Adult Social Care

Gillian Keegan Excerpts

Wednesday 1st December 2021 Commons Chamber

[The Minister for Care and Mental Health (Gillian Keegan)]

With permission, Mr Speaker, I would like to update the House on our plans for adult social care.

Today we are publishing our ambitious 10-year vision for adult social care—our White Paper: “People at the Heart of Care”. It is a product of years of work, not only by every level of Government, but by many involved in the sector, including people who give care, people who draw on care, and their families. I wish once again to underline my appreciation and admiration for everyone who works to deliver this most vital of public services, especially through this challenging pandemic.

Those working in social care—both paid and unpaid—deserve our deepest respect, yet they also deserve a system that works for them, and it is fair to say that that has not always been the case. Time and again, we in this House have heard about the challenges: the high turnover in the workforce; the lottery of how people pay for care; unsustainable local markets; the varying quality and safety of care; the low uptake of technology; those carers who are not just unpaid, but under-appreciated; and the complexity of the system for everyone involved. I am sure hon. Members will have their own challenges to add to that list. Make no mistake, these are complex issues—so complex, of course, that successive Governments, over decades, have decided to duck rather than deal with them. This Government, however, are determined to get it right. After all, we cannot be serious about levelling up unless we are also serious about social care.

In September we took a vital first step on the road to fixing this generational problem when the Prime Minister, the Chancellor, and the Secretary of State announced our new health and care levy. The focus on how we must pay for it is absolutely right, but we were clear then, and we are clear now, that there is much else we need to do. The White Paper contains more detail on what we plan to do over the next three years to transform the sector over the next decade. It is underpinned by three core principles: first, that everybody has choice, control and support to live independent lives; secondly, that everyone can access outstanding personalised care and support; and thirdly, that adult social care is fair and accessible for everyone who needs it.

The principles we hold are important, but we know we will ultimately be judged on our actions. I will therefore set out some of those actions before the House. First, giving everyone the choice, control and support to live independent lives requires both physical and digital infrastructure. We are investing £300 million in housing. That investment will support local authorities to increase the range of new supported housing options, because it is vital that people live in homes that meet their needs and give them the independence they require. Moreover, we are setting up a new practical support service to help people with minor repairs and changes, which will help them to live independently for longer. That is in addition to increasing the upper limit of the disabled facilities grant for home adaptations, which includes things such as stairlifts, wet rooms and home technology.

The digital infrastructure we put in place can be equally transformational, because we know that digital tools and technology can support independent living and improve the quality of care. We are therefore putting at least £150 million of funding to drive the greater adoption of such technology, with the ambition to achieve widespread digitisation across social care. We are setting up a new national website, which will explain all the upcoming changes, and we are piloting innovative new ways to help people understand and access the care and support they need.

Our second principle is to ensure outstanding personalised care and support, and at the heart of that is looking after the people who work in care. We are spending at least half a billion pounds on the social care workforce over the next three years. Some of those funds will help us to deliver new qualifications and better career routes in care, which we know is crucial for holding on to our caring and compassionate workforce. We are also directing funds into stronger mental health and wellbeing support for care staff, because colleagues cannot care for people unless we care for colleagues. We are putting funds behind a change in the services we provide to support unpaid carers, and we will find and test what works best for those who are caring under challenging circumstances. Regardless of whether that solution is old or new, if it works, we want to do it. We are also considering funding local areas to support their efforts to innovate around the care they provide, so that they can provide more options that suit people’s individual needs. Those new models of care, including housing with care, have the potential to play a pivotal role in delivering care that promotes prevention, is more personalised, and enables people to live independently.

Our third principle is care that is fair and accessible for everyone. We are introducing a cap on care costs so that no one will have to pay more than £86,000 over their lifetime. That cap will be there for everybody, regardless of any conditions they have, how old they are, or how much they earn. It is a universal cap. Importantly, it will provide everyone with the peace of mind of knowing that the days of unlimited and unpredictable costs are coming to an end. The reforms will also make the existing means test far more generous, compared with both the current system and with previous abandoned proposals. Crucially, the £100,000 upper capital limit will be available to those in home care, and we expect many more people to be in home care. Let me be clear: no one will be worse off compared with the current system, and many, many people will be better off. All the ambitious plans that we are setting out today must be underpinned by a sustainable care market. The £3.6 billion we are giving to reform the social care charging system will help all local authorities to pay a fairer rate for care, and put back into the system the fairness we all want.

Before I conclude, Mr Speaker, allow me to put on record once again my thanks to everybody who has played their part in developing this important White Paper. The reform of social care in this country has been ducked for far too long, but we will do whatever it takes to take on this tough challenge, and we will get it right. Today’s White Paper is an important step on our journey to giving more people the dignified care that we want for our loved ones, setting out important changes that will last for generations and stand the test of time. As a Government we are determined to get this right—I am determined to get this right—so that we can build the healthier, fairer, and more caring country that we all deserve. I commend this statement to the House.

[Liz Kendall (Leicester West) (Lab)]

I thank the Minister for advance sight of her statement—but really, is that it? There are some things she said for which Labour has been calling for some while, and which we support, such as improving housing options for older and disabled people, and the potential for technology to improve standards of care. However, there are two central flaws to the Government’s approach. Ministers have utterly failed to deal with the immediate pressures facing social care, as we head into one of the most difficult winters on record. They have also failed to set out the long-term vision and more fundamental reforms we need to deliver a care system that is fit for the future.

Last week we learned that a staggering 400,000 older and disabled people are now on council waiting lists for care, with 40,000 waiting more than a year. There are more than 100,000 staff vacancies, and turnover rates are soaring. Because of those shortages, 1.5 million hours of home care could not be delivered between August and October alone, and half of all councils report care homes going bust, or home care providers handing back contracts. Hundreds of thousands of older and disabled people are being left without vital support, piling even more pressure on their families and the NHS at the worst possible time, yet the Minister has announced absolutely nothing new to deal with any of that.

Where was the plan to end waiting lists for care? Unless people get support when and where they need it, they will end up needing more expensive residential or hospital care, which is worse for them and for the taxpayer. The Minister was silent on that issue. Improving access is the first step we need to deliver a much more fundamental shift in the focus of support towards prevention and early intervention so that people can stay living in their own homes for as long as possible. But without enough staff with the right training, working in the right teams, that will never be achieved.

Where was the long-term strategy to transform the pay, training, terms and conditions of care workers, to deliver at least half a million additional care workers by 2030 just to meet growing demand, and to ensure that care workers are valued equally with those in the NHS? Can the Minister tell me why the Government persist in having separate workforce strategies for the NHS and social care when the two are inextricably linked? And can she tell me how some kind of website is going to pay a care worker’s bills or put food on the family table? No wonder staff are leaving the sector in droves.

The proposals for England’s 11 million family carers, who provide the vast majority of care in this country, are frankly pitiful. Unpaid carers have been pushed to the limit looking after the people they love. Almost half had not had a single break for five years even before the pandemic struck, but I understand that the additional funding in the White Paper amounts to just £1.60 a year more for each unpaid carer. Families deserve so much better than this.

What we needed today was a long-term vision to finally put social care where it belongs—on an equal footing with the NHS, at the heart of a modernised welfare state. At its best, social care is about far more then helping people get up and be washed, dressed and fed, vital though that is; it is about ensuring that all older and disabled people can live the life they choose, in the place they call home, with the people they love, doing the things that matter to them most—in other words, an life equal to everybody else’s. That should have been the guiding mission of the White Paper, with clear proposals to make people genuine partners in their care by transforming the use of direct payments and personal budgets and ensuring that the views of users and families drive change in every part of the system, from how services are commissioned to how they are regulated and delivered.

This White Paper falls woefully short of the mark, and the reality of the Government’s so-called reforms is now clear—a tax hike on working people that will not deal with the problems in social care now and will not even stop people having to sell their homes to pay for their care, as the Prime Minister has repeatedly promised. Under the Conservatives’ plans, if someone owns a home worth £1 million, over 90% of their assets will be protected, but if their home is worth £100,000, they could end up losing it all. Millions of working people are paying more tax not to improve their family’s care or stop their own life savings being wiped out, but to protect the homes of the wealthiest. This is not fixing the crisis in social care, let alone real social care reform. It is unfair, it is wrong, and the Government must think again.

[Gillian Keegan]

I thank the hon. Lady for her warm welcome for the White Paper. [Interruption.]

[Peter Kyle (Hove) (Lab)]

It’s not a laughing matter.

[Gillian Keegan]

It is not a laughing matter—it certainly is not. Of course, calling for something is much different from delivering something. We are taking steps to fix social care. We are grappling with this challenge, and we will meet it. In 13 years, what did Labour do? Two Green Papers, one royal commission, one spending review—and the result? Absolutely nothing. They are good at calling for things, but they are not very good at delivering things.

The hon. Member for Leicester West (Liz Kendall) mentioned immediate pressures. It is right to say that there are immediate pressures on all our workforces as we bounce back from the pandemic, but in particular on our health and social care workforces. We have always said that. We have challenges across the winter, and we know that we need to meet those challenges. That is why we put a winter plan in place, and it is why we have given additional funding to the sector. We have given additional funding to the sector all the way through the pandemic. We have given an extra £2.5 billion.

For the workforce specifically, we gave £120 million for January to March this year. That resulted in 7.5 million extra hours in the sector and 39,000 new recruits. As that was a successful intervention, we have repeated it for this period. In fact, that money—£162.5 million—has just started landing in councils’ bank accounts, and that is to take them up to March. We know there are pressures, and we know there is a lot of competition for labour, but we hope that that will be as successful as the previous interventions.

Of course, this is a 10-year vision, and we have to start with that vision. [Interruption.] I know that the hon. Lady and Opposition Members will look forward to reading the White Paper and seeing the vision.

[Peter Kyle]

It won’t take long.

[Gillian Keegan]

It will take long. It is over 100 pages, so it will take a reasonable time if Members are interested in actually finding the solutions.

The hon. Member for Leicester West also asked about workforce strategy and the NHS compared with social care. Obviously, the people in the NHS are employed by the NHS, which is a public body. Social care is largely a private system. There are 18,000 or more businesses. That is why it is a different sector and why we deal with workforce strategy differently. However, we have £500 million to invest in the social care workforce and to make sure that we invest in the knowledge and skills framework, careers options and so on.

There are 1.54 million workers in the sector and they are hugely valued. The hon. Lady said they are leaving in droves. Actually, what we have in the sector is a continual demographic shift in terms of need, and it grows by 1% to 2% every year, so we are always trying to recruit new workers into the sector. Of course, it is very important that these fundamental reforms take place so that we get more people attracted to the sector, more people staying in the sector, more people progressing in the sector and more people providing excellent care all day, every day, providing a lifeline to people across the country.

[Jeremy Hunt (South West Surrey) (Con)]

I thank the Minister for her work putting the White Paper together in a very short period. I know that she has put a lot of effort into it, but it is hard to see it as more than three steps forward and two steps back. The step forward, which we should acknowledge, is the introduction of a cap. Whatever the arguments about what counts towards the cap, having a cap will make a big difference to many people, and that is welcome.

However, these measures do not really give confidence in two crucial areas. The first is the funding to local authorities for their core responsibilities. The White Paper barely gives them enough to deal with demographic change and national living wage increases, and it is a long way off the £7 billion-a-year increase the Health and Social Care Committee called for by the end of the Parliament. It is also hard to see the NHS and social care systems being fully integrated, as they should be, and an end to the workforce crisis, which sees 40% turnover in many companies.

This is a start. The Minister is a very capable new Minister and I personally have great confidence in her, but will she bring forward further measures to deal with those huge problems? Otherwise, we will see hospital wards continuing to be full of people who should be discharged, and older people not getting the care they need because the carers do not exist.

[Gillian Keegan]

My right hon. Friend is right that this is a start. It is a 10-year vision, and obviously we had a three-year spending review and the spending that we set out was a three-year spending settlement, so of course it is just a start.

On the steps to ensure that local authorities move to a fair rate and a fair cost of care, we are exploring a number of options, and we will set out further detail at the local government finance settlement later this year. Local authorities moving towards a fair rate of care is key to building a solid foundation for the future adult social care system, so we will be working closely with them to shape the best possible approach to implementation across different local markets. We will shortly be engaging with local authorities and providers, and we will publish further guidance in due course.

My right hon. Friend is absolutely right about the workforce. I have never worked in a business where the workforce was not key to anything that needed to be delivered, but in the care sector in particular, it is impossible to deliver anything without the workforce. It is also difficult to look at the workforce structure. As I say, it is the largest workforce in the country, with 1.54 million people working in it, but with 40% churn and very high amounts of zero-hours contracts and of retraining. I have never seen something that has that—[Interruption.] This has been the case for decades, and nobody has done anything to address it. [Interruption.] Nobody has done anything to address it. We do need to address it, and that is what we are here to do today, but—[Interruption.]

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. Please do not shout at the Minister.

[Gillian Keegan]

Thank you, Madam Deputy Speaker. As was clear from their 13 years in Government, Labour Members are not interested in finding the answer, and they are certainly not interested in listening to my version of giving the answer.

Having 40% churn and such a high degree of insecurity in the workforce is not sustainable, so we need to fix that. We need to put the knowledge and skills frameworks in place. We need to invest in training and learning. We need to ensure it is captured and transferable. We need to have career routes that mean people can progress in the workforce. In my short time in the job, that has been immediately identifiable. The hon. Member for Sheffield, Heeley (Louise Haigh) and I worked on professionalising the social care workforce about four-and-a-half years ago, when we set up the all-party parliamentary group on social care. The issue has been recognised. It is not easy to fix. It is a large private sector. There is very large and increasing demand, but we are going to take the steps to fix it and the White Paper starts that process.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

The challenges in social care of increasing need and demand are the same across the four nations, but until now the approach has been very different. The Scottish Government have always believed in seeing social care as an investment in allowing everyone to participate in society and live as independent and satisfying lives as possible. I therefore welcome the change in narrative and tone in the statement.

The Feeley review, which was carried out last autumn in Scotland, plans a human rights approach to social care, and sets out a path to developing a national care service to ensure high quality standards right across Scotland for its users, and also fair terms, conditions and career development for staff. As has been said, workforce is absolutely central to all services and social care is delivered by people for people. The Scottish Government pay the real living wage—not some pretendy living wage, but the real living wage. Will the Minister commit to raising pay for social care staff in England to £10 an hour, as the Scottish Government have planned from this month?

Brexit and the loss of freedom of movement have, unfortunately, exacerbated workforce shortages in both the NHS and care systems, with a shortage of well over 100,000 in care. Will the Minister urge the Home Secretary to widen the eligibility of the health and care worker visa to actually include care workers? It is quite bizarre that it does not include care workers.

Scotland is the only nation that provides free personal care, which is now being valued by the UK Government at £86,000 a head. Will the Minister consider, in this redevelopment, providing free personal care to people in England? While the Scottish Government are planning a 25% uplift in social care funding over this Parliament, the national insurance uplift will go largely on tackling the NHS backlog over the next three years. Does she not recognise that the care crisis is right now? The problems in A&E are not caused by people coming to A&E, but by the difficulty of getting patients into beds due to delayed discharges, which are due to the lack of social care provision. Will she state, as has been called for, what funding will go to social care right now to tackle the crisis as we go into this winter?

[Gillian Keegan]

Many countries across the world are grappling with this issue. We have an ageing demographic and we now live in different ways. We live much longer with more complex needs, and often we are not close to our families as we have increasingly globalised. Many countries are looking to address those challenges, including Scotland. It is important that we build the talent pipeline here. It is important that we not only invest in and train our own people, but that we build sustainability. We cannot always rely on taking workers from many other countries. We have a visa route for senior social care workers and we have reduced salary levels—I think £20,480 is the salary level—so in Scotland that probably fits the minimum hourly rate. Of course, we have had different approaches. We had a commission on adult social care which gave results in 2011. That is what we have used to build the basis of our reforms and I know Scotland has taken a different approach.

[Damian Green (Ashford) (Con)]

I congratulate my hon. Friend on reaching this point, which we all agree is just the first step, but it is long awaited. I welcome the principles she set out, but I hope she can expand in particular on the changes that will allow more people to live in their own homes for longer through technology and home adaptations. That would not just reduce the need for residential care and therefore save money, but cut pressure on the NHS and, above all, improve the quality of life of many, many frail older people. What can we expect to see on that front?

[Gillian Keegan]

I thank my right hon. Friend for recognising that reaching this point is actually a milestone. It is the first time that any Government have reached this point.

Housing is key. We will increase the capacity of local areas to deliver supported housing. We will increase local expenditure on support services for those living in supported housing. We will adapt more supported housing units to make them suitable for use, as well as incentivising longer-term investment in new supported housing by local areas and housing providers. In the coming months, we will be working in partnership with local authorities, housing providers and others to design and establish our new investment in housing.

[Mr Clive Betts (Sheffield South East) (Lab)]

I welcome the measures to enable people to stay in their own homes. That is exactly what the Housing, Communities and Local Government Committee recommended some years ago in our report into older persons’ housing.

Will the Minister confirm that in the statement there was no money to improve the pay and conditions of the workforce, without which we will carry on getting churn; no money to help companies that are now exiting the social care sector; and no money to deal with the crisis in funding that local authorities are facing, which both the Health Committee and the Housing, Communities and Local Government Committee recognised? Does she accept that without money for any of those things, nothing at all will change?

[Gillian Keegan]

There is money to invest in the sustainability and professionalisation of the workforce. Local authorities have a local government settlement for this three-year period. We are exploring a number of options and we will set out further detail at the local government finance settlement later this year. That is when the hon. Gentleman will hear more about the costs that councils will have.

[Caroline Dinenage (Gosport) (Con)]

I congratulate my hon. Friend on bringing forward this milestone piece of work. It really is very long awaited. The devil, of course, is in the detail, and I look forward to reading that detail with great interest. I know she recognises that the care cap alone will not solve the adult social care crisis. We need imaginative and bold system reform. We need much better integration, and, above all, a plan to improve how we recruit, retain and value the care workforce and the army of unpaid carers out there. It is a massive task, but I know she is up to it. I am really keen to get her reassurance that once and for all, we have the Government’s commitment to fix this problem.

[Gillian Keegan]

I thank my hon. Friend for all her work in this area. Obviously, I have just come in at the end of the journey and many, many people have been working on this issue for many, many years. They should all take credit for that work and for reaching this point. She has my firm commitment that the Government are absolutely committed to fixing social care. As I said, we cannot level up without fixing social care, and of course we all have a vested interest in having a very good social care system.

[Daisy Cooper (St Albans) (LD)]

This statement is incredibly thin. It feels as though the Government are trying to fiddle with the light bulbs on the Titanic as it is starting to go down. We have an enormous crisis, where people who need care cannot get it and end up going into ambulances, ambulances are now queueing up outside hospitals, and hospitals cannot discharge patients back into their homes or the community because the care is not there. The statement and the White Paper do not address the fundamental problem of fragmentation and integration. The Minister has already accepted that this is now just a first step. Will she be clear with us today on when she will bring forward concrete proposals for how to tackle the problem of fragmentation and integration between the NHS and care?

[Gillian Keegan]

The hon. Lady is absolutely right that the complexity is broad. We have always anticipated that we would have winter challenges to deal with. With the global pandemic, there is a backlog of all kinds of things that people need—diagnosis, operations, electives and so on—plus all the other challenges such as winter flu and new variants of covid, which are still here. That is why we have specifically put a winter plan in place; we have also set out hundreds of millions of pounds of extra funding to look specifically at the winter challenges and the discharge process. It is not easy, because of the absolute growth in demand. We knew that it was always going to be challenging, and we regularly monitor and measure it with our NHS colleagues.

The hon. Lady mentions a fundamental pillar: the integration of health and social care. That will be subject to another White Paper, which will come early next year and will have more details about integration. She is absolutely right that it is another solid foundation on which social care reform will stand.

[Steve Brine (Winchester) (Con)]

Obviously I will study the White Paper that has been published today, and I welcome the cap that we are introducing. Opposition Front Benchers may have turned up in force today, although they have scuttled off now, but they did not do anything about the issue in 13 years in government. As far as I can tell from the response today, there is absolutely nothing coming back across the Dispatch Box from any of the Opposition parties.

I think I am right in saying that the upper limit of the disabled facilities grant for home adaptations is being increased. Can my hon. Friend confirm that that will help my Winchester and Chandler’s Ford constituents with things like stairlifts and wet rooms, which are really important to people’s day-to-day quality of life? Will she say exactly when it will kick in, please?

[Gillian Keegan]

We will commit a further £573 million per year to the disabled facilities grant between 2022-23 and 2024-25. We are also taking steps to ensure that the disabled facilities grant can benefit more people in need. We will consult on some of those steps in 2022.

[Helen Hayes (Dulwich and West Norwood) (Lab)]

It has been two and a half years since the Prime Minister stood on the steps of Downing Street and promised to

“fix the crisis in social care once and for all with a clear plan we have prepared”.

I think we can all be forgiven for asking what on earth the Government have been doing during that two and a half years—a time when the social care crisis has got worse. Right now, more than 100,000 vacancies exist in adult social care. Care homes are refusing new admissions because of staff shortages. Providers are haemorrhaging staff to better-paid roles in hospitality, retail and distribution. The sector is on its knees as we head into the harshest winter in living memory.

The Minister’s statement today was completely tone-deaf on the scale of the crisis. Can she say, because it was not clear from the statement, how she expects the sector to get through the winter? What does she have to say to the families who are waiting right now for a care home place that simply does not exist under her Government’s failing social care system?

[Gillian Keegan]

The hon. Lady seems to be the only person in the whole world who has missed the global pandemic, but it occurred during the same period. To answer her specific question, she is absolutely right that there are pressures right now. There are pressures continually in the system, because there is always a need for growth every year, but right now the winter pressures are challenging. As we bounce back from the pandemic, everything is opening again and there is a lot of competition for labour—there are 1.2 million vacancies in the country.

We have invested £162.5 million, which is on its way—it has probably just landed in most councils’ bank accounts. That investment is there for short-term fixes, similarly to what we put in place for January to March this year, which was very successful; it brought forward 7.3 million extra hours and 39,000 new recruits. We have invested in that funding for the workforce, and we keep it under review—we get data every month through a capacity tracker system. We work closely with the sector and will continue to monitor its needs.

[Robert Jenrick (Newark) (Con)]

Does the Minister acknowledge that one of the flaws with the increase in national insurance is that only 15% of the additional revenue will flow through to local authorities to improve the quantity and quality of care? The remainder will go to protecting relatively asset-rich families’ inheritances and to the very important task of tackling backlogs in the NHS.

Many councils listening to the announcement today will be very concerned about how they will tackle the demographic changes that they face in the years ahead. What does the Minister have to say to them? In the more substantial White Paper that is to follow, what more can she say about reforming the system to integrate care, which might enable efficiencies to help those local authorities to face the future?

[Gillian Keegan]

On the latter point, I cannot say much more at this point, but a White Paper is being developed and will be available early next year. My right hon. Friend is absolutely right that that is another key part of making sure that councils can deliver on the obligations in the Care Act 2014.

The levy raises £12 billion a year, more or less. For the three-year period, the majority of that sum will go towards catching up with electives in our NHS. There are now 6 million people in urgent care, so that is the right thing to do. However, we know that we will need an increasing share of that fund as we go beyond the three-year period. Many of the reforms in the White Paper and many of the things that we will be working on will help to inform the discussions with the Treasury.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

Social care is a vital service that has been in crisis for a decade. What we need is reforms to bridge the funding gap so that unmet needs can be met and more care packages can be delivered; a dramatic improvement in pay and conditions for care staff, to halt the exodus out of care work; and decent support for the 11 million unpaid carers who have done so much extra caring during the pandemic. Sadly, what the Minister has announced falls far short of what is needed. Does she actually believe that these half-hearted measures in any way match up to what the care sector needs to survive?

[Gillian Keegan]

This is a big reform that needs to take place, and it is based on demographic changes in the population all over the world. It is complex, and it will take a lot of time: it is a 10-year vision. I know that the hon. Lady has not had the chance to read our White Paper yet, but I am sure that she will see that there are a lot of things in it.

If we are actually looking to fix something—if we are looking to put a sustainable system in place that offers independence, choice, a great place to work and a great career—we need to fix a lot of solid foundations. I know that the Labour party always wants to throw money at the problem, but actually we need to make sure that the foundations are in place and that proper and sustainable funding is in place. That is what the White Paper delivers.

[Chris Grayling (Epsom and Ewell) (Con)]

I congratulate my hon. Friend on the progress that she has made so far. Care is a real challenge in a county such as mine, where we have high costs and a fast-ageing population; I ask her to bear that point in mind as she works on the next White Paper.

Closer to the immediate challenges, very many families are uncertain about whether they will be able to visit relatives in care homes over Christmas. A patchwork of measures is in place among different care home providers around the country. Obviously we are dealing with a difficult situation right now, but may I ask my hon. Friend to ensure that a very clear set of guidelines is given to care homes for the Christmas period, so that families know where they stand and so that the elderly, who are among those who have suffered the most over the past two years, get the chance to see their family where possible?

[Gillian Keegan]

My right hon. Friend makes a very good point. My grandmother was in a care home with dementia; the thought of not being able to see family has been one of the very difficult things throughout the pandemic. I pay tribute to all the care workers, who in some cases took the place of family during the height of the pandemic and were there with their loved ones day and night.

My right hon. Friend is absolutely right that it is very important that visitors can go into care homes, but of course care homes also have to make sure that they are safe, and we need to get the balance right. We have updated the guidelines for visitors and ensured that there is a named essential care giver who always has access to their loved one in care. We have recently updated that guideline, but obviously we will keep it under review as we learn more about the new variant.

[John McDonnell (Hayes and Harlington) (Lab)]

The Minister has talked about a 10-year vision, but most unpaid carers are just trying to see how they can get through the next week, or the week after that, or the week after that. As has already been pointed out, there are 11 million unpaid carers in the country, many of whom depend entirely on carer’s allowance, a legacy benefit. They never gained the additional £20 of universal credit, and they are living in poverty. What is there in this strategy that will assist unpaid carers and lift them out of poverty?

[Gillian Keegan]

I agree with the right hon. Gentleman. Unpaid carers are an essential part of the system, and I want to pay a massive tribute to all the people who have been offering care, usually to their loved ones, during this period. As the right hon. Gentleman suggests, during the pandemic many vital services on which carers generally rely, such as respite or day care services, have not always been fully open to everyone, so I have urged all local authorities and providers of those services to ensure that they are.

The White Paper provides for money to help local providers to develop the services that carers would appreciate. There is a specific fund for them to work with carers, and there will obviously be input into that as well. We will ensure that we build services to support this vital sector, and, in addition, carer’s allowance will rise to just over £67 in April 2022.

[Mr Andrew Mitchell (Sutton Coldfield) (Con)]

Notwithstanding the somewhat churlish approach of the Opposition Front Bench, today’s announcement marks good and steady progress on the part of a Government who have, after many years, started to tackle this important problem, and I think the House should give the Minister credit for that.

Does the Minister appreciate how much this matters to us in Sutton Coldfield, which has a more elderly demographic? In this context, I agree with my right hon. Friend the Member for Ashford (Damian Green). We need coherent policies enabling older folk to stay in their homes for as long as possible. In particular, the newly agreed and enhanced role of the services emanating from the Royal Sutton Coldfield Cottage Hospital in keeping people in their homes is at the front and centre of our plans for ensuring that the White Paper and the accompanying policy have a real impact in Sutton Coldfield.

[Gillian Keegan]

Of course I am trying not to be too disappointed by the reactions of Opposition Members; I did not really expect an awful lot more.

Areas such as Sutton Coldfield and Surrey are expensive to live in, and we need to recognise that. Most of us, when asked about our future care arrangements, would say that we would like to stay in our own homes, and we want to make that possible. There is a great deal of technology that will help, but it is also important to adapt more supported housing and to work with local groups to deliver the right approach for the right areas, and that will include local hospitals as well.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for her statement, and for the progress that she is clearly trying to achieve.

Workforce availability for care homes is vital. Today a representative of a care home bordering my constituency rang to say that a quarter of its staff are off work owing to close covid contacts, although they are now treble-jabbed, and it has no more staff and a lack of agency staff to employ. What can be done through this strategy, Minister, to ensure that the recruitment and retention of care workers are improved?

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[Madam Deputy Speaker]

I thank the hon. Gentleman very much for that. I can say “Minister”; it is the hon. Gentleman who cannot. Minister!

[Gillian Keegan]

Thank you, Madam Deputy Speaker.

The hon. Gentleman has asked a good question. Dealing with covid is very challenging for many workforces, which is one of the reasons for our taking the difficult step of making vaccination a condition of deployment in this sector, and also offering the third dose—the booster—which many of those people have now had. It reduces the likelihood of transmitting or contracting covid, although it does not eliminate it altogether. The hon. Gentleman is right about the pressures on the workforce, which are increased by the need to manage covid in the case of residents and also people who are in their own homes. We have invested £162.5 million to help with those pressures in the short term.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

I congratulate the Minister on getting a grip on an issue that consecutive Governments have simply ignored since the 1940s, but does she accept that there is a certain irony in our having two White Papers to deal with a matter involving integration?

Will the Minister say a little about how what she has announced today may help to resolve the crying shame of elderly, vulnerable people languishing in acute hospital beds for weeks on end when there is no active medical management plan for them, often at the end of their lives, when they should be being cared for appropriately in homely settings in the community? Will she recognise that until we deal with that, and the huge pressures that it puts on them, their families and our NHS, we will make no progress whatsoever?

[Gillian Keegan]

My right hon. Friend is absolutely right. People are in expensive hospital beds when they would rather be at home because of a lack of services, or a lack of joined-up service, and that affects hospitals throughout the country. It is a large element of the current pressures, and it happens every winter. It happened every winter when I was a hospital governor. This integration, and the Health and Care Bill which the Minister for Health, my hon. Friend the Member for Charnwood (Edward Argar), steered through the House so ably, will help to solve the problem.

[Liz Twist (Blaydon) (Lab)]

Our social care staff, whether they work in residential care homes or in people’s own homes, are at the heart of a real change in social care. The Minister has talked about some improvements, but does she accept that improving the pay and terms of employment of those staff is crucial to fixing the problem? What steps will she take to ensure that that is dealt with quickly?

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[Gillian Keegan]

Of course pay is important, but it is not just a question of pay. I joined a group of carers in a domiciliary care round earlier, and I spoke to them about this. They said that the most important thing for them was changing the way in which the profession was perceived, and that they never wanted to hear themselves described as “just a carer”. That struck me as very important, because it was an aspect of professionalising the workforce. Recognition is also valuable. These are private companies, but of course the council is a big buyer of care services as well, and that will feature in the local government spending settlement towards the end of the year.

[Mr Mark Harper (Forest of Dean) (Con)]

As chair of the all-party parliamentary group on learning disability, I welcome what I understand has been extensive engagement with the sector in the production of the White Paper. I know that it has been much appreciated.

As for the issue of resources, many Conservative Members found it hard to vote for a tax increase of £12 billion a year, but what is really important is for the money to be used effectively. May I pick up what was said by my right hon. Friend the Member for Newark (Robert Jenrick), and suggest that when the local government settlement is published, it should show the settlement for not just one year but a number of years? We could then see a big share of those funds moving from the NHS to social care, which would enable local government to plan appropriately and the NHS to accept that it will not keep that money forever once it has dealt with the backlogs. Many of us are quite sceptical about that. I think that the more transparency there is, the easier the Minister’s job will be in getting those resources into the social care sector.

[Gillian Keegan]

My right hon. Friend is absolutely right. More than 250 organisations worked with us to develop this White Paper, and I want to thank them for their input. Of course they welcome the steps that we are taking. I do not know how many Green Papers, White Papers and other papers they have tried to get some change from, but this one is finally starting on the road to deliver and transform the sector. He is right to say that the longer we can have some understanding of the settlement for funding, the better, and I am sure that my colleagues who are working on that will have heard his question.

[Derek Twigg (Halton) (Lab)]

It is disappointing that the Minister does not take seriously our genuine concerns about the crisis in social care. She will have received a copy of the letter sent to MPs recently from the Association of Directors of Adult Social Services. Why does she believe that it said that, in its professional judgment, these measures as they stand

“will not fix the crisis in social care”?

[Gillian Keegan]

What I have said is that this is a huge step forward. I do not think that I can stand here and say we will fix the whole crisis in social care overnight. As I have said, this is also something that countries all over the world are grappling with. I think that when that letter was written, the short-term funding of £162.5 million had not been sent out to local councils. I hope that they are using that money wisely to increase capacity and retention in the care sector.

[Sara Britcliffe (Hyndburn) (Con)]

I find it incredible that the Opposition can come here again with no plan and then criticise the Government. It is the same thing for their social media. I really welcome the fact that we are trying to do as much as possible to keep people in their homes, and that the Government are doing something to tackle that, but can the Minister assure me that she is still looking at the regional disparities?

[Gillian Keegan]

Yes of course. There are regional differences in care. There are lots of regional differences. There are differences in how much the care cap of £86,000 is worth, which is what I think my hon. Friend is concerned about. There are regional differences in how much people pay for care: it is much cheaper in various areas compared with the more expensive areas. I am asked why we will have a fixed sum of £86,000, and that is a good question. If we are looking at it as a percentage of assets, £86,000 will be different for different people, of course. The question was: why should we not base this on a percentage of assets? When I looked at the system we would have to build, I saw that it would be absolutely unworkable. It will be difficult to implement the cap anyway, because we will need a metering system that every council will have to operate for everyone who is paying for social care at different rates and different times. The system that we will have to build is very complex. Having a cap that will also enable us to talk to other players such as insurers, to see what other insurance products come forth, was considered the only implementable way.

[Madam Deputy Speaker (Dame Eleanor Laing)]

I gently suggest to the Minister that the rule about facing the Chair when addressing the House is not just about courtesy and politeness—I know that she is the most courteous and polite person on the planet. It is also because if she is looking at someone who has asked a question, the microphone does not pick up her voice. I say this to everyone. That is why it is important to face this way; if she does so, she can be properly heard.

[Margaret Greenwood (Wirral West) (Lab)]

The Minister said that there was a lottery in how people paid for their care. There certainly is, and this is raised with me on a regular basis by my constituents. A quarter of Wirral adults with ongoing health needs were denied continuing healthcare over the summer, according to figures from NHS England. I think the Minister would agree that the CHC—continuing healthcare—system is unfair. Just at the very time when families need support, they often find themselves facing huge bills for care and having to consider selling the home of the person who needs care. Can she tell us what action she will take to ensure that no person has to sell their home to pay for their care, or was that just another hollow promise from the Prime Minister?

[Gillian Keegan]

I thank the hon. Lady for her question, because this is something that bothers me. It happened to my grandmother. We had to sell her council house, which she had bought under the right to buy that was introduced by a Conservative Government. It is very important that we start to fix this, because under today’s system, everybody out there can go down to their last £14,250. That is all that is protected. It is therefore a very unfair system today. That is why we are making these changes and introducing this cap, to ensure that nobody will ever have to pay more than £86,000. In addition to that, we are putting the means test up to £100,000, so that the cost of care is shared as a person’s assets get below £100,000. That will also slow down the depletion of assets. It will be a much fairer and better system than the one in place today.

[Paul Bristow (Peterborough) (Con)]

I draw the House’s attention to my entry in the Register of Members’ Financial Interests.

A few months ago, I spoke with a social care service user who told me that living in supported housing made him feel like a king, because he had access to his own private shower. These small, incredibly significant, humanising differences between long-term hospital care and being supported to live independently are striking. Can my hon. Friend confirm that one of the drivers behind this White Paper is to ensure that people can live as independently as possible for as long as possible, and does she recognise that this can be achieved through the integration of social care, mental health and supported housing?

[Gillian Keegan]

My hon. Friend is absolutely right. Half of the social care budget today is spent on working-age adults. It is not just spent on elderly people. Of course, many people with disabilities or learning disabilities want to continue to work and they want to be supported in that. A supported house and the right mental health support are obviously the right approach, and that is something that we will be working on in this White Paper.

[Paul Blomfield (Sheffield Central) (Lab)]

The Minister was right in the way she described the crisis in social care. We have residential and domiciliary provision that falls chronically short of what is needed, care staff who are undervalued and grossly underpaid, and an army of unpaid carers—particularly young carers—who do not have the support they deserve. The problem is that what she has announced does not address any of that. It is frankly extraordinary that she says that this is the product of years of work. Where is the substance? As questions from both sides of the House have recognised, does today’s statement not show that when the Prime Minister promised a plan to fix social care, all he ever had in mind was an asset protection scheme for the wealthier, paid for by the many who would never benefit from it?

[Gillian Keegan]

I want to pay tribute to the 1.54 million people who work in this sector, because they offer the most incredible care, and also to unpaid carers. The hon. Gentleman mentioned young carers, and it is important that we support them. We will work with the Department for Education, which will amend the schools census at the earliest opportunity to include young carers so that we can identify them and put in the support around them. I do not agree with what the hon. Gentleman said about today’s statement. In 13 years, the Labour Government produced two Green Papers, a royal commission and a spending review, but absolutely nothing that has made a difference to anybody. Of course, none of the Opposition Members have yet had the pleasure of reading the plan, but I can assure them that it is a plan that will deliver on a 10-year vision and start the changes that, as my right hon. Friend the Member for South West Wiltshire (Dr Murrison) said, have been ducked since 1940.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

I thank my hon. Friend for all her work on this, as a Back Bencher and as a Minister. As she will know from our many conversations, I am a fan of the German system, not least because of its greater focus on domiciliary care and on personal budgets, which allow people, instead of relying on the professional workforce, to pay a loved one or a neighbour to provide their care. In many cases, that is much more beneficial for that individual. Is that going to be a feature of the White Paper, which I have obviously not yet had a chance to read?

[Gillian Keegan]

I know my hon. Friend’s views on that system, because we have discussed it many times. There are two things that I think he will welcome in the White Paper. The first is the focus on people being supported to stay in their own home or in supported housing for as long as possible. The second is personal budgets, which we will be exploring for people after they have been metered towards the cap. There is some use of personal budgets today, but we will be exploring what greater use of them we can put in place.

[Mohammad Yasin (Bedford) (Lab)]

With 100,000 vacancies in the social care sector, the Future Social Care Coalition has made it clear that failure to act immediately on care workers’ wages will have devastating consequences for the NHS, for the elderly and for other people who are in desperate need of care. Will the Government listen to the sector’s warning that the current and forthcoming hourly rates for care staff are insufficient to retain or recruit staff?

[Gillian Keegan]

As I said, we have put in place £162.5 million-worth of funding and it has only just gone into councils’ bank accounts. We expect councils will use the funding to retain and grow the workforce.

Earlier I mentioned the all-party parliamentary group on social care, which I set up four years ago with the hon. Member for Sheffield, Heeley (Louise Haigh). At that time the vacancy rate was 122,000, even greater than it is today. We have 1.54 million people working in care, and the need grows by 1% to 2% every year because of changing demographics.

[Mr Philip Hollobone (Kettering) (Con)]

The number of stranded and super-stranded patients at Kettering General Hospital has recently been increasing. Thankfully it is not at the level it was a few years ago, when as many as 200 of the 550 beds were occupied by stranded and super-stranded patients. They are mainly elderly and vulnerable people who, as the Minister will recognise, should not still be in hospital because they have completed their medical treatment. They need to be placed in an appropriate social care setting or at home with appropriate social care support. When can we expect firm proposals from the Government to address this issue? Unless we can get these very vulnerable people into the care they need, not only will it make life very unhappy for them but it will be extremely expensive and will clog up our NHS.

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[Gillian Keegan]

My hon. Friend is absolutely right, and this is something that happens pretty much every year. For the short term, we have around £500 million as part of our winter plan to focus on the discharge process and to make it work as effectively and as efficiently as possible. Of course, a big part of that is making sure social care is in place. In the longer term, the integration White Paper is key to making sure we have much better processes so that people get the care they need, with the right care in the right place.

[Robert Buckland (South Swindon) (Con)]

I congratulate my hon. Friend on introducing the White Paper. I see the Secretary of State for Health and Social Care in his place, and I am grateful to him, too, for ensuring the Government published the major part of the White Paper process before the end of the year. We know the integration White Paper is to come, and that will be important.

Other hon. and right hon. Members have asked about accountability on funding and ensuring that we have a share of the pot for social care. In particular, I am interested in the excellent initiative of £300 million going to local authorities for supported housing and increased choice. How will we make sure that money is used to enrich the lives of, in particular, adults with disabilities, who currently do not have the choice they deserve?

[Gillian Keegan]

I thank my right hon. and learned Friend for his question and, indeed, for all his work in this area. I know this is dear to his heart. I look forward to working with him on a solution.

The £300 million is specifically to help to solve supported housing and to provide much better supported living and mental health support for young adults with disabilities or learning disabilities. Based on conversations with my right hon. and learned Friend, we have also put something in the White Paper on further help to get these young people into work, as many of them want help and support getting into work, and not enough of them are getting that support today.