Social Care and the Role of Carers

Baroness Jolly Excerpts

Thursday 24th June 2021 Lords Chamber

Moved by

[Baroness Jolly]

That this House takes note of social care provision in the United Kingdom, and the role of carers in that provision.

[Baroness Jolly (LD)]

My Lords, it is a great pleasure to open this debate on social care. I am sure it will be rich and varied, and that the Minister will struggle to sum up the points made in the time he is given. I am sure we will welcome a letter from him with his responses to our more trying queries. This debate also doubles as my health and care swansong, as I now move to defence.

I start by putting on record my, and our, utmost thanks to all those who work in social care systems, from carers to cleaners and caterers, to management in care homes and domiciliary care, and those who provide so much care for friends and family, expecting nothing in return.

I want to cast our minds back to the time of the coalition, when the Liberal Democrats made reform of social care an absolute priority, and the Dilnot commission provided a framework for us to fix the inherent unfairness in how social care is funded and provided. Cross-party talks were promising and it felt as though progress was being made. Not so. Later, both Prime Ministers May and Johnson said that they would sort it. But somewhere along the way this issue has been pushed into the long grass again and again, despite two Conservative Prime Ministers pledging to make it a priority. Of course, Covid has not helped.

So will it be Dilnot, Forsyth or something completely different? How will it be funded? We have seen, over the last year, what is possible when resources and energy are mobilised to address a crisis. We know that this an issue exercising the Chancellor. I want to be clear: what is happening in social care is a crisis, and we need to approach it as such.

Looking at the sector since the onset of Covid, we see that the Government have provided significant short-term support to help care providers through Covid-19, but it is vital that the Department of Health and Social Care now sets out how it will help providers move beyond it. The costs of the pandemic and the dramatic fall in care home occupancy, from around 90% at the start of the pandemic to 80% in February this year, puts many providers at risk of failing. In response, the Government provided short-term funding through local authorities and the infection control fund. This support has stabilised the market and kept most providers from falling over. However, the department does not have a strong grip on the variable levels of support that individual providers received, and there have been some reports of providers struggling to access some of the additional funding. The commitments around extra funding and free PPE—personal protective equipment—until the end of next March are welcome, but the department does not yet have a road map outlining how long extra funding and support will be in place. Can the Minister tell us please?

The Care Quality Commission warns that ongoing support is likely to be required in 2021-22 if care home admissions remain low or costs are inflated. Can the Minister tell the House whether the Department of Health and Social Care, working with the Ministry of Housing, Communities and Local Government, has an assessment process in place to determine how much support providers need in the short to medium term to deal with Covid-19 and lower occupancy in care homes?

I want to address the role of carers, both paid and unpaid. For those who work in social care, it is time for parity to become a reality. This relates to a number of issues. As I am sure carers themselves would say if they were here, the first issue is pay. Noble Lords will remember the outrage over a mere 1% pay rise for some of our NHS workers earlier this year, but the reality is that this is something our social carers can only dream of. Of course, the sector is far more fragmented, and much of it private, but the Government need to be ambitious in providing a fair, living wage to our social carers for all the hours that they work. This means leading the way on developing a framework that outlines what social care staff should be paid.

Secondly, along with pay, our carers need recognition and career progression. During the first stage of the pandemic, on Thursday nights, we all went outside and clapped to support all the NHS workers and care workers who were doing their very best. But care work, as many of us know, can be immensely rewarding and challenging in equal parts. Our workers need to know that their skills are valued and there is space for them to grow and progress in their career. We know that retention is an issue, when pay matches that in a supermarket. Greater recognition and regulation are needed. In both Wales and Scotland, care work is acknowledged as a profession. Would the Minister explain why care workers in England are not regulated and their pay derisory? What is stopping their recognition and regulation in England, as for those working in Wales and Scotland?

Turning now to unpaid carers, I draw on family experience, which is typical. For five years, my brother was my mother’s carer. He was able to get out of the house and shop when her carers came to get her up or get her ready for bed. His main breaks came when I got back at weekends, or when she went into a care home while we all went on holiday. Caring for a loved one is hard work, particularly when dementia is involved.

A Carers UK report found that, during the pandemic, 72% of carers have had no breaks from their caring role, with an average of 25 hours of support lost each month. Caring for someone can be a 24/7 job, and more. Research suggests that a third of unpaid carers now feel unable to manage their role. What assessment have the Government made of the impact on unpaid carers of the closure of respite care during the pandemic?

Will the Minister tell the House when the Government last looked at the issue of family carers? Family carers deserve breaks, so will the Minister commit to making sustainable funding available, to ensure that respite and day care centres can provide these much-needed breaks? If we fail to do this, we risk seeing an increase in burnout and mental health problems among carers, many of whom are old. This will lead to a vicious circle, where we find ourselves asking the question: who cares for the carers? Many day centres were run by organisations such as Age UK and funded by local authorities, but that funding was pulled five or six years ago by stretched local authorities. We cannot continue to rely on the unpaid labour of women—it is most frequently women—to prop up a social care system that is not sustainable or fit for purpose.

The devolved nations have instituted occupancy guarantees where they are falling, due sadly to the deaths of residents and hesitancy of individuals to move into care settings during the pandemic. In England, occupancy rates have fallen 7% to below 80%. Will the Government follow the example of Scotland, Wales and Northern Ireland and intervene with this short-term measure before wider reforms of funding and provision are announced? If not, I fear there will be no social care system left to reform.

The issue of indemnity for care homes has also been raised in this House many times. This comes back again to the theme of parity. As we hope to enjoy more freedoms over the next few months, these need to be extended to homes, with visits from family and friends and trips out. However, homes will not be able to provide these experiences if they are not adequately insured. Will the Minister please agree to look into this issue as a matter of urgency?

Looking to the future, our current model of care provision is unfair and unsustainable. Funding is one obvious issue. With the sector so fragmented, cuts to local authorities and a postcode lottery, we need to find consensus on how to fund the system. Government funding for local authorities fell by 55% in the decade between 2010 and 2020. Where there are cuts, we now see self-funders picking up the tab, but also subsidising the care of others in the care homes they live in. This is not fair, nor is it sustainable.

Workforce planning is another issue. We need to commit to a 10-year workforce plan that will adequately fill vacancies but also allow care providers to aim higher, providing continuity of care and allowing relationships to develop, to the benefit of both staff and those receiving care. The ideas have all been laid out and opposition parties are ready to work with the Government on the solution. What are we waiting for?

Through Covid-19, the Government provided significant short-term support to help providers. It is vital that the Department of Health and Social Care now sets out how it will help providers to move beyond it. The costs of Covid-19 and the dramatic fall in care home occupancy, from around 90% at the start of the pandemic to 80% by February 2021, puts many providers at risk of failing. In response, the Government provided short-term funding through local authorities and the infection control fund. This support has stabilised the market and kept most providers from failure. They are very grateful but still fear for the future. However, the department does not have a strong grip on the variable levels of support that individual providers received, and there have been some reports of providers struggling to access some of that additional funding.

Commitments around extra funding and free PPE until the end of March 2022 are welcome, but the department does not have a map out. The Care Quality Commission warns that

“ongoing support is likely to be required … if care home admissions remain low or costs remain inflated.”

It recommends that the Department of Health and Social Care, working with the Ministry of Housing, Communities and Local Government, should assess and outline by the end of July—next month—how much support providers need in the short to medium term to deal with Covid-19 and lower occupancy in care homes. Can the Minister outline how this work is progressing?

For several years, I was the chairman of one of the large charities that provide residential care for people with one learning disability or more. We cared for more than 1,000 people across England. Local government pays their fees and essentially what they get is a roof over their heads, full bed and board and care. More often than not, their homes are in large semis in residential parts of town with access to public transport. Supported people are in receipt of benefits, and the older ones a pension. This helps them to save for an annual holiday. They use their buying power to go out in the evening with their carers for a pizza, to the bowling alley or to a film. A day at the seaside is a favourite. Many are helped to find local jobs. Some of the large coffee chains will pay and train people with a learning disability to work the espresso machine, make milkshakes and clear tables. Job placements are carefully chosen and it is rare that the arrangement fails due to lack of commitment. The skill set and temperament that is required to care for someone with a learning disability is very different from what we expect from the carers of older people.

Many of us have seen at first hand the work of care homes, carers in our locality or those caring for family or friends. Many of us have seen people with a learning disability out with their friends enjoying themselves. All that points to dedicated carers in that sector. I know that there will be much expertise and wisdom in this debate today; I look forward to hearing noble Lords’ contributions and the Minister’s responses. I beg to move.

--- Later in debate ---

[Baroness Jolly (LD)]

My Lords, this debate has been as far reaching, well informed, well supported and inspirational as I expected. The message is absolutely clear. The Minister has probably has it, but I would be grateful if he would pull together all our thoughts—I do not think there has been any disagreement across the House on any of these issues—and tell his right honourable friend the Secretary of State that this is what needs to happen and ask him to go and chat to his friend the Prime Minister.

As I said at the beginning, this is my swansong. I say for those noble Lords who might not take part in health debates regularly that there is a sort of core team of “healthies”, and I will miss working with them. I will miss the camaraderie that exists in the core health and care community, and I look forward to working with an all-party defence team. That might take a bit more work to make it all-party, but we will work at it. I thank the Minister very much for his time.

Motion agreed.