Care Sector

Lord Birt Excerpts

Tuesday 25th November 2014 Lords Chamber

[Lord Birt (CB)]

My Lords, we are all grateful to the noble Baroness, Lady Kingsmill, for, in her words, shining a brighter light on this critical set of interlocking issues. I declare an interest as a business adviser to a fund that invests in care homes as well as in many other sectors.

The care of the elderly is an issue about which we all have strong feelings. Those have been expressed many times already. I shall not easily forget, just a small number of years ago, my own father’s last chaotic and distressing months tumbling from hospital to home, to care home, back to hospital, back again home and, finally, to a hospice. It was a journey for the most part marked by high standards of care but absent any trusted guide whatever. He was but a baton passed clumsily from hand to hand.

A fortnight ago, I spent a morning in a care home and was inspired—others have spoken of this—by the utter dedication and kindliness of the staff there, who meet the whole gamut of human and bodily needs over 24 hours a day, seven days a week. It truly is a challenging set of tasks. Some help patients who have severe dementia, while other patients are,

“sans teeth, sans eyes, sans taste, sans everything”.

Almost all those staff were immigrants to the UK. To echo the noble Baroness, Lady Brinton, and the noble Lord, Lord Lipsey, without these immigrants, whatever would we do? The care and nursing sectors in the UK face severe skill shortages. Major businesses are forced to recruit in huge numbers in the Philippines, Romania, India and other countries for the skills that the UK labour market is simply not supplying. Why cannot we manage our education and skills sector so that it produces skills—they are skills—on the scale that we need?

We would all agree that we want the highest standards in the care sector for our loved ones and finally, no doubt, ourselves. Yet we know from excellent investigative journalism—I am sure that we have all seen it and it is very painful—that standards are not always high. The CQC, quite rightly, is increasingly vigorous and rigorous and it is raising the bar. As a result, staff numbers are increasing and costs are rising. Were the Labour Party to assume office and raise the minimum wage, costs would rise higher still in the sector. Yet around two-thirds of those in care homes are funded by local authorities. Local authorities, as we have heard many times in this short debate, are themselves straitened and have been reducing not raising fees by some 5% in real terms over the past three years.

In the home that I visited—the noble Lord, Lord Lipsey, just made the same point—the local authority was paying fees significantly below the actual cost of providing the very services that it and we would expect. This simply cannot continue. It is not viable or sustainable as a policy. The great majority of care homes are privately owned. The returns for those investing in the sector are dangerously low. The whole system is in extreme financial tension and we lack sufficient incentives to ensure that provision will increase, as the noble Lord, Lord Lipsey, has just said, as need grows, which it will. There appears to be a policy vacuum. Whoever forms the next Government simply must provide a holistic policy and financial overview of the care challenge. That must involve the NHS. Everyone can see that unnecessarily filling a hospital bed is vastly more expensive than providing a place in an appropriate care home.

We need an overview from the Government of how best to provide effective, civilised, seamless care to those in the final stages of their lives, whether at home, in care or in hospital. We need appropriate structures—we do not have them—processes and incentives, a single point of responsibility at local level and the right governance in place to ensure that the system is working as it should and as we would all wish. Finally, we need not only to determine the proper balance between state and private funding but to be clear that, where the state accepts financial responsibility and rightly requires high standards, then in turn it must also will the means as well as the ends.