Social Care Reform

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.

I beg to move,

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.

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.