Social Care Funding (EAC Report)

Lord Bates Excerpts

Thursday 28th January 2021 Grand Committee

[Baroness Hollins (CB) [V]]

My Lords, I refer to my interests in the register. I thank the noble Lord, Lord Forsyth, for steering this excellent report. We can no longer ignore the impact that chronic underfunding and political indecision about adult social care are having on the well-being of individuals—something the pandemic has shone a spotlight on.

First, I question whether it is possible sensibly to debate social care for older people at the same time as social care for working-age disabled adults, who are far too often overlooked in debates on social care reform. Perhaps older adults have more political clout. It does not make sense to ignore or exclude a group which, according to the Association of Directors of Adult Social Services, accounts for 64% of demographic pressures on the sector and approximately half of social care spending in England—I know that the noble Lord referred to this.

Secondly, we need a two-way collaboration between health and social care: interdependence rather than dependence. The NHS cures us of disease and mends bones; social care helps to cure loneliness, mends social inequalities and unlocks potential. For social care to achieve its mission, it must have personal fulfilment and independent living at its heart. For many working-age disabled adults, social care is not personal care but rather the support to develop skills such as cooking and maintaining a home so that they are able to make meaningful decisions about how to live their life and to grow in confidence, perhaps to find employment, to make friends and to play an active role in the community. Proposals that include funding mechanisms based on housing wealth, assets, floors, caps and insurance seem to forget about the impact that such models could have on working-age disabled adults. While free personal care would undoubtedly benefit many people, one concern is that underfunding could facilitate a drift towards the medicalisation of social care, where individuals’ horizons are reduced and the goal of the system becomes merely to keep someone alive.

Thirdly, social care must have a better-paid and trained professional workforce, with a meaningful career structure to reward dedicated staff and producing a talent pipeline that creates an avenue for experienced staff to develop, become mentors and pass on their knowledge and skills to a new generation. We know the problems that plague the workforce, including that some people take short-term jobs to fill employment gaps, but it is mainly that low pay and poor career progression lead to high turnover and poor retention. With more than 100,000 vacancies, we cannot underestimate the challenge. These problems are not new. In 2016, I chaired an expert reference group for Health Education England on building a direct support workforce to deliver the transforming care programme for people with a learning disability and/or autism who display behaviour described as challenging. Without adequate support and effective collaboration between social care and community mental health services, that group faces a real risk of ending up in inappropriate in-patient units at huge cost, both personal and financial. Of course, many people post Covid will want to avoid congregate care settings. This will need a different approach to career development and career structures.

The social care sector needs an immediate injection of funding to help improve pay and stabilise the sector, as many have already said, as well as reform in the ways that I have briefly outlined with respect to working-age disabled adults.

[The Deputy Chairman of Committees (Lord Bates) (Con)]

Before I call the noble Lord, Lord Taylor, I remind all participating remotely to keep their microphones on mute unless they are called to speak.

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[Baroness Pitkeathley (Lab) [V]]

My Lords, I declare my interest as vice-president of Carers UK. I am greatly indebted to the noble Lord, Lord Forsyth, for finally securing this debate and very pleased to participate—as pleased as I was, in fact, when I first read the report in July 2019, not just with its content but mostly that it existed at all.

In the 23 years I have been in your Lordships’ House, I have taken part in many debates on social care and have been wont to call those who join me “the usual suspects”. We were a relatively small band who banged on about this subject whenever we got the opportunity and frequently used the expression “a national scandal”, as it is used today. I have to tell your Lordships that it makes pretty depressing reading to go back to those other debates on social care because the problems remain the same and so little progress seems to have been made. But the noble Lord, Lord Forsyth, and his colleagues are not the usual suspects and they reached the same conclusions.

The committee found a situation which, I think it is safe to say, shocked its members. If it was bad in the summer of 2019, how much worse is it now after the ravages wrought by the pandemic? The situation is bad for everyone: for local authorities, for the NHS and for care homes. It is very bad for family carers, as the report acknowledges. We all know now that families and friends are holding the social care system together by providing support for the most vulnerable in society. Many were at breaking point before the current crisis and are now sick with worry. We are asking even more of these unpaid carers than ever before. They urgently need to be supported and their contribution, worth billions of pounds, recognised.

If Covid-19 and the additional focus it has brought on the inadequacy of the care system have any positive outcome, it may be that we are finally forced to take bold decisions about the funding and provision of social care. Over the years, we have all witnessed the endless recommendations about how to reform the system: the reviews, the royal commission, the unenacted legislation and, of course, the endless broken promises. What we need now is a decision of the level and quality that our forebears took in relation to the NHS, but this time it must be about reshaping health and social care around today’s needs, not those of the population of a post-war Britain.

We cannot go on as we are, trying to do more with less, managing demand by simply not meeting it and by being dishonest with the public and the voters. No Government have ever made it clear to the public that responsibility for paying for and arranging care rests with individuals and their families. If they are not prepared to reform the system, the Government must at least be prepared to promote clearer public understanding of how the system works, what people can expect and, more importantly, what they cannot expect.

This problem is not going to go away; it is only going to get worse. The question is not whether these costs will arise, but how they will be met. Will they be met by the public purse or by private individuals? Every independent review of the past 20 years has recommended that future funding of social care, as well as healthcare needs, should come from public, not private, finance. The needs of individuals cannot be divided up neatly into health or social care needs. The time for debate is surely over. We have enough research and experience to enable us to take this decision—to decide on reform. All we need is the will to do so. If we have the will, we can end this national scandal now.

[The Deputy Chairman of Committees (Lord Bates) (Con)]

I now call the next speaker, the noble Lord, Lord Campbell, after whom I will call the noble Lord, Lord Lansley.