Social Care Reform

Kevin Hollinrake Excerpts

Thursday 18th March 2021 Westminster Hall

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

I am delighted to be so. It is a pleasure to speak in the debate with you in the Chair, Dr Huq.

I am going to speak, not for the first time, in favour of a German-style adult social care premium. All the speakers today have made good points about the need to resolve the problem, but we must address it with money. The need can be supported only by a financial solution.

There are three elements to getting anything done in the world: building a compelling case; building a coalition of people; and being very persistent. I am sure that the Minister would agree that we have been persistent on this topic and its solution. There is a compelling case for an adult social care premium, which I shall speak about in a second. I think that there is a cross-party coalition forming around it. My hon. Friend the Member for Northampton South (Andrew Lewer) referred to it, as have others, not least my right hon. Friend the Member for South West Surrey (Jeremy Hunt) and my friend the hon. Member for Sheffield South East (Mr Betts), under whose chairmanship I once served on the Housing, Communities and Local Government Committee. There is cross-party consensus that we can build on.

We have to find a financial solution. When we talk about a social care premium people say, “We have national insurance,” but that is obviously already in the tax system being used. There are huge demographic pressures that according to the Office for Budget Responsibility will drive debt to national income to 314% by 2060 unless we tackle the problems, including pensions and healthcare. All the solutions that we hear of generally involve a blank cheque from the taxpayer or the person in need of care, neither of which can be right.

The German-style system—Germany moved to it in 1995 from a local authority-provided system—means that everyone does what most people do, putting a small amount of income away every month, on a mandatory basis. It is roughly 2.4% of income, to save for later rainy days. It is a pay-as-you-go system, so everyone is covered from day one. It is done through insurance companies, so it is not taxation. They are not-for-profit insurance companies in Germany, and I would recommend going down that route as well. There is cover for people on low incomes, so that they do not have to contribute. There is also a cap for people on higher incomes so that it is fair to everyone. Germany delivered that on a cross-party basis. We have cross-party support, as I said earlier, and I worked on two cross-party Select Committee reports on the matter. The Health and Social Care Committee and the Housing, Communities and Local Government Committee recommended it as one of the solutions.

The key part of the solution is the social benefit, in that someone who is independently assessed as needing care can choose a service from a provider, or draw down the money personally and pay it to a friend or relative. That means that people can be cared for best by those who love them most. That is a great solution, and it is a solution for some of the capacity issues, too. It is simple, scalable and sustainable, and I heartily recommend it.

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[Liz Kendall (Leicester West) (Lab)]

It is a pleasure to serve under your chairmanship, Dr Huq. As many others have done, I congratulate my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) on securing this debate. She has been a tireless, long-standing champion of these issues, and I really do pay tribute to her for her hard work.

I think that reforming social care—along with tackling climate change—is the challenge of our generation. If we cannot sort this issue out after the horror of the covid-19 pandemic, then frankly, as policy and law makers, we should pack up and go home, because this pandemic has brutally exposed the fundamental flaws in our system of social care, on which many people who have spoken today and many people who are watching this debate have campaigned for years.

First, despite all the rhetoric, social care is still not treated as equally important to the NHS. We have only to think about all the effort and focus that went into setting up the Nightingale hospitals and contrast that with what happened to care homes. Frankly, there was not a ring of steel around care homes; that was not the case. We can think about the examples of frontline care workers saying that their PPE was requisitioned for NHS staff. I want our NHS staff to have proper PPE, but to have it actually taken from people when they were caring for some of the most vulnerable in society was appalling.

Secondly, social care and the NHS are still not seen as inextricably linked. We saw that with the discharges from hospitals into care homes without covid-19 tests, and we saw it with many care homes feeling abandoned and feeling as though they did not get the support that they needed and deserved from the NHS at the start of the pandemic.

Thirdly, our frontline care workers are chronically undervalued and underpaid. The Minister will know that of the infection control fund that went to care homes, the vast bulk went towards ensuring that frontline care workers were paid enough so that they could self-isolate if they had to have time off sick, and so that they did not have to have several jobs between care homes. Quite frankly, that should not be additional, extra funding; it should be embedded in the bottom line of funding for our frontline care workers.

Finally, the families who do the bulk of caring in this country get precious little help and support in return. Unpaid family carers have come to my constituency office absolutely broken by the pressure from the extra hours of caring that they have had to do. They tell me that they just have nothing more to give. We have to do more to support families in the longer term. I also think that the pandemic has entrenched the misperceptions about social care: that it is about only care homes, not care in people’s own homes, and that it is about only elderly people, not working-age adults with disabilities, who make up a third of the users and half the social care budget.

Of course, the immediate cause of those problems is the 10 years of cuts to local authority budgets. Local authorities have had £8 billion removed, which has meant fewer people getting help and not enough people getting the type and quality of help that they need. We know that there are longer-term problems, too. Social care was never included in the initial creation of our NHS and welfare state. Any politician who has tried to solve that problem has risked being obliterated by their political opponents. We saw that in 2010, with accusations of a Labour death tax, and we saw it with Theresa May’s Government and the accusations of a dementia tax. In the end, however, it is not politicians who suffer, but the users of social care and their families.

There is another issue that has not been touched on so far in the debate: one reason why this issue has not been grasped is that caring work is predominantly done by women and is not valued in the same way as medical care provided by the NHS. We desperately need a new settlement of investment, yes, but we also need one of reform, because putting more money into a system that is not working is not the right approach.

We need a system that works for older people and for disabled people. I want to pick up on a point that several hon. Members have made: ensuring that people do not have to sell their homes to pay for their care is an issue—an important one—but it is not the issue, because for working-age adults with disabilities, that is not the fundamental problem in the social care system. We need a system that works for both.

We need a real shift in the focus of services and support towards prevention and early intervention. I think we should have a “home first” principle and more options between care at home and care in a home. Other parts of the world have lots of different examples of housing and care being brought together, and that is what we need in this country.

We need a system that is fully joined up with, but not run by, the NHS. One thing that care users will say is that they have to tell their stories time and again to lots of different services. We cannot have that in future, because people do not see a health need over here and a care need over there; they have just one set of needs. We should design services around users, rather than getting them to fit into different parts of the system. We need to put the principle of choice and control at the heart of the system, enabling older and disabled people to live the lives that they choose, with a radically transformed, paid care workforce, and radically transformed support for families, too.

[Kevin Hollinrake]

I agree with virtually everything the hon. Lady has said. A funding solution is key, because in order to expand capacity there has to be more money. Does she have a funding solution for that? Would she consider a German-style system, which has cross-party support, or would she at least be willing to sit down with a number of people who support that system to engage with the idea?

[Liz Kendall]

The hon. Gentleman may know that I have been calling for cross-party work on this issue for the past five years. The principles are clear—we should not leave the costs to individuals alone. We should pool our resources and share risks. That is essential for the future. I do not think any sort of private insurance system works. One issue around the cap on care costs was that the Government thought a private insurance market would spring up. That was not the case, and it will not be the right solution for the future.

The Prime Minister stood on the steps of Downing Street 19 months ago and said he would fix the crisis in social care with a plan that he “had” developed—that he had it already. It is still nowhere to be seen. Lord Bethell recently said that now is not the time to have fundamental reforms, because we are busy dealing with the covid crisis. I argue that now is precisely the time for reforms to give people hope that, after the horrors they have been through, there is a better system for the future. That is why I was disappointed not to see anything in the Budget about social care reform.

Yesterday, there was an unprecedented statement from social care leaders, who called on the Government to end years of inaction and fix the system. They said that as well as emergency funding, we need longer-term plans to make social care a cornerstone of the modern welfare state. The crucial point is the potential for social care not only to transform the lives of millions of older people, disabled people and families who use care, but to create jobs and drive economic recovery.

In the remaining minutes, I will focus on this point. We often talk about the costs of reform, but the costs of not reforming the system are just as important. First, social care has huge potential to create good quality, valued jobs in this country. We need 520,000 more frontline care workers just to meet growing demand by 2030. The Resolution Foundation rightly argues that if we want to create jobs immediately in every community—that is what we need to do to level up all parts of the country—social care is the place we should start, and I completely agree.

Secondly, investing in social care is essential if we want all families to be able to balance their work and caring responsibilities. In today’s world, with our ageing population, social care is as important a part of our economic infrastructure as the roads and the railways. When one in three unpaid family carers have to give up work or reduce their hours because they cannot get the support they need to help their loved ones, it is bad for them, because they lose their job and income; it is bad for business, because they lose their skills; and it is bad for the economy.

Finally, investing in social care is vital to make the best use of taxpayers’ money. We should not be paying more for elderly people to be stuck in hospital when they could be cared for in the community and at home. As we seek to get our public finances back on a more sustainable footing, value for taxpayers’ money is essential. This issue is the biggest challenge of our generation. I hope the Minister will tell us when the Government will introduce their reforms, because reforming social care is not just a matter of social justice, but an economic necessity.

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[The Minister for Care (Helen Whately)]

It is a pleasure to speak under your chairmanship, Dr Huq. I thank the hon. Member for Worsley and Eccles South (Barbara Keeley) and her co-sponsor, my right hon. Friend the Member for South West Surrey (Jeremy Hunt), the Chair of the Health and Social Care Committee, for securing this debate on the important and interconnected subjects of social care reform and the social care workforce.

The 1.5 million people who make up the paid social care workforce, and the 5.4 million unpaid carers, do the most wonderful thing—caring for people, whose lives depend on what they do. It is a service not just to those individuals, but to the whole country, and never has that been more true than during this cruel pandemic. Yes, our social care system needs reform. It has needed it for decades, and my party committed to that in our election manifesto. The pandemic gives us a moment in time; if not now, when? The pandemic has delayed our work, but I reiterate the Government’s commitment to bringing forward plans for social care reform this year.

This has been a really good debate, with many well-informed contributions from across the parties. I will mention just a few of them. The hon. Member for Worsley and Eccles South talked about the long-term nature of the problems with social care; the fact that the system is as important for those of working age as it is for older people; and the importance of unpaid carers.

The Chair of the Health and Social Care Committee, my right hon. Friend the Member for South West Surrey, talked about the catastrophic costs faced by one in 10 people, who end up spending over £100,000—using their life savings—on their care, and about the problem of high turnover in the care workforce. I thank him for his recognition of my personal commitment and the work I am doing, largely behind the scenes, on social care reform.

My hon. Friend the Member for Northampton South (Andrew Lewer) drew on his experience in local government, going back around 20 years, if my maths is right. He spoke about the need for closely integrated health and social care. My hon. Friend the Member for Peterborough (Paul Bristow) draw on his personal knowledge, as I have heard him do with great value before. I very much look forward to reading the report on supported housing that he mentioned, and I will look it up. This debate would have been missing something if my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) had not mentioned the German system as one for us to consider as we work on proposals for reform.

I will set out some of the support we have given to social care and the social care workforce over the last year, because it really is quite different from anything that has been done by Government for social care before. I also want to pick up on several points that hon. Members made during the debate.

At the start of the pandemic, we identified carers, both paid and unpaid, as essential workers or key workers. That was in recognition of how crucial they are, but also so that they could access support, such as places at school for their children when schools were closed, or priority slots at supermarkets. We made it clear, in guidance and communications to care providers and local authorities, that care staff should receive full wages if required to self-isolate because of covid. That has been one of the uses allowed for the infection control fund, which to date has amounted to £1.4 billion in ring-fenced funding for social care.

To the point made by the hon. Member for Luton North (Sarah Owen), who spoke about care workers being told to work despite having symptoms, that absolutely should not have happened. I have heard of a small number of cases and have investigated, and work has been done to stop that happening. It has been made very clear to care providers that nobody should come into work with symptoms. The Government’s funding was provided specifically so that care workers would not have to worry about lost earnings in the event that they were either covid-positive themselves, or required to isolate as a contact. In addition to that, in January we provided a further £120 million to boost the social care workforce and help providers that faced staff shortages, particularly as a result of staff sickness and self-isolation.

During the pandemic we have also provided free PPE, which runs through to June. We have provided millions of tests to identify covid cases in social care, protecting staff and those who receive care. I was disappointed to hear the shadow Minister, the hon. Member for Leicester West (Liz Kendall), suggesting that there was some form of requisitioning of PPE from social care by the NHS. When I heard stories about that, they were investigated, and the investigations simply did not bear that suggestion out.

On vaccinations, as we started the herculean task of rolling out vaccinations across the country, we put care home residents and staff in the highest priority group. Thanks to the dedication and hard work of so many people, by the end of January we were able to offer vaccinations to all residents in over 10,000 care homes for older people. More than 90% of residents and over 70% of staff have now been vaccinated.

The hon. Member for Central Ayrshire (Dr Whitford) talked about how the pandemic had affected social care workers, including how some social care workers have been bereaved by the sad loss of those they cared for. She is absolutely right about that being a hard part of the experience of the care workforce. I have talked to many care workers over the last year and knowing that they have been facing that during the pandemic has been a real concern to me. I have spoken to employers about this, and many care providers have put in resources—access to counselling and mental health support, for instance—to support their staff to cope with what they have been going through. In government, we have worked alongside the NHS and brilliant organisations such as the Samaritans, Hospice UK, and Shout to provide a package of emotional, psychological and practical resources for the workforce, which includes support helplines and guidance and specific support for registered managers in care homes.

I want social care to have a stronger voice in our health and care system and more visible leadership. That is why, in December last year, we appointed Deborah Sturdy as the first chief nurse for social care. Deborah is providing that leadership. She is already a galvanising force, particularly in supporting infection prevention and control, which must continue, even with the high levels of vaccination that we have.

Hon. Members spoke about vacancies in the care sector and the problem of staff turnover. I am well aware of the challenges for social care employers and how some do struggle to recruit and retain the staff they need in both care homes and the domiciliary care sector. We are and have been supporting the sector with a national recruitment campaign across broadcast, digital and social media, highlighting the vital role that the social care workforce has played during the pandemic, along with the longer-term opportunities of working in care. We are working with the Department for Work and Pensions, and I am working with ministerial colleagues in that Department to promote adult social care careers to jobseekers. I am hearing directly from care providers that they are seeing people taking up those jobs in care and discovering the rewards of care work. However, I am clear that that alone is not the solution to the challenges of having the workforce we need in social care and that, as part of our reforms, we must also focus on what is needed to develop and support the social care workforce.

I turn to social care reform. The Government are absolutely committed to the reform of the adult social care system. As I have said, we will bring forward proposals this year. Despite the challenges of the pandemic, we have been gearing up for the reform so that, as we build back better, we have a system that is fairer and fitter for the future. I assure hon. Members that the work has already begun. In fact, our White Paper, published last month, sets out plans for a health and care Bill that will both further integrate health and social care services and improve the oversight of how social care is commissioned and delivered for people. The Bill will also allow us to get better data on what is going on at a local level so that we can follow the evidence about what works.

The enhanced assurance framework set out in the White Paper will introduce an independent voice through the CQC, with clear and consistent oversight of adult social care, supporting local authorities to improve the outcomes and experience of people and their families in accessing high-quality care and support. That is only the beginning. For the long term, we want a sustainable adult social care system that meets people’s needs and aspirations and gives them the care and support that they need to live life to the full. We want to empower recipients of care and support people to live independently in their own homes and communities for as long as possible. We also want to improve the information provided to the public about the social care system, enabling people to plan for their care and make more informed choices. A stable and well-qualified workforce is central to our ambitions for social care.

[Kevin Hollinrake]

The Minister is doing a fantastic job on this issue, which is one of the biggest issues that faces us. If this is not going to be a blank cheque for the taxpayer or for the recipient of the care, does the Minister agree, as I think the shadow Minister, the hon. Member for Leicester West (Liz Kendall) did, that there has to be a pooled solution, perhaps like the German-style system of social care premiums?

[Helen Whately]

My hon. Friend makes an important point. I will not be drawn into further detail about the system at this point. The questions about funding lie with the Treasury rather than with the Department of Health and Social Care. We want to tackle the problem of the catastrophic costs of care that a minority of people face, as mentioned by my right hon. Friend the Chair of the Select Committee. I emphasise that we have made the commitment that no one who needs care should be forced to sell their home to pay for it. How we do that is indeed part of the reform work.

As we emerge from the pandemic, we will continue talking to stakeholders, pivoting the many conversations that we have been having about covid to more conversations about reform. Our reforms will be informed by a wide range of voices, not only colleagues and experts in the sector but also care providers, the workforce and those with lived experience of the care sector.

I thank all right hon. and hon. Members who have contributed to this important debate. I know that everyone who has spoken is deeply committed to their support of the social care workforce and reforming social care. The Government are on the case to make that happen. I take this final opportunity to thank all of those on the frontline providing care—people who go the extra mile to care for our loved ones, day in and day out. Carers have been truly remarkable throughout this pandemic. It is for them and the people they care for that we must move forward with the much bigger plans for the reform of social care.