Social Care Reform

Debate between Liz Kendall and Kevin Hollinrake

Thursday 18th March 2021 Westminster Hall

[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.