Social Care and the Role of Carers

Baroness Brinton Excerpts

Thursday 24th June 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, I declare an interest as a vice-president of the Local Government Association. I thank my noble friend Lady Jolly for instigating this debate and for her wonderful service to the Liberal Democrats’ health team, and to your Lordships’ House, in speaking calmly and authoritatively on health issues for over a decade.

The right reverend Prelate the Bishop of Carlisle was so right to start with the suggestion that we need to go back to the absolute fundamentals of social care, because the current system is plainly not working. Over the last two hours we have heard many stories alongside examples and statistics of how the system is failing. As my noble friend Lady Walmsley said, this needs to extend to housing too. Habinteg has produced homes for life standards that cost only a fraction more when a place is built new but can mean people then stay in one place for their entire life, with very minor and cheap adaptations.

The noble Baroness, Lady Cavendish, is right that we need to think in completely different ways. I, too, want to mention an exemplar from the Netherlands, where students are now living alongside residents in care homes. In return for accommodation, they are also providing some support. Not only has it proved career-changing for the students but the record of dementia has reduced because of regular contact with younger people. That is the sort of radical idea we need to think about.

From these Benches, we are calling on the Government not to delay any longer but to engage urgently in cross-party talks on the future of social care. Our Prime Minister, Boris Johnson, pledged during the 2019 election and then from the steps of No. 10 to

“fix the crisis in social care once and for all”.

With social care services in such crisis, it is time that he and the Chancellor acted. People are selling their homes to pay for care and more than 1.5 million people are missing out on the care they need. Others are stranded in hospital, unable to leave because the follow-up care just does not exist. This is putting an increasing strain on the NHS, which also does not have the cash to cope.

The Dilnot review has been repeatedly referenced, including by my noble friends Lady Jolly and Lady Tyler, and by the noble Viscount, Lord Chandos, who is right that Dilnot’s proposals demonstrated that this is not difficult. I also agree with the noble Lord, Lord Rooker. In 2010, all three major parties agreed on proceeding with Dilnot and then the Conservatives pulled out. A decade further on, nothing has happened.

The noble Lord, Lord Forsyth, might feel that his committee is long in the tooth now but its report was exemplary and will last the test of time. He is right that this is all about money. As many other speakers have said, people’s lives are being damaged because the system has fallen apart. If the Treasury is the block, we must now commit to extra funds to make this work. We cannot continue with this broken system.

In England, publicly funded but means-tested adult social care is primarily funded through local government. It constitutes the biggest area of discretionary spend for local authorities, which are already cash-strapped due to repeated cuts and extra responsibilities. If the adult social care workforce grows at the same rate as the projected number of people aged 65 and over, the number of jobs in that sector will increase by one-third to around 2.17 million by 2035. We are not even thinking about the growth in our demographics and its consequences. Everyone is thinking about mending the short-term problem.

As the noble Baroness, Lady Donaghy, pointed out, new analysis for the Care & Support Alliance found that since the Prime Minister stood in Downing Street and promised to fix social care once and for all, 2 million requests for formal care and support from adults aged over 18 have been turned down by their local councils. This is equivalent to about 3,000 requests being turned down every day, putting immense pressure on unpaid carers as well as the NHS. These numbers show the human cost of the Government’s dither and delay. Will Ministers please stop their internal spats and off-the-record briefings, and start the urgently needed cross-party talks, involving the sector, so that we can look at fixing this urgently?

The cost of inaction is also far higher, as 11.5 million unpaid carers are bearing the brunt of the Government’s failure to reform social care. The pandemic has exacerbated the immense pressures they were already under; many have not had a single break since the crisis began. It is clear that any reform of social care must consider the impact on unpaid carers and include ways to alleviate the pressures that they face. Will the Government commit today to the emergency funding that would give unpaid carers across the country at least a weekly break? Will the Minister also commit to involving unpaid carers and carer organisations in talks on reforming social care services?

Last week, 50 organisations wrote to the Prime Minister, calling on him to fix social care. They wrote in the letter:

“During the pandemic tens of thousands died before their time in care homes from COVID-19. The best possible legacy we can give all those who have lost loved ones would be to ensure that we fix the care system so that a similar tragedy cannot happen again.”


The Local Government Association tells us that the ongoing recruitment and retention problems show that a high vacancy and turnover rate is really affecting service quality. As others have outlined, many staff have uncertain incomes because of the prevalence of zero-hours contracts. Temporary shifts in these patterns due to Covid-19 have highlighted the need to deal with these issues permanently. A recent Skills for Care report on the state of the social care market found that pay in adult social care is on average 25% lower than in the NHS, that the adult social care sector in England still needs to fill more than 100,000 job vacancies on any given day, and that the staff turnover rate of directly employed staff in that sector was 30% in 2019-20.

The ability to attract and retain staff with the highest skillset is hampered by poor pay, poor reward and a lack of coherent career structures that allow people to think beyond temporary work in social care. We need better pay and rewards to form part of a package of reforms and to transform the sector. All this means that we should have a 10-year workforce plan. It is vital that this is part of any proposals made by the Government. Professionalism is key but so is the registration of healthcare professionals in the social care sector, along with proper pay scales and funding for the sector, so that local government is not put in impossible positions. The pressure should certainly not end up with care providers.

My noble friend Lady Thomas of Winchester is right: being a carer is not a low-skilled job. The skill must be recognised. I noted she said that carers are often from overseas and face racial abuse, especially from clients as they slip into dementia. That is another reason why carers need to be trained properly: to help and understand their clients in what is and is not appropriate.

Thanks so much to my noble friend Lady Scott for talking about the role of volunteers in our communities; her speech was very powerful. The noble Baroness, Lady Uddin, referred to disabled children. I repeat her question about proper funding for respite care for the families trying to manage the most vulnerable children in our society.

Unpaid carers can also be children. Our own experience as foster parents to two children who lost their mother through a long terminal illness demonstrates that in addition to missing school, which was already reported on, there are other long-term psychological issues in having to face the death of a parent when they are your sole parent. I give particular thanks here to CAMHS, which provides a service but, as my noble friend Lady Barker said, mental health support is woefully limited at the moment and needs to be tackled.

The cost of inaction and delay is also falling on the shoulders of the 11 million unpaid adult carers in the UK, whose contribution to the current social care system is almost completely ignored by government. The cost of reform may seem great, but without these carers—particularly if they themselves break down—the burden will fall further on government itself.

The Lib Dems are also calling on government to immediately raise the carer’s allowance by £1,000 a year to support unpaid carers and to recognise the huge financial pressure that many of them are facing during this pandemic.

The noble Baroness, Lady Browning, noted that half the social care budget is going on working-age disabled people. That is also important, because there are not often houses to sell afterwards. That is why we have to review everything and completely rethink the way our social care system works. I will end on another point on which I agree with the noble Baroness, Lady Browning. Everybody today has said that we have waited far too long for these reforms. The only block to progress is the Government, specifically the Treasury. Act now. Bring it on.