Health and Care Bill

Lord Birt Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Lord Birt (CB)]

My Lords, I have finally reached the head of the long queue to, like other noble Lords, congratulate the noble Lord, Lord Stevens, on his trailblazer of a maiden speech. As we all know, he has been at the forefront of health reform for decades. He signalled today that he has lost none of his vim and vigour, it has not abated and he will continue his lifetime’s work in your Lordships’ House. We are lucky to have him.

I declare an interest as chair of a company that supplies services to the care sector as well as to other sectors. Like some others, I broadly welcome the Bill and its companion piece—this month’s White Paper on adult social care. Indeed, the White Paper is notably impressive; I have not found myself saying that many times in this House. It is absent of political rhetoric and plainly the result—as has been made clear today—of a long and sensitive consultation both with providers and with those for whom they care. It sets out a truly daunting challenge, making clear the sheer complexity of the conditions that can strike any of us, or our families, at any moment, as well as the sheer scale of current demand. Last year, a fraction under 2 million requests were made for care support. Nearly 850,000 people are currently receiving state-funded long-term care. I make three sets of observations.

First, on front-line integration, I strongly welcome the introduction of the new bodies that will ensure proper integration of the services provided by many categories of public and private suppliers of care at local level; and I welcome the plan that that these new bodies, and local authority providers, will be regulated by the CQC. However, both the Bill and the White Paper are silent on how this integration will be achieved. Almost all large organisations—I have worked in many—struggle with the task of providing a seamless experience for the users of the services they offer, in both the public and the private sector. Which of us has not spent fruitless hours on helplines, passed from pillar to post? How will the integrated care partnerships operate and their success be measured? Will the multiple parties that provide care share a common technology platform? How will user data be shared? Will there be common measures of success? How will good practice be syndicated? That point was made by the noble Baroness, Lady Cavendish. In the last months of my father’s life, the help he received in navigating the multiple parts of the health and care system was well-meaning but chaotic. Will there be a nominated personal navigator for those with complex care needs to help them steer the best path through?

Secondly—many have raised this point—the workforce in adult social care is of a staggering size. Currently, 1.7 million people work in the sector. The White Paper fully recognises the contribution made by those who work in care, but does it go far enough? Do we not need to celebrate the increasing skills now needed in the social care sector? Do we not need a clear career progression with a status and a hierarchy something akin to those deservedly enjoyed by those who nurse? When I worked in government, I was struck—very much like the noble Baroness, Lady Harding—by how poor workforce planning had been in the health system. The elephant in the room is that, plainly, the Treasury bears considerable responsibility for that. There are already chronic worker shortages in care. In the next 20 years, the number of over-85s is projected to increase by nearly 1 million. Like many of your Lordships, I am hoping that I will be among their number. The forecast is that, by 2035, we will need one-third more care workers than we employ now. We will need to transform our approach to strategic workforce planning to bring that about. Will the Government do that?

Thirdly, on the social care contribution cap—which, again, many have mentioned—I recognise that the Government’s new proposal is an improvement on the old, but it has an utterly disproportionate impact on those with little wealth. I urge the Government to think again, to design a scheme where everyone with assets makes a contribution to their care costs, but which is progressive, where those of greater means assume a greater burden.

Overall, though, I welcome the Bill, and the social care White Paper, as real steps forward.