Social Care Funding

Karen Lee Excerpts

Tuesday 1st October 2019 Westminster Hall

[Sir Vince Cable]

I will come to that point later and to the heart of what I understand to be the Labour proposal—on free personal care—in not too polemical a way. It presents opportunities but also serious problems.

We have the growth in demand, the hidden costs, and the burden on local authorities. It is easy to score political points, and I will put my hand up immediately: after the financial crisis I was part of the Government and we cut—in real terms—per capita spending in this area by about 11%. It did not start then. The number of people with so-called moderate needs who were excluded in the previous five years rose from 50% to 75%. It is an old problem as well as a new one, and we are all faced with the challenge of how to finance local authorities. If local authorities are underfunded, we all know the problem gets passed back to hospitals in delayed discharge.

There is the problem of the labour force. It is horrendous. Until I saw the figures, I had not realised just how bad it is. There is an annual turnover of 450,000 care workers for a mixture of reasons, a lot of it to do with pay and conditions. We currently have 100,000 vacancies, and there is the potential for stricter immigration controls, which would create even more vacancies and make them even more difficult to manage. The business model for the companies involved, partly in residential care but also in domiciliary care, is just not viable; as I understand it, four of the leading providers are now up for sale and one is in administration.

The problem, as we all recognise from our constituencies, is that there is a two-tier system: on the one hand, luxurious and comfortable homes for those who do not need to worry about money, but on the other crumbling homes with minimal standards, overseas workers on minimum pay, and a nasty smell of urine—we have all seen them. An intermediate level of care that is attractive and affordable is simply not available.

Those are the problems, as I think we all recognise, but the question is: what can be done? As has been mentioned, a wide variety of brains in and outside this place have been contributing and thinking about it; one of the unintended benefits of the Government’s delay has been that others have filled the vacuum with ideas. The most useful ideas that I encountered seemed to be from organisations such as the Health Foundation and the King’s Fund, which have no political axe to grind that I am aware of. They suggest that rather than trying to deal with all these complicated problems together, we should deal with them in sequence, starting with those that are more manageable. Essentially, they suggest that there are four stages to dealing with them, which I will briefly canter through.

First, we should identify what we need to do simply to stabilise the present position, unsatisfactory though it is, because there is a real danger of going even further backwards as a result of lack of resource. The King’s Fund identifies a need for an extra £1.5 billion by 2021 and £6 billion by 2030 simply to keep the system at its present level, unsatisfactory though it is. I hope we can all agree that that is the absolute minimum that we should aim for.

The second level up is improvement. As the King’s Fund identifies it, that means going back to the standards that prevailed in 2009-10, although they were unsatisfactory even then, and filling in some of the holes in availability of social care. It costs that at approximately £8 billion a year, rising to £10 billion after five years—a significant sum. My party, including colleagues present, has come with up with one suggestion: creating a ring-fenced fund based on a penny in every pound of income tax. That would raise £6.5 billion, which would get us most of the way there. I do not want to be doctrinaire about the best way of doing this, but I hope that there can be some understanding that that contribution, which is very limited in terms of public funding, could get us back to a more acceptable standard. People have different views about which taxes we should use and how we should ring-fence the money, but that seems to me to be the minimum level of ambition—and it could happen without legislation if the parties agreed that we should proceed in that way.

We then get on to the more difficult level, which relates to charging. One thing that has come through to me from reading the various think-tank reports is the growing interest in the idea of free personal care in the Scottish model. I confess that I have always been sceptical about it—I have the traditional economist’s scepticism of free things—but its proponents note two practical attractions that have nothing to do with ideology or party thinking: it aligns social care and healthcare, if we are going to integrate the two systems, and it brings in a lot of people who are currently excluded from social care provision, so that they are more likely to stay at home rather than going into hospital. It has potential benefits as well as costs.

[Karen Lee (Lincoln) (Lab)]

I am an ex-nurse. Does the right hon. Gentleman agree that it is right to offset the costs of social care against what we would save the NHS? I regularly had eight patients, and probably three of them would be medically fit for discharge and did not want to sit in a bed, although they had to do so. When we consider the cost, we must also balance that issue.

--- Later in debate ---

[Karen Lee (Lincoln) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Charles. I will start by talking a little about my experience as a nurse on an in-patient cardiac ward and the number of times we saw delayed discharges. Delayed discharges happened when a patient was medically fit for discharge, had had all their assessments, had received physio and had seen the occupational therapist, and we knew what they needed, but because there was no social care provision, they could not go. Dr Andrews or Dr Kelly would tell them on a Friday afternoon that they could go home, and I used to think, “I’m going to be the one who tells them that they can’t.” Patients really hated that. There was also a cost to it; in cardiology—an acute setting—people would be waiting for a cardiac bed. We might have to choose to outlie that patient in a non-specialty area. We just did not have the beds. It was a constant juggling act.

I was really pleased to hear the announcement last week at the Labour party conference about the national care service; it will play a huge part in relieving the pressures on the NHS. Our NHS is in crisis; the Conservative party will say that it is not, but I still meet my friends for supper once a month, and it is. Part of that crisis is the fact that we have so many people sitting in beds, waiting for social care.

If people get decent social care in their homes when they are discharged, they will not bounce back into hospital so quickly, because there will be someone going into their home every day and keeping an eye on them. I know this from my experience with my mum. If someone is keeping an eye on them, they get to a doctor more quickly, and they are not as acutely ill when they are readmitted, as they very often ultimately are.

Elderly people face significant challenges these days in accessing a general practitioner. The GP service in Skellingthorpe, a village near me, is to be shut; it will be really hard for elderly people there to get to a GP, so they will just get more and more ill before they get to hospital.

Another important point is that when people need increased support, it should be provided by staff who are properly trained, paid and valued. Someone mentioned staff on low wages earlier. I will not utter the dreaded B-word, but when that happens, how will we provide social care, given that none of the staff we are talking about earn £30,000 a year? Labour has come up with a way. Last week, we said that people who earn over £80,000 will pay a little bit more in tax. Surely it is right that the wealthiest in society pay a little bit towards keeping the most vulnerable people safe; I know that does not go down too well with some people, but I think that that is only fair. It is also good to hear that undervalued carers who are struggling will get proper financial support in line with jobseeker’s allowance. We will introduce a cap on care costs for catastrophic illness.

I agree with everything said by my hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy). I have a little grandson—I say little; he is 13 —who has Down’s syndrome, and one of the worries of my life has been what will happen to him when we are gone. It is really important that people with learning difficulties are provided for. I completely agree with my right hon. Friend the Member for Twickenham (Sir Vince Cable); Joe used to go to all sorts of little clubs and things like that, and they have all gone. Things are really basic now. All that is viewed as a commodity. It is as though we do not care about people; it is all about how much things cost. I am sorry, I think my disgust for that view is probably apparent.

Providing social care for an increasing elderly population, as well as many others across our society, is one of the biggest challenges facing us. I am really pleased that my right hon. Friend the Member for Twickenham brought forward this debate. It is really important that we talk about the issue cross-party, because it is a problem that we all face, and we need to come up with answers.