Social Care

Baroness Gardner of Parkes Excerpts

Thursday 29th November 2012 Lords Chamber

[Baroness Gardner of Parkes]

My Lords, I am one of those old hands to whom the noble Baroness, Lady Pitkeathley, referred in her speech. No one knows more on this subject than she does and I pay tribute to the great work that she has always done. However, there is nothing new in this problem. It has grown hugely but there is nothing new about it. I was chairman of social services on a London council in the 1970s under the then Wilson Government. We were terribly short of money and had to choose between providing social care or saving the buildings in which we were doing it. We did not have the money for both. These extremely difficult choices have always had to be made.

Like the noble Baroness, Lady Pitkeathley, I am very disappointed that, one year on, we still have not had a real response to the Dilnot report. However, as she said, everything is stretched. The linkage between housing, health and care has always been terribly important. There is nothing new in that. I would be sorry to see unacceptable standards become the norm, as the noble Baroness fears, but we have reached the point where there is simply no money. Local authorities have done everything they can to reduce their expenditure. They have put a lot of the care out to agencies because that saves hugely on management costs and staff costs and they believe that that is more effective. I am not so sure of that. I met a woman who was going to take on a caring job and found that she had to see eight different clients a day at eight different venues, each one supposedly for an hour. However, in that hour she had to do everything for that client. As has been said, 15 minutes is more the norm—someone runs in, makes a cup of tea, gives the client a bath or dresses them and then is gone. If they are doing breakfast for people, those people are getting their breakfast at all times of the day because the same person is running from house to house.

The woman who applied to the local authority agency found that she would have been paid nothing for her travelling time between jobs, which could be half an hour or more. She would have had to locate each address herself and then go to it. The whole thing was not on. This is a very genuine and loving Latin American woman. I came across her through an immigration issue. She has been here for many years. She works for 48 hours non-stop, day and night, for an elderly lady. She lives with her, looks after her, gets up in the middle of the night and does everything. She does this on a self-employed basis. I have raised this matter before in the House. If you are self-employed, there is no talk of a working wage or even a minimum wage. There is no wage protection for carers who are self-employed. The family of the lady with dementia pays her £100 for two days and two nights—48 hours. That is £2-something an hour. How can we expect people to work for that sort of money?

We rely on people working. In the past you could rely on family because people lived near to one another. In my GLC days you could exchange your social housing and move nearer those who could care for you. None of that—or very little—is available now. Most people are lucky to have a roof over their heads at all. It has reached the point where local authorities have combined forces so that several boroughs can work together to reduce costs and spread the load. These things are not easy now. People are reaching the limit of their resilience. They have made efforts again and again. We keep trying and we make a little progress, and then we find that the demands are growing all the time. The huge growth in the number of elderly people who survive is perhaps something that no one could have foreseen. Perhaps it is a reflection of how successful our health service and way of life are. The basic issue is money.

I went—I think it was yesterday but I lose track of time—to a meeting on the future of nursing. Everyone talked about the need for more time for each nurse to do her job. We read press reports on this. Nothing could have been reported more than the issue we are debating. I have picked out three headlines. The first is very emotive and states:

“Hungry, sick, neglected: the care home scandal”.

The next one states:

“Urgent action needed to tackle care failings that lead to horrific abuse”.

These things are absolutely vital. Care inspections are very important, but will be effective only if they are unannounced and unexpected. If you have told people that you are coming, you will not get the true picture at all. Today, I read in the paper:

“Cruelty had been ‘normalised’ in parts of the NHS, the Health Secretary declared yesterday”.

It may be that that emotive word had been picked out, but what is happening in most cases is not deliberate cruelty. In many cases people are giving a marvellous service. However, the cases that all the press sensation is about are ones where staff are failing.

I was in hospital two or three years ago. I was put in a ward full of elderly people. All night the woman in the bed next to me said, “Help, help, help”—non-stop, for the whole night. Of course the nurse responding to that had become case hardened, because she had heard the woman saying “help” not just the night I was there but probably every day and night of the week. People are amazingly patient and good, but it is an impossible task. Everyone knows that it comes down to the need for more money—but where are we going to find it? The medical set-up is also in a state of chaos while staff adjust to all the changes. It is extremely difficult.

We want to see social care of good, reliable quality. We want to see specialist hospital facilities used only where there is a real benefit from them. We do not want people to be occupying hospital beds that could be used by acute care cases when another type of accommodation might be better. It is alarming for people. They know that they do not have the money to pay for things themselves. But the changes in family patterns—the geographical thing—are very worrying.

Expectation is another big problem. We have all raised expectations to a point where we expect everything to be perfect all the time, but no one has the money for that. This is an extremely complicated issue that we have to be very aware of, and today’s debate must help to increase awareness and show all the various aspects of it. There is no simple solution. I wish there was. It is going to take a lot of time and effort and we will still be relying to a very large extent on volunteers, which the noble Baroness, Lady Pitkeathley, knows so much about.