Social Care Reform

Rupa Huq Excerpts

Thursday 18th March 2021 Westminster Hall

[Dr Rupa Huq (in the Chair)]

I remind hon. Members that there have been some changes to normal practice, in order to support the new hybrid arrangements. Members participating physically and virtually must arrive for the start of the debate in Westminster Hall and are expected to stay for the entire debate. I must also remind Members participating virtually that they are visible at all times, both to one another and to all of us in the Boothroyd Room. If Members attending virtually have any technical problems, they should email the Westminster Hall Clerks’ email address, which I think has been emailed to everyone. Members attending physically should clean their spaces before they use them and before they leave the room. We do not have any Members in the Gallery today, but Members should speak only from the horseshoe, where the microphones are.

[Barbara Keeley (Worsley and Eccles South) (Lab) [V]]

I beg to move,

That this House has considered social reform and the social care workforce.

It is good to have you in the Chair for this important debate, Dr Huq. I am pleased to open the debate. I pay tribute to the House staff who have enabled Westminster Hall debates to return with virtual participation.

The covid-19 pandemic has exposed the failings of our social care system. With more than 30,000 deaths of care home residents, the care sector has been hit hard over the past year. However, the fundamental problems in social care long predate the pandemic. A decade of underfunding meant that we were in a situation, even before the pandemic, where 1.5 million people were not getting the social care they needed. While social care is, rightly, the last thing to be cut by local councils, the reality is that areas that have seen half of their central funding cut since 2010 are left with little choice. Underfunding has led to fewer care packages, cuts to care packages and providers being asked to take contracts that do not even cover their costs.

One clear illustration of how this is going wrong can be found in long-stay in-patient wards, where 2,000 autistic people and people with learning disabilities are detained, at enormous cost to the NHS. One reason for that is the lack of resources in the community to support them. When local authorities cannot afford care and support in the community for autistic people and people with learning disabilities, it becomes easier to put them into inappropriate NHS in-patient units, even though community support would be cheaper and more appropriate. We also have older people forced to sell their homes because they are unable to access publicly funded care support until they have exhausted almost all their assets.

There has been much focus on care in care homes during the pandemic, due of course to the tragic death toll among people living in those homes, but we must also focus on the fact that social care is needed by working-age disabled people too, and that proposals for reform must cover their needs. In fact, one in three users of publicly funded care is under the age of 65, whereas only one in four is an older person in a care home, so the crisis in our care system affects more than vulnerable older people. It is a crisis not only of catastrophic costs, but of hundreds of thousands of people being denied the opportunity to live their lives as they would choose.

This is not a new problem. The reality is that social care has been struggling for more than a decade now. That is why the last Labour Government published a White Paper in 2010 proposing major reforms to the way social care is delivered and funded. However, once in government after the 2010 general election, the Conservative-Liberal Democrat coalition decided to drop those proposals in favour of starting another commission on reform. That led to the provisions of the Care Act 2014, including legislating for a lifetime cap on care costs, based on the recommendations of the Dilnot commission. That would have addressed some of the issues with the social care system, although I do not think any of us believed that it was anything like the full solution. Since that change was first delayed by the new Conservative Government in 2015, we have had any number of promises of future reform.

Ahead of the 2017 election, the then Prime Minister promised far-reaching reforms but promptly abandoned them. After that election, a Green Paper was promised by the end of 2017. At the end of 2017, the cap on care costs was completely abandoned and a new deadline of mid-2018 was set for the Green Paper. That was pushed back to autumn 2018, and then to the end of 2018. In early 2019, we were told to expect a Green Paper by April 2019.

When the current Prime Minister took office, he claimed to have a social care plan ready to go, and he repeated that claim during the 2019 general election. The Conservatives’ manifesto at the last election said that they would seek a “cross-party consensus”, but they have not tried to seek that consensus. In fact, a fairly broad consensus on the future of social care has developed. Politicians from across the spectrum, including the Health and Social Care Committee and the House of Lords Economic Affairs Committee, have endorsed the model of free personal care as introduced by Labour in Scotland. That system is not perfect, but it should be a strong position to start from. However, rather than acting on that consensus, we are still waiting for proposals nearly 18 months after the 2019 election.

When the Minister speaks, she may tell us that the Government are working hard on their proposals and will publish them shortly. She would be the third Minister of State to tell me that since the Government dropped their commitment to the cap on care costs, and we have already missed at least 10 deadlines for reform. That simply is not good enough. We need action now, not the promise of jam tomorrow.

If there is a team of civil servants working on this issue, there a few points that they should consider in order for reform of social care to work. First, reform must deliver a fair deal for care staff. If the crisis of the pandemic showed us anything, it was that without the hard work put in by care staff our care system simply would not work, but too often care staff are underpaid, undervalued and given few opportunities to progress. To fill the more than 100,000 vacancies we have for care staff, social care needs to become a career of choice, with better pay and conditions and better training. When the average starting salary is only £15,000, it is little wonder that people are not turning to a career in social care.

As a starting point, reform should mean that all care staff are paid the real living wage, as my own local authority of Salford is now doing. We need to see investment so that the social care sector offers training opportunities and real career progression for staff, recognising their skills and experience. If we are to fill the vacancies in social care, we need a wide strategy working across Departments to recruit and train the workforce that we need.

The Prime Minister has said that he wants to end the scandal of people needing to sell their homes in order to pay for care. It is right that we should address the issue of catastrophic costs, but that cannot be the only ambition of social care reform. If all we do is end catastrophic costs, we will still have nearly 2 million people not getting the support they need. With providers struggling to make ends meet, local authorities are left with no choice but to cut budgets even further.

We need reform that expands access to social care services. Over the past five years, we have seen fewer older people receiving care every year as eligibility thresholds have crept up in response to budget pressures. Preventive care is increasingly uncommon, with intervention mainly coming after a crisis. Rather than providing low-level support to enable people to continue living independently at home, we are increasingly providing care only once there is no prospect of someone living independently.

When the Health and Social Care Committee looked at access to care, one witness, Anna Severwright, told us:

“I feel that I am not able to live a normal life. I do not have enough hours”—

of care—

“to be able to go out at the weekends and in the evenings, and do a lot of the normal things that make life worth living.”

That is not good enough. People should not see their horizons limited solely because they need social care, but with budgets under ever-increasing pressure, money for anything other than the basics of care is rarely available. There is a better way to deliver social care than 15-minute care visits, and people should not have curfews on their lives because care is not available in the evening.

As well as funding care properly, we could embrace the spirit of the Care Act 2014 and ensure that care packages meet people’s social and emotional needs as well as their physical ones. That kind of person-centred support would enable more working-age disabled people to be productive members of society while also supporting older adults to enjoy later life. At root, social care should be about supporting people to live happy and fulfilled lives without facing financial ruin.

There is a very poor level of support for unpaid carers. There are 13.6 million people providing care to a friend or family member. Without them, our social care system would not cope. Funding for respite care is increasingly hard to get. Many carers say that they would use a respite break to attend a medical appointment.

Responding to an Adjournment debate that I led last Friday, the Minister for Patient Safety, Suicide Prevention and Mental Health said that

“45,000 carers have received respite or other carer support delivered to the person they care for.”—[Official Report, 12 March 2021; Vol. 690, c. 1212.]

We have 13.6 million unpaid carers, including 4.5 million who started caring during the pandemic. For a Health Minister to report that only 45,000 carers received respite care is an appalling record. We must do much more to support unpaid carers, and we could improve their lives by funding formal care services better.

It is now seven years since we put the Care Act into law, but the Government still have not delivered for people who use social care. After years of broken promises and delayed announcements, there is anger at the way social care has been underfunded and reform neglected. This has led to people who rely on social care going without the support they need to live fulfilling lives.

Underfunding has led to care staff being paid the minimum wage and not being given the time they need to provide high-quality care. It has also led to many thousands of people facing catastrophic costs of care, often having to sell their homes to pay for it, and over the past year it has meant 30,000 care home residents dying with covid-19. They were caught in a perfect storm of an NHS discharge policy that seeded infections into care homes before providers could implement infection control measures.

People who use social care deserve better than all of this. They deserve reform that delivers a fully funded, person-centred care system that meets their needs, and they need it now, not at some point in the distant future.

[Dr Rupa Huq (in the Chair)]

Given the popularity of the debate, and the fact that we have three Front-Bench spokespeople and a concluding statement from Barbara Keeley at the end, I am going to start with a time limit of three and a half minutes. There will be a clock visible at the side of Members’ screens, and the chaps here can pull the plug if they go over the limit. With all that in mind, I will start with Andrew Lewer.

--- Later in debate ---

[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.

--- Later in debate ---

[Munira Wilson (Twickenham) (LD) [V]]

It is a pleasure to serve under your chairmanship, Dr Huq. Social care is and has long been the poor relation of healthcare that successive Conservative Governments have promised to fix yet taken no action on. Here we are, eight years on from when the coalition Government announced and subsequently put into law a new model of social care funding based on Andrew Dilnot’s recommendations, but the Conservatives refused to implement it.

Instead, we had real-terms cuts in social care funding, and now we have yet another top-down reorganisation of the NHS that promises integration, but will do nothing to address the structural or funding reform needed in social care. The Budget, at the start of this month, did not even mention social care. Is it any wonder that most people feel that 1.5 million people with unmet care needs are just not a priority for the Government? Thank goodness for our 9 million unpaid carers, who daily pick up the slack and pay an enormous price, both financially and in their own physical and mental wellbeing, without any recognition. Where would we be without them?

Our care system, as many have already said, was already in peril pre pandemic and is even more so now. Adult social care has consistently been an afterthought for Ministers throughout this pandemic, with more than 25,000 lives lost in care homes to coronavirus and delays in securing PPE and testing for the care sector during the first wave. Many care homes are now teetering on the brink financially. The sector is crying out—with one voice, loud and clear—for a proper, joined-up workforce strategy. We have a staggering 112,000 vacancies, and one in six of the workforce are migrant workers, yet the vast majority of social care roles do not qualify under the new points-based immigration system, even after recent changes.

With 1.6 million social care workers earning less than the living wage, a quarter of the workforce on zero-hours contracts and limited career prospects, how on earth can we expect to provide decent, sustainable care for the most vulnerable adults in our country? The hon. Member for York Central (Rachael Maskell) referred to our mums and dads. It is not only our mums and dads but our brothers and sisters, sons and daughters; a large number of those needing care are actually working-age adults—almost half.

It is time for urgent cross-party action. The letter from the Secretary of State for Health and Social Care to all MPs last March inviting suggestions for social care really does not cut it. Over the last year, the Liberal Democrats have twice formally requested that the Government initiate cross-party discussions. As the Health Foundation says:

“These problems are not intractable but solving them requires political will and government spending.”

Given the monumental challenge before us, when will Ministers make good on the Prime Minister’s promise to fix social care and invite others to the table to help develop those solutions?

[Dr Rupa Huq (in the Chair)]

The good news is that Members have been very good at sticking to time, so we actually have a little bit of extra time to play with. If the three Front Benchers all stick to 11 minutes, that will give the hon. Member for Worsley and Eccles South (Barbara Keeley) time to wind up the debate. First of all, we are off to bonny Scotland and Dr Philippa Whitford for the SNP.

--- Later in debate ---

[Liz Kendall]

The hon. Gentleman may know that I have been calling for cross-party work on this issue for the past five years. The principles are clear—we should not leave the costs to individuals alone. We should pool our resources and share risks. That is essential for the future. I do not think any sort of private insurance system works. One issue around the cap on care costs was that the Government thought a private insurance market would spring up. That was not the case, and it will not be the right solution for the future.

The Prime Minister stood on the steps of Downing Street 19 months ago and said he would fix the crisis in social care with a plan that he “had” developed—that he had it already. It is still nowhere to be seen. Lord Bethell recently said that now is not the time to have fundamental reforms, because we are busy dealing with the covid crisis. I argue that now is precisely the time for reforms to give people hope that, after the horrors they have been through, there is a better system for the future. That is why I was disappointed not to see anything in the Budget about social care reform.

Yesterday, there was an unprecedented statement from social care leaders, who called on the Government to end years of inaction and fix the system. They said that as well as emergency funding, we need longer-term plans to make social care a cornerstone of the modern welfare state. The crucial point is the potential for social care not only to transform the lives of millions of older people, disabled people and families who use care, but to create jobs and drive economic recovery.

In the remaining minutes, I will focus on this point. We often talk about the costs of reform, but the costs of not reforming the system are just as important. First, social care has huge potential to create good quality, valued jobs in this country. We need 520,000 more frontline care workers just to meet growing demand by 2030. The Resolution Foundation rightly argues that if we want to create jobs immediately in every community—that is what we need to do to level up all parts of the country—social care is the place we should start, and I completely agree.

Secondly, investing in social care is essential if we want all families to be able to balance their work and caring responsibilities. In today’s world, with our ageing population, social care is as important a part of our economic infrastructure as the roads and the railways. When one in three unpaid family carers have to give up work or reduce their hours because they cannot get the support they need to help their loved ones, it is bad for them, because they lose their job and income; it is bad for business, because they lose their skills; and it is bad for the economy.

Finally, investing in social care is vital to make the best use of taxpayers’ money. We should not be paying more for elderly people to be stuck in hospital when they could be cared for in the community and at home. As we seek to get our public finances back on a more sustainable footing, value for taxpayers’ money is essential. This issue is the biggest challenge of our generation. I hope the Minister will tell us when the Government will introduce their reforms, because reforming social care is not just a matter of social justice, but an economic necessity.

[Dr Rupa Huq (in the Chair)]

Finally, the last of the all-female Front Benchers, Minister Helen Whately.