Social Care in England
Baroness Tyler of Enfield Excerpts(2 years, 6 months ago)
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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?
Social Care Funding: Intergenerational Impact
Baroness Tyler of Enfield Excerpts(2 years, 7 months ago)
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Baroness Tyler of Enfield (LD)
My Lords, I congratulate the noble Baroness, Lady Greengross, on securing this important debate.
We live at a time when the notion of intergenerational fairness is under threat. The accepted post-war norm has been for successive generations to experience better lives than their parents. That is not true anymore for the younger generation, as they are experiencing worse outcomes in terms of pay, job security and housing.
While I welcome the fact that more money is being earmarked for health and social care—although in the first three years it will nearly all go to health rather than to social care—I am disappointed on a number of fronts. First, after so many years of inaction, we were presented with a quickly-hatched and suboptimal solution without the cross-party talks that we had been promised to secure consensus and a long-term sustainable solution. Secondly, the money will come from national insurance rather than through the broader-based and more progressive income tax, thereby hitting low earners and the young hardest. Thirdly, much of the debate has been couched in terms of preventing people from having to sell their houses at a time when so many young people are finding it impossible to get their foot on the first rung of the housing ladder. I have long argued that we should be looking for a solution through the prism of intergenerational fairness in which all generations contribute but no single generation is impacted unfairly. I think that is vital to ensure greater buy-in across the generations.
Despite the dividend taxation and the application of the new health and care levy to the earnings of working pensioners from April 2023, big intergenerational equity issues remain. Tax rises via national insurance, as we have heard, fall disproportionately on the working-age population. A typical 25 year-old today will pay an extra £12,600 over their working lives from the employee part of the tax rise alone, compared to nothing for most pensioners. Some workers earning under £10,000 a year will be affected, but only those earning £12,750 pay income tax.
The extension of the levy to the earnings of working pensioners is welcome, but only one in six pensioner households have earnings. In contrast, two-thirds have private pension income that is exempted from the levy. A levy focused on earnings leaves other sources of income undertaxed, including a lot of rental income, and the package increases the tax gap between the self-employed and employees, raising the incentive for firms to use self-employed labour rather than employees.
Looking to the future and intergenerational fairness, I still hope it may be possible to move to a fairer system, with the majority of money raised through income tax but with a top-up that comes from the over-40s. I always had considerable sympathy with the recommendation of the Barker commission in 2014 that an additional percentage point of employees’ national insurance contributions for those aged over 40, raising some £2 billion, could be earmarked for adult social care. I very much hope that that will be further considered.
Covid-19
Baroness Tyler of Enfield Excerpts(2 years, 7 months ago)
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Lord Bethell (Con)
My Lords, I hear the noble Lord’s points loud and clear. We are seeking to balance the epidemiological, public health practicalities of trying to limit the spread of the disease through mask wearing with accepting the benefits of the vaccine and the limit that puts on hospitalisations and death and trying to restore confidence in the public that we live in a safe environment.
We will be debating in months to come the challenge of trying to get the country back to work and back to economic activity, to get people back into society and back into their communities. It is not that stage right now—we are going into the winter, so naturally our concerns are about hospitalisations and a possible rise in pressure on the NHS—but we must have sight of the exit from this disease. If we have a society where the Government mandate very intimate parts of people’s everyday life and where the impression given to the entire population is that a deadly disease is an imminent threat to them, I am afraid we will run into a problem in trying to get the economy moving and to get society back again.
What we are seeking to do right now is to get that balance right, and it is proportionate. I acknowledge that mask wearing is down, but people are broadly responsible, as the noble Lord rightly pointed out. Central government cannot make every decision in all of society for all time. We need transport providers to make their own decisions, which does mean that it is complicated and that TfL and overground are different. However, it feels like the right approach for right now.
Baroness Tyler of Enfield (LD)
My Lords, I make no apology for pursuing the issue of wearing masks and face coverings, because I feel so strongly about it. My personal experience this morning when coming in on the Tube was that more than 50% of people were not wearing a mask; they were close to me. One man actually took his mask off and sneezed over me. The whole experience made me feel very uncomfortable and very anxious.
I contrast this experience with a recent train journey to Scotland. As soon as we crossed the border, there was an announcement making it quite clear that wearing masks was compulsory on the train. Absolutely every person was wearing a mask, and I felt so much more confident.
I do not really understand the explanation that the Minister has given; I listened to it very carefully. I think he said that it is not a light-touch measure, but, to me, it seems extremely light-touch. It costs very little; it protects others; it does not harm the economy, and ultimately it can save lives, so I genuinely do not understand what the problem is. I think it is about being considerate to others and, frankly and bluntly, not being selfish.
I would certainly add my voice to the comments of the noble Lord, Lord Faulkner. By not wearing masks in the Commons Chamber yesterday, many MPs were sending mixed messages and setting an appalling example to the country.
I want to end by asking the Minister a question asked also by my noble friend Lady Brinton about children who are clinically extremely vulnerable being taken out of that category. Can he explain why that is and what is going to happen to those children, and perhaps write to me and my noble friend on it?
Lord Bethell (Con)
My Lords, I absolutely applaud the sentiments that the noble Baroness articulated: her sense of responsibility and commitment to the community are generally exactly what we are trying to inculcate in a lot of people. But I just do not agree with her or with the noble Lord, Lord Faulkner, that having a state-mandated direction—accompanied, presumably, by fines and, therefore, court appearances for some—could possibly be described as light touch. It is the most intrusive and intimate of measures. If the circumstances require it, we are prepared to do it. We have done it, and, if necessary, we will do it again. But noble Lords really are missing the mood of the nation if they think that the vast majority of the country is in the same place.
I am afraid to say that this is a question of personal choice at the end of the day. The public health judgment—these decisions were made in participation with public health officials—does not support mandatory mask-wearing for the entire country. I agree that visiting Scotland is a completely different experience; there, policymakers have made a different decision, as they have in some other countries. But when we lifted mandatory mask-wearing on 19 July we saw a very large change in the public’s habit. Why? Because some people find it extremely intrusive and not comfortable at all, and they do not like it or are not prepared to do it. Therefore, at this stage of the pandemic it feels proportionate and right to rely on guidance and inspiration and on the leadership of both our national and civic leaders. If necessary, in plan B we will come back to the mandating of those kinds of measures. At this stage it really does not feel proportionate.
Social Care: Family Carers
Baroness Tyler of Enfield Excerpts(2 years, 7 months ago)
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Lord Bethell (Con)
My Lords, I completely agree that the carer’s assessment is the building block of our system. It is incredibly important; we do a lot of work to encourage more carers to get it. I do not know specifically about the point that the noble Lord makes on this additional component, but I would be glad to enter into correspondence with him on it. The broad principle of the importance of the carer’s assessment is one with which I wholeheartedly agree.
Baroness Tyler of Enfield (LD)
My Lords, research shows that, pre pandemic, 600 people a day had no choice but to leave work to manage their unpaid caring responsibilities and that, since Covid began, an additional 2.8 million workers now juggle work and unpaid care. Having access to carer’s leave would help millions of carers and support many of them to remain in work alongside their unpaid caring responsibilities. When will the Government publish their response to their consultation on carers’ leave, which closed on 3 August last year?
Lord Bethell (Con)
My Lords, I recognise the challenge referred to by the noble Baroness. Some 2.9 million carers are employed; that is more than half of all carers. One can only imagine the pressure that they feel trying to juggle their roles as carers and employees. The consultation has been tied up by the pandemic, but we are keen to get a response out soon. Now that we have announced this package, it makes that all the easier. I very much look forward to bringing the response to the House.
Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) Regulations 2021
Baroness Tyler of Enfield Excerpts(2 years, 9 months ago)
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Baroness Tyler of Enfield (LD) [V]
My Lords, this is an extremely tricky issue, and I find myself deeply conflicted. On the one hand, I strongly support the principle of mandatory vaccination of care home workers, for reasons I will explain. On the other hand, I think the Government have gone about it in entirely the wrong way. As so often in this pandemic, we are trying to reconcile forces that pull in entirely opposite directions—in this case, the public health need to safeguard some of our most vulnerable citizens, which in my view is overwhelming, pitched against the individual liberties of care home workers.
For me this is deeply personal. My mother is a long-term care home resident and in the first wave of the pandemic, when hospital patients were being transferred to the home without proper testing, there was a significant number of deaths. I need hardly say that this was deeply distressing for my whole family and, I know, many other families up and down the country.
Care homes have a duty of care to their residents, which in my view they are not fulfilling if they do not require care workers who perform close-contact and intimate tasks to be fully vaccinated, unless they have a medical exemption. In my view, anything else would be negligent. Let us never forget the human tragedy this cruel pandemic has wreaked in care homes. Some 20,000 care home residents died in the first wave, accounting for 44% of all excess deaths for that period in England and Wales. We surely owe it to all who died and their families to ensure that care home residents receive every possible protection at a time when cases are rising again with a far more transmissible variant. Today we learn from the latest ONS figures that care home deaths are on the rise too.
Months ago, Professor Chris Whitty expressed the view that front-line health and care workers have what he termed a “professional responsibility” to get vaccinated, to reduce the risk that Covid poses to patients and care home residents. It seems odd that the mandatory hepatitis vaccination for some front-line health workers is hardly, if ever, queried.
I regret that today we are not looking at both NHS and social care workers together. According to the evidence provided to the Secondary Legislation Scrutiny Committee, published only yesterday, take-up of the first dose in the care home workforce stands at 85.6% but with significant variation, as the Minister set out.
It is clear from the two reports of the Secondary Legislation Scrutiny Committee and the debate in the other place on 13 July that this SI is deficient in many respects. The confusing data provided in the Explanatory Memorandum, the lack of an impact assessment—particularly on the workforce implications—and detailed operational guidance not being available until the end of the month are inexcusable. Frankly, I also found it peculiar that the regulations cover a range of tradespeople and other service providers who are unlikely to have close contact with residents. In reality, proper parliamentary scrutiny was pretty much impossible. I totally get that.
I have argued from the outset that far more support was needed to improve vaccine take-up rates among care workers. In early days, slow vaccine take-up was partly due to practical problems, such as vaccinators coming to homes with enough vaccine only for residents, staff being expected to travel to vaccination centres but not given time off or money to get there, and those staff not on duty when vaccinators came missing out. Despite all the efforts made locally to encourage staff to have the vaccine, crucially, the Government should take more proactive steps for carers to be paid for time spent on getting vaccinated, especially if they have to come in when they are not on shift and if they have to take time off because of any short-term reaction to the jab. These things are critically important to low-paid staff, some of whom are on zero-hours contracts.
GPs spending time in care homes talking to staff who are vaccine hesitant has proved highly effective. On top of this, I feel the Government should step in to help with the costs of redeployment and retraining for staff who still refuse to have the vaccine. Without seeing the operational guidance, we do not know whether this will happen.
It is with a heavy heart and after much thought that I am unable to support the amendment in the name of the noble Baroness, Lady Wheeler. I am sympathetic to its intent and broadly support the first three elements, but I cannot support the final element, which says that stronger supporting evidence for requiring staff to be vaccinated is required. The case is clear, and we need to see both more action and more support to ensure that more lives are not lost. However, we need to see the right action.
I plead with the Government, even at this late stage, to think again and to provide the help and support I have outlined above. I also feel that it sends out the wrong message to the public, who will not be following the minutiae of parliamentary procedures and impact assessments and the like. The message will simply be that we do not support the principle of mandatory vaccine for care workers other than those with the medical exemption, which I do, and strongly. This is the right policy but, sadly, the Government have gone about it in entirely the wrong way. It should also apply to NHS workers and it was wrong to exclude them. However, two wrongs emphatically do not make a right.
Lord Lansley (Con)
My Lords, I am very glad to follow the noble Baroness, Lady Tyler of Enfield. Like her, I would not be in a position to be able to support the amendment to the Motion. I support this statutory instrument but, I have to say, with some reluctance—and it is not simply because of the procedural issues. It is a step we should take only in a health emergency. I will come back to that point before I conclude.
I am grateful to my noble friend, who explained the SI with his customary clarity, but we are especially grateful to the Secondary Legislation Scrutiny Committee, whose painstaking work has illustrated many of the issues, including those I want briefly to refer to. I am looking for my noble friend in responding to this debate to give one explanation and two sets of assurances.
The explanation is because I simply do not understand why care homes have been brought forward and legislated for in this way where other settings have not been. I cannot understand the difference between a care worker going into a domiciliary care setting with a vulnerable person and how that differs from a care worker in a residential care home. I cannot understand how the vaccination of a residential care worker is different from the vaccination of a healthcare worker in a geriatric ward in a hospital. Why are these things different? If the Government are going to move forward on this, they should have moved forward on all these settings together and should have had the clear argument presented rather than what appears to be a piecemeal argument. I hope that my noble friend will explain why the Government have proceeded in this piecemeal fashion with a further consultation to come, which may lead to different conclusions even at the margin for other settings and for care homes, which will create unnecessary confusion.
Secondly, I am looking for an assurance about support for the care home sector. My noble friend said that the statement of impact—which I found on the government website but of course not published alongside the legislation—says that the Government’s central estimate is 40,000 potential losses of staff. This is in a sector where Skills for Care reported 112,000 staff vacancies in the autumn of last year and where we know that there is a dependence on workers from overseas, some of whom have gone back home and not returned. The sector needs help. The impact statement says that recruitment on average costs £2,500, which is £100 million for the sector in consequence of this measure. That is before you begin to look for the other support it needs from the healthcare system, its general practice colleagues, and in dealing with the insurance sector and others. I hope my noble friend will be able to say that the Government will add significantly—at least that £100 million—to the infection control fund, which is £1.1 billion, and do so in close consultation with the care home sector to give it the support that it needs.
Thirdly, and finally, the point of reassurance I am looking for is that I expected, having discussed this with Ministers, that this statutory instrument would be brought forward with a sunset clause. That is transparently something that should apply during the emergency. It would be reasonable if the Government had said, “This time next year, we should be deciding whether legislation of this kind should be renewed, and a sunset clause would enable that to happen.” I have no confidence that a review, as Regulation 7 says, means that if the review concluded that legislation in this form was not needed, it would not be retained. I am sorry, but I am afraid that from the parliamentary point of view, that is unacceptable. Therefore I am looking for my noble friend to make it absolutely clear that if Ministers conclude next year that the review says that this legislation is no longer needed, they will ensure that it is repealed.
Covid-19
Baroness Tyler of Enfield Excerpts(2 years, 9 months ago)
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Lord Bethell (Con)
My Lords, the position of the immunosuppressed is one that we have a huge amount of sympathy for. Those who have blood cancer face a particular challenge. I was very grateful to meet Blood Cancer UK and discuss this matter. The PHE report makes the very clear point that those with suppressed immune systems may have a very strong vaccine response, particularly after two weeks after two doses. Just because someone has a suppressed immune system, it does not mean that the vaccine has left them completely unprotected. I completely accept that the responses of one group and another group may be quite different and it is difficult to lump everyone together. That is why we are investing in the OCTAVE study; I am hopeful it will be published by the end of the month. That will provide some, but not all, the information we need to elaborate on that guidance.
Baroness Tyler of Enfield (LD) [V]
My Lords, with government scientists predicting that up to 4,800 people a day could be admitted to hospital with Covid if England rushes back to normality at the same time as health experts are predicting a surge in flu and other respiratory viruses likely to lead to severe pressures on the NHS, what contingency plans are the Government putting in place to deal with these pressures without leading to the backlog of other much-needed care and treatment growing ever bigger? Will these contingency plans be published?
Lord Bethell (Con)
My Lords, we acknowledge the risks. The noble Baroness is entirely right about flu; the relatively low levels of both flu and RSV in the last 18 months mean that many will not have the immune system that they normally would, and flu is a present danger. That is why we are working so hard on the flu vaccine programme and bundling Covid boosters and flu vaccines for those in the right prioritisation lists. I encourage absolutely everyone to make sure they get their flu vaccine when it comes around. Given the range of uncertainties, we are working with the NHS on its plans for this winter. We will ensure that the service has what it needs to meet those challenges.
Covid-19 Update
Baroness Tyler of Enfield Excerpts(2 years, 9 months ago)
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Lord Bethell (Con)
I applaud the noble Lord for his advocacy of mask wearing, but of course this issue cuts both ways. He is right that we need to build back trust in sharing space with one another, but I am not sure that mandatory mask wearing either builds trust or erodes it. If we give people the impression that wearing masks is somehow a panacea that protects everyone on a tube train or in a lift, that is a false impression. Masks are not a panacea. In fact, for some people, they can be a source of grave concern and be enough to send them back home to seek safety. I take the noble Lord’s point that we have to be clear about this, but I am not sure that mandatory mask wearing, or even ubiquitous mask wearing, is either a universal antidote to the spread of the disease or necessarily builds trust in the manner he describes.
Baroness Tyler of Enfield (LD) [V]
My Lords, continuing on this theme: “masks work” is the clear message from Public Health England. Both Sir Patrick Vallance and Professor Chris Whitty have said that they will continue to wear a mask in crowded indoor spaces, primarily because it protects others. Critically, it does not hold back the opening up of the economy, but rather provides a safeguard as social distancing rules are relaxed. Can the Minister tell me why there is so little in the Statement about our social responsibility to others, including front-line transport and shop workers, and the clinically extremely vulnerable? In this scrapping of masks, we are condemning millions with poor immune systems to be trapped in their homes, too afraid to go to the shops or their workplace or to use public transport.
Lord Bethell (Con)
Since this is the second question on masks, I hope the noble Baroness will not mind if I go off on a tangent. Masks do work a bit; they are not a panacea. What is really important is that when you are ill, you stay at home. That is the big behavioural change that will make a big difference in the year to come. That is where Britain has got it wrong in the past. Too often we have put our workmates, fellow travellers and school friends at risk by heroically going into crowded indoor places and coughing all over them. I hope that is one habit that will stop and that that will be a legacy of this awful pandemic.
Covid-19 Update
Baroness Tyler of Enfield Excerpts(2 years, 10 months ago)
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Lord Bethell (Con)
My Lords, the noble Lord is entirely right that the Porton Down verification team has looked extremely closely at all lateral flow tests and their sensitivity to the delta variant in particular. There is suggestion and some indication that for very low viral loads, the LFTs are not quite as sensitive, or if they are sensitive, the band is less easy to read. However, for higher viral loads—in other words, the kind of viral loads that the body needs to carry to be infectious—there is no change of sensitivity. Therefore, from that point of view the LFTs continue to perform their original purpose very effectively but we need to keep a very close eye on sensitivity with the new variants.
I pay tribute to all UK companies which are coming forward with LFT, PCR or genomic sequencing tests. I am extremely proud of the progress that the UK diagnostics industry has made. We have extremely high standards and extremely high validation and authorisation protocols through Porton Down. Those standards are very difficult to achieve but we are working extremely closely with UK companies to try to get them over the line so that they can play an important role in our response to the pandemic.
Baroness Tyler of Enfield (LD) [V]
My Lords, the Statement places great emphasis on regaining freedoms but has relatively little to say on the specifics of how we learn to live with Covid, as we surely must, given the rising number of new cases and concerns about new variants. Apart from a very brief mention of care workers, there were no other details of how the planned end of restrictions on 19 July will affect care home residents and their families. Can the Minister say what thought is being given to how we learn to live with Covid in care settings and when we can expect to see detailed guidance on this which balances the need for protecting the elderly and vulnerable from infection and improving the quality of their daily lives?
Lord Bethell (Con)
My Lords, the noble Baroness’s question is entirely reasonable and I wish I could be more specific on the precise timing. The honest truth is that we look at the data every day; our experience through this pandemic is that our understanding improves every day and therefore the guidance that we provide is often provided at a relatively late stage. It is an unfortunate aspect of this awful pandemic and one that I know noble Lords have commented on with vigour in the past, but it is an unavoidable fact of life. However, the comments made very thoughtfully and persuasively by noble Lords about the conditions in care homes, the restrictions that are put on residents and the pressure that that puts on them and their families have been heard loudly and clearly by all those in the department and across government, and we will seek to address those concerns when the moment is right.
Social Care and the Role of Carers
Baroness Tyler of Enfield Excerpts(2 years, 10 months ago)
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Baroness Tyler of Enfield (LD) [V]
My Lords, I congratulate my noble friend Lady Jolly on her excellent opening speech and declare an interest, as I have a close family member in a care home. As we have just heard, the pandemic has cruelly exposed the plight of those dependent on social care. The NHS provides free care for all, based on need, but there is no equivalent care service to which families can turn when they or their loved ones need help, causing untold heartache. Only countless money and time from individual families is stopping the system from complete collapse. Age UK has estimated that more than 1.5 million people are missing out on the care they need, and the cost of inaction is falling on the shoulders of 11.5 million unpaid carers, some aged 80 and above. This national scandal is no longer hidden from view due to Covid, but it is something the country increasingly understands and feels is grossly unfair.
Not just the elderly are affected. Younger disabled adults make up half the costs of the adult social care budget and generally do not own their own houses. The NHS provides insurance against the cost of health- care, primarily paid for through taxes, but there is currently no way for individuals to insure themselves for social care. Addressing this requires bold action and a strong political will. We need a comprehensive programme of reform for social care, both now and in the future, and I believe that programme needs three key pillars.
The first is to shore up a fragile and highly fragmented sector reeling from the impact of Covid, increased costs and low occupation rates, with some care homes becoming increasingly unviable financially. Immediate funding is needed to improve the quality of care and introduce minimum standards.
The second is individual funding. A cap on individual social care costs, as proposed by the Dilnot commission 10 years ago, alongside a more generous means test for access to publicly funded social care, would at least fix one of the system’s big problems: the lack of protection for people and their families against potentially catastrophic care costs. The architecture for doing this already exists; Dilnot’s proposals were put into legislation in 2014, with cross-party support.
Thirdly, we urgently need a new deal for the care workforce, with action on pay, training and development, career progression, professionalism and recognition. Care staff, who have given so much during the pandemic, deserve to be paid well above minimum wage.
A reform package including all these elements, as we heard from the noble Lord, Lord Hunt, is estimated at around £12 billion or 0.6% of GDP. How are we going to pay for it? That needs to be the subject of a separate debate but, at this stage, I think we need a solution that takes intergenerational fairness into account. During the pandemic, tens of thousands died before their time in care homes from Covid. The best possible legacy we can give all those who lost loved ones is to ensure that we fix the care system, so a similar tragedy can never happen again.
Covid-19: Care Homes
Baroness Tyler of Enfield Excerpts(2 years, 10 months ago)
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Baroness Tyler of Enfield (LD) [V]
My Lords, respected health commentators and statisticians say that excess deaths—that is, deaths above the expected number—is a more accurate way of looking at the scale of deaths in care homes due to Covid. Care home residents make up just 0.7% of the population. In the first wave of the pandemic, deaths in care homes accounted for 44% of all excess deaths for that period in England and Wales. What does the Minister think this says about the effectiveness of the so-called protective ring thrown around care homes and what lessons have been learned?
Lord Bethell (Con)
My Lords, we were never in any doubt from the very beginning that the virus presented a huge threat to care homes. They are where the elderly and the vulnerable are housed, in conditions where it is extremely difficult to enforce infection control and where there is a large amount of intimacy between residents and staff. We knew from the experience of other countries that care homes were very likely to be an area where infection and severe illness, and potentially death, would be highly prevalent. There is no doubt that care homes suffered the brunt of this virus, and for that matter I am extremely sad indeed. Noble Lords should realise that we put every measure in place that we humanly could have done. We gave a huge amount of resources, including £2.8 billion via the NHS specifically to support enhanced discharge processes and the implementation of the discharge to assess model.