Adult Social Care (Adult Social Care Committee Report)

Baroness Wheeler Excerpts

Monday 16th October 2023 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, we have had an excellent but very sobering debate, throwing the spotlight on the current state of adult social care, against the backdrop of the committee’s landmark report on what the service could look like now and in the future—if the people needing support and care were properly enabled to live the “gloriously ordinary life” which my noble friend Lady Andrews and the committee so expertly advocate.

The report was the central focus of Labour’s major debate on social care in March, and I am pleased committee members have again spoken in support of it today, across the range of vital issues the report addresses. They have all praised my noble friend’s expert chairing of the committee and her excellent introduction. As I have stressed, there is no better person to lead this authoritative cross-party group, and I pay tribute not just to that expertise and wisdom, but to the tenacity and determination she has shown ever since in making sure its key findings and recommendations have been disseminated and discussed across the sector and in Parliament.

I am also very pleased that the right reverend Prelate the Bishop of Sheffield has reminded us about the excellent report from the Church’s Reimagining Care Commission, which very much shared the values and principles espoused by our own committee. I again applaud the vital work that faith committees do to help plug the enormous gaps locally in social care provision, and welcome further discussion on how the proposed national care covenant could help reinforce making social care the national imperative it needs to be.

Before the March debate, we were still awaiting the Government’s formal response to the report, which, as we have now heard was wholly underwhelming and disappointing when it was finally published in May. We were also expecting what was heavily trailed in the press at the time as the imminent publication of the Government’s long-awaited 10-year social care plan, which we all recall had been supposedly scrunched up in Boris Johnson’s back pocket way back in 2010. The Government’s 2021 White Paper had been strong on a vision of what social care could look like, but only partial as a future plan and on the issues it actually addressed. 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 proposals on the care cap costs, or with the fair cost of care proposals. These were delayed a year later in the Chancellor’s budget until October 2024, with the spending reallocated to keep the social care system afloat and to finance reform.

What we actually got in the 2023 next steps follow up, published during the April Recess, was largely more of the same—baby steps, as they have been described—a two-year plan rather than 10 years or addressing the longer term, and cuts or doubts raised over some of the promised White Paper funding. We again had the welcome—but still unplanned—sticking plaster funding solution: disjointed, stop-start, short-term crisis reactions, which continued to fail to identify and deliver solutions to the root causes facing older and disabled people. The short termism was met with universal dismay by the sector, with ADASS lamenting that the reform vision was “in tatters”.

The urgent need for a comprehensive national plan is where the Lords committee report so strongly comes in. It is a major piece of work because it leads the way on reform and the clear stepping stones that are needed. The committee is to be congratulated 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, including those receiving care and support, and unpaid carers and families looking after loved ones.

Its focuses—on giving disabled people and people with learning difficulties, 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 care workers—are the key fundamentals for social care reform, which we fully support. 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 benefiting people, society and the economy, not just as ancillary to the NHS, as my noble friend Lady Andrews so ably stressed.

Today’s reality remains that demand for social care is now hitting a record high—the current picture so expertly underlined by noble Lords. As the King’s Fund has summed up, the trends in social care are still all going in the wrong direction: demand is up and access is down; financial eligibility is tighter and charging reform has been put back; the costs of delivering care are rising, with local authorities paying more for care home places and home care support; the workforce is in crisis; unpaid carers are receiving less support; and public satisfaction with social care is lower than ever.

On unpaid carers, I again reiterate and endorse what all noble Lords have referred to on the urgent need for action on carer’s allowance, paid leave, respite care and pensions. In particular, I commend my noble friend Lord Dubs, who is not only a wonderful person but, as we heard, a carer for many years who has, like many of us, taken on the system and negotiated around it to try to get both the services our loved ones need and the practical recognition of unpaid carers. Carers UK has called on the Government to publish an updated and comprehensive national carers strategy, which has to be part of a comprehensive plan for social care. I look forward to the Minister’s response to that.

We know that the social care staffing crisis is worsening daily, despite the tiny drop—less than 1%—in overall vacancies, largely through the increase in the international recruitment that social care has always depended on and valued. Last week’s Skills for Care annual survey reinforced the overall picture all too dramatically. Of particular concern were the 390,000 social care workers leaving their jobs annually, with a third leaving the service completely—social care’s “leaky bucket” in urgent need of repair, as Skills for Care put it. That is why our shadow Health and Social Care Secretary Wes Streeting’s landmark speech at last week’s Labour Party conference, setting out detailed future plans for gripping the NHS crisis, so forcefully stressed that there is no solution to that crisis without an integrated plan for social care running alongside.

Our new deal for care workers is our essential first step for tackling the crisis by addressing recruitment and retention and giving social care workers the professional status that they deserve and the first ever fair pay agreement for care workers, collectively negotiated across the sector. Skills for Care sums up the essential steps to recruitment and retention as paying above the national minimum wage, ending zero-hours contracts and providing access to training and relevant qualifications—all of which Labour is pledged to address.

When the NHS Long Term Workforce Plan was finally published in July, my noble friend Lady Merron questioned the Minister as to why it did not cover the social care workforce, as the two services are so inextricably linked. His response was that, as the Government were not the overall employer,

“it is not for us to make that plan”.—[Official Report, 4/7/23; col. 1178.]

Does the Minister not recognise that an NHS-only plan is likely to exacerbate the social care workforce crisis and the number of vacancies in that sector? Is it not the Government’s responsibility to ensure that local authorities are properly funded to pay social care contractors in care homes and domiciliary services at least the minimum wage, and to monitor this so that quality care can be provided? The committee identifies a massive 29% overall reduction in local government funding since 2010 and the precarious position that local councils find themselves in as providers of domiciliary and community care and care homes. My noble friend Lady Goudie spoke very forcefully on that.

Labour has also made clear the need, if elected, for fundamental reform and change to the current business model for residential care, which sees many private equity care homes, despite getting around £314 million in public funding each year, spending hundreds of millions servicing debts, giving bonuses to shareholders and avoiding tax. It is hard to understand why hundreds of millions of pounds go out of the service in that way. According to the CQC, one in seven private equity-owned care homes is not providing good levels of care. How long do the Government think that this model of funding for care homes can continue to plough money not into the social care sector but into shareholder profits?

The key message to the Government from the committee and today’s debate is still that reform and change for social care has to be whole-systemwide, long-term, joined-up, comprehensive, integrated care at home in the community to tackle the myriad fundamental problems in the system and deliver a new deal for care workers and unpaid carers. Instead of just keeping the current system afloat with short-term funding, stop/start changes and delayed reform, social care deserves much better and the step-by-step investment and reform that the Labour Party is so strongly committed to.