Queen’s Speech

Baroness Pitkeathley Excerpts

Thursday 29th June 2017 Lords Chamber

[Baroness Pitkeathley (Lab)]

My Lords, in the 20 years that I have been in your Lordships’ House I have spoken in and led many debates on social care. Each time my hopes were raised by the interest in the subject, and subsequently dashed because no real change came about. But the last time I led such a debate, in December last year, I ventured to express some hope. That was because, in spite of the terrible headlines and analysis we were constantly seeing—“Social care is at a tipping point”, “Bed-blocking crisis reaches a new high”; your Lordships will be familiar with the headlines—there seemed at last to be some agreement across all sectors about the extra resources needed and about the fact that healthcare cannot be sorted out and delivered efficiently without the same attention to social care.

Alas, the election and its aftermath have dashed my hopes once again. It was very welcome that the Conservative manifesto focused on social care, even though the proposals were so poorly thought through. The belated pledge to introduce a cap on the lifetime costs of care—also pledged, I remind noble Lords, in the 2015 manifesto—offered the prospect of protection from the catastrophic costs faced by many. Now, though, there seems to be doubt about these proposals, and the agreement with the DUP has apparently taken up all the money that was due to be allocated in this area.

So we are left with a single line in the Queen’s Speech about a consultation on social care—to add to the endless consultations we have already had. The royal commission, the Wanless review, the Dilnot commission, the Barker review—I could go on. Is that what the Government intend: another fruitless exercise, as all of those have apparently proved to be? For heaven’s sake, we know what the problems are; we do not need another consultation to tell us. If we need a consultation at all, we need it on the proposed solutions to the problems.

So I am going to help the Government take a short cut. There is no need for us to spend time finding out the difficulties; I can tell them what they are now, could probably could any Member of your Lordships’ House. I am going to give the Government some simple “dos and don’ts”. I shall start with the “don’ts”. “Don’t” use the consultation as a delaying process; deal with the shortfall in funding now. As we have heard, it is at least £2.5 billion, four out of five councils do not have enough provision and at least 1 million people in urgent need of care are not getting it. That is in spite of the enormous efforts of the dedicated staff who work in this field and of the vast contribution of the unpaid—usually family—carers, whose contribution, I never tire of reminding your Lordships, is worth over £130 billion to the economy.

“Don’t” assume that this is just a problem with an ageing society. Of the people receiving long-term care in the last financial year, nearly 33% were under 65.

“Don’t” rely on a sticking-plaster solution. The Government talk endlessly about the benefits of the better care fund, but I am tired of being offered that by successive Ministers as a solution every time I raise the issue. Of course we should be trying to do more with less and promoting efficiency and collaboration, but basically we manage demand at the moment by ignoring it and putting undue pressure on family carers, 2 million of whom take on these responsibilities each year and are usually shocked to find how little support is available to them.

I now turn to the “dos”. I have only two: do be honest and do be bold. First, on honesty, no Government, of whatever colour or combination, have ever made it crystal clear to the public that responsibility for paying for care and for arranging it rests with individuals and their families, with public funding available only for those with the least money and the very highest needs. As a consequence, no one prepares or plans for care, and they have to scrabble about doing it when a crisis arises and the awful truth dawns on them. In addition, the expectation has grown that savings and the considerable assets now contained in property can be passed on to family without being touched. We must rethink this and be honest about it.

Secondly, we must please be bold. The Conservative manifesto committed to act:

“Where others have failed to lead”—


so now is the time for action. Every independent review of the last 20 years has recommended that the future funding of social care, as well as healthcare needs, should come from public, not private, finance. The needs of individuals cannot be divided up neatly into health or social care needs, as those of us who have tried to fathom the difference between a health bath and a social care bath have long acknowledged. Now is the time for us as a society to acknowledge that the funding cannot be neatly divided, either.

To those who say that this is not the time, with public finances in such disarray, all the Brexit difficulties and so many other problems around, I remind noble Lords that our forebears tackled reform in the middle of a world war when the country was pretty well bankrupt and not the fifth-richest nation on earth. We must embark on a frank and open debate about how to fund health and social care on a sustainable basis into the future. We must remind everyone that such a debate will not be settled in a single Parliament, so we need to secure cross-party consensus on shared principles to guide that reform. We have enough research and excellent material to enable us to do so; we just need the will. We know all the questions about social care. We just need the answers and the solutions. Will the consultation consult on proposals and solutions?