rose to call attention to issues relating to the social care workforce; and to move for Papers.
The noble Earl said: My Lords, it was an unexpected pleasure to see that the noble Lord, Lord Hunt of Kings Heath, would be replying to the debate on behalf of the Government. It is a pleasure to see him back in his old portfolio.
I tabled this debate on the social care workforce because of the important White Paper, Options for Excellence, published in October last year, which dealt with a strategy for the social care workforce. To my mind, that paper has the potential to make the greatest improvement in safeguards for children and vulnerable adults of any document that I have seen in your Lordships’ House over the past 10 years.
I hope that noble Lords will think that this is a timely debate, given that only on Monday a report was produced into the mistreatment of disabled people in a care home. The report emphasised that an important part of the problem was the inexperience, and the lack of training and support of the staff in that home.
This is also an important debate if we are to ensure that taxpayers’ money is spent effectively in this area. Now that we have a strategy rather than a piecemeal approach to improving the workforce, we can be far more confident that the outcomes we pursue will have a result. The Government have invested hugely in this area, tripling the amount spent on training the social care workforce. In recent meetings, the Minister of State for Children, Young People and Families, the right honourable Beverley Hughes—and, in a separate meeting, the right honourable Hilary Armstrong, the Minister with responsibility for social exclusion—highlighted the increase from £1.3 billion to £1.9 billion in the amount spent on the 60,000 children looked after in public care. Yet although there have been improvements, the improvements do not reflect the increased investment. Taxpayers must see a result for their money. If we are to achieve that difference, we need a more professional workforce.
Hilary Armstrong visited Denmark and Germany to look at the model of social pedagogy which is employed there in early-years care and residential care. She said the quality of care was better. In fact, 94 per cent of staff in children’s homes in Denmark are graduates. Far superior, they are paid a similar amount. As the ratio of staff to children in those countries is half that in the United Kingdom, it is cheaper to have better and more professional staff working in those settings.
Another motive for tabling this debate is that although much good-quality care is provided in foster care and in residential care for children, and many children speak positively of their experience of foster carers and of children’s homes, the turnover rate of staff in children’s homes is 27 per cent. I saw a 12 year-old girl in a children’s home over three days, on each of which she had a different agency staff member caring for her. That can only exacerbate her previous experience of broken relationships. I have also spoken to two managers of children’s homes. They told me that the difficulties which some of their staff have with reading and writing present serious problems to their endeavours.
I spoke to a member of staff working with 16 to 23 year-olds about one of the two tables in the dining room. It wobbled so severely that the young people were unable to eat off it. I came back three months later and the table was still there. Nothing had been done. When I raised the matter with her, she was somewhat upset to be challenged on it. It was not so much to do with her as with how overwhelmed the front-line staff who are working with these vulnerable young people are.
In 2005, 10 per cent of children leaving care had more than nine placements. The Commission for Social Care Inspection identified that 40 per cent of children in care are placed in inappropriate placements because there are not enough foster carers. In the Associate Parliamentary Group for Children and Young People in Care, I repeatedly hear of the turnover of social workers. In a recent meeting, one young man said, “I have had five different social workers in one and a half years”. Staff tell me that in looking after children in respite care and taking them into adulthood, they want to get the right services for the child but the turnover of social workers frustrates the transition process. I have spoken to colleagues about care for the elderly and it is apparent that there are many similar considerations. For instance, at a recent meeting with the Commission for Social Care Inspection, a user—an elderly woman—talked about her five or six different carers in two weeks. She described people she knew who had more than four carers in one day and highlighted the indignity of having a different person change one’s knickers every day. Such “personal care” and staff turnover are unacceptable.
Options for Excellence highlights the difference that social care makes to the 2 million adults and children whom social care workers provide for. Let us consider, for example, the number of adults and children in custody in this country. It is significantly higher than the numbers in our continental neighbours. There is currently a surge in the number of children being taken into custody. Professor Rod Morgan, the chair of the Youth Justice Board, recently told a meeting that because of the poor quality of staff development in some children’s homes, staff were not adequately managing behaviour, calling in the police, and children were ending up in custody. That is just one small example of how much it costs us not to invest in social care.
The Government have established a number of important institutions: the Commission for Social Care Inspection; the Social Care Institute for Excellence; the General Social Care Council, to register social workers as professionals; the Children’s Workforce Development Council; and Skills for Care. The Green Paper Care Matters appeared at the same time as Options for Excellence and seeks to transform the experience of children in care. I cannot express how laudable I think that work is. The ambition to introduce a pedagogical framework for foster carers and residential childcare workers and a tier of salaried foster carers at the upper level to generate a career progression attracting more foster carers is exactly right and much to be praised.
Options for Excellence speaks of a vision for the social care workforce: a professional workforce who are seen by the public as a positive element. Several means of achieving such a workforce are described, but chief among them is the need to develop learning organisations. I am glad that the report emphasises the importance of good-quality supervision, not only in looking at performance but in helping carers to manage the relationships and emotional baggage that come with this work. The paper talks about continual professional development, giving newly qualified practitioners the additional support they need and ensuring that new line managers get the support they need to settle into their posts. It looks at recruitment and retention issues, and I welcome the innovation of a degree for social work. That is now attracting more young people into social work.
Before we start trying to change the system, however, we must ask ourselves why we are here. Why have we performed so badly compared with our peers on the continent? It is due to some extent to our philosophical outlook. In a BBC interview in the 1970s, AJ Ayer, the late professor of logic at the University of Oxford and a leader of the logical positivists, said that, in the view of the logical positivists, any statement that was not a formal statement or empirically testable was nonsensical. He went on to say that,
“this tradition is so strong [because] it fitted into the English tradition, right back to the Middle Ages … This hard-headedness, this empiricism, goes right through English philosophy—through Occam, Hobbes, Locke, even Berkeley in his strange way, Hume, Mill, Russell. Whereas it was all consciously hostile to the German tradition of romantic metaphysics”.
I took a short course on philosophy and politics at the London School of Economics some years ago and our teacher had the same low view of continental philosophy. He said that this was universal across the English-speaking world. One can look at our education system for a manifestation of that. Sir Michael Tomlinson, a former Chief Inspector of Schools, recently said that we have the most assessed children in the world. Of course that has immense benefits, but there are dire consequences when it gets out of balance.
This distaste for that point of view makes us less able to recognise the importance of emotions, imagination, empathy and relationships. The area of the subjective is difficult for us to negotiate. That point lies behind some of the difficulties that we have had in our struggles, even in the past 10 years, to improve matters. Its significance is clear in the history of social care, of which I shall try to give a brief sketch. In children’s homes, social work and care for the elderly, it is important that staff have suffered from poor development. They have often been unsupported in their work, and the result has been failure after failure. I think particularly of the way in which Victoria Climbié was let down. The social worker in her case had a caseload of 19, I think, and the maximum was 14. She was not getting the supervision she needed. One of her colleagues said that they were just doing conveyor-belt-care social work. There was no attention to detail.
Each time these disasters happen, a heavier burden of procedure is introduced and the balance is lost. I spoke to the head of High Close School, an excellent school run by Barnardo’s for children with emotional behavioural difficulties. He gave one of his children a hug while we were speaking. He told me that he could do that because he has worked in that area for so long that he has the confidence to do it. But many staff would not have that confidence, not just because of the history of abuse, but because guidance and procedures militate so much against such relationships.
I shall turn to a few of my concerns about the White Paper. It refers to managing caseloads and workload management. It seems to imply that by reorganising and rebalancing the work within the authority, local authorities will manage to give manageable caseloads to those working at the front line. That is not my understanding. I spoke to a deputy director of children’s services who said that her local authority can afford a maximum caseload of only 14 for child and family social workers. Kensington and Chelsea can afford a maximum caseload of six. Do the Government recognise the need to better resource the most hard-pressed local authorities?
With more young graduates coming into social work, it is vital that they have the support they require. The paper moots a new status of newly qualified social worker, which would mean reduced caseloads and increased supervision for those entering. Ian Johnston, the director of the British Association of Social Workers, says that it would be criminal not to introduce such an arrangement. I say with regret that I too think it would be a betrayal of the incomers if the Government did not move as fast as they could to introduce this new status and to give them the support they need. Failure to do so would be bad for social workers and bad for users. If newly qualified workers made a mistake because of lack of support, it would set us all back again.
Finally, if there is another tragedy—and I am afraid that there may be because of the current state of affairs—I hope that the Government will not make a revolution but redouble their efforts to see through the important strategy they have introduced. I beg to move for Papers.
My Lords, I thank the noble Earl for securing this timely debate and look forward very much to hearing contributions from the knowledgeable and committed colleagues who have elected to speak. I must declare three major interests: I am a social worker and proud to call myself so—and in my time I have carried a caseload of 120; I was the first chair of the General Social Care Council and chaired the advisory group that led to its establishment; and I am the chair of CAFCASS, the biggest single employer of social workers in the country. Today, I particularly want to relate the experience of the CAFCASS workforce to the major challenges that we find in the social care workforce as a whole.
First, I want to acknowledge, as the noble Earl has done, what progress has been made in social care. The setting-up of the General Social Care Council, after 20 and more years of waiting, was a wonderful step forward. The council has further increased the professionalism of the social care workforce and the quality of social care services, keeping service users at their heart. It has also ensured public accountability for high standards of professional practice by a trained and trusted workforce. It has done a marvellous job in registering social workers and is anxious to go on now to register the rest of the social care workforce. I know that resources for this are not yet available and are being considered as part of the Comprehensive Spending Review. I seek an assurance from the Minister that the Government are considering this need urgently.
The Commission for Social Care Inspection, the Every Child Matters agenda and the legislation connected with it, and the whole drive to reform public services have brought about a change in the view and status of social care which, frankly, when I was a young social worker or even 10 years ago, could never have been envisaged. Of course, there is a long way to go still, and we shall be focusing in this debate on some of the changes necessary, but let no one doubt that the recognition of the importance of social care, the ambitions for it and its significance in the policy agenda have never been higher. For this, we should be grateful to the Government and even more grateful to the many thousands of people who work in social care for their commitment and dedication to jobs which are difficult and demanding and for which rewards, both financial and emotional, are in short supply.
CAFCASS is, as I said, the biggest single employer of social workers in the country and carries out a complex function that requires experience, knowledge and good practice informed by evidence. Our vision is to deliver a world-class service to children and families in the court setting; that means our staff must be able to receive good-quality training, to access information and knowledge easily and each to have an individual programme of development to help them work to the highest possible standards. All staff in the social care workforce require that support, not just front-line staff.
For CAFCASS, that means our business support staff must similarly be able to support the functions of the organisation effectively and efficiently. I submit that this applies across the social care workforce and that it is essential to ensure all staff are trained and supported; otherwise, our users are not assured of high-quality services at all times. We have to remember that those we engage with are probably contacting us at the most difficult times in their lives, and therefore all staff must deliver to high standards. This places heavy responsibilities on those who manage and—although I know this is not always a popular thing to say—we should value good management skills as highly as we value the skills of engaging with our customers. Good, supportive management is what enables our workers to be effective, as well as to withstand the huge emotional pressures to which they are subject.
However, managers always have to help social care workers grapple with the endless problem of insufficient resources. This is not an arena in which to call for extra resources for CAFCASS—my colleagues and I do that all the time elsewhere—although if the Minister would like to promise me some, I will gladly accept them. The instinct of most social care workers is to provide the best possible service to every individual client, yet knowing always of the numbers of other clients waiting for a service that, by necessity, has to be rationed in some way. This is not a new dilemma for the social care workforce, but we must always be mindful of the extra pressure that the necessity of balancing budgets puts on that workforce and the role of the manager in trying to cope with the inevitable dilemmas that it poses.
A further problem faced by CAFCASS, and reflected elsewhere, is the make-up of the workforce itself. For us, the issue is of an ageing workforce; 60 per cent of our employees are over 50, and replenishing staff at the point of retirement is therefore a key concern. For some employers, the major issue is not about an older workforce but about one that lacks experience, or is largely recruited from other countries, or which is not sufficiently diverse. The dilemmas faced are different but no less serious and, of course, we all compete for good staff. We fish in the same pool, so to speak. This problem used to be largely confined to London and the south, but it is spreading. The high turnover in local authorities impacts on our work, competing as we are with them for staff, and our workers often find themselves doing work that should have been carried out by the local authority but has not been completed.
I know that the initiative chaired by my noble friend Lady Morris with the Children’s Workforce Development Council is looking at some of the issues and I stress the urgency of doing so. I would also like to hear from the Minister what plans are being made for the future work and status of the CWDC. It is, of course, concentrating on early years work but there will be major lessons learnt for the whole social care workforce. While government recruitment campaigns for teachers and nurses have been successful, I understand that similar success has not been delivered for social care. Perhaps the Minister will update the House about what plans the Government have to remedy this and whether they plan a national review of social work salaries.
I want to say a quick work about training and development. When financial times are hard, this is always the budget that takes the hit, and CAFCASS is no exception. Standstill budgets have not enabled us to expand our training and development as we would have wished, although I heartily commend my colleagues for the progress they have made with the development of a knowledge, learning and development strategy and the rollout of a post-qualification framework. As we cannot go on putting more and more pressures on workers without paying and supporting them properly, so we cannot go on expecting them to deal with more and more complex cases without adequate training and opportunities for obtaining further qualification. I hope the Minister will be able to assure us that the Government will address this issue. We would not countenance a worker in the NHS administering a procedure to a patient in which they had no adequate training, yet in social care we enable sometimes inadequately trained workers to operate above their competence level in situations which are no less life threatening to the client.
My Lords, I congratulate the noble Earl, Lord Listowel, on introducing the debate. As always, he has displayed his great commitment to the cause of young people and children, as has the noble Baroness, Lady Pitkeathley, from whose broad experience of these issues the whole House has benefited. I intend to concentrate on services for the elderly.
The purpose of the noble Earl’s debate is to question whether appropriate priority is given to investment in the social care workforce—in other words, is the cash allocated enough to meet the Government’s desired outcomes? Like the noble Earl and the noble Baroness, I pay tribute to the Government’s efforts in defining their desired outcomes. Both the noble Earl and the noble Baroness have mentioned Options for Excellence. There is also its companion document on implementation, Our Health, Our Care, Our Say, and the recent Green Paper on transforming the care system for looked after children, Care Matters. To these we should add the very considerable body of change and work engendered by Every Child Matters and what followed. So there has been no shortage of policy initiatives and frameworks, which are obviously important.
Nor, though, is there a shortage of urgency in the need for action. The Local Government Association paper, Without a care?, published last December, with which the Minister will certainly be familiar, makes clear the concern of local authorities—that is, those that have to deliver the services—about these issues. The paper points to the rising number of people aged 65 and over and aged 85 and over that we can expect in the next decade. It states that it is not simply the increasing number of people that pose a significant challenge but the increasing number of people with complex needs, with rising levels of learning and physical disability and dementia in the older population. These demographic points obviously cannot be denied, hence the timeliness of today’s debate. But the Local Government Association’s paper also points out a disparity between the increase in the government grant for social care services—14 per cent since 1997-98—and spending, which has increased by 65 per cent. So the question is: who is taking the strain?
I declare an interest in that I am patron of two carers’ organisations in the county of Norfolk. In the past I have been a chairman of social services and also the chairman of two health authorities. So I have been in and around the interface of health and social services for a very long time. I absolutely accept the difficulty of the dilemmas, which remain the same, but I also accept—I hope the Minister does too—the significant increase in the challenges.
A very apposite assessment of how matters stand in social care has been given by the chairman of the Commission for Social Care Inspection, Dame Denise Platt. The Minister will be very aware of the contents of her second report, which I believe was published last week. The report paints what I can only describe as a discouraging picture of how present government policy is affecting individuals and their families, and more worryingly, of how the situation is likely to worsen in the future. The position, put simply, is that more and more old and disabled people are relying on care from family and friends. To answer the question I posed earlier about who is taking the strain, in many cases it is carers. Without the support of carers and without finance, such individuals have to carry on until crisis point, when the local council steps in and does what it can. As Dame Denise has said, there needs to be a real debate about how people can prepare for that kind of crisis in their lives, which they may well experience. She added,
“what we comment on in the report is … a change in the balance of responsibility between individuals and the state by default, without the infrastructure in place to help people who are trying to find their own care, and without adequate support for the friends and relatives who are filling in the gaps”.
I stress that I feel that the Government’s intentions are admirable. The White Paper, Our Health, Our Care, Our Say, sets out the Government’s vision for high-quality support. One point made is that there needs to be a fundamental change in the provision of services and the workforce that delivers them to ensure that the vision can become a reality in the future. It suggests that that change is better integration of those working in the NHS and those working in social care. I would not mind a pound for the number of times I have heard that, not least when I was trying to achieve change in those very areas. It is extraordinarily difficult. I have had long and sometimes bitter experience of its difficulty, involving, as it does, the marriage of organisations with different management structures and different accountabilities.
I make a slightly critical point to the Minister. Is such integration being made easier or more difficult at ground level for those in receipt of social care and those trying to organise its provision by the programme of closures and cuts presently affecting the NHS? It truly is not understood by people at a local level how the Government have made—as they have—really substantial increases in health spending when the local media is dominated by reports, as in Norfolk, of the possible closure of all nine of the county's community hospitals. They ask—they are right to do so—how care in the community can become a reality if community beds are to be axed. They ask whether Ministers and those who plan such things really believe that it is an inviting prospect for a vulnerable person, being discharged from hospital after surgery, say, to have to miss out the half-way house of community beds. Dame Denise Platt said:
“For people who meet the eligibility criteria and who are receiving services, many are only allocated a 15-minute ‘slot’, with a high turnover of care workers”.
That is not an inviting prospect.
However, the Government’s intentions in this policy area are admirable. They have shown remarkable energy. There have been real increases in spending on health. But the question posed by the debate is whether appropriate priority is being given to investment in the social care workforce. At this stage, that has to receive a very qualified answer, “Perhaps not”. As Dame Denise said:
“The ‘State of Social Care’ report shows the gap between what social services are saying and what the government wants to do, and what is actually happening in people's experience”.
My Lords, I, too, thank the noble Earl, Lord Listowel, for introducing this debate in a most interesting way. I do not intend to take him on philosophically, but I think he hit on something rather important. He talked about social care in Europe, but he did not mention that in mainland Europe a great deal of social care is provided by charitable, religious or sometimes trade union organisations. It is largely informal and it is subsidised. He mentioned Denmark, which is noted for the high quality of its social care services, but it has a very high tax base and a very high level of public expenditure. That is why I think he is absolutely right to set this debate now. The central question that we and the Government have to answer is: what kind of social care system do we want and how are we going to pay for it? Noble Lords this morning have talked about the raft of policy documents, including Options for Excellence, which set out a vision for social services that is on a par with Denmark. However, what was missing was the realisation that to achieve that there must be resourcing and the question is: where are those resources going to come from?
A central issue to the debate is that over the past few years the nature of social work and social care has changed. Years ago social care was a largely unregulated area of work and it relied on low-skilled and low-paid local workforces. During the past decade, it has become increasingly regulated and reliant on staff who are highly skilled. The problem for local authorities is that, unlike in the health service where there was the Agenda for Change analysis—a huge programme that looked at the skill sets needed to deliver care and an equation of that with remuneration—there has until the publication of Options for Excellence been no similar systematic analysis of what is needed in social care.
The fact that there is a need for greater skills is not in dispute. People are living longer with rising levels of physical disability and a growing incidence of dementia. People with disabilities are surviving into adulthood and they are expecting the intensive care packages which they had as children to continue throughout their lives. For several years, extensive, well researched reports from everybody from the Social Policy Ageing Information Network through to Sir Derek Wanless, who did an exercise for the Treasury, have set out quite clearly that social care is running anywhere between £1 billion and £2 billion in deficit. That is the point from which we start.
Local authorities can do one of two things. First, they can reduce the scale of the services they provide. The CSCI report published last week, very good though it was, was absolutely no surprise. It is no surprise to anybody who works in social care that only critical and substantial needs are being met. Indeed, many local authorities are only funding critical needs, nothing more. The CSCI report was right that unless local authorities have an injection of resources, they cannot do more. However, that does not match public expectations because we know from many research studies that only 10 per cent of the general public expect to fully fund their future care costs.
The other thing local authorities can do is cut costs, and in social care 80 per cent of costs are staffing costs. They can cut salaries, staff numbers and training budgets. The social care sector is already very diverse. Two thirds of social care staff do not work for local authorities; they work in the independent and voluntary sectors. Increasingly, services are being put out to contract through very commercial tendering processes. It is not unusual now for voluntary or private organisations not to meet social care commissioners. They meet procurement officers and procurement officers are only interested in one thing: that is, the cost.
It is also not unusual among private care providers to find practices such as staff having to pay for their own training, with the time that they take for training coming out of their annual leave. Such reductions in overhead costs enable those providers to win the contracts in the first place.
There is a hidden cost to all that, which the noble Baroness, Lady Pitkeathley, mentioned indirectly. The more that services are awarded under contract competitively, the more that you lose the public service ethos and the continuity of staff with clients that is part of the great value of our social care system. A huge loss of expertise and experience comes about through the churn of social care staff.
One policy initiative that has an effect on this is the expansion of direct payments and individual budgets. It is agreed that recipients of social care services should exercise greater choice and be able to commission services much more flexibly. That is to be welcomed. However, less widely recognised is the potential in the expansion of direct payments and individual budgets for the emergence of a second-tier workforce in social care. If people choose to rely on informal, unregulated family carers for whom they have been given a budget, those with the most severe needs may have an opportunity to see highly skilled, regulated social care staff, but the vast majority of people with low-level needs who want small interventions will be going back to a social care workforce much more reminiscent of that in years gone by.
The noble Earl, Lord Listowel, is right in this debate to ask the Government what sort of social care workforce we need to meet their policy aspirations. If we are to have one that fits the aspirations in all the policy documents that we have seen, we will need to see a vast injection of resources in CSR07.
My Lords, I, too, am grateful to the noble Earl for giving us the opportunity today to affirm the work of social carers and the need to provide them with better support as they serve many of the most vulnerable in our society.
I believe that there is still a temptation to regard the vulnerable elderly in particular as out of sight and out of mind. Although no one would acknowledge this, the attitude is there fairly deeply in some parts of our culture. It cuts across the Christian view that all human beings are made in the image of God and are always precious to God. It also cuts across the aims and thinking of a humane society, which I hope and believe have moved beyond the logical positivism of which the noble Earl spoke. The Church of England has sought to address this in attempting to put its own house in order in its recent publication, Promoting a Safe Church.
We hear much in these discussions, as noble Lords have said, of efficiency drives and the need to get the best value from our care force, but what would most help in achieving that is a change of culture and thinking. If we valued our elderly citizens and those, for example, with learning disabilities better, we would be prepared to pay those who care for them better. I believe that that would do much to ease the problem of carers who quickly move to other jobs and that it would give an incentive for an improved framework for training and long-term development of individuals. The Wanless report 2006 calls for a tripling of spending on older people’s care, a modest shift of 1 per cent of GNP that would transform the situation, but our culture of suspicion is such that we lack the political will, and I think the cultural will, actually to do that.
I, too, salute the work done by the voluntary sector, paid and unpaid, in providing support and in its employment of social carers. I do so particularly from the point of view of small local voluntary organisations, and of the work they contribute to overall social care. Think, for example, of the preventative work done in Leeds by a body such as Moor Allerton Elderly Care, which works to provide the support that helps to prevent older people from becoming depressed and helpless and looking to the statutory services for help. The noble Baroness, Lady Barker, has already spoken of the way in which local authorities are only able to provide crisis support. There is therefore an increased importance in those who can and will provide preventative services.
At the other end of the scale, I think of Caring For Life, a small local Christian charity in Leeds that provides lifelong help for the vulnerable homeless, many of them with substantial emotional needs. The voluntary sector, however, particularly the local voluntary sector, cannot replace the statutory, and it is often not well supported by local authorities. I continue to regret that there is still some suspicion of faith-based voluntary organisations, another contrast with so much of the European scene.
The frustration of this situation is that there is so much good will and expertise. The aspirations of Options for Excellence demonstrate the good will. The commitment of individuals, of which there are many stories, and the acknowledgement of the care provided in many cases in both the statutory and voluntary sectors speak to those qualities. But we have not yet found the best way to harness all that good will, skill and commitment. It is only with a change of culture—and therefore, yes, of financial priorities—that that good will and skill will become a reality for some of the most vulnerable within our society.
My Lords, I, too, thank the noble Earl, Lord Listowel, for securing this important and timely debate. I shall contribute by focusing on the kind of workforce we need to ensure that children and young people get the quality of service they both need and deserve. The recruitment, retention and motivation of skilled staff is key to the provision of quality services for children and young people. Health and social service care work is labour intensive, and staffing costs invariably make up about two-thirds of the total spending, so it is vitally important get it right.
There are around 110,000 people employed in health and social care services in Northern Ireland, equivalent to around 6.4 per cent of the population, compared with 5 per cent in the United Kingdom as a whole. Yet recent reviews have indicated that there is still a deficit in the overall numbers of health and social care staff needed, and that we must look at pay and terms and conditions for recruiting more staff.
As Members of this House are aware, I am a council member of Barnardo’s here in the United Kingdom and a chair of Barnardo’s in Northern Ireland. I have seen at first hand both the children and young people who need our help and the staff who provide it. I take this opportunity to say how impressed I am by the dedication and commitment of the majority of staff who provide those services. These are qualified social work staff, dedicated to improving the lives of children, young people and their families. However, they are also a professional body of staff and it is crucial that in considering how we move forward in investing in a social care workforce, staff who work in this area of the voluntary and community sector are not forgotten.
When Government in Northern Ireland introduced new pay and grading arrangements for social work staff, trusts did not calculate for those staff who worked in the voluntary sector setting. These staff often worked for organisations such as Barnardo’s which contract with trusts to provide statutory child protection duties. The new pay and grading arrangements significantly increased salary costs and thus the overall costs of providing the service. It also meant that if Barnardo’s could not match the new level of pay, it would struggle to recruit and retain social work staff.
Barnardo’s and other voluntary sector organisations raised this issue with Government. Their response was that the purpose of the arrangements was to improve the retention of social work staff in the public sector. Government must realise that the voluntary and public sector recruit from the same pool of staff and often do the same kind of work. They also fail to understand that contracting with the voluntary sector requires that such staff have to be regulated, qualified practitioners. To retain current staff and to continue to compete in the recruitment market, Barnardo’s had to provide an exceptional additional allowance, which put an additional strain on the charity’s resources.
If the current Government’s commissioning policy, with its focus on engaging with the private and voluntary sectors and enabling them to provide services, is to succeed, it must create an equal playing field. In essence, this means that if the voluntary sector is to deliver effective, innovative and economical services, it must be funded equally and given sensible contracts.
Too often, voluntary organisations are given 12-month contracts, with renewal often not assured until a few days before expiry. Nothing could be more designed to thwart the success of the voluntary sector or to cause us to lose dedicated and effective staff. For Barnardo’s as a whole this new year, some staff will again not know whether they will have jobs in April because the organisation does not yet know whether the contracts will be renewed. That also means that there are parents and children who do not know whether the vital services they require will continue. This is unacceptable. Public authorities would not treat their own staff like this, and it is unacceptable that they should treat those who work for charities in this way.
The voluntary sector provides high-quality and often innovative public services. Those services often grow from a local base and are trusted. For those reasons, they must be given a chance to deliver. Commissioners need a choice in spending public money as one aspect of getting the services right. But to allow this to happen, the voluntary sector must be treated on an equal footing with the public sector in terms of cost, contracting and a transparent tendering process. Then perhaps children and young people will get the kind of service they deserve.
Over the past number of years, Government have gone a long way towards ensuring that the service must meet regulatory requirements and that it is as safe and of as high a standard as possible. I am sure that we all agree with that. The social care environment should have an increased focus on standards and regulatory requirements. However, we will undersell this if we do not invest in social care staff in a way that enables them to deliver those standards.
Government have clearly signalled the need for a social care workforce that is founded on high quality and regular supervision, where there is increased multi-disciplinary working and the salary levels and opportunity for training will attract highly skilled people. This will not happen without additional investment across all sectors involved in delivering social care services. Without this investment, the services will not be of the quality and kind that children and young people who are vulnerable and in difficulty need. That is why it is crucial that Government prioritise investment in the social care workforce as part of the Comprehensive Spending Review and why, in doing so, they must ensure that the voluntary sector is fully included.
My Lords, I echo the words of other noble Lords in congratulating the noble Earl, Lord Listowel, on securing this debate today. Social care and the importance of social work have begun to be something of a leitmotif in the debates of this House during this Session. The noble and learned Baroness, Lady Butler-Sloss, and the noble Earl himself both made powerful speeches in the debate on the Queen's Speech. Then we had a debate on adult social care introduced by the noble Lord, Lord Bruce-Lockhart, on 7 December and now we have the debate today. I hope that we will continue to have such debates until we as a society have decisively reversed the neglect over decades of social work and the social care workforce to which all noble Lords who have spoken in these debates have attested.
What has emerged from these debates is the low esteem into which the social work profession and the social care workforce have been allowed to fall, with poor reward and consequent demotivation and the attendant ills of rapid turnover, high vacancy rates, low skill levels and backbreaking case loads all reinforcing one another in a vicious downward spiral. The Government have done much to raise the status of teachers and nurses, but social work has remained the Cinderella among the care professions. This House can play its part in creating a climate in which this trend can be reversed.
Social workers fulfil one of the most difficult tasks for the community. They need to have detailed knowledge of the disciplines of psychology, sociology, social administration, human growth and development, research methods and the law, and to maintain a nice balance between compassion and realism, empowerment and control. They need to be aware of their own needs and prejudices and have the strength to ensure that these do not impact on their work. They deal with those who are rejected by society; often those who have put themselves beyond the reach of the agencies of mainstream society—the deprived, delinquent, delusional and the dysfunctional. It is hardly surprising that they do not always get it absolutely right. As the noble and learned Baroness, Lady Butler-Sloss, pointed out in her deeply impressive maiden speech:
“They are damned if they do … and they are damned if they don’t”.—[Official Report, 21/11/06; col. 277.]
Their mistakes are highlighted by the media: their successes go largely unremarked.
My wife was a social worker. She recalls a time when she and her colleagues in local authority children's departments were regarded as highly skilled professionals by the public and courts alike, rather than treated with disdain. Thirty years ago, she taught trainee social workers on what was then a highly respected four-year undergraduate course at the University of Bradford. The introduction of a three-year undergraduate social work degree leading to a recognised qualification is therefore very much to be welcomed as one of the best ways of restoring to the social work profession some of the status it once possessed but which it has so conspicuously lost in recent decades.
As we have heard, the Government have done a number of other things which are very welcome. Skills for Care and the Children's Workforce Development Council have been set up to lead on workforce training, qualifications, support and advice. The establishment of the General Social Care Council to regulate the social care workforce and what is now the Commission for Social Care Inspection to register and inspect providers of social care, coupled with the development of national minimum standards on which inspection is based, are all important developments. We have seen the registration of social workers for the first time, and, since April 2005, the title “social worker” has been restricted to registered practitioners holding a social work qualification recognised by the GSCC.
Enrolment on to the three-year social work degree rose by a third between 2000-01 and 2003-04. As the noble Earl reminded us, government spending on social care workforce development and training in 2005-06 was three times higher than in 2002-03. Those are impressive developments and have the potential to do much to transform the esprit de corps of the social work profession, but they are coming very late and only after a protracted period where the situation has been allowed to slide a very long way. We must also beware the tendency of which I spoke in the debate introduced by the noble Lord, Lord Bruce-Lockhart, for there to be a disconnect between the official picture and what is actually happening on the ground, of which the noble Earl also spoke so eloquently.
The Options for Excellence review on the social care workforce published last October provides a blueprint for sustaining the momentum in the short term, but the longer-term vision is dependent on available resources. As others have said in this debate, this should be seen as a priority in the forthcoming spending review if what has been achieved in the past few years is not to go for nothing. In 2004, there were still 53,000 social work and occupational therapy vacancies, so there is still a lot to do and the problem is not a small one. According to the report which Sir Derek Wanless produced for the King's Fund last year, in 2003-04, 559,000 people were employed in adult social care plus 120,000 in care-related posts in the NHS. If we are to retain people in the social care workforce, pay must rise. That is not an option which we have the luxury of choosing or not. With an ageing population, a social care workforce with the requisite skills and morale and in the requisite numbers will be a necessity if the system is not to collapse.
I want to say a further word about training. The one major weakness in Options for Excellence was that it did not have a lot to say about training going forward. There was a lot about continuous professional development, but not training, particularly the content of training. My impression is that social work training has been considerably degraded since the days when my wife was studying, practising and teaching. There has been a shift away from teaching the core social work knowledge of human growth and development and the case work skills that are indispensable for understanding the motivation and behaviour of highly vulnerable and emotionally damaged people and providing them with the sort of professional relationship that can help them to grow. What can happen when that kind of foundation is not there was all too plainly demonstrated yesterday, as the noble Earl reminded us, by the report on Orchard Hill, where we heard of institutional abuse by social workers who were said not to have meant harm particularly, but who were just inadequately trained. As a result, they were incapable of understanding and managing the behavioural dynamics of those in their care. If we are going to effectively address personal problems in a timely fashion before they become major social problems—another reason for investment in social care if ever there was one—we must give more attention to the content of training as well as to its amount and the number of those who give and receive it.
The move to generic social work in the 1970s, while designed to simplify the complexity of different social service provision and to supply a one-stop shop for customers, largely failed in its aim and served to destroy much of the specialist expertise previously used to benefit children, the mentally ill, the elderly and the disabled. That is nowhere more apparent than in the field of services for people with visual impairment. The principal professional providing support to people with visual impairment is the rehabilitation officer whose role is to provide mobility and other independent living skills training for visually impaired people. While the population of visually impaired people continues to grow, and is set to double over the next 20 years with the ageing of the population, the numbers of qualified rehabilitation workers is in decline.
Only the other day, I received a letter from a rehabilitation officer who said that he was writing on behalf of many of his colleagues who feared that their profession was disappearing. He maintained that the standard of training was dropping and that many courses loosely based around rehabilitation only paid lip-service to the fundamentals of the profession. The Guide Dogs for the Blind Association is currently carrying out a major review of this area and there can be little doubt that it will throw up far-reaching proposals to reverse a long-term decline every bit as serious as that in the social work profession, which the Government will need to take just as seriously as they have the decline in social work.
My Lords, I, too, congratulate the noble Earl, Lord Listowel, on securing this debate. I shall focus first on those aspects of social work that concern children. I have for a long time been very worried about cases in which children have been removed from their parents on the excuse that they were being abused or were at risk of being abused when there was no real evidence that that was in fact the case and a lot of expert evidence, which local authorities chose to ignore, that the causes of the apparent injuries were quite different.
I gave details of two cases in the debate secured by the noble Lord, Lord Giddens, on 22 June last year, reported in Hansard in Volume 683, col. 947. Now I have heard of another one, in which the children have been removed from the mother on the grounds that they were in danger of being abused, and are about to be adopted. Of course, in none of these cases can I, even as a Member of your Lordships’ House, obtain any details of the evidence or copies of the judgment of the judge who heard the case in the family court, so I cannot make any judgment myself as to the rights and wrongs of the cases. But these cases have raised questions in my mind as to whether the social workers involved were sufficiently highly trained to make the recommendations they did and whether they had enough time, due to pressure of work, to perhaps wait and keep an eye on the situation.
I have read or tried to read the White Paper, Options for Excellence, which is, I am sorry to say, as ill written in ghastly jargon and as ill set out as the report on the conventions of the House, on which I spoke on Tuesday, was well written, readable and well set out. Recruiting sufficient social workers seems to be difficult and the training is sometimes inadequate. When numbers are short, it is not going to be easy to spare people for ongoing training and, in any case, training in schools and colleges, while very necessary, is no substitute for training under an experienced practitioner on the ground. A huge variety of different career development projects is probably a very expensive way in which to promote recruiting. Nowhere in the report did I see any suggestion that the way forward might be to pay social workers, carers and so on better, which is the first thing I should consider if I were having difficulty in finding recruits. I am no economist but when I was young I learnt the basic law of supply and demand. When the demand exceeds the supply, the price goes up. In this case, the price is the salaries of the workers. I echo the views of the noble Baroness, Lady Blood, on this, and the views of the noble Lord, Lord Low of Dalston, on this matter and on training.
The same applies to shortages of carers, nursing assistants and auxiliaries. Again, the most important kind of training that they can have is out in the field. A short time ago, a friend of mine was in hospital having had a very serious operation after which she could not move without help. One evening she was attended by a new young nurse, who told her that she was absolutely terrified, that it was her first time on the ward and that although she had been through nursing college and passed all her exams with flying colours, she had never been at a bedside before or been taught any hands-on nursing. That is why I say that training in the field is absolutely vital.
My Lords, I thank my noble friend for introducing this debate. I shall try to develop what he indicated as regards fostering and foster parents. That is where more than two-thirds of the 60,000 children in care are placed. The best estimates show that there is still a shortage of some 8,000 foster homes, which is roughly a 20 per cent shortfall that is most severely felt in London and the south-east. The background to that shortage is the need to be able to place children near their families, friends and existing schools and to be able to give some degree of choice of placement to the older children.
Before now I have described foster parents as being in the very front line of social care. Their role is one of the most personal forms of social service imaginable; they have to give sympathy, understanding and love equal to what they would provide for their own children. A foster parent is called on to be the consistent adult in the lives of children. That is surely the great need of children whose birth family has broken down. It appears that some 44 per cent of children taken into care who are not adopted remain there for a year and sometimes much longer. Stable placements are therefore essential. Few things can be worse for a child than being passed like a parcel between foster and residential homes with perhaps occasional returns to birth parents.
It is fairly obvious what should be provided to achieve stability in placements. There must first be fully adequate pay and allowances. Foster parents should not be expected to make a financial sacrifice when providing an essential public service. Housing, including housing benefit, and pension arrangements will be important, especially in high-cost areas. Economic provision of this kind must be complemented by good selection, training and support on the job. If all these factors are available, there is a good prospect of recruiting and, even more importantly, retaining, high-quality foster parents.
I hope that I have summed up the essential preconditions for stable placements for very vulnerable children. I therefore warmly welcome last year’s decision to lay down national minimum allowances for fostering. I recognise that some local authorities and private agencies already pay more than the minimum rate. Pay should always continue while foster parents are waiting for a new child; such gaps could well be used for training and for mutual support between parents. I welcome the Green Paper, Care Matters, of last October, and particularly the fostering proposals in chapter 4. However, I urge the Government to consider carefully the detailed comments on this chapter from the Fostering Network. These concern more than just one government department.
It is good news that the Children’s Commissioner is now fully active. I trust that he will be influential in raising the status of foster parents so that they are seen and rewarded as indispensable carers. The recording and supervision of private foster arrangements is another urgent issue. I wonder whether the Minister can give us any news of progress on that point. So, too, is the development of special fostering arrangements for children who have a history of being abused or trafficked into this country for gain. I invite the Government to consider whether the financial responsibility for children who are unaccompanied asylum seekers should move from the Home Office to the Department for Education and Skills. Such children certainly deserve to be treated according to best practice. That means that they should not be deported on reaching the age of 18 when their attachment to this country may have become very real and their links to the country of origin have attenuated to the point when they are almost minimal.
There is a further point on which the Children’s Commissioner and several departmental Ministers may be able to be helpful. Teachers and social workers who are the subject of allegations against them by children have defined processes of investigation. These are absolutely necessary because, as we all know, children can fantasise and often lie. Foster parents have, apparently, no such protection, and can be left in limbo with loss of pay and allowances.
I conclude by repeating that foster parents are in the front line of care. Therefore, we should ensure that they are properly recognised and cease to be a Cinderella service.
My Lords, I join others in thanking my noble friend Lord Listowel for this debate and for the tenacity that he has shown in keeping the quality and effectiveness of social care high on your Lordships’ priority agenda. I agree with everything that the noble Lord, Lord Hylton, said about fostering. Foster parents are an incredibly valuable and much underrated resource in this country, and I hope that the Minister will take into account what he said.
My noble friend Lord Listowel rightly reminded us that the subject of our discussion today is a crucial workforce—those involved in both statutory and voluntary roles in the basic social care services. We shall all be dependent on social care of one kind or another at different stages of our lives, most particularly at the beginning and the end. The noble Baroness, Lady Shephard, gave an apt and important warning for us all to think carefully about.
One vital group of workers is those who have responsibility for helping those from deprived backgrounds. They help the most vulnerable and often the most difficult to help within our society. They face the task of making it possible for these children to grow into responsible citizens and achieve their full individual potential, for their own and the community's benefit. For a number of reasons, not least the relentless number of new initiatives under way, these social services, the people who work in them and the resources for the work they do, are under constant pressure, and never more so than now. Adequate finance for new schemes has always been in doubt, and training, as we have heard again and again today, is inadequate. Pressure, not least from the Treasury, grows for ever better outcomes from services for families and children at risk of becoming locked into what used to be called the cycle of deprivation and has now apparently been renamed the cycle of low achievement.
Like other noble Lords, I cannot help thinking what it must be like to be a social worker in these fields. They are hardly among the best paid in the economy and their work is hugely important for community cohesion, yet they are subject to constant criticism in the press and elsewhere about the results not being good enough, whether in education, health, social services or the Probation Service. Noble Lords should imagine the effect of that on staff morale. Social workers also need to absorb and adapt to continual change and increasing bureaucracy. One ends up with a profession which is highly unlikely to attract much needed new recruits. We have heard that emphasised already.
Those pressures and problems prompt me to ask a more fundamental question about our entire system of taking children into care. Have we got it right, or are there real alternatives that deserve to be considered? Given what is happening now with looked-after children, alternatives must be worth pursuing. Harriet Sergeant, in her revealing book, Handle with Care, published in September 2006, tells us that care is,
“failing on a scale that is catastrophic”.
We have heard examples of that in past debates, so I shall not go into too much detail. However, with something like 6,000 looked-after children leaving care every year—6,000 of the 60,000—more than half of them, she predicts, will have no educational qualifications at all. Within two years, 3,000 will be unemployed, 2,000 will either be mothers or pregnant and 1,200 will be homeless. Are we really doing the right thing by taking so many children into care, when the numbers and costs of so doing are growing considerably? Court hearings have apparently risen by 14 per cent during the past five years and their cost by an astonishing 62 per cent. Each case takes between 42 and 51 weeks to complete and costs, I understand, an average of £25,000 in legal aid. As we know, funds for legal aid are drying up fast.
These results are tragic not just for the individuals, almost all of whom are victims of their own abusive, violent backgrounds. Harriet Sergeant argues that a successful system of care would,
“empty a third of our prisons, and shift half of all prisoners under 25 out of the criminal justice system”—
which is much needed at a time when prisons are pretty well overflowing—
“halve the number of prostitutes and reduce the homeless between a half and a third”.
All this may be a little utopian, but these are real issues.
As my noble friend Lord Listowel has already said, Hilary Armstrong, who is the Minister for Social Exclusion and is contributing substantially to the government White Paper, has found that some countries spend less per looked-after child and get better outcomes. No doubt we shall see that White Paper soon.
Meanwhile, how should we assess what has been happening here? Perhaps I may look back on the Government’s agenda when they took office 10 years ago. Specifically, they prioritised education and pledged to end child poverty within 21 years. We should acknowledge what has been achieved. Their interim target of cutting the numbers of children in poverty by a quarter by 2005 may not have been reached, but an impressive 700,000 children have been lifted out of poverty, helped no doubt by a combination of family support and flexible opportunities for single parents to join or rejoin the workforce. But Britain still has one of the highest child poverty rates in developed countries. So a lot remains to be done.
How about the Government’s education target? That is an area where change has been continuous. There have been more than 10 Education Acts. The pattern of constant change must be even more bewildering for teachers and social workers than for the rest of us. However, I am glad to say that the picture looks a little brighter in some respects. At the nursery education level, for example, the increased nursery provision entitlement that has been granted for all children will certainly have helped towards the reduction in the number of children in poverty, not least by encouraging single parents to train to return to some kind of, albeit usually low paid, employment. The earlier help and support are available to needy families, the better the chance of reducing the number of children failed by the system who end up in prison. The 1,000 Sure Start Children's Centres we have now—the target, as we all know, is one for every community of 3,500 people by 2010—bringing together not just early education but also health, employment and family support services, will, we hope, play an increasingly important role.
I shall not say all that I intended to say, but I hope that we will hear answers to many of the questions that have been raised.
My Lords, I congratulate the noble Earl on securing this debate, and I congratulate the Government on the publication of the Green Paper entitled Care Matters. It is very much to be welcomed. I congratulate the Government also on addressing a whole range of problems that many of us have been worried about for some time. The closing date for the consultation on the Green Paper was on Sunday. I hope that the Minister will make an exception and allow the speeches in this debate to be considered when the consultation is taking place.
The Green Paper is about children in care, and it is about children in care that I shall speak. As a society we should have the utmost compassion for children who are in care, who are at risk, or who have been taken into care because their parents have failed them. They are victims through no fault of their own. Along with their parents, we as a society are largely responsible for a variety of reasons, one of which is that we as a society do not respect and support parents and families enough. These are the damaged children whom we ask our social services to look after, and then to deliver back to us as adults who are emotionally secure and well-educated citizens. We must constantly remember that this is an exceedingly difficult and often thankless task.
I should have liked to speak at length about all the good things in the Green Paper but I do not have time. I intend to talk about only three issues which the Green Paper has missed: the case for a larger proportion of any available resources to be devoted to prevention; the case for paying more attention to attachment theory; and where the resources, human and financial, will come from.
First, although the Green Paper addresses prevention, it does not look back far enough into the life of the child. The bulk of it is about administrative changes and earlier intervention. However, the time when real results could be achieved in reducing the care population would be much earlier, at the birth of the child and in the first two years afterwards. Recent research in the USA has shown that a very high proportion—above 85 per cent—of unmarried parents, both fathers and mothers, want, at the time when their first child is born, to be good parents. Why do they fail? Very often it is not their fault. They have left school without adequate preparation for adult relationships, let alone parenthood. We fail to ensure that they have access to the support and help that they need when they meet parenthood face to face. We deny them affordable housing and send them off to live in temporary accommodation or with their mother-in-law at a time in their lives when they most crucially need a home for their new family.
I should like to give two examples of action that can be taken because people often put up their hands and say, “What can we do about it?”. Two years ago I came across a project in Florida that arranges with ante-natal clinics to offer to every first-time mother, at about the sixth month of pregnancy, a free screening to see whether she might be entitled to free services after the birth. As one might imagine, there is a good take-up. Any mother who might have problems is offered free weekly visits by a trained visitor for the first year of the child’s life and longer if necessary. Visitors are supervised and follow a child-development-led programme. Because it is non-stigmatising, the programme is popular and successful.
My second example is that in this country young single mothers with a first baby have to wait many months, often years, to get a home of their own. For young couples the situation is even worse. If we genuinely want fewer children in care, we should make the investment necessary to ensure that every first-time family, whether a couple or a single parent, is offered appropriate and affordable housing within a matter of weeks of the birth of their first child. I have no time to give any more examples. If only we could reduce the number of children who need to be taken into care, we could do the job much better for those for whom care is the only alternative.
My second point relates to secure attachment, which ties in with what my noble friend Lord Hylton said. I should stress the fundamental importance of secure attachment and a warm supportive family life for every child, especially those who have experienced family breakdown. What can we do to increase the chances of more children in care settings getting the start in life that they need?
Ongoing research studying outcomes for Romanian and Bulgarian children who spent their early years in communist state-owned orphanages has confirmed Bowlby’s theories about the importance of early attachment—or, in those cases, the lack of it. Children who have been abused or abandoned by parents whom they trusted are emotionally wounded. Some recover and some do not. The research on Romanian children also showed that when they were subsequently placed in a secure and loving family environment through adoption, the time needed to recover from abuse or neglect tended to increase with the length of time the child was subject to abuse or neglect.
Surely a priority for children who have been taken into care should be to ensure that the period of abuse is shorter by placing them as quickly as possible in a new family that is secure, caring and, as far as is possible, permanent. Successful adoption should achieve that objective. However, if foster care is the only option or is to be the placement, then the Government’s yardstick for adequacy in foster care placement—that is, not more than three placements per year—is disastrously inadequate. We should be thinking much more in terms of years rather than months for a successful fostering placement if we really want these children to recover from the emotional traumas that they have suffered. The very least that we owe them is a chance to rebuild their self-esteem and ability to trust adults, and to learn or relearn the relationship skills which will be the building blocks they need as they go into adolescence and then into adult life.
I was, finally, going to talk about resources. Happily, however, I have run out of time, and many noble Lords have already discussed the subject at considerable length. I support them. I have just one question for the Government. When they come back with a White Paper on this subject, will they put some figures to it? That would only be fair. No one in business offers a proposal of this magnitude without giving the board of directors a chance to know what the figures are. I hope the Government will listen to what I have said.
My Lords, I add my congratulations to the noble Earl, Lord Listowel, on initiating this very important debate. Like the noble Baroness, Lady Shephard, I shall concentrate on the care of older people. I want to focus on paid care workers but not exclusively on those working in care homes, as many of them also work in the community.
The Minister knows very well the difficulty in differentiating clearly between health and social care in these circumstances. Many people in care homes are primarily cared for not by nurses or qualified care workers but by care assistants, many of whom are faced with hugely difficult tasks—for which training is essential, but from which they certainly have not benefited. As the noble Baroness, Lady Barker, pointed out, many workers in such care homes, perhaps most, work in the private and voluntary sector. But in all sectors it is often said that although old people, particularly the frail and vulnerable, are able to receive health and social care services, they rarely receive professional health and professional social care. Other groups are more likely to receive such qualified and trained care.
There is also some excellent news. We all know that people are living longer and healthier lives and that they are benefiting from policies, on which we congratulate the Government, to enhance independent living. The result has been that the care needs of those entering care homes and nursing homes have appeared much later in life than was formerly the case. Their needs are, however, much more complex and difficult to meet. The care director for BUPA has talked about an epidemic of dementia. As we know, those caring for people with dementia have a terribly difficult task. We have to balance the needs of that very vulnerable group of people with the tremendous needs of the staff trying to do their best in extraordinarily difficult circumstances. The costs of caring for some 75 per cent of those whom BUPA cares for are paid for in one way or another by the statutory sector, the Government.
Care needs—co-morbidity, really—are increasingly complex. People get all sorts of conditions together, including diabetes, cardiovascular conditions and dementia. We need a more skilled and better trained care workforce and a professional structure, which does not yet exist. That would deliver care which is far more appropriate and tailored to users and would help to address the acute problems of recruitment and retention of nursing staff and care assistants in all sectors. The Wanless report acknowledged that we need to formalise qualifications for care staff. Unless those deficiencies and gaps are tackled we will continue to place unwarranted pressure on families and informal carers such as friends. We know that. The fact that so many people leave care assistant jobs to work in Tesco is quite understandable; there is a better social life and better pay at Tesco. That is what is happening.
Taking people from abroad to do these jobs, stripping assets in the form of better-qualified people from many developing countries, is another problem. Those countries need these people. The people come here because of better—albeit still low—pay and easy access to jobs. We need to do something about that, otherwise we will also affect the family life of people in those workers’ home countries. We know that many who come to take up jobs as care workers and care assistants get on to adaptation courses that enable them to move from the independent sector into the NHS.
I would like to draw noble Lords’ attention to some studies being carried out by the University of Surrey Healthcare Workforce Research Centre. I was privileged to chair the first meeting of a group that is looking at these issues. Another meeting will be held shortly. We had representatives from the Department of Health, the voluntary sector and the care home sector. The meeting was initiated by an organisation called Friends of the Elderly. The idea is to enhance the role of those being trained to enable them to reach NVQ Level 2. These are the people who provide most of the hands-on care.
The enhancement would be achieved by creating the role of specialist care assistants, perhaps working under the supervision of qualified nursing staff. Training in vital clinical skills relevant to specific long-term conditions would be provided and serve as a bridge between the basic care function and nursing. Some functions currently carried out by nurses could be delegated to suitably trained assistants, who would benefit from having such qualifications. That would free up nursing staff for greater managerial tasks and greater responsibility and allow them to take on specialist gerontological nursing qualifications. It would pave the way to developing better domiciliary care, perhaps following the model of community matrons mooted by the Department of Health.
I hope the Minister will consider those developments and ask his officials to follow up that initiative. I doubt whether it is the only such initiative in the country. It is very important to raise the status of these care workers as they deserve better. More importantly from my point of view, those whom they care for deserve better.
My Lords, I, too, congratulate the noble Earl, Lord Listowel, on once again demonstrating his tireless care for people in care, particularly children, on whom I want to concentrate my remarks. There are advantages and disadvantages to having what one might call the sweeper’s position on the speakers’ list. With such an array of talent and experience speaking before you, most of the issues you might wish to raise have already been covered, leaving you in danger of merely replicating.
However, I want to do a little “so-whatting” and remind the House of the “so-what” of getting this wrong, which I have seen all too often in the prisons, the secure training centres and the local secure homes around this country. I looked at this White Paper with considerable interest, because I hoped that—bearing in mind all the people who had served on the board, many of whom I had spoken to and the experience they represented—the board would have listened to the experiences of the people who had been through the system, and were therefore the “so what” of it, in all that they did. I was very heartened by the first message from one of the board members, Mr Peter Beresford, chair of Shaping Our Lives, who said:
“For service users, the most important person in social care is the person who works face-to-face with them. Their influence for good or ill can be enormous”.
That needs to be shouted aloud and said in spades. I was therefore delighted to hear the noble Baroness, Lady Barker, say that consistency in this person was absolutely essential if good was to be achieved. She gave us the disturbing number of people who did not come from the resident social services organisations, but from agencies and others. This is not to disparage their motivation or contribution in any way, but merely to comment on it.
I feel like this because I paid a visit to a local secure home called Orchard Lodge, the only place in the country to be detailed and originally staffed to look after children with mental health problems. This House has heard this week about the problems posed by the increasing number of children with various mental health problems. It is extremely disturbing that there is only one local secure home in the country capable of taking them. Orchard Lodge is near Crystal Palace, but when I went there, far from finding that people came from the south-east, I found children from Manchester, Cardiff, Newcastle and other places. They were far away from their homes and the continuous support that is so essential in continuing whatever was begun there.
Another thing concerned me about this place. At the time it was being run, quite admirably, by Southwark council. The average tenure of staff members was 11 years. That told hugely in the relationship between staff and children, and their understanding of the sort of problems to be found there. I was disturbed to find the population being changed by increasing numbers of asylum seekers and immigrant children being brought to Orchard Lodge, bringing with them traumas as a result of their experiences in their home countries. This caused the staff intense difficulties, not least with languages. I was also disturbed to learn that Orchard Lodge was being taken out of Southwark council’s control and privatised.
That has since happened. The result was felt immediately in an increase in turnover of understanding staff. This is a very serious point, which needs to be taken into account. Therefore, I was extremely concerned to find such a strong focus on “commissioning” in Options for Excellence. Why do I say that? All too often throughout the criminal justice system—and we shall debate it further next week in the Offender Management Bill—this Government seem determined to commission services from the private and voluntary sector. This is not to say that that is a bad thing; I am all for getting the right services at the right time and in the right way, but they must be the right services at the right time and in the right way. However, when all the evidence from children and experienced people who work in these homes shows that it is important to maintain continuity and make use of such experience, it is dangerous to risk throwing that away in favour of the mantra of commissioning and contracting everything.
Why do I say that? One day, I inspected Stoke Heath young offender institution, where there was a juvenile element among whom there had been the most horrendous amount of bullying, leading to injuries incurred by youngsters. The bullying had been carried out not just by the youngsters but by members of the staff, and injuries had been caused during official procedures of control and restraint. The staff there appealed to me to inspect them and to comment that they had not been trained to do the job.
I am concerned that we have untrained staff in places where juveniles are looked after—and we are talking about training here. Why can we not pick up the remark of the noble Baroness, Lady Shephard, about the need for joint working in all this training? She mentioned the National Health Service and the social services. I would mention the need for the Prison Service and others which look after juveniles to get involved in the training as well, because the “so what” of not getting this right is that more and more young people will enter our prisons. I was horrified to discover how many young prisoners have already experienced care, but I believe that that will be avoidable if we listen to what has been said and incorporate the need for continuity of staff as a major, rather than a minor, add-on to what is otherwise an admirable paper.
My Lords, I thank the noble Earl for tabling this topic for debate today. As we have heard, the social care workforce consists of the people on whom many of the most vulnerable in society depend. They face a variety of challenges, so a debate on the subject is welcome.
In summing up, I shall concentrate my remarks on the situation faced by local authorities. I do so because, first, they are the major employers of social carers and, secondly, as a former leader, it is the area that I know best.
Local government has been facing a fairly tough financial outlook for some years now. The Government argue that it has had a 40 per cent increase in funding during the past 10 years. On the other hand, local government argues that much of that money has been ring-fenced for schools and that therefore the actual amount of money available to councils to spend on all services, excluding education, has been around 14 per cent. Where the balance of that lies is not for debate today, but the fact is that actual spending by local authorities has gone up by 50 per cent over the past decade. The balance has been met by the council tax payer, and the results of that are evident to everyone.
During the past decade, councils have faced growing demands for their services, particularly in social services. The number of people aged 85 and over has increased by 6 per cent per annum. As the noble Baroness, Lady Shephard, pointed out, their needs become more complex and they require a very high level of care. As NHS budgets have been squeezed, almost half of local councils have reported a reduction in PCT support for joint projects. An LGA survey carried out last summer showed that 70 per cent of local councils had been adversely affected by actions such as bed reductions and community hospital closures. In fact, just this week the Local Government Chronicle carries a report which estimates that the cost to Brent council alone of what it describes as the “PCT cost shunt” is around £9 million, and that is threatening joint arrangements and partnerships at all levels of care.
The Government have rightly made education a priority and have protected education budgets through ring-fencing. However, this means that, when local authorities seek to rebalance their budgets, because social services take by far the largest share of what is left, social services’ budgets take the hit most of the time. Currently, councils are spending about £1.8 billion above the amount allocated to them, and the difference can be met only by increasing council tax or by cutting spending.
According to the Commission for Social Care Inspection, increased demand has already lead to,
“a gradual reduction in the numbers of older people receiving state-funded home care”,
“the tight targeting of statutory support towards those with critical levels of need”.
Wanless made similar comments. He said in his report:
“There is evidence of significant unmet need”.
One could argue that that is because local councils are inefficient and are failing in some way. However, all the evidence suggests otherwise. Local government now has a strong record on financial management and service improvement, as judged by the plethora of external inspecting bodies which the Government have created. The Audit Commission’s performance assessment shows that 68 per cent of councils achieve three or four stars and that they are far outperforming the NHS. In November, the Commission for Social Care Inspection reported that local authorities had improved for the fourth year running. There are now no zero-rated authorities, and 78 per cent are in the two or three-star categories.
It looks as though, on current trends, by 2009-10 local authorities will no longer be providing care and support to those with low and moderate needs. These are the people who need only a little help to be able to remain in their own homes, which is what most of us would wish for. In this country, we currently provide home care to 370,000 people—a low figure by international comparisons. Studies have shown that 45 per cent of carers are family members and that it is becoming increasingly unsustainable to keep transferring the burden on to them. Research also shows that relying on an unpaid workforce comprised mainly of women will not work in the future, because, for a variety of reasons, younger women are less willing or able to provide that level of care.
We need to maintain a committed and appropriately trained workforce in order to achieve quality care. The drive to manage costs cannot be entirely at the expense of a workforce which we know needs to be of high quality. The noble Earl, Lord Listowel, rightly referred to the huge strides that have been made in driving up the quality of the social care workforce. Social work is now a graduate-entry profession and registration with the General Social Care Council is mandatory. I pay tribute to the work carried out by the noble Baroness, Lady Pitkeathley, and I join her in paying tribute also to the work of the council in driving up standards in social care. Certainly, its vision, set out in Options for Excellence, has the support of us all in general terms.
However, there are problems. Recruitment and retention are already major issues in social services authorities. Vacancy rates are high. Around 69 per cent of local authorities have reported recruitment difficulties in certain disciplines and 49 per cent have reported problems in retention. The occupations with the highest retention difficulties are children’s social workers and home care workers. Today, we have heard some of the reasons why those areas are the hardest hit. In 2005, 20 per cent of the social care workforce in London consisted of agency workers. That shows the particular problems faced by the capital.
Keeping pay settlements low may be a necessary objective in some circumstances, but councils, like businesses, need to be free to adapt to the situation in their area, and, as the noble Lady, Lady Saltoun, pointed out, there is a market. But it is an area in which we need to exercise some care. Four-fifths of the social care workforce are women. Many of them are care workers on comparatively low wages, especially in the private sector. Driving down wage costs could not only adversely affect recruitment but damage women disproportionately.
As councils are forced to withdraw care from those with low and moderate needs, the social care workers end up making the assessments which they know will result in hardship for their clients. Dedicated professionals in social care who have entered the field motivated by a desire for public service are being forced to ration care packages or deal with a caseload which they know prevents them giving individuals the sort of attention they deserve. The whole thrust of the profession now is to empower service users, but that is becoming more and more difficult as the cuts bite. The noble Baroness, Lady Pitkeathley, is right: this is not a new issue, but it is getting worse and morale is suffering.
Council cutbacks can have an indirect effect on social care—for example, where savings are made in administration, training or legal services. The most commonly used measures to tackle the shortage of social workers include training up social work assistants, improving IT and providing training to support staff in other areas, but these are the areas of spending which tend to be cut first because they are not seen as front-line. I know of areas where, for example, case papers have not been properly prepared by hard-pressed legal departments in local authorities due to time pressures. In an increasingly litigious world, it is highly dangerous if cases are not decided on their merits but are somehow lost by default due to administrative problems.
This is the time for the Government to make a serious choice about matching their genuine vision for social care with the means available to fund it. The current practice of pushing the burden on to council tax payers cannot go on. The noble Baroness, Lady Shephard, is right to say that this is now urgent.
I recognise that the noble Lord can say very little today about local government finance and its complexities, but I hope that he might reassure us that perhaps through the mechanism of the Lyons review, the Government will look again not just at the way in which local authorities are funded but the relationship between health, local government and social care.
My noble friend Lady Barker got it absolutely right when she said that the heart of the matter was to consider the sort of social services we want and how they should be paid for. We all share a vision of improved public services offering a better quality of life, working along with the voluntary sector. We would all like to help to achieve that. We need a mature debate, shorn of the sort of ritual of buck-passing and blame, to find a way forward.
My Lords, I too congratulate the noble Earl, Lord Listowel, on initiating this very important debate. The noble Earl is obviously very passionate about the delivery of services to children and young people. His facts and statistics reveal the great difficulties facing local authorities and providers. All noble Lords, with their expertise and knowledge, have posed many questions to the Government. I look forward to the Minister’s response.
In another place, my colleague Tim Loughton has set up a commission to look into the role, status and future of social workers. The Conservative Party is very keen to see the sector examined and developed properly. We are delighted to note that the noble Lord, Lord Laming, and the noble and learned Baroness, Lady Butler-Sloss, have agreed to be patrons of that commission, and that my noble friend Lady Morris of Bolton is a member of it.
I declare an interest as a health provider. My remarks will be based on my experience in the sector. As a provider, I know the difficulties of an untrained workforce or one that has training that is sometimes inappropriate or does not meet the needs of service users and their families. We need to look at health and social care as two sides of the same coin. We cannot separate them off. While billions of pounds have been spent on the NHS, the social services sector has had insignificant responses to the pressures put on it. We know that the NHS can show tangible results, but in long-term care, such as care for children, we do not see tangible results. Support, care and long-term commitment must be given to people who are dependent on care staff and social workers.
As a provider I have had difficulties with the qualifications of care staff who have poor literacy skills or whose first language is not English. Care out in the community is changing and more and more nursing care is being imposed on care staff. Social workers are given a huge workload. Although I congratulate the Government on their White Paper Our Health, Our Care, Our Say and the Green Paper Every Child Matters, there has to be greater consultation on the sort of support that the Government can offer in developing the training programmes that are offered to social workers and care staff.
I was speaking to our local provider from Age Concern, who agreed that there are great deficiencies in NVQ provision for care staff. I know the difficulties that Age Concern in Leicester has had in trying to roll out the programme with consistency. The retention of people to train care staff to gain NVQs has been very poor. Unless we value the work that care staff and social workers do, the turnover in this sector will always be incredibly high. I am a great believer in training, but it has to be appropriate training. I am pleased to say that Leicester City Council and Age Concern will be piloting a scheme that will look at appropriate training for care staff. They will work more closely with social services and social workers to ensure that there is a match between care provision and what service users require.
I could give several examples of inadequacies in care provision today, but it would mean going round the same issues instead of having a forward look. I would rather work with noble Lords to see how we can improve training and the value put on care staff and social workers. In practices in Leicester we find that we lose staff because the local supermarkets offer more pay, less responsibility and much better flexibility in working times. Care is difficult. A service is expected 365 days a year. There is poor provision in respite help for service-user families, so informal carers end up needing care.
I had a deep conversation with the noble Earl, Lord Listowel, about children in care and the fact that they want continuity. They want somebody who they know will be there when all else is lost. When nobody else is there for them, they want to know that that one person will see them through the system; who will be a friend and advise them when they have highs and lows; and who will give advice on education and future employment.
The subject is huge. We can top it up with lots of facts, figures and statistics, but it boils down to the fact that we are dealing with human beings who are vulnerable and less able to reach out. They are often the quietest, so they do not make a noise when they do not know how to access the services that they duly and rightly should have. It becomes a vicious circle. We have to be the voices, often not just for the service users but for their families to show them where to access help as they themselves are so poorly informed.
As my noble friend Lady Shephard said, there has to be greater joined-up thinking and management, and a greater exchange of training. Local social services have in-house training, but private providers have to find funding and search for training. If they do not find funding, it becomes another cost implication in a sector that is poorly paid. I do not believe that throwing extra money around is always the answer, but appropriate training and negotiations with partners in the health and social services sectors can resolve some of the problems.
Before the debate, I spoke to a number of children in the care sector and from families with needs due to drug or alcohol abuse in the home setting. We developed a sort of thinking, which may sum up some of the difficulties which cannot be topped up with statistics or numbers. A child said:
“I know I’m from a deprived and disadvantaged background. I do not need to be reminded of it. I know that I want to be valued. I want to be given opportunities. I want to make a positive contribution, but I want to be shown how to make that contribution. I want to be shown how to be proud of myself”.
The elderly sometimes feel embarrassed to seek extra help. Children do not know how to seek help. Care staff most often come into the profession because they care about people and want to do their best, but must be resourced to do so with the proper training and respect given to the service they provide. Care staff and social workers do a phenomenal amount for this country, and we do not offer them the status and respect they so rightly deserve. I hope that the Government will work towards ensuring that those groups are offered that status and respect.
My Lords, like other noble Lords, I congratulate the noble Earl, Lord Listowel, on his initiative in securing the debate. Like the noble Lord, Lord Low, I welcome debates on social care and hope that we will in future have opportunities to debate some of the many important issues discussed today. The debate has illustrated the inter-relationship between social care and many other desirable objectives of health and social policy. I am sure that we will return to this subject.
I echo the noble Baroness, Lady Verma, when she says that we must ensure that people using services and their carers benefit from a highly skilled workforce. We want them to be valued. We know that people in this sector have all too often been pilloried in the media when things go wrong, but they do not get much praise. This House can praise the many thousands of staff who work hard and effectively, be it on a statutory, non-statutory or voluntary basis, or individual carers, including—I agree with the right reverend Prelate—faith-based services. I also noted the comments of my noble friend Lady Blood regarding the challenges for organisations such as Barnardo’s in dealing with statutory services. I understand what she said about stable funding and transparent tendering processes and assure her that the Government wish to see that. I understand the frustrations of voluntary organisations that cannot get secure funding over longer periods and would encourage statutory organisations to understand what it is like to run voluntary organisations if you do not have that secure funding.
The noble Earl, Lord Listowel, rightly mentioned the events at Sutton and Merton primary care trust. As we praise, we must also acknowledge that the findings of that investigation were both shocking and saddening. What was happening there was completely unacceptable and action clearly needs to be taken. However, we must set that alongside the tremendous good work that occurs in the sector.
The noble Lady, Lady Saltoun, and the noble Baroness, Lady Howe, asked whether taking children into care is always appropriate. Looking at the outcomes of looked-after children, it is an understandable question. We have debated this matter for a number of years. The outcome for many looked-after children is very poor indeed and the question is therefore valid. The noble Lady and the noble Baroness were right to pinpoint the need for better training and support. We must look at alternatives. I suspect that taking children into care must always be an option, and we should recognise that social workers’ decisions in doing so are difficult. They identify to us how much pressure social care staff come under, working in some of the most difficult circumstances with hard-pressed teams. As noble Lords have mentioned, the workforce experiences high levels of vacancies—persistently around 10 per cent in England—and staff turnover. The level of relevant qualifications is far too low, with around 30 per cent of the workforce having a social care qualification at NVQ level 2 or better.
I accept that noble Lords have been generous in identifying the improvements and some of the encouraging signs we can see. The rise in the number of those training to be social workers—by a quarter since 2000-01—has been notable. The first cohort of students on the new degree, qualifying in 2006, has great potential for the future. We must build on that. The General Social Care Council, Skills for Care, the Commission for Social Care Inspection and the Social Care Institute for Excellence are essential foundations on which to build much greater confidence in the social care workforce.
I pay tribute to my noble friend Lady Pitkeathley for her outstanding work. She is right to suggest that continuing the recruitment campaigns is important. They have been successful and we will continue with them. My understanding is that there will be another burst of campaign activity starting in March this year; not just TV and media advertising, but a lot of work with local employers. I am glad that my old department, Jobcentre Plus, is strongly involved in that.
Noble Lords have mentioned that we have put more resources into training. The GSCC has opened the register for social workers, for protection of title and so on. I understand why my noble friend Lady Pitkeathley asks for the extension of registration to other workers in social care. We are giving that due consideration.
The noble Earl, Lord Listowel, rightly drew attention to the particular vulnerability of young people and the fact that many of the care workers they deal with change, reflecting vacancy and turnover rates over the past few years. In the social care workforce employed by local councils, vacancies are around 10 per cent; that is uncomfortably high, although it is a reduction from 11.5 per cent in 2001. The rates are higher for social workers at 11 per cent, and higher still for some other staff, such as occupational therapists at 14 per cent. Residential child workers are a long-term problem with vacancies at 15 per cent. That is a major challenge, not just for statutory providers.
As the noble Baronesses, Lady Barker and Lady Greengross, suggested, however, government, whether national or local, does not employ the majority of social care staff. About a third are employed by local councils, but the majority are in the private and voluntary sector, from which councils commission services. Care homes are private businesses. Owners must take their own decisions about their business in the framework of standards applying to the sector. In considering the issues of vacancies, turnover and pay, one must bear in mind that we are now talking about a more diverse sector than has traditionally been the case.
I was interested in the views of the noble Baroness, Lady Verma, on some of the challenges facing providers. I have some sympathy with what she said. I was also interested in her views about the changing requirements on care home staff and her desire to make sure that the training programme available is meeting their developing needs. The Leicester pilot sounds very interesting, and I would be interested in hearing further about it.
The issue of pay is clearly important. The noble Lord, Lord Low, and the noble Baroness, Lady Barker, particularly drew attention to it. There is a perception that recruitment and retention issues are linked to pay and rewards. I am not going to stand here and say that pay is not a factor; of course, it is. It is not the only factor because there are many wonderful people who are extremely motivated to work in the social care sector. In addition to pay, many employers have been able to tackle recruitment and retention problems by offering good support and good training programmes so that people feel supported when they work in particular parts of the sector. My noble friend Lady Pitkeathley mentioned the importance of good management in this area. I agree with her.
I was interested in the proposals of the noble Baroness, Lady Greengross, and I will arrange for officials in my department to have a further look at them. They sounded very interesting.
I cannot avoid talking about money. The noble Earl, Lord Listowel, and the noble Baronesses, Lady Barker, Lady Shephard and Lady Scott, particularly focused on issues to do with resources. Resources are clearly a challenge. Noble Lords would expect me to remind them that there has been an increase in resources. I also acknowledge the improvements in efficiency that local authorities have made, which have increased resources for them to use and enabled them to increase the range of services they offer. However, it is a challenge for local authorities to balance priorities. I fully understand the inter-relationship between health and social care and that the actions taken in one sector can have a knock-on effect in another. All these matters have to be taken into account. I read with a great deal of interest the Local Government Association report Without a Care?. It identifies some of those issues from the point of view of local government. About as much as I can say about that is that we are working with the LGA and others, including Sir Derek Wanless and the Association of Directors of Social Services, to understand financial needs for the next spending review.
My noble friend Lady Pitkeathley and the noble Baroness, Lady Shephard, also mentioned the report from the Commission for Social Care Inspection, which was also very interesting. It is not all doom and gloom. It clearly identified some areas of concern, but it stated that for the fourth successive year the number of providers meeting national minimum standards had increased and that there was a welcome improvement in performance. However, it also mentioned the pressures on the commissioners and providers of services. In view of the comments made by the noble Lord, Lord Ramsbotham, about commissioning, the report stated that too many local authorities are still commissioning the same traditional services and that local authorities need to move towards commissioning that supports the independence and choice of service providers. It stated that local authorities need to involve other stakeholders and focus on commissioning for good quality outcomes. I say to the noble Lord, Lord Ramsbotham, that while I do not think I can comment on Orchard Lodge, I think that diversity of provision is a good idea and can bring greater innovation into the provision of services, but it depends on effective commissioning. My experience with the health service is that effective commissioning is difficult. There is no doubt in my mind that to make it work we must do everything we can to help enhance the skills of commissioners so that we get the advantage of commissioning, and not some of the downsides mentioned by the noble Lord, Lord Ramsbotham.
In a sense, that brings us to the core of today’s debate, which is about the workforce, how it can be supported and its training. I do not share the doubts of the noble Lady, Lady Saltoun, about the quality of the writing of the report, but perhaps I have read too many government White Papers to be able to make an independent assessment of its quality. The noble Earl, Lord Listowel, was right to say that it represents an excellent opportunity to set out a strategy in the long term for the entire social care workforce. It has a clear vision, sets out priority areas for improvement and draws on experience of what works, so I believe that it is practically based, which is essential if we are to make the most of this opportunity. The Government are considering how to take it forward. It cannot be divorced from the overall funding available so it is part of the discussions in relation to the Comprehensive Spending Review process. I was interested in the comments of the noble Lord, Lord Low, about the content of training. I shall certainly feed them into the consultation process and make sure that officials who are taking the work forward see a full copy of the debate.
It is clear that the role of government in relation to the social care sector and its workforce is different from its role in the health service. Although government can provide policy direction, legislate and set standards, because it is not the bulk employer of social care staff, it is necessary to make sure that what is being proposed is also owned by the many providers of social care services. I am very keen to make sure that that happens.
I was interested in the comments of the noble Lord, Lord Northbourne, in relation to the children in care Green Paper. He was right to identify it as having a cross-government approach. In order to succeed, it clearly has to embrace many different government departments and local statutory and voluntary agencies. We see that as being at the heart of the Government’s programme to tackle poor outcomes and social exclusion for the most vulnerable groups in our society. I was interested in the noble Lord’s comments about the need for earlier action to help the parents of children. I very much agree with that. A lot of the Government’s programmes are designed to do that. I shall feed his views into the Green Paper process—it is a Green Paper, so we are ever open to ideas—and we would be very interested in further discussions with him on this area.
The noble Lord, Lord Hylton, mentioned foster care. That is an important matter. The noble Lord will know that the Green Paper seeks to address recruitment and improve the capability of foster carers. We see national minimum allowances as important in getting rid of the inconsistency that has been apparent and which he mentioned. As the noble Lord knows, in care matters it introduces a tiered framework of qualifications for foster carers. He made a valid point on the question of allegations. I can assure him that we are working with fostering networks to improve support for carers who are subject to allegations. A key thing is to improve the support that carers get from local authorities. We fund an advice line for carers and we are producing materials for local recruitment campaigns. I can assure the noble Lord that we agree with him about the importance of foster carers.
I want to come back to an interesting comment made by the noble Lord, Lord Low, who referred to the experience of his wife and a possible changed perception of social care workers over the years. I was brought up in Oxford. My father was a social worker in Oxford at the time when Lucy Faithfull was the director of social services there; I think that she was children’s director before that. I do not pretend that there was then a golden age, when social workers were regarded as the most brilliant professionals around. Yet they were held in more respect then than they are today.
There is no question that, given the challenges that the whole social care sector faces, the one thing we can do to improve the condition of its workforce and services is to raise the image of the profession itself. The degree is a start and many other things need to be done. We are keen in Government to do what we can to support a programme and the Secretary of State, Patricia Hewitt, has asked Dame Denise Platt, chair of the Commission for Social Care Inspection, to report by the end of this month on a plan to improve the public image of social care.
To conclude, the people who work in the social care field are a hidden army in many ways; people who provide an essential backdrop to many other well-known services such as the NHS, the police, education and housing. They are well over a million people—a huge number, who provide essential support for some of the most vulnerable and needy people in our society. In concluding this debate, I echo the remarks of noble Lords in thanking those people for everything that they do. Our job is to make sure that the framework, conditions and foundation of how they work are as sound as possible. There is no question that the issues that the noble Earl, Lord Listowel, and other noble Lords have raised today on training and support are critical to that, so I very much hope that we can build on the progress that has already been made.
My Lords, I know I must be brief. I thank all of your Lordships who have taken part in this debate. I particularly thank my Cross-Bench colleagues for their strong support. The noble Baroness, Lady Pitkeathley, has been so helpful with her vast experience and responsibilities in this area.
Now that I know that the Minister’s father was a social worker, it helps to explain why he has made such a difference to children in care with the legislation he has taken through this House in the past, which has introduced a right to independent advocacy and raised from 21 to 24 the age of protection for looked-after children leaving care. I understand now why he was so passionate about those matters.
I also want to thank the noble Baroness, Lady Verma, for emphasising the need for stable relationships for children in care. It is not easy to measure the value of those things, but they must not be overlooked because of that. My noble friend Lord Ramsbotham drew attention to commissioning. We have talked about diversity of provision. I respect and acknowledge the importance of diversity in terms of competition and innovation but it adds complexity. If we acknowledge that we have not got the basics right, then the Government—whose instinct will be to increase diversity—need to think carefully about adding another degree of complexity at this time. The Minister had no time to reply to my specific concern about the newly-qualified social work status, but I am sure that we can discuss that further.
Again, I thank all noble Lords who took part in the debate and absolutely join in acknowledging the huge contribution that all of those working in social care make in this country to the welfare of vulnerable children and adults. I beg leave to withdraw the Motion for Papers.
Motion for Papers, by leave, withdrawn.