Funding of Care and Support

Lord Low of Dalston Excerpts

Thursday 24th November 2011 Lords Chamber

[Lord Low of Dalston]

My Lords, I too congratulate the noble Baroness, Lady Pitkeathley, on securing this extraordinary and interesting debate and on the comprehensive and compelling review that she gave us, which has stimulated so much creative and critical thinking from those who have followed her. I can remember three debates on social care and related issues during my first year in your Lordships’ House—so much so that I observed that social care and the importance of social work had become something of a leitmotif running through the proceedings of the House. This does not seem to have been the case so much of late. Unless I have missed something, the last debate of this kind took place on 9 December last year. It is high time we had another one.

The debate is also very timely. The Government received the Dilnot report last July and are now consulting on it. There also seems to be some disposition for cross-party talks on both sides in advance of the promised White Paper in the spring. If we could get to the point where it was possible to move forward, on a basis of consensus, with reform of the law on social care, the upgrading of social care itself and reform of social care funding, that would truly be a consummation devoutly to be wished.

The debate also does not come a moment too soon, in the sense that hardly a day goes by now without our ears being assailed by further horror stories of the neglect, abuse, dehumanising treatment and downright inhumanity to which the most vulnerable on the receiving end of social care—those in greatest need in our society—are habitually subjected. In the summer we had Winterbourne View; and only yesterday, as has been mentioned, the EHRC was reporting evidence of what it called a “systematic failure” across the country, which amounted to a breach of elderly people’s human rights. Examples that they considered amounted to cruelty included people being robbed, left hungry and unwashed, and food being placed in front of deafblind people without telling them it was there, or putting it in an inaccessible place—something, I have to tell you, that blind people routinely complain about in hospital. On the strength of this, the CQC announced the previous day that it would step up its programme of inspections of homecare services, saying that people who use homecare services often find themselves in vulnerable circumstances and the operation of homecare is not as transparent as care in hospitals and other sectors because interactions happen behind closed doors in people’s homes. The Care and Support Alliance, a consortium of more than 50 organisations representing older and disabled people to which the noble Baroness, Lady Pitkeathley, referred, has recently stated that the social care system is in crisis, unable to meet the needs of growing numbers of older disabled people and those with long-term conditions.

Since the day when I entered this House, and I am sure for some time before, we have been talking about a crisis in social care; now it has become a scandal that many predicted if action was not taken. In some ways, that is a good thing—not that we want anyone to be subjected to inhuman and degrading treatment, but it seems to be the thing that gets Ministers’ attention. Up to now, there have not been any Victoria Climbiés or Baby Ps among the elderly and disabled. My fear is that, when the funding for the deprived and disadvantaged, the most marginalised and dispossessed in our society, is cut or they are subjected to inhuman and degrading treatment, they simply disappear beneath the radar.

Coming towards the end of the debate, I speak after such big-hitting luminaries as the noble Lords, Lord Sutherland, Lord Warner and Lord Lipsey, who all, as the noble Lord, Lord Sutherland, acknowledged, have form on this subject—not all the same form but, nevertheless, considerable form. In their presence, I cannot expect my contribution to be anything more than modest, so I shall content myself with trying to drive home a few key points that seem to me pretty well ungainsayable but cannot be said too often.

We have already mentioned the crisis. As everyone has said, the Government must really bite the bullet on Dilnot now. As has become clear, there is room for a range of opinions on the precise form that the bullet should take, but bite the bullet the Government must no doubt do. Labour did some good things with social care when it was in office, but the past decade, as the noble Lord, Lord Sutherland, reminded us, has been littered with too many reports and policy statements that have remained unenacted. It was to the coalition’s credit, therefore, that it moved quickly to set up the Dilnot commission and it will be even more to its credit if it can build cross-party consensus around it and get on with implementing it. I do not disguise the fact that it is a formidable challenge; expenditure on social care has increased, though not as much as on health and education, but it has not increased enough to keep pace with rising demand stimulated by people living longer, and it needs to increase still further. That is a hard saying at a time of financial stringency, but with the number of 85 year-olds set to double in the next 20 years the level of demand will only go on rising relentlessly. I am afraid that that is just the problem that the Government have to deal with; if they do not, they will attract the opprobrium that rightly attends allowing a scandal to balloon out of control without making any serious attempt to deal with it.

Time is running out. Reforming the funding of social care is not the same as undertaking the upgrading of social care that is needed, so Dilnot is not enough. There will be more to do. I realise that it cannot all be done at once but, in addition to Dilnot, it will be imperative for the Government to commit to embracing a wider agenda. Workforce development is critical, but the proportion of care delivered by the private and voluntary sector has gone up from 56 per cent to 84 per cent in the past 10 years. Much of this will be concerned to keep costs to the bare minimum in order to turn a profit. The noble Baroness, Lady Bakewell, devastatingly laid bare, in the Second Reading of the Health and Social Care Bill, how this issues in a jumbo scandal of its own, with the Southern Cross debacle. This poses real challenges in recruiting a sufficiently high calibre of staff.

Finally, Dilnot’s fourth recommendation says:

“Universal disability benefits for people of all ages should continue as now”.

With the Welfare Reform Bill, that kind of joined-up thinking would appear to have gone by the board already.

There is need for some serious rethinking here. It is not yet quite too late.