Social Care Funding (EAC Report)

Baroness Brinton Excerpts

Thursday 28th January 2021 Grand Committee

[Baroness Brinton (LD) [V]]

My Lords, I declare an interest as a vice-chair of the Adult Social Care APPG. This has been an excellent debate on an excellent report, and almost without exception everyone has said that they support virtually all its recommendations. Those who have had issues have had one or two specific points only. But here we are—again—in another year with yet another debate where we discuss the scandal that is the funding of social care in this country.

In fact, this problem is more than just four or five years old. Twenty-five years ago, when I was a member of Cambridgeshire County Council, there was cross-party agreement that the social care funding system was in deep trouble and needed urgent reforms. Sometimes it really does feel like Groundhog Day. However, this report provides a megaphone to government by expertly identifying the urgent issues facing our social care system. It has made a series of excellent recommendations that have received broad consensus across the parties, and even across the sector.

This debate has also demonstrated that the problems are well known and, in policy terms, much has been done to start to address them. Along with other parties, so ably listed by a number of Peers including my noble friends Lord Razzall and Lord Campbell, and the noble Lord, Lord Young of Cookham, we note that the Conservatives had reforms to social care as key manifesto promises in 2017 and 2019, yet here we are still waiting for even the first and most basic of initial announcements. Why are the repeated calls of this House, the Commons, the sector, residents and their families still falling on deaf ears? I urge the Minister and this Government not to start from scratch again with further prolonged consultation or a Green Paper. What we need now, as my noble friend Lady Tyler said, is action and a White Paper which truly addresses the unfair way in which social care is funded and provided.

The comparison has already been made this afternoon between dementia care and cancer care; it is always worth repeating to demonstrate the total unfairness. Worse than that, the noble Baroness, Lady Browning, just mentioned the case conferences where the NHS and social services are at loggerheads about deciding whether something is personal care. I have witnessed this myself when sitting in on a meeting where a discussion about incontinence was whether it was actually due to the dementia, in which case it would be personal care, or due to osteoporosis and a crushed vertebra, in which case it would be nursing care. This is ridiculous. One of the problems with the current system is that it pits one part of it against the other, and that should end.

The founding principle of our much loved NHS is to provide care that is free at the point of use and ensure that no one is bankrupted or pays catastrophic costs for their care. This principle must also apply to long-term care. We need to revisit and update the Dilnot commission to make sure that the amount people are expected to pay out of pocket is capped with, as the report says, the cost shared between the public purse and the social care user.

The pandemic has rightly drawn attention to the plight faced by our social care workers, and I very much agree with Sir Andrew Dilnot’s evidence to the committee. He said:

“It is easy to neglect how wonderful the people providing this care are and, by and large, they are fabulous people working in circumstances that many people would not find desirable.”


During the first lockdown, we saw evidence of care workers leaving their families and going to stay in care homes for its duration to look after and protect their residents. That is the sort of commitment we see from the workers, so it is wrong that social care staff are not regarded in the same light as NHS healthcare staff. There needs to be a complete attitude change, in government and more widely, about the workforce: their supply issues, their pay levels and parity of investment, treatment and esteem between the sector and the NHS. I believe there should also be a royal college for social care to confirm their status and develop best practice, and to raise the esteem of social care workers.

As the noble Baroness, Lady Pitkeathley, outlined, unpaid carers face a really difficult task and this past year, particularly, has been a major problem with the pandemic. These carers have to navigate ever-changing, complicated government guidance to care for those they love, while facing increased anxiety as there is no one to take over if they fall ill or have to self-isolate. Unpaid carers must be part of the conversation on social care reform. Currently, there are just under 1 million full-time carers, relying on the carer’s allowance of just £67.25 a week. It is the lowest benefit of its kind. What does that say about how we value this sacrifice and commitment as a community? Raising the carer’s allowance would certainly be a start. However, it is not sustainable for mostly female, unpaid carers to continue to hold up the care sector with their free labour. We need to take the report’s recommendation and restore access to local authority funding to ease the pressure on friends and family carers.

I add here a brief word about young and child carers. Their education often suffers and although there are things in legislation about it, they are not universally applied. These young people need that support because they face a real difficulty in trying to manage caring for their relative as well as their education. I applaud local government, where some councils have extremely good young carers’ groups, whose work should be spread across the country as good practice.

As well as funding and support, we need to start being innovative in our approach to social care. This means thinking about how we could enrich lives and our communities and not regard those who need care as perhaps a burden. Schemes such as the Humanitas home in Holland, where university students are offered free accommodation in exchange for volunteering with residents, demonstrate how we can look across sectors to find inventive solutions to societal issues. Good adult social care can transform lives and, in turn, prevent mental and physical ill health, providing savings for the National Health Service in the long term and, most importantly, improving the quality of life for all the residents, whatever their age. Those Dutch university students said that it transformed their views about what they wanted to do in their future lives.

Working-age adult social care patients were mentioned by my noble friends Lady Jolly and Lady Tyler, and the noble Lord, Lord Forsyth. They all made the vital point on adult social care being about so much more than the elderly. That those with long-term disabilities and learning disabilities are treated as if they are in the same category as those who have perhaps led a full life must be remedied sooner rather than later. A fair system would recognise that they are different to those who have had the advantage of 40 years’ working.

Finally, many noble Lords have demonstrated that the impact of the pandemic has laid bare the perilous financial position of our care sector. Let me be clear: I am not referring just to the emergency short-term funding via local authorities, which has been vital. The pandemic has exposed the imbalanced relationship between the NHS and the care sector, demonstrating the need for the long-term financial commitment required to fulfil the recommendations of this report. I am referring to the paucity of local authority funding—not the fault of local authorities, because their own funds have been cut so badly, as so well outlined by my noble friend Lord Shipley—for those who cannot fund their own care. This results in even higher barriers to access local funding, as the boundary below which you cannot get funding is raised higher and higher.

As for the care providers, they have faced extraordinary increases in rising insurance premiums and exclusions, and insufficient clinical indemnity. I note that the Government have come in to help on indemnity, but only until the end of March. Please will the Minister look at this and address it? Care homes are already overwhelmed and it is not as if they are going to solve this in the next six to eight weeks. Although the Government have introduced that cover, it does not provide the broader indemnity required after the pandemic to put homes on a parity with the NHS in future. Worse, the future viability of some care homes is at risk, with staff shortages causing reductions to capacity, not least as a result of workers leaving the country following our Brexit. Beds are not being filled because people are reluctant to go into homes after the high death rate in the first lockdown. The big warning, though, is that any future pandemic preparedness must take into account the impact on the social care sector, with clear guidance on how to protect residents and those requiring care.

What do we think has been the impact of the two years of inaction since the committee’s report was published? How many individuals have not had access to the care they need, or been bankrupted to pay for care? How many individuals have reached a crisis point and put pressure on our NHS in its time of crisis, as they have not had access to appropriate community care? This excellent report makes it clear that the time for action is now. Will the Minister please make sure that happens?