Queen’s Speech

Baroness Bakewell Excerpts

Tuesday 22nd October 2019 Lords Chamber

[Baroness Bakewell (Lab)]

My Lords, I regret the cursory reference in the gracious Speech to the social care needs of the old in this country. The Minister’s statement this afternoon has been confined to sums of money, some of which have already been announced. It was money that she spoke of; there was no substantial commitment to make changes to the system at a time when so much needs to be done. I will make two points which apply to the core issues of the care of the seriously old.

First, when I served as the Voice of Older People between 2008 and 2010, I received many letters asking for help with a problem concerning residential retirement homes and villages: many elderly people had come to rely on the expertise, availability and friendship of the wardens appointed to their care. These wardens were being phased out in favour of electronic alarms, buttons and telephone responses. Years later I sat on this House’s committee looking into AI and its potential. It became clear that artificial intelligence and robotic systems would increasingly offer an efficient and economical way of caring for the isolated old. I wish to issue a warning: old people want and need human contact; it helps them fight depression and loneliness in a way that machines cannot. I ask that future provision, while making strategic use of mechanics, has written safeguards about sustaining human contact with the old and isolated.

My second point is on a larger scale and concerns the business model that underpins the provision of residential care homes across the country: this needs a major rethink. I can only hope that the repeated delay of the long-promised Green Paper is because someone somewhere has woken up to the fact that the system is broken. The well-being and sense of security of frail, old people is at the mercy of the private equity-style business model, with the risk of companies carrying heavy debt burdens and paying extremely high interest rates.

The care home market, as noble Lords will know, is currently dominated by four major care providers: HC-One, Four Seasons, Care UK and Barchester. Between them, they operate some 900 of the country’s 11,000 care homes. Some 95% of the country’s care beds are provided by the independent sector, catering for self-funders and the local authority-supported. Recent austerity cuts to local council funding and the introduction of the living wage have added to pressure on all these companies. Between 2015 and 2019 the big four declared losses totalling £900 million. In their 2017 published accounts their total debt was £2.2 million—I am quoting figures from their own statements as reported by Opus Restructuring. Noble Lords will remember that Southern Cross collapsed in 2011. Currently all four companies are up for sale. A deal for the sale of Barchester collapsed in July this year and Four Seasons put two of its top companies into administration in April this year. Now I am not a banker, and for all I know this is a really healthy state of affairs in the City, but it is not a safe, reliable model for the ongoing care of our older people.

Let us consider it from their point of view. The need for a care home often hits a family very suddenly: the death of a married partner may leave the children looking to provide for the survivor as soon as possible; a frail old person living alone may sustain a sudden injury or a sudden deterioration in health. They need to find somewhere quickly and to meet the complex financial arrangements that have to be made. There is now evidence that companies prefer to set up care homes in the country’s most affluent areas, where there will be more self-funders in their potential market. The market will thus fail to supply the needs of the poorer old, and sudden changes in company finances can leave old residents suddenly bereft and bewildered. Family decisions made quickly in the shadow of bereavement or illness can be the wrong choices, but making complaints or seeking redress is not easy when you are dependent on the staff of the care home. I hope the Minister will address the issue of embedding consumer law in the regulatory regimes of care homes.

Growing old is not an option we can exercise: the alternative is worse. No sector in our society is crying out for reform more than our care of the elderly—and, incidentally, their dedicated and underpaid care workers. Will the Government address these concerns with the greatest urgency, and can they give us a timescale?

Breast Scans

Baroness Bakewell Excerpts

Monday 19th November 2018 Lords Chamber

[Lord O'Shaughnessy]

I am happy to tell my noble friend that we are in the process of recruiting many more radiographers for the NHS, with a plan to recruit nearly 1,900 by 2021.

[Baroness Bakewell (Lab)]

My Lords, it is important that women have scans throughout their lives. They receive a reminder to go for a scan, but those reminders stop at the age of 70. The incidence of breast cancer continues after 70. Will the Minister reinstate reminders for people over that age?

[Lord O'Shaughnessy]

A trial is going on the moment, the AgeX trial, which is looking at the clinical effectiveness of breast cancer screening for women aged 71 to 73. However, that is a randomised control trial, so not all women are being invited.

Adult Social Care in England

Baroness Bakewell Excerpts

Tuesday 10th October 2017 Lords Chamber

Asked by

[Baroness Bakewell]

To ask Her Majesty’s Government how they plan to respond to today’s Care Quality Commission report on the state of Adult Social Care in England in which it states that “some 1.2 million people are not receiving the help they need, an increase of 18% on last year”.

[Baroness Bakewell (Lab)]

My Lords, I beg leave to ask a Question of which I have given private notice.

[The Parliamentary Under-Secretary of State, Department of Health (Lord O'Shaughnessy) (Con)]

My Lords, the Government are committed to improving the quality and availability of adult social care in England. That is why we passed the Care Act in 2014 to provide for the first time a national eligibility threshold for care. It is why we are investing £2 billion more in social care provision over the next three years and have plans to reform how care is funded for the long term.

[Baroness Bakewell]

My Lords, the situation in social care is deteriorating and the Government’s strategy to handle the challenge is inadequate. The situation is getting worse because of the fundamental change in the demographic of this country. Some 15,000 people are now 100 years old, and the size of that cohort is increasing. Surgeries are closing, hospitals are inadequate, and 1.2 million people are unpaid carers and themselves over the age of 65. This calls for a radical, fundamental response, rather than the usual Green Paper and sums of money. That is not enough. This country faces a crisis of demographic change.

[Lord O'Shaughnessy]

I agree in part with what the noble Baroness said in the sense that demographic change represents a big challenge. She mentioned the over-100s. The population of over-85s will double between now and 2037. As the CQC report makes clear, many of those people will have difficulty with the basic behaviours and actions they need to be able to live independently. That is the big challenge that we face. The report provides a very honest exposure of strengths and weaknesses in the current system. The strengths are there, though the noble Baroness perhaps did not give them as much credit as they deserve. The report says:

“Overall, the quality of care remains relatively stable, with the majority of all care rated as good and improvements in some services”.


Indeed, only 1% of services are rated inadequate. Clearly we want that percentage to be zero but it is better than in other sectors. I do not disagree with the noble Baroness about the demographic challenges we face. As I said in my first Answer, we are trying to put more funding in, to recruit more staff and raise quality now that we have this national threshold. We hope to decrease variation and then look for a long-term solution that will solve this problem that we have all been wandering around for the last 20 years.