Social Care

Liz Kendall Excerpts

Tuesday 25th February 2020 Commons Chamber

[Matt Hancock]

My hon. Friend is right that it is about more than just money. The money is, of course, important, but it is also about how the system is structured. There are parts of the country where the co-commissioning he calls for already exists, and we can see the improvement in efficiency that we get out of that. The hon. Member for Worsley and Eccles South (Barbara Keeley) rightly mentioned those with learning disabilities and autism, of whom there are more than 2,000 in in-patient settings. We are reducing that number and supporting more people to move into the community, including in the example that she mentioned. She talked about the challenge of that requiring more money. Actually, community settings are often better for the patient and cost the taxpayer less. As my hon. Friend says, improving the commissioning and the system is a critical part of the solution, so that yet more people can be moved out of in-patient settings.

[Liz Kendall (Leicester West) (Lab)]

The Secretary of State talks about transforming care and services so that we focus more on prevention, early intervention and help in the community and at home. That is what we should be doing, so why, as the National Audit Office has just reported, have we seen less money spent on public health, primary care and community care under this Government in the last five years? This Government are obsessed with hospitals, which is not the way that we want to go—it is about care in the community and at home.

[Matt Hancock]

The hon. Lady is dead right, and I have changed that direction of travel. This year is the first year for a generation when there has been an increase in the proportion of the NHS budget going to primary and community care. That change was at the core of the long-term plan. I insisted on that because I entirely agree with her analysis that getting more support out into the community is critical. This has been going in the wrong direction for a generation, and we are just starting to fix it.

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[Liz Kendall (Leicester West) (Lab)]

We need three things to make our social care system fit for the future: access to good quality care for every older and disabled person who needs it; more support for families to look after the people they love; and better care jobs so that paid careworkers can afford to stay in work and support their families as they care for ours. I will take each in turn.

First, it is a disgrace that in the 21st century, in one of the richest countries in the world, 1.5 million older people are not getting the basic help they need to get up, washed, dressed and fed—that is one in seven of the entire population aged over 65—and that figure will rise to 2 million in a decade’s time unless the Government change course. It goes without saying that this is not good for the people who need support to perform the functions of basic daily living, but it is not good either for the taxpayer, as more older people end up going into hospital and getting stuck there when they do not medically need to be there, with all the knock-on consequences that has for hospital waiting times and NHS budgets. We have got to stop treating the NHS and social care budgets separately, because they are inextricably linked, and we have got to stop fixating on hospitals, because the care system of the future lies in the community and closer to home.

Secondly, we need to give more help to families. Many of the UK’s 6.5 million unpaid family carers face a desperate daily struggle to look after their older or disabled relatives. They often feel pushed to breaking point financially, emotionally and physically. One in three carers have to give up work or reduce their hours because they cannot get the help they need to look after their loved ones, so they lose their income, the economy loses their talent and the Treasury loses their taxes. How does that make any sense? We no longer think parents should be forced to give up work to look after their children, so why do we accept it for those caring for elderly or disabled relatives?

Many of us on the Opposition Benches believe universal childcare to be as much a part of our economic infrastructure as the roads and railways. That we are living longer means we need to see social care, too, as an essential part of our economic infrastructure. With so many people now looking after their elderly mums and dads as well as their own children, we need to be thinking about universal family care and leave to meet the realities of modern life, because families should never have to choose between holding down a job and caring for their own.

[Alex Cunningham]

I ought to have declared that I am a co-chair of the all-party group on carers. I am pleased my hon. Friend has mentioned unpaid carers. The Secretary of State took 19 minutes to acknowledge the existence of the millions of unpaid carers in our society. I wonder if my hon. Friend has any tips for the Government for how they could address their needs.

[Liz Kendall]

Unpaid family carers need family-friendly working arrangements so that they can balance their work and caring responsibilities; they need an NHS that recognises that their own physical and mental health could suffer too, and they need to know that we are there to support them. Rather than criticising families and saying that they should be doing more, we should acknowledge that many carers have not had a break for weeks, months or even years. We have to change that, because this is not going to happen to somebody else. This is going to happen to every single one of us here.

Thirdly, we need better care jobs. Paid careworkers do some of the most important work in the country, looking after the people whom we love, but many struggle on low pay and zero-hours contracts, with high levels of stress and little training. No wonder staff turnover and vacancy rates are so high, although the vast majority of careworkers say they love the work that they do. We need a comprehensive strategy to improve the pay, professional development and employment security of care staff, and we desperately need to increase the number of careworkers too. We shall need more than half a million more careworkers in a decade’s time, not to improve the care system by providing better quality or wider access, but just to meet increasing demand.

That is why the points-based immigration system announced by the Government will be a disaster. If we already need more than half a million extra careworkers just to meet levels of demand, how on earth will we cope with that new system? It will not be possible. I beg the Minister to meet me, and others, to discuss the development of a separate route into social care in the migration system of the future, because otherwise we simply will not cope.

None of those changes—improving access to care, more support for families and better care jobs—can be delivered on the cheap, but the truth is that families, the NHS and our economy as a whole cannot afford for us not take action. We need, first, an immediate and significant injection of cash into the system in next month’s Budget, and, secondly, a long-term plan for investment and reform. Any new funding system must work for disabled adults as well as older people. It must strike the right balance between individuals and the state. I, for one, strongly believe that we should pool our resources and share our risks rather than leaving people to cope alone. The system must also be fair across the generations. I do not believe that the working-age population should pay for all the additional costs of caring for our ageing population Wealthier older people will need to make a contribution too.

Alongside this funding reform must be a change in the way in which social care is provided, so that it is not just about time slots and tasks simply to keep people alive, but about offering great support how, where and when people want it, so that they can lead the lives that they and their families choose.

This radical reform of social care is just one of the changes that we must make to meet the needs of our ageing population, which is one of the biggest challenges that we face as a country. We need to change our housing so that it helps people to live independently at home for longer. We need to reform the world of work so that, as we live for longer, we can work for longer and more flexibly. We need to change our health services so that they keep people fitter and healthier for longer as we live for longer. None of those things will be easy, but if we want to meet the challenge of our ageing population and if we want to make Britain the best country in the world in which to grow old, we need to grasp this nettle, and we need to do it now.

[Several hon. Members rose—]

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[Helen Whately]

The shadow Minister is shaking her head; I know that there is more to do.

At times this has been a heated debate, but I heard on both sides truly constructive suggestions for how we can solve our social care challenges. That gives me much hope for cross-party consensus. I heard suggestions from my hon. Friends the Members for Newton Abbot (Anne Marie Morris) and for Meon Valley (Mrs Drummond), my right hon. Friend the Member for Ashford, the hon. Member for Leicester West (Liz Kendall) and my hon. Friend the Member for Bexhill and Battle (Huw Merriman), whom I thank for his kind words welcoming me to my job. He set the bar high for me to meet.

I am fully aware of the challenges that face our care system and I have no illusions as to the scale of the challenge facing us. In the next 10 years, we expect the number of people over 75 to go up by 1.5 million, and the number of people under 65 with care needs is growing, too. We have a system that is under pressure and the demands are only going to grow.

[Liz Kendall]

In the spirit of being constructive, let me mention, as I did during my speech, the huge and rising pressures on social care. There are 120,000 vacancies here and now. We need more than half a million care workers in a decade’s time just to keep up with rising demand—that is not to improve the system, but just to keep pace with demand. The proposed points-based system of immigration will be catastrophic for social care. Will the Minister meet me and others who work in this area to explore the potential for a separate route into social care, so that we can avoid further pressure and worse care for the people for whom we love and care?

[Helen Whately]

What I would like to emphasise in response to the hon. Lady’s point is the importance of our recognising, valuing and making sure that social care is an attractive career. In that way, those who are already working in social care will continue to work in social care. It will be for us to build the workforce that we need for the future.

[Liz Kendall]

rose—

[Helen Whately]

I am conscious of time, so I must now come to my conclusion.

We all bring our experiences to our work, and, as I conclude this debate, I want to mention one of mine. When my grandmother was 100 years old, she was admitted to hospital and she stayed there for five months. She was signed off as ready to leave numerous times, but each time the failure to find a care package delayed her discharge, during which time she would acquire an infection, further delaying her discharge. She was eventually discharged, but only in time for her to die—thankfully, peacefully at home. This is a cycle with which too many people are familiar, and it means that our hospitals are looking after people who would be better off at home.

As I have said, I am under no illusions about the challenges that we face in social care. The problem that I have just described is nothing new, but let us be the generation that solves it. That is a commitment that we as a Government have made. We will fix the crisis in social care. We will deliver the funding that is needed now to stabilise the system. We will find a long-term solution to the growing need for care and seek to build a cross-party consensus on this. We are committed to the view that the prerequisite of that solution is that no one needing care will have to sell their home to pay for that care.

We will not be supporting the Opposition’s motion tonight, but where I think we can all agree is on the importance and the urgency of reform of social care. As we bring forward those plans, I look forward to working with colleagues from all parts of this House. Just as we had a consensus in the 1940s on the NHS, the time has now come for a new consensus on social care. Let us be the generation that works together and makes our care system work for all those who so badly need it.

Question put (Standing Order No. 31(2)), That the original words stand part of the question.