in the actual legislation before us, and because no reasons have been provided as to why the legislation is not a restricted pandemic measure rather than the permanent measure that the Government are proposing.
The Commons debate was focused on the failure to produce the impact assessment so essential for understanding the full consequences of the legislation. The Health Minister promised that we would have it before our debate today; the Vaccine Minister instead undertook to provide an impact statement, which the committee still had not had at the time of its further report. I am still not clear which piece of the last-minute information promised has been delivered, and the Minister’s speech may have confused me still further about what is and what is not available.
So we have more documentation and more information but not the full and detailed impact assessment that is needed. Overall, we still do not have the answers to the committee’s fundamental questions: why has the vaccination programme not managed to achieve the required levels despite care home staff being prioritised, and why the regional variations? Why has there been no detailed analysis of the impact the policy will have on care home staff and the possible risk to the viability of care homes as a result? We still have had no real analysis of the degree and nature of the opposition to the proposals expressed during the consultation, which could provide helpful guidance on how it is to be addressed.
This SI is muddled, confused and disjointed and, in places, contradictory—across the SI itself, the Explanatory Memorandum and in the Government’s consultation response. This makes even more urgent the publication of clear and detailed guidance which includes not just the practical detail the committee wants to see but the full policy framework. We are assured that the guidance has been produced in consultation with the sector. Can the Minister confirm that this has included care home providers from both large and small group homes, and the staff unions? Is there now a firm publication date, other than just the end of the month, in 11 days’ time, that we have been promised?
Specifically on consultation, the Government’s consultation response document itself admits that 57% of respondents were against the mandatory vaccination of staff. Nadhim Zahawi stressed to the committee how important it was to “carry people with us” and our Minister told the House on 8 July:
“We are in a consultation … it is an honest consultation. We have to take people with us: this is not something that we can impose on people against their will.”—[Official Report, 8/7/21; col. 1454.]
How will the Minister now honour that commitment, and how does he square it with the legislation that the Government have actually produced?
In its report, the committee is particularly scathing about the DHSC’s failure to provide justification for the substantial policy change from using the SAGE advice, mentioned by the Minister, of at least 80% of care home staff needing a first vaccination in order to provide a minimum level of protection against Covid-19 to the requirement for them to have two doses or they will be banned from the workplace and stand to lose their job. Why this shift and what is the detailed evidence which led to such a major policy change?
Despite our deep concern about the health and safety of care home residents, no one doubts the impact that mandatory vaccination will have on care home staff in their jobs, the risks to the viability of care homes and the confusion that will reign, especially in small care homes coping with even worse staff shortages and recruitment problems than they currently have and trying to administer and monitor the trades- person, et cetera, visiting arrangements. The National Care Forum has been particularly vocal on that latter point. We just do not know the scale and extent of the risk in a sector that already has 100,000 unfilled posts.
These are dedicated staff who have been in the front line of care through the pandemic. We need to understand why there is vaccine hesitancy among the minority of staff and build and strengthen the excellent work that has been done with so many to allay fears and assuage concerns arising from cultural or personal health fears.
Can the Minister explain how the Government will ensure that the 16-week grace period is used to intensify and ramp up the take-up campaign and ensure the targeting of regions and areas where there is relatively low take-up? Will it be extended if the impact assessment and implementation plan show that that is needed?
Paragraph 12 of the EM contains only five short points dealing with the serious staff shortages that the care sector will face, starting with the bald understatement that there will be
“the short-term cost of dealing with staff absences”.
Moreover, the EM goes back to the Care Act 2014 provision, which assumes that local authorities have a contingency plan to address workforce shortages and care provider closures. Given the Government’s sweeping council social care funding cuts for the past 10 years, we know just what state councils would be in if they tried to meet that contingency. Last week ADASS reported up to 250,000 vulnerable people across England languishing on social care waiting lists for care assessments or service reviews to check their physical and mental state. Will additional funding be made available to councils to meet the extra costs of staff shortages and turnover?
In conclusion, the House must be reassured that there will be a detailed, coherent, well-resourced and fully thought-through plan for moving forward and finding solutions for carrying and taking people with us—in the words of the Ministers—and addressing the major challenges that implementing the mandatory vaccination of care home staff will present. We must be reassured that the Secondary Legislation Committee’s rightful concerns have been fully addressed. For the record, its 10th report, published yesterday, stresses that, despite the welcome “further information and explanations” from the Government,
“we remain unclear about the justification for some of the policy choices underlying these Regulations and also the basis on which the department struck a balance between public health benefits and the impact on the rights of individuals.”
I look forward to the contributions of other noble Lords and the Minister’s response, and I will wish to test the opinion of the House on this very important issue. I beg to move.
Baroness Wheeler (Lab)
My Lords, I thank the Minister for his response and all noble Lords for their contributions on this very important SI. Of course, I join in the tributes to social care staff across the sector during the pandemic. As I said in moving the amendment, my focus is on the Secondary Legislation Scrutiny Committee’s rightful concerns about the inadequacy of the legislation and the Government’s failure to produce the essential guidance needed or the full impact assessment of the risks to the future of many care homes from the huge disruption that will take place. It is not an SI that is pandemic-restricted, a temporary measure; instead it is permanent legislation, which makes the quality of the SI even more important and reinforces the inadequacy of the legislation we have before us today on such an important issue for care homes, their staff and residents.
My noble friend Lord Hunt and the noble Lord, Lord Lansley, sought an assurance from the Minister that the measures will be temporary and time-limited, but we did not get that assurance. Once again we have an SI that seeks to extend unspecified government powers in legislation without justifying why those powers are needed. In other words, this is, as the Secondary Legislation Scrutiny Committee says,
“guidance exceeding its ancillary function and taking on the role of legislation”.
Noble Lords raised many points and I fear there is just not time now to respond to them. Overall, this SI remains an incoherent, muddled and confused piece of legislation and further last-minute information and reassurances from the Government have not made it any clearer or dealt with the key issues that need to be addressed. I wish to test the opinion of the House.
Health: Dementia
Baroness Wheeler Excerpts(4 years, 5 months ago)
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Baroness Wheeler (Lab)
My Lords, not only are there deep concerns about the sharp drop in memory clinic referrals during the pandemic; the Alzheimer’s Society also has very real fears that the virtual assessments currently taking the place of attendance at memory clinics run the risk of exacerbating inequalities in treatment and excluding large cohorts of patients. What is the Government’s overall strategy for ensuring that vital day care and hospital services are reopened and that the backlogs in referrals are addressed, for providing the rehabilitation that people with dementia need to counteract the effects on their cognitive and physical function, and for providing support for their mental health and well-being?
Lord Bethell (Con)
My Lords, guidance to help enhance best practice in dementia assessment and diagnosis was recently updated and published to support a personalised approach and choice in the delivery of remote consultation or face-to-face diagnosis. The guidance was developed in collaboration with stakeholders, including those with lived experience, and through the Dementia Change Action Network. I completely acknowledge the point that the noble Baroness makes. We are working as hard as we can to get the kind of face-to-face assessments she describes. They play an essential role in what we do.
Social Care Reform
Baroness Wheeler Excerpts(4 years, 6 months ago)
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Baroness Wheeler (Lab)
My Lords, in last week’s very powerful debate on social care, noble Lords from across the House made it clear that we cannot build a better future for our country after Covid-19 without transforming social care, but instead of a firm date for the Prime Minister’s clear plan, we had the usual reassurances from the Minister that it was still absolutely under way, we would see some social care foundations in integrated care systems under the NHS and care Bill but that it would still be the “end of the year” before the Prime Minister reveals his clear plan to all.
Over these nearly two wasted years we have had delays and broken promises. Almost 42,000 care home residents have died from Covid-19, 2 million people have applied for support but had their request refused, tens of thousands have had to sell their home to pay for care, millions of families have hit breaking point and staff have been appallingly let down. Even after all the horrors of this pandemic, nine out of 10 councils say that they face care budget cuts this year.
While the Government dither and cancel key meetings and the Prime Minister blocks various funding options, the social care funding crisis deepens. Now we see in the Daily Telegraph that the new Secretary of State considers that we are completely at the wrong stage of Parliament to launch a new social care strategy. What is going on?
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell)
My Lords, the commitment to publishing a review of social care is absolutely heartfelt. We have delivered on Brexit and the vaccines, and we will deliver on social care. The Prime Minister has made it crystal clear that that will be done by the end of the year; that commitment remains in place. It will require enormous financial commitment by the whole nation at a time when our finances as a nation are extremely stretched. Therefore, it is entirely right that very careful consideration is given to it. It will also involve a very large amount of engagement with other parties and the relevant stakeholders. Again, this is not something that has been rushed. We have just been through the most awful pandemic; it is not possible to do a review of this generational nature at the same time as fighting this awful disease, but we will be true to our commitments and deliver the plan as promised.
Social Care and the Role of Carers
Baroness Wheeler Excerpts(4 years, 6 months ago)
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Baroness Wheeler (Lab)
My Lords, I too congratulate the noble Baroness, Lady Jolly, on securing this debate and on her usual very thorough and thoughtful introduction. Of course, it is deeply frustrating for us all to be yet again debating the ever-deepening crisis in social care in the absence of any sign of the Government living up to their promises of reform and “once and for all” change, in the words of the Prime Minister.
The excellent “national scandal” report of our Economic Affairs Committee was our last major debate on this vital issue and is still an authoritative source for this debate. The committee warned, and it is worth repeating, that:
“With each delay the level of unmet need in the system increases, the pressure on unpaid carers grows stronger, the supply of care providers diminishes and the strain on the care workforce continues.”
That is why it is so important for us all to keep up the pressure, as noble Lords have done this afternoon, hammering home the scale of the crisis and the substantial extra funding urgently needed. This must be sustainable long-term funding, not just the welcome but wholly inadequate plugging-the-hole periodic cash injections that Ministers trumpet at every opportunity as the solution to the deep crisis we are in.
I am also grateful to the noble Baroness, Lady Jolly, for specifying unpaid carers. As usual, her words were movingly reinforced by my noble friend Lady Pitkeathley and by almost every speaker; it is a most welcome and essential focus. They drew on the extensive surveys and reports produced by Carers UK for Carers Week. In these we heard from carers themselves on the huge challenges they have faced during the pandemic—not just the absence of essential breaks and respite but the impact on their own health and well-being and their worries about when the key daycare and other services, vital to the loved ones they care for, will come back.
Many routine but essential services came to a halt during the pandemic, as noble Lords have spelt out. For example, I am a carer and the excellent services at our local community centre—stroke clubs, memory clinics for people with dementia, community meals and support groups—show no sign of reopening until at least September. For carers of disabled people, people with learning difficulties and disabled children and their families, this daily or week-by-week support is so important. It is devastating when it is not there. It helps carers cope, gives them a chance to get on with the other things they have to do and, most important, helps to keep the person they are caring for well, active and engaged.
A longer break for carers and the cared-for is just as important. As Care England has said, respite care provided by many care homes has been withdrawn because of the 14-day isolation requirement. For younger adults with learning disabilities living at home with parents, a few days of respite every month or even week, or care home provision if the carer falls ill, is a key part of their care plan. It helps carers continue to cope. The Minister has promised us a meeting with Carers UK; I hope he is arranging it with the urgency it deserves. Can he please update us on the progress of the department of health and local authority talks and work he referred to last week to ensure that daycare centres and care services are reopened?
We know that the Minister’s response today will contain all the elements we are used to hearing about government funding support for carers, the care workforce and social care during the pandemic, and the now-familiar “later this year” promise of the social care reform proposals. But it is clear from today’s debate that, nearly two years after the Prime Minister’s Downing Street doorstep pledge, such is the despondency, scepticism and doubt about this latest deadline that it is almost not worth asking the Government how they are getting on with it—particularly with the recent press reports on cancelled meetings and the Prime Minister’s obdurate blocking of various funding options.
On the issue of cross-party consensus, raised by a number of speakers, rather than just his usual passing reference it is time for the Minister to explain today just what he means by this. To repeat for the record, we had cross-party consensus on the Care Act 2014 setting up the care cap on funding costs recommended by the Dilnot commission, the eligibility criteria for social care and many other important reforms, such as legal rights for carers to assessment and support. The consensus on the cap was there during the 2015 general election, councils were given lead-in preparation funding for implementation in April 2016, and £6 billion was allocated for care cap costs. But we know the rest of the story: delayed implementation and then cancellation —too costly—the £6 billion gone and huge sums of implementation funding just wasted.
The same cross-party consensus was reinforced in the “national scandal” report, as the chair of that committee, the noble Lord, Lord Forsyth, made clear in the previous debate. On these Benches we have strongly welcomed this report as a fully costed and solid basis for moving forward. It shows the scale of extra funding needed to break the cycle of chronic underfunding and unmet need, and to begin to address the unfairness and disparity in entitlement to care between the NHS and social care.
Many noble Lords have today again articulated the committee’s fundamental principles, which have the widespread support among the social care stakeholders and community that the Government say they want—for example, the top priority of restoring local authority funding for social care to 2010 pre-austerity levels; an end to councils’ dependence on locally raised funding for social care; a new £7 billion-a-year system for providing free personal care to help people with basic daily needs such as washing and dressing; and a major investment in a new deal for the social care workforce and joined-up workforce planning with the NHS. That is an excellent consensus on which to move forward, and the Minister knows it; it makes the current delays and dithering inexcusable.
On the vital issue of a new deal for social care staff, like all noble Lords I add my heartfelt tribute to them, not just for the pandemic but for the year-on-year dedication they have shown in the face of low pay and lack of public understanding and appreciation of the value of their work. They are a skilled profession and need and deserve the training, career and pay structures that properly reflect this. Raising the status and standing of care staff has to be a key part of social care transformation.
The positive signs of the impact that Covid has had on the public’s awareness and perceptions of care work are welcome. For example, the recent survey with care providers, stakeholders, care workers and candidates by the Work Foundation and Totaljobs reinforces this, showing an increase of 39% in people applying for social care roles in the last two years; younger candidates more likely to pursue a career in social work; and 56% of new starters in care joining from other sectors. This is promising, but these staff will stay in the profession for the medium and longer term only if there is fundamental reform to social care staff’s pay and professional status.
One of the key features of today’s debate has been the range of speeches across social care provision—I very much welcome this—not just on adult social care and the care of older people but on working-age disabled adults and children, people with learning difficulties and the importance of mental health social care, so often overlooked. This was referred to by my noble friend Lady Donaghy and the noble Baroness, Lady Barker.
The excellent briefing from the charity Rethink Mental Illness has been referred to in relation to the vital role that this should play in supporting people living with severe mental illness to help them to recover from hospital care, stay well and not go back into crisis. I hope that the Minister’s response will include reassurances that their needs will be included in social care reform. The parliamentary briefings that the seven leading charities representing working-age disabled people are organising for July will be very valuable in increasing our understanding of how social care should be working for this vital group. I hope that as many noble Lords as possible are able to attend.
During the debate, we were constantly reminded that half of local authority public social care funding is spent on working-age people and that local authorities also deliver children’s social care. This was so sharply brought into focus by the publication earlier this month of the first stage of the MacAlister independent review, which called for major reform and investment to ensure the effective protection of young people at risk. Alas, there is no time to debate this today, but we sadly see the same fragmented, disjointed system across multiple government departments and agencies, with the life chances of vulnerable children paying the price.
On residential care, noble Lords have rightly pressed the Minister on the issues that have so dominated our consideration of the SIs, Statements and Questions during the pandemic—on testing, PPE, hospital discharges to care homes, visitor access, indemnity insurance and occupancy guarantees. I look forward to hearing the Minister’s response on this, particularly on how care funding will be provided when the infection control fund ends at the end of this month.
We have had yet another powerful debate today. Noble Lords have made it clear that we cannot build a better future for our country after Covid-19 without transforming social care, and that real progress is needed now. If the press reports and rumours are correct and government focus is on reintroducing the care cap after all, five years after it could have started, this would address only part of the problem. It would not be the comprehensive plan for the reform and sustainable funding of social care that is so vitally needed.
I echo noble Lords’ good wishes to the noble Baroness, Lady Jolly, in her new role. My noble friend Lady Thornton and I have always enjoyed working with her, and we very much value her contribution and work.
Covid-19: Care Homes
Baroness Wheeler Excerpts(4 years, 6 months ago)
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Lord Bethell (Con)
My Lords, I completely sympathise with the point on those in care homes receiving a very tough challenge when they have been prevented from seeing loved ones. We have had to take extremely severe infection control measures, many of which are still in place for the reasons that have been discussed in this Chamber before. But I challenge the noble Lord’s point on testing. We brought in testing when asymptomatic infection was recognised and when the capacity was available.
Baroness Wheeler (Lab)
My Lords, can the Minister explain why the Secretary of State continues to justify himself by quoting the seriously underestimated PHE January to October 2020 data assessment on hospital discharges to care homes of 286 Covid deaths? The National Care Forum of care providers has repeatedly made clear how fundamentally flawed and incredibly partial that data is. Only limited numbers of symptomatic patients in hospitals and care homes were tested, and cases not tested before death are not included. Even the chair of the House of Commons Science and Technology Committee has said that relying on this for a full picture of the situation is a stretch of the imagination. We owe it to the people who have died, their relatives and care home providers to have full, accurate and independent information. How is the Minister going to ensure that it is urgently provided, so that we can genuinely learn from what happened?
Lord Bethell (Con)
My Lords, I acknowledge the noble Baroness’s concerns, but the PHE report is extremely thorough. I am not aware of it being revised, but if it is, I would be glad to share that information with the noble Baroness.
Carers: Support
Baroness Wheeler Excerpts(4 years, 6 months ago)
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Baroness Wheeler
To ask Her Majesty’s Government what steps they are taking to ensure that carers get the support and breaks they need.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, the love, commitment and sheer hard work of Britain’s unpaid carers have saved lives and made a huge difference to the country’s most vulnerable. The nation is hugely grateful. I completely recognise the impact the pandemic has had on access to support and breaks. Local authorities have an important responsibility to assess carers’ needs, and I pay tribute to the efforts of local authorities as we work together to reopen day and respite services.
Baroness Wheeler (Lab)
My Lords, I commend to the Minister Carers UK’s excellent 40-page report produced for Carers Week. In it, we hear from carers themselves, not just on the lack of essential breaks and respite but on caring during the pandemic, their own health and their worries about when key day care and other services vital to the loved ones they care for, and suspended during lockdown for over a year now, will be reinstated. If he reads the report carefully, he will see the reality of everyday life for thousands of carers. Funding given to councils during the pandemic has not been anywhere near enough for the vital role they have been expected to play, and the funding the Minister repeatedly refers to has simply not reached carers. How will the Government address this appalling situation and ensure that unpaid carers are given the funding and support they need and deserve?
Lord Bethell (Con)
My Lords, I too pay tribute to the Carers UK report. I read the very moving personal testimonies in that report and for that reason I took a call with Carers UK this morning in order to understand the recommendations it has made. There is an enormous amount to do. The practical role of the department is to work with local authorities to ensure that day centres and care services are reopened. There are massive infection control issues, but we are working extremely hard with local authorities to ensure that that reopening can happen quickly so that carers get the support they need.