Social Care

Baroness Barker Excerpts

Thursday 30th March 2023 Lords Chamber

[Baroness Barker (LD)]

My Lords, I have had the privilege of being a member of the Adult Social Care Committee, chaired by the noble Baroness, Lady Andrews, and I am now a member of the Select Committee on the Integration of Primary and Community Care, chaired by the noble Baroness, Lady Pitkeathley, so I have come to think of the noble Baroness, Lady Shephard, as my partner in crime on both of those, as we question a series of professionals coming in to try to tell us just how bad the situation is currently.

We are having this discussion in the run-up to a general election, nearly a decade on from the passing of the Care Act and more than two decades on from the royal commission on the future of long-term care, and I suspect we are no nearer a resolution now than we were then. But I think it is important, as we are in the run-up to a general election, to make a few recommendations to all those people in political parties who are drawing up their manifestos.

The first is that there needs to be an update of the Dilnot commission proposals. We need a realistic assessment of the needs of older people and adults with disabilities for long-term care and the extent to which that can be funded by individuals’ capital assets. A crucial element of that assessment has to be the availability and cost of trained skilled staff, because that is a huge issue in the sector. For the first time, a further element needs to be the number of people ageing without children—that is a phrase which covers a number of different circumstances. We have now got to the point where Secretaries of State for Health admit openly that we have a health and social care system predicated on the fact that the majority of care, and management of care, will be done by families. There are at least 1 million people who do not have children, and it is children we are talking about. We do not even record the number of men who do not have children; we do not have that basic data, and yet we are expecting them to manage care. Unless and until we do that, there will be a profound effect on those people when they come to moments of crisis, such as hospital discharge. We need the Government to start to really look at this issue.

The second recommendation is that we need, as a matter of urgency, the development of legislation, policy and protocols that governing the use of, and access to, data of health and social care users. Currently, we have a system in which the sharing of information just between the departments of an acute hospital is utterly random, and between the different parts of the health and social care system, between acute and community health, and social care and local authorities, is non-existent. We talk about care pathways, but they are rapidly becoming a fictional idea. I defy anybody—a professional, a user or a carer—to know what a care pathway is and how to get from one place to another. Unless and until we sort this, we will have an ineffective, expensive mess: duplication of services on the one hand and lack of access to basic services on the other.

My third point is that, as regulators of health and social care—particularly the CQC as it goes into the new single assessment framework—look at these new integrated care systems, they need to specify who is responsible not just for a single episode of care but for care pathways. We have not begun to see that yet, and it is fundamental to our ability to build a system which works in the long term.

I suspect, in the run-up to the election, there will be calls from some people to say that we ought to take care away from local authorities; that for the sake of efficiency, we either put everything under the NHS, or outsource much more to the voluntary sector, charities and faith groups because they will make better use of limited resources. I would caution against that. Local authorities have a public equality duty and access to population data, and to data about individuals within their areas. I think it is crucial that we stick with them.

Finally, as president of the National Association of Care Catering, I want to make a plug for meals on wheels: old-fashioned, much denigrated, but an absolute lifeline to people. I had the privilege of being an undercover meals-on-wheels volunteer a couple of years ago—I said I was a trainee; I do not think most of them would have given me the job. The immense value of low-tech services to older people cannot be overestimated. We really should make sure that those services which give great value are maintained for older people.