Social Care Strategy

Lord Jamieson Excerpts

Thursday 10th October 2024 Lords Chamber

[Lord Jamieson (Con)]

My Lords, I draw attention to my registered interests, in particular as a councillor in Central Bedfordshire and a member of the Older People’s Housing Taskforce. I thank the noble Baroness, Lady Tyler, for initiating this important debate and congratulate the noble Baroness, Lady Keeley, on her maiden speech, which was excellent. I also express my thanks to the extraordinary contribution made by the many people employed in the sector and the carers—with that, I also pass a virtual hug across the Chamber to the noble Baroness, Lady Donaghy.

As many have outlined, social care and health are in crisis. We are all living longer, which is great news, but an ageing population means that more of us will need care for longer. We just do not have the care or health service that is up to providing the services that we need today. As has been mentioned here, it is not just pensioners; there has been a 25% increase in working-age adults needing care and a near doubling of SEN over the past 10 years.

The instinctive solution is to say that we need more funding—more money. Unfortunately, that is just not practicable. In my experience of councils, they have seen the share of expenditure taken up by social care increase from 50% to over 70% in the past 15 years—somebody said that it was 80% for some councils. If we look at government expenditure, we see that the amount spent on health, social care and social security has gone up from 30% to 45% over the past 30 years. The health and social care workforce is forecast to increase from roughly one in 10 of the current working population to one in five over the next 20 years. Unfortunately, this is simply not sustainable. We need a radical change of direction, and we need to be honest with ourselves and stop kicking this can down the road.

As a society, we need to support people to live healthier for longer and to live independently. Of current health outcomes, only 20% are down to health interventions; around 30% are down to the environment in which we live and another 30% are down to the choices we make about how we live our lives. It is outside the health system that we can make the biggest differences to our longer-term health and independence.

As the Darzi report mentioned, we need to change the NHS, focusing on prevention, early intervention and a move away from medicalisation. This means more GPs, community health, better public health and changing how we work, with things such as community health hubs that bring together a multifaceted approach and treatment outside of hospitals. We need to accept that this will mean a transfer of funds away from the acute sector and the consequences of that.

Housing has an absolutely crucial role. An active, healthy life involves having friends and living somewhere suitable that promotes independence. We do not need more mass housing estates; we need to bring people into cities, towns and larger villages, where they can be part of the community and where services are on their doorstep. It is about having the right accommodation for the right point in your life. Having the right housing saves money. In Central Bedfordshire Council, we estimate that extra care facilities save the council and the NHS around £4,000 per apartment and improve the lives of the people living in them.

Technology has a huge role to play, and innovation, as was mentioned earlier. That will happen only if we have real devolution and integration at a local level. I am not in favour of a national social service, but one locally led by local leaders, with devolution of health, housing, DWP, skills and other budgets. Underpinning all this is the need for a cultural change, personally and as a society. The state has a crucial role in supporting those who need it, but it is also there to facilitate the changes we as a society need to make as we plan for our future. It is about facilitating as much as delivering. It is not just funding, it is housing, health and social care—it is culture. We need a radical structural change.