Lords debate on Adult Social Care (Adult Social Care Committee Report) - Oct 16

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Baroness Andrews

That this House takes note of the Report from the Adult Social Care Committee A “gloriously ordinary life’’: spotlight on adult social care (HL Paper 99)
Baroness Andrews (Lab)

My Lords, it is almost a year since the Adult Social Care Select Committee published its report. It is five months since we had the Government’s response. Although this debate has been delayed, there is no bad time to debate adult social care—it is always timely and always urgent. I am extremely grateful tonight that so many Members of this House have stayed for a late debate to share our report and to listen to the Government. I know that members of the committee particularly appreciate the contribution of the noble Lord, Lord Polak, after his highly emotional intervention in the previous Statement.

Many members of our committee could not be here, for very different reasons. I am very grateful to all of them—particularly to those who are here. We will feel the absence of the noble Baroness, Lady Campbell of Surbiton—not only because she is exceptional at what she does, and how she does it, but because she made an extraordinary contribution to our committee. I am also grateful that there are people who were not even on the committee here tonight who want to address the report. It was a great privilege to chair the committee and to have the task of asking the questions we did.

The two great transformational changes of our age are an ageing society and climate change—and they are interrelated. We have known about both for decades. They are both in the “too difficult” box, which is why it has taken so long to organise the courage to address the issues. We are trying to catch up.

In our report, we ask two questions which we thought had been particularly neglected. Why is adult social care so invisible compared to the NHS? What would make a real difference to the poverty and ill health that come all too often to the 1.5 million unpaid carers who do care work for more than 50 hours per week or the 4.5 million carers who are conscious that their own health is suffering?

There were a few differences of emphasis in the committee, but we were of a mind, and we were helped enormously by an outstanding group of officials from the House: Abdullah Ahmad, Daphné Leprince-Ringuet, Alasdair Love and Megan Jones. They shared with us a sense that this committee would do things differently and address these difficult questions and give more justice to them. In that spirit, we put a high emphasis on co-production and our experts by experience—not just our superb special advisers, Jon Glasby and Anna Severwright, but our expert witnesses who have tested our conclusions and stayed alongside us this year while we have debated this report and who will be watching this evening. We put an equal emphasis on empowering those who care and those who are cared for—whether caring for young disabled adults or elderly and chronically sick relatives.

Our recommendations inevitably prioritise the need for clearer pathways through the maze of information that people are offered, putting emphasis on them having a greater say in what they are able to access and use, and on their contribution as well as the labour of love that is caring. We put huge emphasis also on partnership with the Archbishops’ Commission. We shared our witnesses, evidence and conclusions—which often overlapped, because they were rooted in the same values.
Our recommendation, which was probably the most important, made it clear that adult social care is far and above being, as it is too often seen, a vital but secondary handmaiden to the National Health Service. It is so much more than that. “The NHS saved my life,” said one of our witnesses, “but social care enabled me to live that life to its best”. That is the difference, and it is why we say that adult social care must be a national imperative with stronger national infrastructure. This is the way to release its full potential, to make the best of its values and skills, realised not just in better processes but in the trusted relationships that underpin everything done in this area, and to make it possible for people who care, and people they care for, to live that “gloriously ordinary life”—the title of our report that has resonated so widely with everyone who has come across it; it is so modest, and yet it says so much.

Inevitably, there were some recommendations that were hardly new and did not need to be. I defend in particular the need to ditch short-term improvisation and plan courageously for the long term, whether through funding, a carers strategy, or a resilient and versatile workforce, or for appropriate housing to support ageing at home and not in hospital.

We have had a raft of reports this year that have all more or less made the same case, from the Local Government Association, the Association of Directors of Adult Social Services, Social Care Future, and Skills for the Future. Many of them ask for the Government simply to recognise the scale and urgency of the issue of the false economy that has followed from a decade of austerity and massive cuts to local authorities—the lost hours of caring, the higher cost of caring, the endless waiting lists, the exhausted carers, paid and unpaid, the profound inefficiencies in the system, and the lost opportunities that have marked this decade.

Because the people who know so much agree on so much, our report has resonated widely, and the Government will not be surprised that their response to our report has met with dismay. In November 2022, the Prime Minister announced an indefinite delay to capping care costs. The director of Silver Voices saw this as the “final betrayal” of older people. In April, the “next steps” proposals, published during the recess, were met with a genuine sense of dismay because this was a plan for only two years, not for the future. The workforce budget of £500 million had been cut in half. Many of the bolder ideas in the White Paper have been lost in transition. When the NHS workforce plan was eventually published there was not a word about social care, without which, as the King’s Fund points out, none of the ambition, which is great and serious, can be realised.

Therefore, we were not that optimistic about the Government’s response. There was much that we could welcome. For example, the Government acknowledged the central importance of the adult social care sector—how could they do otherwise? They said that they would support the Carer’s Leave Bill, at long last. We also welcomed specific commitments, for example to ensure better data collection, more and better R&D, and more investment in innovation across the sector, but that was the least we could expect, and it should have been in place at least a decade ago. The fact is that the lack of data has reinforced invisibility. It has made it so much more difficult to plan for the right, consistent, scalable and deliverable policies on a day-to-day basis, not just today but in the future. As we report, the expectation is that the family will go on caring, but by 2030 1 million people in this country will have no families to care for them.

That is why we sought to change the lens and interrogate the future, recognising that the demography and expectations of 1947 have changed beyond recognition while the assumptions of who will care have not—it is nearly always still women. Although we have just started to integrate services, health, housing and social care should be planned from the beginning to work as closely as possible together if we are to make living longer not a fearful prospect but something to celebrate.

That is why we put such a strong emphasis on a commissioner for adult social care and support: to bring voice, visibility, agency and challenge to the service. That is why the Government’s response, calling for a chief nursing officer, misses the point. That is why we recommended an urgent review of the Care Act 2014, which held so much promise, only to be told that this would be delivered through the Health and Care Act. Not so: the scope and the potential of these Acts are very different. I ask the Minister to take both these recommendations away for further consideration.

We have also had no response at all to other fundamental questions that impact deeply on the day-to-day possibilities of what carers, paid and unpaid, can expect. We asked for a review of the pay and working conditions that disable the sector and make it so difficult for disabled people to employ and pay for a personal assistant. Where they are available, they do not stay because the employment bureaucracy is so chaotic and, frankly, they can get more money working in the health service or in Asda. These recommendations were rejected. Although there is some good news in the plan for a Skills for Care workforce this week, and numbers of vacancies are slightly down, we cannot build the future of adult social care on improved immigration. It is a contradiction in terms and of the Government’s policy. It is certainly not an answer to 152,000 vacancies across the sector.

What does it mean to build a valued and versatile care force? It means that you have to pay people decent, dignified and proper wages. At the moment, many carers do not even get the national living wage. Can the Minister tell me why and what this Government, in their remaining days, can do about it?

All these recommendations would have strengthened the resilience of the whole workforce, from personal assistants to paid carers, but they would really have helped the unpaid carers, who would have known that their labour of love, which as we know saves us billions of pounds a year but costs them their jobs, their incomes, and their mental and physical health, is valid and visible. So, indeed, would our recommendations for a more forceful and consistent approach from employers towards flexibility and support in the workplace, and for mandatory housing provision and standards.

However, the recommendation that would have made the most difference to unpaid carers was an increase in the carer’s allowance—a shameful £76.75 a week, which, because they have to work a minimum of 35 hours, works out at £2 an hour. We called for an increase not only in the pay available but in the flexibility around the threshold. The Government rejected that recommendation too.

In short, the Government rejected all our key recommendations relating to funding, workforce planning, accessible housing, support for personal assistants and unpaid carers. The subtext of their response was, “We are doing it all already”. We are not.

We asked at the end of our report: if not now, when? When will unpaid carers see real change? The answer came back, “Not yet; not now”, so there is more wasted time when we face record-breaking NHS waiting lists and the distress of all those elderly people who cannot go home from hospital because it is not safe for them to do so.

Our committee’s main message is that we need a new, more positive and more confident approach to adult social care to enable it to deliver those “gloriously ordinary” lives. That means that disabled young people and older people should have more say in the support they are offered, better choice, and a service that will attract people to work in it because it is well paid, progressive, has status with recognised skills, and more capacity because it is built on stronger and sustainable partnerships between paid and unpaid workers, recognises the expertise held by both, uses the full resources of the voluntary sector, has more visibility through a national champion to challenge poor practice, and shows what change looks like. That is the way to spread best practice and innovation. If we invest in the care economy, just as we should invest in childcare, we will build not just a fairer community and strong families but a foundation for a more efficient and more resilient real economy.

7.38pm
Baroness Fraser of Craigmaddie (Con)

My Lords, I was privileged to sit on the Adult Social Care Committee, which was so ably and sensitively chaired by the noble Baroness, Lady Andrews. I thank her for her comprehensive introduction to the debate.

I found it incredibly hard to think of what to say; it has all been said many times. We know what needs to be done. I pay tribute to my noble friend the Minister for his work and perseverance in this area, because I know that he knows what needs to be done and that he understands this sector, but we do not seem to be moving the dial one iota for people.

I travelled down from Scotland this morning, and our experience of attempts to create a national care service is not one I wish to recommend to the House. So far, its development has cost £1.26 million in engagement, £1.38 million in staff costs, an accountability agreement with local authorities and the NHS and an inadequate skeleton Bill that has been delayed three times. As Scotland illustrates, the top-down approach does not work. It is expensive and futile and, despite all the time and money spent on it, not one person’s care in Scotland has been improved.

For me, the Government’s People at the Heart of Care is based on very sound conservative principles, but we will not enable people to have choice and control unless plans are backed up by funding and action. Our committee’s report illustrates how carers, paid and unpaid, are key to ensuring that those who draw on care can indeed lead a “gloriously ordinary life”.

We heard of the huge challenges experienced by people in being able to find good PAs. The Government acknowledged in their response to the report that personal assistants are “invaluable”, yet this crucial and apparently valued workforce is unregulated, too often paid only the minimum wage, on zero-hours contracts and not funded enough to be employed full-time, and has no access to ongoing training and no recognised qualifications.

The Government have promised to improve career pathways and opportunities for progression within the adult social care workforce, and have identified £250 million to do this. Can the Minister give us any details on how this is to be spent? How could it help more people access PAs? I have encouraged the Minister before to look at the charity ENABLE’s PA model in Scotland, and do so again to support this.

As the noble Baroness, Lady Andrews, said, unpaid carers carry a huge burden but are largely unseen, unappreciated and ignored. The Minister will not be surprised to hear me calling yet again for improved identification. The discrepancy in the estimated number of unpaid carers of between 2.4 million and 6.5 million in our report illustrates how woeful our ability to identify this key group currently is.

In May the Government updated their road map for better data for adult social care, which recognises that while a variety of various sources capture some information on unpaid carers, they lack consistency and coverage. As I understand it, a new regular survey focused on unpaid carers is to be created. Can the Minister give us any update on these plans?

The Government’s vision that data should be collected once and shared with those who need it is one of those common-sense statements that sound really simple, but that I know will be very difficult to achieve and implement. Who will social care data be shared with? Will people needing care and their unpaid carers have access to their data? There are examples given, such as GP records being shared with home care managers and authorised social care staff, but who is classed as “authorised” in this context?

My worry is that social care provision is still far too far down the priority list. At the recent party conferences, neither the Prime Minister nor the leader of the Opposition spent any time discussing social care. Even the Minister for Social Care spoke about integrated healthcare teams and community health services, not social care. She spoke about how we continue to look at health and care through the prism of the NHS, saying:

“It often feels like the acute hospital is like the sun in the NHS solar system with everything else spinning round it. But it doesn’t have to be that way”.

She is right. I agree with her, but until we turn the telescope around and focus on enabling people to lead a gloriously ordinary life, social care will always lose out.7.44pm
Lord Bradley (Lab)

My Lords, as a member of the Adult Social Care Committee, I welcome this debate on our report and add my praise to the chair of the committee, my noble friend Lady Andrews, for her wisdom and guidance throughout. I also refer to my interests in the register.

Time is short, so I will limit my contribution to just a couple of our key recommendations. But I start by quoting the very beginning of our report, which posed the question:

“Why should we care about adult social care?”

The blunt answer is that

“it concerns all of us”.

In our lives we are likely to need that support, or to care about someone who does. It

“affects the lives of over 10 million adults of all ages in England at any one time”.

In recent years, driven by the consequence of an ageing society and the cost of residential care, together with the challenges of funding and staffing, the increasing demands on adult social care have rightly forced it up the political agenda. Tragically, though, despite a raft of reports, research papers, White Papers and legislation, very little has improved for those who depend on and provide adult social care. As we said in our report:

“Many aspects of the system remain invisible and overlooked by the public and policy makers alike”.

This is particularly true of unpaid carers, which is why we put a spotlight on them in the report—people with lived experience of the current system.

Our report said:

“We heard the frustration and anger of those who have to battle to access even the most basic support, and who have experienced adult social care becoming ever-more distanced from a service that might enable them to live a life of their choice.

We also heard the testimonies of unpaid carers, the often invisible spouse, child, parent, sibling or friend who has to step up to provide care and support when the system is failing”.

These moving testimonies by individuals and the many wonderful organisations that try to help and support them were not made through bitterness but from a loving and caring perspective, simply asking for help and recognition of the dire and exhausting plight they often find themselves in currently.

It is against this background that the committee made its recommendations. I highlight just two tonight. First, the committee recognised that while a stronger, more resilient and integrated care sector is needed at the local level—and I believe the integrated care boards and systems must make this an absolute priority and drive this agenda forward—

“we also believe that some new and effective national leadership that focuses attention on adult social care is urgently needed”:

a real champion for social care. As Sir Andrew Dilnot described it to us, we need

“a single person whose job it is to think or worry about social care and do that publicly”.

The committee believed that:

“One effective way of doing so would be to establish a Commissioner for Care and Support, tasked with acting as an effective champion and upholding the rights of disabled adults and older people, as well as unpaid carers. The Commissioner would also embed more accountability and challenge in the system”.

What was the Government’s response to this recommendation? They said they believed that

“new statutory roles are not the most efficient way to promote and protect the rights of these groups. The duties covered by such a role are covered by work elsewhere in the system”.

To say that this response is disappointing would be a massive understatement. I do not believe that, for example, the excellent work of the Children’s Commissioner, if abolished, would be well covered elsewhere in the system. The Children’s Commissioner ensures an independent focus on the needs of children, and adult social care deserves the same focus. When he replies to this debate, will the Minister explain where the efficiency, transparency, accountability and, crucially, independence is clear in the current system?

Secondly, and very briefly, I will address our recommendations to review the care allowance, which the noble Baroness, Lady Andrews, touched on. It currently does not reflect in any way the real value of unpaid carers. In my view, it is unacceptable that this is the lowest benefit of its kind, exacerbated by the threshold of caring hours and the low and inflexible earnings limit.

The Government’s utterly complacent response is to say:

“The government keeps the earnings limit under review and considers whether any increase in the limit is warranted and affordable”.

I believe that this is disrespectful to the millions of unpaid carers, without whom this care system would collapse and who need crucial financial support now. Their caring responsibilities often arise through an unforeseen incident or circumstance, such as a sudden diagnosis of chronic illness, a devastating accident or a stroke, so dramatically undermining household income or long-term financial and pension planning. I urge the Minister to reflect on this and respond accordingly tonight.

7.50pm
Baroness Wolf of Dulwich (CB)

My Lords, I welcome this debate and the opportunity to thank the noble Baroness, Lady Andrews, and her committee for a marvellous report, which is enormously informative, and, above all, for the fact that they have highlighted the role of the unpaid carers who keep us all afloat. I have no current interest to declare, but I was for many years a trustee of a small local charity that provided sheltered accommodation and respite care, and I am going to draw on that experience in what I say.

In recent decades, we have seen massive changes in the organisation and delivery of adult social care. In 2019, the Guardian found that 86% of care home beds are now in private for-profit homes, 3% are provided by local authorities and 11% are provided by charities. Yet in every study I have seen, charities are top rated by users ahead of local authorities and for-profit provision. In large part, this is because of what one witness before the committee called the “fine-grained” knowledge of local communities. Charities are uniquely well placed to harness this and to develop opportunities to bring such a fine-grained knowledge to bear on the provision of effective care that responds to individual local needs.
However, the regulatory and funding environment militates against small, local or charitable provision. Complexity comes up time and time again in the report, and rightly so. It creates huge barriers and huge deadweight costs. I think it is worth thinking about those costs because all of what we are talking about takes place within a context of growing demand and growing pressure on care budgets, so if there are ways in which we can save money, we really need to take advantage of them. My experience was of ever-growing regulatory and bureaucratic demands which devoured time and resources and favoured the supposed economies of scale delivered by large chains. These demands also meant local authorities felt safer dealing with big centralised companies, big concerns and people who knew about the latest central diktat and spoke the regulators’ language, but this is not the language of those involved in and dependent on social care. We must tackle complexity and the centralisation that fuels it because it creates a gap between the creators of policy and writers of rules and the people involved in delivery and use. It is not easy to simplify. It takes commitment and time, but it can be done. I wish the Government’s response had acknowledged this more explicitly. Can the Minister provide any further information on whether the Government recognise the need for such a sustained effort to simplify the system?

I also want to endorse as strongly as possible one of the report’s recommendations and its emphasis on respite care and providing breaks for unpaid carers. Recommendation 33 says:

“The Government should dedicate ring-fenced funding to increase the availability and capacity of services that provide flexible short breaks for unpaid carers”.

I very strongly agree. It may seem odd to have devoted most of the time that I have been on my feet to talking about local responsibilities and local decisions, and of course we need to make the system simpler and more local in how things are spent and in reducing regulatory complexity, but we are also, as I said, operating in a system where the pressures on budgets are gigantic. If we do not ring-fence funding this way, I fear the same thing will happen as happened in the local authority where I got my experience, which was that when our little charity closed the door respite care on a regular basis in the local authority effectively ceased. It was a chance for the local authority to reduce expenditure and walk away from something. However, this respite care and these breaks for unpaid carers are a lifeline. They are quite complex to organise and seem quite expensive, but when you take into account the direct benefits to carer well-being and their ability simply to carry on, I think we have to acknowledge that what they bring in results and rewards is enormous and that simply looking at apparent up-front costs obscures this reality. I would have been happy to have seen more recognition of this in the Government’s response.

I would like to take this opportunity once again to thank the committee and its chair for a wonderful report and to say how tremendously important it is that we remember those unpaid carers.7.56pm
The Lord Bishop of Sheffield

My Lords, I start by paying tribute to the noble Baroness, Lady Andrews, and to all the members of the Adult Social Care Committee for the excellent report they produced last year, full of thoroughly perceptive and practical recommendations to government and speaking to the longing we all have to live a life of joy, fulfilment and purpose. The committee undertook its work in precisely the same period as the Archbishops’ Commission on Reimagining Care and it is heartening to see the considerable amount of overlap in the values proposed and the conclusions reached. Both contribute to the growing consensus that we cannot any longer tinker around the edges of the existing system. We must reset and reimagine the way that social care is understood, organised and delivered.

The committee report identifies quite correctly the importance of making social care a national imperative, yet it notes the widely held perception that social care is something that affects other people and that many begin looking for information about support available only once they have reached a crisis. The Archbishop’s Commission on Reimagining Care argued that it will be possible to reimagine social care only if we fundamentally rethink our attitudes in society, where too often we are inclined to treat people as if their value is determined by factors such as age, gender or ability rather than affirming and celebrating the dignity of all human beings, valued for who they are and not for what they do.

At best, social care is the means by which people are enabled to live a full life. This is not the responsibility of the government alone. Churches, for example, have an important part to play in supporting people to flourish in community. I think of the hugely valuable dementia cafés currently organised and hosted by church communities in my diocese, for example, in the parishes of Sprotbrough in Doncaster and Handsworth in Sheffield, which are both run in partnership with local authority well-being services.

The primary recommendation of the Archbishops’ Commission on Reimagining Care is the development of a national care covenant which would clarify the roles and responsibilities for social care to be shared across society. The language of covenant encourages us to move away from ideas of contracts and rights towards powerful notions of partnership and interdependence. We all stand to benefit from a society where our dependence upon one another is recognised and celebrated and promotes the flourishing of all so that each one of us indeed has the best possible chance to live a “gloriously ordinary life”. Will the Minister say how far the concept of a national care covenant has been found useful by the Government in their ongoing efforts to reimagine social care?

7.59pm
Lord Polak (Con)

My Lords, it is a great honour to follow the right reverend Prelate. In the same way, it was a great honour to have been a member of the Adult Social Care Committee. I pay tribute to the noble Baroness, Lady Andrews, and the other members of the committee who took me along with them.
It was a learning experience for me, and there are one or two points that I would like to pick up. I notice that the noble Baroness, Lady Barker, is, sadly, not in her place. The thing I learned from her is something that we do not always think about: she talked a lot about the issue of ageing without children. I thank God that I have family and that we looked after my mother, who I will come on to in a minute. It is something that you do not appreciate until you hear it. The noble Baroness is a great champion for understanding that this will affect many, many people across the country. I was glad to learn that from her.

Similarly, I was very much a supporter of the suggestion, as mentioned by the noble Lord, Lord Bradley, that we ought to have a commissioner for care and support. Just as the noble Baroness, Lady Barker, is a champion for her issue, we need a champion who can help my noble friend the Minister and other members of the Government to focus on this. Otherwise, it gets trodden down and nobody really takes responsibility; it is too big and, in the end, nothing really happens.

I made a plea last time I spoke on this subject and I make no apologies for repeating it. Looking around the House, I say to everybody: the one thing I learned is that it is important to take politics out of social care. Let us get politics out of it and let us try to help.

In the end, for me, it was an experience that suddenly became practical. During the time that we were sitting as a committee, my mother took ill in Liverpool; she sadly passed a few months ago. What is overridingly important is to have something that we missed—we did not understand what to do as a family; I have just made a note to call it a “guide for the ignorant”. We need a guide so that, when people find themselves in a situation like this, they know what to do, who to ring, where to go, who to ask. Currently, it is a lottery.

As it happens, I am from Liverpool and the organisation there was pretty impressive. There was a STARS scheme, which the Marie Curie centre had put on, and they came in to see my mum four times a day while she needed help. Without that, I do not know what we would have done. I live here, my sister lives in London and my mum was in a flat in Liverpool.

The experiences we had throughout were horrendous. As I have said once before here in the House, we experienced the best and the worst. The worst was when a nurse was assessing my mum—who could not speak any more—to see what the next stage of care would be. The nurse was in Maidenhead, or somewhere in Kent, and she was in Liverpool, unable to speak, and they did it on Zoom. It was a relic of Covid, of course, but it was no help to my mum at all. It took weeks before they had to pass on their report, from Margate, to a panel of three people who had never met my mother, to decide what sort of care she would get. It is mad. I repeat: we need a guide for the ignorant. The Government need to provide something like this so that people know where to go.

To conclude that story, the Marie Curie hospice in Liverpool was amazing; the people there were amazing. They cared for my mum for three and half months, which is pretty unusual in a hospice. They could not have been nicer. I remember after she passed, I thanked them for everything they had done and then I said, “But where is the gold watch? She has been in a hospice for three and half months”. They were amazing and I shout out to them.

In conclusion, it was a deep honour to have been a member of the committee chaired by the noble Baroness, Lady Andrews, and I learned so much. Following the point made by the noble Baroness, Lady Fraser, I ask the Minister to explain the role of data and patient records, and how we can use technology to support people to stay in their homes as long as possible.

Baroness Finlay of Llandaff (CB)

My Lords, it is a great privilege—

8.05pm
Lord Davies of Brixton (Lab)

My Lords, it is a pleasure to take part in this debate and I very much appreciate the work of my noble friend Lady Andrews and the committee in producing such an excellent and helpful report.

The big issue, of course, is paying for sufficient care—we have been playing with that issue for 20, 30 or more years—but, short of a grand plan, we can leave that on one side for the purposes of this debate, because, in any event, much can be done. What I would like to stress is the need to take better care of the carers. There is a paid social care service on which there are recommendations that it should be properly funded and properly staffed with appropriate status and skills, but I am very pleased that the emphasis in this debate has been on unpaid carers.

The report sets out excellent proposals and I am sure we have all been sent additional proposals from Carers UK, with an emphasis on issues such as an improved carer’s allowance related directly to the national living wage and—an issue that is extremely important to those concerned directly—some form of carer’s leave.

I want, however, to add an extra point about carers and their pensions. This arises because the unpaid carers are all too often, all too frequently, poor. They are poor because they are unable to work, or have to work limited hours, because of the care they are providing. It affects them directly during the period when they are providing care, but it also lingers on throughout their lives because they have missed opportunities for promotion and career development. The inevitable result is that they end up poor. The problem with their pensions is that, in our current pension system, you get a reasonable pension only if you have had a reasonable income while at work; because of the gap in your employment income, you have a gap in your pension.

There must be some way of improving the pensions provided for carers who have no, or limited, employment income. In one way or another, this will require providing them with credits for additional pension. My favoured approach is that they should get additional national insurance pension on top of their basic pension to make up for the gap arising from their inability to earn while providing care; so, these carers should get some additional credits for their state pension.
This is very much an issue for all carers—male, female, sons, daughters, parents. They are all affected in the same way but, as most care is provided by women, it impacts far more significantly on women. Hence, the main reason for the gender pensions gap, which should get more attention, is that women provide the care. The way to solve that problem is to provide them with some pension entitlements for the period when they were providing that care.

It is not mentioned in the report but I will now be pressing this issue as often as I can. Clearly, it is relevant here: care for carers means providing them with decent pensions.

8.09pm
Baroness Finlay of Llandaff (CB)

My Lords, I apologise to the noble Lord, Lord Davies, that in my keenness to follow the noble Lord, Lord Polak, I jumped up too early. I was very glad to hear about the experience of the noble Lord, Lord Polak, with Marie Curie. I must declare that I am a vice-president of Marie Curie; I should also declare my co-chairing of the Bevan Commission, an independent think tank on health and social care in Wales, and my experiences in palliative care.

The noble Baroness, Lady Andrews, is to be commended for a gloriously inspiring report on adult social care which spotlights how much could be achieved by co-production with those in receipt of services and those on whom they depend. The government response has pointed out that additional funding of “up to £2.8 billion” is available in 2023-24 and “up to £4.7 billion” in 2024-25. Can the Minister explain how this funding will be distributed, whether it is ring-fenced for local authorities and how it will be allocated? Palliative care patients often need both social care and specialist palliative care involving the voluntary sector. Will they be able to draw on this funding for their integrated services, which we have already heard about this evening from the noble Lord, Lord Polak?

“We all want to live in the place we call home with the people and things we love, in the communities where we look out for one another, doing what matters to us”.

This definition, as in the report from #SocialCareFuture, explains how social care is not only about services; it is about having a life. For those with progressive disease, this desire to live to the full becomes pressing and urgent. Palliative care works to restore quality of life and a sense of personal worth. This core aim should be the same across the whole of social care: to add life to years, rather than focusing only on years to life. To achieve it, the workforce must be empowered to use their initiative to meet need and with time enough to go at the pace of the person.

Today, I was fortunate enough to meet a group of mothers who have children and young adults with multiple complex conditions. They were stressing the financial problem: they are unpaid carers who are getting burned out, and there is a huge lost opportunity. They realise that their children must be somehow prepared for independence because, as they get older and die, their children are likely to outlive them. However, the current system does not encourage that. It is simply about providing a response to the most pressing needs, rather than taking a long-term preventive approach, particularly when these young people are still able to develop.

The report highlights the ageist and disability-phobic attitudes that impede the ability of those with disability and who are older to function to their maximal ability in society. Such attitudes exist widely, sadly, including in health. Will the Government work with the voluntary sector to change attitudes and ensure that people are free to state what they need? The question “What matters to you?”, followed by sensitive listening, can guide the provision of services that empower, rather than a menu of services just given to people.

As the noble Lord, Lord Davies of Brixton, pointed out, we cannot expect the social care workforce to achieve the level of personalised care needed unless there is parity of esteem for them and without attention to their own welfare. Many have a wealth of valuable experience: the NHS could co-produce education and training with the social care workforce and with those with experience of receiving care. That would break down some barriers and improve integration.

In their response, the Government refer to the grant funding to Think Local Act Personal. Can the Minister tell us how that is being evaluated to ensure that holistic approaches reach the people on the receiving end of social care? Staff with skills need to be paid at an appropriate banding, with their managers also carrying a caseload so that they understand what is going on. Perhaps colleagues in health and management will then recognise the important job being done.

One thing I want to touch on in my closing moments is timely equipment. It can be essential to maintaining independence and decreasing the calls on hands-on care. What do the Government plan to do to decrease waste by recycling equipment such as mobility aids and so on? If equipment is not being recycled, could it then be sent to countries abroad as part of our aid programme? How much is wasted simply because things are not being used again and recycled in a timely manner?

8.14pm
Baroness Bennett of Manor Castle (GP)

My Lords, it is a great pleasure to follow the noble Baroness, Lady Finlay. Her phrase about services that empower is an excellent one which I may well adopt.

Like everyone else, I wish to thank the noble Baroness, Lady Andrews, and her committee for this brilliant report and for her compassionate, caring instruction. The focus on co-production with experts by experience is a crucial phrase. Given the lack of representativeness of your Lordships’ House, that should really be adopted by all your Lordships’ committees—particularly given that, the way politics is heading, it seems that the nature of this House is unlikely to change anytime soon. Our society is increasingly coming to recognise the importance of those experts by experience.

I would like to pick up the point made by the noble Baroness, Lady Andrews, by reflecting on the disappointment that the Government have essentially rejected all the recommendations of this report. If not now, when? The noble Baroness, Lady Fraser, said that we do not seem to be turning the dial, which was a similar reflection; she also noted that neither of the two largest parties’ leaders spoke about social care at their party conferences.

I am going to put a challenge to all the Front-Benchers who will be speaking shortly. I am well aware that they are not able to make up a social care policy on the Floor of the House, but I am going to challenge them to make a commitment that they will take into the election a social care policy that they plan to take forward—because surely this is so clearly desperately needed. As the noble Baroness, Lady Andrews, said, the delay in debating this report has not made it one iota less relevant because we have not made any meaningful progress.

In the interests of living up to what I am asking others to do, I am very happy to set out the framework of the Green Party’s social care policy that we will be taking into the next general election. It is free social care for all adults who need it in England. That policy was decided democratically at our conference in 2021, led by members who were affected by the need for social care—more experts by experience. This calls for all social care support and independent living services to be free at the point of use and fully publicly funded.

The guideline for this comes from—I ask any Front-Bench spokespeople who might like to respond if they acknowledge these standards—the UN Convention on the Rights of Persons with Disabilities. That should set the standards of what is available. The Green Party says that this should be

“accountable to local democratic bodies with a secure national framework of laws, guidance and funding … the services should be designed and delivered locally and co-productively, involving disabled adults, councils, the NHS, carers and unions”.

With that, I will raise a point that is implicitly referred to in the report, but developments have happened since it came out. Skills for Care, the workforce planning body for the sector, has noted that an estimated 70,000 people took up care jobs in England after arriving in the year to March 2023. That was after visa changes, and there were a further 30,000 to 40,000 people arriving between April and August. Despite that fact, the vacancy rate in the adult social care sector is still nearly 10%.

The noble Baroness, Lady Fraser, referred to difficulties in Scotland. I would point to the fact that Scotland, despite having about 8% of the UK population, took up only about 2.5% of those care visas. That reflects the fact that both Scotland and Northern Ireland have slightly raised the rate of pay already. Scotland is planning next April to raise the rate of pay to £12 per hour. In Scotland, carers are also employed by the local authority, unlike in England where authorities are forced to take legal responsibility for a market in care. Would the Minister acknowledge that the market as a model of providing care is one of our underlying structural problems?

8.20pm
Baroness Goudie (Lab)

My Lords, I thank my noble friend Lady Andrews for the way she led this committee. She set out with us, working together, how we would put this report to the House and the Government. I thank the staff of the committee, who gave us expert advice. Having worked on other committees, I can say that the staff are amazing.

The hardest part was for all of those who gave us evidence. It was very difficult for them giving evidence to us, and for us to accept the kind of lives they were living. Those people are really alive; people forget that they are not just a number or a file but real people. I wish that those in local authorities, in government and in the health service would acknowledge this and not leave them out on the edge.

I support my noble friend Lord Davies. I have worked with him in the other place on the issue of women who end up being carers. It is taken for granted that they can give up work and put everything aside to do this. It is very difficult for them to return to work because they are not necessarily respected for what they have done, which is huge and is saving local authorities and the Government a huge amount of money.

Further, these women understand that the person they are caring for—in some cases, more than one—wants to live at home. Nobody wants to go into an institution or be taken into some place that is not what they like. They end up dying sooner, and it is so unfair. People have to understand that people want to stay at home. We, as a country, must insist that people are allowed to be cared for in their own home.

Moving on to the report, these are the most important points about adult social care in England. First, it is funded largely from the revenue of local authorities. Secondly, a major source of that funding is from central government grants to local authorities. Thirdly, this funding has been dramatically decreasing. Fourthly, this inevitably has had adverse effects on the delivery of social care services. Fifthly, it is also having adverse effects on forward planning for meaningful reforms. If you are not funding and looking to the future at what funding we need, it is impossible to make any reforms. It is now causing huge problems for the National Health Service, in bed blocking and in other forms, which then has a further knock-on effect.

Adequate government funding is essential. I hope the Minister will be able to tell us how the Government see this going forward. As I said earlier, we are dealing with people. Given the present financial constraints, as paragraphs 105 to 109 of the committee’s report observe, access to appropriate social care services is extremely difficult to achieve. Needs assessments are based on increasingly narrow eligibility criteria. It is never explained to people properly what is required. Needs become extreme and urgent before they are recognised as requiring support.

Also, we need to look at why planning to make adequate changes to the inside or outside of a house takes so long. It should be automatic, and you should not have to wait six months or for inspections. This should be done immediately. The cuts in resources and services are very painful. These problems must be urgently resolved and addressed. The Government must deliver realistic, predictable and long-term funding to allow adult social care and its workforce to be properly resourced and planned to thrive.8.23pm
Baroness Hollins (CB)

My Lords, I welcome this excellent report from the Adult Social Care Committee. I congratulate the chair and the members; I would have loved to be one. I declare my relevant registered interests: I manage a family member’s direct payment and I am a director of a not-for-profit support organisation. I will not have time to give examples from my professional experience or my experience as a family carer today.

The committee said that social care is often “invisible”, but the report draws attention to what good care looks like, and it deserves to be widely read. Some groups are more overlooked than others. I will focus my remarks on the social care needs of working-age adults with a learning disability. In 2021-22, the King’s Fund found that 69% of social care expenditure for those aged 18 to 64 was on learning disability support. The Health Foundation’s recent analysis calls for a staggering £18.4 billion to meet demand in the next 10 years.

The sheer scale of underfunding that the system faces has a direct impact on the lives of people in need of social care. Cutting an hour here may mean that a person with a learning disability cannot meet their family or friends for lunch. Cutting an hour there may mean that a young person with a learning disability has no choice but to go to bed at eight o’clock on Saturday night. People rely on social care to access ordinary life opportunities, to live the “gloriously ordinary life” envisaged in the report and to become part of their local community—not simply to survive but to live and thrive in meaningful relationships with other people, and to live a life of their choice, as the noble Lord, Lord Bradley, said, rather than one in which a social worker decides how Care Act-assessed needs will be met by a direct payment. Does the Minister agree with me that that is not the spirit of the Care Act?

I want to mention David Towell, whose work with colleagues at the King’s Fund in 1980 kickstarted the ordinary life movement. Their work was a response to successive scandals and inquiries which exposed cruelty and neglect for many of the 50,000 people with learning disabilities then living in long-stay hospitals. They wanted to provide an alternative vision and model of care. Dr Towell’s book, An Ordinary Life in Practice, was published in 1988. In it he said:

“We want to see people with learning disabilities ‘in the mainstream of life, living in ordinary houses and ordinary streets, with the same range of choices as any citizen, and mixing as equals with the other members … of their own community’”.

This philosophy went on to inform many initiatives, including the 2001 Valuing People White Paper and its principles of rights, independence, choice and inclusion. These values were strongly spelled out in the United Nations Convention on the Rights of Persons with Disabilities, which we ratified in 2009.

The report highlights some wonderful initiatives, such as the Wigan Deal and Think Local Act Personal, which genuinely understand coproduction. But the social care system struggles to have the aspiration of an ordinary life any more because of the systemic issues outlined in the report and the urgent need for reform and culture change. This means learning to listen, particularly to the most ignored and marginalised communities, where the path to tackling injustice is that much higher and more difficult. The true state of social care requires pausing to look deeply at the sector and identify what is working and what is not. A key part of that is looking at the issues facing the workforce. Skills for Care estimates that there are more than 150,000 vacancies in the social care sector, and I welcome the committee’s recommendation for

“a comprehensive long-term national workforce and skills plan for adult social care”.

Without this, how could the significant issues of recruitment and retention be solved?

Roles in social care are highly skilled and vocational. Pay rates and training have fallen behind other sectors, but look at how social care has become a valued profession in Germany. We could transform it if we wanted to. In this country, the invisibility of care as a valued profession, compared with similar roles in the NHS, is one significant reason why people cannot stay in the job they love. The Care Act sets out a good legislative framework, but its spirit is not being adhered to. An audit cycle needs to be used effectively in adult social care: implement, review and change. This is the only way to ensure that lasting and meaningful change can take place. Legislation is just the start. I fear that, without political will to tackle these thorny issues, social care will remain invisible and broken. Remember that better lives lead to better health.

8.29pm
Lord Weir of Ballyholme (DUP)

My Lords, I too commend this report and thank the noble Baroness, Lady Andrews, and the committee for producing it, not simply in my capacity as a Member of this House but as a former carer of my late mother.

The report is deeply prescient. For too long, the issue of the need for change in adult social care has been long-fingered, and it is understandable why parties of different complexions have not grasped the issue, given the toxicity particularly around how we pay for the additional needs of adult social care. But that luxury of putting things on the long finger is something that we cannot afford to ignore any longer.

Mention has been made of an estimated 10 million people in this country being impacted by adult social care, and that number is set to grow almost exponentially, particularly as we see advances in medical science which mean that people will die less of particular conditions but will have to live with them. Nowhere is that more pertinent than with dementia and Alzheimer’s, where the numbers are probably set to double in the next few years.

In the time available to me, I want to touch on three aspects of the report. The first is the need for codesign in any plan for care—codesign with carers and also those in receipt of care. If we simply look for a one-size-fits-all solution for individuals, it will not work; similarly, if we simply seek to impose it on people, it will be a recipe for disaster.

Secondly, we need a consistency of approach across the country. We are all too aware, as is highlighted by the report itself, that for many people the quality and quantity of availability of adult social care is a postcode lottery. I know that, even in Northern Ireland, where there is a greater level of co-ordination, because health and social care are within the same department, that is no guarantee of a perfectly consistent result. I was very fortunate in my own circumstances that the company providing the care for my mother was a very good one, but I know that if I was maybe 10 or 15 miles either side of where I live, that level of care might not necessarily have been available.

As indicated by the report, we need investment in the extent of training required for the workforce—and, frankly, we need to raise the salaries of the workforce to ensure that we attract and retain sufficient numbers to be able to provide that level of social care. On consistency of provision, we need to ensure that the pathways for carers are clear and that it is easy to obtain help. As someone who was an elected representative, filling in the forms and accessing the care was quite easy for me—but many others are left in a very difficult position. I also know that, perhaps because of the level of support that I and my family were able to give my mother through finances and savings, we were able to bridge the gap between what could be afforded and what was required. But for many families that is not available.

Thirdly, we need a level of co-ordination in the system. I have mentioned that in Northern Ireland health and social care are within the one system. That in itself is not a panacea for all issues—but we have seen in a whole range of health issues that within the broader health service there is a level of silo mentality that still maintains. A number of us had a meeting today about palliative care, where again the failure perhaps to realise where there can be investment to save and to ensure a co-ordinated approach damages what can be provided and the quality of that provision.

The report highlights a cocktail of measures that are required to improve adult social care. Ultimately, it requires all of us to commit to a step change in what we can provide in adult social care. I agree with the remarks of the noble Lord, Lord Polak, when he talked about the need to take the politics out of this issue. Rather than try to create a political football in which we blame one party or another, we need to work together to try to deliver a consensus. It is often said that we have a health service in this country that is in danger of being broken. If we do not tackle properly adult social care, it will not be a question of it simply being broken—it will be irretrievably and irreversibly unfixable.

8.34pm
Lord Dubs (Lab)

My Lords, I congratulate my noble friend Lady Andrews and her committee on producing such an excellent and thought-provoking report. I will add a bit of my own experience; in my family, there is a person in receipt of social care and an unpaid carer, so I have lived with this issue, as it were, over some years.

I will talk about invisibility in a minute, but first I make a plea: we need more hard data on the nature of the field. I talked some years ago to a professor who pleaded desperately that we need the data so that we can make harder decisions. Most of it is based on estimates and a bit of speculation. Hard data would be extremely helpful.

I approve entirely of the recommendation that there should be a commissioner for care and support. I know that the Government do not like it; it might make the task of the Government and the Minister a bit more difficult, but it would be very healthy to have someone who can pull this together and be an advocate as the Children’s Commissioner is for children, as my noble friend Lord Bradley said. That would be a good move forward.

I turn to the invisibility of unpaid carers. One reason why they are invisible is that they do not have a voice, because they are so beaten down by day-to-day pressures. They can hardly surface at all, even to lead their own lives for a few minutes every day, so they do not have a voice to speak up. If they could, they would say many things with a lot of passion and emotion. Some of the people they care for are also not very articulate; they are too ill and vulnerable. The professional carers are so busy and underpaid that they too are invisible, because they cannot speak up either. The people who speak up in our society are those who have some space in their lives. People who do not cannot speak up.

I think £76 a week for an unpaid carer is derisory. I know one person—there must be many—who has had to give up all work to be a full-time unpaid carer, so she will not have a pension at all. Can a person live on £76.75 a week? If I have got the figure wrong, the Minister will correct me. There is also the stress that unpaid carers have to undergo and the difficulty of getting a break. Maybe once every two or three years they get a bit of respite care; most of us get a good holiday and we do not even work under such pressure. Goodness me, unpaid carers do. Some of them work flat out virtually seven days a week, so it is no wonder that they need respite care so much, but they get it very seldom.

We need a workforce plan for professional carers. We need to make what they do a profession, with training and a decent level of pay. We need a plan to look at how the whole sector operates and why there is such a low rate of retention—at why it is easier for a paid carer to stack shelves in a supermarket because they can earn more money. Stacking shelves in the supermarket is important, but what sort of society are we when that forced preference is imposed on some unpaid carers? We need a workforce plan.

Finally, there is a need for independence. People can be properly independent by being at home as much as possible and by having the support to lead their lives there. Surely that must be the aim. It is a great report and I hope it will make a difference.

8.39pm
Lord Allan of Hallam (LD)

My Lords, I also congratulate the committee on a very comprehensive and useful report. My noble friend Lady Barker is very sorry that she cannot be here, due to family emergency—rather illustrating the point of the noble Lord, Lord Bradley, that caring affects all of us at various times in our lives. I am sure that she will listen to the debate later and certainly appreciate the comments of the noble Lord, Lord Polak, about the usefulness of her contribution to the committee.

I will pick up on three issues we need to hear more about from the Government. I agreed with the point made by the noble Baroness, Lady Andrews; I looked at the government response and it is very much, “We have got this; it is under control”. However, I do not think they have got this, and we need to hear more from them.

The first issue is around population care needs assessments. The point about data has been raised by the noble Baroness, Lady Fraser, and the noble Lords, Lord Polak and Lord Dubs. I do not think it is a data problem. We are swimming in data. We need the more useful offspring of data, which is information. The Government are, we think, about to spend £500 million to try and transform the health system’s data into useful information. The question has already been raised, however, about whether that will be integrated with care data and whether we can get useful care information out of that kind of project.

I hope the Minister can talk some more about what commitment the Government have to extracting useful care needs assessment information from the data that the ONS and others have already. For example, I saw in the report that the first projections are around people who do not have children; the Office of National Statistics already has that data, so we need to take that and transform it into something useful in the context of care. In doing that, the assessments need to be brutally honest. There is no room for fake optimism here. We need to know what the real needs are and those projections going forward. The old maxim of hoping for the best but planning for the worst is particularly relevant in these contexts.

Having done those population care needs assessments, the next stage is the workforce plan. Now we have a sense of how much care we are going to need, we can start to plan for the numbers of people we will need to meet those requirements. It is really important we are not overoptimistic, and visas for overseas care workers have been mentioned a few times. In an ideal world, it would be great if we were able to get the care workers we needed domestically, but we should be brutally honest if we are not going to meet the requirements. Let us not gloss over it: we should continually evaluate those needs and adjust the visa regime accordingly.

I know this is very sensitive, particularly in the Conservative Party, but we need those care workers. It is not like fruit picking. We cannot say, “We will just not grow the fruit any more if we cannot get the fruit pickers”. These are people who need care. We need to be honest about the balance between those we can train domestically and those we will need to provide visas for because the care needs delivering now; it cannot necessarily wait.

The ageing population is going to be a problem here. More and more people are going to do the informal care and, precisely because of that, be no longer available to enter the market as a paid-for care worker. Again, we need to be honest about the changing demographics and how they will change the availability of workers. It is not going to be like it is today in 10 or 20 years’ time. If there are more people in their 40s and 50s looking after people in their 70s and 80s, that may have an impact on the very workforce we are trying to target in our plans.

The third area is pay. Again, having worked out the needs assessment and the plan for the workforce we need, we need to think about how to attract people into the profession. This affects both paid and unpaid workers, as has been raised in the debate. Both the wage rates for the paid workers and the support available for the unpaid workers matter.

I am sure that the noble Baroness, Lady Bennett, will be happy when I say I am very confident that my party will have a proposal around care in our election manifesto. We have already said that we think there needs to be a higher living wage available for care workers, and we should be talking about that now because that is the only way we are going to solve the crisis. If we are going to will the ends, we have to will the means. I hope the Minister can say that. I have heard him say it all before and he will cite the big numbers the Government have already put in, but those numbers need to be set against inflation and other pressures that have been eating away at the value of those salaries. There needs to be something more fundamental than just saying, “Here is another announcement of a big number”.

The final area is one that has been raised with me, which is the question around who provides care to individuals. This is a question of the choice of carer gender for intimate personal care. It is a very sensitive issue and I do not want to go into the broader issues around gender and identity. Something very specific, though, that has been raised is that there are people—particularly those who have long-term intimate care needs, because they are often younger people with disabilities—who may not be able to choose the gender of the carer who provides that care to them.

I think we can all understand why that is a very sensitive area. Part of the solution is to have a bigger workforce available: if there is more choice of carers out there, it will enable people to exercise a choice over the gender of the person who provides personal intimate care. That is important because there have, sadly, been incidences of abuse. It is also a matter of the right of an individual and their own self-determination that they have some choice over who provides care to them.

I close by thanking the committee and the many members who are here today for a report that is of great benefit to anyone who is trying to understand and respond to the ongoing crisis in care in this country. The noble Lord, Lord Polak, talked about a guide: this is a guide for us as policymakers. I recognise the need for a guide for the person trying to employ carers, but this is a great guide for us as policymakers to the key questions we should be asking. I hope that the Minister will be able to offer some constructive comments on the points I have raised around population needs assessments, care workforce planning and ensuring that carers are properly rewarded.8.45pm
Baroness Wheeler (Lab)

My Lords, we have had an excellent but very sobering debate, throwing the spotlight on the current state of adult social care, against the backdrop of the committee’s landmark report on what the service could look like now and in the future—if the people needing support and care were properly enabled to live the “gloriously ordinary life” which my noble friend Lady Andrews and the committee so expertly advocate.

The report was the central focus of Labour’s major debate on social care in March, and I am pleased committee members have again spoken in support of it today, across the range of vital issues the report addresses. They have all praised my noble friend’s expert chairing of the committee and her excellent introduction. As I have stressed, there is no better person to lead this authoritative cross-party group, and I pay tribute not just to that expertise and wisdom, but to the tenacity and determination she has shown ever since in making sure its key findings and recommendations have been disseminated and discussed across the sector and in Parliament.

I am also very pleased that the right reverend Prelate the Bishop of Sheffield has reminded us about the excellent report from the Church’s Reimagining Care Commission, which very much shared the values and principles espoused by our own committee. I again applaud the vital work that faith committees do to help plug the enormous gaps locally in social care provision, and welcome further discussion on how the proposed national care covenant could help reinforce making social care the national imperative it needs to be.

Before the March debate, we were still awaiting the Government’s formal response to the report, which, as we have now heard was wholly underwhelming and disappointing when it was finally published in May. We were also expecting what was heavily trailed in the press at the time as the imminent publication of the Government’s long-awaited 10-year social care plan, which we all recall had been supposedly scrunched up in Boris Johnson’s back pocket way back in 2010. The Government’s 2021 White Paper had been strong on a vision of what social care could look like, but only partial as a future plan and on the issues it actually addressed. It was also decidedly lacking on how today’s and tomorrow’s demands for social care could be met, addressed and funded, or how it fitted in with the then proposals on the care cap costs, or with the fair cost of care proposals. These were delayed a year later in the Chancellor’s budget until October 2024, with the spending reallocated to keep the social care system afloat and to finance reform.

What we actually got in the 2023 next steps follow up, published during the April Recess, was largely more of the same—baby steps, as they have been described—a two-year plan rather than 10 years or addressing the longer term, and cuts or doubts raised over some of the promised White Paper funding. We again had the welcome—but still unplanned—sticking plaster funding solution: disjointed, stop-start, short-term crisis reactions, which continued to fail to identify and deliver solutions to the root causes facing older and disabled people. The short termism was met with universal dismay by the sector, with ADASS lamenting that the reform vision was “in tatters”.

The urgent need for a comprehensive national plan is where the Lords committee report so strongly comes in. It is a major piece of work because it leads the way on reform and the clear stepping stones that are needed. The committee is to be congratulated on its depth of analysis and its understanding of the extent and reach of social care, impacting 10 million of us at any one time, including those receiving care and support, and unpaid carers and families looking after loved ones.

Its focuses—on giving disabled people and people with learning difficulties, drawing on care and support, the same choice and control over their lives as other people; on fair pay and recognition for care workers; and on support for unpaid care workers—are the key fundamentals for social care reform, which we fully support. It builds on the current legislative framework for care eligibility and entitlement, achieved through cross-party support for the Care Act 2014, and promotes social care’s positive benefits as an essential service benefiting people, society and the economy, not just as ancillary to the NHS, as my noble friend Lady Andrews so ably stressed.

Today’s reality remains that demand for social care is now hitting a record high—the current picture so expertly underlined by noble Lords. As the King’s Fund has summed up, the trends in social care are still all going in the wrong direction: demand is up and access is down; financial eligibility is tighter and charging reform has been put back; the costs of delivering care are rising, with local authorities paying more for care home places and home care support; the workforce is in crisis; unpaid carers are receiving less support; and public satisfaction with social care is lower than ever.

On unpaid carers, I again reiterate and endorse what all noble Lords have referred to on the urgent need for action on carer’s allowance, paid leave, respite care and pensions. In particular, I commend my noble friend Lord Dubs, who is not only a wonderful person but, as we heard, a carer for many years who has, like many of us, taken on the system and negotiated around it to try to get both the services our loved ones need and the practical recognition of unpaid carers. Carers UK has called on the Government to publish an updated and comprehensive national carers strategy, which has to be part of a comprehensive plan for social care. I look forward to the Minister’s response to that.

We know that the social care staffing crisis is worsening daily, despite the tiny drop—less than 1%—in overall vacancies, largely through the increase in the international recruitment that social care has always depended on and valued. Last week’s Skills for Care annual survey reinforced the overall picture all too dramatically. Of particular concern were the 390,000 social care workers leaving their jobs annually, with a third leaving the service completely—social care’s “leaky bucket” in urgent need of repair, as Skills for Care put it. That is why our shadow Health and Social Care Secretary Wes Streeting’s landmark speech at last week’s Labour Party conference, setting out detailed future plans for gripping the NHS crisis, so forcefully stressed that there is no solution to that crisis without an integrated plan for social care running alongside.

Our new deal for care workers is our essential first step for tackling the crisis by addressing recruitment and retention and giving social care workers the professional status that they deserve and the first ever fair pay agreement for care workers, collectively negotiated across the sector. Skills for Care sums up the essential steps to recruitment and retention as paying above the national minimum wage, ending zero-hours contracts and providing access to training and relevant qualifications—all of which Labour is pledged to address.

When the NHS Long Term Workforce Plan was finally published in July, my noble friend Lady Merron questioned the Minister as to why it did not cover the social care workforce, as the two services are so inextricably linked. His response was that, as the Government were not the overall employer,

“it is not for us to make that plan”.—[Official Report, 4/7/23; col. 1178.]

Does the Minister not recognise that an NHS-only plan is likely to exacerbate the social care workforce crisis and the number of vacancies in that sector? Is it not the Government’s responsibility to ensure that local authorities are properly funded to pay social care contractors in care homes and domiciliary services at least the minimum wage, and to monitor this so that quality care can be provided? The committee identifies a massive 29% overall reduction in local government funding since 2010 and the precarious position that local councils find themselves in as providers of domiciliary and community care and care homes. My noble friend Lady Goudie spoke very forcefully on that.

Labour has also made clear the need, if elected, for fundamental reform and change to the current business model for residential care, which sees many private equity care homes, despite getting around £314 million in public funding each year, spending hundreds of millions servicing debts, giving bonuses to shareholders and avoiding tax. It is hard to understand why hundreds of millions of pounds go out of the service in that way. According to the CQC, one in seven private equity-owned care homes is not providing good levels of care. How long do the Government think that this model of funding for care homes can continue to plough money not into the social care sector but into shareholder profits?

The key message to the Government from the committee and today’s debate is still that reform and change for social care has to be whole-systemwide, long-term, joined-up, comprehensive, integrated care at home in the community to tackle the myriad fundamental problems in the system and deliver a new deal for care workers and unpaid carers. Instead of just keeping the current system afloat with short-term funding, stop/start changes and delayed reform, social care deserves much better and the step-by-step investment and reform that the Labour Party is so strongly committed to.8.55pm
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)

I add my thanks to the noble Baroness, Lady Andrews, and all the participants involved in putting together the reports of both the Lords committee and the Archbishops’ committee. I thank Members for an expansive and extensive debate today. We also had a good debate on this in the spring and a good round table on all this, where we were able to take to heart the point made by the noble Lord, Lord Polak, about taking the politics out of the debate. I commend all those speaking in the House on this today for having taken that approach. I know that in all our dealings, the noble Baroness, Lady Wheeler, takes that approach, and it is much appreciated.

I also say that the thrust of what we are trying to do is taking to heart the Archbishops’ report, where care is everyone’s business, whether that is citizens, families, neighbours or carers, and based very much, as the noble Lord, Lord Weir, said, on the concept of co-design, working with the local partners, the local authorities and integrated care system. I will also try to tackle head-on the challenge of the noble Baroness, Lady Bennett, about the policies we feel that, as well as implementing today, we plan to take into the next election as a whole-systemwide approach.

Of course, as mentioned by many noble Lords, this has to start with funding. We have made up to £8.1 billion more available over the next two years. To answer the point of the noble Lord, Lord Allan, I say that funding in recent years represents a real-terms increase of about 2.5% per annum. This will allow local authorities to buy more care packages, help people to leave hospital on time, improve workforce recruitment and retention and reduce waiting times for care. We are also trying to use the money to transform the adult care system, for which we have a £700 million targeted spend on improving care workers’ skills, supporting career progression and investing in technology in digitisation and adapting people’s homes to allow them to live more independently. I will give details on each of those as we go through it all. As mentioned by many speakers, key to that is our £2 billion market sustainability and improvement fund, which is designed to impact and work on reform and improvement of the whole workforce recruitment and retention. I will write to the noble Baroness, Lady Finlay, on how the funding is specifically distributed so that that detail is understood.

We really believe in this vision to transform social care in England. It is a long-term vision which puts people at the centre of adult social care, to make sure that we can draw on the care support and include the absolute necessity of unpaid carers’ role in all that. I say that as someone who was an unpaid carer to good, dear friends of mine for many years.

We want to make sure that people can access outstanding quality in tailored care and support and find adult social care in a fair and accessible way, try to make it joined up in how we do it all and, I think for the first time, really try to involve the CQC in making assessments and ratings to guide where local authorities and local ICBs are doing a good job and where there are areas of improvement. I know that there are many concerns about the burdens that sometimes puts on a system which is always stretched, but I think noble Lords would also agree that inspections are typically a force for good in analysing those areas that are good and those that really need more work and improvement.

Of course, all this would be backed by much better data provision. Therefore, we are investing about £50 million into this area. I will begin by talking more about career progression, to answer some of the staffing points raised by the noble Baroness, Lady Andrews. Key to improving workforce retention is better training, recognition and career progression. The £250 million spend that was mentioned by my noble friend Lady Fraser goes very much to the heart of the training and retention of these people.

As many noble Lords mentioned, fundamental to all that is a career structure that staff feel goes beyond the particular care home that they are in and which they can take forward. Key to that is the creation of a new care certificate qualification, allowing them to move from place to place without needing to retrain each time. It is a modular system, so if they want to they can build that into an overall nursing qualification. Alongside that, we are ensuring that we are providing subsidised training programmes to decrease the turnover. We have modelled that to show that we can improve this by about nine percentage points.

Many comments have been made about how we are going to fill these workforce vacancies. The current run rate in terms of international recruitment is about 150,000 a year. I know that many comments have been made about how good it is that these are filled largely by international people, but that is a function of having a successful economy with full employment—you look to fulfil that. This has been the background to the whole health and social care system, right back to its foundations and a substantial part of the recruitment in the 1950s and 1960s. It brought people to the UK who have been an asset to the life and society that we have today. I had better say that, being married to one of these people, but I feel and hope that this should be the backbone of it and a successful way forward.

Also, it is important to understand the key role that unpaid carers play in this all. We are trying to help in this space. I perfectly understand that whatever we do here will not take the place of a full-time wage. I accept that but I hope that noble Lords will see that we are trying to make steps in the right direction. To answer the question raised by the noble Baroness, Lady Wolf, about the ability to offer respite care, we have earmarked £327 million of the better care fund towards providing those breaks. It is £76 plus the ability to claim benefits on top of that. I will not pretend that this completely compensates for a national wage, but it is not £76 alone. On the point raised by the noble Lord, Lord Davies, about pension flexibilities, I hope that we showed in the case of the doctors that we could be quite creative in that space. I will take that back and ask people who are more knowledgeable in this space than I am to take a proper look at it.

Of course, in all of this, there is the importance of supporting all these people in terms of the digital side. We have invested almost £50 million in the last year to improve the level of digitisation. It now stands at about 55%. I freely admit that 55% is not 100% but it is a big move in that direction and, to answer the points raised by the noble Lords, Lord Dubs and Lord Allan, it is something that we see as critical to the planning and provision of care, where it really can provide that information so you can plan around it.

It can also provide information to make smarter planning decisions. Again, I have seen excellent examples of putting all this data together; places such as Redhill have used it as part of its preventive screening programmes. There is a tremendous opportunity, as we build these bigger databases and include social care, to use that as the key to the prevention programme in which I know noble Lords believe.

The point made by both the noble Baroness, Lady Goudie, and the noble Lord, Lord Polak, was how we can use that to allow people to stay in the place where they most want to be, their home environment. The answer comes from not just using the data and AI to look at prevention tools; the latest funding bid launches technologies that we want to use to help people stay in their home environments. One particularly good example I have seen is a very simple tool that looks at people’s electricity usage each day. They know from people’s patterns that there is a normally a big spike at 8 am, when they turn the kettle on. If they see that that is not the case one day, they know to make a call to that person and check whether it is not because they have had a fall; it could be because they have visited a relative. This can be done on a mass-produced scale, which would give people support and early warnings, when people are at the lighter end of the scale and do not need substantial support. Relatives, local authorities and local bodies would feel that there are those extra guard-rails around this.

I will address the point made by the noble Lords, Lord Bradley and Lord Dubs, about the champion role. This was considered as it was a large part of the report. We have a champion in place in the roles of the chief nurse and the Chief Social Worker for Adults. That is a key part of their roles. I am sure noble Lords will join me in thanking Lyn Romeo for the role she has played in the last 10 years. She retires towards the end of this year.

As ever, because of the brief time we have had, I plan to write in detail to answer all the points I was not able to cover. I have tried to set out what we see as the four pillars: stable funding, a stable workforce, digital enablement and the principle of coproduction in which everyone has a role, as was outlined in the most reverend Primates’ report—because care is everyone’s business.

9.08pm
Baroness Andrews (Lab)

My Lords, I thank the Minister for his thoughtful reply. I should have thanked him at the beginning for making this time available. We had a good round table, and we share a huge number of concerns and an understanding of where things need to be done and can be improved. I will briefly come on to the points where we disagree.

I re-endorse the point my noble friend Lady Goudie made about the evidence we received. Some of the stories we heard about the daily lives of unpaid carers— and we heard a lot of them—were totally astonishing. I would have liked every Member of this House to have heard what people do as a labour of love and how modest their ask is. We should simply respect that they have an expertise that is often ignored. As was eloquently said by the noble Lord, Lord Polak, they do not know who to ask or where to go, and this becomes exhausting and defeating. If we have achieved nothing else from this excellent debate, I hope that any unpaid carer listening knows that we have the experience and empathy across the House to understand this and to want to change the conditions under which they are living and caring.

There has been an astonishing range of experience around the House tonight. There has been passion, of course, and a great understanding of what caring involves, because so many people have been involved. I pay tribute to my noble friend Lord Dubs and everyone else around the Chamber who has had that experience.

I think that what we have all been saying to the Minister is that we respect what the department has been trying to do; we know that it is an extraordinarily difficult task. It is always more difficult and slower to make policy than anyone anticipates, but we are not asking for a great vision; we are asking—without false optimism, with realism but with real urgency—that we step up. We cannot do the incremental thing anymore; it is not working, and it will not work for the future. We can use all sorts of expressions such as “turning up the dial”, but we are all saying the same thing: that there really needs to be a different energy and focus. That is why I return to the point about the champion, the commissioner—there is a lot of support for it around the House and there would be if the House was full. With great respect to the post of chief nurse, it does not do what we want. It needs someone to represent all that potential and frustration and to say, “There’s the good practice; that’s how you do it.” We have heard the example of Wigan from the noble Baroness, Lady Hollins, and there was much good practice referred to in the report.

We have heard some terrific ideas which we did not put into the report, such as filling in the pension gap, and we have heard a lot about the deep complexity. The reason it has not been resolved is that it is difficult, but recognising the difficulty, the realism, is not an excuse for not dealing with it. I sense around the House, and it is common to all parties, that the time has come to make this a national imperative.

I want to thank again everyone who has spoken for their wisdom and for their practical and inspirational contributions, in every respect. It will not be the last time we debate this subject. I just hope that by the time we debate it next we will have a clearer relationship between the vision and the practical implementation of what we would all like to see.

Motion agreed.