Adult Social Care (Adult Social Care Committee Report)

Baroness Andrews Excerpts

Monday 16th October 2023 Lords Chamber

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[Baroness Andrews]

That this House takes note of the Report from the Adult Social Care Committee A “gloriously ordinary life’’: spotlight on adult social care (HL Paper 99)

[Baroness Andrews (Lab)]

My Lords, it is almost a year since the Adult Social Care Select Committee published its report. It is five months since we had the Government’s response. Although this debate has been delayed, there is no bad time to debate adult social care—it is always timely and always urgent. I am extremely grateful tonight that so many Members of this House have stayed for a late debate to share our report and to listen to the Government. I know that members of the committee particularly appreciate the contribution of the noble Lord, Lord Polak, after his highly emotional intervention in the previous Statement.

Many members of our committee could not be here, for very different reasons. I am very grateful to all of them—particularly to those who are here. We will feel the absence of the noble Baroness, Lady Campbell of Surbiton—not only because she is exceptional at what she does, and how she does it, but because she made an extraordinary contribution to our committee. I am also grateful that there are people who were not even on the committee here tonight who want to address the report. It was a great privilege to chair the committee and to have the task of asking the questions we did.

The two great transformational changes of our age are an ageing society and climate change—and they are interrelated. We have known about both for decades. They are both in the “too difficult” box, which is why it has taken so long to organise the courage to address the issues. We are trying to catch up.

In our report, we ask two questions which we thought had been particularly neglected. Why is adult social care so invisible compared to the NHS? What would make a real difference to the poverty and ill health that come all too often to the 1.5 million unpaid carers who do care work for more than 50 hours per week or the 4.5 million carers who are conscious that their own health is suffering?

There were a few differences of emphasis in the committee, but we were of a mind, and we were helped enormously by an outstanding group of officials from the House: Abdullah Ahmad, Daphné Leprince-Ringuet, Alasdair Love and Megan Jones. They shared with us a sense that this committee would do things differently and address these difficult questions and give more justice to them. In that spirit, we put a high emphasis on co-production and our experts by experience—not just our superb special advisers, Jon Glasby and Anna Severwright, but our expert witnesses who have tested our conclusions and stayed alongside us this year while we have debated this report and who will be watching this evening. We put an equal emphasis on empowering those who care and those who are cared for—whether caring for young disabled adults or elderly and chronically sick relatives.

Our recommendations inevitably prioritise the need for clearer pathways through the maze of information that people are offered, putting emphasis on them having a greater say in what they are able to access and use, and on their contribution as well as the labour of love that is caring. We put huge emphasis also on partnership with the Archbishops’ Commission. We shared our witnesses, evidence and conclusions—which often overlapped, because they were rooted in the same values.

Our recommendation, which was probably the most important, made it clear that adult social care is far and above being, as it is too often seen, a vital but secondary handmaiden to the National Health Service. It is so much more than that. “The NHS saved my life,” said one of our witnesses, “but social care enabled me to live that life to its best”. That is the difference, and it is why we say that adult social care must be a national imperative with stronger national infrastructure. This is the way to release its full potential, to make the best of its values and skills, realised not just in better processes but in the trusted relationships that underpin everything done in this area, and to make it possible for people who care, and people they care for, to live that “gloriously ordinary life”—the title of our report that has resonated so widely with everyone who has come across it; it is so modest, and yet it says so much.

Inevitably, there were some recommendations that were hardly new and did not need to be. I defend in particular the need to ditch short-term improvisation and plan courageously for the long term, whether through funding, a carers strategy, or a resilient and versatile workforce, or for appropriate housing to support ageing at home and not in hospital.

We have had a raft of reports this year that have all more or less made the same case, from the Local Government Association, the Association of Directors of Adult Social Services, Social Care Future, and Skills for the Future. Many of them ask for the Government simply to recognise the scale and urgency of the issue of the false economy that has followed from a decade of austerity and massive cuts to local authorities—the lost hours of caring, the higher cost of caring, the endless waiting lists, the exhausted carers, paid and unpaid, the profound inefficiencies in the system, and the lost opportunities that have marked this decade.

Because the people who know so much agree on so much, our report has resonated widely, and the Government will not be surprised that their response to our report has met with dismay. In November 2022, the Prime Minister announced an indefinite delay to capping care costs. The director of Silver Voices saw this as the “final betrayal” of older people. In April, the “next steps” proposals, published during the recess, were met with a genuine sense of dismay because this was a plan for only two years, not for the future. The workforce budget of £500 million had been cut in half. Many of the bolder ideas in the White Paper have been lost in transition. When the NHS workforce plan was eventually published there was not a word about social care, without which, as the King’s Fund points out, none of the ambition, which is great and serious, can be realised.

Therefore, we were not that optimistic about the Government’s response. There was much that we could welcome. For example, the Government acknowledged the central importance of the adult social care sector—how could they do otherwise? They said that they would support the Carer’s Leave Bill, at long last. We also welcomed specific commitments, for example to ensure better data collection, more and better R&D, and more investment in innovation across the sector, but that was the least we could expect, and it should have been in place at least a decade ago. The fact is that the lack of data has reinforced invisibility. It has made it so much more difficult to plan for the right, consistent, scalable and deliverable policies on a day-to-day basis, not just today but in the future. As we report, the expectation is that the family will go on caring, but by 2030 1 million people in this country will have no families to care for them.

That is why we sought to change the lens and interrogate the future, recognising that the demography and expectations of 1947 have changed beyond recognition while the assumptions of who will care have not—it is nearly always still women. Although we have just started to integrate services, health, housing and social care should be planned from the beginning to work as closely as possible together if we are to make living longer not a fearful prospect but something to celebrate.

That is why we put such a strong emphasis on a commissioner for adult social care and support: to bring voice, visibility, agency and challenge to the service. That is why the Government’s response, calling for a chief nursing officer, misses the point. That is why we recommended an urgent review of the Care Act 2014, which held so much promise, only to be told that this would be delivered through the Health and Care Act. Not so: the scope and the potential of these Acts are very different. I ask the Minister to take both these recommendations away for further consideration.

We have also had no response at all to other fundamental questions that impact deeply on the day-to-day possibilities of what carers, paid and unpaid, can expect. We asked for a review of the pay and working conditions that disable the sector and make it so difficult for disabled people to employ and pay for a personal assistant. Where they are available, they do not stay because the employment bureaucracy is so chaotic and, frankly, they can get more money working in the health service or in Asda. These recommendations were rejected. Although there is some good news in the plan for a Skills for Care workforce this week, and numbers of vacancies are slightly down, we cannot build the future of adult social care on improved immigration. It is a contradiction in terms and of the Government’s policy. It is certainly not an answer to 152,000 vacancies across the sector.

What does it mean to build a valued and versatile care force? It means that you have to pay people decent, dignified and proper wages. At the moment, many carers do not even get the national living wage. Can the Minister tell me why and what this Government, in their remaining days, can do about it?

All these recommendations would have strengthened the resilience of the whole workforce, from personal assistants to paid carers, but they would really have helped the unpaid carers, who would have known that their labour of love, which as we know saves us billions of pounds a year but costs them their jobs, their incomes, and their mental and physical health, is valid and visible. So, indeed, would our recommendations for a more forceful and consistent approach from employers towards flexibility and support in the workplace, and for mandatory housing provision and standards.

However, the recommendation that would have made the most difference to unpaid carers was an increase in the carer’s allowance—a shameful £76.75 a week, which, because they have to work a minimum of 35 hours, works out at £2 an hour. We called for an increase not only in the pay available but in the flexibility around the threshold. The Government rejected that recommendation too.

In short, the Government rejected all our key recommendations relating to funding, workforce planning, accessible housing, support for personal assistants and unpaid carers. The subtext of their response was, “We are doing it all already”. We are not.

We asked at the end of our report: if not now, when? When will unpaid carers see real change? The answer came back, “Not yet; not now”, so there is more wasted time when we face record-breaking NHS waiting lists and the distress of all those elderly people who cannot go home from hospital because it is not safe for them to do so.

Our committee’s main message is that we need a new, more positive and more confident approach to adult social care to enable it to deliver those “gloriously ordinary” lives. That means that disabled young people and older people should have more say in the support they are offered, better choice, and a service that will attract people to work in it because it is well paid, progressive, has status with recognised skills, and more capacity because it is built on stronger and sustainable partnerships between paid and unpaid workers, recognises the expertise held by both, uses the full resources of the voluntary sector, has more visibility through a national champion to challenge poor practice, and shows what change looks like. That is the way to spread best practice and innovation. If we invest in the care economy, just as we should invest in childcare, we will build not just a fairer community and strong families but a foundation for a more efficient and more resilient real economy.

--- Later in debate ---

[Baroness Andrews (Lab)]

My Lords, I thank the Minister for his thoughtful reply. I should have thanked him at the beginning for making this time available. We had a good round table, and we share a huge number of concerns and an understanding of where things need to be done and can be improved. I will briefly come on to the points where we disagree.

I re-endorse the point my noble friend Lady Goudie made about the evidence we received. Some of the stories we heard about the daily lives of unpaid carers— and we heard a lot of them—were totally astonishing. I would have liked every Member of this House to have heard what people do as a labour of love and how modest their ask is. We should simply respect that they have an expertise that is often ignored. As was eloquently said by the noble Lord, Lord Polak, they do not know who to ask or where to go, and this becomes exhausting and defeating. If we have achieved nothing else from this excellent debate, I hope that any unpaid carer listening knows that we have the experience and empathy across the House to understand this and to want to change the conditions under which they are living and caring.

There has been an astonishing range of experience around the House tonight. There has been passion, of course, and a great understanding of what caring involves, because so many people have been involved. I pay tribute to my noble friend Lord Dubs and everyone else around the Chamber who has had that experience.

I think that what we have all been saying to the Minister is that we respect what the department has been trying to do; we know that it is an extraordinarily difficult task. It is always more difficult and slower to make policy than anyone anticipates, but we are not asking for a great vision; we are asking—without false optimism, with realism but with real urgency—that we step up. We cannot do the incremental thing anymore; it is not working, and it will not work for the future. We can use all sorts of expressions such as “turning up the dial”, but we are all saying the same thing: that there really needs to be a different energy and focus. That is why I return to the point about the champion, the commissioner—there is a lot of support for it around the House and there would be if the House was full. With great respect to the post of chief nurse, it does not do what we want. It needs someone to represent all that potential and frustration and to say, “There’s the good practice; that’s how you do it.” We have heard the example of Wigan from the noble Baroness, Lady Hollins, and there was much good practice referred to in the report.

We have heard some terrific ideas which we did not put into the report, such as filling in the pension gap, and we have heard a lot about the deep complexity. The reason it has not been resolved is that it is difficult, but recognising the difficulty, the realism, is not an excuse for not dealing with it. I sense around the House, and it is common to all parties, that the time has come to make this a national imperative.

I want to thank again everyone who has spoken for their wisdom and for their practical and inspirational contributions, in every respect. It will not be the last time we debate this subject. I just hope that by the time we debate it next we will have a clearer relationship between the vision and the practical implementation of what we would all like to see.

Motion agreed.