Older Persons: Provision of Public Services

Baroness Pitkeathley Excerpts

Thursday 13th June 2019 Lords Chamber

[Baroness Pitkeathley (Lab)]

My Lords, I too congratulate my noble friend, including on his timing, and acknowledge his long commitment to the cause of support for older people.

I could not agree more with his calls for free TV licences, transport and so on, and I agree that the problem of loneliness in older people is acute. Nowhere is this seen more starkly than among carers who are themselves often elderly while caring for older people. The Carers UK survey published this week for Carers Week told us that carers—especially if they receive no practical support—are eight times more likely to report that they are lonely than the general population. So any practical or psychological support is welcome for the growing number of carers.

I endorse all that has been said about the need for well-funded services. I have to say, with the greatest respect, that without these well-funded services, including those provided by the voluntary sector, any discussion about social care is simply moving deckchairs on the “Titanic”. We have to tackle the wider issue of how to provide social care for an ageing population—how it will be funded and how it will be organised.

I have been in your Lordships’ House for 22 years and I have lost track of the number of times I have led or participated in debates on social care. Of course, when we do this our speeches are assiduously collected by the doorkeepers and returned to us—and some of us are sad enough to keep the hard copies as well as the electronic ones. I looked through the large pile of mine and I can tell noble Lords that they make pretty depressing reading—as do the Hansard records.

This is certainly not to criticise the quality of your Lordships’ speeches in those debates, which were fine, perceptive and innovative. What is depressing is that we have kept making the same arguments over and over again: in fact, I could have stood here and made the same speech for the past 10 years. We all know that social care is underfunded; that it is as important as healthcare but has never been accorded the same status; that people do not understand the system and do not realise that social care is means tested; and that no one plans ahead for their care.

The arguments are familiar, as are all the attempts to deal with the issue: the royal commission, the Wanless review, the Barker review and the Dilnot commission. Occasionally we have a ray of light. One party commits to a policy and it is labelled a “death tax”—that was my party. The party retreats in confusion. Another party—the party opposite—commits to something that is labelled a “dementia tax”. More retreat in confusion. We did get as far as passing legislation on the Dilnot report, but it was never enacted.

In the last Queen’s Speech—can anyone remember that far back?—we were told that there would be a consultation on social care. Even the promise of a Green Paper got us excited. But where is it? Is anything happening? How important do the candidates in the Tory leadership race think this pressing problem is? I do not have much hope that they will take my advice, but I will give it anyway.

I have just two pieces of advice. First, be honest. 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, and that public funding is available only for those with the least money and the very highest needs. As a consequence, no one prepares or plans for care. We must rethink this and be honest. In addition, we have grown up with the idea that savings and the considerable assets now contained in property can be passed on to one’s family without being touched. We must rethink that.

My second piece of advice is: be bold. Every independent review of the past 20 years has recommended that the future funding of social care as well as healthcare should come from public, not private finance. The needs of individuals cannot be divided neatly into either 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. We must embark on a frank and open debate on how to fund health and social care on a sustainable basis into the future, and remind everyone that such a debate will not be settled in a single Parliament—so we need to secure cross-party support.

The Government’s usual response is to say that no more money is available. However, as Andrew Dilnot often says, it is a case not of “can’t afford” but of “won’t afford”. Our GDP shows that we are five times better off than we were in 1948, and time and again we find that social care, properly delivered and of good quality, with an emphasis on prevention, is a better way of caring for frail, elderly or disabled people than healthcare, especially in expensive hospitals. If we pool the risk—after all, only one in five of us will ever need the more expensive types of care—and prioritise this, we can afford it. It is a matter of priorities. Surely it is not asking too much to call for some commitment and vision on this most pressing problem for our society.