Adult Social Care: Challenge Procedures
Baroness Pitkeathley Excerpts(1 year ago)
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Lord Markham (Con)
The main point is that we already have two levels of appeal. In the first instance, someone can appeal to a local authority and if they are not satisfied with that, they can appeal to the local ombudsman. Thousands of people do this every year, and compliance in terms of replies to them is very high. I must admit that I am not sure whether an additional, third level of appeal is really necessary in this case.
Baroness Pitkeathley (Lab)
My Lords, once again, a Question in your Lordships’ House has pointed out the inadequacy of the social care system, be it funding or personnel. In answer to an earlier Question, the Minister teased the House a little about the workforce strategy. Can he be more specific in answer to this Question?
Lord Markham (Con)
First, I take issue with the inadequacy comment. Some 89% of people expressed a high level of satisfaction with the social care provided, which, although not 100%, is pretty good, as I think everyone would agree. As I said, the workplace plan has been drafted. I am afraid I cannot give an exact date of publication—I believe there are local purdah issues now—but I can say that it will be soon.
Social Care
Baroness Pitkeathley Excerpts(1 year, 1 month ago)
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Baroness Pitkeathley (Lab)
My Lords, it is a pleasure to speak in this debate today, and I congratulate my noble friend Lady Andrews. I have lost count of the number of debates on social care in which I have participated in my 25 years in your Lordships’ House, and it has often been a rather depressing experience. I would often have to cajole, persuade or even beg people to take part. I took to calling the few stalwarts who could always be relied upon to speak—the “usual suspects”. We were a small but devoted band. For me, the best thing about today’s debate is the number of your Lordships speaking and the attention that is being drawn to social care, at last. To be able to call my noble friend Lady Andrews and the most reverend Primate the Archbishop of Canterbury “usual suspects” is a measure of the progress being made. Their influential reports mark, in my view, a step change in views about social care, which for so long has been the poor relation or the Cinderella vis-à-vis the NHS.
That is not to say that the social care scene is any better than the dire situation to which I have drawn attention over the years. On the contrary, it is worse, as the statistics and examples cited in the debate today illustrate. There is not enough money, not enough integration, too many broken promises, and too many vulnerable people and their families neglected. I, like others, had hoped that we would have the long-promised plan from the Government today, but in its absence we must once again rely on promises and assurances that the Government hear our pleas and will answer our questions.
Your Lordships will understand that, for me, the most important recommendations in both the reports we are discussing today were about unpaid carers. I thank the noble Lord, Lord Polak, for sharing his moving personal experience on the issue of being an unpaid carer. Our social care system relies heavily on the care and support from these carers. In fact, they outnumber the paid health and care workforce by at least two to one. Many live in poverty or on its margins, often building up poverty for the future because of a lack of access to pensions and paid employment. Their health suffers physically and mentally, as we have heard.
The House of Lords report makes a series of sensible and modest recommendations, recognising that carers have to deal with a baffling range of organisations and agencies, which is stressful and time-consuming. For example, the report recommends that carers should be properly identified and have mechanisms for getting information. It states that carer’s allowance is inadequate and should be reviewed—hurrah—and recognises how important respite care breaks are and that there should be ring-fenced funding to provide them.
The recommendations from the Archbishops’ Commission are summed up as a new deal for carers which ensures that they have the practical, financial and emotional support to be able to provide care, maintain a loving relationship and live a full life themselves. These are modest enough demands which surely every carer deserves so that they have opportunities for a rest, better advice, better financial support, and coproduction so that they are involved in planning. None of these recommendations is rocket science, and neither are any of them unreasonable. They are simply actions and commitments which would help unpaid carers do what they want to do, willingly and with love: provide care for their loved ones, as well as caring for themselves.
It is a great disappointment that the Minister is unable to respond to all these recommendations today in the absence of the Government’s plan. I acknowledge that their White Paper, People at the Heart of Care, published in 2021, set out a 10-year vision for adult social care in which unpaid carers were recognised as equal partners in care. I cannot fault the Minister for the words he has shared many times in your Lordships’ House when acknowledging the vital role played by carers. I was delighted by the support his noble friend, the noble Lord, Lord Johnson, gave to the Private Member’s Bill that would give carers access to unpaid leave, which we hope will receive Royal Assent very soon. However, carers are at breaking point. I ask the Minister to assure the House today that he knows that more funding and better integration is vital for their support. Warm words are not enough.
Beyond carers, can the Minister assure the House that when we finally see this long- awaited plan, it will have some vision in the spirit of that 10-year plan, and that it will make some attempt to address the causes of the difficulties in health and social care and not leave the Government open to charges of yet another sticking-plaster solution? Health inequalities must be addressed. They are the result of poverty and inadequate services, which are in turn the result of many years of spending cuts. The most efficient way to ensure our health and social care services are not overwhelmed is to make sure that people do not need them. If we could rebalance the agenda towards the prevention of ill health, that is the sort of vision and focus that could give some hope for the future of social care and reassure the carers who are its main providers.
Social Care: Workforce Strategy
Baroness Pitkeathley Excerpts(1 year, 1 month ago)
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Baroness Pitkeathley
To ask His Majesty’s Government what plans they have, if any, to reduce their £500 million investment in the social care workforce; and when they will publish their strategy for increasing the size of that workforce.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
The Department of Health and Social Care will shortly publish a two-year plan for how it will reform the adult social care system. That publication will confirm the Government’s commitment to the 10-year vision set out in the People at the Heart of Care White Paper. It will provide specific detail on how we will implement workforce proposals, including funding activity and milestones.
Baroness Pitkeathley (Lab)
I thank the Minister for that Answer, but note that he has not assured me about the proposed or rumoured cuts to the current investment in the social care workforce. As he knows, these rumours have caused great distress to those trying to provide decent care to some of the most vulnerable in our society, against the background of a 13% vacancy rate—so one in eight posts is vacant—with subsequent difficulties in recruitment and retention. The money that has been promised seems very slow in reaching the front line, according to local authorities and carer organisations.
I am very glad to know that we are going to see the plan for the social care workforce; we have waited for it a long time. When we finally see it, which I hope will be before the House rises for the Easter Recess, will it ensure that those who work in social care are properly recognised, rewarded and trained so that, at last, their status is comparable with those who work in the NHS?
Lord Markham (Con)
I apologise because, in some ways, the timing is slightly unfortunate with the report coming out before the Recess, as is my understanding. I am not allowed to steal much of Minister Whateley’s thunder on that, but I will answer as best as I can. I hope that noble Lords will be pleased that questions around training, recognition of the importance of the service and career structure are all addressed in the report.
Physiotherapy: Rehabilitation Services
Baroness Pitkeathley Excerpts(1 year, 2 months ago)
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Lord Markham (Con)
Totally. I am sorry to hear that case, and I think that we would all agree that that is not the sort of service we would want to see. As I said, we have put increases in staff in place—there have been 3,300 extra staff since 2017—but, clearly, we need to do more. That is why I was very pleased to read that this area is an important part of the workforce plan, which noble Lords will be happy to hear we are now seeing drafts of.
Baroness Pitkeathley (Lab)
My Lords, if stroke survivors are imprisoned at home with a bed and a commode, as my noble friend’s Question suggests, does the Minister agree that their unpaid carers are similarly imprisoned? Is the lack of rehabilitation services part of the reason why the numbers of people giving more than 50 hours a week unpaid care is increasing rapidly, as the latest census figures suggest?
Lord Markham (Con)
As I said, physio is key to rehabilitation, whether for strokes, as we have discussed, or for any one of the number of reasons that people are in hospital and trying to come out. As I mentioned, we have seen increases: there are about 7% more people now in training each year, and that figure increases each year. We now have about 50,000 physios in the public and private sectors who are providing those types of services. Clearly, there are examples where we need to do more, but we are also making progress.
Times Health Commission
Baroness Pitkeathley Excerpts(1 year, 3 months ago)
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Lord Markham (Con)
My experience of royal commissions is that they take a couple of years to report. I do not want to wait a couple of years. I want to get on with it now. We have some very good minds in the department working on it, with access to all of this. I am always willing to take on new ideas from new minds but we do not need a two-year report; we need action now.
Baroness Pitkeathley (Lab)
My Lords, does the Minister agree that, in any investigation of health and social care, the voices of patients and users must be loud and strong? How are the Government going to ensure that this happens?
Lord Markham (Con)
Clearly, the patient has to be at the centre of everything. That is what the plan for patients is about. It is also what patient choice is about; we are using other ways to make sure that people can get treatment quickly when they need to. It involves using the independent sector, as pioneered by colleagues in this House, and learning lessons from that so that we can get on top of waiting lists, which we all agree we need to do.
Care Homes: Staffing
Baroness Pitkeathley Excerpts(1 year, 4 months ago)
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Baroness Pitkeathley
To ask His Majesty’s Government how they will ensure that care homes where they block-buy places to assist with hospital discharges are adequately staffed.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
On Monday, this Government announced an additional £200 million of funding for short-term NHS step-down care packages to help ease the pressure on local hospital beds. ICBs will work closely with local authorities to purchase places in care homes and other settings. Using their knowledge, they will commission appropriate beds where there is sufficient capacity, including workforce capacity, to meet patient needs.
Baroness Pitkeathley (Lab)
I thank the Minister for that response, although it seems a bit more knee-jerk than it does a coherent strategy and it poses as many questions as it answers. For example, are the Government planning to pay care homes directly to pay recruited staff or to work through ICBs and local authorities only? What rates are to be paid? Will it be more than care workers currently earn, so as to compete with the retail sector? Given that there are 160,000 vacancies in the care workforce currently, where are those workers to come from, without pulling staff away from an already understaffed NHS?
Lord Markham (Con)
Before we went ahead with this, we spoke to many care providers to make sure that there was capacity within the system to do it. It was understood that the capacity is there. In fact, there is potential underused capacity of as much as 40,000. We are confident that the staffing is in place and that the care packages are there to really make a difference.
Excess Deaths in Private Homes
Baroness Pitkeathley Excerpts(1 year, 4 months ago)
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Lord Markham (Con)
My noble friend makes a challenging point. This will be a subject of the inquiry, on which I look forward to hearing more.
Baroness Pitkeathley (Lab)
My Lords, does the Minister agree that one of the elements here may be the lack of support to family carers, who are often the element most involved in providing care at the last stages of life, and in particular the lack of willingness to engage with family carers, who are the people who know most about the condition? I have lost count of the number of family carers who have said to me, “They just didn’t want to know my side of this element.”
Lord Markham (Con)
I thank the noble Baroness. We have spoken before about this in the House. I agree with the general point that family carers, probably more than anyone, have great knowledge to bear, and so absolutely that should be an important component.
Hospital Beds: Social Care
Baroness Pitkeathley Excerpts(1 year, 4 months ago)
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Lord Markham (Con)
Of course, the noble Baroness is aware that it is the third parties, whether it be the local authorities or the private sector, that employ them. But what we have done in terms of setting the national living wage, which I believe is around that amount, is exactly making sure that there is a minimum amount that these people can get. About 65% of the funding going into the system goes through to wages, so the £2.8 billion increase next year will flow largely into wages and salaries.
Baroness Pitkeathley (Lab)
Every one of the interventions we hear about points to the inadequacy of the social care system and every one of the interventions that the Minister makes, however well intentioned—and I do not dispute that they are well intentioned—concerns piecemeal reforms. Will the Government ever accept that the only thing that is going to solve this ongoing problem, which is only going to get worse, is a wholesale reform of the social care system?
Lord Markham (Con)
There are a lot of questions that we need to answer in this space—I absolutely accept that—and lots of things that need long-term thought. I think and hope that noble Lords are starting to see that thinking emerge. A lot more needs to be done at the moment, but I think that we accept that this is a long-term issue that needs to be resolved with help from all sides of the House.
Care Homes: Severely Disabled People
Baroness Pitkeathley Excerpts(1 year, 5 months ago)
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Baroness Pitkeathley
To ask His Majesty’s Government what assessment they have made of reports that some care charities have been forced to evict severely disabled people from their care homes because of disputes with local authorities about fees.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
The disruption of care where it negatively impacts vulnerable service users is unacceptable. Under the Care Act, local authorities have a duty to shape their markets and provide services to those with eligible needs. The Government are providing up to £7.5 billion over the next two years to support adult social care and discharge. This historic funding boost will help local authorities to start addressing waiting lists, low fee rates and work- force pressures in the sector.
Baroness Pitkeathley (Lab)
I thank the Minister for that Answer, but I cannot say that any of it was a surprise to me. Will he acknowledge that this is just the latest manifestation of a long-standing problem? For years, the social care system for adults with complex disabilities has been held together by charities and not-for-profits that have poured literally millions from their reserves into subsidising the services they provide for the NHS and local authorities. Now these organisations are in financial trouble and can no longer afford to do so. Those who are suffering are those in greatest need. Does the Minister agree that the whole system of funding for social care is broken and that the only solution is complete root-and-branch reform, not the piecemeal solutions offered by the Government?
Lord Markham (Con)
I thank the noble Baroness and echo the sentiment of thanks to the charitable sector for the work it is doing in this vital space. We have shown that we have listened in this area through the £7.5 billion—a 22% increase over two years, which I think everyone would agree is substantial. At the same time, we are in touch with these bodies; we reached out to the charity Leonard Cheshire, which is involved in this, to try to understand the issues. If there are ways in which we can directly help, we will do so.
Social Care Sector: Staff Shortages
Baroness Pitkeathley Excerpts(1 year, 5 months ago)
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Lord Markham (Con)
I agree with my noble friend. Overseas and Commonwealth recruitment is a key area here, which is why I am delighted that we have addressed the visa restrictions and entered social care on an essential workers list. We have already seen 15,000 people come in this space, and that figure is increasing month on month. My noble friend is correct that this is a critical area for recruitment for us.
Baroness Pitkeathley (Lab)
My Lords, does the Minister agree that the more problems there are with paid workers in social care, the more difficulties fall on the nearly 10 million unpaid carers. Of those who are receiving the carer’s allowance, 40% say that they are already in debt and not sure how they will manage through the winter. Does he also agree that, in view of the myriad problems in social care, it is time to listen to what the noble Lord, Lord Forsyth, asked the House last Thursday, and think about a proper review of the whole of social care?
Lord Markham (Con)
My Lords, I thank the noble Baroness. The new funds mentioned recognise that this is critical to the health of our National Health Service and the flow. As part of that, as I mentioned in my Answer, we are looking at staffing plans across allied health professions in the health and social care space, and it is vital that we get the recruitment to this area to solve the overall issue of flow and NHS wait times.