Social Care

Barbara Keeley Excerpts

Tuesday 25th February 2020 Commons Chamber

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

I beg to move,

That this House notes that almost ten years of Government cuts to council budgets have resulted in a social care funding crisis which means 1.5 million older people have unmet social care needs; further notes the increasing funding gap for adult social care; believes proposals from the Government for access to additional funding for both adult and children’s social care will do nothing to ease the crisis or address the funding gap; and calls on the Government to bring forward as a matter of urgency plans to reform social care including plans for free personal care.

It is right that we have a chance to debate social care today: it is two weeks ahead of the Budget and there is the ever present hope that the Government will announce much-needed social care reform. This reform is long overdue. After nearly a decade of cuts, our social care system is on its knees. For the people who rely on social care and for their families, the reality is that things have got much worse under successive Conservative Governments. Every day last year, 2,000 older people who had approached their local authority for help with social care were turned down. The result is that there are currently 1.5 million older people who are not getting the support they need—each one struggling to cope with basic everyday tasks. This can mean people left trapped in bed all day or going unwashed all week, because family carers can visit them only on the weekends, and those are the people who are fortunate enough to have help from unpaid carers. Around half the 1.5 million get no help at all—not even from family and friends. They cope as best they can until they end up in hospital, and then they cannot get out of hospital because they can only be discharged safely once a social care package is set up, with the local authorities struggling to find the funding for it.

Another failure in our social care system is where people are held in entirely inappropriate institutions because the local authority cannot fund the care they need to keep them safe in the community. There are 2,200 autistic people and people with learning disabilities who continue to be detained on in-patient wards. This is one of the most egregious failures of our social care system. They should be able to live in their own homes with a support package, but the funding is not there. For eight years the Government have been promising to end this scandal, but they have failed to do so.

[Thangam Debbonaire (Bristol West) (Lab)]

My hon. Friend is making a great start to a very important speech. Does she agree that it is quite astonishing that the Equality and Human Rights Commission has been forced into a position where it is having to threaten to take action over the Government because of their failure to accommodate people with autism and learning disabilities, and it is people who are suffering as a result?

[Barbara Keeley]

I absolutely agree with my hon. Friend. The only way that we will see real change is if the Government put in funding to provide the housing and support needed for those people currently trapped in inappropriate institutions. I first raised this issue with the Secretary of State in October 2018, citing the case of a young autistic woman called Bethany. It took 14 months before Bethany was moved out of a seclusion cell and into a more supported environment. Now we have, as my hon. Friend has said, the Equalities and Human Rights Commission launching a legal challenge against the Department for its failure to move those 2,200 autistic people and people with learning disabilities out of those inappropriate units.

We must see action on this issue, because it is a national scandal. We need to see reform so that more people can get the care they need, rather than being left to struggle on alone. Even when people are able to access publicly funded care, there is no guarantee that it will be of acceptable quality. Last year, one in six social care services was rated by the Care Quality Commission as “inadequate” or “requires improvement”. That can mean care homes that are so unclean that residents are at risk of picking up infections. It can mean home care agencies that have not even carried out basic checks on their staff, or home care staff being so rushed that they do not have the time to take off their coats during a visit.

Twenty per cent of councils in England and Wales still commission 15-minute care visits. That is clearly not long enough to provide care. It is not long enough to get to know someone and support them to do the things that they want to do.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

A German style system of social insurance would allow somebody who is defined as needing social care to draw down a certain amount of money which they could then use to pay to a relative, a loved one, or a neighbour who understands that person best and who can care for them best. Is that not a sensible basis for a cross-party discussion, between the Opposition and the Government, about whether a German style social insurance system could solve this problem?

[Barbara Keeley]

I thank the hon. Gentleman for making that point; he does make it on every occasion that we debate this subject, so I congratulate him on doing so again. However, the person he needs to be directing his comments about cross-party talks to is sitting on the Government Front Bench. I am hopeful that the Secretary of State is going to tell us what he is going to do about cross-party talks, because those 15-minute visits are really not good enough.

[Mr Toby Perkins (Chesterfield) (Lab)]

I agree entirely about the need for cross-party consensus on this issue, but there can be no consensus until there is an acknowledgement of what has caused the care crisis—the underfunding of the health service and cuts to local government budgets, which have had an impact on A&Es, GPs and other services. Until there is an acknowledgement of what caused the situation, there can be no consensus towards a solution.

[Barbara Keeley]

My hon. Friend is right. I will come to the causes, because it is important to mention them.

The 15-minute care visit reduces the giving of care by care staff to a series of physical tasks, rather than the staff being able to see a person with their own interests, desires and opinions. It really strips them of the time to do the job they want to do. I pay tribute to all care staff, who go above and beyond in their jobs to improve the lives of the people they support. Without them, our social care system would not work, but they do not get the pay and recognition that they deserve.

Care staff, who provide essential practical and emotional support to some of the most vulnerable people in society, are among the most poorly paid workers. The average hourly pay for care staff is below the rate paid in most UK supermarkets. On average, care staff are paid less than cleaners and healthcare assistants in the NHS, and this has led to a vacancy rate of 122,000 care jobs and a turnover rate of 33%. Now the Government are planning to make the situation worse by turning away people who want to come to this country to work in social care. One in seven care workers is from outside the UK, but the average care worker earns £10,000 a year less than the Government’s immigration salary threshold, so will the Secretary of State tell us just how he thinks he is going to be able to fill the large number of vacancies in the social care workforce?

[Lilian Greenwood (Nottingham South) (Lab)]

My hon. Friend is making a powerful speech. Does she share my concern that poor pay and conditions mean not only that these workers are exploited, but that there is a high degree of turnover and a lack of investment in training and development, which in themselves have a significant impact on the quality of care that is delivered to some of our most vulnerable residents?

[Barbara Keeley]

Once again, I absolutely agree. My hon. Friend is right to emphasise that point.

Last week I met home care support workers in my constituency who are campaigning to be paid a real living wage, and they told me about their struggles to manage financially. One staff member talked of working 90 hours for four consecutive weeks at an effective rate of £6.10 an hour. Others talked about being bitten or punched, yet still they continue to do the support job that they love. I pay tribute to their commitment; in the case of social care, doing a rewarding job does not pay the bills.

[Mike Amesbury (Weaver Vale) (Lab)]

Does my hon. Friend agree that far too many essential careworkers are employed on zero-hours contracts, which we really need to see kicked into history?

[Barbara Keeley]

I very much agree. We need to pay care staff the real living wage, provide them with training and end the use of zero-hours contracts.

I think it is clear enough that the Labour party believes that the current system is not working, and I am sure that the Secretary of State knows it too. Councils just do not have the funding required to deliver the care that people need, and they are faced with a stark choice—either they cut back on the quality of care, or even fewer people receive any help at all. Only a third of directors of adult social services think that their budget will be enough to meet their statutory duties this year, which means that thousands of people who approach their local authority for help with their care are turned down for support. Without investment and a plan, social care services will be pushed deeper and deeper into crisis. Expert report after expert report has pointed to social care being on the verge of collapse, and those reports make it clear that councils cannot deliver adequate adult social care provision without a sustainable, long-term funding strategy. Yet what we have seen from the Government, year after year, is short-term and piecemeal funding.

The Secretary of State may repeat, as his colleagues did yesterday, that the Government are allowing councils to raise council tax this year to fund social care services, but the Opposition know that council tax is a deeply unfair way to fund this vital public service. A 2% rise in council tax rates in Wokingham will raise twice as much money as it would in Knowsley. Even if we raised council tax by 2% every year, the Institute for Fiscal Studies says that by the end of the decade social care will make up over half of all local government spending. This means that other vital services will continue to be cut back. That is certainly the situation I see in my own local authority area.

[Alex Cunningham (Stockton North) (Lab)]

The shortage of resource and people in the system means that more responsibility falls on families. I know that my hon. Friend recognises the unsung heroes who are young carers—children who miss out on education, a social life and so much more to care for a parent or sibling. Does she agree that the Government need to do more to help to support organisations like the Eastern Ravens Trust in Stockton, which does so much to help these young carers to have a life of their own?

[Barbara Keeley]

Indeed I do. I am looking forward to the establishment of the new all-party group on young carers, but it is tragic, in a way, that we have to meet in new all-party groups to try to find some way of taking the burden from those young carers.

As local authorities struggle to fund social care, an increasing number of people are forced to take on the financial burden themselves. Some 143,000 people are currently faced with catastrophic costs of over £100,000 for their own care. Over the past three years, 9,000 people have asked their local authority for help after completely depleting their own savings to pay for their care. This means that people are having to sell their homes that they may have lived in for their entire lives to fund the care that they need. The Prime Minister has promised to stop this situation, but with no plan and no proposals for how he achieves that, it is likely that many more people will be put in this position going forward. The Government could drastically reduce the number of people faced with catastrophic costs for their care if they set a lifetime cap on care costs. The Government proposed a cap in 2013. They legislated for it, but dropped it in 2016. That cap would have gone some way towards reducing the number of people now faced with catastrophic social care costs. The Government’s own impact assessment showed that by this year 37,000 people would have benefited from the cap if it had been introduced in 2016.

But reform is not just about protecting housing wealth. It is important to do that, but reform also has to offer a solution to the people who are currently stuck in bed all day unable to get themselves dressed, or needlessly stuck in hospital. The solution that Labour favours is to offer free personal care to ensure that everyone is supported with the basic tasks regardless of their ability to pay. Free personal care was introduced by a Labour-led Government in Scotland in 2002, and it is ensuring that more people there receive publicly funded social care. Free personal care has been backed by the House of Lords Economic Affairs Committee and by charities and think-tanks.

We believe that it is vital that we push forward with this reform because progress to date has been far too slow. In October 2018, the Secretary of State talked about:

“The adult social care Green Paper, which will be published later this year”.—[Official Report, 17 October 2018; Vol. 647, c. 736.]

In 2019, we were told that there would be a Green Paper “that summer” that would set out the future of social care, but it never arrived. It was delayed twice before being dropped completely. Seven months ago, the Prime Minister stood on the steps of Downing Street and said that he had a plan to fix the social care crisis. There is still no sign of it. Perhaps this plan is in the same state as the promised Green Paper. The Government said that they would instigate cross-party talks on social care within the first 100 days of the election. We are now 75 days on and we have yet to hear from the Government on their proposals.

Labour is the only party, as it stands today, with clear plans for the future of social care. Labour’s plan for social care would close the funding gap, cap care costs, and introduce free personal care and improved pay and working conditions for care staff. In contrast, we have no action from the Government on social care. Councils are reliant on piecemeal funding announcements and raising ever higher levels of council tax, yet these measures leave them struggling to meet demand. So Labour’s message to the Prime Minister and the Secretary of State is clear: they need to put in the extra investment needed to stabilise the care system, introduce free personal care, bring back a cap on care costs, and develop a plan to improve the pay and working conditions of the care workforce. I want to make it clear that Labour will be happy to sit down with Ministers and talk them through our proposals, as the Prime Minister does not appear—at this point in time, at least—to have any plans of his own. I urge hon. Members to vote for our motion tonight to ensure that the Government have to finally meet their pledge to fix social care.

--- Later in debate ---

[Matt Hancock]

No. What I am saying is that life expectancy, as I have repeated, is going up, but there are areas where it is not, and we will and we must tackle that. The challenge for us as a country is not to try to pretend that things are different to the facts. The challenge here, which Opposition Members will not accept, is that there are parts of the country where life expectancy is advancing rapidly and there are parts where it is not, and we must tackle that. We cannot have a decent policy conversation if half of the debate will not accept the facts on the ground.

The Marmot report was published this morning. It is absolutely critical that we level up life expectancy. The fact that in Blackpool a healthy life expectancy for men is 53 years yet in Buckingham it is 68 years is a disgrace, and we will put that right, but you cannot put things right if you ignore the facts when you are starting.

[Barbara Keeley]

I just want to round this point off. What does the right hon. Gentleman think happens with life expectancy when 1.5 million older people are going without care? Does he not think that the impact of the lack of social care, especially on women in deprived areas, is a key factor?

[Matt Hancock]

I do not recognise those figures, because—

--- Later in debate ---

[Matt Hancock]

Yes, I have. As the hon. Member knows, my hon. Friend the Member for Chichester (Gillian Keegan) was my Parliamentary Private Secretary, and we talked about this a lot, so I welcome that work. Indeed, the amount of work from various Select Committees and groups in this House has been considerable, as my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) made clear earlier. There has been an awful lot of reports and of very good work, including the work to which the hon. Member has contributed.

[Barbara Keeley]

The right hon. Member knows that I raised with him on the day of the first Queen’s Speech, in October last year, the need for us to set up cross-party talks. He has done nothing about that since then—nothing has happened on that. There was some vague talk about sitting down with the former Minister for Care for a cup of tea, but that is not cross-party talks. Will he say now: is he going to set up cross-party talks?

[Matt Hancock]

We will fulfil all the commitments in the manifesto, which, as the hon. Member set out, includes one on this subject, and that is part of our plan.

--- Later in debate ---

[Huw Merriman (Bexhill and Battle) (Con)]

It is a pleasure to follow the hon. Member for Chesterfield (Mr Perkins) and all the other contributors. There seems to be cross-party consensus that we need to find a solution for all our constituents. I welcome the new Care Minister to her place. We entered the House together, and I know that this subject is a real passion of hers. I am very excited that she is in post, and I think we can expect great things from her in this area of reform. I also thank her predecessor, my hon. Friend the Member for Gosport (Caroline Dinenage); on the day that the chairs were rearranged, she was in my constituency opening a new hospice, and she was absolutely wonderful to all the staff and patients.

It is a delight to speak in this debate, because this issue is the key concern in my constituency, as it will be in many constituencies. We talk about the fact that 18% of people across the UK are over the age of 65, and that that figure will rise to just shy of 25% of the population by 2040. But in my constituency, 30% of constituents are already over the age of 65. That is absolutely fantastic because we are rich in seniority, but it does mean that there are people who have difficult needs and challenges. In a constituency such as mine, people tend to retire down to the coast and downsize, which means they live in smaller properties and pay much less council tax. However, they also tend to need more services from the local community. It is for that very reason that we cannot continue with the concept of council tax funding social care. It is a postcode lottery, and the places that need the most are given the least when it comes to yield.

I would like to see the system centralised, but rather than having another NHS system, we should inject a bit more reform and interest. That is why I said to the Secretary of State that it would be right for us to follow the German model. In the ’90s, Germany had the exact same issues that we have today, with regional imbalances meaning that parts of the German republic just could not afford social care at a local level. There was also great unfairness in the country because certain people just could not access the care that they needed, and it would wipe out their assets. Both parties then fundamentally agreed that it was in the interests of all their constituents to work together on a cross-party basis to deliver reform. That was when the policy of long-term social care insurance funds was established.

The German model requires individuals to pay in. No individual pays more than €138 a month, and the employer matches that amount. Retired people pay the full amount themselves, so the policy gives a nod to intergenerational fairness. It takes risk out of the system; if one individual has greater needs than another, that is not factored into the amount they pay. Crucially, it has been popular. People do not talk about social care as a political issue in Germany in the way that they do in this country.

In a way, this situation is an absolute tragedy. Opposition Front Benchers rightly talk about the years that we have had in Government in which we could have fixed the issue, but they do not focus on what had gone on since 1997. The Labour Government absolutely ducked this issue and were faced with calls from the Conservatives of “death tax”. In return, we got that back in spades when we talked with honesty in our 2017 manifesto and proposed a policy that was then labelled the “dementia tax”. Our constituents—all of us, across the House—must absolutely despair.

[Barbara Keeley]

Will the hon. Gentleman give way?

[Huw Merriman]

I will give way to the hon. Lady, because a couple of years ago when I made the point that I hoped we could work on a cross-party basis, the talk back to me was, “Actually, that cost you the election, and we wouldn’t work with you on that basis.” I found that response rather frustrating, so I hope for more.

[Barbara Keeley]

I do not recall that I ever said that, but there is a key point in what the hon. Gentleman is saying. Our recollection is that it was not the Labour party that labelled the Conservatives’ proposal the dementia tax. I think it was actually one of the national charities and the phrase then got taken up by the media, so I ask the hon. Member not to pin that one on us. It is important that we establish cross-party talks, but the people he should be addressing his comments to are on his own Front Bench. Ministers have had since October to follow up on the point I raised with the Secretary of State about cross-party talks, but they have done nothing. We keep hearing about cross-party talks, but they are not happening because the Government are not doing anything about it.

[Huw Merriman]

I remember well the exchange that I had with the hon. Lady a couple of years ago. The point I was making was that we did not seem that far apart—she talked about the fact that more funds needed to be raised, and so did we, perhaps with people taking individual responsibility—but the response I got back was more like a lesson on why such policies cost us our majority. That may have been a fair point, but my frustration was that we were being honest and straight with people that if we actually want to reform the system, we may need to ask people to pay more in. Most people do not realise that they already have to pay for it; it is only when they access the service that they fully understand what it really costs them. A lot of people—about 50% of the population—think that the NHS takes care of social care for them. They do not understand.

Whenever we try to propose reform around election times, it turns into a political football. In a way, this is the time to have the conversation, because I do not believe there will be an election for many years to come, so there is the opportunity for us to work cross-party. The hon. Lady is absolutely right: for cross-party talks to occur, she needs a proper invite, and I very much hope that that will be forthcoming. However, given that we now have a Conservative majority, in the event that, sadly, these cross-party talks do not work out—as I say, I hope they do, because that is the greatest chance we have of delivering reform and persuading the public that we are all in this together on their behalf—then I very much hope that we will use our ideas, our mission and our majority to put reform through rather than saying that it has faltered because we cannot get consensus.

The most vulnerable, the elderly and the people who have worked hard all their lives are now lacking in dignity within the system because we simply do not have enough money in place. We have not delivered the reforms that we talk about in this place constantly but still fail to enact. I very much hope that this Government will do that, hopefully on a cross-party basis, but if that does not reach fruition, then by inputting our own principles, our own policies and our own devotion to the people I am talking about, so that we give them and the generations to come a better future.

--- Later in debate ---

[Helen Whately]

I thank the hon. Gentleman for his suggestion. It is almost as if he has seen my notes.

One thing I particularly welcome is the number of hon. Members on both sides of the House who spoke about the importance of careworkers, who provide such important care.

My hon. Friend the Member for Peterborough (Paul Bristow) mentioned that both his parents were nurses in the care sector. He drew on his knowledge of care and rightly said that the profession should be held in higher esteem and that, just as we hugely value NHS staff, we should hugely value careworkers. The hon. Members for Warrington North (Charlotte Nichols), for Blaydon (Liz Twist), for Dulwich and West Norwood (Helen Hayes), for Putney (Fleur Anderson) and for Liverpool, Wavertree (Paula Barker) and my hon. Friend the Member for Bury North (James Daly) spoke along the same lines, and I could not agree more.

Not long after I became the Member of Parliament for Faversham and Mid Kent, I joined a careworker, Kim, on her daily round. By the time I met her at 7.30 am, she had already started washing her first client. By lunch time, she had washed, dressed, fed, medicated and chatted with six or seven men and women. Some of them were grateful and some of them, quite honestly, were not grateful, but they were all utterly reliant on her care. That experience really brought home to me the skill, knowledge and compassion of our social care workers. For those who need help, there are amazing carers with hearts of gold, like Kim.

Our care system depends on an extraordinary workforce of capable and compassionate carers, but we need more people to choose care as a career. That means changing the perception of being a care worker. As a society, we must truly recognise the importance of the work. We must make sure that more people realise the range of jobs in care and the opportunities for progression. The Government are currently investing in an adult social care recruitment campaign with the strapline “When you care, every day makes a difference”. We are working with Skills for Care to support workforce development and there is funding for a workforce development fund. That is really important, but we know that we must go further in making sure that we truly value the important work that the care sector does and to make sure that the care profession attracts the workforce that we need and gives them the opportunities to lead a truly fulfilling career.

Several Members rightly talked about unpaid carers, who also provide so much vital care. We fully recognise the value of that work and know the importance of support for those people who do so much caring. That is one reason why the Government will introduce a statutory right to leave from work for one week a year for the 5 million people who juggle work alongside being an unpaid carer.

My hon. Friend the Member for Bury North talked about quality of care, and it was really important to hear that mentioned as part of the debate. He spoke about how good care is in his constituency, and he is absolutely right that we should talk about how good care is throughout England. Some 84% of adult social care providers are currently rated good or outstanding by the CQC. Let us recognise the high quality of care.

My hon. Friend also spoke about the importance of integration—of the NHS, local authorities and care providers working together—as did my right hon. Friend the Member for Ashford (Damian Green), who is knowledgeable on this subject. The interplay between the NHS and social care is critical. The better care fund and the improved better care fund are a success story in respect of enabling more co-operation between the systems. It is crucial that we continue to build on that success so that our care system meets the needs of the individual, not just of the system.

My hon. Friend the Member for Watford (Dean Russell) made some excellent points about how, paradoxically, we can use technology to help to achieve more human and more personal care for a more cohesive and effective care system.

Both my hon. Friend the Member for Thurrock (Jackie Doyle-Price) and the shadow Minister for Care, the hon. Member for Worsley and Eccles South (Barbara Keeley), mentioned those with learning disabilities and autism who are being cared for in in-patient settings. I am new to this job, but I absolutely appreciate the importance of making sure that we do better in this regard. People should be cared for in the best place for their needs. At the end of last month, the number of those in in-patient settings had been reduced by 24% compared with 2015—

[Barbara Keeley]

indicated dissent.

[Helen Whately]

The shadow Minister is shaking her head; I know that there is more to do.

At times this has been a heated debate, but I heard on both sides truly constructive suggestions for how we can solve our social care challenges. That gives me much hope for cross-party consensus. I heard suggestions from my hon. Friends the Members for Newton Abbot (Anne Marie Morris) and for Meon Valley (Mrs Drummond), my right hon. Friend the Member for Ashford, the hon. Member for Leicester West (Liz Kendall) and my hon. Friend the Member for Bexhill and Battle (Huw Merriman), whom I thank for his kind words welcoming me to my job. He set the bar high for me to meet.

I am fully aware of the challenges that face our care system and I have no illusions as to the scale of the challenge facing us. In the next 10 years, we expect the number of people over 75 to go up by 1.5 million, and the number of people under 65 with care needs is growing, too. We have a system that is under pressure and the demands are only going to grow.