I remind hon. Members that there have been some changes to normal practice, in order to support the new hybrid arrangements. Members participating physically and virtually must arrive for the start of the debate in Westminster Hall and are expected to stay for the entire debate. I must also remind Members participating virtually that they are visible at all times, both to one another and to all of us in the Boothroyd Room. If Members attending virtually have any technical problems, they should email the Westminster Hall Clerks’ email address, which I think has been emailed to everyone. Members attending physically should clean their spaces before they use them and before they leave the room. We do not have any Members in the Gallery today, but Members should speak only from the horseshoe, where the microphones are.
That this House has considered social reform and the social care workforce.
It is good to have you in the Chair for this important debate, Dr Huq. I am pleased to open the debate. I pay tribute to the House staff who have enabled Westminster Hall debates to return with virtual participation.
The covid-19 pandemic has exposed the failings of our social care system. With more than 30,000 deaths of care home residents, the care sector has been hit hard over the past year. However, the fundamental problems in social care long predate the pandemic. A decade of underfunding meant that we were in a situation, even before the pandemic, where 1.5 million people were not getting the social care they needed. While social care is, rightly, the last thing to be cut by local councils, the reality is that areas that have seen half of their central funding cut since 2010 are left with little choice. Underfunding has led to fewer care packages, cuts to care packages and providers being asked to take contracts that do not even cover their costs.
One clear illustration of how this is going wrong can be found in long-stay in-patient wards, where 2,000 autistic people and people with learning disabilities are detained, at enormous cost to the NHS. One reason for that is the lack of resources in the community to support them. When local authorities cannot afford care and support in the community for autistic people and people with learning disabilities, it becomes easier to put them into inappropriate NHS in-patient units, even though community support would be cheaper and more appropriate. We also have older people forced to sell their homes because they are unable to access publicly funded care support until they have exhausted almost all their assets.
There has been much focus on care in care homes during the pandemic, due of course to the tragic death toll among people living in those homes, but we must also focus on the fact that social care is needed by working-age disabled people too, and that proposals for reform must cover their needs. In fact, one in three users of publicly funded care is under the age of 65, whereas only one in four is an older person in a care home, so the crisis in our care system affects more than vulnerable older people. It is a crisis not only of catastrophic costs, but of hundreds of thousands of people being denied the opportunity to live their lives as they would choose.
Given the popularity of the debate, and the fact that we have three Front-Bench spokespeople and a concluding statement from Barbara Keeley at the end, I am going to start with a time limit of three and a half minutes. There will be a clock visible at the side of Members’ screens, and the chaps here can pull the plug if they go over the limit. With all that in mind, I will start with Andrew Lewer.
Andrew Lewer (Northampton South) (Con) [V]
Thank you, Dr Huq; it is a pleasure to speak under your chairmanship.
The pandemic has shone a light on the pivotal role that social care plays in our communities. It has, however, laid even more bare the huge pressures that the sector has been facing for the past two decades. Having been in local government since close to the start of this century, I recall papers saying how urgent reform was then, including the 1999 royal commission on long-term care, and it was a constant theme throughout my time as a county council leader. Such is the urgency now that, although a desire to get cross-party consensus on this is a welcome aspiration, it must not be used as a reason for delay.
At a time when, for all the wrong and tragic reasons, public understanding and awareness of the care sector has hugely increased, this should be harnessed to perhaps achieve a positive legacy from this pandemic, and to achieve the long-sought parity of esteem between our hard-working care sector workers and their colleagues in the NHS. Having spoken about this many times before in the House, through several Prime Minister’s questions and work on joint Select Committee reports discussing what reform should look like, I think that there needs to be an emphasis on a joined-up approach between health and adult social care, not only nationally but locally.
Throughout the pandemic, local government has stood shoulder to shoulder with the NHS in tackling coronavirus, and the Local Government Association, of which I am a vice-president, has done tremendous work in highlighting this. However, too often the two services have been placed on different footings. The past 12 months have shown, perhaps more than ever, the need for closely integrated health and social care, and I have seen the hugely positive impact that such an approach can have in my own constituency, through Northamptonshire Health and Care Partnership’s innovative Integrated Care Across Northamptonshire programme.
I therefore urge caution to any colleagues who wish to see the social care sector cut from the local authority remit and subsumed within an ever-expanding NHS. This is an overly simplistic and short-sighted approach. It is not wrong to have varying models of social care provided by different local authorities working with NHS services. That flexibility allows local services to be better through both parts of the demos: demography and democracy.
In the last Parliament, I sat on the Select Committee on Housing, Communities and Local Government, which commissioned a joint report with the Health and Social Care Committee on possible long-term funding models for social care. That report, which I commend to colleagues, specifically left the door open for insurance-style funding solutions to the issue, which have been used in countries such as Germany and Japan. It is a better approach than the usual “rising taxes will fix this issue,” especially when we bear in mind the important, if sadly unfashionable, fact that rises in tax rates do not always lead to rises in tax takes. Having recently been re-elected to the Select Committee, I am very keen that this option should be looked at once again, and I would welcome comments from the Minister on the Government’s consideration of these elements of such proposals in their final plans.
My hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) has eloquently summed up the very sad current situation we find ourselves in, so I will begin by stating the obvious: social care is in desperate need of proper levels of funding. Politicians agree that we need funding but then go on to torpedo any of the suggested solutions. When Labour produced a plan, the Tories called it a death tax, and when the Tories suggested a plan, it was rejected by the Opposition. The price of the war of words has been paid not in pounds sterling, but in the undeniable pain and hardship endured by those denied help and care. Calls for working together and royal commissions never amount to any more than words.
Although proper funding is crucial, it is not the whole story. We need a properly funded system that meets the needs of people receiving social care and that really and truly puts them first—one that is provided by a respected and valued workforce. Money will improve care only as the current system will allow. Social care reform needs to be first and foremost a transformation of the culture surrounding the social care sector. For far too long, care has been treated as the problem no one resolves. In 17 years, we have had 13 documents on social care reform, and over a decade of Tory austerity has left social care a far cry from what it needs to be. It is just not good enough in a civilised society.
The disparity between healthcare and social care only makes the problems worse. Many people in the social care sector feel that they are used as a care overflow or relief service, and that they are treated as secondary to the supposedly more important healthcare workers. On top of that, social care is not even reaching potentially hundreds of thousands with unmet needs.
The status of the social care workforce has declined and needs to be drastically improved. How can we expect underpaid, undertrained and overworked staff to give quality care? Staff turnover is huge, so we need a comprehensive workforce strategy, including proper registration and a regulatory body. That would be an important step in bringing social care workers in line with their healthcare colleagues, and in dispelling the misconception that it is a low-skill industry.
It is a pleasure to serve under your chairmanship, Dr Huq, and to follow such excellent contributions from the hon. Member for Worsley and Eccles South (Barbara Keeley), my hon. Friend the Member for Northampton South (Andrew Lewer) and the hon. Member for West Lancashire (Rosie Cooper). I completely agree with the comment just made by the hon. Member for West Lancashire: it is now or never.
Over the last two decades, we have had 12 White Papers, Green Papers and consultations, and four independent reviews and commissions. I am ashamed to say that a number of them happened when I was Health Secretary for nearly six years, and we were unable to make the progress that I wanted. In the last decade, we have had five Select Committee reports from both the Commons and the Lords.
This time is different, however, because we have just had a pandemic that has shown the whole country how amazing our care staff are and how dependent we are on a group of people who do extraordinary work on very low wages. If we are not going to fix it now, I do not think we ever will. At the same time, the ageing population has continued to age, and last year was the first in human history with more over-65s in the global population than under-fives.
The Health and Social Care Committee undertook a report on this subject last autumn. We are clear that there are three core elements to the reforms. We have to address the catastrophic care costs that see one in 10 people pay more than £100,000 and the terrible dilemma people face of losing their entire life savings to pay for their care home, when they want to leave those savings for their loved ones after they have gone. We should not be forcing people to make those choices in modern Britain.
We have to do more for the workforce, where turnover is about a third. A third of social care staff leave their jobs every year—up to 40% in domiciliary care. Many of them do not get the minimum wage because they are not paid for the time between appointments, yet we know how amazing they are.
It is a pleasure to serve under your chairmanship, Dr Huq. I draw attention to my declaration in the Register of Members’ Financial Interests.
Before examining what needs to change, I want to acknowledge the work of staff in the sector. This has a personal element for me. My dad managed nursing homes and my mum was a deputy sister in a residential home caring for people with dementia. I know how hard staff work each and every day. Pay can be low and recognition can be lacking. Likewise, the care workers who support people in their own homes do so much. We only tend to see their importance in reverse, when the lack of a placement or support prevents hospital discharges.
We need to go much further in integrating our approach. Last month I helped launch a report by Look Ahead. Unlike most of the reports that land on our desks or in our inboxes, it called for reforms that would not cost money. In fact, taxpayers would save money. Look Ahead looked at one element of integration: supported housing. It estimated that nearly £1 billion could be saved each year by extending integrated mental health, social care and supported housing services across England. The report is a robust analysis of how supported housing keeps people with mental health problems out of institutionalised care. This means more than just savings. The online launch began with a video from service users, which had the hairs standing up on the back of my neck. One man told us how it was the first time he had ever had his own private shower. He said that it made him feel like a king. These are small, but incredibly significant and humanising differences.
We know that there is not enough money to sustain the social care system as things stand. Any way to make savings, while improving outcomes, must be seized. Yet, only a handful of NHS trusts and local authorities are adopting an integrated approach. In my view, this missed opportunity comes down to culture. I am not casting aspersions; the system just is not geared towards different organisations working together. Outcomes are what matters and the goal, for most, should be to help people to live as long as possible, independently, away from institutionalised care.
It is a pleasure to serve under your chairship, Dr Huq.
I congratulate my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), a formidable campaigner in Parliament on such issues, on securing the debate. Social care should have been at the forefront of the mind of every single Member of Parliament as we witnessed our care homes face some of the worst times during the pandemic, as carers put their own health and lives at risk to care for our loved ones. I pay tribute to them.
Let me declare an interest: I have been a care worker. It was a while ago, but things have not got better—the challenges have gone unchecked or, sadly, are worse. I hope that I can give voice, in Parliament, to those fantastic overworked and underpaid workers.
As we have seen throughout the pandemic, it is women and black, Asian and minority ethnic workers who have risked the most and been hardest hit. To put that into context, 82% of people working in social care are women, and about 247,000 of them are from overseas.
Our social care system is beyond overstretched. We have been fighting the pandemic with 117,000 fewer care staff than we need, and absences have trebled over the past year. We need to future-proof our social care system from future pandemics. This cannot happen again. Social care has to be well paid, a secure career with the strong terms and conditions that our healthcare heroes deserve. Such people are not unskilled. I never want to hear Ministers talking about them like that again. I challenge anyone who thinks otherwise to spend a day in a carer’s shoes.
Over the past year, I have heard terrible testimonies from care workers who were told that they needed to come into work even when they had symptoms, putting at risk not just their own health, but the health of those they care for. We cannot have the obscene situation in which even in a pandemic, they only get £95.85 a week to live on for sick pay. The Health Secretary has admitted he could not live on that; we should not expect the people who look after our loved ones to live on that when they get sick either.
It is a pleasure to speak under your chairmanship, Dr Huq.
I am glad we are having the debate and thank both the hon. Member for Worsley and Eccles South (Barbara Keeley) and my right hon. Friend the Member for South West Surrey (Jeremy Hunt) for securing it. Simply, this is one of the most important parliamentary reforms in recent years. If we can do one thing in administration before the next general election that would mean more to my constituents, it would be how we reform the social care sector, fund it properly and meet the needs of our ever-increasing older population.
People might expect me to say that, given that I am the MP for North Norfolk, a constituency with the oldest demographics in the country, but my interest is deeper than that. There can be no one who has not been touched in recent times by having a friend or relative cared for in later life. I certainly have, when my aunt gave up literally everything to care for my grandmother. Throughout the pandemic, I have wanted to raise the profile of our social care workforce and our carers—one could call it a crusade—to get hundreds of carers and unpaid carers vaccinated in Norfolk. So many are just unidentified, despite the incredible work they do and the weight they lift off the NHS.
This is a huge topic, but I will deal with just two broad areas: first, how we fund the reforms, and secondly, how we shift the perception of our social care workforce, so that we can value and perceive the workforce as the care professionals they are. Funding is a deeply complex problem where care settings vary hugely, whether that be public or private care home settings for older people, or settings for those with complex needs. Every area needs a proper footing for funding.
I asked the Prime Minister at Prime Minister’s questions on 13 January about a long-term plan for social care—one that matches the NHS. I am pleased to hear that that is coming forward, but care is often misunderstood. We often perceive that it is just for older citizens, but it is not. Half of all social care expenditure is on working-age adults, and an estimated 1.5 million people work in adult social care across England. In Norfolk alone, there are 27,000 professionals in the sector.
It is a pleasure to serve under your chairmanship, Dr Huq.
Social care is in a state of crisis as a result of severe underfunding by Conservative Governments. There is very little detail about social care in the White Paper. The Government say they will bring forward separate proposals later in the year, but under the plans they have put forward, integrated care systems will be given a single budget for the health and social of their area, and an ICS will have the power to increase resources in some places and reduce them in others.
Understandably, people are concerned that they might see a reduction in the NHS or social care offer in their area and that a stark postcode lottery will emerge. What is the sense in creating a system where local NHS and social care providers will be competing with each other for funding at local level? For all the talk of joint working, that is what will happen if this is put on a statutory footing: the system will be robbing Peter to pay Paul, and levels of services and jobs within the NHS and social care will be impacted.
The White Paper states:
“There will be a duty placed on the ICS NHS Body to meet the system financial objectives which require financial balance to be delivered.”
A senior health manager explained to me that the point of having a single budget for a local health and social care system, and the requirement for the system to manage that budget, was to drive efficiencies in the system. He also told me that there needs to be a drive to reduce the number of people in hospital, and the White Paper supports such a drive. The proposals make it easier for hospitals to discharge patients by removing the legal requirement to assess patients for NHS continued healthcare and NHS-funded nursing care before they are discharged from hospital.
What about patient safety? Anyone who has experienced seeing a friend or relative discharged from hospital too early, only to have to be readmitted, knows just how serious this is. What will this arrangement mean for the millions of unpaid carers who will be asked to take over once their family member has been discharged from hospital?
I am delighted to be so. It is a pleasure to speak in the debate with you in the Chair, Dr Huq.
I am going to speak, not for the first time, in favour of a German-style adult social care premium. All the speakers today have made good points about the need to resolve the problem, but we must address it with money. The need can be supported only by a financial solution.
There are three elements to getting anything done in the world: building a compelling case; building a coalition of people; and being very persistent. I am sure that the Minister would agree that we have been persistent on this topic and its solution. There is a compelling case for an adult social care premium, which I shall speak about in a second. I think that there is a cross-party coalition forming around it. My hon. Friend the Member for Northampton South (Andrew Lewer) referred to it, as have others, not least my right hon. Friend the Member for South West Surrey (Jeremy Hunt) and my friend the hon. Member for Sheffield South East (Mr Betts), under whose chairmanship I once served on the Housing, Communities and Local Government Committee. There is cross-party consensus that we can build on.
We have to find a financial solution. When we talk about a social care premium people say, “We have national insurance,” but that is obviously already in the tax system being used. There are huge demographic pressures that according to the Office for Budget Responsibility will drive debt to national income to 314% by 2060 unless we tackle the problems, including pensions and healthcare. All the solutions that we hear of generally involve a blank cheque from the taxpayer or the person in need of care, neither of which can be right.
The German-style system—Germany moved to it in 1995 from a local authority-provided system—means that everyone does what most people do, putting a small amount of income away every month, on a mandatory basis. It is roughly 2.4% of income, to save for later rainy days. It is a pay-as-you-go system, so everyone is covered from day one. It is done through insurance companies, so it is not taxation. They are not-for-profit insurance companies in Germany, and I would recommend going down that route as well. There is cover for people on low incomes, so that they do not have to contribute. There is also a cap for people on higher incomes so that it is fair to everyone. Germany delivered that on a cross-party basis. We have cross-party support, as I said earlier, and I worked on two cross-party Select Committee reports on the matter. The Health and Social Care Committee and the Housing, Communities and Local Government Committee recommended it as one of the solutions.
It is a pleasure to serve under your chairmanship this afternoon, Dr Huq.
The covid pandemic has thrown light on a number of holes in social care provision. That is a pressing issue not only because of the pandemic but also because an ageing population will be a huge challenge for the post-covid future. The key issue facing social care is the privatisation of so many contracts. That has led to private companies being paid by local authorities with public money, but being unable to provide an adequate amount of care for those in need.
The need for a more robust social care system was felt most acutely in my constituency during the first wave of the pandemic. It has been reported that at Aspen Court care home, 21 residents died last year between 28 March and 24 April. The loss of life during that significant period was so substantial that it needs to be investigated at a national level. My condolences are with the families of those who have been lost, who have been impacted directly by this tragedy. The care home is run by HC-One, a private company that runs many care homes across London. Staff at those care homes are delivering care in a privatised system. Questions have been raised about the level of pay, hours being worked and the quality of training available to staff.
This month, I learned that HC-One will sell 52 homes and move into more specialist care. I support the calls from GMB and other unions for the HC-One homes being sold to be brought under local authority control, and for the Government to fund the transition costs. Aspen Court is one example of the national issue of the outsourcing of adult social care, which has exposed the financialisation of chains and larger providers, often funded by private equity firms, that dominate contracts across adult social care provision.
A key concern of the charity Inclusion London is that in many cases, those of working age who receive disability benefits have to use those benefits to pay for adult social care. For those whose disability is making it hard or impossible to earn money, it is completely unjust that disability allowance should be utilised to pay for care. That is why Inclusion London and others, including me, believe that we need a robust social care system provided by the Government and through our NHS.
It is a pleasure to see you in the Chair, Dr Huq. The arguments are well rehearsed, the need well understood, the unfairness deeply felt and the failure exposed in countless reports, but nothing changes. Like an annual custom, the Government announce a social care White Paper to be published later in the year, but nothing ever emerges. Meanwhile, the most vulnerable families have to pay out tens of thousands of pounds, and one in 10 over £100,000, for care by underpaid, undervalued and overworked care staff, either at home or in some institution. This year, they have even been denied seeing familiar faces—imprisoned for the crime of growing old or disabled as their lives have faded into a so-called care industry that largely seeks profit out of frailty.
We must establish the core principle that the state recognises its responsibility to care with parity of esteem with the NHS. My report into care homes in York exposed the failure of governance of funded care, with a business model that protects commissioners and providers, but not residents. We cannot continue to sell the lives of our most vulnerable in the marketplace of social care. Instead, we must make a pact with people who just want to be safe and not exploited. Principle one is that the state has the duty to care. Principle two is simple: social care must be a universal benefit. None of us knows the twists and turns of life that will lead us to need help. A caring society will reach out and meet that need.
Principle three is funding—public not private insurance. As we see in healthcare and care systems around the world, the private insurance industry’s lucrative revenue has driven the sick and the frail out of health and care. Every penny must be reinvested in enhancing care. If we are ever to bring funding together, we need to have one system. We have to be honest—high-quality care costs. And a Government will pay for what they value.
Principle four is quality. First, the care must be safe. My report into care homes showed that the larger care home companies provided some of the worst care. Secondly, the care must be person-focused and meet aspiration; it should not just meet basic need or be based on ability to pay. These are our mums and dads. We need a high-quality care standard, driving up quality.
It is a great pleasure to see you in the Chair today, Dr Huq. I congratulate my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) on securing this important debate and I pay tribute to her for her commitment to and advocacy for social care over many years.
I am grateful for the opportunity to contribute to this debate today as a co-chair of the all-party parliamentary group on adult social care. Throughout most of the covid-19 pandemic, I have met on a weekly basis members of the APPG’s working group, which includes not-for-profit care home providers, home care providers and people with lived experience of receiving adult social care.
These meetings provided a valuable insight in real time into the impact that the pandemic has had on the social care workforce. I have to say that, very often, the first-hand experiences reported to me bore no relationship to the Government’s statements on social care. There was no protective ring around care homes; residents and staff contracted coronavirus and died, because they could not access personal protective equipment or testing. Domiciliary care was completely neglected. There were no protocols on managing infection risk for staff who provide care to multiple people in their own homes. People who manage their own care at home could not get access to advice or PPE. There was not the financial support to enable care workers to self-isolate when necessary, without their having to worry about how they would put food on the table.
Throughout the pandemic, the social care workforce carried on looking after our most frail and vulnerable loved ones, consoling people who did not understand why family members were unable to visit, holding hands, and comforting people as they passed away.
In responding to my written parliamentary question on whether the Government would recognise the contribution of the social care workforce during the pandemic with a payment, as the Welsh Labour Government have done, the Minister said that the Government had issued the care badge. A badge does not put food on the table, help to pay the rent, compensate for lost income due to illness or self-isolation, or help with the stress and trauma that many care workers have endured.
It is a pleasure to serve under your chairmanship, Dr Huq. Social care is and has long been the poor relation of healthcare that successive Conservative Governments have promised to fix yet taken no action on. Here we are, eight years on from when the coalition Government announced and subsequently put into law a new model of social care funding based on Andrew Dilnot’s recommendations, but the Conservatives refused to implement it.
Instead, we had real-terms cuts in social care funding, and now we have yet another top-down reorganisation of the NHS that promises integration, but will do nothing to address the structural or funding reform needed in social care. The Budget, at the start of this month, did not even mention social care. Is it any wonder that most people feel that 1.5 million people with unmet care needs are just not a priority for the Government? Thank goodness for our 9 million unpaid carers, who daily pick up the slack and pay an enormous price, both financially and in their own physical and mental wellbeing, without any recognition. Where would we be without them?
Our care system, as many have already said, was already in peril pre-pandemic and is even more so now. Adult social care has consistently been an afterthought for Ministers throughout this pandemic, with more than 25,000 lives lost in care homes to coronavirus and delays in securing PPE and testing for the care sector during the first wave. Many care homes are now teetering on the brink financially. The sector is crying out—with one voice, loud and clear—for a proper, joined-up workforce strategy. We have a staggering 112,000 vacancies, and one in six of the workforce are migrant workers, yet the vast majority of social care roles do not qualify under the new points-based immigration system, even after recent changes.
With 1.6 million social care workers earning less than the living wage, a quarter of the workforce on zero-hours contracts and limited career prospects, how on earth can we expect to provide decent, sustainable care for the most vulnerable adults in our country? The hon. Member for York Central (Rachael Maskell) referred to our mums and dads. It is not only our mums and dads but our brothers and sisters, sons and daughters; a large number of those needing care are actually working-age adults—almost half.
The good news is that Members have been very good at sticking to time, so we actually have a little bit of extra time to play with. If the three Front Benchers all stick to 11 minutes, that will give the hon. Member for Worsley and Eccles South (Barbara Keeley) time to wind up the debate. First of all, we are off to bonny Scotland and Dr Philippa Whitford for the SNP.
Thank you very much, Dr Huq. I pay tribute to social care staff for all they have done during the pandemic and recognise that they, too, suffered bereavement when they lost residents to covid who they had been looking after for a long time. Instead of sympathy, they often faced criticism and attack in the media.
Like the NHS, social care has faced huge pressures during the covid pandemic, so it was shocking that it was not mentioned at all in the Budget. While the Chancellor claimed the UK was in good shape when covid hit due to the Government’s management of public finances, it actually came at the end of a decade of austerity, with the NHS on its knees and an £8 billion social care funding gap in England alone. Service cuts had led to under-provision, with Age UK identifying that almost 1.5 million people do not get the support they need. While most think of frail, elderly people when they talk about social care, it is also critical to allow those facing end of life to be at home if they wish, and to ensure that younger people with a disability can participate fully in society.
The Government’s Green Paper, first announced in 2017, has been postponed yet again, despite the Prime Minister boasting in the 2019 election that he had a plan for social care that was ready to go. Perhaps he was mixing it up with his oven-ready Brexit plan.
More recently, we have been told the delay is due to cross-party discussions, but I certainly have not seen anything, nor apparently has the shadow Minister for Care. Several MPs in this debate have suggested that the Government should propose an insurance-based model, and Germany and Japan are often held up as examples. However, closer examination shows that both systems have increasing shortfalls and that co-payments are, therefore, growing markedly. Taxation still provides the greatest solidarity and security. The Secretary of State has announced plans to reverse some of the most damaging aspects of the Health and Social Care Act 2012 and promote integration of health and social care. Of course, the devil is in the detail, and there was very little of that about social care in the White Paper.
It is a pleasure to serve under your chairmanship, Dr Huq. As many others have done, I congratulate my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) on securing this debate. She has been a tireless, long-standing champion of these issues, and I really do pay tribute to her for her hard work.
I think that reforming social care—along with tackling climate change—is the challenge of our generation. If we cannot sort this issue out after the horror of the covid-19 pandemic, then frankly, as policy and law makers, we should pack up and go home, because this pandemic has brutally exposed the fundamental flaws in our system of social care, on which many people who have spoken today and many people who are watching this debate have campaigned for years.
First, despite all the rhetoric, social care is still not treated as equally important to the NHS. We have only to think about all the effort and focus that went into setting up the Nightingale hospitals and contrast that with what happened to care homes. Frankly, there was not a ring of steel around care homes; that was not the case. We can think about the examples of frontline care workers saying that their PPE was requisitioned for NHS staff. I want our NHS staff to have proper PPE, but to have it actually taken from people when they were caring for some of the most vulnerable in society was appalling.
Secondly, social care and the NHS are still not seen as inextricably linked. We saw that with the discharges from hospitals into care homes without covid-19 tests, and we saw it with many care homes feeling abandoned and feeling as though they did not get the support that they needed and deserved from the NHS at the start of the pandemic.
Thirdly, our frontline care workers are chronically undervalued and underpaid. The Minister will know that of the infection control fund that went to care homes, the vast bulk went towards ensuring that frontline care workers were paid enough so that they could self-isolate if they had to have time off sick, and so that they did not have to have several jobs between care homes. Quite frankly, that should not be additional, extra funding; it should be embedded in the bottom line of funding for our frontline care workers.
I agree with virtually everything the hon. Lady has said. A funding solution is key, because in order to expand capacity there has to be more money. Does she have a funding solution for that? Would she consider a German-style system, which has cross-party support, or would she at least be willing to sit down with a number of people who support that system to engage with the idea?
The hon. Gentleman may know that I have been calling for cross-party work on this issue for the past five years. The principles are clear—we should not leave the costs to individuals alone. We should pool our resources and share risks. That is essential for the future. I do not think any sort of private insurance system works. One issue around the cap on care costs was that the Government thought a private insurance market would spring up. That was not the case, and it will not be the right solution for the future.
The Prime Minister stood on the steps of Downing Street 19 months ago and said he would fix the crisis in social care with a plan that he “had” developed—that he had it already. It is still nowhere to be seen. Lord Bethell recently said that now is not the time to have fundamental reforms, because we are busy dealing with the covid crisis. I argue that now is precisely the time for reforms to give people hope that, after the horrors they have been through, there is a better system for the future. That is why I was disappointed not to see anything in the Budget about social care reform.
Yesterday, there was an unprecedented statement from social care leaders, who called on the Government to end years of inaction and fix the system. They said that as well as emergency funding, we need longer-term plans to make social care a cornerstone of the modern welfare state. The crucial point is the potential for social care not only to transform the lives of millions of older people, disabled people and families who use care, but to create jobs and drive economic recovery.
In the remaining minutes, I will focus on this point. We often talk about the costs of reform, but the costs of not reforming the system are just as important. First, social care has huge potential to create good quality, valued jobs in this country. We need 520,000 more frontline care workers just to meet growing demand by 2030. The Resolution Foundation rightly argues that if we want to create jobs immediately in every community—that is what we need to do to level up all parts of the country—social care is the place we should start, and I completely agree.
It is a pleasure to speak under your chairmanship, Dr Huq. I thank the hon. Member for Worsley and Eccles South (Barbara Keeley) and her co-sponsor, my right hon. Friend the Member for South West Surrey (Jeremy Hunt), the Chair of the Health and Social Care Committee, for securing this debate on the important and interconnected subjects of social care reform and the social care workforce.
The 1.5 million people who make up the paid social care workforce, and the 5.4 million unpaid carers, do the most wonderful thing—caring for people, whose lives depend on what they do. It is a service not just to those individuals, but to the whole country, and never has that been more true than during this cruel pandemic. Yes, our social care system needs reform. It has needed it for decades, and my party committed to that in our election manifesto. The pandemic gives us a moment in time; if not now, when? The pandemic has delayed our work, but I reiterate the Government’s commitment to bringing forward plans for social care reform this year.
This has been a really good debate, with many well-informed contributions from across the parties. I will mention just a few of them. The hon. Member for Worsley and Eccles South talked about the long-term nature of the problems with social care; the fact that the system is as important for those of working age as it is for older people; and the importance of unpaid carers.
The Chair of the Health and Social Care Committee, my right hon. Friend the Member for South West Surrey, talked about the catastrophic costs faced by one in 10 people, who end up spending over £100,000—using their life savings—on their care, and about the problem of high turnover in the care workforce. I thank him for his recognition of my personal commitment and the work I am doing, largely behind the scenes, on social care reform.
My hon. Friend the Member for Northampton South (Andrew Lewer) drew on his experience in local government, going back around 20 years, if my maths is right. He spoke about the need for closely integrated health and social care. My hon. Friend the Member for Peterborough (Paul Bristow) draw on his personal knowledge, as I have heard him do with great value before. I very much look forward to reading the report on supported housing that he mentioned, and I will look it up. This debate would have been missing something if my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) had not mentioned the German system as one for us to consider as we work on proposals for reform.
The Minister is doing a fantastic job on this issue, which is one of the biggest issues that faces us. If this is not going to be a blank cheque for the taxpayer or for the recipient of the care, does the Minister agree, as I think the shadow Minister, the hon. Member for Leicester West (Liz Kendall) did, that there has to be a pooled solution, perhaps like the German-style system of social care premiums?
My hon. Friend makes an important point. I will not be drawn into further detail about the system at this point. The questions about funding lie with the Treasury rather than with the Department of Health and Social Care. We want to tackle the problem of the catastrophic costs of care that a minority of people face, as mentioned by my right hon. Friend the Chair of the Select Committee. I emphasise that we have made the commitment that no one who needs care should be forced to sell their home to pay for it. How we do that is indeed part of the reform work.
As we emerge from the pandemic, we will continue talking to stakeholders, pivoting the many conversations that we have been having about covid to more conversations about reform. Our reforms will be informed by a wide range of voices, not only colleagues and experts in the sector but also care providers, the workforce and those with lived experience of the care sector.
I thank all right hon. and hon. Members who have contributed to this important debate. I know that everyone who has spoken is deeply committed to their support of the social care workforce and reforming social care. The Government are on the case to make that happen. I take this final opportunity to thank all of those on the frontline providing care—people who go the extra mile to care for our loved ones, day in and day out. Carers have been truly remarkable throughout this pandemic. It is for them and the people they care for that we must move forward with the much bigger plans for the reform of social care.
I am glad that we have, through this debate, paid tribute to the care staff who have been on the frontline of the pandemic and who have stepped up and done a fantastic job. My hon. Friends the Members for Luton North (Sarah Owen) and for Dulwich and West Norwood (Helen Hayes) did that and many other contributions highlighted it too.
From the debate, I would say that there is a real cross-party commitment to improve the pay and conditions, the training and the career progression of care staff, but we have a long way to go to do that. I am glad that a number of hon. Members talked about the important role of unpaid carers. I have recently highlighted the fact that our millions of unpaid carers were not mentioned once in the White Paper on health and social care. That must be addressed because they are partners in care.
I join others in thanking all right hon. and hon. Members for their contributions to this important debate. I believe there is cross-party support for reforming social care so that it delivers better for the people who need social care, for the care staff who deliver it and for unpaid carers who would rely on it if it were better than it is.
I thank the Future Social Care Coalition and other campaigners for their support and briefings ahead of the debate, and the House of Commons Library for its briefing. I cautiously welcome the Minister’s promise that the Government are working on reforms and will bring them forward this year. I hope that is not another promise that ends up being broken.
As I said at the start of the debate, we have seen too many broken promises and everyone involved in social care deserves better than what we have. As the right hon. Member for South West Surrey (Jeremy Hunt) and my hon. Friend the Member for Leicester West (Liz Kendall) both said, if we cannot fix this system now, after the terrible year for the care sector during the pandemic, then we never will. Let us grasp that opportunity.
Question put and agreed to.
Sitting suspended.
This is not a new problem. The reality is that social care has been struggling for more than a decade now. That is why the last Labour Government published a White Paper in 2010 proposing major reforms to the way social care is delivered and funded. However, once in government after the 2010 general election, the Conservative-Liberal Democrat coalition decided to drop those proposals in favour of starting another commission on reform. That led to the provisions of the Care Act 2014, including legislating for a lifetime cap on care costs, based on the recommendations of the Dilnot commission. That would have addressed some of the issues with the social care system, although I do not think any of us believed that it was anything like the full solution. Since that change was first delayed by the new Conservative Government in 2015, we have had any number of promises of future reform.
Ahead of the 2017 election, the then Prime Minister promised far-reaching reforms but promptly abandoned them. After that election, a Green Paper was promised by the end of 2017. At the end of 2017, the cap on care costs was completely abandoned and a new deadline of mid-2018 was set for the Green Paper. That was pushed back to autumn 2018, and then to the end of 2018. In early 2019, we were told to expect a Green Paper by April 2019.
When the current Prime Minister took office, he claimed to have a social care plan ready to go, and he repeated that claim during the 2019 general election. The Conservatives’ manifesto at the last election said that they would seek a “cross-party consensus”, but they have not tried to seek that consensus. In fact, a fairly broad consensus on the future of social care has developed. Politicians from across the spectrum, including the Health and Social Care Committee and the House of Lords Economic Affairs Committee, have endorsed the model of free personal care as introduced by Labour in Scotland. That system is not perfect, but it should be a strong position to start from. However, rather than acting on that consensus, we are still waiting for proposals nearly 18 months after the 2019 election.
When the Minister speaks, she may tell us that the Government are working hard on their proposals and will publish them shortly. She would be the third Minister of State to tell me that since the Government dropped their commitment to the cap on care costs, and we have already missed at least 10 deadlines for reform. That simply is not good enough. We need action now, not the promise of jam tomorrow.
If there is a team of civil servants working on this issue, there are a few points that they should consider in order for reform of social care to work. First, reform must deliver a fair deal for care staff. If the crisis of the pandemic showed us anything, it was that without the hard work put in by care staff our care system simply would not work, but too often care staff are underpaid, undervalued and given few opportunities to progress. To fill the more than 100,000 vacancies we have for care staff, social care needs to become a career of choice, with better pay and conditions and better training. When the average starting salary is only £15,000, it is little wonder that people are not turning to a career in social care.
As a starting point, reform should mean that all care staff are paid the real living wage, as my own local authority of Salford is now doing. We need to see investment so that the social care sector offers training opportunities and real career progression for staff, recognising their skills and experience. If we are to fill the vacancies in social care, we need a wide strategy working across Departments to recruit and train the workforce that we need.
The Prime Minister has said that he wants to end the scandal of people needing to sell their homes in order to pay for care. It is right that we should address the issue of catastrophic costs, but that cannot be the only ambition of social care reform. If all we do is end catastrophic costs, we will still have nearly 2 million people not getting the support they need. With providers struggling to make ends meet, local authorities are left with no choice but to cut budgets even further.
We need reform that expands access to social care services. Over the past five years, we have seen fewer older people receiving care every year as eligibility thresholds have crept up in response to budget pressures. Preventive care is increasingly uncommon, with intervention mainly coming after a crisis. Rather than providing low-level support to enable people to continue living independently at home, we are increasingly providing care only once there is no prospect of someone living independently.
When the Health and Social Care Committee looked at access to care, one witness, Anna Severwright, told us:
“I feel that I am not able to live a normal life. I do not have enough hours”—
of care—
“to be able to go out at the weekends and in the evenings, and do a lot of the normal things that make life worth living.”
That is not good enough. People should not see their horizons limited solely because they need social care, but with budgets under ever-increasing pressure, money for anything other than the basics of care is rarely available. There is a better way to deliver social care than 15-minute care visits, and people should not have curfews on their lives because care is not available in the evening.
As well as funding care properly, we could embrace the spirit of the Care Act 2014 and ensure that care packages meet people’s social and emotional needs as well as their physical ones. That kind of person-centred support would enable more working-age disabled people to be productive members of society while also supporting older adults to enjoy later life. At root, social care should be about supporting people to live happy and fulfilled lives without facing financial ruin.
There is a very poor level of support for unpaid carers. There are 13.6 million people providing care to a friend or family member. Without them, our social care system would not cope. Funding for respite care is increasingly hard to get. Many carers say that they would use a respite break to attend a medical appointment.
Responding to an Adjournment debate that I led last Friday, the Minister for Patient Safety, Suicide Prevention and Mental Health said that
“45,000 carers have received respite or other carer support delivered to the person they care for.”—[Official Report, 12 March 2021; Vol. 690, c. 1212.]
We have 13.6 million unpaid carers, including 4.5 million who started caring during the pandemic. For a Health Minister to report that only 45,000 carers received respite care is an appalling record. We must do much more to support unpaid carers, and we could improve their lives by funding formal care services better.
It is now seven years since we put the Care Act into law, but the Government still have not delivered for people who use social care. After years of broken promises and delayed announcements, there is anger at the way social care has been underfunded and reform neglected. This has led to people who rely on social care going without the support they need to live fulfilling lives.
Underfunding has led to care staff being paid the minimum wage and not being given the time they need to provide high-quality care. It has also led to many thousands of people facing catastrophic costs of care, often having to sell their homes to pay for it, and over the past year it has meant 30,000 care home residents dying with covid-19. They were caught in a perfect storm of an NHS discharge policy that seeded infections into care homes before providers could implement infection control measures.
People who use social care deserve better than all of this. They deserve reform that delivers a fully funded, person-centred care system that meets their needs, and they need it now, not at some point in the distant future.
Unfortunately, the social care sector includes some unethical and unaccountable providers, who will happily reduce the standards of care, employee support and protection in the name of profit margins. Councils continue to give contracts based on the lowest price, because it works for their budgets. To many, it must seem that the system fails to directly consider the needs of the vulnerable people who rely on those services day in, day out.
We have an opportunity to put social care on a proper footing. We need to grab it with both hands and realise as a country that looking after those in need in our communities speaks volumes about our values and humanity. We need to act fast and act now.
We need more funding; we cannot duck that now. The Select Committee thinks a minimum of £7 billion is needed to deal with the catastrophic care issue, the growth in the demography and the minimum wage. We should look at models in Germany and Japan, as my hon. Friend the Member for Northampton South rightly said, when thinking about the best way to fund that.
This is a big ask, but the country was bankrupt after the second world war in 1948 when, with cross-party support, we had the vision to set up the NHS. This is the equivalent challenge for today. It is in tune with the values of the British people. We are a kind country, but our social care system is not kind to the older people who depend on it and get 15-minute slots. It is not kind to the people who work in it.
My message to the Minister is that I know that she cares about this and that behind the scenes she is doing everything that she can, but what is the point of being in Government if not to grasp the nettle on difficult decisions that can transform the lives of ordinary people? Now is the moment to rise to that challenge.
Lasting reform requires not only innovation and leadership by Government, but political courage on the part of the Opposition. If social care funding is left as a political football, we know who is being kicked around. Two decades have seen at least a dozen White Papers on social care reform. The right ambitions are easy to state; it takes legislation and political will to achieve them. As we emerge on the other side of the pandemic, the need for such services will only grow. The Prime Minister has given us a road map for leaving lockdown; a road map for integrated social care would be as profound as the creation of the NHS.
At the heart of any changes, we should hear from the people who need care. They should have a choice and control over who is in their life, who supports them and what the future of social care looks like.
Report after report has said that things need to change. The Health and Social Care Committee published radical proposals for social care last month, just as it did before the last election. My own party put a joined-up national health and social care service, free at the point of use, in our last manifesto, and in the manifesto before that, the one before that and the one before that. The Conservative party promised reform in 2010 and again in 2015. Then, nearly two years ago, the Prime Minister stood on the steps of Downing Street to promise,
“we will fix the crisis in social care once and for all”.
Clearly, from all the speeches today, there is the political will to fix this broken system. People should not have to give up everything in their old age because they need social care. Social care staff who fought the virus with everything they have do not need to be paid a pittance for some of the toughest work that can be imagined. People can and must have dignity. My plea to the Minister is, let us look after the people who have been on the frontline of the pandemic and work together finally to fix social care in our country.
The pandemic has taught us who is best at delivering those services, and I still think that that is local providers, such as through our county councils. They know the families and the individuals on the ground, they know their needs and how best to support people, but they need the funding to properly do that. I know that will be difficult, given the economic shock we are dealing with, but we cannot raise this topic without dealing with the secondary issue of the professional workforce themselves.
If we go and talk to any carer, they will tell us that they are not given the high esteem or value that they should be. That is not good enough in the 21st century. Wages, status and training should be more comparable with those of nurses if we are to properly reform the care sector and look after the growing needs of our country. How else will we be able to recruit the estimated shortfall of 120,000 carers?
Hon. Members might think that is a pipe dream, but why should it be? Twenty years ago, nurses were not esteemed as they currently are, but now it is a degree-level qualification and they are paid far better. Why should not caring be esteemed in the same way? The professionalism and skills required to care for someone with dementia or deliver end-of-life palliative care include patience like no other.
The question of the social care workforce is crucial. Retention is an issue, because carers generally earn a lot less than nurses and other NHS staff. Given the duty of the ICS NHS body to find financial balance within the system, there is a concern that responsible social care employers who look after their staff and pay well will be less likely to be awarded contracts, and that there will be a race to the bottom when it comes to the pay and conditions of care workers. There is concern, too, about the influence that private companies will have on the ICS health and care partnership boards and that providers are being given the power to help to design the very services they want to deliver—representing the opportunity for direct conflicts of interest.
The Government produced their White Paper in the middle of a pandemic, when NHS and care workers are exhausted. They should call a halt to the proposals and carry out a full public consultation once, and only once, covid restrictions are lifted.
The key part of the solution is the social benefit, in that someone who is independently assessed as needing care can choose a service from a provider, or draw down the money personally and pay it to a friend or relative. That means that people can be cared for best by those who love them most. That is a great solution, and it is a solution for some of the capacity issues, too. It is simple, scalable and sustainable, and I heartily recommend it.
In my constituency, the need for proper funding of social care at this time of the crisis is felt acutely. Many constituents rely on extended care offered through charity and voluntary organisations. Organisations such as Neighbours in Poplar and food banks such as First Love Foundation are filling the gaps left by the fragmentation of the social care offer. That will be compounded by the closure of a number of day care centres, which are integral to the well-being of the communities they serve. The suggested care that would replace them would rely further on the voluntary sector, which is utterly inadequate.
The overhaul of social care is needed now. The pandemic has highlighted such issues, and it is important that the Minister addresses how they will be dealt with going forward.
Principle five is robust accountability. Although the Care Quality Commission has its role, I have to say that it seriously needs to beef up its whistleblowing processes; commissioners of care hide under layers of contract confidentiality. We need transparency. The sequencing of the Department’s White Papers has meant that the governance White Paper has been published before we know what the social care White Paper will say. Can the Minister give assurances that the social care White Paper will be published before the Health and Care Bill comes to the House?
Principle six is about staffing. Care professionals must be paid a professional wage, but 1.6 million of them earn less than the real living wage and a quarter of them are on zero-hours contracts. They need associated registration to keep them and the public safe. As for insecure jobs—every person needs to know that they will be loved, cared for and kept safe when they need care.
The pressures on the social care sector were well documented before the covid-19 pandemic, and the pandemic has only made them worse. These pressures are evident across the diversity of the sector: just 4% of local authority social care directors are confident that they have the budget to meet their statutory duties; an increasing number of contracts are being handed back to councils; there are autistic people and people with learning disabilities who are still incarcerated in hospitals because there is no funding for community provision; 1 million people are eligible for care but do not receive any at all; and there are many more people whose care package does not meet the full range of their needs.
Social care has been urgently in need of reform for a decade. There is not a route to social care reform that does not address pay for social care staff. It is a shocking and unacceptable reality that in many parts of the country it is possible to earn more in the local supermarket than it is in caring for the most vulnerable members of the community. That situation must change.
There has been no lack of detailed cross-party work on the options for social care reform. Select Committees, APPGs and independent commissions have all explored the options and brought forward proposals. The lack of delivery is the consequence of a lack of political will. That has to change. We owe it to the workforce, who have been through so much this past year, not to delay any longer.
It is time for urgent cross-party action. The letter from the Secretary of State for Health and Social Care to all MPs last March inviting suggestions for social care really does not cut it. Over the last year, the Liberal Democrats have twice formally requested that the Government initiate cross-party discussions. As the Health Foundation says:
“These problems are not intractable but solving them requires political will and government spending.”
Given the monumental challenge before us, when will Ministers make good on the Prime Minister’s promise to fix social care and invite others to the table to help develop those solutions?
Scotland faces exactly the same issues as the rest of the UK: an ageing population, a growing need for social care support, and the challenge of retaining and recruiting care staff, particularly with new visa requirements increasing the difficulty in recruiting from the EU. However, there are significant differences in both the provision and structure of health and social care in Scotland. After devolution more than two decades ago, the structures of the healthcare market, including hospital and primary care trusts and the purchaser/provider split, were reversed and the Scottish NHS returned to being a single public body with local services provided by geographical health boards. Since 2014, Scotland has been working on integrating the NHS with social care through the establishment of integrated joint boards. They manage half of the total Scottish healthcare budget for the provision of all community services.
Of course, covid highlighted how much further we have to go, as social care is a much more fragmented landscape. The pandemic, however, stimulated a lot of close working, including projects I was part of during the first wave. One involved colleagues from acute medicine, geriatrics and the local hospice holding online meetings with care home staff to discuss difficult cases and provide advice and training in symptom management and end of life care. The other was to try and identify unpaid carers, who often grow into the role so gradually that they do not recognise the part they play. The aim is to reach out to them when they attend their local community pharmacy and encourage them to make contact with our local carers’ hubs, where they can access support, benefit advice, PPE or even just have a chat. Due to their pivotal role, unpaid carers are now being invited to receive the vaccine.
Having been involved in redesign projects over many years as a breast cancer surgeon, it was fantastic to see the usual barriers to innovation simply collapse, and the relationships formed during the pandemic will definitely accelerate integration going forward. Due to its size and rural nature, Scotland already had significant digital health infrastructure, and video consultation systems, such as Near Me, were extended to all areas. Care homes were provided with devices and digital support to connect staff and residents to their families and, when needed, to the NHS. The Scottish Government underwrote sick pay to ensure that staff could isolate if necessary. As well as providing PPE to local social care providers, health boards offered access to NHS locum banks to reduce the need for agency staff and ensure safe workforce levels.
Scotland is unique among the four nations in having provided free personal care to those over 65 since 2002, with the provision increased in 2011 and the age threshold removed in April 2019 by Frank’s Law—named after the footballer Frank Kopel, who developed early onset dementia. Such provision encourages people to stay at home, which most of us would prefer. Two thirds of social care is provided in people’s own homes. That means there is a need for a strong home care sector as well as residential and nursing care homes.
It is important to remember that social care is delivered by people for people, so it is critical to recognise the importance of relationships and the need for continuity, dignity and respect. Social care staff also need respect for their skill and dedication, and for what they do for those we love. Part of that recognition should be paying care staff properly for a tough job that most of us could not do.
The Scottish Government have funded the real living wage for care staff since 2017. They fund overnight sleepovers at the full rate, and they provided a 3% pay rise last year. Social care staff in Scotland have also received the same £500 thank-you payment as their NHS colleagues this month. Unfortunately, the UK Government refuse to exempt it from tax or benefit deductions.
Care staff should not be described as unskilled workers, which we hear from the Home Office, just because they are paid too little. That fails to recognise the difference between wealth and worth. As many MPs have said this afternoon, caring needs to become a career and not be a low-paid stopgap before someone gets a better job on the checkout at Tesco’s. However, this is not just about basic pay rates; it is also about overall terms and conditions and the ability to take pride in one’s work through having an ongoing, satisfying relationship with the person receiving care, not just a rushed, 15-minute transaction.
Last autumn, the Scottish Government commissioned an independent review of adult care in Scotland. The Feeley report has now been published. It proposes the creation of a national care service, with national contracts, clinical standards, training and terms and conditions, to ensure greater equity and consistency across Scotland. It promotes a human-rights-based approach for the care recipient, with the principle of seeing social care as an investment rather than just a financial burden; it should allow everyone to participate fully in society. One recommendation is that all non-residential services should be provided free, in the same way as healthcare is.
We will be the next generation of care users, whether as a recipient of care or as an unpaid carer seeking respite for a loved one. We therefore have a vested interest in reform of the structure and provision of social care in all four nations of the UK and in how the people who deliver it are trained and have access to career development, but also how they are valued. To improve the quality of social care, we must invest in those who deliver that care. Caring needs to become a profession, and a profession that is respected.
Finally, the families who do the bulk of caring in this country get precious little help and support in return. Unpaid family carers have come to my constituency office absolutely broken by the pressure from the extra hours of caring that they have had to do. They tell me that they just have nothing more to give. We have to do more to support families in the longer term. I also think that the pandemic has entrenched the misperceptions about social care: that it is about only care homes, not care in people’s own homes, and that it is about only elderly people, not working-age adults with disabilities, who make up a third of the users and half the social care budget.
Of course, the immediate cause of those problems is the 10 years of cuts to local authority budgets. Local authorities have had £8 billion removed, which has meant fewer people getting help and not enough people getting the type and quality of help that they need. We know that there are longer-term problems, too. Social care was never included in the initial creation of our NHS and welfare state. Any politician who has tried to solve that problem has risked being obliterated by their political opponents. We saw that in 2010, with accusations of a Labour death tax, and we saw it with Theresa May’s Government and the accusations of a dementia tax. In the end, however, it is not politicians who suffer, but the users of social care and their families.
There is another issue that has not been touched on so far in the debate: one reason why this issue has not been grasped is that caring work is predominantly done by women and is not valued in the same way as medical care provided by the NHS. We desperately need a new settlement of investment, yes, but we also need one of reform, because putting more money into a system that is not working is not the right approach.
We need a system that works for older people and for disabled people. I want to pick up on a point that several hon. Members have made: ensuring that people do not have to sell their homes to pay for their care is an issue—an important one—but it is not the issue, because for working-age adults with disabilities, that is not the fundamental problem in the social care system. We need a system that works for both.
We need a real shift in the focus of services and support towards prevention and early intervention. I think we should have a “home first” principle and more options between care at home and care in a home. Other parts of the world have lots of different examples of housing and care being brought together, and that is what we need in this country.
We need a system that is fully joined up with, but not run by, the NHS. One thing that care users will say is that they have to tell their stories time and again to lots of different services. We cannot have that in future, because people do not see a health need over here and a care need over there; they have just one set of needs. We should design services around users, rather than getting them to fit into different parts of the system. We need to put the principle of choice and control at the heart of the system, enabling older and disabled people to live the lives that they choose, with a radically transformed, paid care workforce, and radically transformed support for families, too.
Secondly, investing in social care is essential if we want all families to be able to balance their work and caring responsibilities. In today’s world, with our ageing population, social care is as important a part of our economic infrastructure as the roads and the railways. When one in three unpaid family carers have to give up work or reduce their hours because they cannot get the support they need to help their loved ones, it is bad for them, because they lose their job and income; it is bad for business, because they lose their skills; and it is bad for the economy.
Finally, investing in social care is vital to make the best use of taxpayers’ money. We should not be paying more for elderly people to be stuck in hospital when they could be cared for in the community and at home. As we seek to get our public finances back on a more sustainable footing, value for taxpayers’ money is essential. This issue is the biggest challenge of our generation. I hope the Minister will tell us when the Government will introduce their reforms, because reforming social care is not just a matter of social justice, but an economic necessity.
I will set out some of the support we have given to social care and the social care workforce over the last year, because it really is quite different from anything that has been done by Government for social care before. I also want to pick up on several points that hon. Members made during the debate.
At the start of the pandemic, we identified carers, both paid and unpaid, as essential workers or key workers. That was in recognition of how crucial they are, but also so that they could access support, such as places at school for their children when schools were closed, or priority slots at supermarkets. We made it clear, in guidance and communications to care providers and local authorities, that care staff should receive full wages if required to self-isolate because of covid. That has been one of the uses allowed for the infection control fund, which to date has amounted to £1.4 billion in ring-fenced funding for social care.
To the point made by the hon. Member for Luton North (Sarah Owen), who spoke about care workers being told to work despite having symptoms, that absolutely should not have happened. I have heard of a small number of cases and have investigated, and work has been done to stop that happening. It has been made very clear to care providers that nobody should come into work with symptoms. The Government’s funding was provided specifically so that care workers would not have to worry about lost earnings in the event that they were either covid-positive themselves, or required to isolate as a contact. In addition to that, in January we provided a further £120 million to boost the social care workforce and help providers that faced staff shortages, particularly as a result of staff sickness and self-isolation.
During the pandemic we have also provided free PPE, which runs through to June. We have provided millions of tests to identify covid cases in social care, protecting staff and those who receive care. I was disappointed to hear the shadow Minister, the hon. Member for Leicester West (Liz Kendall), suggesting that there was some form of requisitioning of PPE from social care by the NHS. When I heard stories about that, they were investigated, and the investigations simply did not bear that suggestion out.
On vaccinations, as we started the herculean task of rolling out vaccinations across the country, we put care home residents and staff in the highest priority group. Thanks to the dedication and hard work of so many people, by the end of January we were able to offer vaccinations to all residents in over 10,000 care homes for older people. More than 90% of residents and over 70% of staff have now been vaccinated.
The hon. Member for Central Ayrshire (Dr Whitford) talked about how the pandemic had affected social care workers, including how some social care workers have been bereaved by the sad loss of those they cared for. She is absolutely right about that being a hard part of the experience of the care workforce. I have talked to many care workers over the last year and knowing that they have been facing that during the pandemic has been a real concern to me. I have spoken to employers about this, and many care providers have put in resources—access to counselling and mental health support, for instance—to support their staff to cope with what they have been going through. In government, we have worked alongside the NHS and brilliant organisations such as the Samaritans, Hospice UK, and Shout to provide a package of emotional, psychological and practical resources for the workforce, which includes support helplines and guidance and specific support for registered managers in care homes.
I want social care to have a stronger voice in our health and care system and more visible leadership. That is why, in December last year, we appointed Deborah Sturdy as the first chief nurse for social care. Deborah is providing that leadership. She is already a galvanising force, particularly in supporting infection prevention and control, which must continue, even with the high levels of vaccination that we have.
Hon. Members spoke about vacancies in the care sector and the problem of staff turnover. I am well aware of the challenges for social care employers and how some do struggle to recruit and retain the staff they need in both care homes and the domiciliary care sector. We are and have been supporting the sector with a national recruitment campaign across broadcast, digital and social media, highlighting the vital role that the social care workforce has played during the pandemic, along with the longer-term opportunities of working in care. We are working with the Department for Work and Pensions, and I am working with ministerial colleagues in that Department to promote adult social care careers to jobseekers. I am hearing directly from care providers that they are seeing people taking up those jobs in care and discovering the rewards of care work. However, I am clear that that alone is not the solution to the challenges of having the workforce we need in social care and that, as part of our reforms, we must also focus on what is needed to develop and support the social care workforce.
I turn to social care reform. The Government are absolutely committed to the reform of the adult social care system. As I have said, we will bring forward proposals this year. Despite the challenges of the pandemic, we have been gearing up for the reform so that, as we build back better, we have a system that is fairer and fitter for the future. I assure hon. Members that the work has already begun. In fact, our White Paper, published last month, sets out plans for a health and care Bill that will both further integrate health and social care services and improve the oversight of how social care is commissioned and delivered for people. The Bill will also allow us to get better data on what is going on at a local level so that we can follow the evidence about what works.
The enhanced assurance framework set out in the White Paper will introduce an independent voice through the CQC, with clear and consistent oversight of adult social care, supporting local authorities to improve the outcomes and experience of people and their families in accessing high-quality care and support. That is only the beginning. For the long term, we want a sustainable adult social care system that meets people’s needs and aspirations and gives them the care and support that they need to live life to the full. We want to empower recipients of care and support people to live independently in their own homes and communities for as long as possible. We also want to improve the information provided to the public about the social care system, enabling people to plan for their care and make more informed choices. A stable and well-qualified workforce is central to our ambitions for social care.
Resolved,
That this House has considered social reform and the social care workforce.