Asked by
To ask His Majesty’s Government what assessment they have made of
the financial situation facing adult social care leaders and
providers, following information published by the Association of
Directors of Adult Social Care Services that 83 per cent of
councils expect to overspend by an average of 3.5 per cent on
adult social care in 2023-24.
The Parliamentary Under-Secretary of State, Department of Health
and Social Care () (Con)
The department carries out regular assessments of the financial
pressures facing adult social care. Since the spending review,
the Government have made available up to £8.1 billion in
additional funding over two years to support adult social care
and discharge. This includes an additional £570 million announced
in July. This will put the adult social care system on a stronger
financial footing and improve the quality of and access to
care.
The autumn survey of the Association of Directors of Adult Social
Services paints a worrying picture of the state of adult social
care: a third of directors of adult social care services said
that they have been asked to make additional savings to their
budgets, on top of the £1 billion of savings that they are
expected to make by 2024-25. The Homecare Association’s deficit
report, published on the same day, states that providers are
being paid less than the work costs and cannot pay their
employees a competitive salary. In this context, can the Minister
explain what outcomes social care users can expect to see as a
result of the investments he spoke of?
(Con)
I thank ADASS for its report. The outcomes we are seeing show a
number of things: as well as the £8.1 billion investment we put
in, we have brought down waiting lists for assessment by 13%
since the peak level. We are seeing high levels of satisfaction
with a lot of the work we are doing; 83% of people say that they
are satisfied with the services they are receiving. Yes, there is
a lot more to be done, but there is a lot of good progress as
well.
(Con)
My Lords, in July 2019, the Government promised that they would
fix the crisis in social care. When does my noble friend think
that that will be redeemed?
(Con)
Always at this point, I find that the best tactic is to offer my
noble friend a meeting. The People at the Heart of Care 10-year
plan is exactly what we are trying to design here. I mentioned
some of the progress that is being made: we have seen recruitment
go up and an increase in staffing, and we have a put in place a
qualification for staff, so that they feel there is a career
structure for them. The number of people is going up year on
year. Yes, there is a lot to do, but we are getting there.
(Lab)
My Lords, according to the same survey cited by the right
reverend Prelate, 68% of directors reported unpaid carers having
break- downs because of burnout from stress, and half a million
home care hours had not been delivered because of a lack of
staff. Carers UK published a survey showing that 25% of unpaid
carers are going without food and heating because of the demands
of caring. When will the Government commit to a national strategy
for carers to address some of these problems?
(Con)
We realise that they are the hidden army, and they are
tremendously valued. I think noble Lords know that I have some
personal experience of this. We have tried to put some measures
in place for payments; I perfectly accept that it is not the same
as a full wage, but payments have been put in place. We are also
introducing respite care, so we are taking steps in that
direction to recognise the vital service they all provide.
(LD)
My Lords, I know the Minister is keen to ensure that people who
are fit to leave hospital can do so quickly, but is he concerned
that local government spending restrictions, imposed because of
the state of the finances highlighted in the Question from the
right reverend Prelate, may lead to more delayed discharges this
coming winter? What steps are the Government taking to ensure
that that does not happen—a hospital saying that a patient should
leave, but the local authority saying that there is nowhere to
go?
(Con)
The noble Lord is absolutely correct that the flow through the
hospital is vital to A&E and other wait times. That is why we
have announced things such as the virtual ward: the 10,000 beds
are designed to get people out of the hospital and into a care
environment where they still feel supported, thereby using
technology to help take the strain. The point about this year,
and the whole reason why we announced the £600 million extra
investment over the summer, is that we learned the lessons of the
previous year, recognising that the earlier we can get this money
to the local authorities, the better they can spend it to put the
provision in place.
(Con)
My Lords, investment is welcome but reform is also vital. The
NAO’s autumn report noted that my noble friend’s department ended
its charging reform programme board and
“has not established an overarching programme to coordinate”
reform activity. It is instead delivering reform
“through a series of 27 projects which report to the
director-general … via nine separate programme boards”.
Can my noble friend investigate this to see if there could be
better co-ordination of reform to ensure that it is delivered
more effectively?
(Con)
My noble friend is correct, in that having so many local
authority and private sector providers means it is a confusing
space in which to bring all this together. The People at the
Heart of Care White Paper is trying to co-ordinate that and at
the same time provide a career structure, because we know that
the bedrock of all this is the staffing, and this needs to be an
attractive space for people to work in. Therefore, giving them
that recognised, transferable qualification which they can take
into nursing and other areas as needed is vital in ensuring that
we have the workforce to underpin this.
(Lab)
My Lords, the NAO’s recent figures show that so far, only 7.5% of
the much-vaunted £265 million allocated by government to
addressing social care staffing shortages and recruitment for
2023-25 has been spent due to the DHSC staff recruitment freeze;
and the training workforce development programme has also stalled
because the department has not managed to set up the necessary
systems to administer provider payments. What is the Minister’s
response to this and the ADASS survey finding that government
investment in social care so far has just stopped the ship
sinking and has not moved local authorities out of the storm they
are trying to navigate?
(Con)
As I say, we are seeing staff increases. I accept that there is a
lot to do in this space, but there has been a 1% increase this
year, so we have turned things round quite substantially.
Overall, the number of patients being cared for in this way went
up by 15,000 in the last year. As the ADASS survey showed, there
has been a decrease in the waiting lists, down 13% from the peak,
so we have turned a corner and we will see further
improvements.
(Lab)
My Lords, the Minister said that waiting lists have gone down by
13%. Can he tell us by how much they went up over the previous 12
years?
(Con)
I do not have the figures for those 12 years, but I will happily
send them to the noble Lord.
(Con)
My Lords, further to the original Question from the right
reverend Prelate, is not the real problem facing the care sector
that of recruiting and retaining care workers, who can often earn
much more in a local supermarket than in a nursing or residential
home? What action are the Government taking to make this a more
attractive profession for people to go into?
(Con)
My noble friend is correct; they are the bedrock and are valued,
and it is important that we make them feel valued. As I said, we
are reforming the process in order to give them a qualification,
which means that that work in the social care setting will be
transferable between positions. In addition, if they want to go
further into the medical service, be it nursing or other areas, a
modular qualification system will enable them to build towards
that, so that they not only feel valued but are in a long-term
career structure.
(DUP)
My Lords, many families seeking adult social care can find that
availability and quality are patchy; and particularly for those
living in rural areas, the help they receive can effectively be a
postcode lottery. What steps are the Government taking to drive
consistency and equality throughout the system, so that every
family can receive the level of adult social care that is needed
for their loved ones?
(Con)
That is a good point. We have given the CQC responsibility for
measuring local authority provision of care. Overall, we are
seeing a high satisfaction rate—89%—and the number of complaints
went down by 16% in the last year, so these things are making a
difference.
(Lab)
My Lords, does the noble Lord agree that if we are truly going to
fix the problem, as the noble Lord, Lord Forsyth, said and as
Prime Minister Johnson promised, we have to deal with the issue
of self-funders, who are having to pay thousands of pounds over
years without any support from the state above a very limited
means-test level? When will the Government come forward with
proper proposals to deal with this?
(Con)
I think we all accept the points made by the noble Lord and my
noble friend. By way of context, after 2019, the huge disruption
of Covid came right in the middle of this, with all that that
meant for the dislocation of the health service. We have to
accept that that is a factor. The market sustainability and
improvement fund tried to ensure that the amount local
authorities pay for fees is fairer, as there is
cross-subsidisation of those who pay privately. I accept that, in
terms of the overall objectives set in 2019, there is more work
to do, but that is still the Government’s ambition.
