Social Care

Alex Cunningham Excerpts

Tuesday 25th February 2020 Commons Chamber

[Barbara Keeley]

I very much agree. We need to pay care staff the real living wage, provide them with training and end the use of zero-hours contracts.

I think it is clear enough that the Labour party believes that the current system is not working, and I am sure that the Secretary of State knows it too. Councils just do not have the funding required to deliver the care that people need, and they are faced with a stark choice—either they cut back on the quality of care, or even fewer people receive any help at all. Only a third of directors of adult social services think that their budget will be enough to meet their statutory duties this year, which means that thousands of people who approach their local authority for help with their care are turned down for support. Without investment and a plan, social care services will be pushed deeper and deeper into crisis. Expert report after expert report has pointed to social care being on the verge of collapse, and those reports make it clear that councils cannot deliver adequate adult social care provision without a sustainable, long-term funding strategy. Yet what we have seen from the Government, year after year, is short-term and piecemeal funding.

The Secretary of State may repeat, as his colleagues did yesterday, that the Government are allowing councils to raise council tax this year to fund social care services, but the Opposition know that council tax is a deeply unfair way to fund this vital public service. A 2% rise in council tax rates in Wokingham will raise twice as much money as it would in Knowsley. Even if we raised council tax by 2% every year, the Institute for Fiscal Studies says that by the end of the decade social care will make up over half of all local government spending. This means that other vital services will continue to be cut back. That is certainly the situation I see in my own local authority area.

[Alex Cunningham (Stockton North) (Lab)]

The shortage of resource and people in the system means that more responsibility falls on families. I know that my hon. Friend recognises the unsung heroes who are young carers—children who miss out on education, a social life and so much more to care for a parent or sibling. Does she agree that the Government need to do more to help to support organisations like the Eastern Ravens Trust in Stockton, which does so much to help these young carers to have a life of their own?

[Barbara Keeley]

Indeed I do. I am looking forward to the establishment of the new all-party group on young carers, but it is tragic, in a way, that we have to meet in new all-party groups to try to find some way of taking the burden from those young carers.

As local authorities struggle to fund social care, an increasing number of people are forced to take on the financial burden themselves. Some 143,000 people are currently faced with catastrophic costs of over £100,000 for their own care. Over the past three years, 9,000 people have asked their local authority for help after completely depleting their own savings to pay for their care. This means that people are having to sell their homes that they may have lived in for their entire lives to fund the care that they need. The Prime Minister has promised to stop this situation, but with no plan and no proposals for how he achieves that, it is likely that many more people will be put in this position going forward. The Government could drastically reduce the number of people faced with catastrophic costs for their care if they set a lifetime cap on care costs. The Government proposed a cap in 2013. They legislated for it, but dropped it in 2016. That cap would have gone some way towards reducing the number of people now faced with catastrophic social care costs. The Government’s own impact assessment showed that by this year 37,000 people would have benefited from the cap if it had been introduced in 2016.

But reform is not just about protecting housing wealth. It is important to do that, but reform also has to offer a solution to the people who are currently stuck in bed all day unable to get themselves dressed, or needlessly stuck in hospital. The solution that Labour favours is to offer free personal care to ensure that everyone is supported with the basic tasks regardless of their ability to pay. Free personal care was introduced by a Labour-led Government in Scotland in 2002, and it is ensuring that more people there receive publicly funded social care. Free personal care has been backed by the House of Lords Economic Affairs Committee and by charities and think-tanks.

We believe that it is vital that we push forward with this reform because progress to date has been far too slow. In October 2018, the Secretary of State talked about:

“The adult social care Green Paper, which will be published later this year”.—[Official Report, 17 October 2018; Vol. 647, c. 736.]

In 2019, we were told that there would be a Green Paper “that summer” that would set out the future of social care, but it never arrived. It was delayed twice before being dropped completely. Seven months ago, the Prime Minister stood on the steps of Downing Street and said that he had a plan to fix the social care crisis. There is still no sign of it. Perhaps this plan is in the same state as the promised Green Paper. The Government said that they would instigate cross-party talks on social care within the first 100 days of the election. We are now 75 days on and we have yet to hear from the Government on their proposals.

Labour is the only party, as it stands today, with clear plans for the future of social care. Labour’s plan for social care would close the funding gap, cap care costs, and introduce free personal care and improved pay and working conditions for care staff. In contrast, we have no action from the Government on social care. Councils are reliant on piecemeal funding announcements and raising ever higher levels of council tax, yet these measures leave them struggling to meet demand. So Labour’s message to the Prime Minister and the Secretary of State is clear: they need to put in the extra investment needed to stabilise the care system, introduce free personal care, bring back a cap on care costs, and develop a plan to improve the pay and working conditions of the care workforce. I want to make it clear that Labour will be happy to sit down with Ministers and talk them through our proposals, as the Prime Minister does not appear—at this point in time, at least—to have any plans of his own. I urge hon. Members to vote for our motion tonight to ensure that the Government have to finally meet their pledge to fix social care.

--- Later in debate ---

[Jackie Doyle-Price (Thurrock) (Con)]

I feel like I am in groundhog day. It is approximately two years since I responded to a very similar debate secured by the hon. Member for Worsley and Eccles South (Barbara Keeley). It is disappointing that we are still debating the very same issues that we were then. Of course, there has been much water under the bridge since then in our broader politics in that time, but in respect of social care, to coin a phrase, nothing has changed. The questions we need to settle are exactly the same as they were then. I say very gently that with Brexit done and with a majority Government, there is no excuse for continuing to kick this can down the road. It is time that we genuinely took action.

At the heart of this question, we need to establish to what extent the cost of care should be met by the individual and by taxpayers. We need to establish a consensus on the balance between those two. From my perspective, it is not fair that at the moment that cost is met almost entirely by individuals. Equally, it would be unfair for it all to be met by taxpayers when people have some assets. We therefore need to settle that question properly. I would also gently say that our politics has not been entirely honest about that. It is worth reminding the House that at the moment only £14,250 of capital is protected. As the hon. Member for Worsley and Eccles South mentioned, that means those with very long-term care costs, particularly those who suffer from dementia, can face catastrophically high bills. There are, therefore, very strong arguments for a cap.

There are other reasons why we have to grip this issue now. As the hon. Lady mentioned, local authorities cannot plan their long-term finances. That also brings a real threat to financial stability within local councils. It is fair to acknowledge the challenges within the care sector, too. Many providers are finding the marketplace challenging, not least because of workforce challenges, but also because local authorities are insisting on paying low rates for residential care. That brings with it an additional injustice—people who are deemed able to pay for their care find themselves paying higher rates for the same product than local authorities do for those who do not pay for their care. I think that is a major injustice in the system.

[Alex Cunningham]

Would the hon. Lady support the Government funding local authorities so that they can pay the proper living wage to careworkers?

[Jackie Doyle-Price]

The issue is that local authorities are commissioning care from local care providers and paying the rate that the individual resident is incurring. It is about what they are prepared to pay for that bill and not the local authorities paying living wages directly to employees. However, that is pushing the risk on to care providers, and we need to acknowledge that there will be workforce challenges for those providers. They will be competing more and more for people. While there is that downward pressure from local authorities on what they are prepared to pay and the upward pressure on wages, the risk is being borne by providers.

Part of the solution is also not just about who pays. We need to be a lot more imaginative about this. We all know that we will live longer—beyond 70—and that we will have more years in life in retirement. Just as we make plans for our pensions, we need to make provision for our homes and how we are going to live in old age. The simple fact is that our housing requirements when we are in our 40s and are raising a family are rather different from what we might require in our 90s. We know that falls are one of the biggest burdens on the NHS, so the fact that we are not encouraging people to make sensible lifestyle decisions about their homes is causing additional cost to the NHS, as well as, potentially, the need for more long-term residential care. One reason why we have that issue is that we have allowed, collectively over decades, so much wealth to be stored in our housing stock that we have encouraged people to behave in a way that makes them want to cling to it. I would like us to look more imaginatively at incentives through the tax system to encourage people to downsize and look at different ways of living. We want to use the planning system to encourage the development of retirement villages where people can purchase extra care.

[Jackie Doyle-Price]

I completely agree. That is exactly the kind of incentive that we should encourage. The longer that we can encourage people to live independently, the better their quality of life and the better it is for the taxpayer, because there will not be those ongoing bills. The point is exactly that as we live longer, we will spend many years in a condition of frailty, and that needs to be properly managed through the system.

Every parent, with the best will in the world, will wish to hand on as much of their assets to their offspring as possible, but that could also encourage behaviours that are bad for their health. I want my parents to realise the value of their assets rather than protect their inheritance for me. I am sure that most people would think that about their parents, but there is a lot we can do on the tax system and incentives to encourage families to manage those issues collectively and in a way that is good for people’s welfare as they become elderly and enables them to do more for their children.

It is high time that we tackled this issue. We should also not look at this entirely in isolation from the issues regarding working-age adults, which are also a major challenge for local authorities as they manage their finances in this area. We must look at the issue of people with learning disabilities and autism being increasingly placed in areas of long-term care. The issue is that, although we have been broadly successful in moving out people with learning disabilities through the transforming care programme, sadly the pipeline afforded by those people moving out has been filled by people with autism. The Government have to give a much clearer challenge to commissioners. When faced with people with complex needs, the first instinct should not be to put them in residential care. Too often we have seen how those kinds of placements do harm. We need to challenge local CCGs and NHS England to put much better care upstream by providing early diagnoses for people with autism and giving them the tools to protect themselves.

[Alex Cunningham]

On the workforce issues, surely the answer to the dilemma the hon. Member is describing is to have a professional, well-paid, well-trained workforce that can deal with people with the most complex needs in their homes and allow them to remain there as long as possible.

[Jackie Doyle-Price]

The key words the hon. Member just used were “in their home”. There is no public policy challenge that does not come back to having the right kind of housing solutions. Many of these issues arise from our not investing in the right kind of supported housing environments that would enable more people to live independently. That has to be part of the solution. Local authorities and the local NHS need to come together to commission the right kind of service.

As we are short of time, Mr Deputy Speaker, I will end there, but it is high time we gripped this once and for all.

[Liz Kendall (Leicester West) (Lab)]

We need three things to make our social care system fit for the future: access to good quality care for every older and disabled person who needs it; more support for families to look after the people they love; and better care jobs so that paid careworkers can afford to stay in work and support their families as they care for ours. I will take each in turn.

First, it is a disgrace that in the 21st century, in one of the richest countries in the world, 1.5 million older people are not getting the basic help they need to get up, washed, dressed and fed—that is one in seven of the entire population aged over 65—and that figure will rise to 2 million in a decade’s time unless the Government change course. It goes without saying that this is not good for the people who need support to perform the functions of basic daily living, but it is not good either for the taxpayer, as more older people end up going into hospital and getting stuck there when they do not medically need to be there, with all the knock-on consequences that has for hospital waiting times and NHS budgets. We have got to stop treating the NHS and social care budgets separately, because they are inextricably linked, and we have got to stop fixating on hospitals, because the care system of the future lies in the community and closer to home.

Secondly, we need to give more help to families. Many of the UK’s 6.5 million unpaid family carers face a desperate daily struggle to look after their older or disabled relatives. They often feel pushed to breaking point financially, emotionally and physically. One in three carers have to give up work or reduce their hours because they cannot get the help they need to look after their loved ones, so they lose their income, the economy loses their talent and the Treasury loses their taxes. How does that make any sense? We no longer think parents should be forced to give up work to look after their children, so why do we accept it for those caring for elderly or disabled relatives?

Many of us on the Opposition Benches believe universal childcare to be as much a part of our economic infrastructure as the roads and railways. That we are living longer means we need to see social care, too, as an essential part of our economic infrastructure. With so many people now looking after their elderly mums and dads as well as their own children, we need to be thinking about universal family care and leave to meet the realities of modern life, because families should never have to choose between holding down a job and caring for their own.

[Alex Cunningham]

I ought to have declared that I am a co-chair of the all-party group on carers. I am pleased my hon. Friend has mentioned unpaid carers. The Secretary of State took 19 minutes to acknowledge the existence of the millions of unpaid carers in our society. I wonder if my hon. Friend has any tips for the Government for how they could address their needs.

[Liz Kendall]

Unpaid family carers need family-friendly working arrangements so that they can balance their work and caring responsibilities; they need an NHS that recognises that their own physical and mental health could suffer too, and they need to know that we are there to support them. Rather than criticising families and saying that they should be doing more, we should acknowledge that many carers have not had a break for weeks, months or even years. We have to change that, because this is not going to happen to somebody else. This is going to happen to every single one of us here.

Thirdly, we need better care jobs. Paid careworkers do some of the most important work in the country, looking after the people whom we love, but many struggle on low pay and zero-hours contracts, with high levels of stress and little training. No wonder staff turnover and vacancy rates are so high, although the vast majority of careworkers say they love the work that they do. We need a comprehensive strategy to improve the pay, professional development and employment security of care staff, and we desperately need to increase the number of careworkers too. We shall need more than half a million more careworkers in a decade’s time, not to improve the care system by providing better quality or wider access, but just to meet increasing demand.

That is why the points-based immigration system announced by the Government will be a disaster. If we already need more than half a million extra careworkers just to meet levels of demand, how on earth will we cope with that new system? It will not be possible. I beg the Minister to meet me, and others, to discuss the development of a separate route into social care in the migration system of the future, because otherwise we simply will not cope.

None of those changes—improving access to care, more support for families and better care jobs—can be delivered on the cheap, but the truth is that families, the NHS and our economy as a whole cannot afford for us not take action. We need, first, an immediate and significant injection of cash into the system in next month’s Budget, and, secondly, a long-term plan for investment and reform. Any new funding system must work for disabled adults as well as older people. It must strike the right balance between individuals and the state. I, for one, strongly believe that we should pool our resources and share our risks rather than leaving people to cope alone. The system must also be fair across the generations. I do not believe that the working-age population should pay for all the additional costs of caring for our ageing population Wealthier older people will need to make a contribution too.

Alongside this funding reform must be a change in the way in which social care is provided, so that it is not just about time slots and tasks simply to keep people alive, but about offering great support how, where and when people want it, so that they can lead the lives that they and their families choose.

This radical reform of social care is just one of the changes that we must make to meet the needs of our ageing population, which is one of the biggest challenges that we face as a country. We need to change our housing so that it helps people to live independently at home for longer. We need to reform the world of work so that, as we live for longer, we can work for longer and more flexibly. We need to change our health services so that they keep people fitter and healthier for longer as we live for longer. None of those things will be easy, but if we want to meet the challenge of our ageing population and if we want to make Britain the best country in the world in which to grow old, we need to grasp this nettle, and we need to do it now.

--- Later in debate ---

[Liz Twist (Blaydon) (Lab)]

As I was preparing for this debate, I looked at last year’s debate and, as other hon. Members have said, it was like we have not moved on at all. We are repeating the same arguments, and nothing has really changed. What has changed, however, is that we are seeing increased demand for social care, whether domiciliary or residential, but local authorities’ ability to deliver that support is decreasing because of financial pressures.

Demand is continuing to rise. Age UK says that 1.5 million people aged 65 or over have an unmet social care need and believes that that could rise to 2.1 million by 2030 if the current approach continues. Last year, over half of the 1.32 million new requests for social care resulted in no services being provided. In my constituency, Age UK tells me that 3,012 older people have unmet care needs, and that 2,517 older people are providing the care that family members require. Of course, we must also recognise that thousands of unpaid care workers are providing support to people in their homes, and we must never forget that. I salute them for carrying out that essential work.

I will reiterate some of the points covered in the previous debate, because they remain central to this debate on social care. We need more money. We do not need the drip feed of a 2% increase in council tax, which in constituencies with a low council tax base, such as mine, will not produce anything near the money we need, compounding inequality and injustice. We need a substantial increase, and Age UK estimates that an increase of £8 billion is required over the next two years to stabilise the current system while we look at what will be provided in the future.

We need to look at the market for social care providers. The market is fragmented at the moment in both residential and domiciliary care, and most authorities have seen providers fail in both areas, meaning that they need to step in as an emergency measure to ensure that people get the help they need. We cannot continue with a market based substantially on price competition, because local authorities are forced to look for the lowest bids. We need quality services that deliver the things that people require and deserve. I would like to see more directly provided social care services, because that gives us control.

We must now develop a workforce strategy for social care. We have talked about that a lot in relation to the NHS plan and the future workforce strategy, but we need to look at it here, too. The social care workforce is predominantly female. They provide the most personal and intimate care to the people we love, and we must recognise the value of their work. They need proper pay. They need professional registration, which people working in the sector are considering. They need improved training and development if we are to recruit and retain the staff we need. We must put an end to carers travelling in their own time, to zero-hours contracts, and to 15-minute visits, which all of us would agree are completely outrageous.

[Alex Cunningham]

My hon. Friend mentioned the very personal nature of the care provided by prepared carers, but young carers also do this. They allocate medicines, and they even take their parents to the toilet or wash them. Does she agree that so much more needs to be done to recognise the role of young carers and to give them even greater support?

[Liz Twist]

I certainly agree that we must recognise the work of young carers, who do a tremendous job. We place huge pressure on them, and we thank them for their work. We must look after them, too.

We need a workforce strategy, and there is much more I could say. Others have already touched on the high cost of care for those with dementia, as opposed to a physical illness, and we need to do something in both the short term and the long term. We need a long-term, thought-through plan for providing social care to all those who need it.

We need a plan for social care that supports people when they need it and that cares for people when they need it. It should not just look after them mechanically; it should care for them. The Prime Minister said during the election that he has a plan. Well, let us see it and debate it, because we all know this action is long overdue.

--- Later in debate ---

[Paul Bristow (Peterborough) (Con)]

To begin, I would like to declare a couple of interests. My partner owns a communications consultancy that works in health and social care. Both my parents were nurses. My father managed residential nursing homes until he retired, while my mother was a deputy sister in a residential home, caring for people with dementia.

I would like to focus my remarks on those who work in social care and what we might do to improve the recruitment and retention of staff. In my mind, much of it lies in the value we attach to those who work in the profession. Many of my constituents work in social care, and the profession is just as important as our NHS in helping to support our community. Those working in care homes and in the community across my city and the country should know that they are valued, just as we value our hard-working doctors and nurses. I know how hard the staff in care homes work each and every day. It is often a job that goes without much reward. Pay can be low, and recognition is often lacking, but it is critical.

The National Audit Office estimates that 1.3 million people do these jobs. The Centre for Workforce Intelligence has suggested that an extra 660,000 careworkers will be needed by 2035 if we are to keep pace with demand for care. When we consider that more than a third of staff switch jobs or move out of the sector each year, we begin to see the challenge. Those are worrying figures for families who rely on this service. Why do we have a problem with recruiting and retaining social care staff? Pay is clearly a factor, but it is not the only one. Too often, the profession is held in low esteem, which makes it difficult for some providers to recruit and retain staff.

[Alex Cunningham]

I am pleased that the hon. Gentleman has used the word “profession” several times, because this is not only about training and qualifications but about status; that is a very important factor. I bang on about money for low-paid workers all the time. Does he agree that professional work deserves professional pay, not minimum pay, which the majority of careworkers seem to be on?

[Paul Bristow]

I accept what the hon. Gentleman says —pay is indeed a factor in the recruitment and retention of social care staff, but I also agree that it is not the only factor. Terms such as “low-skilled worker” are far too commonly used in relation to care staff. That language and perception need to be challenged. We need a greater emphasis on professional structures, career development and appropriate reward.

We also need to celebrate these roles and show how rewarding and fulfilling they can be. After all, this is about looking after people. These people are our grandparents, our fathers, our mothers, our uncles, our aunts and, in some cases, our children. One day it is likely to be us. I will never forget a constituent telling me about his job in social care. He said that each and every day, he got to look after, talk to and listen to people who became his friends, and he felt he was almost cheating by calling it work.