NHS and Social Care: Winter Service Delivery

Baroness Jolly Excerpts

Thursday 25th January 2018 Lords Chamber

[Baroness Jolly (LD)]

My Lords, this has been an interesting debate. There are many experts and much experience in this House. There is also a great deal of passion and it is not surprising that there is a lot of agreement.

I start by thanking all care workers who, on low wages and often with little thanks, do a splendid job, day in and day out, whether in a hospital, residential or nursing home, or in a domiciliary setting. There are 1.4 million people employed in social care roles, caring for more than 1 million adults. The winter period is often challenging. Certainly in the rural area where I live, these people have to cope with bad weather, dark morning starts and dark evening finishes, and, invariably, with clients who are less well.

The other unsung heroes in the world of care are the carers. I echo the call of the noble Baronesses, Lady Pitkeathley and Lady Wheeler, for the carer strategy and the action plan, long promised and long overdue. These carers are selfless family members or friends, who often work without help, payment or support, rarely getting respite.

The carer’s allowance, for those who take it—a lot of people are not even aware that there is an allowance that carers can take—is £3,260.40 a year. The winter bit is that there is a £10 Christmas bonus. I wonder: do we value our carers? Your Lordships will know, because the noble Baroness, Lady Pitkeathley, reminds us on a regular basis, that were this huge army of carers to be paid just the living wage, it would cost the Exchequer much the same as the annual national health and social care budget. That is their value, but what are they worth?

Recent research shows that more than half of us believe that we do not know a single family member or friend who cares, while as many as three in five believe that they do not know any work colleagues who help look after a loved one. In reality, one in 10 people in the UK are carers and one in nine people in the workforce are juggling their paid job with unpaid caring. I remind the House that the Care Act calls for carers’ needs to be assessed alongside the needs of those they support. Could the Minister tell the House when the most recent report on this was published? Is this being met right across local authorities? When would he expect the next one, so we can measure improvement?

The solution to many problems is more money. More money can mean more staff and new preventive ideas. It could ease the way for primary care and community care to work more coherently with local social services. I acknowledge that more money has been made available to the care and health systems over the winter period. The better care fund increased social care funds by £4.4 billion over three years, as well as the adult social care support grant of £240 million in 2017-18. But work needs to be done in many parts of the country to improve existing systems—to look into data sharing between health and care as a matter of urgency, for example.

Before I address delayed transfers of care, I will talk about the reduction in social care support. Social care budgets have seen an estimated loss of more than £6 billion since 2010. Between 2010-11 and 2014-15, spending on social care fell by 7% even as demands increased over the same period. The social care precept allowed local authorities to raise council tax by up to 2%, and in December 2016 this was raised to 3%, but, as my noble friend Lady Pinnock and the noble Lord, Lord Smith of Leigh, explained, this tax is inherently regressive in its structure. Local councils in poorer areas are not able to levy an effective council tax as easily to meet social care demands.

Cuts to local authority funding, rationing and a reduction in the level at which support is available have reduced the number of care packages. This will invariably increase the likelihood that someone will become frail and so, when falling ill, will need hospitalisation. If care packages can enable someone to look after themselves, they often avoid going into hospital. Ironically, often self-funders fail to pay for as much support as they need. They can find themselves less able to self-manage and find themselves admitted.

There are financial and physical costs of the delayed transfers of care. The estimated annual cost to the NHS is around £820 million each year and the loss of 1.15 million hospital days in acute treatment—up 31% compared with 2013. There are physical costs. Each additional day in hospital is a higher risk of infection and rate of readmission. The amount of strength lost per day in hospital—I am talking about muscle strength of an elderly person—is up to 5%. Delayed transfers of care seem to hurt twofold: once on the bed shortage, but again on muscle loss. If elderly patients lose up to 5% of their muscle mass daily and constitute the majority of patients under delayed transfers of care, the NHS could indirectly be contributing to a number of falls and hip fractures in the long run.

A lot of delays are attributable to the NHS, with 58.3% of all delays in November, compared with 34% to social care, and 7.6% jointly, with social care’s share slightly falling over the last year. The noble Baroness, Lady Watkins of Tavistock, spoke about the primary reason for social care delays—35.4%—being due to patients awaiting the care package in their own home. Will the Minister explain why there is not enough capacity in the system? Could this be due to a fall in private investors who no longer see this as a good investment? What is the solution? We all know that local authorities have responsibility for market shaping, but what if the market does not wish to be shaped? Where do we find ourselves then?

I shall put in a plug for the local community hospital. Those in my own backyard in Cornwall, having been saved from cuts in 1996 in advance of the 1997 general election—I remember Frank Dobson coming down and waving his magic wand—are now coming into their own as a safe place to transfer patients to when they no longer need medical care but do need nursing and rehab. Additionally, they are a resource for the GP, who can admit a patient for as short a time as a few days to see them over a crisis, rather than have them go into the local acute hospital.

Integration of health and social care is the holy grail of care. We watch with interest devo-Manc, where there is a commitment to integration of health and care, and Cornwall, where there is a move to make the CCG a department of the council. We should also note that Torbay has been working for years like this, now under the auspices of the Torbay and South Devon NHS trust, which states that it provides acute health services, community health services and adult social care. It is not rocket science; others have done it.

I was surprised, and then on reflection pleased, that the Department of Health was to be renamed the Department of Health and Social Care, despite the fact that the Secretary of State has always had responsibility for social care albeit with the support of a Care Minister. However, I am disappointed that, since Mrs May became Prime Minister, the Care Minister has not been a Minister of State—what message does that send us? That particular Minister of State historically has also looked after mental health. Those are two areas where you need somebody with a bit of oomph in the department.

In the first week in January, an article in the Financial Times written by Sarah Wollaston, was headlined:

“Only political courage can save Britain’s health service—It will take a cross-party approach and a willingness to put public interest first”.


Along with others, we on these Benches eagerly await the Green Paper on social care funding and ask the Minister what other topics will be in it. Will it become a portmanteau paper?

But do the Government have the willingness? My honourable friend Norman Lamb visited the Prime Minister along with Liz Kendall and Sarah Wollaston to ask for her support in this cross-party look at the issue. They also asked her to consider raising income tax by a penny in the pound, which would raise £6 billion, which is the gap between where we are and where we need to be financially. Indications suggest that the public would warm to the idea. They see the system creaking and feel it is the least they could do. Those of us on these Benches agree.