Social Care

Lord MacKenzie of Culkein Excerpts

Thursday 29th November 2012 Lords Chamber

[Lord MacKenzie of Culkein]

My Lords, I join in the thanks to my noble friend Lady Pitkeathley for securing this important debate and for her most eloquent speech. This debate is about the ambition to integrate health and social care. I am not, I think, one of the usual suspects because nurses of my generation were not very good on social care. One of the joys of being in this House is that one is always on a learning curve.

The integration of health and social care is a laudable objective and whether it succeeds, as we all hope it will, will depend on a number of important matters. Are NHS trusts, local authorities, clinical commissioning groups and health and well-being boards going to work well together, or will a new commissioning and marketisation framework, together with the existing barriers, lead to fragmentation and diversification in care services and perhaps disrupt any consensus? Will we get the innovation that we need? That must be the way forward. Or could it be that without proper regulatory guidance and funding, any new social service will end up like the present model—best described as patchy, incomplete and with a lot of staff who are poorly trained and paid, and unregulated. Will there be multiprofessional input into clinical commissioning groups? Will nurses be properly involved in hospital discharge policy and the development of community care?

The elephant in the room is: will there be sufficient money? It is fine to talk about efficiencies but so many so-called efficiencies are, in reality, not showing any demonstrable improvement in care. All too often they are a euphemism for cuts, rather than savings being reinvested into services. There are dark clouds on the horizon. The worst scenario, if I can repeat a phrase used a few minutes ago, is a perfect storm of demographic pressures combined with cuts in central grant support, council tax freezes and NHS organisational change, which could lead to a worsening of social care and further reductions in services, leaving the Government’s aspirations and policy in tatters. A lot of the money from the NHS that is designed to encourage joint working is, in reality, being used to avoid further cuts in services. That is a real concern.

I am also concerned about what might be said to be an auction race to the bottom, with providers appearing to win contracts by bidding at lowest cost rather than on quality. For example, when the Serco conglomerate took over the excellent Suffolk Community Healthcare, it was predicted by UNISON that there would be job losses. That was, I understand, denied. Now Serco, following its usual pattern, has proposed cutting more than one in six posts. That is how one can underbid an already good provider by some £10 million. The combination of financial restriction and the delivery of quality care is, to say the least, extremely difficult.

In domiciliary care, there is much reported worry, and much has been said about it today. I fail to see how we can have dignity, client choice and safeguarding with the present “time and task” system, which is so often the pattern. A recent UNISON survey showed a situation for many care staff which rather reminds me of the low-cost airline model of employment, with staff under pressure and paying for their uniform and training, quick turnarounds and wages varying every week. As the noble Baroness, Lady Gardner of Parkes, said, many of these care staff are not being paid for time travelling between visits and have zero-hours contracts. There is one difference: easyJet would not tolerate for one moment its customers being treated in the way that vulnerable elderly people or people with disabilities are being cared for in short, 15-minute visits. It is not possible in so many domiciliary care settings for there to be proper adherence to safeguarding principles and practice, and much too often the possibility of the client exercising choice is not a realistic proposition.

The situation in many care homes is little better. Nurses I speak to report that there are intolerable staffing pressures with often poorly trained staff. When things go wrong, the staff are made scapegoats when the resources are not being provided and managers and home owners are not held accountable.

The pattern is repeated for nurses working in the community. A recent Royal College of Nursing survey showed that 6% of respondents said they could deliver the quality of care that they wished to, and 75% of community nurses indicated that pressure on the nursing team had increased, leading to considerable concern about their capacity to protect adults and children at risk. Much of this problem emanates from cuts in social care budgets.

Who picks up the pieces? We have already heard today, and UNISON and the RCN remind us, as does the King’s Fund, that it is the National Health Service. Pressures on social care budgets lead to increased emergency admissions and pressures on A&E departments and continue the revolving door, with which we are so familiar, delivering inappropriate care in the wrong setting. That is not good for the National Health Service or for patients who are so often denied, for example, the prospect of good palliative care at the end of life at home or in a hospice.

The health charity sector is also suffering at a time when the need for its contribution has perhaps never been greater. There is no doubt that the Government will be looking to it to pick up more of the pieces as funding from local authorities and NHS commissioning is cut. Smaller charities, in particular, are affected, with the probability that staffing will be reduced or, as in the case of that great charity, Turning Point, that staff will be dismissed to be re-employed on poorer terms and conditions. That is an unenviable choice for dedicated staff and for the charities that do so much to fill gaps in our health and social services.

Social care is a complex subject. There are many areas one could speak on, for example, housing and so on. Others have spoken eloquently on them, so I shall conclude by mentioning the Local Government Association’s “Show Us You Care” campaign. I will not repeat all the details or even the bullet points. The Government know full well what that campaign is about. It is about the current funding problems, the future of social care, fairness and the ability in the future to maintain roads, libraries, swimming pools and so on.

This leads me neatly to the Dilnot commission, which has been much mentioned this afternoon. My noble friend Lord Warner said that it may not solve all the problems, but I think it will go some considerable way and would be a good start. I hope that the Minister can tell us when we will hear about the Government’s proposals following on from that excellent piece of work. There were reports in yesterday’s press that we might hear something in the near future, and it would be wonderful if the Minister could confirm that that is the case.

I again thank my noble friend Lady Pitkeathley, and I look forward to what the Minister will tell us when he winds up.