PARLIAMENTARY DEBATE
Social Care Reform - 23 June 2021 (Commons/Commons Chamber)

I thank the hon. 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.

Of course we have focused on supporting social care through the pandemic over the past 18 months; that absolutely had to be the right thing to do when facing an unprecedented challenge. During the pandemic we not only supported social care, including, as I said, over £1.8 billion of extra funding direct to the care sector, but supported local authorities with over £6 billion of extra funding. But yes, we are determined to bring forward proposals for social care reform. We have been absolutely clear that we shall do that. The hon. Lady asked about particular meetings. Actually, the Health Secretary and the Prime Minister talk about social care reform all the time. In fact, I spoke to the Prime Minister only last week about social care reform. These are complex matters. The hon. Lady will know that nearly 25 years ago, Labour Prime Minister Tony Blair said that we needed reform of social care, but during the 13 years of Labour government, was there a plan for social care reform? No, there was not. We are the Government who are going to bring forward social care reforms. I would welcome her support for that. We are a Government who deliver. We have delivered Brexit, we are delivering vaccinations at a phenomenal pace, and we will deliver social care reform.

I thank my right hon. Friend for his support for our determination to reform social care. He makes an important point that we have to look at the NHS and social care together as the two parts of the system affect each other. That is one important reason why the health and care Bill needs to improve the join-up between health and social care. On his point about dementia, it is true that some people who suffer from dementia need care for very many years and this is extremely costly. That is one of the things we want to address as part of our social care reforms.

The Queen’s Speech reiterated our commitment to reform of social care, and that commitment has been reiterated many times by the Prime Minister and the Health Secretary. On the hon. Gentleman’s question about looking at other systems, of course we look and learn. We look at what works across and within England and around the UK, and in fact around the world. This is a complex thing to achieve and we are determined that we will bring forward our ambitious plans for social care reform later this year.

My right hon. Friend makes an important point about the breadth of the reform that is needed. I can confirm that we are looking at how we can support the workforce further, including by raising skills and improving training opportunities and career progression, and how technology can be used to support better care and more independence as well as providing more time for the workforce to do personal care rather than administration. On housing, most people want to live behind their own front door for as long as possible, surrounded by their own things and in their own communities, so that is also absolutely part of our reform.

We have of course had to focus on the pandemic over the last 18 months, but we are already working on reform. We are already consulting widely with the sector; I and the Department have together met and spoken to more than 70 different organisations and representatives of the care sector, from care providers to local authorities, and including care users and carers themselves. We will be working with this broad range of people, including parliamentarians; we need to build a consensus not only across Parliament but in society as a whole for our social care reforms.

My hon. Friend is clearly having conversations in his constituency, and he makes an important point about the scale and number of people who have involvement in the care system. There are over 1.4 million people who receive care, over 1.6 million people in the care workforce, and over 5 million unpaid or family carers. The scale is huge and is growing as more people need care. My hon. Friend is absolutely right that this is not a party political issue; we need to come together and build a consensus across Parliament, but also across society as a whole—and, yes, we will bring forward proposals for reform later this year.

The hon. Gentleman makes a really important point about respite for carers. Being a carer is hard and back-up support and respite services help make it more possible, but frustratingly, during the pandemic many of those services have not been able to function as normal. I am currently working with Ministry of Housing, Communities and Local Government Ministers to help local authorities across England ensure that day services and respite care are fully restarted as that is very important, and I would like to see that across the whole of the UK.

I hope my hon. Friend will forgive me if I am not drawn on the assumption point that he made in the second part of his question, but what I can say to him is that the Prime Minister has been clear that he wants a social care system where no one needing care should be forced to sell their home to pay for it.

Yes, I absolutely can. We know that cost is a real problem, but there is also a real variation in quality of care. In fact, we are already taking steps on that. That is one reason why the health and social care Bill introduces an assurance or oversight system of the provision of care commissioned by local authorities. Yes, the breadth of the issues that my hon. Friend refers to is being considered in our reform proposals.

One thing I am very aware of is that often the debate about social care reform is a lot about care for older people, but that we should also make sure we are thinking at least as much about care for those of working age with disabilities. I and the Government certainly do think about that. We are working on the national disabled strategy, which I have contributed to. It will be coming forward shortly.

I thank my hon. Friend for his invitation. I do my utmost to get out and about—at the moment, mainly virtually—but I am looking forward to being able to go on more visits in the weeks and months ahead. Absolutely, what I want to see is a high standard of care available for everybody across the whole country.

I would just remind the hon. Gentleman of the unprecedented level of support we have given to the social care sector during the pandemic, as I mentioned a moment ago. I know it has been extremely hard, but that is why we provided over £1.8 billion-worth of funding, free personal protective equipment, access to testing, and, of course, priority in the vaccination roll-out. On his point about needing to build a consensus around social care reform, I am already talking to parliamentarians across parties. In fact, just a couple of weeks ago I had a really helpful session with the all-party parliamentary group on adult social care. I look forward to continuing to work with colleagues across the House.

One thing I will say is that during the pandemic GPs and primary care in general have really stepped up to support those in care homes in particular, with every care home having a point of contact in primary care to ensure the support from GPs that those residents require. Yes, quality is at the centre of our proposals for social care reform.

Some really interesting and important work has been done on commissioning, looking at the outcomes of care rather than being so focused on inputs, which sometimes leads to the situation described by the hon. Member. One of the opportunities of the oversight system that we propose through the health and care Bill is that it will shine a light on the different ways in which local authorities commission care and give more visibility to what works. Those ways of commissioning that do not lead to such good outcomes can therefore learn from others. We look forward to seeing an improvement in how care is commissioned and, therefore, the care that people receive.

I can absolutely assure my hon. Friend on that point. One of the things we are committed to addressing is the situation where people may have worked all their lives to purchase and own a home and pay off a mortgage but then find themselves faced with a care bill of a size that uses up the value of their home when, perfectly reasonably, they want to be able to pass something on to their family.

I absolutely respect the experience that the hon. Member brings to this House, but I do not agree with quite a bit of what she said. We have done our utmost to support the more than 1.4 million members of the social care workforce during the pandemic, and our thinking about the care workforce puts them front and centre of the social care reforms that we are developing. That, of course, is because the quality of care is so much dependent on that fantastic workforce. I am determined that they continue to be front and centre of our work on reform. As I said, we will bring forward proposals for reform later this year.

My hon. Friend is absolutely right. The proposals in the health and care Bill are just a step on the road to reform, but they are an important step. That step includes the joining up of health and social care in integrated care systems and putting those on a statutory footing, and the oversight arrangements for social care provided and commissioned by local authorities. We will be building on those plans in our long-term plan for social care reform.

I would not want to upset the Chancellor by talking about tax policy at the Dispatch Box, but, as I have said to colleagues—and, in fact, as the Prime Minister has said—one of the things that we are committed to as part of our social care reforms is ensuring that nobody should have to sell their home to pay for their care.

The hon. Member asks about the hold-up. As I have said quite clearly, we have had a pandemic, which has been an unprecedented challenge for our country, our Government and our social care system. In fact, all those working on social care in the Department have been focused on our pandemic response for most of the past 18 months— perfectly rightly, I think the House would say. Thankfully, as we emerge from the pandemic—thanks to the fantastic vaccination efforts across the country, meaning that a huge number of those in care homes and care workers have been vaccinated against covid—we are now able to focus our attention on social care reform. That is why we will be able to bring forward our proposals for reform later this year.

My hon. Friend is absolutely right; reform has been talked about by many Governments. One of the challenges is that people say, “Social care is broken and we must fix it”, but different people mean different things. Some are particularly concerned about what are called catastrophic costs, including the problem of people selling their home to pay for their care. Others are much more concerned about care—and rightly so—for working-age adults and the increasing costs for those of working age with disabilities. For other people, it is about questions of housing or technology. We are hugely ambitious about our social care reforms and want to bring this all together into a long-term plan for social care.

I would not see this as either/or. We have said that we will bring forward proposals for social care reform. To the hon. Lady’s point about discharge, it is well known at that, particularly for an older person, spending a long time in hospital can be harmful to their prospects of recovering and living a good quality of life. I have seen that in my own family as well as knowing that it is a long-standing challenge across our health and social care system. It is absolutely right that we should take steps to support people to be discharged from hospital to home when they are clinically ready.

Yes, absolutely. One of the strengths of our social care system is its huge diversity, with the different forms of social care and the different ways it works in different communities. In fact, that has been one of the challenges for the Government during the pandemic, because we are reaching out to over 25,000 different organisations, but actually that diversity is a positive thing, so I will continue to support it in the years ahead.

The hon. Lady is right to say that when we went into the pandemic, the social care system already needed reform. That was well recognised, and that was why the Prime Minister committed back in 2019 that we would bring forward social care reforms—[Interruption.] I am not going to talk about tax policy here, but I can reassure her that we are working on our social care reforms and will bring forward the plan later this year.

I thank my hon. Friend for his involvement on the Health and Social Care Committee, whose reports I find really helpful; they provide great insight and contribute to the conversation. He alludes to the different models for paying for social care, and clearly there are many different approaches. We have been considering them, but I am not able to go into detail here and now. I will have to ask him to wait until we publish our proposals for social care reform.

We are working on our proposals for social care reform, and we are working across the sector. As I have said, I am already talking to and meeting those across the sector—care providers, representatives and, in fact, users of the care and carers themselves. This is complex. There are reasons why there have been discussions about this for many years without proposals for reform being brought forward. We are hugely ambitious, and we want to get it right. That is why I make no apologies that we are taking some time, but as we have said, we will be bringing forward our proposals for reform later this year.

My hon. Friend is absolutely right. Care is expensive, and about one in seven people end up spending more than £100,000 on their care. Many people do not realise that care may cost them that sort of amount. It can take them by surprise, so people are not ready for that kind of cost. Yes, people who have worked hard and saved all their lives for their home can be devastated by the value of that home going on the cost of their care. That is why we are determined that this will be one thing that we address in our social care reforms.

Let me say to the hon. Member: we have said we will publish proposals for social care reform, and we will; we have said we will set out a long- term plan for social care, and we will; and we have said we will reform social care, and we will.

I thank my hon. Friend, and I recognise the situation right now. That is one reason why we are providing £3.8 billion in grants for adult and children’s social care this financial year, which has gone up from £3.5 billion in the previous financial year. Of course, looking ahead in our reforms, we do have to make sure that the way social care is paid for is fair across the country.

I pay tribute to the hon. Member for the hours, the love and the effort that she has put into caring herself. She knows, from her own experience, the experience of carers across the country and what it takes in time, physical effort and emotional effort.

Carer’s allowance is not intended to be somebody’s income; it is intended to support people with some of the costs of caring. It is primarily led by the Department for Work and Pensions, but I can say that I am committed to ensuring that there is support for unpaid carers and family carers, and, as I said earlier, ensuring that, as well as caring for and looking after others, those individuals should be able to have time for themselves to lead their own lives.

I do not on this occasion agree with my hon. Friend, but I do very much appreciate his consistency and his commitment to ensuring that we have an informed conversation about the funding options for social care, as well as his well-informed drawing on international examples.

I remind the hon. Member about the unprecedented support we have given social care during the pandemic: extra funding of £1.8 billion, over 2 billion items of free PPE to providers, a new system of distributing PPE direct to care homes and other care providers across the country, distributing over 120 million covid tests to care providers, and vaccinating hundreds of thousands of care home residents and the care workforce. We have been supporting the social care sector to our utmost during the pandemic, and we will introduce our proposals for reform of social care.

It is really important that discharge is carefully planned and that there is care and support at home for somebody when they are discharged from hospital, but it is also really important that we ensure that people are discharged when they are ready to leave. I saw that with my own grandmother, who ended up spending months in hospital owing to problems with her being discharged. Goodness, I wish that she had been discharged sooner—that would have been so much better for her. It is right that we support people to be discharged when they are ready to go home, and we should press ahead with doing that, although we must also ensure that support is there for people in their home.

I cannot at this point go into the details of the proposals that we are working on for social care reform. I have tried to give the House today a sense of the breadth and scale of our ambition. As to the point on timing, the way I see it is that the health and care Bill is a step on the road to reform, including the statutory role of integrated care systems and the development of the assurance system. I do not see them tied together in the timing in the way she sets out. What I can say is that we will be bringing forward our proposals for social care reform later this year.

I thank my hon. Friend very much for his birthday wishes. I was not particularly planning to spend my birthday in this way, but it is a pleasure to talk about social care reform because I feel strongly about it and am clearly spending a great deal of time working on it. What really matters is making sure that the outcomes and the experience of care are better for people. What really matters is that people get to live their lives to the full, whether they are of working age or older, and get to live as independently as possible, as part of a community and with their own front door for as long as they can. It is the outcomes of care that really matter.

Actually what the hon. Member has just read out is completely untrue, completely misleading and does not reflect for a moment what has happened. I am very disappointed to hear her read it out.

My hon. Friend is absolutely right. At the heart of care is the workforce. They are the individuals who are providing the care and who make the difference day in, day out for those who need their important care. Absolutely, I want to make sure that we have the workforce across social care. We need to ensure we have the training there and greater career progression opportunities for those who work in social care.

I hope the hon. Lady will forgive me if I am not drawn on specific models of funding or paying for care, but the Government and I recognise that we have on the one hand the challenge of catastrophic costs and the problems some people face of having to sell their home to pay for their care, which many Members have mentioned already today, but also we have the other part of the system, which is those who receive care funded by the state. Many of them are of working age, as well as there being older people. She is right: in our social care reform, we need to look across the breadth of the system.

My hon. Friend outlines a fantastic example: that is a really good use of town deal funding by Warrington. The academy—there are examples around the country—does an important thing in raising the profile of the social care workforce and developing their skills, which are so important. I absolutely support this initiative and, as and when the time is right, I would be delighted to visit.