Covid-19: Social Care

Damian Green Excerpts

Thursday 22nd April 2021 Westminster Hall

[Damian Green (Ashford) (Con)]

It is a pleasure to serve under your chairmanship, Mr Twigg. As others have said, this is my first speech in the Boothroyd Room, although I reflect, as I look at the wall and see those steely but friendly eyes staring at me, that I have been around long enough to remember that happening live in my first Parliament, with Madam Speaker, as she then was, in the Chair. I am grateful to the hon. Member for Dulwich and West Norwood (Helen Hayes), my co-chair of the all-party parliamentary group on adult social care, for obtaining the debate. I should declare that I am chairing an investigation of social care by Public Policy Projects.

There are two halves to the debate. Obviously there is the covid-19 aspect, but there is also the question of the future of social care more generally, and they clearly come together in important ways. But I shall start with the specific covid-19 aspects. I agree with much of what the hon. Member for Dulwich and West Norwood said. In particular, urgent action is required to facilitate voting by people in residential care homes, on 6 May. That obviously needs to be done in the next few days, and I hope that the Minister can take that message away from the debate.

We have seen the most terrible year ever in care homes —the figures have been put out already, so there is no point in my repeating them. It has been terrible not just for covid victims but for other residents and relatives who have seen the terrible toll of what has happened inside care homes. Happily, we have now moved on from the worst days of this time last year, and the current covid-related issues in care homes tend to relate to access for visitors and the opportunities for residents to make visits outside. Both are hugely important issues for the wider mental health of those living in care homes.

I have a lot of sympathy for my hon. Friend the Minister, for other Ministers and, indeed, for care home managers. The paramount concern must be safety at all times and I can see that there is an extremely difficult balancing act. The solution surely lies in vaccination—not just of residents, but of staff. Through discussions at the APPG working group that we have heard so much about already, I am aware that there is a great disparity of view about how best to encourage vaccination take-up among care home staff.

People argue strongly that threatening to make vaccination compulsory might not be the most constructive approach, and the Government are consulting on that. I await the results of the consultation but, whatever the best system, it is imperative that the percentage of those who work in care homes and who have daily contact with the most vulnerable people in the country should be higher than the national average and not lower, as it is in too many places. That is an urgent aspect of the current situation.

I have fallen into talking about care homes, but domiciliary care is equally important. People move from house to house where there are vulnerable people so the same thoughts apply to that sphere. Those who look after a loved one—“unpaid carers” in the sector jargon—are equally important, and they should be vaccinated as well. I urge my hon. Friend to move fast and get our care workers vaccinated as quickly as possible for the sake of those who need care as well for the comfort of loved ones who will then be able to visit. That will also help to create a sense of normality for those who will then be able to leave the care home that they may have felt trapped in over the past year. That is clearly an important mental health issue.

The crisis over the past 12 months has shone a fierce light on residential social care and has drawn public attention to it in a way that has never happened before. It could scarcely have happened in more tragic circumstances, and the only sliver of consolation from the awful death toll has been the developing consensus that we simply cannot go on putting sticking plasters on to an increasingly fragile system.

It is getting on for a quarter of a century since the first in a list of Prime Ministers said that social care was an urgent issue that needed addressing. I have done some research and I think Tony Blair said that at a Labour party conference in 1997. All his successors have agreed with him, but the problem is that none of them has yet met words with action. That is not for the want of trying.

Under Gordon Brown, Labour produced proposals for a national care service that foundered when it was dubbed a “death tax”. David Cameron put through the Care Act 2014 and a version of the Dilnot proposals. Shaky Government finances meant that was never implemented. In 2017, a new version was proposed by my right hon. Friend the Member for Maidenhead (Mrs May). It was dubbed a “dementia tax” with not great political results. Here we are in 2021 without a solution on the table and the problem is still with us. Later this year, we are promised a sustainable solution in the comprehensive spending review. Let us hope that we see it.

There are many problems to be solved, and some have been mentioned by previous speakers. At the root of them all is funding. The Health and Social Care Select Committee estimates that £7 billion extra is needed to put the system on a sustainable footing. The most intractable problem, as it has been over the past quarter of a century, is how it is raised. If it is all raised from taxation or national insurance, working-age people will, by and large, end up paying for their own care, perhaps later in life, and that of their parents’ generation. That will rightly seem unfair to them.

More promising models offer a mixture of extra public spending and more contributions from individuals—through an insurance system, through a Dilnot-style system or through variations of those models. I argued in a paper for the Centre for Policy Studies that we should look to the pension system for an example of universal state provision being successfully supplemented with private savings. As we have seen with pensions, we have established cross-party consensus under Governments of different parties.

Even when the Government come to a conclusion on how to find the extra money needed—let us hope that it is not from council tax, which is not suitable for funding care—there will be other intractable problems, including workforce planning. The demographics will dictate that we need more workers, so we must make it a more attractive sector to work in. Pay levels have already been mentioned, but the development of a proper career structure for care workers—it can be seen in the NHS, but it is much less easy to see in the care sector—is hugely important.

So much technology of all kinds is available that would improve the daily lives of those receiving care, but I fear that there is no discernible strategy for introducing and experimenting with it.

Housing is a key issue. If we built differently we could keep far more people in their own homes longer, which would make them happier in themselves, most importantly, and be less expensive for the system. I agree very much with Anchor, one of the providers, which says that there should be changes in the planning system that include older people’s housing in local plans and the creation of a new planning classification for retirement communities. That and other ideas are very worth considering.

Finally, and perhaps most importantly, there is the whole issue of what integration we want of the care system and the NHS. I am delighted that the Government produced their recent paper on integrated care systems. It will not be easy to make a reality of that, but it will be absolutely vital.

I make a plea for two things, the first of which is that the voice of the care sector is heard not just in debates on ICSs but inside ICSs when they are introduced. At present it is not clear from the White Paper that that would happen. As a subset of that, simply having local authorities, vital though they are, around those ICS tables is not enough. There are many independent, third sector and profit-making providers whose voices need to be heard.

Secondly, I completely welcome the long-term plan for the NHS—the 10-year plan—but equally it is important to have a 10-year plan for social care that fits with it so that it is seen as a system on its own. It clearly has to mesh very closely with the NHS: it has as many and as complex needs as the NHS and ought to be treated as just as importantly.

I am aware that that is a formidable set of challenges, but 25 years is too long for reaching a decision about how to tackle them. I hope and profoundly expect that this is the year when we will finally see determined and sustainable action on this front.