Adult Social Care (Adult Social Care Committee Report)

Baroness Wolf of Dulwich Excerpts

Monday 16th October 2023 Lords Chamber

[Baroness Wolf of Dulwich (CB)]

My Lords, I welcome this debate and the opportunity to thank the noble Baroness, Lady Andrews, and her committee for a marvellous report, which is enormously informative, and, above all, for the fact that they have highlighted the role of the unpaid carers who keep us all afloat. I have no current interest to declare, but I was for many years a trustee of a small local charity that provided sheltered accommodation and respite care, and I am going to draw on that experience in what I say.

In recent decades, we have seen massive changes in the organisation and delivery of adult social care. In 2019, the Guardian found that 86% of care home beds are now in private for-profit homes, 3% are provided by local authorities and 11% are provided by charities. Yet in every study I have seen, charities are top rated by users ahead of local authorities and for-profit provision. In large part, this is because of what one witness before the committee called the “fine-grained” knowledge of local communities. Charities are uniquely well placed to harness this and to develop opportunities to bring such a fine-grained knowledge to bear on the provision of effective care that responds to individual local needs.

However, the regulatory and funding environment militates against small, local or charitable provision. Complexity comes up time and time again in the report, and rightly so. It creates huge barriers and huge deadweight costs. I think it is worth thinking about those costs because all of what we are talking about takes place within a context of growing demand and growing pressure on care budgets, so if there are ways in which we can save money, we really need to take advantage of them. My experience was of ever-growing regulatory and bureaucratic demands which devoured time and resources and favoured the supposed economies of scale delivered by large chains. These demands also meant local authorities felt safer dealing with big centralised companies, big concerns and people who knew about the latest central diktat and spoke the regulators’ language, but this is not the language of those involved in and dependent on social care. We must tackle complexity and the centralisation that fuels it because it creates a gap between the creators of policy and writers of rules and the people involved in delivery and use. It is not easy to simplify. It takes commitment and time, but it can be done. I wish the Government’s response had acknowledged this more explicitly. Can the Minister provide any further information on whether the Government recognise the need for such a sustained effort to simplify the system?

I also want to endorse as strongly as possible one of the report’s recommendations and its emphasis on respite care and providing breaks for unpaid carers. Recommendation 33 says:

“The Government should dedicate ring-fenced funding to increase the availability and capacity of services that provide flexible short breaks for unpaid carers”.


I very strongly agree. It may seem odd to have devoted most of the time that I have been on my feet to talking about local responsibilities and local decisions, and of course we need to make the system simpler and more local in how things are spent and in reducing regulatory complexity, but we are also, as I said, operating in a system where the pressures on budgets are gigantic. If we do not ring-fence funding this way, I fear the same thing will happen as happened in the local authority where I got my experience, which was that when our little charity closed the door respite care on a regular basis in the local authority effectively ceased. It was a chance for the local authority to reduce expenditure and walk away from something. However, this respite care and these breaks for unpaid carers are a lifeline. They are quite complex to organise and seem quite expensive, but when you take into account the direct benefits to carer well-being and their ability simply to carry on, I think we have to acknowledge that what they bring in results and rewards is enormous and that simply looking at apparent up-front costs obscures this reality. I would have been happy to have seen more recognition of this in the Government’s response.

I would like to take this opportunity once again to thank the committee and its chair for a wonderful report and to say how tremendously important it is that we remember those unpaid carers.