Social Care

Baroness Wheeler Excerpts

Thursday 30th March 2023 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, I thank my noble friend for securing this important debate and for her excellent introduction, and I sincerely endorse noble Lords’ praise for her expert chairing of the Select Committee. She was just the right person to lead this authoritative cross-party group, whose spotlight on adult social care could not be timelier as we are now in sight—we hope—of the Government’s long-promised follow-up White Paper. It is a moment that many of us cannot quite believe in, having waited so long for something to come out of the oven-ready, back-pocket social care plan promises made since this Government took office. We have had a decade of social care reform failure and have become used to hearing that world-leading proposals are on the way, only for them to be delayed, substantially changed and delayed again.

We were led to believe that the White Paper would be the national plan we have been promised, and that we would have it as the backdrop for today. Now we understand it will be published in the recess, that it is a two-year update rather than a plan, and that next week we may have the promised workforce plan—or a bit of it—and a key policy document on primary care. Like other noble Lords, I hope the Minister will be able to enlighten us on what is happening. Can he explain why all this has to be in recess, rather than when Parliament is sitting? We are still awaiting the Government’s response to the Select Committee report. Can he say when that will be published, so that, post-recess, we can have an urgent and full debate on the report as well as the White Paper?

When we get the White Paper and any workforce proposals, we will examine them in detail to judge whether they are anywhere near being the comprehensive national plan for social care we have been led to expect, with the milestones for reform the Minister has promised, including on workforce, data and technology. The first White Paper was strong on vision—on what social care could look like—but only partial in terms of the issues it addressed and the mostly short-term sticking plaster funding it came up with. It was also decidedly lacking on how today’s and tomorrow’s demands for social care could be met, addressed and funded, or how it fitted in with the then proposed cap on care costs, or the fair costs of care proposals.

The urgent need for a comprehensive national plan is where the Lords Select Committee report comes in. It is a giant piece of work that leads the way on reform, with clear stepping stones. I congratulate the whole committee on its depth of analysis and its understanding of the extent and reach of social care, impacting 10 million of us at any one time. The report focuses on giving disabled people drawing on care and support the same choice and control over their lives as other people, on fair pay and recognition for care workers, and on support for unpaid carers. These are the key fundamentals of social care reform which we fully support.

I welcome today’s contributions by so many noble Lords, including eight other Select Committee members, and in particular the contribution from my noble friend Lord Bradley, who spoke from these Benches with his usual wisdom and expertise. Contributions have ranged across key social care issues; we could not have had a more comprehensive debate. I hope the Minister will make sure that he promises to follow up with a written response on any issues he does not have time to address, and will forgive me because I have so much to say and do not have the time to say it.

I want to underline five key issues. First, the Lords committee’s report underlines the imperative for a fundamental rethink and a change in society’s perceptions of and attitudes to social care. It builds on the current legislative framework for care eligibility and entitlement achieved through cross-party support for the Care Act 2014 and promotes social care’s positive benefits as an essential service which benefits individuals, society and the economy, not just as an ancillary to the NHS, as my noble friend Lady Andrews has so ably stressed.

In this context, I welcome the Reimagining Care Commission reflections of the most reverend Primate the Archbishop of Canterbury and the right reverend Prelate the Bishop of Carlisle, which strongly reinforce the Lords committee’s ambition of making social care the national imperative it needs to be. In particular, the commission demonstrates the breadth and reach of social care across communities, and I applaud the vital work that faith communities do which helps to plug the enormous gaps locally in social care provision. In the words of Labour’s shadow Minister for care, Liz Kendall, the report is “refreshingly bold”, which is exactly what is needed. I also commend the commission’s work on the national care covenant, and look forward to continuing dialogue on this.

Secondly, I emphasise the importance of choice and control by disabled adults over their care and support, which was strongly supported by speakers from across the House, in particular in the forceful contribution by the noble Baroness, Lady Campbell, underlining what she has been saying for years, and especially the importance of coproduction. Of course the care of older people is vital, but working-age adults with disabilities make up one-third of social care users and half the budget for social care.

The committee’s spotlight on the more than 1 million people living on their own, without families or children, is also welcome. The noble Baroness, Lady Barker, spoke strongly on this, as did a number of other noble Lords. As a carer, I know how thoroughly the current system relies on advocacy, usually by relatives who are unpaid carers navigating their way for their loved one’s entitlement to care services, which so often fail to speak to each other. I always fear for people living on their own who are receiving domiciliary social care; they are often without other visitors or friends and are utterly dependent on the system working well and seeing to their needs. Their well-being has to be a key part of what a good service looks like.

Thirdly, it is important to value care workers with proper career progression and the pay, training, and terms and conditions that they deserve. Every speaker has made a strong case for this and for the comprehensive workforce plan that is urgently needed. We have today had added expertise and weight from the former general secretary of the TUC, my noble friend Lady O’Grady, and the former general secretary of UNISON, my noble friend Lord Prentis. Record levels of staff vacancies, with the highest rates in domiciliary care, for registered managers and for nurses, need an urgent and long-term solution, not just short-term funding or reliance on local councils to raise funding to meet costs, with all the difficulties and inequities that brings.

Fourthly, I strongly echo the deep concerns of all noble Lords, especially my noble friend Lady Pitkeathley, that unpaid carers are at breaking point. In reality, they have received very little concrete support to date, apart from government backing for the Private Member’s Bill giving them one week’s unpaid leave from work. How are the Government going to address unpaid carers’ huge daily problems of poverty and exhaustion, and the lack of available and affordable respite care?

Fifthly, the key message from today has to be that reform and change for social care must be whole-system wide: a long-term, joined-up comprehensive plan. On residential care, for example, which a number of noble Lords mentioned, every day it becomes glaringly obvious that urgent reform and fundamental changes are needed to the current business model, and this must be an essential part of any comprehensive national plan. Only last week we saw reports of councils spending half a billion pounds over the past four years, buying up beds in care homes rated as inadequate or as requiring improvement by the Care Quality Commission, driving up profits and dividends for private investors at the same time as residents suffer unsafe treatment, mostly because the homes cannot fill their chronic staff shortages in many areas. Poor-quality providers which put private profits before care should not be tolerated. Does the Minister consider that the current business model for residential care is fit for purpose? What are the Government’s plans to ensure that public money is spent caring for residents?

This situation starkly underlines the precarious position local authorities continue to find themselves in as providers of care, care homes and domiciliary care. As noble Lords have said, this is all in the context of a 29% overall reduction in funding since 2010—one-third of the funding has been lost.

The Government have had 13 years to deliver on providing a concrete future for social care, but their measures have, for the most part, been disjointed, stop-start, short-term crisis reactions. They have failed to identify and deliver on the root causes of the issues facing older and disabled people. Demand for social care is now hitting a record high, and the current picture was graphically painted by noble Lords today. The King’s Fund’s excellent briefing sums it up by stressing that key trends in social care are all going in the wrong direction: demand up, access down, financial eligibility tighter and charging reform put back, the costs of delivering care rising with local authorities paying more for care home places and home care support, the workforce in crisis, unpaid carers receiving less support, and public satisfaction with social care lower than ever.

A national plan for social care has to be just that: national. It must be comprehensive, long-term and cross-system to provide joined-up integrated care in the home and community, tackle fundamental inequalities in the current system, and deliver a new deal for care workers and support, care and respite for unpaid carers. Step-by-step investment and reform is the only away to provide the stability, certainty and long-term planning to achieve the fundamental shift towards early intervention, prevention and rehabilitation that is so desperately needed.