Health and Care Bill

Lord Kerr of Kinlochard Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Lord Kerr of Kinlochard (CB)]

My Lords, unlike Mr Gove, the House has definitely not had enough of experts, as our welcome for the noble Lord, Lord Stevens of Birmingham, has shown.

I am an amateur, but a couple of years ago I was lucky enough to serve on the Economic Affairs Select Committee, under the brilliant chairmanship of the noble Lord, Lord Forsyth of Drumlean. I am sorry he is not here today. We wrote a report called Social Care Funding: Time to End a National Scandal, which is well worth rereading in the context of this Bill. I have been trying to work out whether the Bill does much to deal with this national scandal and have concluded, sadly, that it does not—indeed, it does not really try.

I would not have raised national insurance contributions to provide the money that the National Health Service so badly needs right now. Taxing work rather than taxing wealth is intrinsically and fundamentally wrong. But what really sticks in my craw is to brand the increase in national insurance contributions as needed to fund social care, and then to ensure that none of the money can go to social care for at least two or three years—probably never.

In my view, social care funding has to be ring-fenced. If the money is all in one pot, the NHS will always snaffle it for understandable, well-known reasons. An ageing population brings ever-increasing demands; the more successful the NHS, the greater the demands on it; and welcome advances almost always bring strongly positive relative price effects—medical inflation runs well ahead of general inflation. Medicine also provides the prestige jobs. Social care is the poor relation, struggling for attention and not getting it at all in this Bill.

I am all for improved co-ordination between hospitals, GPs and care workers, and I welcome some of the provisions in Clauses 21 and 26, as mentioned by the noble Lord, Lord Stevens, but they do not address the funding problem. Continuing to rely on local government to find much of the money seems to me to be both hypocritical and inequitable. It is hypocritical, because local government has been squeezed by a decade of cuts and because central government will always want to minimise the taxes for which it is blamed, while someone else gets the blame for inadequate local services. It is inequitable, because some parts of the country will always be richer than others.

Of course, the link to business rates is particularly regressive. The 2019 report from the Select Committee pointed out that

“Demand for social care is often greatest in areas where business is least buoyant.”


Social care needs central funding.

On staffing, current levels of pay and conditions for the 1.5 million people who work in the care sector are a scandal that the Bill does not address. Nor does it look at how to find them. In 2019, 8% came from elsewhere in the European Union and 10% came from further afield. They are insultingly and quite wrongly classified as unskilled workers, so will the Home Secretary let them in?

Thirdly, the Bill ignores unpaid carers, that unseen army of friends and family—often children—on whose kindness we trade unfairly. They need help, but the Bill does not mention them; the words do not occur in it.

Fourthly, reading the Bill, one would think that social care is for those in their declining years, and I join those, like the noble Lord, Lord Bichard, who find Clause 140 shockingly regressive. The fact is that well over 50% of what is now spent nationally and locally is to help people of working age, not to fund care homes but for daycare centres, home visits and helping those with disabilities. The provision of social care is notoriously patchy across the country. The Bill will not cure that, and I do not think that a cure will be found until social care has its own ring-fenced national funding, its own national standards and, in my view although not that of the Select Committee, its own national service: an NCS to match the NHS.

So my biggest concern about the Bill is what is not in it. A fortnight ago, the Health Secretary told the other place that it reflects the Government’s

“commitment to end the crisis in social care and the lottery of how we all pay for it.”—[Official Report, Commons, 23/11/21; col. 311.]

I only wish that were true, but I fear that an opportunity is being missed.

I will make one last point very briefly. I was struck by Mr Javid’s rejection of the suggestion that he be required to obtain the consent of the relevant devolved Government before making regulations under the Act in an area of devolved competence. Surely that is what the devolution settlement requires? Whatever happened to the Sewel convention? I rather hope that a version of Amendment 82, which was rejected in the Commons at the Government’s insistence, will be retabled in this House.