Social Care

Damian Green Excerpts

Thursday 24th November 2022 Westminster Hall

[Damian Green (Ashford) (Con)]

I beg to move,

That this House has considered the matter of social care within local communities.

I thank the Backbench Business Committee for allowing me this debate, and it is a great pleasure to serve under your chairmanship for the first time, Ms Ali. I am particularly pleased to see the Minister back in her rightful place, although she will know that now she has taken on responsibility for care, she will have me on her back for as far ahead as the eye can see while she is doing this job.

Much of what I want to say will be unusually positive about what social care offers communities. I am conscious that the social care debate is often surrounded by crisis and difficultly—quite rightly—but there are so many positive aspects to it that I want to touch on. As co-chair of the all-party parliamentary group on adult social care, I am struck by how underrated the positive effects of good care can be, not least economically. Given the recent decision to delay the introduction of the payment cap, as recommended in the Dilnot report, I should also take the opportunity to urge the Government to take wider action. I hope they take the chance to conduct a full review of the whole system, not just funding. I welcome the extra money committed by the Chancellor, but it is clearly yet another temporary solution to try to tide local authorities over. I hope Ministers can be creative in finding a stable and sustainable way of increasing the money available to the care sector. I have my own ideas, but this is not the time for them.

Funding is one key issue, but I emphasise to the Minister that it is not the only one. I will identify four other areas where we need new thinking if we are going to “fix” social care, to go back to the phrase used by the last Prime Minister but one. The first is the workforce. It needs to be bigger, by more than 100,000, eventually. To achieve that, it needs to be better paid and have a higher status. I would like to see, for example, nurses in the care sector on the same “Agenda for Change” pay scales as nurses in the NHS. Otherwise, we will continue to lose nurses from the care sector to the NHS.

The second area is the voice of care within the new integrated care boards. This change is a chance to improve the integration of health and care systems without creating another massive bureaucracy, which is too often the effect of integration. At the moment, I fear that the new ICB system is settling down with the voice of care providers being relatively unheard. Local authorities are clearly key players in the system, but so are other providers.

The third issue I hope Ministers can concentrate on is the use of technology, both for sharing information between different parts of the system and for giving those in receipt of care more control over their daily lives. We are not exploiting widely available technology anything like enough, and the prize for getting it right is that more people will be able to stay in their own homes for longer. That is much better for them—it is what the vast majority of people want—and of course for the taxpayer. Given both those imperatives, I think it ought to be a high priority. It is particularly important for people living with dementia, which is a subject worthy of its own debate.

The fourth issue that I want to bring to the Minister’s attention, which expands on the idea of people being able to stay in their own homes for longer, is the provision of housing. I have written to the Minister and the Housing Minister about how we are failing to build anything like enough supported housing for older people, particularly in the form of retirement villages. Our provision is something like 10 times smaller than that of comparable countries. That is another issue that is worth a debate in itself, so I will refrain from going down that rabbit hole, but it could be a hugely important contributor to improving our care system.

The Minister will be aware that the current problems facing the NHS would be greatly reduced if there were a proper plan for social care. Each month, there are 400,000 delayed discharges from hospitals because of a lack of social care support. That has knock-on effects on NHS capacity and on ambulance delays. Something like 13,000 patients should be receiving care in the community but are blocked in hospital beds. At the end of April, some 540,000 patients were waiting for assessments, care packages, direct payments or reviews, so fixing social care will take some of the strain off the NHS and free up capacity for others. In that regard, I am delighted that the Minister is responsible both for care and for hospital discharges. Having those responsibilities in the same ministerial portfolio is an outbreak of sanity and common sense in Whitehall that we should all welcome.

I promised to be more positive than is usual in social care debates, so I want to spend a few minutes highlighting the value of social care to local communities. First, it has a big economic value to local communities. Skills for Care found that it contributes £51.5 billion in added value to the economy of England every year. Although half comes from the wages of social care staff, a large proportion of the economic value comes through harnessing local business to support the provision of social care through access to transport, maintenance, activities and equipment. That creates a cycle of local spending, benefiting local industries and communities.

I am not just talking about professional care. Carers UK estimates that unpaid care provision saves the economy £132 billion a year, which would otherwise be a cost to the state. In other words, it saves an amount approaching what we spend on the NHS every year. The thought of that money being added to taxpayer-funded provision is unthinkable.

Care provides economic value by supporting people to live independent lives. It gives people the ability to control their own finances and in many cases gets them back into employment. Of course, it contributes to overall economic provision. That in turn reduces the number of people relying on benefits, which reduces the welfare budget.

Interestingly, Skills for Care’s figure of £51.5 billion contrasts with the amount that local authorities spend on care, which was £21.4 billion in 2021-22—less than half the economic value. That is instructive, because the wider public perception is always that social care is a drain on public finances, but it is not. It actually has a net economic benefit.

As I said, the care workforce is one of the key areas where we need investment—not just in the recruitment of staff, which is often the focus of these debates, but in the retention of staff. Social care is about much more than having to fix a broken system or act as a bed-clearing service for the NHS. It is about ensuring that there is support to enable older and disabled people to lead the best lives they can, and with as much control over their own lives as possible. The social care workforce is key to enabling that.

Some 1.79 million people work in social care in England, in something like 39,000 different establishments. The problem of recruitment and retention is evident, because we have 165,000 vacant posts in social care, which is the highest number on record and has increased by more than 50% in recent years. The word “crisis” is overused, but it can be legitimately applied in this case, not least because the number of posts filled has dropped by 50,000—the first drop ever in the number of social care workers.

Average vacancy rates across the sector are nearly 11%, which is twice the national average, at a time when we are finding it difficult to fill posts in many areas of the economy. The reasons are not hard to find. A care worker with five years’ experience is paid 7p per hour more than a care worker with less than one year’s experience, and the average care worker pay is £1 less per hour than that of healthcare assistants in the NHS who are new to their roles. It is not surprising that people in the social care workforce are turning to employers who offer more attractive pay rates.

Because of the issue with pay, the providers of social care increasingly have to rely on short-term agency staff. That has an impact on the standard and continuity of care, but it also has a high cost. A market report by Cordis Bright estimates that there will be a 157% rise in agency costs, which will increase from £56 million in 2021-22 to £144 million in 2022-23. If the trend continues, agency staff costs are likely to increase by between £175 million and £220 million by 2023-24. I suspect that the huge cost will result in services being handed back to local councils by providers, which simply cannot cope with such staffing prices.

A report by Public Policy Projects, which I chaired, recommends a number of things that would help the situation, including raising the minimum wage for social care workers, mirroring the NHS “Agenda for Change” pay scales, and positively promoting social care as a technically skilled and fulfilling career. I would support something similar to the Teach First scheme in order to get some of our brightest and best young people into social care and to raise its status, so that people can see that it is fulfilling work and will provide not just a job, but a career. In the coming months, I hope I can persuade Ministers to commit to bringing forward a full workforce plan for social care, with pay progression in line with the NHS, better terms and conditions, training and other structures.

Apart from that, the sector needs support through long-term funding. The Prime Minister and the Chancellor have understood the importance of a long-term strategy and funding base for the sustainability of social care.

It is always a pleasure when Ministers move straight out of Select Committees into ministerial jobs, because there is a public record of everything they think about individual issues. That is particularly helpful with the Chancellor: while he was Chair of the Health and Social Care Committee, it produced numerous reports setting out the need for an additional £7 billion a year for social care. That is why I have high hopes in this policy area.

I welcome the fact that the Government have outlined their intention to provide £500 million in discharge funding from the NHS to social care. I hope we receive more detail on that and about when, where and how that funding will be made available.

Just like every other sector, social care is suffering from inflation. According to a cost of living survey by Methodist Homes, 94% of its community schemes had heard members or residents express concerns about the rising costs of living, while some 49% of respondents said that increased transport costs were a significant issue among their members.

Social care providers expect their energy costs to increase up to sixfold next year. There is a real danger that rising energy costs could significantly reduce the number of services available and will have an immediate impact on discharges from hospitals into the community.

The Association of Directors of Adult Social Services has reported that nearly half of all directors of social care services are not sure that unpaid carers will be able to cope financially with the inflation problem. That could lead to more demand for professional social care services. I urge the Government to guarantee that adult social care providers are defined as a vulnerable sector in respect of the energy bill relief scheme after April 2023.

An analysis by the County Councils Network found that inflation could cost councils £3.7 billion in extra costs if they keep social care services running. I fear that is not sustainable and the quality of care will decrease. That is just one example of why it is unfair to rely on local council tax payers to fund so much of social care. The pressure should be taken off local budgets and social care should be funded through national taxation. That would be both fairer among different areas of the country with different tax bases and, in the long run, much more sustainable.

The Government made a number of welcome commitments in their “People at the Heart of Care” White Paper, but that was published nearly a year ago. Many of us are eagerly waiting for those commitments to be put into practice. As I have said, the care sector is not only a completely essential service in a civilised society but a positive economic and social force in local communities throughout the country. We need a coherent plan to address the many problems of the sector, but we should never forget that those who need care are often the most vulnerable among us, and those who provide the care are often the best of us. They deserve the best we can offer them.

--- Later in debate ---

[Damian Green]

I will cheer everyone up by not taking the opportunity, which I think would be available to me, of winding up for the next 45 minutes; I will simply make two brief points that have come out of the debate. I am very grateful for the commitment made by the Minister.

The first is the degree of consensus that underlies this difficult subject. Frankly, the hon. Member for Leicester West (Liz Kendall) said almost nothing I disagreed with, and I suspect that I said almost nothing that she disagreed with—and, of course, I agreed, definitionally, with everything that the Minister said. We all know what the problems are and what we need to do to solve them. It is a matter of political will and drive.

That is the other, less cheerful, point. I have personal reasons for my interest in the issue. My father died of dementia, and therefore spent the last few years of his life in the care system, which inspired a deep personal interest, as it does in many other people. However, I was responsible for this matter when I was First Secretary of State. That was five years ago now, and five years later we are still going round the same course again.

Having arrived for the end of the previous debate, on the contaminated blood scandal, I was struck that colleagues across the House were complaining that things were moving very slowly. I set up that inquiry in Government. That problem obviously goes back a long way, but the solution started five years ago, and it clearly has not got there yet. When we have such intractable problems, too often the whole machinery of government—this is not remotely an attack on Ministers—moves incredibly slowly, even when there is large-scale political consensus on what we need to do.

Finally, Godspeed and good luck to the Minister and her ministerial colleagues, because this issue needs to be driven by Ministers. Across the House and within the political parties, we do not particularly disagree about the solutions, but the issue needs the active pursuit of energetic Ministers if the necessary changes are to be made. Those changes are desperately deserved, both by those who provide care and by those who receive it. I wish all the best to the Minister in dealing with this.

Question put and agreed to.

Resolved,

That this House has considered the matter of social care within local communities.