Asked by
To ask His Majesty's Government what plans they have to reform
social care.
The Parliamentary Under-Secretary of State, Department of Health
and Social Care () (Lab)
My Lords, adult social care reform is critical to achieving this
Government's aim that everyone lives well for longer. Our vision
is to create a national care service underpinned by national
standards and delivered locally, supporting people to live
independently for as long as possible. We will also establish the
first-ever fair pay agreement for care professionals. We will
engage widely with the sector and people with lived experience to
inform these plans.
(Con)
My Lords, I welcome the proposals to improve pay and conditions
for those working in the adult care sector that the noble
Baroness just announced. But is she aware of the widespread
dismay at the cancellation of the proposals for reform, due to
come in next year, without anything being put in their place,
particularly against the background of what said during the campaign:
“We don't have any plans to change that situation and that's the
certainty and stability I want to give the system at this
stage”?
The former Health Minister, , said that the Government's
announcement was “misguided”. He went on to say, on the plans for
reform:
“A Royal Commission and a vague aspiration for a National Care
Service is … kicking the can along the road”.
So should the Government not adopt the proposals put forward
unanimously by two Lords Select Committees, chaired by the noble
Baroness, Lady Andrews, and the noble Lord, , and make progress
straightaway?
(Lab)
I understand that, whenever there is a change in direction, there
is concern. I take the noble Lord's point. The inherited
commitment to implement the adult social care charging reforms,
which would have been on course for next month, was undeliverable
because the previous Government did not guarantee the money to do
that. It would have cost nearly £1 billion next year, rising to
£4 billion by the end of the decade. There were many false dawns
in respect of this long—and repeatedly—promised change. It is
also the case that there was not adequate preparation to
implement the charging reforms. Councils warned that they were
impossible to deliver in full in the previously announced
timeframe. With all that in mind, I am sorry to say that we, as
the new Government, had little alternative but to say that these
were not funded or on course to be delivered. We will have to
ensure that we offer a national care service, along with a new
deal for care workers. We will continue to consult and listen to
those with lived experience in order to get it right.
(Lab)
My Lords, the noble Lord was kind enough to reference the Select
Committee report. I think he would agree with me that the value
of that report was that we were able to reveal the extraordinary
voices of those with lived experience and the many unpaid carers
who live such very hard but dignified lives. I have great
confidence from what the Minister has just said that the
Government will listen to those voices, because they know that
there is no quick fix. This is a hugely complex problem, and the
fair pay agreement is a very important first step. I have great
ambitions, as we set out in that report, for a coherent and
systemic change in the aspirations that we hold for social care,
as well as the practical delivery. I hope the Minister shares
those.
(Lab)
My noble friend is absolutely right that there is no quick fix,
and I think that is understood. The national care service, for
example, is a 10-year vision, which will mean long-term reform of
the sector, underpinned by national standards, making sure that
locally delivered care will be of a high quality and consistent
across the country. That is what people will want. As my noble
friend said, we will continue to consult those with lived
experience as well as engaging with workers, trade unions and the
sector to make sure that we offer a new deal for care
workers.
(CB)
I congratulate the Government on the long-term care planning that
they have, and the vision. As a long-term sufferer of cancer and
therefore a consumer of both health and social care services over
a period of time, I encourage the Minister to take a shorter-term
view. Many of us do not have that long to wait for the 10-year
plans and thereafter. Something needs to happen quickly, not only
to reform social care but to have that integration of health and
social care, because most of us with complex needs need them to
work together and be on one spectrum.
(Lab)
I very much take on board what the noble Baroness has said, and I
understand that for many, including her, time is of the essence.
I have described the long-term plan but there will be endeavours
to improve things in the shorter term; for example, trialling
neighbourhood health centres, which will bring together a number
of services under one roof to ensure that health and social care
are provided close to home, so that people can access the care
that they need. We will also develop local partnerships between
the NHS and social care so that we can get people home from
hospital rather sooner than they have been of late—and, indeed,
when they are ready. But it is about patient-centred care, which
will always be at the heart of what we do.
The Lord
My Lords, I welcome the Minister to her post. Does she recognise
that one principal reason why fundamental issues around adult
social care have not been addressed in the past 25 years is not
only the complexity and cost—it is because adult social care is
largely invisible and lacks political priority? Do the Government
intend to address this?
(Lab)
I thank the right reverend Prelate for his kind words of welcome.
I take the point about invisibility in this area, but it would be
fair to say that this Government will want to make this extremely
visible. It is an issue that will not go away, and also one that
is absolutely crucial, not just for those who rely on social care
but for the good functioning and provision of the National Health
Service. The two are inextricably linked, and we cannot sort out
one without the other.
(LD)
Since 2015, the number of working-age adults requesting care has
increased significantly faster than those aged 65, and very few
of them are self-funders, so while I welcome the Government's
commitment to establish a fair pay agreement for the workforce,
it will work only if it is matched by commensurate local
government funding increases; otherwise, it will just squeeze
already overstretched care provider and local council budgets.
What plans do the Government have to ensure that local
authorities have sufficient funding to meet this commitment?
(Lab)
The noble Baroness raises an important point about actually
making it work, but certainly the fair pay agreement is crucial
to professionalising the care service and, indeed, raising the
visibility of and regard for those who work in this sector, which
is nearly 1.6 million people. We will be working closely, as I
mentioned, with trade unions, local authorities, the sector and
all those with an interest to make sure that the first ever fair
pay agreement for care professionals can work and will deliver
what we want, which is a stable, well-regarded and well-trained
workforce.
(Con)
My Lords, during the passage of the Health and Care Act, the
previous Government came up with a compromise solution to fund
healthcare for an ageing population. It was by no means perfect
but it made a start, while addressing the concerns of the
Treasury. The new Government have scrapped this scheme but have
not yet proposed an alternative. A report from the Health
Foundation claimed that Labour's plans for social care are the
most general, with a headline commitment to create a national
care service but no detail about timescales or resources. Can the
Minister give us any indications on the timeframe, such as “the
end of 2024”—preferably a date, rather than “in due course” or
“in the fullness of time”?
(Lab)
I welcome the advice from the noble Lord and I will resist using
those terms, which I am sure he will appreciate. However, as
noble Lords have already understood, this is not going to be done
overnight; we are talking about a 10-year vision but we will be
talking about steps along the way. I think it is very important
that we make progress on the national care service in the short
term, because we have to build the foundations, by working with
the sector and those with lived experience, to develop those new
national standards. It will be work in progress and I hope that
noble Lords will be patient but also press me about what progress
we are making.
