Social Care and the Role of Carers

Baroness Wheeler Excerpts

Thursday 24th June 2021 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, I too congratulate the noble Baroness, Lady Jolly, on securing this debate and on her usual very thorough and thoughtful introduction. Of course, it is deeply frustrating for us all to be yet again debating the ever-deepening crisis in social care in the absence of any sign of the Government living up to their promises of reform and “once and for all” change, in the words of the Prime Minister.

The excellent “national scandal” report of our Economic Affairs Committee was our last major debate on this vital issue and is still an authoritative source for this debate. The committee warned, and it is worth repeating, that:

“With each delay the level of unmet need in the system increases, the pressure on unpaid carers grows stronger, the supply of care providers diminishes and the strain on the care workforce continues.”


That is why it is so important for us all to keep up the pressure, as noble Lords have done this afternoon, hammering home the scale of the crisis and the substantial extra funding urgently needed. This must be sustainable long-term funding, not just the welcome but wholly inadequate plugging-the-hole periodic cash injections that Ministers trumpet at every opportunity as the solution to the deep crisis we are in.

I am also grateful to the noble Baroness, Lady Jolly, for specifying unpaid carers. As usual, her words were movingly reinforced by my noble friend Lady Pitkeathley and by almost every speaker; it is a most welcome and essential focus. They drew on the extensive surveys and reports produced by Carers UK for Carers Week. In these we heard from carers themselves on the huge challenges they have faced during the pandemic—not just the absence of essential breaks and respite but the impact on their own health and well-being and their worries about when the key daycare and other services, vital to the loved ones they care for, will come back.

Many routine but essential services came to a halt during the pandemic, as noble Lords have spelt out. For example, I am a carer and the excellent services at our local community centre—stroke clubs, memory clinics for people with dementia, community meals and support groups—show no sign of reopening until at least September. For carers of disabled people, people with learning difficulties and disabled children and their families, this daily or week-by-week support is so important. It is devastating when it is not there. It helps carers cope, gives them a chance to get on with the other things they have to do and, most important, helps to keep the person they are caring for well, active and engaged.

A longer break for carers and the cared-for is just as important. As Care England has said, respite care provided by many care homes has been withdrawn because of the 14-day isolation requirement. For younger adults with learning disabilities living at home with parents, a few days of respite every month or even week, or care home provision if the carer falls ill, is a key part of their care plan. It helps carers continue to cope. The Minister has promised us a meeting with Carers UK; I hope he is arranging it with the urgency it deserves. Can he please update us on the progress of the department of health and local authority talks and work he referred to last week to ensure that daycare centres and care services are reopened?

We know that the Minister’s response today will contain all the elements we are used to hearing about government funding support for carers, the care workforce and social care during the pandemic, and the now-familiar “later this year” promise of the social care reform proposals. But it is clear from today’s debate that, nearly two years after the Prime Minister’s Downing Street doorstep pledge, such is the despondency, scepticism and doubt about this latest deadline that it is almost not worth asking the Government how they are getting on with it—particularly with the recent press reports on cancelled meetings and the Prime Minister’s obdurate blocking of various funding options.

On the issue of cross-party consensus, raised by a number of speakers, rather than just his usual passing reference it is time for the Minister to explain today just what he means by this. To repeat for the record, we had cross-party consensus on the Care Act 2014 setting up the care cap on funding costs recommended by the Dilnot commission, the eligibility criteria for social care and many other important reforms, such as legal rights for carers to assessment and support. The consensus on the cap was there during the 2015 general election, councils were given lead-in preparation funding for implementation in April 2016, and £6 billion was allocated for care cap costs. But we know the rest of the story: delayed implementation and then cancellation —too costly—the £6 billion gone and huge sums of implementation funding just wasted.

The same cross-party consensus was reinforced in the “national scandal” report, as the chair of that committee, the noble Lord, Lord Forsyth, made clear in the previous debate. On these Benches we have strongly welcomed this report as a fully costed and solid basis for moving forward. It shows the scale of extra funding needed to break the cycle of chronic underfunding and unmet need, and to begin to address the unfairness and disparity in entitlement to care between the NHS and social care.

Many noble Lords have today again articulated the committee’s fundamental principles, which have the widespread support among the social care stakeholders and community that the Government say they want—for example, the top priority of restoring local authority funding for social care to 2010 pre-austerity levels; an end to councils’ dependence on locally raised funding for social care; a new £7 billion-a-year system for providing free personal care to help people with basic daily needs such as washing and dressing; and a major investment in a new deal for the social care workforce and joined-up workforce planning with the NHS. That is an excellent consensus on which to move forward, and the Minister knows it; it makes the current delays and dithering inexcusable.

On the vital issue of a new deal for social care staff, like all noble Lords I add my heartfelt tribute to them, not just for the pandemic but for the year-on-year dedication they have shown in the face of low pay and lack of public understanding and appreciation of the value of their work. They are a skilled profession and need and deserve the training, career and pay structures that properly reflect this. Raising the status and standing of care staff has to be a key part of social care transformation.

The positive signs of the impact that Covid has had on the public’s awareness and perceptions of care work are welcome. For example, the recent survey with care providers, stakeholders, care workers and candidates by the Work Foundation and Totaljobs reinforces this, showing an increase of 39% in people applying for social care roles in the last two years; younger candidates more likely to pursue a career in social work; and 56% of new starters in care joining from other sectors. This is promising, but these staff will stay in the profession for the medium and longer term only if there is fundamental reform to social care staff’s pay and professional status.

One of the key features of today’s debate has been the range of speeches across social care provision—I very much welcome this—not just on adult social care and the care of older people but on working-age disabled adults and children, people with learning difficulties and the importance of mental health social care, so often overlooked. This was referred to by my noble friend Lady Donaghy and the noble Baroness, Lady Barker.

The excellent briefing from the charity Rethink Mental Illness has been referred to in relation to the vital role that this should play in supporting people living with severe mental illness to help them to recover from hospital care, stay well and not go back into crisis. I hope that the Minister’s response will include reassurances that their needs will be included in social care reform. The parliamentary briefings that the seven leading charities representing working-age disabled people are organising for July will be very valuable in increasing our understanding of how social care should be working for this vital group. I hope that as many noble Lords as possible are able to attend.

During the debate, we were constantly reminded that half of local authority public social care funding is spent on working-age people and that local authorities also deliver children’s social care. This was so sharply brought into focus by the publication earlier this month of the first stage of the MacAlister independent review, which called for major reform and investment to ensure the effective protection of young people at risk. Alas, there is no time to debate this today, but we sadly see the same fragmented, disjointed system across multiple government departments and agencies, with the life chances of vulnerable children paying the price.

On residential care, noble Lords have rightly pressed the Minister on the issues that have so dominated our consideration of the SIs, Statements and Questions during the pandemic—on testing, PPE, hospital discharges to care homes, visitor access, indemnity insurance and occupancy guarantees. I look forward to hearing the Minister’s response on this, particularly on how care funding will be provided when the infection control fund ends at the end of this month.

We have had yet another powerful debate today. Noble Lords have made it clear that we cannot build a better future for our country after Covid-19 without transforming social care, and that real progress is needed now. If the press reports and rumours are correct and government focus is on reintroducing the care cap after all, five years after it could have started, this would address only part of the problem. It would not be the comprehensive plan for the reform and sustainable funding of social care that is so vitally needed.

I echo noble Lords’ good wishes to the noble Baroness, Lady Jolly, in her new role. My noble friend Lady Thornton and I have always enjoyed working with her, and we very much value her contribution and work.