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House of Lords Hansard
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15 October 2015
Volume 765

Question

Asked by

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To ask Her Majesty’s Government what they are doing to ensure that quality social care is provided throughout the country and that the wages of care workers are increased.

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My Lords, the Government have made the Care Quality Commission’s regulation and inspection regime much tougher to ensure that people receive safe, high-quality and compassionate care. The CQC’s report, The State of Health and Adult Social Care in England, published today, details how well adult social care is performing overall in respect of quality. The new care certificate is equipping staff to deliver high-quality services, while the national living wage will ensure that they are properly paid.

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My Lords, I am grateful to the Minister for that Answer. I declare my interest as a trustee of Crossroads Care in the Forest of Dean and Herefordshire. The Minister mentioned the new national living wage, which is coming in in April. At the same time, local councils up and down the country will have more and more cuts to their budgets. Notwithstanding what the Minister says, I believe that the sector is in crisis, and the sums simply do not add up. Some care organisations are already pulling out, especially in rural areas, where they do not wish to pay travel times. What are the Government going to do to ensure that there is quality care in isolated areas as well as in other parts of the country? Will the Minister agree to have a meeting with me to discuss this specific issue, which is a matter of deep concern?

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First, I would be delighted to meet the noble Baroness any time—

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—any place! I look forward to that. We will be accompanied by officials. There is no doubt that the local authority-funded care sector is under considerable pressure at the moment and that the increase in the national living wage will add to that pressure. Those pressures are well recognised by the Government. To some extent they have been addressed by the better care fund. I think that pooling budgets between health and social care is a way forward but we have to await the out-turn of the spending round before we can be more definitive.

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My Lords, might I express the hope that the meeting with the noble Baroness is not only productive but chaperoned properly? I ask my noble friend to take on board the very important point she made about travel time. It really is very wrong indeed that people should not be paid for travel time, especially in rural areas.

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I thank my noble friend for that important observation, with which I agree completely.

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My Lords, the better care fund was a good starting point for the integration of health and social care, but the Government deferring the integration of the spending limits in the Dilnot review means, we are told, that there are £6 billion of savings. Will the Government ensure that that saving of £6 billion from not fully implementing the integration of health and social care is put towards the new minimum wage and the new contracts ensuring that staff are paid for travel between appointments?

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The position on the savings from deferring the introduction of the Dilnot proposals is that they are being taken into account under the spending round and I cannot comment further today.

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My Lords, is the Minister aware that data from the Health & Social Care Information Centre show that without doubt the social care system is not just under pressure, as he has said, but at breaking point? The figures also show that family carers are under increasing pressure and receiving far less support and back-up. In fact, their quality of life and satisfaction with social services have dropped hugely in the past two years and now only 39% of them say that they have as much social contact as they want and need. Does the Minister agree that support for family carers is an absolute priority and must be maintained since they are, after all, the main providers of social care?

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The noble Baroness says that the care system is at breaking point. The CQC’s report out today says that it is “fragile”. I think it is very variable. Some care providers are finding life extremely difficult but it is highly variable; it depends very much on the mix of clients that care providers are looking after and the extent to which they are funded by local authorities and the extent to which they are funded privately. But I take on board what the noble Baroness says and take it very much to heart.

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Does the Minister agree that one of the issues in the CQC report this morning was the hospital sector appearing to be in a level of crisis? We have also heard about the funding problems. That is directly related to the crisis in the social care system. It is one for thing for Ministers to say that the Government are aware of that but I suppose the real question is: what are the Government going to do about the huge current pressures in the social care system, which everybody recognises?

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What the noble Baroness says is absolutely right—the two are linked closely, although it is interesting that the main concern coming from the CQC report is around safety, which is not directly related to the point that she raised. The better care fund is a start on this road. The devolution in Manchester is another point along the journey. Increasingly, over the next five or 10 years, we will see a coming together of the health and social care system.

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My Lords, I am sure we all welcome a living wage being paid to care workers, but when this was announced, did either the Treasury or the department do an impact assessment of this new expenditure on the sector?

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The impact on the sector is very clear: it will push up costs in the sector. How those costs are funded will be part of the spending round discussions that are going forward at the moment.

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My Lords, today’s CQC report calls on health and social care providers to focus on ensuring that services have the right staff and skills mix to ensure that care is always safe. Does the Minister acknowledge the impact of the funding crisis on residential care and the commission’s concern at the delay in the introduction of the care cap until 2020? Both residential and daycare have high vacancy and turnover rates and a chronic problem in recruiting and training care staff, particularly under-25s. Would it not be outrageous if the Treasury kept the £6 billion and did not use it to try to address those issues?

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The noble Baroness raises two interesting points. There is a recruitment and a training issue involved in many care homes. This is being addressed by the Government in two ways: first, by raising the minimum wage to the national living wage so that it rises to about £9 an hour by 2020; and, secondly, by the introduction of the care certificate which came out of the Camilla Cavendish report after Mid Staffs, which should improve training in the sector. The funding of local authority-provided care is the issue on which we are awaiting the outcome of the spending round discussions.

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Does the Minister agree that the pressures mounting across the whole range of healthcare, from prevention to primary care, acute care and social care, will just keep getting worse until we address the fundamental issue of adequate resourcing of all the aspects of healthcare? Is it not time to start the debate more widely as to how we are going to do that?

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I thank the noble Lord for his comments and, of course, I understand exactly what he is saying. I will put just two points. First, the fundamental problem is that the Government still have a very high level of public borrowing, which we inherited and has been there—

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It happens to be true. We cannot carry on spending in the way that we used to spend. We have to balance the books. That is a very fundamental point. The second point is that there is huge variation in the system. Some providers, some hospitals and some care systems are delivering much better outcomes with the same money.