Social Care

Baroness Shephard of Northwold Excerpts

Thursday 30th March 2023 Lords Chamber

[Baroness Shephard of Northwold (Con)]

My Lords, it is a privilege to follow the noble Baroness, Lady Andrews, and to have a chance to thank her for her outstanding chairmanship of the committee. I also thank our superb professional team.

Our report’s introduction describes adult social care as

“largely out of sight and off the public agenda until we need it.”

That is in strong contrast to the NHS, despite there having been, in the last 25 years, no fewer than eight Green Papers, four White Papers, three cross-parliamentary committees and two full government inquiries. We should ask ourselves why it is that a sector so vital to one in five of our population at any one time, to the overall health of the nation and to the functioning of the NHS has been so overstudied and, as we found, so underresolved over such a long period.

It is mostly, I suggest, because it has “just grown”, and is now highly and almost unmanageably complex. I give just three examples. The first is funding. Public spending on adult social care, which is around £22 billion, is a mix of central government grant and council tax. Some £11 billion comes from private expenditure. At least £132 billion is contributed by an army of unpaid carers, often family. Actual funding arrangements vary, from self-funding care home residents, through a mix of local authority or NHS top-ups, to the fully publicly funded.

The second example is commissioning. Commissioning responsibility is split, in England, between 152 local authorities and the NHS.

The third example is provision, which is equally complicated, with 95% of residential and nursing beds being in the independent sector. Agencies provide some home care, and, in all, 18,000 organisations run around 34,000 establishments. National accountability and responsibility are, of course, divided between the levelling-up department, the NHS and the Treasury.

The effect of all this on those needing social care, almost always urgently, is that they face a lack of comprehensible information even to get into the system. They then find, all too frequently, a shortage of provision, delays, confusion and unclear accountability. Our report contains wonderful examples of good practice and ingenious solutions to these problems, but also graphic evidence from people struggling to cope at the same time with grievous personal or family situations via a massively complicated system. Their courage, and that of those caring for them, is immense.

The effect on the NHS of neglecting social care must also be tackled. We all know the NHS is experiencing unprecedented problems, some resulting from the pandemic, of growing demand and staffing and funding difficulties. How acceptable is it that every single day 10% of hospital beds are occupied by patients who do not need them but cannot be discharged because social care is not available, and that preventative social care is not available to avert many hospital admissions in the first place? The NHS has got to be fixed, but it cannot be fixed without first fixing social care.

The Government know this, and, to their credit, they do have solutions, not least from reports that they themselves have commissioned, such as the Dilnot report of 2011; from legislation they have passed, such as the 2014 Care Act; and White Papers they have published, such as People at the Heart of Care in 2021. For the one in five of us, and for the health of the nation, it is now time to see some implementation.