Health and Social Care — House of Lords, 2021-09-09
Topic: Health
Angela Smith (Labour, Centre-left): My Lords, yesterday we saw in the House of Commons quite an extraordinary sight. The very day after an outlined policy announcement on social care, the Government rushed through a vote for a 10% increase in national insurance contributions that will not even be used for that purpose until 2023 There is a no doubt that addressing social care is a critical and complex issue, and one that is expensive to address. However, what we heard in the Prime Minister’s Statement was not the oven-ready plan he promised two years ago. The danger for the Prime Minister—and, unfortunately, for the country—is that this now feels like an impetuous decision made for political reasons when there are so many who are willing to work across parties, professions and interests to find a consensual way forward. Despite the usual hyperbole, we did not hear a plan for dealing with a system crumbling under strain; nor did we hear a guarantee that this money will go into social care Despite this measure being flagged as a social care policy, the Prime Minister announced that, for at least the next three years, the bulk of the money raised by the levy will be spent on the NHS to "clear the waiting list backlog". Yet the Secretary of State for Health seemed very uncertain that this would work. Waiting lists were already at record highs even before the pandemic struck, and our health and social care services had been left weakened and exposed when the virus hit Where would that leave both the NHS and social care services? To me, this feels just a bit too close to the Prime Minister’s Brexit bus tactics. Remember: Brexit was going to deliver £350 million a week to the National Health Service. Already, care sector experts and leaders are critical of using the NHS as a political fig leaf to break a manifesto commitment and make the introduction of a deeply controversial tax palatable, as well as using it to cover up many mismanagements and misjudgments during the handling of the pandemic. If the Prime Minister’s tactic of a rushed vote was to avoid scrutiny, it has failed. On an issue of this magnitude, scrutiny is essential. It is not just about holding the Government to account; it is about trying to get the best policy outcomes At the election, the Government promised to ensure that no one needing care would have to sell their home to pay for it. Can the Minister repeat that commitment today? The cap benefits those who live in the most expensive parts of the country or have the most expensive houses, but someone who has a house worth £100,000, for example, will still have to pay £86,000 for their care, even with the cap. That cap does not include the associated care home living costs, which are not covered by the cap and often far exceed the personal care costs of residential care The Chancellor’s explanation yesterday, which I hope that Minister will not attempt today, was that people needing to raise money for care need not sell their homes while they are still alive because they can get a loan that is then repaid when their estate is sold after their death. That is nothing new. Deferred payments were already available. Did anyone really think that this was what the Government’s promise of not selling homes meant I think that most people understand that good services cost money, but it is the unfairness of these tax rises that is wrong, especially with the lack of a proper plan or guarantees. Two and a half million working families face a double whammy: a national insurance tax rise and a £1,000 per year universal credit cut which even the Government’s own analysis has said will have a catastrophic impact. So many of those who kept us going through the pandemic—the medical teams, the care workers, the shop workers, the cleaners, some of the lowest paid workers—will be paying more, but they are the ones who will benefit the least The Government have not listened to warnings or proposed alternatives for supporting social care, nor have they addressed the rising demand. Conservative Governments in the years prior to the pandemic have cut the social care budget by £8 billion. At present nearly 300,000 people are on local authority waiting lists for adult social care services in England because of the funding pressures and delays in assessments for social workers. Yet we heard absolutely nothing yesterday about the role of local government. It would be helpful if the Minister could say how much funding will be provided to support local government in delivering social care. She must understand that despite being on the front line, it is concerned that the NHS will absorb the extra money and that the social care allocation will be swallowed up by the cap costs The Association of Directors of Adult Social Services has said that a chronic shortage of care workers means that more than one in 10 people assessed as needing care in their own homes were instead offered care in residential facilities, often against their own wishes. This is a stark reminder of why we need the investment now. A well-thought-out plan would, as we have repeatedly said, involve a real reform of services that allows people who wish to do so to stay in their homes for longer. There is nothing in the Prime Minister’s Statement about how we use technology, how we improve home adaptations, how we build and adapt more lifetime homes and how we support care workers. Can the Minister tell us whether there has been any engagement with charities and campaigners who deal with these issues every day of their lives, with the national forum, with policy makers, with service users or with carers It is a huge frustration that the long-promised White Paper on reforming social care and integrating it with healthcare has again been kicked into the long grass. All Ministers have said is that it will be published later this year. Would it not have been logical—a response to this would be appreciated—to publish the White Paper, set a timetable to consult and then discuss and engage in order to provide a transformative plan that includes how we support an army of unpaid family carers, how we ensure that working-age adults with disabilities have more control over their lives and how we tackle the workforce crisis and support care workers? Instead, we have an unfair funding plan, no reforms and no guarantees None of us underestimates the scale of the challenge this issue presents in funding and providing the proper services the country needs. Unfortunately, the fear now is that in the Government’s rush, they have missed that opportunity to seize the real prize for the British people. There is a better way to do this.