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Social Care

Volume 807: debated on Wednesday 28 October 2020


Asked by

To ask Her Majesty’s Government when they will publish their proposals for the reform of social care.

My Lords, the Government’s current priority for adult social care is for all recipients of care to receive the support they need throughout the Covid pandemic. While we published a winter plan that looked ahead through winter 2021, we are acutely aware of the long-term challenges to the social care system in England and the importance of reform. Putting social care on a sustainable footing, where everyone is treated with dignity and respect, is one of the biggest challenges our society faces.

I am grateful to my noble friend for that reply, but this is not a happy story. Last year, the Prime Minister said:

“We will fix the crisis in social care once and for all with a clear plan we have prepared to give every older person the dignity and security they deserve.”

A few weeks ago, however, that reply was diluted in a Written Answer that said:

“There are complex questions to address to which we want to give our full considerations in the light of current circumstances.”

That is straight out of “Yes, Minister”. When will we see the clear plan announced 15 months ago, together with a commitment to the necessary funds to redress the imbalance between health and social care, so tragically revealed by the current pandemic?

My Lords, I reassure my noble friend that there is absolutely no dilution in the commitment to a long-term solution. No one in the Chamber would deny that the challenges in this question are extremely complex. The Government are also committed to cross-party talks and everyone in the Chamber recognises that we need a generational solution, not a political fix. In terms of finance, it is undoubtedly the case that the social care system has been under pressure during Covid. That why we have put an enormous number of funds—I could list them—into social care in the past six months. The refinancing of the social care system is one of the items that will undoubtedly be on the agenda.

My Lords, given the long delay in the publication of proposals for the reform of social care, the impact of Covid-19 on carers and care homes, and the implications of reform for the future of the NHS—not to mention the political sensitivity and complexity of the subject, which has been referred to—does the Minister agree that the best way to achieve the cross-party consensus to which he just referred would be through an ad hoc Lords Select Committee, as already proposed from these Benches?

My Lords, the development of a cross-party consensus is one of the great challenges that we have for the future. The mechanism that the right reverend Prelate suggests is imaginative, thoughtful and constructive, which I very much welcome and will take back to the department, but it is for the Prime Minister and the Secretary of State for Health and Social Care to define that precise process. But I completely welcome having our feet held to the fire on this issue. It is a massive priority that is at the top of the Government’s agenda.

My Lords, technology innovations have been used by healthcare professionals in the community during the pandemic. Really, they have flourished and have been shown to be of great benefit to social care. Will the Minister reassure the House that, during the reform of social care, funding is put forward for those innovations to carry on and indeed grow to their full potential?

My noble friend is entirely right. One of the experiences of Covid has been the mobilisation of technology to help those in social care. That has ranged from very basic implementation, such as sending iPads to people in social care so that they can message and video their loved ones when in some form of lockdown, to the work done with broadband providers to ensure that those without it can have access to it, all the way through to the use of the most complex artificial intelligence and big data, to help with diagnosis in social care, and the management of care itself. That commitment to technology will continue and will form an important part of improving the commitment to social care as part of the new regime.

The Royal Commission on long-term social care, chaired by the late lamented Lord Sutherland of Houndwood, reported in 1999. Only two years later, the Scottish Government adopted its main proposal of state support for personal and/or nursing care. How is it that, some 20 years later, successive Governments in the UK have failed to address the issue properly, in the way that the Scottish Government appear to be able to do?

The noble and right reverend Lord is entirely right. There has been a large number of reports on social care, but they have not in themselves brought us closer to a new deal. That is why the Government’s commitment is not necessarily to launch new reviews but to engage in consensus building across the political parties. That consensus building has been lacking in the past and has continually proved to be the stumbling block to reform. The commitment of both the Government and other Benches to those talks is the essential building block of any major reform. I completely pay tribute to the Leader of the Opposition and the Prime Minister for their commitment to those talks.

My Lords, the CQC’s report, The State of Health Care and Adult Social Care in England, was published earlier this month. Last year’s report described social care as being at a “tipping point”, and this year’s makes it clear that Covid has not only exposed but exacerbated existing social care problems and thrown into stark relief the long-standing need for reform, investment and workforce planning, including a new deal for care staff. The CQC stresses that the legacy of Covid for social care must be that these crucial issues are tackled now. Why can this not be a priority for the Government and why can we not have at least a timetable for the publication of the social care reform proposals that the Government keep promising but failing to deliver on?

My Lords, I recognise the power of the CQC’s comments, and its report is indeed powerful. However, I have to be realistic. We are in the midst of a Covid winter, when there are enormous challenges in keeping the show on the road. We have an infection control fund of £600 million invested in social care, which demonstrates both the commitment of the Government to supporting social care and the sheer scale of ensuring that those in social care through this winter are protected from Covid and other influenzas. It just would not be right to launch an important and industry-changing reform process when the focus of everyone in social care is the protection of the vulnerable and our loved ones.

My Lords, the noble Lord, Lord Young of Cookham, is absolutely right to ask this Question on an issue that Covid has highlighted as needing urgent and very long-overdue reform. I am pleased that the Government have plans to work on a cross-party basis to sort out this pressing issue. When does the Minister expect those talks to begin?

Talks are happening in the background in many ways. I cannot give the noble Baroness a precise date, because our focus is very much on managing Covid and learning its lessons, including from the CQC report that the noble Baroness rightly pointed out. But this is a massive priority both for the Government and for opposition parties, and I can reassure the noble Baroness that it will be taken on board at the soonest possible moment.

My Lords, further to the question from the right reverend Prelate the Bishop of Carlisle, the Economic Affairs Committee of this House produced a report on social care that had all-party support and was universally welcomed across the House. That was in July 2019—14 months ago. There has been no proper government response and no opportunity to debate it. How much longer must people in desperate need have to wait for the Government to reach a conclusion? I say to my noble friend that Covid is not an excuse for procrastination but an imperative for urgent action.

My Lords, we all acknowledge the power and intellectual insight of the Economic Affairs Committee report, which was welcomed on the Floor of the House and speaks for itself in terms of its authority and insight. But my noble friend is, I am afraid, not being reasonable when he says that Covid is not an excuse for inaction. There is an enormous focus on the front line and by the management of the NHS and the DHSC on preparing the winter plan, which is ambitious but also extremely stretching. There simply is not the management or political capacity to take on a major generational reform of the entire industry in the midst of this massive epidemic.