Social Care Reform

Margaret Greenwood Excerpts

Thursday 18th March 2021 Westminster Hall

[Margaret Greenwood (Wirral West) (Lab) [V]]

It is a pleasure to serve under your chairmanship, Dr Huq.

Social care is in a state of crisis as a result of severe underfunding by Conservative Governments. There is very little detail about social care in the White Paper. The Government say they will bring forward separate proposals later in the year, but under the plans they have put forward, integrated care systems will be given a single budget for the health and social of their area, and an ICS will have the power to increase resources in some places and reduce them in others.

Understandably, people are concerned that they might see a reduction in the NHS or social care offer in their area and that a stark postcode lottery will emerge. What is the sense in creating a system where local NHS and social care providers will be competing with each other for funding at local level? For all the talk of joint working, that is what will happen if this is put on a statutory footing: the system will be robbing Peter to pay Paul, and levels of services and jobs within the NHS and social care will be impacted.

The White Paper states:

“There will be a duty placed on the ICS NHS Body to meet the system financial objectives which require financial balance to be delivered.”

A senior health manager explained to me that the point of having a single budget for a local health and social care system, and the requirement for the system to manage that budget, was to drive efficiencies in the system. He also told me that there needs to be a drive to reduce the number of people in hospital, and the White Paper supports such a drive. The proposals make it easier for hospitals to discharge patients by removing the legal requirement to assess patients for NHS continued healthcare and NHS-funded nursing care before they are discharged from hospital.

What about patient safety? Anyone who has experienced seeing a friend or relative discharged from hospital too early, only to have to be readmitted, knows just how serious this is. What will this arrangement mean for the millions of unpaid carers who will be asked to take over once their family member has been discharged from hospital?

The question of the social care workforce is crucial. Retention is an issue, because carers generally earn a lot less than nurses and other NHS staff. Given the duty of the ICS NHS body to find financial balance within the system, there is a concern that responsible social care employers who look after their staff and pay well will be less likely to be awarded contracts, and that there will be a race to the bottom when it comes to the pay and conditions of care workers. There is concern, too, about the influence that private companies will have on the ICS health and care partnership boards and that providers are being given the power to help to design the very services they want to deliver—representing the opportunity for direct conflicts of interest.

The Government produced their White Paper in the middle of a pandemic, when NHS and care workers are exhausted. They should call a halt to the proposals and carry out a full public consultation once, and only once, covid restrictions are lifted.

[Dr Rupa Huq (in the Chair)]

Now we go to the last man standing: Kevin Hollinrake.