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Health and Social Care

Volume 785: debated on Thursday 12 October 2017


Asked by

To ask Her Majesty's Government what is their response to the conclusion of the Care Quality Commission in its annual state of care report that 1.2 million adults are not getting the care they need as the health and social care system is “straining at the seams”.

My Lords, the Government are committed to improving the quality and availability of adult social care in England. The Care Act 2014 introduced, for the first time, a national eligibility threshold for care, and the Government are increasing funding for social care by £2 billion over the next three years to meet growing demand.

My Lords, two days ago, in answering a Question on this report, the Minister spoke of a 20-year search for consensus on the funding of long-term care. We had consensus about the Dilnot proposals, which capped the amount a person would have to contribute to their own care. The Opposition co-operated with the Government in getting the 2014 Act through Parliament and the Government announced the cap at £72,000, but then they postponed its introduction and in the election they effectively abandoned it. No explanation has ever been given to Parliament about why the Dilnot proposals have been abandoned.

There has been a 20-year search for a solution to this problem. It was not me who said that; it was the chief inspector of hospitals, who said:

“I think the one thing I regret is that 15 or 20 years ago when we could see the change in the population the NHS did not change its model of care”.

This is something we have all grappled with, but we have not yet come up with the solution that we need. That is why, through this consultation, we will be looking not just at finance but at quality of care, variation and sustainable staffing to rebuild the consensus that we need to move forward.

Given that the report has pointed out that staff resilience is not inexhaustible and that services are at breaking point, do the Government recognise the enormous contribution of voluntary sector providers, particularly—I declare my interest in the area—in palliative and end-of-life care and hospice services, which are maintaining patients in the community and taking a great deal of pressure off statutory services? Are the Government giving any consideration to a national funding formula, such as I propose in my Access to Palliative Care Bill, which has had its First Reading?

I join the noble Baroness in paying tribute to voluntary sector providers and volunteers, whether family members or others, who support care throughout the NHS and social care. There need to be more paid staff to meet the needs of our growing and ageing population, which is why the Secretary of State announced a 25% increase in the number of training places and more nursing associates. That is being put in place to make sure that the system, which is described in the report as stretched, has the capacity it needs to meet patients’ needs.

I shall give the Minister another chance. He did not even begin to answer the question from my noble friend Lord Hunt. Why did the Government drop Dilnot?

My Lords, the CQC report has shown that over the past two years there has been a reduction in beds in nursing and care homes, while the Lancet published the results of a research project in the summer showing that we will need an extra 9,000 beds per annum by 2025—that is more than 70,000 beds. What are the Government proposing to do to make it easier for more homes to be set up and run and to fund the beds we clearly need urgently, not just in 2025 but from now on?

The noble Baroness will know that there has been a small reduction in the total number of residential nursing home beds, although it is a fairly flat picture over a long period of time. We have also seen an increase in the amount of domiciliary care. One of the things we need to get to the bottom of, and this is what the consultation will look at, is the imbalances that exist between the funding regimes for residential and domiciliary care. We have to get to the bottom of it, because it creates an imbalance on the provider side as well, so that we can have proper funding for the kind of care that people need regardless of whether it is in a residential nursing setting or at home.

Could I perhaps try again? I would like to give the Minister a chance to answer the very important question from the Lord, Lord Hunt, which he completely ignored. Why did the Government drop Dilnot?

The Government have not dropped Dilnot. We will be consulting on both the cap and the floor in the proposals that come forward on social care funding, which build on the Dilnot proposals.

Does my noble friend recognise that the importance of the cap on people’s contributions was that it made it an insurable element, and therefore it could be incorporated in people’s long-term pension and other plans? Will the Government please revisit the idea of abandoning the cap, which was a central part of Dilnot?

I reassure my noble friend that he is quite right to point out the benefits that attend to a cap. The intention is to consult on both the floor and the cap.

My Lords, I declare my interest as a member of the Dilnot commission but I will not actually go down that territory. Are the Minister and his department aware that over the last three or four years there has been a considerable surge out of publicly funded social care by all providers, particularly nursing homes? What risk assessment has his department made of the implications of that, particularly for the NHS?

The CQC report, which I am sure the noble Lord has looked at, talks about agencies and indeed nursing home providers deregistering. It also talks about the ones that are registering. There is a fairly consistent turnover in the number of those, so it is about balance. There is a similar number of providers within the market—again, with slightly fewer residential nursing and slightly more domiciliary to reflect the kind of balances of care that we have discussed.

My Lords, as the figures today show that the number of registered nurses in Britain is actually falling, and bearing in mind that the existence of care beds depends upon nurses, will the Minister answer the Question that I asked earlier this week and give us a progress report on the number of students who entered nursing courses at universities this September, so that we can make a judgment on the current position?

I think the noble Lord is referring to the King’s Fund report on nursing. It is important to stress that there are still greater numbers of nurses overall compared to 2010; indeed, over 11,000 more on wards. There are some particular shortages in mental health and community nursing, which have been alluded to before. In terms of the nursing numbers, he will know, because we have discussed this before, that there is a ratio of about 2:1 in the numbers of applications for nursing places. I do not have a more recent update than that. My expectation therefore is that that was the position going into September. I shall certainly write to him with the details. I emphasise that this increase in the number of training places, with funded clinical placements, is designed to address the issue that we have about the need for more nurses as we have a growing and ageing population.