Social Care Funding (EAC Report)

Baroness Browning Excerpts

Thursday 28th January 2021 Grand Committee

[Baroness Browning (Con) [V]]

My Lords, I fully support this report. There are one or two things in some of the detail of it that I would like to see tweaked, but the thrust of it is absolutely right. This is a national scandal and it is far beyond time that the Government started to put it right. I support everybody who has said that this report should be the basis of a White Paper and not a Green Paper, because action is now needed.

I want to make merely a couple of points that are perhaps not covered in the report. I was reminded, when we were talking earlier in the debate about trusts, of the not-for-profit sector, which I believe has a lot to offer, particularly in care homes. Around the country, there are many homes that are run by trusts—we heard from the noble Lord, Lord Taylor, that new ones have been set up under trusteeships. Their great advantage is that, very often, they are small and locally based and therefore serve a particular client base. One hardship of the instability of the care home sector is that, when homes close, people often need to be moved well away from their relatives and areas where they have lived for many years. Therefore, in order to provide nationally a good mix of care that is affordable and of good quality, the not-for-profit sector could play a much bigger role than it does now. I would like us to look at that in a White Paper.

I will also pick up the funding of personal care, which many speakers have mentioned. I can see why some colleagues with a big local government interest are not very keen on this because they can see the bill. We are looking at billions; this is not a penny-on-income-tax policy. But we should look in more detail at what we mean by personal care. What does the day of somebody who needs personal care look like? It is not just about whether they can get dressed or have a meal provided by somebody in the household. Very often, particularly for those with Alzheimer’s or dementia, it is a question of not knowing what clothes to put on and perhaps dressing in the most inappropriate clothes. When it comes to food, it a matter of have they eaten or have they not? People with dementia may forget within half an hour that they have in fact eaten. Maintaining nutrition is therefore very important. This is a group of people who will wake up at 4.30 am or 5 am and think it is time to get up. They need full 24/7 care.

None of this is “medical” according to the definition of the word, but the demands and effect on carers can be quite catastrophic if those basic needs are not met. A failure in nutrition or in personal hygiene—for people who cannot look after themselves as far as their personal hygiene is concerned—can cause urinary tract infections or all sorts of problems that lead quickly to the need for doctors to be called or hospitalisation. I therefore would not underestimate the importance of personal care. It is something that must be factored in.

We have heard a lot about the political parties coming together; I agree that they will need to join together if this is to be successful, but please can we still do more to bring together social services and the NHS? In my experience as a Member of Parliament, whenever I came across a problem in this area, I would have to personally call for a case conference—and who would be sat round that table? Health, social services and the people involved with the problems. There seems to be a real lack of initiative to come forward and the reason is very simple: when you get those people round a table to sort out a problem, it costs money. They will do anything to avoid getting to the point where they have to sit round a table and commit money. I understand why—it is not easy, but we have to overcome that relationship between health and social services if this is going to work; otherwise, we will have these glass Chinese walls, where it is the responsibility of one and the other one does not want to know.

Finally—I have gone over my four minutes—not all households are one-person households. Often there are two people—two elderly people; two parents, perhaps—who need the help.