Health and Social Care Levy Bill

Baroness Brinton Excerpts

2nd reading & Order of Commitment discharged & 3rd reading
Monday 11th October 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, I declare my interests as a vice-president of the Local Government Association and a vice-chair of the All-Party Parliamentary Group on Adult Social Care. I also declare that I am disabled as a result of a long-term condition, and that my husband is my unpaid carer.

From these Benches, our focus is to see how this levy Bill will benefit those using social care and those working in it who are trying to provide an essential but frankly invisible service against impossible odds. There is no doubt that they have hoped that this Government will introduce real reforms for the care sector, especially after Ministers’ abject failure to protect people in care homes during the pandemic: from the lack of tests and PPE, to lies about a “protective ring” around care homes while people died in horrifying numbers. The way hospital patients were moved into care homes to free up space without being tested for Covid was equally horrifying for patients, their families and the staff in care homes, too.

The current underlying problems in our care sector were there long before the pandemic. We have an iniquitous funding system, with the general public not understanding that they are more than likely to have to pay for their care, and that the so-called “hotel costs” of living in a care home—accommodation and food—will now be separated out.

Ten years ago, the three major parties all came together to support the proposals of Andrew Dilnot’s review—but, just before we were going to achieve success, the Conservative Party walked away. Over the succeeding decade, the crisis in the sector has worsened considerably, not least because of the draconian cuts to local councils and other local services, especially to those that are there to help keep people out of homes, to keep their independence and their lives going. The current pricing of beds and the cuts to day services mean that independent living, which really would help keep people out of homes, just is not there. Staff in the care sector, unlike in hospitals, are paid at the minimum wage because, shamefully, as a society we regard social care as unskilled, when those of us who know the sector well see the exact opposite.

Worse, the funding rates for residents are based on most staff being on the minimum wage, making it impossible now for employers to compete with retail, hospitality and agriculture, where employers are charging customers more and are then able to pay their staff more. Worse, these dedicated staff, under this proposal, will be paying an increase in national insurance, which will further reduce their income at the exact time that they are facing cuts to universal credit and increases in the cost of energy, food and many other items. The limits on publicly funded costs and the iniquitous position of privately funded beds now cross-funding those in beds funded by the state must stop—and now. But this means that the real rates need to be paid to reflect that cost.

The paper Build Back Better: Our Plan for Health and Social Care, published last month with a foreword by the Prime Minister, is not a plan for health and social care. It is a funding plan for how people pay for their care and for the NHS, and for what element is paid for by the state. The Minister has set out the structure for paying the costs of those who will need support beyond the proposed cap, but not, as many think, for extra front-line funding for our care homes. Even worse, the public do not understand that this cap excludes all of the so-called “hotel costs”, regardless of the resident’s length of stay. That means that those who believe this Conservative Government’s words that they will no longer have to sell their home might find themselves, if they are asset-rich and pension-poor, likely to have to sell their home anyway for a large portion of their weekly care costs. This sleight of hand is breath-taking.

The extra funding referred to by the Minister in the paper for the next three years is first and foremost for the NHS, which is likely to have to absorb the 3% pay rise that the Government have graciously given it, as well as deal with the backlog from the pandemic. Once again, the Government are blunt: social care will get whatever sits behind and is left from that NHS spend. Already, many in the care sector are concerned that there will be nothing left for social care, so I really hope that the Minister will be able to say what funding from the £12 billion announced in the paper is guaranteed for the social care sector. Will any extra be provided if the NHS needs it all?

I echo concerns about what was said in newspapers over the weekend. There were leaks from the Government that local authorities might well be required to fund support for social care increases via council tax increases of 5% per annum for three years. That is another deeply regressive tax that puts a very specific burden on the lowest paid in our society. I echo concerns about the rumours outlined by the noble Lord, Lord Eatwell, about integrated health and care services in the future. Is this not all totally upside-down and back-to-front? Surely the principles of reform should be announced first, before a funding mechanism is agreed by Parliament. Despite the fact that the Commons is already looking at the Health and Care Bill for integrated care structures, the Prime Minister’s proposals for reform of the social care sector remain stubbornly in his mind and behind the closed doors of No. 10. There needs to be honesty about the direction; reforms must be long-term and total. They are missing at the moment, and this is a key element.

How will the delivery of social care itself be reformed and do we know that the funds sought through the levy will be adequate for it? From these Benches, we were clear in our 2019 manifesto that we would raise additional revenue that would be ring-fenced to be spent only on NHS and social care services through income tax. This would be generated from a 1p rise in the basic, higher and additional rates of income tax. We would use this cash to relieve the crisis in social care and urgent workforce issues and to invest in the mental health and prevention services that I outlined earlier. This frankly represents an efficient and effective way of spending these extra resources and ensuring that they will have the greatest impact on the quality of care that people receive.

We from these Benches have been calling on the Government not to delay any longer and to engage urgently in cross-party talks on the wider future of social care. If the Prime Minister has not yet announced his reforms to social care but keeps saying that he is prepared to talk to other parties, why are we not talking now? Perhaps the Minister could remind him.

Two years ago, Boris Johnson pledged from the steps of No. 10 that he would fix the crisis in social care once and for all, as a top priority. But with social care services in crisis, it is time that he sets out how he plans to do it. Instead, people are selling their homes to pay for care and more than 1.5 million people are missing out on the care they need. More and more people are stranded in hospital, unable to leave because the follow-up care just does not exist, and the staffing crisis in the sector worsens daily. This is putting an increased strain on the NHS, which does not have the cash to cope.

The cost of inaction and delay is falling on the shoulders of the over 11 million unpaid carers in the UK, whose contribution to the current social care system is almost completely ignored. The cost of reform to the Government might seem large, but it is a fraction of the true cost to families across the country. Carers UK estimates that unpaid carers already save the Treasury £193 billion a year. Any discussions of funding for social care services need to include discussions on fair pay and support for hard-working carers employed in the sector. This pandemic has reminded everyone that caring for people’s health does not stop at the hospital exit or the GP’s surgery door. We can improve the NHS only if we properly support carers, whether unpaid family carers or dedicated staff working in homes and in patients’ homes.

This Bill does not build back better; it is a building block to start the funding mechanism, but one that uses national insurance, disproportionately affecting those on low incomes, including, critically, those working in the sector. Perhaps that is this Government’s secret plan. After all, the Secretary of State for Health and Social Care told the Conservative conference last week that we did not need the care sector, as families should just look after their own. Of all the comments from Ministers over recent weeks, that was the most chilling. I hope the Minister can reassure us that the Government believe in, and support, our hard-pressed social care sector and recognise the real need for reform beyond the financial levy. From these Benches, we remain prepared to help.