Social Care and the Role of Carers

Lord Bethell Excerpts

Thursday 24th June 2021 Lords Chamber

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

My Lords, I join other voices in congratulating the noble Baroness, Lady Jolly, on securing this debate on a subject that is absolutely at the top of the agenda, both here in the House and more widely. I wish her godspeed in her journey to other climates in the defence sector—I wish her very well in that new brief. I also genuinely commend noble Lords for an enormously moving and persuasive debate, with very personal and thoughtful contributions from all sides of the House.

Any Minister who listened to today’s debate, or to any of the interventions that we have had on social care in the last year, would want to start by paying tribute to carers, both unpaid and paid, for all the work that they do in care homes, people’s homes, day centres and other settings, year after year, during this awful pandemic and, as many noble Lords have noted, in the difficult period in the near future of getting back to normal life. I have heard and completely acknowledge the testimony about the significant personal and structural challenges faced by the sector from those who live and work in it. These challenges were exacerbated and highlighted in the pandemic. I do not pretend that they have not put pressure on the 290,000 who live in care, the 630,000 who depend on care, the 1.5 million who work in care and the many millions of family carers who contribute to care.

I will take a moment to reflect on the huge amount that we have done to provide support, at pace, to the social care sector during the pandemic. As we went into it, there were both strengths and weaknesses across the sector, but we started from a point where the quality and satisfaction with the care sector was high, and there was a range of provision for those who needed care. That point is sometimes lost in a debate such as this. As of March 2020, 84% of all social care settings were rated good or outstanding by the CQC, and 89% of those receiving local authority-funded support were satisfied with it, with 64% saying that they were very or extremely satisfied. The importance of raising this point is to pay tribute to the hard work and dedication of those who work in social care: the social care workforce, the care assistants, the care home managers, the social care workers and the family members, who have all contributed to those incredibly impressive statistics.

I will take a moment to remind my noble friend Lord Astor, and all the many noble Lords who quite understandably questioned our efforts to protect the sector during this awful pandemic, of a few of the things that we did. We published bespoke, tailored guidelines on how to safely provide care and protect those we love during the outbreak; these were used by families, care homes, care providers, domiciliary carers, unpaid carers, local authorities and others. From a standing start, we built up a huge capacity for regular testing: to date, we have sent out more than 35 million PCR swabs and 85 million LFTs to care homes, and we have done more through community testing in the NHS. We set up a massive PPE supply chain, completely from scratch, and through the PPE Portal, we have provided 2.4 billion items of PPE free to providers. As of 30 May 2021, we have provided 440 million items through local resilience forums and local authorities.

We have prioritised health and care workers and older care home residents in the UK vaccines delivery plan, offering vaccines before 15 February to residents in care homes, to older adults and their carers, those over 70, the clinically extremely vulnerable and, very importantly in this debate, front-line health and social care workers on an equal footing. We moved quickly to provide financial support, and have now provided £1.8 billion in specific Covid funding for adult social care. We set up regional assurance teams, and have supported safe discharge with £2.8 billion—a colossal sum—including an extra £594 million announced earlier this year. With this in mind, I very gently challenge the implication made by some noble Lords that, during the pandemic, we overlooked social care, the vulnerable or the elderly.

To address the specific subject that the noble Baroness, Lady Jolly, has raised in this debate, I turn to the social care workforce. The 1.5 million people who make up the paid social care workforce provide an absolutely invaluable service to the nation, working tirelessly to support people of all ages who need care. As the pandemic has made clear, we as a nation are totally indebted to their selfless dedication and compassion. Like other noble Lords, I pay particular tribute to the moving personal testimony of the noble Baroness, Lady Thomas, who spoke so engagingly about her carers. I thought of the carers who looked after my father and other loved ones, and I was really moved by the way in which she spoke about this. As she and the noble Baroness, Lady Cavendish, said, these people may be low paid but they are extremely highly skilled. I want to make sure that all noble Lords pay tribute to them.

What we heard from the noble Baroness, Lady Thomas, and in other very moving personal testimonies, was completely consistent with what I heard in my meeting with Carers UK and Care England earlier this week. They brought other carers, who talked about their very challenging and difficult lives in the last few months, and I found engaging with them extremely moving indeed.

I completely hear the noble Lord, Lord Pendry, who pointed out the impact of the pandemic on those who work in social care. Perhaps I may reassure him that we have taken steps to support social care workers during the pandemic. We identified paid carers as key workers in response and gave them much-needed acknowledgement of their critical role in keeping people safe and supported. Through the infection control fund, we ring-fenced funding for providers to be used for measures such as helping to maintain normal wages of staff who may need to self-isolate.

More recently, in December 2020, we appointed Deborah Sturdy as the chief nurse for adult social care to provide professional leadership to the workforce, delivering clinical and professional advice across the social care sector. Huge thanks are owed to her for that.

I have heard loud and clear the words of noble Lords on parity, education, recognition, career progression and autonomy, points that were extremely well made. To the noble Baronesses, Lady Donaghy and Lady Barker, I completely acknowledge that the well-being and mental health of the social care workforce are paramount and have been under threat during these challenging times. We have invested over £1 million in social care well-being and worked alongside the NHS and other organisations to provide a package of emotional, psychological and practical resources for the workforce in a way that has not been done before and I hope has made a difference.

There are at least 6.5 million unpaid carers—around 10% of the entire population, according to the census. Other noble Lords mentioned other equally impressive figures. As my noble friend Lady Browning and the noble Baroness, Lady Watkins, rightly pointed out, that number is even bigger if we include informal carers. The life of those looking after those with terminal diseases is particularly difficult, as was rightly described by the noble Baroness, Lady Finlay. As she rightly and positively made the case for a carers’ allowance, I should reassure her that the consultation on carers’ leave last year demonstrated huge interest in this area—there were 800 submissions—and we will reply in due course, as per our manifesto commitment on that.

Of those unpaid carers, 23% have high-intensity caring responsibilities of more than 50 hours a week. I clearly heard the personal testimony of noble Lords. I have met some of those carers and acknowledge that their life has been incredibly challenging during the lockdown when day centres and other forms of respite were closed, and when the full burden of care fell heavily on their shoulders—month after month, night after night.

We recognise the impact that the pandemic has had on carers and we responded. Perhaps I may single out four areas. First, there was the provision of free PPE to unpaid carers living separately from the people for whom they care. Secondly, there was funding to charities, such as the £500,000 to the Carers Trust and £122,000 to Carers UK to extend its helpline. Thirdly, we gave them priority for vaccines, which I have mentioned already, with carers being put into cohort six, in line with the JVC advice. Fourthly, we published guidance tailored to carers, enabling them to identify themselves and their needs so that those could be more easily met, with ongoing work to help carers on respite and breaks.

To the noble Lord, Lord Dubs, and my noble friend Lady Browning, I completely acknowledge that the challenge continues as we try to return to normal. Day services in particular have been raised by a great many noble Lords, as well as by Carers UK and carers England. The services provide an important form of respite for carers, and allow people with support to meet others and have a break from their obligations. The noble Baroness, Lady Wheeler, and my noble friend Lord Astor gave moving, precise personal testimony on that and I completely acknowledge the point. I wish to reassure all those noble Lords that we are helping to ensure the safe continuation and restarting of day services. We are working with the Social Care Institute for Excellence to publish guidance. We have undertaken work with ADASS and local authorities to understand the barriers. Specifically in answer to the question of the noble Baroness, Lady Wheeler, there is now a joint ministerial task force between DHSC and MHCLG, working specifically on that initiative.

Moving on to workforce development, perhaps I may reassure the right reverend Prelate the Bishop of Carlisle that I agree with him completely that this is a key element of how we can improve social care. As we come out of this pandemic, it is essential that we make sure that we continue to have a workforce with the right values, skills and knowledge, and with real prospects for career progression, if we are to provide a high-quality service for those with need of care services.

I reassure my noble friend Lord Forsyth that we are continuing to commission and fund a range of training opportunities and other programmes to help recruit people in this sector. To give a couple of examples, we have provided £27 million to expand the Think Ahead programme to train 360 graduates in career switches to become mental health social workers; and there is the workforce development fund, which distributes about £12 million a year for training and qualification at all levels. That has helped almost 3,000 establishments to support more than 14,000 learners in 2018-19. The 2020-21 fund will continue to focus on key sectors.

I can only agree with the noble Lord, Lord Pendry, that Covid-19 has exposed some of the long-term inequalities in our society. Research from PHE and others continues to show those disparities.

To the noble Baronesses, Lady Jolly and Tyler, and my noble friend Lady Altmann, I agree that there have been some home closures, but so far there has been no major overall impact on bed numbers in the care sector. The largest regional loss of beds since March 2020 has been a 1% loss in London. Perhaps I may therefore reassure noble Lords that the Care Quality Commission is closely monitoring the financial health of the largest and most difficult-to-replace adult care providers. This allows the commission to warn local authorities if a provider is likely to fall over.

In response to my noble friend Lady Browning’s call, perhaps I may reassure her that a plan for reform absolutely is under way. We have before us the building of foundations, which will be laid in the social care measures in the health and care Bill, which will support us in working together. It will increase integration, reduce bureaucracy and enhance public confidence in accountability. I reassure the noble Baronesses, Lady Tyler, Lady Hollins and Lady Watkins, that these measures will include a new enhanced assurance framework to improve oversight of how social care is commissioned and delivered to people.

To the noble Lord, Lord Dubs, the measures will help us to get much better data from providers on what is going on at a local level so that we can, as he rightly described, follow the evidence of what works and what does not. The health and care Bill will also introduce a new place for social care in the integrated care systems, which will capture and build on some of the joined-up working that has accelerated in some areas already during the pandemic where local collaboration between health and local government, and between different parts of the NHS, has previously been essential to supporting people. With that in mind, I reassure the noble Baronesses, Lady Hollins and Lady Watkins, that we are developing enhanced assurance frameworks.

To my noble friend Lord Lilley and all those who raised the long-term reform of financing social care, it absolutely remains a government priority and all options are being considered, including those of my noble friend. The Prime Minister will be making an announcement on this before the end of the year. To the noble Baroness, Lady Pitkeathley, I say that boldness will be our watchword.

By way of conclusion, I thank those who have spoken so eloquently on this important topic. I know that noble Lords are all deeply committed to supporting the social care sector and would once again wish to join me in thanking all those on the front line providing care and going the extra mile every day. I am enormously proud of their efforts and immensely grateful to them all. We absolutely must not lose sight of what is important. This means doing our utmost for people who rely on social care and their families. In the words of several noble Lords, bring it on.