Skip to main content

Adult Social Care

Volume 776: debated on Tuesday 15 November 2016


Asked by

To ask Her Majesty’s Government what is their response to the warning by the Care Quality Commission in their State of Care report, published in October, that adult social care is approaching “tipping point”.

My Lords, we welcome the State of Care report. We know there are serious pressures on the care system. That is why we are giving local authorities access to up to £3.5 billion in new support for social care by 2019-20 so they can increase social care spending in real terms by the end of this Parliament.

I thank the Minister for his usual courteous reply, but I think he knows that the funding he has announced there for the better care fund is both too little and too late. Does he agree that there have never been so many challenges for the social care system? There is terrible pressure on the NHS and on caring families, and many people have no care at all at home, however great their needs. Does he further agree that there has never been so much consensus about what needs to be done? Across all professions and political divides, we hear that what is needed is more money, and more money now. I am well aware that asking for commitments in the Autumn Statement is above the Minister’s pay grade, but could he please assure the House that he and his colleagues are stressing the urgency of this matter to the Chancellor of the Exchequer and asking him to make more funding for social care an urgent priority?

My Lords, I think most people in the health and care system, whether it is Simon Stevens, the chief executive of the NHS, or the Secretary of State, realise how serious pressures are in social care. There is no question about that. The State of Care report from the CQC supports that view. That is why we are putting in more money towards the end of this Parliament. It is back-end loaded—I accept that—but on the other hand the £3.8 billion that went into the NHS this year is front-end loaded. I think everyone agrees that the only way out of the difficulties we are in is for health and social care to work much more closely together.

My Lords, it is good that extra money is coming into the NHS, even if it is loaded in the wrong direction at the moment. However, this Question is much more about care. The real problem at the moment is that social care is significantly starved of funding. What will the Government be doing to ensure that real cash goes into social care to help to alleviate the problems that the NHS is facing due to people remaining in hospital because there just are not the places for them to go nor the assessments for them in social care at the moment?

My Lords, the squeeze in social care started in 2010. Between 2010 and 2015, spending on social care declined in real terms by 12.8%. That was a significant reduction in spending when the noble Baroness’s party was in power in the coalition Government. Since then, it remains very tight in social care. As I said, we are putting more money into the NHS at the front end of this Parliament. We have introduced the 2% precept for local authorities to raise money for social care and we have put £1.5 billion into the better care fund, starting from 2017-18, which will provide more money for social care at the end of this Parliament.

My Lords, everybody agrees that there is enormous pressure on social care which, as has already been mentioned, is impacting adversely on the NHS. Is it not time for an independent commission with cross-party support to look at the whole area of health and social care, including something like the Japanese model, which funds social care so successfully?

My Lords, I know that the noble Lord is very keen on an independent commission, and he knows my views on that. I do not think we need an independent commission to tell us that social care and health care must be more joined up and integrated; we all know that. We can do that through a major reorganisation from the centre—but we know what big reorganisations do to the health service: they stymie it for years—or we can work locally in the STP and local authority areas to try to drive this at local level, which I think is the right way forward.

My Lords, an independent commission on care reported recently. It called for a national care service and for adequate investment in the social infrastructure of care now, not at the end of the Parliament, to give care equal status with the NHS and to prevent us going over the tipping point. The tipping point is here; we cannot wait until the end of the Parliament. Will the Minister and his colleagues take those recommendations seriously and urgently?

There is no question but that we all recognise the enormous pressures on social care. I cannot comment on what may or may not be in the autumn Statement, but I entirely recognise the pressures to which the noble Baroness draws our attention. As I said, the Government did not have resources available to put money into the NHS and social care at the same time at the beginning of this Parliament because we have to live in the real world, which is very financially constrained. As I said, an extra £1.5 billion is going into the better care fund and an extra £2 billion will be raised by the local authority precept by the end of this Parliament.

My Lords, given the well-established engagement of faith groups in the area of social care, such as the Good Neighbours support service in Hampshire, what progress have Her Majesty’s Government made in reducing barriers to engagement by faith and belief groups, as recommended by the Local Government Association in its 2012 report, Faith and Belief in Partnership?

I cannot answer specifically the question raised by the right reverend Prelate, but I would say that voluntary and support groups of the kind that he mentions have a hugely important role to play in delivering social care. I visited Crossroads in Gloucester with the noble Baroness, Lady Royall, last Thursday and was struck by the extraordinary work that voluntary groups do—and what carers do, of course. If we relied purely on statutory services, the whole health and social care system would collapse tomorrow.

My Lords, my noble friend will recall that in the coalition Government, Andrew Dilnot and his team produced a report on how to give longer-term sustainability to social care and enable people not to suffer catastrophic losses when they are long-term care recipients. Will the Government commit not only to introducing the Dilnot recommendations but, perhaps earlier, to funding it, and to do so by bringing the domiciliary care means test in line with the residential means care test, which would raise £1.3 billion a year?

My Lords, the Government are committed to introducing the proposals of the Dilnot commission by the end of this Parliament in 2020, and I understand that during 2017-18, we will bring back those proposals to refresh them, but with a view to phasing in implementation in 2020.

My Lords, the CQC report particularly highlights the crisis in residential care, showing that at a time of growing need the number of care homes in England has fallen by 8% in the past six years. Age UK’s report, published a couple of days earlier, warmed to the plight of self-funder residents in private care homes, who are having to pay higher fees because local authorities cannot afford to pay the actual care costs of the residents whom they support. Is not that the problem that the Dilnot proposals under the Care Act were designed to address, and does not it underline the fact that self-funders are ultimately paying the price for a care system under severe pressure and in desperate need of extra funding and investment?

My Lords, it is interesting with regard to the CQC’s State of Care report that there has been a decline in the number of residential care beds—that is absolutely true. However—and this is an extraordinary statistic—from 2010 to date, the number of domiciliary care agencies has increased from 5,700 to 8,500. The other interesting trend that came out of the CQC report was that, on balance, smaller care homes, nursing homes and domiciliary care agencies tend to perform better than the big ones. That is because they can deliver a degree of personalised care—a sort of home-from-home care—that the bigger concerns cannot. But I totally understand the point that the noble Baroness makes. This sector is under tremendous pressure; we recognise that.