My Lords, it is a pleasure to follow the noble Lord, Lord Rees of Ludlow. I was particularly impressed by his argument that we can influence climate change more than our contribution to carbon through research. It is a very powerful argument and certainly a new one to me. He is, of course, a cosmologist. I want to concentrate, in the short time I have, on social care. Sometimes I feel that officials in the Treasury have the noble Lord’s perspective on time in respect of this issue.
I think it was Winston Churchill who first said that the state has a duty to provide a net below which no one can fall and a ladder to help them get out of the net. Like the noble Baroness, Lady Janke, I believe
that very strongly. Social care policy is about protecting our frailest and most vulnerable people, who cannot climb any ladders and whose quality of life depends on that net. Sadly, as several speakers have said, it is wholly inadequate, full of holes and now disintegrating under the inexorable pressure of demand. By 2040, for every working adult there will be almost one person over the age of 65. The cost of care for older people will double between now and 2035. This is not just an issue of an increasingly elderly population either. Almost half of expenditure on social care goes on people of working age, and that population will increase too. By 2025, there will be 150,000 more working-age adults with moderate or severe disabilities and 16,000 more with learning disabilities.
The system is completely broken, with Age UK estimating that 14% of elderly people have an unmet care need. The number of people receiving publicly funded care has actually fallen in recent years. In England there were 40,000 fewer such people in 2013 than there were in 2009—a 26% fall, despite an increase in demand. The fact is that it is the impact on the budget, not well-being, that now determines whether needs will be deemed eligible for support by local authorities. Just to get to where we were 10 years ago in quality and access to care would cost around £8 billion.
What is to be done? Since I left the Government at the invitation of the electorate in 1997, 12 Green Papers, White Papers and other consultations and five independent reviews have attempted to solve the issue of social care funding. All have pointed to the same answer: we need to find considerably more money and achieve a consensus between the Government and the Opposition to underpin a long-term, stable system. I very much welcome, therefore, the commitment in the gracious Speech to achieve that.
Last year, the Economic Affairs Committee, which I do the best I can to chair, was able to reach unanimous agreement on a way forward. Its membership included two former Chancellors of the Exchequer, two former Permanent Secretaries to the Treasury, a former Cabinet Secretary, a distinguished economist of the left, a retired FTSE 100 CEO, a non-executive director of the Bank of England and other highly experienced members. If we could find agreement, why can the political parties not? It would mean the state writing a big cheque and providing clarity about the future structure, and it would require a determined effort to simplify the system and remove many of the unfairnesses from it. Above all, it would require a major effort to educate the public.
The fact is that most people do not have a clue about the level of support they can expect if they are struck down by illness or fragility and find themselves unable to meet their own basic needs for washing, feeding, continence and mobility. The problem becomes apparent to the voter only when an elderly parent or perhaps a family member has a severe disability. The Local Government Association survey found that 48% of English adults did not even know what the term “social care” meant. The King’s Fund found that people were shocked when the means test, the extent to which they were responsible for paying for their own care and the complexity of the system were explained to them.
There are real injustices in the system which need to be addressed. Self-funders in residential care are being charged 41% more than those who are publicly funded. It is a hidden tax on people who have saved throughout their working lives. In England, it is quite scandalous that access to basic free care is limited by diagnosis and not need; a person with cancer will be helped but someone with dementia or motor neurone disease will not until they have spent every penny down to £23,500. The means test does not include the family home as an asset if domiciliary care is provided, but it is counted for residential care, leaving some families faced with catastrophic costs losing everything.
The pay, treatment and training of the care workers is woefully inadequate. Care homes regularly lose dedicated men and women to stacking shelves in supermarkets and the turnover among staff is approaching 40%. There is a desperate need to invest in the social care workforce and ensure a joined-up approach to workforce planning. I know how wonderfully committed and poorly rewarded care workers are. It is a vocation for most of them, not just a job, and they deserve a proper career path and professional status, like nurses.
Today, yet another Bill or Green Paper is awaited from the Government and, like Billy Bunter’s postal order, it has been endlessly delayed. With each delay the suffering increases, the pressure on unpaid carers grows, the supply of carer providers diminishes, the availability of qualified carers is reduced and the ability to put in place a system of social care that is sustainable and worthy of a civilised country is prejudiced.
To the Government’s credit, the Secretary of State for Health and Social Care wrote to me in September promising that the Government will set out plans in due course to fix the crisis in social care once and for all—to give every older person the dignity and security that they deserve and to protect children, parents and grandparents from the fear of having to sell their home to pay for the cost of care. These words are reflected in the gracious Speech. I hope and pray that they are soon turned into action.
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