Social Care: Funding

Lord Bishop of Rochester Excerpts

Thursday 5th July 2018 Lords Chamber

[The Lord Bishop of Rochester]

My Lords, I too join in with the general rejoicing on this the 70th anniversary of the NHS, but as others have observed, I am glad that this debate has been brought forward by the noble Baroness because it is a necessary counterpoint to that. I join the noble Lord in expressing slight surprise at how few people have wanted to contribute to this debate, but that does give those of us who are speaking a little longer to do so.

As the recent National Audit Office report, referred to by the noble Baroness, into the interface between health and social care indicates, the two areas are inextricably linked. Indeed, the dividing line can be quite hard to define, and that is one of the difficulties. For example, an exchange earlier today in your Lordships’ House touched on the different regimes in the two different worlds in terms of pay and conditions and the issues that that raises. That is but a single, tiny dimension of the challenge of joining up these two worlds. In a speech in March the Secretary of State talked about,

“whole-person integrated care with the NHS and social care systems operating as one”.

That is of course a laudable aspiration which many of us have already affirmed. He also spoke of the desire to find a sustainable funding model, and therein lies the challenge given the tendency over many years for social care always to find itself the poorer of these two siblings. Along with others, we await the Green Paper and what it might say.

Perhaps I may approach this subject in a slightly different way from other speakers by focusing on two specific areas in which I have some experience. As Bishop to Her Majesty’s Prisons, a few months ago I visited HMP Stafford, which is a prison with a growing elderly population. Carers commissioned by the local authority go into the prison to provide personal care for elderly prisoners, and when I met the governor and his senior team they were thinking positively and practically about adapting buildings and regimes to provide, in effect, a care home within the prison. As the Prisons and Probation Ombudsman observed in a report last year,

“prisons designed for fit, young men must adjust to the largely unexpected and unplanned roles of care home and even hospice”.

The challenge in HMP Stafford was clear, and while I commend those on the ground there for seeking a response, it did feel rather as if they were working on their own to find solutions; perhaps something more substantive, structured and deliberate is needed.

Some 17% of the prison population is now aged over 50. While, dare I say it, that in terms of your Lordships’ House that may not seem very old, it is the case that people in the prison population by and large age 10 years in advance of the general population, so it is a serious issue. A possible way forward was suggested when, later in that series of visits, I went to HMP Oakwood where I met fit, young prisoners who were offering informal care and support to older, infirm prisoners. While not wanting to let the public purse off the hook, I did wonder whether prison training programmes might be extended to include training and qualifications in care, thus enabling properly trained prisoners formally to support those prisoners who are their neighbours and in need of some care. Not only would the training do that, but it would give those prisoners a qualification which would enable them to find employment on release from prison. Perhaps the Minister might care to discuss that in due course with colleagues in the Ministry of Justice.

I also wonder whether there is a mechanism whereby local authority funding formulae might be adjusted where there is a prison within the local authority area which houses a disproportionate number of elderly prisoners, given the demands that that places on the local authority concerned.

My second area of comment concerns partnerships between the voluntary, community and faith organisations with statutory and other agencies. Voluntary action and activity does not mean that it is unprofessional, nor does it mean that it should come on the cheap. Many voluntary and community sector organisations employ seriously professional people at proper wages. There is also, however—I hesitate a little in talking about this because again I do not want to let the public purse off the hook—a role for that which is voluntary, in terms of time and remuneration, where people offer their expertise and their skills.

In my own diocese of Rochester, we are working with a national charitable initiative called “The Gift of Years”, with funding from the Henry Smith Charity, to establish a network of Anna chaplains and Anna friends—Anna being an elderly woman mentioned in the gospel of St Luke. Our particular focus is the pastoral care of those living with dementia and that of their carers. After a relatively short period, we now have more than 30 trained and commissioned volunteers. We have one paid professional specialist, funded by the Henry Smith Charity, and our first remunerated dementia chaplain who is funded locally by churches in Bromley. On the partnership side of this initiative, we are finding that—surprise, surprise—the local authority is increasingly beating a path to our door. There are opportunities to work closely with other organisations such as the Abbeyfield housing society and the Heart of Kent Hospice, where our pastoral carers go in to offer support to residents and patients, and of course to their families.

I hope that as government policy develops in this area and as the Green Paper is brought forward, some attention might also be given not just to, as it were, the voluntary and community sector in its big institutional forms but also to the role of local initiatives and how the relatively modest funding that is needed for them might be provided in various ways, possibly by means of grant funds for which people could apply.

I believe that there may be patterns in both of the examples I have given for other places and in other dimensions of care. In relation to the Anna chaplaincy model, it is worth noting that many of those who offer their time and skills as chaplains and friends are themselves relatively elderly people. They find huge fulfilment in serving the needs of those in their own communities.