Health and Care Bill

Baroness Altmann Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Baroness Altmann (Con)]

My Lords, I too congratulate the noble Lord, Lord Stevens, on his excellent maiden speech. I am delighted that he has joined the House, with all his many years of expertise in this area. I look forward to his contributions at future stages of the Bill.

In the time available, I will focus on issues relevant to elderly social care. Some 10 million adults are affected by care needs. Some are short term and others very long term, but over the next 20 years the number of people over the age of 85 will rise from 1.4 million to 2.4 million. Estimates suggest that about 44% of the over-65s already have some form of disability. Clearly, the costs of delivering social care and the amount spent on it in our society will significantly increase.

Council expenditure on care is already over £20 billion a year, with around half of that on the over-65s. But this is almost the same in real terms as it was in 2010. What has happened is that councils are increasingly rationing care, and unmet care needs, especially among the elderly, are rising inexorably. The funding is starting from an exceptionally low base. Much more attention needs to be given to delivering social care.

There are welcome points in the Bill. I welcome the intention to provide a care and support plan to arrange services in order to help people live independently and to prevent or delay the need for care, and the recognition that it is best if people can stay in their own homes. I also welcome the new CQC duties to independently review and assess local authority performance in delivering what the 2014 Act was designed to deliver, which we still have not yet successfully done.

I echo the points other noble Lords made about the need to invest in the workforce, and the fears. What is the Government’s plan to ensure additional workforce capability and capacity now? I fear that we have had a couple of unforced errors—mandatory vaccination for care home staff before it is required in the NHS, and new immigration controls that mean we cannot get staff in from overseas. The pay for social care workers, for whom there is already a 30% turnover rate across the sector, especially front-line staff, is now lower than for shop assistants or cleaning staff, who have better working conditions. I would welcome the Government’s estimate of the number of care staff needed and how they plan to deliver those.

I welcome the extension of prevention measures and the focus on commissioning, with the CQC overseeing the payment of fair rates for care, but I note that the Government continually say that they intend to move towards the local authority paying a fair rate to cover costs. In 2017, the CMA estimated that self-funders pay an extra 41% to cross-subsidise the underpayments by those funded by the councils. Do the Government have an estimate of when councils will actually pay enough to cover the costs, so that we do not put extra burdens on the very people who need care and are funding it themselves?

Regarding the care cap, £86,000 is not a cap on the amount people need to pay for care. Clause 140 has made the inequity even worse. With a fixed cap, those of more modest wealth will inevitably lose far more as a proportion of their assets than people who are much wealthier or who live in areas with higher property values. I hope the Government will pay close attention to the needs of elderly people who do not yet receive care, and the unpaid carers who will look after them, often at the expense of their own health.