Adult Social Care

Lord Markham Excerpts

Wednesday 22nd November 2023 Lords Chamber

[The Lord Bishop of London]

To ask His Majesty’s Government what assessment they have made of the financial situation facing adult social care leaders and providers, following information published by the Association of Directors of Adult Social Care Services that 83 per cent of councils expect to overspend by an average of 3.5 per cent on adult social care in 2023-24.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

The department carries out regular assessments of the financial pressures facing adult social care. Since the spending review, the Government have made available up to £8.1 billion in additional funding over two years to support adult social care and discharge. This includes an additional £570 million announced in July. This will put the adult social care system on a stronger financial footing and improve the quality of and access to care.

[The Lord Bishop of London]

The autumn survey of the Association of Directors of Adult Social Services paints a worrying picture of the state of adult social care: a third of directors of adult social care services said that they have been asked to make additional savings to their budgets, on top of the £1 billion of savings that they are expected to make by 2024-25. The Homecare Association’s deficit report, published on the same day, states that providers are being paid less than the work costs and cannot pay their employees a competitive salary. In this context, can the Minister explain what outcomes social care users can expect to see as a result of the investments he spoke of?

[Lord Markham (Con)]

I thank ADASS for its report. The outcomes we are seeing show a number of things: as well as the £8.1 billion investment we put in, we have brought down waiting lists for assessment by 13% since the peak level. We are seeing high levels of satisfaction with a lot of the work we are doing; 83% of people say that they are satisfied with the services they are receiving. Yes, there is a lot more to be done, but there is a lot of good progress as well.

[Lord Forsyth of Drumlean (Con)]

My Lords, in July 2019, the Government promised that they would fix the crisis in social care. When does my noble friend think that that will be redeemed?

[Lord Markham (Con)]

Always at this point, I find that the best tactic is to offer my noble friend a meeting. The People at the Heart of Care 10-year plan is exactly what we are trying to design here. I mentioned some of the progress that is being made: we have seen recruitment go up and an increase in staffing, and we have a put in place a qualification for staff, so that they feel there is a career structure for them. The number of people is going up year on year. Yes, there is a lot to do, but we are getting there.

[Baroness Pitkeathley (Lab)]

My Lords, according to the same survey cited by the right reverend Prelate, 68% of directors reported unpaid carers having break- downs because of burnout from stress, and half a million home care hours had not been delivered because of a lack of staff. Carers UK published a survey showing that 25% of unpaid carers are going without food and heating because of the demands of caring. When will the Government commit to a national strategy for carers to address some of these problems?

[Lord Markham (Con)]

We realise that they are the hidden army, and they are tremendously valued. I think noble Lords know that I have some personal experience of this. We have tried to put some measures in place for payments; I perfectly accept that it is not the same as a full wage, but payments have been put in place. We are also introducing respite care, so we are taking steps in that direction to recognise the vital service they all provide.

[Lord Allan of Hallam (LD)]

My Lords, I know the Minister is keen to ensure that people who are fit to leave hospital can do so quickly, but is he concerned that local government spending restrictions, imposed because of the state of the finances highlighted in the Question from the right reverend Prelate, may lead to more delayed discharges this coming winter? What steps are the Government taking to ensure that that does not happen—a hospital saying that a patient should leave, but the local authority saying that there is nowhere to go?

[Lord Markham (Con)]

The noble Lord is absolutely correct that the flow through the hospital is vital to A&E and other wait times. That is why we have announced things such as the virtual ward: the 10,000 beds are designed to get people out of the hospital and into a care environment where they still feel supported, thereby using technology to help take the strain. The point about this year, and the whole reason why we announced the £600 million extra investment over the summer, is that we learned the lessons of the previous year, recognising that the earlier we can get this money to the local authorities, the better they can spend it to put the provision in place.

[Baroness Blackwood of North Oxford (Con)]

My Lords, investment is welcome but reform is also vital. The NAO’s autumn report noted that my noble friend’s department ended its charging reform programme board and

“has not established an overarching programme to coordinate”

reform activity. It is instead delivering reform

“through a series of 27 projects which report to the director-general … via nine separate programme boards”.

Can my noble friend investigate this to see if there could be better co-ordination of reform to ensure that it is delivered more effectively?

[Lord Markham (Con)]

My noble friend is correct, in that having so many local authority and private sector providers means it is a confusing space in which to bring all this together. The People at the Heart of Care White Paper is trying to co-ordinate that and at the same time provide a career structure, because we know that the bedrock of all this is the staffing, and this needs to be an attractive space for people to work in. Therefore, giving them that recognised, transferable qualification which they can take into nursing and other areas as needed is vital in ensuring that we have the workforce to underpin this.

[Baroness Wheeler (Lab)]

My Lords, the NAO’s recent figures show that so far, only 7.5% of the much-vaunted £265 million allocated by government to addressing social care staffing shortages and recruitment for 2023-25 has been spent due to the DHSC staff recruitment freeze; and the training workforce development programme has also stalled because the department has not managed to set up the necessary systems to administer provider payments. What is the Minister’s response to this and the ADASS survey finding that government investment in social care so far has just stopped the ship sinking and has not moved local authorities out of the storm they are trying to navigate?

--- Later in debate ---

[Lord Markham (Con)]

As I say, we are seeing staff increases. I accept that there is a lot to do in this space, but there has been a 1% increase this year, so we have turned things round quite substantially. Overall, the number of patients being cared for in this way went up by 15,000 in the last year. As the ADASS survey showed, there has been a decrease in the waiting lists, down 13% from the peak, so we have turned a corner and we will see further improvements.

[Lord Watts (Lab)]

My Lords, the Minister said that waiting lists have gone down by 13%. Can he tell us by how much they went up over the previous 12 years?

[Lord Markham (Con)]

I do not have the figures for those 12 years, but I will happily send them to the noble Lord.

[Lord Young of Cookham (Con)]

My Lords, further to the original Question from the right reverend Prelate, is not the real problem facing the care sector that of recruiting and retaining care workers, who can often earn much more in a local supermarket than in a nursing or residential home? What action are the Government taking to make this a more attractive profession for people to go into?

[Lord Markham (Con)]

My noble friend is correct; they are the bedrock and are valued, and it is important that we make them feel valued. As I said, we are reforming the process in order to give them a qualification, which means that that work in the social care setting will be transferable between positions. In addition, if they want to go further into the medical service, be it nursing or other areas, a modular qualification system will enable them to build towards that, so that they not only feel valued but are in a long-term career structure.

[Lord Weir of Ballyholme (DUP)]

My Lords, many families seeking adult social care can find that availability and quality are patchy; and particularly for those living in rural areas, the help they receive can effectively be a postcode lottery. What steps are the Government taking to drive consistency and equality throughout the system, so that every family can receive the level of adult social care that is needed for their loved ones?

[Lord Markham (Con)]

That is a good point. We have given the CQC responsibility for measuring local authority provision of care. Overall, we are seeing a high satisfaction rate—89%—and the number of complaints went down by 16% in the last year, so these things are making a difference.

[Lord Hunt of Kings Heath (Lab)]

My Lords, does the noble Lord agree that if we are truly going to fix the problem, as the noble Lord, Lord Forsyth, said and as Prime Minister Johnson promised, we have to deal with the issue of self-funders, who are having to pay thousands of pounds over years without any support from the state above a very limited means-test level? When will the Government come forward with proper proposals to deal with this?

--- Later in debate ---

[Lord Markham (Con)]

I think we all accept the points made by the noble Lord and my noble friend. By way of context, after 2019, the huge disruption of Covid came right in the middle of this, with all that that meant for the dislocation of the health service. We have to accept that that is a factor. The market sustainability and improvement fund tried to ensure that the amount local authorities pay for fees is fairer, as there is cross-subsidisation of those who pay privately. I accept that, in terms of the overall objectives set in 2019, there is more work to do, but that is still the Government’s ambition.