(2 years, 6 months ago)
Lords ChamberRead Hansard Text Read Debate Ministerial Extracts
Baroness Pitkeathley
To move that (1) this House takes note of the challenges facing Social Care in England following the pandemic, and (2) further notes the effect that (a) the Health and Social Care Levy, and (b) Her Majesty’s Government’s Social Care plans, may have.
Baroness Pitkeathley (Lab)
Well, my Lords, here we are again. In the 24 years I have been in your Lordships’ House, I have lost count of the number of debates on social care in which I have participated, joined by the intrepid band to whom I usually refer as the “usual suspects”. In fact, at times we have found it difficult to fill a debate, so unpopular was the topic. I am glad to note that it is very different this time; many want to speak. Of course, the Minister is very much not a usual suspect, so we welcome him and hope he will be accommodating and bold in answering this debate, as I have always asked Ministers from all sides to be.
The debate, like Gaul, is in three parts and reflects the new situation in which we find ourselves since our last debate in April 2020. We have come through a pandemic and at long last—at very long last, many of us would say—have some government proposals addressing the crisis in social care which in the past we all agreed—the degree of consensus on this was remarkable—was bad for everyone concerned.
The Public Services Committee, of which I am a member, concluded that while the crisis in acute care during the pandemic was dealt with relatively successfully it was followed by a devastating crisis in adult social care. Older people and working-age disabled people with care needs were left particularly vulnerable. The large number of deaths in this group may have been the most significant public service failing in the pandemic. These were due to the pre-existing weaknesses to which we have been pointing for years, including the lack of integration between health and social care, and successive Governments prioritising the NHS while neglecting to fund social care adequately.
These problems are far from new. Many inquiries, including parliamentary inquiries such as that by the Economic Affairs Committee, have focused on the need to fund adult social care properly, put more focus on prevention and address the poor integration between health and care services. The Covid crisis highlighted the effects of all these long-standing problems between health and social care and, as Age UK put it, “laid bare” the stark inequalities of the current social care system and
“revealed the true extent of the impact underfunding, structural issues and market instability have had on the system’s ability to respond and protect … people at a time of crisis.”
The initial pandemic response made protection of the NHS a priority, which had a detrimental effect on social care. The rapid clearing of hospital beds revealed too little consideration of the fragility of care settings and resulted in too many deaths.
Inevitably, I must focus on the effect on unpaid carers—as your Lordships know, I always emphasise them—who are propping up whatever system of care we have. Let us be clear about the numbers, which are provided by Carers UK. There were 9 million unpaid carers across the UK before the Covid pandemic, providing everything from a few hours of support a week to intensive and complex round-the-clock care. The pandemic has resulted in about 4.5 million new carers, 2.5 million of whom are trying to juggle paid work with caring. This takes the estimated total number of carers to 13.5 million and the annual value of what they contribute is now estimated to be £193 billion every year.
Carers have been particularly hard-hit by Covid and many have had to make extremely difficult decisions about work and family. Some 81% say they are providing more care because services were closed or not available due to lack of PPE and care staff self-isolating or having caring responsibilities themselves. Yet the Build Back Better plan hardly mentions unpaid carers or how they will be supported. The Government have assured us that the forthcoming White Paper will address this, but when the Secretary of State for Health and Social Care said in his speech to the Conservative Party conference that care “begins at home” and people should turn to family first, it was hard to believe that the Government understand that this is precisely why there are 13.5 million carers. They do turn to their families first. His remarks were seen as uncaring and disrespectful to the millions of carers who never questioned their duty to their family.
Let us try to be positive and thankful that at least the pandemic has made us focus on social care more than ever before. The government proposals for which we have been calling for years have now come out, so I will turn to those.
That the social care sector needs more money and that this money should be found from taxation is never in doubt. However, there is puzzlement, even bewilderment, in most agencies about the Government’s chosen method of raising these taxes, using a levy on national insurance. Let us face the stark fact that not a single penny of the money raised by this method will go to front-line social care. We know that it will initially go to the NHS, for at least two years. I do not begrudge the NHS the money. Having just been told that I have to wait 42 weeks for a telephone conversation with a consultant, of course I do not begrudge it. I just do not want anyone to be conned into thinking that the tax raised by the levy will solve social care problems.
Even after social care—endlessly the poor relation whenever reforms are discussed—gets any of the money, it will go to helping a small number of families be relieved of care costs and the need to sell their houses. How will this stop the 15-minute visits by overworked and underpaid care staff, or give them even slightly better pay? Indeed, those overworked and underpaid staff will be paying towards this levy in their wage packet, as will their employers, largely in the private sector, whose profits—the only thing which keeps them in business—will be further eroded.
It is now 10 years since this House passed the legislation for the Dilnot review. Many of us spoke in favour of it at the time. However, the cap has been set so much higher than recommended that it is far from clear whether many people will actually benefit. I must point out—few people understand this—that the cap applies to the cost of nursing in residential homes only and does not include the so-called hotel costs. It will help a few better-off families, leaving most to pick up the bill, or subject to the vagaries of local authority funding.
In addition, it will add to the complexities of an already far too complicated funding system and add to the danger that any money coming to social care will be spent on bureaucracy, making assessments, testing eligibility and explaining to bewildered families why care costs so much, and why the picture in the social care sector is very different from that in the health care sector. Moreover, it will do nothing to improve the standards of care received by older people or those working-age adults with disabilities who make up at least one-third of those needing care, a fact which often seems to be overlooked in the emphasis on older people.
The debate in your Lordships’ House on 11 October makes interesting reading regarding how the levy proposals are viewed. It is hard to find any support for the proposals and there is great disappointment in the failure to address the promises which have been made about “fixing” social care. Surely fixing requires two things above all: enough money and better integration.
As to the former, the Institute for Fiscal Studies, quoted by my noble friend Lord Eatwell in Monday’s debate, says that
“it is clear that the extra funding will not be sufficient to reverse the cuts in the numbers receiving care seen during the 2010s.”
The IFS also points out that
“many people with care needs not considered severe enough will continue to miss out.”
Moreover, the latest IFS report published this week says that the £12 billion which will be raised annually by the tax rise is sufficient only to fix the immediate shortfall faced by the NHS and would need to double by 2025 to have any hope of keeping up with NHS, let alone social care, needs.
Integration with the NHS is seen as a vital need. There has always been political agreement across the board on this, yet I am mystified as to how these proposals will address it. At a time when waiting lists for the NHS are growing longer by the minute, should it not be a priority to ensure that no one stays in hospital longer than they have to by having discharge procedures which provide a seamless transition and making sure that the all too frequent readmission because of inadequate co-operation between the NHS and local authorities is guarded against?
We heard again only yesterday that care jobs are unfilled and requests for care are being turned down because of staff shortages. Local authorities are struggling terribly to recruit enough workers to meet increasing demands. That is no wonder when you can earn far more by filling shelves in Sainsbury’s.
The minute someone is admitted to hospital, health services, social care and the often ignored but very significant voluntary services should plan between them for what will happen on discharge. Sadly, the usual pattern is for a conflict to emerge, on a Friday afternoon, between a hospital ward desperate to empty beds and social care services inadequately prepared or even informed. The Government’s plans should include commitment to such planning and co-operation. Thus far, they do not.
As I turn to the third part of the Motion, the effect that Her Majesty’s Government’s plan for social care will have, I feel more regret than anger, because these proposals represent such a failed opportunity and once again see social care as the poor relation—the Cinderella, as some have called it. Social care could be at the heart of a levelling-up agenda, if we had a vision for its workforce and for the impact it has on the health of a community in its broadest sense. Care providers could be encouraged to diversify their businesses and to reach out creatively into the community by providing tax incentives, for example, or a reduction in business rates.
If we want a high-skill, high-wage economy, as we are increasingly told we do, what better place to start than social care, with its huge workforce, badly paid but certainly not unskilled? Those skills could be developed by providing training, and retention could be dealt with by better career progression and recognition of qualifications. If you provide more support to unpaid carers, you get the very best out of that huge but unrecognised workforce, and if you help them combine paid work with caring responsibilities, you not only help them financially now but save them from poverty in future. Surely that makes good economic sense, as well as being morally imperative.
It is possible that the Government intend to address those issues in the forthcoming White Paper, and I hope that the Minister can assure us about that. I also hope that he can assure the House that integration between health and social care will be seen as a priority, as there is a sad lack of any such incentive in the current proposals. Has he considered an integrated workforce with cross-discipline skills? How about integrated budgets and data sharing? Will all those failed opportunities be addressed in future policies? If they were, I really do not think it would be difficult to get the cross-party agreement and support that Ministers say they are aiming for.
Above all, I regret that there seems to be no attempt anywhere to address the causes of the difficulty in both health and social care, leaving the Government open to the charge of a sticking-plaster solution. Levelling up must surely include addressing the health inequalities which are the result of poverty and inadequate services, and which, sadly, have increased after a decade of public spending cuts.
The most efficient way to ensure that our health and social care services are not overwhelmed by demand is to make sure people do not need them as much. As Sir Michael Marmot has said:
“We need to adopt a health and social care system which prioritises not just the treatment of illness but how it can be prevented in the first place. The pandemic has made it crystal clear over the last 18 months why public health and … the social determinants of health, are so important. The health and social care agenda must be re-balanced … towards prevention”.
That, surely, is the sort of vision we should have for social care.
We eagerly await the White Paper, but I must tell your Lordships that the current proposals, with their inadequacies and lack of understanding and vision, do not fill me with hope. I beg to move.
Baroness Tyler of Enfield (LD)
My Lords, I congratulate the noble Baroness, Lady Pitkeathley, on her excellent opening speech. It is a privilege to follow her.
We debate social care today at a time when, after years in the shadows, the crisis that is social care is no longer hidden from view but at last has come into stark public and political focus. What has changed?
First, as we have heard, the pandemic has cruelly exposed the plight of those dependent on social care. Nothing illustrates this more than the number of deaths of care home residents due to Covid: in England, it was estimated at 40,000 in the year ending this March, unlikely to be an underestimate. As the journalist Robert Peston wrote after reading the damning report published this week by the two Commons Select Committees on the lessons to be learned, the section on care home deaths
“will probably make your blood boil.”
It remains a national scandal.
Secondly, we now have the bare bones of the health and care levy, which many of us debated on Monday. I shall not repeat what I said then, but if the Prime Minister and the Health Secretary read that debate, it would have been a salutary experience. Speaker after speaker—from all Benches—made plain that the much-vaunted fix for social care was, frankly, anything but, with only a small portion of the £12 billion raised likely to go into social care in the next three years. Most of the money will be sucked into existing acute NHS pressures—much needed, of course, but with no guarantee of sustainable funding beyond that.
The cost of decades of inaction has fallen particularly hard on the shoulders of the estimated 11.5 million unpaid carers in the UK, some of them aged 80 and above, whose contribution to the current system is almost completely ignored, despite the fact that they are the only thing stopping it from complete collapse. Carers UK has estimated that unpaid carers save the Treasury some £193 billion a year.
Part of the problem has been the way in which the debate is invariably framed, particularly by the Prime Minister, as being all about avoiding making people sell their homes to pay for care. In reality, it is about so much more than that, and it is not just the elderly who are affected. Younger disabled adults make up half the cost of adult social care budgets.
The social care sector is complex and little understood, and the challenges facing it myriad, but, briefly, despite spiralling demand, particularly due to an ageing population, spending is lower than 10 years ago. Government funding for local authorities fell by 55% in the decade between 2010 and 2020, and the existing means-tested system, with its high threshold for care, has resulted in many people who needed care being unable to qualify for support, either in their own home or in a care home.
The King’s Fund has described the pandemic as having a devastating effect on the quality of care, despite some short-term additional government funding via local authorities and infection control. The costs of Covid and the fall in care home occupancy put many providers at risk of failing or simply handing contracts back. Fees vary considerably, depending on geography, and people who do not qualify for free care—self-funders, in the jargon—end up cross-subsidising local authority-funded residents. Again, they are essentially propping up the whole system.
Perhaps most fundamentally, a vastly underpaid and undervalued workforce receives little or no training or professional development, resulting in high levels of turnover and vacancies. Care companies are facing acute problems in retaining and recruiting staff, including according to a report published this week by Skills for Care, which suggests that there are now more unfilled care jobs than before the pandemic. The Public Accounts Committee has described the pandemic as having
“a devastating impact on the care sector.”
Those recent injections of cash, while welcome, and the local authority precept, provided some short-term relief, but the capacity to raise money is neither sufficient nor evenly spread, leading to reduced local services, particularly in deprived areas, and minimal care packages.
Against that backdrop, can the Minister, who I welcome to his new role, tell us what plans the Government have to bring forward a sector workforce plan, similar to that of the NHS, with proposals on career progression and pay, as called for by both the NAO and Care England?
All the above, of course, causes knock-on problems for the NHS, in both increased admissions for those unable to look after themselves at home without care and long delays in discharge from much-needed hospital beds due to the lack of social care in the community. The post-pandemic NHS backlog will not be solved without an immediate injection of cash for the social care sector. Urgent action is needed to shore up a fragile and highly fragmented sector reeling from the impact of the pandemic, with some care homes, often debt-laden and with unsustainable business models, becoming increasingly financially unviable.
Immediate funding is needed for the quality of care, to introduce minimum standards for care homes and to provide respite for unpaid carers. Above all, we urgently need a new deal for the care workforce, including action on pay, training and development, career progression and recognition. As I have said before, care staff, who have given so much during this pandemic, deserve to be paid well above the minimum wage.
To conclude, social care cannot wait until 2023 for additional funding, so can the Minister tell us what plans the Government have to provide an immediate and significant cash injection to local authorities as we head into the winter months for the delivery of adult social care services, including support for unpaid carers, in the spending review in a couple of weeks’ time?
Lord Astor of Hever (Con)
My Lords, I also welcome my noble friend the Minister to the Dispatch Box and wish him all the best with his new responsibilities. I congratulate the noble Baroness, Lady Pitkeathley, on securing this debate. The issue of carers is very important.
The Prime Minister set out his plans for health and social care reform in his excellent policy document last month. On the one hand, he said, it would add up to the biggest catch-up programme in the history of the National Health Service, and at the same time would address the
“long-term problems … that have been so cruelly exposed by Covid.”—[Official Report, Commons, 7/9/21; col. 153.]
These long-term problems, let us not deceive ourselves, affect each and every one of us.
One of the most challenging problems has been revealed to be the chronic shortage of care staff, a situation that endangers the well-being of the most vulnerable among the population. Also the proper management, training and deployment of care providers needs addressing. Sadly, Brexit, wholly justifiable vaccination requirements, post-Covid fatigue and the prospects of higher pay in other sectors have not helped the situation.
Covid began a nationwide debate, a tumultuous vox pop, that made people sit up, listen and respond with their own accounts of suffering. It drew people together and showed our dependence on each other in the community. Through the media, individuals and family groups up and down the country were able to share personal experiences, often shocking and heartbreaking, which revealed a range of avoidable shortcomings in the health and social care system. I can only hope that, as the past has shown us time and again, out of crises great advancements can be made. This is especially true in health and social care, and I am confident that the Government are capable of setting in motion a bold programme of reform, although it will require a great deal of organisation and commitment, in addition to funding.
Greater integration of social care provided by the National Health Service through local clinical commissioning groups and that provided by local councils is one area that is under considerable pressure; and I should like the Government to focus on that. I understand that radical plans for such integration are being actively considered by the Health Secretary. I am sure that the Minister will address that in his wind-up speech.
The experiences of a family that I know living in the West Country with two severely disabled adult sons suggest that healthcare support across the nation is patchy and variable according to postcode. They have experienced profound ignorance at junior levels as to the delivery of an effective social care service, and believe that the protective territorialism and empire-building that they have witnessed need urgent addressing, with integration managed from the top and implemented locally.
Adopting a holistic modus operandi, with an emphasis on common sense and compassion, must be the best way in which to tackle the complex and multilevel needs of the population. All of us, with our lives being extended through access to modern medicines and diagnostics, will need greater recourse to treatment and support from the National Health Service.
Health and social care reform requires the support of a complete mindset reform to enable these improvements to happen: a recalibration of the imbalance between rights and responsibilities, and the recapturing of the spirit of working together for the greater good that was present at the very inception of the National Health Service.
Baroness Finlay of Llandaff (CB)
My Lords, I congratulate the noble Baroness, Lady Pitkeathley, on obtaining this debate, her important opening speech and her constructive suggestions. I welcome the Minister to his crucial role in the future well-being of the nation. I must declare that I chair the National Mental Capacity Forum and am vice-president of Marie Curie, which provides a great deal of care to people in the community as they are approaching the end of life.
Looking forward, we must fix social care properly. I have worked for decades with social carers in an integrated way through the hospice movement, where it is evident that those providing social care are an essential support to people with severe and life-limiting illness, and to their families. Without input from social care, families would break. Where there is a young parent who is ill, their children need to know the person who is coming to provide support to their parent—a person to whom they often look for emotional support also. Where a child or young person has learning difficulties compounded by physical problems, their social care is literally a lifeline for all in the family. Let us not forget the underage carers in so many families.
No one should think that social care is simply about washing, dressing and eating. It plays a vital role to enable the carers of people at home to cope with their own lives, go to work, go to school and study, and manage all aspects of the home. For the person, social care can make all the difference between feeling a burden, worried that one’s family is being worn down, and being able to function still in one’s role within the family and society. Where good social care is in place, people with profound disabilities are often still able to work with the support of different aids and adaptations, and I have been struck over the years by the number who have run businesses, written papers and even books. It is their carers who they praise as the person enabling them to do this.
Sadly, Marie Curie found that, during the pandemic, 61% of carers said that the person who had died had not had all the help that they needed with personal care before dying at home. More than three-quarters of carers said they did not receive all the care and support that they needed. It is the carers who spot when somebody is less well and when things are deteriorating, and is often the person who triggers the call to the GP or district nurse to come in and diagnose what has changed, alter medication and review the way in which an illness is managed. No one should think that these carers are unskilled or low skilled; they are not. They are very skilled and often have a wealth of experience.
When I was medical director of the hospice in Cardiff, I often looked to the care assistants just as much as the trained staff for important information on patients and families. They spotted whether families were behaving oddly. They would alert me to changes in a person’s condition because, when they took them to the bathroom or helped them with the meal, they spotted changes early. Patients talk to carers because they are not part of the power differential between professionals and patients. Patients often tell doctors and nurses what they think they want to hear, but will be much more open and frank with carers about worries and concerns that they may feel are too trivial to trouble trained staff with but are crucial.
Social care is essential to free up places in hospital. Carers should be there when somebody comes home; that transition from hospital to home is a vulnerable time both physically and psychologically, particularly for those who live alone. If hospital discharges do not happen, the backlog right through the system to the ambulance at the front door of A&E only worsens. It has been estimated that NHS bed days lost to delayed hospital discharges rose by 50% between 2015 and 2017—before the pandemic—when the number of beds available was decreasing in the hospital sector. This, of course, produced greater pressure.
Social care work is hard work. There is a workforce turnover of more than 30% and we must be able to retain skilled and experienced care workers by making sure that this is an important, high-status job, and that the travelling time between clients’ homes is recognised. For those who are unpaid family carers, we should consider carers’ leave, particularly when they are caring for someone who is dying at home.
As we move forwards, the reforms set out in the Health and Care Bill should ensure that every part of England is covered in an integrated care system, with close collaboration between the NHS, local government and other partners. However, it is deeply concerning for people living with terminal illness that there is no requirement on integrated care systems to ensure that they commission palliative care services. I therefore give notice that I will be bringing forward an amendment to the relevant Bill and I hope that the Minister will be able to assure me that the Government will consider carefully amending the Health and Care Bill to include a requirement for every integrated care system to arrange for the provision of specialist palliative care services to meet the needs of the population. Everything must be integrated for the benefit of all.
The Lord Bishop of Oxford
My Lords, it is an honour to contribute to this key debate. Like others, I am grateful to the noble Baroness, Lady Pitkeathley, for her excellent introduction. I welcome the Minister to his new responsibilities. It is a privilege to follow the noble Baroness, Lady Finlay.
One of the key texts on which so much of our human civilisation is based contains these lines:
“Honour your father and mother, so that your days may be long in the land that the Lord your God is giving you.”
The care offered by one generation to another is fundamental to human flourishing and a good society. As we have heard, that care is offered in families generously and unstintingly, but it needs to be supported by the wider community, through creative partnerships with the third sector, and by the state. These principles have led to our current system of social care, which now stands in urgent need of fresh vision and reform.
Honour is critical to both the fifth commandment and the social care system. Our vision and aspiration need to rest on giving honour and dignity to each person—regardless of age, illness or disability—and to all those who offer care, whether volunteers or paid workers. Social care is under strain and goes badly wrong when we lose this concept of the dignity of those who need and offer care.
As has been said, the initiatives taken by the Government in September and the increases in funding are modest. Caveats have been articulated, including by the right reverend Prelate the Bishop of Carlisle in Monday’s debate. Much more is needed. As has been said, the NAO called in March 2021 for nothing less than a
“cross-government, long-term, funded vision for care.”
I hope that this could build on a foundation of human dignity and honour, with a proper emphasis on prevention and equality. The same report calls for a workforce strategy, which, as others have argued, is urgently needed and needs to be built on the same foundation.
In the coming years, the world will face a fundamental revolution in the nature of work, with a massive increase in automation in many industries. The social care sector can benefit from the fourth industrial revolution in many ways, particularly in better systems and the use of data. It is the Government’s responsibility to offer leadership and frameworks for this. However, person-to-person care can never be delegated to machines or systems. Such delegation diminishes dignity and honour. When members of my family have needed social care, the real gift has not been the practical support, vital though that it is, but the caring touch, warm smile, sharp humour and repartee that restores the dignity of the person, even in extremes of suffering. To give this honour and dignity to others, those who work in social care and offer care voluntarily themselves need dignity, recognition and honour.
Increasing that sense of honour demands practical actions that neither public applause nor rhetorical promises alone can fully fulfil. Over the past year, on average, more than 100,000 care sector vacancies have been advertised every day. As has been said, the vacancy rate today is higher than it was before the pandemic. In the coming years, the Government will have an opportunity to develop a new social contract for social care, framed by dignity and which invests in the social caring professions in terms of standards, training, recruitment, pay and conditions. This sector will need to expand, even as jobs are lost to automation in other sectors, and will be a growing part of our economy. That social contract will need to embrace better support for voluntary carers and deeper co-ordination between the NHS and local government, as has been said.
I ask the Minister to comment in his answer to the debate on the values that will need to shape the long-term vision for social care and the place of human dignity and honour within them.
Baroness Warwick of Undercliffe (Lab)
My Lords, I congratulate my noble friend Lady Pitkeathley on her devastating opening speech, which set out vividly the challenges facing social care and the inadequacies in the Government’s proposed response. I am glad to join in noble Lords’ welcome to the Minister.
This is, I think, the fourth time in the last month that this House has expressed its concerns about the Government’s approach to social care. On Monday, the noble Lord, Lord Agnew of Oulton, introduced the Health and Social Care Levy Bill, when speakers from all sides of the House expressed real anxieties that the Government’s proposals will not address the key issue: that too few people are getting the level and quality of care that they need. Given that this is the Government’s flagship Bill to resolve one of the biggest challenges facing the country, the lack of confidence in your Lordships’ House and elsewhere is desperately worrying. I hope that, in replying to this debate, the Minister will seek to assure us all that the Government are listening to these concerns and that they will be reflected in the next stage of their plans for both resources and social care reform.
Successive Governments have neglected social care, and the pandemic has dramatically shown that the sector has been brought to the brink of disaster. Report after report has shown that many vulnerable people died in care homes because the problems of care homes simply were not part of the Government’s thinking. Millions of unpaid carers were left completely unsupported as support services were withdrawn overnight and they were left to struggle alone as best as they could. The impact of that on carers and those for whom they care has clearly been devastating, although I fear that it is as yet largely undocumented. Carers UK is beginning to gather this grim evidence.
Only today, Skills for Care published its annual report, The State of the Adult Social Care Sector and Workforce in England, which documents the impact of the pandemic. It reports that sickness rates “nearly doubled”,
“occupancy levels in care homes have fallen”
and workforce numbers started to fall from March. It states:
“As of August 2021, vacancy rates are now back above their pre-pandemic levels”
and are increasing. The report estimates that, if the workforce is to increase at the same rate as the proportion of over-65s in the population,
“by 2035 the sector may need 490,000 extra jobs”.
How will they be provided?
I say all this to emphasise the urgency of providing the resources to right this terrible wrong now. It is not clear that the Government’s present proposals will do this, however good their intentions. The NHS clearly needs money to tackle waiting lists; this will help families looking after relatives with worsening health conditions. However, the recent announcement does not suggest that there will be any immediate direct investment in social care. The Commons Health and Social Care Select Committee advised that £3.9 billion is needed just to deal with the sector’s wage increases to the national living wage and ageing pressures. The LGA estimates that £1.5 billion is needed each year just to stabilise the care provider market—the difference between what it costs providers to deliver care and what councils pay.
Where will vulnerable patients from hospitals go if there are no care places? In all the public pronouncements and speeches in the House and elsewhere, the Government have scarcely mentioned unpaid family carers. If they are not mentioned in descriptions of how policies will be made in future, that probably means that they will be left out of the picture altogether. Carers UK is concerned that, although the Government’s proposals will help some families, they will not help carers who need help now. For instance, there is no indication that the levy will secure an immediate increase in funding for breaks or respite support for carers. Nor will it help those with the lowest means who cannot afford to pay for their own services and have no other recourse but help from the state or charities.
Can the Minister tell us whether the Government plan to provide immediate and significant cash injections to local authorities for the delivery of adult social care services, including support for unpaid carers, in the forthcoming spending review on 27 October? How will the health and social care levy deliver the funding for underlying social care support so that carers can juggle care and work? Without this investment, it is unlikely that the Prime Minister will be able to deliver on his promise to fix social care.
In adding one final point on supported housing, I declare my interest as a chair of the National Housing Federation. I have stressed many times in this House the essential role of supported housing in delivering independence and well-being for many people with long-term care and support needs. Supported housing takes the pressure off public services and saves public funds. Housing associations, like care homes, are struggling to fill vacancies. The value of local authority contracts is so low that it is not possible to increase wages or reward staff financially for their dedication and the sacrifice made over the pandemic to keep residents safe. The Government have promised ring-fenced funding for the NHS and social care. Can the Minister consider reinstating the £1.6 billion ring-fenced funding for housing-related care and support services and use the opportunity of social care and NHS reform to prioritise preventive services, give security to people with care and support needs, guarantee funding and enable housing providers to continue responding to the impact of coronavirus?
Lord Lipsey (Lab)
My Lords, I declare an interest as unpaid president of the Society of Later Life Advisers.
Today I will concentrate on the cap. It was first proposed in my minority report to the 1999 commission on long-term care and carried forward in the Dilnot report a decade later. Noble Lords might be expecting me to be dancing in the aisles because this long-awaited proposal is now being bought in. Well, dancing I ain’t, and nor should older people who have been deluded into thinking that their care costs and worries are over. Bluntly, this cap is a fraud perpetrated against the elderly and against their children, and one which will not deliver but will come back to haunt its progenitors.
Many elderly people will not benefit from the cap at all. Nearly half get their care for free under the means test. Of the rest, many will not qualify because they do not meet tough requirements for proving that they need care, under which substantial disability must be shown. Even if you jump those hurdles, will you get that help? Will you get back the £86,000 you have coughed up for care? No, because the £86,000 is a purely notional figure which, when analysed, turns out to be nothing like the truth. You can claim only as much as a local authority would pay if it were booking a care home place itself, so for a nursing home, the limit would be £779 per week. Yet self-funders pay much more than local authorities that place people—£1,139 per week according to the true expert, Graham Duffy, from Just. There is a gap of £360, which you will have to fill yourself since the cap does not help you. From what you can get help with, you must then deduct what are rather insultingly called hotel costs—that is, accommodation—of perhaps £200 per week. You may well get a nursing care allowance of £187 per week. That great deduction comes off what you will get back.
You are spending roughly £1,100 per week on your care, but only about £400 of that can count towards the cap. When will you start getting some cash? On my calculation, it will take about five years at £400 a week to get you above £86,000. However, the clock does not even start to tick until October 2023. Anything you pay out before then must come out of your own pocket. Therefore, in practice it will be at least seven years before anyone benefits by a penny from this cap—two years until the scheme is launched, and then five years to reach the £86,000. Here is the rub: the average person in residential care lives only for about another five years. There is a tail of robust and fortunate people who go on for a very long time. They might get some help from the cap, but if as many as one in 10 care home residents benefits from this cap, I will be extremely surprised. Also, as I said earlier, even those who benefit will not get back the money they have paid out. Under the cap, they will get back about a third of it.
Putting my cards on the table, I do not object to the few people benefiting greatly from the cap. After all, the beneficiaries are generally the better-off, who do not have to sell their homes to pay for care because they can borrow from the local authority, and the true beneficiaries are not the old people themselves but their kids, who presently get large and largely unearned windfalls. It is not the lack of generosity of the Government’s scheme that appals me but its opacity—not understandable even by those with great knowledge in this field who have studied it for hours.
I am sorry to blow my own trumpet, but my minority report proposed a very much simpler scheme whereby you must pay for five years of your own care and then you get it all free. That way, you do not have to keep tabs all along on how much somebody is spending. It has the advantage of being purely a chronological qualification. Instead, we have this monstrously complex scheme that is designed for one purpose only: to con the public that the care costs problem has been fixed. It is a cap, yes, but a cap that simple is not worth the palaver.
Baroness Thomas of Winchester (LD) [V]
My Lords, I declare that I receive self-funded care and disability living allowance. I thank the noble Baroness, Lady Pitkeathley, for securing this debate, and for her very powerful opening speech. I will speak very briefly about home carers. This is a growing sector whose growth has been accelerated by the pandemic.
As others have said, more money is needed right away to pay such carers a better wage, and for their travelling time in rural areas, where there are more home carers, and in towns with heavy traffic. This cannot wait until 2023. As we have heard, carers are among the lowest-paid workers, earning less than cleaners and shop workers. This is appalling as most of them are highly skilled. Demand for care from working-age adults rather than from older people is increasing, as we have heard, although as the population ages, this will change quite rapidly. Also, there are about 112,000 vacancies for carers. According to the recent King’s Fund report, more experienced care workers earn only about 12 pence more than those starting their careers, which is one reason why the workforce needs more pay, training and development.
I turn very briefly to unpaid carers. The whole care system would collapse if they did not exist. As the noble Baroness, Lady Pitkeathley, said, they save the economy literally billions every year. I would like to ask the Minister what the uptake of the carer’s allowance is. It is quite a complicated allowance and is not generous, so my message to the Government is to make sure that carers are better rewarded and that the carer’s allowance is simplified and increased.
Baroness Hodgson of Abinger (Con)
My Lords, I thank the noble Baroness, Lady Pitkeathley, for introducing this vital debate today. With people living ever longer, looking after the elderly and infirm well is critical to the individuals, their families and our communities, ensuring that all receive the care they need and have a dignified and secure old age.
At the party conference last week, the Secretary of State urged people in need of social care to turn to families first and not always to look to the state. As has been said, that is already happening. Mothers look after disabled children, often on their own, and many people need care towards the end of their lives. In 2019, it was reported that, on average, women outlive men by about seven years. However, women often shoulder much of the care of their husbands at home, often without enough back-up and support from local services. Society simply does not recognise the contribution that many women already make in this way.
It is often reported that single people have poorer health and higher mortality rates and that, by the age of 85, over 75% of women who were married are widowed. Left on their own when their husbands die, often with no one to look after them, they then need care themselves. Too often, younger members of the family are working, based too far away to help daily, and may not be able to devote the time needed. These women needing care may then find themselves financially unable to stay in their own home, as the costs of full-time live-in care can exceed those of a care home, and they end up having to sell their home to fund their care. Surely people who want to stay in their own home should be able to.
The Secretary of State, in his speech, went on to talk about how we as citizens have to take responsibility for our health, too—all of which I agree with. Thus, having good and regular health checks is essential, leading to earlier identification of conditions and earlier interventions, which may enable people to stay at home and lead a fuller life for longer.
Of course, the role of the GP in all this is absolutely critical. Last week, there was an article in the Times about a study based on Norwegian health records, published in the British Journal of General Practice. This talked about the benefits of having the same GP for years. In Norway, all residents are assigned a named GP. The study found that, compared with a one-year patient/GP relationship, those who had the same doctor for between two and three years were about 13% less likely to need out-of-hours care, 12% less likely to be admitted to hospital and 8% less likely to die that year. After 15 years, the figures were 30%, 28% and 25%. A senior researcher at the National Centre for Emergency Primary Health Care, part of the NORCE research centre in Bergen, added:
“It can be lifesaving to be treated by a doctor who knows you. If you lose a general practitioner you’ve had for more than 15 years, your risk of needing acute admission to hospital or dying increases considerably the following year.”
Yet the model in the UK seems to be moving away from this. This appears to be detrimental not only to patients but to doctors. Most GPs I know found one of the most satisfying aspects of their job was getting to know their patients and looking after them over many years, but practices in the UK are becoming bigger, with more doctors and patients, and less of a relationship between the two.
Patients over 75 in the UK are also given a named GP, and I would like to ask the Minister exactly what their duties towards these patients should be. I hope he agrees with me that medicine should be patient-focused and not administration-focused. While I understand that patients who wish to be seen urgently cannot always see their named GP that day, should the named GP have contact with patients and their families when requested and provide continuity of care? Please can my noble friend be specific about this?
I hope the House will not mind me speaking from personal experience, because my mother suffered from lack of care from her GP at the end of her life. This was just before the pandemic took place. She had had a marvellous, caring GP for 30 years who retired. In the last six months of her life, she was transferred to a larger local practice. The named GP never came to see her or even spoke to us, even when we requested him. There was a lack of continuity of care; she saw a different doctor every time. Visit requests were refused on two occasions, even when she had fallen, hit her head, was badly bruised and her carers were asking for support; and, on another occasion, when the out-of-hours doctor said she urgently needed to be seen. The only way we got the district nurses to come, two weeks before her death, was because one of her marvellous carers actually knew them and rang them, desperate.
If my mother’s experience is the same as that of others in this situation, surely ensuring that named GPs actually attend their patients would be a good place to start, not least because, according to this Norwegian survey, it would ensure that patients stay healthier for longer and would relieve an enormous burden from the care system.
Lord Pendry (Lab)
My Lords, I am sure we are all thankful to my noble friend Lady Pitkeathley for raising this important Motion. I am also pleased that the debate has been rescheduled for a longer period than the one hour originally allocated. Had that not happened, it would have been a nonsense for such an important debate as this. At least we now have something from the Government on the plight of social care workers, but it falls short of a meaningful response to the problems encountered by that sector for those who have to endure its working conditions, low pay and poor employment practices.
Of course, a number of promises by the Government have been jettisoned, which has caused real hardship for social care workers, including that from the Prime Minister not to put up national insurance, which is a solemn manifesto commitment broken. So many manifesto commitments have been broken. The list is endless, and going over them would take too long for this debate.
It perhaps suffices to point out that the new money the Government propose in their so-called plan is in no way at all a plan to reform social care problems. Of the £36 billion already mentioned in this debate that the Government propose for the next three years, only 15% will go to social care. The new money is designated for 2023, which will certainly not help the thousands struggling on low pay, against this background of funding cuts.
However, it is true that Covid-19 has brought to the attention of the nation the real worth of our care workers and the vital role they play in providing social care for those hit by this deadly disease. Thousands have died in care homes, including hundreds of care workers who died in the course of servicing those they cared for.
The Prime Minister, quite frankly, is in denial of the problems. He does not seem to understand the crisis affecting social care and has not responded to the leader of the Opposition, who said that, to bring in a plan
“to genuinely fix the crisis in social care … and … have a fair funding model”—[Official Report, Commons, 7/9/21; col. 157.]
we in the Opposition “will work together” to that end. Let us hope it is not too late. Perhaps when the Minister replies to the debate he might promise that, when the Prime Minister returns from his latest holiday—I hope he will be refreshed physically, but much more importantly mentally—he will remind him of that very sensible proposition and to act upon it.
If not, I conclude by reminding the House of previous debates when UNISON, my union, and others representing care workers, pressed for a national care service, which it has advocated for many times. It would provide greater security for those receiving and delivering care. Let us hope that this debate will add to those who are already trying to bring to the notice of the Government the urgency needed, as was spelled out by my noble friend in proposing this Motion. But let us not hold our breath.
Lord Bichard (CB)
My Lords, I am proud to count myself as one of the usual suspects that the noble Baroness, Lady Pitkeathley, referred to earlier. In that capacity, I congratulate her on winning this debate and on a quite brilliant opening speech.
As we all know, social care has been in need of urgent reform for a decade or more. When history is written, I think it will be one of the greatest failings of Parliament that so little has been done. Resources have been inadequate. Too many providers are struggling to survive, too many users are dissatisfied with the service they receive, too many unpaid carers are, quite simply, exhausted, and too few people see social care as an attractive career option. For people suffering the consequences of these failings, arguments about who is to blame and promises of future improvements feel a world away from their lived reality. Their lives cannot be put on hold; they have to be lived now. They should be, and they deserve to be lived well.
Sadly, the long-awaited White Paper has still not materialised. There was yet another promise that it will be with us in three months; I have lost count of how many of those I have seen. The recently published Build Back Better fails to address the real problems, focusing almost entirely on how to fund the cap on costs. Any future plan and the White Paper itself need to deal with the really big issues comprehensively.
First, we still need to deal with resources, because, as others have said, the Health and Social Care Levy Bill does nothing to increase the capacity of the sector. It is regressive, and somehow even finds a way to increase the financial burden placed on providers and on care staff themselves. The Economic Affairs Committee of this House judged that £8 billion was needed to bring the sector back to where it was a decade ago, and many have suggested ways in which this could be found by reallocating public expenditure if there was no new money available. It needs to be done.
Any future plan needs to ensure, as others have said, that care services are better integrated, but as the noble Lord, Lord Lansley, said in Monday’s debate, that will not be done by great promises about further major institutional changes—reorganisations that often mean nothing in terms of improved services on the ground. A national care service and integrated care services will not provide immediate succour for people suffering as they are. They need us to address the real barriers to collaboration on the ground. People in residential homes do not want promises about new structures; they want free, convenient access to GP services, 24/7.
Again as others have said, we have to confront the crisis of the workforce far more convincingly than Build Back Better does. Social care should be seen as the noblest of professions, not as a last resort for a career. Could we encourage former clients—care leavers, for example—to use their lived experience and join the profession? Could we extend initiatives such as Teach First and Frontline? Do we know enough about why and when people leave so that we can target our workforce planning? How can we improve and make training and development more attractive to the workforce? Nothing will change or improve without a committed, skilled and valued workforce.
Something that has not been mentioned today is that we need to sort out the benefits system. At the moment, you can apply for attendance allowance, higher-level attendance allowance, domiciliary care, residential care or continuing healthcare. Some of these are administered by the DWP, some by local authorities and some by the NHS. Some are means tested and some are not. Continuing healthcare seems to vary widely in the way it is administered across the country. This is a confusing mess. It costs money, but it brings huge stress to people when they are at their most vulnerable.
We could support providers better. Education leaders have been able to access information and support online for a decade or more, but social care providers are left to their own devices, struggling to balance the books, cope with increased regulation and cater for clients with increasingly complex conditions. Why do we not establish an innovation and improvement fund to give them some support in the immediate future? Are we using digital technology as well as we could, not just to help providers but to help more people to stay independent? I do not think we are.
What is the strategy for unpaid carers, so often and rightly mentioned today—13 million of them, saving the Exchequer nearly £200 billion a year? The Secretary of State highlighted the importance of these at conference, but they cannot be taken for granted, so where is the strategy to support them?
Finally, how can we give users and their families a greater say in the way that services are provided? The time should have gone when well-intentioned central bureaucrats decide how services should be shaped and delivered. We need more influence from lived experience.
Fixing social care is about fixing all those issues, not just putting a cap on care costs. I hope the Minister can reassure us on two things today: first, that we will finally see the White Paper by Christmas, and, secondly, that it will cover this comprehensive range of issues.
Baroness Donaghy (Lab)
I congratulate the Minister on his appointment—or should I say commiserate? I also congratulate my noble friend Lady Pitkeathley on introducing this timely debate in her usual comprehensive and extremely impressive way.
The Government certainly took the political initiative—it was a PR triumph. However, the kindest thing the newspaper financial columns could say about it was that it was a dog’s breakfast. My noble friend’s speech and that of my noble friend Lord Eatwell in Monday’s debate on the NIC increases provide the definitive analysis of why the Government’s PR stunt will not work. I do not feel that I can add much more to those speeches, so I will concentrate on why the financial models for care homes and social housing are unsustainable in their current form.
First, on the so-called model of care home funding, we have all heard how hedge funds use them as financial vehicles, but the majority of the sector is made up of small and medium-sized businesses. The Government want banks and lenders to show them flexibility, and the banks say that they are
“actively providing support for viable businesses”—
a quote from UK Finance. The question is: what does “viable” mean?
The reality on the ground is that a growing number of care homes—it is estimated at about 20%—are under pressure from their banks and are in financial difficulty. They dare not tell their local authority or the Care Quality Commission because they fear losing contracts or being taken into special measures. The infection control fund, a pot of £600 million to pay for PPE for social care firms, ended on 30 September. Local authorities in England spent £3.2 billion on adult social care during the first year of the pandemic, including PPE, but they received only £1.49 billion of extra Covid funding from government. This is not a sustainable system for social care.
Social housing for the most vulnerable in our society also sits on precarious foundations, which threatens the existence of some housing associations yet allows City firms to pay out millions in dividends: in the case of one firm alone, £103 million was paid out in dividends over a five-year period. The City is attracted to the £265 million annual housing benefit bill for specialised support housing in England. Some 176,000 vulnerable adults live in these properties. Private companies are piling in with investment, buying up properties and leasing them to housing associations, often locking them in to 25-year leases, which in some cases are unsustainable because housing associations have to pay rent on empty properties and are therefore carrying the risk, while the private company can promise investors a 5% yield.
The Regulator of Social Housing has expressed concern about the business model. Who picks up the pieces when things go wrong? I somehow do not think it will be the investors in Civitas Social Housing, which is listed on the London Stock Exchange. It owns more than 600 homes and accommodates 4,400 people with learning or physical disabilities and mental health problems. Since the near-collapse of First Priority Housing Association, the regulator has published damning evidence on the financial stability of 19 housing associations, declaring that they are non-compliant with its standards. Eight of the 19 are Civitas tenants. The regulator’s view is that the lease-based model is unsustainable in its present form. Why are housing associations taking these risks? It is because they are strapped for cash and are selling off precious properties to make ends meet, due to the shortfall in government funding.
Civitas bought a company called TLC Care Homes. It paid £25.5 million for nine care homes in Essex. Civitas split it into two companies, caring for the residents and owning the properties. The caring bit was then sold to a third company in—wait for it—the Isle of Man, with the idea that the operator would rent the buildings from the property company. These deals are well known in the property sector. They are called OpCo/PropCo. The Isle of Man business was partly owned by two Civitas directors, although this was not publicised. I am not claiming, as the Sunday Times implied, that properties were undersold, or that shareholders were disadvantaged, or that Civitas directors were doing anything illegal by not disclosing. In fact, my problem is that it is all lawful. My criticism is that these sharks and dodgy dealers should be kept a million miles from social accommodation for the vulnerable. This is not a sustainable model. What plans do the Government have for putting care homes and specialist housing on a sustainable financial basis which prioritises the protection and care of the vulnerable?
Lord Cashman (Non-Afl)
My Lords, it is good to be back and to be engaged in this important debate, for which I thank the noble Baroness, Lady Pitkeathley, whom I also congratulate on her wonderful, excellent opening statement. I also welcome the Minister to his position. Of course, I know him well from our many years together in the European Parliament.
During the pandemic, I am sure that others have felt that there is a fear of growing old or of becoming frail or ill. I believe it is our duty as the fifth-largest economy and as a civilised society to remove those fears immediately. I refer to my interests as set out in the register, particularly as a trustee of the charity Neighbours in Poplar. Indeed, I have decided to focus on an April 2021 grass-roots report, of which I am one of the co-authors, which was commissioned by Neighbours in Poplar, which is led by Sister Christine Frost. The organisation serves needs across the London Borough of Tower Hamlets. The report includes input from medics, paid and unpaid carers, care recipients and volunteers. It is a report from the front line, observed, witnessed and reported. It is not a parochial approach. It is evidence-based and, I believe, a microcosm of what is happening across England and what is being experienced by many councils and agencies. Social care is broken and can be fixed only by a holistic approach, with adequate funding. It cannot be done on the cheap. That has been tried, and it has failed catastrophically.
The report, which I will make available through the Library, along with the follow-up report, took this holistic approach across a range of topics such as nutrition, housing, quality of care, access to health services and communications. I will read from the report. Its summary dealt with meals on wheels post Covid. Sadly, the meals on wheels service in that borough had been cut just prior to Covid. Who decides whether our carers are adequate to the task? Are carers engaged or unengaged? How do people excluded from social media and without internet access find out what is going on? How do they engage? How are we meeting mental health and inappropriate housing needs? The report states:
“Please do not take this report lightly. We need to you to be aware that the majority of those to whom we have brought meals and contact with the rest of humanity during the past year were vulnerable, frail individuals of all ages, evidence of which is the 50-plus clients who have passed away since we started on 17 March 2020, two of whom were single, elderly, disabled men living alone and one on the top floor of a block of flats without a lift. He had been unable to get out and meet friends for the last four years. We sent questionnaires to each meal recipient asking two questions: Is there anything you are worried about and what do you need to help? Which services do you most need or want improvements on: health, social services, meal delivery, day centres, carers and others? We have 200 people on our delivery list and we received over 100 responses from the clients and the major need mentioned is hot meal delivery.
We also asked the volunteers to give us their impression, viewpoints, perspective on the seriousness of the recipients’ needs. Many volunteers have been consistent in their deliveries and have noticed the deterioration and increasing needs in the clients and as the majority of these clients are disabled, elderly or frail, their need is increasing rather than decreasing. We ask now: whose responsibility is it to deliver meals on wheels post-Covid?
Our second major concern for the future is the quality of care being delivered to those entirely dependent on the care, expertise, sensitivity and time of those who care for them, a service the client is paying for. We have come to the conclusion that it is not so much the agency which is the issue but rather the quality, standards and suitability of the individual carer. Therefore we ask that every paid carer be required to reach agreed national standards and that registration be required. Every paid carer should be registered as are foster carers. We ask also that the commissioning of care services be far more rigorous, ensuring that what is promised is actually delivered.”
I am coming to the end of my time, so I will chase quickly towards the conclusion. The report goes on:
“Communication has appeared as a major concern. How do people who are not on the internet find out what is available? It came to our attention that many are not in receipt of pension credit simply because they do not know how to go about accessing it. Many spend hours fruitlessly on the phone to council helplines. Mental health and communication are interlinked. Funding and time need to be put into joining people up and rebuilding communities.”
Finally, it is clear that we need to be proactive where we can and help prevent people needing social care. Now is not the time to cut services; long-term negative consequences will follow. Will the Government therefore commit to end the underfunding of local authorities and ensure properly funded services and a high standard of social care for those who need it?
Lord Sikka (Lab)
My Lords, it appears that the noble Baroness, Lady Greengross, is not here; I am next in the queue. I begin by thanking the noble Baroness, Lady Pitkeathley, for this debate.
I will talk about the elephant in the room, which so far has attracted very little discussion: the privatisation of social care and its consequences. The noble Baroness, Lady Donaghy, briefly touched on some of the issues. Privatisation is not really being challenged by the Government or many other people in your Lordships’ House, but it has really reduced the resources for front-line services, fuelled executive pay and given us low wages, which has been talked about.
Care home staff are dedicated but really poorly paid, because the corporate model is to squeeze workers as hard as possible to improve the bottom line. There are some 1.52 million care home employees in England working in 18,500 organisations, but around 24% are on zero-hours contracts. Almost 42% of the domiciliary care workforce is on zero-hours contracts. Care workers’ median real-terms pay last year was £8.50 an hour, less than the average pay for shop workers and cleaners.
Low wages, zero-hours contracts and almost 30% staff turnover mean that personalised care is almost impossible to offer. Visiting some relatives in care homes, we saw care assistants we had never seen before; every time we went, there was a different person. One can see the huge problem of trying to offer staff training, because they are simply not around long enough. I hope the Minister can explain what changes in employment law the Government would make to address this issue.
Meanwhile, executive pay in care homes has soared to around 120 times the pay of care assistants, and record dividends are being paid by care homes owned by corporations. Until the 1980s, around 90% of care beds were in local authority control. Now around 90% are offered by profit-making and non-profit-making organisations. Corporations view care homes as investments. What they are interested in is the return and the bottom line.
Many of the owners are registered outside the UK. These include private equity, real estate investment trusts and US hedge funds. The ultimate controllers of these entities have no contact with staff, patients or the citizens of this country; they live in an elevated world somewhere else altogether. The big 26 providers of care homes are part of large corporate groups that include 2,500 companies. This provides plenty of scope for intragroup transactions to extract returns in the form of rental payments, debt payments, royalty management and anything else you can think of. The Centre for Health and the Public Interest states that some 10.83% of the money is sucked out through internal transactions, which obviously means that less is available for front-line services.
Private equity is the worst culprit. The typical business model is to load the entity with debt—usually artificial debt from an offshore affiliate—charge interest on it and charge anything else they can to inflate the costs. It is estimated that some 16% of the income of private equity care homes disappears in debt repayments, which did not happen when these care homes were owned by local authorities. The five largest private equity owners of care homes have a debt of around £35,072 for each bed and extract interest charges of £102 per bed per week. This amounts to almost 16% of the weekly cost of a bed. Obviously, this is enriching a few people but doing nothing for the rest of us.
The financialisation of care homes has been disastrous. Southern Cross and Four Seasons were just some of the examples of corporate exploitation of care homes. In 2014 the Government responded by creating the Care Quality Commission, which has not been able to check financial engineering in this sector. Indeed, I doubt it has the know-how equivalent to that of the Prudential Regulation Authority for banks to even do the calculations.
I will briefly mention the levy and the finances. The 1.25% Johnson tax is utterly inadequate and does not really provide any basis for the long-term funding of social care. In my talk on Monday, I recommended that the Government think about raising the ceiling, abolishing the 2% rate of national insurance on incomes above £50,300 and charging the full 14% on everything to raise £14 billion, as well as taxing capital gains in the same way as earned income to raise £17 billion, plus £8 billion on national insurance. As a welcome to the new Minister, I invite him to answer why the Government do not wish to consider the financial alternatives I have just pointed out.
Lord Birt (CB)
My Lords, I declare an interest as the chair of a company, listed in the register, that supplies services to the care and other sectors.
The real cost of care is of the order of £700 to £900 per person per week, yet some local authorities pay as little as £500 a week and the average appears to be around £600, well below the cost of providing the service. This is a truly shameful way for the public sector to treat business suppliers. Half of our 12,000 care homes have fewer than 40 beds, and many are SMEs. Around 3,000 are significantly undercapitalised and lack en suite or wet room provision. All face significant problems over pay and recruitment. Prices for care will need to rise, not fall. I hope I have this figure right, but I say from memory to the noble Lord, Lord Sikka, that only 13% of care homes are owned by the major corporations he focused his remarks on. Many are much smaller businesses and struggle.
Will the Minister assure us that paying suppliers less than the cost of provision will end once new funding comes on stream? There has been much debate about funding and far too little about our failure to meet the significant organisational challenges of ensuring a humane and seamless experience for individuals in the last years of their lives. I expect that many of us in this Chamber have seen through our families just how chaotic, unsatisfactory and distressing this experience can be. I echo the noble Lords, Lord Astor and Lord Bichard: surely “holistic” is the critical word.
I hope the Government will create a framework of governance and regulation to ensure that the principal players—and there are many: hospitals, GPs, local authorities, social workers, district nurses and hospices—work together collaboratively with appropriate processes, common systems and performance measurement to capture and share best practice and to identify under-performance. I suspect this can happen only if the Government set an ambitious expectation and, further, if they create some new independent leadership at local level to foster collaboration and sufficient funding to ensure effective administrative oversight. Will the Government set out a plan for transforming the effectiveness of how care is delivered as well as how it will be funded?
Baroness Brinton (LD) [V]
My Lords, I declare my interest as a vice-president of the Local Government Association and a vice-chair of the All-Party Parliamentary Group on Adult Social Care. I am disabled as the result of a long-term condition and my husband is my unpaid carer.
I congratulate the noble Baroness, Lady Pitkeathley, on securing this vital and timely debate today. As she said, it is a repeated debate and, frankly, it will continue to need to be repeated until the Government tackle the issues raised in it. Her speech cogently set out both the long-standing problems and the current emergencies that are tipping the social care sector into real crisis, with our extremely vulnerable citizens now finding that it is harder to get social care support and, even more worryingly, vacant beds in homes along with homes closing meaning that some geographic areas face a real crisis.
The right reverend Prelate the Bishop of Oxford spoke movingly of the role of families in supporting their loved ones, and the dignity that this gives to both the person receiving the care and their carers. We on these Benches agree. People should be encouraged to stay in their homes and with their families for as long as is practicable.
The noble Baroness, Lady Finlay, reminded us that access to professional care is in extremely short supply. That so many people in that survey approaching the end of their lives could say that they felt they needed more help was not a criticism of the care that they received but a demonstration of how broken the system is.
My noble friend Lady Thomas of Winchester spoke from personal experience of the reality of the problems faced by the domiciliary care staff who work for her, and of how they are so low-paid yet highly skilled. This is an iniquity that needs to be remedied.
Care workers need to be paid at least at the same rate as an NHS healthcare assistant. If they were, they would receive an instant £2 per hour rise, which would cost the country £40 million. Healthcare assistants in the NHS are not particularly well paid either, but the key fact is that there is no wriggle room to pay those extra funds from the limited resources allocated to the social care sector. We should not have private beds in care homes helping to subsidise state funding; that is another iniquity.
Workforce issues are already forcing homes to refuse to take patients because they just do not have the staff to look after them safely. We know that these staff are skilled beyond measure but they are paid at the minimum wage because, shamefully, we as a society still regard social care as unskilled. The funding rates for residents are based on most staff being on the minimum wage, making it impossible now for employers in the sector to compete with retail, hospitality and even agriculture, where employers can charge customers more and therefore pay their staff more. Worse, these dedicated staff will be paying the increase in national insurance, which will further reduce their income at the exact same time as they face a cut in universal credit and an increase in energy costs and food and many other items.
The noble Lord, Lord Astor, spoke of the pressures on local commissioning. He spoke of staff territorialism and empire-building, but I think that is the wrong way to look at it. The current assessment system requires the NHS and local authorities to fight over whether personal care needs are caused by health issues or ageing, and this is demeaning at best. Staff with limited budgets argue over whether incontinence was caused by dementia or by a health issue, because of course in their eyes dementia is not paid for by the NHS. I think what he is referring to is not staff empire-building but staff with limited budgets desperately trying to protect their funds for the many more people who need it.
Over the last five years the public funding for social care via local authorities has not increased in line with demographic demand, so that now most councils say they are spending three-quarters of their funds on social care. Skills for Care forecasts that if the adult social care workforce grows proportionate to the projected number of people aged 65 or over in the population between now and 2035, an increase of just under 30% —around 500,000 extra jobs—will be required. That is an eye-watering number. The health and social care levy and the Build Back Better: Our Plan for Health and Social Care report do not even start to address that. What are the workforce plans? I understand that the specific extra amount for the next three years in workforce is about training, not for wages, let alone for pay rises.
Build Back Better: Our Plan for Health and Social Care, published last month, is not a plan for health and social care: it is a funding plan for the NHS, looking at how individuals pay for their social care and which elements will be paid for by the state. We have seen that the structures for paying the costs of these will need support beyond the proposed cap and, as others have mentioned in this debate, will not cover the accommodation and food costs laughingly called hotel costs. That means the public, who think the new arrangements that they are paying tax for mean they will not have to sell their homes, are in for a shock: they are going to have to sell their homes even if they get the health element paid for by the state.
Last week the Secretary of State for Health and Social Care told the Conservative conference that we did not need the care sectors, as families should just look after their own. It is as if he does not know that the cost of inaction and delay is already falling on the 11.5 million unpaid carers in the UK whose contribution to the current social care system is almost completely ignored. The cost of reform to the Government may seem large, but it is a fraction of the true cost to families across the countries. Carers UK has estimated that unpaid carers save the Treasury £193 billion a year already.
What analysis have the Government made of the Dilnot reforms? How will what they are proposing help unpaid carers with the challenges that they face —for example, in securing breaks from their caring responsibilities? Are the Government planning to put in place a cross-departmental and comprehensive carers strategy or action plan to ensure that those providing unpaid care get the support that they urgently need as we emerge from this pandemic?
My noble friend Lady Tyler of Enfield movingly explained the reality of the pandemic for those in care homes, with some 40,000 deaths of residents. That is deeply shocking and, as she said, a real national scandal. It has undoubtedly made the serious crisis in the sector much worse.
We have spent decades waiting for reforms. Fifty years ago, we still had remnants of provision in former workhouses; I know that because I visited elderly residents while I was still in school. Twenty-five years ago, too many local authorities had to close their homes as they did not have the resources to upgrade their accommodation, and that is when the private sector began to blossom. Ten years ago, though, austerity cuts started, not just in social care but in all the vital ancillary services that keep people independent and managing at home: supported housing, adult day services and community nurses. So it was hopeful 10 years ago when the three major parties all came together to support the report by Andrew Dilnot’s commission—but in 2014 the Conservatives walked away, and the crisis in the sector has worsened considerably.
The noble Lord, Lord Cashman, was right to highlight these services. Meals on wheels or lunches at day centres are often now a thing of the past in too many areas because the councils just do not have the resources. There are some good examples. In Cornwall, some services for school lunches for children are now combined with what was meals on wheels. In some really innovative areas, they are beginning to have lunch together. We know that it keeps people active to mix with younger people as well. Why are we not learning from good practice elsewhere? In the Netherlands, some care homes recruit students to live in and work part-time there to help fund their degree studies. That has been noted to reduce the progress of dementia. It keeps residents active and, vitally, changes the career choices of the students who take part in it.
We know that there are limits on publicly funded costs, and the position regarding privately funded beds must stop now, but this means that real rates need to be paid to reflect that cost. By the way, from these Benches we also echo the urging of the noble Lord, Lord Cashman, for real funding for local authorities to recognise their key role in commissioning services to keep people active and healthy. The Government’s proposed council tax increase of 5% per annum for three years to help fund social care is also iniquitous. Council tax is even more regressive than national insurance and, frankly, for some councils that 5% will not touch the sides of their new responsibilities under the reforms for assessment and commissioning.
The worry is that the Government are doing everything upside down. On Monday, your Lordships’ House debated and completed consideration of the Health and Social Care Levy Bill, but we have not yet seen the White Paper on social care that the PM promised on the steps of No. 10 Downing Street two years ago. We heard leaks over the weekend from the Government that there may also be an integrated services White Paper, streamlining health and social care. That is rich, given that the health and social care Bill is going through the House of Commons at the moment and is due in your Lordships’ House before the end of the year.
What is it about this Government that means they subvert the parliamentary process and force parliamentarians to vote on proposals before the details are published for wider consultation? I am afraid that just sets the real context of this debate about social care. For decades, social care has faced a crisis. The pandemic has exacerbated that. We face a real emergency and the Government need to act now.
Baroness Wheeler (Lab)
My Lords, on behalf of these Benches I formally welcome the Minister to his first debate in the House. I am particularly pleased that it is on social care, so that he can focus on addressing the deep concerns across the House about the Government’s social care plan, made clear during Monday’s passage of the hastily thrown together Health and Social Care Levy Bill. It also ensures that he provides much-needed responses to key issues that will not go away, however many slogans and smokescreens the Government throw up.
This has been an excellent debate. Whether from Labour, the Government, other parties or Cross-Benchers, these occasions demonstrate the level of expertise, experience and scrutiny that I am sure the Minister fully realises he will get from noble Lords. This was no better demonstrated than by my noble friend Lady Pitkeathley’s candid and honest appraisal in her powerful speech of the current crisis and what is needed to provide sustainable services in future. She reflects both the knowledge and experience of a lifetime of work on health and social care and of a strong campaigner and advocate on behalf of unpaid carers. We are all very grateful to her.
Like other noble Lords, I particularly pay tribute to unpaid carers because we need to get back to a proper recognition of their crucial role and doing more than just saying how wonderful they are. In 2009, before I joined your Lordships’ House, I was fortunate, as a carer myself, to undertake a 12-month secondment to the Department of Health’s excellent carers strategy team, which had produced the first pioneering strategy in 2008, placing carers at the heart of families and communities. Central to this was recognition and funding for vital local support and networks, regular everyday social services care support for carers and the loved ones they cared for, and ring-fenced grants via GPs and councils for regular care breaks—so crucial, given the relentless responsibility of caring for a loved one around the clock. At that time in DH, there were 10 full- time staff in the carers team. Perhaps the Minister could tell me how many staff there are now.
Today, as carers emerge worn out and exhausted from the pandemic, they have every right to expect immediate funding support. Instead, the Prime Minister’s plan contains no immediate extra funding for carers and the levy does nothing for them in two years’ time. The “health and social care begins at home” and “family first, then community, then the state” comments from Sajid Javid add insult to injury, as many noble Lords have said.
Carers need care workers and social care to support their families; their role complements that of paid staff but they are not substitutes for care workers, who are themselves chronically undervalued and underpaid. They already provide the vast majority of care and love to our vulnerable and disabled people, many of them having had to give up work to do so. That is why Labour’s “home first” principle is so important. It means the state, families and communities working together to enable and support people to live well with dignity, in their own homes, and receive the care they need. Only with “home first” can the focus of support be effectively shifted to prevention and early intervention.
Today shows that we are still in the dark about the key funding concerns raised during Monday’s debate on the Bill, such as how much of the levy will actually be spent on social care and how councils are to be funded for the care cap; ensuring that self-funded care home residents pay the same rate as council-supported residents; what guarantees social care has if the NHS’s herculean task of dealing with the backlog of treatments absorbs the bulk of the levy funding; or, indeed, what funding will flow for social care unrelated to the cap. I welcome the contributions from noble Lords today that have focused on this vital aspect of social care.
However, those of us hoping for answers from the Treasury Minister on Monday to these and other searching questions were sadly disappointed. As in Monday’s debate, several noble Lords cited today the excellent analysis by the independent Institute for Fiscal Studies—a reality check for the Government, if ever there was one, regarding how underfunded their spending plans for the NHS and social care are—particularly its stark warning that the £12 billion raised annually by the tax increase needs to rise to nearly £19 billion by 2025 to meet future NHS and social care demand. Will the Minister promise the House that the Government will respond in detail to the IFS findings, which reflect the serious funding concerns from across the sector?
With the health and social care Bill, currently in the Commons, dealing with the already up and functioning integrated healthcare systems, can the Minister explain how another radical plan by the Government for a health and social care integration White Paper, as reported in the media, will dovetail with that Bill, the social care plan we are discussing and the levy funding? Back-to-front planning and legislation is how many stakeholders have described it: raising the money first and deciding how it is to be spent later.
Can the Minister provide further details on the purpose and timing of the White Paper, and what it will cover? Will it deal with the really big issues, in the words of the noble Lord, Lord Bichard? Will it also address the absolute social care basics that the current plan ignores and that cause such suffering and despair today: the unmet social care needs of 1.5 million older people, who need help with washing and dressing that they do not currently get; the 300,000 people waiting in vain for care assessments by local councils who just do not have the resources to do them; or the needs of the disabled young people and adults of working age whose funding makes up over half of the current social care budget? I particularly look forward to the Minister’s response to my noble friend Lady Donaghy’s expert analysis of the funding issues for care homes and social housing.
Labour has made it crystal clear that Boris Johnson’s plan is not the thought-through and fully funded long-term plan for social care that is so desperately needed. In the words of the Labour leader, Keir Starmer, an unfair tax hike that does not fix social care and does not clear the NHS backlog is not a plan. Any fix for the future of social care has to transform support for older and disabled people within the wider ambition of making Britain the best place in which to grow up and grow old. This plan does not come anywhere near that: no reforms, no guarantees and no long-term sustainability. The Minister needs to provide the clear answers to noble Lords that we did not get on Monday, in particular on fairness. How is it fair and right, at a time when low-paid workers and their families are still reeling from the impact of the pandemic and are hit with rising food, energy and fuel costs, to place the burden of paying for the social care plan on them?
On social care funding guarantees and local council support, why is it not possible now to set even an ambition as to how much of the additional funding from the levy will go to social care in 2023? Less than one in every six pounds raised will go to social care in the first three years of the plan. On local council funding, as the Local Government Association stresses, relying on the continued use of council tax, the social care precept and long-term efficiency savings does not address the current crisis or future social care demand. Councils just do not have the money. Does the Minister acknowledge that, unless the spending review recognises this, even the limited scope for reform in the Government’s plan will fail?
We know that the care costs cap will not solve the huge crisis in social care, and it will not stop people having to sell their homes. We have had many searching questions from noble Lords on how it will be calculated and work, what care needs it will pay for, how much people have to pay before the £86,000 kicks in, and, of course, what rates councils will actually be able to pay that will be counted towards the cap. Why delay bringing in the cap until 2023? The legislation is in place now under the Care Act 2014. The Government have previous form on promising to introduce the cap, which was subsequently delayed twice and finally cancelled altogether. Can the Minister confirm that history will not repeat itself and the cap will not be axed again in 2023 as “unaffordable”?
On social care equality and parity with the NHS, how are the continuing inequalities and the unfairness between the systems, such as the huge financial costs involved in paying for dementia care and the often terrible injustices of who gets NHS continuing healthcare and who does not, going to be addressed? In its “national scandal” report, the House of Lords Economic Affairs Committee set out a key package of reforms to begin to address the divide between social care and the NHS. Why has it been completely ignored?
Like all noble Lords, I pay full tribute to the work and commitment of social care staff, particularly over the last year. They have been on the front line of the pandemic in domiciliary care and in care homes. Fixing social care must mean a new deal for them and the transformation of their pay and conditions. The spending review must address this. My noble friend Lady Warwick and other noble Lords have pointed to the Skills for Care workforce report, which shows beyond doubt the scale of the social care recruitment crisis and reinforces the urgent need for this.
My noble friend Lady Pitkeathley is absolutely right to express her frustration that the Government’s plan for social care is once again a missed opportunity to put social care on an equal footing with the NHS and build a post-Covid vision for social care: a plan of investment and reform, including integrated services and a well-paid, fully trained and skilled workforce. After the way social care was treated as an afterthought during the pandemic, this should have been a central part of the Government’s plan for fixing social care. Sadly, it was not.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
My Lords, I thank the noble Baroness, Lady Pitkeathley, for securing a debate on such an important subject. I also thank the noble Baroness, Lady Donaghy, for her commiserations on my having this post. I pay tribute to the noble Baroness, Lady Pitkeathley, for the experience she brings to the debate today, including her contribution to carers as former chief executive of Carers UK and her work in the voluntary sector, being a founding member of the Association of Chief Executives of Voluntary Organisations and chair of the New Opportunities Fund—one of the National Lottery distributors.
I am sure we all wish to recognise and thank the social care workforce, both paid and unpaid, and many noble Lords have done so in their tributes today. We should thank them for the work they do in care homes, in people’s homes and in day services, day after day, week after week and month after month.
I also thank the noble Baroness for her thoughtful comments and the well-argued case she has put before the House. We have heard many moving testimonies from across the Chamber. As noble Baronesses have said, this pandemic has provided a once-in-a-generation challenge for this country. There is no getting away from the fact that the past 18 months have been incredibly tough for social care. The challenges have been unprecedented—what Nassim Nicholas Taleb would describe as a black swan event. Many people, not only in the UK but in many other countries, have lost loved ones because of the virus. Our hearts go out to each and every one of them. It demonstrates the importance of this debate today.
I thank the noble Baroness for summing up the numbers that we should all be aware of: 9 million unpaid carers before Covid, 4.5 million new carers, totalling 13.5 million—including 2.5 million who are holding down jobs. I also thank the right reverend Prelate the Bishop of Oxford for his quote from one of the 10 commandments. I am sure he will agree that people of many other faiths and no faith also agree very strongly with the importance of parents and looking after our loved ones as they get older.
Many have said that it has been a real challenge, and we agree. As the Prime Minister said,
“we are … committed to learning lessons”—[Official Report, Commons, 12/5/21; col. 138.]
from the pandemic. When the pandemic hit, the Government worked hard to ensure that the sector got the support it needed as quickly as possible. The Government published guidance tailored to care homes and care providers, domiciliary care, unpaid workers and local authorities on how to continue to safely provide care during the Covid-19 outbreak. We rolled out regular testing for the sector and have sent more than 42 million PCR swab test kits and 117 million lateral flow devices to care homes to date. We set up a massive PPE supply chain from scratch and, through the PPE portal, have provided over 3.6 billion items of free PPE for providers’ Covid-19 needs, and, since April 2020, more than 478 million items through local resilience forums and local authorities.
The Government also moved as quickly as possible to provide financial support to the sector, making available almost £2.4 billion in specific funding for adult social care throughout the pandemic. This is in addition to over £6 billion that has been made available to local authorities to address pressures on their services. Many noble Lords spoke about the importance of local authority funding.
Crucially, we have provided health and care workers and older residents with vaccines. From 11 November, vaccinations will be a condition of deployment for care home staff. I know many will want to reflect on this point. It is worth noting that many staff—the vast majority of care home staff—have been vaccinated. It is our responsibility to do as much as we can to encourage others to be vaccinated to reduce the risk in our care homes. I know if I had a relative in a care home, I would feel much better if they were cared for by someone who had been vaccinated. I hope that across the House we can encourage more care workers to be vaccinated. Of course, there are some who are unable to be vaccinated for medical reasons and we should address their concerns too. Those people should call 119 to apply for a medical exemption.
As noble Lords can see, the Government have provided a huge number of resources to the sector to deliver better care. Of course there will always be a debate on whether the spending is enough. I have heard from across the House how many have responded to the numbers suggested. Looking to the future, the Government will maintain support, both in the short term to address the impact of Covid-19 and, more crucially, in the longer term through the social care reforms. In the short term, the sector will be supported by continuing to be provided with free PPE to protect against Covid-19 until the end of March 2022. This is also extended in designated settings, backed by the extension of the designated settings indemnity support scheme, to March 2022, so that no patient who has tested positive for Covid in the past 14 days is discharged from hospital to a care home.
In addition, in September, the Government announced an additional £388 million to prevent the spread of infection in social care settings. This package includes funding for infection control measures, as some have spoken about, £25 million to support care workers to access Covid-19 and flu vaccines over the winter months, and funding for testing costs, allowing testing to continue for staff, residents and visitors, to ensure that residents can see their loved ones as safely as possible. As part of the preparations for winter, plans are being developed in conjunction with the NHS and social care sector stakeholders. This will draw on the recommendations of Sir David Pearson’s review of last year’s winter plan, advice from SAGE and UK HSE, and—more importantly—on the lessons learned so far in the pandemic.
Our country’s social healthcare system has never been under such pressure as it has been over the past year. Many noble Lords have spoken about the pressure. The coronavirus pandemic posed unprecedented challenges to the sector, so we all agree that we must address the long-term future of social care in this country.
Many people have said that this issue has been live for a number of years. The noble Baroness, Lady Tyler, spoke of social care having been “in the shadows” for many years; the noble Baroness, Lady Warwick, said that people have been talking about this for years; the noble Lord, Lord Lipsey, spoke of the 1999 minority report. However, this debate has been going on for much longer. It has been decades—I think someone said 50 years. If we are honest about it, various experts have warned for decades that the combination of an ageing population and increased life expectancy poses a real challenge to social care. What happened? The debate continued, more think tank reports were produced, other reports were produced, and parties published suggestions in their manifestos. But in reality, all of these were placed on the shelf and just gathered dust, while successive Governments, of all colours, kicked the proverbial can down the road.
The Prime Minister decided that his Government would not shirk the responsibility and stepped up to publish a plan, Build Back Better: Our Plan for Health and Social Care, pledging an extra £5.4 billion over three years for social care. I also thank my noble friend Lord Astor for his comments on a bolder programme of reform. We need to make sure that, whatever additional funds are provided, there is reform, so that the public can have confidence that the additional funds will be well spent.
The Prime Minister’s September announcement was an important step on the journey to reforming adult social care. Of course there will be debate—any reform or change leads to debate. I worked for many years in organisational change and know that any change always generates a large debate. There are some short-term winners and losers—many people will clearly claim that they have lost out and others will gain, but, quite often, the gainers are not as vocal as those who have lost out, and rightly so. We should address those who have genuine concerns. It is really important that we learn from many of the concerns across the House today.
The Prime Minister’s announcement showed a real commitment to delivering world-leading health and social care across the whole of the UK. As we speak, details are being discussed in preparation for a White Paper on reforming adult social care, to be published later this year, as the noble Baroness, Lady Wheeler, pointed out in her intervention. We hope that the reforms will make a real difference to front-line adult social care. This includes both care users and the dedicated care workforce, who have been so brilliant throughout the pandemic.
We also know that there has been a debate over whether funding should come from general taxation or national insurance contributions. Having looked at this debate when I was head of research at a think tank, I have seen a range of views across the political spectrum—there are even some who have asked why people should not sell their homes to fund their care. So you can imagine the range of views that we have heard and read over many years. We really hope that these reforms will make a difference. While there is a range of views, I will outline some of the proposed reforms that we hope will deliver better care for adults of all ages.
First, the £86,000 cap on care costs, funded by a health and care levy, means that, for the first time, everyone will have protection from unlimited costs. There are those who have prudently saved for their old age and who have been hit hard by the unpredictable costs associated with their health and care needs; currently, one in seven faces fees of over £100,000.
Secondly, individuals with limited or no savings will be safeguarded by a more generous means test. The increase in the upper capital limit from £23,250 to £100,000, and in the lower capital limit from £14,250 to £20,000, means that the number of adults receiving some state support will increase from around half to two-thirds. In short, some people who need care, and their loved ones, will have the certainty of support when it is needed and will not have to live in fear of unpredictable costs.
In wanting to propose the fairest reforms possible, the Government decided to fund these measures with a new UK-wide health and social care levy. The Government are absolutely clear that we should not pass on the costs to future generations and increase public debt even further. There is much debate over this, but, by using national insurance contributions, the Government are ensuring that both businesses and individuals contribute. Those who are earning more will pay more. It has a clear UK-wide approach, meaning that everyone pays the same, wherever they live in the UK. In addition, by extending the levy to those working over the state pension age from April 2023—many will of course complain, and I understand that—the Government have listened to those concerns and balanced them with intergenerational justice. Many young people have asked why they are being asked to pay for people. We need to make sure that individuals of all ages play their part.
However, we should also recognise that this is not just about the over-65s. In adult social care currently, over half of all state spending goes towards under-65s—so working-age people will also benefit from limits on what they have to pay if they need care for themselves in later life. This was considered consistent with the contributory principle for national insurance contributions, whereby working-age employees pay these NICs and this gives them access to contributory benefits when out of work, including the state pension.
I will turn to the paid social care workforce, which many of us have paid tribute to. We have listened to the sector and prioritised the adult social care workforce, recognising their tireless commitment and dedication during the pandemic. The noble Baroness, Lady Finlay, spoke movingly about the hospice movement and the work/life balance that we want to see. Many people have asked what is being done to ensure that working carers can balance their caring responsibilities with work. The Government are committed to promoting the benefits of retaining unpaid carers in the workforce, for both the carer and the employer. The Government’s response to the consultation on carers’ leave confirms their intention to deliver on the manifesto commitment to introduce a new entitlement to one week of leave for unpaid carers. This will be a day 1 right, available to all employees who are providing care to a dependant with long-term care needs. I will obviously send more details to any noble Lords who would like them.
The noble Baronesses, Lady Pitkeathley and Lady Finlay, and my noble friend Lord Astor and others mentioned spending. We need to make sure that the Build Back Better plan for health and social care sets out an intention to make care work a more rewarding vocation. Many noble Lords have spoken about this. We need to offer a career where people can develop new skills and take on new challenges as they become more experienced. The Government are committed to spending at least £500 million over three years to deliver hundreds and thousands of training places and certifications, pathways, and well-being and mental health support. This workforce package is a significant investment that will support the development and well-being of the workforce. I hope that that partly answers some of the questions of the noble Lords, Lord Bichard and Lord Sikka, and the noble Baroness, Lady Pitkeathley.
We will continue to support the social work fast-track programmes Step Up to Social Work and Think Ahead, designed to support those wanting to change specialism to become a social worker and make a real difference to people’s lives. As one noble Lord said today, this is an incredibly noble profession. We will continue to introduce further reforms to improve recruiting and support for social care, with more details in the forthcoming White Paper. I am as eager as anyone in this House to see that paper, so that we can have a proper cross-party discussion on the reforms that are much needed.
Speaking as Minister for Technology, I will touch on one of the points that many have raised. I have made digitisation and data sharing one of my key priorities, as Minister for Technology, Innovation and Life Sciences. I hope that digital technology will play a key role in helping adult social care workers to do their jobs even more effectively.
However, we should also recognise the vital role of unpaid carers, as many have said, including the noble Baronesses, Lady Warwick and Lady Tyler. We want to build a system of care to better support unpaid carers, as well as helping recipients of care to have more choice and control over their lives, what they do and how they choose to live. Throughout the pandemic, the Government have taken a number of steps to support unpaid carers, such as funding charities that support carers, producing Covid-19 guidance tailored for carers, helping carers self-identify and ensuring access to and priority for PPE and vaccinations. The Government will work with representatives across the sector, including those who represent carers, to develop more detailed plans for social care reform together, ensuring that unpaid carers receive the support, advice and respite that they need.
As the noble Baroness, Lady Wheeler, said, there is an incredible amount of expertise in this House, and that has come through in the many contributions to today’s debate. I will work with noble Lords across the House as the health and social care Bill goes through it.
I am not sure how much longer I have.
Lord Kamall (Con)
Thank you. Noble Lords will have to forgive the new boy. Now someone is saying I have two minutes—there we are.
There are many questions I wanted to go through in detail, so I hope noble Lords will accept my apologies for being too verbose in many ways and not answering the detailed issues. I will write to noble Lords on any particular points. Clearly, I do not have a realistic estimate of my speaking time—let us put it that way.
Once again, I thank the noble Baroness, Lady Pitkeathley—
Lord Birt (CB)
The Minister has, understandably, focused largely on the funding issues. However, does he accept that unless there is fundamental organisational reform at the front line, we will not continue, whatever the level of funding, to deliver services in the most appropriate way?
Lord Kamall (Con)
I thank the noble Lord, Lord Birt, for his question. Yes, I agree.
The Government have provided support to our fantastic social care sector; many will debate whether it is enough and what more can be done, and we recognise that. However, we want to continue to address the many challenges. We will work with stakeholders on the plans for reform that we have set out, publishing more details in a White Paper later this year, when I hope we will have more discussions and debates.
I have spoken far too slowly but, finally, I know that we are all deeply committed to supporting the social care sector. I think we would all want to join together, whatever our views on various parts of the debate, in thanking all the amazing people on the front line providing care, who go the extra mile each day, week, month and year, some for those they love and others because it is a noble profession. As we have an ageing population, it is important that we tackle this issue, which has, as I say, been kicked down the road for many generations. Not all proposals will be perfect and any proposal will of course have its critics —that is the nature of political debate. However, I hope very much that in producing the proposals—and producing something rather more than a blank sheet of paper—that we can all debate, I will learn from the expertise and the points made in today’s debate from across the House to make the forthcoming Bill a more successful and more appropriate Bill that recognises the hard work and dedication of all care workers, whether paid or unpaid.
Baroness Pitkeathley (Lab)
My Lords, I am sure that your Lordships’ House would like me to thank the new boy on your behalf for his tour de force in answering his first debate. We do not doubt his commitment to this issue and we can promise him that this will not be the last time that he replies to a debate of this kind.
Far be it from me to try to sum up all the things that have been said today. There has been much consensus—consensus that we have reached before—that social care is a mess and does not provide to vulnerable people who need it, who work in it or who participate as carers or volunteers, services which allow them dignity or satisfactory and adequate care. Resources are completely inadequate and funding systems far too complex—we have heard quite a lot about that today.
We have heard concerns from all over about the workforce and the lack of integration between health and social care and a lack of understanding of the reality of people’s experience of what it is really like on the front line. I am afraid that that consensus also extends to our opinion of the reforms proposed so far. They will not do—they are not the promised fix. However, this debate has also thrown up something else. Here I echo what others have said about your Lordships’ experience. This debate has thrown up a wealth of constructive ideas about what is needed for that fix if we have not got there yet. The Minister has talked about listening, so I hope that those preparing the White Paper and the next steps in this reform will take into account the wisdom and experience expressed by your Lordships today.