Social Care Reform

Question

15:01:00

Asked by

To ask His Majesty’s Government what plans they have to reform social care.

My Lords, adult social care reform is critical to achieving this Government’s aim that everyone lives well for longer. Our vision is to create a national care service underpinned by national standards and delivered locally, supporting people to live independently for as long as possible. We will also establish the first-ever fair pay agreement for care professionals. We will engage widely with the sector and people with lived experience to inform these plans.

My Lords, I welcome the proposals to improve pay and conditions for those working in the adult care sector that the noble Baroness just announced. But is she aware of the widespread dismay at the cancellation of the proposals for reform, due to come in next year, without anything being put in their place, particularly against the background of what Wes Streeting said during the campaign: “We don’t have any plans to change that situation and that’s the certainty and stability I want to give the system at this stage”? The former Health Minister, Lord Warner, said that the Government’s announcement was “misguided”. He went on to say, on the plans for reform: “A Royal Commission and a vague aspiration for a National Care Service is … kicking the can along the road”. So should the Government not adopt the proposals put forward unanimously by two Lords Select Committees, chaired by the noble Baroness, Lady Andrews, and the noble Lord, Lord Forsyth, and make progress straightaway?

I understand that, whenever there is a change in direction, there is concern. I take the noble Lord’s point. The inherited commitment to implement the adult social care charging reforms, which would have been on course for next month, was undeliverable because the previous Government did not guarantee the money to do that. It would have cost nearly £1 billion next year, rising to £4 billion by the end of the decade. There were many false dawns in respect of this long—and repeatedly—promised change. It is also the case that there was not adequate preparation to implement the charging reforms. Councils warned that they were impossible to deliver in full in the previously announced timeframe. With all that in mind, I am sorry to say that we, as the new Government, had little alternative but to say that these were not funded or on course to be delivered. We will have to ensure that we offer a national care service, along with a new deal for care workers. We will continue to consult and listen to those with lived experience in order to get it right.

My Lords, the noble Lord was kind enough to reference the Select Committee report. I think he would agree with me that the value of that report was that we were able to reveal the extraordinary voices of those with lived experience and the many unpaid carers who live such very hard but dignified lives. I have great confidence from what the Minister has just said that the Government will listen to those voices, because they know that there is no quick fix. This is a hugely complex problem, and the fair pay agreement is a very important first step. I have great ambitions, as we set out in that report, for a coherent and systemic change in the aspirations that we hold for social care, as well as the practical delivery. I hope the Minister shares those.

My noble friend is absolutely right that there is no quick fix, and I think that is understood. The national care service, for example, is a 10-year vision, which will mean long-term reform of the sector, underpinned by national standards, making sure that locally delivered care will be of a high quality and consistent across the country. That is what people will want. As my noble friend said, we will continue to consult those with lived experience as well as engaging with workers, trade unions and the sector to make sure that we offer a new deal for care workers.

I congratulate the Government on the long-term care planning that they have, and the vision. As a long-term sufferer of cancer and therefore a consumer of both health and social care services over a period of time, I encourage the Minister to take a shorter-term view. Many of us do not have that long to wait for the 10-year plans and thereafter. Something needs to happen quickly, not only to reform social care but to have that integration of health and social care, because most of us with complex needs need them to work together and be on one spectrum.

I very much take on board what the noble Baroness has said, and I understand that for many, including her, time is of the essence. I have described the long-term plan but there will be endeavours to improve things in the shorter term; for example, trialling neighbourhood health centres, which will bring together a number of services under one roof to ensure that health and social care are provided close to home, so that people can access the care that they need. We will also develop local partnerships between the NHS and social care so that we can get people home from hospital rather sooner than they have been of late—and, indeed, when they are ready. But it is about patient-centred care, which will always be at the heart of what we do.

My Lords, I welcome the Minister to her post. Does she recognise that one principal reason why fundamental issues around adult social care have not been addressed in the past 25 years is not only the complexity and cost—it is because adult social care is largely invisible and lacks political priority? Do the Government intend to address this?

I thank the right reverend Prelate for his kind words of welcome. I take the point about invisibility in this area, but it would be fair to say that this Government will want to make this extremely visible. It is an issue that will not go away, and also one that is absolutely crucial, not just for those who rely on social care but for the good functioning and provision of the National Health Service. The two are inextricably linked, and we cannot sort out one without the other.

Since 2015, the number of working-age adults requesting care has increased significantly faster than those aged 65, and very few of them are self-funders, so while I welcome the Government’s commitment to establish a fair pay agreement for the workforce, it will work only if it is matched by commensurate local government funding increases; otherwise, it will just squeeze already overstretched care provider and local council budgets. What plans do the Government have to ensure that local authorities have sufficient funding to meet this commitment?

The noble Baroness raises an important point about actually making it work, but certainly the fair pay agreement is crucial to professionalising the care service and, indeed, raising the visibility of and regard for those who work in this sector, which is nearly 1.6 million people. We will be working closely, as I mentioned, with trade unions, local authorities, the sector and all those with an interest to make sure that the first ever fair pay agreement for care professionals can work and will deliver what we want, which is a stable, well-regarded and well-trained workforce.

My Lords, during the passage of the Health and Care Act, the previous Government came up with a compromise solution to fund healthcare for an ageing population. It was by no means perfect but it made a start, while addressing the concerns of the Treasury. The new Government have scrapped this scheme but have not yet proposed an alternative. A report from the Health Foundation claimed that Labour’s plans for social care are the most general, with a headline commitment to create a national care service but no detail about timescales or resources. Can the Minister give us any indications on the timeframe, such as “the end of 2024”—preferably a date, rather than “in due course” or “in the fullness of time”?

I welcome the advice from the noble Lord and I will resist using those terms, which I am sure he will appreciate. However, as noble Lords have already understood, this is not going to be done overnight; we are talking about a 10-year vision but we will be talking about steps along the way. I think it is very important that we make progress on the national care service in the short term, because we have to build the foundations, by working with the sector and those with lived experience, to develop those new national standards. It will be work in progress and I hope that noble Lords will be patient but also press me about what progress we are making.