It is great to have the opportunity to raise the issue of social care in the Chamber, and I am grateful for the time from the Minister and from colleagues to engage with this really important issue. I would also like to thank the Government for finally taking the issue of social care reform seriously and coming forward with plans, which are long overdue.
Social care is absolutely key, not just in itself, but to the success of our wider health services. NHS backlogs could be prevented or reduced by investment in care, with hospital admissions prevented or timely discharges achieved by better integration between the two. For example, an emergency care package could be put in place in a timely way rather than having someone need an ambulance to accident and emergency. It is important therefore to ensure that the funds described as being “for social care”, from the national insurance increase, do make their way to care provision—to local authorities and providers—to improve support and capacity. I know that the Government have prioritised tackling hospital backlogs with the first year or so of that money, but care has backlogs too—in Nottinghamshire we have gone from a waiting list of zero to one of 400 over the course of the covid pandemic. As I have described, care services play a key part in tackling those backlogs in the health service. As ever, we often focus on hospitals, but I have always felt that primary care, community-based services and, of course, social care are by far and away the best and most cost-effective ways to tackle these issues and improve our wider health service provision.
That said, this White Paper and talk of improved integration between the two services is very welcome. I have already described how this is key to reducing pressure on hospitals, but the same applies for our ambulance services and GPs too, if people are able to be cared for effectively without calling on acute or emergency services. As the White Paper says, the current system can be complex and disjointed. The focus on community-based provision and improving healthy life expectancy is a good one, and I welcome the fact that it explicitly talks about support for working-age adults with disabilities, who are so often forgotten. The debate about social care in the public domain and in the media always seems to focus on elderly people, and of course that aspect is vital and really important to us all, but half of the provision of social care is actually for disabled, working-age adults with increasingly long-term and complex support needs, which are also increasingly expensive and unsustainable. That area certainly needs more focus, so I welcome the fact that it is included—
An integrated approach is needed for social care. Nottinghamshire’s social care needs are not the same as those of any other county, so does my hon. Friend agree that a communities-based approach is needed, as is precisely laid out in the social care White Paper?
My hon. Friend knows the challenges in Nottinghamshire social care as well as anybody—I am sure they come across his desk in Broxtowe all the time—and he is right that this work has to be locally led. I welcome the opportunity in the White Paper to build from the community upwards through our integrated care strategy and to work together with health partners around the county. In the long term, locally led and community-based provision will help us to tackle the challenges we face.
This debate is on social care in Notts. As the Minister knows, among those in this place I am unique in being responsible for the direct delivery of social care services in my county and in my Mansfield constituency, so this is a unique opportunity for me to raise the key issues that affect those services with her and with the Government—from the coalface, so to speak. That is part of why I have argued that my dual role can benefit my constituents and the Government. I hope that proves to be true.
The Minister will not be surprised to hear that workforce capacity is far and away the biggest challenge that we face in Nottinghamshire. We have seen a further 5% decline in staffing levels in a sector that was already understaffed. I am grateful that a crisis was averted by the revocation of the mandatory vaccination plans, because they would have seen thousands more leave the sector in Notts. That change of policy was absolutely the right decision.
We estimate that the turnover of staff in home care is around 26%, which is a massive and ridiculous proportion. That reflects the fact that there is significant competition for pay; that people can earn more in other sectors locally; that we are struggling to recruit; and that staff who have been through the wringer in recent years in incredibly tough circumstances are increasingly deciding to retire early or take a break because of the pressures.
We are doing a lot locally to try to combat the amount of turnover, including through new apprenticeships and big recruitment campaigns with market providers, and by incentivising collaboration between providers and offering incentives for them to invest in staff wellbeing or training, but more is needed. We need a national workforce strategy and recovery plan with sustainable funding that recognises the disparities in pay and conditions in the sector, and that needs to be part of the “fair price for care” reforms, which is not currently the case.
Tom Randall (Gedling) (Con)
I congratulate my hon. Friend on securing this Adjournment debate; it is on a very important subject. I am sure that most Nottinghamshire MPs have spoken to people such as Terry Galloway who has some very interesting ideas on this subject. I am talking in particular about people who are of working age but who are leaving the care system—reintegrating into life as it were. They face particular challenges that are almost akin to a benefits trap in terms of leaving care and then having to meet certain costs. Does he agree that, when we talk about resources, it is important that we give these people the resources that they need to bridge that gap? In the longer term, that will benefit both them and the wider system as it will help them to get back to a normal life.
I thank my hon. Friend for that intervention. Terry Galloway is fantastic. He is a real advocate for some of our children’s services—our care leavers’ services in particular—in Nottinghamshire. I am pleased that my hon. Friend has raised his case here today. This is a prime example of where children’s services and adult care services need to talk to each other, and where we need to have those clear pathways into additional support. Some of those children will get support until they are 25 under the current system, but that is not all funded. Equally, we need to do more at a county level to plan for the lifetime of these children. We know that they are there. We know that when they are in children’s services, they are likely to come into adult services, and we need to make sure that we are planning for that in the long term. The same applies to SEND and other local challenges—my hon. Friend is absolutely right about that. We know that the outcomes for care leavers are not great, which is partly why we are investing £14 million over the next three years at County Hall in transforming those proactive and preventive services, starting with our children’s services, making sure that we are delivering the best possible support and offer to them.
I am pleased that the Government are finally grasping the nettle of social care reform and integration, because, just like the never-ending increases in the NHS budget, it is neither right nor affordable for spending to go up and up every year and for that to be accepted by Government or by anyone else. That is not a solution. We must do it differently. If we cannot tackle the growth in cost and demand under the current systems, then those systems need to change—whether they be care services, health services, children’s services, or all of it. In some ways, covid provides us with that opportunity to draw a line, to think again and to reform. I hope Government will take that opportunity, and I look forward to hearing from my hon. Friend the Minister.
I thank my hon. Friend the Member for Mansfield (Ben Bradley) for securing this debate. I also thank him personally for his sterling work during the pandemic as Leader of Nottinghamshire County Council. He brings a unique insight to this debate as a result of being both a Member in this place and someone who works on the frontline dealing with the issues that I also have to wrestle with. I listen to him and very much appreciate all that he has to say.
I commend, too, the powerful contributions from my hon. Friends the Members for Broxtowe (Darren Henry) and for Gedling (Tom Randall). As they said, the adult social care sector faces challenges in recruiting and retaining care staff. We recognise that, and we have put in place a range of measures, as I am sure my hon. Friend the Member for Mansfield would recognise, to support local authorities and care providers in addressing those workforce pressures, including making available a total of £462.5 million in workforce recruitment and retention funds, and the latest phase of our national recruitment campaign, promoting the rewarding and stimulating roles in the adult social care sector. I am sure many hon. Members have seen the adverts now on TV.
The new workforce recruitment and retention funds can be invested in a number of measures to support staff and to boost staff retention within social care. They include, but are not limited to, occupational health, wellbeing measures and incentive and retention payments, and there is a lot of flexibility within that fund, which I am sure is appreciated. On 15 February 2022, we added care workers, care assistants and home carers to the health and care visa and the shortage occupations list for a 12-month period, which will make it quicker, cheaper and easier for social care employers to recruit eligible workers from overseas.
The Government are also providing a sustainable local government settlement, which is designed to ensure key pressures in the system are met, including the national living wage and national minimum wage. An increase in the rate of the national living wage will mean that many of the lowest-paid care workers will benefit from a 6.6% pay rise effective from 1 April 2022. We continue to monitor workforce capacity and the impact of our interventions through the Department’s capacity tracker, workforce data and local intelligence, as well as monitoring the impact on unmet need and NHS discharge—and, of course, hearing from many hon. Members about what is happening on the ground locally.
10:21 pm
House adjourned.
We need to understand what more can be done to increase the stature and status of care workers and the care profession. The workforce plan needs to include clear and defined pathways into health services, so that people see social care as an entry pathway to wider health and NHS careers, where the range and scale of opportunities for different jobs and long-term careers is massive. Care is often perceived to be a low-skilled, low-paid job with little scope for progress or promotion, but that is absolutely mad when we consider the fact that the skills and qualifications are directly transferable into one of the world’s biggest employers, the NHS, which covers every health role under the sun.
The pathways should be obvious and we need to make them obvious and overtly available to care workers and young people in schools and colleges. I hope we can plan some of this work locally, perhaps through the devolution of skills funding in the coming years. We are already working on some of that with West Nottinghamshire College and Nottingham Trent University, which are trying to build the pathways from school directly into the health services in my Mansfield constituency. A national pathway for integrated health and care careers would be fantastic.
The shortage in home care has meant that an additional 10 people a day are waiting to be discharged from my local hospital and much higher proportions of people end up being discharged to care homes when they could and should have gone to their own home. That is not good for long-term outcomes or those people’s wellbeing and also means that our reablement services—those that support people to get back on their feet and be independent in their own home—are overwhelmed. These are observations from Notts, but the trend is regional and national, not just ours. In fact, we have fared better than many other areas.
I thank the incredibly hard-working and dedicated staff in Nottinghamshire’s social care services for everything they have done to manage incredibly difficult circumstances. I include among them our council’s service director, Melanie Brooks, who directly delivered care packages and was on call over Christmas to try to mitigate the pressure. A huge thank you to her and her teams.
We have a lack of housing stock for care provision, and investment in things such as supported accommodation has slowed down, obstructed by covid, construction and supply chain issues and other factors. It often seems like the link between health and housing is not made clear, and it does not seem to feature much in some of the recent proposed legislation, but good housing can reduce social care needs, prevent hospital admissions and support people to remain active and sociable in their own homes and communities.
Homes England funding could be devolved to support local areas to meet their needs. Housing needs to be a key part of care reform. In our two-tier area we are working hard on collaboration among councils and providers to ensure that housing and health services talk to each other, but that is an option rather than something that is automatically built into the system. That needs to change. Similarly, if we have accountable local leaders—the Government have made clear through the Department for Levelling Up, Housing and Communities their intention to devolve significant powers—could we not have more local control over how powers are managed and delivered? That would help us to integrate our local services. Children’s services are also key to this. I question whether all this needs to be linked to the children’s care work that seems to be in the pipeline, through the Josh MacAlister review and the special educational needs and disability review that is happening in the Department for Education. Children’s care services and adult care services are linked, quite clearly, and they need to be integrated just as health and care do. I know that this is complex as it spans multiple departments, but it is also sensible and it needs to happen.
Our local integrated care systems will seek to draw all these things together to offer the best start in life and the right preventive interventions, just as Nottinghamshire County Council is doing with a significant investment in the transformation of our children’s services. More proactive and preventive services will be announced in our budget on Thursday. That is something of which I am incredibly proud and it will, I think, change lives. If local plans across the country seek to integrate adult care services and children’s care services then, clearly, national ones must do so, too.
Financially, Nottinghamshire has some capacity to use adult social care precepts this year, but continued rises in council tax without major reform are also unsustainable, especially when we consider that some London boroughs pay half the council tax that many people do elsewhere, including in my own constituency. That is not fair, but, as an authority, it means that we do have some funds to draw on this year. Our social care budget for 2022-23 will rise by around £12 million compared with last year. That extra funding is very welcome, but, again, we need to understand that that is not sustainable in the current system. Fairer funding for local government needs to be a priority to make sure that we have that level playing field across the country.
There will be a significant challenge in terms of resources and staffing capacity as we try to tackle both the day-to-day care issues that I have touched on—pressures of services and staffing—as well as delivering the significant reform that we are being asked to deliver. Although it is welcome and right, it will present its own challenges and pressures. The Government must ensure that sufficient capacity exists if they want us to do both at the same time.
Turning to our workforce strategy, in our “People at the Heart of Care” White Paper we committed to at least £500 million to develop and support the workforce over the next three years. That is an important part of our wider investment to reform the social care system. The commitment includes developing a knowledge and skills framework, developing career pathways and linked investment to support progression within roles and across the wider sector for care workers and registered managers. That will help to ensure that staff feel recognised, rewarded and equipped with the right skills and knowledge, and that their health and wellbeing are supported.
Moving to the fair cost of care, we are committing £1.4 billion over the next three years to support local authorities in moving towards paying providers a fair cost of care. That will enable local authorities to ensure that local care markets can respond to the changes that reform will bring, and to address under-investment and poor workforce practices.
On funding, our focus has been on ensuring that the social care sector has the resources it needs to respond to covid-19. Throughout the pandemic, we have made available over £2.9 billion in funding for adult social care. Additionally, we provided £60 million for local authorities to support the adult social care response to covid-19 in January 2022 alone; since May 2020, we have provided over £50 million of specific funding to Nottinghamshire to support the adult social care sector in its response to covid-19. The most recent infection control and testing fund provided almost £400,000 of funding to Nottinghamshire to enable vaccination of social care staff.
My hon. Friend mentioned hospital discharge. To support safe and timely hospital discharge, we have made nearly £3.3 billion available via the NHS since March 2020. That includes an additional £478 million to continue hospital discharge programmes until March 2022.
I was delighted that my hon. Friend recognised the importance of housing in preventing social care needs from deteriorating and the link between housing and health. In our “People at the Heart of Care” White Paper we announced that we will launch a new investment in housing of at least £300 million over the next three years to connect housing with health and care and to drive the stock of new supported housing for adults of all ages. We have committed to continuing to incentivise the supply of supported housing through the care and support specialised housing—or CASSH—fund, with £213 million available over the next three years, which works out as £71 million a year.
Our integration White Paper is the next vital step in our journey of joining up health and social care at a local place-based level. Our proposals will help the system to recover from the pandemic. I know that Nottinghamshire has seen the introduction of End of Life Together—a collaboration of local hospices, community trusts, primary care providers and acute trusts that came together to deliver palliative care and end-of-life services. That was much needed in the local area and I am sure it has provided a lot of support to families at their time of need.
We have also focused on training and opportunities for the workforce across the system, and that will allow staff to get on with doing their jobs without organisational silos standing in the way. Both my hon. Friend and I very much hope that the integrated care systems will really help to deliver much better services locally.
I thank my hon. Friend and all hon. Members for their contributions on this important topic today. I know that they are deeply committed to supporting the social care system and making sure that people get the support they need. I hope the actions I have set out today reassure them that the Government are working tirelessly to make that happen, and I look forward to continuing to work with them to make it happen in Nottinghamshire. Finally, I take this opportunity to thank all those on the frontline providing care: people who go the extra mile, day in and day out, to make a vital difference to people’s lives. I say thank you on behalf of all of us.