Asked by
To ask His Majesty’s Government, further to the report of the
National Audit Office Reforming adult social care in England
published on 10 November (HC 184), how much of the £265 million
allocated to reforming social care staffing between 2022–23 and
2024–25 has been spent so far, and what problems they have
encountered in spending the allocated money.
The Parliamentary Under-Secretary of State, Department of Health
and Social Care () (Con)
The Government have made up to £8.1 billion available this and
next year to strengthen adult social care provision.
Specifically, we have invested over £15 million so far this year
in supporting our workforce reform programme. The Government
remain committed to our 10-year vision to put people at the heart
of care and make long-term sustainable investment to future-proof
the sector. Further announcements of support will be made
shortly.
(Lab)
I thank the Minister for that reply. He will know that the NAO’s
report said that only £19 million of the very welcome £265
million that was originally allocated has thus far been spent.
Even if the Minister does not agree that this is an utterly
inadequate response to the crisis in social care, as the King’s
Fund has said, he must admit that the slowness of progress is
somewhat frustrating. Is it because there are not enough staff in
the DHSC to distribute the money? I understand there are about
100 vacancies. Alternatively, is it because there have been many
ministerial changes in his department, or because—as many in your
Lordships’ House will suspect—social care is simply not a
priority for this Government and, once again, millions of unpaid
carers will be left to prop up a crumbling system?
(Con)
I share the noble Baroness’s concern about the speed of
deployment. At the same time, it is fair to say that we are
developing a whole new set of social care qualifications, which
we think we can all agree are key to this. We are also developing
a whole new payment mechanism, because there are 17,000
independent providers and we need a mechanism to allow payment.
It is a complex programme, but I agree that we need to do
everything we can to speed it up.
(LD)
My Lords, a key part of the equation for long-term social care
sustainability is charging reform, yet the National Audit Office
report points out that the Government have scrapped their
charging reform programme board and have no overarching social
care programme in place. Can the Minister confirm where
responsibility for charging reform now sits, and whether we can
expect any progress in this critical area in 2024?
(Con)
Charging reform is still part of the Government’s commitment. At
the same time, I think we all recognise that, largely as a result
of the pandemic, we had to stabilise the social care situation
first. That is what the £8.1 billion in funding has been all
about and what the investment and recruitment have been for—so
that we can stabilise first. I am glad to say that we are
reaching a more stable footing. For the first time, staffing went
up over last year and, likewise, the number of people in social
care went up. We have to stabilise before we move on to the
reform. I think we would all agree that the speed of reform needs
to be a bit quicker, but it is sensible that we stabilise the
situation first.
(CB)
My Lords, in the Government’s search for long-term sustainable
funding for adult social care, what assessment have they made of
the successful models that operate in Germany and Japan, for
instance?
(Con)
The shorthand for the German system is the “double doughnut”,
which tries to give wraparound care. We can learn many things
from that system, which is why a part 2 reform needs to happen
here. I accept that we are clearly not there yet.
(Con)
My Lords, is not the truth of the matter that the Government have
just shuffled off responsibility on to local authorities? Can the
Minister tell the House what percentage of expenditure by local
councils is now being spent on social care to fill the gap, at
the expense of vital local services?
(Con)
My noble friend is correct: on average, it is about 74% or 75% of
a local authority budget. I think we would all agree that that is
not a good situation, because obviously a local authority has a
number of matters it needs to deal with. This is one of the
issues around long-term reform that we will need to consider.
My Lords, we are very familiar with the pressure on the social
care workforce. As the Minister pointed out, we have seen
vacancies fall within the social care sector, which is very
welcome, but that is supported by the recruitment of 70,000 staff
from overseas. I am glad that the health and care sector is
exempt from the new visa charges, because we are clearly reliant
on assistance from overseas. However, given that they are no
longer able to bring dependents on their visa, have the
Government considered the impact that this will have on
recruiting workers from overseas into the social care sector?
(Con)
We have tried to adopt a balanced approach here. While we all
understand the necessity in the healthcare sector, I think most
of us would agree that 750,000 net migration is a very high
number. The balance we have struck is to protect this sector. Our
figures generally show that we will be able to keep the
recruitment coming. We are now moving on to part 2 of the reform,
through the other things we are doing, particularly around
qualifications—we know that people who are qualified are far more
likely to stay in a social care setting. That is what the whole
investment is about. It will be rolled out next year and will
fund hundreds of thousands of places. I think it will make a real
difference to the motivation, recruitment and retention of
staff.
(Lab)
My Lords, to respond to the right reverend Prelate’s question, if
I may, the Migration Advisory Committee has said that the reason
we recruit so many people from overseas is poor terms and
conditions in social care. The Government set the market for
social care, through their poor funding of local authorities.
When will they grasp the nettle and realise that we actually have
to give care workers decent pay and conditions?
(Con)
It is absolutely understood that, to have a highly motivated
workforce, you need to look at everything—pay and conditions, and
training and motivation. We see that while, on average, staff
turnover is almost 30%—which is way too high—about 20% of care
home providers have a turnover of less than 10%. Why is that? It
is because they are investing in their staff and they have a
training programme. That is why we are trying to do a similar
thing. The national care certificate that we are putting in place
will take time; for it to be valuable, we will need to put the
right things in order, including the digital platform to pay the
17,000 providers. These are all parts of the reform, which will
make a difference.
(CB)
My Lords, does the Minister accept that many delayed transfers of
care from hospital are associated with difficulty in getting
social care in people’s own homes? In rural areas, we are still
not paying for time spent travelling. Surely there is something
we could do much more quickly, before the training certificate,
to employ local people in a fair way to provide care in people’s
homes, particularly in rural areas.
(Con)
The noble Baroness is correct about that; it is a key pillar of
this reform. This is why we have tried to learn one of the main
lessons from last year, by putting the £600 million discharge
fund out early, so we can get those sorts of measures in place.
That is why we have expanded the virtual care ward network to
10,000 beds, with the idea that people can be cared for in their
own home but with support from the staff there. That is
absolutely the direction we are moving in.
(LD)
My Lords, the Minister said a moment ago that three-quarters of
local government spending is on adult social care. I would ask
him just to check that figure, because if we add to it children’s
social care, it basically means that every local authority will,
before long, be issuing Section 114 notices. It is very important
to get the facts absolutely clear here. What the Minister said
demonstrates that local authorities are seriously underfunded for
adult and children’s social care, and are cutting other public
services as a consequence.
(Con)
I will absolutely clarify the number to the noble Lord in
writing. It is of course a range, according to different local
authorities, but I think we would all agree that it is a level
that, as a percentage, is too high.
(Lab)
The Nuffield Trust has called the NAO findings a
“damning indictment of the Government’s progress towards
delivering social care change”.
To follow on from my noble friend’s question, the NAO points out
that only 7.5% of the much vaunted £265 million allocated by the
Government to addressing social care staff shortages and
recruitment for 2023-35 has actually been spent, heavily impacted
by the DHSC’s staff recruitment freeze. What specific actions are
the Government taking to address this and ensure that the money
they say is there is actually paid out?
(Con)
There were five parts to the programme of reforms mentioned and
the £265 million. There was international recruitment, which we
have done; it has worked well, and we need to continue doing
that. The second part was a volunteer programme, which, again, we
have done and it is working well. Thirdly, there were digital
skills passports, so that staff could swap from place to place
and take their qualifications with them; we have done that. The
two other things will take longer. The care workforce pathway is
out for consultation. It will mean that people can have a long-
term qualification that can get them into other professions as
well, such as nursing. Lastly, there is the care certificate
qualification. That takes time. Everyone knows that, for that
qualification to be meaningful, it will take time to set it up.
That is the key expense item. The digital platform is going to be
launched next June, so it will be rolling out from there.
