Adult Social Care

Lord Laming Excerpts

Monday 20th February 2023 Lords Chamber

Asked by

[Lord Laming]

To ask His Majesty’s Government what steps they are taking to meet the needs of the 10 million people in England affected by the adult social care system.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

My Lords, 10 million people in England are affected by the adult social care system, including those drawing on care and support, unpaid carers and the workforce. We have made up to £7.5 billion available over two years to put the sector on a stronger financial footing, improve access to social care and address workforce pressures. We will publish further details this spring, setting out how we intend to make improvements to the system.

[Lord Laming (CB)]

My Lords, I am grateful to the Minister. He will know that, at any time, any one of us could suddenly become responsible for the care of another person who has experienced a life-changing condition—indeed, any one of us might need to be cared for in those circumstances. The evidence to the Adult Social Care Committee was extremely compelling, indicating that unpaid carers feel that they carry a huge burden but are largely unappreciated and ignored. One wrote only last week, saying that, “after years and years of nursing experience, I now feel completely worn out and very lonely”. Could the Minister assure the House that the Government will take note of the recommendations of the report?

[Lord Markham (Con)]

I thank the noble Lord for his Question and for the work he has done around this report. As an unpaid carer for a number of years myself, I am familiar with the circumstances and the fact that unpaid carers are the backbone of the social care sector. I like to think that we are making moves in the right direction. The weekly allowance, the ability to have a one-week break and the ability to go to your local authority for extra support where needed are all steps in the right direction. But there is definitely more we will be announcing that we are doing in this space.

Social Care: Integrated Care Systems

Lord Laming Excerpts

Wednesday 11th January 2023 Lords Chamber

[Lord Laming (CB)]

My Lords, I hope the Minister can assure the House that he has had an opportunity to read the Adult Social Care Committee’s report, which was published in December. The report makes it abundantly clear that the NHS will not achieve its objectives—some might even say its survival—unless social care is integrated at every level and includes the voice of unpaid carers. Can the Minister assure the House that these matters will be taken seriously?

[Lord Markham (Con)]

Absolutely. It strikes me—again, I mentioned this yesterday—that less than 10% of the 13,000 so-called blocked beds contain people who will need to be in social care full-time in future. Most of them need short-term support and, once they have it, will be able to go back to living in their home, which is the best place for them to be.

Excess Deaths in Private Homes

Lord Laming Excerpts

Tuesday 10th January 2023 Lords Chamber

[Lord Markham (Con)]

I totally agree with my noble friend. We all know that it was an unprecedented time, and we learned lessons all the way through: we were much more resistant to locking down as time went on, for all the good reasons mentioned by my noble friend. Yes, that absolutely needs to be a key feature of the report.

[Lord Laming (CB)]

My Lords, the Minister will agree that a very important point in all of this has been the restrictions now in force on primary healthcare services and domiciliary services. We have left housebound people to their fate for a great deal of this time. Is the Minister willing to look at these matters?

[Lord Markham (Con)]

It is a whole-system issue, as I have often mentioned in this House, that takes into account some of the elements of home care, and very much the social care and dom care elements. We know that that is very much a factor in the 13,000 beds that we need to free up through things such as dom care, so yes.

Hospital Beds: Social Care

Lord Laming Excerpts

Monday 19th December 2022 Lords Chamber

[Lord Markham (Con)]

The best hospital trusts I have seen have got that absolutely organised. We see a difference in different trusts between as low as 6% bed blocking for social care and over 30%. That depends somewhat on local demography and the amount of care homes, but also on how quickly they can arrange transport, and that is what the best ones are doing, so that cases such as the ones brought up by my noble friend do not exist.

[Lord Laming (CB)]

My Lords, the report from the Adult Social Care Committee that was published just a few days ago—which I commend most warmly to the Minister—highlights that in the past 10 years there has been a 29% real-terms reduction in local government spending power. This is despite the increase in the population during that period. Can the Minister assure the House that the Government are taking seriously the reality of life in social care?

[Lord Markham (Con)]

I thank the noble Lord. Yes, we are, and I think that is shown by the investment we are putting into place. As I say, that will be up to £2.8 billion next year and up to £4.7 billion the year after, which will be a 22% increase. That shows that we are very serious about this.

Children in Care: CAMHS Waiting Times

Lord Laming Excerpts

Monday 5th December 2022 Lords Chamber

[Lord Markham (Con)]

I will need to write to the noble Baroness to give a specific response in that case. It is an area of concern where I think we are increasing awareness, and any diagnosis needs to start with awareness. By definition, that means that more people are diagnosed or come forward, which is a good thing, but it then means that often it takes longer to see those people—I do not say that as any sort of excuse but just as an explanation. As we increase our understanding in this area, and I think that we would all agree that over the last 10 to 15 years there has been a huge increase in understanding, that means that more people are coming forward, but it means also that we need up our game in terms of supporting them.

[Lord Laming (CB)]

My Lords, following the noble Baroness’s question, the Minister will well understand that children do not come into care for trivial reasons; most of them have had a very poor and traumatic start to their young lives. The state has taken on the responsibility to be a good parent to those children. Would it be possible for them to be given priority in the waiting lists for these essential mental health services?

[Lord Markham (Con)]

I would agree. In any case, especially where there is high demand in an area, we need a form of triaging so that we can agree the clearest areas of priority, such as those mentioned.

Care Homes: Severely Disabled People

Lord Laming Excerpts

Wednesday 30th November 2022 Lords Chamber

[Lord Markham (Con)]

I thank the noble Baroness and echo the sentiment of thanks to the charitable sector for the work it is doing in this vital space. We have shown that we have listened in this area through the £7.5 billion—a 22% increase over two years, which I think everyone would agree is substantial. At the same time, we are in touch with these bodies; we reached out to the charity Leonard Cheshire, which is involved in this, to try to understand the issues. If there are ways in which we can directly help, we will do so.

[Lord Laming (CB)]

My Lords, does the Minister agree that there was a time when, if the local authority asked to see the parents, they assumed that this was for a review of what progress had been made by their offspring in residential care? More recently, parents are saying that they fear any approach by a local authority, because it may say that it will have to move their child to a different arrangement because it cannot afford to pay the fees now being set.

[Lord Markham (Con)]

As I say, we are working on this. The CQC has a vital role to play and we had a discussion recently with the Association of Directors of Adult Social Services, which welcomed the relief the Autumn Statement brings in this area. I can only reiterate that we have listened and acted.

NHS: Discharge to Assess Policy

Lord Laming Excerpts

Tuesday 8th November 2022 Lords Chamber

[Lord Markham (Con)]

I welcome the Carers UK report that came out today. It has provided much valued information which will be part of the information that we are using as part of the guidance we will be putting out shortly. It has taken some time because we want to get it right. We have involved NHSE, local authorities and carers, and we are using this report and the Carers UK conference that will take place on Thursday as vital inputs to make sure that we get that guidance out properly. As the report rightly states, the fact that 50% are not getting the guidance and support they need clearly shows that more needs to be done in this space. On the £500 million discharge fund, that has now been agreed, and I understand that that will go out very shortly—in a matter of days.

[Lord Laming (CB)]

My Lords, I am sure the Minister will recognise that any one of us at any time could suddenly have a major caring role thrust upon us —completely unplanned and unexpected. Carers make a huge contribution in our society and to the success of the National Health Service. Can the Minister assure the House that he will do everything he can to ensure that the contribution carers make is recognised and respected and that they are valued?

[Lord Markham (Con)]

I agree. The legislation was put forward by the Government to recognise the vital role that carers have in all this. As we are all aware, there are 5.4 million carers out there, and they make a vital contribution, not only to the health of their loved ones but to the wider economy. Of those, 1.3 million receive the carer’s allowance; that shows how many of them do it completely unpaid. That is why I welcome the legislation, and I hope the guidance will show a big improvement in the way that carers feel that they are valued, because they truly are.

NHS: Winter Challenges

Lord Laming Excerpts

Monday 10th October 2022 Lords Chamber

[Lord Markham (Con)]

I think we are all aware of the importance of the vaccine programme, and I know that, to date, we are following the medical advice as to who the priority groups should be. If I may, I will follow up with a written response so I can give my noble friend the detail required on her question.

[Lord Laming (CB)]

My Lords, the Minister, who we welcome to his post, will know that the efficient use of NHS resources, particularly during the winter, depends in many ways on the availability of social care services. As time is rushing on toward the winter, could the Minister say what action is being taken now to improve the availability of effective social care services during this coming winter?

[Lord Markham (Con)]

The noble Lord is correct that care is at the centre of all of this. The flow of patients through hospitals is vital, and we are all aware that 13% of all hospital beds are held up by people who should be discharged into care. The £500 million investment is all about freeing up those beds. That will ease the flow right the way through the system—right the way into A&E, so that people can be discharged straight into hospitals, and right back to ambulances being able to discharge into A&E. I completely agree with the noble Lord; that is the focus of what we are doing.

NHS: Access to Treatments

Lord Laming Excerpts

Wednesday 7th September 2022 Lords Chamber

[Lord Laming (CB)]

My Lords, some of the conversations that we have had show that the availability of services in the NHS depends to a large degree on efficient access to social care provision. Could the Minister tell the House what the Government are doing to sort out the social care problem in this country, which is getting worse?

[Lord Kamall (Con)]

The noble Lord is absolutely right. There are a number of issues to do with social care. One of the reasons, frankly, is that it has been treated for far too long as a Cinderella service. One of the things we are doing is registration—there is a debate in the care community about whether it should be a voluntary or compulsory register; it is voluntary to start—to make sure that we really understand the sector. No one really has an overall picture of the care sector, and there is a range of different qualifications, which are quite often inconsistent. If we can get all that together, understand what is out there and understand the qualifications, we can make it a proper vocation and career for people. That is what we are doing at the moment.

Integrated Care Boards

Lord Laming Excerpts

Monday 5th September 2022 Lords Chamber

[Lord Kamall (Con)]

My noble friend makes a really important point on this: if you look at the structure at the local level, you will see the ICBs, but they are in partnership with civil society organisations and others to form the ICP. The integrated care boards and integrated care partnerships together comprise the integrated care system locally. When looking at local health needs and the health of populations, particularly in deprived areas, it is really important that we work with local charities and civil society organisations; they are quite often trusted more by local people than professionals.

[Lord Laming (CB)]

My Lords, I know the Minister agrees that the NHS depends very heavily on efficient and effective social care services being available to it. Could the Minister tell the House whether he is satisfied that, throughout the country, local social care services will be involved in these new arrangements from the outset and as equal partners?

[Lord Kamall (Con)]

During the debate on the Health and Care Bill, which became the Health and Care Act, one of the things on which we agreed across the House was that each integrated care board should have the appropriate mix of skills. I think that was thanks to an amendment by the Liberal Democrats. This particular issue shows that we need to ensure that we are considering all the important aspects of health. One of the things that will be very important is the parity of mental health with physical health. All these issues will be considered at the local partnership level.