Independent Commission on Adult Social Care
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Lord Young of Cookham
To ask His Majesty’s Government what progress has been made by the Independent Commission on Adult Social Care.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
My Lords, the independent commission is making strong progress, and its work is on track. Just last week, the noble Baroness, Lady Casey, set out early recommendations for the Government to consider and take forward. This was informed by the commission’s extensive work, which included engaging with people and their families and across political parties. Later this year, the noble Baroness, Lady Casey, will launch the national conversation and publish the phase 1 report.
Lord Young of Cookham (Con)
I am grateful for that. Last week, the noble Baroness, Lady Casey, said that the adult social care system was held together by “sticking plasters and glue” and said on the “Today” programme that the system was “horrendous”. She is due to complete the first part of her review this year—basically, looking at getting better value from the existing system—but the second part, which will look at the long-overdue reform of the adult social care system, will not be completed until 2028. That will be too late for this Government to pass the necessary legislation, making this Parliament the fifth to have ducked this issue. The noble Baroness, Lady Casey, completed her review of grooming gangs in four and a half months. If asked, she could complete the second part of this review by September 2027, which would give us adequate time for this to be done in this Parliament. Will the Minister ask her to do just that?
Baroness Merron (Lab)
I understand why the noble Lord pushes this point, and I am sure that we all share his view. It has also been said that there is not a lack of good ideas, but there has been a lack of good politics. That observation has been made. The noble Baroness, Lady Casey, is chairing an independent commission and she has made it clear how complex and deep-seated these challenges are, as the noble Lord described. The 2028 date is a “by” date; the noble Baroness may report sooner, but that is a matter for her.
Baroness Pitkeathley (Lab)
My Lords, the noble Baroness, Lady Casey, concentrates on workforce issues. I am sure that she and my noble friend agree that patients, families and carers do not care who is employing the social care worker, as long as they are getting support. Should we concentrate on a flexible workforce that works across both agencies without boundaries to meet the changing needs of the population?
Baroness Merron (Lab)
That is key in the mind of the noble Baroness, Lady Casey. We need to better join up the NHS and social care workforces. We will have a workforce plan for the NHS in spring this year and we are also investing in developing our social care workforce to professionalise and respect it.
Baroness Barker (LD)
My Lords, last summer, local authorities came under pressure from the Department of Health to make people and their families go through assessments for continuing healthcare. From the speech by the noble Baroness, Lady Casey, on 4 March, we now know that ICBs were at the same time employing private companies to make sure that their CHC payments went down. Will the Minister undertake to review all the applications for continuing healthcare to each ICB throughout this financial year and publish the results, showing how many were accepted, how many were accepted on appeal and how many families were sent on a runaround between the different agencies?
Baroness Merron (Lab)
What the noble Baroness describes—people getting the runaround—is, of course, unacceptable, and we have discussed this a number of times. I would be pleased to take back her suggestion to the Minister for Care, Stephen Kinnock.
Lord Laming (CB)
My Lords, for what it is worth, I congratulate the noble Baroness, Lady Casey, on her initial findings, which illustrate all too well how serious the situation is. The problem will be made worse by things such as, as the Minister just reported, the NHS workforce plan that will be produced in the near future. That is welcome as far as it goes, but it illustrates the separation between NHS services and local authority services. The reality is that there are very few people using adult social care services who are not simultaneously looking to the health service for their continuous needs. Will we continue to do everything possible to bridge the gap between the two services?
Baroness Merron (Lab)
Yes, indeed. We have three core foundations in place in our government objectives for adult social care, one of which is—to the point made by the noble Lord—strengthening the join-up between health services and social care services, because people need to experience more integrated, person-centred care. I am glad that the noble Lord welcomes the immediate actions, set out by the noble Baroness, Lady Casey, that the Government must take on adult safeguarding, dementia and motor neurone disease. We are not wasting any time in taking those recommendations forward.
Lord Kamall (Con)
My Lords, picking up on the points made by the noble Baroness, Lady Pitkeathley, and the noble Lords, Lord Young and Lord Laming, when we were in government, we published a White Paper on an integrated national health and care service, to be available for patients from birth to their later years. When the new Government were elected, as was their prerogative, the Secretary of State talked about creating a separate national care service, but we have heard little since. Can the Minister tell your Lordships’ House whether we will have to wait until the next stage of the Casey commission, in 2028, to get any further details at all, especially on how it will work in tandem with our healthcare system, or can we expect any clues or hints before then?
Baroness Merron (Lab)
The noble Lord does not have to wait because, in addition to the work by the noble Baroness, Lady Casey, which, as I have said, is independent, she has set out immediate recommendations, which we are working on. We have already made commitments on the disabled facilities grant for housing, so that people can stay in their own homes. We have announced a £500 million investment in the first ever fair pay agreement, and we are uplifting social care allowances to support disabled people more than they ever have been. Those are just some examples, and I would be very happy to direct the noble Lord to other ways in which we are already taking action.
The Lord Bishop of Norwich
My Lords, in 2023, the Archbishops’ Commission on Reimagining Care encouraged a conversation not only between provider and recipient but with all those involved in care and support, to create rounded and fulfilled lives. That includes the voluntary sector, community groups and faith groups, which provide befriending and bereavement support and acts of worship in care homes. What plans does the Casey commission have to ensure that all parties participate in the national conversation mandated in its terms of reference?
Baroness Merron (Lab)
As I said earlier, that will be a matter for the noble Baroness, Lady Casey. But I have every confidence that all the groups the right reverend Prelate referred to will be included, not least because the noble Baroness and the secretariat have already met, travelled widely and had many conversations, including with some 400 groups and individuals, focusing particularly on those with lived experience.
Lord Sikka (Lab)
My Lords, 83% of adult social care is controlled by private equity. Its business model includes high prices, profiteering, low wages, asset stripping and tax abuse. It has profit margins of between 20% and 40% from adult social care. When are the Government going to end profiteering in this sector and ensure that social care is provided by not-for-profit entities only?
Baroness Merron (Lab)
Various sectors have their role to play, and that includes the private sector, the voluntary sector and the public sector. As I have mentioned, we are building a national care service. It will focus on a high quality of care, greater choice and control for individuals and joined-up neighbourhood services, exactly as noble Lords request.
Baroness Butler-Sloss (CB)
What can the Government do about bed blockers before the final report?
Baroness Merron (Lab)
I assume that the noble and learned Baroness is referring to people who are staying in unsuitable settings, such as hospitals, for too long because an alternative is not available. We are looking at reforming the better care fund, which assists a greater joined-up approach, and we are bringing in neighbourhood services so that people can be cared for nearer home. We are also harnessing technology—I have witnessed many good examples of that—whereby people do not have to be in hospital but can be at home, and the money we are investing so that people can improve accessibility within their own homes will also assist people to get back home.