Adult Social Care

Baroness Brinton Excerpts

Thursday 2nd December 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, I thank the Minister for the Statement. It is no exaggeration to say that we on these Benches, along with many other noble Lords, have been repeatedly pushing Ministers to publish this White Paper for years. It is now two and a half years since the Prime Minister announced from the steps of 10 Downing Street:

“My job is to protect you or your parents or grandparents from the fear of having to sell your home to pay for the costs of care. And so I am announcing now—on the steps of Downing Street—that we will fix the crisis in social care once and for all with a clear plan we have prepared to give every older person the dignity and security they deserve … that is the work that begins immediately behind that black door.”


We were pushing because it was evident even then that adult social care was already in crisis. High levels of staffing vacancies, and cuts to local government meant that fewer people who had been entitled to state support would receive it, as the criteria for eligibility were repeatedly tightened. Even then, it was common knowledge that private patients were having to subsidise those funded by the state, as the amount given to local authorities did not match the actual costs of that care.

Even allowing for the inevitable delays caused by the pandemic, this Government have insisted on continuing with their structural reforms, rushing through the Health and Care Bill—which NHS leaders are now asking to be delayed because of the continuation of coronavirus and its pressure on all NHS services—as well as the health and social care levy, rushed through your Lordships’ House in one day, six weeks ago, which now requires amendment in the Health and Care Bill, which will mean that house owners outside the greater south-east will end up paying a higher percentage of their assets than those in the greater south-east. So much for protecting them from the fear of having to sell your home to pay for the costs of care—yet another broken promise from this Prime Minister.

In setting the scene, we and others have pushed for the publication of the White Paper prior to the Bill starting its journey in the Lords, because we cannot understand how any Government could restructure integrated care services between the NHS and the care sector without knowing what plans they have for the future of the adult social care sector. Yesterday’s paper was deeply disappointing—but I think the Government know that, which is why Ministers announced yet another White Paper next year on integration. But hang on: was that not why this White Paper was due to be published? If there is to be another White Paper, the timing is important. Can the Minister say when this new White Paper will be published? This one certainly is not the answer.

Allocating some money to developing the workforce in five years’ time will not even start to address the current crisis in social care: with well over 100,000 vacancies; with social care providers still having to pay for expensive PPE that is provided free to the NHS; and with providers handing back state-funded payments to their local authorities because they cannot provide a safe service for those patients. It does not address the current practice, caused by lack of funding, of domiciliary care workers not being paid as they travel between clients. It does nothing to change the experience of unpaid carers. There are lots of great ideas about following best practice and getting people to talk together, but there is no real offer of funding for regular respite care or other benefits and support.

Reading the full White Paper, the truth about the promises in the Statement begin to be revealed. The Minister knows that, from these Benches, we have repeatedly emphasised the importance of housing in relation to care and support for adults of all ages. It was, therefore, perhaps encouraging to read the recurring phrase

“Making every decision about care a decision about housing”,

but closer examination of the funding for disabled facilities grants increases shows that there will be £570 million a year in 2022–23, 2023-24 and 2024–25. The current budget for this year is already £537 million. Although continued funding is welcome news, this is only a £33 million—or 6%—increase, which, given rising costs of labour and materials, will barely keep up with inflation. It is not the transformative grant that the Statement trumpets. On the funding for

“a new service to make minor repairs and changes in peoples’ homes, to help people remain independent and safe”,

for which most authorities are able to offer only £1,000 to £2,000 per person before they have to look at their assets, no cash amount is specified, but it is hoped that this will give a boost to handyperson services that are so highly valued by older people and provide such a great return on investment.

It is impossible to transform way our social care provision works, keeping people in their homes, unless this White Paper demonstrates the practical support that the Government can give to make that happen. The real difficulty we face is that staff in the sector, providers, the NHS and, above all, the users and their families are severely let down by the White Paper. The word “dignity” is used repeatedly in the Statement. The reality is the opposite: no vision, no real reform and, worst of all, no attempt to deal with the current crisis.

[Lord Kamall (Con)]

My Lords, I thank the noble Baronesses for the points they raise. But let us be clear that for many years—not just five, 10, 15 or 20 years; some noble Lords have said that we knew this issue was coming after the war, in the 1950s—the demographics of the country meant that we were going to have an ageing population, and successive Governments of all colours have not grasped the nettle. They have commissioned a report, it has gathered dust on the shelf and another report has come along. Many noble Lords, including my noble friend Lord Lilley and others, have written papers for various think tanks, but those also gathered dust and nothing has been done. When I have spoken to friends of all political colours, they have said that, frankly, it was too difficult and there were other priorities. So the Government should be given some credit for finally grasping the nettle.

We have set out a vision. Before you set out a strategy, you have to set out a vision, and we have done so. This is a 10-year vision, and we have committed to the first three years. Throughout the White Paper, we have said that we will continue to consult the sector—experts, carers, both paid and unpaid, local authorities and nursing or care home providers—to make sure that we get the right balance and understand the issues. As technology develops—medical technology, information technology and other technology that enables people to live in their own homes—we will see how the vision might adapt, rather than laying out everything from day one. We have laid out the vision and the spending for the first three years, but we will continue to consult to ensure that we are adapting to the changing technology and circumstances.

Compared to the current system, more people will be supported with their social care costs and have greater certainty over what they pay and receive higher-quality care. We think the plans announced represent the best value proposals. As many noble Lords will appreciate, that means balancing many issues: how many people are supported; how much they are supported; and the cost to taxpayers of offering that support. We believe that the plan sets out an appropriate level for the cap and balances that with people’s personal responsibility for planning for their later years. A number of experts have written recently asking why financial advisers advise people to build up ever-larger sums of money but they then leave it to their children at the end of their lives, rather than depleting their assets as they get older to look after themselves. We were clear that the £86,000 would be the amount individuals will need to pay towards the cost of their care, and the amendment to the Health and Social Care Bill reflects the changes. We believe the new system is necessary, fair and responsible.

We admit that the Care Act 2014 was landmark legislation informed by a range of partners, and we want to build on those strong foundations, rather than reinvent the wheel. Many of the provisions in that Bill act as a platform for better, even more joined-up health and social care in future. We are the first Government to announce that we are going to integrate health and social care, and that we will have a system of healthcare all the way through—not social care as a bolt-on afterwards—from your birth all the way through your life.

The Health and Social Care Bill contains several provisions built on the Care Act 2014. We have looked at assurance, with a new duty on the Care Quality Commission, and we have looked at data, to make sure we have the appropriate data on adult social care. People should pass from hospital to social care with no delay and as seamlessly as possible. We have looked at provider payments and the better care fund. The Bill also proposes to put integrated care systems on a statutory footing, which will make sure that, in each area, working with local authorities, account is taken of the needs of social care, joined up with the other parts of the healthcare system.

On 3 November, we published the adult social care winter plan, because we recognise that this is a long-term plan, but we have constantly been listening to stakeholders and have drawn up recommendations with a number of people, including Sir David Pearson, who reviewed last year’s adult social care plan, advisers from SAGE and UKHSA. So we have listened carefully to make sure that we meet some of the short-term issues that we are facing. We have looked at how we can increase spending, where relevant, to make sure that we tackle some of those issues.

Across the House, noble Lords will want to pay tribute to social care workers, both paid and unpaid. We have a track record of responding to workforce pressures—for example, the £162.5 million workforce recruitment and retention fund and the £388 infection control and testing fund. We will continue to keep this situation under control. We are also increasing the rate of the national living wage, which means that many of the lowest-paid care workers will benefit from pay rises. We are also investing at least £0.5 billion in the way we support the development and well-being of our social care workforce—an investment in knowledge, skills, health and well-being, and how we drive the retention of existing staff and boost recruitment. This will set the conditions for professionalisation over a longer period, giving carers recognition. When we look at the social care workforce and how much they are valued, one of the great issues has to be recognition of their skills and giving them a professional development pathway.

In the longer term, as set out in the White Paper, we remain interested in working with commissioners and providers to make that sure care workers have the best terms and conditions possible, including being paid for all the hours possible. This is already set out in our existing market-shaping and commissioning guidance. We will also explore how we can champion best practice and support local authorities, including through the new CQC assurance framework. We acknowledge the prevalence of zero-hours contracts in the social care sector and we are interested in working with commissioners, providers and care workers to understand how those contracts impact this sector.

Chapter 6 of the White Paper sets out three key aims for the workforce strategy over the next three years, backed up by £500 million of investment. We want to create a workforce that is well-trained and well-developed, healthy and supported, sustainable and recognised. We want to make sure that social care is seen as a rewarding career—that it is not only heart- warming but has professional recognition. I should stop there and take some more questions at this point.