Social Care

Baroness Donaghy Excerpts

Thursday 30th March 2023 Lords Chamber

[Baroness Donaghy (Lab)]

My Lords, I thank my noble friend Lady Andrews for initiating this debate, and congratulate her on the Select Committee report. It has been said before, but the report follows other distinguished predecessors. When preparing for this debate, I pulled out my well-thumbed copy of the Dilnot report and the Economic Affairs Committee’s report—otherwise known as “Lord Forsyth’s report”—together with speeches made by my noble friend Lady Pitkeathley. Here we are again: the needs are more desperate and the achievements are less. Some 58,000 fewer older people now receive long-term care, compared with 2015-16. There will be no major development until after the general election, as the introduction of a cap on lifetime care costs and changes to the means test have now been postponed until October 2025. As has been said, these changes were contained in the Care Act 2014, yet we know that 10 years will have gone by before we even start to build a system.

Those providers in the social care industry—if they are caring and conscientious—are seeing diminishing profits and worse deficits. More than half of providers had to turn down admissions and 20% of them have closed services. Those that are less caring and conscientious are making good money out of human misery. Local government funding is half of what it was 10 years ago. What help will the Government give to providers in their remaining two years? In particular, will they continue the enhanced support for energy costs at least to assist providers to stay in business?

With no long-term policy changes in prospect, we have to turn to the short-term mitigations, with the top priority being staffing. Can the Minister tell the House whether it is correct that the Government’s promise in the social care White Paper to dedicate £500 million for

“investment in knowledge, skills, health and wellbeing and recruitment policies”

has been cut by 50%? The executive chair of the National Care Association, Nadra Ahmed, representing the independent carers, believes that the report of these cuts is correct. Martin Green, the chief executive of Care England, commenting on the rumour of cuts, said that

“it will set back social care for many years to come.”

The number of vacancies in the care sector is 165,000. The number of additional social care workers required is estimated to be 480,00 by 2035. Skills for Care has predicted that the UK will lose 430,000 carers in the next 10 years if those aged 55 and over take retirement. Hft and Care England published the 2022 Sector Pulse Check report, which covers, among other things, how the care sector is mitigating staff shortages. The “refer a friend” scheme, international recruitment and increasing use of agency staff each contains its own problems.

“Refer a friend”—a scheme where existing members of staff refer friends or relatives in exchange for financial reward—was the most popular method of recruitment, selected by 24% of respondents. In my view, this method contains real risks that suitability and skills will take second place to the loyalties of relationships. We have seen the consequences of this in various cover-ups of mistreatment of the most vulnerable. I have been a fellow of the CIPD for more than 20 years. Unless the right checks and balances are in place, the “refer a friend” scheme could be seen as a sub-optimal recruitment method.

The second method is international recruitment, used by 15% of respondents. In February 2022, the Government expanded the shortage occupation list; that was welcome but the primary barrier here is pay. The minimum wage that the Government have set for care workers employed from overseas is £10.10 per hour, which causes a disparity in pay between overseas workers and the existing workforce. Obtaining a certificate of sponsorship is bureaucratic and time-consuming, often taking up to 12 weeks. Visa applications are also an issue, with costly legal services beyond the reach of smaller providers. Even the agencies that provide these staff can no longer guarantee to provide workers, which has broader implications for the NHS. Many NHS nurses are doing extra shifts in adult social care rather than working overtime in the NHS. The report concludes that

“failure to manage this market will see nurses leave both the NHS and adult social care and become agency nurses at a few, select high-paying agencies.”

In conclusion, if you are in need of social care and money is not a worry, you can probably still receive a good experience. If you are poor, growing old will be the biggest challenge in your life at a time when you are least able to cope.