The Minister for Care and Mental Health (Gillian Keegan) With
permission, Mr Speaker, I would like to update the House on our
plans for adult social care. Today we are publishing our ambitious
10-year vision for adult social care—our White Paper: “People at
the Heart of Care”. It is a product of years of work, not only by
every level of Government, but by many involved in the sector,
including people who give care, people who draw on care, and their
families. I wish...Request free trial
The Minister for Care and Mental Health ()
With permission, Mr Speaker, I would like to update the House on
our plans for adult social care.
Today we are publishing our ambitious 10-year vision for adult
social care—our White Paper: “People at the Heart of Care”. It is
a product of years of work, not only by every level of
Government, but by many involved in the sector, including people
who give care, people who draw on care, and their families. I
wish once again to underline my appreciation and admiration for
everyone who works to deliver this most vital of public services,
especially through this challenging pandemic.
Those working in social care—both paid and unpaid—deserve our
deepest respect, yet they also deserve a system that works for
them, and it is fair to say that that has not always been the
case. Time and again, we in this House have heard about the
challenges: the high turnover in the workforce; the lottery of
how people pay for care; unsustainable local markets; the varying
quality and safety of care; the low uptake of technology; those
carers who are not just unpaid, but under-appreciated; and the
complexity of the system for everyone involved. I am sure hon.
Members will have their own challenges to add to that list. Make
no mistake, these are complex issues—so complex, of course, that
successive Governments, over decades, have decided to duck rather
than deal with them. This Government, however, are determined to
get it right. After all, we cannot be serious about levelling up
unless we are also serious about social care.
In September we took a vital first step on the road to fixing
this generational problem when the Prime Minister, the
Chancellor, and the Secretary of State announced our new health
and care levy. The focus on how we must pay for it is absolutely
right, but we were clear then, and we are clear now, that there
is much else we need to do. The White Paper contains more detail
on what we plan to do over the next three years to transform the
sector over the next decade. It is underpinned by three core
principles: first, that everybody has choice, control and support
to live independent lives; secondly, that everyone can access
outstanding personalised care and support; and thirdly, that
adult social care is fair and accessible for everyone who needs
it.
The principles we hold are important, but we know we will
ultimately be judged on our actions. I will therefore set out
some of those actions before the House. First, giving everyone
the choice, control and support to live independent lives
requires both physical and digital infrastructure. We are
investing £300 million in housing. That investment will support
local authorities to increase the range of new supported housing
options, because it is vital that people live in homes that meet
their needs and give them the independence they require.
Moreover, we are setting up a new practical support service to
help people with minor repairs and changes, which will help them
to live independently for longer. That is in addition to
increasing the upper limit of the disabled facilities grant for
home adaptations, which includes things such as stairlifts, wet
rooms and home technology.
The digital infrastructure we put in place can be equally
transformational, because we know that digital tools and
technology can support independent living and improve the quality
of care. We are therefore putting at least £150 million of
funding to drive the greater adoption of such technology, with
the ambition to achieve widespread digitisation across social
care. We are setting up a new national website, which will
explain all the upcoming changes, and we are piloting innovative
new ways to help people understand and access the care and
support they need.
Our second principle is to ensure outstanding personalised care
and support, and at the heart of that is looking after the people
who work in care. We are spending at least half a billion pounds
on the social care workforce over the next three years. Some of
those funds will help us to deliver new qualifications and better
career routes in care, which we know is crucial for holding on to
our caring and compassionate workforce. We are also directing
funds into stronger mental health and wellbeing support for care
staff, because colleagues cannot care for people unless we care
for colleagues. We are putting funds behind a change in the
services we provide to support unpaid carers, and we will find
and test what works best for those who are caring under
challenging circumstances. Regardless of whether that solution is
old or new, if it works, we want to do it. We are also
considering funding local areas to support their efforts to
innovate around the care they provide, so that they can provide
more options that suit people’s individual needs. Those new
models of care, including housing with care, have the potential
to play a pivotal role in delivering care that promotes
prevention, is more personalised, and enables people to live
independently.
Our third principle is care that is fair and accessible for
everyone. We are introducing a cap on care costs so that no one
will have to pay more than £86,000 over their lifetime. That cap
will be there for everybody, regardless of any conditions they
have, how old they are, or how much they earn. It is a universal
cap. Importantly, it will provide everyone with the peace of mind
of knowing that the days of unlimited and unpredictable costs are
coming to an end. The reforms will also make the existing means
test far more generous, compared with both the current system and
with previous abandoned proposals. Crucially, the £100,000 upper
capital limit will be available to those in home care, and we
expect many more people to be in home care. Let me be clear: no
one will be worse off compared with the current system, and many,
many people will be better off. All the ambitious plans that we
are setting out today must be underpinned by a sustainable care
market. The £3.6 billion we are giving to reform the social care
charging system will help all local authorities to pay a fairer
rate for care, and put back into the system the fairness we all
want.
Before I conclude, Mr Speaker, allow me to put on record once
again my thanks to everybody who has played their part in
developing this important White Paper. The reform of social care
in this country has been ducked for far too long, but we will do
whatever it takes to take on this tough challenge, and we will
get it right. Today’s White Paper is an important step on our
journey to giving more people the dignified care that we want for
our loved ones, setting out important changes that will last for
generations and stand the test of time. As a Government we are
determined to get this right—I am determined to get this right—so
that we can build the healthier, fairer, and more caring country
that we all deserve. I commend this statement to the House.
13:27:00
(Leicester West) (Lab)
I thank the Minister for advance sight of her statement—but
really, is that it? There are some things she said for which
Labour has been calling for some while, and which we support,
such as improving housing options for older and disabled people,
and the potential for technology to improve standards of care.
However, there are two central flaws to the Government’s
approach. Ministers have utterly failed to deal with the
immediate pressures facing social care, as we head into one of
the most difficult winters on record. They have also failed to
set out the long-term vision and more fundamental reforms we need
to deliver a care system that is fit for the future.
Last week we learned that a staggering 400,000 older and disabled
people are now on council waiting lists for care, with 40,000
waiting more than a year. There are more than 100,000 staff
vacancies, and turnover rates are soaring. Because of those
shortages, 1.5 million hours of home care could not be delivered
between August and October alone, and half of all councils report
care homes going bust, or home care providers handing back
contracts. Hundreds of thousands of older and disabled people are
being left without vital support, piling even more pressure on
their families and the NHS at the worst possible time, yet the
Minister has announced absolutely nothing new to deal with any of
that.
Where was the plan to end waiting lists for care? Unless people
get support when and where they need it, they will end up needing
more expensive residential or hospital care, which is worse for
them and for the taxpayer. The Minister was silent on that issue.
Improving access is the first step we need to deliver a much more
fundamental shift in the focus of support towards prevention and
early intervention so that people can stay living in their own
homes for as long as possible. But without enough staff with the
right training, working in the right teams, that will never be
achieved.
Where was the long-term strategy to transform the pay, training,
terms and conditions of care workers, to deliver at least half a
million additional care workers by 2030 just to meet growing
demand, and to ensure that care workers are valued equally with
those in the NHS? Can the Minister tell me why the Government
persist in having separate workforce strategies for the NHS and
social care when the two are inextricably linked? And can she
tell me how some kind of website is going to pay a care worker’s
bills or put food on the family table? No wonder staff are
leaving the sector in droves.
The proposals for England’s 11 million family carers, who provide
the vast majority of care in this country, are frankly pitiful.
Unpaid carers have been pushed to the limit looking after the
people they love. Almost half had not had a single break for five
years even before the pandemic struck, but I understand that the
additional funding in the White Paper amounts to just £1.60 a
year more for each unpaid carer. Families deserve so much better
than this.
What we needed today was a long-term vision to finally put social
care where it belongs—on an equal footing with the NHS, at the
heart of a modernised welfare state. At its best, social care is
about far more then helping people get up and be washed, dressed
and fed, vital though that is; it is about ensuring that all
older and disabled people can live the life they choose, in the
place they call home, with the people they love, doing the things
that matter to them most—in other words, an life equal to
everybody else’s. That should have been the guiding mission of
the White Paper, with clear proposals to make people genuine
partners in their care by transforming the use of direct payments
and personal budgets and ensuring that the views of users and
families drive change in every part of the system, from how
services are commissioned to how they are regulated and
delivered.
This White Paper falls woefully short of the mark, and the
reality of the Government’s so-called reforms is now clear—a tax
hike on working people that will not deal with the problems in
social care now and will not even stop people having to sell
their homes to pay for their care, as the Prime Minister has
repeatedly promised. Under the Conservatives’ plans, if someone
owns a home worth £1 million, over 90% of their assets will be
protected, but if their home is worth £100,000, they could end up
losing it all. Millions of working people are paying more tax not
to improve their family’s care or stop their own life savings
being wiped out, but to protect the homes of the wealthiest. This
is not fixing the crisis in social care, let alone real social
care reform. It is unfair, it is wrong, and the Government must
think again.
I thank the hon. Lady for her warm welcome for the White Paper.
[Interruption.]
(Hove) (Lab)
It’s not a laughing matter.
It is not a laughing matter—it certainly is not. Of course,
calling for something is much different from delivering
something. We are taking steps to fix social care. We are
grappling with this challenge, and we will meet it. In 13 years,
what did Labour do? Two Green Papers, one royal commission, one
spending review—and the result? Absolutely nothing. They are good
at calling for things, but they are not very good at delivering
things.
The hon. Member for Leicester West () mentioned immediate pressures. It is right to say
that there are immediate pressures on all our workforces as we
bounce back from the pandemic, but in particular on our health
and social care workforces. We have always said that. We have
challenges across the winter, and we know that we need to meet
those challenges. That is why we put a winter plan in place, and
it is why we have given additional funding to the sector. We have
given additional funding to the sector all the way through the
pandemic. We have given an extra £2.5 billion.
For the workforce specifically, we gave £120 million for January
to March this year. That resulted in 7.5 million extra hours in
the sector and 39,000 new recruits. As that was a successful
intervention, we have repeated it for this period. In fact, that
money—£162.5 million—has just started landing in councils’ bank
accounts, and that is to take them up to March. We know there are
pressures, and we know there is a lot of competition for labour,
but we hope that that will be as successful as the previous
interventions.
Of course, this is a 10-year vision, and we have to start with
that vision. [Interruption.] I know that the hon. Lady and
Opposition Members will look forward to reading the White Paper
and seeing the vision.
It won’t take long.
It will take long. It is over 100 pages, so it will take a
reasonable time if Members are interested in actually finding the
solutions.
The hon. Member for Leicester West also asked about workforce
strategy and the NHS compared with social care. Obviously, the
people in the NHS are employed by the NHS, which is a public
body. Social care is largely a private system. There are 18,000
or more businesses. That is why it is a different sector and why
we deal with workforce strategy differently. However, we have
£500 million to invest in the social care workforce and to make
sure that we invest in the knowledge and skills framework,
careers options and so on.
There are 1.54 million workers in the sector and they are hugely
valued. The hon. Lady said they are leaving in droves. Actually,
what we have in the sector is a continual demographic shift in
terms of need, and it grows by 1% to 2% every year, so we are
always trying to recruit new workers into the sector. Of course,
it is very important that these fundamental reforms take place so
that we get more people attracted to the sector, more people
staying in the sector, more people progressing in the sector and
more people providing excellent care all day, every day,
providing a lifeline to people across the country.
(South West Surrey) (Con)
I thank the Minister for her work putting the White Paper
together in a very short period. I know that she has put a lot of
effort into it, but it is hard to see it as more than three steps
forward and two steps back. The step forward, which we should
acknowledge, is the introduction of a cap. Whatever the arguments
about what counts towards the cap, having a cap will make a big
difference to many people, and that is welcome.
However, these measures do not really give confidence in two
crucial areas. The first is the funding to local authorities for
their core responsibilities. The White Paper barely gives them
enough to deal with demographic change and national living wage
increases, and it is a long way off the £7 billion-a-year
increase the Health and Social Care Committee called for by the
end of the Parliament. It is also hard to see the NHS and social
care systems being fully integrated, as they should be, and an
end to the workforce crisis, which sees 40% turnover in many
companies.
This is a start. The Minister is a very capable new Minister and
I personally have great confidence in her, but will she bring
forward further measures to deal with those huge problems?
Otherwise, we will see hospital wards continuing to be full of
people who should be discharged, and older people not getting the
care they need because the carers do not exist.
My right hon. Friend is right that this is a start. It is a
10-year vision, and obviously we had a three-year spending review
and the spending that we set out was a three-year spending
settlement, so of course it is just a start.
On the steps to ensure that local authorities move to a fair rate
and a fair cost of care, we are exploring a number of options,
and we will set out further detail at the local government
finance settlement later this year. Local authorities moving
towards a fair rate of care is key to building a solid foundation
for the future adult social care system, so we will be working
closely with them to shape the best possible approach to
implementation across different local markets. We will shortly be
engaging with local authorities and providers, and we will
publish further guidance in due course.
My right hon. Friend is absolutely right about the workforce. I
have never worked in a business where the workforce was not key
to anything that needed to be delivered, but in the care sector
in particular, it is impossible to deliver anything without the
workforce. It is also difficult to look at the workforce
structure. As I say, it is the largest workforce in the country,
with 1.54 million people working in it, but with 40% churn and
very high amounts of zero-hours contracts and of retraining. I
have never seen something that has that—[Interruption.] This has
been the case for decades, and nobody has done anything to
address it. [Interruption.] Nobody has done anything to address
it. We do need to address it, and that is what we are here to do
today, but—[Interruption.]
Madam Deputy Speaker ( )
Order. Please do not shout at the Minister.
Thank you, Madam Deputy Speaker. As was clear from their 13 years
in Government, Labour Members are not interested in finding the
answer, and they are certainly not interested in listening to my
version of giving the answer.
Having 40% churn and such a high degree of insecurity in the
workforce is not sustainable, so we need to fix that. We need to
put the knowledge and skills frameworks in place. We need to
invest in training and learning. We need to ensure it is captured
and transferable. We need to have career routes that mean people
can progress in the workforce. In my short time in the job, that
has been immediately identifiable. The hon. Member for Sheffield,
Heeley () and I worked on
professionalising the social care workforce about four-and-a-half
years ago, when we set up the all-party parliamentary group on
social care. The issue has been recognised. It is not easy to
fix. It is a large private sector. There is very large and
increasing demand, but we are going to take the steps to fix it
and the White Paper starts that process.
(Central Ayrshire)
(SNP)
The challenges in social care of increasing need and demand are
the same across the four nations, but until now the approach has
been very different. The Scottish Government have always believed
in seeing social care as an investment in allowing everyone to
participate in society and live as independent and satisfying
lives as possible. I therefore welcome the change in narrative
and tone in the statement.
The Feeley review, which was carried out last autumn in Scotland,
plans a human rights approach to social care, and sets out a path
to developing a national care service to ensure high quality
standards right across Scotland for its users, and also fair
terms, conditions and career development for staff. As has been
said, workforce is absolutely central to all services and social
care is delivered by people for people. The Scottish Government
pay the real living wage—not some pretendy living wage, but the
real living wage. Will the Minister commit to raising pay for
social care staff in England to £10 an hour, as the Scottish
Government have planned from this month?
Brexit and the loss of freedom of movement have, unfortunately,
exacerbated workforce shortages in both the NHS and care systems,
with a shortage of well over 100,000 in care. Will the Minister
urge the Home Secretary to widen the eligibility of the health
and care worker visa to actually include care workers? It is
quite bizarre that it does not include care workers.
Scotland is the only nation that provides free personal care,
which is now being valued by the UK Government at £86,000 a head.
Will the Minister consider, in this redevelopment, providing free
personal care to people in England? While the Scottish Government
are planning a 25% uplift in social care funding over this
Parliament, the national insurance uplift will go largely on
tackling the NHS backlog over the next three years. Does she not
recognise that the care crisis is right now? The problems in
A&E are not caused by people coming to A&E, but by the
difficulty of getting patients into beds due to delayed
discharges, which are due to the lack of social care provision.
Will she state, as has been called for, what funding will go to
social care right now to tackle the crisis as we go into this
winter?
Many countries across the world are grappling with this issue. We
have an ageing demographic and we now live in different ways. We
live much longer with more complex needs, and often we are not
close to our families as we have increasingly globalised. Many
countries are looking to address those challenges, including
Scotland. It is important that we build the talent pipeline here.
It is important that we not only invest in and train our own
people, but that we build sustainability. We cannot always rely
on taking workers from many other countries. We have a visa route
for senior social care workers and we have reduced salary
levels—I think £20,480 is the salary level—so in Scotland that
probably fits the minimum hourly rate. Of course, we have had
different approaches. We had a commission on adult social care
which gave results in 2011. That is what we have used to build
the basis of our reforms and I know Scotland has taken a
different approach.
(Ashford) (Con)
I congratulate my hon. Friend on reaching this point, which we
all agree is just the first step, but it is long awaited. I
welcome the principles she set out, but I hope she can expand in
particular on the changes that will allow more people to live in
their own homes for longer through technology and home
adaptations. That would not just reduce the need for residential
care and therefore save money, but cut pressure on the NHS and,
above all, improve the quality of life of many, many frail older
people. What can we expect to see on that front?
I thank my right hon. Friend for recognising that reaching this
point is actually a milestone. It is the first time that any
Government have reached this point.
Housing is key. We will increase the capacity of local areas to
deliver supported housing. We will increase local expenditure on
support services for those living in supported housing. We will
adapt more supported housing units to make them suitable for use,
as well as incentivising longer-term investment in new supported
housing by local areas and housing providers. In the coming
months, we will be working in partnership with local authorities,
housing providers and others to design and establish our new
investment in housing.
(Sheffield South East)
(Lab)
I welcome the measures to enable people to stay in their own
homes. That is exactly what the Housing, Communities and Local
Government Committee recommended some years ago in our report
into older persons’ housing.
Will the Minister confirm that in the statement there was no
money to improve the pay and conditions of the workforce, without
which we will carry on getting churn; no money to help companies
that are now exiting the social care sector; and no money to deal
with the crisis in funding that local authorities are facing,
which both the Health Committee and the Housing, Communities and
Local Government Committee recognised? Does she accept that
without money for any of those things, nothing at all will
change?
There is money to invest in the sustainability and
professionalisation of the workforce. Local authorities have a
local government settlement for this three-year period. We are
exploring a number of options and we will set out further detail
at the local government finance settlement later this year. That
is when the hon. Gentleman will hear more about the costs that
councils will have.
(Gosport) (Con)
I congratulate my hon. Friend on bringing forward this milestone
piece of work. It really is very long awaited. The devil, of
course, is in the detail, and I look forward to reading that
detail with great interest. I know she recognises that the care
cap alone will not solve the adult social care crisis. We need
imaginative and bold system reform. We need much better
integration, and, above all, a plan to improve how we recruit,
retain and value the care workforce and the army of unpaid carers
out there. It is a massive task, but I know she is up to it. I am
really keen to get her reassurance that once and for all, we have
the Government’s commitment to fix this problem.
I thank my hon. Friend for all her work in this area. Obviously,
I have just come in at the end of the journey and many, many
people have been working on this issue for many, many years. They
should all take credit for that work and for reaching this point.
She has my firm commitment that the Government are absolutely
committed to fixing social care. As I said, we cannot level up
without fixing social care, and of course we all have a vested
interest in having a very good social care system.
(St Albans) (LD)
This statement is incredibly thin. It feels as though the
Government are trying to fiddle with the light bulbs on the
Titanic as it is starting to go down. We have an enormous crisis,
where people who need care cannot get it and end up going into
ambulances, ambulances are now queueing up outside hospitals, and
hospitals cannot discharge patients back into their homes or the
community because the care is not there. The statement and the
White Paper do not address the fundamental problem of
fragmentation and integration. The Minister has already accepted
that this is now just a first step. Will she be clear with us
today on when she will bring forward concrete proposals for how
to tackle the problem of fragmentation and integration between
the NHS and care?
The hon. Lady is absolutely right that the complexity is broad.
We have always anticipated that we would have winter challenges
to deal with. With the global pandemic, there is a backlog of all
kinds of things that people need—diagnosis, operations, electives
and so on—plus all the other challenges such as winter flu and
new variants of covid, which are still here. That is why we have
specifically put a winter plan in place; we have also set out
hundreds of millions of pounds of extra funding to look
specifically at the winter challenges and the discharge process.
It is not easy, because of the absolute growth in demand. We knew
that it was always going to be challenging, and we regularly
monitor and measure it with our NHS colleagues.
The hon. Lady mentions a fundamental pillar: the integration of
health and social care. That will be subject to another White
Paper, which will come early next year and will have more details
about integration. She is absolutely right that it is another
solid foundation on which social care reform will stand.
(Winchester) (Con)
Obviously I will study the White Paper that has been published
today, and I welcome the cap that we are introducing. Opposition
Front Benchers may have turned up in force today, although they
have scuttled off now, but they did not do anything about the
issue in 13 years in government. As far as I can tell from the
response today, there is absolutely nothing coming back across
the Dispatch Box from any of the Opposition parties.
I think I am right in saying that the upper limit of the disabled
facilities grant for home adaptations is being increased. Can my
hon. Friend confirm that that will help my Winchester and
Chandler’s Ford constituents with things like stairlifts and wet
rooms, which are really important to people’s day-to-day quality
of life? Will she say exactly when it will kick in, please?
We will commit a further £573 million per year to the disabled
facilities grant between 2022-23 and 2024-25. We are also taking
steps to ensure that the disabled facilities grant can benefit
more people in need. We will consult on some of those steps in
2022.
(Dulwich and West Norwood)
(Lab)
It has been two and a half years since the Prime Minister stood
on the steps of Downing Street and promised to
“fix the crisis in social care once and for all with a clear plan
we have prepared”.
I think we can all be forgiven for asking what on earth the
Government have been doing during that two and a half years—a
time when the social care crisis has got worse. Right now, more
than 100,000 vacancies exist in adult social care. Care homes are
refusing new admissions because of staff shortages. Providers are
haemorrhaging staff to better-paid roles in hospitality, retail
and distribution. The sector is on its knees as we head into the
harshest winter in living memory.
The Minister’s statement today was completely tone-deaf on the
scale of the crisis. Can she say, because it was not clear from
the statement, how she expects the sector to get through the
winter? What does she have to say to the families who are waiting
right now for a care home place that simply does not exist under
her Government’s failing social care system?
The hon. Lady seems to be the only person in the whole world who
has missed the global pandemic, but it occurred during the same
period. To answer her specific question, she is absolutely right
that there are pressures right now. There are pressures
continually in the system, because there is always a need for
growth every year, but right now the winter pressures are
challenging. As we bounce back from the pandemic, everything is
opening again and there is a lot of competition for labour—there
are 1.2 million vacancies in the country.
We have invested £162.5 million, which is on its way—it has
probably just landed in most councils’ bank accounts. That
investment is there for short-term fixes, similarly to what we
put in place for January to March this year, which was very
successful; it brought forward 7.3 million extra hours and 39,000
new recruits. We have invested in that funding for the workforce,
and we keep it under review—we get data every month through a
capacity tracker system. We work closely with the sector and will
continue to monitor its needs.
(Newark) (Con)
Does the Minister acknowledge that one of the flaws with the
increase in national insurance is that only 15% of the additional
revenue will flow through to local authorities to improve the
quantity and quality of care? The remainder will go to protecting
relatively asset-rich families’ inheritances and to the very
important task of tackling backlogs in the NHS.
Many councils listening to the announcement today will be very
concerned about how they will tackle the demographic changes that
they face in the years ahead. What does the Minister have to say
to them? In the more substantial White Paper that is to follow,
what more can she say about reforming the system to integrate
care, which might enable efficiencies to help those local
authorities to face the future?
On the latter point, I cannot say much more at this point, but a
White Paper is being developed and will be available early next
year. My right hon. Friend is absolutely right that that is
another key part of making sure that councils can deliver on the
obligations in the Care Act 2014.
The levy raises £12 billion a year, more or less. For the
three-year period, the majority of that sum will go towards
catching up with electives in our NHS. There are now 6 million
people in urgent care, so that is the right thing to do. However,
we know that we will need an increasing share of that fund as we
go beyond the three-year period. Many of the reforms in the White
Paper and many of the things that we will be working on will help
to inform the discussions with the Treasury.
(Worsley and Eccles South)
(Lab)
Social care is a vital service that has been in crisis for a
decade. What we need is reforms to bridge the funding gap so that
unmet needs can be met and more care packages can be delivered; a
dramatic improvement in pay and conditions for care staff, to
halt the exodus out of care work; and decent support for the 11
million unpaid carers who have done so much extra caring during
the pandemic. Sadly, what the Minister has announced falls far
short of what is needed. Does she actually believe that these
half-hearted measures in any way match up to what the care sector
needs to survive?
This is a big reform that needs to take place, and it is based on
demographic changes in the population all over the world. It is
complex, and it will take a lot of time: it is a 10-year vision.
I know that the hon. Lady has not had the chance to read our
White Paper yet, but I am sure that she will see that there are a
lot of things in it.
If we are actually looking to fix something—if we are looking to
put a sustainable system in place that offers independence,
choice, a great place to work and a great career—we need to fix a
lot of solid foundations. I know that the Labour party always
wants to throw money at the problem, but actually we need to make
sure that the foundations are in place and that proper and
sustainable funding is in place. That is what the White Paper
delivers.
(Epsom and Ewell) (Con)
I congratulate my hon. Friend on the progress that she has made
so far. Care is a real challenge in a county such as mine, where
we have high costs and a fast-ageing population; I ask her to
bear that point in mind as she works on the next White Paper.
Closer to the immediate challenges, very many families are
uncertain about whether they will be able to visit relatives in
care homes over Christmas. A patchwork of measures is in place
among different care home providers around the country. Obviously
we are dealing with a difficult situation right now, but may I
ask my hon. Friend to ensure that a very clear set of guidelines
is given to care homes for the Christmas period, so that families
know where they stand and so that the elderly, who are among
those who have suffered the most over the past two years, get the
chance to see their family where possible?
My right hon. Friend makes a very good point. My grandmother was
in a care home with dementia; the thought of not being able to
see family has been one of the very difficult things throughout
the pandemic. I pay tribute to all the care workers, who in some
cases took the place of family during the height of the pandemic
and were there with their loved ones day and night.
My right hon. Friend is absolutely right that it is very
important that visitors can go into care homes, but of course
care homes also have to make sure that they are safe, and we need
to get the balance right. We have updated the guidelines for
visitors and ensured that there is a named essential care giver
who always has access to their loved one in care. We have
recently updated that guideline, but obviously we will keep it
under review as we learn more about the new variant.
(Hayes and Harlington)
(Lab)
The Minister has talked about a 10-year vision, but most unpaid
carers are just trying to see how they can get through the next
week, or the week after that, or the week after that. As has
already been pointed out, there are 11 million unpaid carers in
the country, many of whom depend entirely on carer’s allowance, a
legacy benefit. They never gained the additional £20 of universal
credit, and they are living in poverty. What is there in this
strategy that will assist unpaid carers and lift them out of
poverty?
I agree with the right hon. Gentleman. Unpaid carers are an
essential part of the system, and I want to pay a massive tribute
to all the people who have been offering care, usually to their
loved ones, during this period. As the right hon. Gentleman
suggests, during the pandemic many vital services on which carers
generally rely, such as respite or day care services, have not
always been fully open to everyone, so I have urged all local
authorities and providers of those services to ensure that they
are.
The White Paper provides for money to help local providers to
develop the services that carers would appreciate. There is a
specific fund for them to work with carers, and there will
obviously be input into that as well. We will ensure that we
build services to support this vital sector, and, in addition,
carer’s allowance will rise to just over £67 in April 2022.
(Sutton Coldfield)
(Con)
Notwithstanding the somewhat churlish approach of the Opposition
Front Bench, today’s announcement marks good and steady progress
on the part of a Government who have, after many years, started
to tackle this important problem, and I think the House should
give the Minister credit for that.
Does the Minister appreciate how much this matters to us in
Sutton Coldfield, which has a more elderly demographic? In this
context, I agree with my right hon. Friend the Member for Ashford
(). We need coherent policies
enabling older folk to stay in their homes for as long as
possible. In particular, the newly agreed and enhanced role of
the services emanating from the Royal Sutton Coldfield Cottage
Hospital in keeping people in their homes is at the front and
centre of our plans for ensuring that the White Paper and the
accompanying policy have a real impact in Sutton Coldfield.
Of course I am trying not to be too disappointed by the reactions
of Opposition Members; I did not really expect an awful lot
more.
Areas such as Sutton Coldfield and Surrey are expensive to live
in, and we need to recognise that. Most of us, when asked about
our future care arrangements, would say that we would like to
stay in our own homes, and we want to make that possible. There
is a great deal of technology that will help, but it is also
important to adapt more supported housing and to work with local
groups to deliver the right approach for the right areas, and
that will include local hospitals as well.
(Strangford) (DUP)
I thank the Minister for her statement, and for the progress that
she is clearly trying to achieve.
Workforce availability for care homes is vital. Today a
representative of a care home bordering my constituency rang to
say that a quarter of its staff are off work owing to close covid
contacts, although they are now treble-jabbed, and it has no more
staff and a lack of agency staff to employ. What can be done
through this strategy, Minister, to ensure that the recruitment
and retention of care workers are improved?
Madam Deputy Speaker ( )
Order. I cannot believe that the hon. Gentleman said “Minister”
again. I thought that he was beginning to get it, and that he
would not make me unhappy any more!
I should have said “the hon. Lady”.
Madam Deputy Speaker
I thank the hon. Gentleman very much for that. I can say
“Minister”; it is the hon. Gentleman who cannot. Minister!
Thank you, Madam Deputy Speaker.
The hon. Gentleman has asked a good question. Dealing with covid
is very challenging for many workforces, which is one of the
reasons for our taking the difficult step of making vaccination a
condition of deployment in this sector, and also offering the
third dose—the booster—which many of those people have now had.
It reduces the likelihood of transmitting or contracting covid,
although it does not eliminate it altogether. The hon. Gentleman
is right about the pressures on the workforce, which are
increased by the need to manage covid in the case of residents
and also people who are in their own homes. We have invested
£162.5 million to help with those pressures in the short
term.
(South West Wiltshire)
(Con)
I congratulate the Minister on getting a grip on an issue that
consecutive Governments have simply ignored since the 1940s, but
does she accept that there is a certain irony in our having two
White Papers to deal with a matter involving integration?
Will the Minister say a little about how what she has announced
today may help to resolve the crying shame of elderly, vulnerable
people languishing in acute hospital beds for weeks on end when
there is no active medical management plan for them, often at the
end of their lives, when they should be being cared for
appropriately in homely settings in the community? Will she
recognise that until we deal with that, and the huge pressures
that it puts on them, their families and our NHS, we will make no
progress whatsoever?
My right hon. Friend is absolutely right. People are in expensive
hospital beds when they would rather be at home because of a lack
of services, or a lack of joined-up service, and that affects
hospitals throughout the country. It is a large element of the
current pressures, and it happens every winter. It happened every
winter when I was a hospital governor. This integration, and the
Health and Care Bill which the Minister for Health, my hon.
Friend the Member for Charnwood (), steered through the House so
ably, will help to solve the problem.
(Blaydon) (Lab)
Our social care staff, whether they work in residential care
homes or in people’s own homes, are at the heart of a real change
in social care. The Minister has talked about some improvements,
but does she accept that improving the pay and terms of
employment of those staff is crucial to fixing the problem? What
steps will she take to ensure that that is dealt with
quickly?
Of course pay is important, but it is not just a question of pay.
I joined a group of carers in a domiciliary care round earlier,
and I spoke to them about this. They said that the most important
thing for them was changing the way in which the profession was
perceived, and that they never wanted to hear themselves
described as “just a carer”. That struck me as very important,
because it was an aspect of professionalising the workforce.
Recognition is also valuable. These are private companies, but of
course the council is a big buyer of care services as well, and
that will feature in the local government spending settlement
towards the end of the year.
(Forest of Dean) (Con)
As chair of the all-party parliamentary group on learning
disability, I welcome what I understand has been extensive
engagement with the sector in the production of the White Paper.
I know that it has been much appreciated.
As for the issue of resources, many Conservative Members found it
hard to vote for a tax increase of £12 billion a year, but what
is really important is for the money to be used effectively. May
I pick up what was said by my right hon. Friend the Member for
Newark (), and suggest that when the
local government settlement is published, it should show the
settlement for not just one year but a number of years? We could
then see a big share of those funds moving from the NHS to social
care, which would enable local government to plan appropriately
and the NHS to accept that it will not keep that money forever
once it has dealt with the backlogs. Many of us are quite
sceptical about that. I think that the more transparency there
is, the easier the Minister’s job will be in getting those
resources into the social care sector.
My right hon. Friend is absolutely right. More than 250
organisations worked with us to develop this White Paper, and I
want to thank them for their input. Of course they welcome the
steps that we are taking. I do not know how many Green Papers,
White Papers and other papers they have tried to get some change
from, but this one is finally starting on the road to deliver and
transform the sector. He is right to say that the longer we can
have some understanding of the settlement for funding, the
better, and I am sure that my colleagues who are working on that
will have heard his question.
(Halton) (Lab)
It is disappointing that the Minister does not take seriously our
genuine concerns about the crisis in social care. She will have
received a copy of the letter sent to MPs recently from the
Association of Directors of Adult Social Services. Why does she
believe that it said that, in its professional judgment, these
measures as they stand
“will not fix the crisis in social care”?
What I have said is that this is a huge step forward. I do not
think that I can stand here and say we will fix the whole crisis
in social care overnight. As I have said, this is also something
that countries all over the world are grappling with. I think
that when that letter was written, the short-term funding of
£162.5 million had not been sent out to local councils. I hope
that they are using that money wisely to increase capacity and
retention in the care sector.
(Hyndburn) (Con)
I find it incredible that the Opposition can come here again with
no plan and then criticise the Government. It is the same thing
for their social media. I really welcome the fact that we are
trying to do as much as possible to keep people in their homes,
and that the Government are doing something to tackle that, but
can the Minister assure me that she is still looking at the
regional disparities?
Yes of course. There are regional differences in care. There are
lots of regional differences. There are differences in how much
the care cap of £86,000 is worth, which is what I think my hon.
Friend is concerned about. There are regional differences in how
much people pay for care: it is much cheaper in various areas
compared with the more expensive areas. I am asked why we will
have a fixed sum of £86,000, and that is a good question. If we
are looking at it as a percentage of assets, £86,000 will be
different for different people, of course. The question was: why
should we not base this on a percentage of assets? When I looked
at the system we would have to build, I saw that it would be
absolutely unworkable. It will be difficult to implement the cap
anyway, because we will need a metering system that every council
will have to operate for everyone who is paying for social care
at different rates and different times. The system that we will
have to build is very complex. Having a cap that will also enable
us to talk to other players such as insurers, to see what other
insurance products come forth, was considered the only
implementable way.
Madam Deputy Speaker ( )
I gently suggest to the Minister that the rule about facing the
Chair when addressing the House is not just about courtesy and
politeness—I know that she is the most courteous and polite
person on the planet. It is also because if she is looking at
someone who has asked a question, the microphone does not pick up
her voice. I say this to everyone. That is why it is important to
face this way; if she does so, she can be properly heard.
(Wirral West) (Lab)
The Minister said that there was a lottery in how people paid for
their care. There certainly is, and this is raised with me on a
regular basis by my constituents. A quarter of Wirral adults with
ongoing health needs were denied continuing healthcare over the
summer, according to figures from NHS England. I think the
Minister would agree that the CHC—continuing healthcare—system is
unfair. Just at the very time when families need support, they
often find themselves facing huge bills for care and having to
consider selling the home of the person who needs care. Can she
tell us what action she will take to ensure that no person has to
sell their home to pay for their care, or was that just another
hollow promise from the Prime Minister?
I thank the hon. Lady for her question, because this is something
that bothers me. It happened to my grandmother. We had to sell
her council house, which she had bought under the right to buy
that was introduced by a Conservative Government. It is very
important that we start to fix this, because under today’s
system, everybody out there can go down to their last £14,250.
That is all that is protected. It is therefore a very unfair
system today. That is why we are making these changes and
introducing this cap, to ensure that nobody will ever have to pay
more than £86,000. In addition to that, we are putting the means
test up to £100,000, so that the cost of care is shared as a
person’s assets get below £100,000. That will also slow down the
depletion of assets. It will be a much fairer and better system
than the one in place today.
(Peterborough) (Con)
I draw the House’s attention to my entry in the Register of
Members’ Financial Interests.
A few months ago, I spoke with a social care service user who
told me that living in supported housing made him feel like a
king, because he had access to his own private shower. These
small, incredibly significant, humanising differences between
long-term hospital care and being supported to live independently
are striking. Can my hon. Friend confirm that one of the drivers
behind this White Paper is to ensure that people can live as
independently as possible for as long as possible, and does she
recognise that this can be achieved through the integration of
social care, mental health and supported housing?
My hon. Friend is absolutely right. Half of the social care
budget today is spent on working-age adults. It is not just spent
on elderly people. Of course, many people with disabilities or
learning disabilities want to continue to work and they want to
be supported in that. A supported house and the right mental
health support are obviously the right approach, and that is
something that we will be working on in this White Paper.
(Sheffield Central)
(Lab)
The Minister was right in the way she described the crisis in
social care. We have residential and domiciliary provision that
falls chronically short of what is needed, care staff who are
undervalued and grossly underpaid, and an army of unpaid
carers—particularly young carers—who do not have the support they
deserve. The problem is that what she has announced does not
address any of that. It is frankly extraordinary that she says
that this is the product of years of work. Where is the
substance? As questions from both sides of the House have
recognised, does today’s statement not show that when the Prime
Minister promised a plan to fix social care, all he ever had in
mind was an asset protection scheme for the wealthier, paid for
by the many who would never benefit from it?
I want to pay tribute to the 1.54 million people who work in this
sector, because they offer the most incredible care, and also to
unpaid carers. The hon. Gentleman mentioned young carers, and it
is important that we support them. We will work with the
Department for Education, which will amend the schools census at
the earliest opportunity to include young carers so that we can
identify them and put in the support around them. I do not agree
with what the hon. Gentleman said about today’s statement. In 13
years, the Labour Government produced two Green Papers, a royal
commission and a spending review, but absolutely nothing that has
made a difference to anybody. Of course, none of the Opposition
Members have yet had the pleasure of reading the plan, but I can
assure them that it is a plan that will deliver on a 10-year
vision and start the changes that, as my right hon. Friend the
Member for South West Wiltshire (Dr Murrison) said, have been
ducked since 1940.
(Thirsk and Malton)
(Con)
I thank my hon. Friend for all her work on this, as a Back
Bencher and as a Minister. As she will know from our many
conversations, I am a fan of the German system, not least because
of its greater focus on domiciliary care and on personal budgets,
which allow people, instead of relying on the professional
workforce, to pay a loved one or a neighbour to provide their
care. In many cases, that is much more beneficial for that
individual. Is that going to be a feature of the White Paper,
which I have obviously not yet had a chance to read?
I know my hon. Friend’s views on that system, because we have
discussed it many times. There are two things that I think he
will welcome in the White Paper. The first is the focus on people
being supported to stay in their own home or in supported housing
for as long as possible. The second is personal budgets, which we
will be exploring for people after they have been metered towards
the cap. There is some use of personal budgets today, but we will
be exploring what greater use of them we can put in place.
(Bedford) (Lab)
With 100,000 vacancies in the social care sector, the Future
Social Care Coalition has made it clear that failure to act
immediately on care workers’ wages will have devastating
consequences for the NHS, for the elderly and for other people
who are in desperate need of care. Will the Government listen to
the sector’s warning that the current and forthcoming hourly
rates for care staff are insufficient to retain or recruit
staff?
As I said, we have put in place £162.5 million-worth of funding
and it has only just gone into councils’ bank accounts. We expect
councils will use the funding to retain and grow the
workforce.
Earlier I mentioned the all-party parliamentary group on social
care, which I set up four years ago with the hon. Member for
Sheffield, Heeley (). At that time the vacancy
rate was 122,000, even greater than it is today. We have 1.54
million people working in care, and the need grows by 1% to 2%
every year because of changing demographics.
(Kettering) (Con)
The number of stranded and super-stranded patients at Kettering
General Hospital has recently been increasing. Thankfully it is
not at the level it was a few years ago, when as many as 200 of
the 550 beds were occupied by stranded and super-stranded
patients. They are mainly elderly and vulnerable people who, as
the Minister will recognise, should not still be in hospital
because they have completed their medical treatment. They need to
be placed in an appropriate social care setting or at home with
appropriate social care support. When can we expect firm
proposals from the Government to address this issue? Unless we
can get these very vulnerable people into the care they need, not
only will it make life very unhappy for them but it will be
extremely expensive and will clog up our NHS.
My hon. Friend is absolutely right, and this is something that
happens pretty much every year. For the short term, we have
around £500 million as part of our winter plan to focus on the
discharge process and to make it work as effectively and as
efficiently as possible. Of course, a big part of that is making
sure social care is in place. In the longer term, the integration
White Paper is key to making sure we have much better processes
so that people get the care they need, with the right care in the
right place.
(South Swindon) (Con)
I congratulate my hon. Friend on introducing the White Paper. I
see the Secretary of State for Health and Social Care in his
place, and I am grateful to him, too, for ensuring the Government
published the major part of the White Paper process before the
end of the year. We know the integration White Paper is to come,
and that will be important.
Other hon. and right hon. Members have asked about accountability
on funding and ensuring that we have a share of the pot for
social care. In particular, I am interested in the excellent
initiative of £300 million going to local authorities for
supported housing and increased choice. How will we make sure
that money is used to enrich the lives of, in particular, adults
with disabilities, who currently do not have the choice they
deserve?
I thank my right hon. and learned Friend for his question and,
indeed, for all his work in this area. I know this is dear to his
heart. I look forward to working with him on a solution.
The £300 million is specifically to help to solve supported
housing and to provide much better supported living and mental
health support for young adults with disabilities or learning
disabilities. Based on conversations with my right hon. and
learned Friend, we have also put something in the White Paper on
further help to get these young people into work, as many of them
want help and support getting into work, and not enough of them
are getting that support today.
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