Asked by
To ask His Majesty’s Government how they are planning to address
current staffing levels in care homes, and any connected delayed
discharges from hospital wards and the impact on NHS waiting
times.
The Parliamentary Under-Secretary of State, Department of Health
and Social Care () (Con)
We estimate that the number of adult social care filled posts
increased by 70,000 in the last 18 months. The Government remain
committed to the 10-year vision to put people at the heart of
care, making up to £8.1 billion available over two years to
strengthen adult social care provision and discharge. Funding is
enabling local authorities to buy more care packages, help people
leave hospital on time, improve workforce capacity and reduce
waiting times.
(Lab)
I thank the Minister for that reply, but I am not sure that I
find it very reassuring. Your Lordships’ House will know that
delayed discharges and long waiting times are largely the result
of shortcomings in the care sector, especially the shortage of
staff in care homes, where international recruitment has been a
lifeline. It was therefore a surprise when the Government elected
to put further pressure on this sector by increasing the minimum
annual salary required for employees applying for a visa, banning
them from bringing dependants to the UK and requiring care firms
to be regulated by the CQC if they are to sponsor these visas.
Far from being broadly relaxed about these proposals, as the
Secretary of State for Health claimed, the care sector is most
alarmed about how this will affect recruitment, especially as no
consultation at all took place before the policy was announced.
Will the Minister please further explain to the House how the
Government intend to ensure that there are enough staff in the
care sector to cover the enormous and growing need?
(Con)
The whole point of the title People at the Heart of Care is the
recognition that staffing is critical to this. While it is early
days, I believe the 70,000 increase in staff over the last 18
months, as I mentioned in my Answer, is a positive step. We had a
very positive announcement just last week about the care pathway,
setting out a career structure, which has been welcomed. For
instance, ADASS, the Association of Directors of Adult Social
Services, said that these are
“positive steps to help make adult social care a real career
choice now and in the future”.
We really are making advances in this space.
(LD)
My Lords, as the Minister has likely anticipated, 2024 is going
to be a year when we keep hassling him for a long-term workforce
plan for social care. Assuming he is not going to announce the
imminent publication of one, can I at least ask him to commit to
commissioning and publishing an independent report into the
potential impact of the visa changes described by the noble
Baroness, Lady Pitkeathley? The Government are of course entitled
to make it harder to get visas, but they should be upfront and
transparent about the downstream effects.
(Con)
The Home Office has made an impact assessment of that. It thinks
it will impact about 20,000 staff; we recruited about 100,000
last year. The main thing is that, by making sure that only
CQC-registered bodies are able to recruit in this way, we are
trying to make sure it is done in the correct, ethical manner by
high-quality providers, which I think we would all agree is the
right approach.
(Con)
I welcome the additional care staff that my noble friend
mentioned, but there are some real pressures in rural areas where
people cannot get carers to come and work. Can he say what is
being done about that? Also, because he mentioned it previously,
can he give an indication of whether there is a greater number of
community hospitals that patients could be discharged into?
(Con)
I thank my noble friend for the question. The whole point of
trying to develop the career structure that we talk about is to
make sure that it is a career that people want to go into across
the board, be it in urban or rural areas. Part of that is putting
in place about 100,000 training places—this is the first place in
the world that has been set up—to try to set up a real career
structure. We are starting to see early signs of it working. The
number of beds blocked has decreased by 10% in the last few
months. It is early days, but it is beginning to work.
(CB)
My Lords, does the Minister not agree that, while the increase of
70,000 people is very welcome, it is in the context of a turnover
of nearly 400,000 every year in care because of the poor career
structure? I understand and appreciate that £70 million has been
put into training and a care workforce pathway, but does he not
agree that it is profoundly inadequate compared with the £11
million a day that is put into NHS nurse training?
(Con)
The 70,000 increase is a net increase, so it takes into account
the turnover of staff, many of whom rejoin somewhere else in a
social care setting. Notwithstanding that, I agree with the noble
Baroness that a turnover rate of around 28% is too high in any
sector. For about 20% of employers the turnover is only 10%, so
clearly some know how to develop a career structure and have
motivated staff who will stay there. The intention behind the
programme and the career pathway we are trying to set up is to
try to get more of that across the system, because retention is
key.
(Lab)
My Lords, the Minister told the House on Tuesday that hospital
discharges have recently been reduced by 10%. However, he knows
that this figure goes up and down as some people leave hospital
while more come in at the other end, and it depends on which
period of time is measured. From July to November last year there
was in fact a steady rise, so we need to be specific about dates
when we talk about making progress. On the care settings that
patients are being discharged to—care homes—how are the
Government keeping track of how the extra funding allocated to
deal with chronic local staff shortages has supported the
discharge process? Will it continue in the longer term?
(Con)
The noble Baroness is correct that the numbers are a result of
flow. We are seeing thousands more people hospitalised through
A&E, so the fact that we have managed to reduce the back end
indicates a positive way forward. To measure precisely what the
noble Baroness asked about, we have now set up a kind of flight
control system for each integrated care board, as I have
mentioned, which looks at data across the system to monitor the
number of hospital beds and places needed on a case-by-case
basis. The noble Baroness is absolutely correct that having that
data is key.
(Con)
My Lords, my noble friend the Minister mentioned the importance
of a career structure to encourage people to work in the care
sector. On the question from the noble Baroness, Lady
Pitkeathley, about visas for carers, one issue that has not been
addressed is that of personal carers. It is very difficult to
sponsor or get a personal carer for individuals, and therefore
there is a massive shortage. Can my noble friend the Minister say
what the Government are doing to make sure that we can have more
personal carers, whether from a domestic workforce or through
immigration?
(Con)
My noble friend is correct that the recruitment of personal
carers is harder. I know that this is close to his heart. I can
probably serve him best by giving him a written reply setting out
the details of what we are doing.
(Lab)
My Lords, to make this an attractive job for a care worker, we
have to not only give them a pay rise above the national living
wage, which is their basic pay, but make this into a profession.
If they are professionals, they will then have a career structure
that is recognised nationally. Will the Minister encourage that
development?
(Con)
Yes, I totally agree. That is why we announced this career
pathway last week, to try to do exactly what the noble Lord is
talking about. It has been welcomed; I quoted from ADASS, but a
number of other bodies have welcomed what we are trying to do. We
aim to do what the noble Lord said: to make it a profession that
people really want to join. There are qualifications for it,
advancement and apprenticeships, which are all part of setting up
a career structure.
Lord Swire (Con)
Does my noble friend the Minister not agree with me that there is
still massive potential with the 500 or so community hospitals we
have in the United Kingdom? Many are extremely well supported by
their local community, and many still retain beds.
(Con)
Yes. I have seen a number of really good examples of the kind of
step-down care that my noble friend is talking about, or
intermediate care that can be used as interim measures. We are
trying to bring more of them on board, as well as the very good
virtual wards. We have set up 11,000 virtual wards, and they are
making a difference as well.
(Lab)
My Lords, the Government say that they have done an assessment on
the effects of the visa changes. Can he tell us how that was done
if the Government did not discuss it or consult with the
sector?
(Con)
It was a Home Office impact assessment, so I freely admit that I
do not know exactly who was consulted; I will happily get back to
the noble Lord on that. I know that the assessment looked at all
the different parts, including the salary cap and the impact on
dependants. For instance, it was not thought that the restriction
would have much impact on dependants because not many people come
with dependants in the care sector. It looked into each bit, but
I will happily let the noble Lord know more in writing.
