Social Care

Lord Sutherland of Houndwood Excerpts

Thursday 29th November 2012 Lords Chamber

[Lord Sutherland of Houndwood]

My Lords, I too, thank the noble Baroness, Lady Pitkeathley, for organising what seems to be an annual reunion of those of us who are the usual suspects. I would like to think that after the Minister’s speech the noble Baroness will organise an annual celebration, but perhaps I will hold my breath on that.

My remarks are intended to help establish two main points. First, the lack of central policy in England on the relationship between social care and healthcare is creating huge uncertainties for both providers and clients. Secondly, much of the difficulty already recounted in the debate is to be found in the practicalities of providing unified care services for many of those who need them. These difficulties of both policy and implementation will not be resolved until there is clear leadership at both national and local levels. Alongside this, structures must be created to enable the positive implementation of new policies. I pay tribute to the analysis that the noble Lord, Lord Warner, just gave on this.

What of the uncertainties that I mentioned? The legacy of a decade and more of a failure of leadership to face demographic realities is that it has brought huge uncertainty and consequent misery. The realities have been known for a long time. The demographic changes in society are as plain as plain could be. Whether we think of the developed or the developing world, even China now has begun to take note of the fact that the one child per family policy is building future demographic nightmares. To compare that with something else, the facts of climate change are all too evident this week as much as any. Those facts now have a leadership response from the Government and things are beginning to happen. Perhaps some would like them to happen more quickly but they are beginning.

The realities of demographic change are equally plain if not less contestable. Why does no similar cold shower of reality bring minds and political will to the table of demographic change? I can think of many reasons for that. One is that we always have on our desks the “too hard” basket. It is easy—and has been too easy—to put this set of issues into that basket. I confess that my own “too hard” basket at home contains a series of domestic tasks that I think are too hard but my wife clearly does not. However, if I were a government Minister, I would have a rather different use for that basket. That is what tends to happen.

The second possible reason is that it will cost too much. The issue has been raised of how much is too much when the reality of demographic change, rather than evading it, calls for a change in leadership direction. Reality, not habit and precedent, should dictate priorities in spending. If reality means spending less on this or that to face demographic change, then so be it. That is not a request for an additional or new priority to be added, but rather to reassert and re-examine what our priorities are. Are they still top of the list in view of demographic change?

A third reason given for doing nothing is, “We shall deal with this after the next election”. We have heard that more than once. What we have after the next election is usually a request for a review, report or even a commission. God forbid that that is where we will be in 2015, but we begin to worry that that will be the reality. The burst of enthusiasm that leaders have before elections for this issue tails off into long discussion and prevarication. The Dilnot report is the latest example of this—and, some are beginning to fear, the latest victim.

What are the uncertainties of which I speak? There are uncertainties, for example, for those attempting to make provision for themselves and their family. There are questions that they all ask: “Where do I go?”, “Whom do I ask?”, “How much will it cost?”, “Can I afford it?” and, “Can I insure against future need?”. Those are real questions masking real uncertainties. There is uncertainty for those in the insurance industry, who could surely help us here. They ask: “Are the risks pooled in any way?”, “Is there a cap on liability?” and, “How much will the market bear as a charge for insurance products in this area?”. We tend not to pay too much attention to private providers and the banks which finance them, but they have uncertainty, too: “Should I invest in building new care homes?”, “Should I invest in extending, refurbishing and improving my current stock of care homes?”, “Will local authorities commission places from me?” and, “Will they be able to afford to do so?”. Bankers might reasonably ask: “Should my bank offer loans to any of the above?”. Unless there is investment, there will not be adequate provision for the future. The banks would reasonably ask what the rate of return will be.

Then, of course, there are the uncertainties for those already in the care system: “Will I have to sell my house?”, “What happens if the money runs out?”, “Is my care package portable if I move to be nearer relatives?” and, “Are benefits assessed and commissioned to common standards or is there still a postcode lottery?”. I acknowledge the points made by the right reverend Prelate the Bishop of Liverpool on that. There will be differences and those will become accentuated. Successive Governments have failed to deal with these core uncertainties over at least 15 years. Ironically, the only certainty is the remorseless march of demographic change and yet we do not recognise it for what it is. The system is burst and we must fix it, and fixing it means radical thought and change.

In conclusion, I refer the Government to some recent research sources which point to future action. The King’s Fund has already been mentioned more than once. It commissioned a series of studies recently, including an excellent and balanced study by Raphael Wittenberg and his colleagues from the LSE. These complement work in this area in pointing to the central pathway down which we must travel—a unified system of providing and funding care, initially and most importantly by removing disincentives to combining assessment, commissioning and the provision of care packages. As the noble Lord, Lord Warner, pointed out, the disincentives are there now and we have to get away from that. We all know something of the problem of delayed discharges and unplanned hospital admissions—indeed, of unplanned readmissions. The separation of the budgets for health and social care and restrictions within healthcare budgets between one area and another add to the difficulty rather than contract it.

Lastly, in the University of Edinburgh and the Royal Infirmary, Edinburgh, there is important new research about what happens to those discharged from intensive care units. The researchers reckon that approximately 60% will be readmitted. Many of those readmissions are unplanned. The reason for that—this is an area to which not enough attention has been given—is a lack of coherent and adequate community provision. A re-examination of priorities would show real leadership.