Social Care

Baroness Cavendish of Little Venice Excerpts

Thursday 1st December 2016 Lords Chamber

[Baroness Cavendish of Little Venice (Con) (Maiden Speech)]

My Lords, I am proud to stand here today as a Member of this House and make my maiden speech. I would like to thank noble Lords on all sides of the House for so warmly welcoming me and the staff for being so magnificently kind and helpful.

Being here is an honour far beyond anything I expected, not least because many of my illustrious predecessors as head of the Prime Minister’s Policy Unit served there far longer than I did—I only count myself lucky that I got out before most of my failings could be exposed. I am especially grateful to the noble Lord, Lord Adonis, and the noble Baroness, Lady Hogg, for their unfailingly generous and always-discreet advice when I was in No. 10. I am also grateful to the noble Baroness, Lady Hogg, for being my supporting Peer, along with my noble friend Lord Bridges of Headley, who is surely this House’s best hope for delivering a Goldilocks Brexit.

I would like to mention one very special aspect of this House, which I came to appreciate when I was a journalist. In some of my darkest moments, when I have been campaigning on an issue and felt that no one was listening, I have sometimes received unexpected encouragement from Members of this House who I have never met—either notes or, sometimes, very useful pieces of information. I cannot tell your Lordships what a difference that has made.

The most astounding example of this landed on my desk one day from the late Lord Rees-Mogg. I was campaigning to open the family courts to the media, and we were being prevented from publishing some of the cases that I believed were miscarriages of justice. Lord Rees-Mogg wrote a letter urging the Times to publish and offering to go to jail instead of me should we be found in contempt of court. The noble Lord said in the letter that he was so old that he thought he probably would not be jailed for the offence, but that if he was jailed, it would help our cause. Luckily, we never had to call on him, because in fact the Brown Government agreed to change the law, but I have never forgotten the spirit that that letter represented.

I am grateful for the opportunity to speak in today’s important debate, and I know that I need to be brief. Too few people in this country are aware of how fragile the social care system is, of what they can expect if they become old and unable to look after themselves and, as others have said, therefore of what provision they need to make for themselves. I think this is partly because we humans do not like to contemplate our own mortality; we do not think it will ever actually happen to us. But the lack of public understanding of this issue is one reason why social care lags down the political agenda behind the NHS, which is experienced by a much wider group of people.

The social care workforce itself is also misunderstood. When I conducted a review of support workers in health and social care for the Department of Health in 2012 I met far too many care workers who said, “Well, I’m only a carer”. Actually, to go into an elderly stranger’s home and cope with whatever you find there, to feed someone who cannot swallow properly and to lift someone with dignity is a hugely skilled task that requires considerable maturity. Too often we still refer to those tasks as “basic” when actually they are anything but.

I am proud to have been part of a Government who introduced the national living wage, which may help to reduce some of the cripplingly high turnover that we see in the sector. But I also think we have to recognise the cost pressures that this is now putting on providers. As the noble Baroness, Lady Browning, said earlier, the fact that self-funders are subsidising local authority payers in some cases is not only beginning to become apparent to people and making them quite angry, it is also of course an enormous financial problem for deprived areas that do not have self-funders and are increasingly trying to make ends meet.

“Integration” is a great word. We probably all know that some version of integration is vital to address these challenges, and heroic efforts are being made in parts of the country, especially Manchester, to do exactly that and to make the health and social care system work as one. But I am afraid that in too many places integration is still just a word; delayed transfers of care are blamed by the hospital on the local authority, and by the local authority on the hospital. The truth is that until we have greater integration of the money we are not going to break through this problem—and we all know how complicated it is to integrate the money.

One aspect that I will raise is the need to create a much more integrated workforce. Even if we integrate the money, we have to have an integrated workforce in health and social care. As the population we are dealing with becomes frailer, with longer-term health conditions, we are seeing a blurring of the old lines between residential care, nursing care and hospitals. I am pleased that the Government are rolling out the training that I recommended in the care certificate; I hope it will start to break down some of the silos. But I also ask the Government to consider extending that care certificate to volunteers, who already play a vital role in this area and could do so much more to help join up some of the health and social care pieces.

The CQC’s latest State of Care report makes some very good arguments for integration that I do not have time to go into here, but all noble Lords know what they are. It was a great privilege for me to sit on the board of the CQC under the chairmanship of my noble friend Lord Prior, and I salute it for its work in raising standards. The challenge of regulating the sector is enormous because of the sheer number of providers. However, I am not sure that the CQC, the CCGs, the local authorities and other public agencies fully appreciate the cumulative burden that they collectively place on providers, especially small providers, which are often the most caring, with the multiple demands that they make on them. I have watched weary staff filling in form after form—each one almost the same as the last but, maddeningly, slightly different—when they ought to be looking after mothers and grandmothers. I make a plea today to the Department of Health and those public agencies that they get together and agree a single set of data to require from providers. At a time when services are under such pressure, that is the least we could do to ease some of the pressure on them.

I entirely agree with the noble Baroness, Lady Pitkeathley, that we need a more honest debate. Those who are in this Chamber have a much better understanding than the vast majority of those outside. We owe it to those mothers and grandmothers to have that debate because, if they are not our mothers and grandmothers today, they will be tomorrow.