Queen’s Speech

Lord Bichard Excerpts

Thursday 19th May 2016 Lords Chamber

[Lord Bichard (CB)]

My Lords, I will talk about social care and will share my disappointment that the gracious Speech did nothing meaningful to address the problem—some might say the crisis—that faces social care and therefore millions of some of the most disadvantaged people in this country. I declare an interest as the chair of the Social Care Institute for Excellence.

I do not think that many people would deny that these are challenging times for social care. Too many users are critical of the services they receive, too many providers struggle to survive, too many commissioners feel disempowered by a lack of resource, and too few people see social care as an attractive career option. For those clients who experience the consequences of this, arguments which we often hear in this House about who should be blamed, debates about budget numbers and discussions about pioneers, vanguards and better care funds feel a world away from the reality of their lives. Of course, those lives cannot be put on hold, awaiting the end of austerity or the next new pilot initiative or organisational restructuring. They have to be lived now, and we all have a responsibility not just to offer promises for the future but to look at ways in which we can improve the quality of lives that are being lived now.

How might we do it? We could start with money. For me, resources are never the complete answer, but social care has suffered disproportionally from recent cuts, and some urgent investment is needed—some urgent reordering of investment, not necessarily new money. We could, for example, revisit the criteria for free prescriptions, 91% of which are now not paid for. We could look again at winter fuel payments paid to well-off pensioners, review free public transport for well-off pensioners, look again at free TV licences for all over-85s, and taper the currently free national insurance for over-65s. There are ways in which, by reordering our resources, we could liberate money for those most in need.

But, as I say, it is not just about money. Users—I meet quite a lot of them—often tell me that they do not get what they need in the form they need it because they were not sufficiently involved in prioritising and shaping services at the outset. I become increasingly passionate about what in the jargon is known as co-design, which is about giving users a real say in shaping services at a point when they can make a difference. Providing services that people do not regard as a priority in a period of austerity is an affront, so let us give users much more control over how reduced budgets are spent.

While we are on the subject of design, I would like to see government, local and central, building its capacity to design services around clients. If that seems a bit esoteric, look at the practical consequences of us not understanding design. Look at the way in which we currently deliver care support. It involves three separate departments, countless assessment regimes and a mix of benefits—some means-tested, some not, and some delivered nationally and others locally. This system was never designed—it just happened, and in ways that made sense to bureaucrats but not to users or their families. We have reorganised much of the benefit system, but not this confused, stress-laden mess. We should and we could do so.

Of course, people will receive whole-person care only if we, the bureaucrats and the politicians, learn to work better across organisational boundaries. The rhetoric of integration has certainly taken root—but, again, the reality is often very different. That is because we talk as if integrating organisations will inevitably deliver better services to people. It will not. People in residential homes want free, convenient access to GP services. Old people who leave hospital need to be able to access domiciliary services. They do not need ambitious promises about how primary healthcare and commissioned healthcare will integrate better at some time in the future.

We have talked a lot today about digital. We could do more to realise the digital dividend. But, again, it is about delivering practical improvements. I will give describe one. The Airedale vanguard enhanced health in care homes will introduce telemedicine links in all 248 care homes this year. So, for example, staff supporting a care home resident with Parkinson’s disease will be able to access clinical advice and support 24 hours a day, every day of the week, through secure video conference. It is not rocket science—they probably would not even bother to mention it in Estonia. There are of course similar examples in this country, but they are not uniform good practice. They should be. Digital technology is not a silver bullet but we could do better and we have been slow to exploit its potential in telecare and telemedicine.

In the same way, we have been slow to come to the aid of and support providers, who currently struggle with increased regulation, increased fees for regulation—I am not sure how that one happened—the living wage and clients with increasingly complex conditions. I know that Governments have always shied away from appearing to support private sector companies, but in this unique situation, maybe we should consider an improvement fund for smaller providers in particular so that they can get better access to the best practice in their industry.

What about the crisis in the workforce? Social care should be seen as the noblest of professions, but in reality it is often seen as a last-resort career. Could we do more? Could we encourage former clients, care leavers perhaps, to join the profession? Can we extend initiatives such as Teach First and Frontline to social care? Do we know enough about why people leave the profession? Should we revisit the excellent report of the noble Baroness, Lady Kingsmill? Too often—it is not just the case in social care—Governments prefer to blame and restructure rather than invest in improving the workforce. But, at the end of the day, whether it is education or social care, it is the workforce that matters and will deliver quality.

Maybe we could do more to reinforce quality and good practice through the inspection process. I am pleased with the work that the CQC is doing; I was pleased to see it moving into area-based assessments. But maybe we should shift our focus away from always looking at the institutions and start asking questions such as, “What does a good life look like in Doncaster?” —I just plucked Doncaster out of the air. Maybe we should look at what happens between the institutions, not always at what happens within them.

Finally, despite all the problems, let us be prepared to innovate in social care. We have talked quite a lot today about the arts and culture. I have become increasingly involved and interested in how the arts and culture can contribute to improved health and well-being. The noble Lord, Lord Howarth, is chairing an APPG at the moment which is uncovering countless wonderful examples of how visual and performing arts, music and dance, are helping to address loneliness, mental illness, stress and pain.

So yes, we can improve social care, even in the time of austerity in which we live—and we must. But I am not seeing much evidence that this is receiving the attention it deserves.