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User-led Social Care

Volume 671: debated on Wednesday 5 February 2020

I beg to move,

That this House has considered user-led social care.

It is a pleasure to serve under your chairship, Sir Christopher. I draw inspiration today from Jerry Ndi, a student at Northolt High School who just last night won the Ealing regional final of Jack Petchey’s “Speak Out” challenge. I am sure that all Members here will join me in saying that everyone who took part and spoke last night should be very proud of themselves.

Social care is in crisis. Some 1.5 million people over the age of 65 do not get the social care they need. More than a third of people who receive local authority-funded care or support have to purchase additional support themselves. In fact, over the past two years nearly 10,000 people have had to approach their local authority for help after running out of money. That is the result of the Government’s deep cuts to public services since 2012, with a total of £7.7 billion taken out of social care budgets. As councils have been forced to narrow the eligibility criteria for social care, far too many people are denied the support that they need. This chronic underfunding, alongside a shift to private providers, has hit not only those who need social care, but those working in the sector—people who are routinely paid below the London living wage or the living wage outside of London.

There are more than 122,000 vacancies in the adult social care sector. Care workers are far too often undervalued, underpaid and overworked. The numbers providing care informally to friends and family is growing rapidly too; 1.25 million people in the UK, nearly 70% of whom are women, combine looking after young children with caring for older or disabled relatives. Nearly 90,000 of these care workers provide more than 35 hours of care each week, and half are still in paid work.

Our social care system is in urgent need of proper funding and a system that no longer incentivises a race to the bottom on quality and on workforce conditions, which is why, on 16 January, after giving my maiden speech, I voted to ensure that health and social care are properly funded, with an additional £26 billion in real terms. This extra funding is vital to support the social care system that we need.

Alongside greater funding, we also need to look at the way that social care is provided, which is why the focus of the debate is on the key role that co-operative principles can play. Under a co-operative approach to social care, care services should be not-for-profit. We will never be the caring society that we should be when services supposed to help the vulnerable are driven by profit. Services should protect workers’ rights. Those who protect this most valuable and often difficult of services deserve our support and protection, not to be forced on to lower wages and insecure contracts. Services should put care workers and providers at the heart of decision making. The commissioning and running of services should benefit from the invaluable knowledge of those who receive and provide care.

These principles and co-operative approaches to care are not just theoretical; they are beginning to be implemented and developed in places across the country. The Equal Care Co-op in the Calder Valley is just one example of a local area leading the way. I am pleased that the London borough of Ealing is also taking a lead on this. Following the local elections in 2018, Ealing Council held a public meeting for local residents who were interested in establishing a care co-operative. That led to a founding group being formed, including carers and those receiving care, who deserve our thanks for their valuable work on this matter. The group is currently developing a feasibility study, and their experience, particularly of the challenges they face, can help us to better understand the barriers that co-operative models of care face more widely, and therefore what support is needed from national Government.

It will not surprise anyone listening to learn that the feasibility study faces the challenge of growing demand for care services in the face of inadequate funding. However, it also faces challenges with the competitive commissioning regime, the current system of Care Quality Commission registration and the lack of an appropriate Government funding framework.

The experience in Ealing shows that councils could do far more if they had support from national Government, so I will put several points to the Minister. First, there should be a right of first refusal for social workers to step in and take over failing private organisations that provide social care. At the moment, when private organisations face financial difficulties, they are often sold on to another private organisation or simply closed down. Where private organisations are failing, employees should have an opportunity to take on all or part of that organisation.

Secondly, we need protection against asset stripping. Mutualised social care services should be asset-locked, to ensure that assets of all types are locked within the organisation, which is crucial to preventing asset stripping or demutualisation. Thirdly, we need regulation to support co-operative models over for-profit ones. Currently, all non-state providers are categorised as independent, which undermines the ability of care users and their families to distinguish between for-profit and not-for- profit providers. The CQC should modify its inspection methodology to ensure that the benefits of non-profit co-operative models can thrive. Fourthly, local authorities should be given a duty to promote co-operative organisations to deliver care in their area. We can learn from the Social Services and Well-being (Wales) Act 2014, which puts a duty on local authorities to promote co-operative organisations to deliver care in their area.

These steps by national Government would help support co-operative approaches to social care, putting the people who need social care, their families and their care workers at the heart of decisions about how social care is provided. We must stop allowing private companies to profiteer while those who rely on social care, and the workers who provide it, pay the price.

It is a great pleasure to serve under your chairmanship, Sir Christopher. I congratulate the hon. Member for Ealing North (James Murray) on securing this important debate. I welcome him to his role—I know that he was only recently elected—and hope that he will have a long and enjoyable career in Parliament.

I join the hon. Gentleman in recognising and paying tribute to user-led organisations, carers, care professionals and the army of incredible unpaid carers working in adult social care, striving for the best possible care and support for people across our country. They do a remarkable job every single day, and they work with great skill and compassion.

The hon. Gentleman is absolutely right to stress that the sector is under enormous pressure, but he is wrong to say that this is new or the result of Government cuts. Unfortunately, I am a very elderly lady—he has the benefit of being a lot younger—and I can recall successive Governments over past decades wrestling with how to fund adult social care.

We have had unpleasant exchanges where adult social care was used as a political football, with unhelpful language on both sides of the argument—nobody is blameless—describing attempts to solve adult social care issues as a dementia tax or a death tax. In the 2017 general election, the Labour party committed in its manifesto to tackling adult social care and putting it on a sustainable footing and never actually got around to doing it. Successive Governments have wrestled with this. We have had numerous Green Papers, White Papers and independent papers and, one after the other, every Government has put this in the “too difficult” pile.

Surely the Minister recognises that, notwithstanding our need for a long-term, cross-party solution to this issue, it is a fact that more than 1 million people who do not receive care today would have been entitled to care in 2010.

I think those facts are a little misleading. We often read about the facts that the hon. Gentleman cites—the Age UK fact that 1.4 million people out there have unmet care needs. In fact, that is a little misleading, because it suggests to me that there are people out there whose care needs are not being met at all. A large number of those people are actually self-funding.

We do need to have a conversation and to try to build a consensus on how much people should be contributing to their care, and whether they should be contributing to it at all, but their care needs are being met. However, the fact is that one in 10 of the population will have catastrophic care costs—care costs in excess of £100,000—and of course that is not acceptable, and we need to find a way to address it. There are more than 10 people in this room, and one of these 10 people will have catastrophic care costs, but the terrible thing about it is that we cannot predict—there is no way of predicting—which one of us it will be. That is why we need to work collaboratively, in a cross-party way, to seek some kind of consensus on how we move forward and address the issue.

Let me talk about some of the things that this Government have done. We have provided councils with access to £1.5 billion for adult and children’s social care next year. That includes an additional £1 billion of grant funding for adult and children’s social care and a proposed 2% council tax precept, which will allow them to raise a further £500 million in council tax. Let us just think about those sums for a moment. We throw around the words “billion” and “million” as if this were pocket change. They are huge sums of cash, which just shows the extent of the issue that we are dealing with. The new funding is on top of maintaining £2.5 billion of existing social care grants. That will support local authorities to meet the rising demand, which has been referred to, and continue to stabilise the social care system. I often hear talk about cuts to the social care system, but thanks to that investment, public spending on adult social care in 2018-19 reached £17.9 billion in cash terms. That is the highest level on record, and since 2016-17 that sustained investment has enabled spending to increase by 7% over this period, so we do need to be up front with the facts.

There has also been a much more open and competitive market in adult social care. For more than 30 years, private providers and voluntary sector organisations have increasingly been responsible for providing services, which leads to increased choice and better outcomes for individuals. That results in improvements in quality. In January 2020, for example, 84% of all registered adult social care locations were rated good or outstanding by the Care Quality Commission, which of course is independent. High-quality, personalised care and support can be achieved only where there is a vibrant and responsive market of service providers. The role of local authorities is of course critical to achieving that, both through the actions that they take to directly commission services for providers to meet needs and through the broader understanding and interactions that it facilitates with the wider market for the benefit of all local people and communities.

The Government want to give people much more choice and control over their care and support, and user-led, strengths-based approaches will help to deliver on our ambitions to achieve better outcomes for all. That is why I am pleased that the hon. Member for Ealing North has brought this debate to the Chamber today; I really welcome the opportunity to talk about this issue. I am delighted that we have taken substantial steps to embed person-centred care and support at the heart of our social care system. Personalised care has demonstrated the ability to improve outcomes and enhance quality of life, enabling people to take a level of control and responsibility that they feel comfortable with. Fundamentally, it recognises what we all know: a person is an individual, with their own unique needs, wishes and opportunities. That is why in the Care Act 2014 we enshrined personal budgets—including user-led, co-produced personalised care and support plans—as the default model of delivery. It is a bespoke way of meeting their needs and circumstances.

Having had this ministerial role for two years, I have met some of the individuals who have benefited from personal care budgets and seen the immeasurable impact that they have had on their lives. They included one incredible lady called Jackie, a former Metropolitan police officer who was injured in the line of duty, and who had quite extensive health and care needs. She is in a wheelchair and has a whole range of physical and mental health needs, to the extent that she was being blue-lighted to hospital about 70 times a year. By using her personal care budget, she now has an assistance dog, called Kingston. He is quite remarkable and fabulous: he understands about 200 commands, which is incredible, and he has changed her life. He is able to predict an epileptic fit about 45 minutes before she has one, and he can ensure that she is in the right position to be able to cope with it. Also, without any training, he can predict a diabetic attack about 15 minutes before she has one, and he then brings her the insulin kit. Since having Kingston, Jackie has not been blue-lighted to hospital at all. That shows that, as well as being an amazing friend and companion to her, he has had an immeasurable impact on her health and wellbeing. That is the strength of a personal care budget. It is really remarkable.

Ultimately, our ambition is for high-quality, personalised care to become the norm across the health and social care system. I am confident that we will maintain the energy and commitment necessary to meet that goal, but the ambition cannot be achieved without a cultural shift to holistic, strengths-based practice. What I mean by that is shifting the focus to what people can do—their strengths—not what they cannot do. It concentrates on the things that really matter to the individual, their family and their local community. It engages and empowers people to identify solutions that will allow them to experience the care and support that they need to live as independently as possible and to fulfil their wishes. Through that approach, social care practitioners and commissioners can connect people to the types of support and community organisations that will enable them to improve their overall quality of life. It is gaining ground across the country and working very well in areas such as Wigan, Hertfordshire and Thurrock.

Person-centred practice and co-production are at the heart of social work. The hon. Member for Ealing North mentioned social work, and it comes as no surprise that social work has led on developing and applying strengths-based approaches. In 2017 we published a report, alongside the Social Care Institute for Excellence, on strengths-based social work, and last year the chief social worker for adults produced a practice framework for supporting practitioners. Social workers are unique in working alongside people to consider the totality of their life and advocate for their freedom, dignity and human rights. They are also key in working with our communities as a whole, supporting people to live independently and to live much more included lives.

To achieve the transformational, personalised care across the country that we want to see, we must work much more collaboratively. Cutting across multiple agencies and professions, social workers undoubtedly play a role in ensuring that that happens. Together with the chief social worker, we will continue to support local authorities to embed that kind of practice in adult social care. We will also continue to collaborate with leading—they are incredible—user-led organisations such as Think Local Act Personal, which encourages good person-led practice locally.

The hon. Gentleman spoke about co-operatives. Under the Care Act, local authorities are required to shape their whole local markets to ensure that they are sustainable and diverse and that they offer high-quality care and support for people in their local area. Clearly, there will be local areas where co-operatives can play a really important role in the provision of care services. More- over, as part of their Care Act responsibilities, local authorities have successfully worked with individuals and communities to develop preventive and community-led social care opportunities.

We know of course that social care is under pressure, because of growing demand from the ageing population. Sometimes I get frustrated because we all talk as if the ageing population is a terrible thing. That people are living longer is a good thing and something to be celebrated, but we need to ensure that those additional years of life are happy and healthy for as long as possible, that people are able to live independently for as long as possible and that care is there when people need it. That is why we are providing councils with a £1 billion grant for children’s and adult social care, on top of maintaining £2.5 billion of existing social care grants. The additional resources will help councils to commission care services that are sustainable and diverse and that offer sufficient high-quality care and support for people in their areas.

The Government have been very clear that fixing the issues with social care is a significant priority. As my right hon. Friend the Prime Minister has said, the Government will deliver on our promises: we will bring forward a plan for social care this year. These are complex questions to address, which is why we are seeking to build a cross-party consensus, but we have been very clear that everybody will have safety and security, and nobody will be forced to sell their home to pay for their care.

Question put and agreed to.

Sitting suspended.