Social Care

Baroness Donaghy Excerpts

Thursday 29th November 2012 Lords Chamber

[Baroness Donaghy]

My Lords, I am extremely grateful to my noble friend Lady Pitkeathley for her perseverance in this important area. Those of us who sat through the debates on the Local Government Finance Bill can be in no doubt about the parlous state of local government funding, and the Question asked in the House yesterday about cuts in arts funding in Newcastle brought it home even more how councils are having to set priorities which are assessed on the least harm rather than the most good. I start from the standpoint of being a supporter of local government, but that is not to say that there are no failings in the system, if you can call the state of social care in this country a system. I will concentrate my remarks on care for the elderly and, in particular, those who need nursing care as opposed to residential care.

A growing number of frail elderly people are living alone when it is no longer safe for them to do so. The care they receive, if they receive it, is often totally inadequate for their needs. This is not new, as the noble Baroness, Lady Barker, pointed out, it is just getting worse. Let us look at the demographics. Last year, 720,000 people reached the age of 65, the largest number ever to do so. They are the cod liver oil generation and they are better nourished than any previous generation. Some continue in paid employment, and a considerable proportion of their number will still be around in 2031 when they reach the age of 85. That is good news, but by then many more will require support in their homes or in residential or nursing care. Moreover, many among those 720,000 people are already caring for elderly relations, as I did a few years ago. They are finding out for the first time in their lives the extent of the financial and administrative hurdles they have to overcome on behalf of their loved one or ones.

Today’s 85 year-olds are not a sufficient political lobby to frighten any Chancellor of the Exchequer into taking action on social care, but the generation that retired last year is a different matter. Their experience as carers and their concern for their own futures will affect the political agenda. By way of a word of advice to my noble friend Lady Pitkeathley, if she moves the same Motion for debate this time next year, she ought to ask the noble Lord, Lord Sassoon or his successor to reply instead of the noble Earl, Lord Howe, because this is a Treasury issue.

We all believe that care is in desperate need of reform, that it is urgent and that cross-party consent is probably the only way we are going to achieve it. Having said that, I first participated in a debate on the urgent need to integrate health and local government services for the elderly in 1973—so the word “urgent” is losing its meaning. It is shocking to learn that social care for older people in England makes up about 1% of total public expenditure in the UK. We know that much of NHS expenditure is also concentrated in this area, to some extent subsidising the failure of social care, the lack of adequate housing and the diminution of the role of extended families. Although the Government have announced new social care funding, rising from £1.18 billion in 2011-12 to £2 billion per year by 2014-15, which of course is welcome, that is in the context of overall cuts and cancelled funding from central government of £3.5 billion.

This area has always been underfunded. Age UK has said that,

“care is not fit for purpose”.

Each year, the level of unmet need has increased as people are excluded from accessing services or have their care packages reduced. In 2009-10, the total hours of support purchased by local authorities for older people fell from 2 million hours to 1.85 million hours. People who are unable to undertake essential personal care tasks find themselves ineligible for support depending on where they live. It is estimated that 800,000 older people with care-related needs receive no support of any kind from public or private sector agencies. This figure is likely to rise to 1 million people by 2020. Those who are poor and have no family support face a grim future.

As the noble Baroness, Lady Wheatcroft, said, although funding is of course very important, we must look to different ways of spending it. We should find out why our elderly are more isolated than elderly people in some other countries in Europe, where specially built communities exist. Perhaps older people in this country cling on to their own— sometimes hopelessly inappropriate—accommodation because it is preferable to going into a home or living with their children. Of course there are purpose-built homes with community facilities now, but we must find ways of ensuring that, once someone has bought a property in such a purpose-built facility, the annual service and maintenance charges do not overtake their budget and reach nightmarish levels. At a time when housing budgets are facing dire shortfalls, it may seem fanciful to demand new forms of housing or to persuade the elderly to move from the suburbs into the city, as they do in Copenhagen, but when times are desperate we need to be at our most imaginative.

Another area that I think deserves independent examination is the administration of the estates of deceased nursing home residents, many of whom have no living family member. I realise it is not something that the CQC can deal with, but I feel that a lot of money is being made by some solicitors, and probably banks, with little oversight. This is an area where local authorities could become entrepreneurial—the salaries of the staff who are employed would be covered several times over and the elderly residents’ interests would be better protected.

We should ask ourselves whether nursing homes, as presently constituted, are the right model for the future. There is no doubt that cuts in local authority funding force authorities to cut the fees they pay to private nursing homes, which forces many to close. After all, local authorities fund about half the places, but shareholder value may well be the decisive factor. Is the comfort and well-being of the patients in nursing homes given more priority than their potential for bed-wetting? I ask these questions because of my own experience. The CQC report is, if anything, an understatement of the real problem. I wish my noble friends Lady Pitkeathley and Lord Warner, and other colleagues, all the best in their endeavours to keep Dilnot alive.