Adult Social Care (Adult Social Care Committee Report)

Lord Allan of Hallam Excerpts

Monday 16th October 2023 Lords Chamber

[Lord Allan of Hallam (LD)]

My Lords, I also congratulate the committee on a very comprehensive and useful report. My noble friend Lady Barker is very sorry that she cannot be here, due to family emergency—rather illustrating the point of the noble Lord, Lord Bradley, that caring affects all of us at various times in our lives. I am sure that she will listen to the debate later and certainly appreciate the comments of the noble Lord, Lord Polak, about the usefulness of her contribution to the committee.

I will pick up on three issues we need to hear more about from the Government. I agreed with the point made by the noble Baroness, Lady Andrews; I looked at the government response and it is very much, “We have got this; it is under control”. However, I do not think they have got this, and we need to hear more from them.

The first issue is around population care needs assessments. The point about data has been raised by the noble Baroness, Lady Fraser, and the noble Lords, Lord Polak and Lord Dubs. I do not think it is a data problem. We are swimming in data. We need the more useful offspring of data, which is information. The Government are, we think, about to spend £500 million to try and transform the health system’s data into useful information. The question has already been raised, however, about whether that will be integrated with care data and whether we can get useful care information out of that kind of project.

I hope the Minister can talk some more about what commitment the Government have to extracting useful care needs assessment information from the data that the ONS and others have already. For example, I saw in the report that the first projections are around people who do not have children; the Office of National Statistics already has that data, so we need to take that and transform it into something useful in the context of care. In doing that, the assessments need to be brutally honest. There is no room for fake optimism here. We need to know what the real needs are and those projections going forward. The old maxim of hoping for the best but planning for the worst is particularly relevant in these contexts.

Having done those population care needs assessments, the next stage is the workforce plan. Now we have a sense of how much care we are going to need, we can start to plan for the numbers of people we will need to meet those requirements. It is really important we are not overoptimistic, and visas for overseas care workers have been mentioned a few times. In an ideal world, it would be great if we were able to get the care workers we needed domestically, but we should be brutally honest if we are not going to meet the requirements. Let us not gloss over it: we should continually evaluate those needs and adjust the visa regime accordingly.

I know this is very sensitive, particularly in the Conservative Party, but we need those care workers. It is not like fruit picking. We cannot say, “We will just not grow the fruit any more if we cannot get the fruit pickers”. These are people who need care. We need to be honest about the balance between those we can train domestically and those we will need to provide visas for because the care needs delivering now; it cannot necessarily wait.

The ageing population is going to be a problem here. More and more people are going to do the informal care and, precisely because of that, be no longer available to enter the market as a paid-for care worker. Again, we need to be honest about the changing demographics and how they will change the availability of workers. It is not going to be like it is today in 10 or 20 years’ time. If there are more people in their 40s and 50s looking after people in their 70s and 80s, that may have an impact on the very workforce we are trying to target in our plans.

The third area is pay. Again, having worked out the needs assessment and the plan for the workforce we need, we need to think about how to attract people into the profession. This affects both paid and unpaid workers, as has been raised in the debate. Both the wage rates for the paid workers and the support available for the unpaid workers matter.

I am sure that the noble Baroness, Lady Bennett, will be happy when I say I am very confident that my party will have a proposal around care in our election manifesto. We have already said that we think there needs to be a higher living wage available for care workers, and we should be talking about that now because that is the only way we are going to solve the crisis. If we are going to will the ends, we have to will the means. I hope the Minister can say that. I have heard him say it all before and he will cite the big numbers the Government have already put in, but those numbers need to be set against inflation and other pressures that have been eating away at the value of those salaries. There needs to be something more fundamental than just saying, “Here is another announcement of a big number”.

The final area is one that has been raised with me, which is the question around who provides care to individuals. This is a question of the choice of carer gender for intimate personal care. It is a very sensitive issue and I do not want to go into the broader issues around gender and identity. Something very specific, though, that has been raised is that there are people—particularly those who have long-term intimate care needs, because they are often younger people with disabilities—who may not be able to choose the gender of the carer who provides that care to them.

I think we can all understand why that is a very sensitive area. Part of the solution is to have a bigger workforce available: if there is more choice of carers out there, it will enable people to exercise a choice over the gender of the person who provides personal intimate care. That is important because there have, sadly, been incidences of abuse. It is also a matter of the right of an individual and their own self-determination that they have some choice over who provides care to them.

I close by thanking the committee and the many members who are here today for a report that is of great benefit to anyone who is trying to understand and respond to the ongoing crisis in care in this country. The noble Lord, Lord Polak, talked about a guide: this is a guide for us as policymakers. I recognise the need for a guide for the person trying to employ carers, but this is a great guide for us as policymakers to the key questions we should be asking. I hope that the Minister will be able to offer some constructive comments on the points I have raised around population needs assessments, care workforce planning and ensuring that carers are properly rewarded.