Social Care in England

Baroness Tyler of Enfield Excerpts

Thursday 14th October 2021 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I congratulate the noble Baroness, Lady Pitkeathley, on her excellent opening speech. It is a privilege to follow her.

We debate social care today at a time when, after years in the shadows, the crisis that is social care is no longer hidden from view but at last has come into stark public and political focus. What has changed?

First, as we have heard, the pandemic has cruelly exposed the plight of those dependent on social care. Nothing illustrates this more than the number of deaths of care home residents due to Covid: in England, it was estimated at 40,000 in the year ending this March, unlikely to be an underestimate. As the journalist Robert Peston wrote after reading the damning report published this week by the two Commons Select Committees on the lessons to be learned, the section on care home deaths

“will probably make your blood boil.”

It remains a national scandal.

Secondly, we now have the bare bones of the health and care levy, which many of us debated on Monday. I shall not repeat what I said then, but if the Prime Minister and the Health Secretary read that debate, it would have been a salutary experience. Speaker after speaker—from all Benches—made plain that the much-vaunted fix for social care was, frankly, anything but, with only a small portion of the £12 billion raised likely to go into social care in the next three years. Most of the money will be sucked into existing acute NHS pressures—much needed, of course, but with no guarantee of sustainable funding beyond that.

The cost of decades of inaction has fallen particularly hard on the shoulders of the estimated 11.5 million unpaid carers in the UK, some of them aged 80 and above, whose contribution to the current system is almost completely ignored, despite the fact that they are the only thing stopping it from complete collapse. Carers UK has estimated that unpaid carers save the Treasury some £193 billion a year.

Part of the problem has been the way in which the debate is invariably framed, particularly by the Prime Minister, as being all about avoiding making people sell their homes to pay for care. In reality, it is about so much more than that, and it is not just the elderly who are affected. Younger disabled adults make up half the cost of adult social care budgets.

The social care sector is complex and little understood, and the challenges facing it myriad, but, briefly, despite spiralling demand, particularly due to an ageing population, spending is lower than 10 years ago. Government funding for local authorities fell by 55% in the decade between 2010 and 2020, and the existing means-tested system, with its high threshold for care, has resulted in many people who needed care being unable to qualify for support, either in their own home or in a care home.

The King’s Fund has described the pandemic as having a devastating effect on the quality of care, despite some short-term additional government funding via local authorities and infection control. The costs of Covid and the fall in care home occupancy put many providers at risk of failing or simply handing contracts back. Fees vary considerably, depending on geography, and people who do not qualify for free care—self-funders, in the jargon—end up cross-subsidising local authority-funded residents. Again, they are essentially propping up the whole system.

Perhaps most fundamentally, a vastly underpaid and undervalued workforce receives little or no training or professional development, resulting in high levels of turnover and vacancies. Care companies are facing acute problems in retaining and recruiting staff, including according to a report published this week by Skills for Care, which suggests that there are now more unfilled care jobs than before the pandemic. The Public Accounts Committee has described the pandemic as having

“a devastating impact on the care sector.”

Those recent injections of cash, while welcome, and the local authority precept, provided some short-term relief, but the capacity to raise money is neither sufficient nor evenly spread, leading to reduced local services, particularly in deprived areas, and minimal care packages.

Against that backdrop, can the Minister, who I welcome to his new role, tell us what plans the Government have to bring forward a sector workforce plan, similar to that of the NHS, with proposals on career progression and pay, as called for by both the NAO and Care England?

All the above, of course, causes knock-on problems for the NHS, in both increased admissions for those unable to look after themselves at home without care and long delays in discharge from much-needed hospital beds due to the lack of social care in the community. The post-pandemic NHS backlog will not be solved without an immediate injection of cash for the social care sector. Urgent action is needed to shore up a fragile and highly fragmented sector reeling from the impact of the pandemic, with some care homes, often debt-laden and with unsustainable business models, becoming increasingly financially unviable.

Immediate funding is needed for the quality of care, to introduce minimum standards for care homes and to provide respite for unpaid carers. Above all, we urgently need a new deal for the care workforce, including action on pay, training and development, career progression and recognition. As I have said before, care staff, who have given so much during this pandemic, deserve to be paid well above the minimum wage.

To conclude, social care cannot wait until 2023 for additional funding, so can the Minister tell us what plans the Government have to provide an immediate and significant cash injection to local authorities as we head into the winter months for the delivery of adult social care services, including support for unpaid carers, in the spending review in a couple of weeks’ time?