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Social Care Reform

Volume 813: debated on Tuesday 29 June 2021

Commons Urgent Question

The following Answer to an Urgent Question was given in the House of Commons on Wednesday 23 June.

“I thank the honourable lady for her question, and for giving me the opportunity to talk about social care reform. I start by paying tribute to carers, paid and unpaid, for all they do in looking after people in their homes and in care homes every single day with kindness and compassion. To any who may happen to be watching or listening today, I say ‘Thank you for what you do.’

Over the past year in government, we have rightly focused on supporting social care through the pandemic. This has included an extra £1.8 billion of funding, sending more than 2 billion items of free personal protective equipment to care providers, distributing more than 120 million Covid tests to social care and vaccinating hundreds of thousands of care home residents and most of the care workforce.

While the pandemic has posed unprecedented challenges to social care, it has also strengthened the argument for reform, and we now have the opportunity to build back better in social care. We have a once-in-a-generation opportunity to build a care system for the future, and I am hugely ambitious. I want a care system in which we can be confident, for our grans and grandads, mums and dads, brothers and sisters, children and grandchildren and, indeed, ourselves. I want people to be able to get the care that they need when they need it, and to have choices—to live life to the full in the way they want, living independently and part of a community for as long as possible, without facing an astronomical bill.

I want to join up health and care around people, so that it works as one system dedicated to meeting the needs of individuals, and giving them the personal care they want and need to live their lives to the full. I want the care workforce to be properly recognised and valued for what they do—for their skills, their compassion and their commitment. I want them to have more training, more opportunities and more prospects for career progression. I am committed to supporting unpaid carers not only in the care they provide but with their own health and well-being, so that they can live their own lives as well as caring for others.

We are already taking steps on the road to reform. The health and care Bill will introduce Care Quality Commission oversight of local authorities’ provision of social care. It will also help to join up health and social care by putting integrated care systems on a statutory footing. We are working on our long-term plan for social care, and we will bring forward our proposals for social care reform later this year.”

My Lords, in last week’s very powerful debate on social care, noble Lords from across the House made it clear that we cannot build a better future for our country after Covid-19 without transforming social care, but instead of a firm date for the Prime Minister’s clear plan, we had the usual reassurances from the Minister that it was still absolutely under way, we would see some social care foundations in integrated care systems under the NHS and care Bill but that it would still be the “end of the year” before the Prime Minister reveals his clear plan to all.

Over these nearly two wasted years we have had delays and broken promises. Almost 42,000 care home residents have died from Covid-19, 2 million people have applied for support but had their request refused, tens of thousands have had to sell their home to pay for care, millions of families have hit breaking point and staff have been appallingly let down. Even after all the horrors of this pandemic, nine out of 10 councils say that they face care budget cuts this year.

While the Government dither and cancel key meetings and the Prime Minister blocks various funding options, the social care funding crisis deepens. Now we see in the Daily Telegraph that the new Secretary of State considers that we are completely at the wrong stage of Parliament to launch a new social care strategy. What is going on?

My Lords, the commitment to publishing a review of social care is absolutely heartfelt. We have delivered on Brexit and the vaccines, and we will deliver on social care. The Prime Minister has made it crystal clear that that will be done by the end of the year; that commitment remains in place. It will require enormous financial commitment by the whole nation at a time when our finances as a nation are extremely stretched. Therefore, it is entirely right that very careful consideration is given to it. It will also involve a very large amount of engagement with other parties and the relevant stakeholders. Again, this is not something that has been rushed. We have just been through the most awful pandemic; it is not possible to do a review of this generational nature at the same time as fighting this awful disease, but we will be true to our commitments and deliver the plan as promised.

My Lords, in last Thursday’s debate on social care and carers, the Minister said

“a plan for reform absolutely is under way. We have before us the building of foundations, which will be laid in the social care measures in the health and care Bill, which will support us in working together”.—[Official Report, 24/6/2021; col. 447.]

Arising from that, is it planned to publish a White Paper or any other consultation document or, as the Minister’s speech implied, will the reforms be published as part of the health and social care Bill without any wider consultation? Given his answer just now to the noble Baroness, Lady Wheeler, will parliamentarians be ask to make decisions on the health and social care Bill without seeing the details of the future social care reforms?

My Lords, new legislation will increase integration between health and social care by removing barriers to data-sharing, enabling joint decision-making and putting more power and autonomy into local systems. The noble Baroness is entirely right on that. The Bill has been published and the noble Baroness is very welcome to engage in some of the engagement sessions that I have had on it already. I should be glad to run more, if that would be helpful to her. A White Paper and a public consultation are not planned.

My Lords, press reports suggest that the Prime Minister is in favour of including in social care reform the Dilnot commission recommendations that are now a decade old. In doing so, he could bring into force Sections 15 and 16 of the Care Act 2014, which this Parliament passed seven years ago. Will the Government now consider doing exactly that to enable a cap on care costs to be implemented rapidly?

My Lords, we are extremely respectful of the Dilnot commission report and the recommendations in it, particularly those highlighted by my noble friend on Sections 15 and 16. It is one of many proposals that we will look at very carefully. We cannot make a commitment to anyone in particular at this stage but, as I said to the noble Baroness, we will put forward a full plan by the end of the year and will remain true to that commitment.

Can the Minister assure the House that any proposals on the funding of social care will ensure that working-age disabled people who use care services can access the support that they need to live a full and independent life in the community and that the funding will be sufficient to ensure that they no longer have to pay for it, avoiding inequitable and unfair financial hardship?

My Lords, I hear the noble Baroness loud and clear. Indeed, the needs and priorities of those with disability and the role of care for disability and the emphasis on care in the community are things that we hear loud and clear. I am not in a position to make any commitments on finances standing at the Dispatch Box at the moment, but the noble Baroness’s points are heard loud and clearly, and I would be glad to take them back to the department.

Does my noble friend agree that it would be better for the state to enable homeowners to insure against the potentially catastrophic risk of social care, rather than diverting billions of pounds desperately needed to pay for the care system for those unable to pay for themselves, instead using those funds to subsidise people, like most Members of your Lordships’ House, who want to pass on to our heirs homes worth hundreds of thousands or even millions of pounds? How would that be levelling up?

My Lords, the point made by my noble friend is entirely thoughtful and persuasive. Indeed, there may well be a role for insurance rather than any other mechanism, and it will be one of the options that those who define the policy will look at extremely carefully. The point that he makes about the desire of homeowners to pass on their homes to future generations is completely understandable and human, and one that will take into close consideration.

My Lords, further to my noble friend Lady Campbell’s question, will the Minister commit to mentioning working-age disabled adults every time social care reform is discussed? The needs of older people living in care homes are important, of course, but that is an easier focus for improvement. The real challenge is to improve care and support for disabled adults living in their own homes, including people with learning disabilities and autistic people.

I am extremely aware of the point the noble Baroness is making. A very large proportion of those in care are not elderly at all but the young and adult disabled who need some care for some condition, whether physical or mental. Their needs are paramount in these reforms. We will not forget the people the noble Baroness describes; the financial arrangements for supporting them are one of the things we absolutely want to take on in these reforms.

My Lords, as well as declaring that he had a clear plan to fix the crisis in social care, Mr Johnson stressed in his infamous Downing Street speech of July 2019 that he was the Prime Minister of the whole United Kingdom. When the social care plan is finally brought forward, what guarantees can the Minister give to demonstrate that Mr Johnson’s Government value the social care needs of the people of Northern Ireland every bit as highly as those of patients residing in England?

My Lords, the noble Lord makes an entirely fair point. The needs of those who reside in Northern Ireland are paramount in our minds. I would be very glad to meet the noble Lord and discuss how their views and needs can be best incorporated in the policies we are developing.

My Lords, does the Minister accept that public opinion has shifted, and that the public are now prepared to pay more to ensure that the elderly and vulnerable are properly looked after? Will the Government look at other countries’ attempts to deal with this tricky problem in terms of financial commitment? Japan has a surcharge for people over a certain age—I believe it is between 40 and 45 —and Germany has long had a solidarity tax to pay for particular hypothecated items. Will they at least look at this before the autumn spending review?

My Lords, I reassure the noble Baroness that we are looking at foreign parallels. The examples she gives are extremely instructive and thoughtful. I cannot speak for certain on where the public are on this, but I share her sentiments; I think the pandemic has demonstrated that the public are more connected with and thinking more about those in care than ever before in our nation’s history. It is exactly the right moment in terms of public sentiment to address some of these issues. The generosity of spirit towards the elderly living in care could not have been higher than it was during the pandemic. In that matter, I completely agree with the noble Baroness.