Social Care Funding (EAC Report)

Lord Bethell Excerpts

Thursday 28th January 2021 Grand Committee

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)]

My Lords, I join those who have congratulated my noble friend Lord Forsyth on securing this debate on this most important subject. The Economic Affairs Committee has done a huge service with this remarkable report. I reassure him and the committee that reform of adult social care is one of the most important priorities for this Government. It was a manifesto commitment and remains a major priority for us.

One of the silver linings of this awful pandemic has been the widespread appreciation for our carers, paid and unpaid, and I start by acknowledging the many fine words from noble Lords about the hard work of carers. I pay tribute to them and the incredible work they do every day. We owe it to them to get these reforms right.

The House of Lords Economic Affairs Committee, in its excellent and often-praised report, and many noble Lords today have made important points on social care which I want to address systematically. The committee’s report sets out the need for reform of adult social care, and on that the Government completely agree. I reassure noble Lords that, as detailed at the spending review, the Government are committed to sustainable improvement of the adult social care system and will bring forward proposals this year.

My noble friend Lord Lansley spoke with candour about the challenge facing Ministers, and I completely agree with him. Putting social care on a sustainable footing, where everyone is treated with dignity and respect, is one of the biggest challenges that our society faces. This is a complex area, a range of options are being considered, and we very much look forward to working with other parties on building a consensus around these reforms.

As many noble Lords noted, a stable social care provider market and a qualified, committed and well-paid workforce will be central to our ambitions to raise the quality of and access to social care. We want to empower recipients of care by supporting people to live independently in their own homes and communities for as long as possible. A number of noble Lords noted the Cinderella status of the sector. We want to improve the information provided to the public on the social care system, enabling them to plan for their care and make better choices when the time is right for them, and to raise the status of the sector in the public consciousness.

As regards our direction, we have made absolutely clear our commitment that nobody needing care should be forced to sell their home to pay for it. Our ambitions will necessarily take place on a longer timescale because of the pandemic, but, as the PM reaffirmed at the Liaison Committee in the House of Commons, we will bring forward proposals this year.

On social care funding, we recognise that the Covid-19 pandemic has imposed significant pressures on the social care sector, but I agree with my noble friend Lord Forsyth that the pandemic is not an excuse for inaction. In fact, it is a reason for supporting the social care sector, and that is exactly what we have done. We have now made £4.6 billion available to local authorities so that they can address the pressures on local services, including social care, that have been caused by the pandemic.

I remind noble Lords, including the noble Lord, Lord Hunt, of some of the measures we have undertaken during this period. Through the infection control fund, set up in May, we have provided over 1.1 billion of ring-fenced funding for the care sector. This has funded important measures for infection prevention and control, such as financial security for staff who are isolating, as well as PPE. On 23 December, we announced an extra 149 million to fund costs associated with increased testing in care homes, to help ensure the safety of staff and residents. Today’s announcement of the test and trace results shows the impact of that money. On 16 January, we announced another £120 million of funding to help local authorities to boost staffing levels in the care sector, which could include setting up their own staff bank to assist care homes when their staff need to isolate.

As well as this specific funding for Covid-19, we have also provided councils with access to an additional £1.5 billion for adult and children’s social care in 2020-21, on top of maintaining £2.5 billion of existing social care grants. As announced in the recent spending review, we are providing councils with access to over £1 billion of additional funding for social care in 2021-22. This includes £300 million of new grant funding for social care, on top of the £1 billion social care grant announced last year, which is being maintained in line with our manifesto commitment.

The Government are also enabling local authorities to access up to £790 million of new funding for adult social care through a 3% adult social care precept or top-up to council tax bills. The Government recognise, as is cited in the Economic Affairs Committee report, that the amount that each local authority can raise from this precept is dependent on a number of factors: for example, council tax bill levels. We are looking to address this through using some of the social care grant funding for equalisation. We also expect to provide councils with estimated funding of around £3 billion to help manage the impact of Covid-19 across their services, including in adult social care, and to compensate for income losses. This is a substantial track record of investment during a time of national emergency, and a significant response to the Covid pandemic.

I will say a word about market fragility. The report raises concerns about the strength of the social care provider market. As many noble Lords have noted, this market is varied and includes public, private and voluntary organisations. This is both a strength and a weakness. As noble Lords have noted, not all providers last for ever, but I reassure the noble Lord, Lord Liddle, and my noble friend Lady Browning that entering and exiting is a normal part of a functioning market, and local authorities should have appropriate plans in place to minimise any disruption of services.

I agree with my noble friend Lord Young of Cookham. I say to the noble Lord, Lord Shipley, that local authorities are best placed to understand and plan for the care needs of their populations, and to develop and build local market capacity. That is why, under the Care Act 2014, local authorities are required to shape their local markets.

To push back gently against the noble Baroness, Lady Brinton, on capacity, the number of overall care home beds has remained broadly constant over the last 10 years, from around 460,000 beds in 2010 to around 458,000 beds this month. At the same time, the number of care home agencies in England has increased. There are over 4,000 more care home agencies now than there were in 2010. This reflects the growing trend, noted by the noble Baroness, Lady Wheeler, towards caring for people in their own homes wherever possible. This is largely to be welcomed.

A number of noble Lords commented on the quality of care. I am grateful to the noble Baroness, Lady Young, for her testimony on her time at the Care Quality Commission, which is the independent regulator of all health and social care services in England. It notes that 84.6% of all social care organisations are currently rated as good or outstanding. As my noble friend Lord Lancaster put so well, this is testament to the hard work of so many people in adult social care, who speak of positive experiences in adult social care. We should not forget this.

I also want to cover unmet demand. We have enshrined in law, through the Care Act, the responsibility of local authorities to meet eligible needs. This eliminated the postcode lottery for eligibility across England. Under the Care Act, everybody who appears to have needs is entitled to an assessment. If, following the assessment, they are found to have eligible needs, the local authority has a duty to meet those needs, subject to a financial assessment.

That brings me to the difference highlighted in the committee report and raised by my noble friend Lord Forsyth between, say, cancer care, which is funded by the NHS, and other conditions that people may be living with, such as dementia, and those who have to pay for that care. The reason for this is the type of care required. There are limited treatment options for people living with dementia, so care is predominantly social care and support, rather than the medical treatment afforded by the NHS for those who have cancer. Social care, as we know, is subject to means testing. As I mentioned earlier, the Government are committed to social care reform, so that no one has to face excessive social care costs in their lifetime, whatever their underlying need. In answer to noble Lords, such as the noble Baroness, Lady Hollins, who asked about a timetable, we will bring forward proposals later this year.

The noble Baroness, Lady Finlay, and the right reverend Prelate the Bishop of Carlisle, asked about personalisation and choice. The report raised concerns about disabled people not having choice and control over basic decisions in their lives, such as when they get up in the morning and whether they can leave the house, due to lack of care and support.

My noble friend Lord Taylor of Holbeach was quite right when he called for dignity and respect in social care. On that, the Care Act introduced new functions for councils to focus on promoting well-being and prevention, including offering personal budgets, which are designed to give people control and choice over how their care is planned and delivered. It is based on what matters to the individual and their needs. It enables a new relationship between people, the care system, and health and care professionals, and is a step towards offering people the chance to have a say about their own care. The evidence suggests that, by doing so, people are more satisfied with their care, have better outcomes and can explore more innovative approaches to meet their needs.

I agree with the noble Lord, Lord Razzall, and other noble Lords that our NHS and social care system is facing increased pressure and that it needs to be fundamentally transformed and adapted to meet this demand. Our mission is to deliver integrated health and care services by placing people at the centre of the health and care system, working with them holistically to deliver the outcomes that matter to them most.

I want to say a word about the workforce, but, before I do, let me recognise the very large number of tributes paid to it by noble Lords. I completely acknowledge the comments on the status, training and workload of those working on the front line of social care. As the report recognises, the 1.5 million people who make up the paid social care workforce provide an invaluable service to the nation. We are indebted to their selfless dedication, and we have a duty to give them the support they need.

I have already mentioned the infection control fund to the noble Lord, Lord Liddle, and I reassure him that the £1 billion of funding to which we have given councils access in 2021-22 is designed to ensure that key pressures in the system are met, including the national living wage and national minimum wage. I reassure my noble friend Lady Fookes that the increase in the national living wage means that many of the lowest-paid workers will benefit from at least a 2.2% pay rise next year. The vast majority of care workers are employed by private sector providers, which ultimately set their pay. They must abide by national wage legislation, but they are independent of central government. Local authorities work with care providers to determine a fair rate of pay based on local market conditions.

On recruitment and vacancy rates, which were raised by a number of noble Lords, including the noble Baroness, Lady Hollins, we completely recognise that adult social care employers can struggle to recruit and retain the right number of staff. We are pleased that the vacancy rate reduced to around 7% for the period March to November 2020 from 8.4% in February 2020. We want this to reduce further and are working alongside stakeholders in adult social care to support a growing workforce with the values and skills to deliver high-quality, compassionate care.

It is vital that the spotlight we have seen placed on the social care workforce during Covid-19 is transformed into a long-lasting legacy of recognition for the workforce, as was noted by a number of noble Lords. We will celebrate their work and give them the acknowledgement and appreciation they deserve. To answer my noble friend Lady Fookes and the noble Baroness, Lady Brinton, we have responded to calls to provide the social care workforce with a shared identity to unite the sector. CARE badges are currently available free of charge, to be worn as a symbol of pride across the social care sector, and 1.1 million of them have been provided.

To noble Lords who asked about unpaid carers, I say that, like the report, the Government recognise the vital role unpaid carers play, especially given the difficulties the coronavirus pandemic has placed on those caring for family members, relatives and loved ones. We were all moved by the testimony of the noble Baronesses, Lady Kingsmill and Lady Wheeler. I want to pause for a moment to reflect the country’s gratitude to the people who have stepped up to help one another in their communities during the pandemic, alongside those who care day in and day out for their older or disabled loved ones. As the noble Baroness, Lady Jolly, said, this pandemic has highlighted the invaluable contribution of unpaid carers just as much as that of NHS and social care workers.

I reassure the noble Baroness, Lady Pitkeathley, that we have supported unpaid carers throughout the pandemic by funding the work of a number of charities that support carers, by publishing guidance tailored to carers, and by working with the social care sector to strike a balance between maintaining day care and respite services that we know are critical to many families and controlling infection risks.

In 2018, we set out a two-year programme of cross-government action on unpaid carers in our carers action plan. We will continue to work with carer organisations to support unpaid carers’ access to the support they need to maintain their own health and well-being while continuing to support their loved ones.

This is a comprehensive report. This debate has raised some really good points, and I acknowledge the frustration felt by many that there has not been more progress on this agenda. However, as my colleague, the Minister of State for Care, wrote in her response to the committee chair, this is an important priority, and we are working hard to make progress on it. We are considering the report’s recommendations carefully, and, as the noble Lord, Lord Lipsey, rightly acknowledged, we remain committed to cross-party talks to build a consensus. We remain committed to this vital work and will bring forward proposals later this year.