Asked by
To ask Her Majesty’s Government what assessment they have made of
the survey by the Association of Directors of Adult Social
Services, published on 13 May, which found that more than 500,000
people in England were waiting (1) for a social care assessment,
(2) for their care package to begin, or (3) for a review of their
care.
The Parliamentary Under-Secretary of State, Department of Health
and Social Care () (Con)
Local authorities are responsible for meeting the needs of those
who require care and support under the Care Act. The ADASS survey
highlights that their waiting lists are increasing, which is why
we are investing to support improved outcomes and experiences of
care for people and their families, including through an
additional £5.4 billion over three years to begin a comprehensive
programme of reform.
(Lab)
My Lords, both the ADASS survey on social care waiting lists of
500,000 and Age UK’s estimate of 1.6 million people with unmet
care needs are a stark wake-up call for the Government’s mantra
of having fixed social care. The Minister knows that the official
figures that he always quotes and quotes today are nowhere near
enough to meet current and future demands, as key stakeholders
and the expert think tanks routinely remind him. What are the
Government doing to prioritise care and support in people’s homes
and local communities? Does the Minister not recognise that the
situation is getting worse, not better?
(Con)
Many noble Lords recognise the challenges faced by not just this
sector but all sectors, during Covid. One issue we have been
looking at for many years, over subsequent Governments—we
discussed this during the Health and Care Bill—is that social
care was seen as a Cinderella service for many years. For the
first time, thanks to noble Lords’ support, we managed to get the
Health and Care Bill through to have a properly integrated health
and care system. We are also looking at how we can make sure that
we properly understand the health and care landscape, with the
register and the hub, and that it is a vocation that more people
find attractive.
(Con)
My Lords, I urge my noble friend, in light of the extraordinary
number of vacancies in the social care sector—more and more staff
are leaving to join other sectors—to urge the Government to
revisit the Immigration Rules that do not allow overseas care
workers, who could fill those gaps, to come in. We have a special
system for agricultural workers; surely my noble friend agrees
that we must not put picking fruit and vegetables above the needs
of the most vulnerable in our society.
(Con)
I thank my noble friend for the question, but make the point that
it is important that we look not only to our domestic workforce
but to recruit people from far and wide to fill those gaps. We
have always done that. As I often say from this place, we must
remember that public services in this country were saved by
people from the Commonwealth after the war. They played a very
important role in making sure that this country and its public
services recovered after the war. On recruitment from overseas,
on 15 February, we added care workers to the health and care visa
and shortage occupation list, allowing these roles to be
recruited from overseas. We hope that will enable us to fill
thousands of eligible vacancies.
The Lord Speaker ()
My Lords, the noble Baroness, Lady Brinton, is participating
remotely.
(LD) [V]
My Lords, I go back to the previous question: this ADASS survey
shows that almost 170,000 hours of homecare a week could not be
delivered for the first three months of this year, because of a
shortage of care workers. This is a sevenfold increase on the
previous year. The changes proposed to the social care system
will not increase the rates of pay for social care workers, at
the moment, to make it attractive to others, who can work in
hospitality. But there is a dire need for people now. What will
the Government do right now to help solve this crisis?
(Con)
As the noble Baroness will acknowledge, some of the problems have
been in evidence for a long time. Sometimes, we are tackling the
legacy of this neglect of the social care system. At the same
time, we have to remember that many social care providers are not
run by the state; they are private providers. Following the
People at the Heart of Care White Paper, we want to make sure
that, first, we encourage better conditions for workers. We also
want to make sure that local authorities determine a fair rate of
pay based on local market conditions. We have seen an increase in
the national living wage, which means care workers will get an
increase. But we are looking at all this as part of the overview
of the social care landscape.
(CB)
My Lords, could the Minister comment on the March 2022 progress
report on the Out of Sight – Who Cares? report, which came out in
October 2020? It found that of the 17 recommendations, none had
been fully achieved and only four had been partially achieved.
Can the Minister say when Government will address these
recommendations and end the excessive use of the dehumanising
isolation, segregation and seclusion within adult social care?
(Con)
On that specific question, I will have to go back to the
department and get an answer. I will commit to write to the noble
Baroness.
(Non-Afl)
My Lords, 500,000 is a staggering number, but the number
experiencing the deepest emotional and physical impact on
families may be in the millions. Is the noble Lord and his
department aware of the costs associated with neglecting these
people and how many may have lost their lives while waiting for
these services?
(Con)
When we look at the 500,000 number, we are talking about an
assessment of any kind. These are not people who are outside the
system; sometimes they may be in the system but waiting for
another assessment within the system. For example, they could be
waiting for Care Act deprivation of liberty safeguards,
occupational therapy assessments, the beginning of direct
payments or a review of their care. It means they are in the
system but just waiting for another part of the system to work.
The other thing about the report was that there was a 61%
response rate, and it was extrapolated from that. Anyone who has
read behavioural economists Daniel Ariely or Daniel Kahneman will
know that people are more likely to focus on losses rather than
gains and, similarly, in surveys people are more likely to report
bad things than things that are going well.
(Con)
My Lords, does my noble friend accept that what these figures
show is that local authorities with insufficient resources are
introducing rationing of services to some of the most vulnerable
people in the country? Why did we pay more in national insurance
if the money was not to be made available to social care until
three years down the line and the crisis is now?
(Con)
I wonder if I could correct my noble friend. The Government
implemented a comprehensive review of the programme on adult
social care with a £5.4 billion investment over three years from
April 2022, of which £1.7 billion will be used to begin major
improvements across adult social care in England, including but
not limited to £500 million investment in the workforce and £150
million to improve technology. As many noble Lords recognise, for
too long this sector has been neglected. In some cases, there is
a lack of understanding about the breadth of the sector. We are
trying to understand it and get people to register, and then we
can improve it.
(LD)
My Lords, I declare my interests as set out in the register. Some
hospital NHS trusts have a third to a quarter of their beds
bed-blocked by people who are clinically ready for discharge but
cannot leave because of no social package being available. What
are the Government doing now to deal with this problem? It
undermines the NHS waiting list backlog as well.
(Con)
The noble Lord makes an important point, and the fact is that if
some patients do stay in hospital too long, they can lose control
of certain faculties and see muscular deterioration. So it is our
priority to ensure that people discharge safely, as quickly as
possible, to the most appropriate place. Local areas should work
together to plan and deliver hospital discharge, and the
department is working with NHS England, NHS Improvement, local
government and social care providers to monitor and understand
the underlying causes and do something about them.
(Lab)
My Lords, the Government say this is a long-term problem, but
they have been in power now for 10 years. What have the
Government been doing to address this issue, bearing in mind that
Andy identified this as a problem and
was attacked by the Front Benches when he put forward some
suggestions on how they could deal with it? This is a crisis made
by this Government.
(Con)
I am afraid I will have to humbly disagree with the noble Lord,
because this has been a problem for subsequent Governments, as we
discussed during the passage of the Health and Care Bill. In some
cases we can see reports going back 50 years. What has happened
over the years is that Labour, Conservative and coalition
Governments have put those reports on shelves to gather dust. We
were the first Government to introduce an integrated health and
care system and to grasp the nettle.
(Con)
My Lords, there is some anecdotal evidence that patients are
being discharged from hospital without having a full care package
in place. Could my noble friend say exactly what the Government’s
policy is to ensure this does not happen? These are some of the
most vulnerable people, such as individuals who have had a
stroke. On occasions, they are sent home with no support
mechanism at all.
(Con)
I thank my noble friend for the question. It is a really
important issue that we discussed many times not only during the
passage of the Health and Care Bill but subsequently. We have to
make sure that everyone in the system is working together to make
sure that a hospital knows who it is discharging to and that the
carer who will receive or help that person has not only the
support but the facilities and capabilities at home, or wherever
that person is being discharged to, to work with that person.
There are gaps in the system; it is not perfect in all places. We
are working with local authorities and others to make sure we
improve the system.
(CB)
My Lords, would the Minister care to associate himself with
today’s celebration of the arrival of the HMT “Empire Windrush”
in 1948, whereby a statue has been unveiled at Waterloo station
to remember that it was Caribbean citizens who, frankly, came to
the rescue of the National Health Service? Are there lessons to
be learned that the Minister might wish to apply to today’s
situation?
(Con)
I am so keen to answer that question because of my own Caribbean
background. In fact, my father was part of that Windrush
generation. He travelled from Guyana to Trinidad in 1952, and
then from Trinidad to the United Kingdom, where he worked first
on the railways and then as a bus driver. His brother worked in a
post office and his sister was a nurse. That shows the vital
contribution that people from the Caribbean made to this country
post war.
